Using our large medical database, Banfield conducts analyses that shed light on the current challenges to pet health. Banfield data represents population health status in general practice; for example, dental tartar (calculus) topped the disease list for cats and dogs in 2010 and 2011. As such, annual dental prophylaxis is a major component of prevention in our hospitals—we know that untreated dental tartar leads to periodontal disease, which is associated with both kidney and heart disease. Interestingly, our top disease list differs somewhat from the top illnesses of pets seen in veterinary practice reported by a veterinary insurance company, because we report on all diagnoses regardless of related treatment costs, and insured pets do not represent the majority of pets seen in general practice.

 Overweight and obesity increased 37 percent in dogs and 90 percent in cats over the last five years, while the prevalence of arthritis also increased 38 percent in dogs and 67 percent in cats. Although the 2012 report shows an increase in chronic diseases, only 36 percent of dog owners and 28 percent of cat owners surveyed by Kelton Research said they would take their pet to see a veterinarian to manage an existing disease or condition. 

The power of this knowledge can be leveraged by veterinarians to support care recommendations for the companion animals in our care. All elements of prevention (vaccination, dental care, parasites, nutrition, and behavior) are important to integrate into communication during veterinary visits, ideally when pets are young and healthy. Results from both the 2011 and 2012 State of Pet Health reports provide evidence that veterinarians can use to advocate for preventive care.

Partnering with pet owners to focus on prevention can improve overall quality of life and reduce the number of pets living with undiagnosed or unmanaged chronic diseases. As Banfield generates future annual reports, we hope that we can look back to see where we’ve been able to turn the tide on the increasing prevalence of disease and threats to pet health and well-being.

 So when did this happen?” you ask. “Oh, about an hour or so ago,” the client replies.
“How has she been acting?” “Pretty normal,” the client says, rubbing his chin.
“Do you know what she got into?”
“Yep,” he says with certainty. “It was rat poison.”
You stop and think for a moment, realizing that there are several different kinds of rodenticides on the market. ”What kind?”
The owner looks thoughtful and replies, “Well, it was a hard greenish block.”
“Do you know the brand?”
“I know I bought it at Wal-Mart. It was on the bottom shelf near the mouse traps.”
“Do you still have the bag?”
“Nope, threw it away after I put the bait out. Why? Is that important?”

If you’re in the veterinary field, you’ve probably experienced an exchange similar to this one. We’ve all been in the position of trying to coax pertinent information out of the client in order to figure out what the pet may have ingested. At the very least, it’s frustrating not having the information, and often that knowledge can be vitally important.

Hopefully, every vet understands the importance of specifically identifying the active ingredient of a given toxin. For example, in recent years, there has been a movement away from anticoagulant rodenticides to those that cause death by cerebral edema. Time is of the essence in poisoning cases, and the wrong decision can mean the difference between life and death. If you jump in and treat a rat poison case with anticoagulants, you may miss an opportunity to prevent brain damage. Conversely, if you start mannitol for edema, you might end up with the patient bleeding to death. As you are likely aware, the more specific we can be about the toxic agent, the better chance we have of properly diagnosing and treating the patient in time.

The first step is to understand that the client is likely in a bit of a panic and doesn’t realize that there is more than one kind of poison. It’s likely they simply thought, “Oh, my goodness! I have to get to the vet now!” and then rushed right out the door and into your office. In their haste, they probably didn’t think to bring the package or the plant with them to make identification easier. They aren’t deliberately trying to make the situation difficult, and it’s important to be patient with these worried pet owners.

Train your staff to begin asking the right questions when owners call. While owners are on the phone asking what they should do, have your staff tell them that they need to bring the package in with them in the case of rodenticides, herbicides or pesticides. This is also important with any human medications, especially prescription medications we may not be familiar with in the veterinary field. If poisoning was caused by a plant, check to see if the owner knows the exact species. For example, there are some plants with the name “lily” that aren’t technically in the Lilium genus and aren’t toxic. So a client saying that their cat ate a “lily” isn’t enough information to make an accurate treatment plan. Unless you or someone on your staff is really into horticulture or botany, or unless you have a great plant toxicology text with pictures of every species, a client bringing in leaves isn’t likely to be helpful in identifying the plant. If your staff can get the client to bring in the package or label, it helps the case significantly.

So what do you do if the client simply doesn’t know and doesn’t have the packaging anymore? In these cases you simply have to do your best. If the pet is in distress and it’s an emergency situation, treat based on the symptoms and make your best guess as to the cause. It’s always appropriate to ask the owner to go back home and get the package or have someone at home call back with the information. This might inconvenience the owner a bit, but it can also mean the difference between life and death for their pet.

Also remember that Pet Poison Helpline is there for vets as well as clients. Clients can call before they ever reach your practice and learn what needs to be done prior to coming in. You can also get information from poison specialists that may help you make the best treatment decisions for the case.

I was inspired to write you a letter after discovering a blog called A Letter to My Dog, a charming website that encourages dog-lovers to wear their hearts on their sleeves and gush about their four-legged companions in a letter that is shared with the world. I would write you a sappy letter in a heartbeat (especially since you’re my very first puppy and I just love you to pieces), but since you’re only 7-months old, I’ll save my sappiness for when you turn 1 and become a young adult. Instead, I thought I would approach your “puppy” letter differently. 

We humans think it’s fun to find out what happened and what was popular the year we were born. For example, I was born in 1979—Jimmy Carter was president of the United States, the first snowboard was invented in the USA, “Kramer vs. Kramer” was the top grossing film and Sony introduced the Sony Walkman. According to the U.S. Bureau of the Census, the U.S. population was over 225 million, the most popular girl name was “Jennifer” and most popular boy name was “Michael.”

That information might not be interesting to you, but you might be interested in the year you were born (2011). “Max” was the most popular male dog name and “Bella” was the most popular female dog name. In 2011, approximately half (51 percent) of all dogs seen at Banfield were small or toy breeds. Being a Bernese Mountain Dog, you’re considered a giant breed, and the least represented group at 3 percent of all dogs. Don’t take it personally that your breed didn’t make the five most popular breeds in 2011; it just means you’re unique and extra special to me! But, you have lots of doggie friends representing these popular breeds, which are Labrador Retriever (10 percent), Chihuahua (8.2 percent), Shih Tzu (5.8 percent), Yorkshire Terrier (5.6 percent) and Pit Bull (4.9 percent)¹.

In 2011, dental calculus, otitis externa and overweight were the top three diagnoses in all of the breed categories.¹ Knowing this information, I can make promises to you that will help provide you with a great quality of life! Mavis, I promise that you’ll have twice-yearly comprehensive exams so that you receive preventive care and screenings for certain diseases. I promise to feed you a high quality diet and play with you instead of giving you a bunch of high-calorie treats. Because your breed size is prone to obesity, I want to make sure you maintain a healthy weight throughout all of your life-stages. And since your risk of periodontal disease will increase as you age you’ll likely have your first comprehensive dental cleaning when you turn 1.¹ We’re both getting better at brushing your teeth regularly at home (we’re messy though!), so this will help reduce your risk of developing dental disease—which is associated with more serious diseases, such as heart and kidney disease.¹

You should know that in 2011 the top diagnosis for juvenile dogs (that’s you!) was fleas.¹ This is scary since parasites can carry disease and make you sick. You’ll have no need to worry though, because you’ll receive flea and heartworm prevention medication every month, all year round. In addition to parasite control, nutrition and dental care, we’ll continue our behavior training classes. We’re bonding during these classes and I enjoy teaching you new things. You’re really smart—I was so proud of you when you passed your AKC S.T.A.R. Puppy test! Lastly, I promise to make sure you receive the proper vaccines that will protect you from the germs puppies can get from interacting with other dogs.

I make these promises to you because you’ve placed your trust in me. Not to mention that you’re my best dance partner, you listen closely when I tell you about my day, you let me be goofy, you make me smile when I’m crabby and you’ll cuddle with me for hours. Mavis, it’s been neat to watch you learn about the world (you’re rather inquisitive) and I want you to be around for a really long time so that we can discover more of this world, together.

Reference

1. Banfield Pet Hospital data, Banfield Applied Research & Knowledge (BARK) team, Portland, OR.

Understanding how the DTM “works” will help your interpretation. The DTM incorporates antibiotics (gentamicin and chlortetracycline) to suppress bacterial growth, cycloheximide to suppress saprophytic fungal growth, and phenol red as a color indicator. It provides both carbohydrate and protein nutrients. Dermatophytes (fungi belonging to the genera Microsporum, Trichophyton and Epidermophyton) preferentially use protein as an energy source, whereas most saprophytic fungi use carbohydrates first. This is the key to interpreting the color change that may be seen with DTMs (Figure 1). The early growth of dermatophytes will usually (but not always!) cause the DTM to change from yellow to red, due to the production of alkaline byproducts of protein metabolism. Saprophytes may do the same, but usually only when the colony is much larger. This is why it is important to check the fungal cultures daily—if a large colony has already grown over the DTM, a red color change is not meaningful. 

Figure 1- Trichophyton growth on DTM

In addition to observing for a red color change, the interpretation of DTM growth should include an assessment of macroscopic and microscopic colony morphology.  Dermatophytes grown on DTM are generally lightly pigmented (white, buff, tan or cinnamon-colored), whereas common saprophytes are often darkly pigmented. The colony surfaces of the dermatophytes of veterinary importance are often described as powdery, granular or cottony.

I prepare a slide for microscopic examination of suspect colonies by lightly touching a piece of clear cellophane tape to the surface of the colony, then placing it on the slide with a drop of the blue stain from a modified Wright’s kit. Macroconidia of M. canis (Figure 2) and M. gypseum (Figure 3) are usually easy to find, but T. mentagrophytes often doesn’t produce macroconidia on DTM. M. canis macroconidia typically have six or more cells, thick cell walls and knobby ends. M. gypseum macroconidia tend to be numerous, ellipsoid, have thinner cell walls and four to six cells. Some microscopic characteristics of T. mentagrophytes that can be seen are spiral hyphae and grape-like clusters of one-celled microconidia. 

Figure 2- Microsporum canis macroconidia

Figure 3- Microsporum gypseum

Integrating the results of any color change, the macroscopic colony appearance, and the microscopic findings yields the most accurate interpretation. The fungal culture is one of the most important laboratory procedures in veterinary dermatology. It should be used to rule out ringworm, as much as to confirm it. I tell veterinarians that if most of their cultures come back positive, they may not be recommending it often enough.

In review, leptospirosis is a disease that is caused by pathogenic spirochetes of the genus Leptospira. It is considered the most widsespread zoonotic disease in the world, and has recently been recognized as a re-emerging infectious disease among animals and humans. It is a disease that is distributed worldwide, but is most common in the tropics.

Humans and a wide range of animals, including mammals, birds, amphibians, and reptiles can develop Leptospira infection. However, humans are rarely chronic carriers and are therefore considered accidental hosts. Leptospirosis is transmitted via direct contact with the body fluid of an acutely infected animal or by exposure to soil or fresh water that has been contaminated with the urine of an animal that is a chronic carrier. For dog owners, the first signs of leptospirosis in a pet often are several days of anorexia, vomiting, lethargy, depression, muscle pain and sometimes diarrhea or bloody urine. Veterinarians examining dogs with leptospirosis find depression, fever, dehydration, jaundice and abdominal pain. The disease damages the animal’s kidneys and/or liver, sometimes resulting in renal failure and death. Due in part to the often non-specific clinical presentation, leptospirosis is often undiagnosed or misdiagnosed.

Worldwide, there are more than 200 known serovars of leptospirosis infecting many kinds of mammals. While currently available vaccines do protect against some serovars of this potentially fatal bacterial disease, there is room for improvement in the vaccination protocols. Having personally implemented a case-control study on the disease in a tropical setting, I continue to advocate and administer the vaccine in compliance with the Veterinarian-Client-Patient relationship guidelines. In addition, I often hand clients Banfield’s leptospirosis information handout, to help them further understand the risks and how to protect their entire family. The leptospirosis handout is also available on the Banfield website.

As veterinary professionals, we are reminded daily of our oath to promote public health and the protection of animal welfare, and educating our clients is an essential key in doing so.

References:

1. Keenan J, Ervin G, Aung M, et al. Risk factors for clinical leptospirosis from Western Jamaica. Am J Trop Med Hyg. 2010;83(3):633–636.
2. Yang CW. Leptospirosis in Taiwan—an underestimated infectious disease. Chang Gung Med J. Mar-Apr 2007;30(2):109-15.
3. Cachay ER, Vinetz JM. A global research agenda for leptospirosis. J Postgrad Med. 2005; 51: 174–178.

Fast-forward four years, and I have since seen out my contract with that hospital, completed a Master of  Veterinary Studies in Conservation Medicine, and switched to working primarily with dogs and cats. This has placed me in a unique position to compare my experiences working with exotic pets, wildlife and traditional pets. I have found that “bravery” was not the main attribute required in working with exotic pets. There are, however, several other attributes that will serve an exotic pet practitioner well:

1. Curiosity
   We’ve all heard the proverb “curiosity killed the cat,” but in the case of exotic pets, curiosity is more likely to save a life. Many problems with exotic pets result from the lack of proper care and diet, and one thing I have learned working with exotics, is that detailed questions must be asked of any client owning an exotic pet, to ensure that their care of the pet is not what is causing the symptoms displayed by the pet itself.
2. Resourcefulness
   When the care and diet provided are not suitable for the pet in question, providing the right advice becomes critical. It may be impossible to remember what every single species of exotic pets requires, but having the resources to look it up when required is invaluable.
3. Empathy
   There is a school of thought that exotic pets do not form the same bond with their owners as dogs and cats do, but that could not be further from the truth. Many young children do not shed a tear when their family dog is being euthanized, but will do so for their own pet hamster. Rabbits display a wide variety of affectionate behaviors that their owners will spend a lot of time recounting during a consult. And guinea pigs make different noises under different circumstances, which their owners very quickly pick up on. Rat owners are also very committed to their pet’s health and well-being, and will go to any extent to save their beloved friend. What I have learned from working with exotic pets and their owners is that I need to draw on my own experiences owning such pets and realize that I am not the odd one out in experiencing an indescribable attachment to my small furry friend. Size truly does not matter when it comes to the pet-owner bond.
4. Gentleness
   Most exotic pet species are prey in the wild and do not appreciate being roughly handled. Being gentle helps them relax and makes the physical examination much easier for the pet, the owner and the veterinarian. Gentleness also applies when surgery is performed on exotic pets. Many exotics are much smaller than traditional pets, and the veterinarian has to become accustomed to working in tight spaces, with critical organs in close proximity to the organs that are being worked with. Gentle tissue handling will result in much better surgical outcomes.

When considering how to develop a quality of life assessment for pets, I thought it was important to research how the concept of quality of life has previously been applied to veterinary medicine. I performed a PubMed search and found, to my surprise, that very little information regarding quality of life as it pertains to positive health exists in the veterinary field. The vast majority of research relating to quality of life in pets is focused on identifying and quantifying the burden of illness.  That research is extremely important, as it can be used to help with end-of-life decision making and to evaluate the effectiveness of different treatments and therapies.  However, there is also a great deal of value in using quality of life to identify and assess factors that help otherwise healthy pets to enjoy a better life.  

In fact, when the question of what constitutes a “good life” is applied to humans, there is a multitude of people from a wide variety of disciplines who are dedicated to finding the answer.  Professionals in such varied fields as medical science, social science, economics, advertising, and politics use quality of life assessments to evaluate policy or assess the impact of interventions.¹ Many of these assessments contain a mixture of objective measures (e.g,. life expectancy, standard of living, physical health, education) and subjective evaluations (e.g., happiness, satisfaction, freedom) which are combined to generate an overall assessment of well-being among individuals and societies.

There is an opportunity for veterinary medicine to follow the lead of human-centered disciplines and expand the definition of quality of life to include positive health and well-being.  My role as a clinical study monitor frequently puts me in touch with loving pet owners. I’ve found that people are eager to provide their pets with every opportunity to thrive and give a great deal of thought to their pet’s happiness. They think about their pet’s quality of life in the same way they think about their own, in terms of the potential for happiness rather than the burden of illness. I believe there would be a great deal of interest in a quality of life assessment that classifies the essential elements of animal well-being and helps veterinary professionals and pet owners identify areas for improvement. I know that Smallie, for one, would be excited to know we’re working on a tool that may help to make her good life even better! As a veterinary professional, would you encourage your clients to assess their pets’ quality of life?

1.  Sirgy MJ, Michalos AC, Ferriss AL, Easterlin RA, Patrick D and Payot W. The Quality-of-Life (QOL) Research Movement: Past, Present, and Future. Social Indicators Research. 2006;(76):343-466.

So I started thinking, what am I doing to all these active, happy dogs with ligament ruptures and other acute injuries when I tell the clients that the dog needs to be crate-confined for the next four to six months? Traditionally in veterinary medicine, when a pet suffers an injury, we significantly alter the pet’s lifestyle and put them on pain medication until the pain goes away. But there must be a better way to return these pets to their former lifestyle faster and possibly even stronger than they were before.

Physical therapy is not a new concept to veterinary medicine, but it is definitely a highly underutilized one. Physical therapy adapts human techniques to animals and encompasses a variety of modalities, including widely used exercises such as passive range of motion, controlled walking and massage, to less frequently used modalities including balance and strengthening exercises, cryotherapy, laser and ultrasound therapy and hydrotherapy. And the best part of physical therapy is that it can help such a wide range of ailments that you can make almost any pet feel better. Physical therapy is crucial for our post-operative orthopedic patients, for our Dachshunds with back injuries, for non-surgical ligament injuries, for maintaining high performance in our performing pets, and for all of our older, aging patients.

Banfield veterinarian Amy Hille, DVM, listed in a recent blog a lot of the common ailments that affect our geriatric patients, including arthritis. Often, we as veterinarians, and our clients, just chalk arthritis up to one of those things that happens with age. But we don’t have to ignore it. Glucosamine and essential fatty acids are important, but physical therapy may mean the difference between long-term pain medication ending in euthanasia, and a dog that feels like a puppy again and lives past its estimated life span.

So the next time you roll out of bed groaning in the morning or you are at the gym fighting your way through your workout, remember, pets feel the pain too. Just about every dog or cat can benefit from physical therapy in one way or another. And who doesn’t love a great massage?

Midnight, of course, was a pitch-black, male cat with piercing yellow eyes. According to the client, he had been vomiting nonstop all day. Now, at 10 p.m., with Midnight progressively getting worse, the client brought him to me. A physical exam revealed multiple enlarged lymph nodes, difficulty breathing and a thickened portion of small intestine in the upper area of the abdomen. “Cancer,” I thought, with a sinking feeling in my stomach for the conversation I feared I was getting ready to have with this client.

“Can you tell me about the vomiting?” I asked.

The answer shocked me.

“He’s been throwing up on and off for about 2 years! And the last few months, he’s lost a lot of weight,” the client had said, obviously frustrated. “I have taken him into my vet four times for the vomiting and weight loss over the last month. I saw three different vets and they all told me occasional vomiting in a cat is normal. They are really nice, but I never know which doctor I’m going to have.  

She started to cry. “They never suggested any tests or X-rays. I should have taken him somewhere where they would listen to me!”

Well, the story doesn’t get any better. Midnight had multicentric lymphosarcoma. Although this client was willing and able to pursue treatment, after a thorough evaluation and upon the advice of a local oncologist, she elected to end Midnight’s suffering. Midnight was caringly euthanized the next day.

Now, back to the point.

I’m not trying to criticize these three different doctors or suggest that they somehow “missed it.” I’ve been there! People make mistakes. I know how busy and stressful a day in the hospital can be. However, the lesson Midnight taught me is that our pets deserve more from us than just being a “regular” vet. They need someone who will take complete responsibility for their care from kitten/puppy-hood to “senior-hood.” This lesson rings in my head every time I see a patient. What might have happened if one of these doctors had taken the responsibility to call Midnight “my patient” and had owned his health from start to finish? I suspect that any of them would have put the pieces together. Maybe Midnight would never have ended up at the ER that night. Midnight didn’t need a “regular” veterinarian; he needed a primary provider. This is a solemn responsibility.

The point is, this selection process hasn’t happened to the same extent with birds; selective breeding in birds has mostly been to develop color variations. This means that in terms of behavior, birds are still close to their wild cousins—anyone that’s hand-raised a bird will know that hand-raising doesn’t guarantee that the bird will make a good pet. The idea that pet birds need to be allowed to act like wild birds, to express their normal behaviors, is becoming more popular, with toys that encourage foraging becoming more common. What hadn’t occurred to me until recently, is that this also applies to social behaviors. All the things that we like to do with our pets—kisses, cuddles, scratches—are things that birds do when they’re pair-bonding. Even the act of providing food is an act of courtship to a bird. When we cuddle our dog or cat, we’re saying to them “let’s be friends,” but when we do the same thing with a bird, we’re saying “let’s go steady.” When we stroke their back, we’re actually saying “let’s mate”!

In a recent discussion among avian veterinarians on an email forum, a few mentioned diseases with physical manifestations (e.g., wing web ulcerations, even when the birds weren’t over-preening) that could only be kept at bay with hormonal control, such as deslorelin implants. The general consensus was that this happened because the owners’ behavior was sending sexual messages to the bird, resulting in hormonal changes that led to these diseases. The group thought that owners should be encouraged to be one of the flock, rather than acting like a mate. We have so much to learn about birds as animals, pets and patients, it’s impossible to have all the answers in the clinic. Now, though, when I’m thinking “treat it like it’s a small dog,” I’ll think, “treat it like it’s a bird” instead.

References:
1. Trut L, Oskina I, Kharlamova A. Animal evolution during domestication: the domesticated fox as a model. Bioessays. 2009;31(3):349-360.