Reasonable Expectations: Written Cost Estimates

by Nancy Kay, DVM 

This is the eigth part of a series describing how people are developing new expectations when it comes to veterinary care for their pets. Parts one through five can be found at www.speakingforspot.com/blog.

You’ve just taken your best buddy to see your veterinarian because he’s been vomiting for three days and is now beginning to refuse his food. 

Your vet performs a thorough physical examination with all normal findings, so she recommends blood tests along with X-rays of your dog’s belly.  If these tests don’t provide a diagnosis, she tells you that the next recommended step would be abdominal ultrasound.

Of course you want to proceed with this testing because your dog is a beloved family member and you want him to get better, but do you know how much the recommended diagnostics will cost?

Will you be charged $300, $800,  $1,300? 

Unless your dog is a “repeat offender” how in the world could you possibly know? Three hundred dollars might be completely within your budget; whereas $1,300 might mean coming up short on your mortgage payment.

Whether you are independently wealthy, barely making ends meet, or somewhere in between, know that it is perfectly reasonable to request a written cost estimate from your veterinarian before services are provided.  

Why must you be responsible for asking- shouldn’t your vet automatically offer forth a written cost estimate?

Much to my chagrin, I must tell you that only the minority of vets voluntarily provide written estimates. This was documented by veterinarian/researcher, Dr. Jason Coe and his colleagues. Their research appeared in 2009 within the Journal of the American Veterinary Medical Association.  The article titled, “Prevalence and Nature of Cost Discussions During Clinical Appointments in Companion Animal Practice” documented the following:

• Actual cost is addressed in only 29% of veterinary appointments.


• When cost is discussed, 33% of the time it is the client and not the veterinarian who initiates the discussion.


• Talk related to cost information constitutes a mere 4.3% of the total dialogue time.


• Written cost estimates are discussed during 14% of appointments.


• Written cost estimates are actually prepared and delivered to the client in only 8% of appointments.

Dr. Coe’s research certainly supports the notion that veterinarians are squeamish when it comes to discussing fees for their service.  

I must admit it is certainly one of the least favorite parts of my job.  Nonetheless, I consistently provide written cost estimates, particularly if I’ve recommended something other than a single treatment or test, in order to avoid communication snafus and clients who are disgruntled when it comes time to pay their bill.

Why is a written estimate preferable to a verbal estimate? 

Written estimates require time and focus. Guaranteed such estimates are far more likely to be accurate than those prepared by the vet using mental math while “on the fly”.  Additionally written estimates avoid uncomfortable conversations such as, “You told me it would be $100, not $300……..” and, “But you never told me you were going to do that……”.

So, please don’t encourage your vet to simply give you a “ballpark estimate” or an estimate “off the top of his or her head.”   

I avoid providing such guesstimates at all costs (no pun intended).  Try as I might, I invariably lowball such estimates because of my innate desire to make the cost for my client as reasonable as possible.  And when this happens I end up cutting corners (not a good thing for the patient) and/or having to make uncomfortable phone calls advising clients of added expenses (and I definitely get called into the principal’s office).

It is completely reasonable to receive a written cost estimate before services are provided, but keep in mind, you may need to be the one who initiates this process!

With written estimates everybody wins- communication is so much clearer and there are no surprises when it comes time to collect fees.  

Additionally, a written cost estimate provides an itemization for you of everything that is planned for your pooch. Have you received estimates from your veterinarian?  If so have they been delivered verbally or in writing?

***

Dr. Kay  is the fortunate recipient of the 2011 Bustad Companion Animal Veterinarian of the Year Award- presented by the AVMA to the veterinarian who promotes and exemplifies the human animal bond!

DR. NANCY KAY wanted to become a veterinarian for just about as long as she can remember. Her veterinary degree is from Cornell College of Veterinary Medicine, and she completed her residency training in small animal internal medicine at the University of California—Davis Veterinary School.

Dr. Kay is a board certified specialist in the American College of Veterinary Internal Medicine and published in several professional journals and textbooks. She lectures professionally to regional and national audiences, and one of her favorite lecture topics is communication between veterinarians and their clients.   Since the release of her book, Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life, Dr. Kay has lectured extensively and written numerous magazine articles on the topic of medical advocacy.  She was a featured guest on the popular National Public Radio show, Fresh Air with Terry Gross.

Dr. Kay is a staff internist at VCA Animal Care Center, a 24-hour emergency/specialty care center in Rohnert Park, California. As a way of providing emotional support for people with sick four-legged family members, Dr. Kay founded and helps facilitate the VCA Animal Care Center Client Support Group.  She also facilitates client communication rounds for VCA Animal Care Center employees.

Dr. Kay was selected by the American Animal Hospital Association to receive the 2009 Hill’s Animal Welfare and Humane Ethics Award.  This award is given annually to a veterinarian or nonveterinarian who has advanced animal welfare through extraordinary service or by furthering humane principles, education, and understanding.  The Dog Writers Association of America selected Dr. Kay for two awards.  The first was the 2009 Eukanuba Canine Health Award recognizing Speaking for Spot as the publication that best promotes the health and well being of dogs. The second award was for the Best Blog of 2009 (www.speakingforspot.com/blog).

Dr. Kay’s personal life revolves around her husband (also a veterinarian), her three children (none of whom aspire to be veterinarians) and their menagerie of four-legged family members. When she’s not writing, she spends her spare moments in the garden or riding along the beach atop her favorite horse. Dr. Kay and her family reside in Sebastopol, California.

Articles by Dr. Kay:
Reasonable Expectations: The Ability to Discuss Your Internet Research With Your Vet
Finding Dr. Wonderful And Your Mutt's Mayo Clinic: Getting Started
A Different Way to Spay
Making Tough Medical Decisions For Your Dog: Lily's Story
Even The Best Veterinarian Can Make A Mistake

Don't Knock It Until You Tried It: Animal Chiropractic

The goals of having chiropractic adjustments can be as simple as having your animal feel and perform better, to resolving biomechanical problems, to helping heal extreme pain and paralysis.

Source: Dog Kinetics

Animal chiropractic? Really?

Well, until recently, I didn't know much about it either.

When I first read about it, as interesting as it sounded, I would have never consider it for my dog. Anecdotal evidence issue aside, in my mind, the word chiropractic stood for painful bone-crunching torture. I'd hesitate to put myself through something like that, let alone my precious baby.

But one can always learn something new.

Eight out of 10 dogs seem to find some type of instant relief from dog chiropractic therapy.

Source: Organic Pet Digest

Animal chiropractic is a very gentle procedure!

Well, it does sometimes hurt some when the chiropractor finds the spot. But how much pain might your dog be in constantly, without you even knowing?



When the sore area is found, your dog might react with a growl or "don't do that it hurts" response. This part is actually useful, as it helps to identify where the problem is. (Diagnostic points in Traditional Chinese Veterinary Medicine (TCVM) work much the same way.)

The adjustment itself consists of applying gentle pressure until things pop back into their rightful place.

Reading about animal chiropractic is one thing. Experiencing the results is another.

As Jasmine started going for her physical therapy, her vet included chiropractic as part of the process.

This often consists from a check up only. But sometimes misaligned areas are found and adjusted.

Jasmine is a very social and outgoing dog and she loves attention and petting. But sometimes she would get sensitive to touch in one area or another.

We guessed that she might be painful in that area but didn't really understand why, as there was nothing obvious to be found.

After she started seeing the physical therapist/chiropractor, things suddenly made sense. Every time she'd become sensitive to touch in a certain area, some misalignment would be found.

The most dramatic result we witnessed was when one day Jasmine suddenly started limping on her rear leg terribly. 

She wouldn't use the leg at all! Not even laying down or getting up!

It looked worse than when she tore her cruciate ligament! At that time we already new that the knee surgery failing that long after it has healed was not likely at all.

What was going on? Another muscle or tendon injury?

We took Jasmine to her physical therapist right away. She checked her out and found a major hot spot on the spine right at a hip area. As she applied steady pressure, suddenly we could actually hear the pop!

And that was that. Still little sore that night, Jasmine's was walking fine the next day!

Same thing happened with her recent limp on front left leg.

Three hot spots at the shoulder area were found and adjusted. The next day the limp was gone.

And those are just the things that are easily visible.

Because of Jasmine's high activity level, she is perfectly able to tweak her spine here and there. I can't even imagine what her life would be like without the benefit of the chiropractic adjustment.

It also puts many things into a different light.

I read stories of highly reactive dogs who mellowed right out after getting chiropractic help. No wonder the'd be aggressive, with so much pain.

Today I believe that getting a chiropractic check-up should be part of the diagnostic arsenal, whether your dog is visibly suffering pain or just being more grumpy or aggressive than they should. Particularly with a sudden onset.

No harm in that. While it might not always be the case, a chiropractic adjustment just might solve your dog's problem.

Yes, there are evidence-based practice veterinarians who frown on such hack as animal chiropractic. Ours is not one of them. He's, in fact, the one who introduced us to Jasmine's physical therapist.

I guess it's just one of those things where seeing is believing. For me, anyway.

Don't knock it until you tried it.

Does your dog see a chiropractor? Share your experience.

It's your dog's health,
Jana



Further reading:
Dog Chiropractic Basics
Dog Chiropractic Therapy: An Option for Your Dog?
What is Animal Chiropractic?
Veterinary chiropractic

Vomiting in Dogs: Is He Actually Vomiting?

by Lorie Huston, DVM 

Vomiting is a common occurrence in dogs and can be a major concern for their owners. There are many causes of vomiting and vomiting can range from being an isolated incident of very little concern to your dog’s health to being a major threat to his health and well-being.

But how do you determine the difference? 

Firstly, you need to determine whether your dog is truly vomiting.

Is Vomiting Really Vomiting?

While vomiting is a very real symptom and one we see frequently in dogs, there are a few other instances that can cause symptoms that appear very similar while not actually being vomiting in reality.

In order to accurately diagnose the cause of a symptom or illness, we need to understand what we are seeing.

Let’s start by defining vomiting.

Vomiting is defined as the forceful expulsion of contents from the stomach. 

The contents “thrown up” when your dog vomits may be anything that is in his stomach, including undigested or partially digested food, yellowish-colored bile-tinged fluid, or even foreign objects your dog has swallowed.

Vomiting is typically an active process and you will usually see your dog’s abdomen heaving as he vomits.

At the same time, your dog may be nauseous, in the same fashion that you probably feel nauseous when you are vomiting. Nausea may result in excessive salivation or drooling and it is possible that your dog may feel nauseous even if he is not actively vomiting.

Vomiting Versus Regurgitation

Vomiting must be differentiated from regurgitation.

Regurgitation is the term that is used to describe the expulsion of the contents of the mouth, pharynx or esophagus. 

In other words, regurgitation involves “throwing up” food and other content that has not yet made its way to the stomach.

Regurgitation is a more passive process than vomiting. 

There is no abdominal heaving involved. There may be a little gagging involved but basically undigested food will simply pass back up through your dog’s mouth when he regurgitates. In most cases, the regurgitated material will be undigested food and it may be covered with mucus.

Respiratory Symptoms and Vomiting

Another scenario that may be mistaken for vomiting can happen when a dog is experiencing respiratory symptoms and is coughing up respiratory secretions.

This can usually be differentiated from true vomiting by the presence of other respiratory symptoms such as coughing, gagging, wheezing and/or difficulty breathing. When coughing up respiratory secretions, the “thrown up” material is likely to be white and frothy in appearance.

Diagnosing the Cause

Naturally, if any of these symptoms are occurring for your dog on a regular basis, it’s time to visit your veterinarian.

With a thorough physical examination and good history of your dog’s physical symptoms, it is usually possible to determine whether your dog is truly vomiting or experiencing some other health issue.

Bringing a sample of the material your dog is “throwing up” can help determine whether the material is made up of stomach contents if you are uncertain. 

Because of the acidic nature of the stomach, stomach contents will have a pH value that is much more acidic than that of regurgitated food or other materials. The pH value can easily be measured.

The list of possible causes for true vomiting is much different than the things that can cause regurgitation.

Similarly, if your dog is experiencing respiratory issues rather than gastrointestinal issues, the differential list changes dramatically.

Once it has been determined that your dog is truly vomiting instead of regurgitating, a diagnostic plan can be pursued to find the cause and a treatment plan can be chosen to resolve your dog’s illness.

***

Lorie Huston has been practicing veterinary medicine for over 20 years. Besides a successful career in a busy small animal hospital in Providence, RI, Lorie is also a successful freelance writer specializing in pet care and pet health topics. 

Currently, she is the feature writer for the Pet Care section at Suite101.com and the National Pet Health Examiner at Examiner.com. Lorie also publishes her own blog, The Pet Health Care Gazette and manages an increasingly popular facebook page, The Voice of Pet Care. 


Articles by Dr. Huston:
Lyme Is Lame (Pun Intended)
The Ticking Bomb
Don't Let Heartworm Become A Heartbreak!
Summer Perils: Blue-green Algae
Your Dog And Leptospirosis
Canine Parvovirus
Canine Distemper Virus
Why Is My Dog So Itchy? Top 5 Causes Of Itching In Dogs 
Vaccination Concerns and Potential Side Effects 
Natural Flea Control for Dogs 


Related articles:
What's In The Urine? (Part I)
What's In The Urine? (Part II: Urinalysis)
Excessive Drinking
Bad Odor
Excessive Panting
Bad Breath (Halitosis)
Where There Is Smoke, There Is Fire: A Symptom Is Your Friend!
When Is It An Emergency?

Canine Massage: Every Dog ‘Kneads’ It”

by Susan E. Davis, PT

Massage has always been a “cornerstone” treatment for physical therapists.  

It is one of the first courses a PT student takes when beginning their professional coursework.

The benefits of massage to human beings having various medical conditions has been acknowledged for decades and is now being utilized more in the animal world.  The benefits dogs receive from massage are many of the same benefits that humans do such as decreased tension, pain and inflammation, increased blood flow and healing, decreased swelling and reducing fibrous adhesions.

And you can never underestimate those non-tangible benefits of the healing touch that calm, sooth and allow the body to heal itself.

The technical definition of massage is “soft tissue manipulation or mobilization” and involves moving the hands along the skin and moving the underlying tissues, directed toward a specific purpose, aimed at achieving a physiological and psychological change.

In animals it is generally done in direction of hair or coat, but sometimes done in the direction of the heart.


There are 4 basic types of massage:

1. Effleurage or Stroking: which utilize gliding motions using the therapist’s palm and fingers.

This technique is   excellent for removal of swelling and increased lymph drainage.  It improves circulation and produces a “flushing out” effect.  Bear in mind that the weather plays a role in affecting the soft tissues. When the barometric pressure in the atmosphere is low, tissues tend to swell and become more tender.

If your dog is arthritic you may notice their symptoms seem worse on low barometer/humid/damp days and better in dry or high barometric conditions.  Massage can be used to combat the uncontrollable effects that the weather has on your dog. Therapists may be likely to use this type of massage technique for swollen, tender tissues.

2. Petrissage:  kneading, compression, and skin rolling using thumbs and fingers.  

This technique is best for soft tissue tension, commonly referred to as “spasm” or “guarding” and nodules, etc.  They form from repeated strain, injury and micro trauma that cause muscle tightening.

This tightening is the body’s natural reaction to trauma, shifting from a relaxed to a protective mode. If the tightened, protective mode continues for very long without relief, the muscle becomes overused and fatigued, and changes start to occur within the cells.

Within skeletal muscle cells are protein molecules called actin and myosin.  These are small filaments that are organized into units of muscle tissue called sarcomeres .In turn, they are arranged in series, overlapping each other, like a ratchet system.  This is the mechanics behind muscle contraction.

Upon injury with muscle guarding and spasm, the cells simply start to run out of energy, they secrete excess protein and the sarcomeres tighten upon each other (think of those bright colored little woven Chinese torture tubes you may have played with as a kid, where you insert your fingers on each end and as you pull apart the tube gets tighter and tighter.)

Mild to moderate tightening that can be relieved by applying gentle pressure is called “guarding”.  Harder tightening that tends to feel very hard and worsens with pressure is “spasm”.  Guarding and spasm usually occur in an entire muscle belly and it can’t relax without intervention.

Small concentrated formations of tightness can occur within the muscle called “nodules” or knots.  They can also be called “trigger” or stress points.

So, how to cure this problem?  

From a physiological standpoint you want to flush out the excess protein and elongate the sarcomeres.  This can be accomplished by the use of physical modalities like heat or cold, ultrasound or laser, massage, stretching and muscle length rebalancing. The muscle also needs rest.

This is why it sometimes seems to take longer to heal a muscle injury than a broken bone!  

A bone can fairly readily be rested through casts and splints, but muscles can be “flexed” even with restricted movement from a cast or sling, via isometric contractions.  In severe instances medication may be needed such as muscle relaxers, injections or dry needling techniques.

3. Tapotement: tapping, cupping, vibration and shaking using sides of hands, fist, or heel of  hand. 

It can include gentle squeezing and wringing.  These techniques are used on more dense, thicker areas of muscle tissue such as the thigh and hip or buttock area.  It is generally used to relax very tense areas and sometimes used over the ribcage in respiratory conditions.

4.  Cross Friction or Transverse friction:   for adhesions or scarring.  

It uses the thumbs and index fingers perpendicularly across the direction of the fibers.  It can be uncomfortable for your dog but usually yields fast and good results.

 
Who should do animal massage? 

Veterinarians, Physical therapists, Massage Therapists and other health professionals who have received massage training and instructions.

Giving a proper massage requires study of animal anatomy, medical background and where/how to apply the various therapeutic techniques and maneuvers.  It also takes practice.  As a pet owner, your health care professional /Vet can show you some basics for your particular dog’s needs and issues.

Please understand that without prior basic instruction, massaging your dog can do more harm than good.  

I have often been asked to give mini lessons to groups on animal massage but have declined the invitations for this very reason.  In addition, you can never fool an animal and they really know when the hands touching them are trained or not.

The dog should be relaxed and trusting for the “healing touch” to have the best effect and they will not fully relax if they sense you are not prepared. 

I cannot stress enough that a dog always knows “trained hands’.  A trained practitioner should pay close attention and listen for the feedback dogs give.


When should massage be avoided?  

During fever, shock, active bacterial or viral infections, distemper, neuralgia, fungal sin conditions, open wounds, conditions where there is acute and severe inflammation (need to wait a day or 2 for the inflammation to be less acute).

*** 

Susan E. Davis (Sue) is a licensed Physical Therapist with over 30 years of practice in the human field, who transitioned into the animal world after taking courses at the UT Canine Rehabilitation program.  She is located in Red Bank, New Jersey.

She has been providing PT services to dogs and other animals through her entity Joycare Onsite, LLC in pet’s homes and in vet clinics since 2008.

She also provides pro bono services at the Monmouth County SPCA in Eatontown, NJ.  Sue is the proud “dog mommy” to Penelope, a miniature Dachshund with “attitude”.  For more information see her website www.joycareonsite.com , or follow on Twitter @animalPTsue.


Sue is also the author of a fantastic book on physical therapy, Physical Therapy And Rehabilitation For Animals: A Guide For The Consumer.  

Physical therapy can do so many great things for your dog. Understanding all the possibilities physical therapy can offer will change your dog's life. This book definitely belongs on the shelf of every dog lover.

Articles by Susan E. Davis:
Functional Strengthening Exercises: the What, Why and How
One Thing Leads To Another: Why The Second ACL Often Goes Too
Compensation: An Attempt To Restore Harmony
Paring Down to the Canine Core
Canine Massage: Every Dog ‘Kneads’ It”
Photon Power: Can Laser Therapy Help Your Dog?  
Physical Therapy in the Veterinary World  
Reiki: Is it real? 
Dog Lessons: Cooper  
The Essentials Of Canine Injury Prevention: 7 Tips For Keeping Your Dog Safer 

The Challenge Of Degenerative Myelopathy (DM): Knowledge Is Power (Part I)
Degenerative Myelopathy (DM): Top 10 Management Suggestions (Part II) 
Great (Or Not So Great) Expectations with Femoral Head Osteotomy (FHO) Part (I) 
Great (Or Not So Great) Expectations with Femoral Head Osteotomy (FHO) Part (II)

It's Not Just Walking, It's Therapy! 
Treatment And Prevention Of Canine Intervertebral Disc Disease (Part I)
Treatment And Prevention Of Canine Intervertebral Disc Disease (Part II Physical Therapy)
Range Of Motion: It’s A Matter Of Degree…
The Weight Of Water And How It Helps Dogs 
By Land or By Sea? A Comparison of Canine Treadmills 
Unraveling The Mystery Of Fascia And Myofascial Trigger Points (Part I)
Unraveling The Mystery Of Fascia And Myofascial Trigger Points (Part II) 
Scar Tissue: Is it Too Much of a Good Thing? 
Physical Therapy Tip Of The Month: Ramps! 
Physical Therapy Tip Of The Month: Indoor Duo Dog Exercises!
Physical Therapy Tip Of The Month: Best Practices After Your Dog’s Surgery


For further information:
Tallgrass Animal Acupressure and Massage Institute
National Board of Certification Animal Acupressure and Massage

What Acupuncture Did For Intervertebral Disk Disease (IVDD)

 We had dabbled into Traditional Chinese Veterinary Medicine (TCVM)
 when the conventional medicine failed to find either an answer nor a solution to some of Jasmine's health issues.

We tried food therapy, herbal therapy and acupuncture with very good results.

You might also remember Viva's story. Viva's spondylosis also responded very well to acupuncture.

As anecdotal as the evidence may be, dogs are benefiting from these treatments. What more does one need to know?

Here is an account of an experience of one of my dear friends, great veterinarian, Dr. Daniel Beatty, who just recently decided to explore this modality.


Canine Case of the Week: Bear and Cervical IVDD

by Dr. Daniel Beatty, DVM

Canine Case of the Week is Bear a special dog with Intervertebral Disk Disease in the cervical spine. What makes Bear special is that he is also a cancer patient, OK he is a good dog too!

Bear is one of my lucky patients that has been able to take advantage of the new information about acupuncture I have learned from the Chi Institute in my process to acupuncture certification.

Bear is a 10 year old neutered male black Lab. He was diagnosed with Osteosarcoma of the jaw in December 2010. The tumor was wrapped around his lower canine and it bled every time he ate. When it was discovered that it was cancer Bear underwent surgery to have the front third of his lower jaw removed. He recovered fine from the surgery and no longer had bleeding every time he ate.

Shortly after his jaw surgery he started limping on his left front leg. 

Of course thinking the worse his owner brought him right away to a specialist and discovered that no, the cancer had not spread, but actually Bear had a strained tendon in his elbow. The specialist injected the elbow with corticosteroid and the limping improved. Unfortunately he developed a neck problem 2 weeks afterwards.

Bear has had issues with his neck for a long time.

He would be stiff and a little painful to the touch. His owner would give him aspirin and in a day he would bounce back, however this time was different. He did not bounce back and in fact became worse.

He could not turn his head to the left without being in pain. 

Back to the vet Bear went. His cervical spine was radiographed and luckily no signs of cancer, but also no significant findings for a problem relating to his pain in the neck.

He was diagnosed with Cervical Intervertebral Disk Disease or Cervical IVDD. 

An MRI could be done to confirm the diagnosis but with the expense, the fact that an MRI may not be as reliable as once thought for diagnosis of IVDD, the fact that Bear has gone through a lot already and most important the owner was not wishing to put Bear through another surgery and only wants him comfortable for how ever many months she has left with Bear, an MRI was not performed and

Bear was given typical conservative pain management pharmaceuticals – muscle relaxers and pain relievers. 

He did this for a couple of months. It did not help enough and in May it became much worse. He could not raise his head comfortably and he was placed on more pain relievers.

In June when nothing else seemed to be helping Bear’s owner called me.

My first visit Bear was mildy depressed but still happy to visit. He could not raise his head very well, looked uncomfortable and certainly could not turn his head left. He was not sleeping well at night. He was very painful when touching his neck or trying to move his head.

I spent time massaging and doing chiropractic adjustments to help relieve some of his tension and pain. 

I also prescribed Gabapentin for the neuropathic pain since none of the pain relievers he was on were seeming to help.

A week later I revisited and readjusted. He was improved. His pain was mostly gone but he still could not turn his head to the left.

The next week I revisited again and now he could turn his head about 50% to the left and still no pain. I adjusted him again and was happy with the progress.

However Bear had other plans with his new found reduction in pain.

The problem with giving a dog pain relievers, or doing modalities such as chiropractic or acupuncture is that they do relieve pain. The problem with relieving pain is that the area is still healing and can take 12 weeks to heal completely, but since there is no pain the dog will use the area like there is nothing wrong.

If the dog feels better and does something it should not it can re-injure the area and start the whole cascade of events all over. 

That’s what Bear did!

He was happy feeling better and became excited one day. The owner knew that she needed to keep him calm and not do any activity with him, but Bear had other ideas and decide to play hard for a couple minutes and re-injured himself.

When I saw him we were back to square one! 

He was in pain again and could not turn his head at all. We started over. I massaged and adjusted him and and was coming back the next week, after my trip to the Chi Institute.

Monday, after my course work at the Chi Institute I visited Bear He was out of pain but still could not move his head to the left. 

I had some small needles that I usually use for horse legs.

I did some acupuncture for Bear’s neck and I have a laser machine and lasered a few acupuncture points as well. 

The treatment lasted about 20 min. After the treatment was over, Bear got up shook all over and whined at the door. He went out, went to the bathroom, came back in and went right for his toy box. The owner and I were quick to tell him – OH NO. She told him to go lay down.

The owner and I could tell he was feeling very spunky and wanted to play. 

He felt very good. So I went onto my soapbox and told her how he needed to rest and definitely needed to be confined and not allowed to play. The problem with acupuncture is that they feel too good and can re-injure themselves. All the while I was talking (preaching) Bear was laying with his right side against a wall, obviously upset that he was told he could not play, and at one point the owner and I looked at him and he looked back at us.

It only took a couple seconds for it to register that he was turning his head to the left to look straight back at us!

Here was a dog that had for months not been able to turn his head to the left and I thought I had made some big progress with the chiropractic treatments to get him to turn his head 50% of the way and now he was turning his head like nothing was ever wrong.

He had no pain and had full range of motion from one 20 min treatment of acupuncture!

Today I visited Bear and he is almost completely normal. He is off all the medications except for the Gabapentin which he has started weaning off. He has a little limp in his left front leg but his neck shows no sign of pain and has about 90% range of motion. I treated him with electroacupuncture today and will visit him again in two weeks.

I have a new found respect for acupuncture and will be incorporating it more and more in my treatment protocols. 

I will be suggesting it to clients more frequently and eventually I can see that my practice will be a Traditional Chinese Veterinary Medicine (TCVM) practice using herbs and acupuncture with some chiropractic and physical therapy added. Thank you Bear for the excellent results that were way beyond my expectations. With more treatments I am hoping to help him with his elbow pain and extend his life comfortably despite living with an aggressive cancer.

***

Daniel Beatty, DVM is a wholistically minded veterinarian, with a love of giving out information to make the dog owner more knowledgable and able to handle any health issue with confidence.


Dr. Dan, as he is affectionately known is a 1996 graduate of the University of Illinois, College of Veterinary Medicine. He began his career as a large animal general practitioner in Princeton, Illinois. 

While there, he completed advanced course work in animal chiropractics and became certified by the American Veterinary Chiropractic Association (AVCA). And that is where the start of the quest began.

Along with focusing on body mechanics and nutrition in dogs, he works on other health improvements such as reducing the number of vaccines and working with the dogs immune system through supplemental support and pathological issues using more alternative treatments in combination with conventional treatments to help my clients dogs improve their health and performance.

Check out Dr. Dan's Dog Kinetics blog or connect with him on Twitter or Facebook.

Related articles:
Acupuncture Is Not Voodoo
When Modern Medicine Doesn't Have The Answer: TCVM
The Theory Behind The Traditional Chinese Veterinary Medicine
What To Expect During A Traditional Chinese Veterinary Medicine Exam
Healing Your Dog With Food: More To Food Than Nutritional Value?
Why Integrative Veterinary Medicine?
Battling IMHA With Integrative Veterinary Medicine (part 1)
Battling IMHA With Integrative Veterinary Medicine (part 2)
Buddha Recovers From Third Degree Burns
The Many Faces Of Arthritis: Viva Has Spondylosis
Alternative Treatment Of Arthritis: Viva's Update

Dog Versus Human Anatomy Facts

Have you ever wondered what anatomical differences there are between us and our dogs?

Enjoy there fun facts about dog anatomy created b Pet365 - a UK supplier of dog collars, leads and pet accessories. Click here to view the full post.

Let There Be Water: Jasmine's Underwater Treadmill Session

Do you remember from my earlier article how Jasmine is convinced that she needs to help things along in order to get the tank filled? Here is a proof!



We first tried underwater treadmill for Jasmine's muscle injury.

After she was all recovered from both of her knee surgeries she suddenly started limping on her rear leg again.

At first we worried that her knee had gone bad again after all.

But it turned out being a muscle injury. 

As much as that part was a good news, after some initial improvement the lameness wasn't going away.

NSAIDs are not an option for Jasmine and pain drugs didn't seem to had been making much difference. After some debate we decided to treat her injury with physical therapy.

While that particular injury was difficult to treat and it took a long time to resolve, underwater treadmill ranks high on our list of treatment options orthopedic issues.

Underwater treadmill at Jasmine's rehabilitation center, Woodcock Veterinary Services

We have returned to hydrotherapy after her latest problems, in conjunction with latest stem cell therapy, and decided to keep it up on maintenance basis.

You can't go wrong with underwater therapy, whether by itself, or in combination with other treatments.

The benefits of hydrotherapy are multifaceted.

The buoyancy reduces weight bearing strain. Gentle resistance improves muscle strenght. Water level and temperature can be controlled to achieve different goals. Find out more about How Water Is Used for Dog Physical Therapy.


Related articles:
Don’t Forget the Physical Therapy
Functional Strengthening Exercises: the What, Why and How
One Thing Leads To Another: Why The Second ACL Often Goes Too
Compensation: An Attempt To Restore Harmony
Paring Down to the Canine Core
Underwater Treadmill
Keeping Your Dog’s Muscles Healthy and Strong
Arthritis? What Arthritis?

Meet Jasmine
I'm Still Standing! (Happy Birthday, Jasmine)
How Dogs Think (Well, Jasmine Anyway)
How The Oddysey Started: Jasmine's ACL Injury
Jasmine is Vet-Stem's poster child!
Rant About Quality Of Life Versus Quantity, And Differential Diagnoses
Jasmine Is Headed For Her Next Stem Cell Treatment
Jasmine's Stem Cells Are In

Spider Bites Dog

By Roxanne Hawn from Champion of My Heart

Lilly, the fearful border collie who serves as the canine heroine in my life, is a bit famous for being bitten. She turned 7 years old this spring and her tally includes:

• Many fly bites over three summers, leading to creepy larva under the skin
• Two rattlesnake bites to the face and one close call, in four known encounters at home
• One nasty, festering spider bite

Lilly's Rattlesnake bite

We’ll never know what kind of spider led to the hardboiled-egg-sized lump in her neck. 

It could have been a brown recluse or simply a “no name” spider in our pastures at 8,200 feet above sea level in the Rocky Mountains of Colorado.

I found the bite while looking for another lump I wanted our veterinarian to check during Lilly’s routine wellness exam.

I was groping around for the pea-sized lump, when I found a big, fairly squishy mash.

I had bathed her days earlier and brushed her that morning and feel positive I would have felt it then, so based on her behavior as the day wore on, the lump’s discovery that afternoon, and the bloody discharge my veterinarian drew out with a syringe, we’re fairly certain the spider bite happened the same day I found the lump.



Most people don’t discover spider bites on their dogs until days later, when the aspirate comes out as mostly puss from a vibrant infection.

Still, after shaving a spot on Lilly’s neck and drawing out 12-15 ccs of bloody fluid, our veterinarian squirted some on a paper towel and took a whiff. “Yep, that’s pretty rank,” she said. “It’s already badly infected.”

Spider Bites in Dogs: What to Look For

Unlike snakebites, with clear fang marks and extreme, rapid swelling in a matter of minutes, spider bites tend to show up with these symptoms:

• Swelling and itching within 1-2 hours of spider bite
• Noticeable bruising around the spider bite lump
• A squishy outer lump with a firm spider bite center
• Possible muscle pain, cramping that makes dogs reluctant to stand up or move
• Possible drooling

Dogs tend to process spider bites a bit better than cats, who can even develop paralysis from black widow spider bites.

Some bites, including those from poisonous brown recluse spiders, can become quite swollen, red, and tender to the touch. 

They can even begin sloughing dead tissue, revealing a nasty open wound that can take a long time to heal.

Spider Bite Treatment for Dogs

We sprung into action, giving Lilly shots of both powerful antibiotics and powerful steroids. Fair warning, the injection hurt like crazy … causing Lilly to fling herself to the floor screaming and writhing. So, if your dog ever needs an injection like this, hold on tight.

I had pre-dosed Lilly with Benadryl in anticipation of vaccines to which she has less-than-ideal reactions, so it didn’t hurt that she already had an antihistamine in her system before we arrived at the veterinary hospital.

We went home with both antibiotics and steroids to give her twice a day, with recheck veterinary appointments every few days.

Surgery would be needed, if the:

• Spider bite lump grew
• Spider bite lump didn’t shrink fast enough
• Dog developed any other complications such as fever, trouble breathing, tremors or seizures, extreme lethargy

In those cases, veterinarians want to do surgery to cut out the necrotic (dying) tissue and put in drains to get infected fluids out of the body.

The primary risk is that the infection might go septic (into the blood stream), which can be deadly in a matter or hours. 

I assume the bite being so close to big arteries in Lilly’s neck put her at greater risk for sepsis and organ shutdown.

Spider Bite Recovery for Dogs

Other than showing more generalized fears the first few days and running a low-grade temperature, Lilly seemed mostly normal, but tired, during her spider bite recovery. We did, however, keep her quiet in the house:

• Only going outside to potty
• Not going on long (or any) walks
• Not playing or roughhousing with us or our other dog

Lilly needed several follow-up appointments so that our veterinarian could check the spider bite lump. We kept Lilly on both steroids and antibiotics for several days past when the lump felt completely gone. Then, we finished the prescribed antibiotics and carefully tapered her off the steroids over about a week.

Spider Bite Dog Emergency

If you find a sudden, suspicious lump on your dog, consider it a veterinary emergency and seek diagnosis and treatment immediately.

***

Roxanne Hawn is freelance writer and award-winning blogger. Roxanne’s work has been published in many national outlets, including The New York Times, Reader’s Digest, The Bark, HealthyPet, Bankrate.com, WebMD and many more. Her blog Champion of My Heart is a real-time memoir of life with fearful border collie. 





You can find Roxanne and Lilly on the blog as well as:

Twitter – @roxannehawn, @champofmyheart
Facebook – Facebook/ChampionofMyHeart

Happy Birthday, Jasmine!

Wow, seems like just yesterday I wrote Jasmine's birthday post and now I'm writing another one!

Jasmine just turned eight!

That's 61 in human years according to Pedigree Dog Age Calculator and 66 according to Stanley Coren's formula!

She has about 7,000 walked miles on her paws!

But she doesn't look a day over 29!

Well, except the graying muzzle giving her away when you look closely. But to me she will always be my little puppy.

Her birthday is particularly special to us; there were times we thought we were going to lose her. And here she is, full of life, piss and vinegar!

Her biggest life accomplishment?

She trained a woman!

Yes, that's yours truly. Hubby says that if we could can that we would make a fortune!

Her secret ambition is world domination. She working at it one human at a time.

She has my vote!

Happy birthday, my baby,
Jana

Further reading:
Jasmine’s Story: Can Chronic Diarrhea and Soft Tissue Injuries be Normal?
Jasmine’s Story: An ACL Injury and a Cancer Scare
Jasmine’s Condition Deteriorates: Another ACL Injury and an Abdominal Abscess
Jasmine Recovers from Surgery and Jana Discovers TCVM
Who’s Minding Your Pet’s Health?
Pet Owner Perspective On Stem Cell Therapy
Difficult to Manage Lameness Treated with Physical Therapy
Our Journey to Traditional Chinese Veterinary Medicine

Related articles:
Meet Jasmine
I'm Still Standing! (Happy Birthday, Jasmine)
How Dogs Think (Well, Jasmine Anyway)
How The Oddysey Started: Jasmine's ACL Injury
Jasmine is Vet-Stem's poster child!
Rant About Quality Of Life Versus Quantity, And Differential Diagnoses
Jasmine Is Headed For Her Next Stem Cell Treatment
Jasmine's Stem Cells Are In
Arthritis? What Arthritis?

Did You Ever Wonder How Antibiotics Work?

by Shawn M. Finch, DVM

Antibiotics are wonderful but narrowly specific tools in the fight against disease.

An Antibiotic’s (Anti)Life Vision

The goal of an antibiotic is to rid the body of disease-causing bacteria without causing harm to the animal. 

Not All Bacteria are Mean

Bacteria are single celled living organisms with a cell wall and without a nucleus.  Most bacteria are harmless, and some are even beneficial to animals.  Trouble starts when disease-causing bacteria invade our pets’ bodies and proliferate at a rate that is too overwhelming for the immune system to handle alone.

Image: Science Class: The inside of a bacteria!

Bacteria Have Achilles’ Heels

Antibiotics tend to target unique components of bacteria, for example, their cell walls.

Animal cells do not have cell walls, and thus are not harmed by cell wall-destroying antibiotics.










Specific Mechanisms of Antibiotics Commonly Used in Small Animal Medicine


Penicillin and cephalexin antibiotics interfere with the production of bacterial cell walls.  The cell walls becomes unstable (somewhat like a soap bubble about to pop) and eventually burst. 

Lincosamide, aminoglycoside and tetracycline antibiotics inhibit one of the two subunits of bacterial ribosomes.  Proteins cannot be synthesized without ribosomes, and the bacteria are either unable to replicate or they die.

Metronidazole is taken up by bacteria and is changed to a substance that prevents DNA synthesis, causing the bacteria to die.

Fluroquinolones prevent bacterial DNA supercoiling and synthesis.

Sulfonamides and trimethoprim interfere with different steps of bacterial folic acid synthesis.  Animals are able to obtain folic acid from their diet, but bacteria must make their own.  Without folic acid, bacteria cannot survive.

Does an antibiotic kill ALL bacteria?

Antibiotics kill certain types of bacteria, based on:

• Whether the bacteria are gram positive or gram negative
• Whether the bacteria are aerobic (needing oxygen) or anaerobic (not needing oxygen)
• What the specific bacteria species is
• What the specific bacteria (individual) is
• What body system the bacteria is in
• What disease the bacteria is causing
• How fast/actively the bacteria is multiplying
• What the individual animal's reaction, including the strength of their immune system reaction is
• How the individual antibiotic and bacteria and host interact

Should antibiotics be used for suspected viral infections “just in case?”

No!  Antibiotics have no effect against viruses.

How do antibiotics work with the immune system?

The antibiotics kill or stop many of the bacteria while the immune system kills bacteria that the antibiotics have stopped, and also kills bacteria the antibiotics have missed. 

Meanwhile, the remaining bacteria are multiplying.  At each “round” (that is, dose of antibiotics) the antibiotics strike another blow against the bacteria, ideally gaining a bit more ground each time.

Can I stop antibiotics when my pet feels better or his or her clinical signs have improved?

No!  The goal of the antibiotic is to bring the bacterial numbers low enough that the immune system can finish them off.  Your veterinarian will have given you the number of doses that typically reaches this goal.

If antibiotics are stopped before bacterial numbers are low enough for the immune system to finish off, only the bacteria that have “outsmarted” both the antibiotic and the immune system so far will be left to multiply, perhaps causing the next generation of bacteria to be stronger and “meaner” than ever.  This contributes to antibiotic resistance and is unsafe for your pet. 

Are You Listening, Me?

I prescribe antibiotics more than any other drug class, and I love having such a great arsenal of medication available.  Reviewing how antibiotics work provides a good reminder why choosing an appropriate antibiotic, giving it at the appropriate dose and for the appropriate duration are so very important!  On behalf of the entire veterinary and medical communities, I will say that we need to hear this as much as anyone!

For Further Reading:

Plumb, D. C. 2011. Veterinary Drug Handbook, Seventh Edition. Ames: Iowa State University Press.

***

Dr. Shawn is a veterinarian and mom in Omaha Nebraska. She writes for CareFRESH, Life With Dogs (new!) and Omaha.net.

Dr. Shawn graduated from Iowa State University Veterinary Teaching Hospital in 1998 with a Doctor of Veterinary Medicine (DVM) degree. She works part time at Banfield, The Pet Hospital of Papillion, seeing small animals: dogs, cats, rabbits, ferrets, rodents, birds, reptiles and amphibians.

Her veterinary passions (besides her patients, of course!) are preventative/wellness care, pet owner education, positive reinforcement training and solving pet overpopulation.

You can also connect with Dr. Shawn on Twitter or Facebook

Articles by Dr. Shawn:
Xylitol And The Basset Hound