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Monday, August 31, 2015

Trying To Decipher Food Allergies

I was asked this question back in June, but I had done so many nutrition topics recently that I decided to postpone my response.  Here's what Crystal wrote.

My yorki poo is currently 7 months old. She had an ear infection when we first got her at 8 weeks old. She just got spayed 2 weeks ago and she had another ear infection. The Dr said that it could possibly be from food allergies. I am hesitant to change her food without knowing for sure if it is food allergies. He didn't say if it was a yeast or bacterial infection but that it was red and inflamed. She has been on Royal Canin's puppy food since we've had her and the only change with that line of food was going from the mini starter to the mini puppy. At a previous visit to the vet we were told that she has a lot of hair in her ears which needs to be pulled to prevent infections. We haven't been very successful at pulling the hair and doesn't that hurt her? I'd love to hear your suggestions. It feels like looking for a needle in a haystack trying to decipher what food would be a good one to switch to if we were to switch. The varieties on the market are overwhelming.

The average pet owner doesn't really understand what food allergies are, how they come about, and how they are treated.  Please understand that this isn't a criticism, as this is a more complicated issue than most people realize and vets haven't always done a good job of really explaining the disorder.  I'm here to try and correct that failure!

Let's start with the symptoms of food allergies.  Most commonly this shows in the pet as chronic or recurrent skin and ear problems, including infection, redness, and itching.  Sometimes chronic ear infections are the only sign of a food allergy.  The symptoms happen any time during the year and are independent of the seasons.  Less commonly in dogs we can see gastrointestinal signs such as diarrhea and vomiting.

Pets are not born with food allergies.  An individual pet may be born with a tendency for a specific allergy, but it does not affect them right away.  A dog or cat needs to be exposed to a particular ingredient for a long period of time in order for their body to develop a sensitivity to it.  Usually that requires prolonged exposure, at a minimum of several months but more commonly a few years.  That's why the average age in which a pet starts showing signs of food allergies is 1-5 years old.  While it is not impossible for a dog to have food allergy symptoms at less than six months old, it is uncommon and not our first thought.

Food allergies are to specific ingredients, most typically proteins and sometimes carbohydrates.  This means that the allergy is not related to any particular brand and won't improve merely by switching to a different manufacturer since so many ingredients are the same.  Many people don't realize that the problem isn't just the food, but anything the pet eats.  If your dog has a wheat allergy and you're feeding a food without wheat but giving treats that include it, you're not doing anything to help and are continuing to trigger the allergy.  With food allergies every single little ingredient, food, and treat needs to be considered.  If you change the food but aren't careful about anything else, you're not treating the problem.

Sometimes a pet can cross-react with similar ingredients.  For example, a dog with an allergy to chicken has a possibility of also reacting to any other kind of poultry such as turkey and duck.  Therefore when a pet has a confirmed food allergy you need to avoid any related ingredients.  In the above example you would want to avoid foods with any kind of poultry ingredients, not just chicken.

Pet owners should also realize that veterinary dermatologists and allergists don't consider any over-the-counter pet food to be truly hypoallergenic.  The main reason for this is that it's common for unintentional ingredients to make it into foods.  More than one study has identified proteins in pet foods that weren't on the ingredient list, meaning that you may not know every trace ingredient in the food.  This is not a concern at all for the majority of pets, as those trace materials won't matter.  But to a pet with a sensitivity, even a trace amount can be enough to trigger an allergic response.  

So what is a pet owner to do?  How do you diagnose the problem?  And how do you treat it?

While there are blood tests for food allergies, I've never talked to a specialist who thinks they are accurate.  Therefore the only way to accurately determine if a pet has an allergy is to put them on a very restricted, specialized diet for a minimum of 6 weeks and potentially up to 12 weeks.  During this time the pet can have nothing else to eat.  Even a single bite of something to which they are allergic can set them back to square one.  If the pet improves, we then "challenge" them with their previous food and look for a return of the symptoms.  This is the only real way to test for a food allergy.

Truly hypoallergenic diets are indeed expensive, which many people think they can't afford.  But start to add up the costs of the steroids and antibiotics you typically give to treat allergy flare-ups, as well as the non-financial aspect of the discomfort your pet is going through.  If they respond well to the specialized food, then we can try exposing them to single ingredients to further determine what their specific allergy is.  In some cases we can then try over-the-counter diets that avoid certain ingredients.  I have a patient who has a confirmed wheat allergy (though a diet trial), and as long as the owner avoids foods and treats with wheat the pet is okay.

The key here is to make sure your vet is comfortable diagnosing and treating food allergies, and then follow their directions to the letter.  Any deviation at all can result in a delayed or incorrect diagnosis.

Monday, August 24, 2015

Lessons From The Flu Outbreak

A few months ago I blogged about the recent canine influzena outbreak that happened here in the US.  At that time I had few concerns and worried about the panic that the media seemed to be fostering.  Little did I know that I was going to face the problems in my own clinic and have some of my views changed.

The last time I blogged about this issue we had barely started seeing any cases in the Atlanta area.  Back then I had no idea that we would become the number two hot-spot for canine influenza in the country.  Several local boarding facilities had outbreaks and had to temporarily shut down in order to to thoroughly clean and disinfect.  It hit the news outlets and resulted in numerous calls to area veterinarians.  At my own clinic we diagnosed a couple of cases and had others that we suspected of being influenza.  

I've been practicing for 18 years and I've never seen a disease spread this quickly and this widely.  It happened so fast that I don't think the profession was really ready or knew how to prepare.  The distribution of the cases has also been odd, with the two worst affected areas being over 600 miles (965 km) apart.  I haven't heard of anyone confirming it, but I suspect that it has to do with the large airports in both cities.

Because of the severely contagious nature of influenza we were telling people to keep their pets at home if there were only mild symptoms such as coughing or sneezing, but the dog was otherwise doing well.  If we had a more severe case we treated it with utmost care.  My staff wore disposable protective gowns, gloves, and limited suspected cases to a single exam room.  For cases that needed to truly be hospitalized for supportive care we planned on referring to local specialty clinics who had set themselves up as true isolation facilities.  Thankfully we didn't have to go that far, but the disease is extremely contagious and we didn't have the setup to keep them ourselves.  If we had tried to hospitalize an influenza case ourselves we would have put every other dog at risk.

The veterinary college at Cornell University has been tabulating and monitoring the spread of canine influenza across the US, with the most recent data released July 28th.  The patterns are interesting.






You can see that even though Atlanta and Chicago were hit hardest, there are multiple pockets of infection throughout the country.  There is a strong likelihood that we will continue to see outbreaks and new areas affected.

In my area the immediate crisis appears to be over.  However, the virus is now in the environment and the dog population.  We're now going to have to continue to watch out for pets presenting with possible flu symptoms and handle them appropriately.  This is a new normal for the veterinary profession.

Friday, August 21, 2015

The Importance Of Post-Op Restrictions

Whenever your pet has surgery your vet likely tells you to restrict activity for a period of time.  For routine spays and neuters that can be difficult since the patients are so active and recovery so quickly.  But these restrictions are actually very important to your pet's recovery, and bad things can happen if you fail to limit their activity.  We saw that this week.
 
About two weeks ago one of my associates performed a routine spay on a happy, active puppy.  The surgery was uneventful and she went home without problems.  About 10 days later she called to check on the puppy and talked to the owner.  The owner reported that there was some swelling, which there shouldn't have been at that time.  She brought the puppy in so the doctor could look at her, and it was discovered that even though her skin had healed well, the abdominal incision had opened and she had developed a hernia.  Thankfully she was still acting like nothing was wrong, and was still just as active and happy.
 
When discussing the situation with the owner we learned that they hadn't been successful in keeping her activity restricted.  We tell all clients to keep activity minimal for at least a week after even a routine procedure like this, as the restrictions lower the risk of complications.  In this case we were trying to decide if the puppy had gotten too active and had broken the internal sutures, or if there was a problem with how the procedure was performed.  I suspected the former, as my associate has nearly three years of experience and is a good surgeon.
 
The owner agreed to let us repair the hernia (not that there was much choice....leaving it was dangerous).  I did the surgery this time as it fell on one of my surgery days, and discovered that the suture had broken in the middle of the incision.  It did look like she became too active and over-stressed the suture.  I was able to repair the problem easily, and used some different methods to make it more secure.  We also sent the puppy home with a tranquilizer to help keep her calm.  Hopefully this time the restrictions will be successful and she won't re-injure herself.
 
I've seen things like this happen before.  Several years ago one of my patients tore her ACL (anterior cruciate ligament....an important stabilizing structure in the knee).  Her owner had surgery performed with a local surgical specialist and it went well.  Three or four weeks after the surgery she was doing so well that the owner let her start being active, even though the surgeon had said to restrict activity for at least six weeks.  Of course, she tore her knee again because the surgery hadn't fully healed.  So she had to have a second surgery to repair the problem.  After that the owner was much more careful to keep her restricted.  Unfortuantely his brother watched her one weekend, about four or five weeks after the second surgery, and didn't keep her inactive.  Yes, you guessed it.  She tore her knee again
And that meant that she needed a third knee surgery!
 
When we veterinarians tell you to keep your pet inactive after surgery, we're giving you this instruction for some very good reasons.  We know that it's hard to keep a young puppy or kitten slowed down, but there are definite risks in not trying.  Complications aren't automatic, but they certainly go up if there are no restrictions. 
 
When your vet tells you about restricted activity post-operatively, listen closely and take it seriously.  If not, you may end up with your pet in an additional, unnecessary surgery.

Tuesday, August 18, 2015

Dangerous Peanut Butter?

No more comic books!  Back to veterinary stuff!

I frequently use peanut butter to give pills to my own dogs and recommend it to many clients.  Peanuts are non-toxic, most dogs love it, it's cheap, and it's easily available.  It really is a good treat for most of my patients and even my own pets.  However, there may be some dangers.

Xylitol is a common artificial sweetener, most frequently used in sugar-free gum.  If eaten in large enough amounts it can cause severe hypoglycemia and even liver damage in animals.  Historically we've only worried about it in gums and similar sugar-free products (I blogged about it back in 2009 if you want to read more details).  Now it has begun cropping up in peanut butter and it carries the same risks.

Thankfully xylitol hasn't been included in major brands of peanut butter.  So far, only three small brands use it as an ingredient:  Nuts 'n More, Krush Nutrition, and P-28 Foods.  Here are some images of these companies' products for easy reference.




If you use any of these products, do not give it to your pets.  If you're uncertain, check the ingredient label.  But here's another warning....some companies will list "sugar alcohol", and while most chemicals in this category are safe, this listing could potentially include xylitol.  It's better to be safe than sorry, especially considering that a large amount of xylitol could easily kill a dog, so if you're in doubt avoid the product.

This is a new situation and warning, so veterinarians will be keeping any eye on whether or not the big companies will use xylitol in their peanut butter.  For now, most brands of peanut butter are perfectly safe, and I'll continue giving it to my own dogs.  Just be cautious, and read the label closely.

Tuesday, August 11, 2015

1000!!!!!!!!!!!!!

I don't know how in the heck I've done it, but this is officially my 1000th blog post.  Wow!  I know that I'm impressed with myself.  Back in 2008 when I started this I honestly wondered if I'd be able to keep writing for very long.  Most people who start to blog eventually give it up because it does take a lot of work, commitment, and time.  Not only that, but trying to come up with that many things to write about without being significantly repetitive can be challenging!  I've had times when my time or motivation has waned, but I've always come back to it. 

Thanks to everyone who has been a part of my readership for the last seven years!  Whether this is the first of my posts you've read or if you have somehow managed to read all 1000, I truly thank you for taking the time to visit my little corner of teh interwebs. 

And since this is a milestone post (though honestly no different than my last one or the next one) I'm changing the appearance of the blog a bit.  It's been years since the last redesign, so this is as good of a time as any.

Now let's see if I can make it to 2000! 

Sunday, August 9, 2015

More Marvel Animals

I really didn't intend this to be a series of posts about comic book animals.  Really!  I planned on the two posts and that was going to be it.  But I just discovered that Marvel Comics is doing a series of variant covers with their characters as animals.  It's part of their new "Marvel NOW" launch, and it's a new twist on the characters.  Here are some of my favorites.









Okay, this is my last post about comic books or superhero animals for a while.  Seriously!

Thursday, August 6, 2015

Superhero Pets

My last post made me think about all of the animals that actually made it into comic books as the pets of superheroes or superheroes themselves.  For those of you who aren't major comic geeks like I am, there have actually been quite a lot of them over the years, even into recent times.

Jumpa, Wonder Woman's Kanga


Yes, this is actually one of the strangest entries in this area.  On Paradise Island the Amazons don't ride horses, they instead have mounts that are actually aliens that resemble giant kangaroos.


Redwing, Falcon's...ummmm...Falcon


In Marvel Comics the superhero Falcon has a falcon with whom he shares a telepathic bond.  I wonder if they'll ever include that in the Marvel movies.


Lockheed, Kitty Pryde's Dragon

This is probably my favorite superhero pet!  Lockheed is actually an alien creature that resembles a small purple dragon.  He met Kitty Pryde on one of the X-Men's adventures in outer space, and became her closest companion.  He has a really fun personality, and dragons are just cool!

Zabu, Ka-Zar's Sabertooth Tiger


A lesser-known hero, Ka-Zar has a lot in common with Tarzan, except he lives in a prehistoric jungle rather than the wilds of Africa.  His constant companion is a sabertooth tiger.  How cool is that?

Storm and Topo, Aquaman's  Giant Pets


 As one of the biggest Aquaman fans you'll meet, I'll admit that these two have contributed to the unfortunate misconception that the King of Atlantis is too silly.  A giant seahorse steed and a giant octopus friend?  Yeah, I'll admit that they're not the best pets to enhance Aquaman's image.  Thankfully they updated Topo a bit in recent years.  


Lockjaw, Black Bolt's Dog



With the Inhumans showing up on the Agents of SHIELD TV show and an Inhumans movie planned, hopefully we'll get to see Lockjaw on the screen.  A teleporting giant bulldog/mastiff?  What's not to love?

Ace, Batman's Dog



Over the decades Ace has gone through several incarnations, but the idea of a "Bat-Hound" keeps coming back up.  He was even featured in an animated series with Krypto the Super-Dog.

Krypto, Streaky, Comet, and Beppo, The Super-Pets




As if Superman and Supergirl weren't already powerful enough, writers have added several similarly powered animals to their family over the years.  While many people know of Krypto, the super-dog, fewer know of Streaky the cat, Comet the horse, and especially Beppo, the super-monkey.  And if that wasn't odd enough, at one point all of these animals joined together as the Legion of Super-Pets!


The Pet Avengers


And not to be outdone with animal super-groups, Marvel brought together several of their super-animals to form the Pet Avengers (even though only a couple of them had masters who were ever Avengers).

Okay, all of this is cool (at least to us comic nerds), and I'm waving my geek flag high right now.  But besides sharing that side of myself, why else bring it up in this blog?

Because earlier this year I started thinking......these super-animals need care as do mundane pets.  What would it be like to be a veterinarian for them?  Can you imagine a waiting room with Batman, Falcon, and Supergirl sitting their next to their respective pets?  And what kind of specialized equipment would I need to treat them?  Since Krypto is as invulnerable as Superman, it would be pretty tough to immunize him against parvo.  And with his super immune system and alien physiology would he even be able to become infected with it?  How would you go about analyzing blood tests on a dragon-like alien? The questions are endless and incredibly fascinating to a comics fan like me.

I've actually considered sitting down and trying to write a story or even a novel about this exact scenario (so this is me officially declaring that this is my idea.....don't go stealing it!).  The main character would be a veterinarian and he would be trying to treat problems in the pets of superheroes.  Perhaps a super-villain has created a virus that is infecting all of the super-animals, even though it's across species!  And the hero-vet must find a way to stop the disease, thus saving the pets of the worlds greatest heroes!  Maybe this vet has powers himself, such as x-ray vision, microscopic vision, or the ability to actually speak to his patients. 

Not that I have time to write more than some blog posts here and there.  Still, the idea keeps rattling around in my head.  If I can squeeze the time and work out a good plot outline I may give it a try.