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Tuesday, March 31, 2015

Horse Manure Toxicity

Stefanie emailed me with the following....
I ran across a couple of warnings on line about the dangers of dogs eating horse poop because of the potential of horse wormer being present. This is one of the sites:
I'd like to know if you've ever experienced anything like this first hand or heard of it? My dog loves horse poop - and given all the hiking we regularly do, we run into it pretty regularly, so it is an on-going training process in getting her to leave it alone. Or maybe I am being overly cautious and should just let her have her dog fun?
I'll admit that this was the first time that I've heard of this particular problem.  However, I've always practiced in suburban areas with few livestock around so it's never really been a concern.  With that in mind, I read the blog post above with interest and did some digging on my own.  And I do think that there is a cause for concern.
Intestinal parasites are common in horses and can really affect their health.  Because of this risk horse owners commonly use over-the-counter dewormers as a routine treatment or even in the feed.  Most of these dewormers contain ivermectin or moxidectin, as these products are very effective against a broad spectrum of parasites.  They are also considered very safe to horses and have been used extensively for decades.
Some of the dewormer can be excreted in the feces, though it's less than they ingest.  The problem isn't that the chemicals are inherently toxic.  Ivermectin is found in the majority of heartworm preventatives on the market and moxidectin is found in ProHeart (an injectable heartworm preventative for dogs).  At appropriate doses these compounds are very safe, even for collie breeds that contain a mutation making them more sensitive to side effects of this category of drugs.  However, the horse products are far more concentrated and contain a far higher dose than is used in dogs.  Remember, virtually all dogs are going to weigh less than 100lbs (45kg) and horses can easily get over 1000lbs (450kg).  It's this higher concentration that is the concern, and can be found in potentially dangerous amounts in horse feces.  Side-effects of ivermectin or moxidectin are typically neurological and if treated appropriately most dogs can make it through if the symptoms aren't too severe.
So yes, there can be concern from eating not only horse manure, but the feces of any livestock.  Cases have been documented by vets, and the amount of ivermectin found in manure has actually been studied.  It's a pretty low concentration, so a dog has to eat a fair amount to become toxic, but it can happen.  The half-life of ivermectin in horse and cow feces has been measured at as low as 11 hours and as long as 9 days.  That means that it can take up to 9 days for half of the ivermectin to become inactivated, then up to another 9 days for half of the remaining amount, and so on.  Realistically you can have measurable ivermectin in the manure for 1-2 weeks.
Stefanie, I think that answers your question!  Don't let your dog eat livestock manure. 

Wednesday, March 25, 2015

What Defines Dog Size?

Here's a question from a reader.....
Why does the canine world categorise dog breed size using its weight?
Why don't they use height instead?

Pet food company sell food meant for large, medium, small, toy breed by categorizing them through weight. What about the dogs on the cusp? For example, a female Belgian Shepherd could be 25kg, the male Belgian Shepherd would be well over 30kg. Does that mean a certain breed needs different sized pet food for differrent gender?

I understand pet food are formulated taking into account of kcal, minerals ratio for a certain size, however, a tall dog can often be thin, think greyhounds etc. Does that turn them into a medium breed?

What do you think of the categorisation? How did it came to be in the first place? Who placed the call to set the figures as such initally? I think this should be very interesting.

I'll start with the last questions.  I honestly don't know how categorizing dogs into "small", "medium" and "large" came to be, and I don't think it can be traced to a single person or moment in time.  This has kind of developed and become accepted without there being hard and fast rules.  Some of the breed clubs do have rules as to what weight a dog of a given breed should be, but that doesn't translate across all breeds.
In general we consider dogs to be "toy" if they are under 10lbs, small if they are under around 20-25lbs, medium from around 30 to 50lbs, and large if they are over 50lbs.  However these are not hard, set rules, and there can be variation around the borders of the categories.  It also depends on what that dog's normal weight should be.  If a dog who should weigh 8lbs actually weighs 13, we'd still consider it a toy breed because of the normal weight range.
Height is irrelevant in determining general size for food, as the calories and nutrient requirements are based off average basal metabolic rate, which is closely tied to weight. Two 60 pound dogs (assuming both are of the same body condition, i.e. neither is over- or underweight) would burn a similar amount of calories even if one was short and stocky and the other was tall and lean.  The height of a dog is determined by bones and the genetics of their development rather than the soft tissue structures.  A basset hound is short because of their leg structure, but they are rather stout dogs.  If their genetics caused them to have longer legs, they would still be of the same body size.

We also don't "split hairs" (no pun intended) when it comes to gender.  In the reader's example of a 25kg female and 30kg male, those 5kg really don't make a big difference.  The average of the breed determines whether it is small, medium, and large, not the individuals within the breed.  Also, the actual amount fed is determined by the individual dog's weight.  Labrador retrievers are considered a large breed, but I've seen normal weight vary from 60lbs to 90+lbs.  We obviously wouldn't feed individuals on either end of the range the same amount of food.  The smaller lab would need far fewer calories than the larger one.

Really, we don't need to over-think this.  Sometimes the only difference in the foods is the size of the kibble and not the nutrient content.  If you have questions about which food to feed your own dog, ask your vet.

Sunday, March 22, 2015

Monster Lipomas!

Lipomas are a common occurence in dogs, especially those that are overweight and at least middle-aged.  We typically consider these benign growths and rarely do we talk about surgically removing them.  Once a dog starts to develop one lipoma the chances of developing more of them increases.  It is also common to leave some cells behind, potentially resulting in regrowth at that location.  If we remove one or two of them there is no guarantee that more won't form.

When we do remove them it is usually because either they are rapidly growing and thus have a higher likelihood of malignancy, or because they are affecting the dog's mobility.  The latter was the case with a dog we recently saw, who we'll call Lumpy.

Lumpy is a sweet older chocolate lab who had had multiple lipomas for several years.  A few of them had been growing, and one on his left front leg was starting to interfere with normal movement due to its size.  After discussion with the owner it was decided to remove that lipoma as well as two larger ones elsewhere on his body.

The surgery was a long one but went smoothly.  I was able to get all three large lipomas out, as well as some smaller ones that were right next to them.  The challenge came in closing up all of the open space (what we call "dead space") that used to be taken up by the mass.

Here's what Lumpy looked like before going home.  I kicked myself for not taking pre-surgical pictures!  But you can get an idea of the locations.

Here is a great photo of the lipomas together.  That's my hand to give you a sense of scale.  The largest one (top right) was the one around the left elbow and shoulder.  As you can see, they are huge!

Believe it or not, these aren't the largest I've seen on dogs.  I had one patient that had a lipoma covering the entire side of its chest.  And we didn't even come close to removing all of the lipomas on Lumpy.  He still has at least a good half-dozen small ones scattered over his body.  But he's doing well and the owners are glad that he can move a little easier now.

Thursday, March 19, 2015

Bored In Veterinary Medicine?

Here's a question from Genesis..........

Hi, my name is Genesis, I'm currently studying biology and have been interested in veterinary medicine since I started my bachelor. The problem is, I'm very concerned about the debts, about the fact of me getting tired of the job and the probabilities of finding a job once I finish vet school. This is why I've been thinking about going into med school or the possibility of finishing vet school, and then specializing in surgery.
I actually don't see myself working all day with people doing the same thing over and over again. I love to do different things and to have a change once in a while, but I'm not sure if Veterinary medicine is the same.

Let me start with the first concerns.  Debt load is a huge concern for newly graduated vets.  In fact, many people (myself included) would consider this at crisis levels and the single biggest concern in the profession right now.  So anyone wanting to enter the field needs to do some serious financial planning before ever entering vet school.  I posted recently that while veterinary job prospects may have been slightly lower recently, overall it's very possible to get a job.  While it make take more effort than when I graduated, as a whole it's a profession with extremely low unemployment.  Do a search of my blog and you'll find several posts on these subjects.

Now let's tackle the bigger concern....boredom.

In any job you'll reach a point where you'll see numerous routine cases.  Human doctors see the same problems in patients again and again, and give the same advice over and over.  If you look at general practice veterinary medicine it may superficially seem like just about all you're doing is vaccines, spays and neuters, and skin problems.  Even veterinary surgeons tend to do a lot of the same procedures, with routine things like ACL and broken bone repair happening more often than you may think.  So the first thing I'd recommend is to realize that no matter what job you have there will periods where you do repetitive work and tasks that you do daily.  

Correct me if I'm wrong but I would suspect that you haven't spent a lot of time in a veterinary practice.  Yes, we do a lot of basic preventative care every day.  Yes, there are some disorders that we see almost every day (ear infections, diarrhea, itchy skin all jump to my mind first).  And yes, we're continually giving the same kinds of advice to people daily.  But I would never say that the job is boring.  

Every day brings surprises.  Often I'll expect one thing in a room and end up finding something different.  Just a couple of weeks ago I had to cancel my afternoon appointments so I could do an emergency c-section on a cat.  I commonly have to make challenging diagnoses, some that really test my knowledge.  Even routine cases will have variety.  Not every ear infection is exactly the same, and can vary in the infectious organisms, degree of infection, secondary changes, and so on.  Also, each day is far from the same.  Some days will be virtually nothing but sick or injured pets, leaving me wishing for a simple preventative care case.  Sometimes we'll get a run of a particular case; recently one of my associate doctors kept diagnosing pancreatitis, making her almost develop a complex about the next vomiting dog.We do see some cases commonly,  but the mixture of cases is different every day.

Genesis, I'd first ask why you think being a general practitioner is boring, and how you would specifically define "doing the same thing over and over again".  Knowing the specifics of your fear of boredom might help determine if this is a realistic apprehension.  If you're looking for a job with absolutely no repetition or routine, you won't find that in any sort of medicine.  If you haven't spend a lot of time in or around veterinary medicine I'd strongly recommend getting a job in a practice, even a part-time one.  That may change your impression about what we do.

Because the job certainly isn't boring.

Monday, March 16, 2015

Is It Okay To Cut A Dog's Whiskers?

I haven't had questions from readers in a while, and now I have several of them to answer.  Here's one from Crystal.

I am a fairly new subscriber to your blog.  I have a 4 month old Yorki Poo.  I was wondering if it is ok to cut her whiskers when grooming her face.  I've read different opinions online some saying to never cut the whiskers as they are needed and the dog's behavior can change if they are cut.
I'd love your opinion.

I answered a similar question about cat whiskers several years ago.  The same principle applies here.  A dog's whiskers aren't quite as important as a cat's whiskers, especially in captivity.  There is absolutely nothing wrong with trimming the whiskers along with the rest of the facial hair.  In fact, there's no way to trim the hair close without cutting the whiskers as well.  Grooming the facial hair happens routinely at grooming salons, and I have clients come in all of the time with small, fuzzy dogs who have had this part of the coat shortened, including the whiskers.  In 18 years of practice and 31 years in the profession, I have never seen a dog have any sort of problems after cutting whiskers.  Does it change the way they sense and feel things around their face?  Sure.  Because of the functionality of the structures it has to.  But this doesn't seem to cause any change in behavior or how they react to their environment.  Through selective breeding we have already significantly changed the structure and behavior of dogs from their wild ancestors.  We're not going to alter that significantly with a haircut. If it was my dog I wouldn't have any worries about doing this.

Friday, March 13, 2015

The Limits Of Diagnostics

Recently we had a dog come to our clinic to evaluate a mass next to her rectum.  It was pretty large and felt very invasive.  We sedated her to do a needle aspirate, which is the most common first-line diagostic for masses.  It's pretty simple and minimally invasive, and typically done without sedation.  We did sedate this dog due to the potential discomfort at that location.  We use a large-gauge needle, poke it into the mass, pull back to aspirate material, then send it off to our pathology lab for analysis.  This "fine needle aspirate" (FNA) is one of the most common and easy diagnostic tests that veterinarians do, and is much less expensive and less invasive than a surgical biopsy.
Sometimes, however, we don't get good answers.  In this particular case the mass was very fibrous, and the pathologist didn't see any significant cells, making the sample non-diagnostic.  One of my associates talked to the client, who was understandably confused and even frustrated that the test didn't give us any sort of answer.  However, that's one of the realities of medicine.  Diagnostic tests don't always tell us what we need to know.
"Well, then why am I paying for you to do them if you can't tell anything?"
No matter what test we are running, there are limitations.  A full chemistry panel may come back completely normal in a sick pet, leaving us with almost as many questions as when we started.  The FNA may come back without appreciable cells, meaning that the next step is cutting into the mass with a scalpel.  Every test has some degree of false negatives or false positives, as well as limits to what it can detect.  Yes, sometimes we do get a clear answer, and it's easy to support the decision to run the test.  I wish that was always the case.
But even "normal", "negative", or "non-diagnostic" tests can help some of the decision process.  If a chemistry panel is normal, I may not be able to tell exactly what the problem is, but I can definitely make some assessment of what it is not.  For example, if the everything on the panel is within normal range, we can rule out liver or kidney failure and start looking at other parts of the body.  The non-diagnostic biopsy that we performed actually gives us some clues, as fibrous tumors don't shed cells very well and we likely can narrow down the possibilities to that category of cancer.  We may still need to do further follow-up, but we have a little more of a direction to go.
That discussion can sometimes be difficult to have with clients.  We need to celebrate the normal results and help them understand that this is valuable information that helps the diagnostic process.  Yes, we may need to do more tests, do a more invasive biopsy, or otherwise go to the next step, but we at least have a little more direction than we did before.  Ruling something out is just as important as ruling something in.
Diagnosing a disease is a process.  Rarely is it "run this test and then we'll have the answer and can start X treament."  It's more along the line of "start with this test, then based on the results we may have to go down diagnostic pathway Z rather than pathway W."  Yes, this can be frustrating, and it does cost money.  But it really is the only way to get to the bottom of what is going on.  Be patient with your vet, ask lots of questions, but understand the challenges and limits of these tests.  Your vet is doing the best that they can to figure out what is wrong with your pet, and it is not always straightforward to do so.

Tuesday, March 10, 2015

"You Will See Me NOW!"

Is it a full moon?  Based on a cluster of recent clients, I think it's a possibility.  In the past few days we've had three different clients be absolutely demanding and insistent on being seen immediately.  All of them are good, long-term clients, and none of the situations was an emergency.
The first client, Mrs. Panic (not her real name) called because her dachshund, Ooze (not his real name), had some bloody urine.  It was a busy day and we said we'd work her in, but one of the doctors was in surgery and the other at lunch, plus a full appointment schedule.  She said "I'm coming in right now and anyone else will just have to wait!"  We actually called the doctor who stepped out for lunch and asked her to come back.  It turned out that the "bloody urine" was some kind of red-tinged goo and the urine we collected was completely normal.  Ooze was perfectly fine and we never did figure out where the goo came from, but it didn't look like it came from him.
A day later Mrs. Worry brought in her elderly schnauzer, Gerry, for a routine exam and checkup.  Her other dog was dropped off for a dental cleaning, so she let Gerry be dropped off at the same time.  She brought them in before I arrived and told my receptionist that she wanted me to see her dog "before he touches any other animal!"  She was concerned that with Gerry being so old it would be stressful to have her here for long.  Keep in mind that this is a dog I've seen for years and even though old has had no serious problems.  And I had a full morning appointment schedule with several sick pets that needed to be seen first.  I finally got to looking at Gerry around lunch time, and they were ready to go by 3pm.  When I called Mr. Worry he didn't have concerns about the wait and was as pleasant as always.

The last of this run of impatient people happened the following day.  Two dogs were dropped off on a busy day for routine preventative care services and the owner said that they didn't need to pick up at any certain time.  Since they were the last drop-offs to arrive and we had lots of other patients, we waited to work on them later in the day.  Around 3:00 the client called and was upset when we said that the dog's weren't ready.  She went on a rant about how she had a 4:00 appointment and then couldn't pick them up until after 6:00.  She didn't drop off until around 11:00 that morning and we close at 7:00, so we didn't see the problem.  It was more surprising because they didn't have any sense of urgency when they dropped off.  My receptionist had to do some smooth talking to calm her down and agree to let us keep the dogs a little longer.  She finally showed up around 6:50, still a bit miffed but calmer.  By the time we were done going over the exam and discharge instructions she was as pleasant as could be.

I know that people want their pets back as soon as possible, but I don't think people really put thought into the fact that we have a dozen or more pets in our clinic besides theirs.  Believe me, we don't want them to stay any longer than they have to either!  We go through pets in the order they came, but put sick pets over well pets in the priority list.  When there are a lot of sick pets that means the well ones may have to wait longer.

I've said it before and will keep saying it.  If anyone wants to go into veterinary medicine because they don't like people, they are in for a very rude awakening.

Saturday, March 7, 2015

Product Review: Lead Mate

As part of being a blogger, I've occasionally had the opportunity to evaluate and review products.  A few months ago I received prototypes of a gadget that hasn't actually been produced, and have been using it in real-world situations.
The product is called Lead Mate.  When I first was contacted about it I thought it was interesting but to be truthful I didn't see a huge need for it.  But because of my curiousity I agreed to try it out.  I can't believe how wrong my initial instinct was!  The Leash Mate is incredibly simple and effective, helping with a problem I didn't realize I had.
The concept is pretty basic.  The device is made of two halves with a channel containing "teeth".  I received two prototypes, one for small leashes (such as small dogs or cats) and one for larger ones.  You unscrew the pieces, place the leash in the channel, and then screw them back together tightly.  The teeth grip the leash with surprising strength and don't slip.

Okay, that's nice and all, but what's the point?  Isn't that why a leash has a handle?
I thought so too, but then started looking at my own dogs.  I have two dogs, a lab and a lab-husky mix.  Both are good dogs, but they do have a tendency to pull on their leashes when excited.  When I bring them to work with me they certainly respond to the stimulation and want to pull everywhere.  Until I had the Lead Mate I would hold the handle of the leash, and then wrap the leash several times around my hand and wrist, thus making it short and giving me better control over my dog.  Yes, that works, but if I was having to walk them for more than a short distance that would start to dig into my hand and be very uncomfortable.  I've never liked retractable leashes because they make it even more difficult to control a dog, especially if they are at the limit of the leash when you want to bring them back.
The Lead Mate takes away the need for wrapping or retracting the leash.  It is adjustable to where you want it on the leash, making it easy to position how close you want the dog to you.  My biggest surprise was how comfortable and natural it is to hold!  Seriously, it is very easy to grip and feels incredibly comfortable.  The shape makes it easy to hold tightly without feeling like you're squeezing with a death-grip.  Even when used on my strongest puller I could easily hold onto the Lead Mate and it didn't slip on the leash.  I did notice that after a while of using it the device can unscrew slightly, leashing to some slippage.  However, that was easily corrected with just a few twists to tighten it back down.

The Lead Mates I evaluated were 3D printed prototypes, while the final product will be injection molded and therefore a lot stronger and more durable.  While the pictures above are from Lead Mate, it's only because I never got around to taking pictures of my own dogs with it.  I received black ones which look and function exactly like the photos.
I have to say that this is one of the oddest pet devices I've seen, but one I can't imagine hasn't been invented before.  I keep it on my own dog's leash and use it every time I walk them.  I've shown it to staff at my clinic and they've been pretty interested in it.  This is probably the strangest product I didn't realize I needed!
At the time of this writing it isn't in production yet, but you can find out more details and see more photos at  There will also be a Kickstarter campaign starting in a few weeks to help fund the initial development.  I would definitely recommend checking it out!  Believe me, it's much more useful and cool than I first thought, and I think this has the potential to help out a lot of people.  If these go into production and I lose mine, I will absolutely buy a replacement.

Wednesday, March 4, 2015

Veterinarian, Breeder, Store Clerk....Who Do You Trust Most?

I make recommendations to clients with every visit.  It may be about vaccines, the kind of heartworm prevention they should use, which foods to feed, and so on.  My opinions are based on four years of medical school, 18 years of practice, over 300 hours of continuing education over the years, and countless journal articles.  I'm not perfect and I don't know everything, but I'd like to think that my knowledge base is pretty comprehensive.  This is why it still surprises me when someone believes a breeder or pet store clerk over their veterinarian.
I've run into many situations where a breeder tells a client "whatever you do, don't let your vet do XYZ!"  Some of these breeders are quite vehement about their opinion, frightening the client into compliance.  "Your vet will tell you to do this, but don't do it!  I've been breeding for 30 years and I know dogs!  This is very harmful and your vet is just trying to make money and doesn't care about the risks!"  Yes, I've heard these very words, and even seen similar ones written on papers given to a client when they purchase a puppy.  I have to sigh and shake my head, wondering at the influence that the breeder really has.  And they do have considerable influence, because I've had clients disregard my words and recommendations based on what the breeder told them.
Similar things happen with pet store clerks.  I'll talk about food choices, and make some strong recommendations based on what nutritional specialists have said to me.  The client then goes to the pet store and pick something else because the clerk said that what I suggested was bad. 
Let me be clear.  Not every vet is right, and not every breeder or clerk is wrong.  But stop and think about this situation for a minute.  On one hand we have someone with a medical degree and years of experience, plus mandated continuing education every year and with subscriptions to multiple scientific journals.  On the other hand we have a breeder who "knows dogs" and visits internet forums.  Or we have a clerk that's worked in the pet store for a few years but hasn't had any formal training in the subject.  Who does it make sense to believe?  The person who studies immunology at a cellular level, or the person who reads a lot from like-minded people online?  The person who has learned the microscopic structure of the intestinal lining and how nutrient absorption works, or the person who has attended an at-work seminar? 
If you're doubting your vet because a non-vet told you something, stop and ask yourself why.  What training or experience does the non-vet have that trumps the training and experience of vet?  I can bet that most vets can run rings around the non-vet with actual data and studies, rather than just relying on "years" of breeding/working/experience.  Feel free to question your vet (in fact, I encourage it), but in the end stop and realize who really has the best background to make recommendations for your pet.