Thursday, January 5, 2012

Mary Gardner and Dani McVety Speakers at NAVC


Lap of Love founders speaking at 
North American Veterinary Conference (NAVC) 
January 14th - 18th 2012



NAVC
is one of the largest veterinary continuing education events in the world! It holds hundreds of educational sessions, hands-on labs, round table discussions and an exhibit hall containing 'all things vet/pet related'! 

Dr. Dani and Stoli
Drs. Mary Gardner and Dani McVety have been asked to speak at NAVC to help spread the word about Hospice care for geriatric and terminally ill pets.  They have also been asked to educate veterinarians on how to make the euthanasia process less stressful for pets and parents.  Having helped thousands of families in the South East, Lap of Love is one of the leaders in providing At-Home Pet Hospice and Euthanasia services. 

Dr. Mary and Herbie
"Our goal is to spread awareness among the vet community about the importance of Hospice care, how to educate parents about terminal diseases and teach families how to properly gauge Quality of Life." Dr. Gardner says.

To add to the excitement - many of the Lap of Love veterinarians will be attending the conference and getting together as a 'family' for the first time!  We will be sure to update all of our friends with pictures and information about the conference!


About Lap of Love:
Lap of Love is a group of compassionate veterinarians that provide peaceful veterinary hospice and euthanasia in the home. We empower owners to help care for their geriatric or terminally ill pets in an environment most comfortable for them - home.
    

Tuesday, January 3, 2012

Animal Life Enrichment Stories - Robyn Kesnow


Thank you Robyn Kesnow, RVT for offering a look at Animal Enrichment for our pets in the "Paw Print - Lap of Love Newsletter January 2012". 

Below are some wonderful stories about Pet Life Enrichment:

 Bella
Bella is a border collie-ish girl that lived on a sprawling estate and vineyard.  Bella's main joy and task in life was to patrol the property and keep away and would be animal-intruders.  As Bella aged, she gradually adjusted her perimeter from the whole property to eventually just the main house.  Bella's mobility became inconsistent and potentially unsafe, especially around the home's fountains and pool.  Bella's people made the decision that her perimeter patrol was such an integral part of who she was, rather than sequester her to a safe room in the house, they brought in help.  Between friends, neighbors, the family and the occasional pet sitter, Bella was able to circle the home to her heart's content.  There was always someone with her during the day so she could make her rounds safely.  The community our pets can create for us may surprise you. 

 Ashby
Ashby is a rescued cattle dog from a shelter at 14 years old.  Not knowing him well, his new family relied on dog training basics to find what would motivate this dear deaf boy.  Many trainers will note the basic drives used to motivate or reward a dog for desired behavior: Pack, Prey, Fight and Food.  Some believe all dogs have the 4 drives, and there are usually 2 that are the highest and most likely to be rewarding to an individual dog.  After consulting with a trainer and observing Ashby in his new environment for a couple weeks, food drive and pack drive seem to be his motivators.  Armed with this information, Ashby now eats all his meals from a Aikiou bowl and has daily one on one cuddle rituals with his people before bedtime.  A little observation and honoring of him with a game, ritual and added value at meal time give this young pup a great second chance for life.

 Toby
Toby is an incredibly active dog with a great family.  At 3 years old Toby experienced and injury and knee surgery.  While his situation was not permanent, his mobility and lifestyle were dramatically altered as he recovered.  The trainer found an overwhelming pack drive, to the extent the 2 human family members had to enter the home separately.  Entering at the same time and without Toby able to greet them as usually, he was going to seriously re-injure himself.  After a consultation with a more experienced trainer, the family was able to increase his food drive and interested him in Kong and chew toys in a new way by using the pack drive to build food drive.  The family also learned a safe quiet way to play tug lying down.  If Toby got up or got too aggressive, the game was over.  Toby quickly learned his new rules and his family was able to support him and even help him enjoy his recovery time.

 Semie
Semie is a wonderful 18 year old cat.  Semie's been healthy her whole life and she and her person have enjoyed each others companionship for all of her years.  When Semie found herself on medication, Semie's person got creative.  Semie didn't want to take pills, shoved down her throat; and Semie's person wasn't interested in risking their great relationship for any pill.  They tried mixing it in with food, with treats, in pill pockets, compounding to liquid, injectable, this pair tried every trick known to every pet care provider and crazy cat lady with access to internet.  Finally, originally being a student of animal behavior, Semie's person considered the drives and how Semie may feel about the different areas of her cat life.  It occurred to her that outside of their bond, Semie loved to chase.  After much experimentation, Semie now gets her pills stuccoed to the side of a hard Greenie treat with about 1/4 of a pill pocket.  Her person sets her up with an 'are you ready' cue and Semie lines up on the carpet and looks back, waiting eagerly for the treat to be thrown. 

Reference:
Aikiou bowl: http://aikiou.com/
Greenies and Pill Pockets: http://greenies.com/


ABOUT ANIMAL RN & ROBYN KESNOW:
Animal RN was founded by Robyn Kesnow, a Registered Veterinary Technician.  Seeing the need for skilled, in-home pet care Animal RN has come to be a valued service to the community of Santa Rosa California.



Our pets are now more than property; they are our friends and our family.  Animal RN strives to provide a quality of service suitable for our own pets. 


For our special needs pets, Robyn works with you and your veterinarian to be sure all protocols are followed strictly.  Whether you need regular insulin dosages or temporary help while recovering from a surgery or illness, you will have complete confidence that your friends are in good hands.
For more information:
Phone:   707 695 2500
Robyn and a patient playing modified ball



When should you bring home a new pet after losing one

When to bring home a new pet after losing one?

After the loss of a pet - many people question when to get a new addition to the family. Maybe other pets in the house miss their friend and owners want another companion for them or pet owners miss the bond they had with the pet they lost and long for that again.  However - many people are also emotionally torn and feel like they are 'cheating' on the pet that they lost.   

This is a very personal decision and every situation and family is different.    A client of mine recently asked for me to post a blog about this to get other people's opinions to help her in the decision that she is facing.   Here is what she wrote:


"I'd like to hear about other people's experiences with grieving the loss of one pet and the decision to bring a new one home. Dr. Mary, thanks so much for "e-listening" to me today on this topic and I appreciate your feedback. I'm curious how other people have dealt with this issue and if they found themselves feeling guilty or in conflict with themselves over it. I also am curious if anyone has brought home a new pet that resulted in a bad emotional experience after a hard loss or if most people found it healing. I'd be interested to hear stories from other people who have had this same struggle. I'm curious also, if people have found it easier to choose a pet that reminds them of their lost pet or if its better to choose a pet that is completely different. I'm feeling the need to find a dog that reminds me of Solomon. But that seems awful. I don't know. See why i need this blog topic? Thanks, Dr. Mary!!!"


Solomon
So please post your comments/stories below as it will not only help Solomon's mom but many others!
Thanks in advance!
Dr. Mary Gardner
www.lapoflove.com

Monday, January 2, 2012

Veterinary Oncology Consulations - Lap of Love

Dr. Miller and Annie

Lap of Love announces its new offering of Skype/Phone Consultations with Board Certified Veterinary Oncologist - Dr. Karri Miller 




Most people are surprised to learn that dogs and cats are susceptible to the same types of cancer as humans are. Cancer is the number one reason for death in our companion animals. Some common types of cancer in dogs and cats are lymphoma, osteosarcoma, melanoma, mast cell cancer, prostate cancer and mammary cancer. 

Emily getting chemotherapy

If you have a pet that has been diagnosed with a type of cancer - you will probably feel a multitude of emotions ranging from anger, helplessness, confusion, and sadness.  One of the best things you can do is get properly educated on your pet's disease - so that you know what options you have and what to expect. Many families are nervous about oncology because they relate it directly to human cancer and chemotherapy.  Luckily, therapies for our pets are extremely well tolerated and pets have great quality of lives during treatment. 

Bringing your pet to an Oncologist (a doctor that specialized in cancer) is always the best thing you can do to understand and get fully informed about the disease your pet has.   However, you may not have an oncologist in your immediate area or you simply would like some more information before proceeding to that step. 


Dr. Karri Miller has teamed with Lap of Love to provide Skype and Phone consultations to families across the United States whose pets have been diagnosed with cancer. As a Board Certified Oncologist, she will be able to provide your family with information about cancer, treatment options, and expectations.
Bessie with Dr. Miller after treatment
Dr. Miller received a Bachelor’s degree in Animal Science in 2000 and her Doctor of Veterinary Medicine in 2003.  While in veterinary school at UF, Dr. Miller found that her true passion in veterinary medicine was medical oncology.  She loved that you could extend a pet’s lifespan, while maintaining a very good quality of life.

Lily & Duchess with their favorite Oncologist
 After completing veterinary school, Dr. Miller went on to complete a medical and surgical internship at Texas A&M University and an oncology internship at Regional Veterinary Referral Center outside of Washington DC.   

Dr. Miller then returned to the University of Florida in 2005 to pursue a Masters in Veterinary Science with a focus on veterinary oncology. She received her Masters degree while starting her medical oncology residency at UF’s College of Veterinary Medicine.  Dr. Miller completed her residency in July 2009 and became a board certified member of the American College of Veterinary Internal Medicine at that time.   

To learn more about Dr. Miller and to schedule a consultation - please click here!

Tuesday, December 27, 2011

Child Safety With Dogs

My What Big Teeth You Have!

(And How Can I Avoid Them?)

 

courtesy of invisiblefence.com
How do you avoid getting bit by a dog?  
Young children should always be supervised with a dog, even the family dog. Experts agree that no child under school age should be left alone with any dog for even one moment, no matter how gentle the child or the dog.  

Is it safe for a child to be the one who walks the dog?  
It puts the child at risk of getting injured when another dog attacks the dog being walked.  Children should not walk the family dog unsupervised until they are adult sized, and using good judgment.  

courtesy of invisiblefence.com

An essential safety rule for children with any dog is to ask the responsible adult for permission before approaching or touching the dog.  If there is no adult to ask, leave that dog alone. 







Many dogs instinctively protect territory.  This can include a car the dog is sitting in, a yard the dog is confined in (this includes electric fenced yards-which a child can wander in very easily) or when the dog is on a walk with the owner.   Never approach an unfamiliar dog, especially if it is tied up or in its yard.  A dog who doesn't know you may see you as a threat.  Never turn your back to a dog and run away.  A dog's instinct will be to chase you down and catch you, just like it would do with its prey.

courtesy of safedogobedienceadvice.com
The same dog might be safe for a child to pet when the dog is on a leash but not in its yard, or vice-versa.  Some children make the problem worse by deciding that a dog is a mean dog (the dog next door who barks at everything, Grandma’s little lap dog who barks when the kids run around the house, etc.) and they taunt it.   Soon the dog is particularly protective against children in that situation.  The child who gets bitten may be another child, not the one who did the teasing.

Don't disturb a dog, even if you know the dog, while it’s sleeping, eating, or playing with a toy, especially if it’s a flavored chew toy, which in its mind equals food.  Always ask an adult if you can play with the dog with its toys.  

Don’t disturb a momma dog with her puppies.  She might try to protect them from you.  

And when you do pet a dog, let him see and sniff you first.  Offer a closed hand from below the chin, not a hovering hand over the dog’s head.  An overhead gesture can frighten a fearful dog and he may try to protect himself.  Don’t wiggle your fingers in a dog’s face or yank your hand away either.  The dog may bite your fingers in play, thinking your fingers are prey.

 

What to do if you think a dog may attack? 

If you are approached by a dog who may attack you, follow these steps:  Remain motionless, and avoid eye contact with the dog.  Attempt to slowly back away from the dog to safety.  Resist the urge to scream and run away.  If the dog does attack, in a firm voice, say, “NO!” and offer him your  purse, grocery bag, jacket, glove, shoe, bicycle, or anything that you can distract the dog with.  If you are knocked to the ground, curl into a ball tucking your face into your knees, and try to cover the back of your neck and ears/cheeks with your arms.  Stay as still as possible.  Try not to scream or roll around.

 

What to do if I you bitten by a dog?
If you are bitten by a dog, as soon as you can safely get away, immediately wash the wound thoroughly with soap and warm water, and then seek medical care.   Report the bite to your local animal control agency. Tell the animal control officer what the dog looked like, and if you know his owner's name and/or address.  If the dog is a stray, tell the officer where you encountered the dog, and in which direction he went.


What about cats?
courtesy of petstyle.com
Do not tease a cat with your fingers.  Do not pick up a cat against its will. Do not touch a cat outdoors that you come across unless the owner is present and says that it is safe to do so.   

How to interpret cat language: a cat swishing its tail, a cat hissing or growling, a cat with big pupils, a cat with its ears flat to its head, or a cat who has its back hunched:  these are cats that are saying, “back off!”  The same guidelines apply if you get bitten by a cat as by a dog.

Blog by:
Dr. Dana Lewis
Dr. Dana assists families with Pet Hospice and In Home Euthanasia in the Raleigh North Carolina area (Raleigh, Durham, Chapel Hill and the greater Triangle, as well as Wake, Durham, Orange, and Chatham counties.)

Tuesday, December 20, 2011

Reverse Sneezing in Dogs

Reverse Sneezing

Does your dog suffer from this condition? CLICK HERE

Reverse sneezing, or pharyngeal gag reflex, is a spasm caused by an irritation of the wall of the pharynx. It is similar to a sneeze, which is caused by an irritation to the nasal passages. While the reverse sneeze can look quite alarming, no treatment is needed, and episodes are self-limiting.

Reverse sneezing can have many causes. Common causes can include allergies, nasal mites, foreign bodies (such as a blade of grass or seed), viruses, masses or infections.

Reverse sneezing episodes can also occur when a dog is sniffing, excited, or pulling on a leash.  Exposure to pollen, dust, smoke, perfumes, aerosols, or other allergens or respiratory irritants may also lead to reverse sneezing in some dogs. 


Dental disease and oral infections can worsen irritation of throat and pharynx / larynx, and may predispose some pets to reverse sneezing. 

I'm often asked about Reverse Sneezing by my clients - What to do when it occurs, and how can it be prevented. I advise my clients of the following: 
  • If mild and self-limiting, no treatment or prevention is necessary. If the pet is reverse sneezing, and you want to do something that may be helpful, sometimes rubbing the nose or throat can help to end an attack. 
  • If episodes are more chronic or frequent, you may want to evaluate your pet's environment for potential irritants, and look for ways to minimize your pet's exposure to dust, allergens, and other respiratory irritants. You may also wish to consider an antihistamine trial, which may help reduce symptoms of allergies.
  • For severe and recurring reverse sneezing, I recommend a thorough examination of the pet's throat and oral / nasal cavities using a small endoscope. 
Dr. Bacon services the Greater Knoxville Area, including Farragut, Lenoir City, Oak Ridge, Clinton, Luttrell, Maryville, Sevierville, and Dandridge.

Friday, December 16, 2011

Kidney Failure in Dogs and Cats

Almost Everything You Need to Know About
Chronic Renal Failure
But Might Be Afraid to Ask

First - let's get some definitions down: 

Chronic: long term. 
Renal
: kidney. (we use them interchangeably)
Failure: the inability to perform a task adequately. 

Chronic renal failure (CRF), also called chronic kidney failure, refers to the situation where the kidneys have not been able to perform at least one of their many tasks adequately for some time (months to years). Many doctors opt for the term chronic renal insufficiency, as many cases can be treated successfully and can look forward to months or often years of quality life, while failure connotes negativity. In addition, at this time we do not usually do dialysis with pets, but there are some programs for kidney transplants available in cats.

Kidneys:  two bean-shaped organs present in our abdominal cavity that make urine and a whole lot more!  The kidneys are made of thousands of tiny filtration units called nephrons. Once a nephron is destroyed by a disease, it is not replaced; the number of nephrons we have has to last a lifetime (or at least quite a few need to last a lifetime-we do have extras).

Many people have no idea what our kidneys do for us beyond that they have something to do with urine production. In fact, the kidneys are involved in conservation of water, stimulating red blood cell production, regulating blood pressure, balancing salts, activating Vitamin D, and more. Any of these functions may be failing in the renal failure patient.

The kidneys remove toxic wastes from our bodies and when these substances cannot be adequately removed, we develop excess thirst, nausea, pain, weakness, appetite loss, intestinal bleeding, even seizures. Our goal in early stage patients is to postpone or even fully prevent the development of uremia. Our goal in later stage patients is to resolve the uremia and bring the patient back to an earlier stage of disease. 

If the pet is still making plenty of urine, how can there be kidney failure?
In chronic kidney failure, urine is usually produced in excessive quantities. What the kidneys are failing to do is conserve water and they fail to make concentrated urine. The body produces numerous toxins as it goes through its daily tasks. These toxins circulate to the kidneys where they are filtered out and urinated away. An efficient kidney can make highly-concentrated urine so that a large amount of toxin can be excreted in a relatively small amount of water.



When the kidneys fail, they lose their ability to concentrate urine and more water is required to excrete the same amount of toxin. This usually starts to happen when about 2/3 of the nephrons are no longer working.  The animal will begin to drink more and more to provide the failing kidneys with enough water. Eventually, the animal cannot drink enough and toxin levels begin to rise. At first owners might notice only that they are filling the water bowl more often, or the litter box is wetter, or that the dog has to go out more often or is having accidents.  Later the pet owner might notice weight loss, listlessness, nausea, constipation, and poor appetite.
Fortunately, we have many extra nephrons, so many extra that overall kidney function does not fall behind until we are down to about 1/4 of our original number of nephrons.

Nephrons can be destroyed quickly or slowly. Usually, by the time less than 1/4 of our original nephrons are left, whatever the inciting disease process was is long gone and there is no way to tell what happened. All we can do is make the kidney workload easier by making up for the kidney’s inadequate performance with medication or supplements. Hopefully, we can also slow the progression of the failure. Therapy is highly individual depending on which jobs the kidneys are having trouble doing.

Azotemia:  the condition where toxins have built up in the bloodstream and lab tests are definitely abnormal. It does not necessarily mean the patient is experiencing reduced life quality as a result of these abnormal lab findings. 

Uremia means that the patient is experiencing uremic poisoning. In other words, not only are the tests abnormal but the patient is feeling the effects of the toxic build up.

Therapy:  Our goal in treatment is to prevent, postpone, or resolve uremia. Resolving azotemia may not be realistic.  In most cases, by the time the diagnosis of kidney failure has been made, the initial disease that started the kidneys on their path to failure is long gone, leaving a progressive loss of function to march unrelentingly onward. Our goal is to stop that march, and get to a stage where the patient does not feel the consequences of the disease. We cannot make failed kidneys become normal again, but we may be able to re-balance our patient’s metabolism so that he or she feels as though we did. What makes a case hopeless or hopeful depends on the patient’s ability to respond to therapy nearly as much as it depends on the stage at which the condition is discovered.   See suggestions after each of the lab parameters we monitor.

Lessons in Lab Work:
Let’s begin with some of the relevant lab values that come up in the course of screening a pet’s kidney function. Your veterinarian may also recommend other tests besides these, such as urine sediment and/or culture if there is a chance that there is a urinary tract infection present as well.  It is helpful to familiarize yourself with these terms so you can understand what your veterinarian is monitoring:


Urine Specific Gravity:  One of the kidney’s most important jobs is the conservation of the body’s water. The kidney must excrete the toxic by-products created by the body’s metabolism but it will want to do so in the least amount of water possible. The healthy kidney is able to make very concentrated urine.


When we analyze a urine sample, one of the most important parameters is the specific gravity. This is a measure of how concentrated a urine sample is. Water has a specific gravity of 1.000. A dilute urine sample has a specific gravity less that 1.020.  A concentrated urine sample would have a specific gravity over 1.030 (dogs) or 1.040 (cats). A failing kidney by definition cannot make concentrated urine and the patient must drink excessively to get enough water to excrete the day’s toxic load.  At certain times of the day our urine is more concentrated than others-our first morning urine tends to be our most concentrated of the day since we usually don’t drink much at night if we are in good shape, but if we just had a big drink, our next urine will be more dilute.



Blood Urea Nitrogen (BUN):  This is a protein metabolite excreted by the kidney (it is one of the toxins we are concerned about, though it may be more of a marker for other toxins that are less easily measured). In a normal animal, the BUN is around 25 mg/dl (milligram per deciliter). Often at the time of diagnosis, BUN is well over 150, 200, or even 300. We’d like to keep the BUN no more than 60 to 80 mg/dl. BUN is influenced by dietary protein (including the patient’s own blood that has bled into the intestine).

Creatinine:  This is another protein metabolite (though this one is less dependent on dietary protein intake than is BUN). A normal creatinine is less than 1.4 mg/dl, certainly less than 2.0. Patients begin to feel sick when values meet or exceed 5.0 so we try to keep the value at 4.5 or less. BUN and creatinine will be tracked (as will several other parameters) over time and in response to different treatments.

Therapy to address fluid loss and azotemia (elevated BUN and Creatinine): 

First, is giving fluids to help keep the pet hydrated, to optimize blood flow to the kidneys, and to help flush out toxins from the blood stream.  Also, we institute dietary management to give the body proteins that it can utilize best and to decrease excess protein metabolites.  Additionally, we use gastrointestinal medications such as stomach acid blockers of various kinds, appetite stimulants, and anti-nausea medications since kidney failure leads to excess stomach acid secretion, and nausea. 


Phosphorus:  The calcium/phosphorus balance becomes deranged in kidney failure due to hormone changes as well as the inability of the failing kidney to excrete phosphorus. If calcium and phosphorus levels become too high, the soft tissues of the animal's body will become more like bone with deposits of mineral in them that are inflammatory, uncomfortable, and often cause intestinal bleeding. The bones will weaken as well, in some cases actually becoming rubbery. Keeping phosphorus levels in the low normal range has been correlated with improved survival.




Therapy for excess phosphorous:  Phosphorous binders added to the diet, and if we can get the phosphorous and calcium down low enough (so that if you multiply the numbers you get for each mineral the answer should be less than 60), a medication called calcitriol may slow further kidney decline.

Potassium:  The failing kidney is unable to conserve potassium efficiently and supplementation may be needed. The sign of hypokalemia (the scientific name for low blood potassium) is weakness, especially drooping of the head and neck.


Therapy for low potassium is a potassium supplement.


Packed Cell Volume / Hematocrit:  This is a measure of red blood cell amount. More literally it represents the percentage of the blood made up by red blood cells. The hormone which stimulates the production of red blood cells is made by the kidney. The failing kidney does not make this hormone in normal amounts leading to a reduction in red blood cells (anemia), in turn leading to weakness, poor appetite, and overall poor life quality.


Therapy for anemia in kidney failure is using an injectable form of the hormone that stimulates bone marrow to make red blood cells. 

Blood Pressure:  Blood pressure is important to monitor in kidney patients as there is a tendency for hypertension (high blood pressure) to develop in kidney failure.


Therapy consists of medication to lower blood pressure and certain medications work better in certain species.

Thyroid Hormone:  In our cat patients, it is important to screen thyroid hormone level as hyperthyroidism can lead to high blood pressure and kidney damage.


Therapy involves stopping excess thyroid hormone production via one of several ways: a medication usually given orally, dietary management, surgery to remove the overactive tissue, or radioactive iodine treatment. 

Urinary Protein:  One of the functions of the kidney is to prevent loss of the body’s blood proteins. The kidney’s filtering mechanism that enables it to remove toxins is designed to leave larger molecules (such as proteins) inside the body where they belong. But if holes develop in the filter, protein can be lost. If this complication cannot be controlled, survival time is dramatically shortened.

Therapy consists of using a medication that is used in heart disease, called an ACE inhibitor.  These medications also reduce blood pressure somewhat and decrease protein excretion in some patients.

REMEMBER, While all of this information may seem overwhelming and insurmountable, remember that many cases of kidney failure can be treated successfully and patients can look forward to months or often years of quality life with management!

Blog by:
Dr. Dana Lewis
Dr. Dana assists families with Pet Hospice and In Home Euthanasia in the Raleigh North Carolina area (Raleigh, Durham, Chapel Hill and the greater Triangle, as well as Wake, Durham, Orange, and Chatham counties.)