New Application Helps Better Manage Diabetic Pets

We recently received some exciting information at our office from Abbott Animal Health, the makers of the AlphaTrak Glucometer, a product made specifically for home monitoring blood glucose of both dogs and cats.

Abbott Animal Health has created a data management program for veterinary diabetic patients. This is something that has long been available to human diabetics and has been desperately needed in veterinary medicine. The AlphaTraker, Electronic Data Master, is a very simple to use program that you can download to your PC (we did not try it on a iPad or other tablet). The program can be used if you do not use an AlphaTrak Glucometer, which is great since many clients choose to use different brands of glucometer. If you do not have an AlphaTrak you will choose manual entry. If you do have an AlphaTrak the glucometer can be attached to your computer with a cable (this is sold separately) and will automatically download the glucose readings for your pet.
What this application allows you to do is enter your pets glucose readings, times they ate, what they ate and time and dose of insulin administered for each day. You can also keep track of other laboratory testing, other medications being administered and veterinary appointments. The program easily converts this information to graphs that allow you to quickly identify trends and, most importantly, it allows you to share this information very succinctly with your veterinarian.

I feel that the key to successful long term management of most diabetics is communication between the owner and the veterinarian. No matter how diligent the owner, it is difficult to accurately communicate the day to day minutia like appetite, activity, etc. I also see many clients assume that once they establish an insulin dose and a home regimen they are on autopilot and they can either stay the course or adjust insulin doses as they see fit. This can lead to disasters or at least a poor long term outcome (shortened life expectancy, diabetic neuropathy, etc). The AlphaTraker program appears to have helped solve this issue.

Take a look at the site and download AlphaTraker and give it a try!   http://alphatraker.software.informer.com/

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Testimonial From a Dog Food Convert

I am very happy to share this article written by one of my clients. I think we can all agree that diet plays a huge role in our well being and when we have other illnesses, the quality and the content of our diets can play an even greater role. Unfortunately, not many of us have the time to cook for our selves, let alone our pets. Very often I see clients caught up in trying to sort out the best commercial food by reading labels. Pet food labeling is both confusing and deceptive. The key to sorting out the pet food dilemma is not label reading or consulting the pet store clerk, it is education. The effort Kira made for Adler has really paid off. Recently, when he was visiting my office for his semi-annual examination, he was not overweight (he had been), he had a beautiful coat, his epilepsy was well controlled and we are now able to decrease his anticonvulsant doses! I am grateful that Kira was willing to share her and Adler's story. JAH

DOG FOOD CONVERT

In April of 2010 our 6 ½ year old German Shorthair had his first seizure.  This was the start of a journey through medications, feeling helpless, many questions and also having our dog’s annoying side effects of meds almost drive me and my husband crazy.  We have been working with Dr. Hass since the beginning of this journey and got to a point in January of 2012 where the seizure frequency was twice a month and he was 20 lbs. overweight.  In addition to introducing a new medication, Dr. Hass suggested trying a hypo-allergenic diet based on some of the described symptoms.  I knew that the prescription dog foods were very expensive so she suggested a home-made diet.  

My first reaction to this was only crazy people make food for their dogs.  This reaction was based on childhood experiences working in a vet office.  I took care of the boarding animals and we had one lady in particular who would drop off Ziploc bags of pasta with marinara sauce and veggies for her enormous St. Bernard dog.  I was taught by the vet techs that this was crazy and that the dog wasn’t getting the essential vitamins he needed.

After some thinking, research at the library and visiting some blogs on line I changed my mind.  The mid to high price low fat “natural” dog food I was buying was obviously not working and Adler had this overall dullness about him.  Born and raised in San Francisco, I was taught the healing power of food and natural supplements and figured if I would do it for me why not my dog?  Even if he didn’t have a food allergy, he did not appear healthy or happy after trying multiple name brand pet foods.

After taking the plunge the visible changes in Adler were immediate.  He dropped the extra pounds, had more pep in his step and we were able to cut his meds in half or more.  His seizure frequency also decreased dramatically.  On a recent visit to see Dr. Hass she asked if I could share this success story with others as we both acknowledged it wasn’t easy to figure how to start.  I will warn you though.  There is no going back.  Your dog will most likely not want dry dog food ever again and the benefits of homemade food are so apparent that feeding store bought food just seems like a bad idea.

Original recipe by Donald R. Strombeck  (provided to me by Dr. Hass)

High-Fiber, High-Carbohydrate, and Low-Fat Diet (for 12-13 lb dog)

1 ¼ cups oatmeal or rolled oats, cooked

3 ½ oz (1/4 cup) kidney beans, canned

1 egg, large, hard-boiled

1 cup mixed vegetables, cooked and drained

1 ½ calcium carbonate tablets (600 milligrams calcium)

1 multiple vitamin-mineral tablet

To convert this recipe for larger weight dogs, I eventually discovered through a pet blog online that you need to use a nutritional calculator (the one I used is listed below, but there are many out there).  Using a multiplier based on weight / pounds is not correct.  

http://nutritiondata.self.com/

Food prep and cooking:

First you need to confirm how many calories a day your dog needs.  This is usually shown on the side of a pet food bag or you can search online or ask your vet.  Keep in mind the amount of activity per day can vary the calorie intake.  Then you can input the food ingredients (keeping the correct ratio) into the calculator until you have the right amount.  I entered the ingredients for the original recipe to see how many calories and grams of protein it provided to give some idea of a base line.  Once you figure out how much food is required in a day you multiply for a weeks’ worth of food.  For Adler this came to 6 cups of food per day (he is fed 3 cups twice a day due to meds and his insane hunger).  For one week’s worth of food I have the following recipe:

Adler’s recipe:

Oatmeal, cooked

• 18 cups old fashioned oatmeal (about 1 ½ 42 oz containers)
• 22 cups water

(2) 32 oz bags frozen mixed veggies, cooked and drained

(4) 15.5 oz cans of kidney beans

18 hard-boiled eggs

This recipe makes 1 more serving than required for a full week.  I recommend doing this so you have an extra bag on hand in case you can’t make food at the normal time.  This also allows you to build up a buffer of additional food in the freezer over time.

At this point my recommendation is to jump right in and start cooking.  During the first two weeks you need to mix the food with your dog’s current food so you will only be making half of the total quantity.  About a month into making this food I was able to find the exact recipe that worked.  

I make Adler’s food once a week.  I would prefer to make two weeks at a time but I found that it was an overwhelming amount of food to make without purchasing a set of enormous pots to cook with.  I cook everything separately and then split the ingredients evenly into to two large pots and mix to combine.  Then I scoop 3 cups each into quart size freezer bags and flatten the bags to allow for easy stacking in the fridge / freezer.  I leave 6 bags in the fridge and the remaining 8 or 9 go into the freezer.

Adler is crazy about this food.  I’m not sure if it is because he connects it with me making food (used to and still does get small amounts of table scraps) or if he is just crazy for any food based on his meds.  In addition to this food, Adler’s favorite treats are carrots and ice cubes.  I have also considered dehydrating slices of sweet potato for something chewy.

Supplements:

Second you need to decide what calcium and vitamin supplements to add to your dog’s food.  Based on my library research I had a pretty good idea of what a dog needs to stay healthy, but the trick was to find something that didn’t had a lot of other additives and was affordable!  There are many companies out there with some pricey vitamins for your pet .  

Vitamin supplement:

I found “Be Well for Dogs” at 1-800-PetMeds.  One bag last me about 1 ½ months and costs around $17.00 (usually there are always coupons too).

http://www.1800petmeds.com/Be+Well+Dog-prod10845.html

Calcium carbonate:

Based on reading I found that you can use leftover egg shells as an inexpensive way to provide calcium and with all the hard boiled eggs in this recipe it is feasible.  However, this does take extra time so I chose to purchase calcium tablets and give them to Adler right before eating (he is very good at taking pills at this point).  I confirmed how much calcium he needed using one of the charts in the reference books.

Reference material:

Home-prepared dog & cat diets : a healthful alternative 1st ed.  By Donald R. Strombeck  

The holistic guide for a healthy dog by Volhard, Wendy.

I see there are even more books out there since I did my research over a year ago.  I found that each author had a different take on exactly what was right and wrong regarding the food and supplements a dog requires and most do not dive into vegetarian diets too much.  I read them all and used the information I felt was consistent and not too extreme.

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Mittens The Laundress

One of the really great things about my job is everyone that visits me has a funny or entertaining story about their pet that they share during their visit. Sometimes they tell me what they went through to get the cat in her carrier, or about their pets entertaining activities at home, regardless of the exact details, inevitably there is some kind of a story. These stories illustrate to me how much we value the companionship of our pets, how important they are to our families and how boring things would be without them.

Sometimes there are stories like the one about Mittens and her owner Julie. Julie and her husband, Tim, visited with me at a recent community event. Julie enjoyed talking about their dog, Mittens. Mittens was adopted as a puppy by her two sons and at the time they already had two dogs. Her sons were responsible for caring for Mittens and they developed an interest in training her. Mittens quickly learned the basics and then she learned how to skate board, pick up objects on command and retrieve. She seemed to have a real aptitude for learning and the whole family enjoyed her antics.  A few years ago Julie had extensive spinal surgery that left her with limited mobility. Bending and picking up even the lightest objects was a challenge. Julie quickly realized that Mittens was ready and willing to help pick things up. Mittens was not a service dog, nor were Julie and her family professional trainers, but together they were the perfect team. 

Mittens can remove laundry from the dryer (the video is attached above). Tim was so excited to show me the video, he went home to get his camera so we could see Mittens in action! Julie explained that Mittens enjoys tidying up so much that she picked up the parts her son had laying out in the garage while he was repairing a car and brought them to her! 

Mittens and Julie’s story reminded me of another patient. A few years ago, I treated an Australian Cattle dog named, Mason. Tom, his owner, explained that he had been a very busy executive, traveling around the world. However, he developed a severe seizure disorder and became housebound. He had always wanted a dog, but had never had the time for a pet. Tom said he thought, with everything else going so badly for him, he could at least adopt the canine companion he always wanted. So he went to the local shelter and adopted Mason. Mason had been surrendered because he had a few problems, but Tom felt they were a perfect match. Unfortunately, Mason was not the easiest to live with at first. But they became closely bonded in a very short time. Slowly, Tom began to realize that Mason could tell when he was going to have a seizure. This gave Tom the ability to intervene and avoid a seizure and gradually his seizures subsided. Tom and Mason began leaving the house. They walked more and more, getting further and further from their home, something Tom never thought he could do again. Soon, Tom and Mason were able to begin leaving their home for trips. Tom began driving and working, always with his friend at his side. He explained that he has been seizure free for years and he attributed his cure to Mason. Now Mason is a first class world traveler and Tom’s constant companion.

These stories make me wonder what forces conspire to bring these people and their companions together at just the right time. Maybe sometimes the helping hand we are looking for is actually a paw.

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How a Veterinary Hospital Can Help Make a Community Sustainable

Until earlier this spring, when I attended a land conservancy meeting, I had not really thought about the issue of a communities sustainability. Once you begin to ponder sustainability, you appreciate it is at the core of the survivability of any organism. It is a philosophical approach to the growth, development and maintenance of a community that could be applied just as easily to a living creature, a family unit, a regional economy, your own professional development or a country. Basically, in order for a community to be sustainable it has to have some very fundamental things like a healthy environment (clean water, clean air, etc), jobs, education, and infrastructure to support the jobs (government, good roads, community safety). 

However, to be truly sustainable a community needs more. It needs to be a place where people want to live. It needs to be the type of place where once you have grown up there you want to return to that place and raise your family, own a house and contribute back. The community needs people to continue to sustain the place that nurtured and nourished them when they were young. It also needs people to be drawn from other areas, because it is so desirable to live there. This is the most difficult aspect of being sustainable. However without jobs and roads, schools and good government, its almost impossible to focus on the less tangible issues like quality of life. Parks and recreation, wildlife preservation, festivals and fairs, art shows, museums, concerts and historical recognition events, all these things help promote our community by showcasing the things that are special in our villages and townships.They entertain those of us that live there and encourage others to consider visiting us more often or even moving to our community. 

Communities that care for  the less fortunate, the aged and the sick demonstrate kindness and empathy. Community outreach services, care of the less fortunate, and  efforts to support service organizations also create an environment of philanthropy that helps attract like minded people. These qualities aid in creating a sustainable community.

Sustainability is the name of the game for business owners as well. If the town that our business is located in cannot encourage new residents, new businesses, maintain infrastructure, or even keep the current inhabitants from moving, then the business will wither and die along with the community. 

Working to keep a community sustainable is not necessarily something that leads to remarkable immediate benefits. The efforts initiated in the present will reach far into the future, laying the ground work towards making our town more attractive, vibrant, and functional. Eventually the return for everyone involved can be significant.

So how does our little hospital help such a lofty cause? We are fortunate that we are located within a  very vibrant community and although we are in Michigan and near Detroit, parts of our community have found innovative ways of growing despite significant disadvantages. 

Like so many privately owned veterinary hospitals we do not have a large budget to devote to supporting community events, but we recognized we could begin by offering our time and our skills. We became members of the area chambers and supported them by attending their events. We joined two major service groups, the Rotary and Optimists. Both of these groups focus on improving the community. We also cared for any wildlife that we could. We either served as a conduit to a rehabilitation facility or we cared for them ourselves and released them. We all enjoy having a large wildlife population in our town and offering care to the injured aids in supporting everyones quality of life. Now we are fortunate to have a doctor that has advanced training in wildlife medicine and the management of exotic pets. One of the reasons she was attracted to our facility was because of our long history of stewardship to wildlife. 

When we can, we help sponsor things like the 4th of July fireworks show, art fairs and other festivals. Sometimes we have exhibits and provide information on pet safety and health care.

We have used our clinical skills and resources to help a local food pantry offer spays and neuters to their clients that cannot afford veterinary care. We have also made it our ‘pet’ project to help raise funds for the Pet Pantry so they can purchase dog and cat food and distribute it to families in need. We have had annual events like, Dogs Playing Poker and Santa Paws (photos with Santa) to raise awareness of the need and raise funds. 

Our hospital is starting a new initiative with Meals On Wheels. We are helping them distribute pet food to pet owners that can neither afford food nor have the mobility to seek additional services. These individuals rely heavily on that pets companionship. 

Our doctors have visited libraries, schools and career days with demonstrations about exotic pets or explaining what it is to be a veterinarian. We were the first veterinary hospital in the state and possibly the nation to distribute oxygen masks to local fire departments. 

It has taken years for us to establish contacts in the community and develop he programs we have in place. We now have other staff members that help in performing these outreach activities and they too have learned how enjoyable it is to give your time to the community and see the people and animals that benefit from their efforts. 

I think that one of the keys to a sustainable community and a thriving business is to act responsibly through volunteerism, utilization of your business skills to  benefit the community, and supporting public events. It does not necessarily have to be financially burdensome, nor does every member of your business have to participate. I am confident that when a business begins to work towards supporting its community’s sustainability, they both will thrive. 

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Could our influence on our pets be creating new illnesses?

I was speaking with a classmate from veterinary school recently, she reminded me, albeit gently, that we graduated from Michigan State's College of Veterinary Medicine 24 years ago. It is difficult to comprehend that it has been that long and that we are now the old timers that we looked upon with disdain when we graduated! Since that conversation, I have been thinking about how much patient care has changed since 1986. Almost every hospital and certainly every emergency clinic and referral hospital can monitor blood gasses with a hand held device, SpO2’s are checked on patients throughout surgery and recovery, MRI’s and CT’s are commonly available. These changes have aided our patients and their owners immensely and they have helped our profession grow by leaps and bounds. I am confident that even our professors would not have been able to foretell how our profession would grow. I have recently read a few articles that brought the passing of time into perspective, but these articles spoke to how our patients and their maladies have changed.

Over the years the type of cases I see and the degree with which I understand the patient’s condition has changed immensely as well. After finishing my residency training in the early 1990’s I was with a large referral practice called Veterinary Referral Associates in Gaithersburg, Maryland. We were presented with a wide variety of referral cases at VRA.I recall one of the dermatologists in the area referring a Doberman that sucked the skin on it’s flank area and self mutilated. This was quite a curiosity and the dermatologist was unable to find cause. Fortunately, the dog would stop if an Elizabethan collar was applied (an e-collar, a clear piece of plastic that prohibits the patient from getting access to certain areas on the body). We too thoroughly evaluated the patient and found him to be normal except for his overwhelming desire to suck and lick his skin. We tried sedatives, anticonvulsants and analgesics to no avail. It was unfortunate, but the dog was relegated to wearing the e-collar on and off for the rest of its life. I recall that it was rarely that we would see this type of case and they would first see a dermatologist since they had all the hallmarks of a severe, irritating skin condition that plagued the poor animal to distraction.

In 1992 , I returned to the Detroit area and with a gradually increasing frequency I would be consulted regarding Dobermans, Bull Terriers and other (usually terrier) breeds that tail chased, flank sucked, spun in circles and self mutilated to the point of doing themselves serious harm and driving their poor owners crazy as well. As time progressed we grew to learn that these were Obsessive-Compulsive Disorders. Although many feel that they are best cared for by behaviorists, I argue that these are not solely behavioral problems. I think these cases are neuro-psychiatric conditions, that have multiple factors, certainly environmental, behavioral, but also genetic, neurochemical and structural factors are at play as well. Obsessive Compulsive Disorders are best managed, similar to many human psychiatric conditions, through the management of the environment, diet, retraining (behavioral modification), medication and the treatment of other underlying neurological and metabolic disorders.



So why are these conditions more common? Are we just more observant? Are pet owners more tolerant of these problems and seeking help rather than pursuing
euthanasia?

Possibly, however, the two articles I mentioned earlier, I feel, better explain this escalating problem. First, in the journal, The American Naturalist, two biologists, Christian Klingenberg, PhD, of the University of Manchester and Abby Drake, PhD, of the College of the Holy Cross, looked at the diversity in the structure of the canine skull (the container within which the brain is housed). They found that over the past century, with the benefit of human influence and selection for specific structural traits, we have created an extremely diverse population of animals that are so different they are not similar to the other members of the family Canidae. This means that we, us humans, have exerted our influence to such an extent that we have created animals that could not survive in nature, that are not even akin to their naturally evolving relatives in structure and function. By changing the structure of the skull in some breeds we have taken away their ability to naturally reproduce (ie .the bull dog). By changing the skull shape and hence the brain structure what else have we unwittingly changed? We know that by selecting for a certain skull shape we may have created a serious neurological condition in the King Charles Cavalier Spaniel. What other problems have developed via the unnatural selection pressure of the ‘breed standard’?

The second publication addressed the genetic link for canine compulsive disorders (CCD). In the study, the researchers found an association between CCD and the neural cadherin-2 gene (CDH2) on chromosome 7 in the dogs. Dogs exhibiting multiple compulsive behaviors had a higher frequency of the risk DNA sequence than dogs that showed less severe behaviors (60 and 43 percent, respectively, compared with 22 percent in non-CCD dogs).This article was in the journal,Molecular Physiology.

I think that these two articles illustrate that our patients have changed and are changing, sometimes at a rapid and unnatural rate. As the result of the selective pressures we have applied to that canine breed we aided in creating significant health issues. Possibly, we have inadvertently selected for genes that make Veterinary Neuro-psychiatry a burgeoning field.

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Not All MRI's Are Ceated Equal....

I have been performing MRI's on my patients since I left my residency in the early 1990's. Back then we utilized human facilities when they were closed. The trips to an MRI facility were clandestine events, in the dark of night, entering at the back door or loading dock of the facility. Basically the MRI's that we performed were run by skilled, trained technicians and they were of the same quality as the MRI's that were being produced by the facility for people. All the MRI'sd that I had the experience of performing were of excellent quality. The techs would even joke that they preferred our patients over the humans, because our patients were, in general, much easier to deal with! Then, over time, the human MRI facilities became so busy that they began to run 24/7 and there was no time to squeeze in the veterinary patient during off hours when no human patients would be bothered.

In a way it was a relief to not have to get up at 3 AM to deliver a patient to the MRI facility and manage its anesthesia then to arrive back at work to start my clinic day. But along with all that extra sleep time there came a new problem, where were we going to take the patients that needed an MRI? Slowly, facilities developed that provided MRI and CT to veterinary patients, we began using The Lawson Imaging Institute , www.MBVS.CA. This facility is awesome. It is run by a group of individuals that are devoted to providing the highest quality images and patient care. I can say that I have never had a bad experience or customer complaint about their services except that they are along drive away in Mississauga , Canada. These folks have the very best equipment and they price their studies (including anesthesia and interpretation) at about $ 1,500 US. Many members of this operation are scientists, engineers and physicists. They understand the way that the MRI works and the need for the best quality equipment to achieve the most acurate study. Although I would love to have a MRI within our facility, I have always said that we would only consider it if we could provide a similar service to the one provided by our colleges in Canada and for a similar cost. Otherwise, sending my patients to Mississauga, where they can get the best study for the best price, is the right thing to do.

As time went on otherlocal hospitals got MRI's. These were small mobile units or even less powerful machines that were far inferior to what was provided across the border and they were charging 2-3 times more. Colleagues were impressed by these other hospitals providing a MRI service, but very few were able to appreciate, or they didn't care to address, the differnces in study quality.

A few months ago my partner forwarded an article from the New York times explaining how how MRI machinary can vary and the quality of studies can vary to such an extent that misdiagnosis' can occur. Take a look at this article entitiled 'The Scan That Didn't Scan', http://s.nyt.com/s/NbdAuJZ. I was very pleased to see that someone was trying to eduacate the general public regarding the differences in MRI services. I hope that over time veterinary clients too will become more informed consumers. Just because a tool is in a hospital it does not mean that it is the newest or best quality and sometimes you do not get what you pay for!

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