What is BAER (Brainstem Auditory Evoked Response) testing all about?

What Is BAER (Brainstem Auditory Evoked Response) Testing All about ?

The process of hearing is extremely intricate. Whether the sound is loud or soft, high or low an incredible number of very intricate biological processes have to occur in a strictly choreographed manner. 

When you think about it, it is amazing that so many of us DO hear. There are such a multitude of places along the biological path of hearing where malfunctions can occur, it’s amazing that there are relatively few individuals that are deaf. 

Sound begins its journey into our senses, our consciousness, as waves transmitted through the air. These air waves then cause vibrations in the tympanum or ear drum. These sound waves move the ear drum and then move three tiny bones (the smallest bones in the body) that sit within the middle ear. This moves liquid within the cochlea, a spiral, sea shell shaped organ, of the inner ear. Another series of membranes are moved by the liquid which causes small, pigmented hair cells to move. These are receptors for the 8th cranial nerve (CN VIII). At this point the movement triggered by the sound waves is now conducted through the nerve and the brainstem as electrical activity within the skull. 

Dogs and cats, just like people, can be born deaf. This is typically due to sensorineural deafness or a dysfunction of the sensors that allow sound to enter the nervous system as electrical impulses (the hair cells). 

BAER testing is a hearing test. In veterinary medicine we cannot rely on the pets response to sound to check their ability to hear.  Dogs and cats with hearing deficiencies can depend heavily on vibration and visual input to compensate for their hearing loss. It can be very difficult to tell if a pet is completely deaf or even deaf in one ear. They are very capable in adapting and compensating for their disabilities.  Rather than depending on our observations (subjective analysis) we use BAER tests (objective analysis) to follow the sound as it is conducted from the inner ear to the brainstem. 

Few dogs are trained to raise their paw (or finger as a person would) when they hear a to a certain tone. BAER testing helps us analyze their ability to hear without relying on their conscious responses. BAER testing is easily performed on either an awake or anesthetized pet.  We recommend that the pet be at least 6 weeks old and preferably 12 weeks old for this test. When they are less than 12 weeks old there is a slight risk of false negative tests (this means that a hearing ear might tests as deaf). 

Each ear is tested separately and 3 small needles are placed under the pets skin, one at the top of the head, the next at the base of the ear being tested and the last, a ground lead, is somewhere out on the pets body. The needles at the base of the ear and the top of the head will record the electrical activity as it is conducted from those little hair cells into the brain stem.  Then an ear phone or ‘clicker ‘ is placed in the pets ear and it will emit a clicking tone at a volumes of 80-100 decibels. We use an 87 decibel sound. The machine then records each click as it is conducted along the 8th cranial nerve and on through the brain stem. 

A pet that has a hearing response on the BAER test will demonstrate a series of peaks that occur at certain time intervals on a graph. This is a normal BAER test.

If the pet has an inherited deafness or deafness as a result of damage to the inner ear and the hair cells within the inner ear , the test would have no peaks and would be flat(see below).

BAER testing can be used to check for other interruptions in the hearing process such as tumors of the 8th cranial nerve and damage of areas within the brainstem. 

At our office, BAER testing is performed on awake patients, we seldom find that we need to sedate or anesthetize puppies and kittens that are tested. Sometimes when more detailed tests are indicated or a pet is particularly uncooperative anesthesia can be used. 

BAER testing should be performed on any pet suspected of being deaf or one of the breeds listed below, prior to their being adopted into a new home. Deaf animals can make great pets and companions, but owners must be aware of their special needs so they can  learn to communicate with their new pet and train that animal adequately. This will allow the pet to avoid injury and learn to function well within the household. 

Dog and Cat breeds associated with reported congenital

 (inherited deafness)

Akita	French Bulldog	Springer Spaniel
American-Canadian Shep	German Shepherd	Sussex Spaniel
American Eskimo	Great Dane	Tibetan Spaniel
Am. Staffordshire Terrier	Great Pyrenese	Tibetan Terrier
Australian Blue Heeler	Ibizan Hound	Toy Poodle
Australian Cattle Dog	Italian Greyhound	Walker American Foxhound
Australian Shepherd	Jack Russel Terrier	West Highland White Terrier
Beagle	Kuvasz	Whippet
Bichon Frise	Labrador Retriever	Yorkshire Terrier
Border Collie	Maltese	Felines
Borzoi	Miniature Pinscher	European White
Boston Terrier	Miniature Poodle	White Cornish Rex
Boxer	Mixed Breed Dog	White Devon Rex
Bull Terrier	Norwegian  Dunkerhound	White Manx
Cardigan Welsh Corgi	Nova Scotia Duck Tolling Retriever	White Persian
Catahoula Leopard Dog	Old English Sheepdog	White Scottish Fold
Cavilier King Charles Span.	Papillon	White Turkish Angora
Chihuahua	Pit Bull Terrier	White American Shorthair
Chow chow	Pointer	White British Shorthair
Cocker Spaniel	Puli	White Exotic Shorthair
Collie	Rhodesian Ridgeback	White Oriental Shorthair
Dalmatian	Rottweiler
Dappled Dachshund	Saint Bernard
Doberman Pinscher	Schnauzer
Dogo Argentino	Scottish Terrier
English Bulldog	Sealyham Terrier
English Cocker Spaniel	Shetland Sheepdog
English Setter	Shropshire Terrier
Fox Hound	Siberian Husky
Fox Terrier	Soft Coated Wheaten Terrier

From: Dewey CW. A practical guide to canine and feline neurology 2003;Ames: Iowa State Press: 232.

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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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Taking Ownership of Our Pets Weight Problems

Pet obesity has become a major concern, like its human counterpart, it is considered an epidemic. The epidemic is becoming more and more obvious at our practice. The cause of this serious health problem is multi-factorial. Here is my view of what the main factors are:

1. Lack of portion control- Our pet foods are better made than ever. They are yummy and are low in residue (meaning less poop for us to pick up), but we have to be very careful to follow the feeding guide lines. Did you realize that every food has a different set of guide lines?  This better, yummier food cannot be free fed. You have to feed your pet a fixed amount daily. Did you realize that the average house cat needs about 180 calories daily ? That is a 1/2 a cup of Meow Mix dry or if you are a fan of the more premium brands a 1/4 cup or less of their dry foods daily. If you feed canned food you might give your cat 2- 3 oz cans of Fancy Feast daily or 1/3rd of a 5 oz can of one of the premium brand foods, but no dry! Now think about this carefully, does that seem like a significant amount less than what you feed?  I know when I began measuring my dogs food with an actual measuring cup, they began shedding the pounds! 
2. Changing pet foods is OK, but you have to adjust how you feed -As you read above, each food contains a different number of calories per can or scoop. Read the labels and do the math! 
3. No schedule- Leaving food available through out the day can make pet care much easier. However it makes your pets health care very difficult. Our pets rely on us to provide their health care, that means knowing what a they are eating, if they are eating  and how much. Decreased appetite is often one of the first signs of illness and a free feeding schedule, particularly in a multiple pet household, makes an appetite change hard to appreciate. Regular, moderate meals may also aide in house training, preventing gastrointestinal upset, and increase the frequency of  your interaction with your pet. 
4. Lack of Exercise - Our dogs and cats are leading more sedentary lives, just like we are. They look to us for their activity. If we are busy at the computer or at work, they are content to stay at rest. We have to be sure that they are staying mobile. Cats are the most challenging. However, playing with them, using toys to entertain them, moving food bowels so they have to seek out their food, and even taking them outside for fresh air and a stroll in the garden can help keep you both active. Regular play and walks for your canine friends  can benefit them as well.
5. Inappropriate standards - Did you know that the average house cat should weigh between 8 and 10 lbs? Seems kind of small doesn’t it?  I think we have adjusted our expectations, thinking that the 12 pound and 15 pound cat is the new normal. Take a look at your dog. Can you feel its ribs as you pet him long the side of  his chest? You should feel the general contour of his ribs and when you look down along his back he should have a slight waist, it should not be straight line from shoulders to hips!

Our pets are completely dependent on us and we are responsible for their health. By ignoring the fact that this extends beyond the purchase of the newest, freshest and most organic pet food and not considering how much, when, and why the food is fed we are helping create problems like arthritis (this can be caused by obesity), cancer, hypertension, diabetes, joint injuries, heart disease, respiratory disease, skin conditions and a shortened life expectancy. Once these conditions have developed, it is far more difficult to correct them and the obesity that helped cause the illness. 

Along with changing how we attend to our pets diets and feeding schedule, we also need to be sure that they are getting exercise. We need to spend time with them, appreciating changes in appetite, body weight and conformation. These observations may not only tell us that they are gaining weight, but may alert us to changes in their health. Early identification of illness and avoiding health problems related to obesity could allow you both many happy years of companionship. 

Visit www.petobesityprevention.com  to read more about managing your dog and cats weight, calculating their caloric requirements and find out the caloric content of your favorite pet food. 

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Beware of Practitioners of Negativity

As in any profession, there are as many different approaches to the practice of veterinary medicine as there are veterinarians. No one method is wrong, however some may be better than others. I am a big believer in education of the client, walking them down the path of understanding the condition that is affecting their pet and explaining the best plan and the potential outcomes. It may seem intuitively obvious to you that this is the way any medical consultation should be handled, but it is not everyones approach. There are practitioners that do not take the time to create a complete plan and provide a picture of the reasonable expectations for the patient. They tend to take short cuts and, if they are not careful, they can become practitioners of negativity.

As my parents have aged, I have become increasingly aware of certain doctors making treatment choices based on their age and seemingly lowering their expectations for their patients.  How often have you heard of a veterinarian saying that the pet was too old, or the condition too ‘bad’ to treat?

“It’s too serious” or “ poor prognosis” with out an explanation or a discussion of options is quite frankly a cop out. I do not mean to imply that every disease can be cured. Unfortunately, ultimately, some disease does eventually lead to the demise of every organism. The issue at hand is how do we fend off disease and how well will the patient fair during that treatment process and how acceptable is the plan to it’s owners . I like to refer to it as our philosophical approach to the patients illness.  With each patient, each set of clients, and each disease process  a philosophy for the management of the illness has to be developed. This is even more important in veterinary medicine where the cost of the services, the amount of at home care the patient will need, and the cost of medications all play a roll in developing that ‘philosophy’. 

It takes a considerable amount of effort, continuing education, experience and time to be able to allow owners an idea of what is wrong with their pet, why it is an issue, what can be done and how their pet will recover. I recently had this discussion with an emergency doctor. I had  noticed that a number of her cases where given a grave prognosis and the owners had elected either euthanasia or ‘hospice-type’ care. There was a common thread among these patients, they all were older and they each had a hemoabdomen (free blood in the abdomen). We discussed these cases and what I appreciated was that her scope of understanding regarding possible causes and outcomes was limited. She needed to go beyond recognizing the condition was serious and realize what options were available. Now she is realizing that there are diagnostics that can define just how serious the condition is and identify the cause. Once this is understood the owners can be educated about the choices they have and potential outcomes. Some of these patients can go on to live normal lives, just because it ‘looks bad’ on initial presentation.

I have a friend that had an geriatric cat that had a number of illnesses. I tried to help her as best as I could long distance. She visited with specialists that appeared to be unenthused about managing a geriatric with multiple health problems. They provided palliative treatments. Here is where they really failed my friend, they did not explain that by following this conservative approach a certain outcome was to be expected. They also did not provide an over view of the potential benefits and risks of a more aggressive approach. My friend quickly became disenchanted with this practitioner. Later, when the pet was failing even more, she visited another veterinarian who played the ‘it’s bad’ card and recommended euthanasia. Again, that may have been a very appropriate choice under the circumstances, but it is a choice. A choice made by the owner with information and options, that is what a good practitioner owes their clients. 

Over my career I have managed patients that other clinicians had declared to have a poor prognosis or a serious condition. These owners wanted more choices, and we together crafted the plan that met their expectations and their pets needs. Many of these pets lived on, very happily, to far exceed their previously poor prognosis. 

Painting an inappropriately rosy picture is wrong, but educating and providing options is definitely the name of the game. Even with the benefit of information some clients are going to choose conservative plans, and that is alright. The important thing is they made educated decisions. 

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Are Vaccines Still Necessary?

Vaccines, whether they are for people or animals, have become a very controversial subject. They serve to protect us and our pets from life threatening illness. However, like any medication, they can also cause side effects in certain individuals. Basically, vaccines expose the patient to a small infection. This ‘infection’ then triggers the immune system to respond by developing antibodies or immunity to the infectious organism. Then, when the patient is exposed to a full blown infection, their body can effectively fend off the disease. Vaccines are created in such a way that they trigger that immune response, but spare the patient the illness necessary with a natural infection. 

One of the main reasons we do not see diseases like polio, canine distemper, and rabies in our communities is because of vaccinations. Vaccines reduce our risk of illness when we travel and prevent us from spreading those diseases. Even though certain diseases are uncommon or absent in our community, vaccination may remain necessary. 

The vaccines that are selected for a patient are variable, depending where they live and what our pets do and where they travel. Veterinarians have become better at selecting vaccine protocols to fit our patients. We have also become more prudent recognizing that yearly vaccine protocols are rarely warranted and that vaccine titers can be used to assess whether vaccination is even necessary. We have also become careful about how vaccines are administered. All these efforts help in limiting potential side effects.

Vaccine reactions are rare, however vaccination does carry inherent risks. Just as in people, minor allergic reactions, local inflammation, pain, local tumor growth, or even life threatening shock and anaphylaxis may all occur as a result of vaccination. These events are very uncommon and are far outweighed by the risks of disease. We have learned that vaccines should not be administered to patients that have previously suffered from immune mediated diseases or cancer since vaccines could cause these patients harm. 

Vaccines are important because infectious diseases still exist. The viruses and other infectious organisms we vaccinate against are a constant threat and they are changing and developing all the time. Vaccines and vaccine protocols are changing too. Also new diseases are emerging that warrant completely new vaccines. Major veterinary groups such as AAHA, AVMA and ACVIM have responded to the changing canvas of infectious diseases in our country and our expanding knowledge about our pets immune systems, by creating carefully crafted vaccination protocols. 

We at Veterinary Care Specialists and VCS Pets First have considered all the available scientific data and created a series of vaccine recommendations for the life of your dog or cat. These protocols can be found at www.vcsmilford.com or www.vcspetsfirst.com. Please visit these sites and, as always, feel free to call, email or visit our office to ask questions and learn more about the vaccines, the diseases they prevent, and what would be the best choice for your pet. 

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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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Not Every Problem Gets Better With Surgery !

Elbow Hygroma Day 1

Elbow Hygroma Day 60

 I have to admit, I am not a surgeon. I also have to admit that there are many times, as a veterinary clinician, that I really like the option of recommending surgery for some patients. The ability to have a procedure performed that  promptly removes a problem or eradicates a disease is very attractive, but often unrealistic.

As the practice of veterinary medicine has become more refined we have learned that resorting to the seemingly easy answer of surgery is not always the best option for our patients. The case of Jade is a great illustration. Jade is a young adult Labrador that had developed hygromas on both elbows. A hygroma is an area of swollen, fluctuant tissue that is often ulcerated and plagued with secondary infections. They are typically on the lateral (outside) aspect of the elbows and they can be painful.

Jade with her styling new elbow braces

When Jade came to see me the owners were seeking a second opinion. They had tried changing Jade's bedding and they tried wrapping her  elbows, nothing worked. Another veterinarian had recommended surgical excision. I've witnessed the result of trying to remove hygroma's. Just imagine removing abnormal, inflamed tissue from a bony protuberance, like the elbow, where most of these dogs abrade that area whenever they lay down. The removal isn't difficult, it's the healing that is almost impossible. The patients that do have surgery suffer a protracted and difficult recovery time and often have a recurrence of the hygroma.

I suggested to the owners that they consider braces to protect Jades elbows and support the tissue so it might heal.  Two months later the owners sent me these great photos. I have seen Jade since and she continues to do well. She enjoys wearing her braces, in fact the owner says she doesn't like to leave the house without them!

Jade is happy and so are her parents and so surgery!
( Braces like Jade's can be purchased from www.dogleggs.com. )

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