If you have a large breed dog then you have to know everything there is about a very scary condition call Gastric Dilatation and Volvulus (GDV), often called bloat.  It is the leading cause of death in large and giant breed dogs in the United States. 

A GDV occurs when the stomach fills up with air (dilatation) and rotates on itself (volvulus).  This action all but eliminates blood flow to the stomach and the tissue rapidly begins to die creating a host of horrible conditions.  What is truly terrifying is GDV comes on very suddenly and without surgical intervention rapidly leads to death.  Many dogs never even make it to surgery and the mortality rate for those that do is still quite high at 15-33%.

Now that I have you good and scared let me give you the good news, we can prevent this from happening!  By performing a simple procedure called a prophylactic gastropexy we can stop the volvulus part of the equation and eliminate GDV. 

First we should determine if your dog is at risk.  Dogs that weigh greater than 60 pounds have a 23% lifetime risk of GDV.  Especially those that are deep chested like Great Danes, Weimaraners and standard poodles.  The AKC has a great list of at risk breeds on their website.

Other risk factors include: 

Here is more good news - we are now performing the grid gastropexy technique, which is much less invasive than the traditional huge incision along of the midline of the abdomen. We make a small 2-3 inch incision just behind the last rib, reach into the abdomen and grab the stomach.  It is then tacked to the inside of the body wall and the muscle and skin is then closed over the defect.  This method is very quick, causes less tissue trauma that results in faster healing and decreased pain.

My patient Hank the labradoodle getting ready for his neuter and gastropexy

The best time to have this performed is during your dog’s spay or neuter procedure.  There is no additional down time and this procedure has very few complications.  The most common ones we see are swelling under the skin or an annoying puckering of skin, both of these resolve on their own.

If you have a dog that has already been fixed but you still feel is at risk it is reasonable to consider having the gastropexy done as a stand-alone procedure.  When I neutered Frank we were not doing the gird technique and I didn’t want to make a large abdominal incision for the traditional gastropexy technique.  Every time I see him inhale his food in less than 15 seconds I kick myself that I didn’t do the gastropexy at the time of his neuter.  In the next few months I am going to put him under anesthesia again and perform the pexy.  With this technique there is no reason not to protect your dog and give yourself some piece of mind.

Last week I had the pleasure of visiting the Hill’s Pet Nutrition Center in Topeka, Kansas.  Dr. Nicola Moore and I spent 3 days touring the facility, listening to lectures and discussing the pet food industry with the Hill’s team and other veterinarians from around the country.  It was an amazing learning experience and I am now an even bigger fan of Hill’s Prescription and Science Diet foods.

There are so many misconceptions about Hill’s food perpetrated by the Internet, pet food stores and other pet foods.  I have to say I always find it amazing (and more than a little disheartening) when I have a client take the advice of their breeder, an 18 year-old store clerk at Pet Smart or some random website over my professional, medically based opinion.  I know that all pet owners just want to feed their dog or cat the very best thing to keep them healthy and as a veterinarian that is my goal too.  

So here are a few nuggets of info I learned last week that convinced me Hill’s produces a superior product.

Hill’s has five manufacturing plants in the US and two in Europe that produce ninety-five percent of their food.  That other five percent consist of treats and a pouch type food sold in Europe.  Most pet food companies outsource the production of their diets to a third party; this opens the door to quality control issues.  An example of why this is problematic can be seen with the Blue Buffalo recall due to toxic levels of vitamin D found in their foods.  The plant that made these affected lots of food had produced a vitamin D supplement, not cleaned the production line and then processed the Blue Buffalo food resulting in vitamin D toxicity.

 If you are concerned about salmonella contamination as we saw in the 2012 Diamond Pet Food recall you may be interested to learn that in 2008 Hill’s decided to voluntarily test all of their products for salmonella and other food borne pathogens.  Each lot of product is tested and is not released for distribution until the test comes back negative. In addition, Hill’s has their plants graded by an independent inspection company that evaluates human food plants as well.  The Hill’s plants routinely score higher than the plants producing human food!

Hill’s performs rigorous testing and inspecting of all the raw materials they use and will reject an ingredient if it doesn’t meet their standards.  They only use meat and poultry sources from USDA inspected plants to ensure that the animal and the meat it produces are handled correctly and disease free.  In 2007 after the widespread melamine recall that affected many brands of food, Hill’s made the voluntary decision to stop sourcing materials from China*.  Again, many human food production companies do not choose to do this.

I hope I have peaked your interested and demonstrated some of the reasons for why I am loving Hill’s.  Not convinced yet?  There is a lot more to come, stay tuned for info on specific nutrient levels, protein content, the vilified by-product, how they test their products and more.

*Currently they do obtain taurine from China.  This is one of two plants in the world producing this raw ingredient.  The other plant, which they had been using, was destroyed by the 2011 tsunami in Japan.

Last fall I attended DC Academy; a continuing education meeting held monthly for local veterinarians. The speaker was Dr. Goldstein, an Internist from Cornell Veterinary School, who discussed his latest findings and recommendations related to Lyme disease.  What he said about Lyme disease completely challenged what I had thought about vaccinating against this all too common disease.

I have said in previous posts that I hate Lyme disease, this did not change during my day at DC Academy.  In fact the issue became even more confused and it took the last few months for me to research the issue and come up with an opinion.  Ultimately I have changed my view of the vaccine and now recommend it for specific at risk dogs. 

I have always recommended against vaccinating for Lyme, concerned that the vaccine is not effective and reportedly causes more vaccine reactions than the other vaccines we give.  Besides, we have so many dogs test positive for Lyme that never develop any clinical signs, it doesn’t seem like a disease that causes many problems – until you consider Lyme nephritis which terrifies me.

Lyme nephritis is a syndrome characterized by acute kidney failure that almost always results in death.  It occurs most frequently in younger adult dogs and there may be a higher incidence in Labrador and golden retrievers.  Clinical signs come on suddenly and include increased thirst, increased urination, lethargy, decreased appetite and vomiting.  Despite aggressive treatment dogs that develop Lyme nephritis rarely survive.

The topic of vaccination for Lyme is such a hotly debated issue in veterinary medicine that even the members of the American College of Veterinary Internal Medicine (ACVIM) Lyme Disease Task Force could not come to a consensus.  Dr. Littman of the University of Pennsylvania College of Veterinary Medicine does not believe in vaccinating for Lyme.  She argues that the vaccine has not been proven to prevent Lyme nephritis and in fact may predispose dogs that have been infected with Lyme disease to developing Lyme nephritis.

After processing all this information I now feel that the best way to protect your dog against Lyme nephritis is with a combination of a monthly topical tick preventive and vaccination.  Owners should be applying preventives once a month every single month.  After attending a lecture at NAVC I now have an even greater repulsion for ticks, their resilience and their disease carrying capacity.  Keep in mind that ticks transmit countless other disease that are equally as nasty, if not more so than Lyme disease.  Therefore keeping ticks off you, children, dogs and cats is vitally important.

I am not advocating that we vaccinate all dogs against Lyme disease, only those that are at increased risk.  This group includes dogs that frequent dogs parks, Rock Creek Park and any other wooded area that they would be likely to come into contact with ticks.  I would also strongly consider vaccinating all Labs and goldens given their tendency to contract Lyme nephritis.  The final caveat with vaccination is I would think very hard about vaccinating a dog that is already positive for the disease given that we really don’t know if the vaccine contributes to Lyme nephritis.

Since Frank and Poppy are retriever crosses and negative for Lyme I vaccinated them using the Recombitek Lyme vaccine by Meriel.  This is the only Lyme vaccine I would consider giving as the other ones on the market have a greater reported incidence of vaccine associated reactions.  I have also switched my dogs from Frontline Plus to a newer product called Parastar Plus.  If you have cats in your house please discuss the risk of using Parastar Plus with your veterinarian.

I still feel Frontline Plus works very well but Parastar Plus is reported to kill ticks within one hour, which theoretically prevents transmission of any disease.  We used to believe that the tick had to be attached an feeding for more than 24 hours to transmit disease but current research suggests they may transmit disease in as little as 4-6 hours.

So there you have it, my updated opinion on Lyme disease and the best way to prevent it.  In the end there is no one right answer, even veterinarians can’t come to a conclusion.  Whether or not to vaccinate is a personal decision that you need to make for your dog based on the risk of disease and the risks associated with the vaccine.

Summer is my favorite time of the year but many summertime activities can be dangerous to your pet’s health.  By far the most common threat is the risk of overheating. At Friendship we see so many cases of heat stroke every summer I feel it is necessary to revisit my annual hot weather warning.

Dogs are much more susceptible to heatstroke than their human companions are. As if wearing thick fur coats weren’t enough of a challenge, dogs have only two ways of dissipating heat: by panting, and through their paw pads.  When the temperature rises, neither of these cool-down tricks works too well: Panting becomes much less effective when the weather is hot and humid. And when your dog walks on a scorching sidewalk his paws stay too hot to help him cool down.

If you’re out on a walk with your dog and he suddenly lies down, collapses or becomes unresponsive, seek veterinary care immediately. DO NOT try to cool down your dog on your own. Instead, get to a vet as quickly as possible.

All dogs can be affected but the “Smushy-faced” (“brachycephalic” is the technical term!) dogs like bulldogs and pugs are especially susceptible to heat-related illness. This is because breed characteristics such as narrow nostrils and elongated soft palates decrease their ability to effectively cool themselves.  Please keep this in mind if you have a brachycephalic breed at home.

If for some reason you can’t make it to a veterinary hospital immediately there are a few cooling measures you can begin.  Fist take your dog’s temperature rectally with a digital thermometer, normal is 100-102.  You can then soak a towel in tepid (not cold) water, place it over your dog, and aim a fan at him.  Continue to closely monitor his temperature and once it hits 103 degrees discontinue cooling.  Even if your dog seems fine you should take him to a veterinarian as soon as he is more stable.

What makes heat stroke potentially fatal is that the patient can develop a condition called disseminated intravascular coagulation or DIC that causes massive and widespread damage to the blood vessels.  This quickly results in multiple organ failure and the patient loses the ability to clot his blood.  Treatment consists of aggressive supportive care and plasma transfusions, both of which are very expensive and not guaranteed to prevent death. 

When it comes to heat stroke, the best treatment is prevention.  Here are some commonsense tips to help keep your dog cool and comfortable:


1. Avoid taking your dog out during the hottest times of the day.  (Quick rule of thumb: If it is too hot for you, then it is definitely too hot for your dog!)

I have a few soapboxes that I like to stand on when it comes to advice on how to take care of your pet.  Coming in at the top of the list are the importance of spay/neuter, keeping your dog from getting heat stroke and dental disease.  Imagine my horror when I discovered that my own kitty Furla had a grade three FORL!

FORL, which stands for feline odontoclastic resportive lesion is a condition that appears to be unique to cats.  The lesions are similar to human cavities in that there is a defect in the enamel of the tooth and it is very painful.  If your cat is over the age of 5 years old then there is a 72% chance a FORL is present. As with all dental disease, FORLs can lead to increased bacteria circulating in the blood stream resulting in liver, kidney and heart disease.

These nasty FORLs are usually found along the outer surface of the tooth where it meets the gum line.  They can present in many stages requiring dental radiographs to determine if the tooth root is involved.  At the beginning stage an enamel defect is present which then progresses as the FORL penetrates the enamel and invades the pulp cavity, they appear as pink or red defects in the tooth where it meets the gum.  As the lesion develops it becomes increasingly more painful for your cat.  Treatment entails a full dental exam under anesthesia and surgical extraction of the offending tooth.

Every few months (I should do it monthly…) I check all my animal’s teeth to look for any signs of dental disease.  Usually with FORLs you can see clinical signs such as difficulty eating, drooling, bleeding along the gums and dropping food from the mouth.  However, some cats like Furla to not show any signs at all.  At eight years old overall she had lovely teeth with minimal tartar and gingivitis – except for that nasty, painful FORL.

As I managed my feeling of guilt for neglecting one of my animals I immediately scheduled a dental to address the issue.  Here is where it gets even worse – they found a second FORL that had completely resorbed which means it had been there for a while.  They also found she had a dead tooth that needed to be extracted.  This is the perfect example of dental disease that is lurking under the gumline and cannot be found without a full dental exam under anesthesia.

Furla seemed unfazed by her dental and having two teeth extracted, she was happily snacking on canned food a few hours after she woke up from anesthesia.  I have certainly learned my lesson and I hope this serves as a cautionary tale for all pet owners about the important of checking your cat’s teeth regularly.  Finding and treating these lesions early will result in a healthier, happier kitty.

I have written multiple posts about how much I admire and respect neurologist extraordinaire Dr. Bill Bush; you can then imagine how thrilled I was when he started seeing appointments at Friendship on Thursdays.  We are so lucky to have such an amazing neurologist right in the hospital that we can refer clients to. 

I think the story of Puck the Corgi illustrates just how gifted a clinician Dr. Bush is and the cutting edge treatment options he has available to his patients.  Puck presented to Friendship after having multiple seizures for the first time in his ten years of age.  Dr. Bush evaluated Puck and immediately suspected that he had a brain tumor, he literally pointed to Puck’s forehead and said, “There is something going on right here”. 

Sure enough an MRI at Bush Veterinary Neurology Service (BVNS) in Leesburg confirmed that Puck had a tumor in the olfactory-frontal lobe of his brain.  Puck immediately went to surgery for a transfrontal craniotomy to have the tumor removed.  A post-operative MRI showed that Dr. Bush and his resident Dr. Hague were able to remove the entire tumor.  Puck recovered quickly and was back home in a few days.

Here is where it gets really cool!  The tumor was submitted to the Ohlfest Brain Tumor Laboratory at the University of Minnesota where they are performing groundbreaking research in treatment of brain tumors for both dogs and humans.  They were able to use Puck’s tumor to create a vaccine that will be administered under his skin to target and kill any remaining tumor cells.

Four months after surgery Puck is doing great and even updates his fans on his very own Twitter feed @puckthecorgi.  Visit BVNS’s website for more amazing stories of dogs and cats that Dr. Bush and his team have helped.  Remember he is available for consults at Friendship on Thursdays, visit our website for more information.

It is that time of the year again; spring is almost here and with the tulips comes Fashion for Paws.  This will be my third year participating and I could not be more excited to embark on my fundraising efforts.  Last year my Labradoodle Frank and I were very proud to walk down the runway after raising more than $18,000 for the Washington Humane Society (WHS).

This is a cause near and dear to my heart and I am grateful for the opportunity to give back to an organization that gives so much to our community.  WHS provides care to more than 30,000 abused, neglected and abandoned animals every year.  They are the only open-access shelter in the District which means that at any time if someone feels they cannot care for their pet WHS will accept them.  They take in an average of thirty animals per day.  This service alone saves thousands of animals from needless suffering.

In addition to the shelters WHS has numerous programs that benefit not just animals but humans as well.  Their Humane Education program aims to educate school children about animal abuse to stop the cycle of abuse that so many children grow up with.  There is a direct connection between animal cruelty and domestic violence.  If we can educate these children to show compassion to animals it is thought that this will translate to other aspects of their life and prevent future violent acts.

The dedicated and tireless officers of WHS’s Humane Law Enforcement are available twenty-four hours a day to investigate reports of animal cruelty.  They witness horrendous acts against innocent animals that we all prefer not to think about, a cat intentionally set on fire or a dog left to die in a dumpster after extensive bite wounds.  These officers subject themselves to witnessing the worst in human behavior and yet they keep at it day after day in order to keep the animals of the District safe.  I feel this is truly commendable.

These are just a few of the many programs that WHS provides to the animals and people of the District.  Without them we would be lost and many innocent animals would pay the price with needless suffering.  As someone who has dedicated my life to helping animals I am proud to raise money for this wonderful organization, please consider supporting Frank and me in Fashion for Paws this year.   

Visit http://support.washhumane.org/goto/frank for more information.

Dogs developed by eating whatever they could scavenge so it makes sense to me that their gastrointestinal (GI) tracts should always be digesting something a little different.  Since every brand and type of food has a different combination of protein, carbohydrates, fats, vitamins and minerals; I can be confident that if one brand is lacking something another brand should make up for it (in theory).

Just about every time my dogs eat they get a different combination of food.  I have two to three bags of different types of dry food and an assortment of canned foods in my house at all times.  I then alternate the dry foods and add in a scoop of canned food to make it a little bit more exciting.

You are probably thinking that suddenly switching a dog’s food like that will result in a nasty bout of diarrhea. This is true if you feed the exact same thing every single day, but if the GI tract is used to being surprised then it adapts quite well.  As I said my dogs get a different mix of food at every meal and they have lovely stool.

In addition to their diet I also give all the dogs an omega-3 fatty acid supplement such as those found in fish oil.  You can read in my previous post on fish oil and all the amazing benefits it provides to the body.  Dogs have a difficult time utilizing the fatty acids found in flax seed or oil so fish oil is a much better choice.  There are a variety of human and veterinary products to choose from, just remember to find a reputable brand such as Nutramax or Nordic Naturals.

Given the multiple pet food recalls some owners want to cook for their pets feeling this is a safer alternative to commercial foods.  I never recommend feeding a home cooked meal unless the owner consults with a veterinary nutritionist or a website like www.balanceit.com.  Without specific guidelines and supplements it is almost impossible to feed your dog a diet that meets all of his nutritional needs.  Just throwing some meat and veggies into a bowl is not providing your dogs with the nutrients he needs and will result in health problems.

Despite what many pet foods companies will tell you corn is a viable protein and carbohydrate source that provides many essential nutrients; it is not just filler.  I have no problem feeding my dogs a diet that contains corn, however, I don’t want that to be the only grain they eat.  This again illustrates why rotating diets is so important in giving your dog a balanced diet.

Finally, the super high protein foods are not necessarily better.  Dogs are omnivores like humans and are made to eat a combination of meat and plant material.  These diets provide excess protein that you dog does not need and excreting these proteins creates increased work load on the kidneys.  In animals that have decreased kidney function these high protein diets are actually harmful and can worsen progression of disease.

This is my favorite brand

I hope this helps you decide what is the best food for your dog; I know it can be overwhelming.  Just remember there is no one best food and by rotating brands you have the best chance of providing your dog a complete and balanced diet.

Happy New Year!

As I embark on my annual New Year’s resolution to eat better and exercise more I thought I might once again try and tackle the ever looming question asked by owners: what is the best food for my pet? 

In truth this is a question without a definitive answer so I will tell you what I feed my pets and why I have chosen these foods.  I will start with my three cats, two of which have medical issues that require them to eat prescription diets.  Vegas has food allergies and if the majority of food he eats is not venison based he will scratch his face creating horrible open sores. 

Because of this Vegas and my other cat Furla eat a combo of dry and canned Hill’s Prescription Diet D/D Venison.  Furla doesn’t particularly need this diet but she likes it and feeding it to both of them is easier for me.  I feed them mostly canned with only a small amount of kibble for them to munch on during the day.  For cats I feel the canned food is better for them as it is higher in protein and moisture that more closely mimics the diet their bodies were designed to process.

Unlike dogs and humans that are omnivores, cats are obligate carnivores meaning all of their required nutrients come from animal tissue.  For example cats have evolved to eat multiple small meals that they spend the day hunting, think mice and birds.  Giving your cat a huge bowl of dry, carbohydrate-based food that he plops down to inhale at one sitting is not compatible with the development of his gastrointestinal tract.  There is a theory that feeding our cats this way has lead to the numerous cases of obesity, inflammatory bowel disease and intestinal lymphoma that we see.

My third cat Breaker has a sensitive stomach and after extensive diagnostics to look for a cause of his frequent vomiting I found that feeding him Hill’s I/D eliminated the issue.  For the reasons listed above I would prefer to feed him only canned food but he refuses to eat it.

In addition to their main diets I also like to add in a few things to keep it interesting for them.  One of my favorite treats for cats and dogs is Hill’s T/D, which is designed to act like a little sponge packed with enzymatic cleaners to wrap around the teeth and break down the tartar.  This is actually a complete diet and can be fed alone but I prefer to use it as treats.  I sprinkle a handful on top of the cat’s dry food, they love it and will pick out the T/D pieces to eat first.  I firmly believe this stuff works, all of my cats are around 7 years old, have never needed a dental cleaning and have lovely teeth with minimal tartar.

I also like to increase their omega-3 fatty acid intake by giving them Evanger’s Whole Mackerel in Gravy canned food once or twice a week.  I have tried squeezing fish oil capsules on their food but it is messy and they refuse to eat it.  As I have states before in previous posts I am a firm believe in the magic of omega-3’s helping every body system.

I hope this gives you an insight into how I choose what to feed my kitties and will help you find a diet that works for your cat.  There is an overwhelming amount of information about pet foods out there so I encourage you to do some research and speak with your veterinarian about what will help your cat live a long and healthy life.