Category Archives: Wellness

Quality of Life and Euthanasia

The Decision

piggie10When a pet owner and a veterinarian decide that a pet’s health is failing and their quality of life is poor, the possibility of putting them to sleep (also called “euthanasia”) may be considered. Whether this is a decision arrived at gradually as a pet’s health declines with age, or suddenly in the event of catastrophic injury or illness, the choice is never an easy one to make. Our goal is to help you understand how, when, and why we may consider euthanasia when it is beyond our ability to keep an animal comfortable and feeling well.

How do we decide when an elderly pet whose health has been in decline is finally having so much trouble that euthanasia should be considered? Every pet’s situation is different, and there is no single answer that applies to every owner’s choice. Here are a few things that may be taken into consideration:

1. “Three Favorite Things” – What were your pet’s three favorite things to do when they were well and in optimal health? Can they still do at least one or two of these things? If not, their quality of life is in decline, and it may be appropriate to consider euthanasia.

2. Basic Needs – When a pet can no longer urinate and defecate easily, if they cannot easily access food or water when they need it, if breathing is difficult with minor exertion, and if they cannot rest comfortably, these are serious factors to consider when evaluating their quality of life. Not all pets will necessarily stop eating when they are very ill, but a complete loss of appetite would be a strong indication that the pet is uncomfortable. Furthermore, if a pet seems to be losing interest in what is going on around them, their quality of life is declining.

3. Your Ability to Provide Care – An owner who is retired and can spend all day tending to the needs of a sick or elderly pet is in a very different situation than a person who works ten-hour days and cannot assure their pet is comfortable and well attended-to at home. While some owners hesitate to consider their own needs when deciding what is best for a pet, it is appropriate to consider what you will be able to practically handle at home.

The Process

When facing a stressful situation, it often helps to know what to expect. Some owners make an appointment to discuss their pet’s quality of life with a doctor as they begin to consider putting an animal to sleep. Others are already certain that euthanasia is the best course of action in their situation. In either case, a pet owner will have the opportunity to speak to the veterinarian before making a final decision.

badeau4Different veterinarians and different veterinary practices may have slightly different protocols and preferences in terms of which medications are administered for euthanasia. Sometimes, an initial medication dose is given to help an animal feel calm and relaxed, or even completely asleep, before the euthanasia drug is given. This drug which directly causes death is a barbituate given at a high dose (at a low dose, a barbituate would cause sedation). In simple terms, this drug causes the pet to fall asleep and then stops function of the heart and lungs. The veterinarian will give this drug via a needle or catheter into a vein, wait a few moments, then listen to check that the pet’s heart has stopped. Sometimes an animal will take a few last deep breaths or experience some muscle twitching after they have passed away. These are just the effects of the body’s cells losing oxygen after death, they are not anything the pet feels or is aware of.

When a pet is deceased, the owner may choose to have them cremated or take their remains home for burial. Bolton Veterinary Hospital works with a reputable pet cremation service, Inserv. A pet’s cremated remains may be returned to the owner, or alternatively left with Inserv (the company scatters the ashes in an environmentally friendly manner on a Long Island property). An owner who chooses to have their pet’s ashes returned to them may also choose to have a clay imprint of their pet’s paw made as a keepsake.

All of us in the veterinary profession have been in the position of having to decide whether it is time to say goodbye to a pet whose health is failing. We know how difficult this decision is, no matter the circumstances. It is quite normal for a pet owner, and even other pets in the household, to experience a grieving process after the loss of a pet. We have provided a series of resources for grieving pet owners below.

Resources

The Pet Loss Support Page – http://pet-loss.net/

The Pet Loss Support Hotline – http://www.vet.cornell.edu/org/petloss/

Books on Pet Loss and Grieving – http://www.petlossathome.com/pet-loss-books/

Inserv Pet Crematory – http://www.inservcorp.com/

Quality of Life and Euthanasia – View/Print as PDF

Feline Nutrition: The “Carnivore Connection”

Have you ever considered the differences between dog food and cat food? Or the differences between what our pet’s ancestors would have eaten, and what we feed them today? There is no species to whom this matters more than our feline friends. Both dogs and cats prefer to eat predominantly meat, but a cat’s physiology is quite different than a dog’s. Cats are considered “obligate carnivores,” meaning they would rely almost exclusively on eating prey, not plants, in their evolutionary setting. Dogs, by contrast, are more omnivorous, and can more readily use both plant and animals sources of nutrition. Cats’ evolutionary past sets them apart in a variety of ways, and this has important consequences for what we should feed them today.

What Wild Cats Eat and Why It Matters

brianacat11A wild cat’s prey would be predominantly rodents and small birds. These are food sources high in protein, with moderate levels of fat, and very little carbohydrates. Cats require two to three times more protein than omnivores, and a kitten’s requirement is even higher. Protein and fat are used as a source of energy, to synthesize new proteins, rebuild cells, and carry out all of a cat’s normal biochemical functions. If a dog is fed a diet low in animal protein, it isn’t a critical problem; dogs, humans, and other omnivorous species can synthesize the proteins they need from plant sources and their metabolism can adapt to what is available. Cats are not able to do this, and illness will result from a severe or long-standing deficiency. It isn’t just the lack of protein that presents a problem; an overabundance of carbohydrates may contribute to obesity, diabetes, osteoarthritis, urinary tract disease, liver disease, and skin conditions.

Cats’ unique nutritional needs do not end with protein. They also have a greater need for a variety of B vitamins, as well as vitamins A and D. Healthy cats rarely run into trouble with this, but a deficiency can develop quickly if a cat stops eating.

Prey is also a major source of water for wild carnivores. Cats are evolutionarily a desert species, and as a result they do not readily feel thirsty when they are becoming dehydrated. Research has demonstrated that a cat eating kibble takes in 50% less water in the course of a day than a cat who eats canned food. Cats eating predominantly kibble may spend a significant portion of their lives dehydrated, constantly putting a strain on their kidneys.

So, What Should We Feed?

Pet food companies might have you believe that a “grain-free” diet is a “carb-free” diet. This is not the case. Carbohydrates are still present in all kibble diets, and in many canned diets too. A carbohydrate is necessary to form a kibble (think about it – trying to make kibble without a carbohydrate source is like trying to make pancakes with only eggs, milk, and oil). So how does the pet food manufacturer manage this? An alternate carbohydrate source such as potato flour will be used. It’s not a grain, but it’s still a carbohydrate! So we acknowledge that a carbohydrate source will ALWAYS appear somewhere on a dry food ingredient list, but a canned diet can be made truly carb-free.

zoey2Will your cat eat canned food? If so, great, even if you find it convenient to still offer kibble at another meal. You can mix additional water in with her canned food to make it “soupy” and increase her water intake further. Look on the ingredient list for animal-sourced proteins as the first few ingredients: meat, poultry, fish, eggs, whey, etc. Do you see something like “poultry by-product” on the label? Fear not – it may not be the wrong choice. “By-product” earned its unpalatable-sounding name because it consists of parts of animals not typically used as human food, such as organ meat (liver, kidney, etc), fat tissue, bone, and viscera. Organ meat in particular represents a rich nutrient source, and the small particle size of a finely-ground meal aids in digestion. Do plant sourced ingredients (such as rice, soy protein, wheat gluten, corn starch) feature prominently on a canned food label? They do not need to be there. The lower they are on the ingredient list, the better.

Does your cat prefer kibble? While it can be more challenging to meet a cat’s nutritional and water needs via a kibble-only diet, there is evidence that a dry food contributes less to dental disease than canned food. We can choose a variety of dry food that most closely matches the needs of an obligate carnivore by selecting one that lists animal-sourced proteins as the first two or three ingredients. Encourage your cat to drink plenty of water by providing multiple water bowls in different locations around the house.

mg24The array of pet foods available may seem endless, and there is no single best food to suit every cat. Food allergies, taste preferences, and lifestyles all come into play. If this article leaves you still wondering exactly what to feed your cat, we hope you will talk to your veterinarian about it at your next appointment. You might also be interested in reading further in our blog: we have also written an article called “What Should I Feed My Pet?

Feline Nutrition – View/Print as PDF

 

References and Further Reading:

The information in this article is based upon “The Carnivore Connection to Nutrition in Cats,” by Debra L Zoran, DVM, PhD, DACVIM. The original full-text article appeared in the Journal of the American Veterinary Medical Association, Vol 221, No. 11, on December 1, 2002, and can also be found at http://www.catinfo.org/docs/DrZoran.pdf.

There is a great deal of additional information at Dr. Zoran’s website, www.catinfo.org.

 

Worried About Vaccine Reactions?

“My friend told me her puppy had an allergic reaction to a vaccine, and it made me worry. Are all these vaccines really necessary?”

While some vaccinations are considered “core” or required by law, many others are lifestyle-dependant, and certainly not all pets require every vaccine. On one hand we are fortunate that some of the most ominous diseases can be prevented with something as simple as a vaccine, but of course there are some pets whose immune systems do not respond as well to vaccination as we’d like.

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What kind of reactions are we talking about? The vast majority are more of an annoyance than anything else. It is not uncommon for dogs and cats to feel a little tired or sore after receiving vaccines, particularly if they have had multiple in one day. This represents the immune system’s normal function and is nothing to worry about. Some may develop a low fever, experience soft stool or an episode of vomiting, and this kind of reaction is concerning only if it continues or the pet seems really uncomfortable. The kind of reaction that is really concerning (and fortunately rare) is an animal who develops hives, continues to vomit or have diarrhea, seems restless or agitated, experiences swelling (most commonly of their face), or has difficulty breathing. Not to worry, even the most severe reactions can be reversed – this is why your veterinarian will advise you to keep a close eye on your pet for a little while after vaccines, especially as a puppy or kitten.

The first step, of course, is to discuss your pet’s lifestyle with your veterinarian and determine which vaccines make sense to use. Does your cat go outdoors and interact with other cats? Does your dog enjoy a weekend hike in the woods, or does she attend doggie day care? If the answer is no, some vaccinations are altogether unnecessary. Do you regularly apply a tick preventative product and find it to be very effective? Then we might consider skipping the Lyme vaccine, even if your dog spends a lot of time outside.

What should be done about a dog who we’ve determined SHOULD have a given vaccine, but in the past, she has had a serious reaction following vaccination? And what about pets who have autoimmune diseases, and we are concerned their condition may flare up due to the stimulation of the immune system that is caused by a vaccine? Fortunately, there are steps we can take to ease these concerns.

For a pet who has had a history of a vaccine reaction, simply giving a dose of Benadryl before vaccines can prevent a similar reaction. Your veterinarian can advise you on an appropriate dose of Benadryl to give at home before the appointment, or it can be given by injection just prior to giving vaccines. We might also avoid giving multiple vaccines on the same day, to make the immune system’s job easier and reduce the likelihood of any reaction. Your veterinarian also knows that some specific brands or categories of vaccines have a slightly higher reaction rate that others (data is continually collected on this, and even the most reactive vaccines affect less than 2% of dogs and cats), and she may already be avoiding these products altogether for your pet.

For a pet who is at risk of having a severe reaction, we have a chance to avoid vaccination altogether, while still assuring the pet is protected from infectious diseases. An antibody titer is a blood test that can be sent to a laboratory and determine if your pet already has immunity lasting from the previous time they were vaccinated. Many pets do! The required vaccines for adult dogs and cats are typically considered “good” for up to three years, many pets will actually have immunity longer than this. Not all will, of course – but we may be able to avoid unnecessary re-vaccination in majority by checking a titer.

Why don’t we do this for everyone, you wonder? The answer is due to cost. Regardless of what veterinary hospital your pets visit, a titer is likely to be significantly more expensive than a vaccine. And because less than 1% of pets have serious trouble after getting their vaccines, it usually makes sense to go ahead and give a booster shot. But for the occasions when we want or need to know if vaccination is necessary, a titer test is available. We hope you will discuss the need for vaccinations or titers with your veterinarian if you have any concerns about vaccine reactions in your pet.

Vaccines and Reactions – View/Print as PDF

Considering Pet Insurance?

You may have heard of the concept of pet insurance and wondered if it is worthwhile for your pet… you might also have begun looking into it and become overwhelmed by all the companies offering it, and the lists of different plans and options. We’re here to help – and we’ll begin by telling you that this is an unbiased review of pet insurance. We promise you that any product or service we review in this blog is completely impartial, not influenced by sponsorship or advertising, and presented exclusively to help you decide what is best for your pet.

1. Pet insurance is like any other insurance: There is a monthly or yearly basic cost, and a co-pay and/or deductible paid per-event.
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Just as your own insurance costs you “X” dollars per year and if you see the doctor there is a co-pay, pet insurance requires a basic monthly cost as well as a co-pay and/or deductible for a vet visit. These costs vary depending on your pet’s age and breed, what area of the country you live in, and what kind of policy you choose. It is also possible that an annual or lifetime limit on payouts may be applied. Most companies have a website that can readily provide you with a price quote.

2. There are two basic types of pet insurance: Indemnity and Major Medical. Not all companies offer both.

Most pet insurance is meant to help a pet owner cover “indemnities” – the sudden and unexpected expenses of illnesses or injuries. Pet indemnity insurance is a lot like car insurance: if something goes wrong, a large portion of your bill is covered, but basic necessities are not accounted for. For a car, basic necessities are things like gas, oil changes, and routine maintenance. For a pet, basic necessities are things like annual wellness exams, vaccines, and flea control products.

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Major medical insurance for pets is much like human medical insurance. Whether you go to the people-doctor or the doggie-doctor for an annual physical or because you are sick, a large portion of the cost is covered by your insurance. Because major medical insurance covers more of your expenses, it generally costs more per month and/or has a higher deductible.

US-based companies that offer each type of insurance are listed at the end of this article.

3. Unlike human insurance, you will pay up-front and then be reimbursed by your insurer. 
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With human insurance, we are accustomed to walking out the door after paying a small co-pay. Pet insurance generally does not work this way. If your pet is hospitalized at a cost of $800, you will need to pay your veterinarian this amount at the time of hospitalization. Your veterinarian will then help you submit a claim form, and a little while later, your pet insurance company should reimburse you some portion (or all) of this cost. How much is reimbursed will vary with each company, and some have more straightforward rules than others.

4. There is NO pet insurance company that covers pre-existing conditions. bday

It makes sense, after all – You couldn’t crash your car into a ditch and then try to buy insurance to get it repaired the day after. Pet insurance is no different. If your vet finds out your pet has a heart murmur and recommends he be evaluated for heart disease, you cannot buy insurance to cover diagnostics and treatment after the murmur is discovered.

Some companies will also exclude certain conditions based upon breed. For example, bulldogs are prone to develop breathing problems due to the shape of their head and face. Given the high likelihood of any bulldog having breathing problems, a pet insurance company may exclude coverage of this type of condition for all bulldogs. Different insurance companies may have very different coverage as far as hereditary (breed-related) conditions – be sure to research this (or adopt a mutt!).

5. You can use any veterinarian with any insurance.

Veterinarians have no silly rules about which pet insurance they will accept. It’s all fine with us! It helps, though, if you bring a copy of your claim form with you so your veterinarian doesn’t have to puzzle out what kind of paperwork you need (they’re all different).

6. Your pet’s lifestyle may affect their likelihood of illness or injury, and therefore the type of insurance your pet should have (if any).

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An indoor-only cat doesn’t lead a very treacherous lifestyle; by keeping your cat safely indoors, you’ve ruled out scores of illness and injuries that might otherwise affect her. On the other hand, a labrador puppy is a furball of trouble on four legs, and you should probably plan for a lifetime of sock eating, ear infections, torn toenails, wildlife encounters, and maybe even a little jaunt out playing in traffic somewhere along the way (it happens!).

Some companies also offer coverage for exotic pets. Again, consider your pet’s lifestyle: Are they likely to be injured? An adventurous parrot whose flight feathers are not clipped can find himself in quite a lot of trouble, whereas a hamster’s life is generally far less perilous. Would the cost of treatment for an exotic pet affect your willingness to bring them to the vet if they become seriously ill?

7. You might be better served by saving up an “emergency fund” and skipping the insurance.

If you are a person who can stick with a budget and is generally responsible about your finances, the best course of action is to save up an emergency fund BEFORE you adopt a pet, so that you can proceed confidently knowing you are ready for anything. An emergency fund of $1000 – $2000 is a reasonable goal, and with over $3000 you can comfortably cover the initial cost of just about any trouble your pet may run into. Do these amounts sound terribly high? If that is the case, pet insurance may be a good choice for you, taking down your expenses to something along the lines of $20 – $50 per month. But hey – if you saved that $50 per month, you’d have a generous emergency fund all set in a few years.sx21

If this all sounds entirely out of reach, we hope you will honestly consider whether now is the right time for you to adopt a pet. When you adopt a pet, you take on a responsibility for their care, no matter what life brings. As veterinarians, we wish the question of money was never an issue, but for many pet owners, it becomes a deciding factor. We hope you never find yourself in that terribly difficult situation, because it’s one we don’t want to face either!

Still overwhelmed?

Call, email, or visit your vet – they can help you decide the best course of action. You may also find the links below helpful.

PetInsuranceReview.com – An unbiased review of US and Canadian pet insurance companies (see the left sidebar for links to a summary of each insurer)

PetPlan – The world’s largest pet insurance provider. Offers indemnity and major medical insurance. Hereditary conditions are covered.

Healthy Paws Insurance – Offers indemnity insurance only. Hereditary conditions are covered, except hip dysplasia in dogs who enroll after age six. No payout limits apply.

Pets Best – Offers indemnity and major medical insurance. Hereditary conditions are covered.

Trupanion – Offers indemnity insurance only. Hereditary conditions are covered. Hip dysplasia is covered. No payout limits apply.
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AKC Pet HealthCare – Offers indemnity and major medical insurance. Hereditary conditions are not covered.

Embrace – Offers indemnity and major medical insurance. Hereditary conditions may be covered.

PetFirst Healthcare – Offers indemnity and major medical insurance. Hereditary conditions may be covered. Addition of the chronic coverage rider is recommended.

VPI – The first and largest US-based pet insurance provider.  Offers indemnity and major medical insurance. Hereditary conditions may be covered.

24 PetWatch – Offers indemnity insurance only. Hereditary conditions may be covered.

PurinaCare – Offers indemnity and major medical insurance.

ASPCA Pet Health Insurance – Offers indemnity and major medical insurance. Hereditary conditions may be covered.

Protect Your Bubble – Offers indemnity and major medical insurance. Hereditary conditions may be covered.

Pet Premium – Offers indemnity and major medical insurance. Hereditary conditions may be covered.

Considering Pet Insurance – View/Print as PDF

What Should I Feed My Pet?

How do I decide what to feed my dog or cat?pugs_psnd2

Assuming your pet is generally in good health, without any specific dietary sensitivities or food allergies… There is still no simple answer! There are countless options to choose from in a maintenance diet for dogs and cats, and a healthy pet will do reasonably well on almost any of them. That being said, some diets simply meet the basic requirements for nutritional content, while others provide higher-quality protein sources, more “natural” ingredients, supplements to support healthy joints or a shiny coat, fewer preservatives, and so on. It is worth mentioning that any brand – inexpensive or premium – can potentially have a recall.

 

So what is the difference between a bag of kibble that costs $15 at the supermarket and a premium brand for $40 at the pet store? Do these differences matter, or are pet owners just being tricked into spending more?

Let’s start with protein quality and digestibility. Any dry or canned food labeled as a complete diet meets the basic standards for protein content, but the sources of protein can vary. Both meat and grains are sources of protein, but in general, higher-quality meat is a superior protein source due to the fact it provides a better amino acid balance.

Read the label of your pet’s food – you may see the words “poultry,” “poultry byproduct,” or “chicken meal.” These terms may sound vague (and have you fearing what “byproduct” might contain), but they have specific meanings:

Meat – The flesh of any species of slaughtered mammal, typically pork, beef, or sheep.

Poultry – The flesh, skin, and bone of domestic poultry; typically chicken, turkey, or duck.

Byproduct – Parts of animals not typically used as human food, such as organ meat (liver, kidney, etc), fat tissue, bone, and viscera.

Meal – Any ingredient that has been ground down to a small particle size (for example, “chicken meal” would mean the flesh, skin, and bone of chicken).

Though the organ meat (liver, kidneys, etc) contained in a “by-product” is not typically part of an American diet, these are excellent nutrient sources and provide high-quality protein. Bone meal is a good source of calcium, but the protein it contains is not readily digested by cats and dogs.

“Whole chicken”  as a first ingredient may give us the impression of a less-processed superior quality diet, but whole chicken used in pet foods is high in fat and may contain 65-70% water! This high volume may earn it the first place in the ingredient list, but leaves it as a small contributor to protein content and is more important as a fat source.

Plants such as corn, soybean, and flaxseed may also be used as protein sources. Their digestibility is equivalent to some animal protein sources, but they are deficient in some of the amino acids required in canine and feline diets, so for this reason we would hope not to see plant-based products as a primary ingredient. If soy accounts for 50% or more of a diet’s protein, loose stool and flatulence may result.

All this information may leave you with more questions than answers about your pet’s food. We invite you to discuss your pet’s diet with your veterinarian at your next appointment – as we began saying, every pet is an individual with their own needs and preferences – there is no simple answer!

 

What about limited ingredient diets? Grain free? Raw diets?

For pets with special needs (food sensitivities or allergies, for example) a specialized diet may be the key to solving their problems. However, there is a specific way to determine the best diet for a food-allergic dog… just switching brands is not likely to be the answer. Feeding a raw diet is a point of controversy and is not without risks, but if done correctly, it may provide a solution as well. These topics are beyond the scope of this blog post (we’ll write another, we promise), but we hope you’ll talk to your vet about changing your pet’s diet if you are concerned food allergies or sensitivities may be affecting your pet’s health. There is no single solution that works for every animal. 

 

How much should I feed my pet?

No quick answer here either! Most brands of pet food will provide guidelines for how much to feed based upon weight. This amount is frequently an overestimate (after all, they’d like you to buy more of their product!), so you may use this as a starting point, but pay attention to your pet’s weight and adjust accordingly. Feed a measured amount – not “a handful” but a measured cup – so that you will be better able to increase or decrease the amount fed as needed.

 

How do I know if my pet is overweight?

Of course your veterinarian can provide guidance on this topic, but in general, your pet should have a “waist” when viewed from above or from the side. Place your hands flat over the sides of her chest… with very gentle pressure, you should be able to easily feel where her ribs are. If finding her ribs requires poking in with your fingertips, or if you can’t feel them at all, she is overweight. Maintaining an appropriate weight contributes to better overall health and even an extended lifespan!

 

Can I feed a home-prepared diet?

Many recipes are available for home-cooking for your pets. However, it is essential to be certain what we choose to feed on our own is nutritionally complete, particularly if the recipe being used is not approved by a veterinarian. Many veterinary teaching hospitals and referral centers offer a nutrition consult service, and can tell you exactly what vitamins and supplements may be necessary to balance any home-cooked diet. Here are links to a few:

Angell Memorial (provides recipes), CornellOhio StateDavis

We hope this article has given you a solid starting point in finding the best possible diet for your pet’s lifelong health. And if you have any lingering questions, look to your vet for the answers!

What Should I Feed My Pet – View/Print as PDF

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