What's going on in your pet's mouth?

Clean teeth are a necessary precursor to overall health. We all know this, and new research is showing that even the marginal amount of periodontal disease in humans can contribute to heart disease and early mortality.

Sparkly white teeth after a dental prophy

We have some evidence-based knowledge about what oral disease does in pets. We have seen for many years a link between dental disease and heart disease. In addition, the bacteria overload from dental and periodontal disease in the mouth has been implicated in kidney disease, urinary tract infections, and even chronic GI issues.

How often do you look in your pet's mouth? I'll be honest, I have great dogs and a full knowledge of how dangerous dental and periodontal disease can be and even I can go months without peering into the dark dank recesses of my dogs' mouths.

February is National Veterinary Dental month. It is a month when we dedicate ourselves to remembering how overlooked the mouth often is in our day-to-day interactions with our pets. Even people who are way more diligent than I am about brushing their pet's teeth may not actually be looking at what they're doing.

I would like to walk you through a Comprehensive Oral Health Assessment and Treatment (COHAT) (typically called a dental) which is a systemic assessment, cleaning, polishing, and treatment of your pet's oral cavity done under anesthesia. I will explain what makes a COHAT far more than a routine "cleaning" or "scraping". In addition, I will explain why it is necessary and what we are looking for and why it is important not to wait until your dog has bad breath, red gums, and disease.

The picture above is of my own dog, Cassidy. She got a COHAT here about two weeks ago in conjunction with a mass removal. If you look at the picture above you will see that she has minimal tartar on her teeth and a little bit of redness. By doing the dental now I chose to avoid waiting until she had ongoing disease.

In this picture, the technician is using an ultrasonic polisher with a sand-paper like paste to polish the teeth after the cleaning. Both the cleaning and the polishing must occur above and below the gum line to remove all of the bacteria. Leaving bacteria below the gum line is actually worse than doing nothing because the teeth are now clean, but the gums and underlying structures are spreading infection. We use an ultrasonic cleaner specially designed for subgingival (below the gumline) use. The gingiva is delicate and sharp objects (such as tooth scaling equipment) can damage it.

After we clean the teeth we, polish every part of the exposed tooth surface. This is an important step, as the dental tools cause microscopic grooves which will serve a great surfaces for bacteria to reproduce.

In this (admittedly too bright) photo, the veterinarian is probing the gingiva for pockets. Pockets often hide diseased roots and can indicate bad teeth that may need to be removed. Each root and each edge of the tooth along the gumline is probed and the resulting depth is recorded. Three millimeters or less is considered healthy. Even perfectly healthy looking teeth can be harboring bad roots (think of your own teeth). Probing is a vital part of the dental process. Cassidy, here, had no pocketing of any significance.

This is the goal of preventive care - absence of disease - not waiting until disease occurs and then going in and fixing what is now broken.

In this picture (of a different dog) you can see the yellowish material - that is tartar. Under the tartar bacteria are destroying the teeth along the gumline and under the gums at the roots. There are times when knocking the tartar off causes the tooth to fall out.  Against the gums especially along the gum line, you can see a darker line. that darker line is actually active infection (pus). Around the canine tooth (the long one in the front) you can see the redness and inflammation caused by the infection.

In this dog's case there was significant pocketing around several of the teeth, and the last tooth on the back (with three roots) had to extracted due to the fact that it could not be saved. This dog's owner "waited" until the teeth "looked" bad enough to treat.

The teeth have been shedding bacteria into the bloodstream for months, the gums are red and painful, deep pockets are forming exposing sensitive roots and dentin to attack and teeth had to be extracted as a result. This is too late - this is not preventive medicine, and this is why we do not want to wait until the teeth look 'dirty' before we do a COHAT.

Cool new products

One of the coolest aspects of my job is seeing all the great new products that arrive every year from our drug companies to help us help our pets. Right now Ventana Animal Hospital is assessing two new drugs to establish how helpful they will be to our clients.

A fair amount goes into any decision to carry a new medication. We must ask and answer several questions before we even consider bringing a new medication into our hospital.

First and foremost, does it solve a problem that cannot otherwise be solved. If we carried every cool drug out there we would have no room to treat pets, and we would be broke because all our money would be tied up on our shelves. Many drugs are redundant, or they cover the same ground as older drugs, or they have one small change over an existing drug - in these cases, there would have to be a very compelling reason to add them to our pharmacy. We are only interested in truly breakout drugs or innovations that really make a difference to your  life or the lives of your pets.

Second we ask ourselves what the research really says. Many medications, especially ones that people hear about on the internet or from the media are poorly or not at all supported by the science. We only bring in new medications that have been FDA approved, which mean that they have undergone extensive research into efficacy and safety. Even after undergoing FDA scrutiny we will oftentimes wait on a medication until others have used it for a while.

Lastly, we look at cost and need. Just because a medication is effective, it's use might be so limited that we would never use it, or use it so rarely that we could never use all of the product before it expired on our shelf. We also look at cost. If a medication is prohibitively expensive and it is not a huge improvement on existing medications we will not carry it.

So, what cool medications are we looking at right now?

First we are looking at a new flea and tick product called NexGard. Unlike every other flea and tick product on the market, this one is not topical. Instead of having insecticides on your dog - and your hands and furniture - the dog eats a chewable tablet once monthly. The tablet contains a naturally occurring insecticidal molecule - found, interestingly enough in living sponges to kill sea snails which will eat them otherwise.

In addition to NexGard we are also studying a new medication released by Zooetis for skin allergies. This medication has already been used successfully by local dermatology specialists. The product is called Apoquel. We are still looking into some of the details of this medication, how, exactly, it works, safety, dosing etc...

Every month we receive notice of some new medication, protocol, or gadget. We try to think about how these products can improve the quality of care that we offer. We rarely end up pursuing these new things because they often do not meet our criteria, so it exciting that we are looking at two new products at the same time.

How to tell if your pet needs to go to an Emergency Center

One of the biggest issues owners face is a veterinary situation that happens after hours or during the weekend when their primary veterinarian isn't open. Ventana Animal Hospital is open from 8-5:30 on weekdays and from 8-12 on Saturdays - but we all know that accidents and illnesses don't always conform to business hours.

It's hard to know when something is an emergency and something isn't. Two am is also not the time to be trying to guess how dangerous your dog's symptoms are, or where the nearest veterinary emergency center.

We list two Tucson area veterinary emergency centers on our website. Both are affiliated with Specialty Veterinary Centers, and both provide excellent after hours emergency care.

Now that you know where to go, it's helpful to know when to go. Of course, before I list these symptoms that should send you scurrying to your nearest veterinary center, I must make the usual disclaimers: This list is in no way exhaustive - when in doubt, go to the Emergency Center, or give them a call - they will usually tell you how to proceed. (Their numbers are listed on the Ventana Animal Hospital website linked-to above).

So, what is an emergency?

Excessive bleeding, bleeding from the ears or nose, or bleeding in conjunction with swelling.

Any facial swelling or swelling anywhere especially after going outside and especially if there is a small drop of blood (we worry about rattle snake envenomation)

Any seizure that doesn't stop within seconds - a first seizure is scary and always needs to have a follow up at your regular veterinarian. Groups of seizures or a seizure doesn't stop can be life threatening.

Any signs of difficulty breathing - this is especially true of cats - blueish gums, heaving chest, unwillingness to lie down are all signs of repiratory distress in dogs. If your cat is breathing through an open mouth, that is generally a sign of breathing issues.

Any time a small dog is attacked by a larger dog even if there is no visible injury.

Any attack by wild animals - especially javalinas which create huge amounts of damage below the skin - always have your pet up to date on rabies.

Any possibility of a rattlesnake bite at all.

A broken bone, or possibility that a bone was broken.

Collapse of any kind.

Possible ingestion of a toxic substance (dark or bakers chocolate, sugar free gum, rat bait, household cleaners, diet pills, human medications, or anything that would freak you out if your kid ate it) - even if you know how, NEVER induce vomiting at home, some toxins an be inhaled into the lungs when vomited up and cause serious complications or even death.

Ingestion of anything sharp or anything that can cause blockage - especially dangerous are cutlery, rocks, tennis balls, toys, toy stuffing, anything that can act like string,

If your pet falls off anything from a significant height, chews on an electrical cord (the damage to the pet can be massive and life threatening even if you see nothing), your pet is hit by a car, golf cart or ATV, Your pet is kicked by a horse.

A cat (especially male) that cannot urinate, is yowling or straining in the litter box.

Any puppy under six months old with vomiting or diarrhea.

Any eye injury at ALL!

Of course there are a zillion other crazy things your pet can get into that weren't included here. The strange and terrifying things that your pet can get into are limitless. Many of them are scary but not life-threatening. But for those things that are dangerous, it is important to know what should cause you to drive to your nearest Emergency Center (or regular veterinarian if they are still open).

We sincerely hope that you never need to become acquainted with Tucson's Emergency Hospitals, but if you ever do, we hope this information helped you make a life-saving decision for your pet.

Welcome to 2014!

Happy 2014! We all hope you had a fantastic and safe holiday season and are now recovering by calling all of your friends who live back east and telling them how tan you are.

A new year is a great time to make a new start. We promise ourselves to make broccoli a bigger part of our diet and limit ice cream for dinner to special occasions. We also promise to be better at being us.

Our pets can benefit from the new us too. Research has shown for some time that people who walk their dogs are fitter. Our pets benefit from the exercise and the ability to explore the sights and sounds of the bigger world. Dogs that go for walks benefit from the socialization as much as we do.

I run with my dogs - well, one dog. This dog:

Kate on a mountain bike ride

These two dogs

Miss Kitty

Ketchum

Stay home. They stay home for two rather inexcusable reasons. First, these two, as the pictures above illustrate, embrace dirt, and all sorts of unknown, and unknowable, sketchy whatnot. Frankly they are kind of yucky.

Second, Kitty is well behaved, but, Ketchum - not so much. Her recall is dubious, her sit is non-existent and she thinks a leash is a lethal device and will flop around like a trout if I put one on.

This is sad - after all, I know how to bathe a dog and I certainly know how to leash train a dog.

So for 2014, I promise this blog will contain more stories of these two neglected pooches having adventures with their mom - which, of course, they really really want to do.

To get that achieved, I intend to use some of the coupons we have here at Ventana Animal Hospital to help everyone fulfill their pet's new year's resolutions. We have bags of Purina OM dog food for pets who need a jump start to a slimmer waistline, and for slackers like me, we have coupons to Central Pet for grooming and training.

Not only will Ketchum and Kitty benefit from smelling slightly less offensive, but learning to walk on a leash and come when called will allow them to go running and cycling with me.

Becoming better us's sometimes means helping our pets become better them's.

We look forward to seeing your better you in 2014, and we are very happy to help you help your pets become better them's.

Vaccine protocols

Want to have fun? Go to any holistic pet forum and ask about vaccines. The opinions will come immediately (generally in all caps) and most of them will follow the general line that you may as well take your pet out and shoot it as give it vaccines.

Of course, as we all (hopefully) know, vaccines save tens of thousands of puppies a year from the ravages of parvovirus and distemper. Vaccines help keep our pets safe from rabies and feline leukemia. However, for all the good they do, vaccines do carry risks. Not the vague and crazy risks discussed in the forums, but real risks of feline sarcoma, anaphalaxis (dangerous immediate allergic reactions) and abscesses.

Some of these risks can be very dangerous or fatal. They are also remarkably rare. Feline sarcoma is found in fewer than 1/10,000 cats, and severe allergic reactions (anaphalaxis) leading to death are rarer still. However, for those pets affected these events can be terrible.

For fifteen years the veterinary community has been trying to find a way between these conflicting dangers. For many, including all of the veterinary schools and all of the professional organizations, the solution has been to divide vaccines into core and non-core and limit the number of vaccines given over a life time.

As an example, in indoor only cats Feline Leukemia is a non-core vaccine, meaning that these cats should not receive the vaccine unless other risk factors warrant it (owner brings in strays or the like). Bordetella vaccines in dogs are treated much the same way.

As for limiting vaccines given over a life time, the research conducted by universities (not vaccine manufacturers - we will get back to this) shows that many vaccines last longer than the recommended year. The recommendation stemming from this research calls for giving core vaccines (excluding rabies) every three years or to check titers (which tells us if the pet's immune system still recognizes the pathogen) and possibly go out longer on vaccines.

This has led many veterinary hospitals to adopt a three year vaccine protocol. We have not. And the reason we have not is because Dr's Burrows and Nielsen have seen too many parvo puppies die to trust these studies.

Our newest doctor, however, embraces three year vaccines.

We have discussed this as a team, because we know that it will cause confusion if we are not providing people the same recommendations. But, to ask Dr. Estheimer, Burrows, or Nielsen to change their medicine - to make a medical decision - based on research or life experiences that they are uncomfortable with is unethical.

Rather, we decided that our clientele is educated and smart, and if we provide the facts to them (you) and allowed you to choose for yourselves, you would make the decisions that best fit your lifestyle and personal philosphy. In keeping with our philosophy of providing pet owners the tools to make informed decisions, we have elected to give you our point of view and the facts that brought us to our current decisions.

These are the facts of vaccination:
Vaccines do not cause any debilitating illnesses or diseases - everything out there that contradicts this statement is based on hearsay and has no basis in science.
Vaccines still save tens of thousands (if not millions) of lives per year.
All pets MUST be vaccinated for rabies, regardless of indoor status, according to state laws and vaccine labeling.
Failing to adequately vaccinate puppies exposes them to potentially fatal diseases - these diseases are common - there is no scientific or ethical reason to fail to adequately protect puppies and kittens.
Almost all vaccines (excluding rabies) given as a three-year vaccine is labeled by the manufacturer for one year - very few vaccines are actually labeled for three years.
Adequately vaccinated pets can still occasionally get the disease that they were vaccinated against.
No-one can define "over vaccinated", nor is there any evidence concerning patient health and the number of vaccines they receive in a life time.

We have agreed to disagree on vaccine intervals in our hospital. We do this because we believe that we must follow our hearts as well as our heads when it comes to the care of your pets. Please, if you have any questions about any of the vaccines your pets receive, ask your veterinarian.

October is Client Appreciation Month!

Guess what? Our most important staff members are not on the pay roll! Our most important staff members are the people who entrust their pets' care and lives with us. These are the people who have chosen to allow us to help their pets.

On, Saturday October 12 from 10am to 2pm, we invite all clients, friends, pet owners and neighbors to join us for a celebration of our most valued employees - You!

Without our clients, we would not exist. Without our clients we would not get to play with kittens and puppies for a job.
Without you, I would be talking to myself.

So, for the month of October we will celebrate you, our clients. Client Appreciation Day will feature give-aways, raffles, a tour of the hospital, meet and greets with our entire staff and educational talks. We hope that you will be able to make it out to meet us.

As part of Client Appreciation Month, Ventana Animal Hospital will be introducing you to our entire staff. We understand that doctors, though vitally important, are just part of the picture. We know that your experience starts from the moment you pick up the phone and doesn't end until your technician helps you out to the car. Every interaction that you have is a reflection of us. Our goal is to illustrate our care and compassion during every point of contact.

We have taken great pains to select a compassionate and caring staff that has obtained the training necessary to provide your pet the best quality veterinary care. Ventana Animal Hospital asks every staff member to share Continuing Education at our monthly staff meetings, allowing all of us to stay on the cutting edge. We encourage a culture of learning and knowledge so that we may provide your pets the most current medicine available.

Ventana Animal Hospital has three full-time veterinarians, Drs, Karen Burrows, M. Nielsen, and Michele Estheimer. Supporting these doctors are five technicians, Alaina, Kianna, Mary, Rebecca, and Angela. Ronnie is the communication hub of the building, fielding most phone calls and greeting everyone when they walk in the door. I often lurk near the front desk, but will work as a technician as needed. Karyl keeps the place spic and span, and helps out in the back with patient work ups and surgery.

For a small hospital, Ventana Animal Hospital boasts an unusually high number of Certified Veterinary Technicians. Alaina, Mary, Rebecca and I are all CVTs, licensed in the state of Arizona. Kianna has graduated from a technician program but has yet to pass the very rigorous testing required of a technician. Angela, in spite of not being a CVT, is highly qualified, having worked within the industry for many years and most recently in a surgical specialty center.

Over the next month we will be introducing our staff to you to help put names to faces. Caring for pets involves a team approach, and we feel that our team is both dedicated and compassionate, we hope that you will agree. Please check out the biographies page on our website, and keep up with us on Facebook.

Everyone, friend and stranger, is invited to our Client Appreciation Day, we want to meet you, chat with you, share your stories and hopefully teach you something new, but mostly, we just want to say,

Thank You!!!

Ventana Animal Hospital - a snapshot

The great thing about our computer system (now a year old) is that it affords us the opportunity to really examine what we do on a daily basis. With a few clicks of a button I could tell you how many pills to treat valley fever we sold last week (985), or how many bags of prescription cat food we currently have in the building (21).

I may have had ugly battles with math in college, but when it comes to these kind of details I'm hopelessly enamored.

What we have not set up in our system is a diagnosis protocol that will tell me what the doctors said your pet has - this is often different than what you say your pet has. A coughing pet, for example is not diagnosed with a cough (which is a symptom) but with valley fever, or cardiac disease or collapsing trachea or something more obscure.

However, in the meantime, I have an even more interesting - at least as far as you may be concerned - database to mine: Presenting Complaints. Now, presenting complaints are not entirely scientific and can be wildly misleading as far as telling us about what is really going on in the population is concerned. A perfect example of this would be routine well care visits. The purpose of a routine well care visit is to look for things that may be wrong and address them - we know that - but the computer simply states: Exam.

However, presenting complaints tells us what you see as wrong with your pets. The chart below is a snapshot of presenting complaints over the past few weeks.


 



It shows us that most of our pets are healthy (YAY!). Well Care includes puppy and kitten care, vaccines and other exams. Now, just because someone says that they're here for an exam, that doesn't mean that we didn't diagnose ear, skin, or dental disease (the most common). Again, diagnosis is a whole different animal from presenting complaint.

Second, and not surprisingly are ears, eyes and skin, with the lion's share falling evenly between ears and skin. Skin can include anything from allergic dermatitis to lumps and bumps. Skin issues seemed to fall largely 60-30 in favor of allergy type issues over lumps and bumps.

GI issues come in right behind ears, eyes and skin. Pets get into things and then often have cause to regret it. Most GI issues are straight forward, and several were puppies with known parasite infestations.

Sick (general) is largely a grab bag called loosely defined in-hospital as ADR. ADR is veterinary-speak for 'Ain't Doing Right'. How many of these ended up being valley fever I have no idea, but it would be a fair estimation that at least a quarter were.

Blood work includes cases of routine follow up blood work for valley fever, diabetes, hypo and hyperthyroidism and the like, as well as diagnostic testing where the next thing on the list was blood work, and therefore the client asked for it by name.

Lameness falls into several categories: cuts and scrapes on the feet, and soft tissue injuries and fractures. Some of these may have ended up being diagnosed as valley fever too.

Dental care includes both preventive dentistry ("It's time for Fluffy to have her teeth cleaned again") and diseased dentistry (diseased gums, loose teeth and fractured teeth).

Last is surgery, I included spays and neuters - which was the bulk of our surgery over the past few weeks - as well as other surgeries triggered by disease and injury.

Again, this is hardly scientific, but it is a fairly representative snapshot of why we see pets on a regular basis. Of course some weeks are different than others. The snapshot I showed you would have included three drop-offs for hospitalization on the same day - something far outside the norm, and may be a bit shy of skin issues.

Regardless of the limitations of this little exercise, I hope that you found it as interesting as I did.

Thanks, and have a great day,
Liane