Pet Care, Veterinary Health Topics

Pet Dental Care: Why the Resistance?

Pet dental care is so much more than white teeth and great smelling breath. 85% of dogs over the age of 3 will have some degree of periodontal disease. Periodontal disease not only leads to unsightly tarter and bad breath, but causes infection, bone loss, and chronic pain when left untreated.

Dental disease is one of the most common diagnoses in the exam room yet brushing and regular maintenance is hard. For puppies and kittens, we send home dental kits with the hopes of acclimating them to a lifetime of brushing and at-home dental care. We hope for regular, routine dental care throughout the pet’s lifetime with the intention of avoiding infection and pain and that one monumental dental experience as a senior pet where a lifetime of inattention results in dental extractions.

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How do we define neglect? What if I showed you this picture of a dog’s mouth and told you she was a puppy mill survivor forced to have a litter every year, living in a tiny cage with matted fur, with no dental care (not even a dental treat in her lifetime). Is this neglect?

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Now what if I told you these were the teeth of a very beloved 10 year old Pomeranian who lived in the lap of luxury with a well tended hair coat and wardrobe accessories. She had complete adoration and attention to all of her medical needs….except dental care. What if I told you while her owner loved her very much it was that very love that prevented her from tending to her pet’s dental issues? What if I told you her person’s fear of anesthesia forced her to live with chronic pain, infection, and rotting bone. Is it neglect now? (*For the record, this is not a client photo but some random internet PetMD image).

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There are many resistances to pet dental care. I believe strongly in the benefit of routine dental care. I have heard too many testimonials to not believe it matters to our pets quality of life. If we wait until our pets have stopped eating or cry in pain, we have simply waited too long. Remember these are animals that survive because of their ability to withstand pain and disease without drawing attention.

Your coworker may complain of a tooth abscess but still eat his lunch and show up at work day after day, just dealing with the chronic pain until one day that infection becomes so bad he lands himself at the ER with injectable antibiotics. Our pets are no different at hiding that pain.

Common Points of Resistance to Dental Care

Fear of anesthesia.

I love my pets and have those same feelings of concern and fear but I know the benefits will out way the risks. I also know that all precautions including a balanced anesthetic approach, careful and detailed monitoring with a designated trained technician, IV fluid support, thermal support, and pain control will be part of the anesthesia event to minimize risks.  I can’t take away the fear… as your veterinarian I can only assure you that we do everything in our power to minimize the risks to hopefully relieve your fears. Many owners may have had a terrible experience a decade ago. We are always striving to improve your pet’s anesthetic experience, using the newest research and medications to allow the best experience possible.

The cost.

Truth. Pet dental are is expensive, especially if we are undoing years of inattention. Personally we cap our dental estimates because we believe very strongly that the pets NEED this service. It is unfair to leave behind painful or infected teeth and wish to reward the owner taking the steps to care for their pet.

Too Young or Too Old.

I always got a little squeamish when I saw the 14 year old dog with a mouth of pus, mobile teeth, and a risk of a jaw fracture secondary to that infection knowing I needed to say the words, “Your pets needs a comprehensive dental assessment and treatment”.  It all felt like too much too late.

There were probably many years of dental recommendations and now the teeth were in desperate need of attention. Or if they new clients to us they may have heard for 5 years “Their pet was simply too old for anesthesia or dental care.” But then I treated the 12 year old dog, and then the 14 year old dog, and then the 15 year old dog or the 16 year old cat and I couldn’t deny how much better they felt afterwards.  Owners would report “I had no idea but now they feel like a puppy or kitten again!”  My oldest dental patients are usually 15-16 years of age and I love the reports of how much better life is after. “Where there risks?” “Yes” but they were calculated in the hopes the benefits would outweigh them. Does quality of life matter more than quantity?

Save all the teeth! Fear of tooth loss.

My job as your pet’s veterinarian is simple…to give him a pain free, disease free mouth so it is a disservice to leave any compromised or infected teeth behind just to “save a tooth”. The reality is these teeth are worthless and most pets eat better without them. Also pets use their teeth very differently than we do. They have fewer molars and don’t do a lot of “grinding” and since we don’t make them hunt for their food, many don’t slow down a bit with eating or playing even when we take every single tooth. For those worried about how their pet could possibly eat without the teeth, many actually eat much better without mobile or painful infected teeth.

But do they really need it or is this just some great upsale?

I am not a sales person but I do have a passion for dental care. There are too many times to count when a tooth “looked” just fine and the pet didn’t complain only to find a problem and have the pet feel so much better. I tell clients “Our pets can’t tell us where it hurts so it is my job is to find the problem and fix it.” An exam under anesthesia and with dental radiographs tells the story. Just like eat food and brush everyday we are still advised to have our teeth cleaned regularly. Relying on just eating a kibble or dental chews is often not enough.

Some breeds are very prone to developing dental disease (smushy faced breeds, smaller or toy breeds, those with crowding). Researching the breed and preparing for the dental care necessary in the pet’ s lifetime is big step in responsible pet ownership.

So here is my big secret…I don’t brush everyone of my pet’s teeth every SINGLE day. I barely get my kids to brush the necessary times per day. I try! Regular dental assessments, cleanings, and appropriate treatment are a priority though. We are all human, just doing the best we can for those we love and care about, including our pets!

If your pet has had a dental treatment recommended and you have stalled, resisted, or just ignored the recommendation I urge you to really think about the reason why. As a veterinarian, it is my job to help pets and their owners enjoy a great quality of life and effective communication must be part of the equation. Don’t hide those fears or concerns! Tell us and we may have ideas or solutions to those hurdles holding you back from getting those teeth the attention they need. 

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Source: Making the Case for Dentistry. Paul Q. Mitchell, DVM, DAVDC

Pet Care

The Fat Cat Epidemic. How my cats got the weight off and will hopefully keep it off!

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Feline obesity is an epidemic. I dare say only 10-15% of the cats I see are an ideal weight, while many are overweight and way too many are just plain obese! National statistics indicate that over 30% of cats are classified as obese and over 50% are overweight.  My own cats have struggled with the “Battle of the Bulge”. 

Sonny, my big orange Garfield, came to me after being dropped off for euthanasia for inappropriate urination. He had bouts of idiopathic cystitis. Basically for some reason, often stress, he would have bladder inflammation and pee out of the litter box. He was fluffy, chubby, and well adorable. Sonny was fat and as a veterinarian surely I could get him to drop the weight. My dogs were fit and trim…how hard could this be.

Why do I even care that my cats are fat?

The #1 reason I don’t want a fat cat is because I don’t want to manage a diabetic cat. Just like Type 2 diabetic persons, fat cats can develop insulin resistance and full blown diabetes. Twice daily insulin injections and the management of blood glucose curves just isn’t something I want in my life. Often with diet change and weight loss, cats can go into remission but why not prevent it. Not to mention the increased strain on joints and bones not made to carry twice the weight they should or the risk of developing a fatty liver if they should miss a meal or two.

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What didn’t work…

I tried portion control and failed. I tried a variety of great well marketed cat food and fed the set amount. Well my cats thought they were starved. I remember getting an automated feeder. I was so smart! No human error! Food delivered in a set amount and on  a schedule with no  worry of lack of human fortitude when those demanding eyes pierced my soul. We went away for an overnight only to return to the automated feeder disassembled, the entire pound of cat food consumed, and more diarrhea in the litterbox (thankfully) then I had ever seen.

So what worked…

Well I mentioned my fear of diabetes and thought well what is recommended for diabetic cat remission….a HIGH PROTEIN/LOW CARB diet! Basically “Catkins”. Here is the thing…unlike us or dogs cats are true CARNIVORES and they eat meat.

Why does a diet high in protein and low in carbs work?

Cats evolved as hunters. Their body evolved to handle meat protein not carbohydrates (grains, peas, potatoes, etc). The average house cat would hunt about 10-12 mice per 24 hour period. You know how many calories there are in a single mouse?  30-35!!!! That’s right! There are ~100 calories in a cube of cheese and 2-3 calories per kibble of cat food! How hard does the average house cat work to eat a bowl of food…NOT VERY and it is gone in a few minutes! How hard did the hunter work for that same amount of calories via mice, birds, rodents, etc. There was hunting, stalking, jumping, covering a territory, etc.

So not only do I feed high protein and low carb but I feed multiple smaller meals and use treat balls, hiding kibble in the cat tree, etc to mimic “hunting”. Do my cats still try to steal Cheetos out of the pantry…heck yes! Carb junkies I tell ya!

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What’s best?

As  a veterinarian, I do believe in “All cats… all canned…all the time”. Cats do not consume large quantities of water and again evolved to ingest high moisture prey. Canned diets are naturally lower in carbs and higher in moisture. This not only plays a role in obesity and diabetes but in urinary and bladder issues too. Remember we can’t just look at the label comparing protein in a canned and kibble diet….we need apples to apples so they have to both be compared on a dry matter basis.

There are actually a lot of over-the-counter canned foods that are low in carbs (less than 7%). For my diabetic patients I recommend canned Purina DM (no kick-backs here) because of the success of this diet in getting my diabetic patients into remission.

I am going to be honest here…. I feed kibble…calorie dense, low moisture kibble basically for two reasons 1)I want to stay married…my hubby literally gags at the smell of canned food a mile away 2) I am lazy…if they made a supplemental baby kibble I’d by it. Throw down some kibble=easy.  But I do feed the lowest carb kibble available… Purina DM dry. It is calorie dense but I have found reasonable portions, increased activity, and low carb have really got the weight off.

WANT MORE INFO…Including lists of good low carb options check out.

What I have learned with a household of cats is just like people some really struggle to maintain a lean body condition score. Are all my cats a perfect 5/9 BCS? No but I remain committed. If you have a fat cat I urge you to recognize it and make the change. Not only will your cat be healthier and more energetic, but also less likely to have the many medical issues that come hand-in-hand with obesity (and the expense of treatment and management).

Life as a Veterinarian

The Story is in the Details

DSC_0507 copyEveryone of us has a story, whether we share it or not. Our stories come alive because of the details…the words the author chooses to share cause us to we feel, see, taste, and touch. The details of our days bring the ordinary to life and create the extraordinary.

In the veterinary world, the story often starts a mystery…the villain is disease and dysfunction; the detective is me. People see their pets everyday and I often ask the question “How did they not see this?”. Sometimes it is just a matter of “We don’t see what we look at every day” but years of training in detection and deduction allows me to see the details when others simply don’t look or can’t see. It is those skills which define the veterinarian’s skill and competence.

Like a photographer that starts with a wide-angle lens I note the posture, behavior, general overview of the animal and then zoom in until I have a macrolens. Most clients just assume I am petting their dog or cat. But it is a systematic uncovering of details.

I start at the eyes…the windows to the soul and teller of what lies beneath. Move to the ears…teeth…gums. I run my hands under the fur and feel boney protrubances, palpate the tendon attachments, all while looking for the subtle discussion my patient may start…a look of worry, a grimace…Most owners assume their pet will cry or tell of pain but in nature pain is hidden and reserved for the weak.

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My nose seeks scents that may indicate infection or a change of the breath that tells of disease within. The little dogs and cats often smell of their owner’s perfume as they spend most of their day’s minutes in arm or cuddled.

I feel the fur thru my hands, matting or greasiness a detail not missed. The rounding of the mid-section with ribs deep below tell of a meals too large and walks too short. I slip the loops of intestine thru my fingers, seeking the details that tell of infiltrative disease or function not perfect. The cat’s bean-shaped kidneys should be smooth and without pain and in our senior friends a finding of irregularity or smallness tell of aging that has been unkind.

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The detective has many tools at hand.  To ausculate means to listen and so I auscultate to the heart and lungs. To hear a crackle or wheeze of air that doesn’t follow its set path thru the trachea and bronchi to fill the microscopic sacs of air that form our lungs. The heart beats its song of  “lub-dub”, “lub-dub”, lub-dub”. A missed beat, the song too fast or too slow, an irregularity in the lyrics tell of cardiac disease.

In the geriatric small breed dogs, I often hear a quiet whisper that sneaks its way in between those lubs and dubs…”lub-shhh-dub”.  The details tells the story of a heart valve that was once smooth and efficient, a door ushering the blood between the rooms of the heart. As I hear the “lub-shhh-dub” I visualize that blood now turbulent and paint a picture in my mind of a valve now nobby and irregular, the victim of degenerative disease.

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I collect a blood sample. How spectacular is the story that blood can tell. Within the liquid life are cells, hormones, and enzymes that tell the details of the inner organs. Within the blood are cells and under the microscope I can see warrior immune cells. With the subtle changes within them I can tell if the army is just being mobilized or if they are battle wary and fighting for the life of the pet.

And as the technology advances it takes the story and gives us more details… more ways to enter into the fascinating world. How clever are nature’s systems and we the detectives that seek to uncover the complexities, abnormalities, and find attackers and invaders.

Within minutes, the details tell the story of health and wellness or disease and dysfunction.  While I chat and pet and give treats my hands, my mind, my nose seek the details that make the story. For my patients that can’t talk I write the story of their health. In the discovery of details I often put a voice to their pains, aches, dysfunction, and disease.

Each of us have days filled with details.  What details tell your story? The details of my work have become an almost meditative invitation. I sought the extraordinary but found it in the ordinary.

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