Table of Contents
Contents Acknowledgments....................ix
Foreword....................xi
Introduction....................1
Note to the Reader....................2
(1) Medical Advocacy 101....................7
Why Your Dog Needs a Medical Advocate....................9
Why the Advocate Needs to Be You....................13
Advocacy Starts Early....................14
(2) Medical Decision-Making You and Your Dog Can Live With....................25
How to Make Choices....................25
Your Dog's Best Interest....................28
What Best Serves Your Peace of Mind?....................32
(3) Finding Dr. Wonderful and Your Mutt's Mayo Clinic....................39
Getting Started....................41
In Search of the Ideal Veterinarian....................43
The Importance of Communication....................45
Time to Pay a Visit....................48
Finding Your Mutt's Mayo Clinic....................53
(4) The Office Visit: What You Can Do to Help Your Dog ... and Your Vet....................59
What to Expect During a Routine Visit....................59
The 10 Commandments of Veterinary Office Visits....................65
(5) Wow, I Didn't Know You Could Do That on Dogs!....................77
Veterinary Specialists....................79
Ultrasound....................81
CT and MRI Scans....................83
Digital Radiography....................84
Nuclear Medicine....................85
Fluoroscopy....................87
Interventional Cardiac Procedures....................88
Endoscopy....................89
Laparoscopy, Thoracoscopy, and Arthroscopy....................91
Chemotherapy....................92
Radiation Therapy....................92
Cancer Vaccine....................93
Blood Transfusions....................94
Amazing Surgical Procedures....................95
Lithotripsy....................96
Pain Management....................96
Physical Rehabilitation....................98
Advanced Dental Procedures....................99
Prescription Diets....................100
Dialysis....................100
Stem Cell Therapy....................101
The Wave of the Future....................104
(6) The Vaccination Conundrum....................107
Vaccinating in the 21st Century....................107
AAHA Vaccination Recommendations....................109
Available Vaccines....................110
Vaccination Adverse Reactions....................119
Vaccination Clinics....................127
Vaccinating Your Own Dog....................128
(7) Important Questions to Ask Your Vet ... and How to Ask Them....................131
General Recommendations....................133
Universal Questions....................135
Questions on General Topics....................139
(8) When the Diagnosis Is Cancer....................165
What Causes Cancer?....................168
Cancer Lingo....................170
Preparing to Make Decisions about Your Dog's Cancer....................173
The Three Levels of Decision-Making....................176
Final Words of Wisdom....................199
(9) A Second Opinion Is Always Okay....................207
The Courage to Talk to Another Doc....................207
When to Get a Second Opinion....................211
Where to Get a Second Opinion....................214
Second Opinion Etiquette....................217
(10) Money Matters....................225
Money Talk....................226
Price Shopping....................227
Cost Estimates....................229
Financing Your Dog's Veterinary Care....................230
The Money-Savvy Advocate....................243
(11) Euthanasia: Making the Best of a Difficult Situation....................245
Who Should Make the Decision?....................245
When Is the Right Time?....................247
"Closure Time"....................249
Choices to Consider....................250
What Actually Happens When a Dog Is Euthanized....................254
Alternatives to Euthanasia....................255
Appendix I: Common Symptoms and Questions Your Vet Will Ask about Them....................259
Appendix II: Common Diseases and Questions You Should Ask Your Vet about Them....................283
Resources....................373
Monitoring Your Dog's Vital Parameters....................373
Toxic Substances....................374
Recommended Reading....................376
Forms and Charts....................376
Illustration and Photo Credits....................377
Index....................378
Read a Sample Chapter
SPEAKING FOR SPOT
Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
By NANCY KAY Trafalgar Square Books Copyright © 2008 Nancy Kay
All right reserved. ISBN: 978-1-57076-405-9
Chapter One Medical Advocacy 101
You've now found yourself totally enamored of a hairy, four-legged creature and will want to do the very best possible job you can to care for him. You feed him high quality food, and provide him with regular exercise and plenty of play time. You even let him sleep on the bed! That's the easy part. The hard part comes when you need to make significant medical decisions that will impact your dog's health. You may not have thought much about it at the time, but when you accepted your dog as part of the family you agreed to take care of him both in sickness and in health. You "signed" an unwritten contract, whereby you accepted "power of attorney" to act for your dog and be willing and able to make medical decisions on his behalf.
Your role now becomes much more than caretaker and friend. In exchange for that wagging tail and unconditional love, you now become your best friend's medical advocate. Maintaining your dog's health means gathering information, making important choices, dealing with illness, and potentially tackling the question of euthanasia. Welcome to the toughest part of sharing your life with a dog.
Consider the example of Riley, a 12-year-old German Shepherd mix who is cared for and adored by the Johnson family. Riley is the family exercise partner, newspaper retriever, nanny, bedmate, and comic relief in his busy household. He's also in charge of training the newest family member named Bubba, a 10-week-old Shepherd puppy. But recently, the normally ravenous Riley has been leaving some food in his bowl, tiring on his walks, and vomiting. The family veterinarian has determined from some blood tests that Riley has kidney failure. She's recommended that Riley be hospitalized for round-the-clock intravenous fluid therapy as well as an abdominal ultrasound examination, specialized blood tests, and a possible kidney biopsy to determine the cause. Although the outlook is bleak, it certainly isn't hopeless. The cost for all this is estimated at $3,000 to $5,000.
On first hearing the news, the Johnsons are devastated and confused. They had no idea Riley was so sick. They ask if they had brought him to the clinic sooner, could all of this have been avoided? The three Johnson children have never known life without their beloved pet. How will they respond to this news? Who will model civilized "doggie" behavior for Bubba? The Johnsons aren't sure the recommended care will be affordable. They don't want to throw in the towel too early, nor do they want Riley to suffer. Should they get a second opinion? Is it reasonable to proceed with the recommended diagnostic tests and treatment with a 12-year-old dog?
The veterinarian asks if they have any questions. Questions? The Johnsons don't even know where to start. They want to do what's best for Riley. The problem is they aren't exactly sure what that is. They feel incapacitated by their lack of medical knowledge and their emotional turmoil.
I suspect that some of you are reading this book because you have a "Riley" of your very own and are perhaps experiencing many of the Johnsons' struggles and emotions. If this is the case, now is the perfect time to learn how to effectively "speak" for your dog.
Why Your Dog Needs a Medical Advocate
Gone are the days when you simply followed your vet's orders and asked few, if any questions. The vet is now a member of your dog's health-care team, and you get to be the team captain! Your job description has evolved from receiving and following doctor's orders to processing and making decisions. This is no easy task given the volume of information and number of diagnostic and treatment choices available today. Consider the fact that in the human field, medical knowledge doubles approximately every seven years. I suspect that this is true in veterinary medicine as well. Many positive changes in the veterinary profession such as ultrasound, advanced surgical procedures, cancer treatments (the list goes on and on) have created even greater need for people to act as their dog's medical advocate. There are far more choices than ever before.
In addition to the family vet (the veterinary version of our primary care physician), people now have access to a barrage of specialists, including internists, cardiologists, neurologists, dermatologists, ophthalmologists, radiologists, surgeons, nutritionists, and dentists. Other veterinarians specialize in alternative, or complementary, medicine that encompasses acupuncture, chiropractic, homeopathy, and herb therapy. And, certified veterinary rehabilitation specialists can profoundly and positively impact recovery time and comfort level for dogs suffering from arthritis or recovering from back or joint surgery.
Veterinary technology is also keeping pace with its human counterpart (see chapter 5, p. 77, for details). MRI and CT scanners are now options as are 24-hour veterinary critical care facilities. Dialysis is available for the dog with kidney failure. Chemotherapy and radiation therapy have turned many canine cancers from a death sentence into a treatable disease. Advances in veterinary health care are allowing dogs to live longer lives, so it makes sense that veterinarians are recognizing and treating far more age-related disorders such as kidney failure, heart disease, arthritis, and cancer. Vaccinations are available to prevent 13 different canine diseases. Hundreds of prescription diets exist for dogs with diabetes, kidney, liver, gastrointestinal, heart, skin, and joint diseases. It seems there are more Web sites on dog health issues than there are dogs. Whew! No wonder your dog needs a medical advocate!
What are the chances that you'll never be called upon to act for your dog in a medical situation? Probably the same as winning the lottery. I'd love to be more reassuring, but the fact is, after almost three decades as a practicing veterinarian, I know only a handful of dogs who maintained a lifetime of completely good health and vigor right up to the moment of gently and painlessly passing away in their sleep. Sooner or later, almost every dog becomes sick, and for the majority of people, emotional attachment just about guarantees difficult, sometimes gut-wrenching medical decisions will need to be made down the line.
Why the Advocate Needs to Be You
Now you know why your dog needs an advocate, but why must it be you? Why not pass this responsibility on to your veterinarian, or your girlfriend who is a nurse, or your first cousin who happens to be a pediatrician? After all, their medical backgrounds seem to give them a clear advantage.
What you may not realize is that you are the most qualified of all because absolutely, positively no one knows your dog better than you do. You are acutely familiar with the nuances of his daily routine and behavior. You are the one who has the best idea what his soulful expression is meant to convey. Deep down you know better than any veterinarian, medical doctor, nurse, well-intentioned relative, boyfriend, girlfriend, or busybody neighbor what will most likely cause your dog to wag his tail in triumph. You are also the one who knows whether or not your buddy likely wants to "keep fighting the good fight" when the going gets tough.
By all means, solicit opinions from experts and people you trust, but, for your dog's sake, be certain that final decisions come from your own mind-and heart. The person who is willing to step up to the plate when it comes time to make medical-care choices is far more likely to walk away with peace of mind than one who has deferred to others' opinions. And, even when the outcome is poor, the active participant derives comfort from knowing she had nothing but the best of intentions for her beloved dog. She can take solace in knowing she put forth her best effort to make informed decisions. When the decision-making responsibility is relinquished and things don't turn out well, it's very easy to feel you have abandoned your best buddy during his time of greatest need. And, when death is the outcome, it can be extremely difficult-and sometimes impossible-for anyone who "bowed out" to move past his or her grief.
Advocacy Starts Early
Consider the following scenario-one I can assure you every small animal veterinarian has endured. It's time for a puppy's first examination. When the vet enters the room, she encounters an incredibly cute, wiggly, waggly fluff ball and his adoring, newfound humans, who are beaming with pleasure. The vet listens to the pup's heart with a stethoscope and detects a heart murmur, darn it. Maybe she heard incorrectly, so she listens again. Yup, it's there for sure, and it's a loud one. One test leads to another until the birth defect has been clearly defined. It's a heart anomaly that will, with certainty, result in a profoundly shortened lifespan. Smiles turn to tears and heartache.
Before You Fall in Love
Your primary goal is a healthy dog, so doesn't it make sense, if possible, to start out with a dog you know is healthy? Don't fool yourself into believing that, like a new appliance, you'll simply be able to return the new dog if problems are discovered. Please don't be tempted by breeders and adoption agencies who guarantee a replacement pup if yours is discovered to have flaws. They'll make good on their promise, but you'll be hard-pressed to relinquish the new love of your life. Trust me when I tell you that it typically takes no more than four minutes and 23 seconds for the average person to fall hopelessly in love with a dog. And four minutes and 22 seconds just isn't enough time to make sure all the necessary medical checkups have been performed-or if they have, to study the results! Do yourself a favor and protect yourself from a broken heart by getting the information you need before-not after-you adopt or purchase a new dog.
Whether you are adopting from a shelter or purchasing a dog from a breeder, make sure that a veterinarian has evaluated your prospective pup, before you meet him! Then make the effort to learn what it is the veterinarian discovered. Don't be seduced by the classified ad that says, "vet-checked" because this says nothing about the veterinarian's actual findings. Try to speak directly with the veterinarian who performed the exam, or at least read through the official medical record. You want to be sure beforehand that the little guy now chewing on your shoelace doesn't have a cleft palate, heart murmur, hernia, or any other congenital health issue.
I realize that it's not always possible to have a dog "vetted" in advance of adoption. If you find yourself in this situation, it's best to schedule an exam with a veterinarian as soon as you can-preferably on your way home from picking up your new pup.
Special Considerations for the Purebred Pup
Let me begin by saying that I strongly encourage you to find the next love of your life at a pet shelter or a breed rescue service that finds homes for displaced purebred adult dogs. (In addition, I recommend you work with a shelter or breed rescue organization that performs an extensive behavior evaluation on each dog so you have a better chance of finding just the right match.) I recognize, however, that for some a specific breed fits the bill best, a puppy rather than an adult is desired, and a particular breeder is the source that has been recommended by friends, family, or other dog lovers. If this is the case, there are important details to consider before making a puppy purchase.
Here is a situation that every veterinarian can relate to. A one-year-old Labrador Retriever has just started training for his career as a field trial dog. Just a week into the training program, the pup comes up stiff and sore with pain in both front legs. X-rays show that he has an elbow abnormality commonly inherited in Labs. Surgery will be required, and there is significant potential that he will have lifelong arthritis in both elbow joints. His future as a field trial dog has just unraveled. The client is disappointed because the pup's dam and sire (parents) had both been officially certified and found to be free of elbow disease. A little bit of retrospective research, however, reveals that several of the dog's aunts and uncles had unfavorable elbow screenings.
If you plan to share your life with a purebred dog, before you so much as peek at a puppy, learn as much as you possibly can about potential breed-specific inherited medical issues. The more you know, the more likely you are to choose a puppy free of, and unlikely to develop, such inherited health issues. A word of warning: don't dare rely on the proverbial, "None of my dogs have ever had that problem."
A conscientious breeder will offer forth official paperwork rather than verbal reassurances. Study the documents to find out if the parents have been officially and favorably screened for the appropriate breed-related diseases. Don't stop there. Take the time to get the same information about the dam's and sire's littermates (all those aunts and uncles). More and more, we are learning the best way to ensure a puppy will be free of inherited diseases is by looking for squeaky-clean health screening results for all his aunts and uncles in addition to his parents. What if the dam and sire each had 10 littermates? This means that you are going to be looking at a lot of paperwork!
A dog can be officially certified free of specific inherited diseases in a number of ways. First, you need to do some homework to figure out which are the most appropriate screening tests for the breed you are investigating (see below). For example, auscultation of the heart (listening with a stethoscope) may be all that is needed to screen for an inherited heart defect in one breed of dog. In another breed, an ultrasound evaluation of the heart may be the test of choice. How are you to know which screening certification to be satisfied with? Here are some steps to help you figure it out:
(1) Research which diseases are common or potentially inherited in the breed you fancy. Potential sources of information include your veterinarian, reputable breeders, the breed association, the American Kennel Club, inherited disease registries, and reference materials found online or in current publications.
(2) Find out which screening tests are considered most reliable to check for such diseases and which family members should be screened for them (puppy, dam, sire, aunts, uncles). You can get this information by talking with the experts. Begin with your own veterinarian as well as those who specialize in the health issue of concern. Compare what they have to say with reputable representatives from the breed association (not just the person trying to sell you a puppy).
Let's take Newfoundlands, for example. This breed is predisposed to subaortic stenosis, an inherited heart defect. Learn which heart-screening test is best-listening to the heart with a stethoscope or performing an echocardiogram-by talking with your veterinarian and a board certified veterinary cardiologist, or if that is difficult, a knowledgeable "Newfie" nerd or two. With other breeds, a bone disease might be of concern, so ask for advice from a board certified veterinary surgeon; for eye disease, a board certified ophthalmologist. See chapter 5 for help finding veterinarians who specialize in different diseases. (3) Learn how to interpret test results. For example, when it comes to hip screening, the Orthopedic Foundation for Animals (OFA) and the University of Pennsylvania Hip Improvement Program (PennHIP) are the bodies that evaluate X-rays to determine the presence and severity of hip disease. You'll want to know what test result or "ranking" is acceptable (this varies from breed to breed). What about the puppy with three of 18 aunts and uncles with "poor" hip ratings? Rely on the same expert you consulted in Step 2 for guidance.
(4) Ask the breeder to provide you with all the paperwork (certificates documenting the results of official examinations) you need to evaluate in order to do the best possible job landing yourself a healthy puppy.
(Continues...)
Excerpted from SPEAKING FOR SPOT by NANCY KAY Copyright © 2008 by Nancy Kay. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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