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Good Articles for Owners

 

 

 

  Three articles on this page. 
The first is a article about early spay and neutering of dogs
The second is a article about caring for the old dog and some very good advice.
The third is about chosing a Veterinarian, a very good article.
 
 

The Question Of Neutering and at what age

(Put together by Gregg Tonkin, Little River Labradors from postings by Pam Davol and Maryanne Foote, both Labrador breeders)

Owners who are considering neutering need to take all factors into consideration, not simply the benefits of neutering when making a decision as to when to neuter.

If one looks close enough, one will find that neutering is one of those topics in veterinary medicine that is extremely biased: that is, most often one will find more emphasis placed on the pros of neutering with more often than not, very little or no discussion of the cons. Veterinarians, and responsible breeders as well, face a true dilemma when discussing neutering. The overpopulation crisis presents a very real concern with regard to the necessity of ownership responsibility. Prepubertal/early neutering or required neutering provides a means for vets/breeders to enforce owner responsibility by ensuring surgical sterilization of dogs not destined to be used in breeding programs. Again, this enforced neutering is typically presented along with a preamble of all the benefits that go along with neutering. However, I believe that breeders, if not veterinarians, need to begin questioning the ethics of this approach to prompt or require owners to neuter; especially in light of the facts that early neutering may not be as benign a process to the health of a dog as one would believe.

Yes, neutering prior to the beginning of estrus does reduce risk for mammary cancer in females, but it also significantly increases risk for urinary incontinence in bitches which predisposes these bitches to diethylstilbestrol (DES) dependency (Stocklin-Gautschi et al., J. Reprod. Fertile. Suppl. 57:233-6, 2001 and many other references)--in some instances, DES is not effective at controlling incontinence and will force some owners to elect euthanasia. Though with lesser risk compared to females, early neutering also increases risk of urethral sphincter incontinence in males (A. Aaron et al., Vet Rec. 139:542-6, 1996.)

With regard to cancer, spayed females have a 4 times greater risk for developing cardiac hemangiosarcomas (vascular tumors) compared to intact females (neutered males also show a significant increase in risk for these tumors compared to intact males) (Ware and Hysper, J. Vet. Intern. Med. 13:95-103, 1999.). Additionally, both neutered males and females have a 2-fold greater risk for developing bone tumors (osteosarcoma) compared to intact males and females (Ru et al., Vet J. 156:31-9, 1998.).

Some evidence suggests that early neutering may also predispose to endocrine disorders later in life (Panciera DL. J. Am. Vet. Med. Assoc., 204:761-7 1994.). Furthermore, there is also an indication that early neutering (because absence of sex hormones delays maturation of osteoclasts and thus results in delayed closing of the growth plates in the long-bones) may predispose to increased risk for various orthopedic disorders (such as cruciate ligament disease as I had mentioned in a previous post). Also, some evidence suggests that there is a correlation between increased time for growth plate closure and incidence of HD in Labs (Todhunter et al. J. Am. Vet Assoc., 1997).

If one conducted a research of the literature on the detrimental effects on physiological development associated with sex hormone deficiencies during adolescent development in any other species other than the dog and cat, one will find a wealth of literature stressing the importance of sex hormones for sound physiological, endocrine and metabolic development. Additionally, if one examines the scientific research that reports the benefits of early neutering in absence of any side-effects in dogs, one will discover that the methodology of these studies are designed in very specific ways to assure that outcome in neutering is presented in a favorable light (this does not mean that the data is biased, this simply means that the comparisons made do not provide for adequate interpretation of long-term effects of neutering).

In light of this, though it is understandable for vets/breeders to urge dog owners to neuter their pets early with regard to the greater good (i.e. reducing risk of accidental breeding), the physiological soundness of the individual dog should take precedence over any other issues. As such, it is my opinion, based upon the literature that I have reviewed that to reduce risks to physiological soundness, etc, that I am of the personal opinion that dogs should be a minimum of 1 year of age before neutering.

(written by Pam Davol of Wing-In-Wave Labradors, a noted research scientist and a Labrador genetic expert)

"And in Addition"

To Neuter or not to Neuter...

There are a number of studies that suggest that those of us with canine athletes should be carefully considering our current recommendations to spay or neuter all dogs at 6 months of age or earlier. A study by Salmeri et al in 1991 (Salmeri et al JAVMA 1991;198:1193-1203) found that bitches spayed at 7 weeks were significantly taller than those spayed at 7 months, and that those spayed at at 7 months had significantly delayed closure of the growth plates than those not spayed (or presumably spayed after the growth plates had closed). The sex hormones close the growth plates, so the bones of dogs or bitches neutered or spayed before puberty continue to grow. This growth frequently results in a dog that does not have the same body proportions as he/she was genetically meant to. For example, if the femur is normal length at 8 months when a dog gets spayed or neutered, but the tibia, which normally stops growing at 12 to 14 months of age continues to grow, then an abnormal angle may develop at the stifle. In addition, with the extra growth, the lower leg below the stifle becomes heavier (because it is longer), causing increased stresses on the cranial cruciate ligament. This is confirmed by a recent study showing that spayed and neutered dogs have a higher incidence of CCL rupture (Slauterbeck JR, Pankratz K, Xu KT, Bozeman SC, Hardy DM. Canine ovariohysterectomy and orchiectomy increases the prevalence of ACL injury. Clin Orthop Relat Res. 2004 Dec;(429):301-5).

In addition, a study in 2004 in JAVMA (Spain et al. JAVMA 2004;224:380-387) showed that dogs spayed or neutered before 5 1/2 months had a significantly higher incidence of hip dysplasia than dogs spayed or neutered after 5 1/2 months of age. If I were a breeder, I would be very concerned about this, because it would mean that I might be making incorrect breeding decisions if I were considering the hip status of pups I sold that were spayed or neutered early. Interestingly, this same author also identified an increased incidence of sexual behaviors in males and females that were neutered early.

A number of studies, including the one by Spain referenced above, have shown that there is an increase in the incidence of female urinary incontinence in dogs spayed early. This problem is an inconvenience, and not usually life-threatening, but nonetheless one that requires the dog to be medicated for life.

Yes, there is the concern that there is an increased risk of mammary cancer if a dog has a heat cycle. But it is my observation that fewer canine athletes develop mammary cancer as compared to the number that damage their cranial cruciate ligaments. In addition, only about 50 % of mammary cancers are malignant, and those that are malignant don't metastasize very often, particularly in these days when there is early identification and removal of lumps found on our dogs.

In addition, when considering cancer, there is another study of 3218 dogs that showed that dogs that were neutered before a year of age had a significantly increased chance of developing bone cancer (Cooley DM, Beranek BC, Schlittler DL, Glickman NW, Glickman LT, Waters D, Cancer Epidemiol Biomarkers Prev. 2002 Nov;11(11):1434-40), a cancer that is much more life-threatening than mammary cancer, and which affects both genders.

Finally, in another study, unneutered males were significantly less likely than neutered males to suffer cognitive impairment when they were older (Hart BL. J Am Vet Med Assoc. 2001 Jul 1;219(1):51-6). Females were not evaluated in that study.

For these reasons, I have significant concerns with spaying or neutering dogs before puberty, particularly for the canine athlete. And frankly, if something is more healthy for the canine athlete, would we not also want that for pet dogs as well? I think it is important, therefore, that we assess each situation individually. If a pet dog is going to live with an intelligent, well-informed family that understands the problem of pet overpopulation and can be trusted to keep their dogs under their control at all times and to not breed them, I do not recommend spaying or neutering before 14 months of age.

(written by Maryanne Foote of Winroc Labradors, a noted and long time Labrador Retriever breeder)
 
 
 
         
 
 
 
OLD DOGS ARE SPECIAL

There is a lot that is special about old dogs. Not only have they learned to wait at the door instead of blasting through it; they patiently wait for tablescraps instead of snatching them off your plate; they dominate other dogs in the house with a stare, ruling by fiat, instead of a growl and show of teeth; they stroll along at your side instead of trying to rip the leash out of your hand; they crawl up on the bed, curl up and go to sleep instead of racing around with covers and pillows flying everywhere. Most all of this seemingly more "intelligent" behavior is due to the wisdom of their years. There is a lot that is special about health care for old dogs as well. Geriatric medicine is a relative newcomer to the veterinary specialties. It is of little concern in food animals, slaughtered long before old age, or in racehorses too old to run anymore. Rather, it is a branch of veterinary medicine largely reserved for companion animals. To understand the unique needs of the old dog, we must try to understand the process of aging. The underlying cause of aging has not been defined, although there are many theories. There are, however, aging factors that can be anticipated. Genetics: smaller breeds live longer. Nutrition: obese pets have shorter life spans. Environment: "outdoor" animals have a shorter life expectancy. Neutered animals live longer. Generally, Dobermans begin to have diseases associated with aging in their 7th to 10th year. Many of the effects of aging can be predicted. Decreased metabolic rate plus lack of activity decreases caloric need by 30 to 40 percent. Immune competence, that is, the ability to fight disease, decreases. Successful geriatric medicine requires detailed communication between the veterinarian and the owner as well as exceptional compliance with medical recommendations and nursing needs. Most medical problems involving older patients are chronic rather than acute. Chronic diseases require lifelong treatment with intermittent patient monitoring and modification of the treatment regimen as conditions change. The common characteristic of all aging systems is progressive and irreversible change, which may be hastened by disease, stress, malnutrition, lack of exercise, genetics and environment. ELDERLY ANIMALS SELDOM HAVE A SINGLE DISEASE, but instead have a unique combination of multiple organ disease with varying levels of dysfunction. Poor health and old age, however, do not have to be synonymous. The importance of the annual physical exam (see the previous article) cannot be overemphasized. Treatment of hidden disease before it becomes apparent can add years of life to the old dog. There are specific ways to combat the effects of aging. As the skin loses elasticity, hair is lost and normal oil secretions become waxy; the resultant hair coat may be dry, dull and lusterless. External applications of oil-free moisturizers or oil-based coat conditioners offer help, but overbathing with harsh shampoos may aggravate a dry coat. To prevent the skin from freezing, dogs lose large amounts of skin moisture in cold weather, especially Dobermans with no undercoat. Buy a sweater or coat and use it regularly on the old dog if the wind chill is below freezing. Or let your old friend wear one of your sweatshirts when it's chilly. Not only will it protect him or her from the elements, but it will make them feel very special to wear something of yours! As the dog ages, its skin loses elasticity and that combined with a loss of muscle mass may result in bed sores, or pressure point calluses which can become infected. Provide thick soft bedding and rubber mats to help cushion the dog who is losing his or her natural padding. Proper dental hygiene includes brushing a dog's teeth at least twice a week and routine dental prophylaxis. Chronically infected teeth cause pain and bad breath as well as a constant source of bacteria in the blood stream with a chronic assault on internal organs causing life-shortening kidney and liver disease. Regular dentistry is a vital part of geriatric health and can add years of life to the geriatric pet. The function of the esophagus is decreased by loss of nerve cells that can result in chronic inflammation of the stomach lining and heartburn. Gagging is common. Medications are available to facilitate esophageal function, and feeding a moist diet often helps. Eating grass should be discouraged - - sometimes hard to do with Dobermans who love to graze! As liver, pancreatic, and intestinal function diminish, absorption of food decreases. Motility in the colon may decrease resulting in constipation. Metamucil as a source of fiber may be beneficial. "Senior" and prescription geriatric diets are very helpful as well. Cardiac output decreases 30% in the last one-third of life. Congestive heart failure develops as a result of chronic valve disease or cardiomyopathy. There are many drugs and drug combinations used to treat heart disease, but great care must be exercised in their use. Some are eliminated from the body by the kidneys while others are removed by the liver. Remember, the geriatric patient probably has some sort of progressive liver and/or kidney disease as well as heart disease. Ongoing reassessment of kidney and liver function are a necessary part of heart treatment. Constant adjustments in therapy may be necessary. Drugs that control blood pressure, strengthen heart muscle contractions, prevent irregular heartbeats, dilate air passages in the lungs, and remove excess fluid are often used. These are potent medications with potentially serious side effects. Continual monitoring and adjustment is a necessity. The heart patient should be allowed free exercise so long as heavy breathing, weakness, coughing, fainting, or fatigue do not occur. Extremes of temperatures -- extremely cold or very hot and humid conditions -- should be avoided if possible. If you live in such a climate, keep your old dog inside where it is warm or cool, and expose him or her to the elements only when necessary and then only for very short periods at a time. In advanced heart disease situations, a high degree of excitement should be avoided when possible. A gradual decline in kidney function is a normal part of aging. Kidney failure is one of the top four causes of death in old dogs. Progressive renal failure can be slowed with the use of diets containing low amounts of highly degradable protein and reduced salt and phosphorus, but there must be adequate amounts of fat and carbohydrate to meet daily caloric needs. "Senior" and prescription kidney diets are of great value. When urine by-products build up in the blood stream, as a result of loss of kidney function, uremia and anemia will develop. Drugs that prevent high blood pressure, low blood calcium, and vitamin deficiencies help. Water, free choice, should ALWAYS be available to the geriatric patient, even if it means more work on your part to let them outside more often. Urinary incontinence is a common geriatric disorder that can be caused by urethral malfunction, urinary tract infection, and diseases that cause increased water intake, like kidney disease or diabetes. The precise reason for incontinence must be ascertained before proper therapy can be instituted. Hormonal dysfunction and bladder tumors may complicate the condition. Absorbent padding used in human hospitals and nursing homes and extra soft padding will keep the old incontinent dog dry, more comfortable, and prevent bed sores. The respiratory system of aged dogs is susceptible to infection (pneumonia) and obstructive diseases like asthma, chronic bronchitis and emphysema. Decreased lung volume and thickened mucus contribute to the problem. The cough reflex is weakened. There are medications your veterinarian can prescribe that will help but, again, a precise diagnosis is necessary. Respiratory disease often mimics or exists in combination with heart disease. Respiratory allergies are rare in dogs, but polluted air and sudden changes in temperature (like going in and out of the house in wintertime) aggravate old dogs just like they do old people. The aged animal experiences a significant decrease in the secretion of hormones by the thyroid, testes and ovaries (if still intact), and pituitary gland. The adrenal glands may oversecrete, resulting in Cushing's disease (another cause of increased water consumption, like kidney disease and diabetes) or undersecrete resulting in Addison's disease. Mammary glands may become cystic or develop cancer. A good reason for early spaying is that nodules or tumors are found in 60% of intact females by age 11. Mammary tumors make up 25% of all cancers in the bitch. Fifty percent of these are malignant and about 50% of these will metastasize (spread elsewhere). Spaying before the first heat eliminates almost all mammary tumors, but this beneficial effect is lost if the spay is done after 2 years of age. Prostate diseases, including hyperplasia, cancer, cysts, and infection are the most common genital disorders of aged dogs, especially Dobermans. Treatment for all prostatic disease is castration. Other specific treatments include surgical drainage of cysts and abscesses and antibiotic therapy, but these are often unsuccessful over the long term. Chronic prostatic infection is life-threatening because of the frequent resultant septicemia (blood poisoning). Prostatitis in the male Doberman should never be compared to that in man. The anatomy is different. The chemistry of prostatic fluid is different. Non-cancerous prostatic disease in the Doberman should be considered potentially dangerous. Many male dogs meet an early and untimely death because their owners refuse to castrate them. Old dogs lose muscle and bone mass. Reduced oxygen supply due to circulatory changes and decreased use of oxygen by the muscles compromises their function. Intestinal absorption of calcium is decreased resulting in thinner, more brittle bones. Cartilage becomes less well lubricated. Arthritic areas develop between the vertebra and in the joints. Degenerative joint disease (DJD) occurs, resulting microscopic fractures in the joints and thickened joint fluid. Obesity compounds the effects of arthritis. New drugs are being used in the treatment of the arthritic patient, some (RIMADYL) with dramatic results. Ask your veterinarian about them. Non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin may be beneficial, but others like ibuprofen and acetaminophen should not be used, as the therapeutic dose is very close to the toxic dose in dogs. This is particularly important in the aged where normal excretion of medication may be slowed by the compromised condition of other organs. Common side effects of NSAIDs include gastrointestinal ulcers, reduced blood flow to the kidneys, bone marrow toxicity and subsequent anemia, and decreased platelet function and subsequent hemorrhage. You can do a lot to make your old, arthritic dog more comfortable. If you have slippery floors, put down a rubber mat, rug, or carpeting in the areas where your dog walks and spends much of his or her time. Help your dog up and down the stairs, up on the bed, and into the car. Elevate their food and water. Don't let them lie in cold drafts or get soaked out in the rain. Provide lots of soft bedding, and most of all, lots of TLC! Often the first sign of senility in dogs is the loss of house training. Other senile changes include disturbance of the sleep/wake cycle; inattention to food; inattention to surroundings, including people and other animals; and an apparent inability to recognize familiar people and places, or to respond to familiar commands. The aged brain is chronically short of oxygen as a result of poor blood supply. The effects of stimulus are prolonged. Short term memory is impeded but long term memory is apparently not affected by reduced oxygen. Tremor and motor hesitancy result from impairment of brain function. Treatment of senility and cognitive dysfunction in the dog is currently in its infancy. Sometimes it is hard, however, to tell if the old dog is actually getting senile or just indulging in "selective Hearing" because they happen to be enjoying whatever it is they are doing at the moment and are in no particular hurry to respond to your call! Perhaps this is their version of the privilege of old age and "stopping to smell the roses"! This is also where patience on your part becomes a necessity as well as a virtue! Geriatric patients often have a multitude of conditions that make them more sensitive to anesthesia. Except in the case of unexpected emergencies, a complete physical exam should be given to fully assess the risks prior to general sedation. Perhaps the greatest ally you have in supporting the old dog is your own intuition, defined as the act of knowing without the use of rational process. In other words, you just know something is different or not right. If you suspect something is wrong, get professional help. Do not give in to denial. Too many owners refuse to admit their dog is getting old. Too many decide that nothing can be done because of the age of their pet. Act on your intuition. Don't succumb to denial. Your old friend's life may depend on it! Too many dogs have been put to sleep before their time because owners don't have the time or the will to care for them. Frequently the excuse is "I don't want him or her to lose their dignity." Loss of dignity is not the equivalent of accepting help. Old dogs love being pampered, helped up and down the stairs, and up on the bed. They don't object to being let outdoors more frequently, fed more often and given medication on a regular basis. This doesn't mean they should be left to suffer, but there needs to be a distinction drawn between pain and discomfort. How many of us have a few aches and pains we didn't have 20 years ago? But are we suffering to the point where life is no longer enjoyable? I think not. Certainly extreme and uncontrollable pain is suffering, as is chronic, uncontrollable vomiting or diarrhea, but too often "loss of dignity" becomes a euphemism for "I don't want to bother any more". The correct time to elect euthanasia is always a traumatic, gut-wrenching decision. Perhaps the best way to deal with the question is to ask yourself, "Am I continuing with my old friend because he or she is still enjoying life, or because I am too selfish to give him or her up?" An honest answer doesn't make the immediate decision any easier. But it does give you a sense of having done the right thing after the grieving period we all experience has passed its most intense phase. As your dog gets older, and long before you reach the point of having to consider euthanasia, do yourself and your dog the favor of learning about the aging process. None of us like to think about growing old -- ourselves or our dogs. But none of us are going to get out of here alive, so make the most of life and enjoy the "golden years" together. Talk to your veterinarian. Talk to your friends who have had old dogs. Make the effort to provide medical and physical adjustments for your old dog. And in addition to the pills and potions, remember the best medicine is often patience and TLC in very large doses! The reward may be months, even years, of quality companionship with that very "special" old friend.

 

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Submitted by C. David McLaughlin, DVM President of the Doberman Pinscher Foundation of American

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Reprinted with permission from the original article printed in Doberman Digest --------------------------------------------------------------------------------

 

 
 
 

HOW TO BEST CHOSE A VETERINARIAN


How To Best Use Veterinary Service THINK PARTNERSHIP
Your choice of a primary care veterinarian may be the single most important decision you make for your dog(s). DO NOT wait until a crisis occurs to select one. The relationship between you, your dog(s), and your veterinarian needs to be a true partnership, an exchange of trust and honesty. Your veterinarian has a responsibility to provide the best medical advice and care possible with both candor and compassion. You have a responsibility to follow instructions, accurately report progress and meet financial obligations. An emotion-packed emergency is no time for your first encounter. Your veterinarian needs a chance to evaluate your wants and needs and you need time to assess his/her ability to meet them. Make sure you have established a mutually comfortable working relationship prior to a crisis. To establish this relationship, make a list of veterinarians near enough to you to provide emergency care. Call for appointments to interview them and ask to see their facilities. You should offer to pay an office call for this visit. Be especially aware of cleanliness. Look for a friendly and helpful staff. Are laboratory, surgical, and imaging (x-ray and ultrasound) services provided? Are wards clean and well lighted? A sincere veterinarian will appreciate your concern and frankness. Ask about emergency care. Is it in-house and if so, is it supervised 24 hours a day by a veterinarian? If not, does the hospital cooperate with an emergency clinic that is close enough to adequately meet your needs. If the hospital makes no provisions for emergency care, you should terminate the interview and go on to the next name on your list. Ask about the hospital's referral policy and access to specialists. A good veterinarian will unhesitatingly refer you for second opinions if he/she feels it is in the best interests of your pet. Moreover, a good veterinarian should assist you in a referral if you ask for another opinion, and willingly consult with the chosen specialist and make all records, x-rays, EKG's, laboratory results, etc., available. Records are technically the legal property of the hospital. Some veterinarians will give you copies of records to transport, while others prefer to send them directly to the referral veterinarian. Either is acceptable. Your primary care provider should have good rapport with the referral specialist so that follow-up care is maximized. New communication technology provides some, excellent referral capabilities to even the most remote areas of the country. For example, veterinarians can subscribe to a service that sends electrocardiograms via telephone to New York City, where data is interpreted 24 hours a day by cardiology specialists who make diagnoses and suggest treatments within a matter of minutes. This can be particularly valuable for a breed predisposed to cardiomyopathy. Because veterinary medicine has become so complex, it is unfair to expect one individual to best serve all your needs. Just as you need to cultivate a partnership with your veterinarian, that veterinarian in turn should have a working relationship with associates and colleagues. Bear in mind that all areas of the country do not have the same access to all veterinary services. Ask about billing and credit policy. If a particular facility has had no chance to work with you, or if you don't pay for routine care in a timely fashion, don't expect special privileges when that unanticipated, expensive emergency arises. Do not insult a veterinarian by suggesting that because you are a breeder or because you have a show dog, you expect special privileges or a discount. No dedicated professional treats, or should treat, a family pet, purebred or not, any differently than a Best in Show winner. Do not expect discounts because you refer new clients to your veterinarian. After all, if you really believe you have the best, how in good conscience could you refer them somewhere else? Good medicine is expensive. Sometimes difficult decisions must be made due to financial limitations. During any particular office visit it is always appropriate to ask how expensive tests and therapy will be, what is the diagnosis (tentative or final), and the prognosis? An acceptable answer is "I don't know" but it should be followed by "Here's what we need to do to find out." Your candor will be appreciated. The doctor should provide you with all the alternatives at every step. The ultimate financial decisions are yours. If you have received a specific quote, be sure the doctor knows what to do in case the unexpected arises. If your pet is hospitalized (or even boarded for that matter) a phone number should always be made available 24 hours a day where someone who has authority to make medical and financial decisions can be reached at once. Once you begin to use a particular facility, continue to assess whether or not your needs are being met. In the era of multiple person practices it is important that you acquaint yourself with more than one doctor. There is a natural and understandable tendency to claim one particular doctor as your favorite. That doctor has a right, however, to days and weekends off, and cannot work at peak efficiency 24 hours a day, 7 days a week. Disharmonious personality conflicts and lack of confidence can and do occur between veterinarians and clients. This is a problem that needs to be confronted, assessed, and solved prior to that life-threatening crisis. Make an effort to find at least one (and preferably more) doctor(s) you are comfortable with in the absence of your favorite one. Most veterinarians make an effort to be punctual for appointments. You should do the same. Emergencies do arise, however, and must be given priority. You would not want an attending veterinarian to leave your critically ill emergency to give a rabies vaccination to another client's pet. Your patience and tolerance in such situations will be appreciated, especially by the hospital staff. There are clients who are disrespectful of hospital staff while being congenial to the doctor. Conversely, staff can be disrespectful to a client without the doctor's knowledge. If after several visits you find that your needs and expectations are not being met, discuss them with the veterinarian. Understand that the staff and doctors can have good days and bad days just like you. Sometimes the emotional roller coaster that occurs in an animal hospital where people really care takes its toll. Imagine the difficulty of dealing with a life-threatening emergency followed by having to recommend -- and complete -- a euthanasia for an old friend's 15 year old dog (also an old friend), and then have your next appointment be with an elated family with their new puppy! Most people avail themselves of veterinary services not because they get pleasure from taking their pet to the hospital, but because their animal is ill or injured. Clients are frequently apprehensive and uncomfortable, often fearing the worst. The veterinary staff should, and in most cases, does understand this. All of this potentially can lead to an explosive situation and on occasion, empathy and civility breakdown. If, after discussing your feelings, misunderstandings, and problems with the doctor, you find your concerns are not or cannot be resolved, begin the interviewing process all over again. If you try several veterinarians in the same or different facilities, and you cannot find anyone you can work with, the likelihood is that you harbor unrealistic expectations as to what veterinary medicine can provide. How to Enhance the Office Visit In the era of high-tech medicine it is easy to overlook the single most important diagnostic tool veterinarians have at their disposal. Granted, a complete physical exam is essential and laboratory, imaging (x-rays, CAT scans, ultrasound), and electrocardiograms are necessary. But it all begins with an accurate and thorough case history that dictates the direction everything else takes. An inaccurate case history may cause other diagnostic adjuncts to be misdirected, thereby costing valuable time and unnecessary monetary expenditure. DO NOT send an uninformed child, spouse, friend or relative that does not have firsthand knowledge of the dog's normal habits or is not aware of the specific reasons for the current visit. The person presenting the dog for examination should be prepared to answer the following: Has there been an increase, decrease, or no change in appetite, weight, water consumption, frequency and amount of urine produced? Is blood and/or mucus present in stool or urine? Is there diarrhea and/or vomiting? With blood or mucus? Is there lethargy or discomfort? Is there pain or lameness? Associated with exercise? Is there exercise intolerance? Does the dog ingest foreign material? (Rocks, blankets, toys, pantyhose) Is there gagging and retching, coughing or difficulty breathing? Is there excessive scratching? When was she last in heat? Was it normal? Was she bred? How long has she been in labor? How long has the condition persisted? Often these and many other questions are answered incorrectly. Frequently the answer is "I don't know." Obviously such answers can lead to loss of valuable time and increased expense in arriving at a diagnosis. An accurate history is the number one responsibility of the client. The person presenting the dog needs to have the authority to make medical and financial decisions, sometimes immediately. Further diagnostic or surgical procedures may be necessary and occasionally a short period of time can make the difference between life and death. To repeat, with both the dog's welfare and the owner's finances in mind, quality medicine is expensive and time is frequently essential. A word about co-ownerships. There is nothing more frustrating for a veterinarian than to be presented with a dog in need of emergency care (like a Caesarian section) only to have the client announce "I can't make the decision without the consent of the co-owner and they can't be contacted." In the case of co-ownership, the person in possession of the dog MUST have authority to make medical decisions and assume financial responsibility. If you have a pregnant bitch that you anticipate may have a difficult delivery, notify your veterinarian several days in advance. Take time to understand signs of pre-labor and labor. Keep a twice daily log of rectal temperatures several days prior to the due date and watch for unusual vaginal discharge. Prepare a whelping area in a quiet area of the house and plan to be with her for her delivery. Don't assume that someone else's dog, exhibiting what you consider to have similar symptoms as yours, has the same disease, or would respond to the same regimen of therapy. Rarely do dogs exhibit all or the same textbook symptoms of a disease. Moreover, a dog may have two or more unrelated conditions occurring at the same time, thereby presenting confusing and complex diagnostic challenges, for example, arthritis and a bone tumor. Your veterinarian should inform you as to how a particular regimen of therapy is expected to proceed and what to look for if it doesn't. If the information is not volunteered, ask. Medicine reactions occur, medications may be ineffective, splints and bandages may slip, original diagnoses may be incorrect or change, or the condition may worsen. If you suspect the treatment is not producing the anticipated beneficial results, or the condition is worsening, it is your responsibility to check with the doctor. If you travel with your dog to different parts of the country inform your veterinarian where you have been and how long ago. Some diseases have long incubation periods. Fleas (allergies and tapeworm hosts), ticks (several blood borne diseases), and mosquitoes (heartworm) are more prevalent in some parts of the country than others. The same can be said for poisonous plants, snakes and toads, variable temperatures (heat stroke or frost bite in unacclimated individuals), infectious diseases (wildlife hosts), and fungal diseases (internal like Desert Fever and blastomycosis, or external like ringworm). Local flora contributes to allergies and contact dermatitis. Various internal parasites are more indigenous to some areas, less so in others. Demographics play a role as well. Distemper still lurks in inner city ghettos and economically depressed areas, while it is nearly eradicated in more affluent locations. Don't expect a mixed-practice veterinarian in the middle of a cattle ranching region to have the same expertise in treating dogs as the doctors in a canine specialty practice. Even if the same expertise were present, the likely client base (financial) would not allow for necessary equipment or enough patients to develop technical skills. Conversely, the small animal specialist would be equally as handicapped on the ranch. If you opt for herbal and nutritional fads that continually surface and resurface, at least let your veterinarian know you use them. There is undoubtedly some efficacy associated with the witch doctor's and shaman's potions that are harvested from our mountain tops, rainforests, and oceans. The reality is, we don't know which ones work and which don't. We don't know how or why they work. We don't know how they interact or react with each other or with conventional medications and nutrients. Every medication potent enough to be of benefit has potentially dangerous side effects, and the effective and/or safe doses for these compounds are not documented. Though they may cause no outwardly apparent signs of harm, they may alter components of chemical tests thereby leading to erroneous interpretations that confuse diagnoses and/or therapy analysis. They may cause changes that are not immediately apparent, but are, over a longer period of time, detrimental, irreversible and life shortening. Just as you should let your physician know you smoke tobacco or use alcohol, allow your veterinarian insight into your use of unconventional nutrients and remedies. The first rule of veterinary medicine is "Do no harm". It should be yours as well. If you are aware that a particular problem occurs with frequency in the line your dog originates from, inform the doctor. It is quicker and less expensive to confirm a probable diagnosis than it is to start from scratch. Exit studies have documented that clients remember 80% of what they have been told by the time they go from the exam room to the reception desk. By the time they get to the parking lot, 40% is retained, and when they arrive home, only 20% is kept in memory. If you don't understand, ask for clarification. Don't hesitate to take notes if written instructions are not provided. Give all medications as directed and until gone unless otherwise directed. Summary Although medicine is an inexact science, technology has accelerated advances at a dizzying pace. Some medical textbooks are obsolete even before they are published. So much knowledge has been accumulated that no one person can be skillful in every phase of veterinary medicine, or even canine medicine. The best route is to use the team approach. You and your primary care veterinarian should share the paramount responsibility and direction for your pet's health, but you should draw on the available expertise of the cardiologists, neurologists, orthopedists, dermatologists, ophthalmologists, gerontologists, endocrinologists, internal medicine specialists, and others when the situation is warranted. Choose a veterinarian you can work with and then do everything possible to work harmoniously together. THINK PARTNERSHIP!


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Submitted by C. David McLaughlin, DVM President of the Doberman Pinscher Foundation of American

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Reprinted with permission from the original article printed in Doberman Digest --------------------------------------------------------------------------------


 


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