Animal hospital protocal: A few rules of petiquette

As I say goodbye to my clients with dogs, I open the door to the waiting room.  Too often, the client allows the dog to rush headlong into the seating area and run up to other pets.  Most of the time the pets sniff each other and all is well, but occasionally the hackles go up, and one or both humans are tugging on the leash to prevent an altercation.  In a small waiting area, totally avoiding other pets is difficult.  But a near miss the other day got me thinking:  Shouldn’t there be some rules of decorum for the reception area?  After all, a clear set of do’s and don’ts might help avert disaster.

I huddled with my staff, and we’ve come up with a dozen waiting room protocol tips:

1.  All dogs must be on leashes or in carriers, but leave the retractable lead at home, or make sure it’s locked.  Keep your small dog in your arms, and your larger dog close to your side, as you enter the waiting room.  Lots of dogs in our office sniff each other, wag their tails, and seem to enjoy the experience. Nevertheless, I suggest restricting your pooch’s interactions with his own species to the dog park.   Also, an excited dog running figure eights on a retractable lead can wind around the legs of both dog and human, resulting in injury to one or both.  I was once lacerated by a retractable leash with a 15-pound dog on the business end; it took two years for that scar to fade! 

2.  Along the same lines as Tip #1:  Don’t let your dog run up to cat carriers, even if the dog adores kitties.  That will terrify all but the mellowest of felines.  

3.  All cats, without exception, should be in a cat carrier.  Even if your kitty lives with a dog and isn’t afraid, some dogs are cat-aggressive.  To them, your furry little friend looks like prey!

4.  Be mindful about cell phone use.  If you’re the only person waiting, a quiet phone conversation is acceptable.  If others are around, go outside for all but the briefest chat.   Nobody wants to hear about what’s for dinner, your cheating boyfriend, or your business transactions.

5.  Very young children may become bored and whiny while waiting, which is apt to cause distress for them and their parents.  They are often uninhibited and curious, and may approach a pet that doesn’t care for kids.  That could result in a serious bite (usually to the face).  Arrange to leave your child at home if he or she is likely to cause a disturbance.  I often joke with my daughter that she seldom saw the inside of a grocery store until she was 7 years old; it took her that long to mature enough to handle the situation without turning into a little monster. 

6.  I’ve overheard pet owners dispensing behavioral and medical advice to other clients.  I’m sure they mean well, but the person on the receiving end isn’t likely to be in the mood to hear something that might seem like veiled criticism, or something they already know about.  Refrain from giving fellow pet owners unsolicited suggestions. 

7.  For some dogs, walking into our office is their cue to bark incessantly.  It’s best to leave a barking dog in the car; if it’s warm outside, both of you should stay in the air-conditioned vehicle.  Call us when you’re in our parking lot to let us know you’ve arrived, and we’ll give you a buzz when the doctor is ready to whisk you directly into the exam room.  Consider having us prescribe an anti-anxiety drug such as Xanax to help the poor pooch cope with his over-excitement.

8.  The same goes for aggressive dogs, whether they’re dog-aggressive or people-aggressive:  Call us when you arrive, and stay in your car.  Also, all veterinary hospitals really appreciate it when clients muzzle their cantankerous dog before they walk in the door.  If you’re unsure about how your dog will behave, play it safe and use a muzzle (which we are happy to provide).  Dogs usually bite out of fear; why subject them to such stress?   I adhere to this variant of DuPont’s old slogan:  Better living through chemistry!  A little Xanax is in order.

9.  Don’t pet other animals without the owner’s permission.  Better yet, don’t pet other animals. I wouldn’t approach any but the most obviously friendly dog in the waiting room, because some owners are in denial about their dog’s propensity to bite. 

10.  If you suspect that your dog has something contagious, such as kennel cough or mange, let the receptionist know when you make your appointment.  Other clients will appreciate it if you leave your pet in the car until it’s time to see the doctor.

 

11.  It seems like our front desk bears the brunt of some people’s disgruntlement.  If you have a complaint, It’s OK to tell the receptionist, but please be gentle about it.   

12.  Unless another client volunteers information, don’t ask them why they are at the animal hospital.  It’s really not your business, and their reason for being there might be embarrassing.  Even worse, they might be terribly worried about their beloved pet, or they might be there to have the pet euthanized.  When faced with having to make difficult decisions, the most stoic person may dissolve into tears if they have to talk about it.

Even if you are a maven of manners, sometimes your own well-disciplined dog can misbehave or have an accident in the reception area.   I know that might be embarrassing to some pet owners, but to them I say, “Gee, this hasn’t happened … for at least ten minutes!”  Just do your best to follow these tips, but don’t worry: We’re used to all kinds of rowdiness in the waiting room.  Unlike the supermarkets where I wouldn’t take my grouchy young daughter, the vet’s office is a place your pet can’t -- and shouldn’t -- avoid. 

Have fun with your dog: Fido's got game!

Pet  owners tend to have busy lives.   More often than not our dogs get left behind, without much to do except sleep, stare out the window, or get into trouble.  Boredom is the bane of their existence.   I think many dog owners understand that and feel guilty about the benign neglect of their furry friend.  As much as we love our dogs, we can’t seem to think of much to do with them except throw a ball, pet them, feed them too many treats, or take them for a walk.

But there’s a fun solution: You can play games with your dog!  Besides staving off boredom, playing doggie games can:

•        Prevent behavior problems
•        Help ward off anxiety
•        Bond your dog to you
•        Afford mental stimulation
•        Create a fun atmosphere for learning commands
•        Provide exercise

Most pups can start learning games when they are only a few months old.  If your puppy doesn’t get the idea, just give him a little more time to grow and try again.  There’s no upper age limit to learning to play a game unless there are physical problems, such as arthritis or illness.

Although unfairly maligned, tug-of-war is another great game.  The misconception is that tug games promote dominance, but played correctly, they are a fun and confidence-building activity for your dog. But there are rules!   The owner should initiate the game and shouldn’t allow the pooch to touch his hands – that is a foul and results in a temporary halt to the fun.  And the dog must relinquish the toy on command, so this is a fun way to teach the “drop it” command.  Similarly, playing fetch lends the same confidence enhancement as tug games and also teaches “drop it.”

A less-familiar dog game is hide-and-seek.   You can hide a person, a treat, or a toy.  Each requires a different training technique.  Teaching a dog to find a toy or treat must be done in small steps to avoid frustration.   This is a great game for either inside or outside the house.  

Playing hide-and-seek using another person not only reinforces recalls but also encourages a dog to think.   The person in hiding calls the dog, and the person holding the dog then says, “Find Joe!”  When the dog locates the hidden “Joe,” a tasty treat is given, or a favorite toy, or even a game of chase.  Inside or out, hiding or not, people can take turns calling the dog back and forth.  Watch your pal become fit and proficient at recalls — possibly a life-saving skill.

With 132 million hits for “dog toys” on Google, finding something fun for your furry friend to play with is easy.  Some of these toys are interactive, requiring effort from your dog to achieve a reward or requiring human input.  But no matter what the toy, being a part of playing with your dog will bond him to you and help prevent him from becoming possessive of his playthings.

Remember playing with your food (despite stern warnings from your parents) when you were a kid?  Some dogs, too, love playing with their food.  Throw a hard treat down the hall and make him wait for a command to chase it and devour it.  Interactive feeding toys, such as Kongs and treat balls, offer an important chewing opportunity with a tasty reward.   Interactive food bowls help slow hasty eaters and make meals more interesting for some dogs.   Not every dog will enjoy having to work for every bite, but puzzle feeders can make dogs have to think to find their food.  

AiKiou's interactive feeder

A lack of mental stimulation is one of the main causes of behavior problems in dogs. Don’t miss opportunities to enrich your dog’s life.  You can incorporate play into many routine daily activities.  We have a nation of unemployed, indolent dogs.  Let’s put them to work! 

Heat stroke in dogs: Having a hot dog is not cool

Last summer I walked out of Jewel, and as I put my groceries in my car I happened to glance at the car next to mine.  The windows were opened about three inches all around, and inside the car was a Boston terrier.  He was panting so hard that I could clearly hear his distress.  I stood there for a few minutes, then decided I was either going to break the car window, have a Jewel employee try to page the owner, or call the police.  Fortunately the owner returned to her car with a cart full of groceries (clearly at least a 20-minute shopping trip).  Although my blood was boiling, I told her as politely as possible that I was a veterinarian and that she was putting her dog’s life at risk due to heat stroke.  “Mind your own business” was her retort.

While some people think it’s okay to leave a dog in a hot car – it wasn’t the first time I’d seen that happen – I think most pet owners know better. But what they might not realize is that other scenarios can cause heat stroke just as surely as a sizzling sedan. Those include:

• Exercising strenuously in hot, humid weather.
• Being muzzled while put under a hair dryer, or getting overheated in a dryer cage.
• Being confined on hot concrete or asphalt surfaces.
• Being confined without shade and fresh water in hot weather.

Although it’s true that too much exercise in hot weather can be dangerous, I’ve found that most cases of hyperthermia involve confinement. The pet’s anxiety at not being able to escape the heat exacerbates the rise in body temperature.  A rapidly panting, over-exerted dog who is brought indoors to air-conditioning and given water will usually be fine.  If the same dog is tied up without shade on a hot day, even with a big bowl of water, it’s a recipe for heat stroke. 

There are risk factors that predispose certain dogs to hyperthermia.  A few weeks ago I saw Charlie, a 13-year-old Lab mix who had been running at the dog park and collapsed.  He was taken to the emergency clinic with a temperature of 104 degrees.  A dog’s normal body temperature is 100 to 102 degrees; the average heat stroke patient presents with a temperature of 105.8 degrees.  Although Charlie had all the symptoms, his body temperature was not typical of a heat stroke patient.  When I saw him a few days later, his breathing was noisy and somewhat labored.  I diagnosed him with a condition called laryngeal paralysis, which makes it hard for him to take in air.  It’s largely a problem in older dogs, especially Labradors and Lab mixes, and predisposes them to overheating.  

Dogs rely on an increase in air flow over the internal nasal folds (called turbinates) to facilitate evaporation and thus cool them off.  Charlie’s inability to move enough air through his nasal passages put him in danger of death from heat stroke.  Except for their paws, dogs can’t sweat, so panting is their way to prevent their bodies from overheating.  Eventually their cooling system will fail if they can’t pant fast enough to dissipate heat.  

Other risk factors for heat stroke include:

·         Age extremes (very young, very old).

·         Heat intolerance due to poor acclimatization to the environment (such       as moving from a cold geographical location to a hot one).

·         Obesity.

·         Poor heart or lung conditioning.

·         Underlying heart or lung disease, such as cardiomyopathy or asthma.

·         Short-nosed, flat-faced (brachycephalic) characteristics common to           such breeds as bulldogs, Shih Tzus, pugs, and Pekingese.

·         Thick hair coat.

·         Dehydration, insufficient water intake, restricted access to water.

The most obvious symptoms of heat stroke are heavy panting, labored breathing, and collapse.  The saliva may be very thick, and the dog’s tongue and mucous membranes may appear bright red, although as shock sets in, they may turn gray or white.  Vomiting, bloody diarrhea, and seizures may occur.  The mortality rate, even with treatment, is 50%.

Most pets with heat stroke should be seen by a veterinarian, but it’s a good idea to treat a pet as soon as possible at home if you recognize the symptoms.  If his rectal temperature is above 104 degrees, begin cooling the dog with a hose, or immerse him in a tub of cool water (not ice water).  Dogs also cool down nicely if they are wetted down thoroughly and placed in front of an electric fan.  Monitor the dog’s rectal temperature every few minutes until it falls to 103.  At that point, stop the cooling process, dry the dog, and give us a call.  If you cool him off further, he may become hypothermic and go into shock.  

If your dog has one or more of the risk factors mentioned above, be especially vigilant, and make sure his or her underlying condition is treated, if applicable.  As for Charlie, my patient with laryngeal paralysis, even mild overheating could result in his death.  I recommended surgery to help open up his airways and stressed that he should be kept indoors in air-conditioning on hot days.  Because of his age, his owners opted out of the surgery, but they’ve now seen firsthand how scary it is to see a dog gasping for air when he’s overheated and will assuredly be diligent about keeping the old guy cool.  

Preventing heat stroke involves common sense:

·         Keep your dog indoors during the hottest part of the day.

·         Never leave your dog in a hot car, not even for a minute.

·         During hot weather, keep exercise sessions very short; during a               serious heat wave, omit exercise altogether.

·         Keep your pet unconfined during hot weather; that applies even if             he’s indoors if you don’t have air-conditioning.

If you see an animal left in a parked car on a hot day, notify someone in the store where the owner was likely to go as soon as possible.  If you can’t locate the pet owner, call the police.  Resist the temptation to smack or verbally assault the pet owner — we now have concealed-carry laws in Illinois, so you never know who’s packing!  A mild admonishment like the one I gave is acceptable; just don’t expect the pet’s owner to appreciate it.

If your dog has one or more of the risk factors mentioned above, be especially vigilant, and make sure his or her underlying condition is treated, if applicable.  As for Charlie, my patient with laryngeal paralysis, even mild overheating could result in his death.  I recommended surgery to help open up his airways and stressed that he should be kept indoors in air-conditioning on hot days.  Because of his age, his owners opted out of the surgery, but they’ve now seen firsthand how scary it is to see a dog gasping for air when he’s overheated and will assuredly be diligent about keeping the old guy cool.  

  

Easy ways to cleaner teeth

Veterinarians agree that tooth brushing is by far the most effective way to maintain a healthy mouth, but a preponderance of pet owners reject the toothbrush.  At first there’s some enthusiasm: You buy the toothbrush kit, go to YouTube, choose a video (60,300 of them at last count), and learn how to do the deed.  You might even brush for a few days.  But in most cases, the toothbrush and paste get shoved in a drawer, not to be found again until moving day. 

What’s a caring canine owner to do?  The pet industry realized years ago that we dog people want an easy way to maintain our pet’s teeth and gums.  It can’t take too long, and it has to be enjoyable for both the person and the pup.  In response to those desires, there are now hundreds of products on the market that claim to prevent plaque and give Fido good breath. 

Plaque is a sticky, colorless biofilm on teeth that forms when bacteria attach to the tooth surface.  The bacteria that live in plaque secrete acids that irritate gum tissue.  The irritation causes an inflammatory reaction that eventually leads to gingivitis and periodontal disease.  If plaque isn’t removed regularly, it hardens to create calculus, also known as tartar. 

Killing bacteria is the best way to prevent plaque from forming in the first place.  The most effective products contain the antiseptic chlorhexidine and usually are oral rinses or gels. Unfortunately, chlorhexidine has a bitter flavor, even if the products are formulated with palatability enhancers.  My clients’ compliance in using these products is almost as dismal as for tooth brushing. 

An easier way to keep plaque from forming is by scraping it off every day.  If brushing isn’t your thing, let your dog’s choppers do the work! 

Special dental diets are very effective in preventing and removing plaque.  In our practice we use Hill’s t/d CanineDental Health.  To have a tooth brushing effect, dry dog food has to hold together while the tooth sinks in.  With regular food, only the tooth tip makes contact with the food before the kibble breaks up.  With t/d, the entire tooth sinks into the kibble and is wiped clean before breakage occurs.  Hill’s secret is using long vegetable fibers to bind the kibble together as the tooth slides through.   Regular kibble merely crumbles.  Other companies coat kibble with sodium hexametaphosphate (HMP), a food additive that breaks down tartar and prevents plaque.  

In addition to special dog foods, hundreds of hard edible biscuits make oral health claims.  Just like kibble, they work by mechanically removing plaque and tartar. Some are coated with HMP or proprietary food additives purported to control bacteria and plaque. 

Close cousins of biscuits are edible chews.  Greenies and rawhide are perhaps the best known of this genre.  They work like kibble and biscuits, but in addition may contain enzymes and other additives to help prevent plaque.  Many contain ingredients such as chlorophyll, cloves, cinnamon, and vanilla, which temporarily freshen your dog’s breath. 

Google “edible chews for dogs” and you’ll see over 1 million hits.  Many of these products overlap in their functions.  For example, Breath-Less™ Brushless-ToothPaste™ Chews have a hard, ridged exterior that mechanically cleans your dog’s teeth as he chews, while the toothpaste inside controls bacteria, boosts the scrubbing effect and freshens breath.  The company declares that “your pet is practically caring for his teeth entirely on his own!”  

Non-edible chews can also be useful in removing plaque.  Soft Nylabones and floss or rope toys are typical.  To prevent tooth breakage, veterinary dentists caution pet owners to choose chew toys that are not too hard.

Both edible and non-edible dental chews can fracture teeth.  Edible chews also can cause gastrointestinal obstruction if your dog doesn’t chew them thoroughly, so make sure you oversee your dog when you give him one of these products, especially the first time.

Research in humans has shown that our tongues are the main reservoir of plaque-forming bacteria, so regularly scraping your tongue is helpful in preventing bad breath and tartar.  To that end, there’s the Orapup doggie tongue brush.  A tasty solution that supports a healthy oral bacterial population is applied to the ultra-soft bristles.  Your dog’s licking gently removes the bacteria on his tongue, which also helps improve bad breath.

Food additives are another convenient way to prevent plaque.  One product I like is PlaqueOff by Proden. 

Once calculus is formed, removal becomes trickier. A plethora of sprays, gels, water and food additives can soften plaque and tartar to boost the effectiveness of the above-mentioned products. We like VetzLife Oral Care Spray or Gel at our animal hospital.  The application (especially for the spray) is quick and easy.  When the product is used after meals for a month or two, the tartar will soften and can be removed much more efficiently by mechanical means.  I’ve seen thick tartar virtually crumble when scraped after regular use of these products.  Once the teeth are clean, you can usually reduce 

How does one choose from this deluge of products?  The Veterinary Oral Health Council (VOHC) Seal of Acceptance is awarded to home oral hygiene products that meet or exceed the VOHC standard for preventing the accumulation of dental plaque or tartar.  A complete list of products that have been granted this seal of approval is available at their website.  These products have been vigorously tested by the VOHC, but that doesn’t necessarily mean other products on the market are ineffective.  

Although home-care dental products are a boon for preventing and removing plaque and tartar, some dogs really do need a professional dental cleaning.  However, using these products after your dog’s teeth are clean can extend the time between cleanings by months or even years. 

I often see a client cringe when I open their pet’s mouth during my exam.  They remember that last year I applied a solution to their dog’s teeth and showed them all the areas of plaque, which stained a bright pink.  They remember that I recommended brushing, and they probably left the office with good intentions.   With all of these oral care products on the market, there’s no reason to feel guilty anymore.  Just pick a few, use them regularly, and give your dog’s mouth a healthy makeover.  

  

A Trip Down Memory Lane

Every morning I drink an ice-cold green smoothie.  I got the recipe from “The Dr. Oz Show.”  The berries and leafy greens in my concoction not only prevent cancer, they’re great for the brain.

Not too long ago, one of my clients broke into my smoothie time with a call.  “Doc, do you remember when my dog Munchie had that bout of vomiting and diarrhea a few weeks ago?”   It was hard to forget, since poor Munchie had stayed with us a whole day and kept my assistants busy with the bucket and mop.  “Well, I looked it up and I figured out that Munchie had a case of Balantidiasis! I’m surprised you didn’t think of that yourself!”

I admitted I’d heard of it in passing but told him that I thought Munchie’s intestinal problems were much more likely linked to the garbage they had found all over their floor that fateful morning than to an obscure protozoal disease whose name wasn’t in my memory bank. 

But he did bring up a good point: Why don’t we remember every syndrome or disease and consider them in our diagnostic possibilities when we see a sick pet?

Here is a highly scientific-ish graphic which I’ve produced to help illustrate the answer to this question:

Part of the reason I love medicine is that there’s always new stuff to learn.  That’s also why being in any branch of medicine is a challenge:  You just can’t know it all.  We’re bombarded with medical newsletters, journals, webinars, conferences and e-mails.  It’s fun, it’s informative, and it’s also overwhelming. 

In recent years, the internet has created many more resources for pet owners, too.  In fact, it’s not at all unusual for a client to come in with a sick pet whose illness they believe they have already identified based on a web site or a discussion group they belong to.  We don’t mind—in fact, we think it’s great that they care enough about their pet to do research.  And it can be fun when, like Munchie’s owner, they call our attention to an odd ailment that we haven’t thought about since veterinary school.  

But the best and safest diagnosis will always be the one done by a vet who can actually take a thorough history, examine the pet, perform tests,   and integrate his or her clinical experience with the hard data to come up with an appropriate treatment plan.   

Fortunately, we are trained to think like doctors and to use all of those resources.  As far as remembering all of it, pass the green smoothie, and add a side of brain-enhancing fish oil!