Recognition & Integrative Prevention & Treatment For An Often Overlooked Disease In Senior Aged Dogs

I hear it all the time when I ask how a senior aged canine patient is doing at the beginning of a well visit. The answer often goes something along the lines of  these variations:

“He is good, but doesn’t seem to hear well because he doesn’t come sometimes when I call him.”

“He is good, but doesn’t seem to hear that well because he doesn’t always greet people at the door anymore.”

“He is good but has selective hearing…he doesn’t not always come when called, but for some reason, he always hears his food dish being filled.”

…Etc.

In the majority of cases, simple hearing tests I perform as part of my routine physical examination reveal that the patient can hear just fine. What the owner perceives as lack of hearing or selective hearing is usually the early stages dementia, also known as Canine Cognitive Dysfunction. In fact, a Washington State University study determined that by age 11, 30% of dogs are showing early signs of dementia. The percentage of dogs with dementia increases with age until by age 16, 100% of dogs according to the same study have dementia.

Dementia in dogs results from age related changes in the brain that lead to reduced perfusion of the memory centers of the brain. These degenerative changes also lead to personality changes such as heightened anxiety, depression, insomnia, or even aggression. These changes can start as early as 7 years of age.

Clinical signs of dementia in dogs begins with them not always coming when called or not running to the door to greet people. They often seem to have selective hearing because they may still recognize their favorite cues like hearing the food bag open or seeing their owner getting the leash for a walk. As the most exciting things in their lives, feeding and walks stand out most prominently in their minds and those memories are often the last to go.

Eventually, dogs with progressing dementia may fail to recognize food and not eat, experience pacing and vocalize often in the evening hours. They may also go from having been very well house trained all of their lives to eliminating in the home.

If you have a senior aged dog (7 years or older), the following are integrative solutions that serve as proactive prevention and treatment of dementia:

1.) Omega-3 Fatty Acids: Omega-3 Fatty Acids derived from fish oil have potent anti-inflammatory activity in the body. As a key component to the cell membrane, omega-3 fatty acids also protect and maintain the integrity and health of cells. In the case of the brain, with the body lacking the ability to make new brain cells known as neurons (like people, dogs are born with a finite number of brain cells), this is key. Omega-3 fatty acids also help preserve the health of blood vessels, helping to maintain good blood flow to the brain and other organs.

2.) S-Adenosyl Methionine (SAM-E): SAM-E is a molecule that is formed naturally in the body. It can also be made in the laboratory. SAM-E is involved in the formation, activation, or breakdown of other chemicals in the body, including hormones, proteins, phospholipids; and certain drugs involved in the formation, activation, or breakdown of other chemicals in the body, including hormones, proteins, phospholipids, and certain drugs.

As a supplement, SAM-E is known to help improve mental performance, reduce depression and anxiety, and help in the treatment of many other diseases.

3.) Daily Walk: In addition to the benefits of exercise, taking your dog for a walk is mentally stimulating for them and helps to keep their mind stimulated and alert. Mental stimulation maintains blood circulation in the brain, playing a key role in brain health.

Items 1-3, I would implement for any dog 7 years or older. There is no adverse side effects or negative aspects these strategies. In fact, in addition to brain health, by implementing these simple strategies, you will also promote health in many other areas of the body. If your senior dog is experiencing confusion, selective hearing, and/or night pacing, in addition to 1-3, I would add treatment number 4.

4.) Selegiline: Selegiline is sold under the veterinary brand name Anipryl. Taken once daily, it increases dopamine production in the brain that increases perfusion to the memory centers of the brain. Selegiline also increases serotonin production in the brain, which reduces stress and anxiety associated with dementia.  Selegiline requires a prescription from your veterinarian.

If you have a senior age dog, now that you have read this article, be cognizant of subtle signs of dementia. Whether you see signs or not, take a proactive approach to prevention once your dog enters the realm of the senior years at age 7.

Dr. Roger Welton is a practicing veterinarian and highly regarded media personality through a number of topics and platforms.  In addition to being passionate about integrative veterinary medicine for which he is a nationally renowned expert, Dr. Welton was also an accomplished college lacrosse player and remains to this day very involved in the sport.  He is president of Maybeck Animal Hospital , runs the successful veterinary/animal health  blogs Web-DVM and Dr. Roger’s Holistic Veterinary Care, and fulfills his passion for lacrosse through his lacrosse and sport blog, The Creator’s Game.

Exciting Cutting Edge Stem Cell Therapy Advances In Veterinary Regenerative Medicine

Regenerative veterinary medicine refers to the repair of tissues by using the body’s own intrinsic healing mechanisms.  We activate the body’s cellular, neurological, and blood born healing capacities with side effect free therapies like Class IV therapy laser and acupuncture and the results have been remarkable.  With increasing momentum of stem cell and platelet rich plasma treatment (PRP), we are now taking regenerative medicine to another level.

Stem cells are progenitor cells that can differentiate into any tissue cell type.  By harvesting the patients’ own stem cells, activating them, and injecting them into injured areas, we are able to repair tissues at the cellular level.  In the past, the harvesting of stem cells has required a minor surgical procedure with general anesthesia where fat from the body is sampled and sent off to a lab to have the stem cells extracted and processed into an injectable media.  Since injection of joints, one of the most common uses of stem cell therapy in veterinary medicine, almost always requires sedation, the costs and client perceived invasiveness associated with anesthesia, minor surgery followed by sedation, clients have often been reluctant to consider it for their pet. As a result, although most veterinarians are strong advocates of this branch of medicine, to date we have found it a tough sell for pet owners.

With new technology from PrimoStem, the general anesthesia and surgical portion of stem cell therapy has been taken out of the process.  Their new technology does not require tissue harvest for collection of stem cells, but instead is able to extract and activate stem cells from a simple blood draw.  The blood is sent off to their lab and within 2 business days arrives to the clinic ready for injection.  Thus, your pet can now enjoy the benefits of stem cell therapy for any number of conditions with a simple blood draw, gentle sedation, and injection into damaged areas of the body, all within a 3 day turn around and two outpatient visits.

Stems cell solutions are directly injected into damaged joints and acupuncture points to seek out, differentiate into the given tissue cell type, and repair it. In addition to direct injection, the patient is given an additional intravenous bolus of stem cells to provide systemic regenerative benefits throughout the entire body.

The applications of this type of treatment is poised to go far beyond orthopedic repair.  As I write this article, there are currently studies in process to assess the benefits of this treatment for chronic degenerative disease such as kidney failure, cirrhosis of the liver, and several degenerative neurological conditions that traditional veterinary medicine previously had no answer for.  Conclusions are still pending as the data continues to be collected, but initial results seem very promising.

Dr. Roger Welton is a practicing veterinarian and highly regarded media personality through a number of topics and platforms.  In addition to being passionate about integrative veterinary medicine for which he is a nationally renowned expert, Dr. Welton was also an accomplished college lacrosse player and remains to this day very involved in the sport.  He is president of Maybeck Animal Hospital , runs the successful veterinary/animal health  blogs Web-DVM and Dr. Roger’s Holistic Veterinary Care, and fulfills his passion for lacrosse through his lacrosse and sport blog, The Creator’s Game.

A Cautionary Tail Of 3 Dogs

I closed out my last week of 2017 presented with 3 eerily similar canine cases that all presented severely sick.  The breeds may have all been different, but outside of breed, all three dogs had striking similarities in their history, presentation, disease predisposing factors, and diagnosis.

History

Each dog was relatively young, between 7-9 years of age, and all three were males.  The owners of each dog claimed regular wellness veterinary care, but none went beyond a discount vaccine clinic and based on records, none had been actually examined in years (there is an abysmal legal loophole in Florida that allows vaccines to be administered to patients by technicians or assistants without an examination as long as a licensed veterinarian is in the building).

Presentation

All three dogs were depressed, weak, dehydrated, and not eating.  Each dog had severe dental disease, a major predisposing factor for what the ultimate diagnosis would ultimately be for all 3 dogs.

Diagnosis

All three dogs were found to have severely elevated kidney values and phosphorous in their bloodwork, a finding which led to a diagnosis of chronic kidney failure.  Based on their numbers and presentation, all three dogs were given a poor to grave prognosis.

The timing of these diagnoses was very difficult for the owners in the week leading up to Christmas and New Year, with each family desperately wishing to keep their pet with them at least through the holiday season.  Thus, each owner despite the odds elected to attempt treatment.

Luckily, in the case of chronic kidney failure, other than the cost, there is little to lose in attempting treatment.  Consisting primarily of aggressive IV fluids,  GI protectants, anti-nausea medication and antibiotics, it is not an invasive course of treatment and only takes 2-3 days to play out to see if the patient will respond.  Ultimately, only one of the three would recover to the extent that he would make it through the holidays and even still, he carries a poor to grave prognosis.

I did not write about this to depressed pet owners, but instead shared my experience as a cautionary story for pet owners to learn from.  The demise of these dogs was likely very preventable.

Had these dogs received proper veterinary care with actual yearly hands on examination by a veterinarian, the dental disease would have pointed out well before it reached such a severe point.  Had the dental disease subsequently been treated in the early stages, a major predisposing factor for chronic kidney failure would have been eliminated.

Regular yearly wellness bloodwork starting at age 5 would have caught kidney disease in its early stages and proactive measures could have been put in place to maintain the longevity of the kidneys and subsequently the longevity of and quality of life of the patent; rather than tragically lose them well shy of their 10th birthday.

A regimen of kidney protective diet (protein, sodium, and phosphorus restriction), GI protectants, and anti-oxidants often extend the lives of chronic kidney disease patients for years.

Chronic kidney failure is only one of countless life shortening diseases that can be managed or even prevented with proper and timely veterinary wellness care.

Dr. Roger Welton is a practicing veterinarian and highly regarded media personality through a number of topics and platforms.  In addition to being passionate about integrative veterinary medicine for which he is a nationally renowned expert, Dr. Welton was also an accomplished college lacrosse player and remains to this day very involved in the sport.  He is president of Maybeck Animal Hospital , runs the successful veterinary/animal health  blogs Web-DVM and Dr. Roger’s Holistic Veterinary Care, and fulfills his passion for lacrosse through his lacrosse and sport blog, The Creator’s Game.

Pet Owners Should Not Take “Natural” To The Point Of Absurd

I can appreciate pet owners who wish to feed their pets organic and natural food, pursue natural, side effect free alternative treatment options, and avoid chemicals, preservatives, and pesticides.  I try to do that for myself and my human and furry family as much as it is feasible.  As an integrative practitioner of veterinary medicine, I often attract these kinds of pet owners and enjoy a great working relationship with them most of the time.  There are occasions, however, when I deal with such naturally minded pet owners that draw a lines in the sand that defy common sense and venture into the realm of the absurd.

In a recent case of an 8 year old female boxer, I determined on a routine yearly visit had stage 3 out of 4 periodontal disease.  The owners were aware of the periodontal disease with their previous veterinarian having made dental recommendations as well, but until seeing me (they had just moved here from another state), the previous veterinarian had told them of the condition of the teeth but did not actually show them (so they told me, anyway).

She was a very good patient, so I was easily able to lift the lips and show the owners how decayed her teeth were with severe gum recession in many spots, tooth root exposure, and even pus along some of the gum margins.  I strongly recommended a professional dental cleaning and what would likely amount to several extractions for teeth beyond repair.

The owners were up front about their preference for natural treatment but to their credit, understood that no amount of enzyme/grapefruit seed extract dental sprays would fix these teeth.  We rran pre-anesthetic blood work which revealed that at an unusually young age, the boxer has significant kidney elevations that indicated chronic degenerative kidney disease.  I still recommend the dental because there is a direct correlation between chronic periodontal disease and acceleration of kidney failure in dogs and cats.  I would take the necessary precautions with my anesthesia protocol to maximize the patient’s safety.

The patient ultimately came through nicely through anesthesia, dental cleaning and oral surgery to removed several teeth.  At discharge, I discussed with the owners that I will circle back with them at the 2 week post-operative re-check to discuss dietary management as the primary means to manage chronic kidney failure in dogs.  The owner said that she would be back for the re-check, but the dietary discussion would not be necessary.  I was not quite sure at the time what the owner meant, but she quickly left and I got distracted with more discharges and forgot about her statement.

At re-check, I confirmed to the owner that all of the surgical sites had healed well and the gum infection had completely cleared.  I then turned the discussion to my recommendation of a prescription renal diet, as these diets are comprised of highly bioavailable protein sources (that are in turnassociated with minimal protein metabolic waste), restricted in sodium and phosphorus, and are fortified with antioxidants to combat toxins that accumulate in the body as a consequence of kidney failure.  All of these aspects of prescription diets for patients in kidney failure combat high blood pressure, reduce the work-load of the kidneys, and produce minimal toxins as metabolic waste that help to maintain quality of life and body condition.

The owner’s demeanor suddenly changed and she became defensive and reminded me that she had already told me that a discussion about diet was not necessary.  She went on to tell me that she and her husband are passionate about feeding raw meat and vegetables to their dogs and that they did not intend to vary from that.  She said that she could not justify intoxicating her dog with processed food and preservatives no matter the claims of the diet.

During circumstances like these, I generally have to take a moment to swallow, take a deep breath, allow my blood pressure to stabilize and collect myself; which I did.  I then patiently explained to her that I respect her passion for all things natural, but in this case, a prescription diet does have preservatives and is processed (since it is engineered to have exactly what a kidney failure dog needs to maintain quality of life and facilitate longevity), but the proteinaceous waste, sodium, and phosphorous levels her raw diet provided the dog would be far more harmful in disease progression than any preservatives or processing.  I offered this owner statistical data that clearly proved the benefit of prescription kidney sparing diets in dogs.

Alas, it was all to no avail.  While she seemed to listen and I thought I may have made a dent, she simply told me no thank you, she and her husband  did not believe in feeding processed food and preservatives to their dogs and that they are fully prepared to take their chances.

This is when I had to resist the temptation to bang my head against the wall as a wonderful boxer that could have had many months, even years, added to her life by simply being fed a special diet, walked out the door to have her life shortened and her quality lessened over her owner’s sheer narrow mindedness and stubbornness.

Natural and alternative medicine minded pet owners frequently complain – often rightfully so – that many veterinarians are dismissive of discussing or looking into natural alternatives to feeding and therapy, and are close minded and  focused on only traditional western veterinary medicine.  Unfortunately, integrative veterinarians that are not close minded, sometimes encounter the flip side to that coin with occasional owners such as the subject of this post, that are to too entrenched in their natural dogma to be reasonable…and the pet at no fault of her own is the one who suffers needlessly.

Dr. Roger Welton is a practicing veterinarian and highly regarded media personality through a number of topics and platforms.  In addition to being passionate about integrative veterinary medicine for which he is a nationally renowned expert, Dr. Welton was also an accomplished college lacrosse player and remains to this day very involved in the sport.  He is president of Maybeck Animal Hospital , runs the successful veterinary/animal health  blogs Web-DVM and Dr. Roger’s Holistic Veterinary Care, and fulfills his passion for lacrosse through his lacrosse and sport blog, The Creator’s Game.

Cannabis Medical Marijuana Uses For Dogs & Cats

Medical marijuana was just passed in Florida by referendum in the 2016 election.  Despite the voter referendum, conservative counties backed by our republican controlled executive and legislative state government are running interference across the state to disrupt the implementation of medical marijuana leaving it still largely unavailable.

The reality of medical marijuana is that it has a number of legitimate uses for disease management that are virtually side effect free when dosed properly.   The marijuana flower has glandular structures known as trichomes that contain essential oils.  When these glands are separated from the plant, “cannanioids” may be separated out and formulated into the proper ratios that facilitate medical uses with little to no side effects.

Cannabinoids fall into 2 categories.  Tetrahydrocannabinol, or THC, is responsible for the psychotropic effect; while cannabidiol, or CBD, provides the main medicinal component.  However, CBD alone is not clinically as effective as combining it in proper ratios with THC, and the right combination provides enhanced medicinal efficacy via what researchers term the “entourage effect.”

One very common use of medical marijuana in people is treatment of seizure disorders, of which we see a great deal in veterinary medicine, particularly in dogs.  Life threatening complications or organ damage are highly unlikely with properly dosed medical marijuana in comparison to traditional anti-convulsant medications which are know to tax the liver.  Other applications for medical marijuana include management of GI disease, nausea, spinal pain, arthritis pain, anxiety, and cancer management (stimulation of appetite and control of pain).

Are there any risks to treatment with medical marijuana in veterinary medicine?  The biggest risk medical marijuana carries is accidental overdose.  Even then, life threatening reactions to medical marijuana are exceedingly rare.  Also, we must recognized that accidental overdose potential exists with traditional medications as well, often with far more devastating consequences.

Will we be prescribing medical marijuana in veterinary medicine any time soon?  The answer to this is: not likely.  The first barrier is that standardized dosing research in dogs and cats is still very much in progress with little clear consensus.  The second barrier is that the purchase of medical marijuana in states like California (and likely Florida once it is available) require a medical marijuana card.  In California where medical marijuana has been legal for years, there is no legal mechanism by which a dog or cat can be issued a medical marijuana card.  I assume the same will be the case here in Florida where I practice once medical marijuana is available.

The best option available to pet owners at this time is to talk to a veterinarian who has experience with pets being treated with cannabis oil about proper dosage and reputable manufacturers.  How these veterinary practitioners navigate the legal side of prescribing medical marijuana is not clear to me, however.

In summary, practical applications of medical marijuana are well established in people and early research and anecdotal reports indicate that the same is true for dogs and cats.  While it will likely be some time before this alternative treatment approach will available to dogs and cats, as research evolves and doses are standardized, there will likely be more pressure for a legal avenue to make it available to dogs and cats.

Dr. Roger Welton is a practicing veterinarian and highly regarded media personality through a number of topics and platforms.  In addition to being passionate about integrative veterinary medicine for which he is a nationally renowned expert, Dr. Welton was also an accomplished college lacrosse player and remains to this day very involved in the sport.  He is president of Maybeck Animal Hospital , runs the successful veterinary/animal health  blogs Web-DVM and Dr. Roger’s Holistic Veterinary Care, and fulfills his passion for lacrosse through his lacrosse and sport blog, The Creator’s Game.

Should A Dog’s Diet Be Supplemented With Vitamin C?

Most of us are familiar with vitamin C and its health benefits for people.  Vitamin C has been proven to have powerful immune system boosting properties to help to prevent infectious disease and cancer.  Vitamin C is also a biological sponge, that is, it has molecular properties capable of binding to free radicals that form in the body every moment of our existence and eliminating them from the body.

Free radicals are charged ions and compounds that damage tissues and organs via a chemical process called oxidation.  They form as the result of physical stress on the body, mental stress, and as the result of age.  When we take vitamin C and other vitamins known to be “antioxidants,” these compounds effectively bind, neutralize, and facilitate the removal of free radicals, thereby protecting the body from disease and slowing the aging process.

It should necessarily follow that we should administer vitamin C to dogs as well, right?  They are after all, physiologically built very similarly to us and suffer many of the same disease processes, as well as experience the gradual break down of their bodies from father time.  However, when it comes to vitamin C, they are quite different.

The major difference between people and dogs when it comes to vitamin C is that people necessarily depend on outside supplementation of vitamin C either through dietary sources (such as oranges and other fruits) or supplements.  This is because we possess a very poor ability to synthesize our own vitamin C.

Dogs, on the other hand, are physiologically quite capable of synthesizing their own endogenous vitamin C.  Having this ability, under normal circumstances, as long as they are fed as nutritionally well balanced diet, they do not require outside supplementation with vitamin C.

For some of you that are particularly well informed, you may know that vitamin C is a water soluble vitamin and, as such, it has little potential to cause toxicity (excesses in water soluble vitamins are easily eliminated by both dogs and people).  If this is what you are thinking, you are correct.  You may also be thinking that if this is the case, what harm would there be to offer your dog a little extra vitamin C?  The answer is that that for an adult dog, other than a mild, self limiting case of loose stools, there really is no harm.

For growing puppies, on the other hand, there is great potential for harm.  Vitamin C has the potential to cause spikes in serum calcium.  In response to this, the body activates a hormone called calcitonin that interferes with the proper development of bone density and proper remodeling of a puppy’s skeletal system as they grow.  This is especially true in large breed puppies.  As such, I generally advise against supplementing a puppy’s diet with vitamin C.

Still, although dogs do effectively synthesize their own vitamin C, there are certain conditions where it is beneficial to prescribe additional supplementation with vitamin C.  Female dogs that suffer from chronic recurring urinary tract infections is one case example that I would  recommend supplementation with vitamin C.  In this case, vitamin C not only directly boosts the immune system both locally and systemically to fight infection, as a water soluble vitamin eliminated primarily via the kidneys, vitamin C also acidifies the urine directly to create a less hospitable environment for bacteria to proliferate.

In the case of any pet under treatment for cancer, I also recommend supplementation with vitamin C.  Cancer in the body creates systemic free radicals that vitamin C helps to eliminate.  Boosting the immune system with vitamin C helps to prevent secondary infection dogs are predisposed to when under treatment with chemotherapy.  Boosting the immune system also aids the dog’s immune system to fight the cancer itself.

As a general rule, vitamin C is not necessary for healthy dogs fed a nutritionally balanced diet.  It is potentially harmful to supplement puppies with vitamin C.  However, there are specific health circumstances where supplementation with vitamin C is beneficial to dogs.  Be sure to discuss with your veterinarian before considering any nutrient supplementation regimen for your dog.

Dr. Roger Welton is a practicing veterinarian and highly regarded media personality through a number of topics and platforms.  In addition to being passionate about integrative veterinary medicine for which he is a nationally renowned expert, Dr. Welton was also an accomplished college lacrosse player and remains to this day very involved in the sport.  He is president of Maybeck Animal Hospital , runs the successful veterinary/animal health  blogs Web-DVM and Dr. Roger’s Holistic Veterinary Care, and fulfills his passion for lacrosse through his lacrosse and sport blog, The Creator’s Game.