Margaret C. Saiki, D.V.M.,
Dipl. ABVP 93-2003
Over 20 Years of Experience!
(408) 399-5353
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How to detect if your dog is experiencing chronic pain

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         painful dog reluctant to proceed up stairs, sign use pet hospice care                  Painful dog on bed

 

How to detect if your dog is experiencing chronic pain

 

As part of our mobile veterinary house call practice in the San Jose, Ca. area, we use many of the topics discussed in this blog to assess chronic pain in your dog. Pain and pain management is an integral part our pet hospice care service. In addition, it helps in the evaluation for decision making concerning humane pet euthanasia.

Introduction

In this website as well as on an earlier blog post you will find a discussion on how to determine the quality of your pets’ life using the HHHHHMM QOL scale. “Hurt” is the first “H” is this quality of life scale and is the subject of this blog article.

Dogs tend to mask pain mainly as a species based protective mechanism. Not outwardly showing pain does not mean they don’t feel pain. In addition there are also differences in each individual dog in their ability to tolerate pain. Differences are noted in different breeds and different personalities of the patient. In most cases the best way for an owner to determine if a dog is painful is to note changes in their behavior and posture. It is therefore imperative that owners understand this for they are the best resource for determining the changes in their pets’ behavior.

In pet hospice care, it is usual for veterinarians to give your pet the benefit of the doubt, and treat for pain sooner rather than later. It is also not uncommon for owners to note how their pets’ respond to pain management and then realize the signs they missed.

Some sources of pain in the palliative of hospice care patient

·        Osteoarthritis (OA)

·        dental disease

·        malignancy/cancer

·        congestive heart failure (difficulty breathing)

·        pulmonary disease (difficulty breathing).

 

Arthritis and dental disease are by far and away the most common conditions which cause chronic pain which is difficult for owners to detect.

Assessing Pain

It is difficult to accurately assess pain in our companion dogs. Obviously it is difficult for them to describe the location, type of pain (burning aching, etc.) and severity (1-10). Therefore our best clues come from pet owners who are in the best position to relay nuanced changes in their pets’ behavior, psychological attitude, level of activity and estimated level of comfort.

Since signs of chronic pain cannot be accurately assessed other causes for behavioral of psychological changes should be ruled out with a work up. This may include a history, physical exam, comprehensive lab work and radiology.

There are 3 basic categories used to help determine if a dog is painful.

1.                 Psychological or Behavioral Changes.

Psychological changes include differences in general well-being and general attitude. Is your dog happy, curious, paying attention to what is going on around them and seeking attention? Or not interested in interacting and staying away.

Some behavior changes seen that may indicate pain

•    changes in activity

•    loss of brightness in the eyes

•    agitation

•    aggression

•    licking at painful area

•    altered appetite

•    altered interaction with family members

•    changes in sleep pattern

•    loss of house-training

•    altered response to handling

•    vocalizing

•    facial expression

2.                 Changes in Posture

Chronic pain may be displayed in abnormal positioning of the body. Again, it is helpful for owners to recognize what is normal for their pet in order to detect what is abnormal. 

·        Limping or lameness in one or more limbs.

·        Head bobbing. Usually a dog will head bob trying to take weight off the painful leg.

·        Sitting abnormally with one hind leg extended. The leg extended can have a painful stifle or knee because they are reluctant to flex it to sit.

·        Hunched back

·        Stiff short striding hind legs. This can mean pain in the hips or pain in both stifle or knee joints.

·        Reluctance or slow to rise from a sitting position

·        Difficulty getting up on the bed, couch or into a car.

 

3.                 Lastly, pain can be detected through palpation. This procedure is usually done by a veterinarian as part of a physical exam.

 

CSU Canine Chronic Pain Assessment Scale.

This scale describes the psychological, behavioral, postural and palpation changes seen and corresponds these signs to the level or severity of pain. It is a valuable resource not only for veterinarians, but owners as well.

 

AAHA/AAFP Pain Management Guidelines for Dogs & Cats

These are guidelines are used by veterinarian to manage pain in companion animals therefore its content is quite in depth and technical.

Many dogs mask their pain even more when presented for examination by a Veterinarian. They will therefore not present the more subtle behavior and postural signs they would when at home this is all the more reason for owners to be versed in these signs.

Hopefully the information in this blog helps owners determine if their dog might be in chronic pain. Owners are a valuable resource for information especially in determining the psychological, behavior and postural signs of chronic pain. Knowing and understanding these signs will help the Veterinarian to select the proper treatment or medications to relieve pain.

Future blogs on this topic, the HHHHHMM QoL scale, will cover each aspect of this scale in depth. We hope you book mark this site and return to this blog for these future articles. 

 

Chicken Jerky Treats for Dogs: Another warning by the FDA

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 Girl giving dog treat mobile vet announces fda warning                                   chicken treat mobile vet announces fda warning

 

Chicken Jerky Treats for Dogs: Another warning by the FDA

Over the past few years the FDA has been investigating incidences of chicken treats manufactured and imported from China causing illness in dogs.  First reported in in 2007, dogs eating these chicken treats developed signs “Fanconi syndrome”. Fanconi  Syndrome is gluocosuria (glucose in urine) in the face of either normal blood glucose levels (euglycemia) or hypoglycemia (low glucose levels in the blood). Signs of this disease include lethargy, vomiting, decreased appetite diarrhea and alterations in thirst and urination.

Unfortunately, no one has been able to find any component in the treats that would cause the disease. The FDA has noted 70 reports of Fanconi-like Syndrome associated with chicken jerky treats in 2010.

FDA Recommendations:

Chicken treats should be given in small amounts and should not be a major part of a pets’ diet.

Watch for: “Signs of decreased appetite, decreased activity, increased water consumption, increased urination, vomiting and/or diarrhea.”

http://www.fda.gov/AnimalVeterinary/NewsEvents/CVMUpdates/ucm280586.htm

For other interesting information about veterinary medical go to our mobile veterinary house call website. (Serving: San Jose, Santa Clara, Saratoga, Cupertino, Campbell, Los Gatos, Los Altos, Sunnyvale and Mountain View)

 

 

 

Zonisamide a new type of anticonvulsant in the Canine

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Buddy canine on new anticonvulsant in mobile vet practice san jose

Zonisamide a new type of anticonvulsant in the Canine

Currently in my Mobile Veterinary Practice, I have a patient name “Buddy M” (See the picture above…. Isn’t he cute!) . He has been diagnosed with Canine Epilepsy and is currently on both Phenobarbital and Potassium Bromide. He is on both medications because he had been experiencing seizures, which clustered together. When seizures occur together, the patient is more likely to go into “Status Epilepticus”, which, can be life threatening.

Since starting Buddy on an add-on drug called potassium bromide, Buddy has been drinking a lot of water, and eating voraciously. Because of these side effects, my goal is to try to get him off this drug.

 After determining that Buddy has therapeutic blood levels for both these drugs and is still having cluster seizures I have decided to start a drug called Zonisamide.

Zonisamide is a sulfa drug and seems to have few side effects in dogs. When first starting the drug, some ataxia (unsteadiness), sedation, vomiting and loss of appetite can occur. Because Zonisamide is a sulfa-based drug we need to watch Buddy for signs of dry eye. A disease which causes a decrease in tear production by the lacrimal gland.

After introducing this drug, my goal is to try to slowly wean Buddy off his other meds.

Wish us luck!

 

Update:

As of 11/20/11 Buddy has been on the new medication for 3 months. He has not had a seizure and is off the phenobarbitol completely. Because he had to be heavily dosed with the phenobarbitol to control his seizures, he was showing side effects. Since being off this medication he is no more alert and enjoying life. We are still in the process of weaning off the other medication potassium bromide. 

Carolyn's Buddy's mom reports:

 

"Since you switched his medication to Zonisamide for his seizures he is doing so much
better. He has energy again.  The side affects of his previous medications are gone. 
He is no longer stumbling. He has a normal appetite, no longer is he ravenously hungry
and eating everything in sight.  The drooling and drinking excessive amounts of water 
have stopped completely. With Zonisamide  he is alert, happy, and back to this old self.  
Thanks from both of us for finding this medication for him."
 
 

How to decide the quality of life of my pet

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Pet euthanasia San jose: Does my pet have quality of life

Pet Euthanasia: Does my pet have quality of life?

 

For many a cherished pet is member of the family. So having to decide to euthanize a pet is uniquely painful. In fact for many this might be their first experience with having to make such monumental, emotionally painful decisions.

A decision to euthanizing a pet is personal one. It is based on ones’ own sense of what they feel right for them and their animal. With the responsibility of pet ownership, comes the responsibility of being their stewards in life. Unfortunately, indecision plagues us. Did we do it too soon? Did we wait too long? Did I make the right decisions? Not resolving these feeling of anger and guilt slows the grieving process. A Pet hospice care veterinarian (Villalobos A, VPN, 09/2004) recently developed the HHHHHMM Quality of Life (QOL) Scale for use in patients. This scale has several functions. It can be adapted to help determine the quality of life for a pet, as well as help us decide when euthanasia is the right thing to do. 

 

The HHHHHHMM Quality of Life (QOL) Scale for Dogs and Cats

Hurt

First and foremost, when measuring a pets’ quality of life (QoL) is that pain is adequately managed. There is no quality of life if the pet is experiencing the distress and pain of respiratory distress. Difficulty breathing is detected by closely watching the effort needed to breath. If the pet is having difficulty breathing there is no quality of live. Hospice care is not warranted and humane pet euthanasia is indicated. Diseases which cause difficulty breathing include those involving the heart, lungs, chest cavity, trachea and larynx. Patients should be examine to establish the source and type of pain the patient is suffering from. Pain medication can be given orally, transdermally and by injection. There are many different types of drugs used to control pain. Keep in mind that cats are nortorious for their ability to conceal pain. It is best to start pain medication on a preemptive basis. Many cats endure pointlessly because of this.

 

Hunger

 

Is the pet eating and is it eating enough. Weight and food intake should be monitored. Good nutrition helps to maintain the petx' immune system, which is essential to decreasing secondary infections. If in 3-5 days the pet losses 10% of its body weight, supplementation is required. Cats in particular can be quite finicky. It may take patient coaxing and hand feeding in order for them to eat. Heating the food is important for most cats need to smell their food in order to eat. There are a variety of appetite stimulants which can be prescribed to increase their food intake. They seem to work especially well in the cat. Cancer has been shown to alter the body’s metabolism of protein, fat and carbohydrates. Cancer uses simple carbohydrates preferentially as an energy source so the optimal diet is one that is lower in simple carbohydrates and higher in proteins and fats. A veterinary oncologist or cancer specialist should be consulted for recommendations.

 

Hydration

 

Pets must be drinking enough water to prevent dehydration. Adequate fluid intake is 22ml/kg/day. Subcutaneous fluids can be administered to help maintain a pets hydration. This is the administration of a balance sterile electrolyte fluid just under the skin. Many owners when trained feel comfortable enough to administer fluids subcutaneously on their own. Others hire trained pet care takers to administer the fluids.

 

Hygiene

 

Is the pet able to maintain proper bodily function and thus able to maintain good hygiene. Owner can help in many aspects by keeping wounds clean, preventing weight sores brushing and cleaning. Good hygiene is important for the pets mental well-being Cats are fastidious groomers and feel much better when well kept.

 

Happiness

 

Estimate the level of happiness of your pet? Does you pet seem bored, depressed, anxious do they interact with the rest of the family?

 

1. Bring about events you know your pet will enjoy. Play with them, talk to them and pet them.

 

2. Move them closer to where the family interacts not keep them apart.

 

3. Does your cat purr and enjoy being on your lap? Does your cat still bat at a toy? Watch a laser light? Perk up with catnip?

 

4. Take your pets outside to sit on the grass and enjoy the sun.

 

Mobility

 

1. For larger dogs mobility can be a challenge. Is your pet able to stand and move about on their own? If left immobile, they are prone to secondary recumbent pneumonia and bed sores. 

 

2. Sadly, for these larger dogs, the inability to be mobile because of various musculoskeletal problems is a usual reason for humane pet euthanasia.

 

3. Provide your pet with soft bedding.

 

4. Is your pet able to move around the house for meals, elimination or to be closer to the rest of the family? For cats changing to low rimmed litter boxes or providing small steps up and down to the bed are ideas to improve their mobility about the house.

 

More Good Days than Bad Days

 

1.A pet quality of the life is compromised if they experinece more than 3-5 bad days in a row. Humane pet euthanasia shoule be considered. 

 

2. Bad days maybe those filled with undesirable experiences such as vomiting, nausea, diarrhea, frustration or falling down, or when they are not experiencing events of happiness. 

 

Suffering to death:

 

Some individuals feel that they want their pets to have a natural death. However some dying pets suffer at the end with dreadful respiratory distress they thrash about and become agonal before death. This is not a natural death. In the wild, sick and ill animals will naturally become pray and do not survive long enough to endure suffering to death. Although euthanasia (Greek: good death) is not natural, but it is humane.

 

A visit by a mobile Veterinary service or a veterinary house call practice makes it more convenient and less stressful for the pet hospice patient. Many pets dislike traveling to the Veterinary hospital. null A home visit also allows the veterinarian (Mobile House Call Veterinarian) especially one who provides pet hospice care has the ability to judge and make suggestions about the pets' environment which can improve the quality of life for your pet. Lastly, many owners now have a alternative to have their pets pass peacefully in the comfort of their homes with an in home pet euthanasia

 

For a more detailed description on the HHHHHMM QoL scale, loving in home pet euthanasia and pet hospice care please visit  the rest our website

 

Welcome

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If you are visiting this website and viewing this blog: A Big Welcome!

Please let me introduce my self and my practice. This is a full service Veterinary mobile practice. It is not your typical brick and motor practice, but one on wheels. I bring my whole hospital to your doorstep. I just don't come in an SUV or truck, but a fully equipped clinic, one at the ready to provide a complete house call. This way you don't have to go to another clinic and pay another office visit for a procedure to be performed.

Just think of the time you will save if you have multiple pets. Think of the stress free experience you and your pet will have, not having to get them in the car only to wait in the waiting room.

This state of the art mobile veterinary unit is fully equipped for exams (it has a hydraulic lift table, walk on scale) anesthetic procedures including surgery and a full laboratory.

In addition, I have resources for hospitalization if needed.

With over 20 years of clinical veterinary experience and a specialty in companion animal medicine I am capable of most soft tissue surgeries and have examined thousands of pets. Moreover, as a former medical director of a major metropolitian emergency clinic,

 
 
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