Bad-Mouthed Pets, Part 1

Let me start by saying that I understand ignoring oral care. I spent four years in veterinary school without a trip to the dentist. When I finally went, it took two trips and local anesthesia to get them clean. It hurt. It bled. I don't recommend it. It was a good thing I got in when I did, though. Bear in mind, I brush my teeth a couple times a day, and they didn't look nearly as bad as the pets I see every day.

February is National Pet Dental Health Month, and this is the first of several articles on oral care. I'm going to cover home care, what veterinary cleaning entails and why it is necessary, and the questions and concerns you should have as a pet owner when deciding where to get dental care. But first I need to convince you that oral health is important - important enough to spend your time and money, because dental disease does effect overall health and it does result in pain.

Like many things in medicine, most periodontal disease revolves around bacteria and inflammation. Bacteria in the mouth form a biofilm - basically a colony of germs that creates a slimy film to make them stick to a surface (teeth) and also serves to protect them from the environment. That biofilm is better known as plaque. Over time that slimy plaque layer will mineralize and harden into tartar; this creates a rough surface that is great for more plaque to attach to. It's a handy cycle if you're a bacteria.

Note the dark, heavy buildup (tartar),
and the red, puffy gumline (gingivitis).

Problem is, the body doesn't like bacteria, so the immune system gets fired up and causes inflammation of the surrounding gums. That's gingivitis, and it is readily visible as reddening and swelling at the gumline (go check your pet's teeth, I'll wait). Making matters worse, that biofilm does a good job of protecting bacteria from the immune system, so the inflammation just worsens without solving the problem. Over time all the inflammation damages the attachment between the tooth and bone (the periodontal ligament) and the gingiva recedes; eventually even the surrounding bone itself gets eaten away, leaving a loose, painful tooth.

That's the obvious part of dental disease - except it usually isn't obvious. You don't need a medical degree to see thick, dark calculus on the surface of teeth, but plaque buildup below the gumline causes the worst problems. Likewise, the front teeth often don't look nearly as bad as the molars in the back (see above) - I often call those the "vet" teeth, as the vet is usually the only one to see them. Worst of all is that the real problems for your pet - pain and loose, non-functional teeth - can be almost impossible to recognize. Most of the time the only signs of dental pain are subtle changes in behavior and attitude that often go unnoticed. The pet will avoid using the affected teeth, but if the other side of the mouth isn't too bad there's no change in appetite. Anyone who has ever had a toothache will tell you it's a dull, constant pain they wouldn't wish on an enemy - but they probably muddled grumpily through with it, pain meds in hand, until they could tell the dentist what hurts and wait for them to fix it. Pets can't do the latter; they rely on us to figure out the problem  so they don't have to muddle grumpily and painfully through.

The jagged, dark area is a large fracture
on the inner surface of the tooth.

Fractured teeth are a huge problem, too, given dogs' love for chewing. When a broken tooth exposes the pulp cavity - the vital, living part of the tooth - it is extremely painful. Eventually the root dies and the pain will subside, but now there's a tube leading right up to the bone, setting up for nasty infections. I find alot of fractured teeth wellness exams - and probably miss at least that many, since very few animals will permit a thorough oral exam without being heavily sedated. Indeed, I recently found a fractured tooth on my own dog during a dental cleaning - he'd broken part of it off on the inside surface, which is pretty much impossible to visualize on an awake animal. The pulp was long since dead, so it likely wasn't hurting anymore, but that hole was begging to set up a nasty infection in the jaw.

Speaking of infections - that's probably the most accurate way to think about periodontal disease. You have gobs of bacteria (plaque) causing inflammation (gingivitis) leading to damage of the surrounding tissues. But what's more, those inflamed gums are red and puffy due to increased bloodflow, which means all that bacteria gets quick access to the bloodstream. So, the bacteria could potentially spread anywhere, and studies have shown periodontal disease results in an inflammatory state throughout the body. Another study showed a correlation between dental disease in dogs and changes in the kidneys, liver, and heart. Indeed, in human dentistry correlations between dental health and all sorts of other problems are well established.

This is a long article, so I'll keep the summary short. Dental health is a vital part of overall health and well-being, and we owe it to our pets not to ignore it.

Continue to Part II - Home Oral Care.

Quick Tip: Training Your Dog Not to Jump

Dude. Chill.

Clients often ask me how to get their pets to stop jumping up on them. If you're patient and consistent, it's a very easy behavior to change. You just need to keep in mind two basic principles: all behavior is reward-seeking, and it's easier to learn a new behavior than to unlearn an old one.

First, we have to remove the reward the dog is seeking - attention. When asked how they've tried to get their dog to stop jumping, many say they yell "stop!" and push them away. Well, that's not the best attention in the world, but for a dog it's better than being ignored. To get rid of the behavior you have to stop rewarding it: ignore the dog completely by silently turning away.

Secondly, the real trick is to teach the dog to do different, acceptable behavior to get the reward. The simplest example is teaching them to sit instead. At some point while bouncing around, trying to get your attention, the dog will likely sit on its own - immediately look at them and give a verbal reward ("good dog!"). If they don't do it on their own, you can issue your "sit" command once they stop jumping, but do not look at or otherwise interact with them until they sit. Whenever they stop sitting, ignore them again.

Much like a child throwing a tantrum , the dog may escalate the behavior in an attempt to get your attention, but be patient and consistent - they'll give up eventually. A useful trick if they won't settle down is to walk into another room, then quickly turn and shut them in when they follow, instituting a time-out without actually interacting with the pet (which would reinforce the undesirable behavior). Being patient and consistent are the toughest, most important parts. But stick with it - your dog will learn that the way to get the attention they want is to sit obediently in front of you, rather than bounce annoyingly on top of you.

The Truth About....Anal Sacs.

In any other profession, if a little old lady walked into the office and asked me to "squeeze Muffy's butt," I'd be looking for hidden cameras.

I went to vet school, not art school. Obviously.

Anal sacs, also referred to as anal glands, are pockets that sit right by your dog or cat's anal opening at 5 and 7 o'clock. They produce a thin, nasty smelling fluid which is supposed to be excreted through a small pore every time the pet defecates (apparently in the animal kingdom, it doesn't stink enough on its own). There's muscle pressing up against them also, so pets can express them when stressed out, as anyone who's ever really ticked their cat off can testify.

So, there's my first point - every pet has anal sacs, it is perfectly natural that they fill up and empty, and unless there's a problem they should not need manual expression. There is absolutely no reason for your vet (or more likely, groomer) to empty them unless the pet has a problem that prevents them from doing so on their own. In fact, messing with them unnecessarily may even cause problems.

That said, it is not uncommon for pets to have trouble with their anal sacs. Because the opening they empty through is very small, if the tissue becomes irritated and inflamed those openings may become too constricted to allow complete emptying. As the fluid sits in the gland it tends to thicken, making emptying even more difficult and creating a cycle that will worsen without intervention. This is very uncomfortable for the pet - you can liken it to having a big zit that doesn't want to pop - and often results in signs like:

• Scooting (dragging their rear on the carpet)
• Licking/biting at their rear
• Acting uncomfortable when defecating

Moderately abnormal anal sac secretions.

However, anything that causes irritation of the anus, such as allergies or parasites, will also cause those signs. So when signs first crop up, you should visit your veterinarian to figure out exactly what the problem is. They can identify if the sacs are too full (again, it's perfectly normal for some fluid to be in there) or if the fluid is abnormal; and, if neither is the case they can pursue other problems that may be causing the irritation. Most of the time there's no infection involved, but when there is the vet can also flush the sacs out and infuse them with an antibiotic/steroid cream to calm things down. 

Likewise, if there is a problem with the anal sacs we should be trying to figure out why if possible. In my experience quite a few of these pets have underlying allergies that get the tissue inflamed in the first place; when we address the allergies, the other problems decrease or disappear. Small or soft stools may be part of the problem as well; in these cases adding some fiber to the diet can be quite helpful. Tumors may also develop in this area and prevent emptying of the sacs. 

There are definitely some pets who will have chronic, recurring anal sac issues regardless of the underlying causes or what we do about it. Once we know that, having them expressed by a groomer or technician is a great way to keep them comfortable and save some cash on veterinary visits. But it's important to remember that your vet is the only one who's really qualified to diagnose the problem and make sure something else isn't going on. Occasionally, with repeated infections or ruptures, we may even decide to surgically remove the sacs. And, for those brave, willing souls whose pets have trouble a few times a year, I'm happy to teach them how to properly express them. "Squeezing Muffy's butt" is one thing I have no interest in cornering the market on, after all. 

Don't Slow Down! - Dealing with Arthritis, Part II

Click here for Part I.

Since arthritis ultimately both results from and causes long-term changes to the joints themselves, we can't really expect to cure it. Fortunately, there are many options to improve comfort and interrupt the inflammatory process. A multimodal approach - one using multiple strategies in combination - is by far the most effective and safest; your veterinarian can tailor a plan to your pet's individual problems, monitor improvement, and adjust therapy when and if their arthritis worsens. The ultimate goal is always to keep pets happy and comfortable while slowing progression.


NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)
These are drugs that work in the same manner as aspirin or ibuprofen. They are the medical treatment with the most proven benefits - the right NSAID will make pets more comfortable - but they also have the most risk of side effects. Major concerns include stomach ulceration, as well as kidney and liver damage. Dogs, and particularly cats, are much more sensitive to side effects from these drugs than people, and for this reason they should only be used under the supervision of your veterinarian. That said, when used properly they are incredibly valuable in treating arthritis because they both reduce pain and directly interrupt the inflammatory process, potentially slowing progression.

A practical note - while aspirin can relieve pain in dogs, please don't take it upon yourself to give it to your dog without talking to your veterinarian. It has a high incidence of gastric side effects, and due to the subtle differences in the way it works from other NSAIDs we have to stop aspirin and wait several days before starting more appropriate pain medications. Not doing so can have life-threatening consequences.


Exercise, Weight Loss, and Physical Therapy
While heavy exercise can exacerbate arthritis, moderate exercise is a pillar of dealing with it. Walking is ideal for keeping joints flexible and improving blood flow; swimming is even better when possible, since there's no impact involved. Weight loss is another pillar - it doesn't take a medical degree to realize painful joints hurt more when loaded with unnecessary weight. Fat also produces proteins that encourage inflammation, so it might even directly worsen arthritis. Check out this article for weight loss tips.

Just like with people, physical therapy can be immensely valuable for dealing with arthritis. Often this includes low-impact exercise such as underwater treadmills and specialized stretching. In many urban areas there are veterinarians with special training and facilities for physical therapy; ask your regular vet for recommendations.


Nutraceuticals
There's a laundry list of nutritional products with claims to reduce arthritis. I habitually start arthritic pets on omega-3 fatty acid supplementation, as much research supports their effectiveness at reducing inflammation. Glucosamine and chondroitin sulfate also have some support. I try to keep an open mind - if there's a reasonable body of evidence a supplement is safe for pets, it's worth trying if owners are interested. One thing to keep in mind about nutraceuticals - they are virtually unregulated, so there's no real guarantee of the amount or quality of the product on the label like there would be for an actual drug. For this reason, it's probably best to avoid the bargain product off the shelf at Wal-Mart. Your veterinarian likely carries some supplements who's quality they trust, or they can recommend specific products.

PSGAGs (polysulfated glycosaminoglycans) also have reasonable scientific support for improving comfort and function. They are given as an injection, and having personally seen some dramatic improvement from them recently, I strongly recommend talking to your veterinarian about them early on when trying to address arthritis.


Novel Therapies
Arthritis is very prevalent in older animals; not surprisingly, new treatments are constantly being proposed. Some of these hold promise - stem cell therapy, for example, is already being used in pets, has shown promising results, and has growing research support. Therapeutic lasers have also become very popular. Just like with people, many swear by things like acupuncture, herbs and the like. Myself, I'm skeptical of anything without verifiable research to support it. Believe it or not, the placebo effect has a prominent effect in animals too.  On the other hand, when proven therapies become insufficient, it's hard to argue against trying other modalities so long as there is reasonable evidence they are safe.

When treating any disease, our ultimate goal is to improve pet's quality of life. Considering that, treating arthritis is one of the most rewarding parts of being a veterinarian, because we so often see dramatic improvement in activity, energy, and enjoyment. It all starts with you recognizing that there is a problem, though. So if Muffy doesn't seem to have the spring in her step she used to, ask your veterinarian if there's a way to get it back!