We can choose a good end of life for our veterinary patients…

Frank: 13 years old, 10 months after cancer diagnosis. Enjoying warm rocks at cold New Hampshire river.

I have always been interested in end-of-life care for my patients. A good death and a good end to life is the greatest gift that we can give our canine and feline family. Veterinary medicine has the unique ability to provide relief from pain and suffering when there is no hope that meaningful life can continue. And in that space between diagnosis of a terminal condition and the end of life, we can provide our pets with medical and comfort care that will allow them to feel like themselves for as long as possible.
None of this became so real to me as when my dog Frank was diagnosed with prostate cancer. I have helped my other dogs to a dignified and comfortable end over the years, but none of them had the opportunity to live a significant amount of time with their terminal health conditions.
With Frank, it is different. He was diagnosed with prostate cancer, a diagnosis I don’t frequently see in my patients and a diagnosis that has minimal to no chance of cure. We can only hope to provide patients with a good quality of life for as long as possible. Given that he was diagnosed with a terminal condition at 12 years old, I decided to provide palliative and hospice care to Frank for as long as he was feeling good and living his life the way he had before his diagnosis. The things that make him the dog I have known for the past 12 years are the things that I needed to protect and assess each day and each week to make sure that he is still living a comfortable and meaningful life.
With daily medication to help slow the cancer down and alleviate pain, as well as anti-nausea and gastrointestinal protectant medications, hospice has been an excellent experience for Frank and for our family. There are occasional days when he doesn’t feel well, but the vast majority of his days are similar to the way they were before he was diagnosed with cancer.
By paying close attention to pain management, nausea control, nutrition, anxiety relief, and day-to-day routine, our veterinary patients can have a good life with a terminal condition. Death is inevitable and one of the most important times in any patient’s life, and we, as the human guardians of our pets, have the unique ability to help them to have happy and comfortable final days, weeks, and months. We also have the unique ability to decide that it is time for our furry family to pass. One of the most wonderful things about animals is that they live in the moment and do not think about their tomorrows. Because of this, saying good-bye before our pets begin to suffer does not mean we have cheated them of time or of more living. It means that we are giving them the gift of living every moment they can up until their health condition causes them to suffer.
We don’t know how much time we have left with Frank…in fact, he has lived far longer than I would ever have thought. I am so thankful for the time we have with him, and I am so thankful that he has taught me how good hospice can be for our veterinary patients. Please enjoy this short video of Frank living his life with cancer and a good hospice plan.

Kennel Cough

We’ve recently been experiencing a little uptick in the number of canine patients with kennel cough. This is a relatively benign cough, but it’s a major nuisance for the dog and its people.

“Kennel cough” is actually a catch-all term for any infectious cough that dogs get. Many organisms are known to cause it, ranging from viruses to bacteria. The affected dog has a cough that typically sounds like something is caught in his throat, and this cough usually ends with the dog gagging.  The dog usually feels fine and has good energy levels and appetite, but just suffers from this highly annoying cough. And the owners may be kept up at night listening to this cough!

Since this is spread from one dog to another when an infected dog coughs or sneezes on a susceptible dog, kennels are ideal environments for transmission. Of course, wherever dogs meet up with each other, kennel cough can be spread. While we see cases all year round from dogs that have boarded at kennels or spent time in daycare centers, many of our recent cases have come from dogs that play in the area’s dog parks. Less frequently, dogs can pick up kennel cough at the groomer’s.

It’s not easy to prevent kennel cough. It’s just like the common cold: you can eat right, exercise, and seem like the healthiest person around…until someone coughs or sneezes on you and you get sick. There are vaccines for kennel cough, but these are not always effective. At least ten or more organisms are known to cause kennel cough, and most vaccines only contain two to three of these agents.

The vaccine is most commonly given in the nose (“intranasally”) where it creates a low-grade infection that the immune system should, in theory, respond to. It can take at least a few days if not longer for the immune system to build up adequate resistance to these few germs. The most common problem we see is that owners get this vaccine last-minute- the same day the dog is due to enter a boarding kennel- and the dog has not had time to develop immunity before being exposed. In addition, this dog, when placed in a kennel without the rest of its pack (of humans), is stressed. Stress causes release of the hormone cortisol, which suppresses the immune system, which can make the dog get kennel cough from the vaccine! It’s not surprising that kennels that require this vaccine still experience many cases of kennel cough.

What can you do to try to prevent or treat kennel cough? Probiotics may help. These healthy bacteria can stimulate the production of the type of antibody that guards the respiratory tract. Studies in humans have shown that people who take probiotics at the onset of the common cold get over the cold much faster than those who do not take probiotics. It’s not a bad idea to put your dog on probiotics if you are going to board her, take her to daycare, or just socialize her frequently.

Homeopathic remedies can help sometimes. When the correct remedy is given, the coughing dog may return to normal within hours to a day.

Cough suppressants help in many cases. The over-the-counter versions tend to not be as effective as the prescription ones. Drowsiness is the major side effect, but sleep is restorative! We rarely prescribe antibiotics as these may actually prolong the course of the illness. We reserve antibiotics for dogs that are not in good health or have other problems that put them at higher risk for pneumonia.

Can I still board my dog if she has kennel cough? Sorry, no. The goal of every kennel is to prevent the appearance of this nuisance illness. If you know that your dog has kennel cough, you should not board your dog or take her to daycare or parks until she has been better for at least a week. Normal otherwise-healthy dogs who contract kennel cough typically get over it in 7-10 days. New dogs in the house may take up to a month to stop coughing. You will have to rearrange your plans, enlisting friends and family or hiring a professional pet sitter.

Kennel cough is an annoyance but rarely becomes serious in the healthy dog. If your dog shows signs of kennel cough, keep him away from other dogs and give him lots of TLC to speed the recovery.

Things that go BOOM! in the Summertime: Thunderstorms and Fireworks

Summertime can really push the limits for many dogs with noise fears. Thunderstorms and fireworks alike can cause these dogs to shake, hide in bathtubs and closets, destroy things in the house, and in the worst cases, jump out of windows. Many of us just want to cuddle with our petrified buddy, although this is not possible when the thunderstorms occur while we’re at work.

We have many tricks up our sleeves for ameliorating dogs’ fears during these events. Here are some of them:

  1. Composure by VetriScience. This is a natural and safe calming supplement that comes in a chewable form that dogs like. Its active ingredient is L-theanine, which is found in green tea and is what gives you that calm feeling after drinking it.  We carry this supplement at WAH.
  2. Tight wraps like ThunderShirts. These take about 10 minutes to calm your dog. The ThunderShirt company claims a “dramatic calming effect for over 80% of dogs.” You can order this on-line.
  3. Melatonin. This is a hormone that some people with insomnia take. It appears to have a beneficial effect in calming dogs with thunderstorm phobias. It is recommended to give it one hour before a storm for the most benefit. This is generally available at most stores that sell nutritional supplements.
  4. Adaptil collar, diffuser, and spray. This is a product that mimics the natural pheromones that a bitch produces when she is nursing her pups. This hormone has a calming effect. The company is marketing it with thunderstorms and fireworks as indications for its use. We carry this product at WAH.
  5. Addendum 6/26/13:  We’ve just learned of a product out of the U.K. called “de-stress and calming” by Pet Remedy.  Its active ingredient is valerian in a low concentration and it works via aromatherapy.  Anecdotally, many of Dr. Epstein’s U.K. colleagues rave about this product.  It is available as a plug-in diffuser as well as in spray mist form.  You can order it on line but be sure you get the plug-in prongs that fit U.S. outlets!
  6. Addendum 8/20/13: We have the product and the preliminary reviews are very favorable! We are now carrying the aerosol plug-ins, a large spray bottle, and a tiny spray bottle.

Some dogs will do well with just one of the above measures, while others may require two or more. All are compatible with one another.

We do not generally recommend reaching for sedatives like acepromazine first, unless there is a real concern that the dog will harm himself or be destructive to your house. Most sedatives do nothing to relieve the fear, but they instead make the dog so drowsy that he will not be able to express his reaction as effectively.

At Wilmington Animal Hospital, we see many patients that suffer from noise fears and phobias. We are happy to discuss management of your dog’s specific thunderstorm, fireworks, and noise phobias. Please visit our website for more information on how to reach us: WilmingtonAnimalHospital.com.