Friday, November 20, 2009

Dentistry Pearls from the AVDS Forum including breed specific dentistry Oct 2009

By Dr Ken Lambrecht

I have just been back for just less than a month from the American Veterinary Dental Society’s annual forum and wanted to share some pearls that can help your 4 legged friends have better breath, prevent pain, tooth loss and even prevent generalized disease.

This annual 3 day conference was held this year in Phoenix (the weather WAS AWESOME especially compared to Madison's cold rainy fall) but even so I went to 90% of the lectures proving I am a true dentistry geek! Seriously, the best & the brightest in dentistry convene and they let practitioners like me listen to their brilliance! I have attended this conference since its inception in 1986 and in the past 5 years have taken staff Drs & my CVT’s as well. It never disappoints. Here are some pearls I brought back!

1) Breed specific dentistry is becoming much more advanced and now that rescues, “designer” and mixed breeds are more prevalent it is important to know the genetic background so that we can be more proactive as to what dental conditions a pet might be “at risk” for.

WFPC has practiced breed specific dentistry for over 5 years (the following breeds need a different dental prevention and treatment focus)

Here is what we typically watch for in each of these breeds.

1) Retrievers = chipped teeth and discolored teeth
2) Pugs, Bostons, Boxers, Shitzus, Lhasas, Bull dogs = missing teeth, crowded, partially erupted canine teeth, deciduous canine teeth
3) Yorkshire terriers, Miniature poodles, Chihuahuas and many other toy breeds = retained deciduous (baby) teeth, missing teeth, un-erupted teeth
4) All small dogs less than 20 lbs = prone to periodontitis & teeth loss because of very thin amount of bone around each tooth
5) Greyhounds = genetically prone to periodontitis

This is a very partial list and one that is rapidly expanding. It makes me believe that if we knew from an accurate DNA genetic test (Wisdom Panel) that a dog had greyhound DNA whether an aggressive home care program could help counteract their tendency towards severe periodontitis and tooth loss?

2) Home care pearls for all dogs

A comprehensive personalized home care plan can provide you with many tools to help prevent too frequent dental cleanings. The question becomes which are going to be easily accomplished and the most effective?

See veterinary oral health council (VOHC) for complete list of validated products that have proven effective. My advice is choose which ones work best for you and your pet and can be done routinely.

My historical favorites are:

1) Periodontal vaccine (helps prevent bone loss)
2) VOHC approved foods (best compliance)
3) Oravet ® barrier sealant (effective & easy)
4) Evidence based tooth brushing pastes & rinses (most effective)
5) Treated rawhide chews like CET Chews ® (easy)

Now a new product that looks to have great promise in small dogs & cats is the evidence based water additive called Healthymouth ® the first water product to get the VOHC seal of approval.

Fish oils were discussed in two separate lectures (particularly EPA) as up & coming treatment in humans to treat severe periodontitis both in food and topically. Any of you who know our style of practice at Westside Family Pet know that we are huge proponents of high levels of EPA/DHA for many organs and have often discussed the possibility that they would benefit the mouth too. It seems that proof may be on the way! Stay tuned!

3) There are 10 Vital Steps to Good Pet Dental Care

(Complete explanation at westsidefamilypet.com)

Proper care of your pets teeth really boils down to making sure your pets dental program includes all of these 10 vital steps

1. Is comprehensive and follows established guidelines within the veterinary profession (AAHA & AVDC) Dentistry Guidelines have been established by the American Veterinary Dental College (AVDC) and the American Animal Hospital Association (AAHA) since 2005.

Link to AAHA Dental Care Guidelines
Link to American Veterinary Dental College AVDC

2. Includes dental x-rays in all pets.
3. Preemptively addresses concerns about pain
4. Takes into account breed specific conditions.
5. Completely addresses home care & a strong preventative approach.
6. Is cost effective in these tough economic times
7. Detects “surprises” to possibly avoid an additional anesthetic episode.
8. Includes special training & equipment to perform additional procedures identified after cleaning & dental x-rays performed
9. Addresses anesthetic risks & concerns completely
10. Includes referral to a dental specialist or telemedicine consult if needed/desired

Not all pet dental health care is equal. We need to keep evidence based information at the top of all our pet dental care recommendations. Make sure your veterinarian is doing all of these things especially in the high risk dogs listed in my breed specific section. Saving teeth, preventing infection pain and additional cost will all be likely outcomes!

Further reading at Link to Pet Dentistry Library

We hope you find this useful for your pet’s dental health!

Feel free to ask any questions you have. If I can't answer it I will gladly refer you to a dentistry oriented colleague who can!

Dr Ken Lambrecht

Saturday, November 14, 2009

Treating & Preventing Disease with Nutrition

Evidence based nutrition & supplements: Which products have the ability to treat & prevent disease?

As a practicing wellness veterinarian for over 25 years no area has been as exciting (or challenging!) as treating and preventing disease with nutrition. The following data has been compiled from the following lectures given by board certified veterinarians (most un-affiliated with pet food companies). I have provided links directly to peer reviewed websites as many as possible so you can do you own research in this very exciting area.

I am well aware that talking about nutrition is akin to discussing politics & religion. We all have firmly held beliefs and our emotions are often involved. As a veterinarians based in science we owe you the best science based perspective to help you make the right decisions regarding nutritional products, amounts to feed and what wellness issues are specific to your breed (or mixture of breeds). There is even some exciting emerging evidence that certain breed specific feeding has merit.

Recent lectures by board certified DVM’s (Nutrition, Internal Medicine & Surgeons) that I have attended to compile this review.

Naturally Neutraceutical Dr Rob Silver DVM Madison WI Sept 2006
Using Nutrition to Enhance Patient Care Dr Lisa Freeman DVM DACVN Oct 2007
Hills Symposium of Evidence Based Nutrition Dr Phil Roudebush DVM DACVIM Nov 2007
UW Orthopedic Considerations for the Canine Athlete Dr Paul Manley DVM DACVS Nov 2007
Rehabilitation in Veterinary Medicine Sherman Canapp DVM DACVS et al April 2008
International Veterinary Rehabilitation Symposium Dr Julie Churchill DVM DACVIM Aug 2008
Practical Small Animal Nutrition Dr Kathyrn Michels DVM MS DACVN Lake Delton Feb 2009

Important Disclaimer:

This information is in no way to be used without the guidance of your own veterinarian. The assessment of health status and deciphering the best nutrition & supplements for your dog is a complex science and art!

ALL OF THIS INFORMATION NEEDS TO BE CROSS CHECKED AND USED WITH THE ASSISTANCE & GUIDANCE OF YOUR VETERINARIAN

Without their guidance with regard to lab testing , a good physical exam including a body condition score, knowing all underlying conditions (and for rescues/mixed breeds their true genetic makeup) much of this information cannot be properly or safely applied.

Most common diseases that we see as wellness clinic veterinarians

  • 75 to 85% have Periodontal Disease
  • 50 to 60% are above their Ideal Weight
  • 20 to 30% have Osteoarthritis
  • 10% to 20% have Allergies (inhalant or food)
  • 10% to 20% Organ Failure (Kidney, Liver, Pancreatitis, Diabetes)
  • 5 to 10% have Urinary Stones (kidney or bladder)

Many of these are breed specific i.e. small breeds get much more periodontitis and larger breeds generally have much more arthritis & orthopedic problems like hip dysplasia

List of diseases we commonly treat with Rx foods & supplements (partial list)

  • Diabetes
  • Obesity (over 20% of ideal weight)
  • Periodontitis
  • Renal failure
  • Inhalant allergies
  • Food allergies
  • Liver disease
  • Pancreatitis

1) To prevent Periodontitis (Grades 1 & 2) affects 75 to 85% of pets

Best resource for products: Veterinary Oral Health Council vohc.org

Best assurance of quality: VOHC seal of approval given if food is at least 20% better than typical commercial brand in preventing. Plaque claim is better than just a tartar claim

Specialists viewpoints Dr Fraser Hale DVM FAVD Dip AVDC

Dr Jan Bellows DVM FAVD Dip AVDC

Products Rx Foods Hills T/D ® & Purina Dental Diet ® (VOHC accepted plaque & tartar claim)

OTC Foods Hills Oral care ® (VOHC accepted plaque & tartar claim) & Iams Dental Defense ® (VOHC tartar claim one product in family)

Rawhide chews Cheweez rawhide chews have VOHC acceptance, CET Hextras have good evidence (but are not VOHC labeled)

Water additive healthymouth.com 1st VOHC seal for a water additive

Home care using tooth pastes, a plaque retardant gel (Oravet) and a periodontal vaccine are outside the scope of this nutritional discussion but are the mainstays of prevention and should be discussed with your veterinarian.

more information

Breeds we specifically need to watch

All dogs under 20#, all Brachycephalics (bulldogs, pugs etc) because of teeth crowding and greyhounds (have a genetic predisposition towards)

Best source to discuss: dentistry oriented veterinarian- ideally an American Veterinary Dental Society Member (AVDS) or a board certified veterinary dentist (We have 3 at U of Wisconsin!)

2) To treat & prevent Obesity (20% over Ideal Weight) affects 40 to 50% of pets

Best national site Association for Pet Obesity Prevention

Best resource for why & how your veterinarian or westsidefamilypet.com

Products Prescription Rx Foods: Hills, Royal Canin, Purina, Iams (all available from your veterinarian) Rx because physical exam, lab testing and calorie counting to be safe and effectively used.

“Over the counter” OTC foods: “light formulas” (must be under 320 Calories/cup)

Supplements: L-Carnitine, Isoflavones, EPA/DHA (fish oils), Level 2 evidence exists

Breeds we specifically need to watch Beagles, Pugs, Scotties, Dalmatians, Labs & Golden Retrievers

3) To treat & prevent Osteoarthritis (includes degenerative disease related to hip dysplasia, elbow dysplasia, ACL tears) 20 to 30%

Best way to prevent JAVMA wt loss study

Best resource for supplements Consumerlab.com

Products Rx Foods Purina JM ® & Hills J/D ® (force plate studies have been done by each company)

Over the counter (OTC) Foods Calorie Appropriate Feeding

EPA/DHA Fish oils 20mg of EPA per lb per day (details)

Joint supplements (DASUquin ® & Glycoflex ®) per label (details)

Challenges: Not FDA controlled so there are major quality control & effectiveness issues

Breeds we specifically need to watch Labs, Golden Retrievers & all large breeds, Cavalier King Charles, cats!

4) To help treat Allergies (inhalant & food) 10 to 20%

Nonspecific treatment only (inhalant blood testing & food elimination trials must be done to diagnose)

EPA/DHA 20mg EPA/lb about 7 to 8 human fish oil capsules for a Labrador

Challenges: dosing & convenience/compliance

Best resource for general info (human & some pet info) consumerlab.com

5) Probiotics (emerging area)

Proviable by Nutramax first to have good evidence

Nutriflora, Vetriscience & Prostora

Quality control a huge issue (colony forming units etc)

6) Breed specific nutrition

Royal Canin has established some very interesting information with regard to breed specific nutrition. Although there is certainly not data for all breeds and it needs to be researched much more they have provided some excellent and comprehensive background. See their Yorkshire Terrier example

Other useful websites for additional information:

Ohio State College of Vet Med website “Comparing Prescription Diets”

www.vet.osu.edu

Your thoughts welcomed! Lets begin the dialogue.

Dr Ken



EPA/DHA Fish oils resources

Freeman, Lisa OSU Waltham 2002 Nutritional Conference

Mueller RS, et al. J Sm An Proc 2004, 45:293-297.

Simopoulos AP. J Amer Coll Nutr 2002, 21:495-505

Bauer JE. I Am Vet Med Assoc 2006, 229:680-684.

Caterson B, et al. Hills European Symposium Genoa, Italy, Apr 2005:14-18.

Brown SA, et al. J Nutr 1998, 128:2765S-2767S.

Smith CE, et al. J Vet Inter Med 2007, 21:265-273.

Obesity resources

1. “Feeding for Fitness” Dr Julie Churchill DVM DACVIM PhD Intl Rehabilitation Symposium Aug 13 2008.

2. “Obesity’s missing link: The union of metabolism, genome & disease” Dr Jane Armstrong DVM MS MBA DACVIM U of Minn

3. “An evidence-based review of the use of therapeutic foods, owner education, exercise, and drugs for the management of obese and overweight pets” Dr Phillip Roudebush DVM, DACVIM et al JAVMA Vol 233 No 5 Sept 1, 2008

4. “An evidence-based review of the use of nutraceutical and dietary supplementation for the management of obese and overweight pets” Phillip Roudebush DVM, DACVIM et al JAVMA Vol 232 No 11 June 1, 2008

5. Effect of weight reduction on clinical signs of lameness in dogs with hip osteoarthritis Mark A Tetrick, Peter Muir Journal of the American Veterinary Medical Association Apr 2000, Vol. 216, No. 7, Pages 1089-1091: 1089-1091.

Misc resources

Isoflavones Research Report Purina Research Report Volume 12 Issue 1

Obesity’s Missing Link: The union of metabolism, genome and disease Hills

Tuesday, November 3, 2009

Breed Specific Wellness

Breed specific wellness 2009!

Breed specific wellness is not brand new but it is certainly getting exciting.

First to give credit where credit is due this area of wellness has been pioneered by two colleagues Shannon Pigott CVPM and Nan Boss DVM.

Nan’s American Animal Hospital Accredited (AAHA) practice in Grafton, Wisconsin has already implemented these programs. I especially like her emphasis on breed specific conditions for mixed breeds after finding out what different breeds are present using the new DNA test (more below) http://www.bestfriendsvet.com/html/wisdompanel.htm As many of the dogs and cats we see at WFPC are mixed breed rescues this has direct application.

Ms Pigott’s coaching and business skills and her broad reach in the veterinary community will be a great asset to spread this concept. (She just presented this at our the Wisconsin State Veterinary Meeting in October) She has been working on breed specific conditions since 1998 and will be integral in stimulating the development of tools to help us as veterinarians to implement this.

With over 200 recognized breeds you can imagine the volume of information that needs to be sorted through to insure reliability of both medical disease and behavior prediction. This site www.upei.ca/~cidd/intro.htm is just a glimpse and has not been updated since 2004 so it has likely already been superseded by the rapid explosion of genetic testing capabilities that is currently underway.

Another AAHA colleague in Arizona has developed quite a nice list of conditions specific to certain breeds.

http://www.hillsidepets.com/index.php/pet-care-pages/66-canine-breed-wellness

So here is how it might play out in our clinic.

Scenario #1

A client brings in a rescue that appears to be part cocker spaniel. We take an easy blood sample and a DNA test is performed (cost of around $125) and indicated that indeed the pet is 45% cocker spaniel. We know that Cocker Spaniels are prone to glaucoma, ear infections, and many other things and we want to do all we can to prevent those diseases and detect them before they cause problems if possible.

As a result of the DNA test we take ocular pressures with our Tonopen to screen for glaucoma and find at least for now everything is OK but set up a schedule of annual rechecks to make sure we keep on top of this now known underlying condition. For the possibility of allergies and ear infections we advise the addition of anti-inflammatory doses of EPA (the key anti-inflammatory ingredient in fish oil) to her diet and discuss how to detect allergies.

Scenario #2

We sit down at a puppy consultation (we offer these as a courtesy to our clients) and discuss the many behavioral and medical characteristics that a client might encounter with a certain breed of puppy (or a mixed breed that contains a majority of a particular breed) say a Boxer who as a breed are know to have higher rates of cancer than other breeds. We would use a referenced list of medical conditions to substantiate our discussion. The outcome might be that the owner having just lost a family member to cancer decides she just doesn’t want to take that additional risk and chooses a different breed despite the great behavioral and fun look that boxer dogs have.

Wellness has always been the backbone of Westside Family Pet Clinic. Annual blood work and laboratory testing, dentistry, ideal weight, osteoarthritis, prevention of tick carried diseases and vaccinations have always been our core wellness steps in all breeds but now we are ready to take this next step forward towards breed and breed group specificity.

This is how we currently apply breed specific wellness:

1) Breed specific dentistry

We have always spent 2 or 3 times as long discussing dental disease with a smaller dog that with larger dog. They simply have more dentistry issues and we need to be much more proactive in these small breeds to prevent disease and tooth loss. Greyhounds have a known genetic predisposition to severe periodontal disease. Brachycephalic (short nosed) breeds have a much higher incidence of missing teeth and crowded teeth as well as periodontitis. Knowing this at an early age could prevent much in the way of severe damage to the bone and associated tissues Link to benefits of a 12 step teeth cleaning

2) Breed specific nutritional supplements

Perhaps more of a specificity for a breed grouping like the retrievers, sporting breeds and agility breeds than just one breed a nutritional supplements like joint supplements are more important to some breeds than others including our active sporting breeds and large and giant breeds like Labradors, Golden Retrievers, German Shepherd Dogs, St Bernards, Great Danes, Newfoundlands. They need the benefit of high quality joint supplements as well as appropriate levels of EPA & DHA (fish oils) than other breeds to help combat the higher risk of Anterior cruciate ligament (ACL) injury link to supplements

3) Ideal weight

Our Ideal weight programs over the pat 3 years have shown that certain breeds are overrepresented. Obesity prone dogs like Beagles, Labradors, Golden Retrievers, Dalmatians and Pugs have outnumbered all others. What a great thing to see that coming and take steps to prevent it. The new Mars test promises to give an ideal predicted weight. Stay tuned to see how accurate and useful. Any guess towards a dog’s true ideal weight is good guess in the right direction! Link to benefits of ideal weight

4) Tick related disease in Labradors & Golden Retrievers

Just presented information at the WVMA meeting indicates that both Golden Retrievers and Labradors are more prone to the tick carried diseases both Anaplasmosis and the fatal complication of Lyme nephritis than other breeds. Knowing that these breeds are at increased risk will allow us to emphasize that and hopefully get more specific protection in place via vaccination or optimal tick prevention.

read more at tick disease update 10/09

5) Breed and lifestyle specific vaccination

Also at the Wisconsin Veterinary Medical Association conference this past week a Dr Richard Ford a world renowned vaccination expert acknowledged that certain breeds like Dachshunds are more likely to have vaccine reactions because of their size and possible underling genetic predisposition. We will be taking steps like separating out certain vaccines to avoid complications when the same might not be at all necessary for a Labrador puppy. As stated above for a Labrador or Golden Retriever puppy coming to our practice a Lyme vaccination discussion is going to more important than another breed based on emerging evidence.

Interested in testing your mixed breed or rescue?

There are several DNA tests currently on the market including both saliva for owner use and blood test for professional use. The Wisdom professional panel test is a blood test available through veterinarians for over 200 breeds and has recently added a breed specific condition report and even a predicted adult weight.

The test should be considered for any non pure bred dog to determine breed specific health risks. One caution is that phenotype (the outward appearance) and genotype (DNA) do not always allow us to guess accurately from visual appearance. See lots of great results on the Wisdom “Doggie DNA“ Facebook fan page.

Please let us know if you have any questions or comments in this exciting area. This is an open blog so please feel free to share! Dr Ken