Breed Specific Wellness for Pugs
The is the first of comprehensive breed specific wellness preventative programs based in part on the work of Dr Nan Boss & Shannon Pigott (see below). My intent is to apply breed by breed cutting edge genetic information with nutritional & preventative wellness steps to allow pugs to live as healthy a life as possible!
I have chosen pugs for three reasons. First, I love the breed! (One of my boyhood pets was an English Bull Dog, named Chloe, so have always had a fondness for the “smushy faced” breeds!) Secondly, we see a lot of them at our practice in Madison, Wisconsin and finally I need to speak to pug owners at the Milwaukee Pug Fest in May (over 1100 pugs in one place can you imagine?) and want to give them the very latest information specific to their breed so yeh pug wellness, here we go!
Credit where credit is due is to Dr. Nan Boss who is medical director of a fantastic practice (Best Friends Veterinary Center in Grafton, Wisconsin) and has been practicing breed specific wellness for many years in her practice. Dr Boss has partnered with Ms Shannon Pigott, a well known veterinary consultant to provide a soon to be released book and other tools to veterinarians to help enhance the staff training & delivery of these details. With over 200 recognized breeds you can imagine how much work has gone into this project! Thanks Nan & Shannon for your efforts on behalf of all breeds!
All veterinarians practice some degree of breed specific wellness depending upon the most common breeds they see and their special medical interest areas (in our practice Ideal Weight, pain management, dentistry, use of the fish oils EPA/DHA are daily discussions with clients.
So, by organ system we know pugs have these increased health risks/conditions and these are the steps we can take to detect them early and hopefully prevent as many as possible:
DENTAL
The combination of a brachycephalic(shortened) jaw and very little bone around teeth (compared to larger dogs) makes the pug very prone to Periodontitis and premature tooth loss because of bacterial destruction of the bone surrounding the teeth.
In addition, the premolars just behind the lower canines are often un-erupted and embedded in the jaw (much like wisdom teeth in people) which can cause dentigerous cysts if not removed.
The lower & upper canines can be partially erupted which can cause osteitis (infection in the maxillary or mandibular bone). Finally in puppies the upper and lower deciduous (temporary) canine teeth can be retained and interfere with the development of normal jaw occlusion/alignment.
What can be done for early prevention/detection?
1) Follow a professional 10 step dental program starting at time of spay/neuter
(usually between 4 & 8 months based on tooth eruption)
2) Full mouth radiographs (x-rays) while under anesthesia
3) Selective removal of teeth (un-erupted or overcrowded or deciduous)
4) Aggressive home care starting at 6 months
5) Use of periodontal vaccine
CARDIAC
Sick Sinus syndrome - a condition that causes a slowing of the heart rate due to excessive vagus nerve or a pacemaker problem.
What can be done for early detection/prevention?
1) Annual physical to include pulse, auscultation with stethoscope and ECG as needed
DERMATOLOGIC
Something in a pugs genetic makeup causes alopecia (hair loss), atopy (inhalant allergy), demodex (skin mites), to be more common and their excessive skin folds (which make them so darn cute!) also makes skin-fold dermatitis more common.
What can be done for early detection/prevention?
1) Have suspicious lesions diagnosed for mites
2) Consider daily anti-inflammatory doses of EPA fish oils
3) Consider use of preventative gels & wipes in skin folds
4) Inhalant Allergy testing (blood test)
5) Maintain Ideal Weight
ENDOCRINE/METABOLIC
Heat stroke is more common in pugs and needs to be avoided
What can be done for early detection/prevention?
1) Maintain ideal weight
2) Follow safe exercise guidelines
3) Consider palate resection (if severely affected)
MUSCULOSKELETAL
Legg-Calve-Perthes disease; patellar luxation are both more common in pugs
What can be done for early detection/prevention?
1) X rays of hips & knees to establish a baseline
2) Consider evidence based joint supplements & daily anti-inflammatory levels of EPA (fish oil)
3) Maintain Ideal Weight
NEOPLASTIC (Cancer)
Mast cell tumors (MCT), oral melanoma are both more common in pugs than most breeds
What can be done for early detection/prevention?
1) Have all masses aspirated and aggressively removed as indicated by aspiration
2) Consider anti-inflammatory doses of EPA as possible partial protection (No solid evidence yet but EPA has been shown to be anti-cancer with other types of cancer)
3) Vaccination is now available now to treat Grade 3 MCT
NEUROLOGIC
Hemi-vertebrae (fused vertebrae) is rare but does occur
What can be done for early detection/prevention?
1) X-ray spine w/ spay/neuter
2) Maintain Ideal Weight
OPTHALMIC
What endears us to a breed also sometimes causes them to be “high maintenance” in terms of health/medical. Thus it is with the beautiful big eyes of a pug! They are what we call a bupthalmic breed (eyes protrude) which is related to the previously mentioned brachycephalic or shortened jaw. The following are common eye problems in pugs Cataracts, corneal ulcers, distichiasis (abnormal eyelid lashes); Keratoconjunctivitis Sicca (KCS or dry eye) proptosis (eyes out of socket) are all issues we need to contend with.
What can be done for early detection/prevention?
1) Fundic (internal eye) exam & Tear function test as part of wellness exams
2) Anti-inflammatory levels of EPA (has been shown helpful to treat KCS in people)
3) Use harness and gentle restraint at all times
4) Referral to board certified veterinary ophthalmologist as needed
RESPIRATORY
Respiratory dysplasia (elongated soft palate)
What can be done for early detection/prevention?
1) Maintain Ideal Weight
2) Consider palate resection at time of spay or neuter
UROGENITAL
Dystocia (difficult births)
What can be done for early detection/prevention?
1) Maintain Ideal Weight
Again far from trying to scare anyone about all that is “out there” that can affect all the dear pugs, (or any breed) just knowing what can happen, what to look for and taking preventative steps is key.
From my perspective/count by maintaining ideal weight we can help prevent or mitigate to some degree more than half of the listed conditions. If pugs follow the studies done in Labradors they will live an average of 15% longer just by keeping them their ideal weight.
Our Ideal Weight Facebook Group has lots of fun ways to help and great links & resources too!
It will be interesting to see as we move on to the most common breeds we see how many of their health conditions can be similarly controlled by weight management.
If there are over 200 recognized breeds then this is one down 199 to go (anyone see the movie Julie & Julia? (-: ...
Not going to happen (esp in a calendar year from me I can tell you that, but maybe Dr Nan & others may want to address that (-;
The basic preventative concepts overlap greatly form breed to breed especially with regards to ideal weight & supplements so stay tuned on that theme here!
Look forward to seeing you perhaps at Pugfest!
Dr Ken
Saturday, April 10, 2010
Tuesday, March 2, 2010
Preventative Nutrition = Ideal Weight & Evidence Based Supplements… but which ones truly are safe & effective.... & which specific breeds can benefit?
If I were asked to list the “high leverage” nutritional steps that can be taken to help pets live longer, feel better and have fewer health problems, Ideal Weight would top the list, but supplements would be next in importance based on recently published scientific articles.
From a breed specific focus, some supplements are appropriate for all breeds (the omega 3 fish oils = EPA/DHA); others such as dental prevention products have more of a small breed focus, and joint supplements are more important for larger breeds. The expenditure of a pet owner’s hard earned dollars (especially in this economy!) on a pet food or a supplement that claims to prevent tartar on your pet’s teeth or alleviate joint pain needs to be taken seriously!
There is now very good evidence to support the use of certain nutritional supplements in pets. Because supplements are not FDA regulated, proof of effectiveness and quality and even safety is not assured, effective doses are not listed on labels, and consumers (and veterinarians) are offered little support in the form of evidence based studies. A natural product like fish oil cannot even be patented which reduces the incentive for companies to promote and perform in-depth studies. With studies finally emerging, at least for certain categories, the product landscape is getting deeper and more competitive and the time is now for analysis so it can truly benefit our pet’s health.
It is very important that consumers have a place to turn for good information. Many of these products are expensive and effective blood or tissue levels must be reached to see any benefits. Interaction with other medications, purity, quality and recent safety issues are all-important issues. With the veterinary medical credo of “above all do no harm” we feel that we as practicing veterinarians need to be on the cusp of this rapidly emerging area to provide optimal wellness to pets.
A few definitions are in order.
Evidence based simply means that there is enough proof done in a controlled, unbiased manner to substantiate that a product really has a desired effect on a specific condition. Evidence is ranked from level 1 (best) to level 4 (anecdotal) according to how many pets participated, how the study was conducted and generally how unbiased the information is. As scientists, we need quality studies to be able to give you the proper dose or recommend one product over another.
A nutraceutical is any nutritional supplement that has the ability to treat or prevent disease. Because these products are not drugs there is no FDA regulation of effectiveness or quality. That means every claim of health benefit must be scrutinized carefully and the quality & the integrity of the company researched. Quality assurance needs to be proven by independent sources like Consumer Lab www.consumerlab.com, National Animal Supplement Council (NASC) www.nasc.cc or the United States Pharmacopoeia (USP) www.usp.org as some expensive ingredients have been “left out” historically and contaminants identified when independent tests were performed.
Proof of effectiveness is not required for supplements so we need organizations like the Veterinary Oral Health council vohc.org (which is similar to ADA in human dentistry) to insure the effectiveness of products. It is an independent board of veterinary dentistry diplomats that review scientific studies and verify dental product claims. For other categories of supplements we rely on published studies by board certified specialists in peer reviewed scientific journals.
Breed specific wellness If you have followed any of my blog posts you know that veterinarians are increasingly fine-tuning wellness to specific breeds. With over 200 breeds this is a huge collaborative undertaking! We have broached dentistry, ideal weight and now supplements, (breed specific nutrition is next!) because these are the most common things we see in our busy daily preventative practice. It has been predicted this is the future of wellness for pets ….I strongly agree!
Just two IMPORTANT clarifications ….
Who are the experts? There are only 50 or so board certified veterinary nutritionists worldwide. (They are so rare the University of Wisconsin Veterinary Hospital doesn’t have one!) Many work for the larger pet food companies but some are in academia and/or have consulting services. The American Academy of Veterinary Nutrition(AAVN) is a growing community of board certified veterinary nutrition experts devoted to sharing & getting good independent information out there.
All of us (veterinarians,too!) make the final decisions for our pet’s wellness. Given the scarcity of good studies and the lack of a strong motive for companies to educate & prove effectiveness, final decisions need to be a combination of the best information available, applied to a specific breed wellness program, and based on a complete physical exam and appropriate wellness testing. Only your personal veterinarian has the knowledge, training and the established client-patient relationship to provide that.
I am here to simply open the door to the questions that I feel should be posed to your veterinarian and increasingly the pet food & supplement industry to give us better information & regulation. The American Animal Hospital Association(AAHA) task force is just finishing its initial set of Nutritional Guidelines. I look forward to seeing their stance and resources for supplements as those should help us address some of these issues. There is also a great book about pet nutrition coming in May 2010 that I hope will contain some supplement information “Feeding your pet Right” by Marion Nestle & Malden Nesheim.
The future is bright for evidence-based veterinary nutrition!
Dr Ken
Based on available evidence here is my list of well referenced supplements that have good science to support their use and what breeds should benefit the most:
1) Fish oils = Eicosapentanoic (EPA) & Docosahexanoic acid (DHA)
Breed specific information: All breeds will benefit! There is not a single breed that doesn't have one or more inflammation related diseases (heart, kidney, inflammatory skin disease, osteoarthritis, cancer, periodontitis) The "inflammation of daily activity" has even been recently researched!
Why: If we could only stock one supplement at our clinic my staff knows it would be EPA/DHA fish oils! I first began prescribing fish oils for skin allergies in 2002 based on the advice of a UW Veterinary Medical Hospital veterinary dermatologist. In the 8 years since, good studies have emerged supporting their use (at ever increasing doses) not only in allergic skin disease but heart disease, kidney disease, osteoarthritis, cancer, and now even dental disease in human dentistry, if used at anti-inflammatory levels. Dr Lisa Freeman’s DVM PhD DACVN study is very well respected for this work. (See dosing & references below)
Most common confusion/myths: an effective anti-inflammatory dose is MUCH higher than what most labels state…Flax seed oil is NOT fish oil (flax seed oil is poorly converted in pets, less than 20% and will not confer the same benefits as fish oils)… The ratio of Omega 6 to 3 in pets is not as important as the absolute level of EPA delivered… I know these statements will surprise many people, but I have verified these statements with some of the most highly regarded veterinary nutritionists (Thanks to Drs Lisa Freeman, Kathryn Michels, Phil Roudebush, et al!) and they are all referenced below.
Purity and quality: Hg levels and other contaminants are concerns but seem to be minor issues for most products (See consumerlab.com) Stability and getting the right doses are the major issues. They need to be kept protected from light, and contain Vit E to preserve their freshness. Not found typically in OTC foods as fish oils decrease shelf life and are more expensive than other fats/oils.
Evidence based proof: Lisa Freeman’s article applies to heart disease but most veterinary nutritionists use the dose she established as the minimum dose to treat any inflammatory disease. Recently published studies support the effectiveness of an anti-inflammatory dose of EPA in Hill’s Rx pet food J/D to treat osteo-arthritis in dogs.
Dosing: The anti-inflammatory dose is 20mg EPA per lb given daily. For a 60lb ideal weight Labrador retriever, that would require giving 7 of the typical human fish oil capsules (each contain 180mg EPA) to achieve an anti-inflammatory effect of 1200 mg EPA for a 60lb dog.
Best products and way to Deliver/dose:
Human/over the counter products
1) Typical human fish oil capsules contain 180mg EPA per capsule (some newer high potency capsules contain up to 400 mg EPA per capsule).
2) Unflavored human liquids (Nordic Naturals) are usually between 160 to 180 mg EPA per ml but many are far less.
Veterinary products
1) Veterinary liquid formulations are our favorites for cost, purity & compliance are unflavored Omega G3, Ascenta meat flavored, or EFA-Z a premeasured deodorized product (all are from 160 to 180mg EPA per ml)
2) Rx Foods: Purina JM ® & Hills J/D ® Force plate studies have been done by each company and peer review articles have been published by Hills for J/D JAVMA reference (Contains 395 mg EPA per cup of food-amt delivered will depend upon calories consumed)
Bottom line: Check labels carefully and go by the concentration listed on the label and calculations NOT the bottle dose if you are interested in achieving the health benefits of anti-inflammatory effects. The concentration of EPA in many over the counter (OTC) products is often too low, making effective supplementation expensive, diarrhea a possibility and adding excessive fat calories which could cause weight gain and unbalance the diet.
Remember 1 tsp = 5ml and need to deliver 20mg per lb of EPA for each pound of body weight to be anti-inflammatory. (Will be about 1200 mg for a 60 lb dog)
The future: Will be found in over the counter foods at high enough levels to prevent supplementation?, labels indicating how much EPA in each cup of dog food, bioavailability of different forms (free fatty acid form vs. ethyl esterification) and super concentrated tablets? (We can dream, can’t we?)
2) Dental treats foods & supplements
Breed specific information: All dogs that weigh less than 20 pounds (thinner bone around teeth is more rapidly destroyed), especially the very small & toy breeds like yorkies, shitzus, Maltese, all Brachycephalics (bulldogs, pugs, etc) because of teeth crowding and greyhounds (have a genetic predisposition towards Periodontitis) Recently I have found 3 Labradors with severe bone loss evident on dental radiographs at a young age and although not ready to add them to this list I will be watching closely for a genetic or dietary cause/effect.
Why: Periodontitis affects 80% of the patients that wellness veterinarians see on a daily basis. Even though brushing (using dog approved tooth pastes)is the gold standard of pet dental homecare it is not very popular among most pet owners! The use of foods, treats, and water additives (that have proof of effectiveness) often gets better compliance because they are easier to implement for most pet owners.
Most common confusions/myths: Products that contain a label claim of preventing tartar do not have to do ANYTHING to support that claim! Only the Veterinary Oral Health Council (VOHC) seal of approval gives consumers any assurance that the products are actually effective. To get the VOHC seal foods have to be 20% or better than an average food and treats and water products 10% better.
Important side note:
No bones or hard chews please! They don’t do anything to improve oral health in dogs! Nylabone, cow hooves, etc that “hurt when you hit them on your shin” are too hard and will chip teeth and do little if anything for the gums. Rawhide chews are much more effective at softening and rubbing on gum line where most dental disease occurs. The myth that bones are naturally OK for dogs is an all too pervasive! We seal teeth and do root canals daily on teeth that have been chipped by bones which can be avoided!
The proof: Veterinary Oral Health Council www.vohc.org American Veterinary Dental College www.AVDC.org
Evidence based Products: Rawhide chews: Purina Cheweez rawhide chews® have VOHC acceptance, Virbac CET Hextras ® are NOT VOHC listed but are rawhide chews with added evidence based ingredients (Chlorhexidene & hexametaphosphate a safe calcium chelater) By default, all rawhides should be effective to some degree.
Water additives: Healthymouth 1st VOHC seal for a water additive with natural ingredients including Zinc Gluconate (safe & found in many products) there are many others but none with VOHC proof of effectiveness.
Rx Foods: Although not technically a supplement they are very effective when fed as a primary food and some people do use these as treats. Hills T/D ® & Oral Care ® both have the VOHC plaque & tartar claim, Rx Purina DH has a VOHC tartar claim & Iams Dental Defense ® has a VOHC tartar claim for one product in family There are many other products that can promote healthy mouths with evidence based products. Here are the products we use at our clinic. Westside Family Pet Clinic's website
The future: Sogeval Clenzadent ® water & food additives and mouth rinses are claiming to control the biofilm (bacteria & cell layer that makes up plaque) and look promising but no peer reviewed studies yet.
3) Joint supplements (Glucosamine, Chondroitin sulfate, Avocado Soybean Unsaponifiables (ASU), Perna green lipped mussel, blue green algae, etc)
Breed Specific information: Labradors, Golden Retrievers, German Shepherds, Great Danes, Newfoundlands, St Bernards, and many other large breeds, some small breeds like Cavalier King Charles Spaniels and Boston & Yorkshire Terriers are predisposed to orthopedic disease.
Why: Joint supplements have been shown effective in treating disease and it a very reasonable leap that they should be able to help prevent disease especially in very active breeds, although very few studies are available to support this presently. Proceeding with “do no harm” philosophy, supplementation should be done with the most effective products.
Degenerative orthopedic disease (hip dysplasia, elbow dysplasia, OCD of many joints) and resulting in osteoarthritis in over 20% of a typical clinics patients.
Hip dysplasia affects most breeds over 40 lbs and disproportionately affects German Shepherd Dogs, Labradors, Golden Retrievers, Newfoundlands, Rottweilers with 2 medium breeds, English Bulldogs & Cavalier King Charles Spaniels overrepresented.
Canine cruciate ligament tears (CCL) commonly referred to as ACLs, occurring in many breeds (especially Labradors & Golden Retrievers, Boxers & Rottweilers) and Medial Patellar Luxation (MPL) being over represented in Boston & Yorkshire Terriers, and other small breeds. Once cartilage deterioration and inflammation starts in a joint, it will continue life long so the inflammation needs to be controlled early on.
Ideal weight and a good exercise program is paramount and evidence based supplementation (fish oils & joint supplements) should strongly be considered to help moderate these diseases.
Most common myths: That there is enough glucosamine in a pet food that supplementation is not necessary (it is in fact a labeling (legal)issue that foods cannot have enough to be therapeutic so supplementation is ALWAYS necessary) We as veterinarians are bombarded with claims from products that claim effectiveness from a long list of ingredients. The ones we know are active are often listed in very small sub-therapeutic doses. Good studies are few and far between!
The newest myth that needs to be addressed immediately is that this group of products are all pretty safe. The ASPCA poison control just published a letter to the editor in the March 1st JAVMA that there have been 21 incidents of liver poisoning in 2008 & 2009 including 2 reported deaths from overdoses of chewable over the counter joint supplements. 5 different brands of supplements were involved with 10 incidents involving a single brand, 8 involving a second brand. It is unknown if it is an ingredient issue, a contaminant or an interaction as many of these supplements contain multiple ingredients and and all are unregulated. The authors suggest aggressive measures to treat any overdose of these OTC and unregulated products. Based on this and quality issues I do NOT recommend any joint supplements except two that have long safety & effectiveness records.
The evidence: Cosequin & DASUquin studies, Glycoflex force plate study (not yet published) see below
Purity & Safety: www.consumerlab.com, www.nasc.cc, www.usp.org
Recommended products: unlike EPA/DHA, in this category there are lots of issues with purity and effectiveness and very recently safety. Because there is no FDA regulation of products and many do not contain what they claim. I only have two current recommendations both currently available only from your veterinarian.
DASUquin ® by Nutramax is the only one that contains Glucosamine, Chondroitin Sulfate & Avocado Soybean Unsaponifiables (ASU).
Note: All studies for glucosamine & chondrotin sulfate performed (human or pet) have used Nutramax's patented ingredients. Further, this company produces a high quality human line recommended by more orthopedic surgeons & rheumatologists than any other product. Additionally they continually provide the best evidence for their extensive line of veterinary nutraceutical (antioxidants, liver & urinary tract support, and Probiotics)
Their most recent study is McCarthy G, O’Donovan J, Jones B, et al: Randomized double-blind, positive-controlled study to assess the efficacy of glucosamine/Chondroitin sulfate for the treatment of dogs with osteoarthritis Vet J 174(1):54-61, 2007
Glycoflex ® made by VetriScience uses Perna green lipped mussel as their active ingredient. A recent force plate study was reported at a major national veterinary conference (NAVC) but not published yet in a peer reviewed journal.
University of Washington Pullman supported the effectiveness of this product. Martinez S, McCormick D, Powers M, Davies N, Yanez J, Hughes K and Lincoln J. The effects of GlycoFlex® III on a stable stifle osteoarthritis model in dogs: a pilot study. 2006. Presented at NAVC 2007
The future: I would like to see a peer reviewed published force plate study that puts the best products “head to head” in their effectiveness to modulate osteoarthritis. We need more proof and a dose that these products actually prevent disease. More evidence based studies on blue green algae; products like Metagenics (human product) for pets, etc are hopefully in progress.
4) Supplements for weight loss/management
Breed specific information: Labradors, Goldens, Beagles, Pugs, Bichons, Yorkies, Dalmatians, Cocker Spaniels, Cavalier King Charles Spaniels (and many other breeds) are obesity prone!
Why: With close to 50% of pets over their Ideal Weight this represents a huge place for a supplement to make a difference. Of course careful measuring of food & treats, a good exercise program and knowing the Calories in each cup of food fed is all important(groundbreaking article on range of caloric density, cost per calorie etc in "weight managment foods" by Lisa Freeman)
Typically we use a prescription food with adequate protein levels and a low Calorie desnity per cup if pet is 20% more over ideal weight per Dr Julie Churchill or an OTC food if less than 20% over. Pet satiety, preserving lean muscle mass and handling the oxidative stress that occurs as fat is metabolized as well as down regulating inflammatory mediators are the goals of both the food and/or effective supplement. There are certain these foods already contain these as ingredients and have level 1 evidence but they may need to be added to other foods. JAVMA article by Dr Phil Roudebush
Products:
L-Carnitine is added to many pet foods and has level 1 evidence in cats and level 2 in dogs.
Isoflavones (green tea active ingredient) Purina OM ® uses this and level 3 evidence exists for its use.
The fish oils (EPA/DHA) have Grade 2 evidence in dogs and can be found in two prescription foods or supplemented as outlined previously (Need to account for 9 Calories per capsule!).
Slentrol is a prescription appetite suppressant supplement that has Grade 1 evidence.
The future: With upwards of 40% of the pet population overweight this represents a huge VetriScience (the makers of Glycoflex) has just brought a new weight loss product to market, Vetri-Lean Plus which contains a “Phase 2 pet starch neutralizer”. They will be presenting the science to my staff in late March. Stay tuned!
5) Probiotics
Breed specific information: Any breed with higher incidence of GI issues, urinary infections, and immune system deficiencies.
Why: These are typically presently used to treat or prevent diarrhea. There are new uses and areas emerging almost as fast as in human medicine. Over 400 new bacteria have been recently DNA mapped in dog’s gastrointestinal tracts. Stay tuned in this exciting area!
The proof: No published studies exist to my knowledge but the multi-strain product by Nutramax evidently presented a paper at ACVIM in 2009
Products Proviable ® by Nutramax, Purina Nutriflora®, VetriScience® Iams Prostora ®
Dose/Delivery/Quality control: are huge issues (colony forming units should be listed and should be in billions) proper storage (these are live organisms) and should be dated as these products have a limited shelf life. One study showed of 13 available products none contained what the label claimed. The major recent concern is the ability of pathogenic strains to be present. Be careful in choosing these products! Consumerlab.com does a great job for human products and they now include pet products too!
The future: Multiple vs. single strain, canine or feline specific better? Better labeling. Stay tuned! …evidence seems to be coming faster!
My colleagues, clients and any visitors here....Your thoughts welcomed. Let’s begin the dialogue!
Dr Ken
EPA/DHA Fish oils resources
Freeman LM, Rush JE, Keyhayias et al: Nutritional alterations and the effects of fish oil supplementations in dogs with heart failure J Vet Internal Med 12 (6):440-448, 1998
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.
Ideal Weight & weight management 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 Publication
From a breed specific focus, some supplements are appropriate for all breeds (the omega 3 fish oils = EPA/DHA); others such as dental prevention products have more of a small breed focus, and joint supplements are more important for larger breeds. The expenditure of a pet owner’s hard earned dollars (especially in this economy!) on a pet food or a supplement that claims to prevent tartar on your pet’s teeth or alleviate joint pain needs to be taken seriously!
There is now very good evidence to support the use of certain nutritional supplements in pets. Because supplements are not FDA regulated, proof of effectiveness and quality and even safety is not assured, effective doses are not listed on labels, and consumers (and veterinarians) are offered little support in the form of evidence based studies. A natural product like fish oil cannot even be patented which reduces the incentive for companies to promote and perform in-depth studies. With studies finally emerging, at least for certain categories, the product landscape is getting deeper and more competitive and the time is now for analysis so it can truly benefit our pet’s health.
It is very important that consumers have a place to turn for good information. Many of these products are expensive and effective blood or tissue levels must be reached to see any benefits. Interaction with other medications, purity, quality and recent safety issues are all-important issues. With the veterinary medical credo of “above all do no harm” we feel that we as practicing veterinarians need to be on the cusp of this rapidly emerging area to provide optimal wellness to pets.
A few definitions are in order.
Evidence based simply means that there is enough proof done in a controlled, unbiased manner to substantiate that a product really has a desired effect on a specific condition. Evidence is ranked from level 1 (best) to level 4 (anecdotal) according to how many pets participated, how the study was conducted and generally how unbiased the information is. As scientists, we need quality studies to be able to give you the proper dose or recommend one product over another.
A nutraceutical is any nutritional supplement that has the ability to treat or prevent disease. Because these products are not drugs there is no FDA regulation of effectiveness or quality. That means every claim of health benefit must be scrutinized carefully and the quality & the integrity of the company researched. Quality assurance needs to be proven by independent sources like Consumer Lab www.consumerlab.com, National Animal Supplement Council (NASC) www.nasc.cc or the United States Pharmacopoeia (USP) www.usp.org as some expensive ingredients have been “left out” historically and contaminants identified when independent tests were performed.
Proof of effectiveness is not required for supplements so we need organizations like the Veterinary Oral Health council vohc.org (which is similar to ADA in human dentistry) to insure the effectiveness of products. It is an independent board of veterinary dentistry diplomats that review scientific studies and verify dental product claims. For other categories of supplements we rely on published studies by board certified specialists in peer reviewed scientific journals.
Breed specific wellness If you have followed any of my blog posts you know that veterinarians are increasingly fine-tuning wellness to specific breeds. With over 200 breeds this is a huge collaborative undertaking! We have broached dentistry, ideal weight and now supplements, (breed specific nutrition is next!) because these are the most common things we see in our busy daily preventative practice. It has been predicted this is the future of wellness for pets ….I strongly agree!
Just two IMPORTANT clarifications ….
Who are the experts? There are only 50 or so board certified veterinary nutritionists worldwide. (They are so rare the University of Wisconsin Veterinary Hospital doesn’t have one!) Many work for the larger pet food companies but some are in academia and/or have consulting services. The American Academy of Veterinary Nutrition(AAVN) is a growing community of board certified veterinary nutrition experts devoted to sharing & getting good independent information out there.
All of us (veterinarians,too!) make the final decisions for our pet’s wellness. Given the scarcity of good studies and the lack of a strong motive for companies to educate & prove effectiveness, final decisions need to be a combination of the best information available, applied to a specific breed wellness program, and based on a complete physical exam and appropriate wellness testing. Only your personal veterinarian has the knowledge, training and the established client-patient relationship to provide that.
I am here to simply open the door to the questions that I feel should be posed to your veterinarian and increasingly the pet food & supplement industry to give us better information & regulation. The American Animal Hospital Association(AAHA) task force is just finishing its initial set of Nutritional Guidelines. I look forward to seeing their stance and resources for supplements as those should help us address some of these issues. There is also a great book about pet nutrition coming in May 2010 that I hope will contain some supplement information “Feeding your pet Right” by Marion Nestle & Malden Nesheim.
The future is bright for evidence-based veterinary nutrition!
Dr Ken
Based on available evidence here is my list of well referenced supplements that have good science to support their use and what breeds should benefit the most:
1) Fish oils = Eicosapentanoic (EPA) & Docosahexanoic acid (DHA)
Breed specific information: All breeds will benefit! There is not a single breed that doesn't have one or more inflammation related diseases (heart, kidney, inflammatory skin disease, osteoarthritis, cancer, periodontitis) The "inflammation of daily activity" has even been recently researched!
Why: If we could only stock one supplement at our clinic my staff knows it would be EPA/DHA fish oils! I first began prescribing fish oils for skin allergies in 2002 based on the advice of a UW Veterinary Medical Hospital veterinary dermatologist. In the 8 years since, good studies have emerged supporting their use (at ever increasing doses) not only in allergic skin disease but heart disease, kidney disease, osteoarthritis, cancer, and now even dental disease in human dentistry, if used at anti-inflammatory levels. Dr Lisa Freeman’s DVM PhD DACVN study is very well respected for this work. (See dosing & references below)
Most common confusion/myths: an effective anti-inflammatory dose is MUCH higher than what most labels state…Flax seed oil is NOT fish oil (flax seed oil is poorly converted in pets, less than 20% and will not confer the same benefits as fish oils)… The ratio of Omega 6 to 3 in pets is not as important as the absolute level of EPA delivered… I know these statements will surprise many people, but I have verified these statements with some of the most highly regarded veterinary nutritionists (Thanks to Drs Lisa Freeman, Kathryn Michels, Phil Roudebush, et al!) and they are all referenced below.
Purity and quality: Hg levels and other contaminants are concerns but seem to be minor issues for most products (See consumerlab.com) Stability and getting the right doses are the major issues. They need to be kept protected from light, and contain Vit E to preserve their freshness. Not found typically in OTC foods as fish oils decrease shelf life and are more expensive than other fats/oils.
Evidence based proof: Lisa Freeman’s article applies to heart disease but most veterinary nutritionists use the dose she established as the minimum dose to treat any inflammatory disease. Recently published studies support the effectiveness of an anti-inflammatory dose of EPA in Hill’s Rx pet food J/D to treat osteo-arthritis in dogs.
Dosing: The anti-inflammatory dose is 20mg EPA per lb given daily. For a 60lb ideal weight Labrador retriever, that would require giving 7 of the typical human fish oil capsules (each contain 180mg EPA) to achieve an anti-inflammatory effect of 1200 mg EPA for a 60lb dog.
Best products and way to Deliver/dose:
Human/over the counter products
1) Typical human fish oil capsules contain 180mg EPA per capsule (some newer high potency capsules contain up to 400 mg EPA per capsule).
2) Unflavored human liquids (Nordic Naturals) are usually between 160 to 180 mg EPA per ml but many are far less.
Veterinary products
1) Veterinary liquid formulations are our favorites for cost, purity & compliance are unflavored Omega G3, Ascenta meat flavored, or EFA-Z a premeasured deodorized product (all are from 160 to 180mg EPA per ml)
2) Rx Foods: Purina JM ® & Hills J/D ® Force plate studies have been done by each company and peer review articles have been published by Hills for J/D JAVMA reference (Contains 395 mg EPA per cup of food-amt delivered will depend upon calories consumed)
Bottom line: Check labels carefully and go by the concentration listed on the label and calculations NOT the bottle dose if you are interested in achieving the health benefits of anti-inflammatory effects. The concentration of EPA in many over the counter (OTC) products is often too low, making effective supplementation expensive, diarrhea a possibility and adding excessive fat calories which could cause weight gain and unbalance the diet.
Remember 1 tsp = 5ml and need to deliver 20mg per lb of EPA for each pound of body weight to be anti-inflammatory. (Will be about 1200 mg for a 60 lb dog)
The future: Will be found in over the counter foods at high enough levels to prevent supplementation?, labels indicating how much EPA in each cup of dog food, bioavailability of different forms (free fatty acid form vs. ethyl esterification) and super concentrated tablets? (We can dream, can’t we?)
2) Dental treats foods & supplements
Breed specific information: All dogs that weigh less than 20 pounds (thinner bone around teeth is more rapidly destroyed), especially the very small & toy breeds like yorkies, shitzus, Maltese, all Brachycephalics (bulldogs, pugs, etc) because of teeth crowding and greyhounds (have a genetic predisposition towards Periodontitis) Recently I have found 3 Labradors with severe bone loss evident on dental radiographs at a young age and although not ready to add them to this list I will be watching closely for a genetic or dietary cause/effect.
Why: Periodontitis affects 80% of the patients that wellness veterinarians see on a daily basis. Even though brushing (using dog approved tooth pastes)is the gold standard of pet dental homecare it is not very popular among most pet owners! The use of foods, treats, and water additives (that have proof of effectiveness) often gets better compliance because they are easier to implement for most pet owners.
Most common confusions/myths: Products that contain a label claim of preventing tartar do not have to do ANYTHING to support that claim! Only the Veterinary Oral Health Council (VOHC) seal of approval gives consumers any assurance that the products are actually effective. To get the VOHC seal foods have to be 20% or better than an average food and treats and water products 10% better.
Important side note:
No bones or hard chews please! They don’t do anything to improve oral health in dogs! Nylabone, cow hooves, etc that “hurt when you hit them on your shin” are too hard and will chip teeth and do little if anything for the gums. Rawhide chews are much more effective at softening and rubbing on gum line where most dental disease occurs. The myth that bones are naturally OK for dogs is an all too pervasive! We seal teeth and do root canals daily on teeth that have been chipped by bones which can be avoided!
The proof: Veterinary Oral Health Council www.vohc.org American Veterinary Dental College www.AVDC.org
Evidence based Products: Rawhide chews: Purina Cheweez rawhide chews® have VOHC acceptance, Virbac CET Hextras ® are NOT VOHC listed but are rawhide chews with added evidence based ingredients (Chlorhexidene & hexametaphosphate a safe calcium chelater) By default, all rawhides should be effective to some degree.
Water additives: Healthymouth 1st VOHC seal for a water additive with natural ingredients including Zinc Gluconate (safe & found in many products) there are many others but none with VOHC proof of effectiveness.
Rx Foods: Although not technically a supplement they are very effective when fed as a primary food and some people do use these as treats. Hills T/D ® & Oral Care ® both have the VOHC plaque & tartar claim, Rx Purina DH has a VOHC tartar claim & Iams Dental Defense ® has a VOHC tartar claim for one product in family There are many other products that can promote healthy mouths with evidence based products. Here are the products we use at our clinic. Westside Family Pet Clinic's website
The future: Sogeval Clenzadent ® water & food additives and mouth rinses are claiming to control the biofilm (bacteria & cell layer that makes up plaque) and look promising but no peer reviewed studies yet.
3) Joint supplements (Glucosamine, Chondroitin sulfate, Avocado Soybean Unsaponifiables (ASU), Perna green lipped mussel, blue green algae, etc)
Breed Specific information: Labradors, Golden Retrievers, German Shepherds, Great Danes, Newfoundlands, St Bernards, and many other large breeds, some small breeds like Cavalier King Charles Spaniels and Boston & Yorkshire Terriers are predisposed to orthopedic disease.
Why: Joint supplements have been shown effective in treating disease and it a very reasonable leap that they should be able to help prevent disease especially in very active breeds, although very few studies are available to support this presently. Proceeding with “do no harm” philosophy, supplementation should be done with the most effective products.
Degenerative orthopedic disease (hip dysplasia, elbow dysplasia, OCD of many joints) and resulting in osteoarthritis in over 20% of a typical clinics patients.
Hip dysplasia affects most breeds over 40 lbs and disproportionately affects German Shepherd Dogs, Labradors, Golden Retrievers, Newfoundlands, Rottweilers with 2 medium breeds, English Bulldogs & Cavalier King Charles Spaniels overrepresented.
Canine cruciate ligament tears (CCL) commonly referred to as ACLs, occurring in many breeds (especially Labradors & Golden Retrievers, Boxers & Rottweilers) and Medial Patellar Luxation (MPL) being over represented in Boston & Yorkshire Terriers, and other small breeds. Once cartilage deterioration and inflammation starts in a joint, it will continue life long so the inflammation needs to be controlled early on.
Ideal weight and a good exercise program is paramount and evidence based supplementation (fish oils & joint supplements) should strongly be considered to help moderate these diseases.
Most common myths: That there is enough glucosamine in a pet food that supplementation is not necessary (it is in fact a labeling (legal)issue that foods cannot have enough to be therapeutic so supplementation is ALWAYS necessary) We as veterinarians are bombarded with claims from products that claim effectiveness from a long list of ingredients. The ones we know are active are often listed in very small sub-therapeutic doses. Good studies are few and far between!
The newest myth that needs to be addressed immediately is that this group of products are all pretty safe. The ASPCA poison control just published a letter to the editor in the March 1st JAVMA that there have been 21 incidents of liver poisoning in 2008 & 2009 including 2 reported deaths from overdoses of chewable over the counter joint supplements. 5 different brands of supplements were involved with 10 incidents involving a single brand, 8 involving a second brand. It is unknown if it is an ingredient issue, a contaminant or an interaction as many of these supplements contain multiple ingredients and and all are unregulated. The authors suggest aggressive measures to treat any overdose of these OTC and unregulated products. Based on this and quality issues I do NOT recommend any joint supplements except two that have long safety & effectiveness records.
The evidence: Cosequin & DASUquin studies, Glycoflex force plate study (not yet published) see below
Purity & Safety: www.consumerlab.com, www.nasc.cc, www.usp.org
Recommended products: unlike EPA/DHA, in this category there are lots of issues with purity and effectiveness and very recently safety. Because there is no FDA regulation of products and many do not contain what they claim. I only have two current recommendations both currently available only from your veterinarian.
DASUquin ® by Nutramax is the only one that contains Glucosamine, Chondroitin Sulfate & Avocado Soybean Unsaponifiables (ASU).
Note: All studies for glucosamine & chondrotin sulfate performed (human or pet) have used Nutramax's patented ingredients. Further, this company produces a high quality human line recommended by more orthopedic surgeons & rheumatologists than any other product. Additionally they continually provide the best evidence for their extensive line of veterinary nutraceutical (antioxidants, liver & urinary tract support, and Probiotics)
Their most recent study is McCarthy G, O’Donovan J, Jones B, et al: Randomized double-blind, positive-controlled study to assess the efficacy of glucosamine/Chondroitin sulfate for the treatment of dogs with osteoarthritis Vet J 174(1):54-61, 2007
Glycoflex ® made by VetriScience uses Perna green lipped mussel as their active ingredient. A recent force plate study was reported at a major national veterinary conference (NAVC) but not published yet in a peer reviewed journal.
University of Washington Pullman supported the effectiveness of this product. Martinez S, McCormick D, Powers M, Davies N, Yanez J, Hughes K and Lincoln J. The effects of GlycoFlex® III on a stable stifle osteoarthritis model in dogs: a pilot study. 2006. Presented at NAVC 2007
The future: I would like to see a peer reviewed published force plate study that puts the best products “head to head” in their effectiveness to modulate osteoarthritis. We need more proof and a dose that these products actually prevent disease. More evidence based studies on blue green algae; products like Metagenics (human product) for pets, etc are hopefully in progress.
4) Supplements for weight loss/management
Breed specific information: Labradors, Goldens, Beagles, Pugs, Bichons, Yorkies, Dalmatians, Cocker Spaniels, Cavalier King Charles Spaniels (and many other breeds) are obesity prone!
Why: With close to 50% of pets over their Ideal Weight this represents a huge place for a supplement to make a difference. Of course careful measuring of food & treats, a good exercise program and knowing the Calories in each cup of food fed is all important(groundbreaking article on range of caloric density, cost per calorie etc in "weight managment foods" by Lisa Freeman)
Typically we use a prescription food with adequate protein levels and a low Calorie desnity per cup if pet is 20% more over ideal weight per Dr Julie Churchill or an OTC food if less than 20% over. Pet satiety, preserving lean muscle mass and handling the oxidative stress that occurs as fat is metabolized as well as down regulating inflammatory mediators are the goals of both the food and/or effective supplement. There are certain these foods already contain these as ingredients and have level 1 evidence but they may need to be added to other foods. JAVMA article by Dr Phil Roudebush
Products:
L-Carnitine is added to many pet foods and has level 1 evidence in cats and level 2 in dogs.
Isoflavones (green tea active ingredient) Purina OM ® uses this and level 3 evidence exists for its use.
The fish oils (EPA/DHA) have Grade 2 evidence in dogs and can be found in two prescription foods or supplemented as outlined previously (Need to account for 9 Calories per capsule!).
Slentrol is a prescription appetite suppressant supplement that has Grade 1 evidence.
The future: With upwards of 40% of the pet population overweight this represents a huge VetriScience (the makers of Glycoflex) has just brought a new weight loss product to market, Vetri-Lean Plus which contains a “Phase 2 pet starch neutralizer”. They will be presenting the science to my staff in late March. Stay tuned!
5) Probiotics
Breed specific information: Any breed with higher incidence of GI issues, urinary infections, and immune system deficiencies.
Why: These are typically presently used to treat or prevent diarrhea. There are new uses and areas emerging almost as fast as in human medicine. Over 400 new bacteria have been recently DNA mapped in dog’s gastrointestinal tracts. Stay tuned in this exciting area!
The proof: No published studies exist to my knowledge but the multi-strain product by Nutramax evidently presented a paper at ACVIM in 2009
Products Proviable ® by Nutramax, Purina Nutriflora®, VetriScience® Iams Prostora ®
Dose/Delivery/Quality control: are huge issues (colony forming units should be listed and should be in billions) proper storage (these are live organisms) and should be dated as these products have a limited shelf life. One study showed of 13 available products none contained what the label claimed. The major recent concern is the ability of pathogenic strains to be present. Be careful in choosing these products! Consumerlab.com does a great job for human products and they now include pet products too!
The future: Multiple vs. single strain, canine or feline specific better? Better labeling. Stay tuned! …evidence seems to be coming faster!
My colleagues, clients and any visitors here....Your thoughts welcomed. Let’s begin the dialogue!
Dr Ken
EPA/DHA Fish oils resources
Freeman LM, Rush JE, Keyhayias et al: Nutritional alterations and the effects of fish oil supplementations in dogs with heart failure J Vet Internal Med 12 (6):440-448, 1998
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.
Ideal Weight & weight management 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 Publication
Sunday, January 10, 2010
Pet Ideal Weight and Preventative Breed Specific Nutrition
With winter ice & snow here (making exercising our pets difficult) and the holidays past (extra treats are the biggest reason pets gain weight too!) NOW is the time to talk about Ideal Weight in pets.
Unless steps are taken now we are going to see many pets get more overweight before spring comes. Calorie counting & a good exercise program are very important throughout a pet’s life (especially during our cold snowy winters here in Wisconsin) no matter what breed we are referring to.
That said if you happen to have any of these breeds or you have rescued a mixed breed that has a large percentage of one of these breeds it is even more important.
Labrador, Golden Retriever, Beagle, Pug, Scottish, Yorkshire or Rat Terrier, St Bernard, Bichon, Bulldog, Boston Terrier, Corgi, Basset Hound, Dachshund, Dalmatian, Newfoundland, Cocker Spaniel, Chihuahua or a “designer breed” (Puggles, Labradoodles, Golden doodles, etc)
1) Why do we need to “go there”?
A groundbreaking study done in 2002 (using Labradors) showed a literal guarantee that if a pet is their ideal weight from birth through their whole life they will live an AVERAGE of 15% longer and feel better... That’s why…This would mean over 2 years for a Labrador retriever and even longer in a smaller breed! I have met very few clients in my past 25 yrs of practice that didn’t want more healthy years for their pet.
The other reason it is preventative care is the best care. The myriad of diseases that are caused or exacerbated by pets being overweight is constantly growing. With the rising cost of pet care (just like human health care) preventing disease is vital in these economic times. I frequently tell clients that keeping their pet at their ideal healthy weight is the best health insurance plan they can invest in.
Less veterinary bills, less drug bills for diseases like osteoarthritis and less dog food cost are all pretty much guaranteed! With diabetes, osteoarthritis, cancer and an even urinary & skin disease now linked to pets being overweight a preventative ideal weight approach prevents disease and saves money, period.
A good friend Dr Dave Brunson DVM, ACVA, a board certified veterinary anesthesiologist has voiced another very valid concern. He first "walked the talk" by getting the weight off his own pet Pearl, a Beagle AND a Katrina survivor (talk about easy to "emotionally feed") and who now speaks nationally about how important it is to keep pets lean for safe anesthesia. With dental cleaning required in all pets it is not a matter of IF they need anesthesia to prevent dental problems it is a matter of WHEN making ideal weight throughout life safer with regard to necessary to routine procedures like dentistry too.
Here is a good video link to “start the conversation” especially when it is imperative that all household members be on the same page.
http://today.msnbc.msn.com/id/26184891/vp/34204934#34204934
2) How does a pet owner know if their pet is over their “Ideal Healthy Weight”?
Dr Kathryn Michels DVM, MS Dipl ACVN, a board certified veterinary nutritionist recently stated in Veterinary Practice News “There is a skewed difference between owners and vets on what a healthy weight is” I agree, and the time is now to have a good definition.
With over 200 different breeds (from pugs to Great Danes!) there is no good Body Mass Index (BMI) like in people because of the incredible variation. There is however Purina has developed a good 9 point body condition score (BCS) and Hills has one from 1 to 5. These are great tools that we use as veterinarians and of course a reliable scale is needed keep track numerically. We often use a pet’s weight at 1 yr of age as their ideal healthy weight.
A very simple and effective tool to determine if a pet’s weight has reached ideal weight is one Dr Michels recently described when she spoke to area veterinarians. She advised us that a pet’s ribs (just behind their shoulder) should feel just like your fingers below the knuckles when you make a fist (pronounced ridges & valleys) NOT like the skin above the knuckles where you can’t feel any ridges or valleys. This works for all breeds and is a great way to know if we “are there yet!”
If your pet is 20% over ideal weight or has any health issues an assessment by your veterinarian is needed complete with blood work, nutritional consultation and an ideal weight guess…. but be prepared…It will probably be lower than you expect …but it is very important that an accurate assessment be made for your pet’s behalf.
3) Are just a few pounds overweight a big deal?
We know that fat is metabolically active and produces inflammatory and disease causing compounds (see below) so yes even 2 to 3 pounds is detrimental to health. Further the 15% longer life benefit applies if dogs are their ideal weight their entire life so let’s accomplish this by starting now!!
In small breeds like pugs (and I am not picking on them… they are a great breed!) where a pug comes in for its 2 year annual wellness exam weighing 15 lbs. (and its ideal weight is 12 lbs) it is already 25% over its ideal weight. It is very challenging to keep small breeds less than 20lbs because they need so few calories and today’s foods and treats are so calorie rich. So just like dentistry, ideal weight can be breed specific and we will spend much more time discussing it at an early age to prevent problems in many smaller breeds and certain larger breeds like labs & goldens.
Update: I was asked recently to speak at the Milwaukee Pugfest to discuss breed specific preventative nutrition. It will be great to hear from all of those owners (dedicated pet owners who do their own research always teach me something new!) I hope to be a pug nutritional specialist after May 16th!
http://www.milwaukeepugfest.com/
In the United States, over 40% of pets are considered obese and many more than that are over their ideal weight with certain breeds being overrepresented it is very important that we take a close look at how to prevent this before it occurs.
4) What is the most effective to way to get weight off if they are already overweight?
Ah, down to the nitty, gritty of it once the deed is done! It is not rocket science but it is not easy, either because of the emotional attachment we have to our pets and to food in general! There is actually no great secret of how to get weight loss accomplished. It is simply good evidence based education & a firm owner commitment to carry it out (despite those pleading eyes!). Knowing how many calories in each cup of food and especially measuring at every meal time & keeping track of treats are key to any program.
We realize there is a strong emotional bond and that many people show their love to their pet during the feeding process. We know that we have to work with pet owners to find ways to augment that interaction to include the right number of calories.
Some great tools can be found at American Association for Pet Obesity Prevention
We have outlined some important concepts gleaned from working with pet owners on our website as well
http://www.westsidefamilypet.com/nutrition-introduction/ideal-weight/
5) Calorie counting or exercise … which is more important?
There is still some confusion out there even among my veterinary colleagues about whether calorie reduction or exercise is more effective. I recently moderated 3 days of veterinary lectures at our state veterinary conference where at two of the sessions two different board certified veterinarians (one an endocrinologist and the other a boarded nutritionist) each told the audiences that they hadn’t had much luck in dieting pets using caloric restriction alone. My staff and I almost fell out of our chairs. Our experience has been quite different!.
With a fitness center as part of our pet health care center it would be tempting for me to give every pet a “Fitness Rx” (and we do for some) but it just isn’t practical or economically feasible for every pet owner. I personally am an outdoor athlete and would always prefer to exercise any personal pet in the woods or fields of our beautiful state. So exercise is important part but I personally feel counting calories is key.
A personalized program outlined by your veterinarian following your pet’s annual wellness exam is the best place to start.
6. What is the cutting edge of preventative ideal weight pet nutrition?
Credit where credit belongs to Gail, Kealy et al who did the study showing lean dogs live an average of 15% longer. The study was done in 2002 at Purina’s research facility using Labradors but by totally independent outside researchers and is one of the most respected and longest running nutritional study ever done in dogs (It took 14 years!)
http://www.upenn.edu/pennnews/article.php?id=144
The short version is that fat is not the inert substance we once thought but more a very active endocrine organ. Producing and interacting with many other hormones in the body. The most destructive products they produce are a group of chemicals called cytokines which can be inflammatory mediator which makes inflammation elsewhere in the body worse it these cytokines or adipocytokines makes it worse for example in osteoarthritis.
http://www.michvma.org/documents/MVC%20Proceedings%202009/Schickel,%20%20Weight%20loss%20proceedings.pdf
Royal Canin ® has formulated some breed specific diets’ Dr Brent Mayabb, technical services director for Royal Canin states about Labradors “This breed is predisposed to excessive weight gain because it was bred to have a layer of fat insulation as a dog trained to retrieve game from water” Quite interesting (although not an excuse!) and may explain why they are so challenging! For the record I am not as convinced regarding some of their claims that their foods prevent plaque and tartar as they have not obtained the vohc seal of acceptance to back up their claims regarding preventing dental products. I am all for a similar program that would prove a food would help maintain an ideal weight for each breed.
http://www.royalcanin.co.uk/my_pet/dog_products/breed_health_nutrition/labrador_retriever.aspx
As part of their new DNA test the Wisdom Panel Professional ® is now predicting ideal weights based on a dogs DNA. This is the most comprehensive DNA test on the market, requires a blood test and detects over 200 breeds. The concept of predicting an ideal weight range is a great concept which should help “plant the seed early about the importance of ideal weight for mixed breeds too.
http://www.wisdompanelpro.com/
What about cats? Cats present a further challenge. Just how do you exercise a cat? The indoor cat initiative by Dr Tony Buffington is brilliant but we still have to count calories big time. I can tell you it isn’t easy as one of my cats (sorry Lance buddy, have to call you out) would love to weigh 15lbs. (His ideal healthy weight is 10#) more on cat challenges in coming weeks. .Here is one of my favorite nutrition sites for cats & dogs.
http://vet.osu.edu/index.php?id=1846
We already know we can treat and prevent disease with food so breed specific prevention using food is pretty compelling. My feeling is that if done with an evidence based approach it could revolutionize the pet food industry. We know the pet food industry is way prone to over marketing so evidence based nutrition is mandatory.
I will be devoting more time to these and other specific challenges weekly in our clinic website’s nutrition section as we ramp up towards our 3rd Ideal Weight Contest and 2nd annual "Pets Reducing for Rescues" Ideal Weight contest with proceeds from every pound lost donated to contestants favorite rescue.
Contest kicks off this Sat Jan 16th from 12 to 2PM at our Preventative Nutrition (Ideal Weight & supplements) Open House.
“Iron Dogs”(just 5 to 20% over ideal), “Biggest 4 Pawed Losers” (20% or more over ideal) and “Fat Cats” and "Iron Cats" (most cats do “virtual weigh-ins”) are all part of the fun.
Good luck with your efforts getting your pets to ideal weight!
Dr Ken
Join our FB fan page at Facebook.com/westsidefamilypet to see previous contestants from 2008 & 2009 and some great pictures of clients who got the job done! New contestants for 2010 will be posted this week.
With winter ice & snow here (making exercising our pets difficult) and the holidays past (extra treats are the biggest reason pets gain weight too!) NOW is the time to talk about Ideal Weight in pets.
Unless steps are taken now we are going to see many pets get more overweight before spring comes. Calorie counting & a good exercise program are very important throughout a pet’s life (especially during our cold snowy winters here in Wisconsin) no matter what breed we are referring to.
That said if you happen to have any of these breeds or you have rescued a mixed breed that has a large percentage of one of these breeds it is even more important.
Labrador, Golden Retriever, Beagle, Pug, Scottish, Yorkshire or Rat Terrier, St Bernard, Bichon, Bulldog, Boston Terrier, Corgi, Basset Hound, Dachshund, Dalmatian, Newfoundland, Cocker Spaniel, Chihuahua or a “designer breed” (Puggles, Labradoodles, Golden doodles, etc)
1) Why do we need to “go there”?
A groundbreaking study done in 2002 (using Labradors) showed a literal guarantee that if a pet is their ideal weight from birth through their whole life they will live an AVERAGE of 15% longer and feel better... That’s why…This would mean over 2 years for a Labrador retriever and even longer in a smaller breed! I have met very few clients in my past 25 yrs of practice that didn’t want more healthy years for their pet.
The other reason it is preventative care is the best care. The myriad of diseases that are caused or exacerbated by pets being overweight is constantly growing. With the rising cost of pet care (just like human health care) preventing disease is vital in these economic times. I frequently tell clients that keeping their pet at their ideal healthy weight is the best health insurance plan they can invest in.
Less veterinary bills, less drug bills for diseases like osteoarthritis and less dog food cost are all pretty much guaranteed! With diabetes, osteoarthritis, cancer and an even urinary & skin disease now linked to pets being overweight a preventative ideal weight approach prevents disease and saves money, period.
A good friend Dr Dave Brunson DVM, ACVA, a board certified veterinary anesthesiologist has voiced another very valid concern. He first "walked the talk" by getting the weight off his own pet Pearl, a Beagle AND a Katrina survivor (talk about easy to "emotionally feed") and who now speaks nationally about how important it is to keep pets lean for safe anesthesia. With dental cleaning required in all pets it is not a matter of IF they need anesthesia to prevent dental problems it is a matter of WHEN making ideal weight throughout life safer with regard to necessary to routine procedures like dentistry too.
Here is a good video link to “start the conversation” especially when it is imperative that all household members be on the same page.
http://today.msnbc.msn.com/id/26184891/vp/34204934#34204934
2) How does a pet owner know if their pet is over their “Ideal Healthy Weight”?
Dr Kathryn Michels DVM, MS Dipl ACVN, a board certified veterinary nutritionist recently stated in Veterinary Practice News “There is a skewed difference between owners and vets on what a healthy weight is” I agree, and the time is now to have a good definition.
With over 200 different breeds (from pugs to Great Danes!) there is no good Body Mass Index (BMI) like in people because of the incredible variation. There is however Purina has developed a good 9 point body condition score (BCS) and Hills has one from 1 to 5. These are great tools that we use as veterinarians and of course a reliable scale is needed keep track numerically. We often use a pet’s weight at 1 yr of age as their ideal healthy weight.
A very simple and effective tool to determine if a pet’s weight has reached ideal weight is one Dr Michels recently described when she spoke to area veterinarians. She advised us that a pet’s ribs (just behind their shoulder) should feel just like your fingers below the knuckles when you make a fist (pronounced ridges & valleys) NOT like the skin above the knuckles where you can’t feel any ridges or valleys. This works for all breeds and is a great way to know if we “are there yet!”
If your pet is 20% over ideal weight or has any health issues an assessment by your veterinarian is needed complete with blood work, nutritional consultation and an ideal weight guess…. but be prepared…It will probably be lower than you expect …but it is very important that an accurate assessment be made for your pet’s behalf.
3) Are just a few pounds overweight a big deal?
We know that fat is metabolically active and produces inflammatory and disease causing compounds (see below) so yes even 2 to 3 pounds is detrimental to health. Further the 15% longer life benefit applies if dogs are their ideal weight their entire life so let’s accomplish this by starting now!!
In small breeds like pugs (and I am not picking on them… they are a great breed!) where a pug comes in for its 2 year annual wellness exam weighing 15 lbs. (and its ideal weight is 12 lbs) it is already 25% over its ideal weight. It is very challenging to keep small breeds less than 20lbs because they need so few calories and today’s foods and treats are so calorie rich. So just like dentistry, ideal weight can be breed specific and we will spend much more time discussing it at an early age to prevent problems in many smaller breeds and certain larger breeds like labs & goldens.
Update: I was asked recently to speak at the Milwaukee Pugfest to discuss breed specific preventative nutrition. It will be great to hear from all of those owners (dedicated pet owners who do their own research always teach me something new!) I hope to be a pug nutritional specialist after May 16th!
http://www.milwaukeepugfest.com/
In the United States, over 40% of pets are considered obese and many more than that are over their ideal weight with certain breeds being overrepresented it is very important that we take a close look at how to prevent this before it occurs.
4) What is the most effective to way to get weight off if they are already overweight?
Ah, down to the nitty, gritty of it once the deed is done! It is not rocket science but it is not easy, either because of the emotional attachment we have to our pets and to food in general! There is actually no great secret of how to get weight loss accomplished. It is simply good evidence based education & a firm owner commitment to carry it out (despite those pleading eyes!). Knowing how many calories in each cup of food and especially measuring at every meal time & keeping track of treats are key to any program.
We realize there is a strong emotional bond and that many people show their love to their pet during the feeding process. We know that we have to work with pet owners to find ways to augment that interaction to include the right number of calories.
Some great tools can be found at American Association for Pet Obesity Prevention
We have outlined some important concepts gleaned from working with pet owners on our website as well
http://www.westsidefamilypet.com/nutrition-introduction/ideal-weight/
5) Calorie counting or exercise … which is more important?
There is still some confusion out there even among my veterinary colleagues about whether calorie reduction or exercise is more effective. I recently moderated 3 days of veterinary lectures at our state veterinary conference where at two of the sessions two different board certified veterinarians (one an endocrinologist and the other a boarded nutritionist) each told the audiences that they hadn’t had much luck in dieting pets using caloric restriction alone. My staff and I almost fell out of our chairs. Our experience has been quite different!.
With a fitness center as part of our pet health care center it would be tempting for me to give every pet a “Fitness Rx” (and we do for some) but it just isn’t practical or economically feasible for every pet owner. I personally am an outdoor athlete and would always prefer to exercise any personal pet in the woods or fields of our beautiful state. So exercise is important part but I personally feel counting calories is key.
A personalized program outlined by your veterinarian following your pet’s annual wellness exam is the best place to start.
6. What is the cutting edge of preventative ideal weight pet nutrition?
Credit where credit belongs to Gail, Kealy et al who did the study showing lean dogs live an average of 15% longer. The study was done in 2002 at Purina’s research facility using Labradors but by totally independent outside researchers and is one of the most respected and longest running nutritional study ever done in dogs (It took 14 years!)
http://www.upenn.edu/pennnews/article.php?id=144
The short version is that fat is not the inert substance we once thought but more a very active endocrine organ. Producing and interacting with many other hormones in the body. The most destructive products they produce are a group of chemicals called cytokines which can be inflammatory mediator which makes inflammation elsewhere in the body worse it these cytokines or adipocytokines makes it worse for example in osteoarthritis.
http://www.michvma.org/documents/MVC%20Proceedings%202009/Schickel,%20%20Weight%20loss%20proceedings.pdf
Royal Canin ® has formulated some breed specific diets’ Dr Brent Mayabb, technical services director for Royal Canin states about Labradors “This breed is predisposed to excessive weight gain because it was bred to have a layer of fat insulation as a dog trained to retrieve game from water” Quite interesting (although not an excuse!) and may explain why they are so challenging! For the record I am not as convinced regarding some of their claims that their foods prevent plaque and tartar as they have not obtained the vohc seal of acceptance to back up their claims regarding preventing dental products. I am all for a similar program that would prove a food would help maintain an ideal weight for each breed.
http://www.royalcanin.co.uk/my_pet/dog_products/breed_health_nutrition/labrador_retriever.aspx
As part of their new DNA test the Wisdom Panel Professional ® is now predicting ideal weights based on a dogs DNA. This is the most comprehensive DNA test on the market, requires a blood test and detects over 200 breeds. The concept of predicting an ideal weight range is a great concept which should help “plant the seed early about the importance of ideal weight for mixed breeds too.
http://www.wisdompanelpro.com/
What about cats? Cats present a further challenge. Just how do you exercise a cat? The indoor cat initiative by Dr Tony Buffington is brilliant but we still have to count calories big time. I can tell you it isn’t easy as one of my cats (sorry Lance buddy, have to call you out) would love to weigh 15lbs. (His ideal healthy weight is 10#) more on cat challenges in coming weeks. .Here is one of my favorite nutrition sites for cats & dogs.
http://vet.osu.edu/index.php?id=1846
We already know we can treat and prevent disease with food so breed specific prevention using food is pretty compelling. My feeling is that if done with an evidence based approach it could revolutionize the pet food industry. We know the pet food industry is way prone to over marketing so evidence based nutrition is mandatory.
I will be devoting more time to these and other specific challenges weekly in our clinic website’s nutrition section as we ramp up towards our 3rd Ideal Weight Contest and 2nd annual "Pets Reducing for Rescues" Ideal Weight contest with proceeds from every pound lost donated to contestants favorite rescue.
Contest kicks off this Sat Jan 16th from 12 to 2PM at our Preventative Nutrition (Ideal Weight & supplements) Open House.
“Iron Dogs”(just 5 to 20% over ideal), “Biggest 4 Pawed Losers” (20% or more over ideal) and “Fat Cats” and "Iron Cats" (most cats do “virtual weigh-ins”) are all part of the fun.
Good luck with your efforts getting your pets to ideal weight!
Dr Ken
Join our FB fan page at Facebook.com/westsidefamilypet to see previous contestants from 2008 & 2009 and some great pictures of clients who got the job done! New contestants for 2010 will be posted this week.
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
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.
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”
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
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