Wednesday, November 30, 2016

The Dreaded Nail Trim ~ Heather, Technician & Blog Editor

There are few things in the world of pet ownership that people avoid like the task of trimming nails. We get it--you don't like it, your pet doesn't like it, and if it goes wrong, things can get scary looking very quickly. Don't let fear and frustration get in your way! If you avoid trimming your pet's nails regularly, the problem will only get worse, and it can result in walking difficulty and nails getting snagged and torn off.

Nail Anatomy

One of the most important factors in trimming a dog's nails properly is knowing exactly what and where you're trimming. Some dogs have translucent white nails that make this a little easier; for dark-nailed dogs, the key is going relatively slowly.

Underneath each nail, there is a fleshy portion full of sensitive blood vessels known as the "quick". When this is cut, it can be very painful for your dog, and it also has a tendency to bleed like crazy. 
No matter how careful you are, this is always a possibility. Be sure to have styptic powder (also known as "Kwik Stop") on hand to stop the bleeding should this occur. Take a small amount of this dry, yellow powder and blot it directly on to the bleeding area of the nail. In a pinch, you can also use flour or corn starch and apply pressure to the area. 
Some dogs have longer quicks than others, especially if nail trims don't happen often. The best way to reduce the length of the quick (short of surgical intervention) is to trim the nails often over a long period of time (every 2-3 weeks, depending on how quickly your dog's nails grow). 

New Puppies
If you're starting from scratch with a new puppy, the world is your oyster. Don't waste this precious time to make sure that future nail trims will be a positive (or at least tolerable) experience. From the time that they first come home, make it a point to touch their feet and ears. Play with their feet constantly--make it a normal occurrence. 

When their sharp little puppy nails begin to grow, you can start training them for trims (the earlier the better!). Most puppy nails can be trimmed easily with cat nail scissors, pictured right. DO NOT attempt to tackle all four paws on the first go. Instead, break out a delicious treat (peanut butter is one of our favorites), trim a single nail, and reward that puppy!!! Throw a party of excitement and praise. If your puppy did well with the first nail, trim another in a few minutes, repeating the treat and praise. If your puppy was a little stressed during the first one, that's OK--this is new, and you will teach them that it's safe. Continue to play with their feet and give occasional treats during this process. Try the trimmers again tomorrow. 

Each time you trim, add one or two more nails, repeating the treat giving process. If done consistently, there's a good chance that your dog will associate nail trims with petting and treats rather than terror. 

Adult Dogs
With adult dogs, acclimation to nail trims can be a little more tricky, particularly if they never got used to their paws being touched or if they've had negative experiences with past nail trims. I owned a basset hound when I was young who would scream like he was being murdered when he saw the nail trimmers come out of the drawer, even if he was on the other side of the room (Maxwell, my droopy drama queen).

Re-training is possible in many adult dogs. You'll need to follow the puppy process (foot touching, treating, one nail, treating, two nails, treating, and so on), but you'll have to be very careful to do this at their pace. Be patient, and avoid irritation or anger--they will pick up on your feelings, and this will create stress.

Having the right tools can also make a big difference. Not all dog nail trimmers are built alike, and each creates a different feeling for the dog. If blades are dull, they can feel uncomfortable pressure, and it makes trimming much harder for you. Don't buy the cheapest plastic trimmers you can find, even if they tout built-in "safety guards". As we discussed with nail anatomy, all dogs are different, and those companies can't possibly predict where your dog's quick ends. (I also find that the nail guard pieces can be a hindrance that just blocks you from seeing where you're about to cut, so I avoid these in general.)

There are three primary tools for adult dog nail trimmers: 
  • Guillotine Clippers - These clippers work just as the name implies. You slip them over the front of the nail, apply pressure, and the tip comes off like a guillotine. In my professional opinion, there is no good reason to ever use this type of trimmer. This old-fashioned design is harder to use and often results in accidental quicking. Avoid!
  • Miller's Forge Trimmers - For adult dogs, these are my trimmers of choice. Opt for a design with a thick, stainless steel blade and a sturdy handle. With this design, you can trim a large section, or you can turn it as needed to "shave" small bits of the nail from multiple angles (ideal for dark nails) until you find the quick. 
  • Dremels - Yes, the power tool. It's not as scary as it sounds, and many dogs prefer this option unless they are particularly sensitive to noise or vibration. Dremels create a tingling sensation that can feel strange, but it is not painful (I've used them on myself!). They're also faster, harder to quick your dog, and you can get much closer to the quick, helping to reduce its length over time. Opt for the name brand pet Dremel, which is both powerful and relatively quiet, cordless, and has "low" and "high" settings and a wall charger. 

Other pet brands are often more expensive and less effective, and some garage dremels are too powerful (and also loud and scary). As with regular trimmers, a slow introduction with treats is best. Start by just turning it on near your dog and giving treats so that they get used to the appearance and sound.

Fearful or Aggressive Dogs 
For some dogs, retraining can only go so far. When there is true anxiety surrounding a nail trim, sedation is not a bad option. This can mean anything from a chew or pill given at home 30 minutes to an hour prior to the nail trim, or in extreme cases, an injectable sedative administered by your veterinarian. This is not to be confused with full anesthesia, and it generally poses very little risk to your pet. Rather than being a ball of stress and nerves while the person trimming struggles, your dog takes a nice nap and wakes up with shorter nails and little to no idea of what just happened. We would be happy to discuss the different options should your dog be a candidate for nail trim sedation.

Cat Claws
Cats are a mixed bag when it comes to nail trims. Their claws are much easier to trim in general since they are translucent and small, but as most feline fanatics already know, they don't always tolerate things that are not their idea. It never hurts to have a helper offering a distraction (or gentle restraint of the head or other paws if needed). Since cats retract their nails, the easiest way to start is to use your thumb and pointer finger to apply a very gentle pressure at the top and bottom of the paw at the joint behind the claw. Once the nail is exposed and you can see the pink area of the quick, you can quickly and easily snip off the sharp tip with cat nail scissors. As with dogs, sedation might be recommended if your cat becomes particularly stressed out during this process.

Helpful Tips  
  • For many dogs, less is more. Restraint is necessary in some cases, but some dogs are more bothered by the idea of being held still than by the nail trim itself. Always err on the side of caution, however. If your dog is prone to biting and wary of having his feet touched, it is not a good idea to attempt this technique without a muzzle or a helper. 
  • Try a different environment. My roommate's 85 pound rottweiler mix is a giant baby if you try to trim his nails in the kitchen, but he cooperates in the bathtub with little issue. See if your dog has a "safe" place that he might prefer. 
  • Let someone else take over. Frequently, dogs know what they can get away with when they're dealing with mom or dad, or they might be feeding off of your own anxiety or stress. When another person steps in, the process could go entirely differently. As always, we are happy to help with this. We can even provide housecall nail trims should your pet do better with these in his home environment. 
  • Walk your dog on rough surfaces. Asphalt can act like a nail file, grinding down the nails and helping to keep them relatively short. 

Request a Demonstration
If you're unsure how to use any of the tools that we've discussed here properly or just need a good idea of how to go about trimming your dog's nails, we are more than happy to show you. Personally, I enjoy trimming nails, and I am always ready to help others feel more confident about it. On your next visit to Shiloh, don't hesitate to ask us for a demonstration.

Comments? Questions? Reply to this post below! We would love to have your input on any and all of our posts.

Wednesday, November 16, 2016

What Is Veterinary Chinese Herbal Medicine? ~ Christa Riddle, DVM, CVA, CVCH

Chinese herbal medicine is one of the five branches of Traditional Chinese veterinary medicine. I am fortunate to have the knowledge to apply Chinese herbal medicine to many of my patients with chronic conditions such as Cushing's disease, kidney failure, chronic urinary tract infections, seizures, cancerallergies, asthma and arthritis. The list of conditions that I can use these herbal medicines on could go on and on. I see good results in many patients that have not received adequate or lasting results with conventional modern medicines and pharmaceuticals. I think Chinese herbal medicine is powerful in that regard! It's incredible to me that something so ancient, simple, and with reduced side effects can be such a powerful medicine for so many conditions.

Western Herbal vs. Chinese Herbal Medicine
Many clients are familiar with herbal remedies, but usually Western herbals.  Echinachia is an example of a Western herbal. We know it can help strengthen the immune system and help us fight colds or the flu. The major difference between Chinese herbal medicine and Western herbal medicine is that Chinese herbal medicines are given in a formula of multiple herbs and Western herbs are generally given as a single herb. Chinese herbal medicines also use minerals and some animal products in addition to plant based roots, seeds, stems, leaves, flowers, fruits, and petals. A Chinese herbal formula is a recipe of herbals from the Chinese materia medica (or formulary) to create a supplement that is balanced. The side effects of a single herbal will be balanced with one or more herbals to create balance in the formula. In my experience, Chinese herbal medicine appears to have fewer side effects compared to pharmaceuticals and this is most likely due to the balance created by combing multiple herbals in a formula.

Chinese Herbal Medicine Use in Dogs and Cats
Use of Chinese herbal medicines in veterinary medicine (especially dogs and cats) is much newer than its use in humans. In the United States, Chinese herbal medicines have been used for less than 40 years.  Chinese herbal medicine has been used in humans for over 1000 years! Compare that to pharmaceuticals that are used and/or tested in animals before application in people. It is comforting to me that humans have been the "guinea pig" for these traditional medicines. Many formulas were developed hundreds of years ago and are still used because of their effectiveness.

Pattern of Imbalance vs. Disease
In our modern culture, pharmaceuticals are used to treat specific conditions or diseases. All patients with the same condition are treated with the same medicine. For example, take the case of a dog with arthritis. If the dog is limping or stiff and has evidence of degenerative joint changes on a radiograph we would diagnose arthritis or degenerative joint disease and prescribe an anti-inflammatory pain medicine. By contrast, an arthritic dog treated with Chinese herbal medicine would receive a formula based on the pattern of imbalance. Therefore, every arthritic dog doesn't get the same formula since there are at least three choices for arthritic dogs. One pattern would be too much heat in the body where the dog would pant, have preference for cool areas of the house, have panting and/or increased thirst, and maybe do better in the winter months. The second pattern of imbalance would be a patient that has too much cold in the body and have preference for warm areas of the house or lie in the sun, the body might feel cold especially the feet and ears, and the arthritis might be better in the summer. The last imbalance might be too much dampness in the body which might be a dog with an oily coat, obesity, and worse on rainy or humid days. These three dogs all have arthritis and would be treated with the same anti-inflammatory medicine if we use a pharmaceutical, but three different Chinese herbal formulas since their patterns of imbalance are different. For this reason, examination of the patient is crucial when prescribing Chinese herbal medicines. If the cold patient gets the herbal formula that is best for the hot patient it might make the patient feel worse.

Integrated Medicine
Many clients are concerned with using herbal medicines with pharmaceuticals. Only in rare cases can the two not be used together. The good news is that you don't have to choose one therapy since most of my herbal patients get both conventional pharmaceuticals and Chinese herbal medicines. Treatment with both may be the most effective treatment for the patient. For example, the "hot" arthritic dog treated with an anti-inflammatory will have reduced pain but can also get herbals that help with reducing the excess heat signs in the body. The quality of life is enhanced when we can help with pain and the other symptoms that are associated with the body's imbalance.

Forms of Herbal Medicine Available
Chinese herbal medicines are generally in tablet, tea pill, capsule or granular form. See the pictures below for details. Some Chinese herbal formulas can also be used topically as a salve, dry powder, ear drop, or eye drop. Many clients are sometimes uncomfortable with the "volume" of herbal medicine given. It's important to remember for herbal medicine especially that volume does not always equal potency. Most herbals are ground in the whole plant form so only small amounts of active ingredients are present in the final product. Contrast to pharmaceuticals, where the active ingredient is synthesized, purified, and concentrated to create a potent powder or tablet. We are comfortable with the small size of our modern medicine in capsules and tablets and sometimes feel out of the comfort zone with the herbals most of time only because of the volume of granules needed, or number of capsules or tablets needed. Herbals are much less potent and therefore more volume is necessary to achieve the desired effect.


Herbal powder/granules and capsules with powder

Herbal Tablet
Most of the herbal products used in Chinese herbal medicine are only native to regions in Asia, specifically China. Safety of these raw products is cited as a major concern of many who use or oppose Chinese herbal medicine. The products that I prescribe are produced in the United States by companies with Good Manufacturing Practices (GMP) and who diligently get third party testing for toxins and impurities such as heavy metals, antibiotics and antifungals, mold, bacteria, pesticides and insecticides. Some herbals need to be processed by cooking or stir-frying to reduce the toxicity of them. The companies that I use ensure the raw ingredients are properly processed and tested prior to creating the formulas and final products. Some people may also know that traditional medicines in Asia sometimes use products from endangered plant and animal species. The companies I use do not use these endangered products. Examples of these products would be tiger bone, rhino horn, and bear bile. It's also important to know that ephedra is not used in any Chinese herbal product produced in the United States.

Example of Commonly Used Chinese Herbal Formula
To illustrate what a Chinese herbal formula really is, look at the ingredients of a very commonly used supplement below. The indications for this formula would be vomiting, diarrhea, and poor appetite. I have used it successfully in herding breeds with anxiety induced low appetite and body weight. I have also used it in patients with liver disorders and poor appetite. It can also be used in pets with anxiety induced appetite or digestive concerns. In people it can be used for treating PMS. The formula name: Xiao Yao San can be loosely translated as Free Wanderer, Rambling Ease, or Going With the Flow.

Formula Name: Xiao Yao San
Bupleurum (Chai Hu)
Angelica (Dang Gui)
Peonia (Bai Shao Yao)
Atractylodes (Bai Zhu)
Poria (Fu Ling)
Licorice (Gan Cao)

There are six herbs in this formula that work together to restore harmony and balance to the liver and digestive tract. 50% of the herbs work on the liver and 50% work on the intestines. 

I have spent more than 165 hours of continuing education in the last two years to gain more knowledge in this branch of Traditional Chinese Veterinary Medicine (TCVM). The intention of this post was to introduce the reader to basic information about the benefits and applications of Chinese herbal medicine in veterinary patients. I have witnessed the healing power that Chinese herbal medicines can provide to patients, especially with chronic diseases. It's safe to use this medicine in both the young and old. It can be safely and successfully combined with modern medicines, including chemotherapy. It can dramatically improve the quality of life in older pets with incurable conditions. If you haven't considered its use for your pet, I encourage you to take a second look. If you have already witnessed the benefits of its healing properties, I encourage you to share your experiences with others or by leaving a comment on this blog. 

Comments? Questions? Reply to this post below! We would love to have your input on any and all of our posts.

Wednesday, November 2, 2016

Matters of the Heart ~ Trisha, Technician

Ruby (whom you met in my park walk blog post back in August) is my approximately 6-year-old boxer mix rescued 2 years ago from a puppy mill. After the Genetic Health Analysis test, we determined that she is actually 7/8 American Staffordshire Terrier and 1/8 Boxer, but she is the perfect dog for our family.

When we adopted her, I knew that she was heartworm positive. I wasn’t aware of her other medical issues (mammary tumor, mast cell tumors, and fractured canine tooth), but we were able to manage those.

Heartworm disease is thankfully not very prevalent at Shiloh Animal Hospital because we have such great owners who really see the importance of giving their monthly heartworm preventative. However, heartworms are definitely heavily prevalent in North Carolina as a whole.

Heartworms are spread through mosquitoes, and we know that even indoor animals are susceptible since we can obviously be bitten by mosquitoes even in our homes.
Through a complex life cycle, the immature stages of heartworms infect the mosquitoes after they have a blood meal from an infected animal. If the mosquito then goes for another blood meal in a non-protected dog, then those immature heartworms progress and have an opportunity to turn into the full, adult form. The monthly heartworm preventative that you give (Heartgard, Trifexis, Advantage Multi, Interceptor, Sentinel, etc.) works by killing the immature, larval stages before they’re able to grow into the adults. Once the adults are present in the animal’s heart and lungs, preventative cannot treat the existing worms (but it will prevent more from developing).

Once we confirmed Ruby’s heartworm disease with a simple blood test, I knew that we would have to proceed with treatment. You might have heard that there is a “slow-kill” method involving giving multiple doses of regular heartworm preventatives. Unfortunately, "slow-kill" is not ever really a good option, as all it does is prevent more from developing and waits for the adults to die on their own which can take 5-7 years! In that time, the damage that can be done to the dog's heart and lungs is irreparable. Ruby’s health depended on getting her body rid of the worms. We submitted a full blood panel to check on the function of the internal organs, and everything looked good. We also performed radiographs to assess if there were any changes to the heart and lungs that we needed to be aware of. For treatment, we started with an antibiotic that actually kills the internal gut of the existing worms and prevents them from being able to produce the immature stages that mosquitoes would then continue to spread. We also had to use a tapering dose of steroids to ensure that her body would be less reactive to the dying process of these worms.

The immiticide injections are a necessary hardship. The product is administered intramuscularly in a series of 3 injections as recommended by American Heartworm Society. The first injection helps to kill off approximately 50% of the worms along with continued steroid use helps to prevent any reactions. One month later, we then administered injections 2 & 3 on consecutive days, which then statistically treats another 50% of the worms each day. These injections can be uncomfortable, so we recommend treating with a cold-light laser, ice pack, and/or pain medications to help decrease inflammation at the site.

Ruby was a champ and really didn’t let the injections change her life at all. The biggest change came from her owners, who had to stop running or playing for the next 3 months. This in some ways can be the hardest part of the treatment, since everyone loves playing with their dogs!  But this crucial step helps to minimize the potential for reaction. As the immiticide kills the adult heartworms, the disintegration of the worms in the heart and lungs breaks the worms up into small pieces, and we need to avoid over-exerting the heart in an effort to prevent throwing a clot or blockage of those pieces to the blood vessels.

On January 1st, Ruby got to start the new year by going back to paying and running! We got her a lacrosse ball for Christmas that year, and boy did she love running the yard. There was only one more step in this process. Four months after the last injection, we had to recheck a heartworm test. The 3-injection protocol is the surest way to fully treat the disease, but there is a small chance that there might still be heartworms even after this treatment. Ruby was negative, meaning we were successful and cleared!

Needless to say, we still give her heartworm prevention EVERY SINGLE month both during and after the treatment. There are no winter breaks, since North Carolina can still have mosquitoes all year long. Even as a holistic practice, we recommend one of the commercially available pharmaceuticals since there is no proven natural product at this point, and it’s not worth the risk. All dogs and even cats are at risk, and so we recommend it for every pet we see.

From the moment that a pet gets bitten by an infected mosquito, it takes 6 months to test positive on the blood test, yet at that point, the heartworms are too developed for regular  preventatives to have any effect.  And even if detected “early,” we would still recommend the same level of care and treatment protocol to give us the best chance of treating the full infection. I don’t wish this infection upon any pet or owner, so keep your pet protected with the simple, cheap, and effective way of preventing this devastating disease.

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