Our Magnolia of the Flowers

Recently the human took me to The Stevens-Coolidge Place, a property belong to the Trustees of the Reservation, for a spring photo shoot. With the backdrop of land first farmed in 1729, a myriad spring flowers, it was an ideal setting. The unanticipated problem was that I decided that the spring time blossoms were delicious.

As you can see, I'm fast--but not nearly fast enough to escape detection by the camera. I was hungry. I couldn't help it. I'm powerless of delicious flowers.

The human thought he might command more of my attention if he came in for a close up.

I wasn't much in a listening mood. In fact, as you can tell by my expression, I was rather irritated.

Really. Delicious. If the human would let me eat them I'm sure they taste just like spring chicken. I'm sure of it. Of course, all I heard was "leave it" and some kind of grumbling about the flowers being there for everyone to enjoy. Yeah yeah yeah,I know. If every dog ate a flower there wouldn't be any for the humans to enjoy. 

What the human didn't seem to understand was that I was there first, so I should get to sample some of the flowers. He's so mean, that human.

Foiled again by the camera. A therapy dog can't catch a break, can she. Apparently she also can't catch a flower.

Chinese Medicine to the Rescue

Many of you know me as a rambunctious, cuddly, and generally outgoing puppy. I've not always been that way--as I puppy I was a rather shy dog. With lots of good socialization I've transformed much of that shy behavior into something generally gregarious.

That's not always the case for me. My anxiety has been creeping back up again over the last few months. First I thought it was because of some bad experiences at the vet. You'd be anxious too if you had those sorts of exams. The human built back up a schedule of socialization and kept on giving me many positive interactions with things that I was scared of (visiting the vet office, going to unfamiliar places, meeting men with facial hair). This was going along well and then my anxiety went back up: driving to work one day we went over a patch of interstate that was being resurfaced. The rumbling got me me and I started shaking. Now I'm prone to trembling every time I get into the car. The 12 hour car ride to Cleveland didn't help.

Things keep on moving in the wrong direction so the human decided to bring in professional help. Yesterday afternoon we headed out for a consult with our friendly veterinarian and holistic health specialist, Dr. Cirnigliaro, also known as Dr. Dan.

I sure did put on a good show for him. I pranced right into the waiting room and put my paws up on the reception desk. Friendly as friendly can be, right? Well as soon as the assistant came out I hid behind my human and started licking my lips trying to calm myself. Two licks was all it took before I decided it was time to panic. I started trembling--softly at first and then my whole body vibrated. I tucked my tail tight between my legs for good measure.

Yes. It's true. I'm a fearful dog. Only in certain circumstances, and not even in those certain circumstances with any degree of regularity.

Still--this is no way to live!

Dr. Dan gave me an exam. I'm perfectly healthy. Despite my shaking and trembling he commented that I have nearly a perfect temperament. I let them examine me--I didn't fight or argue. With a little coaxing I came to them (they had food--like I was going to give that up!). Before I knew it both assistants were on the floor cooing over me. I approached slowly, on my own terms, from the side. They knew not to look straight at me--and I knew to look at them from the side of my eyes. We did this little dance and it let me feel safe. Before we knew it I was rolling over getting my belly pet and kissing the assistants.

That Dr. Dan is a different story--he has facial hair. I'm not so sure about that.

So Dr. Dan did a regular wellness exam. He also felt my various pulses and looked at my tongue. Can you believe that? I'm told this part of the examination is for the traditional Chinese Medicine. I was very cooperative with this part of the examination. I was nervous so I was yawning in an attempt to calm myself down. It just so happens that when I yawn I unfurl my tongue. Volia. Examination complete.

After lots of careful thought and conversation, we've decided I'm going to start on an herbal preparation called Shen Calmer.

Shen what? Depending on where you are, shen means different things. In ancient Egypt a shen ring was a circle with a line at a tangent through it. When objects appeared inside the shen ring, the object was considered to be eternally protected. In Chinese mythology shen (which means large clam monster) is a shape shifting dragon that is known to cause mirages. In this particular case, shen comes from traditional Chinese medicine--and it is associated with the element of fire. From this perspective I have too much shen (fire) and need to cool down a bit so I can be back in balance. The herbal mixture that I'm taking, called Shen Calmer, is designed to calm my shen and cool me down.

I'll report back to you all in three or four weeks. Dr. Dan tells me that it will take about that long to see if this preparation works for me. If it doesn't, or if I need more support, we might consider acupuncture.

The human of course will be upping his behavioral interventions. I'll be doing a lot more structured supervised socialization activities. I'm probably going to be going for a lot of short car rides and be given a steady stream of tasty chicken. Why, you ask? Multiple short exposures to things that frighten me (car rides) paired with pleasurable activities (eating chicken) is an excellent behavioral intervention for anxiety.

I also have the feeling that my daily exercise program is going to increase. The snow has gotten in the way of our hour long walks every morning. That's a wonderful opportunity to use up some of my extra energy and provides a calming tonic effect on my well-being.

If you have similar things going on I strongly invite you to consult with a well qualified veterinarian and dog coach. Some of these interventions seem simple (chicken in the car, for example) but really aren't. When exposure therapy is done wrong, you'll make your anxiety go up. That's not what you want to happen!

Overdue update on my health

Have you ever noticed when there is a problem in life, every bit of your attention goes to that problem? Have you also noticed as soon as the problem goes away you forget about all that attention? I sure do. This past summer I was plagued with bladder problems. If you didn't know me back then you can read about my travails here and here.

The human took me to five different vets. Five! I was poked, prodded, tested, and forced to do very unpleasant things. I was finally diagnosed with having calcium oxalate stones--a condition that isn't treatable, persistent, and required bladder surgery. Even if I was to have surgery to remove the stones, I was told I would have to be on a bland (unhealthy!) prescription diet for the rest of my life and I would STILL be likely to get the stones again.

The human fired the first three vets--he felt like they were treating him like he was ignorant. One made me have a painful procedure without proper sedation. He fired the fourth vet because despite his vocal statements about not willing to put me on a prescription diet (do you know the main source of animal protein in most prescription foods are things like chicken feathers? Did you know that prescription diets are associated with their own set of health problems?) the vet continued to suggest I go on a prescription diet. That vet also refused to give me proper sedation despite my obvious and extreme display of fear during a procedure.

I was beginning to worry about my human. In rapid succession he fired everyone that met me. I was worried that he was the problem. As it turns out, he wasn't. He finally brought me to a doctor that understood my problem and was able to solve my problem. He also saved me from having surgery that would have cost over $1,800 and had the risk of life-long incontinence. I don't even know for sure at this point if I actually had the condition that I was supposed to get surgery for.

Anyway--that catches you all up to date. I don't think I told you all that I was better. I am. I am much better. The human took me to Dr. Dan's Integrative Pet Hospital. After carefully listening to my human's concerns, after gently examining me, and after some reflection together, Dr. Dan essentially said this is no big deal. He prescribed me a supplement called UT Strength STAT for dogs. This is the same company that makes the wonderful non-toxic non-scary flea and tick be-gone product that also changed my life (thanks Dr. Dan!).

I've not had a single problem with my bladder since then. With one product I went from having a life-long condition that would likely require multiple expensive operations to having no condition (I don't even use the supplement anymore). I thought you might all want to know, since I certainly complained enough about the problem when I was having it.

If any of you reading this have a similar problem, don't run out and order the UT Strength. You need to consult a vet that you trust: what worked for me might not work for you. What is important here, and what is the moral of this story, is take the time to find a vet you trust. Take the time to find a vet that is knowledgeable. If you believe in a holistic approach, by all means take the time to find a vet that is well trained in holistic medicine. Having a vet that speaks your language is what is important here.

In fact, you can ask my cat-brothers that very same question. They were lucky because the human already had a vet that specialized in cats (in fact, he only sees cats). Dr. Carlson at the Cat Doctor was the one initially responsible for getting the human so strident and uppity about pet food. After having two cats die from fatty liver disease the human finally found Dr. Carlson--and heard him say something along the lines of we've been killing cats for years with prescription diets and dry foods that cause problems rather than help prevent them.

My cat brothers, you see, were also having bladder problems. This was before I was born. The way the cats explain it they discovered painful (yet oddly pretty) crystals in their pee. The human stuffed the cats in a box, drove them all the way to New Hampshire, and upon exiting the box they saw Dr. Carlson. After an hour long lecture about how horrible many cat foods are, and being taught the evils of a dry food only diet, and learning a whole lot of other useful stuff... Anyway, the cats say Dr. Carlson said "wet food only" and "mix it with broth until it's like a beef slurpee." The cats have never had crystals again. Never.

Easy as that.

So--go find yourself a good vet. And as for Dr. Carlson and Dr. Dan--I know you both read this blog sometimes--thank you for being smart and thoughtful.

These Pesky Stones

So the human had a consultation with Rebecca Remillard Ph.D., DVM at Angell Medical Center. I'm glad he did: surgery is postponed. Here is the basic information: it's useful for any of you out there you might be coping with bladder stones.

Way back when this all started, the vet tried to get a urine sample but wasn't able to. Because I had all the signs of a UTI, I was put on an antibiotic. This was the first error. Had a urine sample been taken and cultured we might have already solved my problem. Dr. Remillard shared that if a culture of my urine grew staph, it would have been indicative of struvite stones. This could likely be solved through a nutritional intervention. An alternative culprit could be urate stones. These can be solve through nutritional interventions as well. Lastly, the initial diagnosis of calcium oxalate stones might still be correct. These cannot be solved through nutritional interventions.

Or, can calcium oxalate stones be remedied through diet?

In the May 2010 edition of the Whole Dog Journal featured an article on the diagnosis, treatment, and prevention of calcium oxalate kidney and bladder stones. It reviewed some anecdotal evidence that these types of stones can indeed be successfully treated by nutritional interventions. The diet focus on increasing water consumption, raising urinary pH a bit, feeding a diet low in oxalates, and various vitamin supplements.

Here are two highlights that were particularly interesting in the article:

• Standard treatment from many vets for stones of all sorts are prescription diets that among other things, restrict protein, calcium, and phosphorus. The article mentioned research published in 2002 by the American Journal of Veterinary Research. It showed that canned food diets low in protein, calcium and phosphorus and have the highest amount of carbohydrates were associated with an increased risk of calcium oxalate crystals. Whoops. No prescription diets for me!

• The American Journal of Clinical Nutrition and The Journal of the American College of Nutrition, among others, have published research four more than 40 years demonstrating that patients with long-standing, recurrent calcium oxalate kidney stones receiving supplements including magnesium oxide with or without vitamin B6 for five or more years demonstrate stone formation falling by more than 90 percent.

After consulting with my vet, we've decided on a different treatment plan that doesn't involve surgery right now. I'm finishing up my course of treatment with Baytril. After that, we are going to carefully watch any symptoms that develop. The small risk is that I'll get an obstruction which would be a medical emergency. Assuming that doesn't happen, 14 days after I stop the antibiotic I'll have a urinalysis to see where I am. Assuming that doesn't show anything significant we'll repeat the urinalysis again 30 days after I completed the course of antibiotics. If that shows signs of staph, I'll have my diet altered to treat struvite crystals. If there is no staph, we'll re-evaluate and go for plan B. Not sure what plan B is yet.

Okay, that's not exactly true. The human took the cats to the Cat Doctor of Bedford and Nashua this past Friday. Dr. Carlson was informative as always. He suggested that I talk to my vet about having a cystoscopy. They would use a special instrument to peek inside my bladder, see what is there, and remove a stone for analysis. Something worth discussing!

Calcium Oxalate. Say what?

For those of you who are regular visitors on my Facebook fan page, you know that I've been plagued by ongoing urinary tract problems for the better part of the last month. It's not been pretty. I used to love going to the vet--I walked in fearlessly and enjoyed all the attention. Now I'm digging my paws into the ground when I am outside the front door of the vet's office and once inside, I stand by the door with my nose against the doorjamb hoping that I can somehow escape.

I've had urinalysis done twice, two ultra sounds, x-rays, and blood work. Though it's not definitive, it is looking like I might have calcium oxalate stones in my bladder. These little stones roll around inside irritating the tender lining of my bladder and, well, it's uncomfortable.

The human first noticed all these problems four weeks ago. Almost overnight, I started needing to stop and pee five or more times on an hour walk. This is very unlike me--I usually once going once or twice. The vet first diagnosed it as a UTI. I tried a course of amoxicillin. That didn't do much. I was then put on Rimadyl as I finished the course of antibiotics. Little did I know there were a whole host of side effects with Rimadyl. Let's just say while I wasn't peeing a lot because of the stones, I was going outside a whole lot to do some other stuff. I promptly went off the Rimadyl and we got a second opinion from another vet.

A urinalysis, by the way, did not indicate that there were any bacteria. There also weren't any evidence of stones, either. My pH was a bit off, and there was blood in my urine. Both are problems. An ultra sound suggested that there might be stones in my bladder.

My second doctor (whom I'm very fond of, are you reading this Dr. A?) at Linwood Animal Hospital tried me on a second course of antibiotics. This time I tried Baytril. After a week there wasn't a significant change. The human had me pee into a cup (this must have been fun to watch) and I was back into the vet. Much to my horror I spent the morning at the vet. They shaved my belly and did x-rays and an ultra sound. The x-rays showed the outline of stones and the ultra sound confirmed it. The urinalysis shows no bacteria and traces of calcium oxalate.

This however is unclear: the human consulted Dr. Google and found clear evidence that when urine samples are refrigerated or more than 30 minutes old tend to precipitate calcium oxalate regardless of the presence of stones. The human tells his patients that Dr. Google is no substitute for the advice of an actual living doctor. The human needs to remember his own advice.

Dr. A's best recommendation is to have bladder surgery. They will open up my bladder, clean out all the stones, send them out for analysis, and close me back up. This however doesn't sound very pleasant. The human is investigating plan B.

The human is having a nutritional consult with Dr. Rebecca Remillard at MSPCA Angell. That might turn up a few options. We're also having a consult with Dr. Dan Cirnigliaro who is a local vet with a holistic outlook. That might turn some other stuff up too.

The human tried to see if there were less invasive options available to treat the stones (there certainly a whole host of possibilities in humans!). This was a disappointing adventure. Being wary of rising medical costs, the human was willing to pay for a consult as long as he knew there were other options potentially available. Despite being willing to pay for a telephone consultation to find out specifically if there were other options available for treating bladder stones, both Foster Hospital for Small Animals at Tufts Veterinary school and MSPCA Angell both declined to answer the question or put the human in touch with someone who could answer the question. The only way to find out about less invasive options is to schedule an appointment (at a rather significant expense) and travel to both hospitals. Great if there are other options. Not so great if the answer is the only treatment is surgery.

Of course, no one can suggest treatment just from a brief phone call--that makes sense. Every dog is different and every situation is unique. It just seems that a simple question (are there a variety of interventions available) deserves a simple answer.

Our friendly dog coach Maureen Ross provided a couple recent editions of The Whole Dog Journal. There was an excellent article in the May 2010 edition called "Stoned Again: Diagnosing, treating, and preventing calcium oxalate stones in dogs." The article reviewed some of the latest research and in particular, talked about the work done by Leslie Bean in bringing together some of the latest information about calcium oxalate stones in dogs. The article has given some hope that there are specific dietary interventions that can prevent the reoccurrence of the stones (which are pesky, and tend to come back within three years). The article also gave a bit of hope that it's possible for dietary intervention to resolve the problem without surgery.

Much more research is needed. For the time being I'm scheduled for surgery at the end of the month. The human is going to keep asking questions until he hears answers that he likes. If he doesn't hear answers that he likes--well that means something. It means that surgery is the best option.

No Dry Food

Once again, my quick wits saved the day. Though still groggy, I was patiently waiting outside the litter box this morning for some play time. Iggy, one of my feline household companions, was playing hide-and-go-seek. I caught onto this and was waiting outside the box surprise him. A lick or two behind his ear was in order. When he spent the better part of ten minutes inside the box I became concerned and did what any thoughtful dog would do: I barked.

Jason came and investigated. Things didn't sound very good. He took the top of the litter box and Iggy did some serious complaining. There was some hushed talking downstairs and a short while later Iggy was whisked out of the house in a plastic box with holes cut in the side. Could you imagine having to travel around in that?  Why not walk? Those cats are very strange. I do believe I will never totally understand them.

Anyway, I was very upset that I couldn't come. I wanted to get out of the house. I was informed that dogs weren't welcome at Iggy's doctor because it's for cats only. The nerve!

As usual, the vet talked Jason's ear off for a good hour. This guy seriously knows everything there is to know about cats. For example, last year Dr. Carlson told Jason about the evils of dry cat food. He was aghast to learn that dry food was the worst possible food to feed cats. If not a contributing cause to the fatty liver disease that took the lives of Jason's previous cats, a dry food only certainty didn't help. Here is a link that will take you to a page that pretty much describes the evils of a dry-food only diet for cats. Want to know even more? Here is another similar source of information.

Back to today. Dr. Carlson was at it again teaching Jason. He explained that cats evolved from desert dwelling creatures: they adapted to their environment by having their moisture requirements met solely by the moisture found in their prey. When is the last time you saw a cat in the wild hunt down a bag of dried cat food? What does a wild back of dried cat food look like anyway?

Iggy mostly eats a canned food diet with a little bit of dry kibble. The problem is that there is just not enough water in the canned food for him. Iggy, being picky, only likes to drink out of the dripping faucet. Jason, being frugal, thinks it's a bad idea to leave the faucet on all day for the cat. See the problem?

Iggy basically had sand in his bladder, the pH of his urine was off the charts, and he was wicked uncomfortable. He got some pain meds and muscle relaxants (he's been no fun today--sleeping up on the fourth forth floor which is out of my puppy reach).

Dr. Carlson also now has both cats on a slurpee diet. Canned food only--and that food is now mixed with as much water as the cats can tolerate. Jason whisked equal parts food and water together. He thinks it looks gross. The cats however find it delicious. I also find it rather yummy. Of course, I also find dead frogs on the road yummy so my tastes are somewhat suspect.

Looks like things are getting back to normal. If you have cats in your life, give some thought to their diet. Opening up a bag of dry food just isn't good enough.