Pet Health Insurance – Friend or Foe?

Pet Health Insurance – friend or foe?

Pet Health Insurance – here we have another topic where opinions vary widely and debates over pros and cons are in no short supply. You may ask, “Do they really have such a thing?” The answer of course is “Yes.” They actually even have pet life insurance. But for this week, we’ll concentrate on the health insurance topic.

Insurance of any kind is one of those things that you buy and hope you never have to use. Having said that, given our pet’s relatively short life spans in comparison to our own, I think it’s common sense to realize that it’s highly likely our pet’s are going to get ill or have accidents and at some point in their lives require significant medical care. And that care can be expensive.

I suppose I could summarize the entire blog at this point with a statement like “Pet Insurance – Get It”. There you have it – my opinion is out of the ‘proverbial’ bag. But I think we can certainly expand on the “why?” of it all and look at some of the pros and cons.

First let’s talk about what it is. Pet health insurance, much like human health insurance, helps cover the cost of medical expenses for illness or accidents. Some pet insurance plans even offer options to cover routine health and wellness visits to include things like vaccinations, annual exams, spaying/neutering, heartworm testing and medications for an additional cost. However, I think the best use of pet insurance is for the unexpected, catastrophic accident or medical events that are difficult to budget for.

Oh come on Dr. V, what are the odds of something really bad happening? Can’t I wait to purchase the insurance until my pet achieves middle age and then purchase it?” I suppose the answer to that is “Yes you can.” But is that the best choice you can make for your pet? That answer is no. To elaborate, let’s look at who is in the hospital right now. Or more specifically, let’s look at a typical day in the life of WBAH.

.. 4 year old dog, whose owners woke up and thought ”let’s go for a walk on the beach with our dog”. It’s a beautiful Saturday morning in January” They were walking on the beach with their dog on a leash, when a much larger dog, broke away from his handler and attacked….. severe lacerations requiring surgery

.. there’s the cat that swallowed a small cork from a bottle….fit perfectly into the diameter of his small bowel….plugging it up completely… requiring surgery

.. the little dog, who lived happily with a big dog, until there was a disagreement…. again lacerations and muscle damage

. middle age dog, runs out in back yard…. comes back holding up rear leg… ruptured cruciate ligament. Requires surgery

…….Senior dog’s entire back right leg is completely swollen from hip to toes within a period of 24 hours and dog can hardly walk. Dog needs surgery to relieve massive swelling. Leg is shaved to begin surgery and puncture wounds are found with skin already dying. Leg is opened up and it looks like a hand grenade had gone off inside the muscle. This dog was bit by a nasty spider…black widow? In its own back yard!

Each of these clients was faced with unexpected veterinary medical bills. These situations are ideal examples of cases that could benefit from the owners having pet health insurance. The sad part is only one of these clients actually has pet health insurance.

Your next question might be “how does it work?” Pet insurance is similar to human health insurance in that it has premiums, deductibles, co-pays and maximum payouts. Covered California doesn’t exist for our pets, so it does not cover pre-existing conditions. Pet health insurance does have waiting periods that define when coverage starts, usually 30 days for the most part but this can be longer for more serious conditions. It differs from human health insurance in that it is a reimbursement program. This means you pay the vet bill and then you file the claim with the pet insurance company for reimbursement. Most insurance companies do have a fairly quick turn-around time for reimbursement and payments are usually in your hands by the time your credit card bill is due. A great benefit with this type of insurance is that pet insurance companies do not use networks so you are able to visit any licensed veterinarian in the United States.

Selecting an insurance company is an individual choice because each person has different needs based on the pet’s breed, the owner’s geographical location and the owner’s budget. Here are my personal suggestions to consider when shopping for your pet insurance:

  • Make sure the plan has good medical coverage. The most comprehensive plans cover accidents/injuries and illness.
  • Make sure the plan has coverage for cancer and coverage for chronic illness and make sure the coverage for chronic illness/disease has a continual coverage option. Some companies will only cover the chronic illness/disease in the policy year it was diagnosed in, after that you will have to pay for continuing coverage.
  • Check to see if it has coverage for hereditary and congenital diseases? Does it cover diseases that are common to your pet’s breed?
  • Pay close attention to “per incident limits” as well as “annual maximums”. Always buy the policy with the highest “per incident” limit that you can afford.

Accident Only policies are cheaper and as the name implies, only cover accidents. They do not cover medical costs caused by illness. Remember that as a pet ages, the number of accident related injuries decreases in comparison to the number of illness related conditions. I would recommend asking many questions of the insurance company. In particular for the middle aged dog who will be running in the backyard and come in limping with a torn cruciate ligament in his knee. You might think this an accident while your insurance company might consider it a chronic disease due to the breed of your dog.

The pros seem fairly obvious. Pet gets sick or pet gets injured and pet insurance helps you pay for that unexpected expense. One of the hardest things I see on a regular basis is an owner that loves their pet and has to make the decision to euthanize because they don’t have insurance and simply cannot afford to treat the animal. And I will say it again – “Pet Insurance – Get It”. I have no reason to promote one brand of insurance over another and it simply does not matter to me or any of us at WBAH which insurance you choose. We just don’t want to see our clients forced into a decision of euthanasia due to lack of funding. That’s just heartbreaking for everyone involved. We do offer Care Credit, but in this day and age, not everyone will qualify for that financing option. Pet insurance on the other hand is available to everyone, regardless of your credit score.

Are there any cons to consider? Pet health insurance has been available in one form or another for more than 20 years. However it still seems to be a subject that confuses people and even makes some wonder if it’s really worth the cost. How do you compare companies and policies without spending hours on end trolling through every available website? I have an answer! There is a website called Pet Insurance Review that can help you. There is a lot of great information on this site, including a way to compare rates and coverage. http://www.petinsurancereview.com/

Another resource is a website called Pet Insurance University. It’s written by a veterinarian by the name of Dr. Wilkerson and offers lots of great information as well. Dr. Wilkerson goes into far more detail on his site, in explaining the details of pet health insurance than I can go into here.  It’s well worth a look and a read. http://www.pet-insurance-university.com/

In questioning clients who have pet health insurance for their pets, and who have had to use it, the general satisfaction with it seems fairly high. Like any insurance, I don’t think it is always easy to use and I think policies need to be carefully looked at when purchasing. I’ve heard so many stories from clients about how pet health insurance has saved the day for them. One client, we’ll call her JH, was kind enough to share her story with me as to the value of pet insurance in her situation.

I got insurance for Canela when she was about 9 years old. I had debated if it was worth it and finally decided to get it in case of cancer or other huge illness or injury. I researched the companies and realized some gave 80 or 90% return while others gave very little return.   I was still unsure if it was worth it.  However about six months after I got the insurance a mass was found in Canela’s lungs. Diagnostics alone were over $4,000. I paid a little over $400 of that.  She was diagnosed with cancer and given only a few months to live without treatment. Canela lived another year with cancer.  She actually became a little miracle dog.  The cancer never grew.  In the end it was something else that took her.  I never would have had that last year with her without insurance.  Her medical bills were probably close to $15,000 and I paid probably around $2,000 including premiums, etc.  She was my girl and, like so many pet owners, I loved her dearly.”

 

With the high cost of medicine, we have long reached the point where medical insurance for our pets should be a strong consideration. It’s food for thought in any case.

Dr. Voorheis

Preparing For The Unexpected – Disasters and your pets

Preparing for the unexpected

January 23, 2014

 

Last Thursday, as I left my home at 6:30 am to head to work, I turned the corner and looked smack at the distant hillside on fire. I knew it wasn’t likely to affect my home directly (wrong way of prevalent winds and it would have had to jump a freeway to do so). So I continued on to work, and paid attention to what was happening as did most of Southern California that day.   Later that day, this would be called the Colby Fire which burned in some capacity for several days.  On my way in, I began to wonder if my clients know what to do for their pets in an emergency situation like fire and earthquakes. It did get me thinking about how prepared I am or how prepared we all are as a community for the next big disaster. Certainly those who live in the common burn areas of Southern California experience these types of disasters more commonly than those of us who live in the more urban areas. However, we should all be equally prepared. Planning is crucial to surviving a disaster.

 Keep in mind that if you need to evacuate from your home, you should take your pets with you. They will most likely be unable to survive on their own and they count on you for their safety. In the event that you are separated from your pets during an emergency or disaster, being able to reunite with them will depend largely on what you have done prior to the incident taking place. Microchips are your best possible tool in being able to find your lost pet. I can’t stress this enough. Microchip your pets. The technology is there now, so that all major chip manufacturers’ chips are read by each other’s scanners. It used to be that one manufacturer’s chip reader would not read another manufacturer’s chip.  Universal scanners are now the norm. In a major disaster, stray animals will be gathered up and taken to the pound or other temporary shelters. Without an identifying chip, the likelihood of these pets returning to their homes is slim. Literally hundreds if not thousands of dogs and cats were relocated across the country following Hurricane Katrina. They were never returned to their homes of origin causing an immense amount of sadness for pets and owners alike. It bears repeating, “Microchip your pets”.

 

So, how do we best survive a “natural disaster”?  The first thing on your list in any emergency, disaster or otherwise, should be to remain calm. Slipping into a panic mode will not help anyone, including your pets. You’ll want to keep their stress level down so that things like running from the home and or biting someone to do not take place. Know ahead of time what to do, who to call, where to go and what to take with you. These same principles apply for humans as well. Spending some time preparing for an earthquake or other natural disaster removes some of its power over us.

 

The two main challenges in Southern California are fire and earthquakes. So let’s take a look at that earthquake kit you’ve got in the garage or back bedroom that you can use is either scenario. You know……. the one that isn’t there but you keep meaning to put together?  Yeah, that one. Your disaster kit should have a 5 to 7 day supply of food and water for each pet in your home. This is in addition to all suggested items that are needed to take care of your non furry family members. If you pet has a required prescription medication, keep an additional supply in the disaster kit. The exception is insulin which must be kept in a refrigerator. Your best bet in an earthquake is to keep the door to the refrigerator closed and hope that the fridge stays cold. Icepacks may help. Having a first aid kit specially stocked for pets is also a great idea. Make sure your pet carriers and/or leashes, harnesses and muzzles are readily accessible as well. There is a great pet survival guide available from FEMA on line that I recommend highly. Just click here: 

http://www.ready.gov/sites/default/files/documents/files/pets_brochure.pdf

It’s also a good idea to have all your emergency numbers in one place so that they are easily accessible, like on the refrigerator. Things like the veterinarian’s phone number, the pet poison control phone number, numbers to local animal shelters and the emergency vet’s phone number for after hours issues should all be at your fingertips. You should also know where the emergency vet is located. You won’t want to try and figure that out in the middle of an emergency. While things are calm, do a “drive by” to your local emergency vet’s office. Know how to get there quickly and where to park. This may save precious minutes later.

As discussed above, we should start in our own homes with being organized and prepared for the unexpected. Then, we can move on to our neighbors and community. This is where a website such as www.bereadyla.org can be really helpful. It offers suggestions for a neighborhood contact list, neighborhood meetings, etc. Asking questions like who else in the neighborhood has pets or kids and how you can support one another can prove to be very useful in an emergency.  By involving and getting to know your neighbors (yes even the annoying ones), you will increase your odds of helping your family and pets, and others as well. We will all need to come together in the event of a disaster.

 

On a bigger scale, Los Angeles County has an Animal Emergency Response Annex, who has put together a manual for disaster relief operations for animals.   http://www.smgov.net/departments/oem/sems/sheltering/losangelescountyoperational areaanimalannex.pdf

The county provides emergency shelter for evacuated animals and there are provisions for temporary shelters being set up near where people are evacuated as well. Veterinarians have formed the California Veterinary Medical Reserve Corps (CAVMRC) The CAVMRC is guided by the Disaster Preparedness Committed of the California Veterinary Medical Association. Its mission is to preserve animal wellbeing and protect the public health and welfare by providing emergency medical care and expertise in all phases of disaster preparedness and response. Every veterinarian at Washington Blvd Animal Hospital is a CVMA member and supports the CAVMRC.  In the event of a major disaster, these resources will be taxed, but if you have taken the time to prepare then you will have a better sense of control over the situation and feel much more confident about your ability to care for your family and your animals.

 

Preparing for a disaster is something that most of us chose to ignore. I think we all live in denial to a certain extent and just try to wish it or will it away. But keeping our heads buried in the proverbial sand does no good at all for anyone, especially our pets. Do you need to be prepared for a disaster tomorrow? Who knows. Disasters don’t exactly give notice of their pending arrival. Even though it can be overwhelming to prepare these disaster kits and get ready for the “big one”, whatever that may be, it’s time to start. At least take some baby steps in the right direction. Maybe a New Year’s resolution? Before you know it, you’ll be ready and stocked up. Heck, you might even be the one that everyone else in the neighborhood looks to in a time of need.  Putting some type of disaster plan together, will make you feel better about the care of the critters in your charge.

 

Until next week……… 

 

Dr. Voorheis 

Vaccinations – Who, What, When, Why and How?

January 15, 2014

Vaccinations are a controversial subject these days with both humans and animals. There are certainly many varying opinions as to whether or not to vaccinate and when it should be done. So, this week let’s talk about the Who, What, When, Why and How of it all. I’d like to break this all down so that our valued clients have a clear understanding of why vaccinations are necessary and sometimes not necessary. I would also like to talk about the immune system which works hand in hand with vaccinations as well as offer some relevant information about the origin of vaccinations in order to provide a bigger picture and hopefully a better grasp on the topic as a whole. I promise an interesting read!

Before we get this ball rolling, let me say this. Bringing your pets in for an annual exam is crucial to their health and well being. I cannot stress this point enough. Often the exam is MORE important than the actual vaccinations. With the annual exam, things can be caught early before they turn into serious and expensive problems. With your senior pets, exams should be done every six months. Just like people, good health becomes a bigger challenge with our pets as they age. Sticking with one veterinarian is also key. If you see the same vet year after year, that vet knows your pet and will quickly catch any major differences in body condition or lab work. Again, this is crucial in catching things early and fixing things before they grow into larger issues. Now, on to vaccinations.

I’ll start with this statement:  there is a tremendous amount of information and misinformation that is readily available to anyone who has access to the internet, much like our topic from last week – nutrition. So I think a good place to begin is with a basic understanding of the immune system, how it works and how it does what it does so amazingly well.

HOW

How does the immune system work? Suffice it to say that the immune system provides multiple layers of defense for an animal (and for people too) to resist infection. These layers interact with one another in a complex dance that keeps us alive and healthy in a microbial world. Some layers of defense are effective against many different types of invaders while others are very specific in their area of protection. Some act against bacteria, some against viruses, and some against parasitic, fungal, or protozoal invaders.

Think of the animal (or human) body as having layered defense mechanisms against microbial invaders. The big three, would be physical barriers such as skin, innate immunity such as inflammation and adaptive immunity such as antibody production. In general, think of the innate immunity as the rapid response that keeps things at bay until adaptive immunity can develop. Adaptive immunity not only recognizes foreign invaders, but also destroys them and retains memory of the encounter. If the animal encounters the organism again, the adaptive response is quicker and more effective. Adaptive immunity can work in two ways. One is the humoral immune response – think antibodies directed against invaders. The other is the cell mediated response – think invaders have gotten inside of cells and antibodies can’t get to them, so then specialized cells destroy these abnormal or infected cells. Make sense?

I think sometimes we lose touch with the fact we, in our modern society, think we are somehow above or distant from a microbial world. In reality, it’s quite the opposite. A healthy immune system constantly protects us and our pets from disease.  Here is a vivid example: the animal body (warm, moist and full of nutrients) is extremely attractive to microorganisms. The magnitude of this can be seen at the time of death, where, within hours, a body decomposes rapidly as bacteria invade its tissues because the immune system is no longer working. So these invaders are there, always lurking and waiting for the opportunity to wreak havoc.  Are all microbes a threat? No. The world is full of microbes (bacteria, viruses, fungi, protozoa, and worms). Enormous numbers of these colonize the skin and intestines, but don’t seek to invade and normally don’t cause disease.  These are called commensal organisms. Others, are more aggressive and do seek to invade and those are called pathogens. Influenza (the flu) is a pathogen as is canine distemper, HIV, Brucella abortus, rabies and a host of others.

Where did vaccines come from and when did it all start? In the late 1800’s Louis Pasteur (of pasteurization fame) discovered that by using an aged culture of the bacterium to be known as Pasteurella multocida, he could protect chickens against “fowl cholera”. He then worked on anthrax, and discovered growing the anthrax organism at high temperatures rendered it avirulent (it wouldn’t cause disease), but the avirulent organism was protective against the virulent organism when injected in sheep. Vaccination was born. These early scientists did not know why or how the immune system worked; it had been left to others to determine the molecular and cellular basis of antimicrobial immunity. Knowing this has enabled us to use immune mechanisms to develop resistance to infectious diseases, thus creating more vaccine possibilities. And that work is still being done today.  I think this is a good time to get into the who, when and what. 

WHO, WHEN and WHAT

Ever wonder why we vaccinate at the age we do? Why 8 weeks of age? Why not 4 weeks of age? It’s called passive immunity. Newborn mammals are temporarily protected against infection by transfer of immunoglobulins derived from the mother. How that protection gets to the newborn depends on what kind of mammal you are. In humans and other primates, the placenta is hemochorial which allows certain maternal to transfer directly to the fetus. Dogs and cats have an endotheliochorial placenta, which basically means not a lot of passive transfer takes place in the uterus; 5 to 10% is transferred to the puppy or kitten. The rest is transferred in colostrum, the milk that is produced by the mother in the first couple of days of life. In horses, pigs, and ruminants, no transfer in the uterus takes place at all so colostrum is critical as their newborns are entirely dependent on antibodies transferred through milk. Maternal antibodies absorbed from a puppies intestine, reach maximal levels in serum by 12 to 24 hours after birth and have a half-life of about 9 days (kittens – about 10 days). On average, the level of maternal antibodies to distemper declines to insignificant levels by about 10 to 12 weeks, although this ranges from 6 to 16 weeks. Simply put, we don’t vaccinate puppies or kittens at 4 weeks of age, because passive antibody will block the vaccination. The vaccination will be not be effective. Several years ago, many people in an effort to “protect” their puppies were vaccinating against parvo virus at 4 weeks of age. Sadly, this resulted in no protection, a false sense of security and a waste of money. There is an exception to this rule which is the puppy or kitten that received no colostrum from the mother. These babies can and must be vaccinated “early”. For this colostrum deprived puppy or kitten, they can mount an immune response as young as 2 weeks of age.

The earliest age recommended to vaccinate a puppy or kitten with a reasonable expectation of success is at 8 weeks. Two additional vaccinations are recommended spaced about 4 weeks apart. Simply remembering 8, 12, and 16 weeks is the safest way to vaccinate a puppy or a kitten. This is because, some (and we cannot tell which ones), will be susceptible at 8 weeks of age, so they need to be vaccinated at that age. Some will still have maternal antibodies in sufficient numbers to block that vaccine so their first effective vaccination won’t be until the 12 week injection. All maternal antibodies will be gone by the time the 16 week injection is administered, with the 16 week injection acting to boost the amnestic (memory) response. A booster shot is then given at one year of age. Here are two charts for an easy and quick reference.

Core Vaccines for Dogs

##Dogs Distemper Adenoviru s 2 Parainfluenz a* Parvo Rabies
8 weeks xx xx xx xx  
12 weeks xx xx xx xx  
16 weeks xx xx xx xx xx
1 year xx xx xx xx xx

*Parainfluenza is not considered a core vaccine by many veterinary internal medicine specialists, however it’s inclusion in 4-way,   5-way and 7 way vaccine protocols is standard amongst vaccine pharmaceutical companies.

Core Vaccines for Cats

##Cats

FPV

Panleukopenia or feline parvo virus

FCV

Calici virus

FHV-1

Herpes Virus or

Rhinotracheitis

Chlamydia

*

FeLV**

Rabies

8

xx

xx

xx

xx

   

12

xx

xx

xx

xx

xx

 

16

xx

xx

xx

xx

xx

xx

1

xx

xx

xx

xx

xx***

xx

*Chlamydia, is often included by major vaccine manufacturers – in the “4 way vaccine” known as FVRCCP; it is felt by many to be a significant component of the feline upper respiratory disorders. It is not considered “core” by the American Association of Feline Practioneer’s Vaccine Advisory Panel. We include it in our core vaccination.

**Feline Leukemia Vaccination – as of 2013, the AAFP Advisory Panel has moved feline leukemia vaccination into the list of core vaccines. The reasoning – is that at 12 and 16 weeks of age, the ultimate type of home the kitten will be in is often unknown and the risk of Feline Leukemia is too great to overlook. At Washington Blvd Animal Hospital, a discussion of where the cat lives and with who, precedes a decision to vaccinate against FELV. If a decision is made to vaccinate against feline leukemia there must be a negative test for feline leukemia prior to vaccinating.

*** Feline Leukemia Core Vaccination at 1 year – at one year of age it is reasonable to know whether or not the cat is an outdoor cat, or an indoor cat. Or a mix of both. Outdoor cats, and indoor-outdoor cats, OR inside cats who have exposure to cats that are indoor-outdoor should be vaccinated against feline leukemia.

You will notice I didn’t fill out the chart for dogs and cats beyond the first year. In part, that is because I don’t think there should be a table of all possible vaccinations and when they should be administered. In addition, I believe the decision of how often to vaccinate, and against what, is a medical decision not just an automatic one. A discussion of your dog and cat’s vaccination needs should be part of every annual exam. For example, the dog that is frequently boarded and groomed at professional facilities and/or visits doggy day-care or dog parks certainly has different vaccine requirements than the 4 year old house dog that never leaves the house. In addition, while we now know that the core vaccinations have an effective “protective” life of 3 years or greater, many of the non-core vaccinations are only effective for six months (i.e. bordetella). 

The same thought process is true for cats, but with cats, we have the added dimensions of the stress of multiple cat households and lowering of immunity for that reason. Shelter cats, rescue cats, all change how we vaccinate.  The bottom line on vaccinations is that during the annual examination, the decision to vaccinate is brought up and discussed. In general with cats, this same every 3 years vaccination holds true, with the exception of the rabies shot, which is yearly.

WHY

Most of us see the requirement for a rabies vaccination, as a pain in the neck. It is seen as more of a government intrusion in our lives.  You might think “we have to pay for a license, we have to get this shot for our animals and we have never even seen a case of rabies”. Yet worldwide, rabies kills more than 50,000 people a year! Most of those cases are caused by being bitten by a rabid dog. The reservoirs for rabies in California are skunks and bats.  Rabid bats are also found every year in Los Angeles County believe it or not. According to the Veterinary Public Health and Rabies Control Program of the Los Angeles County Department of Public Health. Of note, LA County has reported record-setting numbers of rabid bats in the past few years. Usually between 8-12 are found per year, but 30-50 per year have been found in the last few years. These are not limited to mountainous regions. In fact, one was found in downtown Los Angeles not too long ago. You can find maps and more data on their website. Here is their rabid bat map for 2013: publichealth.lacounty.gov/vet/rabiesmap2013.htm  Overall, in North America, the top three mammals affected with rabies (other than the bat) are Raccoons, Skunks and foxes. Coyotes have been found with rabies as well (South Texas).

Vaccination and licensing programs are the key to keeping human rabies cases low in this country. Without a doubt, rabies vaccination programs save lives.

A special section of this blog should be devoted to the subject of feline injection site sarcomas. Vaccine associated sarcomas were first recognized as an issue in cats in the early 1990’s. Initial studies suggested a rate of 2 cases/10,000 and in one study that jumped up to 13-36 cases/10,000 (that’s a huge increase). Finally, current estimates based on very large studies suggest the risk of sarcoma development is actually low, well below 1 per 10,000. BUT, there is a risk. Some cats, who have been vaccinated against feline leukemia or against rabies, developed cancer. The risk is low, but we can lower it even further by vaccinating only those cats at risk. By using the appropriate type of vaccinations and by placing the vaccinations in a location that would allow better management of a cancer should it occur. The flip side of the coin should be examined as well. If you’re an outdoor cat, there is a greater risk of catching the feline leukemia virus and dying from it than there is developing an injection site sarcoma. Feline rabies cases are more common than canine rabies cases, so the need to vaccinate, the need to protect feline and human lives against rabies is real.  So yes, I still recommend vaccinating against feline leukemia for at risk cats. I still recommend vaccinating against rabies in cats as well. In some areas, you are not given the choice because the county requires it. In other areas, it becomes a choice of looking at who is at risk.

Which almost brings me full circle and I would ask your indulgence in a brief discussion of vaccinations in both humans and animals. I have been practicing veterinary medicine long enough (31 years) to have seen animals infected with disease that my younger associates rarely see.  Prior to my entrance into veterinary school in the early and mid 1970’s – I worked at this same hospital as a technician (remember the first blog). I dealt with cages of cats with severe upper respiratory disease that dwarf the upper respiratory diseases we see now.  In the early years of my practice career, cases of canine distemper were frequent. Puppies with severe distemper pneumonia would manage to survive only to die from the neurologic form of the same disease. I remember when “any sick cat” that showed up first had to have feline leukemia ruled out because it was so common. Parvo virus wiped out thousands and thousands of dogs when it first broke out in the late 1970s and early 1980s. It is now primarily a disease of unvaccinated puppies, but the virus is resistant, long lived and is spread by flies. This year I saw my first adult dogs with parvo virus in years. It is my sincere hope that this was just a blip on the radar, but let’s get something straight. Vaccines, in both humans and animals save lives. In veterinary medicine they have been blamed for immune mediated disease, hypothyroidism and other disorders. There is no evidence for this at this time in peer reviewed journals. When a vaccination has been linked to a problem, (as with the feline injection site sarcomas) it has been studied, published and answers and recommendations have come forth. In human medicine, vaccinations have been unfairly linked to epilepsy and to autism. It is natural to confuse subsequence with consequence. Many of the babies that were vaccinated against pertussis that developed seizures and severe neurologic disorders ultimately were found to have a genetic defect in the sodium transport system in their brains. Same goes for autism, there are no credible links of vaccinations causing autism. When we don’t vaccinate our dogs and cats, when we don’t vaccinate our children… we put the “herd” at risk. We risk being revisited by the diseases of my early veterinary career, and we risk being revisited by the diseases of my parents and grandparents generations. To quote another colleague of mine, Kathleen Barry M.D., “Vaccinations are the crowning achievement of the 20th century”. I simply could not agree more. Until next week……………… 

Dr. Voorheis

What Should I Feed Fido & Fluffy?

January 8, 2014 

 

Happy New Year to all our WBAH clients and their furry friends! As promised, it’s time for the second entry of the Veterinarian’s Blog. As it is every year, most people make New Year’s resolutions to get healthier, exercise, lose weight, etc. Well, that’s an admirable goal for all of us but it’s also a good plan for our pets. So, today, let’s talk about cat and dog nutrition. Now, as it was with the first blog entry, this too will be my personal opinion. It is an opinion based on 30 plus years as a veterinarian, including but not limited to nutritional education in veterinary school, reviews of current medical literature and presentations at professional meetings as well as firsthand knowledge of how a poor diet can negatively affect an animal. 

 

So why the qualifying statement you may ask? I believe the field of nutrition, both veterinary and human, is filled with people who consider themselves “experts”. It seems that if you have internet access, you can become an expert. With some slick packaging on your website, you can become a highly regarded expert. We all eat, so we all develop an opinion on nutrition. I have to wonder what the professionals who have devoted their careers and lives to nutrition think about the unsubstantiated claims about the benefits of certain ingredients, fad diets or alternative meal plans. As a veterinarian, it can be frustrating to listen to claims about meal plans unsubstantiated by fact or research, offered by so called “highly regarded experts” who can easily be a 19 year old salesperson in the dog food aisle at your local pet supply store simply hiding anonymously behind a keyboard. So, let’s try to dispel some myths and set the record straight and get our furry friends on the right track. We could literally talk for days on this subject, but for now let’s concentrate on commercial foods and alternative nutrition such as home cooked or raw food diets. 

 

But before we delve into all of that, let me first state that the most important thing to cross the lips of your dog or cat is fresh, clean drinking water. Always have plenty available. This is crucial for their health and well-being. And one more thing that goes hand in hand with a good meal plan is exercise. It’s just as important to your pets as it is to you and I. Activity keeps them healthy and happy and also keeps their weight under control. Obesity can cause serious health issues in cats and dogs, especially as they grow older. Obesity in humans has been labeled an epidemic in this country. While not quite the same in the world of our pets, obesity is growing at a very quick pace. So much so in fact that special commercial foods are now produced by many manufacturers that assist with weight control and weight loss. The best one I have seen in years is a new line by Hill’s Science Diet called “Metabolic Diet”. I’ve had great success with this diet in both clients and in my own home. I have a cat that has dropped a considerable amount of weight and will now live a much healthier life.

 

But how are our pets gaining all this extra weight? I find it’s not necessarily over feeding of the food an owner chooses for their pet. It seems to be an overabundance of treats. Pet treats that come from a pet supply store or worse yet, the owner’s table scraps. We need to keep in mind that our pets are not garbage disposals. They don’t need our leftovers. What we choose to eat is usually a bit richer and higher in calories than our pets are built to deal with. Table scraps can upset the sensitive stomachs of your pets and should be avoided. There are also many foods that animals cannot digest properly and some of those foods can make your pets very sick or possibly even lead to an accidental poisoning or worse. Foods to keep in mind that should NEVER be given to your pet include but are not limited to onions, grapes, raisins and currants, chocolate, macadamia nuts and xylitol which is found in sugar free gum and candy. A full of list of dangerous foods is readily available on the internet. In case of an after-hours accidental ingestion of one of these foods or any household cleaners or human medications, you should call the animal poison control center at 888-426-4435 for instruction.   

 

Commercial Foods  

The vast majority of commercially available foods that meet AAFCO standards are perfectly fine for the needs of most dogs and cats. They are easy to feed, with minimal preparatory effort. This is also what most veterinary board certified nutritionists say as well. A very important point to remember is that homemade diets typically have not undergone animal feeding trials or even laboratory analysis to confirm that they support the life stage for which they were designed. With commercially available foods that part of the dilemma is resolved, with different diets by the same company developed for different stages of the pet’s life. There are several good pet food companies with long track records of excellence in nutrition and nutritional research (these include but are not limited to Hill’s Science Diet, Iam’s/Eukanuba, Nutro, Royal Canin and Purina). If you and your vet are happy with the health of your dog or cat and there seem to be minimal issues surrounding your pet’s diet, then my advice would be, why change? 

 

Home Cooked Diets  

There seems to be an increase in the interest and use of home prepared diets. Some of that is fueled by issues in the pet food industry with recalled foods. This is a valid concern. This however has led to the perception that commercially available pet foods are all lower grade foods and therefore unhealthy. This is not the case. This perception is readily exploited by manufacturers of “niche” commercial dog foods. It is important to realize that no feeding approach is without potential pitfalls and it is important to assess the risks and benefits of all feeding regimes with the help of currently available scientific evidence. 

So, what about pet owners who are no longer comfortable with commercial diets, or have a pet that won’t eat a commercial diet, or they simply feel that preparing a homemade diet ensures they are going the extra mile for their pets and giving them the very best possible shot at excellent nutrition? There are also animals with medical problems that may do better on a home cooked diet than they do on a commercial diet or a prescription diet. One of the more common conditions where homemade diets have been extremely useful is in managing food allergies. Can a properly prepared a “home cooked diet” work? The short answer is, yes. The longer answer is, it takes a great deal of commitment to do it properly. Benefits of home cooked diets include palatability, high digestibility and ability to control exactly the ingredients and/or nutrient levels of the diet. The diet can be made to the exact needs of that particular pet. Which leads to the question of “how do we know the exact needs of that particular pet”? This is where the real experts come into play. 

 Homemade diets should be formulated by consulting your veterinarian who will work closely with a board certified veterinary nutritionist. Some of the best veterinary nutritionists are located at The Nutrition Support Center aligned with the veterinary school at UC Davis. Through a website called www.balanceit.com, they offer a great deal of support for the home cook. You are asked a few basic questions about your pet’s age, status/gender, weight and body condition (don’t worry, that last one has a drop down menu to choose from….or you can just ask your veterinarian). After you enter this information, you are able to look through various recipes and chose one that sounds good for you and your pet. Upon choosing a recipe, you are provided with a complete breakdown of that recipe including calories needed for your pet, percentage of protein vs.carbohydrates vs. fat as well as how much balancing powder you need to supply your pet with the necessary vitamins and minerals required for them to stay healthy. This service is free of charge and you can even click on any health issues your pet may have. If that option is chosen, a nutritionist will request authorization from your veterinarian and once approved, they will send you a menu based on those special dietary needs for the medical condition or conditions you selected. As I said, it does take a good deal of commitment on your part to do this the right way. I have clients that chose to do this that tell me it isn’t much more expensive to do than buying a bag of dry food. BUT it is a substantial time commitment, both in preparation and feeding. If you home cook, you need to do it right, all in. Doing it wrong can severely compromise the health of your pet. Recipes must be followed and substitutions should not be made without consulting a certified veterinary nutritionist. There is a very delicate balance with this home cooking so the devil is in the details. 

 The advantages of feeding a home cooked diet are lost when a generic recipe is used off of the internet or from random books. These recipes are not custom made for your pet, and include Vague ingredients, such as “ground beef” (unspecified fat content), “cooked chicken” (unspecified cut and method of cooking), or multivitamin (what type, what one, human? animal?). Pet multivitamins are generally formulated to be safe when added to commercial diets so the levels of potentially toxic nutrients (such as Zinc, Vitamin A and D among others) are not provided in excessive amounts. That does not mean that a multivitamin added to a batch of a home cooked food is adequate or balanced. It is not. There are also potential disadvantages in the impossibility of performing feeding tests to ensure nutritional adequacy. When feeding a homemade diet, it’s a good idea to have blood work done a regular basis in the beginning to make sure all your pet’s needs are being met. In a study published in the 90’s that evaluated 116 home cooked diets, 90% were not nutritionally adequate for adult maintenance according to current recommendations at that time. We have come a considerably long way since then in formulating diets for ‘home cooking”, but the best way to formulate a home cooked diet is in consultation with a certified veterinary nutritionist. We also use the American College of Veterinary Nutritionists www.acvn.org which is another great option to review. 

 

 

Raw Foods  

Proponents of raw food diets are often very passionate in their defense of this type of meal plan. It is the closest thing to arguing politics in the exam room. I have found them to be conscientious owners who want the best thing for their pets (they are willing to go to all the trouble to prepare these foods).But, they don’t have a veterinary nutritionist in their kitchen. There is lack of scientific evidence to support any health benefit of feeding raw diets compared to commercial diets or to home cooked diets. However, there are many websites that provide testimonials and success stories of animals fed raw diets and evidence of their superiority to home cooked or to commercially available diets. These claims are fairly extensive and are not supported by any study published in any reputable scientific journal that I’m aware of. There are 3 main types of raw food diets; 

 

  1. Home prepared, such as recommended by Dr. Billinghurst (B.A.R.F. – Biologically Appropriate Raw Food)  http://www.barfworld.com/html/barf_diet/barfdiet.shtml 
  2. Combination diets a premix can be bought to mix with a raw meat. 
  3. Bones and raw food diet (usually sold frozen). 

 

There are 3 major issues as related to feeding raw food diets: 

1. Nutritional adequacy of home prepared raw foods can suffer from the same nutritional inadequacies as home cooked diets, unbalanced, vague in instruction and nutrient drift (ingredients being substituted at will). 

2. Many of these diets rely on bones to provide enough calcium the bioavailability of calcium varies depending on type and size of bone used. There are published papers showing problems with calcium and phosphorus balance in raw food diets. Bones can also cause intestinal foreign body obstructions, gut perforation, and constipation. They can also break teeth. 

3. Bacterial contamination – there are numerous published papers documenting bacterial contamination of raw meat. Pathogens (harmful bacteria), such as Salmonella, Campylobacter, E.coli 0157:H7, Clostridium perfringens.

 The percentage of bacteria found in these raw meat sources ranged from 40-60%. The risk here is not just to the dog or cat being fed these raw meat diets. It is to the human preparing the foods as well as other humans in the household. Organisms such as salmonella are very difficult to get rid of once environmental contamination has occurred. The high risk population is the young (your kids, the elderly, and those with compromised immune systems). There are numerous studies documenting the nutritional inadequacies of a raw diet which I have listed at this end of this article. I offer these because I feel that I have a role here to educate. There is no known health benefit of feeding a raw food diet. Dr. Freeman (DVM, PhD, DAVCN), published a top ten myth list about raw foods diets which can be found here: http://www.tufts.edu/vet/nutrition/resources/raw_meat_diets.pdf . I also recognize that, like politics, there’s usually nothing that can be said to convince a mind that’s already made up. With that said and in the interest of safety, I must at least address some common sense practices if raw foods are going to be fed: 

 

  1. Hand hygiene is critical – hands must be thoroughly washed before and after handling raw meat. 
  2. Do not store raw meat where it will come in contact with other food items. 
  3. All items that raw meat comes in contact with should be disinfected after use. Ex. Cutting boards, knives, feeding dishes etc. 
  4. Cutting boards for raw meat should NOT be used for anything else. EVER.  5. Bowls should be thoroughly cleaned to remove debris and then disinfected. 
  5. High risk individuals (mentioned earlier) should not have contact with feeding this kind of diet. 
  6. Fecal contamination of the environment should be cleaned promptly, and wash hands after contact with feces. 

 

So the conclusion I must reach as a veterinarian is to advise my clients against the feeding of raw food diets. For most of you, this is common sense. For those that choose to feed raw food diets, I suspect I will convince only a small percentage of you. For those thinking of feeding a raw food diet, maybe I’ve reached you and you’ll think twice in consideration of the information provided here. 

 

In my long blog on diets, I have not addressed vegan or vegetarian diets for dogs and cats, or the current fad of “grain free diets”. I will do so briefly. We cannot make a cat into a vegetarian. Cats are obligate carnivores. No currently available vegan diet meets the minimum nutrient amounts in the AAFCO cat food nutrient profiles. It cannot be at all recommended for cats. The long term nutritional adequacy for these kinds of diets for dogs is unclear. My advice would be to avoid. About grain free diets – when did grains become bad? In looking at food allergies in dogs, the only grain commonly in the top food allergens is wheat. Corn (commonly blamed for a lot of ills) did not even make the top ten. Feed grain free diets if you so choose as long as they meet the AAFCO standards, but there is currently no evidence that a diet free of grains is far superior to feeding any other commercial pet food. 

Well, digging into foods has been fun. Next week I will tackle some other fun topic like  ???? 

 

Dr. Voorheis 

 

 

 

These are the studies documenting nutritional inadequacies of raw food diets: 

(Vet Dermatol 1992;3 2328  

Abstract Forum American College of Veterinary Internal Medicine, Baltimore, MD 2005), contamination of raw foods ( J Vet Diagn Invest. 1993;5 (3): 3727,  

J Vet Diagn Invest. 1993; 5(3) 378385;  

Finley R. Msc Thesis, University of Guelph, 2005, J Am Vet Med Assoc

2001;218  

(5): 705709.), fecal shedding of pathogens (Can Vet J. 2007; 8 (1); 6975), clinical infection (J Am Anim Hosp Assoc 2003; 39 (6): 53842), environmental contamination (Can Vet J. 2006;47 (9): 887889),  documenting human infection (J. Clin Microbiol. 2003;41 (10): 457882).  

Looking Forward to 2014

Happy New Year to all and welcome to my weekly blog! This year promises to be one of huge growth and positive change for Washington Blvd. Animal Hospital. There are many things on deck for 2014, the most important of which will be revealed at the end of this entry. It’s my cliff hanger so to speak!

Why a blog you might ask? I have started this blog in an effort to share a little bit of myself and my journey in both veterinary medicine and on a more personal level with the clients here at WBAH. My goals are to educate, amuse and grow your confidence in your own ability to help your pets live a great life. It will also be a great journal for me to look back on. I am being trusted with your very precious furry friends, so I figure we should get to know each other a little better. My hope is that you will all enjoy reading the blog as much as I enjoy sharing it with you. If you smile, laugh and learn a little bit, my goals will have been accomplished. We’ll cover everything from carefree topics like aquaponic gardening and long distance backpacking to useful veterinary/medical topics in an effort to grow your knowledge and confidence in dealing with your pet’s health. A little bit of everything I’d like to say…sort of “a year in the life of Dr. Voorheis”. So, let’s start with the basics…who am I anyway? Well, I am a veterinarian, a general practitioner with a special interest in surgery and oncology. But let’s step back and find out how this all came about.

The beginning seems to be a logical place to start. I am the middle child of 5, four boys and one girl and my formative years were spent in a rural setting. In those days, we self entertained. My brothers and I truly loved baseball. We all played and I was hooked from the moment I put on my first glove. Watch the movie Sandlot- that was the Voorheis boys in a nutshell. Aside from baseball, my family raised goats, chickens, sheep, cattle and pigs on a “backyard” farm in Norco. I was heavily involved in the local 4H club and primarily raised small ruminants (cloven hoofed mammals with four “stomachs”). My family was into sustainable farming before it ever became a popular term. We were pretty much into growing our own vegetables and fruit as well, and my mom canned what we did not eat as fresh. To the amusement of my younger veterinary colleagues, yes I have churned cream to make butter and I have made ice cream from goat’s milk/cream… although I have long since forgotten how.
My interest in veterinary medicine began at a young age, and from the time I was 12, it has been the only career that I could ever see myself in. The local veterinarian was a very special person in our home… there is no question that he sparked my interest in veterinary medicine. When I mentioned to him that I wanted to be a veterinarian, he encouraged me, as I have to numerous kids who have mentioned the same thing to me. I have passed on the same advice he gave me as well, which is “study hard, do well in school (A’s are a good thing) and don’t let go of the goal”. As I grew older he would allow me to ride on calls with him. We have remained friends to this day.

In high school, I buckled down and began to focus on my goal of becoming a veterinarian. I came across my high school yearbook once and many references included “good luck as a vet”, so it was well known that this was to be my path. After high school, I attended Cal Poly Pomona and graduated with top honors and a BS in Zoology. Next it was on to UC Davis where I received my DVM in 1982. This was a great year for two reasons. The DVM being one and meeting Suzy (my now wife) being the other.
Suzy and I have known and worked closely together since 1982. I have watched her grow professionally from an assistant to the best vet tech at WBAH. Many years went by with us enjoying a great working relationship and then a little bit of life happened to each of us. We each, independently, had a first marriage dissolve. After that happened, we began dating. Needless to say, we quickly found that we were soul mates. She is my partner and my rock in every sense of the word. She has taught me to let my guard down and show the people around me how much I care, especially clients. She has made me a better veterinarian and a better man. Together, we have a fantastic blended family with my two kids, Grace and Luc and her two sons, Tyler and Ryan. All college age and beyond and all amazing, each in their own way. We also enjoy a house full of various critters including a Great Dane, a Labrador, a Doberman Pincher, a Pomeranian and three cats. I trip over chew toys on a regular basis….and I rather enjoy it.
In my free time, I enjoy some wonderful hobbies. Aquaponic gardening has become a love of mine which evolved from both traditional gardening (reference back to my childhood – but I HATE weeding so I had to find a different way) and hydroponic gardening. With hydroponics, there were chemicals to balance and I really didn’t notice a better quality to the veggies I grew. Then I came upon Aquaponics which is right up my alley. More on this later. I don’t want to spoil it because you can be sure there will be an entire blog entry on this subject!

Hiking and backpacking are my other obsessions. I have hiked and backpacked since the 70”s. It started with my older brother Jeff and has continued with other family members and friends over the years, none more special than my daughter Grace, who by the way lives her name every day. My lifelong ambition has been to hike the entire length of the John Muir Trail, all 220 miles of it. It’s 30 years beyond when I started reaching for that goal and I am still reaching. It will be done one day. More on this later. Again, there will be an entire blog entry on this topic in the near future.
But back to the “vet” in me. Being a vet is not my job, it is my profession. But more importantly, it is my true passion. It is what drives me to rise from my bed every morning. It’s in my blood and it always will be. I wake up every morning at 4:45am. I read veterinary journals and textbooks for about an hour before I feed the critters and return emails to clients. Then it’s off to the office for a day that goes about 10 hours, often more than that. Then home to read a bit more before collapsing for the night.

Sidebar- it’s a good thing Suzy and I work in the same building or she just might forget what I look like. She encourages this work ethic in me and doesn’t mind my long hours of working, reading about “work” topics and being obsessed with being the best veterinarian I can possibly be. See? Soul mates.
When I look back on the naive young man who made his way to UC Davis way back in 1978, I remember thinking that most everyone I would be going to school with would be pretty much like me, with the same goals and ideals. Thankfully I was wrong. I was no longer the brightest guy in the room. I was in a room full of bright men and women and they were all pretty much used to being “the brightest guy/gal in the room”. Over 35 years have passed since I met that motley crew. There are a few things that stand out about that group. They are an amazing bunch of diverse and wonderfully productive people. That class has produced world renowned veterinary specialists in a host of disciplines such as internal medicine, radiology, dermatology, cardiology and surgery. We have a writer for Scientific American and there is a University of Maryland dean in that class too. We have a veterinarian, who as part of his research has been able to explain a difficult to understand topic – “global warming /climate change” into what is happening on a local level (disease spread because vectors can live in areas they weren’t found in previously). We also have a significant number of outstanding general practice veterinarians each who have contributed to their communities. I am fortunate to be in that group.

Professionally, I have been fortunate to have been associated with some amazing veterinarians during my veterinary career. There are a few worth mentioning as having a profound influence on me. Richard Fink, founding veterinarian of Washington Blvd Animal Hospital; Dr. Fink is worthy of an entire blog entry himself, but suffice it to say he realized the importance of the client/pet/veterinarian relationship. He enjoyed his career, and how he loved to laugh and stir things up. He devoted his life to organized veterinary medicine and his own practice. He also realized the importance of surrounding himself with quality veterinarians as part of his own organization. Much like I do now. It has been my pleasure and honor to work with many quality veterinarians at Washington Blvd Animal Hospital. When I joined Washington Blvd. Animal Hospital, on June 1, 1983, I joined a practice that was established and already entering past its 30th year of practice. There were six of us, at the time (Drs. Fink, Whitford, McKitterick, Throgmorton, Pendray and Voorheis). Dr. Pendray and I had gone to undergraduate and veterinary school together, and had both worked at WBAH while working on our undergraduate degrees. Dr. Pendray and I have been close friends longer than anyone I have known, and even though he no longer practices at WBAH we still consult one another weekly on cases.

Each of the above veterinarians have given me something, some part of themselves to aid in the evolvement of who I have become as a veterinarian. Dr. McKitterick showed how important the vet/client relationship was and Dr. Whitford taught me the physical exam (a lost art). A special paragraph should mention Dr. Throgmorton. “Dr. T” and I
have worked together for over 30 years, been partners for nearly that length of time and it is hard to put into a few sentences what he has taught me and what I admire most about him. He is the consummate professional. He gives each client and animal his best. He keeps current through continuing education and reading journals. We are much alike in these ways. I cannot tell you how many times over the years we would be discussing a case and he has said, “Did you consider this?” This comment of course bringing in the missing piece of a puzzle. On a personal level, he has been a steadying influence on me and has always been there for me without fail. He is another rock in my life and I hold our working relationship and friendship in very high regard.
Our local specialty practices have had a strong influence on how I practice, thanks to Dr. Rosenberg and her colleagues at Veterinary Cancer Group, Drs Duesberg and Chung at Advanced Veterinary Internal Medicine, traveling board certified surgeon Dr. Cechner, and Dr. Ravi Seshadri originally at AllCare, then later at Advanced Critical Care and Internal Medicine. Each of these veterinarians and many other specialists have come to the phone and continue to come to the phone to answer and consult with me on a regular basis.

There is another group of veterinarians I have the pleasure of working with, and that is the current team of veterinarians working here at Washington Blvd Animal Hospital. This is as devoted a group of veterinarians, as passionate about their profession as any I have ever worked with. They care deeply about their individual cases, and are terrific communicators. They attend weekly rounds; they share cases well and pursue advanced diagnostics for our clients. I am happy to work with Drs. Throgmorton, Burhum, DeLaCal, Husain and To. This lively bunch keeps me on my toes and ensures that WBAH continues to provide top level veterinary care to our community.

Another group I have been very proud to be associated with is my clients. You have all taught me so much about listening and caring and what it really means to be given the privilege to care for the cats and dogs that so many of you consider family members, children even. My relationships with my clients mean the world to me and without all of you, there would be no me. So, for that I sincerely thank you all.
Dr. Fink told me long, long ago that I would probably have to tear this building down and rebuild it one day and low and behold here comes my cliff hanger……… It is our hope, to begin construction on a new hospital this year, a state of the art veterinary hospital for the City of Whittier. We are VERY excited and we hope you are too! The building will be constructed on the same property that we are on now, and yes we will remain open during the construction process. Building progress will be kept up on our website and a more personal take on construction will be noted in this blog. Plans are in front of the city as I write this. It certainly promises to be eventful! Until next week……….