The Companion Therapy Laser System
The doctors and staff of the Kenosha Animal Hospital are proud to introduce the newest technology available for companion animals to our area. It was recently approved by the FDA for use on animals (as well as with humans) to provide drug-free, surgery-free and pain-free relief through the use of a laser.
LASER is an acronym for Light Amplification by Stimulated Emission of Radiation. By definition, a LASER is any devise which can be made to produce or amplify electromagnetic radiation in the wavelength range from 180nm to 1 mm, primarily by the process of controlled stimulated emission. Lasers are classified into different categories (Class I - Class IV), depending on their power output and potential to cause body harm if used inappropriately. We live in a world dependant on lasers, often used in manufacturing, construction, printing, reading bar codes, playing music, or surgery.
Recently a new and important use was researched and developed for use with humans and animals. This technology, known as Laser Therapy, uses laser light at a specific wavelength and power to stimulate damaged tissue cells for faster healing and repair. The science behind this novel therapy is fascinating and although the concept is simple, it has been around since the beginning of time. Two very basic examples are photosynthesis in the plant and Vitamin D conversion in our skin using sunlight.
With all these benefits, people often wonder, "Does it hurt?" The answer is no, if it is used properly. It actually feels like gentle warm heat to the patient, which is often comforting, especially with soreness and inflammation; but the real action is more complex, occurring at the cellular level. This activity is known as "photobiomodulation" and "photobiostimulation;" simply put, physical and chemical changes made within the tissue cells using a light source.
Anytime there is an injury within the body, regardless of location, Laser Therapy can be of great value. Depending on the power setting applied, it can be focused anywhere from the superficial layers of the skin to the far deeper tissues, including bone, when a higher wattage is employed. I'm extremely excited with the results that I've already seen with my patients, and for the endless possibilities that exist with our ability to help them through their recovery from surgery. Some of the many disorders that I have already treated patients with include, osteoarthritis, injured ligaments and tendons, spinal back pain, ear infections, anal gland diseases, skin infections and other skin disorders such as chronic lick sores, bladder infections, stomatitis and gingivitis (inflammation of the mouth and gums), traumatic wounds, and for post surgical pain relief and accelerated healing.
As you consider treatment plans for your pet, this now gives you another alternative to discuss with your veterinarian. It can be used in conjunction with other therapies, and in some cases, can be a truly stand-alone therapy. In most situations (except in the some of the chronic, long-standing disorders) it can often provide immediate results with only one or two treatments; and most importantly, without any dangerous side effects.
Next month, I'll delve into the science behind this fascinating technology.
William T. Carlisle, DVM
In Part 1, we were introduced to a new and exciting technology, laser therapy. In the next few articles I hope to be able to explain the science behind it, but first a little history lesson.
The knowledge that light is not only beneficial, but actually a necessity for good health has been known for centuries. In fact, as early as the 6th century B.C., light was used in the treatment of diseases, known as heliotherapy. It was at this time that Herodotus determined that sunlight was required for normal bone growth. Once Sir Isaac Newton discovered the visible spectrum with the separation of light using a prism in the 1660's, a new age in the understanding of light began; but up until 1903, sunlight was still the only available source for therapeutic applications. This changed when a Danish medical doctor was awarded the Nobel Prize for successfully treating surgical tuberculosis, rickets and lupus vulgaris with ultraviolet light. Thirteen years later, the theory of lasers was postulated by Albert Einstein in an assumption necessary to support the Theory of Relativity, when he correctly proposed, "when a photon of the correct energy level collides with an atom that has been energized under the right conditions, two photons of precisely the same energy would be emitted." This theory would require another forty-four years of research before the technology could be developed to prove Einstein correct, when in 1960; the first Ruby laser was developed. The Uranium laser and Helium Neon laser followed soon after.
In 1967, a breakthrough in the application of the use of the laser in medical therapy occurred when Dr. Endre Mester, a researcher from the Budapest University in Hungary, discovered the biostimulating effects of the laser. He was trying to determine whether laser irradiation could cause cancer with an experiment using two groups of mice. After shaving the hair off the backs of the mice in both groups, and subsequently exposing one group to energy from a low powered Ruby laser, he was surprised to find the laser exposed group grew the hair back much faster than the unexposed group. More importantly, none of the mice developed cancer. Unfortunately, this medical research never made its way to the West during this era of the Iron Curtain; however, these new discoveries in the benefits of laser therapy was quickly spreading through Eastern Europe, China and the Soviet Union during the 1970's and early 1980's. After the collapse of the Soviet Union, research documents regarding laser therapy became available to Western Europe and eventually made their way to the U.S. with a flurry of interest by researchers. In 1993, the first Independent Research Board for Laser Acupuncture Research was established in Boston, Massachusetts; and finally in 1998, the North American Association for Laser Therapy was established with the mission to improve the understanding of the photobiological mechanisms, basic laser physics, treatment parameters and protocols, techniques and regulatory issues.
To be continued next month.
William T. Carlisle, DVM
In the last twelve years since the establishment of the North American Association for Laser Therapy, a preponderance of published scientific evidence is now available for review supporting the therapeutic value of this exciting new technology. In addition, with the thousands of practitioners around the world utilizing it with their patients on a daily basis and receiving positive feedback, the question should no longer be, "Does it work?" but instead, "How can I best utilize this new technology?" And today, with the recent FDA approval of the more powerful Class IV laser, I continue to find new answers to that question. In the past seven months, after personally treating hundreds of patients suffering from a wide variety of ailments, I am no longer surprised by the positive results that I am seeing, in fact, I've come to expect it. On the other hand, I also realize that it is just another tool that we can utilize to help our patients; it is truly not a panacea for every problem. Everything has its own limitations, and laser therapy is no exception. For example, chronic, longstanding conditions will often require several treatments before any positive results are seen; and in some cases, the pain may actually get slightly worse before any improvement is made, as the tissue begins to heal. A second example would be partially torn or stretched ligaments. While I have witnessed phenomenal results after treating damaged knee and other joint ligaments, if the patient re-injures it before it is completely healed, a return to lameness is expected. At any point, if the ligament sustains a complete tear, the only hope for repair is surgery; although the laser can still be employed throughout the rehabilitation, aiding the speed of recovery.
So how does this relatively small box (with the price tag of a nice automobile) actually work? In order to properly answer this question, I need to break the machine down into three main components: an energy source - electricity; a lasing or amplifying medium - which stores the energy supplied to it; and a resonating cavity that is bounded by mirrors - with one end less than 100% reflective, allowing the release of charged photons (energized light) of a single wavelength to pass through it and down the cable connected to the working hand piece, where it is directed into the damaged or inflamed tissue. Essentially, as energy is supplied to the lasing medium, collisions of an energized atom and a spontaneously emitted photon results in stimulated emission of two photons. These two photons in turn collide with other atoms and a result of this chain reaction is an avalanche of photons all with the same photon energy and wavelength, resulting in the production of the laser light.
Next month, with some understanding of this background information, I want to discuss how laser light affects abnormal tissue.
William T. Carlisle, DVM
Now that we have a brief understanding of what laser light is and how it is produced, this month I want to spend some time discussing how laser light affects abnormal tissue; after all, this is the reason why we are so excited about this new technology.
As the laser photons penetrate deep within the tissues, they stimulate cell membranes and internal cellular structures, such as the mitochondria, of unhealthy individual cells. The mitochondria are the "factories" that produce energy for the cell. They contain a substance (chromophores) that absorb the photons and in turn increase the production of ATP (Kreb's Cycle), which normalizes cellular function, decreases pain and has a profound affect on healing, through increased production of DNA and RNA. The laser photons are also absorbed by the membranes of the cells, which has an important effect on controlling pain and decreasing swelling. These photons are not absorbed by the chromophores or membranes of healthy cells and therefore do not have any effect on them.
The therapeutic laser has many benefits far beyond our current understanding; in this article, I will list ten scientifically documented biological effects on abnormal tissue. Although an individual article could be written focusing on the physiology of each item, I will spare you the details and briefly discuss each. These include:
- Pain Relief - Activates acupuncture points, reduces the activity of trigger points, relaxes the musculature, stimulates the release of B endorphins and stabilizes the cell membranes of nerve cells.
- Reduction of Inflammation - Increases microcirculation through vasodilatation, improves lymphatic flow and decreases edema and inhibits the synthesis of inflammatory prostaglandins
- Acceleration of Tissue Repair and Cell Growth - Increases cellular energy through increased production of ATP, increases cellular mitosis, activates synthesis of collagen and activates production of various types of tissue repair cells, stimulates regeneration of nerves and remodeling of scar tissue.
- Circulation Improvement - Stimulates the growth of new capillaries (blood vessels) into damaged tissue and increases blood flow through temporary vasodilatation, reducing bruising and edema.
- Cellular Metabolic Activity Increased - Direct chromophore stimulation results in increased production of ATP and other important cellular enzymes.
- Reduction of Fibrous (Scar) Tissue - Increases wound healing minimizing scar tissue formation and stimulates remodeling of old scar tissue into normal elastic tissue.
- Nerve Function Improvement - Increases the regeneration of damaged nerve cells and normalizes impulse transmission through the stimulation of the cell membranes.
- Wound Healing Accelerated - Increased production of fibroblasts and other tissue cells that aid in the repair of damaged tissue, increased blood supply to bring necessary nutrients and blood cells such as macrophages that "clean-up" damaged tissue debris.
- Immune System Stimulated - Stimulates production of immunoglobulins and lymphocytes that are responsible for controlling infection.
- Stimulation of Acupuncture and Trigger Points - The laser photons have a direct photobiostimulation effect on these points which is often referred to as "needleless" acupuncture.
Next month, I will begin a short series discussing some of my own case reports.
William T. Carlisle, DVM
Now that we have a better understanding of the history of light therapy, what laser is and how it is produced, and the benefits achieved through its effects at the cellular level, we are nearly ready to begin our discussion of actual clinical cases. These will include "Shadow", an extremely active Black Labrador Retriever, that ruptured her Cranial Cruciate Ligament (CCL), had surgery and once she started to feel better, sustained a minor post-op setback after getting too excited and slipping, but following treatments with the therapeutic laser made a full recovery; "Zeus", a German Shepherd whose owners were prepared to have his partially torn CCL of his right knee surgically corrected, but elected to first consult with me for a second opinion. I discovered that Zeus had also strained his left CCL and offered his owners the option of laser therapy for both knees. They agreed and today Zeus walks without any noticeable lameness on both of his hind legs; "Snoopy" and his sister "Peanut", two Dachshunds with Spinal Disc Disease that were close to requiring spinal surgery, are now happy and pain free as a result of their laser treatments; Haley" an abused and rescued Pit Bull that I wrote about a few years ago, who had surgery on both of her knees to repair torn ligaments and cartilage. Since the laser was not available back in 2006 when I performed her operations, I decided to treat her in an attempt to break down some of the built-up scar tissue and increase her range of motion with excellent results; "Doobie", a Beagle that after years of a chronic recurring ear infection had one of the most dramatic outcomes that I have witnesses so far; "Sara", a rescued "Katrina Kitty" that now enjoys a pain free mouth after a severely debilitating stomatitis; "Thumper" a Pomeranian that sustained a complicated fracture of his front leg, developed a non-union, but following treatment runs and plays on all four legs; "Trooper" a Rat Terrier that presented with a complex fracture of his Humerus with massive surrounding muscle contusions and bleeding leading to severe swelling of approximately three times normal. Two days after surgery (four days after the injury) and following three laser therapy treatments - most of the swelling and bruising was gone and "Trooper" was walking almost normally; and many, many more that I hope you will enjoy reading about as I much as I enjoy recalling and writing about.
But before I get started with the details of these cases, I would be remiss if I failed to discuss some of the basic principals of using the Therapeutic Laser next month.
William T. Carlisle, DVM
General Principles of Clinical Use
- The clinical application of the Therapeutic Laser is to minimize and control pain, swelling and inflammation; aid and increase the rate of healing; and most importantly - alleviate the cause or source of the pain, inflammation or pathological lesion.
- The laser photons will only stimulate or affect the cells already damaged, leaving the normal, healthy cells unchanged.
- Each therapy session is cumulative - generally after 3 - 4 sessions, a good response to the therapy can be noted, and with each successive treatment, continued improvement is expected until resolution of the clinical problem is accomplished.
- Early, aggressive treatment in the course of the disease will optimize the clinical outcome. After the first several weeks, when the initial symptoms are diminished, the frequency of treatment can be reduced to a schedule designed to maintain the desired results.
- In certain conditions, especially chronic, musculoskeletal disorders, the patient may experience an increase in pain or discomfort after the first and/or second session. This is evidence that the damaged tissue cells are being stimulated and that the initiation of healing has begun. By the third session, these patients usually realize the benefit of the therapy.
- Several different disorders or conditions on the same patient can be treated simultaneously.
- The established goal or desired outcome following laser therapy needs to be realistic and expressed at the beginning of treatment. It is impossible to make an old patient young again, but with the help of the therapeutic laser, they may begin to feel that way.
- Most importantly, healing cannot begin with the patient until therapy is initiated. In veterinary medicine today (as well as human medicine) the focus is an evidence-based (scientifically proven) practice of medicine. With laser therapy, since the photons only affect abnormal cells, treatment can be started with only a tentative or working diagnosis. If and when a definitive diagnosis is made, adjustments to therapy can be made as indicated.
In Nike's words, "Just do it" - I'll think that you and your pet will be grateful that you did. You should expect a relief of their symptoms, a restoration of their joints' range of motion and function, a reduction in the usage of medications, and a noticeable improvement in your pet's quality of life.
As I begin to discuss specific case studies in future articles, I hope that you will gain a better understanding of the phenomenal benefits of laser therapy, that may help in your decisions regarding the care of your pet.
William T. Carlisle, DVM
In Part V, I mentioned a few of my clinical cases that I would be discussing in future articles. I would like to start with one of the most common orthopedic injuries in the dog, the Cranial Cruciate Ligament (CCL) injury of the stifle (knee) joint. The CCL injury in the dog closely resembles the ACL injury in humans and often requires surgical intervention to stabilize the joint, control the pain and improve mobility for the patient. Frequently, the associated pain and lameness following the injury is so severe, that without surgery, it can become quite debilitating.
Today, with the introduction of the therapeutic laser, there is another option to help patients with a partial tear of the ligament, stimulating the tissue to repair itself, thus preventing the tear from progressing to a complete rupture. If this happens, the laser can still be used to decrease surgical pain and swelling, as well as to stimulate faster healing of the tissue.
In this article, I'll be discussing both of these scenarios with the same patient, a high energy, nine year old female Black Lab named Shadow. Shadow lives with an equally energetic yellow lab, Dawn, and their owner, Susan. Shadow first sustained an injury to her left knee, a partially-torn CCL two years ago. Laser therapy was not available for use with her as our practice was only in the early stage of investigating the safety and value of this new technology. She was put on leash-restricted exercise and Rimadyl, an anti-inflammatory medication, but approximately two months later she re-injured the leg, only this time she completely ruptured the ligament, creating joint instability which required surgery. In December of 2008, I took Shadow to surgery to stabilize her joint.
Despite Susan's and my best attempts to keep Shadow restricted and calm with low doses of a sedative, she slipped four weeks post-op before the leg was fully healed and created a minor set-back to her healing. Eight months later, after another slip, she injured both of her knees. Luckily, the "artificial ligament" in the left knee did not fail, which would have required another procedure to replace it; but she did suffer moderately severe soft tissue damage surrounding the joint that would have normally taken weeks to months to heal. She also had swelling and a minor partial-tear of the CCL of her right knee. The Kenosha Animal Hospital had just purchased the Companion Therapeutic Laser, so I immediately started treatment with the laser on both of her knees. We were impressed by how smooth and fast her recovery was from her injuries. I recently examined Shadow and found her to be healthy and completely free of any lameness. As a result of her laser therapy, both of her knees are now fully healed.
Next month, I will introduce you to a few more of the many dogs with CCL injuries that I've had excellent results using the therapeutic laser.
William T. Carlisle, DVM
In these next two articles, I will briefly discuss six more dogs with injured Cranial Cruciate Ligaments (CCl), four with partial tears that healed completely without surgery and two with complete ruptures of the CCL which required surgery. All dogs responded very nicely with the laser therapy, returning to a lame-free gait. As mentioned last month, if the ligament is only partially torn, I have found that in the majority of cases, laser therapy with restriction of activity has been a successful and affordable option for the treatment of this common orthopedic injury.
In Part V, I introduced Zeus, a beautiful, black German Shepherd with a partially torn right CCL, whose owners were ready to proceed with surgery; decided to consult with me for a second opinion, and after I also found joint effusion in the left knee due to a strained CCL, elected to give laser therapy a "try". After the first six treatments, according to his owners, "he was almost back to normal." Today, seven months after his injury, he has had a total of twelve treatments, including a few maintenance treatments; for less than 1/10 the cost of the CCL surgery, Zeus enjoys life once again with long walks with his owners free of any lameness.
Bak, a working black/tan German Shepherd owned by the Kenosha County Sheriff's Department injured his left CCL, developing a partial tear after jumping. Bak also went through a similar laser treatment program as Zeus and we were very pleased that eight months after his injury, the outcome was as successful as Zeus. Even though Bak's right knee was not injured, I will often treat both knees to prevent inflammation from potential overuse since these dogs are usually quite lame on the injured leg.
Libby is a friendly and energetic Yellow Labrador Retriever that over the years put on too much weight. Her owners scheduled an appointment with me because she would become stiff and uncomfortable after exercising. After diagnosing her with an almost complete tear of the left CCL, her owners elected to proceed with laser therapy as compared to surgery, with the understanding that surgery may inevitably be needed. After five treatments, she was doing so well that her owners elected to wait and see how she did before scheduling additional sessions and remarkably she healed completely without any further treatment. I would still advise an occasional treatment to insure long-term success, but Libby has now been free of lameness for ten months.
- to be continued next month
William T. Carlisle, DVM
continued from last month...
Lola is a two year old, happy and friendly American Bulldog, who injured her right CCl almost one year ago. Her owner was ready to proceed with surgery, but requested a second opinion with me. After my evaluation, I determined that she actually had a problem with both knees. The laser therapy vs. surgery discussion followed and her owners decided on the more conservative approach, Laser therapy. After eight laser treatments of both knees, Lola responded with a lame-free gait. She continues to have occasional treatments as a precautionary and preventative measure, since she still has the energy of a puppy and tends to be a little rough on her joints. I have often said that the best orthopedic patients are the easy-going ones; however the patients that we usually need to treat are the extremely active, high energy, athletic dogs. Guess which one Lola is?
Kaiya is a very well-mannered and obedient German Shepherd that has had a number of orthopedic problems. In June of 2009, I performed a left hip surgery to eliminate the pain and discomfort of severe osteoarthritis secondary to hip dysplasia. She recovered quickly and returned to full mobility. Seven months later, when she suddenly started to experience pain with walking, we wondered if she was having trouble with her other hip, so we scheduled an appointment for a lameness evaluation. I discovered the source of her pain, an almost completely torn CCL, which we confirmed with radiographs; and an inflamed lower back. We were on the road to recovery with the laser treatments; unfortunately three weeks out, after jumping off a bed, Kaiya developed a complete tear of her right CCL, which required surgery. I continued her laser therapy post-op and her owners and I were amazed at how fast she healed. Today, she is once again running and playing with her sister, Zayda, who also had a right CCL surgery with me three years ago.
Haley was an abused Pit Bull that I wrote about a few years ago, who was rescued by Sue, our head receptionist, and her husband Chuck. I performed surgery on both of her knees to repair torn ligaments and cartilage back in 2006. Even though Haley is not showing any lameness yet, but had a slight decrease in her range of motion, I decided to treat her with the laser since it was not available back then. I am very pleased with the results that we are seeing.
The seven dogs discussed in the last three articles represent only a small percentage of the dogs with ligament injuries that I have had tremendous success with employing the use of our therapeutic laser; in many cases to prevent the need of surgical intervention or speed up the recovery in those patients that required surgery. With the knowledge and experience that I have been able to acquire over the last one and one half years in this new field, I can confidently recommend it for any patient with an orthopedic problem. I know my clients are as pleased as I am with the results that we are achieving.
Next month, I'm excited to tell you about a remarkable and much-loved German Shepherd named, Arwen. Actually, she wasn't just a dog, she was a queen. Oh, and yes, she was also a laser therapy patient.
William T. Carlisle, DVM
Today, we are exposed to the problem of human obesity on a daily basis. It is almost impossible to turn on the television, radio or open a newspaper or magazine without being inundated with some new weight loss supplement or diet plan. There is a good reason for this, since obesity has now become the leading public health crisis in the United States and is currently growing at an alarming rate.
Our pets are also suffering the same consequences of our own poor nutritional habits. The reasons for these are unlimited, but just as the media is supported through billions of dollars of advertising for healthy lifestyles and proper weight management, it also feeds on the snack and fast food industry's investment to get us to purchase more and more of that which is causing the problem; and as our pets have been given the "family member" status, this same type of advertising is now becoming rampant with the pet food and treat industry, pushing us to purchase highly palatable, fat laden treats for our special friends. In fact, nearly half of our pets are now classified as overweight or obese by leading veterinary healthcare providers, although most pet owners don't recognize it. This is a very serious problem that must be addressed if we hope to maintain our pets' health and enjoy their companionship well into their senior years. It has been noted with scientific studies that if you keep your pets thin, they'll live 15 percent longer; that averages to two years with the larger dog breeds and much longer with small dog breeds and cats. In addition, studies have proven what we already know, that normal weight pets suffer fewer health issues. By keeping our pets' weight controlled, many serious medical conditions such as diabetes; heart disease; hypertension; orthopedic problems including hip dysplasia, torn ligaments and related osteoarthritis; liver and kidney disease; and even cancer can be prevented. So simply stated, the worst condition caused by obesity is a greatly reduced life-span and unnecessary suffering.
To bring some important attention to this problem, I will be writing a multipart series. Some of the topics will include: causes of obesity, health risks associated with it, how to tell if your pet is obese, steps to get them back into shape, and information on an exciting new drug, Slentrol, that is the first safe and effective weight-loss medication made specifically for obese dogs.
Unfortunately, because of the unique nature of the cat's internal chemistry, this medication cannot be given to them. There is, however, ongoing research in search of a similar weight control medication for them and we hope that one will be available in the near future.
Is your pet fat - or just large-boned?
What shape do you honestly think your dog is in? Unfortunately, for many of us, our impression rarely equates reality. In this article, I hope to teach you how to determine your pets' body condition scores (BCS) in a relatively objective way. Once you master the basics of a simple 5 point system and check all of your pets' scores on a regular basis, you can easily advance to a 9 point scoring system to fine tune their body weight. Which ever system you decide to use, 1/5 or 1/9 correlates with an extremely underweight condition and 5/5 or 9/9 is correlated with obesity. The perfect "ten" would then be a midpoint, either 3/5 or 4 - 5/9. I have a tendency of breaking down the 9 point system into halves so my ideal BCS for pets equals 4.5/9. And just as most of us would offer up an occasional "eleven" or "twelve" for that special girl or guy, I will sometimes find an extremely obese pet that tops the 9/9 score.
The criteria used for the standard 5 point body condition score system was initially developed for dogs and cats, but can be relatively easily adapted to almost any animal species. The easiest way to learn it is by using the following guidelines for Ideal Weight (3/5), Overweight (4/5) and Obese (5/5). Of course, the pet may also be Underweight (2/5) or Emaciated (1/5), but that's a topic for another article. So take a few minutes and study the diagrams and descriptions for each BCS and start scoring your own pets. Their overall health and longevity is dependant on you taking charge and keeping their weight under control.
Ribs are highly visible. Increase the amount you are feeding. After 2 or 3 weeks, compare again. Adjust until dog exhibits ideal body condition. Feeding to ideal body condition provides real, long-term health benefits, and the chart below should be used to monitor your dog's body condition. Since every dog is different, modify your feeding amounts as needed to help your dog reach ideal body condition.
The Body Condition System was developed and tested at the Purina Pet Care Center, and has been documented in the following publications: Laflamme, DP. Body Condition Scoring and Weight Maintenance. Proc N Am Vet Conf Jan 16-21, 1993, Orlando FL, pp 290-291. Laflamme DP, Kealy RD, Schmidt DA. Estimation of Body Fat by Body Condition Score. J Vet Int Med 1994; 8:154. Laflamme DP, Kuhlman G, Lawler DF, Kealy RD, Schmidt DA. Obesity Management in Dogs. J Vet Clin Nutr 1994; 1:59-65.
Dog has no waist when viewed from above. Belly is rounded when viewed from the side. Decrease amount you are feeding. After 2 or 3 weeks, compare again. Adjust as necessary.
Ideal Body Condition
Can feel and see outline of ribs. Dog has a waist when viewed from above. Belly is tucked up when viewed from the side. Maintain current feeding regimen.
- Promotes a leaner, longer, healthier life
- Reduces potential for developing weight-related health conditions
- Reduces a dog's percentage of body fat for better health
- Helps maintain healthy blood sugar levels
- Helps maintain healthy blood pressure and heart rate
Most of us would equate obesity with overeating, but this is only partially true. In reality, it is an imbalance of too much food with too little exercise, or when the amount of calories consumed exceeds those that are expended over a lengthy period of time, commonly known by nutritionists as "a positive energy balance". A good example of this is the Olympic swimmer and gold-medalist, Michael Phelps, who during his heavy training consumes roughly 5 - 6 times or more calories than the average adult, yet remains extremely lean. However, if he continued to eat this much without his rigorous training, he would eventually become morbidly obese. On the other hand, when weight loss is our goal, a negative energy balance is required. If Phelps didn't consume such a large amount of food during his training season, his body would eventually waste away to the point of emaciation.
Regarding our pets, whether they are lapdogs who enjoy an occasional walk, house cats who prefer to lay in the sun, or canine athletes competing at a high level, a balance between the amount of energy (calories) consumed and energy expended or burned is critical to maintain a normal BCS (body condition score) and good health. When we encounter weight problems with our pets, the positive energy balance created as a result of their overeating or lack of exercise can usually be blamed on us, their owners. Most often, it is a result of feeding them free-choice or by not measuring the amount of food placed in the bowl, allowing the pet to eat from other pets' food bowls, feeding calorie dense foods to sedentary pets, feeding table scraps, or giving too many treats. Inadequate exercise becomes a greater factor with our indoor or kenneled pets, our already overweight pets, or our older, injured and/or arthritic pets.
Beyond these two primary factors, obesity can also be affected by several other risk factors, some of which are beyond our control. These include: hormonal imbalances such as Hypothyroidism; genetic predispositions of certain breeds known to have body weight issues (Cocker Spaniel, Dachshund, Sheltie, Terrier, Beagle, Basset Hound and Labrador and Golden Retriever); whether the pet is neutered or spayed can also impact weight control, similar to the middle age or older pet, as these pets have a slightly decreased metabolism and therefore will require less food intake; and finally, behavioral related problems usually created by owners that are constantly conditioning the pet into thinking that food or treats equals "love". Unfortunately, this is one of the most common causes of chronic obesity and the most difficult to control; because overtime, it becomes extremely difficult to break them of the constant begging or "sad eyes" look that results. Except for Hypothyroidism, these other factors can be easily controlled simply by feeding an appropriate amount of food and gradually increasing their exercise. Hypothyroidism can easily be overlooked in otherwise normal appearing patients. However, when diagnosed with a blood test, it can be easily corrected with an appropriate replacement hormone therapy; and once controlled, these pets will also respond to a properly managed weight loss program.
In the next article, I will discuss the four most common excuses veterinarians hear from the owners of overweight pets.
As a veterinarian, my responsibility in practice, whether in the exam room, the medical ward or the O.R. is to be an advocate for my patients. And too often it can be a bit frustrating having to deal with owners of overweight or obese pets. I know that it may be hard to believe, but I really do not enjoy having these conversations, sometimes numerous times with the same owner regarding their pet's weight problem. So why do I take the time to have these discussions - because I care.
If you take this subject seriously and help your pet maintain a normal BCS (Body Condition Score), your pet can enjoy a longer life, suffering fewer health issues, thereby decreasing your pet health related expenses. In this article I will be sharing four of the most common excuses that pet owners respond with when we (veterinarians) discuss our concern over their pet's weight. Do you recognize any?
- "I can't understand how she could be overweight, she hardly eats a thing." This is undoubtedly the most frequently heard comment. If the owner would just take a moment and think about what they are saying, they would see the fallacy in their statement, because whatever their pet is eating, it is obviously too much. In the majority of cases the pet has food available all day and nibbles a little at a time. By dinner time, the pet no longer has an appetite, so the owner starts to add "extras" such as high fat, calorie dense table food which not only creates the obesity problem, but also creates other problems noted below.
- "What am I to do, he won't quit whimpering (or meowing) and giving me those sad eyes until I give him his treats." Over time the pet discovers that the more of a fuss it makes the more likely the owner will to reward them for their negative behavior. The owner out of frustration succumbs to the pet's demands and offers some food or treats to keep it quiet. In a short time this obviously "snowballs" to become a serious problem.
- "But he's such a good pet and loves to eat - we don't want him to go hungry." In this situation, the owner equates love with food or treats, and when there are multiple family members that all secretly do the same thing; the pet is the one that suffers in the long run. We all experience a certain satisfaction with seeing our pets have a good appetite and enjoy a meal, but we need to balance this out with proper attention to other things such as grooming, dental care and exercise.
- "I don't know what else we can do - she absolutely refuses to eat her own food." This pet has unfortunately been allowed to choose what it wants to eat and usually ends up eating high fat, poorly nutritious foods, the same things that children would pick if given the chance. This pet overeats not only because of the improper balance of nutrition, but because the endless variety of table food tastes so good, there is an immediate reward in eating.
We must face the fact that our pet's health and well-being depends on us; after all, we choose what, when and how much they eat.
In Part I, some of the problems associated with obesity were introduced. This article will focus in greater detail on two of these complications. If we are overweight, we probably hear about weight related problems all of the time, either from our doctor, family and friends and/or television shows such as Oprah or The Biggest Loser. Our pets are prone to develop many of the same problems. Excessive weight endangers the heart and cardiovascular system, the lungs and joints; but other ailments such as diabetes, liver and kidney disease, skin and hair coat problems and even cancer can result from chronic obesity. In fact, every organ in the body is adversely affected by this condition, leading to the realization that obesity is truly a primary medical condition, which usually results in the degenerative secondary conditions already mentioned. This concept originated with the discovery of the hormone Leptin in 1994, considered by most researchers to be the most important breakthrough in the study of obesity. Since that time, new discoveries are continually being made, uncovering the complex factors that contribute to this serious disease. Today, the study of obesity is second only to cancer in research funding by the National Institute of Health.
Two of the most visible problems related to obesity in the dog is osteoarthritis and impaired respiratory function, and unfortunately, many pet owners do not associate these with their pet's weight problem, because obesity is an insidious condition that develops over time. It is now universally accepted that there is a direct correlation between chronic obesity and the development of osteoarthritis in weight and nonweight bearing joints, due primarily to the release of certain inflammatory chemicals by the fat cells of these patients, disrupting the normal balance of joint fluid, cartilage and bone within the joint. The stress of excessive weight on the joints is also a contributing factor, although not as important until the patient becomes morbidly obese.
Normal respiratory function is very often affected by chronic obesity, ranging from exercise intolerance to life-threatening medical emergencies such as collapsing trachea and heat stroke. These problems are associated more with the degree of excessive weight than with chemical production, as clinical studies have shown a significant decrease in lung expansion and dangerously increased efforts required during breathing.
If we can reduce or even eliminate these or any other consequences of obesity in our pets by simply helping them maintain a proper BCS (Body Condition Score), the fight against pet obesity is a battle worth winning.
In the next article, I will discuss the fat cell, and how it can evolve from being the storage organ for fatty acids and energy to a dangerous metabolically active secretory tissue.
Fat, also known as adipose tissue, was once only thought of as a storage organ or "depot" for energy. In animals, it occurs in two forms, brown or white fat. Brown adipose is found mainly in hibernating animals and neonates. It has a good blood supply, helps to regulate body temperature and is an important aid in the metabolism of energy. White adipose tissue is the less vascular, most common form and easily and readily accumulates in overweight and obese animals. It has a necessary function in the storage and release of important fatty acids, but it also has the ability of becoming the greatest risk to our overweight pets' good health. This is also true with us, as we and/or our pets gain too much weight, the white adipose tissue quickly begins to accumulate in the abdominal cavity, and as we will soon learn, becomes a secretory organ, producing a number of very dangerous chemicals. In this article, I will discuss, without getting into too much science, how this happens. There is a tremendous amount of information that can be reviewed if you become so inclined, with new information coming to light every day.
The primary white fat cell, also know as the adipocyte, can begin to develop the ability to produce and release surprisingly high levels of more than twenty-one known chemical mediators, once a certain level of obesity is reached. This level can vary from individual to individual, and is not yet fully understood. Similarly, there is also a point at which the fat cells are triggered to multiply, creating an even greater threat to wellness. It is now well accepted that excessive white fat can become as metabolically active as the brain, thyroid, adrenal glands and pancreas, producing hormones that create insulin resistance leading to diabetes; the resistance of another important hormone called leptin, leading to an increased appetite and depressed metabolism; and other chemicals known as proinflammatory cytokines that can damage many body parts, including the joints, heart, blood vessels and lungs. The affects of these chemicals eventually leads to a diminished quality of life and premature aging. Once these fat cells divide, they become a permanent addition to the body. The only way to reduce the chemical production by these toxic metabolic factories in the body is to shrink their size with gradual and steady weight loss.
The take home message that I hope you will receive from this article is that prevention of obesity is much easier than trying to lose weight once we, or our pets, are already obese, due the hormone changes that occur, affecting appetite and energy metabolism. In light of all of this information, obesity is now recognized as an extremely serious disease that deserves the same urgency that clinicians have for other dangerous medical conditions.
In the next article, I will focus on three relatively easy steps that you can do at home to help your pet lose weight.
The one question that I'm always happy to hear from a concerned owner of an overweight pet is, "How can I help my dog lose the weight?" In this article, we will look at three simple steps to take when trying to achieve this task, or as I would prefer to call it - responsibility. As I have repeatedly mentioned, the health and quality of life that our pet enjoys is a direct result of our efforts as their owner.
The most important thing that we can do is to practice some "tough love" with our best friend. This means measuring precisely the amount of the proper food, usually a commercial diet, that your pet is receiving every morning and evening. This is to ensure that your pet is receiving the necessary nutrients at the correct levels to protect their health during the weight loss period. It also requires that we keep treats to an absolute minimum. This can be a challenge when your pet is sitting by your side begging with those big, sad eyes. And be sure to inform your family, friends and neighbors so they aren't compromising your efforts by giving extra snacks to your pet.
Secondly, we need to increase exercise gradually as your pet gets into better shape. Start out with easy-paced five minute walk during the cool part of the day. As your pet's endurance increases, so should the length of the walks. Just as with dieting, this is common sense, but difficult to follow through with until you get back into a habit. If your pet is older, has an illness or injury, or is extremely overweight, check with your veterinarian on how to best introduce an exercise program with your pet.
And the third part of the process is open communication with your veterinarian. It is very important to keep them in the loop so that you can utilize their knowledge and experiences should you encounter a problem with your pet's weight loss program. They will be able to answer questions such:
a) What is my pet's ideal weight and how fast can I safely reduce the extra pounds?
b) What food, how much and how often should I feed?
c) When and how do I begin an exercise program - and how fast can I increase it?
d) Should I give any treats and what type would be best?
These three steps will require commitment on our part, but as my dad used to always tell me, anything really worthwhile may take some time and energy, but the satisfaction achieved with reaching our goals will more than make up for our effort. This is especially true with our pet's weight loss. Our reward is having them enjoy more happy and healthy years with us.
The Pfizer Animal Health Company developed the following quiz to be used by dog owners to help evaluate their current feeding and exercise habits. Please take a few minutes and answer the following questions. You may want to share your answers with your veterinarian to help determine if your dog is at risk for obesity. (Unfortunately, a specific questionnaire for cat owners is not yet available. As soon as I find or develop one, you'll be reading about it in a future article.) Pfizer named it the BARC quiz, an acronym for Body Assessment Rating for Canines.
- Is your dog a breed that is prone to obesity, such as retrievers (Labrador and golden), beagles, basset hounds, cocker spaniels, dachshunds, shelties, and terriers?
- Do you have a multi-dog household? (Dogs in multi-dog households tend to eat more and faster than dogs in one-dog households.)
- Is your dog over 5 years old AND still being fed the same type and amount of food as when he or she was younger?
- Feel your dog's ribs. Do you find it difficult to determine where one rib ends and one begins?
- Stand at your dog's side and look at the tuck-up - the belly area between the rib cage and hindquarters. Is the body more "square-shaped" in this area?
- Do you regularly feed your dog table scraps and/or multiple non-meal treats each day?
- When you feed your dog, do you just pour the food into the bowl (rather than giving a specific measured amount each time)?
- Does your dog have difficulty standing up or jumping on the couch?
- Does your dog get less than 20 to 30 minutes per day of outside exercise/play time?
Total the number of times you answered "yes":
1 - 3: There is a low risk that your dog is overweight or obese. You may want to repeat this survey every few months, especially if you see changes in your dog's weight.
4 - 6: Your dog may be overweight or living a lifestyle that could lead him or her to become overweight or obese. You may want to discuss your dog's weight at your next visit.
7 - 9: Your dog is at a very high risk for being overweight or obese. See a veterinarian immediately to discuss an action plan for your dog.
Pfizer Animal Health, the division of the Pfizer Pharmaceutical Company, recently launched SLENTROL, an exciting new weight loss medication for dogs. After years of research and extensive testing in the US and Europe, final approval as a prescription medication was received from the FDA. It is formulated in an easily administered, once-a-day liquid that can be given directly by mouth or on a treat. Through surveys and other independent studies, Pfizer estimates that as many as four million American dogs are obese and potential candidates for this therapy. Pfizer is quick to point out that this is not a passport to abandon exercise or diets, but rather an important aid for owners who have a hard time cutting back on doggy treats. Slentrol is in a class of its own in the way that it works to reduce the appetite, hence the constant begging that results in our overindulgence with treats. Unlike human weight loss drugs that prevent fat absorption by the intestinal lining cells, (for example - Alli) resulting with certain undesirable side effects such as oily discharges, cramping and excess gas, Slentrol works in the small intestines of the dogs and through the release of certain hormones, stimulates the appetite center of the brain to feel full or satisfied. Without getting too scientific, I'll spend the remainder of this article on how this works.
As the dog consumes his meal, the fat (triglyceride) must be broken down into individual fatty acids and monoglycerides by a pancreatic enzyme (lipase) that is released into the small intestine, before the fat can be absorbed by the body. This absorption occurs in the cells lining the inside of the intestinal wall, known as enterocytes. Once inside the enterocyte, these digested fats are then "repackaged" with proteins to a form compounds (chylomicrons) that are then absorbed into the bloodstream and utilized by the body. When an excess amount of fat is absorbed, these chylomicrons are laid down as fat depots. (Refer to Pet Obesity - Part III) With Slentrol, this "repackaging" into chylomicrons is inhibited once inside the enterocyte, thereby preventing the absorption of the consumed fat by the body. As a result, these digested fats accumulate within the enterocytes, triggering the release of certain hormones (PYY) that enter the circulation, reach the hypothalamus (the appetite center of the brain) and acts as a satiety signal. This results in a decreased appetite to a level that is necessary to support a normal body weight for the dog. This negative feedback hormone system is responsible for 90% of the weight loss that is achieved with Slentrol. The other 10% is a result of the fat contained within the enterocytes leaving the body through the feces, as these cells are normally sloughed off every few days. Because there is no "free fat" in the feces, the consistency or volume of the stool is unchanged.
Preanesthetic Testing for Pets
Today, it is almost unheard of for any person, no matter how young, to have an anesthetic procedure without first having some tests in order to minimize the risk. Similarly, it is becoming more common to have your veterinarian or veterinary technician discuss with you preanesthetic tests for your pet prior to a surgical procedure, to help ensure your pet's health and safety. So why are these recommendations being made today, as compared to years ago? Are these new tests and procedures that were not available in the past? Will this testing completely eliminate the risk of anesthesia? Should young pets that appear to be healthy undergo testing? These may be a few of the many questions that you may have and in this article I hope to address them and help you understand the importance of preanesthetic testing.
In many respects, technology in veterinary medicine has increased over the last few decades to mirror the advancements made in human medicine. These advancements have been particularly driven by client requests and increasingly higher levels of expectations, sometimes demanding that their family's pet receive a similar level of care as to what they would be provided. As these are met, the level of the standard of care for the region is raised another notch. And in today's litigious society, it is imperative that standards of care are achieved or exceeded by all practitioners, or if a problem is encountered without the proper testing, a liability issue could exist. Today, due to the availability and affordability of in-clinic diagnostic and laboratory equipment, these tests can now be performed in the office at a reasonable cost, as compared to twenty years ago when the majority of blood health profiles were sent out to state labs. In addition, there are also many outside laboratory services now available to the veterinarian, with much shorter turn-around times.
Although every test provides valuable information to the doctor when evaluating anesthesia safety, primarily to rule-out otherwise undetectable internal organ dysfunction, there is not one test or panel of tests that can guarantee complete safety with every individual every time. Even as the veterinary and human pharmaceutical companies continually improve the safety of medications, there will always remain the potential for an adverse event or reaction with a small percentage of the population.
Finally, pets of all ages should be evaluated for safety, since certain congenital or birth defects affecting the major organs can remain hidden or sub-clinical until a potentially stressful event such as illness, injury or surgery is encountered.
It is important that your veterinarian is allowed to rule out as many of these problems as possible, irregardless of the age of your pet, to help ensure a successful and safe outcome with your best friend's procedure.
William T. Carlisle, DVM
This article is dedicated to a very special pet, Angel, who recently passed away at the age of nearly twenty one. She lived over seventeen years with a wonderful couple, John and Arlene O'Connor. They adopted her at the age of 3, and from that moment she was indeed treated like an angel. John would always say, "Pets give us more unconditional love in a year than most people could in a lifetime, and all you have to do is care for them." I was fortunate to have been a witness of that bond from the beginning until the end. Although Angel had developed several major health problems through the years, some life threatening, John and Arlene would never quit trying to help her, and Angel would always rally back to health. However, at the end, when old age was finally taking its toll, and Angel developed a very serious medical problem, John and Arlene made the right and kind decision to prevent any suffering. This brings up the question that pet owners must ask themselves at some point, "when is euthanasia the right decision?"
The relationships that we have with our pets are special and unique, and just as we are responsible for their care and welfare; we are eventually faced with making life or death decisions. A decision concerning euthanasia may be one of the most difficult decisions you will ever make regarding your pet. Your veterinarian and your family and friends can assist and support you, but in the end they cannot make the decision for you. You must consider what is best for your pet and your family. Quality of life is important for pets and people alike. If your pet is experiencing more pain than pleasure in his or her life, is terminally ill or critically injured, or if the financial or emotional cost of treatment is beyond your means, then euthanasia may be a valid option. It is important that you fully understand your pet's condition, so if there is any part of the diagnosis or quality of life issues that you don't understand, ask to have it explained again. In most cases, you will have time to consider all the facts before needing to make a decision. As you make your decision, you may also wish to discuss the care of the remains of your pet's body with your family and veterinarian.
Euthanasia is perhaps the saddest veterinary experience, both for the owners and the veterinarian and his or her staff. It is also the kindest thing we can do for our friend, when medically indicated. Euthanasia, which means "easy death", is usually a quick intravenous injection of an overdose of a barbituate, a type of anesthetic agent, which allows your pet to go into a quiet, deep and irreversible unconsciousness, followed quickly by death. It is humane, rapid and pain free.
Next month, I will discuss saying goodbye and how to face the loss of a pet.
PET LOSS & HUMAN EMOTION
Saying goodbye and dealing with the loss of a pet can be a very emotional, trying period in the life of a pet owner. After all, pets are family and we treat them, and often grieve them, as such. Just as with humans, death is a natural part of life, but because our pets have a very concentrated life span, the cute little puppy that we develop such a strong bond with is usually at the end of its geriatric years within two decades. It cannot be avoided, but its impact can be met with understanding and compassion. And, when the loss of a faithful friend and companion happens suddenly and without warning, it can be extremely difficult for adults as well as children. It is often the child's first experience with death, and his or her feelings must be discussed. Excluding or protecting them from the facts, because they are thought to be too young to understand may only complicate their grieving, especially if it involves a decision of euthanasia. Children should be encouraged to ask questions and deserve straight-forward, truthful and simple answers. If they are prepared adequately, they are usually able to accept a pet's death. When a decision of euthanasia is necessary, the act of saying goodbye is both an important and personal step that should be taken. Whether it is a last evening spent with the pet at the hospital, this goodbye is very helpful in managing the normal and health feelings of grief, sorrow, and sense of loss. Farewells are always difficult, and knowing that your decision is both right and kind for the pet is an important step in accepting the loss.
Often, well-meaning family and friends may not realize how important your pet was to you and may fail to comprehend what you are going through. Sitting down with them and discussion your feelings is important so that they can understand the intensity of your grief. You must also be honest with yourself about the deeper feelings of your loss. If despair mounts, talk to someone who has been through the loss of a pet, who will take the time to listen to you talk about your pet and the illness and death. Then, if you or someone you know is still struggling with the loss of a pet, it may be best to get in touch with someone trained to understand the grieving process such as a grief counselor, clergyman, social worker, physician, or psychologist. Your veterinarian certainly understands the human/animal bond and your feelings of grief and sorrow, and may be able to direct you to a pet loss support group or hot line. Talking about the loss of your pet is always the first step and usually the most important one in helping you get through this difficult time.
Next month we will discuss the stages of grief.
PET LOSS & HUMAN EMOTION
Grief, for some individuals, can be the most difficult emotion to deal with on a personal level. Whether it is for a member of your immediate family, a relative, friend, or family pet, adjusting to a life without that individual or pet can be a long, trying period. Over the years, many people have confided in me that the loss of a favorite pet was more troubling to them than when they lost a relative or acquaintance. I think that this is because our pets, on a daily basis, depend on us so much, similar to a special needs child. Our life becomes centered on their care, exercise, and medical needs, to the point that there is a tremendous void when they are no longer with us. So how do we face the loss of our special friend? I think that it is very important to know that it is natural and normal to feel sorrow and sadness with their loss, everyone experiences it, although at different levels, and understanding the grieving process is the first step in accepting the loss of our pet. There are four main stages of grief: denial, anger, guilt, and acceptance. We may or may not experience each stage, and the order that we encounter each emotion can vary. Denial can start even while your pet is still alive, after learning about an injury, or receiving the diagnosis of a serious illness. This is when talking with your veterinarian, spending time with your pet, and saying goodbye are very important steps to help you accept the reality of your loss.
Anger frequently follows denial and is often directed towards people you normally love and respect, including your family and your veterinarian. You may say things that you really do not mean and strike out at people unfairly.
Guilt usually follows anger and can be the most difficult period to get through, because it is frequently accompanied with depression. It is the period of your greatest sense of loss when you may be drained of energy and direction, and a time that you may need special assistance to learn to cope with life without your friend. Acceptance son follows, once you are able to resolve the other issues and come to terms with your feelings. However, in some situations, the feelings of denial, anger, guilt/depression may reappear, but are usually resolved easier and quicker with each recurrence. With time, sadness will be replaced with the happy and fond memories of your pet.
By understanding these stages of grief, you will be better prepared to cope with your own feelings of loss and assist others with theirs.
PET LOSS & HUMAN EMOTION
After the loss of a special pet, many people struggle with the decision of when (or if) to get another pet, especially if euthanasia was necessary. Sometimes, the initial reaction is that by getting a new pet, this will somehow diminish the bond that the deceased pet shared with the family. Also, if members of the family are still grieving, this can be an especially difficult time to consider this. It is generally best to wait until all family members have resolved their grief before discussing the adoption of a new pet. When counseling clients, I try to focus on the wonderful home that they provided for their pet and the bond and love that they shared. I ask them to recall the joy of the special times spent together, the quiet sense of understanding that they shared and quirky traits that they may have had. By remembering those things, we begin to realize how important a special relationship with a pet becomes. Although our deceased companions cannot be replaced, the bond that was shared with them can be rekindled over time with another pet. The love and joy that we give to our pets is always returned ten-fold.
There are many short stories and poems that celebrate the human-animal bond. Here is one of my favorites, as it appeared in the Dear Abby column:
There is a bridge that connects heaven and earth that is called the RainbowBridge because of its many colors. Just before the RainbowBridge, there is a land of meadows, hills and valleys with lush green grass.
When a beloved pet dies, it goes to this place. There is always food, water, and warm spring weather there, and all the old and frail animals become young again while those who were maimed are once made whole. Here they play all day.
The only thing missing is that they are not with their own special person who loved them so very much on earth. So, each day they run and play until the day comes with one of them suddenly stops playing and looks up! The nose twitches! The ears go up, and the eyes are staring because they have waited so very, very long. And suddenly this pet runs from the group!
You have been seen! When you and your pet meet, you take him or her in your arms and embrace. Your face is kissed again and again, and you can once again look into the beautiful eyes of your beloved pet. Then you both cross theRainbowBridge, never to be separated again.