New Animal Hospice and Palliative Care Textbook!

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Over the past year, I have had the honor of writing a few chapters in the newly published textbook: Hospice and Palliative Care for Companion Animals, as well as contributing to the first offering of the IAAHPC Animal Hospice and Palliative Care Certification Program, a combination of online and in-person training for veterinarians and veterinary technicians on topics from philosophical and ethical considerations in animal end-of-life care, quality of life considerations and the technical aspects of offering palliative care ("comfort care") to animals in their last days weeks and months.

This is a relatively new field in veterinary medicine and it has been a pleasure to work with the caring individuals involved in developing educational materials and information for professional providers and caregiving families. The beauty of this care is that sometimes animals, just like people, actually live longer than expected when care is focused on comfort and the enjoyment of the life that is still present.

There are many considerations to weigh when faced with terminal illness including prognosis and the possibility of cure. I find these discussions are best approached in the home, involving the whole family, and with multiple visits as we monitor changes and different needs and questions that arise. Please
contact me if you would like more information or to schedule an in-home palliative care consultation for your animal.

Herbal education and self-care

Corolla horses
I have had the opportunity to put my varied background as veterinarian, herbalist, martial artist, Waldorf playgroup facilitator, Girl Scout leader, teacher, nature geek, and quiet introvert to use!

My good friend, Dr. Laurie Dohmen, past president of the VBMA (Veterinary Botanical Medicine Association) asked me to join her in teaching an herbal medicine course for veterinarians in the Outer Banks, North Carolina. We just finished the first introductory class last weekend and it was so much fun! She has a full 5 module course planned for hands-on herbal learning and self-care:
Veterinary Herbal Apprenticeship and Retreat

Along with herbal and palliative care lectures, Laurie gave me free range to add in a nature gratitude meditation on our herb walk, a nature table in the lecture room to explore the plants and other treasures we found (luckily the horseshoe crab didn't smell too horribly by the end of the weekend!), and some Qi Gong and movement in-between lectures.

Veterinarians are notoriously bad at taking care of themselves (as are any of us with caregiving tendencies…), and putting this aspect of the course together is a great reminder for me to take time to enjoy the little things in every day. This is something I try to remind my animal-loving families of as well.

In order to sustainably take care of our family and our pets we really need to take care of ourselves. This includes the usual advice to rest, exercise, eat well and drink plenty of water, but also to see the beauty in life. Even on the very worst day, I can be grateful knowing that the sun is still shining, the birds are still singing and life is continuing on all around me in its tenacious way.

Gratitude to all!

New online store and pharmacy

After many years working with various suppliers and companies for medications and supplements, I have set up an online store and pharmacy to better serve my clients and patients and to simplify my own life. As a housecall veterinarian and herbalist, it is difficult to keep every possible medication in stock.

I will continue to keep the essentials on hand for personal delivery and use local human pharmacies, especially for more immediate needs. This store will be for pharmacy use and for items I do not keep in stock. I will also continue to make and deliver my own herbal formulations as those are individualized and from trusted professional quality herbal sources.

I have been concerned about supplements purchased from Amazon or other third party suppliers as they are not coming directly from the manufacturer and are more susceptible to tampering and poor handing (i.e. temperature control, etc.). With this new store, I can offer you a wide variety of products, often at a lower price, and be more sure of the handling and sourcing of these items without having to keep them all on hand myself.

Some products you will find are supplements and nutraceuticals such as
joint support (Dasuquin, MegaFlex and other glucosamine/chondroitin supplements), fish oil (RX Ultra, Nordic naturals, Welactin), Probiotics (RX Biotic), anti-oxidants (Cell Advance), anti-parasitics such as flea and tick preventatives (Frontline and others), heartworm prescription medications of all sizes and quantities (Heartgard, etc.), prescription diets (more choices for renal failure and other special diets including Honest Kitchen), anti-anxiety products (Feliway and Adaptil), and more. On the front page I have been able to add some of my favorites to help guide you. Please contact me before ordering anything you are unsure of as the number of products can be overwhelming. Prescription items will need a current exam and authorization before ordering

Here is the link:
Harmony Housecalls - Vets First Choice
http://harmonyhousecalls.vetsfirstchoice.com

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There is also a link on my home page.

And a coupon code for first time users: welcome62
There are other regular discounts and coupons so be sure to ask!

** Please talk to me before ordering as there are some products that I don't recommend and some that I have specific reasons for choosing for individual patients. This is not meant to substitute for our regular exam visits, but to enhance them with more care options and allow you to control purchasing.

I appreciate any input on your experience with this new store option, you are by no means obligated to use it.
Contact me with suggestions or needs.

Spring reminders!

Although here in Iowa we are still fluctuating between summer and winter temperatures, spring will get here soon! It is time to be sure heartworm preventative medications are on hand along with any flea and tick preventatives as needed for your animals' exposures.

If you need reminders about how nasty Heartworm Disease is, go here:

www.veterinarypartner.com - Heartworm Information Center

And Lyme Disease seems to be becoming more prevalent as well. The best preventative is keeping the ticks that spread it away. It is surprising how tiny these ticks are—the size of a poppy seed, so really hard to find in dog fur!

Info on Lyme (Not Lyme's!) Disease here:

www.veterinarypartner.com - Lyme Disease

I am often asked if there are more "natural," non-chemical or non-toxic products that can be used to keep these parasites away. Unfortunately, and this is a consensus among most of the herbal veterinarians I know, nothing works as well and as quickly as the pharmaceutical products for flea, tick and heart worm prevention. Many of these pharmaceutical products are very low dose and I do have some favorites for that reason. Herbs and essential oils that are anti-parasitic can quickly move into the more toxic realm depending on dosage and use. Herbs are not chemical-free, they are made up of plant chemicals (phytochemicals) which are the sources of many pharmaceutical medicines. Many phytochemicals are extremely helpful, some can be toxic. It is important to learn the difference, which is why I have spent so much time studying them!

Some essential oils can be used safely in dogs for flea and tick prevention—they need to be applied multiple times a day, but in a very dilute form and long term use in animals with a such sensitive noses may cause their own problems. Many of my clients, including myself, do not have the time and/or memory to spray their dog multiple times a day. Cats, with their different liver metabolism, are especially sensitive to essential oils and I am cautious about dogs with any liver problems as well. I'm glad there are options.

Learning the natural cycles of the insects throughout the day can help with avoidance, but is not foolproof. Those insects do not always follow the rules. For example, mosquitoes which spread heart worm disease are generally more active during dawn and dusk, but can also be quite active in cool moist areas any time of the day. Heart worm is such an awful disease, I really don't recommend risking it. Ticks tend to hang out in tall grass waiting for their victims to walk by. They are also much more prevalent in the spring, but again they can really be around any time the weather is above freezing. I hear having chickens in the yard is a great way to keep tick populations down!

I do my best to help people minimize toxic chemical exposures and reduce the amount needed by only treating during the active seasons. Feel free to
contact me if you'd like a longer discussion on these important issues.

GDVWHM

Siri GDVWH
No, that's not some new text slang I learned from my teenagers!

After quite a long haul working toward this degree, I have completed my Graduate Diploma of Veterinary Western Herbal Medicine
(GDVWHM) through the College of Integrative Therapies (CIVT). This was an intensive course working through botanical identification, chemical composition, traditional uses as well as scientifically verified medicinal actions, adverse reactions, herbal medicine making, quality control, and much more.

My final research project was a paper on herbal medicines for use in animal hospice and palliative care, joining two of the most important aspects of my veterinary services. One of my biggest take-away findings in writing this paper is that just about every medicinal plant that we use has antioxidant and anti-inflammatory properties to some degree. This makes sense as the plants use these qualities for their own healing and self-preservation. Many of these plants are used as food and teas and can be added into the diets of our animals for gentle support.

There are most certainly times when stronger medicines are needed and I definitely advocate for addressing any distressing clinical signs such as pain, nausea and other concerns with appropriate and timely treatments with pharmaceutical drugs. This is why I like the term "integrative medicine" where we can integrate multiple aspects of care for each individual patient.

I am very much looking forward to spring, planting my herb garden and getting to know the plants even better!

Continuing Education Season

Fall is the season of continuing education for me, though it does seem to pop up year round. There is always something more to learn. Just this past June, I participated in the second part of the Herbal Immersion course for veterinarians through the CIVT (College of Integrative Veterinary Therapies.) I lectured on the use of herbal medicines in animal hospice and palliative care including some of the gems I have gathered over the last several years from some of my dearest patients. Just when I think I know just how to do things, I learn something new to bring home and share with my clients, patients, family and friends.

In September I will be off to the
AHVMA (American Holistic Veterinary Medical Association) meeting preceded by a day of lectures on medicinal mushrooms from the ACVBM (American College of Veterinary Botanical Medicine.) At the AHVMA meeting, I have my eye on some interesting talks on more herbal medicine, but also essential oils, nutrition and acupuncture.

Then in October, I will attend the
IAAHPC (International Association of Animal Hospice and Palliative Care) meeting. This year is the debut of the new animal hospice and palliative care certification course. Part one began online starting in July, part two will be in person at the conference, then parts three and four plan to be released online in January. This course is currently for veterinarians and technicians, but plans are to create a certification course for other animal hospice care providers as well in the future. I have 2 lectures in the Advanced module (part 3) on “Balancing Efficacy and Burdens of care” and “Complementary and Integrative Medicine in Animal Hospice and Palliative care.” These are my two chapter topics in the upcoming textbook due for publishing in 2017.

It is a busy season and I will do my best to keep you updated on my whereabouts and be sure to take care of any medication and herbal refills during this time!

Adapt animals to handling to provide better care!

In order to provide care to animals in need, some handling is usually required. As a vet who has worked in zoo and wildlife medicine, these become serious challenges when an animal refuses care. Our "domestic" animals are not always that much different!

Sometimes the ability to provide care to animals is hampered by their fears and distrust of our handling. They don't know why we need to get blood or give them fluids under the skin. They see no benefit whatsoever in being poked with a needle! They also don't get why we are trying to brush their teeth, trim their nails, clip the hair under their tail or any number of invasive things we try to do. 

Sometimes what we really need is for them to just trust that they won't be hurt in the process. This comes with gentle training, positive reinforcement and good experiences. For some animals a treat is enough reward or even a friendly voice or pet on the head. For others even that is offensive or suspicious behavior. 

Zoo animals are sometimes taught to allow safe handling for certain procedures. Some gorillas will put their arm through the cage bars for a blood-draw! Our domestic animals can learn these skills as well.

It is best to start when they are young and impressionable. Puppies and kittens between the ages of 8-12 weeks are the most malleable and good experiences during this time can really pay off with socialization to other people and animals as well as physical handling. 

But don't despair if your beasts are older and getting set in their ways. We can always learn new things and so can they. 

Gentle massage and manipulation of paws, ears teeth and gums can be enjoyable attention for many animals. Start slow, even just a few seconds of pleasant stroking or gentle massage is good. Do a little bit every day. Gradually increase the time spent with these physical touches and try to stop before the animal feels at all uncomfortable—leave them wanting more! They may be coming to you for a back rub or foot massage soon! 

Be aware of your animal's likes and dislikes. Some really don't like to have their tail touched, leave that for later or never. Start with the favorite spots like rubbing a cat's neck—know your own animal's preferences! And please, don't put yourself in a position to be bitten. This is meant to be a pleasant experience for all and should not be forced. 

Once they are comfortable with their favorite people doing this, invite others to start slowly. Again, don't put your friends and neighbors in danger of being bitten either! Respect your animal's limitations and watch for body language such as tensing up, twitching lips or ears back that say "That's enough, I'm not enjoying this." Try to stop the handling session before this happens. It should always be a positive experience. Food rewards often work well. Even allowing someone new to give a treat can be a huge step in acceptance!

Gentle handling and conditioning at home when they are healthy can really help when animals need veterinary care, grooming or other physical care. 

Don't Hug the Dog?

Many of us love giving and receiving hugs—doesn't everybody? Well, no actually, there are some people who are not comfortable with hugs and usually they can tell us when it's ok and when it's not.

It's a little different with our four-legged friends. Dogs (and all animals) can't tell us how they feel with words, but if we watch them closely, they might be saying more than we once thought. They're just speaking in a different language—body language.

Most of us recognize a growl or bared teeth as a sign that a dog does not like what we're doing, but they can also show more subtle signs of discomfort with a situation. When dogs are feeling stressed or uncomfortable they may lick their lips, yawn, look away or avoid eye contact, lift a paw, put their ears down, close their eyes, or even have dilated pupils and "wide eyes" showing the white area around the eye.

This topic has been in the news lately with a report in Psychology Today noting how many photos there are on the internet of happy people hugging anxious dogs. The signs of anxiety are often not recognized by people since dogs, more than any other animal species, are willing to put up with a lot to please their humans.

Here is a link to the Psychology Today article:

https://www.psychologytoday.com/blog/canine-corner/201604/the-data-says-dont-hug-the-dog

And a New York Times article on the topic:

http://www.nytimes.com/2016/04/28/science/can-you-hug-your-dog-yes-but.html

The photos included in the articles are great examples of uncomfortable-looking dogs. I should know, I'm a veterinarian, I make animals uncomfortable for a living! I try to reduce their stress as much as possible and learning their language is very helpful. See if you can figure out what your animal is trying to say to you today!

Enjoy the spring and go hug your 2-legged friends!

Choosing the right pet


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Dragons
Caution

You never know what you might run into in the UK!

My family and I are getting ready to come home to Iowa soon, and much to my girls' disappointment we haven't seen any dragons in our time here. If we had, they might have wanted to take them home along with the hedgehogs they were hoping to see, which are all sleeping the winter away. As a veterinarian, I can't recommend wild animals as pets. It's not fair for the animal and can be harmful to the keeper!

But what about other creatures we might decide to keep in our home? Dogs, cats, small rodents, horses? Ok, only small horses inside…

Shelters are full of animals that need our love and care. Some things to think about when deciding to bring a new animal into your home:

1. Do I have the time to give this animal the daily care and attention he/she needs?

- All animals are living beings and require regular exercise, feeding and a clean, safe and emotionally secure environment. Most dogs need regular walks and cats need daily clean litterboxes!


2. Do I have appropriate housing and space for this animal?

- Different animals have different housing requirements and space needs. Small puppies and lizards can grow to be quite large as adults. A big dog is not usually an appropriate choice for a city apartment, and all living beings need protection from weather, predators and other dangers.


3. Is this an appropriate match for me and my family members?

- Very nervous animals are usually happier in a quiet home with few comings and goings. Some are able to adapt, but many develop anxiety and health problems as a result of the emotional stress.

- Animals that live with children need to be tolerant just as children need to be taught to treat animals with respect and kindness. It can be wonderful for all involved in the right setting with the right match.

- Other animals in the household need to be considered as well. Will they be compatible or will they be a danger to each other? Will the energy of a new young animal be too much for a geriatric animal?

- Physical care needs are also a consideration especially with disabled or elderly pet owners. Will you be able to handle the energy of a puppy or physically care for your animal as he/she ages?


4. Do I have the financial resources to provide food and care?

- It is a fact of life. Animals, like people, need nourishment and regular medical care to maintain optimal health. Young animals need vaccinations and neutering, while older animals begin to have age-related health problems. Plan ahead for emergencies and your pet's senior years.



This is an important discussion to have with your children when they are begging for a pet dragon, believe me, I know…

Holiday (and everyday) hazards: Xylitol Toxicity- read your labels!

Xylitol is a sugar alcohol commonly used as a sweetener that is apparently non-toxic to humans, but quite toxic to dogs and other animals that metabolize it differently. Found in more and more food products that our pooch friends can't seem to keep their lips off, the most recent concern is that it is showing up in more peanut butter brands. Peanut butter is commonly fed to dogs in homemade treats, slathered on dog toys and used to more easily get pills down. Other sources of Xylitol are toothpastes, gums, mints, and baked goods such as cookies and muffins especially marketed to diabetics as low sugar.

Most everyone knows to keep their dogs out of the chocolate treats this time of year, and hopefully Xylitol has become well-known as a hazard as well. Poor dogs—they can't keep their mouths off foods.

Don't think the cats are too clever for harm, they just have different preferences—string, ribbon and tinsel (why??) These can become lodged in their intestines and require emergency surgery to remove.

Both dogs and cats can get into the toxic plants—holiday or otherwise. Watch out for poinsettias, lilies, and other seasonal lovelies.

Here is a recent article on holiday safety for our beasts:

http://protectingyourpocket.blog.palmbeachpost.com/2015/12/17/tinsel-pet-treats-plants-and-other-holiday-hazards-can-harm-pets/