Dr. Phil Zeltzman’s Blog

Luna, an 11 year old shepherd mix, had a large mass (larger than a golf ball) between her toes in the left front leg.

WARNING – WHAT FOLLOWS IS GRAPHIC – YOU HAVE BEEN WARNED.

Actually, the mass got much smaller suddenly, after she literally chewed up half of it. That left a large open wound, which got infected, and caused a horrible smell.

Luna was limping because of the severe pain this mass caused.

Her family vet did a needle test (“fine needle aspirate”), which came back normal or as we say “inconclusive”. So there was nothing to worry about right? It was likely a benign mass after all.

Amputation was mentioned, but Luna’s loving owner could not accept the idea. She thought it was a horrible idea and Luna would be miserable. She found me through my website, reached out to me, and we had a little heart to heart. I explained my concern that this was not a benign mass at all, and that amputation was the only reasonable option.

After agonizing over this difficult decision, Luna’s owner eventually agreed to do the right thing for her beloved dog and scheduled the amputation.

But first, we needed to take chest X-rays, because the cancer I suspected typically spreads quickly to the lungs. Fortunately, no spreading was visible at that point.

We performed the amputation (let’s call it day 1) and surgery went smoothly. Luna went home that night – walking. Below is a summary of what happened after surgery, to give you a feel for the emotional roller-coaster Luna’s owner went through.

Day 1: surgery was performed. Luna went home and had a rough first night. Of course, Luna’s owner questioned her decision.

Day 2: I recommended adding a third pain medication.

Day 3: One of my nurses called to check in. Luna felt much better already.

Day 5: Luna’s owner wrote: “Hi Dr. Zeltzman, she seems to be doing great so far. She’s acting more like herself each day. She’s just sad she can’t get on the couch or bed.”

Day 6: The biopsy results came back. The news was not good. As expected, the mass was indeed cancerous. It’s called malignant melanoma.

In spite of the bad news, Luna’s owner was relieved that her dog was finally out of pain. She wrote: “Thanks again. We can’t thank you enough for the amazing work you did to her!”

Day 28: Four weeks after surgery, Luna’s owner wrote: “Hi Dr Zeltzman. Just wanted to thank you again for the wonderful care you gave to Luna. She is doing wonderful and living a happy pain free life. I wanted to share a picture of her because she looks so beautiful and happy!”

So what is the purpose of this blog? I’m not sharing this story to brag. And I am not here to try to convince you that amputation is a wonderful thing and a walk in the park (no pun intended) .

What I would like pet lovers to believe is that when we recommend sacrificing a leg, it’s never for fun. It’s always to help a cat or a dog feel better, once the source of the pain is removed.

The biggest obstacle is most often in the pet owner’s mind. They are often terrified that amputation is cruel. I suspect that, subconsciously, they think of themselves as an amputee, walking on one leg. Well, remember, pets walk on 3 legs after amputation and they adapt very well. And typically, they start walking a few hours after surgery!

Pets don’t even know they’re missing a leg, all they know if that they don’t feel the pain anymore.

In Luna’s owner’s own words: “She is doing wonderful and living a happy pain free life.”

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

Dr. Phil Zeltzman is a traveling veterinary surgeon in Pennsylvania & New Jersey. An award-winning author, he loves to share his adventures in practice along with information about vet medicine and surgery that can really help your pets. Dr. Zeltzman specializes in orthopedic, neurologic, cancer, and soft tissue surgeries for dogs, cats, and small exotics. By working with local family vets, he offers the best surgical care, safest anesthesia, and utmost pain management to all his patients. Sign up to get an email when he updates his blog, and follow him on Facebook, too!

Your pet can experience pain and discomfort in multiple ways. Belly pain (e.g. pancreatitis), severe coughing, injuries and cancer, to name a few, are difficult for our furry friends.

Pain and its expression can vary dramatically from breed to breed, and from pet to pet.

Animals in general are very good at hiding when something is wrong. Remember, in the wild, if an animal acts sick, they get eaten. Sadly, our pets have kept this ability to hide pain until they can’t take it anymore.

Subtle symptoms that you may not think twice about but should include:

. Sleeping in spots they don’t usually go to

. Grooming less

. Grooming excessively and/or one particular spot

. Reluctance to play as long or at all

. “Accidents” in the house

. Less excited to see you, jumping less

. Panting for no obvious reason

. Seeming anxious

. Hiding

Sometimes our pets will be more obvious and show us symptoms such as:

. Vocalization but PLEASE do not count on that to decide your pet is in pain. Many pets who are in pain do not cry out!

. No longer wanting to be petted or picked up

. Limping

. Shaking or tremors

. Hunched position

. Guarding an area (e.g. not wanting to be touched on the head because of an ear infection)

. Aggression

. Not wanting to get up

. No interest in normal routine, such as going on a walk.

It’s hard to think of our loved ones in pain. The good news is there is something you can do about it.

The first thing you need to know is you SHOULD NOT give anything over the counter or any human medication unless directed by your veterinarian. Many human drugs are toxic to our pets, even fatal.

Bring your pet to be checked sooner rather than later. The sooner you figure out what is wrong with your pet, the more options you have.

Remember, age is not a disease. We can successfully treat countless ailments we were unable to help with before. You no longer have to accept your pet no longer playing or wanting to go on walks because he or she is old. It’s probably because they are painful.

Also keep in mind that there are many ways to decrease or stop the pain without medications, including: surgery, weight loss, cold therapy, heat therapy, joint supplements, environmental changes, improving traction, harnesses, rehab, massage etc.

In my world as a surgeon, surgery is a classic way to help painful patients. Fixing a broken leg, repairing a torn ACL or removing a cancerous mass are just a few examples.

We are here to help.

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

Dr. Phil Zeltzman is a traveling veterinary surgeon in Pennsylvania & New Jersey. An award-winning author, he loves to share his adventures in practice along with information about vet medicine and surgery that can really help your pets. Dr. Zeltzman specializes in orthopedic, neurologic, cancer, and soft tissue surgeries for dogs, cats, and small exotics. By working with local family vets, he offers the best surgical care, safest anesthesia, and utmost pain management to all his patients. Sign up to get an email when he updates his blog, and follow him on Facebook, too!

What do you do with unused or expired medications from your cat or your dog?

Toss them in the trash can?
Flush them down the drain?

Keep them on the shelf, “just in case”?

None of these options are a good idea. Many pet lovers will self-diagnose and self-medicate in spite of what I say, so let’s focus on why it’s not a good idea to discard medications improperly.

Septic systems and even water treatment facilities cannot possible remove 100% of these toxic chemicals from the water they process.

Whether you toss old meds in the trash can or flush them down the drain (sink or toilet), they are very likely to end up contaminating water, which affects wildlife… and humans.

Chemists have found traces of antibiotics, anti-inflammatories and anti-depressants in ground water.

The fact is, we have rarely received proper instruction on how to dispose of drugs properly. This is something that can easily be changed.

The easiest way to ensure unused pharmaceuticals don’t end up in our drinking water, is to make sure that your pet receives the full course of medication, as prescribed by your family vet. Of course, this eliminates the chance of unused medications.

In the event you do end up with unused medications, here is what to do:

. Never flush or pour anything down the drain (sink or toilet).

. Ask your local pharmacist, they may be able to point you toward a mail back program or “take back” event.

. Occasionally your local police station will do the same with any drugs involving a needle.

. If you cannot locate a local program visit www.unwantedmeds.org to find out other options for drug disposal in your area or simply search online using a drug disposal locater like AWARxE.

. If you are instructed to dispose of a medication in the trash it is always important to remove all personal information from prescription bottles. Crush tablets, empty capsules or pour liquid medications and combine them with something unpalatable like cat litter, dirt, sawdust or used coffee grounds. Seal the contained and place in a leak proof bag before tossing into the trash.

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

Dr. Phil Zeltzman is a traveling veterinary surgeon in Pennsylvania & New Jersey. An award-winning author, he loves to share his adventures in practice along with information about vet medicine and surgery that can really help your pets. Dr. Zeltzman specializes in orthopedic, neurologic, cancer, and soft tissue surgeries for dogs, cats, and small exotics. By working with local family vets, he offers the best surgical care, safest anesthesia, and utmost pain management to all his patients. Sign up to get an email when he updates his blog, and follow him on Facebook, too!

The survey is out. Unfortunately, I have some discouraging results to share. Despite the amount of education provided, the campaigns, the warnings, the all-natural foods, the grain free diets, and all kinds of other diet fads, pet overweight is more and more common, year after year. The results of a recent survey showed that 60% of our cats and 56% of our dogs were overweight in 2017.

These results are provided by the Association for Pet Obesity Prevention (APOP) (www.PetObesityPrevention.org), a non-profit created by my colleague Dr. Ernie Ward in 2005 (full disclosure: I’m a member of the board – only because I am passionate about this topic. Oh, and because I wrote a book about it. More info below).

There are many reasons for this growing trend, including too much food, too many treats and not enough exercise. Therefore, the solutions are pretty easy: fewer calories and more activity. Easier said than done…

Meanwhile, excessive weight in pets:

. puts unnecessary strain on the joints.

. increases the risk of heart disease.

. increases the risk of diabetes.

. increases the risk of some tumors and cancers.

. increases the risk of many other preventable diseases.

. dramatically decreases your pet’s quality of life.

. reduces a dog’s lifespan by an average of 2 years!!!

Over 50 % of those surveyed (veterinary professionals and pet owners) were interested in weight loss in their pets or patients, but did not achieve results due to various reasons. Those reasons included time constraints, physical limitations (of the pet or the owner), behavior issues or limited access to exercise areas.

There was a great disparity amongst the opinion of veterinarians and pet owners about what ingredients are good for pets. Veterinarians predominately agreed that corn was an acceptable ingredient but grain free and raw diets were not (please hold the hate email, I am only sharing results of a survey here).

Owners in the survey believed corn was not good for their pets but believed grain free was healthier. They were unsure about the health properties of raw diets. Both owners and veterinarians agreed that commercial diets have improved over the last 10 years.

Veterinarians and their support staff have an integral role in combating overweight pets, yet fewer than 50% of pet owners were given food recommendations. Veterinarians confirmed this: only 50% surveyed said they provided dietary recommendations.

Owners surveyed received approximately 50% of their dietary recommendations from veterinarians and 50% from Internet searches.

So what’s the moral of this story?

A few important points:

. Learn how to assess if your pet is overweight with the help of your veterinarian. There is about a 60% chance that he or she is.

. Do not attempt weight loss or weight management without assistance from your veterinarian. The overall health of your pet contributes to his or her weight and there may be an underlying disease that requires medical treatment.

. Don’t listen to the hype. Many pet diets are promoted by brilliant marketing specialists, but that’s where their expertise stops. Your veterinarian will help you pick a diet that meets your pet’s specific needs, with the research and quality control to back it up.

. “Light” or “restricted calorie” diets are not appropriate for weight loss. I see that all the time in my patients. However, they are great to maintain the weight after weight loss.

. In my mind, all neutered or spayed cats and dogs should be on a “light” diet to prevent weight gain because their metabolism slows down after the surgery and makes them prone to being overweight.

. Many dedicated pet owner home cook for their pet. I get it. However, it is extremely difficult to create a balanced diet at home. There are countless nutrients, vitamins and minerals that are needed in small quantities. Serious pet food companies spend a fortune calculating the right amount of different ingredients to create balanced diets. Use them to your pet’s benefit.

. Most of our pets cannot survive on a vegan diet. It will severely harm them.

. Grain-free diets have recently been linked to heart disease (DCM or Dilated Cardio-Myopathy). So much for a healthy diet… (read more here: https://vetnutrition.tufts.edu/2018/06/a-broken-heart-risk-of-heart-disease-in-boutique-or-grain-free-diets-and-exotic-ingredients/)

. Do not starve your pet for the sake of weight loss. Cutting the portion in half and experiencing a rapid weight loss can endanger your pet. And it can kill a cat. A slow, gradual, weight loss is very important and should be supervised by your veterinarian.

. Your vet can suggest creative ways to provide exercise despite your physical and spatial limits.

Weight loss for your pet can be difficult to achieve, but it will be well worth it for the comfort and longevity of your pet.

Incidentally, I wrote a book about weight loss… called “Walk a Hound, Lose a Pound” (How You & Your Dog Can Lose Weight, Stay Fit, and Have Fun), you can find it by following the link below.

https://www.amazon.com/Walk-Hound-Lose-Pound-Human-Animal/dp/1557535817

Bottom line: pet lovers have a huge responsibility in the health of their pet, which includes their weight. Please help your pet have a healthy weight.

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

Dr. Phil Zeltzman is a traveling veterinary surgeon in Pennsylvania & New Jersey. An award-winning author, he loves to share his adventures in practice along with information about vet medicine and surgery that can really help your pets. Dr. Zeltzman specializes in orthopedic, neurologic, cancer, and soft tissue surgeries for dogs, cats, and small exotics. By working with local family vets, he offers the best surgical care, safest anesthesia, and utmost pain management to all his patients. Sign up to get an email when he updates his blog, and follow him on Facebook, too!

Phoebe is a 3 year old bulldog who was struggling to breathe. Her breathing was very loud and harsh. She couldn’t function without panting. She snored while sleeping. Was easily overheated.

Things got progressively worse and she was nearly suffocating. She was taken to the emergency clinic where she was sedated to place a breathing tube to allow her to calm down, lower her temperature and get her oxygenation up to normal.

All Bulldogs (French, English), Boston Terriers, Pekinese, Boxers and Pugs are called brachycephalic breeds (which means “short skull”). They have a short snout and a flat face. Not all brachycephalic breeds have brachycephalic syndrome, but it should be suspected until proven otherwise.

Brachycephalic syndrome usually has three parts:

. An elongated soft palate, which means that the back of the roof of the mouth is so long that it covers the opening to the windpipe.

. Saccules are fleshy structures at the opening of the airway. When brachycephalic breeds have difficulty breathing, over time, the saccules are mechanically pulled out into the airway.

. Stenotic nares are smaller nostrils than normal, which again prevents getting enough oxygen.

Notice the tiny openings before surgery

There is at least one more issue: Bulldogs, in particular, have a tiny windpipe. There is nothing we can do about it, but it certainly doesn’t help these dogs breathe.

We can however fix all 3 issues mentioned above.

Phoebe needed all 3 repaired:

. Her elongated soft palate was shortened.

. Her “everted” saccules were removed.

. Her almost non-existent nostrils were widened.

Notice the much wider nostrils after surgery

Some surgeons recommend doing a nose job on brachycephalic puppies as early as 3 to 4 months of age. Why so young? Because we hope that if we fix the nose at that age, and the dog doesn’t struggle to breathe, the soft palate and saccules may remain pretty normal.

So we feel that it’s better to widen the nostrils at a young age, which is not very invasive, than to do the full 3 surgeries at a later age. At that point, there are many other additional changes that we simply cannot repair.

While the pup is under anesthesia, we also recommend doing a spay or a castration. This is a great way to prevent spreading the bad genes to future generations, among many other benefits.

Phoebe recovered very well after surgery. She was able to breathe much better by day and stopped snoring at night. Ironically, it also helped her owners sleep better at night.

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

Dr. Phil Zeltzman is a traveling veterinary surgeon in Pennsylvania & New Jersey. An award-winning author, he loves to share his adventures in practice along with information about vet medicine and surgery that can really help your pets. Dr. Zeltzman specializes in orthopedic, neurologic, cancer, and soft tissue surgeries for dogs, cats, and small exotics. By working with local family vets, he offers the best surgical care, safest anesthesia, and utmost pain management to all his patients. Sign up to get an email when he updates his blog, and follow him on Facebook, too!