Friday, January 30, 2015

Fear and Guilt. Why these won't help your pet get better, and why our pets are smarter than we are.

 
Chloe smiles for our selfie.
The emotional attachment that we have with our pets is undeniable. It is the reason we take those cold early morning potty walks, go out of our way to purchase the gourmet snacks, kibble, sweaters and personalized collars, and choose to stay home on date night rather than leave the kids at home.  Our love for our companions drives us to baby talk and bedside cuddles. It also causes some of us to be crippled in the decision making process.

Those emotions also leave some us to be enslaved to an emotional roller coaster of inner turmoil.

You can't have one strong emotional attachment, like love for our pet, and not have the rest of the emotional baggage that goes along for the ride.

Guilt and fear are the ugly step sisters to love. I have to remind myself that my clients might not admit it, but much of their reasoning, reactions, and behaviors are due to guilt and fear.

These two terrorists harbor nothing positive for you or your pet when it comes to healthcare.

As your vet I will admit that I get afraid too. I also have a decade of experience to remind me that there are always consequences. Fear of knowing the truth doesn't allow you a different truth. It just provides you a shorter list of opportunities. Fear of anesthesia only leaves you with regret when the operable mass, dental disease, or failure to spay at 6 months old is now your pets death sentence. Fear of cost will cost your conscious. Fear of treating to spare your pet the pain of a treatment is an unfounded assumption.

There isn't one fear in your heart that we haven't thought of, planned for, nor provided an answer to. Say it out loud to us. We will listen and we will be your pets champion. BUT, this discussion can only happen with the foundation of trust in place.

You have to trust in your heart that we have your pets best interest in our hearts. If you don't nothing that follows, nor any decision that you make will feel right, settle peacefully, nor help you face the same emotional hostages the next time.

I know that we veterinarians can seem a bit reserved and composed when we talk about all of the scary things we do routinely. But, doing them routinely keeps us emotionally able to perform our jobs. Would you want a crying hysterical surgeon standing over you? No, we can't concentrate on your pet, or our task, if we are in a fog of fear, guilt, or emotional instability.



I had a very good reminder of these the other day.

One came in the form of a Pawbly question. Monalisa asked;
"Can a vitamin liquid supplement cause your 3 year old cat to die prior to your pet having a severe sickness?"

Here is my answer;
I receive many questions from clients reeling from the loss of their pet and desperate to try to identify what happened to ease their guilt and despair. The answer is always incredibly difficult to answer. Primarily because I empathize with the terrible burden of pain that it is to bear losing a pet.

So, first, I always remind my clients that their greatest gift to their pet was their love to them. It is the greatest joy to share your life with a pet, and the hardest thing to lose them. BUT, without you they may have never known love, or laughter, or what a real home is. That is everything. You were everything to your pet and I am sure your pet is grateful for the time they had with you.

Many pets die without us knowing why or what happened. Some of them can hide or mask signs of illness and this makes understanding that they need medical help difficult.

Can poisonings or toxicities occur? Yes, I am always very conservative with the products I recommend because the labeling and rules on pet products are not as strict and stringent as they are with human products.

Is it likely that it was the supplement? Probably not. But there is really no point in beating yourself up over loving your cat. I'm sure that you were trying to provide them the best life possible.

I hope that this helps, and please don't hesitate to ask about how we can help you care for your pets. That's what we are here for.

My deepest sympathies.

Your pet knows that life is something that you live in this moment. No fear, no regrets, no second to trade for this one. They also know that you are the best

And from a friend I received this;
I would like to talk to you about my dog who is 10. I am terrified about his lumpy leg. He had FNA twice in recent years. It was diagnosed as a lipoma, but so big now. Feel OK talking to you. 
If he needs surgery I think I'd like you to do it.

My friend also sent me this; The Secret Reason Your Clients Are Afraid.

My answer back;

"I'm happy to see you both. Please call the office and schedule an appointment."

That was 5 days ago. No call and no reply from my very devoted pet parent friend.

I sent a note asking if she had gotten my reply? She confessed that her fear was crippling her. She was so afraid she couldn't pick up the phone and call my office, or reply to my email.

"What if I look at it and decide it isn't significant enough to even discuss removing? Why don't we take it one step at a time?"

Where do I think my best advice lies? Well, I suppose we all need to be brave enough to open up the dialogue by opening up our mouths, confessing the emotions of our hearts, and build a meaningful relationship centered around trust.

Your pet lives in the here and the now. They are free from guilt and fear and live with love and joy. It is our job to think and act for a happier and healthier tomorrow. Be proactive and become the master of both your destinies.. and always keep a little bit of faith  in your heart.


Related Blogs;
There Has To Be Mercy Before Money.

Too Afraid To Fail. When Your Fear Costs Your Patients.

How Do Our Perceptions Lead Us?

To ask a pet question on Pawbly.com just sign up and ask away. All questions are free to ask and the Pawbly community will add their thoughts and opinions. Pawbly is free for all to participate.

If you would like an appointment with me, or any of the other amazing people at the clinic please find our information on our Jarrettsville Vet website or Jarrettsville Vet Facebook page.

I am also on Twitter @FreePetAdvice.


Thursday, January 29, 2015

Drooling, Bad Breath, and The Stick Chewer..


Hank
Hanks mom brought him in on a Sunday to promise me that she wasn't crazy.. "but he keeps licking his lips, won't eat his food like he normally does, and lately has very bad breath. He is normally very happy, playful and full of energy. Oh, and he loves to chew sticks!"

"Huh? Sticks you say?"

And there within two minutes was our answer to all of Hanks ills.


I know that most people would just stick their finger in his mouth and try to fix this problem quickly, but it is a Sunday, and I am only here for another hour,, and well, he doesn't like my fingers sticking in his mouth.
"Could you bring him back tomorrow morning so I could look in his mouth without a tongue in the way, or chomping teeth, and allow me to take care of him properly?" I bashfully inquired..

You see there is a fine line between rogue-vet style (my usual preference where I act like a MASH doctor,, all MacGyver and cast caution to the wind) and performing a task with as few variables as possible. Medicine is all about managing worst cases scenarios, being prepared for them, and jumping in.. (see? That's I love that MacGyver stuff!).


Hank's mom was so happy that I had confirmed that she was an astute mom (and not crazy) that she afforded me the liberty of general anesthesia the following day. That calm quiet Hank under anesthesia allowed me to see...


the culprit...

Wedged very tightly and very deeply in the hard palate (OUCH!! can you imagine?) is a stick!

When it got there is hard to tell? I would guess about 2 weeks?

video

Within a few seconds that bothersome unwanted stick was out of Hanks mouth.

Are you wondering why I was asking for permission to remove this with Hank under anesthesia?
Here were my concerns initially;
  • That stick was wedged so deep that I was afraid the hard palate, or teeth, would bleed like crazy. The gums do this to wash away all that yucky bacteria our mouth is full of.  The advantage to having an excellent blood supply, and bleeding, is that the gums heal very quickly. The disadvantage is that you need to not let blood go down into the trachea. An animal under general anesthesia has an endotracheal tube that seals off the trachea so nothing can trickle down into the lungs. We can tilt the nose down to drain out the mouth, or suction it out of the mouth.
  • That stick was just as likely to go down the hatch (trachea) as it is to go out the way it came in. Swallowing a stick, or very worse yet, inhaling a stick, is very expensive to retrieve and potentially fatal. (Not worth my much beloved MacGyver gusto). And,,
  • What if I needed to suture the holes the stick left behind? Or,,
  • What if it was so wedged I needed that I needed to break  it up to get it out? Worst case,,
  • What if there was an open hole (we call it a fistula) between the oral and nasal cavity? (Did you know that you can pierce a hole between the roof of your mouth and your nasal cavity.. it would bleed and hurt and cause massive infection).
  • I was worried that there would be other hidden mysterious problems in the mouth. Being under general anesthesia allows us to take a calm, thorough look at them all. 
Hank is a very good boy but a chewing mouth, a stick, bleeding, and a myriad of other possible complications isn't worth asking for trouble.

The stick looks so harmless here.
The stick left behind two puncture holes between the molars. We flushed the holes to remove any residual pieces of stick, all the plugged up debris, and clean the wounds. A few minutes of pressure and the bleeding stopped. Lucky boy, no sutures needed!



But the tongue. Well, it had obviously been licking at a hard sharp object for awhile. Can you see the ulcerated area in the center of the tongue in the center of the photo?


Hank woke up quickly and calmly. He took a few licks of the roof of his mouth and went home with fresh breath and a smile of relief! 

Many Thanks to his mom for letting me share his story with you.

Break down of Hanks visit; Exam: $60, Anesthesia: $100, injectable NSAID; $40, Stick retrieval: Free (because I was so excited to get it on video). Happy mom, Stick free pup and relieved vet: Priceless..

If you have a pet question, a story to share, or just want to be a part of a community dedicated to helping pets and their people please join us on Pawbly.com. Pawbly is free and open to anyone who loves pets.

For veterinary care you can find me at Jarrettsville Vet in Jarrettsville Maryland. Or on Twitter @FreePetAdvice.

Monday, January 26, 2015

The Bump That Gets Too Big. (Warning; Surgery Scenes). Why a team approach will always tilt the odds in your favor.



This is Cody's story.

He is an older Springer Spaniel who has been visiting me for the last four years. He came to me seeking a second opinion because his primary veterinarian had given him a very poor prognosis and no plan.

Now, I am a realist. Medicine is about statistics... (by the way, I loathe statistics, numbers; boring, scenarios; boring, population studies; boring, math..well, you get the picture), but as much as it is boring it is a factor in guiding our decisions and our recommendations. Veterinarians look at the physical exam findings, lab work, and then decide which diagnosis fits your pets billet. From there we discuss treatment options and  their corresponding most likely prognosis. To many clients it is a difficult wad of information to chew on and digest, never mind to try to make a decision upon.

My job, as your vet, is to help you all understand your pets ailments, options, and decide where to go with them.

Some vets do this better than others. If your vet, (who I will almost guarantee is one smart cookie), cannot adequately articulate and help you understand which direction to head in, or even worse, if they cannot give you any options, or sign of hope, it's time to rethink the value they add to that relationship.

Soapbox Time: WE HAVE AN OBLIGATION TO HELP YOU NEVER LOSE HOPE, OR AT LEAST PROVIDE YOU WITH AN OPTION TO HELP END SUFFERING! If your vet doesn't give you this find one who will.

Cody's parents did not want to give up on him. At eight years old he was their kid and they felt he had a few years left ahead of him. They came to visit me and we laid out a plan this included a change in diet, a nutritional supplement, carefully planned scheduled monitoring (which includes a plan for Best AND Worst case scenarios), and access to me, or any of the other veterinarians at the clinic to help when the plan changed, as it inevitably will.

Cody has a plan, a clear written list of items for his family to do at home, a schedule to follow and a support network to utilize if anything comes up along the way that his family needs assistance with.

That was over four years ago.

Over those four years Cody has blown two cruciates, had them surgically corrected. He has beaten the odds at every challenge. He has an army fighting for him, and we all know that the odds always shift in your favor when you have a team approach to your problems.

Cody was visiting this time because one of his many bumps had gotten rather large and worrisome.

Like many dogs Cody has gotten a little lumpy as he aged. We have kept track of all of them, monitored them closely and none have changed size, shape, or texture. Well, that was until this one. Cody's previously thought to be a lipoma (benign fatty tumor) had all of the sudden gotten much bigger. It had evolved from golf ball sized to bigger than softball.


Cody's mass is on his lower neck/upper chest area. It is firm, round, and felt as if it was adherent to the underlying tissues (in other words I was not able to get my fingers underneath it and pull it away from the muscle). The skin covering the mass was very red, had visible blood vessels and the hair was beginning to wear off. This is a sign of the mass being either abraded by the surfaces that he is laying on (thereby wearing off of the hair and causing the skin to thin), and/or the skin is being stretched to the point of beginning to tear). Either scenario is a problem.




We discussed Cody's current predicament.

His family had come in because they understood that something had to be done.

Their options were;
1. Do nothing. Not a good one, because unless we thought Cody had only a few weeks left that mass was going to open and we would have a heck of a time (I used the word "impossible") keeping it from bleeding continuously, and/or it could become a source of infection. It is impossible to keep these kinds of masses bandaged, and even keeping as bandage on does not prevent infection. Chronic bleeding will lead to anemia and there is no permanent way to treat this without stopping the source of the bleed. You will end up with your back against a wall deciding whether to euthanize your pet because you cannot manage an open and non-healable mass. Don't wait for this. don't euthanize your pet without trying to heal them.
2. Take it off, cross your fingers that you can close your incision and remove the cancer in total just in case it is a tumor that can spread. to other parts of the body. Plan and hope for excision to be curative.
3. Perform a fine needle aspirate and/or biopsy.  We do these to try to identify what the mass is before deciding which step to take next. Sometimes we classify this as "de-bulking" because we feel that we cannot get the whole mass removed cleanly.

Cody's family opted to take off the mass before it opened up and became a big messy problem.


That same evening in addition to Cody's physical examination we checked a CBC, full chemistry, urinalysis, and three view chest x-rays. 

Thankfully, everything was normal. Cody was scheduled for surgery the following week.

I have to admit that I was pretty nervous. None of us want to admit to being paranoid, but I was afraid that I had pushed my luck too far with Cody already. This was the sixth "older dog not really sure what I am going to find mass removal surgery" in about as many weeks. Could I really be so lucky to not have one of these guys NOT make it through surgery?  And, damn it, I liked these clients a lot,, we had been through too much together already.. weight of the world on my shoulders we went into surgery.



They always look waay more ominous when they are shaved.







The first big sigh of relief. The preliminary exploration of the mass and it all appears to be fat!


Now all I have to do is get my fingers all the way around the big ball of fat, hope that they don't encounter any big angry blood vessels and get this thing off.







The lipoma is off, and I have enough skin (always think about this before you place scalpel to skin) to close the incision. Almost nothing is worse than having a bigger problem after surgery than you did before because there is too much tension, or, it takes months and months to heal because you didn't have a good exit strategy.



A big mass always leaves you a big hole.


Starting to close is more technically challenging than any other part of this surgery..






In the end there is a large incision. It always looks worse after than it does before,prepare your clients for this.



TAH-DAH!

A closed incision must be able to maintain function. Expect some pocketing, some bruising, and monitor very closely for any signs of infection. Some pets need to be hobbled. We bandage the front legs together so they cannot splay open accidentally, or otherwise, and put excessive stress on the incision.

Cody recovered well and seems to have once again proven that if you have a team behind you, and you face the challenges life throws you head on with them, anything is possible!

Related Blogs;



If you are a pet person and would like to help others, or, if you are ever in need of help with your pet, please join us at Pawbly.com. Pawbly is a place where pet people can meet other pet people and exchange their questions, experiences, and thoughts. It is free and open to anyone who loves pets. We know that together there is a way to help every pet in every corner of the globe.

If you would like to follow me on Twitter I am @FreePetAdvice. Or find me at the clinic Jarrettsville Vet, in Jarrettsville Maryland.

This is my team.. resting for the challenges life might throw them..later.



Wednesday, January 21, 2015

When a "Bump" Causes You Concern; You Slay It With A Diagnosis!


Lexi
This is Lexi. She is a  sweet, docile, lovable 5 year old spayed female dachshund. She is is an integral part of her family and is usually found snuggled up under their wings.

Can't you see the happiness in her eyes?

Her parents, being the devoted doting people that they are, noticed a few days ago that a round bump had appeared on her side They called me and rushed her right in for an examination.


When it comes to bumps there are a few guidelines that we use to help us identify which are worrisome and which are most likely  to be simply benign and/or just cosmetically unpleasing. Learning which is which takes both practice and an in person hands on examination.


I am asked frequently to diagnose and provide guidance based on a picture alone and I always hedge my skepticism on being concerned versus trying to reassure a client that they are "probably OK."

Lexi's bump was firm, round, about 6 cm in diameter and directly behind her right armpit. It also seemed to appear quickly over the last week. There are a few things in this list that caused me concern; I am worried about the size, the area, and the quick appearance. Because of these we decided we needed to do something more than just watch it.

There are a few options when we talk about lumps and bumps on pets. you can;
  1. Watch and wait and see approach. This should only be done after your vet has examined it and agreed that it is most likely a cosmetic benign mass. This takes years of practice and is still at best an educated guess. There should be some take-home instructions if this approach is chosen. Here are mine; The mass is measured (a ruler r calipers on a scheduled basis. Record measurements in a journal. Have a "size to return to the vet" rule. I.e. if it grows by 20%, or gets this big.. we return. Don't wait until it is so big we can't safely remove it.) Here is a good example, Charlie's story.
  2. Fine Needle Aspirate option. This is performed with a large bore needle (I prefer a 16 or 18 gauge needle) being placed into the mass to collect cells. This is a cheap, quick diagnostic tool. It doesn't require anesthesia, (I have never sedated a pet for it either), and within a few minutes a sample of the mass can be collected and submitted on slides for cytology. The cost at my clinic for this is about $40 for the aspirate, and $140 for the slides to be submitted to the lab for analysis. The disadvantage is that you have to be very careful that the needle is in the mass, not in the surrounding fat, or tissue, and that you can get a good sample. Occasionally, I have had difficulty in getting a good sample due to excessive bleeding.. and sometimes you aspirate a terrible tumor that bleeds and gets soo angry that you make the tumor bigger and scarier. Also, the more tissue you collect the better the pathologists ability to diagnose correctly.. FNA is about 70-95% accurately diagnostic. In the world of human medicine biopsies are the tissue sample size of choice and treatment plans are rarely decided on aspirates.
  3. Biopsy. This is the best way to make a decision about a mass.. More tissue allows for more information to be collected for the pathologist. It also allows the surgeon to see what they are collecting. More tissue allows for more accurate diagnosing, which allows for a more successful treatment plan. This requires general anesthesia and hence is more costly. I would like to add that this also allows for a chance at excision being curative. In other words I approach every biopsy as an opportunity to remove something that I hope will not ever have to deal with again. A biopsy is accurate about 90-99 % of the time.
I should add that in some cases my clients elect to take the quicker, cheaper, and less invasive approach by having a fine needle aspirate done, but later need a biopsy and or mass removal after the FNA is done. This can be more expensive in the long run, (about $150 at my clinic).

In Lexi's case they elected for a FNA.


I prefer to used an 18 gauge needle on a syringe. I isolate the mass in one hand and pierce the mass with the needle while pulling back on the plunger of the syringe. We call it the "woodpecker" technique because we stab the mass multiple times to pull as many cells into the syringe as possible.


After the sample is collected we examine them on a slide and submit the slides to the lab for a pathologist to analyze. I usually get an answer on a FNA in a day or two, versus a biopsy which usually takes about 4-6 days.


Luckily for Lexi, her FNA sample was all fat cells. We decided that as long as it didn't change too significantly that we would just keep an eye on it. Why did it appear to have grown so quickly? Well, Lexi's diet had actually begun to work, and now her new waistline was revealing a lipoma. The fat cells will grow bigger or smaller with weight changes to some extent, but fat cells only disappear with liposuction, or surgical excision.

Here is how I recommend that you monitor a mass;
  1. Measure the mass using either a ruler or calipers.
  2. Record the size in either your pets file, on your yearly refrigerator calender or ask your vet to help you by adding it to the pet record.
  3. Have a plan for action. Know what size is the time to go back and go to plan B. 
  4. If the mass becomes too big for your pet to haul around go to plan B.
  5. If the skin covering the mass starts to tear, thin, or weaken, or if the mass ruptures go to plan B.
Identify plan B.. In almost all cases plan B indicates that it is time to stop watching the mass from the couch.. it is time to slay it with a scalpel and bid farewell to it forever.

Please join me on Pawbly.com where we exchange pet care information, share stories, help pets the world over, and build a stronger bond between pets and their people every day. Pawbly is open to everyone who loves pets, and free to use.

You can also find me on Twitter @FreePetAdvice, or in the veterinary clinic, Jarrettsville Vet, in Jarrettsville Maryland.



Sunday, January 18, 2015

The House. Making it a sanctuary for both you and your pet. Household dangers, toxins, and learning from other clients mistakes.



The pups guard the front door to the kitchen
I spent the whole weekend moving into our new kitchen.

Quite exciting to put it lightly. It has been 5 years in the making.

You see we live in a very, very old house. 1811, to be exact, and when you live in a house this old you feel an odd obligation to do right by her. If people haven't mucked her up in over 200 years, then by golly I'm not going to be the first.

So, four years ago we started to lay the 3 foot thick solid stone foundation to support the log cabin that we have dis-assembled, tagged and shipped to our house from the 30 mile away York, Pa. This project has been a labor of stubborn determination. Thankfully and luckily for me, those are my two strongest attributes.

Being 'under construction' with pets is a somewhat arduous task. Keeping the pets away from the construction workers, their tools, their trucks, and keeping the cats out of every nook and cranny whether they be going up or coming down requires multiple eyes in multiple locations all at the same time.

To facilitate safety and minimize the stress we closed off the side of the house that was being worked on. We  kept everything as quiet and consistent as was possible in the rest of the house. Every person coming and going from our house was required to meet and greet the dogs. And if I can't trust you around my dogs then you can't be at my house. It is a simple rule, but it sticks.

Diarrhea, vomiting and intestinal upset are all common sequela with stress. Moving, holidays, guests visiting, loud noises, change in schedule, the list goes on and on. any change in your household can be very stressful to your pet.


Household pet safety is paramount.

To help you keep your pet(s) safe think about your house and try to view it from the perspective of your pet. If you have a small pocket pet like a hamster, ferret, gerbil, etc., then you need to look for really small holes. You see small air leak and poor insulation and they see portal to another dimension. Before you bring home a pet please investigate your home thoroughly for any potential unsafe areas. All items that can be chewed, eaten, swallowed, cause a choking hazard, or even entrapment should be removed.



Here are some of the home hazards that I have seen lately in practice that reminded me of how careful we need to be with our pets..

1. Pocket pets that fall.. Never put your hamster up on anything, they will fall off. They are made of little tiny bones that can break,, and I have seen lots of head trauma in these guys.

2. Puppies tied to a porch. Puppy falls through the rails trying to get off porch. Hangs themselves. AWFUL!

3. Puppy playing around lawnmower. OK, awful again. That story here.

4. Pets that chew everything..electrical cords is very bad, carpet gets lodged in the intestines, pieces of toys get stuck in the gut, the list goes on. If they chew it and you think they chew it see your vet about it.

5. Cats love string. any long linear item that they can chew they swallow. The hairs on their tongue are pointed backwards. When they lick they propel any item that they pick up into their mouth, down their throat, and into their stomach. This can cause an obstruction.

6. Pancreatitis can be caused by ingestion of a large quantity of high fat foods. If you leave a tray of brownies on the counter your pet might try to eat it. High fat and chocolate, the double whammy.

7. Household cleaners. Why pets eat them, chew on the bottles, drink out if the toilet after the cleaner has been dumped in, I don't know? But they will lick the floor you just cleaned, etc., so think about every item you bring into your house.

8.Laundry pods. They are little packages of killer toxin that are almost impossible to treat, remove, and save your pet from. The convenience factor for us housewives is huge. The danger to your pets and kids is even greater. Keep in a tightly sealed inaccessible location. Or go back to old fashioned pouring.

9. Poisons. If it is a poison to any other kind of being, it is probably a poison to your pet. Rat poison is my particular most frequently visited toxin. I cannot express how much I detest this stuff. It can and will kill everyone it meets. A safer rodent eradicator is your cat.

10. Chewing gum. These can contain xylitol,. Toxic to your pets. Don't buy it, don't tempt them.

11. Your kitchen is a veritable cornucopia of concerns. Toxic foods, spices, the list is long and varied.
More information on this here.

Magpie sleeps safe and sound

Here is my list of Kitchen Toxins.

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Friday, January 16, 2015

Why is my pet peeing in the house? Submissive Urination

My cat Wren, she plays I work,
how is that fair?
None of us get to the place where fear cripples our ability to function normally without having had a road of choices behind us. Trying to remind and convince my clients that an unwanted behavior is simply the accumulation of missed opportunities along the way is every pet parents responsibility and one of my biggest challenges.

I am not sure if these behavior questions are the result of not understanding the failings and mistakes we humans have made along the way, or, our want of absence and accountability when forced to take to look in the mirror and face our part in the problem, or, being so caught in the fast pace of our lives that we think we can get a quick-fix for everything. But, I get asked about one behavior problem more than any other.. I get asked it a lot,,, and I cringe every single time.


My pups, Charlie and Jekyll

Here is the BIG dilemma for behavior problems;
  1. They took a while to get there, therefore, 
  2. You have to assume that it is going to take a while to get back to where you went astray, and,
  3. You are in all likelihood responsible for some part of the problem. 
Here is the good news, things can get better. Pets are trainable and there are people who can help.

One of the most common problems I get asked to help with is the proverbial 
"peeing in the house" pet.

I answer this question from two perspectives.
  • First, as a veterinarian, and, 
  • Second, as a behaviorist.

My happy cat finds a sunny spot.
No worries with this kid..

When I am discussing any problem with a client in the clinic I always start with a talk about what is going on?, What is "acceptable" versus "unacceptable" in the clients eyes? The length of time it has been going on, and what environmental factors might be contributing to the problem? This is a discovery process which requires an open honest dialogue. It also requires trying to understand the world through your pets eyes. We reason with a humans perspective, but, when trying to solve a pets problem,  we need to be tackling the issue with the pets perception and life in mind.

Behavior problem resolution is about three things;

  1. Understanding what the parents problem is,
  2. Understanding why the pet believes what they are doing is necessary.
  3. Convincing both parties that they can help each other and return back to harmony.



The first place to start with every pet problem is your vet. Here's why,, assuming that it is a behavioral problem and not looking for a medical problem could worsen the medical condition and possibly cause additional behavior problems.

The question I was recently asked was about a submissive urination in a young dog who had been raised in a household with a lot of yelling. Her fearful urination persisted for years and has progressed to now urinating even when getting praise and treats.

Here was my advice;

See your vet first. Your vet will look for any possible complicating or compounding issues, especially when it has been such a longstanding problem. I know it sounds like a long shot, but I have found many, many medical issues when we were focused on what we believed to be simply a behavioral issue. These included underlying kidney and liver issues, underlying bladder stones, bladder infection, and even anatomical disorders that can cause leakage or inability to hold urine. This examination and work up should include a thorough examination, including looking at the urinary anatomy and palpation of the bladder. I would also recommend blood work to include a CBC, chemistry and urinalysis. At my clinic this would cost about $170.

After these we address any possible behavioral issues. These can include stress, anxiety, fear, changes to the environment, etc. Another possibility (dogs) is spay incontinence. More information about this disease is here.

I also advise seeking help from a trained, reputable, and experienced behaviorist or trainer who can come to your home and understand the scope of the issues. In this case it sounded like any emotional interaction would elicit urination,, therefore, the goal is to minimize all interactions from being surrounded by emotion, or with the possibility of causing an emotional response. This is not to say that you don't interact and provide exercise, attention, and training, BUT, you don't use emotions to provide them. You provide care and attention just not treats, praise, or commands that are with baby talk or harshness (i.e. emotionally driven). Too may people try to re-wire their pet with soft, silly, baby talk which is almost as anxiety ridden as yelling or demanding. Be a confident, quiet, example of composure, love, and dedication to helping your pet on the road to re-wiring an re-training.

Never, ever yell, never scold, and never reprimand their behavior in a negative fashion. Usually, we suggest that you train with praise and reward, but for these guys it can cause submission and subsequent urination. Your job is to create an environment and atmosphere of self-esteem, confidence and love, not a place where your pet is submissive to anyone else.

For example, re-inforce housebreaking with the tips here, but all interactions should be without words. Try using minimal hand signals or body language also. Instead approach him without words, place a leash on him, and go for a walk. I would also recommend that you minimize the interactions with other people as they will not understand his specific training needs. Pets with submission issues should be walked without talking or without you being anything other than a calm, patient, dog walker. Learn and teach them to how respond with hand signals and minimize showing your emotions. A little bit of gentle calm training with your pet will be reflected in their confidence with dealing with the world, and from these baby steps you can move forward without pee on the floor at every meet and greet.

I wish you the very best of luck!

My Jitterbug gives a head butt and a hug.
Related blogs; Submissive Urination

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