The Last Biggest Loser Contestant

Last week I saw three fat dogs on my appointments. The last dog of Tuesdays appointment was Squishy.

Squishy is a four year old spayed Pug. She is like many of the Pugs we see; short, fat, happy, and eternally (sounds) congested. She is a sputtering, spitting, tongue lashing tan rounded mass with a curled and kinked tail that lobs around in no definable motion and a tongue that doesn't quite fit the confines of its' mouth home.
She was originally purchased by the daughter of my clients. But soon after Squishy came to the "grandparents" for a very short over night stay it seems they got to attached to her and she never went back to her mom.

Not only was she not originally their dog, but she was also not originally called Squishy. She was a more respectably named "Layla." Although to know her I have to agree that she is more fittingly a Squishy than a Lyla to me.

Squishy is what her mom always called her and that's how I will always think of her. Both of them face to face making kissing gestures at each other and elated by how adorable Squishy is. It was mutual adoration and the Mrs never went anywhere without her Squishy by her side.

I have been Squishy's Vet since she was first a Squishy. She has since the very beginning, always had a weight problem. We see it so commonly in Pugs that I almost think that society thinks this is what they are supposed to look like. I have to remind my clients that Pugs are supposed to have a round head, but that only their head is supposed to be globoid. Pugs are actually supposed to have a stocky wide shoulder and heavy upper body but a small waist and hind quarters. It's sort of like a miniature Bulldog stance.

I spent most of every single appointment with Squishy reviewing the Pug anatomy, drawing pictures, trying any way I could possibly think of to convince Mrs Squishy how vitally important it was to keep her thin and healthy. Every trip in our door was the same. She never lost a pound (rather she usually had gained one or two). It got to the point that the Mrs. just didn't want to hear my concerns, and didn't care what Squishy's waistline looked like. She just wanted Squishy to have everything she wanted and wanted her to be happy.

The problem with most of the Pugs that I see is that they are so attached to their owners that they have forgotten the needed limitations and discipline that their little 15 pound bodies need to follow. They are master beggars and manipulators. Most of the Pugs that I see have no diet that resembles a high quality commercial dog food.

In Squishy's defense she is actually on a very good dog food. But it has taken us three years to get her there. She eats DeliFresh. It is a refrigerated meat based dog food that resembles bologna loaf available for you and me at the grocers deli counter. She LOVES her food! And because it is the only food we have found that she and her owners both love, we have stuck to it. The problem now lies in the snacks. She gets a reward snack for every move she makes. They love her so much that they can't help but reward her for her attention. So she gets treats galore and she rewards them with attention galore! And everyone is happy except me and her waistline.

The absolutely disastrous aspect of having a fat Pug is that their already abnormal head and anatomy gets pushed even harder into maintaining an open airway than it was due to breed conformation.

I have gone over the "brachycephalic syndrome" already, but for those of you who missed it here it is again.

Brachycephalic dogs are those dogs with the short noses. Actually many of them have a black spot of a nose but no extension of the bone between the nose and the eyes. We have essentially genetically bred them over centuries to have no nose. We pushed their nose into their face and in the process some of the anatomy that was supposed to be in that space got lost or jammed into another space. These Pugs always sound like they are snorting because their nose, which should be a three dimensional cube like structure, is now a flattened broadened structure. This is much better described by a picture.

The second anatomical abnormality we imposed on the Pug is the elongated soft palate. We pushed this back into the throat so now the soft palate infringes on the turf of the larynx/pharynx area and we get a dog that has a very difficult time breathing.

The above pictures are from this great vet text.

To make matters even worse the small nose can't pull air in well because the alar wings are shutting off the nose (they ALL need a Breathe-Right strip), and the elongated soft palate closes off the back of the throat. The saccules in the larynx get beaten to a swollen fleshy mess and can't fit in their pouches anymore so they evert and take up more space in an already crammed area. The final blow to the ability to breathe is a weakened trachea that is not a stiff cartilaginous tube with nice heavy duty cartilage rings to keep your tracheal tube open, but instead a weak tube that actually collapses with stressful breathing.

http://www.youtube.com/watch?v=-bOwDBowtds A great video on Brachycephalic Syndrome, and surgical treatment options and general recommendations.


It's a snowball disaster for some brachycephalic dogs. THE WORST thing that you can do to an already breathing challenged Pug is let them get fat! It is another burden that some of them have no room to bear.

This was always my point with Squishy and her mom. My voice began to fall on deaf, dreading the sound of my voice, ears. So I laid off of all of them.

I have learned that there really isn't anything as important as how much an owner loves their pet. Nothing trumps that love. And if I ever feel as if I am venturing into a territory that will lessen that bond I back off. I can only try to offer advice and then help out if needed later.

So a year ago I decided to not brooch the subject anymore and just try to offer advice with the Mrs. if she asked for it.

About 5 months ago we got a call saying that Mrs. Squishy had had a fatal heart attack.

We sent cards and sympathies and I felt terrible for ever opening my mouth and being the bad guy that I thought she recognized me as. I worried about her family and I worried about Squishy.

Last Tuesday the Mr. came in with Squishy. She was every bit as happy and fat as she had ever been. Mr. on the other hand was sullen, quiet, and sad.

"Dr. Magnifico, would you help me with Squishy's weight? I couldn't bear to lose her too." He said with a barely audible voice.

I could feel the sorrow in his soul. I almost broke down in the room with him. This little fat exuberant pup was all the most important loved one in his life and he wanted to keep her and his wife's memory alive as long as he could.

We started Squishy's weight loss plan with the following.

We were going to measure how much food she was given and he was going to promise to not feed her any treats for a week. I suspected the excessive calories were from the treats and I wanted a week to test my theory.

On day 1, Tuesday March 13, 2012 Squishy weighed 20 pounds.

We also decided that Mr and Squishy would come in every Tuesday night for a chat, a weight check, and because I think he needed a schedule and a visit from friends.

Last night, Tuesday March 20, 2012 Squishy's weight was 20.9 pounds.

So much for my great plan.

We discussed what the last week composed of and it turns out Mr. just had shoulder surgery, so the walking got cut way back. (He normally walks three times a day. We might need to quantify a distance).

But the with hold treats suggestion was forgotten.

So this week Squishy went home with one bag of treats that were 3 1/2 calories each and instructions to only feed 5 per day. (I also suggested he break 1 treat into 4 smaller treats).

We will see what next Tuesday's numbers look like.

Best of Luck Squishy and dad!



http://www.youtube.com/watch?v=-bOwDBowtds A great video on Brachycephalic Syndrome, and surgical treatment options and general recommendations.


For more information please see;
http://www.petmd.com/dog/conditions/respiratory/c_multi_brachycephalic_airway_syndrome

Fat Tuesday

Yesterday was Tuesday March 13, 2012.

I have said before that I still find it funny how things seem to come in batches.
Yesterday it was fat dogs.

For whatever reason I saw three very fat, (we call them obese and sometimes I throw a "morbid" in front of the obese to drive my point home) dogs in a row. Now there are a multitude of issues we as veterinary medical professional have to address when it comes to obesity in pets.

We have to address all of these;

1. See if the owners also think that their pet is overweight. Denial is a powerful tool of avoidance and if the owners refuse to see that their pet is overweight you can't even begin to tackle how to resolve the problem. (Yes, admitting there is a problem is the first step in overcoming the disease).

2. There is great debate and discussion in veterinary medicine as to how we "delicately and adequately address the problem" with the pet owners. It is documented that the estimates for obesity among household dogs and cats is about 35%. On the human side the statistics are about 50%, (higher in some geographical areas). The statistics are devastating, and the effects of obesity in our pets is just as detrimental as they are in humans. So often the overweight pet is owned by an overweight owner. We don't want to be assigning blame, or issuing guilt, but how do I get an owner who likely doesn't exercise themselves to exercise their pet? The only way I know how to do this is to give the same advice to everyone. For instance, I don't assume someone won't go for a referral if I think it is warranted because they don't look as if they can afford it. I make my recommendations based on what I think is ideal for the pet and then we discuss from there.

3. Discuss how treats play a detrimental role in weight loss. Remember my raw diet blog? If you missed it I learned that a large biscuit is about 200 cals. (That is about equivalent to 1 chocolate chip cookie for us). How many of us can lose weight eating chocolate chip cookies? Try to imagine giving your dog a candy bar every time you are rewarding them. We all get fat from eating candy bars.

4. Once the owners move past the acceptance of the reality that their pet is overweight I ask them what they feed? If they don't know what brand it is, (oddly most owners draw a blank when I ask), then I ask them where they get it? I will say that in general you are not going to find great pet food at the supermarket or big box stores or any store  that touts itself on selling the "cheapest" anything. You get what you pay for AND you are what you eat.

I tell this to my clients all the time. So let me say it again;

You get what you pay for AND you are what you eat.

Therefore, I always recommend that you buy your pets food at either a gourmet high-end pet food store, or PetSmart, Petco, etc., where they have a huge selection of both the low end (don't buy this, well, not unless we tell you to, but that's another topic), and the high end food.

In general, I want my clients to buy the most expensive (lifestyle and breed appropriate) food that they can consistently afford.

5. The question that I am always asked next is, "How much food should I feed?" The answer is always the same for this one. "Every food has a different calorie count, and every pet has a different metabolism and activity level. So one cup of food might be too much, too little, or just perfect for three different dogs that are all 20 pounds."
I will give what I think is an appropriate amount based on how much is being fed now, or what the feeding recommendations are for the food I am switching them to. And then schedule a weight check and re-check in two weeks, and adjust from there.

For those of you doing this weight loss plan at home with your now "great dog food" I recommend that you reduce the amount that you are feeding by 25%, (that means you need to be measuring from now on, and please use a real measuring device, (like a measuring cup), because a "Big Gulp" may be a cup that you use for feeding, but it sure isn't a measuring cup you would use for a recipe, and we all need to be speaking the same language). Feed this amount for two weeks, with no snacks outside of that amount of feeding, and then re-weigh. If your pet hasn't lost any weight then reduce again by 25%. Re-weigh two weeks later. If your pet is not losing weight then have a talk with your Vet. You are either cheating with the snacks, not exercising enough, or have a metabolic disorder.
After you get to your target weight we have to re-adjust the food to maintian this weight.

6. I very clearly understand that the action of giving your pet a treat is a strongly bonding experience. Every pet parent wants to see those sweet begging eyes looking at us with love, affection and longing. And we all know that that face is often tied to a treat. We as parents are very good at rewarding good behavior, and some of us are even very good at rewarding begging. Nothing melts my heart and makes me feel better than seeing my sweet Jekyl-pup looking at me like I am the center of his whole universe. And boy can that Beagle work a snack like a pro. I don't ever want to be telling owners that they can't spoil their pets. If I say "No more treats ever!" I am dooming that plan to failure. Those pups have been trained by snacks, they expect that snack, and if you are Jekyl you are OWED that snack. So snacks are allowed in all of my diet plans. BUT, your snack allowance comes out of your daily calorie allowance.

Jekyl-pup as a puppy. SOOO, cute, you can't say "No" to that! It's not possible.
(I'm getting up to to go give him a treat now)

For instance, if I say that you can feed 1 cup of brand X (usually it is Hill's Science Diet r/d, available by prescription only and only after we have a long talk about everything), twice a day to Fido, then I don't care if you feed a half a cup for breakfast and a half a cup for dinner and use the remaining 1 cup as your "snack allowance" for the rest of the day. Put that 1 cup on the counter, or in the treat jar and trick your pet into thinking it is the "treat" instead of the normal boring food. In most cases they won't know the difference.

And one last note on food and snacks. If it comes with a cartoon on it, or has food that comes in colors that are not of the "normal food color" like that nuclear orange or red, then please think of it as equivalent to kids cereal. The "junk cereals" come with toys, artificial coloring and prizes. It is not the "best quality cereal/food" so don't buy it!
I tell my owners that all of the horrible stuff you hear about overweight people also happens to their overweight pets. Diabetes, cancer, joint disease, heart disease, the list goes on and gets longer every year. Sadly the statistics also get higher.

I also tell people that just like on the human side you don't live a long healthy life and die of old age if you are obese. There is nothing more heartbreaking than having to euthanize a pet because they are no longer able to ambulate on their own and because their joints are shot due to their excessive weight.

Obesity in pets is a result of many things. Certainly a large part of it is lifestyle. Maintaining optimum weight is the balance of calories in and calories out. Or said another way, the amount you eat and the amount of energy you burn.

I will now stick my neck out and say. No pet wants to be fat. They may really want that treat in your hand, but after I have seen the miraculous change in the overall degree of happiness of a pet that has lost its excess fat I will tell all of you that a happy active pet is worth the sacrificed treat every single time.

After all of that discussion of FAT dogs I do need to add that there are some medical conditions that cause pets to put on weight and slow down their metabolism. These conditions are often diagnosed with blood work tests. I strongly encourage any pet that is having difficulty losing weight after all of the above issues have been discussed to have a talk with your Vet about some of the tests that can be run to help rule out thyroid disease, and other endocrine diseases. I have had more than 1 fat Lab turn out to be a hypothyroid fat dog. None of us want to discover that all of the guilt, blame, and interrogation over who is feeding what behind whose back is instead the fault of the thyroid gland being defunct. This discussion at the first fat pet visit will save everyone a whole bunch of grief, and that fat poor dogs time from being wasted in treat withdrawal torture.

I wanted to give you all some idea of what the treats that you are buying and feeding look like in terms of calories. The following list is from PetMD's website. The full article is provided at the bottom.

Here are some calorie counts on some of the most popular treats;

• Milk Bones: 20 for the tiny ones to 225 calories for the biggest ones
• BusyBones (by Purina): 309 for the small ones to 618 for the big ones
• DentaBones (by Pedigree): 105 for the small, 188 for the medium and 300 for the large ones
• Pig ears are about 130 calories for the small ones
• Rawhides? 100 to about 600 calories

Here are some low fat, low calorie options;

• Frozen (or fresh) Green Beans (23 calories per half cup)
• Frozen (or fresh) Broccoli (20 calories per half cup)
• Baby Carrots (4 calories each)
• Apple Slices (32 calories per one half apple)
• Cantaloupe Slices (30 calories per one half cup)
• Canned Pumpkin (40 calories per half cup)
• Air Popped Popcorn (15 calories per half cup)

Ok, After I list those I want to add, these can be used as snacks, or fillers to the great food I hope that you have switched to to make your pet "feel full" without providing excess calories.

After I offer this list I have owners coming in 6 months later and telling me that they feed 1 cup of green beans to their 10 pound dog, or 1 can of pumpkin to their 50 pound dog, and I say, "the treat is a treat, not half of your dogs food allotment."

So I often put a limit on the "acceptable treat" list, like "say 4 carrots a day," etc.

http://www.petmd.com/blogs/fullyvetted/2009/may/calorie-counting-your-pets-go-easy-treats

Here are Tusdays dogs. I will introduce each dog in the next few blogs and let you know how they are doing as the weeks go on.

I have asked each of them to come back for routine "weigh-ins." It's our version of Weight Watchers. And because I want this plan to work this time and I am happy to help adjust the plan as we need to.

Here's this season's "Biggest Loser" participant roster;

"Dazzle" the Dachshund. Owned by a devoted mom who wants very much to "fix the weight problem." She weighed 26 pounds, our target weight is about 21-22 pounds.

"Duke" the black Lab. Owned by a wonderful loving family, with a very busy schedule. His current weight is 106 pounds, his target weight is 85-90 pounds.

"Squishy," the happy, snorting, smiling Pug. Owned by a recent widower hear broken by his loss of his wife and hoping to keep her dog alive as long as he can by getting her to her target weight. Her current weight is 20 pounds, her target weight is 16-17 pounds.