Shelter Feeding Guidelines. No, Once A Day IS NOT GOOD ENOUGH

One of the most furiating cost saving measures I heard about at the Humane Society of Harford County, is that they reduced the feeding schedule to once a day as a cost saving measure.

Here are the recommendations from the experts; What we call "best practice" standards.

Journal of Shelter Medicine and Community Animal Health Guidelines for Standards of Care in Animal Shelters- 2x daily

https://jsmcah.org/index.php/jasv/article/view/42/20

The amount and frequency of feeding vary depending on life stage, species, size, activity level, health status of the animal, and the particular diet chosen. Ideally, healthy adult dogs are fed twice daily, and cats are fed multiple small meals or allowed to forage throughout the day. When managing starved animals or those with unique nutritional needs, veterinary input must be sought. Healthy puppies and kittens as well as lactating and pregnant animals must be fed small amounts frequently or have food available through the day (i.e. free-choice).

ASPCA PRO for Shelters- 2x

Feeding Frequency 

All animals should be fed on a predictable schedule to provide enrichment, reward, and to reduce stress. Ideally, all animals are offered food at minimum twice daily with food intake monitored throughout the day. Uneaten food should be discarded and replaced at least every 24 hours.  

• In breeds like deep-chested or large breed dogs, feeding two smaller meals may reduce risk of life-threatening bloat and gastric torsion which occurs when an animal eats quickly and takes in excessive air.  

Best friends- 2x daily

Should you change your dog’s diet over the course of his or her life?

You should change your dog’s diet according to age and special needs requirements. Most puppies are eating dry puppy food by six weeks of age; they need three or four small fresh meals offered throughout the day. At six months, puppies can go down to two meals per day.

https://bestfriends.org/pet-care-resources/feeding-your-dog#:~:text=Most%20puppies%20are%20eating%20dry,his%20growth%20through%20diet%20change.

Why is feeding twice a day so important?

These animals are under a high degree of stress, much higher than a normal at-home-couch-potato dog. They need extra calories. Even if they don't "look" stressed, they are. It is a noisy, bustling place. Lots of people, animals, noise. Think of being in a county holding facility, I guarantee your gi tract is going to tell you that your body is stressed. 

These dogs look forward to food. Because, they are hungry, if they aren't so stressed out that they are nauseous. Then the whole catabolic body system forces the immune system into overdrive. Ever wonder why disease runs a much higher risk to shelter animals? This is part of the equation.

Some dogs are so hungry that they resource guard. They are under great scrutiny at the shelter to be deemed "safe for adoption." Some of these dogs are just afraid of losing their food so they guard it. Want to know how many animals are euthanized at the shelter due to behavioral issues? I don't because I am worried this current feeding schedule will exacerbate the aggression/fear/anxiety. 

Investing Too Much. When, and Where Do You Draw The Line?

Perhaps I went into this for all of the wrong reason(s)?

Maybe not the wrong reasons, but, perhaps the expectations were unrealistic? Maybe there was too much of me in this endeavor for others? Maybe it's the other way around?

These are the questions I ask myself as I muck through the maze of my daily life as a veterinarian in general practice.

One of the many delightful faces of my vet life day

Yesterday I spent a long time, (to be honest 20-30 minutes), with a sobbing client as she dropped off her dog, Brunswick, for a forelimb amputation. She was, (as every single other amputation pet parent has ever been), reluctant to consent to this surgery. Of all the procedures that we do, and, for all of the many indications this procedure is recommend for, there is no other life-saving, pain alleviating surgery that is met with such pet parent reluctance and resistance. In my clinic over the last 15 years that I have been practicing, I would say that only about 1/4 of the pets who need this procedure, and, I believe would benefit immensely from, actually get it. Most pet parents will sacrifice the pet to spare the removal of a limb. There is this incredibly difficult and deeply rooted mental block on consenting to limb removal as a treatment option. We were at this place; sitting in the front office, debating whether to consent to cutting off the leg of her otherwise perfectly healthy and happy pup.

Brunswick is a timid 7 year old, 50 pound, mixed breed dog. She is a tawny brown with big erect triangular ears, a wide faced and her soft white body is liver spotted from neck to tail. She has a history of a mass removal from this leg that yielded a diagnosis of "lipoma" many years ago. That mass has returned, slowly growing within the armpit of her front leg. It is now pushing the limb out and away from her torso. It has gotten so large that it has exceeded her skins ability to further contain it. The underside of the arm was red, raw and ulcerating. The mass that has been slowly growing for years now is outgrowing her. The cold cruel eventuality of Brunswick's leg was lose the leg or lose her as she would soon have an open wound that would never heal but instead continue to erode her leg, cause her increasing pain, and chew its way up her neck and across her sternum. 

Brunswick walks front legged short stepped, cowboy style. It manifests as a limp. The mass is hidden from obvious view by her bushy hair. The dappled coat hides the magnitude of the mass until you pet her. The diameter of the upper part of her left front leg is easily twice that of her slender athletic right leg. Her demeanor is always stand-offish for a few moments, but, if you are patient, quiet, and gentle in allowing those few moments to pass she will warm up to you to flounder flop on her "good" side for a full belly reveal. It is her not so subtle invitation to focus your affectionate rubs on the tender fleshy part of her belly. She is easy to fall in love with. Her handicap simply reinforces her charm. Her mom adores her. She will tell you that "Brunswick is her first child." 

And, now,,, here we are. Sobbing. Crippled with fear and doubt, and stuck about what to do with it all.

Many conversations get to this point. That critical pivot point where biology, disease and prognosis has met the timetable of limited options. That juncture in a pets life where you have to choose? Are you a proactive parent seeking to gain as much time with your pet as medicine is able to provide? Or, do belong to the crowd that does not believe in surgical procedures for pets? Do you choose to invest multiple thousands of dollars, hours, and caregiving requirements to gain the precious commodity of more time with your companion. Do you value your pet as a member of your family? Are they one of your kids? Can anyone possibly speculate all of the twists and turns that lie ahead if you do, or don't, take action? 

Most pre-op surgical discussions go like this. 

In Brunswick's case we had already done multiple examinations. Two with me, one with the surgeon. At each time we (the "professionals") agreed the best resolution to this tumor was to remove the leg. There were about a dozen emails back and forth to discuss every possible question and concern. And,, yet,, here we were, crying at drop off. 

I sat with her and said; "I know how hard this is. Please do what you think is right. Not what anyone else tells you to do." I firmly believe that this needs to be said to every parent. The road ahead is too full of twists, turns, and potentially even life-threatening landmines. I should add the cost of care, but, for me it is not a part of the equation I will let decide options. If we believe a treatment option is needed we will find a way to make it accessible. (Note: we use multiple payment plan options to help people not let the financial burden be the deciding factor).

I try to ask myself who will benefit from these decisions? Who am I looking after? These are huge weighty decisions with dire consequences. I try to be unbiased, neutral, indifferent. I try to present facts, argue all sides. I soo often feel that I fail miserably at this. I am not ever able to remain indifferent. I am not on anyone's team outside of my patients and their family. It is the dark force that grips my soul surrenders my conscious heart at midnight.

Brunswick post op

Here's where the muck meets the sole. Brunswick needs this operation. She will die within a year from the mass if she doesn't have it. How do I advocate for that? A: I just have to be honest. Then I have to accept the consequences. But, I know Brunswick is loved and I know her mom is making this decision based on that. Seems silly to some, maybe? But that is always enough for me. I am not the vet for indifferent people who don't value pets. That I cannot do. That would kill me.

My pups; Frippie and Storm

These are the elephants I carry on my back all day every day. They remain cumbersome, consuming and catabolic even after I get home at night.

I didn't sleep much after midnight. That mystical witching hour.  My typical work day has me arriving home after 9 pm, a 12 hour day of work without breaks, meals or niceties logged in the record books.  My shear exhaustion leads me to literally passing out on a pillow having foregone the obligatory teeth brushing, face washing, moisturizing and evening medical supplement regimen. They are all tossed out the window for the sake of sparing my legs the 80 paces they would require. There are loads of nights like this. Wrung out dry. I enter home as this zombie-eyed shell. I sleep for 3 hours and the death cipher lets go her grip for the anxiety ridden stressed-out-Suzie to take claim. Its always this exchange of custody each night between the hours of midnight and 2 am. A shared custody battle as the sun sleeps. 

My Frippie always brings me a gift

Why does the day weigh so hard? Brunswick is one example.. this is another. This one happens too often these days. COVID has created a huge demand for puppies. None of them are being socialized appropriately and for some (often breed specific) it is causing potentially disastrous consequences.

The other emotional dilemma of my day was an 11 month old German Shepherd, (let's call her GS), who visited for a pre-spay exam with bloodwork. Her mom had brought her inside the clinic vestibule on a one foot leash to a tight prong collar. Even with moms double fisted grip she could not get GS to remain with four feet on the floor nor have any kind of focus. She had no control of her adolescent puppy, and, she knew it. She told me that she "doubted I would be able to get her blood." She passed my technician the one foot lead and watched us all as we struggled to lead her to the treatment area. All GS needed was a 5 minute physical exam and 30 seconds to pull a blood sample. These appointments are not charged for as they should only take 6 minutes to complete. That didn't happen.

GS was a happy, outgoing 75 pound determined to party firecracker. She was elated to be around people, and in absolute resolve in not sitting for longer than one split second for anything. She knew commands, and she knew how to decide to avoid them. She surged, jumped, boxed, and thrashed. She twisted arms, crashed heads, and started to lunge and bite to have her demands heard.

Our dinnertime excitement

I always stop here...... The three of us; myself, my technician, and GS. We all looked at each other. What to do now? Take a breath? Try a different tactic? All of the above? We took breaks. We tried treats. We tried calm quietness. I tried a large muzzle, just to see if that would settle her. Fifteen minutes into the endeavor and one thing was clear; Nothing worked. We were at the place where one of three things was going to happen;

    1. I lose my patience and I hog tie, muzzle and we pig-pile on her to attempt to bruticaine (brute-force-paralysis vet lingo), and see if she is so shocked by this she gives in.  I just turn into a cold hearted drill sergeant. Bark orders. Intimidate. Force her to be what I want her to be. Force her to hold this command until I feel she has learned who is in charge. Quickly restrain GS and get it done. Get the blood. Skip the exam. Smile and return her to mom. After all what she doesn't know isn't my problem. She can't claim naivete when she already admitted unruliness. Make friends with the owners, even if it  is at the patients expense. A lot of vets have learned this trick. Two faced. Sweet to people, not so much to patients. A bite will likely follow at some point. What the real consequence of this is; To hell with the next guy who has to deal with her.  Might work for some dogs, never works for shepherds. Shepherds are too intelligent, they cement resentment like dolphins. If I do this to her she will never again come happily into our doors.. She will start every future interaction with fear and aggression. A bite will follow at some point soon.

    2. I give up knowing the short game loss is worth the long term gain and we have a family meeting to try to find a way to make her appointments more enjoyable and productive. Her mom had already expected that today wouldn't go well. We come up with a plan for next time. This should include training at home with the family to allow others to handle her. Working with a trainer to help her focus on commands and execution of them with focus and safety. And medications to help bridge the gap as we work on training. 

    3. I just get bitten. No chance to compromise, or convince her that we are not trying to hurt her. She just explodes and bites as fast as she  can. She is done with us and she will remind us she is in charge. 

What happens when a "bite" happens? Paperwork, fear, and almost always the pet parents compounds the tragedy by isolating their dogs in an attempt to avoid future potential bite provocations. Muzzles, prong collars, yelling, over protecting orders and mounting anxiety across all fronts. It's a snowball. Attempt to avoid situations leads to a lowering of estimation of the pets perceived threats. They used to like everyone. They were puppies meeting a world of new sights, sounds and smells. Now they are guardians that bark at the door knocking, or, strangers. You can't take them out in public anymore because now they bark at everyone. Everyone is a perceived threat. They are 100 pounds and you cannot restrain that amount of determined muscle. They become isolated. We reinforce the idea that everyone is a stranger. I used to see them every two to three weeks. We had fun visits. Now I am the stranger. I ask for unreasonable acts of discipline and focus. They don't know me and they certainly can't see a reason to obey me. Hence the bruticaine and indifference. 

Buster

Who's fault is a bite? Well, for the huge majority of clients vets see daily they would say it is our fault. For every time I have handed back a shepherd to say "we need a different plan to make this visit enjoyable." I almost always get, "well, you don't know how to hold her. She is fine with me." Oh, how I long to reply; "Ok then you do the bloodwork and  the spay. I like my fingers and face." Or, "she would never bite me, therefore, you are the problem." 

Here's my advice; it is the advice that every seasoned pet care professional will give you. Train your dog to accept a muzzle. It is NOT a reflection of a persons failure. Nor the pets. It is a tool to provide assistance as we transition out of anxiety based fear laden actions and reactions. Every pet parent should openly and provide permission for a muzzle to be used if deemed necessary. Man-handling, bruticaine, that is not permissible.. ever (unless a pet is endangering another's life). How do we insure this? Trust. If you don't trust your pet care professionals ask to be present for all possible procedures. Ask, demand, insist that pre-anxiety medications be given. Set ground rules for care. Resistance is a flag for scrutiny. Leaving a practice because a person intervenes on your pets behalf is only going to hurt your pet. 

About 30 minutes after I aborted pushing GS any further I sent her home with a training plan and sedatives to try at the next vet visit. I chose to not push her, not exacerbate a bite, and not make it impossible for the next time. Here's what I got for that, a call from the husband saying "they had a bad experience with us and they are going elsewhere." I doubt I will ever see GS again. There is pride before a fall. There are Shepherds relinquished everyday because no one intervened on their behalf at this critical development time. And, worst of fall there are vets who get court orders to put animals down after a "bite" history deems them a danger to the public. Will the next vet push her so hard she bites? Or becomes passive aggressive? Or fears people so much she reacts with defensive aggression to everyone outside of her family? In my opinion she needs help. Will she  get it? It's one of the reasons I awaken at midnight with elephants.

Tex. His first puppy visit. My goal is to have every patients visit look like this.

The truth is that people pine as much as I do, if not more, on what to do for their companions. What is the right/best/safest/compassionate course of action to take? What will consequences for that looks like? Will I hate/berate/beat up/chastise myself for the action, or lack there of, I take? I have been in these shoes. At every moment of my professional life I remind myself that I am still that devoted pet parent who is in turmoil about what to do? Do I trust my own judgement? Do I have enough pertinent information to base my judgements upon? Is there trust here. Maybe GS's parents lack that? They just don't trust my call? The reality is that she is being set up to fail, not flourish, and her "bite" won't be on my account of failing her. 

Brunswick. One week post-op forelimb amputation

What these two cases have in common is that I did my best to make decisions, present options that were in the  best interest of my patients. period. I can fall asleep knowing that. The rest, the worry, the grief, the elephant on my shoulders that I failed them, their parents, or the relationships we have is the midnight hour that clutches my throat and drags me into the abyss of self-doubt of avenues from that first decision to "do no harm."

Magpie helps me motivate for another morning.

For more information on anything and everything pet related please ask us for free at Pawbly.com.

If you are a pet care provider who is willing to help pets in need with your advice and compassionate words of kindness please consider joining us and adding your pet care experiences and thoughts at Pawbly.com. We are always in need of reputable professionals who can educate and inspire.

For more information on Jarrettsville Veterinary Center please visit our Facebook page, or website; JarrettsvilleVet.com

I am also posting lots of informative videos at my YouTube channel here.

The Worst Situation In The World

Today I wanted to share Dr. V's blog. She is sheer literary genius (seething jealousy) but this one is as eloquently written as I could ever hope to do, so I'll just accept inferiority and defer to her.

Please let me know what you think.

The worst situation in the world

by Dr. V | Tuesday | July 16, 2013 | 17 comments

A couple of days ago, the wonderful Dr. Nancy Kay posted a story I hope all parents (human and pet) read about the trend of kids and dogs in pictures getting into potentially scary situations.

If you haven’t read it yet, she punctuated the apprehension she feels seeing pictures like this:

And this:

with a story from her own practice, where a parent disregards her attempts to help her children interact with their dog more safely. And the story ends, after the dog bites one of the children in the face, with Dr. Kay tearfully euthanizing the dog after another home could not be found.

While most of the respondents reacted with sadness about the situation, a good-sized number of commenters took Dr. Kay to task for euthanizing the dog. While she is too gracious (or smart, but I’ve never pretended to be that) to respond to the people who think they know what goes through the mind of a veterinarian in these situations, I feel somewhat compelled- OK, really compelled- to say this:

You have no idea how hard, how awful, how utterly agonizing these situations are, because if you did you would never call her a murderer. And until you’re the one holding the syringe in your hand, I implore you to take a step back and return the discussion to its original context, how we all need to do a better job by working together to prevent these situations in the first place. Because here’s the truth:

That is an utterly impossible situation to be in. Yes, vets have a lot of wiggle room when it comes to “my cat is peeing on the rug” or “my dog has flea allergies” or even “my dog growled at a kid” to say, “I am not comfortable with euthanizing this pet.” But once a pet bites a person, a line has been crossed and everything changes.

The law is stacked against any dog who bites

Once upon a time, a person went to their veterinarian and said, my pet snapped at my neighbor and I don’t know what to do. The veterinarian said, let’s try to work through this with a good behaviorist, or find a rescue who can take this on.

Later on, the dog bit someone. The person who was bitten sued not only the owner but the veterinarian for not suggesting the aggressive dog be put to sleep. And they won. That is the legal precedent we function under, the standard of care to which we are held.

So let me reiterate: if a dog comes to us after biting a person and we do not counsel the owner the dog should be put to sleep (even if the owner never brought it up), we are liable if that dog bitesanyone in the future. If a dog with a history of biting a child comes in, the owner requests euthanasia, and you refuse? You are basically agreeing to hand over your license, your livelihood, and your ability to be an effective advocate for anyone should another bite happen. Even if a rescue agrees to take the dog, which despite protests to the contrary is pretty rare. That is not to say I have euthanized every dog who’s ever nipped- far from it- but yes, every time I send them away for behavior work I’m taking a risk that only I can truly assess.

And when you have an extreme case in front of you like Ben? That is a horrible, awful corner to be backed into as a veterinarian. There is no happy solution. You’re either a murderer or someone willing to gamble away their entire career on a really bad bet or someone passing the buck to a shelter employee. It is awful and nausea inducing and likely to cause migraines and the sort of thing we all struggle with and few are brave enough to mention out loud for fear of judgmental types who think they know better questioning our dedication to animals. So you take that weight on yourself, mentally apologize to the dog for the crap hand he has been dealt, and cry. At least that is what I did the one time I was put in the same position.

Solving the problem we all helped create

I don’t want to play advocate Olympics here and saber rattle over who has done the most good for dogs, but if that’s your thing- Dr. Kay, for example, quite literally wrote the book on animal advocacy. And it makes me sick to my core to have people react to her with nastiness because of that unwinnable situation that we have all contributed to.

We contribute when we suggest any situation be handled through specious lawsuits.

We contribute when we throw shade at each other and erode the trust between the public and veterinarians.

We contribute when we roll our eyes at well meaning but ultimately uninformed parents instead of trying, with kindness and care, to change the way we educate new parents about pet safety. With compassion, and consistency. I am sure the people who took the above pictures love their kids and their dogs, as do I: only difference being I have no pictures like this because I understand the risk more than they do and don’t allow that situation to happen in my house.

Now if you’ll excuse me, I have to go continue the conversations I’ve begun about ways to make life easier and safer for parents then get on a plane to South America for a volunteer spay/neuter initiative . Signed, your local animal murderer/advocate (you decide).

Here is the comment I left on her blog;

Thank you for writing this, for being honest, and for not living in the grey zone.

I find that I often have to practice medicine by addressing worst cases scenarios and deciding which consequences I can live with. It is a constant juggling act of helping pets, protecting human beings, and being able to live with the decisions that are made.

I know that in some cases I must chose between a pet, a human being, and my conscious. I also know that even though a human being is in many cases at fault, the pet will pay the ultimate price.

Along the way I have had to make heart-breaking, gut-wrenching decisions, and then follow through with being, judge, jury, and executioner. It is not a task for the faint of heart, nor the soul devoid of compassion. 

To not care anymore is to abandon the purpose of my chosen profession.

I am the last person in that pets life to let them down, and I carry the responsibility and the disappointment through every day of both my personal and professional life.

Every night I hope that the actions taken that day will still let me wake up the next and remember all of the reasons that I longed to be a veterinarian in the first place and still want to get out of bed.

To read the entire article, view the comments and subscribe to Dr. V's blog, please visit Pawcurious

Life Lessons' and the Vets' Voice

Can you imagine how effortless life would be if all of the mistakes we all made were accumulated, documented, taught, reviewed, and then cataloged  We would all be able to saunter serendipitously through the sunny side of life?

Why shouldn't it be that easy? I mean we all essentially have the same challenges, the same basic  path through life, we should all get together sit down to discuss the challenges life has thrown us, the big and little tumbles, and help each other avoid them.

Fashion, hairstyles, cooking, relationships, kids, the list is endless. Gosh, I am almost euphoric thinking about how blissfully simply it could all be.

In my own little way I am going to try to spare you from a few of the tragic mistakes I have made.

Call it my personal testimonial for your benefit. Here are some my personal suggestions for a long, happy, healthy life.

• OK, sunblock is a necessity. You will grow old and your skin will age you faster than anything else. Wear it everyday religiously and never use a tanning bed.

Sun burnt noses.

• You should recycle everything at least every three years. Head to toe. That includes hairstyle, all garments, and shoes. Truly. (Admittedly, I don't live by this, but I am not sincerely proclaiming myself to be fashion-forward, just fashion-aware).

This hair style didn't last long.

That's all I can say about the human side. The veterinary side, well, that I can talk about for years. For me to tell you all that you need to know on the pet side we need a big pot of coffee, a table full of snacks, and a thick college ruled notebook.

With every medical problem that crosses my threshold I decide whether it is an indigenous problem or an environmental insult.

You see we human beings can muddle up any perfect system.

For instance, we might forget to lock up 7 loaves of banana bread and your puppy sees opportunity to score, so he does. Lesson learned, if you think your puppy might disappoint you, don't give them the opportunity to do so. Those 7 loaves of banana bread cause the delicate pancreas to go into overload, it swells, it hurts, and it causes your dog to vomit until they are emptying their own juices onto the floor. The pendulum shifts and the body starts to shut down sacrificing itself to preserve its most valuable asset the heart, lungs, and brain. without immediate medical intervention they may die.

Our own "7 loaves of banana bread chow hound" bulimic.

Lesson number two. If your pet doesn't stay in your allocated protected home they are at risk to nearly every imaginable fate. Theft, and possible horrific consequences, trauma, and it's expensive and possible fatal consequences, and your pet, like it or not, is seen by the rest of the world as just another cog in the intricate blood thirsty food chain. Lesson learned; Keep your pets close to your hip at all times.

Our most notable HBC patient.
Hit by a truck on a very busy road when the child left to be responsible for her
let her out without being on a leash.
She ran straight into the road and was hit instantly.
She has found a loving home of her own and is thriving!

Lesson number three. If the label says "Do not use on cats." It is not a suggestion. It should say, "This is very likely to kill your cat."

Lesson number four. If the vet warns you to never use scissors when cutting out mats. She is kindly trying to tell you that every person that brings in a pet that she has to sew back together has told her the same thing, 'I'm always very careful."

Cutting out a matt.

Lesson number five.  Your pet is a life-long ever changing, ever challenging responsibility  With this comes great joy, great love, health and longevity benefits to you, and expense and ultimately loss. The success of their ability to thrive is up to you. Get lots of advice, socialize them from the first moment, and ask yourself everyday if your companionship builds a stronger safer life for them and the rest of the community.

My Oriole, who was a feral stray,and is now the sweetest love.

Linda and her pair.

The kids and Jekyl in a pig pile.

If you have a concern that your pet is not safe around others (insert anything into 'others') then get help immediately. Don't wait until someone, or something is hurt.

Both of the above dogs were attacked by another dog in their household.

Lesson number six. All things are possible with love and kindness, let them guide you every step of the way.

Alright, lesson six is for all of us.