Does this tooth hurt? You betcha!

I get asked all the time by pet owners if I think their dog or cat is in pain.  The simple answer is that if it is something that would cause pain to a person, it will cause pain in a dog or cat.  What is different is how dogs and cats in pain behave compared to people.  The signs can sometimes be very very subtle.  Of course most of us would not miss a dog that just had its foot stepped on and is delivering an ear piercing cry that can be heard halfway down the block.  Puppies are particularly good at this and if anyone has a husky or a beagle, then you KNOW how loud they can be when they are hurt.  But this is a case of sudden onset of pain.  What about chronic pain?  How about an example.

Very early in my veterinary career, I treated a beautiful Golden Retriever whose name escapes me.  I'll call him Max.  Max lived on a farm and like a lot of farm dogs, he would occasionally go exploring in the woods.  One day Max went missing and didn't come home for 3 days.  When he finally showed up at the farm house, he was badly injured and his owner brought him into the clinic for me to examine.  Max's left rear leg had been shot with a high powered rifle.  The tibia leg bone below the knee had been shattered.  No, more like evaporated into nothingness.  Most of the skin and muscle was gone too.  There was a 1" wide strip of skin still there and that was all that was holding Max's lower leg and paw to the upper part of the leg.  So I walk in the examine room and here is this beautiful, happy, tail wagging, bouncing around on three legs, Golden Retriever.  He was so excited to see me and as he was bouncing around the exam room, the lower part of his left leg that was dangling by a strip of skin was twirling around every which way.  He never cried out.  He never slowed down.  Was he in pain?  I guarantee he was.  What happened was that he had just spent the last 3 days out in the woods adjusting to living with his pain.  Life goes onward in a dog's mind.  The end of the story was that I amputated Max's leg and he went on to live his happy Golden Retriever life.

The point of that story is two fold.  First, dogs and cats have nerve endings that send pain signals to the brain.  I am 110% absolutely positively you can't convince me otherwise sure that our pets feel pain.  Second, you cannot always tell if an animal is in pain by its behavior alone.  Sometimes you can, but sometimes you can't.  If there is something that you can see or feel that looks like it should be painful, then it is painful.

On to a tooth story.  Yesterday a regular client brought in her dog for me to check a tooth.  She had heard a story on the radio about dental health in pets and decided to look at her dog's teeth and a back tooth didn't look quite right.  Here is a picture of the tooth:

Do you see that pink spot on the tooth?  That is where the outer enamel has broken off the tooth and is exposing the pulp cavity of the tooth and yes, exposing the nerve.  Does that not make you cringe seeing that raw tissue exposed?  It makes me cringe.  I just wanted to rush over and give this client a big hug for being so observant and knowing when something didn't look right.  But I did restrain myself because, well, you know, it's probably not proper exam room etiquette to rush into someone's personal space and give them a big bear hug.  *grin*  I do just love it though when pet owners are really in tune with their animals.  Now this dog was not showing a bit of behavior that would make you think it was in pain.  I can guarantee this tooth was painful.  There are two choices for treating a broken tooth: extraction or root canal with a crown needed in some cases. In this case, the owner chose extraction which we did today.  This dog will go home with oral pain medicine for 4 or 5 days and then should be on her way to a painfree mouth.

Now I don't think that all pain needs treated in all animals (although we probably should be treating pain more often then we do).  If I bang my knee and it turns all black and blue and sore, I don't go reaching for the bottle of Advil right off the bat.  But I do think that animals hurt the same way you and I hurt.  I think different individuals have different pain tolerances too just like in people.  So while not 100% of pain needs treated, just know that even if they an animal is not acting painful, if you see something or feel something on your pet that looks like it should hurt, well, then it does hurt.  If you have any doubts, ask your veterinarian.

Banging head against a brick wall

According to the free dictionary online, the definition of "banging head against a brick wall" is to keep asking someone to do something that they never do. Sometimes there are very valid reasons why someone doesn't listen to what you are asking them to do. You wouldn't go play out in traffic or jump of a cliff just because someone asked you to, right? Right. But most of the time when I am talking to clients in the exam room, I am not asking for anything so extreme. You see, I love my animals very much and I assume that everyone loves their pets as much as I do. I want my animals to live happy and healthy lives and I want that for my patients. So why do have I such a hard time convincing people to put their overweight pets on a diet? I know this isn't just a "me" problem because my friends who are vets have the same problem. But why is this a problem? That's what I am here to explore today.

The facts are there. We are bombarded in the news media about the health risks of obesity in people. We know that obesity speeds the aging process. Purina did a cool study in Labrador Retrievers a few years back that showed that lean dogs live almost 2 years longer than dogs that were overweight. We know fat cats get diabetes. We know that fat dogs develop arthritis much earlier than lean dogs. We know that too much fat in the body causes inflammation throughout the body.

Now I know the issues dealing with obesity in people are complex and I guess they are in dogs too, BUT. Don't you just love the "but" part. Two days ago I was talking to a client in the exam room about how we take better medical care of our pets than we do ourselves. I can totally relate to this. I will bring my own dogs into the clinic every year to get their teeth cleaned, but I won't get my own teeth looked at unless there is a problem. From my reasoning, I think I do this because I see my pets as very innocent. They need me to feed them and look after them. I can choose to have rotten teeth if I want to. They cannot choose. It is up to me to make those decisions and I choose to take care of their routine medical needs to the best of my ability. You would think obesity would be a simpler solution then regular medical/dental care. After all, health care costs money and in this economy, sometimes money is hard to come by. But we all have to feed our pets. In fact if we feed them less, that would save MONEY! But yet pet obesity is rampant.

As I started typing this blog, I found myself reaching into the box of chocolates sitting on my desk next to me. I can choose to do this. My dogs cannot choose how much they eat because I choose the amount for them. They cannot go to the grocery store, or the drive-through burger joint, or open the refrigerator or even open the locked-as-tight-as-a-drum container that holds their dog food. If they would they could, but they can't. How much they eat is my decision. I am the ruler of the household. Ok, only on this one subject, but hey, I'll take what I can get.

Back to the banging head part. Case #1 Just this month I saw a little dog owned by a woman who lives by herself. She came to me because her dog couldn't walk and wanted to put it to sleep. I could tell how attached she was to this dog. She thought the dog couldn't walk because it was getting old and had some disease. Well, the dog did have bad arthritis, but 90% of the reason this dog couldn't walk was because it was obese. I put it on medicine for the arthritis and talked long and hard about weight loss. But how does this happen? How can someone feed their dog so much that it gains weight until it can't walk? And how can they not know this is happening? Someone please explain this to me.

Case #2 I'm in the exam room seeing a dog for its annual physical exam and notice that every year it has gained weight and every year we have counselled the owner on feeding and weight loss. So the conversation goes like this. Client: "But doc, I only feed Muffy 1/2 cup of food twice a day like you told me last year." Me: "It doesn't matter what I told you last year. If that is what she is eating and she is still gaining weight, then she needs to eat less.". Client: "But if I feed her any less, she will starve to death.". Ok, tell me how this makes the slightest bit of sense?

Case #3 Seen by Dr. C. this month. A couple with an obese Chihuahua. The dog can hardly breath and has heart problems. They go on and on about how much they love this little dog and what this dog means to them. Really? They are slowing KILLING their dog. Why is reality so hard to grasp?

All this head banging though will go on. I will continue because there are successes. In fact I wrote about a couple of them in a November 2009 blog on obesity. I also know that what works well for one person doesn't work so well for another. The one thing I will not do though is shut up about this. This is too important. Pets' lives are at stake. I am their advocate. Their voice. I want them to live long healthy lives. That is what I want for my own animals. I expect no less for all animals that I see at the clinic.

If anyone has an overweight pet and would like help, I am an email away. Or you can wander over to Dr. Ernie Ward's web site on pet obesity prevention. LOTS of good information over there. Maybe you have your own story of what works and what doesn't for you and your pets. And if you have any suggestions on how to motivate people to get their pets to lose weight, I am all ears.

ps I wrote this blog last week and just yesterday I saw a patient that had lost 8 pound from last year. Looked great! So yes, there are successes. That was a very nice part of my day.