Kim asked me what I think about pet insurance. Me? I love it. It means people who would normally be unable to afford an emergency surgery or illness are able to get their pet treatment.

Most veterinary clinics don’t offer payment plans. We all wish we could. The problem is not that we don’t want to deal with it, but that they never work. There are too many people who renege on it and ruin it for everyone else, so the only way we can stay in business is to be paid at the time of services rendered. Insurance has saved many lives.

The other reason I like it is actually something most owners probably dislike. I really don’t have anything to do with it. There is none of that craziness human MDs have to deal with, no coding and negotiated reimbursements and arguing with medical billers. You pay, you fill out the papers, you get reimbursed. I just sign off on what we did.

The disadvantage to that is of course that you still have to have the money available to pay, even though you are reimbursed. I can’t speak as to the positives and negatives of individual companies since I don’t work with them much at all, but I know I have heard some grumblings about reading fine print. Be very aware of the exclusions- many insurance companies have a list of breed related conditions they will not pay to treat, regardless of its medical indications.

I’m not sure how beneficial it is for preventive care, but I see its greatest value in emergency treatment and catastrophic illness. If I didn’t have this job already, I would definitely be looking into it. The feedback I have heard is definitely quite positive as a whole.

Anyone here have pet insurance? What do you think of it? Would you do it again?

In Part 2 of the ER guest post, Dr. Baebler divides some of the most common emergency complaints into three categories based on degree of urgency.

PART 2: DO I NEED TO GO INTO THE EMERGENCY ROOM OR NOT?

Onto the meat of this post. Below are a list of signs/disease conditions and the urgency with which they should be attended:

Get thee to the ER doctor ASAP (remember to call us to let us know you’re on your way!):

- Trouble breathing or choking

- Trauma – obvious broken bones, open bleeding wounds, hit by a car, etc

- Eye problems – squinting, yellow/green eye discharge. Often eye problems can escalate quickly, so we will always advise an eye problem to be seen sooner rather than later.

- Your pet is unresponsive or minimally responsive when you attempt to rouse it

- Seizure lasting longer than 1 minute, or more than 1-2  seizures in a 12 hour period. Most vets say that more than 1 seizure per month warrants medication, but if your pet has had seizure #2 for the month at 9pm, is acting normally afterwards and doesn’t have any more problems, you can usually wait to see your regular vet in the morning.

- Your pet has eaten something it shouldn’t have – If your lab wolfed down your underwear or snacked on a sock, we can induce vomiting to get it out before it gets further down the digestive tract and requires surgery. If it’s sharp and pointy, we usually have to remove it surgically, and the sooner we do that, the better the prognosis is. The same goes for ingestions of toxic substances (see below).

- Your pet has been vomiting or having diarrhea on a regular basis for more than 2-3 hours, or there is a large amount of frank (red) or digested (black and tarry looking) blood in their stool or vomit.

- For large breed, deep-chested dogs (usually shepherds, danes, labs, boxers, etc) – Acutely bloated abdomen, especially if it happens right after they wolfed down dinner, then ran around like a maniac in the back yard.

- Your pet is straining to urinate and/or defecate (this is especially critical in male cats).-Your regular veterinarian has advised you to take your pet to the ER clinic based on signs for a specific disease condition (ie excessive coughing/increased respiratory rate in heart disease patients, diabetic patients that don’t want to eat, etc.)

- Vaccine/allergic reaction: Swollen face, hives on body, vomiting. diarrhea, often after having vaccines given or a bite/sting from an insect.

- For those of you with small herbivores (bunnies, guinea pigs, chinchillas): No eating or stool production in 8-12 hours is a medical emergency. So is diarrhea. Animals with decreased appetite or small, irregularly shaped stools should be seen as soon as possible as well.

Call for further clarification. Probably should be seen:

- Intermittent mild vomiting or diarrhea

- lameness with no open wounds

- prolonged painfulness

- bleeding toenail (or blood feather in birds) that you cannot stop  yourself

- Pet slightly lethargic, appetite decreased

- Mild upper respiratory problems – mild nasal discharge, occasional coughing (a dry honking cough is usually kennel cough, and unless it is keeping you and your pet up at night, it is usually self-limiting and rarely needs antibiotics. That being said, always follow the advice of your vet)

OK to wait until tomorrow morning:

- most skin conditions, unless the pet is very uncomfortable or they are scratching to the point of drawing blood

- external or internal parasites with no other signs of illness (worms in the poop of a puppy without vomiting or diarrhea, fleas, ticks on a pet that is otherwise acting normally, etc)

- most ear infections (unless the pet is very uncomfortable or shaking head a lot)

- vaccinations and regular exams. ER vets are not here to do routine care. Most do not carry routine vaccines, heartworm preventative, or flea control in their clinics. We will be happy to refer you to a local day practice for these types of services.

- My clinic will not see skunked animals. Most ER clinics are not set up to be able to groom a skunked animal. There are many recipes out there on the internet for getting the skunk smell out. Those with things like hydrogen peroxide, dish soap, and baking soda in them usually work best. We will only see skunked animals if they have been bitten or have other obvious injuries that need immediate attention.

Here is a list of common toxins I see in my practice:

- Chocolate. Baking chocolate is the worst, followed by dark chocolate, then milk chocolate.

- Caffeine. This includes chocolate covered espresso beans. Usually spent coffee grounds have less caffeine in them, but they could still be problematic.

- Over-the-counter topical spot-in flea/tick preventatives (pyrethrin based). Especially problematic in cats.

- Marijuana and other illegal substances. Side note – if your dog gets into your ’stash’ of any substance, your vet needs to know. We just want to fix your animal. The guilt and veterinary bill you incur are usually punishment enough 

- Tremorgens. These are toxins created by moldy food (attention: dumpster divers/trash can surfers!). They can cause disorientation, tremors, and seizures.

- Grapes and raisins. Toxic in dogs.

- Onions. Raw are more toxic than cooked.

- Avocados.

- Tylenol, ibuprofen, and other over-the-counter human pain relievers – Most human pain relievers can cause big, big problems in dogs and cats. Don’t try to self-medicate your pet at home with human medications of any kind unless directed to do so by a vet.

- A note about toxins in dogs and cats: Veterinarians aren’t all knowing when it comes to toxic substances. Often, we will ask you to contact an animal poison control center or will do so ourselves when you come in to make sure we are treating your pet appropriately. There are too many things out there for us to be versed in everything your pet could potentially eat!

Poison control centers: ASPCA Poison Control: 1-888-426-4435.

Pet Poison Helpline: 1-800-213-6680.

Pet poison control centers charge a fee for consultation so they can keep the phones on and veterinary toxicologists on staff to answer questions at 3am.

I hope this helps. Don’t ever hesitate to call your regular veterinarian or local ER veterinary clinic if you have concerns about your pet. This list isn’t all-inclusive, and it’s always better to be safe than sorry.

Dr. Baebler is an ER/exotic pet veterinarian in the Chicago area. She been practicing medicine for 2 1/2 years now, and completed a specialized internship in exotic pet medicine. In her emergency practice she sees dogs, cats, and most small exotic pets, including birds, rabbits, ferrets, and non-venomous reptiles.

Ah, fall. The leaves are turning, the air is getting chill, and people everywhere are assembling the assorted holiday regalia that autumn brings. Now we all know chocolate is bad for pets, right? I don’t need to tell you about that. Don’t leave it on the counter. Here are a few others, some well known, some less so, that many of us run into this time of year and may not realize how dangerous they are.

1. liquid potpourri

Little old ladies the world over take note: Sure, it makes your house smell like a simmering nutmeg-gy teapot. That’s exactly why those liquid potpourri warmers are so inviting to cats and dogs. Besides its scalding temperature, the ingredients themselves can cause painful damage to the delicate tissue of the mouth, throat, and esophagus. I’ve seen this one in practice and it was the astute owner who actually brought the container in for me to see; the person on the other end of the customer care line confirmed that is a known danger with these products. (Thanks to Dr. Louise Murray, whose tweet pointed me to this helpful ASPCA article linked at the beginning.)

2. sugar free gum

You’re trying to be good for the holidays, so you keep some sugar free gum on hand to keep your mouth occupied. This is one of those weird ones. Who’d have thunk it? We happily chomp away at our sugar free Doublemint without a second thought, but xylitol- the sweetener often used in these products- can cause life threatening hypoglycemia in pets. It takes very little to cause illness, which makes it even more scary. Xylitol is also found in other sugar free foods, candies, and toothpaste. The sweet taste makes it especially inviting for unsuspecting pets.

3. macadamia nuts

OK, so I don’t know anyone who hands out macadamia nut candies for Halloween, but they are certainly plentiful in many people’s nut mixes left out on the table for holiday parties. Macadamia nut toxicosis manifests in a variety of ways, from wobbliness to increased body temperature; there are a wide range of dosages that can cause toxicity. Better safe than sorry, I say, and eat them all yourself as soon as you open the can. Or send them to me.

4. Tylenol (acetaminophen)

So, maybe you overindulged a little at the office party punch bowl, and need a Tylenol to help you through your headache. In your impaired state, you leave them open on the counter. Or you see your cat has a bit of a limp, so you give them just a pediatric dose of Tylenol to help them through. Bad idea. This one is fairly well-known for people involved in animal health, but there are still a great many pet owners out there unaware of just how toxic this can be. Cats lack the ability to metabolize acetaminophen the way other animals can; the result is life threatening destruction of the red blood cells. One tablet may be enough to kill a cat.

5. Grapes and raisins

OK, all you health nuts who don’t serve alcohol, nuts, or candy at your fetes and instead put out a big fruit plate- you’re not off the hook. Keep the grapes away from Fido. The toxic property of these is unknown, but grapes and raisins have been found to cause acute renal failure in dogs and cats. Other produce such as onions and garlic are thought to be toxic in high volumes, but the exact amounts needed are unclear (as in, if onion powder is listed as the 16th ingredient in your dog food, it’s probably not going to be a problem.)

The ASPCA maintains an excellent database of articles for those wanting a more thorough rundown of poisons in the house. I use them as a reference all the time, particularly in regard to plants. The ASPCA Poison Control Hotline is well renowned as a resource for both owners and veterinarians, and I believe they maintain the most current database of pet poisons there is.

OK, I don’t know if they are myths so much as long-held veterinary standard talking points, but it was a lot easier to type “myths” than “standard procedures and protocols with which I disagree.”

1. Feed your pet the same food every day or they will get sick.

This is true in some cases, namely if you have a pet on a prescription diet or a pet with dietary sensitivities, but for most healthy pets, there’s no reason not to switch it up. You have to be careful if you are watching your pet’s caloric intake- the calories per cup can vary very widely from food to food- but the vast majority of pets do just fine on a rotating diet. And let’s be honest- the recent pet food debacles have made many of us more leery than ever of quality control issues, so switching it up may dilute the risk of having a problem with any one batch of food.

2. My pet needs to be on dry food because of her teeth.

Dry food is good for a pet’s teeth, don’t get me wrong. There are prescription dental diets that are clinically proven to reduce tartar, and hooray for that. That being said, there are plenty of other reasons wet food should be a part of your pet’s diet (and particularly if you have a cat, I think it should be the majority of their diet!)

Having moisture content as a part of your pet’s diet is a good thing. Food in its natural state is not dessicated. We all need water to digest our food. Dry food is convenient, and less expensive than canned food, and does play a role in keeping teeth clean. But there’s no reason you can’t rotate canned food in there as well.

3. The more expensive the food, the better.

The only way to know if you are feeding your pet a good food is to become proficient at reading pet food labels. (I did a blog series on this complicated topic here.) Generally speaking, the more expensive foods do tend to have better quality ingredients, but you’d be surprised at some of the things found in “premium” foods. When ownership of pet food companies changes hands, it is often accompanied by a change in formulation, so read often.

One of my employees is always telling budget-minded people to buy Kirkland dog food- you know, the Costco brand? When I overheard this, I asked her what the heck she was doing. She showed me the label, and I’ll be darned- they have a very decent ingredient list, far better than many other foods in that price category. So now, when people are reluctant to go for the super-premium stuff due to price, I often tell them get Kirkland.

I know most people probably know this, but I’m astounded by the people who pull out those little plastic trays of food and tell me how great it is. Behold the mighty power of marketing. That food is the exact same food you find in cans, except it’s processed one step further to force it into meat-shaped spam-like chunks meant to fool you into thinking it arrived straight off the cow there in its natural state. They then float it in some chemical laden sludge, slap on a label of a cute poufy dog in a fancy looking plastic tray, and charge you a huge markup for the privilege.

4. My dog is spoiled rotten. He only gets chicken and rice. Isn’t he lucky?

No. No more lucky than the cat fed only tuna. Nutritional hyperparathyroidism, taurine deficiency cardiomyopathy…there are lots of nasty things that can happen to a pet on an unbalanced diet. I have no problem with people who really want to cook for their pets- I think it’s wonderful, actually, to devote that time to your pet.

But if you’re going to spend the time and money to do so, invest in some research to do it correctly. There are some great- and some not so great- resources available online. I have used Balance It, one of several online services; many veterinary schools also offer services with veterinary nutritionists available to create recipes tailor made to any pet, with any health condition.

5. I don’t need to put my dog on a special diet for a food allergy trial. I tried the “sensitive skin” diet/ lamb formula/ coat formula from the store and it didn’t work.

I can’t say this enough: There is no reliable test for diagnosing food allergies. The *only* way to diagnose food allergies is to put your pet on a lengthy and regimented food trial for 8-12 weeks, and see how they do. No treats, no flavored Heartguard, no rawhides.

The diets used by veterinarians to diagnose food allergies have one solitary protein source and one carbohydrate source. The protein is something unusual- venison, hydrolyzed soy broken down enough that the body doesn’t recognize it as an antigen; as is the carbohydrate.

“Sensitive skin” diets are not appropriate for food allergies because they usually have the exact same ingredients found in most other pet foods. “Lamb and rice” formulas often have chicken in them as well- if you review the pet food labelling rules you’ll see why. I am only aware of one over the counter commercial diet appropriate for a food trial. The other options are prescription diets or home cooked diets.

*I will, as I always do, add in the disclaimer that this post is skipping entirely the topic of raw foods, which I remain neutral on. Those who have gone down that road often have devoted many hours of research into nutritional topics and don’t need to be told any of the things in this post anyway.

I feel compelled to do one of those serious “issue based” posts, with “facts” and all that boring stuff. Partly because I’ve spent most of the week blathering on about my animals, but mostly because my friend shared last week’s vaccine post on Fark and someone responded with something the equivalent of, “Well, the lady has a point.”

NO SHE DOESN’T. She has a pointy head and that I will concede. Let me be clear: If you say to me, hey, I have some concerns about overvaccinating my pet, can we talk about risk versus benefit and come to an agreement about the optimal schedule, I will say, “Yes. That is amazing. Thank you for taking the time to be involved in your pet’s care.” But if you say, hey, I know you just want to make a quick $2 off me by making my dog sick so I refuse to vaccinate my puppy, ever, I will raise my eyebrow and shake my head because THAT IS A TERRIBLE IDEA.

That doesn’t mean to say that I think overvaccination doesn’t happen, because it does. In my first job, I worked for a guy who vaccinated every pet for everything. Hunting labrador? You’re getting the distemper/parvo combo, bordetella, leptospirosis, corona, rabies, giardia, and lyme. 17 year old lap dachshund with a history of vaccine reactions? You’re getting the distemper/parvo combo, bordetella, leptospirosis, corona, rabies, giardia, and lyme vaccines, plus a benadryl injection. Don’t like it? Find another hospital. (Which is incidentally exactly what I did.)

There are a couple of key points one must keep in mind when discussing vaccines, for dogs, for cats, for kids.

1. Vaccines are not benign, side-effect-free sugar tablets. They are potent biologics, with the potential for adverse reactions. To ignore this fact is wrong.

2. That being said, for most recipients, the benefits of an appropriately chosen vaccine far outweighs the risk. Accepting that risk is a part of the game. You accept the risk of a vaccine associated sarcoma when you vaccinate your cat for feline leukemia, just as you accept the risk of, well, feline leukemia, if you don’t vaccinate your cat. You choose.

3. The key, and the art, is choosing what that appropriate vaccination protocol is. There is a lot of wiggle room here.

Here is the gist of things in a nice bite sized form for those intimidated by the size of this post, or just in a hurry, or already bored:

ALL Puppies and kittens need a series of vaccines for a handful of life-threatening diseases. This series is necessary to create a long term immune response.

They need to be boosted in one year.

After that, do what you want (though I’ll still suggest boosting.)

All right. Those who are still here, let’s break it down: read more >>

As a vet, I get asked behavior questions all the time, both at work and here through the blog. They are important questions, questions that set the tone for the entire bonding process and the life of the pet. They are complicated questions, more often than not. I am happy to answer them as follows:

“Has he been to training?” I ask. If they say no, I tell them to go find one. If they say yes, I tell them to call their trainer and ask them. Boom. Next question. Hopefully it’s about roundworms.

The thing is, I know a lot of the basics: crate training is good, fear is the source of much aggression, number of litterboxes should equal number of cats plus 1. I know the concepts, but the execution thereof is another story altogether. It usually involves a conversation longer than I am able to address in the time I am given for an appointment, even if I were well qualified, which I am not. I don’t mean to be dismissive when I’m not able to go into the minutiae of crate training during a vaccine appointment, I just feel you are better served by someone who answers that question all day every day. I would hope the trainer would do in kind by referring specific health questions to me, which they usually do. In severe cases, a veterinary behaviorist may be in order.

With both Emmett and Mulan I put them through a basic adult obedience class at the local pet store; it was fine for general manners, but I wouldn’t say either of them were highly obedient. I decided since I had a puppy, young and impressionable and not yet screwed up, I wanted to go all the way and train him thoroughly.

So I did what any seasoned, insider veterinary professional would do when looking for a dog trainer- I googled “San Diego dog trainer.” (I’m lazy.) There are a lot of options. A family member suggested a program that uses electric collars- I know it worked for her and her dog did well, but I just couldn’t bring myself to feel right about it. I read some reviews, thought about what was important to me, and found a place whose philosophy seemed in line with mine.

We had our first private session this weekend, and it confirmed an approach that seemed natural, logical, and effective. The trainer, as it turns out, has worked with a few of my colleagues- all with great dogs (I suppose I could have saved myself some time by just asking them for recommendations in the first place, but it would have deprived me of the joy of surfing the web). The training tools we will use are a plain collar, a leash, and my voice, and we’ll go from there. When Brody’s done with his vaccines, we’ll add in group classes. They offer beginning through advanced obedience, therapy dog / good citizen certification, and agility. They know a lot more than I do about what dogs are thinking.

I feel the same way about kids, which is why the preschool teacher for my two was able to accomplish in one week the potty training I had failed at for over a year. The idea of homeschooling gives me the shakes and I get all sweaty. Mammalian behavior, in general, is not my strong suit.

There is something reassuring about having someone more experienced than you walking you through a process and giving you feedback, even if it’s stuff you kind of know, but not particularly well. I’m hoping it will also help me give a little more solid advice in the office; at the very least, I can offer a bit more sympathy to those having housetraining issues before handing them my trainer’s card then returning to feeling for descended testicles.