Patient Summary and Recommendations
Patient
Client
Client's Email
Weight
Our Appointment Today Was
By Video Chat
By phone
Other
Body Condition Score (Assessment of Body Fat, target is 4/9 or 5/9)
1/9. Very little body fat present.
2/9. Too skinny, we can increase caloric intake
3/9. A little too skinny, we can increase caloric intake
4/9. Ideal healthy fat levels! Keep up the good work and continue current amount of food
5/9. Healthy fat levels. Could lose just a touch more fat to be really nice and lean but keep up the good work
6/9. About 10% overweight. Equivalent of a human being 10-20 lbs overweight. This excess fat is inflammatory and exacerbates other inflammatory conditions like allergies, arthritis, Inflammatory Bowel Disease, and asthma. It increases risk of arthritis, diabetes and cancer. It's really important to reduce calories to get your pet to a healthy weight
7/9. About 20% overweight. Equivalent of a human being about 40-50 lbs overweight. This excess fat is inflammatory and exacerbates other inflammatory conditions like allergies, arthritis, Inflammatory Bowel Disease, and asthma. It increases risk of arthritis, diabetes and cancer. It's really important to reduce calories to get your pet to a healthy weight
8/9. Obese. About 30% overweight. Equivalent of a human being about 60-80 lbs overweight. This excess fat is inflammatory and exacerbates other inflammatory conditions like allergies, arthritis, Inflammatory Bowel Disease, and asthma. It increases risk of arthritis, diabetes and cancer. It's really important to reduce calories to get your pet to a healthy weight
9/9. Morbidly Obese. 40% or more overweight. Equivalent of a human being 100 lbs or more overweight. This excess fat is inflammatory and exacerbates other inflammatory conditions like allergies, arthritis, Inflammatory Bowel Disease, and asthma. It increases risk of arthritis, diabetes and cancer. Being this overweight is likely to shorten your pet's lifespan. It's extremely important to reduce calories to get your pet to a healthy weight.
8/9. Obese. About 30% overweight. Equivalent of a human being about 60-80 lbs overweight. This excess fat is inflammatory and exacerbates other inflammatory conditions like allergies, arthritis, Inflammatory Bowel Disease, and asthma. It increases risk of arthritis, diabetes and cancer. Good work making some progress but we still have work to do to get to a healthy weight and fat levels! Continue our diet plan.
7/9. About 20% overweight. Equivalent of a human being about 40-50 lbs overweight. This excess fat is inflammatory and exacerbates other inflammatory conditions like allergies, arthritis, Inflammatory Bowel Disease, and asthma. It increases risk of arthritis, diabetes and cancer. Good work making some progress but we still have work to do to get to a healthy weight and fat levels! Continue our diet plan.
6/9 About 10% overweight. Equivalent of a human being about 10-20 lbs overweight. This excess fat is inflammatory and exacerbates other inflammatory conditions like allergies, arthritis, Inflammatory Bowel Disease, and asthma. It increases risk of arthritis, diabetes and cancer. Good work making progress on fat loss but we still have a little work to do to get to a healthy weight and fat levels. Continue our diet plan.
Weight seems stable
Does still have fat under the skin, weight loss is more from the muscle loss
Other
Heart Rate
Heart Rate
Normal
A little fast, may be a little excited or worried
Fast, probably excitement/nervousness
Normal for a relaxed animal
Very fast likely due to pain and stress
Fast, likely due to underlying disease
Other
Respiratory Rate
Respiratory Rate
Normal
A little fast, may be a little excited or worried
Fast, probably excitement/nervousness
Fast, probably due to underlying disease
Panting may be due to pain, anxiety or a combination
Panting likely due to heat
Panting likely due to nervousness/anxiety
Other
Pain Assessment
Pain Assessment
None
Minimal
Mild
Mild to moderate
Moderate
Moderate to severe
Severe
Animals are very good at hiding pain
With chronic pain they typically get quiet and withdrawn
We often think that if pets are painful they will whine or meow or otherwise make noise. They may do that for acute pain like if you step on their foot or tail
Other signs of pain include tight muscles/spasms of skin and muscles, reluctance to jump or move around
Panting can be a sign of pain but can also be related to anxiety and heat
Meowing is a way cats communicate with us (or try to!). They may be bored, hungry, lost, wanting fresh water or their heating pad turned out or any number of things. Pain makes them quiet, generally the louder and sadder the meowing the less likely it is to be related to pain
Whining is usually a way that dogs try to communicate with us. They may be bored, hungry, lost, wanting you to do something for them or any number of things
A good resource for assessing pain/discomfort/nausea in cats is the Feline Grimace Scale: www.felinegrimacescale.com which is available as an app too. Target is under 4 on the scale, if it's consistently higher than that we can reassess our pain management plan
Another resource for assessing pain/discomfort in cats is the BEAP Scale: https://bluepearlvet.com/wp-content/uploads/2024/07/070924_Form_BEAP_Pain_Scale_Cats_MED_PH.pdf . As it says many of the things on this scale can be associated with other issues unrelated to pain as well
A good resource for thinking about and assessing pain/discomfort in dogs is the Colorado State University Chronic Pain Scale: https://360petmedical.com/wp-content/uploads/2020/03/Canine_Pain_Scale.pdf As it says some of the things on the scale can be due to other issues and unrelated to pain as well
A good resource for thinking about acute pain from a flare up or a new issue is the Colorado State University Acute Pain Scale: https://vetmedbiosci.colostate.edu/vth/wp-content/uploads/sites/7/2020/12/canine-pain-scale.pdf
Some tight muscles and arthritis but that is not really painful and it's not that it's too painful to do things, it's that the nerves aren't working
Some tight muscles just from living life but probably doesn't bother your pet
Eating is unrelated to pain. Pets in significant pain even with significant oral pain will still eat. It is a survival thing
Other
Behavior notes
Shen or "Spirit"
Please Select
Good
Slightly Diminished
Diminished
Poor
None
Movement and Walking
Normal
Mildly stiff both front legs
Mildly stiff both hind legs
Moderately stiff both front legs
Moderately stiff both hind legs
Very stiff both front legs
Very stiff both hind legs
Not moving knees well
Not moving hips well
Not moving elbows well
Over extending wrists
Difficult to assess due to patient's young age but apparently normal
Unable to accurately assess due to patient behavior
Short strided both hind legs
Short strided both front legs
Head bobbing to take weight off more painful leg
Mild neurologic dysfunction both hind limbs causing some "scuffing" and dragging
Moderate neurologic dysfunction both hind limbs causing "scuffing", dragging, crossing feet over and instability
Severe neurologic dysfunction both hind limbs
About the same as last visit
A little more stiff
Less stiff than last visit
A little more "wobbly" than last visit
Less "wobbly" than last visit
Here's a video showing the difference between a normal walk/trot and amble/pace: https://www.youtube.com/watch?v=eqBcBsmMQVA
You can see in the video how with walk and trot the back feet almost come up to where the front feet are. That is normal stride length. Amble/pace where legs are moving at the same time on the same side of the body should happen only briefly when slowing down or speeding up, when it's happening most of the time that's not normal
Here's a video of how a dog should be using it's legs and body going up stairs. One leg at a time, bending and extending, no hopping. https://www.youtube.com/watch?v=zovLg702H84
Here's a video of a cat walking normally: https://www.youtube.com/watch?v=Hzt18V3Uaxc
You can see in the video that the back legs almost come up to where the front feet are and extend out behind the cat until the lower part of the leg is straight up and down. That is normal stride length
Here's a video of how a cat should go down stairs normally. One leg at a time, bending and extending, no hopping. https://www.youtube.com/watch?v=i52vQ6EE2Xw
Other
Notes on gait and ambulation
Conformation/Structural Abnormalities
No significant conformational defects
Brachycephalic (squished face)
Predisposed to issues breathing issues, dental problems, face fold infections and eye trauma due to structural abnormalities of the head and face
Chondrodysplastic (genetic abnormality causing short, twisted legs)
Poor stifle angulation, straight through stifles
Poor stifle angulation, excessively acute stifle angulation
"Toed in"/pronation front
"Toed out"/supination front
"Toed in"/pronation hind
"Toed out"/supination hind
Short back
Long back
Cow hocked/tarsal valgus
Tarsal varus
Short neck
Long neck
Elbows out
Elbows in
Carpal valgus (wrist turns out)
Carpal varus (wrist turns in)
Tail amputated (docked)
Malformed tail ("screw tail", kinked tail)
Distal phalangeal amputations ("declawed")
"Bowed" appearance to front limbs consistent with chondrodysplasia
"Bowed" appearance to hind limbs consistent with chondrodysplasia
Difficult to assess due to patient's young age
Difficult to assess due to patient behavior/temperament
These abnormalities cause some abnormal forces on the joints and tissues
This can predispose to things like arthritis and soft tissue injuries
Can't change how they're put together but we can use rehab, chiropractic and other treatments to keep everything moving as normally as possible and prevent inflammation
Other
Postural Analysis
Normal posture
Kyphosis
Lordosis
Scoliosis concavity right
Scoliosis concavity left
Weight shifted to front
Weight shifted to hind
Weight shifted right
Weight shifted left
Head tilt left
Head turn right
Head turn left
Mild lumbar kyphosis
Moderate lumbar kyphsis
Severe lumbar kyphosis
Mild Thoracolumbar kyphosis
Moderate thoracolumbar kyphosis
Severe thoracolumbar kyphosis
Trying to keep weight off painful leg
Indication of back pain, leg pain, abdominal pain or a cominbation
Mild arched back
Moderate arched back
1
Other
Muscle Condition
Please Select
Normal muscle condition for age, breed, and lifestyle
Mild muscle atrophy
Mild to moderate muscle atrophy
Moderate muscle atrophy
Moderate to severe muscle atrophy
Severe muscle atrophy
Hypertrophied muscle
Muscle Condition
Normal for age, breed, sex, lifestyle
Mild generalized muscle loss
Mild muscle loss along the back
Mild muscle loss both hind legs
Mild muscle loss both hind legs worse on the right
Mild muscle loss both hind legs worse on the left
Mild muscle loss right hind leg
Mild muscle loss left hind leg
Mild to moderate generalized muscle loss
Mild to moderate muscle loss along the back
Mild to moderate muscle loss both hind legs
Mild to moderate muscle loss both hind legs worse on the right
Mild to moderate muscle loss both hind legs worse on the left
Mild to moderate muscle loss right hind leg
Mild to moderate muscle loss left hind leg
Moderate generalized muscle loss
Moderate muscle loss along the back
Moderate muscle loss both hind legs
Moderate muscle loss both hind legs worse on the right
Moderate muscle loss both hind legs worse on the left
Moderate muscle loss right hind leg
Moderate muscle loss left hind leg
Moderate to severe generalize muscle loss
Moderate to severe muscle loss along the back
Moderate to severe muscle loss both hind legs
Moderate to severe muscle loss both hind legs worse on the right
Moderate to severe muscle loss both hind legs worse on the left
Moderate to severe muscle loss right hind leg
Moderate to severe muscle loss left hind leg
Severe generalized muscle loss
Severe muscle loss along back
Severe muscle loss both hind legs
Severe muscle loss right hind leg
Severe muscle loss left hind leg
Severe muscle loss right front leg
Severe muscle loss left front leg
Other
Muscle Loss
Muscle loss due to normal aging processes that cause breakdown of muscle called "sacropenia"
Muscle loss due to chronic inflammation that causes breakdown of muscle called "cachexia"
Difficult to reverse but can be slowed by reducing inflammation and using rehab for muscle strengthening
Muscle loss due to not using the muscles normally called "disuse atrophy"
Can be reversed with rehab to encourage normal weight bearing and muscle use
Muscle loss due to nerves not stimulating the muscles any more called "neurogenic atrophy"
Can't be reversed
Processes aren't really reversible
Has nothing to do with caloric intake and very little to do with exercise so feeding more food or doing more exercise won't rebuild the muscle
Weight loss can be from fat loss or muscle loss and their weight loss has been mostly from muscle loss
Still has too much fat which is inflammatory and makes the muscle wasting worse
Probably a combination of multiple things causing muscle loss
We probably can't reverse it but goal would be to slow the progression
We can do this by managing inflammation everywhere in the body and trying to keep nerves functioning as well as possible and your pet using their body as normally as possible
Other
Muscle Condition Notes
Muscle Tension
Please Select
None
Mild
Mild to Moderate
Moderate
Moderate to Severe
Severe
Muscle tension
Normal, no tight areas
Mild everywhere
Moderate everywhere
Severe everywhere
Mild neck
Mild shoulders
Mild along upper back
Mild along lower back
Mild thighs
Mild to moderate neck
Mild to moderate shoulders
Mild to moderate upper back
Mild to moderate lower back
Mild to moderate thighs
Moderate neck
Moderate shoulders
Moderate upper back
Moderate lower back
Moderate thighs
Moderate to severe neck
Moderate to severe shoulders
Moderate to severe upper back
Moderate to severe lower back
Moderate to severe thighs
Severe neck
Severe shoulders
Severe upper back
Severe lower back
Severe thighs
Mild right biceps
Mild left biceps
Mild to moderate right biceps
Mild to moderate left biceps
Moderate right biceps
Moderate left biceps
Moderate to severe right biceps
Moderate to severe left biceps
Severe right biceps
Mild everywhere else
Severe left biceps
Moderate everywhere else
Severe everywhere else
Mild to moderate everywhere else
Feels better!
Better after treatment
Tight muscles from compensating
Other
Muscle tension notes
Joint Range Of Motion Notes
Leg Joints Range of Motion and Palpation Notes
Normal
Rest normal
Slightly decreased right shoulder
Slightly decreased left shoulder
Slightly decreased right elbow
Slightly decreased left elbow
Slightly decreased right wrist
Slightly decreased left wrist
Slightly decreased in toes
Bony changes
Slightly decreased right hip
Slightly decreased left hip
Slightly decreased right knee
Slightly decreased left knee
Slightly decreased right ankle
Slightly decreased left ankle
Moderately decreased right shoulder
Moderately decreased left shoulder
Moderately decreased right elbow
Moderately decreased left elbow
Moderately decreased right wrist
Moderately decreased left wrist
Moderately decreased toes
Moderately decreased right hip
Moderately decreased left hip
Moderately decreased right knee
Moderately decreased left knee
Moderately decreased right ankle
Moderately decreased left ankle
Severely limited right shoulder
Severely limited left shoulder
Severely limited right elbow
Severely limited left elbow
Severely limited right wrist
Severely limited left wrist
Severely limited toes
Severely limited right hip
Severely limited left hip
Severely limited right knee
Severely limited left knee
Severely limited right ankle
Severely limited left ankle
Likely mild arthritis
Likely moderate arthritis
Likely severe arthritis
May be early/mild arthritis, may be just muscle and soft tissue tightness
Muscle and soft tissue tightness and pain as well
Same as last visit
Improved from last visit
Could be due to hip dysplasia
Could be due to elbow dysplasia
Xrays would help diagnose
Likely a torn ACL
Tight biceps right
Tight biceps left
Tight biceps both sides
Tight right shoulder
Tight left shoulder
Tight right hip
Tight left hip
No swelling right knee
No swelling left knee
Minimal swelling right knee
Minimal swelling left knee
Mild swelling right knee
Mild swelling left knee
Moderate swelling right knee
Moderate swelling left knee
Severe swelling right knee
Severe swelling left knee
Instability right knee
Instability left knee
Bony changes right knee
Bony changes left knee
Bony changes right elbow
Bony changes left elbow
Bony changes right wrist
Bony changes left wrist
Iliopsoas (muscle that goes from back to inside hind leg) tight right
Iliopsoas (muscle that goes from back to inside hind leg) tight left
All joints comfortable today
Better after treatment
Comfortable movement within the range used for normal activities
Rest of joints comfortable
Other
Knee Caps
Right normal
Left normal
Right a little loose
Left a little loose
Right slips out of place
Left slips out of place
Called "Luxating Patella"
Not painful when it slips out of place but creates abnormal forces on the knee joint and the bones by being out of place
These abnormal forces predispose to arthritis in the knee and hip as well as a torn ACL which itself leads to arthritis in the knee
These abnormal forces have led to arthritis in the knee
They learn to walk abnormally which then predisposes to hip pain and arthritis and back pain and arthritis and can contribute to disk issues
Use glucosamine/chondroitin (Cosequin, Dasuquin are good options) to help slow joint damage
Do Passive Range of Motion stretching exercises gently bending and extending the knee 5-10 times daily if possible
Do "reach for it" toe stretches, hold vertically around the chest with back legs hanging straight down, lift up so they're in the air but their toes are just above the couch or floor, they'll instinctively stretch their toes to try to reach the couch/floor. Do 5-10 times daily if possible
Do "sit to stand" exercise 5-10 times daily
Other
Reactivity/Temperature Changes Notes
Neck and Back
Mild arched back
Moderately arched back
Severely arched back
Indication of back, leg, or GI pain
Most likely due to back pain
Likely due to trying to shift weight from hind leg
Likely due to trying shift weight from hind legs
Could be disk issue (slipped or bulging disk), restrictions in normal spinal movement causing nerve irritation, arthritis causing nerve irritation, or some combination
Normal nerve function, spinal cord is functioning normally
Could go to a neurologist for MRI, possible surgery
Likely due to a combination of genetics and abnormal forces on the spine caused by how body is put together
Arthritis in knees and hips also contributes to abnormal forces on the spine
Will always be predisposed to "flare ups" because of these underlying issues
Goal is to reduce frequency and severity of flare ups
Do massage picking up loose skin on neck and back daily
Use gabapentin for nerve pain as needed for flare ups
Use anti-inflammatories as needed for flare ups
No skin and muscle spasms along the back
Mild skin and muscle spasms
Moderate skin and muscle spasms
Severe skin and muscle spasms
Indication of back pain
Back feels comfortable today
Needed a few spinal adjustments
Needed a few spinal adjustments neck
Needed a few spinal adjustments upper back
Needed a few spinal adjustments lower back
Needed a few spinal adjustments hips
Other
Feet
Nails/claws appropriate length, keep up the good work!
Nails/claws long
Nails/claws very overgrown
Shouldn't touch the ground when standing and shouldn't hear them when walking on hardwood or tile
May need to trim a little bit every week or two to work them back
Does actually change the angle of the foot which creates abnormal forces on the joints and soft tissues
Nails dry, cracked
Nails on hind feet more worn than front
Nails digits 3 and 4 on hind feet more worn than others
Uneven nail wear
Likely due to nerve dysfunction causing some scuffing and dragging of toes
Pads normal
Cornified areas pads
Pads dry
Pads cracked
Interdigital inflammation
Interdigital moistness
Likely due to allergies
Can use Vetericyn spray 2-3 times daily as needed as a natural antimicrobial to reduce yeast and bacteria
Can apply a very small amount (touch the roller ball to your finger first then just lightly apply to the feet) of the essential oil HD Clear by DoTerra
Can apply a topical Chinese herbal called Toenail Tincture by Blue Poppy, can set up prescription and have it delivered to you
Decreased ROM toes
Decreased ROM front feet
Decreased ROM back feet
Bony changes toes
Bony changes front feet
Bony changes back feet
Arthritis in the toes
No issues from scuffing/neurological dysfunction
Visual exam only due to patient behavior/temperament
Indication of Blood Deficiency in Chinese Medicine
Indication of Damp in Chinese Medicine
Look better today!
Other
Additional Notes Feet
Additional Notes musculoskeletal, chiropractic, and gait/posture
Abdomen
No overt fluid
No overt mass effect
No overt discomfort
Tense
Soft
Discomfort
Thickened intestinal loops, consistent with GI inflammation
Pancreas palpable, thickened, consistent with GI inflammation
Difficult to assess due to excess fat deposits
Unable to assess due to severe fat deposits
Unable to assess due to patient temperament
Difficult to assess due to tension
Normal
Normal gut sounds
Tension in front part of abdomen
Indication of Liver Qi Stagnation in Chinese Medicine
Other
Respiratory and Cardiovascular
No murmurs
No arrhythmias
No crackles
No wheezes
No harsh lung sounds
No cough on tracheal palpation
Mild murmur
Likely some dysfunction with one of the heart valves
Heart disease or dysfunction is not the same as heart failure
Many patients have no clinical symptoms from murmurs for months or years
Can have a cardiologist evaluate the heart's function
Monitor Sleeping Respiratory Rate: count how many breaths are taken in 15 seconds and multiply by 4, if that's less than 30 then the heart is functioning adequately
Moderate murmur
Loud murmur
Harsh lung sounds consistent with asthma or chronic bronchitis
Tachycardia
Tachypnea
Dyspnea
Panting throughout exam
Harsh panting likely due to laryngeal paralysis
Stertor
Cough on tracheal palpation
Very difficult to assess due to severe excess fat deposits
Unable to assess due to patient behavior/temperament
Normal
Upper airway noise
Didn't hear a murmur today
Other
Teeth, Gums, Oral Exam
Pink
Slightly pale
Pale
White
Pigmented
Moist
Slightly tacky
Tacky
Dry
CRT less than 2s
CRT >2s
Unable to assess due to patient behavior/temperament
Mild gingivitis
Moderate gingivitis
Severe gingivitis, gums are very inflamed which is painful and allows bacteria as well as all the inflammatory mediators in those areas to enter the blood stream and hit all the organs in the body
No/minimal gingivitis
Broken teeth, gums look ok so likely not infected but would need a dental xray to be sure
Broken teeth, gums look inflamed, may be infection in the tooth root
Recommend a complete oral health/dental evaluation and treatment at a regular clinic
Will require anesthesia but with appropriate monitoring and tailored pre-anesthetic, perioperative and post-operative management and care risk of complications is no higher than when spayed/neutered
Worn down teeth, just cosmetic
Stained/discolored teeth, just cosmetic
"Baby" teeth present, normal for age
"Baby" teeth haven't fallen out as they should have. Need to be removed as they will crowd the adult teeth and cause dental disease
Loose teeth
No/minimal tartar
Mild tartar
Moderate tartar
Severe tartar
Mild dental disease
Moderate dental disease
Severe dental disease
Feline Odontoclastic Resorptive Lesions (FORLs) where the body is reabsorbing the tooth enamel. This is a very painful process and the affected teeth need to be removed
Mass
Missing teeth
No masses seen
There are some supplements we can do to help support gum health
Will still need dental cleaning but can help reduce inflammation in the meantime
Can use 1-TDC for gum health, it's a fatty acid like omega 3's but really targets the gums and tissues around the teeth and has been effective in studies at reducing gum inflammation and bone loss associated with dental disease
Can get online over the counter, dose is by weight on bottle and it says to apply to gums but you can just squeeze it into their mouth or even just wipe it on their lips or if they won't go for those you can put it on food just try not to mix it in or it will end up more absorbed in the stomach (which is ok since it actually helps joints and other inflammation too) than in the mouth
Another option for dental health is the product Biodent by Standard Process which has some glandulars/organ extracts as well as trace minerals which helps gum inflammation
Can get Standard Process products through my online dispensary Fullscript: us.fullscript.com/welcome/seatoskyholisticvet
Other
Teeth, Gums, Oral exam notes
Lymph Nodes
Normal
Appear normal visually
Other
Skin
Black spots are called post-inflammatory hyperpigmentation
It's an indication that there has been inflammation but it can show up days, weeks or months after the inflammation
It often comes and goes and changes in appearance and location
Hyperpigmentation armpits
Hyperpigmentation inside back legs
Hyperpigmentation belly
Indication of chronic/recurrent inflammation
Likely due to allergies
Currently quiet, no inflammation or infection
Mild dermatitis
Moderate dermatitis
Severe dermatitis
Mild crusting
Moderate crusting
Severe crusting
Scabs and crusting tail base
Scabs and crusting neck
"Pimples/zits" on chin
"Pimples/zits" on lips
Likely Feline Acne
Similar to acne in people
Typically resolves on it's own in 7-14 days
Stress is a factor
Looks better today!
Other
Skin notes
Coat
Shiny
Dull
Slightly dull
Greasy
Slightly greasy
Dorsal grease stripe
Dry
Slightly dry
Coarse
Thin
Full, thick
Barbering
Partial alopecia
Alopecia
Coppery instead of black
"Burnt Appearance"
Pulls out easily
Mats
Live fleas
Flea "dirt"
Fur staining
Looks like your pet is doing a good job grooming
Looks like your pet isn't grooming as well in the back half the body
Looks like your pet isn't grooming much anymore
No evidence of fleas
No dandruff
Mild small dandruff
Moderate small dandruff
Severe small dandruff
Mild large dandruff
Moderate large dandruff
Severe large dandruff
Indication of Blood Deficiency in Chinese Medicine
Indication of Yin Deficiency in Chinese Medicine
Indication of Blood and Yin Deficiency in Chinese Medicine
Indication of Damp in Chinese Medicine
Indication of Qi Deficiency/Wei Syndrome in Chinese Medicine
Other
Eyes
Both eyes stick out from the face more than normal
Right eye sticks out from the face more than normal
Left eye sticks out from the face more than normal
Likely due to skeletal abnormalities of the breed resulting in eyes that are basically too large for the face
Both eyes sunken in
Right eye sunken in
Left eye sunken in
Watery discharge both eyes
Watery discharge right eye
Watery discharge left eye
Likely due to skeletal abnormalities of the breed resulting in eyes that are basically too large for the face and block the normal tear drainage ducts in the eyelids
Likely due to herpes which causes irritation of the tissue around the eye leading to some discharge
Irritation of tissue around the eyes could be due to irritants in the air, allergies or viruses, something stuck under the eyelid is possible but rare
Crusted discharge both eyes
Crusted discharge right eye
Crusted discharge left eye
Thick discharge both eyes
Thick discharge right eye
Thick discharge left eye
Increased "cloudiness" both eyes
Increased "cloudiness" right eye
Increased "cloudiness" left eye
Likely a process called lenticular sclerosis where the lens gets hard and cloudy but they can still see through it unlike a cataract
No discharge both eyes
No discharge right eye
No discharge left eye
Lens and cornea clear both eyes
Lens and cornea clear right eye
Lens and cornea clear left eye
Normal visual response both eyes
Normal visual response right eye
Normal visual response left eye
Can see, may be a little more blurry than before but not blind
Holding eye shut both eyes
Holding eye shut right eye
Holding eye shut left eye
Doesn't like light in eye both eyes
Doesn't like light in right eye
Doesn't like light in left eye
Mild irritation around eye both eyes
Mild irritation around right eye
Mild irritation around left eye
Moderate irritation around eye both eyes
Moderate irritation around right eye
Moderate irritation around left eye
Severe irritation around eye both eyes
Severe irritation around right eye
Severe irritation around left eye
Corneal ulcers/scratches both eyes
Corneal ulcer/scratch right eye
Corneal ulcer/scratch left eye
Not necessarily caused by an actual "scratch"
Likely due to herpes or other virus which can damage the cornea surface and cause ulcers/scratches
Likely self trauma from itching/scratching/rubbing at face/eyes
Fur staining near both eyes
Fur staining near right eye
Fur staining near left eye
Missing fur around both eyes
Missing fur around right eye
Missing fur around left eye
Swollen tissue around both eyes
Swollen tissue around right eye
Swollen tissue around left eye
Inadequate tear production both eyes
Inadequate tear production right eye
Inadequate tear production left eye
Third eyelid elevation both eyes
Likely due to nausea
Third eyelid elevation right eye
Third eyelid elevation left eye
Pupils dilated both eyes
Pupil dilated right eye
Pupil dilated left eye
Pupils constricted both eyes
Pupil constricted right eye
Pupil constricted left eye
Normal ability to blink both eyes
Normal ability to blink right eye
Normal ability to blink left eye
Pupils symmetrical
No abnormal eye movements
Can use Optixcare Eye Health ointment (red box), contains natural anti-inflammatories, available online
Can use Optixcare Eye Lube ointment (purple box), helps with "dry eye" and has hylauronate that helps the eye heal, available online
Look good!
Look better!
Other
Eyes notes
Ears Western
Cropped
Painful
Abnormally thickened canal right ear
Abnormally thickened canal left ear
Abnormally thickened canals both ears
Chronic changes to cartilage both ears
Tympanum visualized and intact right
Tympanum visualized and intact left
Hyperpigmented, indicating previous inflammation
Thickened skin, indicating previous inflammation
Normal
Look good!
Look better!
Swollen canal
Swollen ear flap
Mild inflammation
Moderate inflammation
Severe inflammation
Crusting
Mild debris
Moderate debris
Severe debris
Chronic changes to ears due to history of chronic/recurrent ear infections
Likely caused by underlying allergies
Allergies cause skin to be inflamed and it no longer functions as a normal barrier that keeps the yeast and bacteria that are always present on the skin and in the ears out. When skin is inflamed the yeast and bacteria can get in and cause pain, itching, and more inflammation creating a vicious cycle
Currently quiet, no inflammation or infection
Use Zymox Otic (green or yellow box) enzymatic treatment for 7 days, follow package instructions. Use once a day and don't use any other cleaners before or after
Use Zymox Otic (green or yellow box) enzymatic treatment for 14 days, follow package instructions. Use once a day and don't use any other cleaners before or after
Use Zymox Otic (green or yellow box) enzymatic treatment daily, follow package instructions. Use once a day and don't use any other cleaners before or after
Use Zymox Otic (green or yellow box) enzymatic treatment for 7 days as needed for flare ups, follow package instructions. Use once a day and don't use any other cleaners before or after
Use Zymox HC (blue or red box) enzymatic treatment with anti-inflammatory for 7 days, follow package instructions. Use once a day and don't use any other cleaners before or after
Use Zymox HC (blue or red box) enzymatic treatment with anti-inflammatory for 14 days, follow package instructions. Use once a day and don't use any other cleaners before or after
Use Zymox HC (blue or red box) enzymatic treatment with anti-inflammatory daily, follow package instructions. Use once a day and don't use any other cleaners before or after
Use Zymox HC (blue of red box) enzymatic treatment with anti-inflammatory for 7 days as needed for flare ups, follow package instructions. Use once a day and don't use any other cleaners before or after
Use Cameo Otic (available online or I can set up through my online store) natural anti-inflammatory and antimicrobial. Follow package instructions
Can use Zymox Otic (yellow or green box, available online) an enzymatic cleaner once a week or as needed for maintenance
Make sure to put the tip of the bottle as far into the ear as you can, there's no way you'll go "too far"
Massage the base of the ear after applying. Your pet will shake after you put things in so try to massage before they shake but it's still helpful to massage even if they already shook
Use as needed if having a flare up
Other
Ears Traditional Chinese Veterinary Medicine
Hot ears
Hot central ears
Hot ear tips
Hot ear edges
Warm ears
Warm central ears
Warm ear tips
Warm ear edges
Slightly warm ears
Slightly warm central ears
Slightly warm ear tips
Slightly warm ear edges
Neutral ears
Neutral central ears
Neutral ear tips
Neutral ear edges
Slightly cool ears
Slightly cool central ears
Slightly cool ear tips
Slightly cool ear edges
Cool ears
Cool central ears
Cool ear tips
Cool ear edges
Cold ears
Cold central ears
Cold ear tips
Cold ear edges
Indicates Excess Heat in Chinese Medicine
Indicates Yin Deficiency in Chinese Medicine
Indicates Blood Deficiency in Chinese Medicine
Indicates Yin and Blood Deficiency in Chinese Medicine
Indicates Yang Deficiency in Chinese Medicine
Indicates Qi Deficiency in Chinese Medicine
Indicates Yang and Blood Deficiency in Chinese Medicine
Normal
Other
Ears notes
Nose
Moist
No discharge
No swelling
Dry
Cracked
Hyperkeratinization
Narrow nostrils
Watery discharge
Mucous like discharge
Crusted discharge
Swelling
Congestion
Depigmentation
Macule
Right nostril
Left nostril
Both nostrils
Normal
Indication of Yin Deficiency in Chinese Medicine
Indication of Blood Deficiency in Chinese Medicine
Indication of Yin and Blood Deficiency in Chinese Medicine
Likely inflammation/irritation in the nose caused by herpes
Could be inflammation/irritation due to allergies/environmental irritants
Additional testing could include xrays, CT, sedated exam +/- biopsy or cultures for bacteria and fungus
Likely has permanent damage to the inside of the nose due to multiple episodes of inflammation/damage
Because of damage/scarring to inside of nose predisposed to ongoing flare ups of herpes virus and to bacterial overgrowth and any environmental allergies/irritants
Will likely always have some degree of discharge, sneezing, congestion, goal is to reduce severity of symptoms as cure isn't really possible
Use a HEPA filter to reduce any environmental allergens/irritants
Avoid processed food especially dry food/kibble and avoid chicken, lamb, venison, bison and boar as can be inflammatory
Can use Pe Min Kan herbal (available from Plum Flower/Mayway brand on Amazon and via a link on my website under Pharmacy and Products)
Dose is 1 teapill twice a day, fine to give with food and can be given whole or broken up and mixed into food or treats
Inflammation anywhere in the body creates more inflammation everywhere so working to reduce other inflammatory conditions will also help nasal inflammation
Other
Tongue Diagnosis in Traditional Chinese Veterinary Medicine
Pink
Pale
Lavender
Dark Pink
Red
Dark Lavender
Purple
Pigmented
Swollen
Thin
Scalloped tip
Dry
Cracked
Phlegm lines
Wet
Slightly pale
Slightly lavender
Slightly swollen
Dark pink edges
Dark pink tip
Red edges
Red tip
Lavender edges
Lavender tip
Dark lavender edges
Dark lavender tip
Indicates Liver Qi Stagnation
Indicates Liver Yin Deficiency
Indicates Qi Deficiency
Indicates Blood Deficieny
Indicates Stagnation
Indicates Dampness
Indicates Yin Deficiency
Indicates Yin and Blood Deficiency
Indicates Damp Heat
Other
Pulse Diagnosis Traditional Chinese Veterinary Medicine
Full, strong, even
Synchronous
Deep
Weak
Wiry
Rapid
Slippery
Weaker right
Weaker left
Stronger left
Stronger right
Superficial
Bounding
Thready
Indicates Damp in Chinese Medicine
Indicates Blood Deficiency in Chinese Medicine
Indicates Qi Deficiency in Chinese Medicine
Indicates Yin Deficiency in Chinese Medicine
Indicates Yang Deficiency in Chinese Medicine
Indicates Stagnation in Chinese Medicine
Other
Urogenital
Normal appearance external genitalia, consistent with reported age, sex and reproductive status
Testicles both present palpate normally
Right testicle not present in scrotum, left present palpates normally
Left testicle not present in scrotum, right present, palpates normally
Vulva hooded
Vulva tipped
Vulva large
Visual exam only due to patient temperament/behavior
Normal
Other
Masses
None seen or felt
No changes
Skin masses are probably benign
Soft masses under the skin are probably benign
Would need to take a sample or remove to know for sure
Does tell us that your pet's ability to recognize and destroy abnormal cells the way it should isn't quite normal
Other
Masses Notes
Cranial Nerves
No apparent deficits
Visual assessment only due to patient temperament/stress but no apparent deficits
No menace bilateral
No menace OD
No menace OS
Normal
Other
Neurologic Evaluation
Normal cranial nerves
Normal feeling and responses in all 4 limbs
Mild decreased feeling and responses both rear feet
Moderate decreased feeling and responses both rear feet
Severe decreased feeling and responses both rear feet
Some dysfunction of the nerves
Likely due to Geriatric Onset Laryngeal Paralysis Polyneuropathy (GOLPP)
We don't understand yet what causes it but it's likely related to genetic predispositions and inflammation
Nerves to larynx (controls opening to airway), back legs and sphincters become dysfunctional causing harsh panting, difficulty breathing, hind end weakness and incontinence issues
The coughing/gagging is probably related to this same issue
Likely disks pushing up and interfering with the spinal cord/nerves causing symptoms
Likely arthritis and bony changes in the spine affecting the spinal cord and nerves causing symptoms
Could go to a specialist vet neurologist for additional diagnostics like MRI to help diganose
Could be other things as well
Causes the weakness/wobbliness in the hind end
Dysfunction can affect all the nerves including those to the GI system, urogenital sphincters, esophageal sphincter, and throat
The nerves to the sphincter are probably not working very well causing the incontinence
No cure but can try to slow progression by trying to reducing inflammation and improve neurologic function
Rehab, acupuncture, laser, massage and chiropractic can all help reduce inflammation, improve/maintain nerve function and try to slow progression
There are supplements that can be helpful as well, a lot of it like omega 3's and antioxidants are already in real food but there's others we can try too although there's no miracles
I have a bunch of supplements that have shown some benefit for nerve function in my Nerve and Cognitive Function "protocol" on my online dispensary Fullscript: https://us.fullscript.com/protocols/seatoskyholisticvet-nerve-and-cognitive-function
Here are some supplements that can be helpful in seizure or seizure like activity in my online dispensary Fullscript: https://us.fullscript.com/protocols/seatoskyholisticvet-seizure-management-support
Normal
About the same as last visit
A little better than last visit
A little worse than last visit
Other
Thyroid
Feels normal
Large
Could be indication of thyroid dysfunction
Would be best to get bloodwork to check thyroid function
Consistent with hyperthyroid disease
Other
Blood Pressure
Normal!
Normal! We can continue current meds with current dose and frequency
A little bit high but hard to know if it's accurate
We could start meds now or check at the next appointment and if it's still high consider them then
We could increase meds now or check at the next appointment and if it's still high consider it then
Blood pressure was consistently very high today
High blood pressure can damage kidneys, heart and eyes
High blood pressure can cause headaches and blindness
We can treat high blood pressure with medications effectively
We usually start with a medication called amlodipine which is very safe and recheck blood pressure at the next appointment since we often have to adjust the dose over time
Only typical side effects of blood pressure medications would be wobbliness if blood pressure ends up too low, if we're seeing that we can reduce the dose
Type option 4
Other
Rest of Exam
Same as last visit
Other
Traditional Chinese Medicine (TCVM) Signs
Your pet has signs of a Yin Deficiency in Chinese Medicine
Yin (like Yin and Yang) is what nourishes and moistens tissues in Chinese Medicine, it's also the body's "air conditioning"
Your pet has signs of a Yang Deficiency in Chinese Medicine
Yang (like Yin and Yang) is the body's "heater" and helps with movement in Chinese Medicine
Your pet has signs of a Blood Deficiency in Chinese Medicine
This isn't the same as a conventional anemia; in Chinese Medicine blood nourishes all the tissues especially the skin and coat and tendons and ligaments
Your pet has signs of a Qi Deficiency in Chinese Medicine
Qi is the energy which flows through the body and allows all the cells, tissues and organs to function properly
Your pet has signs of Damp in Chinese Medicine
Damp is an abnormality in Chinese Medicine which makes it harder for things to function properly
You pet has signs of Stagnation in Chinese Medicine
Stagnation means that Qi and/or Blood aren't moving properly in the body, this can be due to physical issues like pain and inflammation, masses, or organ dysfunction or it can be due to emotional factors like anxiety and stress or a combination
We'll address these issues with the treatment today and with all the things you do between appointments
All the treatments today will help
The herbs we're doing help
The food we're doing helps
We can add Chinese Herbal medicinal formulas as well to help address these imbalances
There will always be some little imbalances to be addressed
Often there are just Deficiencies or issues that certain individuals tend to just because of their genetics, temperament, etc
Our goal is just to try to normalize and balance as much as possible
Type option 3
Type option 4
Other
Additional notes
GI Symptoms
Likely IBD given history, signalment and signs
History of partial anorexia and food aversion likely secondary to nausea and inflammation consistent with IBD
Likely "flare up" of IBD gastritis/enterocolitis/colitis secondary to stress
Rule out other primary GI (lymphoma, pancreatitis, infectious, other GI neoplasia, toxin, FB, parasites, intestinal accident, etc) vs non primary GI (endocrine, renal, hepatic, other neoplasia)
Would need further diagnostics (Abdominal US, biosy, etc) to definitively diagnose
Symptoms like not finishing all food right away, walking away from food, taking a few bites and then walking away or sitting down, and being a "picky" eater are all symptoms of nausea
Nausea is an extremely complex physiologic process that involves receptors and nerves in the GI tract and receptors and processes in the brain
In most cases GI inflammation sets off physiologic chain reactions which lead to nausea
Hairballs are not normal, they are vomiting, another symptom of GI inflammation and nausea
Inflammatory Bowel Disease is the most likely cause of symptoms
May be other contributing factors like allergies, stress, other inflammatory conditions in the body
Hyperthyroid disease also causes direct GI inflammation
Kidney disease can also directly contribute to GI inflammation
Inflammatory Bowel Disease can progress to lymphoma in many cases so given age and history of likely IBD can't rule out that possibility
Attempting to find a definitive diagnosis would require additional testing such as bloodwork, fecal exam, xrays, abdominal ultrasound, surgical or endoscopic biopsies
Inflammatory Bowel Disease (IBD) is an issue with an over reactive immune system in the GI tract (similar to Crohn's Disease and Ulcerative Colitis in people)
There's no cure for IBD, the goal is management to try to reduce severity and frequency of "flare ups" but will always be at increased risk of GI upset (nausea, vomiting, diarrhea)
Any sort of "stress" can increase chance of a "flare up"
Stress for animals can be any changes in routine or their environment
Other
Behavior
Situational anxiety
Rule out Generalized anxiety
Likely generalized anxiety
Likely separation anxiety
Likely attention seeking behavior
Rule out true separation anxiety
Likely Canine Cognitive Dysfunction (CCD)
Likely Cognitive Dysfunction
Neurologic signs
Likely laryngeal paralysis given history, signalment, signs
Likely Geriatric Onset Laryngeal Paralysis Polyneuropathy (GOLPP)
Possible Lumbosacral Disease (LSD), +/- IVDD, +/- spinal DJD/spondylosis
Would need advanced imaging (MRI/CT/US) to definitively diagnose
Likely IVDD
Rule out neoplasia, FCE, toxin, etc
Upper Respiratory Signs
Likely secondary to herpes viral infection
Rule out other causes (neoplasia, infectious, FB, parasites, oronasal fistula, etc)
Cough/Respiratory signs
Patient likely has collapsing trachea given history, signalment and signs
Patient likely has chronic bronchitis given history, signalment and signs
Likely combination of collapsing trachea and chronic bronchitis
R/O other causes (infectious, neoplasia, parasites, left sided heart failure, etc)
Likely Canine Infectious Respiratory Disease (CIRD) Complex given history, signalment and signs
Patient likely has asthma given history, signalment and signs
Likely combination of asthma and chronic bronchitis
Cardiac
Murmur likely due to myxometous mitral valve disease MMVD given history, signalment and signs
Rule out other cardiac disease (Dilated Cardiomyopathy, other primary cardiac disease, congenital disease)
Dynamic murmur rule out Dynamic Sub Aortic Stenosis vs Dynamic Right Ventricular Outflow Tract Obstruction vs iatrogenic
Rule out hypertrophic cadriomyopathy
Likely secondary to hyperthyroid disease
Likely normal sinus arrhythmia rule out other causes of arrhythmia (electrolyte disturbance, endocrine, primary heart disease)
Clinical signs not consistent with heart failure at this time
Lower Urinary Tract signs
Likely Pandora Syndrome (aka FIC/FLUTD/FUS) given history, signalment and signs
Rule out stones, neoplasia, infectious
DJD with secondary myofascial pain
Likely
Right coxofemoral joint
Left coxofemoral joint
Right stifle
Left stifle
Right tarsus
Left tarsus
Metatarsals
Phalanges
Right glenohumeral joint
Left glenohumeral joint
Right elbow
Left elbow
Right capus
Left carpus
Cervical spine
Thoracic Spine
Lumbar Spine
Lumbosacral junction
Conformational and postural abnormalities
As described above, causing altered and abnormal biomechanics leading to abnormal forces on spine and joints
Presdisposed to stifle DJD, abnormal biomechanics and back pain
Predisposed to Cranial Cruciate Ligament (CCL) Disease
Dental disease
Mild
Moderate
Severe
Suspect Feline Odontoclastic Resorptive Lesions
Likely tooth root abscess
Retained deciduous teeth
Other
Weight
Overweight
Obese
Morbidly obese
Underweight
Muscle loss consistent with cachexia
Additional Western Assessment
TCVM Assessment
Blood Deficiency
Yin Deficiency
Yang Deficiency
Damp
Heat
Liver
Lung
Large Intestine
Spleen
Small Intestine
Stomach
Heart
Pericardium
Triple Heater
Gall Bladder
Kidney
Bladder
Excess
Cold
Qi Deficiency
Qi Stagnation
Blood Stagnation
Rebellious Qi
Sunken Qi
Shen Disturbance
Yang Rising
Liver Overcontrols Spleen
Internal Wind
External Wind
Unanchored Yang
Bony Bi Syndrome
Steaming Bones
Wei Syndrome
Jing Deficiency
Wind Damp Heat Invasion
Wind Damp Cold Invasion
Other
Spinal Range of Motion (Chiropractic) Assessment
Chiropractic Assessment
OSR
OSL
ASR
ASL
APR
APL
PC2
PC3
BRC3
BLC3
BRC4
BLC4
BRC5
BLC5
BRC6
BLC6
BRC7
BLC7
PT2
PRT2
PLT2
PT3
PRT3
PLT3
PT4
PRT4
PLT4
PT5
PRT5
PLT5
PT6
PRT6
PLT6
PT7
PRT7
PLT7
PT8
PRT8
PLT8
PT9
PRT9
PLT9
PT10
PRT10
PLT10
PT11
PRT11
PLT11
PT12
PRT12
PLT12
PT13
PRT13
PLT13
PT14
PRT14
PLT14
PT15
PRT15
PLT15
PT16
PRT16
PLT16
PT17
PRT17
PLT17
PT18
PRT18
PLT18
PL1
PRL1
PLL1
PL2
PRL2
PLL2
PL3
PRL3
PLL3
PL4
PRL4
PLL4
PL5
PRL5
PLL5
PL6
PRL6
PLL6
PL7
PRL7
PLL7
RPI
RAS
LPI
LAS
SBP
SBPR
SBPL
SAR
SAL
RIT
LIT
We Discussed
All exam findings, potential diagnoses, and options for referral, additional testing and treatment
Nutrition
Behavior
Herbal medications
Supplements
Exercise
Rehabilitation
Quality of Life
Pharmaceutical medications
Goals, expectations and next steps
Other
Today We Did
Acupuncture
Laser Therapy
Massage/Tui-Na/Acupressure/Myofascial Release
Spinal Range of Motion Assessment and Mobilization (Chiropractic)
Rehabilitation Stretching and Joint Mobilizations
Therapeutic Ultrasound
Aromatherapy
Electroacupuncture
Aqua-acupuncture
Vaccination
Pain medication
Fluids
Anxiety medication
Anti-inflammatory medication
Sedation
Nail trim
Comprehensive Exam
Visual Exam
Brief Exam
Rehabilitation Exercises
Remote Consult via video chat
Remote Consult via phone
Teishin acupuncture
Blood Pressure
Solensia injection for arthritis
Other
Your Pet
Loved it!
Did great!
Did well!
Fell asleep!
Wasn't in the mood for a lot of treatment today
Was a little nervous at first but relaxed
Was a little nervous
Was very scared today
Was a little nervous but did great!
Type option 4
Other
Your Horse
Loved it!
Did great!
Did well!
Fell asleep!
Wasn't in the mood for a lot of treatment today
Was a little nervous at first but relaxed
Was a little nervous
Was very scared today
Type option 4
Other
We Can
Continue the same plan as last visit
Add some things (details below)
Make some changes (details below)
Stop some things (details below)
Other
Rehabilitation Exercises
Food and Nutrition Plan
Whole foods (dehydrated, commercial fresh foods, or home made) are best
Feeding less processed foods is associated with lower risk of developing dementia and cancer and with a longer life span
Less processed foods still contain all of the antioxidants, phytonutrients, and lots of high quality, bioavailable nutrients
Commercial options (dehydrated, fresh cooked, fresh/frozen raw) are all fine if home made isn't an option
However I don't recommend any specific brands since I don't actually know what's in any of them, what their sourcing/Quality Control, etc is
The best thing to do is to get a variety of brands (can find them online, local pet store, etc if you ask/search for "dehydrated pet food" "fresh pet food" etc) and rotate through them periodically so if there's any issues with one it will be balanced out since we're feeing different ones over time
Can use BalanceIt.com for homemade, must use supplement as directed for complete and balanced diet, see handout
If you follow the BalanceIt.com recipes and add the supplement as directed that will get the correct amount of calcium and all the other important nutrients, you won't need to add any other calcium or vitamin/mineral supplements
If you want to create a home made diet NOT using BalanceIt.com we need to be sure it has acceptable amounts of all nutrients, particularly calcium
Use a human multivitamin like Centrum Silver dosed at 1/4 tablet a day for every 25 lbs of body weight (1/2 tablet a day for a 50 lb dog, 1/8th tablet at day for cats and dogs under 12.5 lbs, etc)
Add 1000 mg of calcium for every 1 lb of cooked food (if the recipe you're using makes 1/2 a lb of food you'd need to add 500 mg of calcium to it to have enough
Calcium carbonate has 1200 mg of bioavailable calcium in each teaspoon so if you needed to add 500 mg of calcium based on the weight of the food then you'd do a little less than half a teaspoon
I can help you create a custom recipe and check for nutrients or you can use the above guidelines. You can also use nutrient analysis programs available online like BalanceIt.com, myfoodrecord, etc to help you check for adequate levels of nutrients especially calcium
There are specialist veterinary nutritionists who can create custom balanced home made diets
Discontinue all dry food/kibble
Kibble is highly processed which means it contains more inflammatory compounds and most of the antioxidants and phytonutrients have been damaged and nutrients are not as bioavailable
Because kibble is cooked at extremely high temperatures and pressures the fat is all burnt off and they have to spray fat back on in order to have fat and fat soluble vitamins in it
Industry standard is to use chicken fat to spray on. This doesn't have to be included on the ingredient list since it's a small amount. This fat rapidly oxidizes and becomes a source of inflammation
See handout for help in transitioning off dry food
Canned food is still pretty processed but is way better than kibble
Avoid chicken, lamb, venison, bison, boar as can be allergens and can be inflammatory
Avoid rabbit, turkey, fish, as can be allergens and too cooling
Recommend cooked food vs raw as too cooling/damp
Diet change will take 8-12 weeks for full effect
Continue doing real food, that's the best!
Good to rotate different flavors/proteins/brands of food every 6-8 weeks or so. This helps avoid any issues with any particular food formulation and helps give the body something new to "look at" which reduces immune over-reaction and helps keep the gut flora more diverse and healthy
We can add some Miralax to help soften the stool
Dose is about 1/4-1/2 tsp 2-3 times a day and can increase or decrease as needed
Could also add lactulose to help soften stool, prescription
Continue to feed whatever your pet will eat
Can try a variety of foods "smorgasbord" style with a small amount of different things to see what they might be interested in
Ok to try human food like hot dogs, ice cream, bread, yogurt, liverwurst, deli meat, tuna, etc
Ok to try a variety of foods including "McDonalds" foods like those meal toppers, gravies, lickable treats, Friskies canned cat food, etc
Other
Home Made Food
Home made foods must be complete and balanced
They need to contain all the required nutrients, vitamins, minerals and amino acids for normal body function and they need to be in the correct amounts
You can use "kits" or foods where a company provides a "base" or a supplement powder with all the vitamins/minerals and you just add the fresh ingredients
I can create tailored recipes for you (these are the same hourly cost as all professional services)
You can work with a veterinary nutritionist to create recipes for you
BalanceIt.com is one option for the "kit" style where you do the fresh ingredients and use their supplement to get all the vitamins/minerals
If you follow the recipes in the "kits" those should be complete and balanced and all the calcium, vitamins, etc they need
These are just complete and balanced in terms of required nutrients, these will not include other beneficial supplements like glucosamine/chondroitin, etc that we may have discussed for your pet as well
If you don't use a commercial option like the kits or BalanceIt.com we will have to add calcium and other vitamins/minerals/nutrients to the home made food
If a diet is not complete and balanced it could cause serious health issues and make things worse
Calcium is the biggest concern; pets need way more than people do and all home made diets will be very low in calcium so we will have to add it in
Calcium carbonate is the best option and the rough dose is 1200 mg (1.2 gram) of calcium carbonate for every 1 pound of food OR about 300 mg of calcium for every 200 calories we're feeding
So if your pet gets about 400 calories they'd need about 600 mg of calcium added to the food a day to meet their calcium needs
Calcium carbonate has 1200 mg of bioavailable calcium in each teaspoon so if you needed to add 600 mg of calcium you'd do 1/2 teaspoon of calcium carbonate for each day worth of food
Calcium carbonate is available in tablets, capsules and loose powder and is sourced from eggshells, algae, or limestone
Some reputable brands of calcium carbonate include the Now brand, Bulk Supplements, Brand, Swansons, Puritan's Pride, for algae calcium a veterinary specific one is TerraCal
In addition to calcium we do need to add some vitamins and minerals since home made food is typically really low in things like Vitamin D, Vitamin A, iodine, copper, zinc, magnesium and B vitamins like riboflavin, thiamine and B6
I have some of the supplements we might use to make a home made diet complete and balanced on Fullscript here: https://us.fullscript.com/plans/seatoskyholisticvet-home-made-food-balancing-supplements but only get the ones that we discuss since if we use these when we don't need them we can do too much of some things
We can create tailored recipes with ingredients that will make up a lot of these deficits and I can give you very specific supplement guidelines to just supplement the few remaining things
We can use a human (not pet those are way too low in everything) multivitamin which will be less exact but will at least be close to minimums for most things
Rough dosing for a human multivitamin would be 1/4 tablet a day for every 25 lbs your pet weighs
A good human multivitamin is Thorne Basic Prenatal (I know it sounds weird but the prenatal is better than the regular multivitamin since it has some extra vitamins). Dose is 1 capsule for every 1000 kcals (Calories) of food
So if your pet is 50 lbs they'd need 1/2 of a human multivitamin a day
I can send some generic recipes that were created on BalanceIt.com to give you an idea of what those look like and ratios of different ingredients, etc and you can just use those if you follow the instructions and use their Balance It supplement, since they're just generic recipes they're all about 1000 kcals (Calories) so you may need to do some math based on how many kcals or Calories your pet actually needs a day and how big of a batch you want to make
Type option 4
Other
How Much to Feed/Diet Plan
Feed about 150 Calories a day total
Feed about 200 Calories a day total
Feed about 250 Calories a day total
Feed about 300 Calories a day total
Feed about 350 Calories a day total
Feed about 400 Calories a day total
Feed about 450 Calories a day total
Feed about 500 Calories a day total
Feed about 550 Calories a day total
Feed about 600 Calories a day total
Feed about 650 Calories a day total
Feed about 700 Calories a day total
Feed about 750 Calories a day total
Feed about 800 Calories a day total
Feed about 850 Calories a day total
Feed about 900 Calories a day total
Feed about 950 Calories a day total
Feed about 1000 Calories a day total
Feed about 1200 Calories a day total
Packages may say something like 100 kcal/cup same as 100 Calories per cup
If you follow the instructions on the package it is usually about double what your pet actually needs
Total includes treats
Just a starting point, your pet may need a little more or a little less just depending on their metabolism, activity level, etc
Good low calorie treat options include freeze dried treats (liver, lung, etc) which can be finely diced into small high value treats, bonito flakes, and veggies
Treat balls, lick mats, frozen peanut butter kongs, snuffle mats, puzzle feeders and slow feeders can all be good ways to keep them occupied and fed without a lot of calories
At a healthy lean weight you should be able to see a waist from above, there should be no "kitty beer belly" and you should easily be able to feel ribs when you place your hands behind their shoulders without pressing
At a healthy lean weight you should be able to see a waist from above, see a few ribs in a short haired animal, and you should easily be able to feel ribs easily when you place your hands behind their shoulders without pressing
Too skinny would be if your hands fall into the spaces between the ribs
If your pet gets too skinny it's easy to increase the amount of food and get them to put weight back on
Weight is good, continue current amount of food!
Increase calories/food intake about 10%
Decrease calories/food intake about 10%
The most accurate way to measure the amount of food is by weight not by volume (cup, teaspoon, etc) or "eye balling" or even "half the package" since there can actually be slightly different amounts in each package
There are lots of cheap digital kitchen scales available
You can "tare" the scale by placing the bowl or whatever you want to measure the food in on the scale and then press the zero or on button. Then it will just measure the things you add to the bowl
Other
Fiber
Fiber helps to feed the "good bacteria" in the gut and helps normalize the function and movement of the intestines and colon
Adding more fiber can help with diarrhea
Adding more fiber can help with constiptation
Fiber can be used all the time and increased (can try double your usual dose) if we're having flare ups of issues or can just be used "as needed" for flare ups
Psyllium husks are a natural soluble fiber
Metamucil is psyllium and there's a vet brand called Vetasyl but you can also find many other brands of psyllium husks at the grocery store, online (including my online dispensary Wellevate.me/aja-senestraro), etc and it can come as powder, capsules, or wafers (some pets like the Metamucil wafers), sugar free is better if possible
Dose is about 1/4-1/2 tsp 2-3 times a day, can increase or decrease as needed
Dose is about 1/2-1 tsp 2-3 times a day, can increase or decrease as needed
Dose is about 1-2 tsp 2-3 times a day, can increase or decrease as needed
Dose is about 2-3 tsp 2-3 times a day, can increase or decrease as needed
Dose is about 1-1.5 Tbsp 2-3 times a day, can increase or decrease as needed
Dose is about 2-3 Tbsp 2-3 times a day, can increase or decrease as needed
Wheat bran is a natural insoluble fiber, because it's insoluble fiber it can be a natural stool softener as well
Wheat bran is available at the grocery store
Dose is about 1/4-1/2 tsp 2-3 times a day, can increase or decrease as needed
Foods that are naturally high in fiber include legumes (lentils, beans, peas, chickpeas, etc), oats, barley, quinoa, sweet potatoes, carrots, broccoli, pears, chia seeds
Since fiber is a "prebiotic" feeding the "probiotics" many probiotics and other GI, gut, digestive health, and anal gland supplements will have some fiber too although typically relatively small amounts
Type option 4
Other
Prebiotics, Probiotics, Microbiome
Probiotics can be helpful for many issues but we're still trying to figure out best doses, strains, timing, etc
Because of this and the fact that each individual pet is going to have different needs it's good to rotate through different products
Prebiotics are substances that "feed" the good bacteria. There are many but it includes many types of fiber and complex carbohydrates found in fruits, vegetables and legumes
In people Lactobacillus rhamnosus in Culturelle showed improved cognitive function
in people Bifidobacterium longum as well as multiple strain (Lactobacillus and Bifidobacterium) probiotics have heslped with anxiety and depression
In people several different probiotic products have helped with allergies including Bifidobacterium longum and lactis and Lactobacillus casei
A probiotic strain commonly recommended to help rebalance flora after a disruptive event like oral antibiotics, major illness, hospitalization or anesthesia is Sacchromyces boulardi
Some good pet brands widely available include Synacore and Proviable
Some good human brands widely available include Visbiome, Culturelle, Pure Encapsulations
I have some good recommendations available under my Probiotics protocol on my online dispensary Fullscript: https://us.fullscript.com/protocols/seatoskyholisticvet-probiotics
A fecal transplant would be something to consider as well
There have been some good results in people and some limited positive results in animals (just some very small studies in dogs with diarrhea)
However we'd want to be very careful about the donor as the gut flora affects lots of things and we still know very little about all the other potential effects
Fecal transplant can be done with an enema or with oral capsules
There is a commercial oral capsule option from Animal Biome (animalbiome.com)
If using Animal Biome you just need the fecal capsules not all the other stuff they try to upsell you
Other
Omega-3 Fatty Acids
Pets only really get benefits from 2 specific Omega-3's: EPA and DHA
Best sources are fish oil, algae, and specific EPA+DHA supplements
For some diseases really high doses of these have been found beneficial but it's hard to get doses that high without using EPA+DHA only supplements or giving a lot of oil
Also those were dogs eating processed foods and not getting any other supplements or holistic treatments
So I think that we can do a lower dose and still get benefits but I'll give you the high end of the dose too
We do have to watch the calories with oils based supplements as well
For cats a good target dose is about 100-300 mg of total EPA+DHA a day
This usually works out to about 1 human fish oil capsule a day
Your pet's dose would be about 400-1500 mg total EPA+DHA
Your pet's dose would be about 600-2000 mg total EPA+DHA
Your pet's dose would be about 800-3000 mg total EPA+DHA
Your pet's dose would be about 1000-3500 mg total EPA+DHA
Your pet's dose would be about 1200-4500 mg total EPA+DHA
Your pet's dose would be about 1600-6000 mg total EPA+DHA
Your pet's dose would be about 2000-8000 mg total EPA+DHA
Your pet's dose would be about 2400-10000 mg total EPA+DHA
Your pet's dose would be about 2800-12000 mg total EPA+DHA
Your pet's dose would be about 3200-14000 mg total EPA+DHA
Your pet's dose would be about 4000-15000 mg total EPA+DHA
Some good high concentration options include Pure Encapsulations EPA/DHA 1000, OmegaGenics EPA/DHA 1000
EPA and DHA supplements are widely available online or locally, quality can vary and many products (even ones marketed for pets) are actually pretty low in EPA and DHA
I have a list of bunch of good brands that are pretty high in EPA and DHA on my online dispensary Fullscript: https://us.fullscript.com/protocols/seatoskyholisticvet-omega-3-s-and-6-s
Foods that are naturally high in EPA+DHA include fish and shellfish, especially salmon (all species, canned, frozen, fresh), tuna, trout, mackerel, herring, sardines, anchovies, mussels, oysters, clams, shrimp, crab, lobster
Feeding a real food diet that is based on one of these "oily" fishes typically provides levels of EPA+DHA around the low end of the therapeutic doses
Other
Additional Notes on Food/Nutrition
Discussed musculoskeletal issues and joint health
We can't "cure" the bony changes of arthritis but we can reduce pain and improve mobility and optimize Quality of Life
We can't "fix" the underlying problems but we can work to reduce inflammation and pain to help everything work as well as it can for the most normal mobility and best Quality of Life possible
There are surgical options available
Braces can be used but must be custom fit and are intended to be worn all the time
Add runners/rugs to help with stability especially on stairs and by the food/water dishes
Environmental modifications below can make a big difference
Motion is lotion and massage and rehab exercises are some of the most effective treatments
Try stairs/ramps to make access easier, often takes some patience and treats to encourage them to use it but once they figure out it feels better they usually use it pretty well
Try elevating food/water dishes so your pet doesn't have to reach so far down which can put extra weight and abnormal forces on the front legs and neck and be uncomfortable
Avoid explosive activity such as running, jumping, twisting, playing with other dogs
Controlled leash walks and controlled rehab work is fine
Jumping down and running/jumping down stairs is hard on the front legs and especially on the neck and spine
Encourage use of ramps or padded small stairs
May take a while but usually will use them if you're persistent
Lift them down, carry down stairs when possible
If there are places you know your pet will jump down put memory foam rugs or anti-fatigue kitchen mats down so at least the impact isn't so severe
Tailor activity to levels that maintain the Quality of Life aspects but don't make your pet tired or sore
Signs that walks are too far including them lagging behind you, plodding, not interested in smelling things or checking out surroundings
"Token walks" are fine just in the yard or a couple houses down so they can get the experience of the walk without getting tired
Can drive them to parks or different neighborhoods so they can get new smells even with short walks
May need to walk separately from other pets
Consider a wagon or stroller so they can still get the Quality of Life benefits of a walk
"Motion is Lotion" but they get quite a bit of exercise moving their joints just walking around the house so they don't really need long walks at this point
Getting to a lean healthy weight is important since fat is inflammatory and puts extra weight on the joints
Massage and rehabilitation work that you do in between visits will really help
Laser rental or purchase is an option so you can provide laser therapy to reduce pain and inflammation for your pet in between visits, see below for additional information
PEMF (Pulsed Electromagnetic Field Therapy) is another non-invasive option, more information on this below
In person appointments for acupuncture, laser, massage, and chiropractic treatment all help
We can also do supplements for the joints
I have some reputable brands for a variety of joint supplements with dosing listed on my online dispensary Fullscript: https://us.fullscript.com/plans/seatoskyholisticvet-joint-support
Continue the supplements your pet is already on to help their joints!
Continue the glucosamine/chondroitin supplement for your pet's joints
Some studied and effective joints supplements include omega 3's, Green Lipped Mussel (GLM, Perna canaliculus) UC-II (undenatured type II collagen), hydrolyzed collagen, glucosamine + chondroitin, colostrum, herbal medicinals
There is individual variability in how well particular supplements work plus differences in forms available (powder, liquid, chews, etc) as well as other ingredients/allergens that might be in the product. All of these things can affect whether your pet should or will take it so the best one may be the one your pet takes reliably and doesn't cause issues with any allergens
Some reputable brands and dosing for Omega 3's are below
Some reputable products for Green Lipped Mussel include GlycoFlex II and III, YuMove, DaVinci Perna, and you can get freeze dried whole green lipped mussels. Dose is about 100-300 mg of mussels a day for every 10 lbs your pet weighs. The vet brands dosing on the package is on the low side but an ok starting point
Some reputable products for UC-II include Flexadin, Healthy Origins UC-II. It actually works by modulating the immune system, it doesn't get absorbed really so the dose is 40 mg for all animals. Note that pretty much all UC-II is derived from chickens so may be an issue with chicken allergy
Some reputable products for hydrolyzed collagen include Sparkle Wellness Joint Boost, Designs for Health Whole Body Collagen, Sports Research Marine Collagen, Ancient Nutrition Multicollagen Protein. Dose is a variable range starting from 150-500 mg a day for every 10 lbs your pet weighs. 500 mg is about 1/8th tsp
Add glucosamine/chondroitin supplement (Cosequin/Dasuquin are good brands)
Some reputable products for glucosamine/chondroitin include Nutramax Dasuquin/Cosequin, K9 Glucosamine Liquid, Kirkland Glucosamine/Chondroitin. There is a Cosequin for horses unflavored powder that can be used in cats and dogs, dose is about 1/8th tsp per day per 10 lbs (so 1/4 tsp for a 20 lb dog, 3/4 tsp for 60 lbs, etc). Dose on package of the pet products is a good starting point. Dose is around 1500 mg a day total for pets under 35 lbs and around 3600 mg a day for pets larger than that
Colostrum is another natural anti-inflammatory. It does not contain any milk sugars like lactose. Some reputable products are Duralactin and Microlactin dose is by weight on package
Another option is an Assisi Loop which is a PEMF (Pulsed Electromagnetic Field) device which works similarly to the laser in that the PEMF affects the tissues and leads to reduced inflammation and pain
There are pharmaceutical options for pain management as well
Do Passive Range Of Motion (PROM) stretches, just gently move each joint back and forth bending and extending in a comfortable range
Do PROM stretches 3-5 times back and forth daily if possible
Other
Environmental Modification Recommendations
Great work on the modifications you're already doing!
Can add rugs, runners, mats (rubber, antifatigue, puzzle piece, etc) for traction
Traction around food/water is really important
Traction on the stairs and especially the landing is really helpful
Elevated food/water dishes help joints, spine, balance
Consider Help Em Up harness, can wear all the time. Here's a referral link to purchase: https://pawprospershop.com/?referral-code=102279283054
Can try booties look for "shoe" type (Ruffwear, etc) with rubber soles for traction
Booties need to come off part of the day for the foot to breathe though
Can try paw protectors rubber covers like Pawz
Can try Dr Buzby's Toe grips
Can try Paw Friction sticky stuff for paw traction, can try climber's chalk
Try firm "orthopedic" bed vs really soft one
Consider walking separately
Consider a wagon/stroller
Consider a carrier/backpack/sling
Don't have to use all the time but can help make walks doable and enjoyable for everyone
Consider baby gates or "ex pen" to create smaller worlds
Consider moving things closer together so it's easier to access
Consider adding more litterboxes
Try pet stairs/ramps or create your own small steps or jumps to make it easier
Encourage use with treats and positive reinforcement and they may eventually use it if you leave it out even if they don't at first
If there are places you know your pet will jump down use padding where they jump like a memory foam rug, antifatigue kitchen mat, or even a foam pad like a balance cushion, make sure whatever it is doesn't slip or it will make them afraid to jump down onto it
Air purifiers and HEPA filters can reduce environmental allergens
Aim for humidity between 30-50% (can get a hygrometer on Amazon, etc cheaply to measure) to help with allergies, breathing, coughing, asthma, nasal congestion, and other respiratory issues
Can use a humidifier if it's too dry
Can use a dehumidifier if it's too humid
Can use halo like Muffin's halo so don't bump into things. Here's a referral link to purchase Muffin's Halo https://pawprospershop.com/?referral-code=102279283054
Can put child proof corner and edge protectors on things so they don't bump into them, can DIY with pipe insulation
Try to keep extra cool
Can use small/personal fans on/near them
Can try cooling mats, vests, bandanas, etc
Avoid activity during hottest times
Can try kiddie pool
Swimming is ok but it is hard work so be careful not to overdo and use a life vest so they don't have to work too hard
Can try heated beds (ones for pets are designed to not get too hot, turn off, etc)
Can try an infrared heat lamp but only for 5 minutes at a time
Can try wearing Thundershirt all the time
Can try wearing sweater/jacket more often/all the time
Type option 4
Other
Massage and Bodywork Recommendations
Pick up loose skin and "walk it" along the neck and back
Can go down the shoulders and thighs as well
Gently rub the neck and back on either side of the spine
Gently rub the inside of the thighs
Gently rub the biceps muscles along the front of the front legs
Gently rub the latissimus dorsi muscles from the shoulder up to the spine over the rib cage
Gently rub the face, this stimulates the same area of the brain that gets signals from the legs so it can help it "practice"
Gently rub the belly starting towards the direction of their head and moving in the direction of the tail
Gently rub the belly starting towards the direction of their tail and moving in the direction of the head
Start off very lightly just petting and slowing increase the depth and pressure of the rubbing
Very light gentle "petting" around the injury/painful area is ok and helps to turn of the pain pathways
If it's too much and uncomfortable for them they'll let you know
Gently shake the whole leg
Rub like you're trying to warm up your hands all along the legs and bottoms of the feet to stimulate nerves
Do "puppy kegels" to help sphincter function, gently tap around the anus and vulva a few times
Do "puppy kegels" to help sphincter function, gently tap around the anus a few times
Do "kitty kegels" to help sphincter function, gently tap around the anus a few times
Tickle or even gently squish the toes to get them to pull their leg back, this helps the nerves fires and keeps muscles and joints functioning
Do massage daily if possible
Massage helps stimulate nerves, normalize blood and lymph flow, and turn off pain signals
I have some videos to give you an idea of some different massage you can do on my website https://www.seatoskyholisticvet.com/pandemic-resources/massage
Keep up the good work, your pet had less muscle tension today!
Continue doing massage for your pet
Other
Rehabilitation & Exercise Recommendations
Rehabilitation & Exercise Recommendations
Stairs can be great rehab IF your pet goes slowly and does one foot at a time
If your pet just wants to hop up or "controlled fall" down then it's not really helpful and should be avoided as much as possible
Especially going down at high speed/out of control is hard on the spine, neck and front legs
Do "puppy squats" having your pet sit and then quickly stand up to work on hind leg strength and moving the hip and knee joints
Do them 3-5 times in a row 1-2 times daily if possible
Have your pet walk backwards to work on weight bearing, joint movement and nerve function
Do 5-10 steps backwards 1-2 times daily if possible
May need to do it along a wall if they want to cheat
Do "pushovers" where you (gently!) push their hip towards the opposite side. This works on core strength, leg strength, nerve function and balance
Do 3-5 pushes in each direction 1-2 times daily if possible
Do 5-10 pushes in each direction 1-2 times daily if possible
Have your dog put their front feet up on something. The higher it is the more it stretches the back, extends the joints of the back legs and works on weight bearing in the back legs
Start relatively low and work up to higher things like the couch
Making the thing their standing on less stable (foam pad, dog bed, throw pillow, wobble cushion, etc) makes it more challenging
You can add some pushovers or 3 legged standing to front feet elevated work for extra challenge
Do front feet elevated 10-30 seconds 1-2 times daily if possible
Have your pet go in circles both directions (or a full Figure 8) which works on weight bearing, flexibility, balance, core strength and nerve function
Start with large circles ~6 feet diameter and make them smaller as your pet improves
Start with large circles ~4 feet diameter and make them smaller as your pet improves
Keep the circles large enough that your pet has to move the inside back leg not just pivot on it
Do 2-3 circles each direction 1-2 times daily if possible
Do 5-10 circles each direction 1-2 times daily if possible
Have your pet do cavalettis (walking over obstacles). This works on balance, body awareness, nerve function, joint movement and strength.
The key is WALKING not jumping or hopping over the obstacles
Make sure they go slow so they have to walk and can't hop over
Can use your legs, broomsticks, a row of canned goods, home made or store bought obstacles (search for practice hurdles or dog agility equipment)
Do 5-10 steps 1-2 times daily if possible
Use the sidewalk curb to work on walking up and down a step. This works on balance, nerve function, body awareness, joint movement and strength
Go slow so your pet has to step one foot at a time not just jump or hop
Do 3-5 steps up and down the curb 1-2 times daily if possible
Do 5-10 steps up and down the curb 1-2 times daily if possible
Walk uphill 1-2 times a week to work on hind leg strength, weight bearing, and joint movement
Walk uphill 3-5 times a week to work on hind leg strength, weight bearing, and joint movement
Pick up 1 leg (can be just a little bit off the ground) so your pet has to balance on the other 3 legs. This helps with balance, strength, core strength, and weight bearing
Have your pet balance on 3 legs for 5-10 seconds 1-2 times daily if possible rotate which leg you hold up
Rotate which leg you hold up, the most challenging will be the diagonal leg of the leg(s) that are affected
Add "cookie stretches" to front feet elevated so they have to lean side to side to get a treat, this increases the difficulty and works on extra weight bearing, strength and flexibility
Have your pet follow a treat towards each shoulder to work on neck range of motion
Have your pet follow a treat towards their tail to work on lower back range of motion
Have them follow a treat to the left and the right 3-5 times 1-2 times daily if possible
Have them follow a treat to the left and the right 5-10 times 1-2 times daily if possible
Encourage your pet to walk sideways. You can gently walk "into" their side or sometimes you can encourage them with a treat. Works on joint motion, flexibility, balance, strength and nerve function
Do 3-5 steps sideways in each direction 1-2 times daily if possible
Do 5-10 steps sideways in each direction 1-2 times daily if possible
Encourage your cat to reach for toys to work on moving the joints
If your cat will stand up to beg for food or go after a toy that's great rehab for the back and hind legs!
Walking across the bed or couch is good rehab to work on nerve function and strength
Have your pet do 3-5 "laps" walking across the bed or couch 1-2 times daily if possible
Have your pet do 5-10 "laps" walking across the bed or couch 1-2 times daily if possible
Here's are some referral/affiliate links to some of the rehab equipment like what I use but you can get creative with stuff around the house too: https://www.seatoskyholisticvet.com/pandemic-resources/pet-fitness or https://pawprospershop.com/?referral-code=102279283054
This YouTube channel from a vet clinic that does rehab has lots of good quick videos of different exercises to give you ideas but it's ok if it doesn't look exactly like the video https://www.youtube.com/@westdelrayveterinary3267/videos?view=0&sort=dd&shelf_id=0
Don't try to do every single exercise every day since you won't have time for anything else and your pet will get tired/frustrated
Try to do 2 or 3 exercises each day and switch them up
Even if you can't do all the reps or can't get to it every day it will still be helping your pet!
Your pet can determine their own exercise levels
All movement is good to keep nerves firing
All the things we're already doing help to slow progression of disease
All movement is good to help the joints, muscles, and tissues
Motion is lotion!
Continue doing rehab exercises
Continue to encourage movement and play
Other
Laser Therapy (Photobiomodulation, Low Level Laser Therapy, Cold Laser, Therapeutic Laser)
Laser therapy uses near infrared wavelength light which is not visible to the human eye. The light we can see coming from the laser is mostly so we know it's on, we can't see the infrared light. Near infrared light goes into the tissues and cells and hits the mitochondria and changes what they are doing
It "turns off" pain and inflammation pathways and "turns on" tissue healing and repair pathways
Laser helps with any inflammation and/or nerve issues, also stimulates acupuncture points
It's often used in human physical therapy and to help wounds and surgical incisions heal faster
Usually doesn't feel like anything but can feel warm or tingly
There are different "strengths", the one that I use and the ones you can rent are lower strength so no risk of burns even if used in one area up to several times a day
I can set up laser rental for you through a company called Medco Vet for a handheld laser that looks similar to mine but is a little less powerful, that is $40/week or $1500 to outright purchase
You can rent or buy another brand of laser called Respond directly from their website (respondsystems.com). It is more powerful than the Medco one but it's a larger machine (about 5 lbs) with a connected handheld portion
You can buy a laser. They are expensive but it's an investment. You can buy the laser I use (Multiradiance TQ Solo or My Pet Laser) on Amazon. Another handheld option is B Cure laser which you can order directly from their website
If you already have a laser or would like to try another brand look for wavelengths between 650-950 nm and lower Watts (power) is ok, it just means it will take longer to have the same effects. For reference the one I use is 500 mW, both the Medco Vet rental laser and the B Cure brand laser are 250 mW.
You can hold it in one spot or move it around. You can use it over neck, back, legs, joints, belly, anal glands, outside of mouth, etc
Avoid shining it directly in their eyes (if they look at it for a few seconds it's not a big deal)
The official recommendation is not to use it on tumors since theoretically it could stimulate the malignant cells but it can still be used in other areas of the body
Continue doing laser for your pet
Other
PEMF (Pulsed Electromagnetic Field Therapy)
Uses specific pulsed electromagnetic frequencies which releases nitric oxide and increases microcirculation.
This allows the substances involved in pain and inflammation to get out of the area and the substances that allow for tissue healing and cell nutrition to get into the area
Lots of research in people with arthritis and it's used in human physical therapy
Available as beds or mats in different sizes (more expensive) to treat multiple areas/the whole pet at once but your pet has to lay on it and smaller loops that are less expensive and you can just put it on your pet but don't treat as big an area
Veterinary specific brands are Assisi Animal Health (beds and Loops), Respond (beds) and PetsPEMF (beds)
The treatment area comes out from the loop/bed about 5 inches in both directions (imagine a really long football in the middle of the loop)
Doesn't feel like anything and doesn't make any noise and you can just set it on your pet while they're sleeping or even put it under the blanket/bed where they like to sleep and if you see them there you can just turn it on and treat them
Loop and beds runs automatically for 15-30 minutes, Loop battery lasts longer if you wait 2 hours between treatments but not necessary
For both Loop and beds if your pet gets up or doesn't want the full automatic treatment time that's ok, it's still helpful. You can turn the PEMF device off so you don't "waste" it especially for the Loop since it has a limited life span.
Loop does have a limited number of uses (several hundred) then will need to be replaced
You can get the Loop from Amazon, Chewy, or from my online pharmacy (https://seatoskyholisticvet.vetsfirstchoice.com)
You can get the Assisi beds/mats on Amazon/Chewy, direct from PetsPEMF.com, or Respond ones with this referral link: https://pawprospershop.com/?referral-code=102279283054
Comparing laser vs PEMF if both are an option then do both, they work through different pathways and are both helpful. PEMF does go a little bit deeper into the tissue than laser. Mostly it just depends on what makes sense for you and your pet as far as cost, what your pet tolerates, etc
Continue using PEMF for your pet
Continue using Loop for your pet
Other
Pharmaceutical Recommendations
Pharmaceutical Recommendations
Gabapentin is for nerve pain
It's very safe and has no side effects on the liver or kidneys
Gabapentin does slow nerve firing which helps pain for abnormally firing pain nerves but it slows nerve firing to regular nerves too so it can cause or worsen hind end weakness, wobbliness type symptoms
Gabapentin can cause general drowsiness
Gabapentin is very safe and we can increase the dose as needed if/when the disease progresses
Gabapentin comes as a liquid or capsule or it can be compounded with flavoring or as a chew or paste
Can use gabapentin it as needed for flare ups or all the time
Probably best to use it all the time for where your pet's disease is at
We can do a trial of gabapentin to see if we notice any improvements in mobility, energy levels, or comfort
An anti-inflammatory would be an option to help manage pain and discomfort
Several options available: carprofen (Rimadyl), robenacoxib (Onsior), derocoxib (Deramax), meloxicam, Galliprant
Carprofen and meloxicam are available as generics so are least expensive
Available as liquid, chewable, capsules, tablet, injectable and as compounded flavored liquids, chews, or pastes
Meloxicam dose would be 1 drop every 3 days (72 hrs)
All NSAIDs (Non-steroidal Anti-inflammatories) can reduce blood flow to the kidneys which can affect their function however it's dose and time dependent so lower dose for a shorter period is less likely to have this effect
Meloxicam at a low dose has been shown in studies to be safe and effective even in cats with pre-existing renal disease
All NSAIDs can cause damage to the liver. However this is an individual reaction, some pets just have it happen regardless of the dose. It typically presents within the first 3 weeks of starting a chronic course. It typically resolves when the medication is stopped. There's no evidence that having pre-existing elevated liver enzymes increases the risk of an individual pet being one that develops this reaction.
All NSAIDs can irritate the GI tract. Galliprant is the least likely to do that since it works through different mechanisms than other drugs in this class. It is dose dependent so higher doses for a longer time are more likely to cause issues than lower doses.
Quality of Life and comfort is most important and needs to be part of a risk vs benefit assessment
The benefits of managing pain with an NSAID likely outweigh the potential risks of side effects
The benefits of managing pain with an NSAID may outweigh the potential risks of side effects
Solensia is an injectable option that binds to one of the things that causes inflammation with arthritis
Each Solensia injection lasts around 4 weeks
Solensia injections can be done at the regular vet or at home
Potential side effects would be local reaction to injection (swelling, pain) and rarely abnormal itching. We'd expect any local side effects to be just a few days and abnormal itching to resolve after the injection wore off in 4 weeks
Steroids would be something to consider to help your pet's issues
There are many forms of steroids including tablets, injectable versions and we can get it compounded as a liquid
Steroids reduce inflammation, they also can increase appetite and overall help them feel good
Steroids can have a number of side effects including GI irritation and upset, immune suppression, drinking more and peeing more, muscle loss, agitation/restlessness, elevated liver enzymes, and other things
Steroid side effects are mainly dose and time dependent, so the longer we use them and the higher the dose the more likely we are to see more side effects and more severe side effects
With all treatments we have to weigh risk vs benefits
Benefits of using steroids to manage symptoms may outweigh potential risks of side effects
Benefits of using steroids to manage symptoms likely outweigh potential risks of side effects
If we want to stop steroids we do have to "wean" off of them. The body makes it's own steroids (cortisol) so when we give steroids for more than a few days the body stops making it's own. If we stop steroids and the body isn't making any that can actually be bad so we want to reduce the steroid dose over time so the body will start making it's own again
We can't combine steroids and NSAIDs since they have overlap in their side effects so we'd really increase risk of side effects especially GI side effects
Tylenol (acetaminophen is the generic name) would be a good pain management option
Tylenol works a little on inflammation but mostly works on pain by affecting the spine and brain's perception of pain and turning off pain signals at those levels
Tylenol can be used with other medications safely
Tylenol is actually has fewer potential side effects than NSAIDs do, at higher doses and very chronic use it can increase liver enzymes but it shouldn't do that at the doses we'd be using
All oral medications can theoretically cause GI upset but Tylenol isn't one we'd expect it with
You may see scary stuff on the internet about Tylenol being toxic to dogs. It is toxic at extremely high doses, so are NSAIDs, and every medication. Even water is toxic at the right dose. The dose we're using is safe and effective
Addressing pain through different pathways is most effective
Chlorambucil would be a medication we could try for inflammation in the gut
It can be used alone or with steroids or other immune modulating medications
Chlorambucil reduces inflammation and modulates the overactive immune system
Chlorambucil comes as tablets or can be compounded as capsules or liquid
Chlorambucil is pretty expensive
Chlorambucil can cause skin irritation so it comes with gloves and because it's used for chemo in people it will come with a bunch of scary labels all over it but it actually has way fewer side effects in pets and is safer than steroids
The major concern is that it can cause low white blood cells but that's actually rare in pets, we can check bloodwork in 6 weeks to be sure that's not happening
Anti-nausea medications are an option to help manage your pet's symptoms
Ondansetron is an anti-nausea medication which comes as a very small tablet
Ondansetron is a generic human medication so it's often available inexpensively
Cerenia is an anti-nausea medication and it also has some pain management effects
Cerenia is not available as a generic so it is pretty expensive
Cerenia and ondansetron work through different mechanisms so you can use both together or start with one and add the other if needed
We could try some Prilosec (generic is omeprazole) once a day to reduce stomach acid and "heart burn" symptoms
Fine to use for up to a week but don't want to use long term since the body will actually start producing more stomach acid
Can do 1 week on and 1 week off if we do need the Prilosec long term
Prilosec dose would be 5 mg (1/4 tablet) once a day
Prilosec dose would be 10 mg (1/2 tablet) once a day
Prilosec dose would be 20 mg (1 tablet) once a day
Prilosec dose would be 40 mg (2 tablets) once a day
Prilosec dose would be 60 mg (3 tablets) once a day
Can try Benadryl (generic is diphenhydramine) for allergies, doesn't work in all pets and can cause drowsiness but it's an option to try
Benadryl dose is the same as their weight and up to double it given 2-3 times a day
For example if your pet weighs 20 lbs their Benadryl dose is 20-40 mg every 8-12 hours
Your pet's Benadryl dose would be 10-20 mg every 8-12 hours
For example if your pet weighs 10 lbs their Benadryl dose is 10-20 mg every 8-12 hours
Can try Zyrtec (generic is cetirizine) for allergies, doesn't work in all pets but it's an option to try and is non-drowsy so really no side effects
Zyrtec dose is your pet's weight divided by 4 up to your pet's weight divided by 2 given once a day
For example if you pet weighs 20 lbs the Zyrtec dose would be about 5-10 mg once a day
Your pet's Zyrtec dose would be 5 mg (1/2 tablet) once a day
Can try Chlorpheniramine (many brands available like AllerChlor, etc) for allergies, doesn't work in all pets and can cause drowsiness but can also help reduce anxiety a little so it's an option to try
Chlorpheniramine dose would be 2-4 mg (1/2 to 1 tablet) every 12 hours
There are medication options for anxiety
Just like in people the response to different anxiety treatments is very individual and variable so it's typical to need to try a couple different doses and combinations of things to find what works best for your pet
Some anxiety medications can be used on an as needed basis (short stressful even like fireworks, car ride), some are best for using everyday and some can be used either way
Some short acting options would be benzodiazepines (Xanax, Ativan), trazodone, and amitriptyline
Benzodiazepines last about 4-6 hours so are best for specific short term stressors (fireworks, visitors, etc), we can use them alone or in combination with other things. There's nothing wrong with using it daily, it just may not be working all day or we might need to give it a couple times a day
Some people feel like benzodiazepines can make them lose inhibitions and make aggressive behavior more likely. Probably this is more an issue with people thinking the drugs are magic and not continuing to avoid triggers and watch body language but you may hear about "disinhibition" with this class of drug
Trazodone lasts about 12-24 hours and can also be used as needed or can be used daily
Amitriptyline lasts about 12-24 hours as well so can be used as needed or every day
Long acting ones would be SSRI's like Prozac. These do take a while to get to full effects, up to 6 weeks of giving them daily, so if we wanted to try it we'd want to plan on using it every day for at least 6 weeks to decide if it was helping. Yes we do typically "wean off" SSRI's by tapering them down if we want to stop them
We can do SSRI + one of the short acting things for extra stressful times or events
All SSRI's can decrease appetite and interest in food
Side effects of all anxiety medications are potentially drowsiness and wobbliness. The higher the doses and the more we combine the more likely we are to have those side effects. All of them are safe to be on long term if needed. Because brains are complicated all of these anxiety medications can either just not work at all or can actually kind of have the opposite effect and make pets seem more anxious. Rarely combining multiple at high doses can cause something called serotonin syndrome which actually causes more anxiety and restlessness
It is common to need to make dose/medication adjustments with anxiety medications to find what works best for your pet. If we're seeing drowsiness we can try lower dosing. If we're not seeing effects we can try higher dosing or just a different medication. If anything seems to make things worse we can stop it and try a different medication
With any human over the counter products double check that it's just the drug you're looking for and no extra aspirin, acetaminophen (Tylenol), salicylates or other drugs in it which could be harmful for your pet
With any human over the counter and especially liquids double and triple check that there's no xylitol in it as this artificial sweetener is very toxic to dogs
If you're not sure if a human product would be safe just text or email me a picture of the ingredient list or the bottle and I can check quickly for you (these consults by text or email are charged the same hourly rate as in person appointments)
Continue your pet's medications as prescribed
Continue the rest of your pet's medications as prescribed
For over the counter medication you can get that at any drug store or grocery store
Other
Prescription Medications
For prescription medications there are several options to get these: the easiest is for you to order them from an online pharmacy, I can also set up a prescription through a couple specific online pharmacies, I can call some medications into a local "human" pharmacy, or I can give you a written prescription that you can take to a local pharmacy
Local pharmacies will carry medications that humans also use but check goodrx.com/pets for coupons as some human medications can be very expensive
Costco and Walmart regularly carry veterinary medications that other drug/grocery stores don't usually carry (you don't need to be a Costco member to use their pharmacy)
There are many online pet pharmacies. I have accounts with Chewy, VetSource (https://seatoskyholisticvet.securevetsource.com), and Covetrus/Vets First Choice (https://seatoskyholisticvet.vetsfirstchoice.com). Amazon carries limited pet prescriptions (mostly flea/tick prevention but also Apoquel and Pimobendan) and they are fulfilled by VetSource. These pharmacies already have all my licensing info, etc so they notify me a prescription is waiting for approval and I can approve it with a couple clicks. I do make a very small percentage from these pharmacies.
If you use my practice specific VetSource or Covetrus links all you have to do is put the meds in your cart and add your pet's info and check out. It's already linked to me and I'll automatically get notified for approval. Vetsource: https://seatoskyholisticvet.securevetsource.com. Covetrus/Vets First Choice: https://seatoskyholisticvet.vetsfirstchoice.com
For Chewy and Amazon pharmacy orders you'll have to search or enter my contact information and they'll contact me for approval. Search for Sea to Sky Holistic Vet and it should let you select me as the vet and they'll send it to me for approval. Let me know if it's been more than 24 hours since you requested a medication and send the order number just in case they don't actually notify me so I can call them and approve it. If they ask for it make sure that you put in all my info correctly (Dr. Aja Senestraro seatoskyvet@gmail.com 425-492-0323, no fax)
There are other online pharmacies out there too but because they don't have online portals for me to set up an account they have to call me to verify and it can be longer to get prescriptions approved. You'll have to enter my contact information and they'll contact me for approval. Let me know if you do that and send the order number just in case they don't actually contact me so I can call them and approve it.
If you'd prefer I can set up the prescription through VetSource or Covetrus/Vets First Choice for the right medication and size and pre-approve it and you just have to put in billing and shipping info and they'll send it to you.
The major online pharmacies have algorithms for price matching for most of the common medications so price is usually similar between online pharmacies
Online pharmacies are usually cheaper than local pharmacies but not always so you can check goodrx.com/pets as well
We can get medications compounded into different forms like flavored liquids, tablets, capsules, even gels that absorb through the skin for some medications
We can get compounded versions of the medications that are more concentrated so you can give a smaller volume of liquids or we can get multiple medications in one liquid, tablet or capsule so you can give fewer things
I can set up prescriptions through several different national compounding pharmacies and many things are available through Chewy, Covetrus, and VetSource
Compounded medications are typically more expensive since they are made specially for each patient
Occasionally the pharmacy (local or online) will not contact me (or will try to send a fax even though I have no fax number) and will then tell you I cancelled the prescription or wouldn't approve it. I typically approve prescriptions within a few hours of being notified about them. Also I would only ever decline a prescription if it was the wrong medication or size and if I did I would let you know
Note that calling in prescriptions and setting up prescriptions via my online pharmacies and/or compounding pharmacies can take anywhere from 5-10 minutes per medication and this time is billed at the usual hourly rate.
However I don't charge for doing quick approvals for medications you've requested since that is just a few clicks
Other
Comfort Kit/Crisis Kit
I can give you injectable calming/sedation medication that you can use in case of a crisis or as part of hospice assisted natural death
I'm leaving you an injectable calming/sedation medication you can use in case of a crisis or as part of hospice assisted natural death
It's a combination of butorphanol (mild opioid) and midazolam (like valium) so just calming and a little pain management
Won't cause euthanasia, just help keep calm and relaxed
Can be given under the skin, into the muscle on the back or thigh, you can unscrew the needle and give orally, you can unscrew the needle and screw on the little attachment and give rectally
If you don't end up needing it you can squirt it out onto coffee grounds or kitty litter or something like that do destroy it
Remember that you have things available to use in case of any sort of sudden decline/change or urgent situation
Other
Herbal Recommendations
Herbal Recommendations
We can add Quercetin as a "natural Benadryl" anti-histamine and anti-inflammatory to help with allergies
Human products are good and often contain Bromelain as well which is fine
Some good brands are bulksupplements.com for powder, MRM, Solaray, Solgar, Jarrow for capsules, Source Naturals for liquid
Available at the grocery store or drug store, on Amazon or if you have concerns about sourcing I can set up a recommendation for a trusted brand direct from a distributor
Dose is the same as for people so what ever the dose is on the bottle for people it would be the same for your pet
For Standard Process products I can order them and have them shipped to you (more expensive option) or you can go directly to their website (standardprocess.com) click on Patient Direct and register using my code (N4TAT9) to order the product yourself
Chinese Herbals by Mayway/Plumflower are often available on Amazon but if not or you're worried about sourcing I can order them directly and have them shipped to you and add that to the invoice
Chinese Herbals by Kan Herbs are often available on Amazon but if not or you're worried about sourcing I can set up a prescription directly through Kan Herbs
Chinese Herbals by Jing Tang, Blue Poppy, and Golden Flower are only available by prescription but I can order it for you and have it shipped to you and add that to the invoice
Use Yunnan BaiYao for bleeding
Can order from yunnanbaiyaousa.com, I can sell it to you or you can get it from any local Chinese herbal shop
The dose is variable and can be increased
Save the little red pill (in bottle or in the middle of the sheet of capsules for emergencies
Can do Ashwagandha for anxiety (also has some anti-inflammatory and anti-seizure properties)
Available as liquid, capsules, loose powder
For liquid look for a glycerin extract since alcohol extracts don't taste good
Good liquid options include Nature's Answer Ashwagandha or Ayush for Kids Ashwagandha
Ashwagandha root powder from Mountain Rose Herbs is a good powder option
Capsules from Nature's Way Ashwagandha or Sundown Naturals Stress Support are good options
Dose is 1-2 drops a day, can be increased if needed
Dose is 2-3 drops a day, can be increased if needed
Dose is 3-4 drops a day, can be increased if needed
Dose is 1 mL a day, can be increased if needed
I have links to some herbs on my website https://www.seatoskyholisticvet.com/pandemic-resources/herbal-links
You can find many of these herbs on my online dispensary Fullscript: us.fullscript.com/welcome/seatoskyholisticvet or specifically here: https://us.fullscript.com/protocols/seatoskyholisticvet-commonly-used-traditional-chinese-herbal-medicinals although they don't carry everything so some things I may have to order directly and have shipped to you
I have a "protocol" on Fullscript with a bunch of good Mushroom brands for both individual mushrooms and some blends: https://us.fullscript.com/protocols/seatoskyholisticvet-mushrooms-for-immune-support
Other
Additional Nutraceutical Recommendations
CBD Information
Because of federal DEA regulations I can't actually prescribe or possess CBD but I can discuss published information including how it works, published dosing information, side effects and potential issues with quality
CBD (Cannabidiol) has been shown to help with pain management, seizure management, allergies, nausea, and anxiety
Dosing is really variable and individual, published doses range from 2-3 mg CBD up to 40 mg CBD for every 10 lbs of body weight
Dosing on packages is typically intentionally very low
Higher doses may cause drowsiness, stumbling or acting "drunk", and can cause GI upset
CBD products should never contain more than trace (should be 0.3% or less) amounts of THC. THC causes the "high" of marijuana and makes pets anxious, agitated, and nauseous and is not appropriate to use in pets
Full spectrum products contain other molecules from the hemp plant which may act synergistically and increase the benefits of CBD
CBD isolates may be less strong smelling/tasting and better tolerated than full spectrum
CBD can interact with other supplements, herbs and medications that are processed in the liver and can cause elevated liver enzymes at high doses for a long time
As with all supplements there can be quality control issues; look for products which have done 3rd party testing to confirm purity. Consumer Labs and NASC both do 3rd party testing and certify products as well
I can't recommend any specific brands but here are a few which have done independent testing and contain the amount of CBD they claim and no THC at all: HempRx by Rx Vitamins for Pets, Garden of Life, Charlotte's Web, Elixinol, Manitoba Harvest, Plus CBD, Swanson's
There may be many other good brands as well. CBD is available as chews designed for pets, capsules, or liquid. For human products there is sometimes flavoring which some pets may or may not like. All the ones listed above also have no xylitol (toxic to dogs), avoid gummies marketed for people as they're high in sugar and may have xylitol
Should say how much CBD in mg per capsule, per dropperful, per mL or per drop
If you need to calculate the dosing and it just says total mg of CBD in the bottle then divide that total CBD by number of mL in bottle. This gives you amount of CBD per mL. Most droppers are 1 mL. If you want to know how much CBD per drop divide the amount of CBD in a mL by 20
If you want me to look at the ingredient list to double check it looks ok and/or to help you figure out the dose you can always email or text pictures (those consults are the same hourly rate as in person appointments)
Other
Diarrhea Treatments
Unfortunately there's nothing that really stops diarrhea it's all just symptomatic treatment
Can try BioSponge for diarrhea
Basically a clay which binds bacterial toxins and helps slow transit through the intestines to help stop diarrhea
Available online through the manufacturer Platinum Performance (Platinumperformance.com)
Available as capsule, paste or loose powder, dosing is by weight on the package
Powder or paste is probably the easiest to dose for your pet's size
Another option for diarrhea is a product called Diagel
It's a gel with some natural anti-inflammatories in it which helps slow things down and reduces inflammation
It's best for acute diarrhea but can sometimes help with chronic diarrhea as well
Good to have on hand in case of a flare up of diarrhea
Another option is a slippery elm "sludge" which helps kind of coat the GI tract, bind bacterial toxins and slow things down a bit
I'll send a recipe for that
I'll send a handout on a bunch of things we can do supportively for diarrhea
Other
Melatonin
Melatonin is a hormone naturally produced in the body
Melatonin is involved in sleep and normal sleep/wake cycles
Melatonin is also an antioxidant and anti-inflammatory
Melatonin can help slow neurodegenerative processes
Melatonin can help with some types of hair/coat thinning
Dose is 3 mg every 12 hours
Dose can be variable depending on what we're treating
For sleep we usually start with 3 mg about 1 hour before "bedtime"
We can increase or decrease the dose as needed
Dose is 3 mg once a day, you can give it with dinner or about 1 hour before "bedtime" if your pet seems sleepy after
Dose is 6 mg once a day, you can give it with dinner or about 1 hour before "bedtime" if your pet seems sleepy after
Dose is 9 mg once a day, you can give it with dinner or about 1 hour before "bedtime" if your pet seems sleepy after
There are many brands and forms available at the grocery/drug store, online, etc
Human brands may contain xylitol, an artificial sweetener which is toxic to dogs so double check labels and if you're not sure text or email the ingredient list to me and I'll double check (those consults are the same $180/hr as in person appointments)
I have variety of forms (tablet, liquid, capsule, etc) with dosing instructions listed under the Melatonin Protocol on my online dispensary Fullscript: https://us.fullscript.com/protocols/seatoskyholisticvet-melatonin
The ones listed in the Melatonin Protocol I've checked for xylitol
Foods that are naturally high in melatonin include mushrooms (button, porcini, chanterelle), oats, barley, corn, tomatoes, eggs
Other
Topical Treatment Recommendations
Topical Treatment Recommendations
Use Vetericyn (natural antimicrobial) on affected areas 2-3 times daily
Use a topical turmeric "golden paste" for anti-inflammatory affects 2-3 times daily
Will email recipe or many available online as well
Use an ozonated oil (uses ozone which is a natural anti-inflammatory, helps wound healing and can be anti-cancer) on affected areas 2-3 times daily
Good brands include ozoneoils.com and PureO3
Safflower or Hemp oils are good for high ozone content
Use Duoxo Calm Mousse to reduce inflammation 2-3 times daily as needed
Use Optixcare wipes (have hylauronic acid to help the skin repair) on affected areas 2-3 times daily
Type option 3
Type option 4
Other
Aromatherapy Recommendations
Use Feliway (calming pheromones) via diffuser
Constant use of Feliway typically works better than intermittent use
Manufacturer says 1 diffuser for every 400 sq ft and recommends replacing the plug in part every 6 months
There's also a spray that can be used directly in areas your pet prefers to spend time in but it wears off more quickly (several days)
Citrus Essential Oils (bergamot, lime, orange, lemon, grapefruit, etc) are a good emotional balancing option and are safe to use 1-2 drops in a diffuser
Vetiver is a good "grounding" Essential Oil option and is safe to use 1-2 drops in a diffuser
Only use essential oils diffusers in large area where your pet can choose to avoid it if desired
Can use diffusers several times daily if needed or just occasionally for more stressful times
Can apply a very small amount of oil topically but dogs are much more sensitive to smell then people so don't apply it directly, touch the bottle to your finger rub it into your finger until it's mostly rubbed in and only then rub that finger on your pet
Can apply it along their back
Can apply it to the bottoms of their feet
Avoid cheap essential oil brands which may not be pure
For cats don't use anything directly on them, use high quality oils that are pure and avoid high phenol content oils (clove, basil, oregano, thyme, cinnamon) since those are harder for them to process
You may read things that say that essential oils are toxic. Everything is toxic at the right dose including water. Essential oils are powerful and need to be used carefully but if they are high quality pure oils and you're using them as directed we should not have any concerns
A couple brands I like include Snow Lotus and Mountain Rose Herbs
Tonify Metal by Snow Lotus is a good option to help process grief and loss
Use Adaptil (calming pheromones) via collar and/or diffuser
Available as a collar, diffuser and spray
Collar lasts 1 month, diffuser is supposed to be 1 for every 400 sq ft and the plug in part is supposed to be replaced every 6months, spray lasts for several days but can be used directly on beds, blankets, carrier, etc
Adaptil can be used constantly or just as needed for more stressful events like travel, etc
Use diffuser in area your pet spends most time in
Available at the pet store and on Amazon
The ThunderEase and ComfortZone brands are the same ingredient so should work fine
Other
Aromatherapy Recommendations
Behavior Recommendations
Work on counterconditioning/desensitzation
Avoid triggers
Use separate feeding areas to reduce competition and stress around meals
Add additional resources (litter boxes, feeding/water stations, trees, toys, etc) to reduce competition and stress around these things
Can try Cat Attract litter
Try different types of litter, closed/open boxes etc to see what your pet prefers
Use positive reinforcement training
Work on socialization and exposure to many types of places/people with rewards
Avoid highly contaminated places such as dog park and any sick animals
Interacting with other appropriately vaccinated puppies and adult dogs is safe and an important part of normal social behavior
Continue doing positive reinforcement, socialization and training
Great work on the things you're already doing!
There are a lot of myths and misinformation about pet behavior and their body language can actually be pretty subtle and difficult to interpret
Here are some good resources for learning more about subtle dog body language that can help us to identify when your pet may be getting anxious or fearful. Poster style pictures: https://www.wihumane.org/dog-body-language. Short video: https://www.youtube.com/watch?v=mC6z6ZAtpA8 Longer video: https://www.fearfreehappyhomes.com/video/dog-body-language-101/
Other
Discussed doing a Dental (Complete Oral Health Assessment and Treatment)
Any "regular" brick and mortar clinic can do a dental for your pet
There are dental specialists as well, I'll send a list of all of them in the area
They will be quite a bit more expensive than a regular vet but do have tons of experience with older or more complex patients
Sometimes the corporate clinics make the most sense since they have very established protocols for monitoring
Age is not an increased risk factor for anesthesia
Heart disease is only an increased risk factor if they are in heart failue
Kidney disease is only an increased risk factor if they are in kidney failure
The things that will make a dental the most safe is excellent pain management and excellent monitoring
Ask about pain management plans (should include local blocks and medication that will cover at least 72 hrs after the dental)
Ask about monitoring (should have a dedicated person monitoring your pet the entire time they are anesthetized AND until they're fully conscious again)
Dental xrays are needed to be able to actually know what's going on with the teeth and if they are truly healthy or need to be removed due to infection and disease
Except for really bad teeth where the disease is so advanced it's visible above the gumline there's really no way to tell if their tooth is rotten or has other issues without xrays
Because it's impossible to know if the tooth needs to come out without xrays and we can only do the xrays under anesthesia don't be surprised if we end up needing to remove more teeth than we thought
Dental disease does cause pain and inflammation
Inflammation allows bacteria into the bloodstream which hits all the organs as well as causing more inflammation everywhere
With appropriate monitoring and tailored care the risk of complications is no higher than when your pet was spayed or neutered
Recommend full mouth radiographs
Will likely need the bad tooth extracted, may need others as well
Will likely need several teeth extracted, may need more
Will likely need quite a few teeth extracted
Will do fine without those teeth and will be happy not to have rotting painful teeth in their mouth
Will probably recommend antibiotics, not really needed (no longer recommended in humans or by most veterinary dentists) and can disrupt the gut flora and cause GI upset
Ask them not to use a spring loaded gag, these are no longer recommended in cats since they open the mouth too wide and can cause blindness
Recommend ask for local blocks, NSAID
Note that tramadol does not have pain management value in canine patients and should not be used alone as a pain management protocol
Other
Discussed Cardiac abnormalities
Heart disease is not the same as heart failure
Monitor Sleeping Respiratory Rate (SRR), if >28 breaths per minute (>7 breaths in 15 seconds) consider further diagnostics/treatment
Can go to a cardiologist for additional work up
Likely due to hyperthyroid disease
Consider pimobendan
We could add pharmaceutical medications
Consider furosemide
Consider enalapril
Other
We Also Discussed
Vaccines
Parasite prevention/treatment
Spay/neuter
Socialization and training
Other
Discussed Vaccines
Rabies vaccination is required by law
Rabies be given anytime over 12 weeks, then a booster is done at 1 year and then it's required every 3 years
A Rabies certificate may be required for grooming, boarding and travel
An animal which bites someone has to be quarantined for 10 days whether vaccinated or not
You can get antibody titer testing for diseases we vaccinate against
Rabies titer tests are not legally accepted instead of vaccination
Titers only measure the response of one type of immune cell and there are many different types involved in immunity and the disease fighting process so titers are not always reflective of actual level of protection
The Distemper/Adenovirus/Parvovirus vaccine is a commonly recommended vaccine as those disease can be serious
Vaccination is very effective and immunity appears to last at least 7 years
Type option 2
Type option 3
Type option 4
Other
Vaccines Given Today
Rabies
Distemper/Adenovirus/Parvovirus (DAP)
Bordetella (Kennel Cough) Oral vaccine
Feline Viral Rhinotrachetis/Calicivirus/Panleukopenia (FVRCP) Intranasal
Other
Rabies Certificate Owner and Pet Info
Owner: Address: Telephone: Pet Name: Age: Breed: Sex: Size: Color:
Rabies Certificate Vaccine Info
Date of vaccination: Date next vaccination due: Vaccine: Merial ImRab 3TF 18626 24APR26 Initial or Booster Dose Tag:
Rabies Certificate Vet Info
Aja Senestraro VT60402465 Sea to Sky Holistic Vet 2908 S Charlestown St Seattle WA 98144
Rabies Certificate Signature
Vaccines given additional info
Discussed Spay/Neuter
Recent research regarding shows correlation between spay/neuter after first heat/skeletal maturity and reduced risk of some diseases
However only in a few dog breeds (German Shepherd, Goldens), unclear if it applies to others, correlation vs causation, etc
Would seem to make sense though since estrogen and testosterone are hormones which have effects on other tissues in the body so if they are not present as part of normal development and puberty it could affect things
Historical research showed a decreased risk of breast cancer in dogs spayed before first heat
Risk increased with increasing heat cycles
Not every dog spayed after their 1st heat gets breast cancer but in that study (which was about 60 years ago) spaying after the first heat increased the risk about 5 times (from ~1%-~5%)
There are clearly limitations to the current body of research knowledge we have available
Risks of not performing a spay at any time would include a uterine infection (which is life threatening), unintended pregnancy, ovarian, uterine or breast cancer
Risks of not having your pet neutered at any time would include unintended mating with a female dog, prostate infections, hernias, testicular torsion (which is extremely painful and needs emergency treatment), testicular cancer
Potential issues could include dealing with a heat cycle (there is discharge, male dogs even if neutered will try to mate with her, male dogs may be more likely to be aggressive with each other around a female in heat, won't be able to go to doggie daycare, dog park), making sure there's no risk of unintended pregnancy, some doggie daycare's won't allow unfixed pets over a certain age
Potential issues could include having to make sure there's no risk of your dog mating with a female dog, can increase likelihood of attempting to escape the yard and roam or to display territorial behavior but much of this is unrelated to testosterone levels, some doggie daycare's won't allow unfixed pets over a certain age
You'll need to weigh the risks vs benefits for your pet
First heat is usually anywhere between 6-18 months
The bones will be finished growing usually around 12-18 months
Consider delaying sterilization until after first heat/skeletal maturity
Other
Discussed Likely Allergies
Allergies are a chronic, progessive issue that's not curable. Goal is management to reduce frequency and severity of flare-ups
Likely allergic to many things including environmental allergens (like dust, pollens, grasses, trees, etc) as well as food allergens
Use Vetericyn topically as needed on affected areas during flare ups
Can wipe down daily (especially feet and face) to reduce topical allergens
Damp washcloth is fine or you can use a fragrance and dye free wipe like Optixcare Eye Wipes or Mustela Micellar Water for Babies
Can bathe weekly to reduce topical allergens
Because lots of things can cause a flare up and it can take weeks for the symptoms to go away after they get triggered it's very difficult to directly attribute any changes to any flare ups; just because they start itching after they get a new toy doesn't necessarily mean they're allergic to that toy
Can do blood test for environmental allergens and have immunotherapy (allergy shots or oral version) made to reduce symptoms
Can go to a dermatologist for allergy skin testing and to have immunotherapy made
There are pharmaceutical options we can consider for inflammation to reduce symptoms
There are herbal options we can consider to help reduce symptoms
See handout
Other
Discussed Likely Flea Bite Allergy
Very likely that your pet is allergic to flea bites which means that a single flea bite can cause itching and symptoms for 2-3 weeks
It doesn't mean that there's a flea infestation on your pet or in your house, pets with this kind of allergy are SO sensitive that one random flea bite that a normal animal wouldn't even have noticed creates a big reaction for weeks
Best option to control inflammation, itching and reaction is pharmaceutical flea control
May need to be on it year round
May take 3-4 weeks for current inflammation to go down
Other
Discussed Likely Inflammatory Bowel Disease (IBD)
Disease is chronic, progressive, and not a curable condition. Goal is management to reduce severity and frequency of symptoms and flare-ups
The immune system over-reacts to normal things causing inflammation in the GI tract
This inflammation leads to nausea, and can lead to vomiting/hairballs, diarrhea, and/or constipation
Inflammation anywhere in the body causes more inflammation everywhere in the body
If your pet is nauseous because of this inflammation and eats a food they may start to associate that food with not feeling good and then they won't want to eat it again because they think "I didn't feel good after I ate that so I'm not going to eat it again" even though it wasn't really the food it was their underlying disease. This process is called "food aversion" and is what leads to "picky eating"
It has nothing to do with you or with the food itself, it's the underlying disease in their body that makes them nauseous
Can do human probiotics 1/2 human dose
Could consider a fecal transplant
Definitive diagnosis would need referral for further diagnostics (additional bloodwork, abdominal ultrasound, biopsies, etc)
Any "stress" (can be change in routine, going out of town, new people or animals in home or neighborhood, etc) can contribute to flare-ups
Lots of components (immune cells, diet, inflammation, nausea, gut flora, etc) so difficult to directly attribute any changes to any flareups or improvements
Will always be predisposed to GI upset (nausea, vomiting/hairballs, diarrhea, constipation) and subsequent food aversion
See handout
Other
Discussed likely Pandora Syndrome
Likely has a predisposition to over-reactive stress hormones (like cortisol, adrenaline), anxiety, and inflammation
Disease is chronic, no curable. Goal is management to reduce severity and frequency of flare ups
Goal is to reduce inflammation and stress as much as possible
Create separate resource areas (food/water, toys, litterboxes, sleeping areas, etc)
See handout
Recommend behavioral modifications as above
Use additional litterboxes and may need to try different types (with and without lid, different sizes, different litter, locations, etc)
Use glucosamine/chondroitin supplement to help protect the bladder lining (Cosequin/Dasuquin are good animal brands, many other options available)
Other
Discussed likely Cognitive Dysfunction
Basically like dementia and Alzheimer's in people
It can be hard to definitively diagnoses since lots of other issues can cause similar clinical signs but there are some cognitive tests and scales we can use that can suggest there's cognitive dysfunction. Here's a link to the CADES scale: https://trimalaska.com/wp-content/uploads/2024/04/Canine-Dementia-Scale-CADES-worksheet-1.pdf
Disease is chronic, progressive, not curable unfortunately. Goal is management to try to slow progression
Try to keep your pet mentally engaged
Go to new places, walk a different route
Get your pet some new toys
Do some simple rehab exercises since these provide mental stimulation and have physical benefits
Try an interactive feeder like a slow feeder, puzzle feeder, treat ball, lick mat, or snuffle mat
Teach your pet new tricks and have them do the commands they already know
Can try medication called seligiline or one called amantadine
I have a bunch of supplements which have shown some benefit in humans, animals, or both through my online dispensary Wellevate under the Nerve and Cognitive Function protocol (Wellevate.me/aja-senestraro)
Can try veterinary supplements like Cholodin or Senilife (antioxidant based)
Can try supplements like alpha lipoic acid, MCT (medium chain triglycerides), B vitamins, melatonin, and other vitamins, minerals, and phytonutrients
Real food helps since it doesn't have inflammatory compounds like really processed foods (kibble) do and it has more bioavailable nutrients including vitamins, minerals and phytonutrients
Fish based foods are especially high in omega 3's, B vitamins, and selenium
Will send handout
Sleep disturbances are common with cognitive dysfunction
Nothing really consistently causes sleep, it's actually very complex and treatments are really variable and individual; we can try a lot of different things including supplements, herbs, and pharmaceuticals
I have a lot of supplements we can try to help sleep disturbances on Fullscript under the Sleep "protocol" and one just with melatonin. Sleep supplements: https://us.fullscript.com/protocols/seatoskyholisticvet-sleep
Other
Other resources and links
I have some articles and links to some products on my website that you can look at as well
I'll email a handout about the homemade food using BalanceIt.com
I'll email a handout on stress which has lots of different things we can try and includes doses, brands, etc
I'll email a handout on Allergies which includes lots of different things we can try and includes doses, brands, etc
I'll email a handout on End of Life Decision Making that helps go over things to think about
I'll email a handout on dementia in pets that talks about different things we can try, doses, etc
I have an article on my website with a bunch of rehab exercises listed and some links to products: https://www.seatoskyholisticvet.com/pandemic-resources/pet-fitness
I'll email a handout on Cranial Cruciate Ligament Disease (ACL tears) which goes over all the treatment options and has rehab exercises we can do
I have links on my website for many different products that help with stress and anxiety: https://www.seatoskyholisticvet.com/pandemic-resources/managing-pet-stress
I have a "plan" which is a bunch of products for anxiety and/or sleep issues with dosing listed on Fullscript my online dispensary. They are potential options, you don't need to get all or any of them. The Calming and Sleep support "plan" has supplements for both since there is significant overlap: https://us.fullscript.com/plans/seatoskyholisticvet-calming-and-sleep-support
I have links on my website for many different products that help with allergies: https://www.seatoskyholisticvet.com/pandemic-resources/products-for-allergy-management
I have a home remedy "first aid kit" list on my website of helpful over the counter items that are good to have on hand: https://www.seatoskyholisticvet.com/pandemic-resources/home-remedy-list
I have a blog post with links to a bunch of great products for older pets: https://www.seatoskyholisticvet.com/blog/best-products-for-senior-pets
I have a blog post with links for lots of good things to think about having on hand with a new kitten: https://www.seatoskyholisticvet.com/blog/holistic-kitten-starter-kit
I have a blog post with links for lots of good things to think about having on hand with a new puppy: https://www.seatoskyholisticvet.com/blog/holistic-puppy-starter-kit
I have a bunch of helping calming supplements in a "Plan" on my online dispensary Fullscript. It's not actually a "Plan" that's just a way for me to curate a variety of products which are safe for pets and allows me to put in notes about dosing for all of them. Here's the link: https://us.fullscript.com/plans/seatoskyholisticvet-calming-support
I have a blog post with tips on helping pets through the moving process: https://www.seatoskyholisticvet.com/blog/moving
I have an account with an online naturopathic dispensary which carries lots of good quality brands of supplements and herbs: https://us.fullscript.com/welcome/seatoskyholisticvet/signup
I have a bookshop.org affiliate shop (it supports local bookstores) with some books I like on lots of holistic topics and pet behavior, etc: https://www.bookshop.org/shop/seatoskyholisticvet
There are "regular" vets who do house calls; in the Seattle area some options are Montgomery Mobile, Better Vets, and The Vets
You can look for holistic vets here:https://www.ahvma.org/find-a-holistic-veterinarian/#!directory/map/ord=lnm
Other
Quality of Life
Monitor "happy things": think of 6-8 things they do that you know indicates they are happy and enjoying life.
One should be eating/drinking normal amounts, one should be urinating/defecating without assistance/in normal areas, and one should be grooming the rest is just whatever their "things" are
One should be eating/drinking normal amounts, one should be urinating/defecating without assistance/in normal areas the rest is just whatever their "things" are
It's good to start the process of thinking about what your pet's "happy things" are and what things are important for their Quality of Life so we can be sure we're supporting those things as the disease progresses
We may need to make modifications to help them be able to enjoy things
If we're getting down to just things like eating and sleeping then that's just survival
If only able to do less than half even with modifications that's poor Quality of Life
We can track good and bad days to look at trends and see if it's overall more good or bad
Only humane options would be aggressive treatment or euthanasia
Euthanasia is the most humane option
If we're having more bad days than good days that's not good Quality of Life
If it's more bad days then good that's not good Quality of Life and it's best to let them go
If your pet's Quality of Life is not good it's best to let them go
Continue monitoring Quality of Life, if it's poor euthanasia is the best option
Some people like to use apps for tracking symptoms, good vs bad days and Quality of Life such as Grey Muzzle, DogLog, CareClinic, Wave Health, diary/journal apps
Some people like to create excel sheets for tracking things or create a diary or just mark things on the calendar
There are quantitative Quality of Life scales available online which some people find helpful but your pet isn't a number so it's just another tool to help think about these things, we wouldn't make a decision just based on that number alone
There are several different versions so you can just google Veterinary Quality of Life Scale and check out different ones and see what resonates with you
Here are some links to Quality of Life scales: https://journeyspet.com/pet-quality-of-life-scale-calculator/, https://www.allcatshospital.com/wp-content/uploads/2016/11/Quality_of_Life_Scale_to_PDF.pdf, https://www.lapoflove.com/how-will-i-know-it-is-time/lap-of-love-quality-of-life-scale.pdf
Continue to monitor Quality of Life, Shen, good vs bad days, and ability to do "happy things"
Sounds like your pet is able to do all the things they enjoy!
Sounds like your pet's Quality of Life is great!
Other
Quality of Life Additional Notes
Contacting Me
The best way to contact me is email or text
I am available to discuss things by phone or on Zoom by appointment only
If you have any questions about anything we've discussed or if any new issues come up I am available for email and text consults daily between 10am and 10pm, including weekends and holidays
Texts typically get a response in 2-3 hours, emails within 18 hours daily 10am-10pm
As a reminder I charge the same hourly rate for ALL professional services including appointments in person, by phone, and on Zoom, as well as all text and email consults
The hourly charge also applies to any work done for your pet outside of appointments like responding to text or email inquiries about your pet, reviewing any lab work or test results, and calling in or setting up prescriptions for your pet
If you think you may have a lot of questions or would just like peace of mind I do offer a VIP monthly subscription
For $89 a month for a VIP subscription you get unlimited consults by email and text
You can start or stop the VIP membership at any time
You are on the VIP subscription which includes unlimited email and text consults!
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