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)
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.
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
Other
Behavior notes
Shen or "Spirit"
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
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
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
None
Mild
Mild to Moderate
Moderate
Moderate to Severe
Severe
Muscle tension
Normal, no tight areas
Mild everywhere
Mild everywhere else
Moderate everywhere
Moderate everywhere else
Severe everywhere
Severe everywhere else
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
Other
Muscle tension notes
Joint Range Of Motion Notes
Leg Joints Range of Motion
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
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
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
Other
Feet
Nails/claws appropriate length
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
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
Visual exam only due to patient behavior/temperament
Indication of Blood Deficiency in Chinese Medicine
Indication of Damp in Chinese Medicine
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
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
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
Other
Teeth, Gums, Oral exam notes
Lymph Nodes
Normal
Appear normal visually
Other
Skin
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
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"
Pull out easily
Mats
Live fleas
Flea "dirt"
Fur staining
No evidence of fleas
No dandruff
Well groomed
Poor grooming caudal half of body
Poor grooming
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
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
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
Superficial
Bounding
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
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
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
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
Normal
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
Rest of Exam
Same as last visit
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
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/Tuina/Acupressure
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
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
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
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
See handout for help in transitioning off dry food
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
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
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
Increase calories by about 10%
Decrease calories by about 10%
Weight is good, continue current amount of food
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
Probiotics can be helpful, especially ones with Lactobacillus
Dose is variable, start with 1/2 human dose or what package suggests for your pet's weight
Some good pet brands are Synacore, Proviable, Vetriscience. Good human brands include Visbiome and Culturelle
Good to rotate through different products when you run out of one as we just don't really understand yet what's best for each individual as far as strains, dosing, etc
Continue doing real food, that's the best!
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
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
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 is available so you can provide laser therapy to reduce pain and inflammation for your pet in between visits, see handout for additional information
In person appointments for acupuncture, laser, massage, and chiropractic treatment all help
We can also do supplements for the joints
Continue the supplements your pet is already on to help their joints!
Continue the glucosamine/chondroitin supplement for your pet's joints
Add glucosamine/chondroitin supplement (Cosequin/Dasuquin are good brands)
Can do Cosequin for horses, 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)
Add Duralactin/Microlactin natural anti-inflammatory, dose is by weight on package
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
Massage 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 from the shoulder up to the spine over the rib cage
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 massage daily if possible
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 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
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
Do 2-3 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!
Type option 4
Pharmaceutical Recommendations
Pharmaceutical Recommendations
Gabapentin is for nerve pain. It's very safe and has no side effects on the liver or kidneys. It does sometimes cause drowsiness and sometimes they're so sleepy they act a little "drunk". To avoid that we can start with a low dose and increase it over time, we also start by giving the dose just once a day at night for the first 5-7 days in case they do get sleepy.
Gabapentin is very safe and we can increase the dose as needed if/when the disease progresses
Available as a liquid, capsule or compounded with flavoring, as a chew or paste also
Can use 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
Anti-nausea medications are an option to help manage your pet's symptoms
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
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
Continue your pet's medications as prescribed
Continue the rest of your pet's medications as prescribed
For prescription medications I can either write you a prescription that you can take to any human pharmacy for some drugs that people take too (check goodrx.com/pets for best pricing) or Costco or Walmart for any drug or you can order it online through places like 1800petmeds or I can set up the prescription through an online pharmacy I have an account with (I do receive a few dollars from purchases through the pharmacies I have accounts with)
For over the counter medication you can get that at any drug store or grocery store
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
Type option 3
Type option 4
Additional Nutraceutical Recommendations
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, don't apply oils directly to your cat and stick with recommended oils as there are some that are hard for them to process
Good brands include Snow Lotus, Mountain Rose Herbs and DoTerra
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
Other
Recommend 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 as SVS on 8th and Madison and at Animal Medical Center in Shoreline
They will be quite a bit more expensive than a regular vet but do have tons of experience with older 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
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
Advised tramadol does not have pain management value in canine patients and should not be used alone or in combination 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 bpm 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
There's no evidence of benefit of these medications for pet's that are not actually in heart failure
Consider furosemide
Consider enalapril
Other
We Also Discussed
Vaccines
Parasite prevention/treatment
Spay/neuter
Socialization and training
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 18456 Exp 07NOV21 Initial or Booster Dose Tag:
Rabies Certificate Vet Info
Aja Senestraro VT60402465 Sea to Sky Holistic Vet 17310 267th Dr SE Monore WA 98272
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
Disease is chronic, progressive, no 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
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
Can try supplements like Cholodin or Senilife (antioxidant based)
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
If only able to do less than half even with modifications that's poor Quality of Life and it's best to let them go
Track good and bad days, if more bad than good in given period (7-10 days) that's poor Quality of Life and it's best to let them go
Only humane options would be aggressive treatment or euthanasia
Euthanasia is the most humane option
Continue to monitor Quality of Life, Shen, good vs bad days, and ability to do "happy things"
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
Other
Quality of Life/Hospice/Palliative Care Additional Notes
Additional recommendations/discussion
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