Pet Talk Podcast

For Episode 14, we dive right into poop. You read that right. Poop. As the famous book says: Everybody poops. And for everyone in the animal healthcare field, that’s a good thing! Your pet’s poop tells us a lot about what is going on with them. It can be a very easily seen (and smelled!) sign that can tip you off that something may be up with your furry family member. So, in this episode of Alicia Pet Care Center’s Pet Talk Podcast, the owner and chief of staff of the hospital, Dr. Matthew Wheaton, sits down to tell us why it really IS All About The Poop. So here is a transcript of the podcast episode (that you can listen to by clicking above, as well):

We believe this is a big topic for dogs and cats and an important one on the veterinary side and an important one for your pet’s health to know what's normal and what's not, as far as poop goes. Getting you up to speed on that is the goal of this podcast episode. We start off in kind of a weird place because there's a little bit of variance. Not to get too personal, but there's a bit of variance in every person on their poop consistency and their observance of it. Knowing when you are falling outside of the normal variance is one of the important points that I want to make. As I tell my clients a lot, when they ask about gastrointestinal health, choice of diet, how to assess whether their dog is healthy or not, or certain goals that they might want to do different with philosophies and feeding.

It's all about the poop. It really is all about the poop. So, if you have a pet that's not having the correct consistency of poop, you go to change the diet. It's kind of a no brainer there. But it sometimes takes a little while for owners to do that. Most importantly we'll start off with “normal”, as far as poop goes. Normal poop for a dog and cat should be a firm, well-formed stool. Color is not really all that important, though occasionally you have this strange color of poop for an extremely long period of time. When you have stool that is firm but not hard and has a segmented appearance and there's really no residue on the ground: that is a normal poop.

That's what we should see pretty much every single day. We should see it every day and we should certainly see it every poop. Sometimes there can be a daily variance in things. There are lots of ways to get out of the norm and there's not necessarily one particular diet that's going to get that accomplished. And every single pet is a little bit different. There are some universal things that we can point to that are more likely than not to make things go one direction or the other. But that's what you're looking for. I think if you get out of that zip code, let's say, on the consistency, then you have an abnormal poop. That means the intestines and/or stomach theoretically (but mostly it's the intestines) are maybe not right. And if you start to see some patterns, then maybe you have a pet who is “not right” more than just a tiny bit of the time.

Those are things that you don't want to overlook. Because what's going on to make the stool abnormal is not going to go away on its own, if it's taking longer than, say, a week. It would be one thing if you had soft stool maybe two or three times per week. But that should only go on for one or two weeks. I mean, why would that continue to keep going on? Every single soft stool is that particular pet, via their poop, telling you that something is not entirely right with their intestine. So, when we are told about things early on in the course of the disease, process, whatever that may be, we have a much better chance of getting early intervention, and an easier way out of things. When we wait too long to report illnesses to our veterinary team, that just sets the pet up for having a more difficult struggle.

Sometimes people really live in that place of hope. Again, it's fine to do that for a certain amount of time. But when we're working on multiple weeks going by or months with a visible issue -- or potentially even years, honestly, with some of the dogs that we see.  

Question from podcast host: “So, with regards to what you were describing as a good poop -- I know somebody who has two cats and they have one cat that sounds like a good pooper and their other cat, I guess, they kind of have that soft serve ice cream kind of poop intermittently. So, what's the story with that?”

Dr. Matthew Wheaton’s response: That “soft serve poop” is oftentimes not called ‘diarrhea’ by people. That's the first thing that I think we should make sure that we understand. Diarrhea is kind of a bad term. It's really a bummer because people think that unless it's liquid, like straight up liquid stool, it's not diarrhea. But diarrhea, I'm going to define it as a loose stool. And there are gradations of that, going from complete liquid to kind of a soft, unformed stool. You know, that soft serve ice cream kind of thing is definitely not normal. So, we shouldn't see that ever. Again, it's about trends, it's about time courses. Does your pet have soft stool for a day and then get better and everything is okay and normal for six months? And then there's another soft stool episode and that's fine. No big deal. We're not going to do anything for that. I don't think there's any consequence of that. And that doesn't speak to some underlying condition that we need to address or worry about. But a day-to-day kind of mildly, not-formed stool could potentially be a symptom of intestinal parasites or inflammatory bowel disease as our most common problem in dogs and cats. Maybe not as much for dogs, but on the inflammatory bowel disease side of things: definitely for cats.

Let’s talk more about that soft, not fully formed stool: that is not normal. It's kind of like a plop. That's kind of a moderate diarrhea and then a severe diarrhea liquid: it's not okay. All of those things are going to get you to the vet eventually. With the very liquid poop: I'll tell my clients that if nothing else is going on and the dog is wagging its tail and seemingly normal aside from the liquid stool: you're going to wait no more than 48 hours to bring your dog to the vet.

So, once you're working in that 72-hour window: a lot of people come in before that because, quite honestly, it's not fun. Potentially, the dog is defecating inside the house. If it's cats, they’re possibly defecating outside the box and it’s super stinky. The dog is uncomfortable, the kitty is not happy about things and you all might be waking up in the middle of the night to deal with this now more urgent feeling kind of situation. So sometimes you don't get the opportunity to sort of try to wait it out. You need to come into the vet for some help. And we generally don't get too crazy with a bunch of tests or whatever at the beginning of this. If it's a first episode or it's kind of a one-off episode, we generally will take it in stride and see it for what it is. It's an upset stomach that's causing diarrhea and we've got treatment for that that's very reliable. That oftentimes involves an injection typically of an antibiotic that's targeted towards the intestine and then a combination of antibiotics and probiotics going home.

I think we should talk about this briefly because it’s common for us to do this and it's occasional for people to have questions about it, but: why would we use antibiotics? Oftentimes, when you have diarrhea, you're dealing with multiple things going on at the same time. So, there's typically a flux in your gut bacteria and something sparks it, right? It's either a parasite or inflammation or it could potentially be a virus. It could be a diet change. Your gut has got a lot of stuff going on, so the bacteria is relatively sensitive to their environment that you're providing for them on a consistent basis. And when you alter that by changing the pH or changing the temperature or causing a bunch of inflammatory cells to rush in there: any of those things are going to potentially change the gut bacteria.

Additionally, you usually have a change in motility. Your gut motility is kind of like a wave pool in a way. It's got these very rhythmic contractions that are kind of going at a set pace. You've got kind of a rhythm that's going and that rhythm gets altered massively when you have a diarrhea situation. So that's going really fast usually. The rhythm could be kind of haphazard, weird and then oftentimes it has sped up. And if it's speeding up, the rhythm of the gut, things are going to get pushed a lot faster. You're going to have potentially a lot of intestinal discomfort too because there's a lot of nerves associated with the intestine and when it's moving around really fast or it's getting dilated by gas, that does not make the nerves happy. You're going to get some discomfort there, maybe that bloating feeling and that "you want to curl up into a ball kind of feel".

When you're moving really fast, you're not going to be able to have the body take up the water from the ingesta that is soon to be poop, and so if it can't get the water back up into the system, absorbing that water out, then you're going to have a much more watery stool. And then we're off to the races with diarrhea. Some other things that you might see with an altered stool consistency is all the other stuff that typically goes along with intestinal inflammation and an upset stomach, which could be blood. You might see fresh blood in the stool. That's pretty common because, a lot of times, our dogs are dealing with colitis, which is inflammation of the colon. Our cats will do this too. Dogs do it quite a bit with stress. Cats don't do it quite often with stress. Their stress organ is usually their urinary bladder. But occasionally, a cat will dump stress into their colon and this is not a long-term chronic stressor, by the way. We see this occasionally in boarders. We see it sometimes in a situation where a dog gets left behind in its own environment with a pet sitter. An environmental change like that's pretty stressful for a dog. So, they may put that stress into their colon and get a little bout of stress colitis.

Intestinal parasites and/or giardia are very common for this to cause gastrointestinal distress and mainly that plays out in the colon. The colon is inflamed, so you may see blood there because the inflammatory cells, when they are going in and attacking whatever, they oftentimes will kill off some of the normal intestinal cells and those are going to bleed when they're undergoing damage. So, you may see blood ending up in the stool. Which, when it's red blood, we know that it's coming from the colon because it doesn't have time to digest that blood. Whereas, if there was blood coming into the stomach or the upper small intestine, the intestine will be partially digesting that blood and it wouldn't pass through with a red coloration. It would be blacker in appearance or kind of a dark purple. We oftentimes will see mucus. That'll look kind of like KY jelly or snot. It's pretty gross. But, oftentimes, you'll see mucus with that kind of colitis episode and that can sometimes throw people off too. Occasionally we get mucus without a super abnormal poop. So sometimes we'll get a little mild colon inflammation.

There is a chance that those dogs will actually be fiber-responsive. That's where your usage of pumpkin comes out. A lot of people listening to this probably know that pumpkin is a great fiber source that you can easily obtain. You can use canned pumpkin from a grocery store and that's not a bad play to make on your first day of diarrhea if you really wanted to kind of do something at home. That's probably one of the things that I would universally give a thumbs up to because nobody's going to get harmed by that. But you certainly might see mucus...sometimes that'll look like a casing on a sausage. It's kind of weird. Sometimes it's super gross. It looks literally like somebody has pneumonia or something and they coughed up a bloody loogie and that's what's on the poop.

The pictures that people text me -- we actually do really like pictures of poop when the patient is being presented for diarrhea or if there's a chronic diarrhea issue or chronic soft stool issue. We can really benefit from that kind of documentation. That's actually a wonderful thing about technology and cell phones now; you can easily take a picture of that and then we don't have to guess at what you’re seeing or trying to describe to us. And we don't have to show you pictures that you have to select out of a police lineup or something like that to show us what your dog's poop looks like.

One of the other things that you would see potentially in a colitis episode besides blood and mucus and soft stool is straining to defecate. And this definitely throws people off quite a bit. We have people come in quite often that think that their pet is constipated. And they might've already given something to their pet, which we really do not recommend doing. But sometimes people think that the dog is constipated because it's sitting there straining to defecate and not much is coming out. Often, it’s just a small bit of liquid...very small amounts of liquid poop potentially or mucus. And if that happens, that frequently is coming because the rectum is irritated as well. And the rectum, when it's inflamed or undergoing some degree of damage, is going to be sending all these messages to the brain that it has to do its thing.

Many of us may have experiences we can reference that seem similar to this. Sometimes it can be helpful to look at your pet's experience through your own experience. Say, if you're eating wasabi today and the super-hot ghost peppers or anything like that, tomorrow you're probably not going to have normal poop. But your dog and cat are not doing that. So, don't get thrown off by your crazy diet and your potential gastrointestinal distress being the normal thing to expect for your dog or cat. Most of the time, they're eating similar diets daily, so they really shouldn't have a lot of variance. Why would they have variance in their poop if they're eating the same thing every day? So, it behooves us to be logical. Don't freak out and definitely be a good historian for us, as well. Minimizing the problem that the pet truly has doesn't really do the pet any good because it's not really telling the right story to the veterinarian. So, that is kind of a synopsis on the colitis side of things.

I want to talk about something that's kind of interesting. It's a study that was done in cats that, I think, people get their mind blown a little bit when I tell them. I'm going to take an opportunity to tell this story right now and I will also use it to plug our upcoming future podcast on cat food and feeding your cat; the basics of nutrition for a feline. It's a study that was done with cats and dry food versus canned food and they looked at stool consistency and the weight of the stool, which relates to how much water content is in the stool. And the heavier the stool is, the more water contents are going to be in there, which means the more loose it is, right? Which one is going to have more water in it? A cat that's eating canned food or a cat that's eating dry food. The obvious thought would be that it's canned (or wet) food, right? Well, that's wrong.

Cats are water eaters. They are not water drinkers. Since cats are water eaters this means that they have to eat their water. If they don't eat their water, they have to drink their water… and they suck at drinking water, so they don't do it well. Cats as house pets are borderline dehydrated all the time. If a cat is eating dry food, here's what happens. The dry food goes in, it sucks a bunch of water towards it like a sponge. Cats have an extremely fast transit time in their gut because they are strict carnivores. You don't need to ferment animal protein very long in the gut to digest it. Their gut has evolved with them to be strict carnivores, creating that really fast transit time. What happens with the dry food is that it makes it out of the stomach before it's actually sucked all the water towards it from the body. It's going to puff up to kind of like a maximum capacity just like a sponge would. And that's a factor of science; osmolality it's called. So, your water wants to always kind of be equal throughout. If you have something that's really dry next to something really wet, it's going to pull the water towards it and they're going to equal out. That's kind of osmolality in a nutshell. What happens is a cat will get it out of their stomach into their small intestine and it is still sucking up water from the body through the intestine. It makes it midway down the small intestine. It's still potentially sucking water towards it and then by the time the cat's trying to now get the water back – because, that's a thing. The cat and dog and person: we're all sucking water out of our gastrointestinal tract into our body to retain it so that we stay hydrated. But a cat is now having this very moist, water-laden sponge coming down its pipe too fast for the body to actually suck the water back up. Thusly, the poop comes out and is kind of watery. Even if it's formed, it's wetter than a canned food fed cat.

In the canned food cat story, the cat brings the water in with the food, it's in the stomach and it doesn't really draw a lot of water towards it. It's already potentially at equilibrium because a lot of the canned foods come in at about 70% water content. A body is about 80% water content, 77% something like that. So, there's not a lot of equilibrium that has to be attained there. And so, the cat, relatively quickly, at least by the time it's in the small intestine, is already able to start sucking that water out and making that poop into a firm poop.

Another thing that I want to talk about is kind of the opposite thing: when poop gets too hard. That's a thing that's going to cause constipation because the poop is too firm. And we deal with this in cats and dogs in sort of different stories. Let's start with dogs first, they're a little simpler. Pretty much we're not going to deal with constipation in dogs. It's extremely rare. So, unless you are feeding a particular type of diet, it's very unlikely that you will ever have your dog be constipated. It's even more rare that your dog would ever need treatment for constipation. In over 20 years of doing this, I really can't think of a dog without some kind of pathology in its colon or rectum that had to have an enema as a treatment for being constipated. So, if your dog is constipated, there's usually a really, really big problem going on back there. If you think your dog is constipated, you should definitely go to the vet.

Like I was saying earlier, people (unless they hear this podcast) are going to think that their dog is constipated when it's actually having diarrhea and frequently having colitis and it's straining to defecate. So, we're talking again about a very, very hard poop. In a dog, the reason why you would typically deal with that is a dog that's fed a raw diet that's almost all animal content. This possibility for constipation can increase if you're putting a bunch of bone in their diet. Bone is not entirely digestible. So, the dogs are going to do their best with it. They're built to digest bones, but if it’s an uncooked bone; it's just a lot. It's going to be a very small amount that they would actually normally eat; half of their diet wouldn't be bone.

I think most would agree that dogs now will eat what you feed them, right? So, if you feed them a big huge bone with a small amount of food, whatever that is, they could potentially get constipated with that. I've seen some bone-constipated dogs that have needed to be anesthetized to actually get that wad of bony stuff out of their colon safely. That is not nice and it’s seriously sad.

I would say for anybody that's feeding raw: be careful. I'm not going to go crazy on the raw people. I don't really have a problem with it as long as the poop is okay. And most of the time it is. But sometimes the poop from those raw fed dogs will be a little bit too dense. So, there's just no fiber in there and there's not a lot of partially digestible filler, if you want to call it that. But there's no fruit, vegetable, fiber, that kind of stuff that's going to add to the bulk of the poop. So, you have this really nicely digested food item that just has very little residue left. The poop is really compact and there's not a lot to it except for just the remnants of that broken-down protein. Consequently, you're going to have these really, really rock-hard poops. So be careful of that. Oftentimes, that needs a bit of a diet change to rectify that. And you can do that with various things by adding pumpkin or by just adding a little bit of some other diet to your raw.

If you're doing that in a cat, it's a totally different scenario. We don't really deal with raw fed cats having hard poops. That's not really a thing in kitties because, remember: they're strict carnivores. So, it's normal for them to eat that kind of diet. But we do see constipation in cats from a couple of different reasons. We get the old cat that has some kind of condition, usually chronic kidney failure, that makes them lose too much water from their system in their urine and keeps them clinically (maybe mildly) dehydrated a lot of the time. And if they have that, then they're just dry and their poop is going to just get the liquid. So, with chronic kidney failure, these cats will be clinically dehydrated a lot of the time and they're going to suck as much water from any place that they possibly can to stay as close to hydrated as possible.

Again, it's simple science. The water basically wants to go from the dry thing to the wet thing to maintain equilibrium. Consequently, they will suck this water out of the poop in their colon and then the poop will be very, very dry and small, oftentimes, in these cats and they're just not moving their bowels very well because they're just kind of dried up. It's just not so great. So, if you hydrate those cats, they actually get back to normal pretty quickly. So, you have to keep them hydrated. That, oftentimes for the chronic kidney failure cat, requires you to be doing fluids underneath the skin (subcutaneous fluids) at home; certainly, doing a canned food diet, again, because if they start with a watery food source, they're much more likely to be set up correctly. That's one version.

The second version is the cat that has something called megacolon. This does not happen in a dog, really. It's extremely rare for it to happen in a dog. But in a cat, it can happen. It's not so fun. They get this big, floppy, basically nonfunctional colon, and it's just a bag that just stores poop and it is inevitably going to lead to that cat developing not only constipation but also something called obstipation. The difference between those two things are a constipated individual, in theory, if they try hard enough, they're going to be able to get it out. They don't necessarily need significant intervention to resolve them. The obstipated cat: it's going to die if it doesn't get fixed. So, it's got a complete intestinal obstruction due to fecal matter sitting in its colon. And if it doesn't get resolved, it's going to just basically die of toxicity due to not being able to defecate.

Those cats are going to be uncomfortable. They're going to be straining to defecate. They're going to be acting the same as a constipated cat. But what's going to happen on physical exam is that they have this humongous tube full of poop. And I mean really humongous. These colons can get like three to four inches in diameter and the poop is oftentimes the consistency of clay… like hard clay. So those cats require an anesthesia to allow us to do multiple enemas and digitally (with a glove on), get the poop out of there. It's one of my favorite procedures to do on a cat. It is so rewarding; instant gratification that's like mowing your lawn. You know, you get this really weedy lawn and you go out there and you work for an hour and you're all sweaty and it looks amazing. Same kind of thing. 15 minutes, 20 minutes in: I have completely fixed that cat, it's empty as can be and squeaky clean. I feel like a hero in those moments dealing with a megacolon cat.

Here’s a brief addendum on the megacolon cat: sometimes they're difficult to manage with medicine. Diet plays a role and stool softeners and that kind of thing. But we frequently struggle with those kitties and they can receive a surgery to remove most of their colon: it's called a subtotal colectomy where the vast majority of their colon is surgically removed. That typically resolves the problem in the cat. Occasionally you'll get a cat that kind of pushes the issue beyond that, but it's pretty rare. Most of the time, it's one and done after the surgery is performed.

What else can we say about poop? Color doesn't matter all that much. Frequency: I guess we should talk about that. I don't think it's abnormal for a dog to poop four times a day. Here's a good point. If your dog goes out on a walk and it poops one time and you're continuing to walk -- let's say you walk for 2 miles. Certain dogs, they get stimulated on a walk. So that dog might poop 3 or 4 times and by the 4th time, that poop is probably going to be a little bit soft. I don't see that as an abnormal finding in that circumstance. Whereas, if your dog is going outside into your yard and it poops twice and the second poop is relatively soft, that's not normal. I mean, that dog should be able to poop twice and have still normal consistency to the poop. That's a frequent thing that confuses people a little bit. Not to worry if you're a long walker and the dog is a multiple pooper.

One thing that's not normal is a huge volume of poop being produced. And this we can see in a condition called exocrine pancreatic insufficiency: EPI. That's a condition where the pancreas loses its ability to produce digestive enzymes. That is the exocrine function of the pancreas. The endocrine function of the pancreas is to produce hormones. But the exocrine part produces digestive enzymes. If that part fails, and that happens with EPI, you then don't have an ability to digest your food. So, you have this situation where the poop is extremely voluminous and sometimes is pretty moist, but it's not usually straight up diarrhea. It's usually kind of a cow pie consistency poo. Most of the time this happens with dogs and most of the time, quite honestly, it's German shepherds. But these dogs are ravenous. These dogs are thin, underweight typically, producing loads of poop. And they are hungry like the wolf. They really are so hungry because they are not digesting their food. Otherwise the dog might still be looking okay and it oftentimes fools people for a while.

This is not unusual for us to see that dog coming in after two to three months of doing this at home. We don't want that dog to wait that long. But it's not unusual to hear the story playing out for weeks or months. Sometimes it's because we're seeing cases as a second opinion, which we frequently do. But it's not something that you want to overlook for a long period of time. Especially if you have a German shepherd. A special message to the German shepherd people out there: hear me now. Get pet insurance, first of all. Look for the exocrine pancreatic insufficiency symptoms that I just talked about and be aware that your German shepherd is also one of the highest risk breeds for inflammatory bowel disease, which in a dog is typically going to produce intermittent soft stool and potentially nausea. Oftentimes, that comes in the form of just not wanting to eat perfectly, being a little bit of a finicky eater, maybe the intermittent vomiting; most of the time it's a stool issue in a dog.

I think we've hit on a lot of poopy parts of poop. So, keep your eyes open for those other episodes that we talked about recording because we are on a roll now and we are definitely getting a good solid output of podcast episodes now. This episode also goes together as a phenomenal companion piece to our previous release: “Let’s Talk Liver Disease”. We know that a lot of people with pets with liver issues, we talk a lot about the poop in those scenarios. So, if you still need to hear that part, go check out Episode 13 about liver disease and elevated liver enzymes.

Make sure you listen to this actual episode to hear the part near the very end (appropriate, right?) where we read off some of the responses we got from people when we asked: “What do you call your pet’s poop?” There are some hilarious answers from all of you on there. Thanks to everyone who participated in that little bit of fun!

If you have more questions or if you have more topics that you want us to discuss, send us a line. You can drop us an email at: [email protected]. You can also contact us through social media.

You can find Alicia Pet Care Center on Instagram, Twitter, Snapchat with our username @APCCvet. We are on Facebook as Alicia Pet Care Center. You can send any questions and topics you'd like us to discuss on a future episode to [email protected]. Our hospital's website is www.mypetsdr.com and the podcast website is www.PetTalkPodcast.com.

The podcast is available on the Apple native app, and for you Android users, it’s available on Google Play and the Stitcher Radio app. You can share those with your neighbors, or friends, or family members that may be dealing with any of these issues as well.

Thanks for listening!

For Episode 13, we want to talk about liver problems in dogs and cats, and give you an overview of the potential causes of liver disease, some of the solutions, and some of the thought processes that go into figuring out how to determine which cases need a big workup, what are the potential pathways that we can go down, and try to chip away at this very confusing, but super common topic to affect the health of dogs and cats.

So as a very broad overview: a lot of you all are going to have a conversation at some point with your veterinarian that your pet's liver enzymes are abnormal. And as an extremely brief overview of that, all we're seeing are liver enzymes that are elevated in the blood that indicate that there's some part of the liver cells that are unhappy, and undergoing some degree of damage, and those enzymes are leaking into the bloodstream and we're picking those up when we check the blood.

They mean different things based on different enzymes, and whether it's a dog or cat, and the severity of the enzyme elevations will provide different information. In general, in a dog, we have three different categories of things that can cause liver enzymes to be elevated. And that is: 1) hormonal conditions such as Cushing's disease or hypothyroidism, 2) primary liver disease, which includes about a dozen different problems that can affect the liver on a primary basis, diseases that are actually happening in the liver itself, and 3) secondary liver disease, which is the bulk of our dogs that are dealing with abnormal liver enzymes. That is because the primary condition is in the gut, and the liver in that way functions as a big lymph node in the abdomen, draining all of the blood that goes to the intestine. If there's something wrong with the intestine, usually inflammation, the liver is going to take the brunt of that and be secondarily inflamed, and release those enzymes into the bloodstream.

In cats, they don't quite have the same story. Cats usually, when they have elevated liver enzymes, it's primary liver disease. Occasionally, you'll have a situation where you have a secondary component, but that is not as common. And the causes behind the liver enzyme abnormalities in a cat are going to be different. So we'll save them for last because cats are special and they're the cherry on top of our story today.

That's the 30,000 foot view on liver disease. Probably 80 to 90% of our dogs are going to have secondary liver problems. A very small percentage, probably 5% at the most, of our dogs overall that have elevated liver enzymes are going to have primary liver disease. And then the rest of them are going to be hormonal. And in cats, it's complicated, of course, because they're cats.

So let's dive into a little bit of this and I'm going to give you a primer on the liver enzymes and how they work, and then we'll go deeper into the potential causes.

Abnormal Liver Enzymes

At any rate, you do your labs, we give you a call and say: “Your pet has an abnormal liver enzyme". So let's talk about what the significance of that is. Let's go through some of these things. The most common liver enzyme that we're going to see abnormal in a dog is going to be alkaline phosphatase. We also call this ALK Phos. Alkaline phosphatase is a nonspecific liver enzyme, which means that it comes from places other than the liver. So we can see this elevated from one of the most notorious things. Maybe something that people think about a lot is with cortisone, and that can be external cortisone that we're doing via a pill or some other medication. Prednisolone or prednisone is a common one that will cause this. But, internal cortisone called cortisol, that's coming from the adrenal glands and it can also cause this to be elevated.

And that is actually an interesting wrinkle on this enzyme situation that those things cause elevation of an isoenzyme. And the isoenzyme is not exactly the same as alkaline phosphatase, but the machine sees it as the same result. So it's not exactly ALK Phos, but the machine is going to spit it out as ALK Phos.

I'm getting a little deep in the weeds already, but one of the things that can cause that ALK Phos to be elevated is Cushing's disease, which is too much cortisol coming from the adrenal glands, or externally because of medication. It seems like there's some degree of knowledge out there with some of our clients on that side of this.

Alkaline Phosphatase aka ALK Phos

Alkaline phosphatase is an enzyme that we'll see elevated in a dog, and there are other liver enzymes. ALT, which is the more common enzyme that we see elevated in cats. It's frequently elevated in a dog. It's probably the most important liver enzyme that we see. And that is because it's a primary liver enzyme. So it only comes from the liver. It doesn't come from anywhere else. Those are from the actual hepatocytes or the liver cells that are leaking this enzyme into the bloodstream, and we're picking it up when we take the blood. So we'll get back to that.

There's a couple other enzymes that are minor players: AST, which is another nonspecific liver enzyme. So we can see that coming from muscle tissue. And then we have GGT, which is a special liver enzyme. That points to a particular area of the liver associated with: the bile system (aka the Biliary system), the gallbladder, or inside the liver itself, the biliary tree or the cells that are actually secreting bile. So that's a bile avenue that we go down.

The only other liver test that is really just a liver test is called a bile acids test, which is a liver function test. And then we have some liver associated tests that can be things that go up or down depending on liver function. So I'm going to back up.

Let's say your dog has an elevated ALK Phos in the blood test. We are going to call and have this conversation, and we're going to say there are three potential categories of things that can cause this particular enzyme to be elevated. And I would say this stands true for a cat with an elevated ALT, and a dog with an elevated ALT, and a dog with an elevated AST, and maybe we can throw GGT in there to some extent, although that deserves its own little special conversation. So primarily, it's ALK Phos and ALT in a dog.

We look at three different categories within this: hormonal causes, primary liver disease, and we look at secondary liver disease. So let's talk a little bit about the hormonal causes in the dog.

Hormonal Causes

Cushing's disease and hypothyroidism are the main ones that we think about. Cushing's disease is extremely complicated and it deserves its own podcast episode, so look for that as a future offering by us. But Cushing's disease briefly is an overproduction of cortisol, which is natural cortisone from the adrenal glands. 15% of the time that that happens in dogs, it comes from a primary adrenal tumor. So the adrenal glands are little, teeny tiny glands that are next to the kidneys. Adrenal glands produce hormones. They are told to produce hormones various ways. The part of the adrenal gland that produces cortisol is told to do that by the pituitary gland in the brain.

So 85% of the time that we have Cushing's disease in a dog, it's going to come from a pituitary tumor that is producing too much adrenocorticotropic hormone, aka ACTH. So, it's producing too much ACTH and that's stimulating the adrenal gland to produce too much cortisol. That's going to cause that ALK Phos potentially to be elevated. And, that can happen and affect ALT as well. So that's Cushing's disease as far as the potential contributor.

There are some common symptoms associated with Cushing's disease. So when we're having this conversation, generally we'll ask if you are seeing any of those common symptoms. The four common symptoms that we see with Cushing's disease in a dog are: 1) drinking excessive water, 2) producing a dilute urine. So you're going to have a higher volume of urine that's being produced. Potentially your dog is going to stand there for a longer amount of time urinating and producing a larger pool of urine. 3) increased appetite. That could potentially be something that you're not going to notice if, say, you have a Labrador retriever that wants to eat everything under the sun, you're not going to probably know when there's an increased appetite because it's relatively high all the time. But some dogs will really go crazy for this.

I've had people bring their Cushing's dogs in for diagnosis because they are really causing havoc at home. They're breaking into the kitchen cabinet, and they are getting the food out of the cabinet. I have had dogs present with this symptom that have taken cans of food (literally a tin can), and the owner comes home and the cabinet is open, and these cans are just flattened because the dog has actually taken the can in its mouth, punctured the can, gotten everything out of the can, and squished the can with its jaw, basically getting every speck of food out of the can. Crazy stuff. These dogs truly and literally go insane with hunger. Oftentimes those are dogs that have pituitary tumors and those tumors are potentially pushing on things, making the dog extra hungry. But an excess amount of cortisol can do that.

Then the 4th and final symptom is panting at rest. So you'll find that your dog may potentially not be in a hot environment and will be sitting there panting. Panting is a really tough one to pin down because there are a lot of different potential causes for excess of panting in a dog. The most frequent cause is anxiety, and anxiety is going to be secondary to something. Typically that might be pain. That could be some sort of illness. A dog that is nauseated or a dog that is extra itchy, potentially will pant because of anxiety associated with the symptom that's underlying that. But the Cushing's dogs will just pant excessively because of metabolic changes that have happened inside their body, and that is all associated with the excess of hormone from the adrenal glands.

The other hormonal problem that we see is hypothyroidism. So that's a low thyroid hormone coming from the thyroid glands, and that's not an uncommon problem in dogs. It's extremely rare in cats, but in dogs it's relatively common. This is the typical issue that we see in people as well. The mechanism of why hypothyroidism causes alkaline phosphatase to be elevated is still complicated and a little bit confusing, and I am not going to go in depth on that here. But know that that is one of the potential conditions that can cause that ALK Phos to be elevated in a dog.

Half of the time, Hypothyroidism, by the way, is going to have completely no symptoms being noticed at home. Nothing seems to be wrong with your dog. And some of the time you're going to have the classic thing where you have an overweight dog who can't lose weight, who's very low energy overall, maybe a poor coat, maybe some skin problems, not necessarily itchy, but some skin problems can be going on. Skin infections, flaky skin, yucky dull coat. But a lot of times there's nothing to see there. So we diagnose that a lot of the time as a surprise to people as well. And oftentimes when we supplement them with hormones, people notice that there's a big difference in their overall energy level and the dog's back on track.

So we can sometimes get some hints of this and we're having our conversation with you that, "Oh yes. Over the past six months I've noticed that my dog is really, really hungry and panting a ton, even when it's in an air-conditioned house. Yeah, there's actually a lot of water that's being consumed. I'm filling the water dish up more frequently." So, some of these things can be obvious that they might be contributing in that hormonal bucket.

With some of the things that we see with Cushing's disease, we’ll also be able to determine based on lab work. So sometimes when we do the labs, we can say that Cushing's disease is not likely at all because the urine is very concentrated or something else along that line. So all of that falls within the hormonal bucket.

Primary Liver Disease

Then the next bucket is primary liver disease. And this would be, I think, what most people think when they are being told that their dog has a liver enzyme abnormality is that the primary liver disease is what's going on. But that's actually less than 10%, maybe 5% of the actual dogs that have elevated liver enzymes will have true liver disease.

So, with primary liver disease, something happened directly in the liver. So our common things in dogs are chronic active hepatitis, which is inflammation of the liver. That is not a viral cause like it is in people. This is an inflammatory condition. Oftentimes it's linked to other things going on in the gastrointestinal tract. You can also have cancers of the liver. So if you have cancer of the liver, even if it's benign, it potentially is angering some of those liver cells. And when the liver cells are angered and they're undergoing some degree of damage or inflammation, you will have the enzyme leak into the bloodstream and then you're going to pick that up.

You can also have degenerative changes. So there are several different types of degenerative conditions that can happen to the liver of dogs. And they're all a little bit different, but there's some degenerative changes. Then there are some issues associated with the gallbladder that will affect the surrounding liver cells, and that's not just GGT that's going to be elevated with a gallbladder issue, but potentially just ALT or ALK Phos.

So with primary liver disease in dogs and an ALK Phos that's elevated, oftentimes that pushes us in the direction of the biliary tract, although not entirely. Again, GGT is the special one that would really help with that. GGT is not on every blood test, by the way. So if we were to do a mini panel that doesn't include GGT, we're not going to have that particular enzyme being measured. One of the benefits of doing a more comprehensive panel is we get more information about the liver, in particular. But if GGT was elevated and ALK Phos was elevated, we would have concerns about the dog's biliary tract, which would be the gallbladder and everything that leads into that.

At any rate, ALK Phos can give us a little bit of a hint on that as well with primary liver disease. There are about 12 different conditions, minimally. There are some really rare ones too, of course, so the list actually goes on a lot longer than that, but there are a number of different conditions that are primary liver disease.

And these are things that are all treated differently to some extent. So you don't have a “one size fits all” as far as medicine goes with primary liver disease, and those are all things that would really be determined by a liver biopsy. So we'll get there. That's about the bulk of the story with primary liver disease as it pertains to an ALK Phos.

Secondary Liver Disease

Our third category is secondary liver problems, which certainly we'll see ALK Phos elevated with this as well. And this is our most common problem that we see causing liver enzyme elevations in dogs. Secondary liver problems are going to typically relate to a primary cause of intestinal disease, and usually intestinal inflammation. And usually, that intestinal inflammation is coming in the form of inflammatory bowel disease. In a human, this would often be called Crohn's disease, which is a chronic inflammatory condition of the gut. So, if you have inflammation that's happening in the gut, your main lymph node in your abdomen is going to be your liver. Your liver does lots of different things. One of its functions is to function as a big lymph node. And if your intestine is inflamed, your liver will be secondarily inflamed and then you're going to see those enzymes light up.

So with ALT, which is a different enzyme, we will often see a similar type of causation behind that, where you have the same three buckets still in play. But ALT is going to be less commonly associated with Cushing's disease. It can happen, but it's not the common enzyme. Hypothyroidism, again, is not as common as ALK Phos being elevated, but it can happen. Primary liver disease: this is where we see the ALT almost always elevated because ALT, remember, is a primary liver enzyme. So it oftentimes will be elevated in a primary liver condition because the liver cells are undergoing some degree of damage from the actual condition that's happening in the liver itself.

Let's use Hepatitis as our good example for this. You have inflammation in the liver. That's going to cause death of cells. When the cells die or are damaged, they're going to release that enzyme into the bloodstream and we pick it up. So that is very commonly associated with primary liver disease.

Secondary liver disease, we actually have quite a bit of this as well. And that's really because the end result is the same. You have the root problem in the intestine, but the liver is dealing with that. So the liver ends up being secondarily inflamed, and then you have cellular death and damage, and release of the enzyme into the bloodstream. So that's ALT.

So, let's talk a little about AST, which again can be elevated with muscle cell damage. We don't see this a lot, but occasionally you'll have, let’s say: a Labrador that comes in who has exercise-induced rhabdomyolysis. "Myo" means muscle. So rhabdomyolysis is where the muscle cells undergo damage during exercise, and they break apart, and they then spill their enzyme into the bloodstream. And that's a bad thing for a Labrador to have; that's a genetic condition typically. It can frequently happen to dogs that are active... including, but not secluded to, hunting dogs. It's basically an overexertion thing. But it's not just overexertion. It's going to be a special version of overexertion in a particular individual that is potentially going to then spin them into having a severe problem with their liver. You have to do something with these muscles when they get broken down and damaged that then filters through the entire system and causes all these secondary issues. There's very, very few dogs that we see with rhabdomyolysis. But another potential cause of that AST being elevated would be muscle damage. Most of the time, it's actually coming from the liver. That is going to fall into those same categories that are going to cause it to be elevated.

And then you have GGT, which is much more specific, like we talked about before. Could you see it with a secondary liver problem? It's not very likely. With intestinal disease, you're likely not going to have this unless you have some kind of problem with the biliary tract, which can happen because these things are all intimately associated with one another. So the liver is producing that bile and putting it into the small intestine. If you have inflammation in the upper part of the small intestine near that outflow tract from the gallbladder, you can then pinch off that tube and potentially end up with a partial biliary obstruction, which makes it so that the gallbladder can't get the fluid out.

Or, you can have an infection in the intestine, which of course you have bacteria in the intestine all the time. But if you have inflammation that's happening, that's potentially diminishing the body's own ability to fight off infection. And you have an ascending infection that goes from the intestine up through the gallbladder, up the biliary duct, and can infect the gallbladder. And then you're going to have GGT be elevated because the gallbladder's infected or the gall bladder's inflamed, or you have a partial biliary obstruction and the gallbladder is very angry because it can't get that bile out. So there's lots of different ways that GGT can be elevated that has its root in intestinal disease or pancreatic disease.

The pancreas has its own outflow right near the gallbladder's outflow. So all these tubes are all conjoined in this weird, busy intersection. When you have that kind of situation, you have a lot of overflow from a lot of different areas. And that's kind of what happens in that upper part of the small intestine called the duodenum. That's where all those tubes come into play. And if you have disease in the upper part of the small intestine, which is not unusual in a dog, you potentially have interplay of all these things.

It's so complicated. It's actually "fun" as a veterinarian to figure this stuff out. And we are ready for the challenge, by the way, at Alicia Pet Care Center. But, it is very complicated. So it's impossible (as you can probably tell) to give a lot of information. That's why, when I have these conversations, I will tell people the extent of my knowledge at this point is that the liver is not happy about something. That's what we know. We don't know what the problem is. We typically won't know what the problem is unless we do extensive diagnostics, which we don't always do. And that is really dependent on the individual patient's struggles and whatever limitations are put on us by pet owners, or whatever the individual case may be.

Let’s Talk Cats

Let's move to the kitties because they are much more simple. A cat can have an elevated GGT, and that is not unusual because they are little bit more likely to have biliary disease. That is because they frequently have inflammatory bowel disease much more commonly than dogs, and that biliary tree can be impacted by that.

More commonly, you're going to see an elevation of ALT -- that's going to be the most commonly elevated liver enzyme in a cat by far. An ALT is going to be elevated most of the time from something called cholangiohepatitis, which is inflammation of the liver. Especially the part of the liver associated with biliary production for the biliary tree. And that is because that is the area that's susceptible to inflammation creeping up from the duodenum and affecting that biliary tract of the liver.

But we will also see ALT elevated in a cat due to inflammatory condition without involvement of the gallbladder. And we can see that with cancers as well. So if you have a 17 year old cat, we don't really love to see elevated ALT's because sometimes that means that there's a tumor that's growing in the liver itself.

And we can also see that the other liver enzyme, alkaline phosphatase is elevated in a cat. And that is almost always associated with something called hepatic lipidosis; the common term for this is "fatty liver syndrome". That's a condition that happens to cats when they are not eating. If a cat tries to produce energy from fat in its body, it has to go through this process that's very complicated. It basically turns its fat into energy via the liver. When a cat does this, it does it in a very particular way, and it will clog the liver up with these fat cells. That will impair the ability of the liver to function. The liver basically gets clogged up with fat, and that causes a cat to become sick with hepatic lipidosis or fatty liver syndrome.

So most of the time, we can get an idea that this is happening because we've had a fat cat that, for whatever reason, went off of its food and lost a lot of weight. And the owner might be actually excited about that. But we do lab work on them, and oftentimes we do this when they're sick. And we see that their alkaline phosphatase is elevated, which points in the direction of this fatty liver syndrome.

Occasionally, we'll see ALK Phos elevated just as a normal screening tool in cats. It's really uncommon that that's the case. Usually they're sick when they have an elevated ALK Phos as an adult.

We talked about ALK Phos at the beginning of this: remember, it's the nonspecific liver enzyme. One of the things that we can see in our young dogs and cats that are growing is that the alkaline phosphatase would be elevated in a growing bone situation. The bones when they are growing are releasing enzymes into the bloodstream as well. And those alkaline phosphatase elevations in a young, growing puppy or kitten are things that we expect and we blow off because, even though it's falling outside of the normal range, it's very common to see it elevated and it's not really meaningful outside of a normal bone growth situation in a young animal.

The Conversation and Decision-Making Process With Our Clients

So let's say we are having this conversation about liver enzyme abnormalities in your dog or cat, and we've now explained (in an extremely confusing way) that there are a number of different conditions that can cause it to be elevated, and we don't know what it is. And there is a real limitation on our level of being able to interpret these results. We can kind of guess a little bit, but that's dangerous. And so we're going to have a conversation of: “What do we do next?”

Of course, part of that is guided by you. So we really do rely on our pet owners to be historians for us, because we're not at your home. So we need to hear, regarding a dog, let's say: is the poop intermittently soft? Is it a little bit soft every single day? I have found over time that no dog owner is going to call soft stool "diarrhea". They will only call it diarrhea if it's liquid stool. So we have to be careful also about how we ask our questions, because chronic, intermittent soft stool in a dog is the number one symptom that we see with inflammatory bowel disease. And if we have inflammatory bowel disease going on, we very well might get a secondary liver problem happening and see this elevated liver enzyme.

So when we ask the question how is the stool, we are not asking it just so you can say everything is great. We want to hear the real report that's happening at home. Because if we have an inkling that we might have inflammatory bowel disease going on, that's going to change the way that we're going to approach that particular case. So it's important to be very critical.

It’s All About The Poop

Just as a side note, you really should be expecting a normal poop from every dog every time. We are going to release a new episode shortly called “It’s All About The Poop”, so keep an eye out for that. In the meantime, let's talk about the idea of "normal" poop. I think we all kind of know, I guess we assume that we all know what normal poo is. It should be dense and easily picked up with no residue. Color's not so important; it's the consistency of the stool. So it should be a nicely formed, dense stool, that doesn't leave a residue when you pick it up. It's not really extra moist. It doesn't squish easily when you pick it up, you're kind of like picking up a soft serve ice cream cone.

So we will go down this question & answer sort of situation and determine what the next step is. Oftentimes, we're going to want to prove a second data point. I think, if the dog is not sick or the cat is not sick, maybe in a cat it's a little more meaningful in a cat if we see liver enzymes, so we might move quickly. But if we see that the enzymes are elevated, we might wait a beat and recheck that enzyme in 1-3 months, something along that range. It's a little bit up to the veterinarian's discretion. And if we get a second data point, we see that those enzymes are elevated again, the important part is not that they are a little higher or a little lower, it's really that they're persistently elevated. So if we see that they're elevated again, we're going to have a deeper conversation of, "Well now what do we do next?"

So what we do next is really going to be up to the team making this decision with whatever limitations, philosophies, urgency from the veterinary side… all of those things in mind. Not every dog is going to get a full liver workup. I would hazard a guess that the vast majority of them are not going to get a full liver workup, at least not at Alicia Pet Care Center. This is because we are a very results-oriented practice. So we have found at the beginning of the story of us determining patients having liver enzyme abnormalities, we have determined that not every single one of these needs to be worked up fully. Oftentimes you have a dog who has a mild liver enzyme elevation throughout its entire life with no clinical significance.

But every dog is different. Every situation is different. So we have to operate in a way that is going to protect the group against having those rare situations come to a higher level, and us losing our opportunity at minimizing progression and creating a disease state.

Different Tools To Dig Deeper Into Liver Issues and/or Abnormalities

So, our next move might be that we want to look at that individual's liver with an ultrasound. And if we do an abdominal ultrasound on a dog or cat, we're going to be able to evaluate all of the liver, the gallbladder, the intestines, the stomach, the pancreas, and the rest of the organs in the abdomen. But those are the big things. Those organs are all going to relate to potential liver enzyme abnormalities that we might pick up.

So that's a great tool because it's a noninvasive tool. It doesn't require anesthetic, it's not going to require surgery or anything like that. Most of the time it's not going to require a sedative for that pet. So it's a pretty good test, like an x-ray. It's relatively easy to do and relatively easy to interpret. It's a little more complicated to interpret than an x-ray, but our doctors at Alicia Pet Care Center are all highly trained in ultrasounds. So we should be able to give you a pretty good idea of what's going on based on our doctor staff performing the test and giving you that feedback.

Some of the things that we're going to be able to determine on an ultrasound right off the bat are: 1) is there a lesion in the liver that we can see inside the actual structure of the liver? 2) Does the gallbladder look normal or not? 3) Is the biliary tree, the part of the liver that leads up to the gallbladder, or the biliary duct that leads from the gallbladder out to the intestine, are those things normal? 4) Is the liver small, or is the liver big, or is the liver misshapen, or is there an obvious tumor? Those are all things that we'd be able to determine on an ultrasound.

Now, there are massive limitations to ultrasound. And with the liver primarily, there is a big limitation because you can have advanced disease in the liver and not have any structural changes on the liver that the ultrasound would pick up. So it is not a perfect test. It's going to miss some things.

We can also look at the pancreas. So if the pancreas is abnormal, we're going to see that on the ultrasound, and it's going to look a couple of different ways depending on what the actual problem is with the pancreas. We're going to be able to look at the small intestine. This is an important thing as it pertains to intestinal disease. If you have inflammatory bowel disease, there's a good chance that your intestine wall is going to be thickened because of inflammatory cells that have gradually added on top of each other in the intestinal wall. So that may cause intestinal wall thickening that we would also be able to determine based on an ultrasound in a dog or cat.

And, we may be able to determine that there are no abnormalities associated with either one of those things, which puts us into a position of breathing a sigh of relief, potentially, that we don't see anything. So we just gradually keep watching these enzymes, unless our patient is acting sick.

So that's one thing that we can do to flesh this out a little bit more. One of the other things that we can do is called a bile acids test, which is a liver function test. The liver function test tells us just that: what is the function of the liver? Is it normal or is it abnormal? And if the liver function is abnormal, if the bile acids test comes back abnormal, that is concerning because the liver has a lot of redundancy. Just like our intestinal tract, there's a lot of redundancy there as well. But with the liver, if you were to chop out a third of the liver surgically, you would have no negative consequences of doing that. Which reflects this redundancy thing that we talk about, which means that you can have a lot of disease in the liver and still have a very functional liver.

So, if you have an abnormal bile acids test, it does put a little bit of a fire underneath you to figure out what is going on, because this condition is so significant, that it's now affecting the function of the liver. And I'm extra concerned about that because the liver has a ton of redundancy.

The bile acids test is not going to tell you what the problem is, but it may tell you how severe it is and may push one case or another to do more definitive testing to find out what the actual issue is.

The main test that's going to tell us exactly what's going on in the liver with primary liver disease is a biopsy. And we are in a great place at Alicia Pet Care Center now to obtain liver biopsies because we can do that with our laparoscopic surgery equipment.

Our doctor team is fully trained for laparoscopic surgery. This is a very routine and relatively easy procedure to perform with laparoscopic equipment, where you now are making a very small incision in the abdomen. It does require a general anesthetic, but you're able to go in with a camera, visualize the outside of the liver. You obviously can’t visualize the inside of the liver; you're doing that with ultrasound primarily. But you can go and look at the outside of the liver with your camera and determine exactly where you want to take that biopsy. You can see that you're doing it very safely. You can obtain that biopsy and a very nice-sized sample that the pathologists are appreciative of, not having these tiny fragments to work with.

So, we'll get a great quality biopsy sample, and we're going to be able to determine with the camera viewing it the entire time that there is no problem with bleeding after the fact. If we do have a little bit of bleeding, we can use a blood clotting sponge that we can put in there with the laparoscopic equipment. And then, again, monitor and make sure that the liver is not continuing to bleed. So that's an excellent way to get a liver biopsy.

There are two other ways of getting a liver biopsy that are not as preferable to laparoscopy, because they're either more invasive or they're more dangerous / also not giving us a great sample.

So the more invasive way to do it is with an abdominal exploratory surgery, where you're going in surgically and you are taking chunks of the liver out with your hands and instruments. The benefit of doing it that way in certain cases is that we can also do intestinal biopsies at the same time if we have a concern that we might be dealing with intestinal disease as the primary condition. As stated before, this is a really common scenario. So, that is not necessarily a bad test. It's a more comprehensive test, and it actually might tell us a lot more than just getting a simple liver biopsy in certain cases.

The other way of doing the liver biopsy is to do it via ultrasound guidance with a biopsy needle. The biopsy needle goes in externally. Usually the patient is heavily sedated for this. And the biopsy can be monitored through the ultrasound and directed towards a specific area of the liver. Then your biopsy is a core biopsy, which is a little worm fragment taken from inside the liver. This can work out relatively well, but you do have some potential downsides of: sometimes your sample quality is not great, because you're blindly going in. It's not entirely blind cause you can see it with the ultrasound, but it's not perfect. You can have bleeding, and the bleeding is problematic because you're not in there, you're not able to actually do anything externally except for just monitor it with the ultrasound. And you're also not entirely able to visualize the area that you want. Because with liver disease, oftentimes you have widespread disease so you're not able to actually see anything other than the internal structure of the liver with the ultrasound. Sometimes, you can see that there's a lesion there. And quite honestly, sometimes we get a little scared about sticking a needle into a lesion in the liver without being able to see what's going to happen afterwards. So there's some risk associated with a guided biopsy of the liver via ultrasound with a needle. There's some potential for not getting the samples that we want, and there's potential for some negative consequences from taking that sample itself.

Liver Shunts

That's primarily it as far as diagnostics go for the liver, aside from something that we might do in particular breeds and particular circumstances. One of the things that we haven't talked about yet is something called a portosystemic shunt, or a liver shunt. These are special circumstances that tend to happen in particular breeds. So we think about the Yorkie as the number one breed for this condition. The Yorkshire terrier has a very high risk genetically of developing a liver shunt. A liver shunt is a blood vessel that was supposed to go away when the embryo developed that did not go away. It takes blood away from the liver when it's coming out of the intestinal tract.

So normally, what happens is: blood vessels (like we talked about before)… the blood goes from the intestine to the liver back up into the circulation. That works really, really well for life because the liver is going to detoxify the things that are coming out of the intestines. It's going to break down waste products and toxins, in a way of working as a filter and a detoxifying organ. But that's not allowed to happen because the blood vessels didn't go away. So this blood vessel potentially stays there and shunts blood away from the liver. And now the liver is not able to do its job. So we have a consequence from that: generally, our young patients have toxins that are going straight to the brain instead of going through the filter of the liver. So it will cause potentially neurologic disease in a younger patient; it can make them have ataxia, which is incoordination. They can be very dull, and they're basically being poisoned all the time, a little bit, from their own body because the liver is not able to do the normal job that it's set up to do because the blood is not getting to it.

So there's a really great test for this that can be done at one of our neighboring specialty hospitals up in Tustin that's called a shunt scan. It is a radioactive enema. This is sometimes called a “tech scan”. The technology is called technetium, and it is radioactive. So, you put this radioactive substance up into the colon. The normal liver is supposed to be taking that out of the intestine through the blood, through the vessels that lead straight to the liver. So in a normal patient, you would be able to see this radioactive marker on a computer screen that's assessing the radiation in the patient. It goes into the colon, and then it goes up to the liver and then it goes back up into the heart. But in a patient that has a liver shunt, the liver just gets bypassed. It just goes straight into the colon because we put it up there, and then it goes straight up into the heart and bypasses the liver entirely. You can see this in the monitoring equipment that's looking at these radioactive markers that we just put up in there.

Now, rest assured, it's not dangerous to do this process. This is a benign radioactive material that is just excreted, and no bad things happen to the individual patient. But it's a great test for a shunt. We're actually very lucky in the country to have a facility so close to us that does this because a lot of the country has to travel hundreds of miles to get to a specialty center that would offer something like this. But we have it right in our backyard. It's a really quick and easy way to get to the answer of: "does my dog have a shunt or not?"

There are other things that we can do for diagnosing a shunt. Usually what happens is: your puppy has an abnormal liver enzyme. Oftentimes, this is being done prior to a spay or neuter. And we see the ALT is five times normal. Let’s say you happen to have a three-pound Yorkie, maybe that's also doing some odd things at home by acting a little weird, especially around meals. After a meal, it gets a little quiet, a little lethargic. Maybe it's having more symptoms than that. But we immediately say okay, we need to do a bile acids test on this dog before we spay it because we're going to put anesthesia in that's going to have some degree of an effect on the liver. We don't want that to happen, because the shunt patients will potentially take two days to wake up from their anesthetic event. That's one of the big reasons why we do blood testing in regards to an anesthetic patient, because the liver is going to play a big role in detoxifying all the anesthesia that we put in.

At any rate, we're going to do a bile acids test on that patient and the numbers are going to come back super high, typically. Because the liver is not functional. Remember, the liver is not getting blood flow. So not only is it not able to do its job, but it's also not getting nutrients that it needs to be able to successfully grow and be a healthy organ. So the liver function is going to be bad and your bile acids are going to be almost always relatively high.

If we have that scenario play out, then we're going to send a young dog up for a shunt scan up to Dr. Broome in Tustin. Dr. Broome is going to do his shunt scan and he's going to call us back and say: "Your patient has a liver shunt." So that's the story of shunts in a puppy.

Quick reminder, we got to liver shunts because we were talking about bile acids being abnormal.

Cats’ bile acid will be abnormal relatively infrequently because they usually don't have such severe disease, that it actually causes them to go into liver failure. But remember, the bile acids test is a liver failure test or a liver function test. And so some dogs that have primary liver disease will have, at the end of their liver disease playing out, significant decrease in function because they've eaten up their liver cell's normal abilities to do their normal thing.

We sometimes get ourselves into a situation where we have very difficult decisions to make. With liver disease, I think it's especially challenging because much of the time, we don't know what the actual problem is. And that's because much of the time, we're not going to do a liver biopsy because the patient's symptoms don't necessarily warrant it. Maybe we measure these liver enzymes over a period of 6 to 12 months and we see that they don't really elevate all that much above the mild elevation that they had. Or maybe they fluctuate and they normalize, and then they come back up again. And maybe our patient doesn't really seem to care whatsoever. We don't want to get lulled into a place of complacency because that can end up biting us in the butt. But we also don't want to do a liver biopsy on every single patient because there is some risk associated with that test. So we don't want to paint every single patient into the same place. They're all different. And it's all very complicated.

With liver disease, especially, we have to practice veterinary medicine as an art. A lot of this also has to do with our owner limitations. So if we have a financial restriction, that's going to limit what we can do test-wise. It is also really common for us to have an owner that's having a hard time getting their head around this. Honestly, I understand this a lot. People look at their dog, the dog is totally normal. And the ALT might potentially be 600 and it shouldn't be above 130; it's a super high number. And maybe the patient is walking around like nothing's wrong. It's going to be very difficult for most owners to say: "Let's go and spend $400 to do an abdominal ultrasound, and go pursue a laparoscopic liver biopsy at a cost of several hundred dollars." Most people are not going to want to do that unless there is a significant reason to do so. So, we have to balance out the search for knowledge based on our patient's needs and what the likelihoods are and our clients' hopes, dreams, desires, limitations.

So it's super complicated, as you can tell. And we are only scraping the surface here. There's so much to talk about with various liver diseases. In theory, a whole podcast episode could be done on cholangiohepatitis in a cat or copper storage disease issues in a dog.

It’s Extremely Complicated

I think the main takeaways that we want you to get with this podcast is that it's extremely complicated. It is not necessarily the end of the world to get your pet diagnosed with a liver enzyme abnormality, but it is also something that we can't blow off. It's something that we have particular treatments for based on the individual diagnosis that is made if we get to the point of making a solid diagnosis.

I think the thing that I would want to leave with is a discussion about liver supplementation because that is oftentimes what we end up doing, in a dog especially. Oftentimes, again, the best we're going to be able to do is to say that we know that there's something that's making the liver unhappy about things. And we (our doctor team at Alicia Pet Care Center) don't want to get super aggressive. The client doesn't want to get super aggressive at diagnosing the liver problem itself. So we're not going to get a liver biopsy done. We might not be able to do a bile acids test. We might be put in a position where our monitoring is not happening as often as we would like. And the patient potentially is not showing any degree of illness associated with this.

The nice thing about the liver is that we can actually play this supplementation card to enhance the special things that we have about liver cells. And one of the things that's special about the liver is that it's like a lizard's tail, where it can regenerate. Besides the fact that there's a ton of redundancy, a cool thing about the liver is that its cells can actually regenerate. So if we set the liver up to improve its health, we're going to have the potential of helping that liver regenerate itself and protecting ourselves against chronic degeneration of the liver that eventually can lead to a very bad situation where we don't have a whole lot of functional liver cells left.

Liver Supplementations

So we think about three different categories of liver supplementations as well. These are all evidence based things, which means that there are studies that have been done multiple times to prove that these are very effective moves that can help with the liver cells being more healthy and being able to regenerate themselves.

So those three liver supplements are Omega-3 fatty acids, milk thistle, and SAM-e. So we'll start with SAM-e. SAM-e is an amino acid that has various properties, but one of the things that it does is it helps the liver cells be more functional. It decreases inflammation mildly in the liver, and stabilizes the cell membranes. So it resists ongoing damage to the liver. Interestingly, SAM-e in people has lots of different uses including treating depression. So it actually can do a lot of different things. One of the things that I would say about SAM-e is that it's one of the more expensive products that we're going to use. And, ideally (it doesn't always have to happen this way), it's given on an empty stomach. So most of the SAM-e is going to want to get to the mid-intestinal zone. And it can only do that if it's not being digested in the stomach.

Once you feed a pet, there are all of these digestive enzymes that are going to be released from the pancreas and from the gallbladder. All of these things that are happening in the stomach and upper small intestine that are going to break things down, we don't want that breakdown to be happening there. So we want to try to slide into the mid-intestinal zone so that the product can actually be taken up there rather than being broken down and digested in the stomach and upper small intestine.

In my own personal practice [Dr. Matthew Wheaton], and I don't mean Alicia Pet Care Center, because we're all a little bit different in this: I will save SAM-e for my patients for last, because I think it's a little harder for the client to do this particular supplement because the timing is important and it's a little bit more expensive.

I like going with Omega-3's first, and that's because it's also going to help with a lot of different areas of the body. So Omega-3 fatty acid supplementation absolutely deserves its own podcast. But that is a product realm that can help almost every cell in the body improve its function or health. So everything that ends in 'itis', every inflammatory condition. So gastroenteritis, hepatitis, arthritis… all of those inflammatory conditions will be helped by Omega-3's because Omega-3's are natural anti-inflammatories. They also stabilize cell membranes and decrease ongoing damage to cell walls. They have some degree of an antioxidant property to them as well. So, there are a lot of cool things that come from Omega-3's. So you're not going to only get your effect in the liver, but you're going to get it all over the place. And if you have a situation where we have intestinal disease as our primary condition and our liver is taking the brunt of that; then again, Omega-3's are a great choice because you're going to get anti-inflammatory on both ends of the problem.

Omega-3's, again, deserve a long talk. But the really, really brief statement on this would be that fish oil is a middle of the road choice. It would be an affordable choice for dogs and cats to get Omega-3's from fish oil. They're readily available. They're pretty affordable. You are going to be getting primarily DHA and EPA out of that and it's easy to do.

The stronger Omega-3 is going to be from green-lipped mussel oil. Briefly, on green-lipped mussel oil, you are dealing with a much stronger anti-inflammatory because of the spectrum of Omega-3's that are in green-lipped mussel oil. Green-lipped mussel comes from the sea creature in New Zealand and there are 18 different Omega-3's associated with green-lipped mussel oil and they are going to be produced in a low heat environment. So it's going to maintain the structure of those long chain fatty acids.

And maybe most importantly, there is a fatty acid called ETA that is coming from green-lipped mussel oil that's found nowhere else in the world (as of yet) that is very, very similar to something called arachidonic acid. So that is the thought of why it likely is much better on the anti-inflammatory side: it is potentially being substituted into the inflammatory cascade instead of arachidonic acid. So, ETA becomes a very important Omega-3 that is only found in green-lipped mussels. Omega-3 is definitely a helpful move and something that is potentially going to provide widespread benefits.

Milk thistle would be our third supplement that we would think about. And milk thistle is, again, affordable. It is pretty widely available, although you're going to find different forms of it. We have a great supplement here that comes from an organic farm up in Montana. Milk thistle is a product that has been around obviously for an extremely long time. Indigenous population has been using this as a liver supplement since probably prehistory times. And it just does really cool stuff for the liver cells in that it decreases inflammation, increases the ability of them to regenerate and heal, and is a very benign, safe medication that doesn't have to happen on a particular time schedule like the SAM-e does.

Oftentimes, what's going to end up happening is we're going to identify that the liver enzymes are abnormal. We may do some additional testing. If we don't do a liver biopsy, frequently the end result is that we're going to use liver supplementations and ongoing monitoring to determine what the next move is. If we move somewhere else to do more diagnostics, that's probably going to take the form of either doing an abdominal ultrasound or a bile acids test. Either one of those tests may lead us to doing a liver biopsy, which is where we're going to actually find the real cause of the liver enzyme abnormalities themselves; that is very occasionally done. But that would tell us the full story.

And this is why we love looking at our blood tests when we get to work in the morning. If we did maybe half a dozen wellness labs on our patients the day before, when we get in we look at our labs almost as our first thing. We commonly will see that we have two or three dogs that have abnormal liver enzymes. We get relatively frustrated because we feel compelled to give our clients the answers to their questions and to give them a clear understanding of what's going on. And, much like so many things in this world, it's very complicated. So we feel compelled to have some degree of this conversation.

Hopefully this podcast will serve as a resource for pet owners to get an extended version of that talk. Potentially even for pets that we are not actually vetting across the world. But hopefully, this has been helpful to you all to understand the complicated nature of liver enzyme elevations and what they might potentially mean, and how to deal with them.

Question from podcast host: "I know that I've had my understandings from the outside world of liver issues and maybe not so much as with animals as with humans. But can you talk about: what about the people who get very yellow and they're very sick when they have liver issues. Is this not something that carries over to the animal world?"

Dr. Matthew Wheaton's response: That's a great question. We do have that in dogs and cats, but it has to be advanced disease. Generally, that can happen actually from things that are not liver problems. So your red blood cells can break apart and cause that same kind of thing. But if it's liver disease, you will potentially become jaundiced. So you've likely heard that word: jaundice. It's sometimes used with babies. I think that's the most common thing that we hear about is "my baby was born jaundice and I need to do those special UV lights". That's a whole different thing entirely. We don't deal with that at all in dogs and cats.

But you can become jaundice with end stage liver problems. That's really bad. So when we have a patient that comes in yellow, it's usually a very advanced liver condition that's going to be difficult for us to actually get back to normal. We may be able to manage that patient for a time, but usually those are our more severe liver problems. And generally it reflects, unfortunately, conditions that have been allowed to progress for a long period of time and they've just eaten away the function of the liver over time. And then you have liver failure in the area of the biliary tree, and you get a buildup of those 'dyes', so to speak. It's different colors that happen that the liver is supposed to be taking care of, and then your body will show that yellowy color. It's very bad in a dog and cat to have that sort of thing show up. Because it's now so late in the game. A lot of times there's not a lot that we can do to reverse the problem and we end up just managing that end stage liver disease patient for as long as we can based on their quality of life maintaining “okay”.

The symptoms are tough because they're usually very vague. The most common thing is that you're going to see chronic intermittent soft stool with a dog that reflects intestinal disease, that then reflects back on the liver and you get a secondary liver problem. Beyond that, unless your dog is extremely sick, you're probably not going to know that there's liver disease going on at all. So symptoms are tough. Most of the time, this reflects an owner that is allowing for us to do our normal annual wellness panels and finding these markers before the clinical symptoms come.

Question from podcast host: "I have a friend of mine from years ago whose dad died of cirrhosis, and you didn't really mention that at all. Is cirrhosis even something that goes on with pets?"

Dr. Matthew Wheaton's response: It is. Cirrhosis actually just really means “scarring”. So you can absolutely have cirrhosis of the liver in a dog or cat. That is going to end up being a very bad scenario, again, because you're going to have scarring in the liver. And that's typically an end stage liver disease sort of scenario. There's different conditions that can lead to cirrhosis in people and in animals. But in people, the vast majority of it is going to be related to alcoholism; you're just basically damaging your liver cells all the time. They're functioning as a toxin remover, but you're killing them and doing it in a consistent way. If you're an alcoholic, and let’s say you're drinking every single day, potentially, and never really giving your liver a chance to regenerate. So you just destroy your liver that way.

It can also happen secondary to inflammation. So, on the human side, another cause for cirrhosis would be any of the hepatitis viruses. So there's different types of hepatitis in people, but hepatitis means inflammation of the liver. So you have a chronic smoldering inflammatory condition of the liver that's caused by a virus.

In dogs and cats, it's not typically viral. We actually have vaccines against those things that are routinely done. That's another reason why you want to stay on top of your vaccines. Beyond that viral cause are inflammatory causes. And those are a very high cause for our primary liver disease patients to present. Dogs and cats having hepatitis are common types of primary liver disease. If you have hepatitis that's going on for a long period of time, you eventually will take away the ability of your liver to function properly because you have replaced liver cells with inflammatory cells. And you now have scarring that results from that, and you end up with a cirrhosis scenario and typically a yellow patient.

The podcast host: "Well this is all, as you said, extremely complicated. I didn't realize, personally, what we were walking into as we started this episode. And I feel like I understand it a lot more. I know that we already have some of these things planned to go into other podcasts, and I think we've opened up a couple more that we now know we need to record. So I will tell you all: make sure you look at the list of our different episodes so you are linking some of these things together.

Thank you to Dr. Wheaton for taking this time out of one of your days off to educate us on liver disease and liver enzyme abnormalities. I know that this will be a huge resource for a lot of people. Like you said, potentially not just patients that we are vetting in the hospital… but pets around the world."

Dr. Matthew Wheaton: I hope that it's going to add to your normal veterinarian's talk that maybe was confusing to you. Because, again, I feel really bad having these conversations with people because we're trying to dump literally two years of physiology and specific learning that we have obtained on liver conditions into an owner's brain in, hopefully, no more than 15 minutes on the phone. It's really challenging to do that. So hopefully this will be an added resource to a lot of people out there to enhance the conversation that you've already had with your veterinarian and to be able to understand it a little bit better.

Okay, and that is the end of this episode on liver disease. Thank you so much for joining us. We hope this answered a lot of your questions and provided some extra clarity. If you have more questions or if you have more topics that you want us to discuss, send us a line. You can drop us an email at: [email protected]. You can also contact us through social media.

You can find Alicia Pet Care Center on Instagram, Twitter, Snapchat with our username @APCCvet. We are on Facebook as Alicia Pet Care Center. You can send any questions and topics you'd like us to discuss on a future episode to [email protected]. Our hospital's website is www.mypetsdr.com and the podcast website is www.PetTalkPodcast.com.

The podcast is available on the Apple native app, and for you Android users, it’s available on Google Play and the Stitcher Radio app. You can share those with your neighbors, or friends, or family members that may be dealing with any of these issues as well.

Thanks for listening!

We are extremely proud to have a staff full of people who want to further themselves personally and professionally. At the time of writing this, we have 6 Registered Veterinary Technicians (aka RVT's) in our hospital. We also have 7 of our other staff members currently in school. Here at Alicia Pet Care Center, we have always considered ourselves a highly educational facility; not only for pet owners but for anyone we hire, as well.

In this episode, we sit down with each of our current RVT's to get some background on how they navigated the path to become a Registered Veterinary Technician. Not only does this give our clients a deeper insight to the people who take care of their furry family members, but it also gives great information to anyone out there considering the veterinary field as a career that may be wondering how to accomplish that.

Each of these six RVT's has a unique story to share; which is fitting and should be encouraging to others who want to work in this field. There is not just one path that you have to take to obtain success. And the stories these ladies tell is not representative even of the only paths one can take, either. We are sure there are plenty of others out there who would also have their own unique tale to tell. 

We should start by stating that our ultimate goal with any employee that comes to us without previous experience is to have them work their way up our version of the corporate ladder. That means starting as a kennel attendant: that gives us the opportunity to observe their work ethic and for them to learn about things like: pet behaviors, proper restraint for treatments and services, medications and how to properly administer some of them and what our hospital’s unique culture is and how to not only work within that culture, but to be a positive contributor to it, as well.

Successful kennel attendants have the opportunity given to them to move into our reception team. Whereas the work in kennel is 90% focused on animal-related issues, that gets flipped in reception to 90% working with those pets’ human owners. The work and tasks that got touched on previously, are now more fully saturating their knowledge-base in reception, as these staff members have to effectively communicate so many situations and topics to our clients. For those who want to make the subsequent move into our treatment area, their communication and knowledge skills are thoroughly analyzed before they are able to be looked at for that move.

Our hospital prides itself on “practicing what we preach” with this recipe for success. Currently, 4 people in our treatment staff worked previously in reception at APCC and 4 worked in kennel. Out of our 8 receptionists, 4 of them previously worked in kennel. We absolutely feel the benefits of this experience within our hospital. That extends not only to each individual’s level of knowledge with a myriad of things, but also with how well our staff works together… which is of the utmost importance to our success.

Amanda, the first person you hear from in this episode, started at our hospital as a 17 year old, still attending high school, as a part time kennel attendant. Amanda was actually one of the very few who got asked to become one of our treatment staff members without spending any time as a receptionist. She spent about 2 years working in treatment before she started going to school to further her abilities here.

Kaitlin came to us as an experienced technician from another local hospital. She knew during her senior year in high school that this was what she wanted to do. Following time at Saddleback College, she started working at a local veterinary hospital before she enrolled in a specialty school and took her state and national tests to become an RVT.

Hunter came to our hospital from working in clothing retail and made the jump to working as part of our kennel team. It didn’t take long for everyone to recognize her superior customer service skills and she moved into reception. Hunter was one of those people who got moved as a tremendous member of the reception team into the treatment team. She spent roughly 3 years as a technician before she completed her schooling and passed her tests to become an official RVT.

Cristie’s path was completely unique in comparison to the others here. She actually went to Saddleback and transferred to Cal Poly Pomona and obtained her bachelor’s degree in animal health science. While she was at Cal Poly Pomona, she completed 4 separate internships in animal hospitals. Independently, she took the state and national tests following that and became a Registered Veterinary Technician prior to becoming part of the APCC team.

Lauren also has a very unique path unlike her fellow RVT’s. We met Lauren as she inquired about completing her internship for a local veterinary university. She was welcomed into APCC to complete her required hours as an unpaid intern. During that time, the feeling of wanting to take our working relationship with Lauren to the next level was mutual. We hired her immediately following her graduation and shortly thereafter, she took and passed her tests to become an RVT.

Samantha rounds out our conversations on the podcast, fittingly. She is the longest running member of the hospital staff, outside of the Owner, Dr. Wheaton. Samantha was hired as a receptionist way back in the summer of 2005. She had already “paid her dues” as a kennel person, having worked at a grooming facility during her high school years. It wasn’t long before Samantha was forcing the conversation to look at moving her into the treatment team, based on her desire to be a technician as well as her overall fantastic work ethic and ability to work well with everyone: staff and clients alike. Nothing has changed since her move to treatment: Samantha remains an excellent example of what Alicia Pet Care Center has always stood for in its core values: providing the absolute best care for our patients while being extremely dedicated to assisting in the education of our clients on the how’s and why’s of our doctors’ plans for treatment.

You can find Alicia Pet Care Center on Instagram, Twitter, Snapchat and Periscope with our username @APCCvet. We are on Facebook as Alicia Pet Care Center. You can send any questions and topics you'd like us to discuss on a future episode to [email protected]. Our hospital's website is www.mypetsdr.com and the podcast website is www.PetTalkPodcast.com.

Thanks for listening!

This episode is our conversation with a couple of the key members of the Just Food For Dogs company. If you're one of our clients and you've been into our hospital since December of 2017, you've seen the Just Food For Dogs pantry that was built into our lobby. We analyzed Alicia Pet Care Center's standard of care for our patients and the dedication of Just Food For Dogs to improving the lives of your pet. It was a fairly simple conclusion to align our hospital with this progressive pet food company and offer their whole-food nutrition in the most convenient way possible. 

APCC's Office Manager Tim Wheaton sits down in this episode with Shawn Buckley, the Founder of Just Food For Dogs and their Chief Medical Officer, Dr. Oscar Chavez. While discussing the creation of the company, Shawn and Dr. Chavez both detailed some of their startling discoveries in regards to the ingredients in commercial dog foods. 

Shawn stated that when he learned what is allowed to be in dog food, he knew that he needed to create something that operated outside of that norm. Dr. Chavez detailed how using ingredients that are USDA-certified for human consumption changes the game of pet nutrition. They both discussed how the pet food industry is practically unregulated. The Association of American Feed Control Officials (AAFCO) was created to "regulate" how pet food is made. However, this is not a government-regulated entity. As a matter of fact, AAFCO is a voluntary membership association.

When the established AAFCO feeding trials were run by the scientists at Dr. Chavez' university, the scientists came back to him with a proposal to up the ante on the standard trials, stating AAFCO's trials were too rudimentary. Dr. Chavez brought that to Shawn, who immediately agreed to push everything further than what other pet food companies were doing. 

Just Food For Dogs has published a document called the "White Paper", which is "an evidence-based analysis of the dog food industry in the USA". We talked about the toxins, contaminants, and adulterants that get into pet food.

Shawn broke down kibble in a fairly simple analysis: you can't put meat in a bag at room temperature for a year... you shouldn't do it for more than an hour. You can't really do it for a day, and they [other pet food companies] do it for a year. So, they implore us to think about what would have to be done to that kibble (that "meat") to put it in a bag for a year at room temperature. The answer is: major chemical preservatives. The most common of those chemicals: ethoxyquin, which is a known carcinogen and is not allowed to be in human food. 

Dr. Chavez reminded us about the somewhat recent discovery of the barbiturate Pentobarbital in cans of pet food. He put the question out there of "how could something like that happen?". The answer to that is troubling. Dr. Chavez discussed the "compliance policies" created by the FDA that, paired with the lack of regulations on pet food, would allow something extremely unfortunate like this (to put it lightly) to occur.

The giants of the industry have thrived on a somewhat "smoke and mirror" approach to advertising their products to the public. Dr. Chavez said it very succinctly when he said: "...they've stopped talking about nutrition; because they can't really do that very well anymore...".

In an industry that is full of images of cute puppies and kittens running through perfect, green grass and looking incredibly happy, Just Food For Dogs is inviting anyone and everyone to take a deeper look. 

Furthermore, in a world where nearly every segment of pet-related industries have kept pace with the idea that so many of us have embraced: that your pet is a member of your family... pet nutrition is the industry that is trailing far behind all others. Veterinarians, veterinary medicine and especially pet owners have all moved forward with the mindset of elevating their pet's status within the household. However, so much of the pet food industry has remained anchored in the past with kibble: something that hasn't progressed in over 70 years.

One of the incredibly unique qualities of Just Food For Dogs -- even amongst some of the newer competitors that are, on the outside, seeming to replicate their business model -- they are still the only company in the industry where consumers can be in a kitchen and watch their pet's food be made. In late July, Just Food For Dogs held a "Yappy Hour" and a Cooking Demo right here in Alicia Pet Care Center's lobby for a number of customers and clients.  

You can learn more about Just Food For Dogs at their website here. If you want to read their "White Paper", you can view that by clicking here. 

You can find Alicia Pet Care Center on Instagram, Twitter, Snapchat and Periscope with our username @APCCvet. We are on Facebook as Alicia Pet Care Center. You can send any questions and topics you'd like us to discuss on a future episode to [email protected]. Our hospital's website is www.mypetsdr.com and the podcast website is www.PetTalkPodcast.com.

Thanks for listening!

This episode is the conclusion to the spay & neuter conversation with Dr. Wheaton. If you listened to the previous episode, you heard: a multitude of fascinating and eye-opening statistics regarding the pet overpopulation and some of the prevalent issues that are commonly seen when pets are not spayed or neutered. No punches were pulled in the first episode...and that holds true in this equally important second episode. 

Here's a link to that 1st episode in iTunes for you: Spaying & Neutering Part 1

Dr. Wheaton tackles one of the most pervasive myths about the very real effect that letting your female dog undergo even one heat cycle can have on her health. It's an issue that should not be ignored and, unfortunately, is not as well known by pet owners as it should be. 

We also discussed some recent studies out of Europe and here in California (at Dr. Wheaton's Alma Mater: UC Davis) that showed some very serious results concerning breast cancer. Dr. Wheaton even shed some light on what spaying or neutering too early in a dog's growth cycle can mean for the growth of its limbs. Perhaps oddly and surprisingly: the limbs tend to grow longer (than they otherwise may have), which can lead to lots of ACL issues. 

Shortly before the detailing of the surgical process here at APCC was given, Dr. Wheaton talked about how important and life-changing it can be for pet owners to get their pet insured. 

We created a lengthy article on our blog as a written companion piece to this podcast episode. We will do that with the second half of the episode, as well. You can read over that article and share it with others by clicking here. For the article created from the 1st episode, click here.

You can learn more about our affordable spay and neuter program we have set up for new clients at www.practicallyfreespays.com

You can find us on Instagram, Twitter, Snapchat and Periscope with our username @APCCvet. We are on Facebook as Alicia Pet Care Center. You can send any questions and topics you'd like us to discuss on a future episode to [email protected]. Our hospital's website is www.mypetsdr.com and the podcast website is www.PetTalkPodcast.com.

If you want to see some of how the spay and neuter process takes place here at Alicia Pet Care Center, we have multiple videos from our Ford Petersen Spay Days we hold annually to honor a former employee. You can view Spay Day 2014, Spay Day 2015 and Spay Day 2016 by clicking on any of those links to watch.

Thanks for listening!

In this episode, Dr. Wheaton sits down to talk about all things spay and neuter. The information included in this conversation was so robust, we had to break it into two full episodes. This first half of the conversation breaks down the four classes we deal with here at Alicia Pet Care Center: male dogs, female dogs, male cats and female cats. There are some eye-opening (and maybe even jaw-dropping) statistics that get broken down. Some of the possible and fairly commonly seen results of avoiding the surgery for your pet are thoroughly spoken about. 

On the male side, we discussed what extending the time of testosterone can lead to in your dog or cat: patterns of aggression, urine marking and that embarrassing inclination for your intact male dog to turn a pillow or a stuffed animal or even your favorite neighbor's leg into his "hump buddy". 

On the female side, Dr. Wheaton really got into some of the nitty-gritty on how much spaying your pet can cut down the risk of certain cancers. Dr. Wheaton also detailed something called a Pyometra and what that can entail for your pet and for you. Specifically, with the female cat, we talked about how they are "induced ovulators" and what that can lead to for you cat owners. 

We created a lengthy article on our blog as a written companion piece to this podcast episode. We will do that with the second half of the episode, as well. You can read over that article and share it with others by clicking here. 

You can learn more about our affordable spay and neuter program we have set up for new clients at www.practicallyfreespays.com

You can find us on Instagram, Twitter, Snapchat and Periscope with our username @APCCvet. We are on Facebook as Alicia Pet Care Center. You can send any questions and topics you'd like us to discuss on a future episode to [email protected]. Our hospital's website is www.mypetsdr.com and the podcast website is www.PetTalkPodcast.com.

If you want to see some of how the spay and neuter process takes place here at Alicia Pet Care Center, we have multiple videos from our Ford Petersen Spay Days we hold annually to honor a former employee. You can view Spay Day 2014, Spay Day 2015 and Spay Day 2016 by clicking on any of those links to watch.

Thanks for listening!

For this episode, we brought in a special guest that has worked for years with many of our clients' pets: Vladae Roytapel aka The Russian Dog Wizard. Vladae originally started his career in dog training in the former Soviet Union; he was a Red Army and Soviet Union Government awarded trainer before relocating to Michigan here in the USA. Since that time, the decoration of Vladae as a world-renowned professional dog trainer has continued. He won multiple awards during his time in Michigan, including honors from the state government. During his time in the midwest, Vladae became very popular through multiple news programs, radio shows and even appearances on CNN and Late Night with David Letterman. 

Vladae is now located in Southern California's Orange County. He has been named the #1 ranked Best Pet Trainer for the OC Hot List awards in 2014 and 2016. Vladae offers affordable dog training classes of many varieties. His extremely effective dog training techniques are based on his stunning ability to communicate directly with your dog during training and then teaching you (the human) the same techniques. 

You can listen to us talk about the top 3 reasons that pet owners struggle with their dogs. Vladae discusses some of the techniques that he uses with his clients that have been amazing people for well over a decade now; many times with immediate same-day results. 

You can find Vladae online by either simply googling "Russian Dog Wizard" or by checking out his website at www.socaldogtraining.com. 

You can find us on Instagram, Twitter, Snapchat and Periscope with our username @APCCvet. We are on Facebook as Alicia Pet Care Center. You can send any questions and topics you'd like us to discuss on a future episode to [email protected]. Our hospital's website is www.mypetsdr.com and the podcast website is www.PetTalkPodcast.com.

Thanks for listening!

In this shorter episode, Dr. Ashley Dewey sits in front of the mic to fill us in on her usage of acupuncture in the hospital, what led Dr. Dewey to the world of acupuncture in the first place and how that all catapulted her into learning the technique.

She details those stories and the process of acupuncture in general. We then discuss some of the amazing results we have seen with some of our own patients here at Alicia Pet Care Center.

You can find us on Instagram, Twitter, Snapchat and Periscope with our username @APCCvet. We are on Facebook as Alicia Pet Care Center. You can send any questions and topics you'd like us to discuss on a future episode to [email protected]. Our hospital's website is www.mypetsdr.com and the podcast website is www.PetTalkPodcast.com.

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For this episode, we sat down with integral members of The Pet Rescue Center: Development Director Jan Henry, Operations Director Kati Winters, Executive Director and Co-Founder Blythe Wheaton as well as a brief introduction by Medical Director, Board President and Co-Founder Dr. Matthew Wheaton.  

Kati with Pygmy; The Wheatons with Sally Sparkle and Fezzik Hodor; Jan with Monty.

A great deal of information is thoroughly gone over with these guests, helping us learn more, not only about The Pet Rescue Center, but about the world of pet rescue, in general. Alicia Pet Care Center partners with a large number of local rescues because of how much we care about helping homeless animals and the people that endeavor to shepherd them through their struggles to the point of finding their forever homes. We continue to be one of the largest, most-caring, state-of-the-art veterinary hospitals in all of South Orange County that prides itself with immeasurable compassion for rescue and a well-educated and motivated staff.

You can find us on Instagram, Twitter, Snapchat and Periscope with our username @APCCvet. We are on Facebook as Alicia Pet Care Center. You can send any questions and topics you'd like us to discuss on a future episode to [email protected]. Our hospital's website is www.mypetsdr.com and the podcast website is www.PetTalkPodcast.com.

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This is a shorter episode focused on a discussion with Alicia Pet Care Center's Dr. Brömme, talking about her recent trip to Guatemala. She was involved with Veterinarians International to provide services to a large number of local pets for surgeries and vaccines and general assistance for the pets of Todos Santos. 

You can find us on Instagram, Twitter, Snapchat and Periscope with our username @APCCvet. We are on Facebook as Alicia Pet Care Center. You can send any questions and topics you'd like us to discuss on a future episode to [email protected]. Our hospital's website is www.mypetsdr.com and the podcast website is www.PetTalkPodcast.com.

Thanks for listening!