Website Relocated - Visit AllTradesDVM.com

 I am excited to announce that I have completed my veterinary curriculum and graduated! And alongside that, I have relocated the website to a new URL- AllTradesDVM.com

I hope that you'll join there. Moving forward, please share links from this new URL. Old links will no longer work. This website will no longer be updated.

I started this blog in 2019, during my first year of veterinary school. It was started out of a passion to share the information I was learning with the public, especially areas where I was frequently seeing incorrect, even dangerous, information online.

Since then, the website has been viewed over 100,000 times. I have 1500 followers on Facebook. To those that have been here along the way, thank you so much for your support. For those that are just joining, I hope you like what you find. Please join me for the next part of this journey at the new website; again, alltradesdvm.com

- Dr. Caitlin (;

Trending Studies: Is Once a Day Feeding Healthier for Your Dog?

  PLEASE VISIT THE NEW WEBSITE URL FOR VIEWING AND SHARING THIS ARTICLE: 

https://www.alltradesdvm.com/news/research/covering-studies/once-a-day-feeding 

  

 A huge study from the Dog Aging Project (DAP) is currently making rounds in headlines and across social media for a surprising finding: dogs fed once a day score better on some health inventories than dogs fed two or three times per day. This finding may alarm pet owners, considering the vast majority of dogs in the US eat at least twice per day. The last thing anyone wants to do is harm their pet's health-- but these findings shouldn't have you rescheduling your dog's meals just yet. There are some important considerations that were highlighted by the authors but are being missed in the noise and bustle of social media.  

What is the Dog Aging Project?

    In their own words from the front page of their website, "The Dog Aging Project is an innovative initiative that brings together a community of dogs, owners, veterinarians, researchers, and volunteers to carry out the most ambitious canine health study in the world. The Dog Aging Project will follow tens of thousands of companion dogs for 10 years in order to identify the biological and environmental factors that maximize healthy longevity." This project has funding from the National Institute on Aging under the NIH, and is working with both University of Washington and Texas A&M University. 

What did they publish? 

"Once-daily feeding is associated with better health in companion dogs: results from the Dog Aging Project." Bray, E.E., Zheng, Z., Tolbert, M.K. et al. GeroScience (2022).
https://doi.org/10.1007/s11357-022-00575-7

 During recruitment for the 10 year study, owners completed online surveys. The 'Health and Life Experience Survey' (HLES) collected owner-reported information pertaining to the lifestyle and health status of enrolled dogs. A 'Canine Social and Learned Behavior Survey' (CSLB) collected information for scoring cognitive health and decline. Alongside this score, a score was generated from the HLES using a binary "yes has a condition" / "no does not have a condition" within 9 broad categories, such as skin, orthopedic, or cardiac. 

    Overall, there were roughly 24,200 responses to HLES and 10,400 responses to CSLB surveys. Of the respondents, 8% of dogs were fed once per day, and 92% were fed two or more times per day. Within statistical analysis, the authors were able to control for sex, age, breed (if purebred), and body size (if mixed breed). They also accounted for supplement administration physical activity, and history of training when assessing cognitive health. In analysis, the authors found a statistically significant association between being fed once per day and both better cognitive scores and decreased odds of having health conditions in certain categories. 

What does that mean for pet owners? 

    There are a number of considerations for this study. While it presents an interesting finding, it should be treated less as an indication for any feeding recommendations and more as an open door for informing further, more targeted research. The authors even write, "Given the limitations of this cross-sectional, observational study, the results of this investigation should not be used to make decisions about the feeding or clinical care of companion dogs." Some of those limitations that should be considered include: 

• This survey was conducted at a point in time (luckily, DAP is a 10-year project). Based on this survey alone, it is unclear how long dogs were fed the number of times per day reported in the survey (was it their entire life, a recent change, a transient period, etc). 
• Shifts in feeding style may coincide with diagnoses, such as feeding twice daily in order to administer medications twice daily (reverse causality)
• Calorie intake and body condition were not reported for this survey, but previous research indicates these variables influence health outcomes. Once-daily feeding may also be associated with lower average calorie intake or appropriate body condition. Luckily, future portions of DAP will include obtaining electronic medical records that should include body condition.
  
• As an owner reported survey, there are inherent limitations to how the data can be extrapolated; to some degree, this is counteracted by the sheer volume of responses.  
• The nature of this study precludes establishing causation from the observed correlation, and any number of concurring factors that trend alongside once-per-day feeding may underlie the findings. 
  

    At this stage, pet owners should feel comfortable with what works best for their dog. Some dogs experience vomiting when fasted for extended periods, or don't tolerate once per day feeding due to food-seeking behaviors. These and similar factors have to be considered on an individual basis, and are best discussed with a veterinarian in the context of a patient-client relationship. There is not enough data in the area of time-restricted feeding to justify broad recommendations yet, so owners should not feel concerned that they are harming their dog by following the feeding schedule that works best for them. However, it is good to be aware that this is an active area of research, and data may emerge in the coming years that does change recommendations. 

    The authors end their paper, "We view these results as an exciting first step of an ongoing exploration on the impact of diet on companion dogs living in human environments. Given the intense interest in, and popularization of, "longevity diets" such as intermittent fasting, and time-restricted feeding, these types of studies in dogs are both timely and important. We believe these studies will ultimately offer insights into factors that promote health and longevity for both dogs and humans."

   As of right now, the best thing you can do for your pet's health is ensure that they have routine veterinary wellness visits, recommended blood work, and are kept in lean body condition (obesity is associated with numerous negative health outcomes), as scored on an objective chart. This may mean restricting calories through less food or less treats, but should be done in conjunction with a veterinarian to ensure weight loss is healthy and appropriate, as well as to rule out medical causes of weight gain.  

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Randomized feeding trial in Labradors supports link between DCM and diet

PLEASE VISIT THE NEW WEBSITE URL FOR VIEWING AND SHARING THIS ARTICLE: https://www.alltradesdvm.com/topics/diet-associated-dcm/dcm-articles/waltham-feeding-trial

Literature Discussed: "Responses in randomised groups of healthy, adult Labrador retrievers fed grain-free diets with high legume inclusion for 30 days display commonalities with dogs with suspected dilated cardiomyopathy." Bakke, A.M., Wood, J., Salt, C. et al. BMC Vet Res 18, 157 (2022). https://doi.org/10.1186/s12917-022-03264-x

Key Takeaway: Dogs eating a grain-free, legume-rich diet developed changes to their blood parameters after 30 days which are similar to changes seen in dogs diagnosed with DCM, which provides early evidence of potential pathology. 

Summary: In light of ongoing concerns of diet-associated/non-hereditary DCM noted in the US among dogs eating grain-free and legume-rich diets, researchers conducted a short-term (30 days) feeding trial on a small group of Labrador retrievers. These dogs were selected from a colony at the Waltham Petcare Science Institute. Prior to inclusion, all dogs had baseline blood parameters measured as well as cardiac clearance via echocardiogram with a boarded cardiologist. 5 dogs were fed a grain-inclusive, no-pulse legume diet, and 6 dogs were fed a grain-free, pulse legume-rich (60% inclusion) diet. These were experimental diets formulated for the purposes of the study. Blood work was checked on days 0, 3, 14, and 28. Additionally, urine taurine was measured. The dogs were scheduled to receive end-of-trial echocardiograms, but due to the cardiologist falling ill, only six dogs were scanned. 

Change of diet reduces measurement of heart damage marker in dogs fed grain-free

Literature discussed: "Effect of diet change in healthy dogs with subclinical cardiac biomarker or echocardiographic abnormalities” Haimovitz D, Vereb M, Freeman L, Goldberg R, Lessard D, Rush J, Adin D. J Vet Intern Med. 2022 Apr 14. doi: 10.1111/jvim.16416

Key Takeaway: Heart abnormalities in otherwise healthy dogs eating grain-free diets can be resolved/reversed with a change of diet. This is consistent with the findings of multiple previous studies as well as clinical observations.

Summary:
    A recent study (Adin et al.,2021) revealed elevated levels of biomarker cardiac troponin I in healthy dogs eating grain-free diets as compared to dogs eating grain-inclusive diets. This biomarker has been associated with damage to cardiomyocytes, the heart muscle cells. It was proposed that elevations of that marker in dogs eating certain diets may be attributable to low-level cardiac damage. In follow-up of that finding, researchers continued to monitor a subset of cases and measure serial levels of that marker after a diet change. That data has now also been published in a new paper  (Haimovitz et al., 2022).

Preparing for Pet Emergencies: What To Do and When To Go

     No one ever wants for an emergency to happen with their pet- and despite our best efforts to maintain the health of our companion animals, unexpected things can happen. In the event of a true medical emergency, time of often of the essence, and has a significant impact on outcome. Being prepared for an emergency, as well as knowing how to recognize the signs of common ones, could potentially save your pet's life, and in some cases, reduce the cost of care needed for their recovery. 

Disinformation Still Dominates Diet & DCM Dialogue

PLEASE VISIT THE NEW WEBSITE URL FOR VIEWING AND SHARING THIS ARTICLE: https://www.alltradesdvm.com/topics/diet-associated-dcm/dcm-articles/disinformation-still-dominates-diet-dcm-dialogue

    It's been four long years since the 2018 announcement from the FDA about a heart disease called DCM and it's potential link to certain types of grain-free or pulse-legume heavy diets, and the conversation is still dominated by disinformation.

   Three and a half updates from the FDA and eight epidemiological studies later, there's a lot we still don't know. There's a decent bit we do know, too. We know enough to make risk-minimizing decisions based on the information available, while research continues into the foreseeable future, and these risk-mitigation decisions have the potential to save lives. We know that dogs are still being diagnosed and passing away from this disease. Unfortunately, the narrative available to pet owners through social media and trending articles isn't one that reflects the research and the reality in veterinary clinics. 

Another DCM study (2022) shows improved cardiac parameters when changing from non-traditional diet

     Dilated cardiomyopathy is discussed on this site so often, people are often surprised when told I don’t intend to specialize in nutrition or cardiology. My interest in this topic is fueled instead by a passion for countering misinformation and providing education to the pet owning public, as well as enthusiasm for epidemiology and emerging disease science. On that note:

     “Prospective study of dilated cardiomyopathy in dogs eating nontraditional or traditional diets and in dogs with subclinical cardiac abnormalities” was published 03/17/22 in the Journal of Veterinary Internal Medicine, with authors representing both nutrition and cardiology. The paper is open access, meaning anyone can read it without a login, subscription, or fee.  In as few words as possible, the main findings of the paper are summarized at the end of the abstract, “Dogs with DCM or SCA [subclinical cardiac abnormalities] previously eating NTDs [non-traditional diets] had small, yet significant improvements in echocardiographic parameters after diet changes.” 

Has data revealed that DCM in dogs did not increase with grain-free sales?

     A new research paper from BSM Partners was published this month and has already started to circulate online, ostensibly addressing the question of whether DCM cases have increased over time as grain-free diets have become more popular and widely fed. As a reminder, BSM Partners is a consulting firm that formulates pet foods for various companies, including Zignature, one of the top named brands associated with the FDA’s investigation. Employees of this company were the authors behind a widely criticized, non-systematic literature review on DCM published in 2020. Their conflict of interest on this subject has also previously been discussed in an article by Dr. Brennen McKenzie, known on his blog and social media as SkeptVet, and still applies to the current paper. Undisclosed for this paper, BSM Partners also received explicit research funding from several pulse legume interest groups.

To preface, a well-conducted study such as this could provide useful information to add to the developing issue. Unfortunately, this particular study failed to collect sufficient data, and in being published despite that, paints an incomplete picture that cannot provide many meaningful conclusions. While the findings can be easily characterized to dismiss the notion that atypical DCM cases, as being investigated by the FDA, are linked to certain grain-free or legume-rich diets, the striking limitations must be given consideration.

WSAVA, AAFCO, DACVN? Navigating Pet Food

     For most people, pet food is no easy game. The conflicting recommendations (both online and off) and near-constant onslaught of new selling techniques and novel formulations from companies trying to get a leg up in the market creates a labyrinth of decision-making for consumers. Luckily, there are resources available from a variety of reputable organizations and experts, but even keeping those straight can be confusing. This primer should help lay a foundation to better understand a lot of the buzz in pet food forums. 

Dog Owners Recount DCM Heartbreak in FDA Comment Docket

     September 21, 2021, the FDA CVM hosted a virtual Listening Session on the Oversight of Pet Food. In addition to the live, recorded session of oral presentations, a comment docket was opened for public submissions and closed 11:59PM EST on 10/25/2021.

In total, the docket has 137 published entries. Broken down by topic:

• ~20 pertain to the use of 4D (dead, dying, diseased, down) meat in pet foods
• ~12 are on the subject of transparency and access by the public to FDA (and/or AAFCO) meetings
• ~12 are in regards to various other issues or general opinions of the FDA
• Nearly 100 are about diet-associated (non-hereditary) dilated cardiomyopathy (DCM)

Of those, a handful are from concerned pet owners, advocates, and veterinary professionals. The vast majority, however, are the heart-wrenching personal stories of affected pet owners and their dogs, including those deceased, those continuing to battle, and those recovered. These pet owners represent only a minuscule fraction of the over 1100 complaints submitted to the FDA (as of 7/20/2020) and yet they are a poignant reminder that this issue is more than data, statistics, research papers, and debates between academia and industry. 

There are real dogs, real people, real families, and such real heartbreak underlying this investigation. Many of them have called on the FDA to take more action towards this issue.

What's in a DVM?

 

 What's in a DVM?

Are not those whom we call doctor, for any given species, just as competent?

    Veterinarians, much like physicians, dentists, pharmacists, nurses, and others, are healthcare providers. Veterinarians and physicians, particularly, are two sides of the same coin, providing roughly the same scope of services to two different populations of patients: humans and non-humans. But what exactly happens in a DVM curriculum? How does it compare to an MD program? What exactly is the scope of veterinary medicine? Given the frequency with which veterinary professionals seem to find their status as medical professionals undermined, answering these questions is prudent. Let it be emphasized that the purpose of this article is not to disparage any other healthcare profession or to imply the superiority of another. Rather, the aim is to highlight the rigor that is present in both programs and illustrate that veterinarians are just as much medical professionals as any other practitioner, prompted by shared experiences across the profession where our competence, qualifications, and education are routinely questioned.  

My Dog Got Sick After I Changed Her Food.

 My dog got sick after I changed her food. 

It was my first year of veterinary school, and I started her on a diet to try and finally lose the extra weight she'd been carrying for too long. My dog loved food. The first red flag was when she had less appetite. "Well, it's a diet food," I thought. "She probably doesn't like it as much, or it's helping her stay full." 

The second red flag was a loss of energy. My dog was older, 12 at the time. "Well, she's getting up there," I thought. "She isn't going to act like a puppy forever." 

The third red flag was smaller, less frequent stools. Again, this was a new diet for weight loss. "It's higher in fiber," I thought. "That should cause bigger stools, more often, but maybe she's just adjusting." 

Finally, my dog collapsed. It was a brief episode, she was back to herself afterwards, but I was out of reasons. That night, we drove to my old workplace back home and I had her seen. 

An Open Letter On Entering a Profession In Crisis.

     Normally, I like to keep it science-y here. As any long-time readers know, I'm very passionate about evidence-based medicine and accessible science communications. This one is personal. Feel free to turn back now. 

    In less than a year, I'll be a veterinarian, but I am already very much a part of this profession. I have been there in the flurry of CPR on a dog whose name I don't even know-- because he arrived already coding. I have spent day after day with long term ICU patients providing nursing support to get them back with their family. I have worked through strings of 14-16 hour days. I have cried alongside people I barely know in the collective grief of providing a suffering animal permanent relief, a safe and peaceful passage to the rainbow bridge. And I have suffered. 

But I've also played with puppies. I've assisted in the wonders of helping new lives come into this world. I've cuddled kittens. I've danced in the play yard with the boarding dogs. I've laughed. I 've worked alongside so many amazing people. I've loved my patients. I love interacting with pet owners. And I love this field. 

    I love this field so much, I'm currently staring down more than $200,000 in student loans-- and that's with scholarship aid! I love this field so much, the mounting debt and the bad days and the sights of suffering and the long hours and the sleepless nights and the grueling curriculum rarely haunt me. I love this field so much, I am at total peace with the awful debt to income ratio that awaits me, burdened with the knowledge that I and my colleagues will be almost certainly overworked and underpaid.

But today I had an experience that shook me. One that was not the first, and will not be the last, and is not unique to me, but that represents a really dark side to being in this profession:

Some of the people whose pets we treat see us as monsters. 

   

When is correlation due to causation?

    "Correlation isn't causation," is an accurate statement that is, unfortunately, oft' misemployed when members of the public discuss science or research. Specifically, it is used (incorrectly) to undermine actual instances of causative relationships. "Correlation," refers to an association between two events, scenarios, or factors. "Causation," refers to such things directly impacting one or the other in a cause-and-effect type of relationship. What becomes confusing is that correlations can be due either to a non-causative, indirect relationship (such as a common causative factor, or simply random chance) or to a mechanism of causation. Whenever causation is present, correlation is as well. 

Rather than broadly dismissing actual instances of causation by appealing to the existence of a correlation between two values, one must ask themselves: When is correlation due to causation? 

Biochemical Analysis of Dog Foods Provides New Clues On Causes of Diet-Associated DCM

    Research Cited: August 5, 2021 "Investigation of diets associated with dilated cardiomyopathy in dogs using foodomics analysis" Smith et al., Scientific Reports volume 11, Article number: 15881 (2021) https://doi.org/10.1038/s41598-021-94464-2

    If you aren't familiar with the ongoing investigation into atypical Dilated Cardiomyopathy in dogs as it relates to diet, please see the Comprehensive Diet-Associated DCM Q+A and Nutrition page for additional information and resources. 

    Much of research investigating diet-associated DCM in dogs thus far has focused on the clinical pictures of affected and unaffected dogs in relation to their diet and patient factors. New research published in the open-access journal Scientific Reports took a deeper look, instead, at the diets themselves. This research took an approach previously dubbed 'foodomics,' or the in-depth study of food, nutrients, and their relation to individuals, health, and disease. While the findings of this study did not identify a definitive cause or mechanism for the atypical cases of DCM that have been seen in recent years (and continue to be diagnosed), it did open several doors for further research, bringing us one step closer to identifying the problem. Because Scientific Reports is an open-access journal, anyone can read the paper without paying. However, the methods and analysis are very technical, and may be less approachable for some readers. For that reason, important information is summarized below in a way more readily accessible to the average pet owner. 

Raw Re-Visited: Recent Research

    Raw diets have previously been discussed on this blog in early 2019, with the ultimate takeaway that the inherent risks associated with raw food diets are not offset by any current evidence of benefit from this feeding method. That position is shared by many public health and veterinary organizations, including the FDA, the CDC, AVMA, AAHA, and WSAVA. However, raw food diets remain an increasingly popular feeding option for pet owners to pursue, both in commercial and homemade forms. The purpose of this update is to review emerging literature from 2020 and 2021, re-evaluating the risk-benefit tradeoff of a raw food diet. 

Doggie Dentistry: Is Non-Anesthetic Better?

     More than ever, owners are taking proactive initiative in their pet's oral health as veterinarians recommend annual comprehensive dental care for both dogs and cats. The health of the teeth and gums is incredibly important; periodontal disease is the most common disease of companion animals! Disease of the mouth can have downstream effects on other organ systems. While we can often be reasoned through our fear of the dentist, a proper oral exam for dogs and cats requires anesthesia-- this allows the veterinarian to fully open, examine, and radiograph the pet's mouth, which is a very stressful experience for an awake patient. However, anesthesia is equally stressful to many owners, and the combined use of anesthesia, radiographs, and dental care can make the appointment rather pricey. This has led to a rise in "non-anesthetic teeth cleanings" offered by groomers and other pet care professionals. This alternative appeals to a number of pet owners, for good reason! It costs less, it doesn't involve anesthesia (so it's perceived as safer) and in many cases, it's quicker, too. Unfortunately, non-anesthetic cleanings are not a safe or reliable alternative to ensuring dental health in your dog or cat. They offer essentially no benefit other than cosmetic, and may even be dangerous or painful to your pet. The individuals offering these services often have the best of intentions, and simply do not realize the immediate and indirect risks associated with the procedure. 

Canine Diet-associated Dilated Cardiomyopathy Timeline

 Please see the Comprehensive Diet-Associated DCM Q+A and Nutrition page for additional information and resources. 

Background: Research in the 1980s-2000s previously linked DCM in both cats and dogs to taurine-deficiency, and in dogs to L-carnitine deficiency and certain lamb and rice diet formulations. Currently, there is concern regarding a link between grain-free and/or high-pulse diets and DCM in dogs. A timeline of this current concern is as follows:

Pondering Prescription Diets: Science or Scam?

As our pets age (sometimes even in youth) it is a sad reality that they may develop chronic health conditions requiring long-term management. Luckily, as modern medicine marches forward, the treatment options available continually expand. Astute pet owners may take notice of the ever-growing array of dietary solutions marketed for disease management in companion animals. These diets, available both online with a prescription or directly through veterinarians, provide tailored nutritional support for conditions of the skin, gut, liver, kidneys, urinary bladder, and even brain. Par for the course of nutrition information available online, however, misconceptions and misplaced criticism abound. A common allegation states that these diets are scams, because they don’t contain specific medications, they use ingredients similar to those of traditional diets, and they’re often expensive. This has led some pet owners to question why a prescription is even necessary! Like with most pet food misconceptions, a bit of background information readily remedies these concerns.

Why Are (Some) Grapes Toxic For (Some) Dogs?

    As an emergency veterinary nurse, I saw many dogs presented for toxin exposure. Rat bait, prescription medications, NSAIDs, chocolate ... grapes? While many pet owners are still surprised to find out grapes are toxic, veterinarians have been suspect of the fruit as early as 1998, when an association was noted between otherwise unexplained kidney failure and recent consumption of grapes or raisins. These concerns were popularized in a 2001 JAVMA Letter to the Editor, and several studies followed to try and discern the mechanism underlying this association. Curiously, only some dogs experienced the kidney injury, and not always the first time they ate grapes. It was also never clear what amount of grapes was toxic, as it seemed to vary considerably between case reports. For over two decades, answers eluded researchers, prompting poison control centers to treat any exposure to any amount of grapes as a medical emergency, and leading veterinarians to urge pet owners to never allow their dog to consume grapes. These recommendations haven't changed, but as of March 2021, the cause of toxicosis may have finally been revealed.