Is Your Pet Hurting Silently (Part 3)

Pain can be very debilitating to most patients and we try everything we can to prevent it. Acute or surgical pain can be prevented with a preemptive plan starting before the surgery begins. After receiving a complete physical examination the morning of their surgery our patients are provided with a individual pain prevention plan. This can include a combination of pain injections before anesthesia begins, a local block at the site of the surgery, analgesic medications in a constant rate infusion drip during surgery, extended injections after surgery and a safe combination of oral medications for the family to give at home. We also have cryotherapy and laser therapy that can aid in controlling post-operative pain while your pet is recovering in the hospital. We make specific recommendations about home care including icing, limiting activity and preventing self trauma. In combination all of these steps help our patients to recover quickly and with the least amount of pain.

Chronic pain can be prevented, delayed or minimized by planning in advance. For example, the single most important thing that can be done to limit your pet from developing pain secondary to osteoarthritis is to maintain your pet at an ideal body weight. Because not all 50 pound dogs or 13 pound cats are created equal, we use a Body Condition Score to know if that weight is the correct one for your pet. A score of 5/ 9 using the Purina Body Condition Score Canine BCS  or Feline BCS demonstrates what your pet should look and feel like.   The next step is to be sure you recognize the early signs of discomfort and investigate them. If we find a tendon or ligament injury early it can be treated and your pet’s pain may be very limited. If we detect osteoarthritis or myofascial pain early we can reduce discomfort and limit the development of compensatory pain in other parts of the body (Pain Handout). Some interventions may even slow down the damage or progress of disease and maintain mobility and a longer quality of life. Our team can talk with you about supplements and exercises that can support your pet in an active, comfortable lifestyle. As your pet ages and may begin to show a decline in mobility, we can offer suggestions for assistance devises and environmental modifications that can limit the development of new pain.

Is Your Pet Hurting Silently (Part 2)

Have you ever wondered if animals feel pain? Many people do because animals don’t seem to express pain like we do. They don’t talk about it to their spouse or parent, they don’t joke with their co-workers, they don’t call the doctor to make an appointment to discuss it. Rest assured they do feel pain. Think about a limping pet…they don’t cry or whine, they don’t complain, they just power through and carry on as best they can. They suffer silently.

Is pain bad? Pain most certainly can be bad and in more ways than most people think. Acute pain can serve a purpose – to warn the body there is something wrong. It brings out a protective response and should go away quickly. However, chronic pain serves no protective purpose and can be a disease in itself. There are far reaching chemical effects in the body when it is dealing with pain all the time. These effects can slow digestion, delay healing and have a psychological impact on our pets. Long term pain left untreated can actually lead to more pain. This is called Windup Pain and is a physiological response.

Long term untreated pain teaches the body to act in abnormal ways. One part of the body will over compensate for the pain present in another part of the body. From this we find compensation pain or dysfunction. We can go from one sore leg to two or three sore legs because of bad mechanics. A pet can go from slowing down to suddenly unable to rise or walk at all.

It can be hard to recognize pain in some pets because they hurt silently There are many signs we can all use that can indicate that our pet is uncomfortable.  Here is a link to a great Pain Handout you can use at home. Pain is not an all or nothing phenomenon so keep in mind that just like you, our pets can have different levels of pain, and words like tender, sensitive, sore, or ouchy can come to mind.   Not all pain is 10/10 pain but pain that starts out mild can grow to severe if left untreated. Check out our mobility report card CODI and see if you think your cat or dog is starting to show early indicators. The earlier we start to treat your pet’s pain the better.

By:  Dr. Erin Troy

Is Your Dog Hurting Silently?

By Dr. Erin Troy

How do you know when someone you love hurts? Normally, you can ask them, but we don’t speak the same language as some of our most beloved family members. Most of our dogs don’t tell us in an easily understandable way when they are sore or uncomfortable.

As responsible pet parents, we need to watch for the early, subtle signs of pain and discomfort. Many of us think the most obvious sign of pain is whining or crying, but that could not be further from the truth. We need to be looking for more subtle clues, such as taking longer to stand or lie down, difficulty or refusal to get on the bed or into the car, and slowing down on walks. Other indicators include excessive panting that is not temperature related, restlessness at night, and reclusive behavior. Keep in mind that if your dog has a sore back or is uncomfortable in more than one leg, he or she will not limp but will still be suffering.

The earlier pain is recognized, the earlier it can be treated and the less damage done to your dog’s body. Chronic untreated pain can have far-reaching effects and cause dysfunction in all parts of your dog’s body. Many of us believe it is normal for an aging dog to slow down, and we attribute many mobility changes to “He is just getting older.”  A senior dog deserves as much comfort as we can provide, and there are many ways that you and your veterinarian can help your dog age gracefully and pain free.

If you are concerned about your dog’s comfort, the first step is a thorough examination by your veterinarian to assess muscle pain, orthopedic pain and neuropathic pain. This includes gait evaluation, palpation and, potentially, x-rays.

Once localization of discomfort is made, you can talk with your veterinarian about a multimodal approach to manage the discomfort and prevent the development of compensatory dysfunction. This plan can consist of medications, supplements, nutrition, acupuncture, chiropractic care and physical rehabilitation, which can include therapeutic laser treatments and targeted exercises.

Unrecognized problems go untreated, and discomfort in our dogs is no exception. Don’t be afraid to look for pain in your dog. Make it a show of love – to be sure your dog is as active and comfortable as he can be throughout his entire life.

Osteoarthritis Treatment Using the Assisi Loop™ by Erin Troy DVM

Our doctors frequently prescribe the Assisi Loop™ for treating a variety of conditions including pain and osteoarthritis.  Read Dr. Troy’s case review here for more information  Assisi Animal Health – Osteoarthritis .  Click here for more information about the Assisi Loop™  or ask your doctor at your next visit.

Dr. Erin Troy Finalist in AVMF’s America’s Favorite Veterinarian Contest

AVMF_AFV-Logo2 We finally have the outcome of the America’s Favorite Veterinarian contest and while Dr. Erin Troy made a strong showing, Dr. Tim Hunt from Marquette, Michigan is this year’s winner.  Please continue to check the AVMF’s website, for more information on this worthy foundation.  We would like to thank each of you for all of your support for Dr. Troy.  She is honored to have been nominated and selected as a finalist. We are so lucky to have such amazing clients!

Dr. Erin Troy Achieves Veterinary Pain Management Certification!

Please join us in congratulating Dr. Troy who has earned the title of Certified Veterinary Pain Practitioner! The second veterinarian in the state of California to earn this esteemed title from the International Veterinary Academy of Pain Management (IVAPM), Dr. Troy has worked toward this certification for over 4 years. Her dedication to excellence has required her to: complete over 80 hours of continuing education specifically in pain management, master a list of pain management skills, acquire letters of professional reference, pass a written examination, and submit two case studies. Dr. Troy joins this multidimensional and internationally recognized group as one of only 53 people with this title in the world. We are so very proud of Dr. Troy for following her passion, and continuing to be a leader in the field of not only Veterinary Medicine, but of Pain.



Exocrine Pancreatic Insufficiency (EPI)

Exocrine pancreatic insufficiency or EPI can be thought of as a type of maldigestion.  The problem starts in the pancreas, which is an important organ that sits near the stomach and small intestine.  The pancreas has multiple functions including making and storing enzymes needed for digesting starches, fats, and proteins.  Without these important enzymes, as occurs in EPI, proper absorption of food is impaired.

There is thought to be a genetic basis to EPI and while it can develop at any age, it is usually seen before the age of 4.  The incidence is reportedly much higher in German Shepherd Dogs and Rough-Coated Collies, but it has been diagnosed in many other breeds.

The main symptoms of EPI include weight loss or the lack of weight gain, and soft stools or diarrhea.  Diagnosis is based upon physical exam, pertinent historical information and a serum blood test for a specific enzyme.  The test is called the TLI or trypsin like immunoreactivity test.  There have been other tests used in the past but they are not as accurate as the TLI test.  Keep in mind that dogs with EPI can have other concurrent medical issues so it is always a good idea to have a full work up done including a general health screen blood panel, urinalysis, fecal parasite check and the levels of folate and cobalamin measured.

If a dog is diagnosed with EPI then treatment is centered on supplementing for the missing enzymes.  There are a variety of choices of enzyme replacements available so discuss with your veterinarian about cost, form and quality.  You should also discuss the manner in which the supplement is given to your dog.  If other medical issues are discovered then additional medications or a diet change may be indicated.

While EPI is not a curable disease and does require life long medication, it can be managed so your dog can have an active healthy life.

Alternative healing: Interview with animal acupuncture expert Dr. Jennifer Yamamoto

Posted on October 4, 2012 by naomi

Jennifer Yamamoto, DVM, is the second subject in our series of interviews with rehabilitation and veterinary specialists using the Assisi loop. Dr. Yamamoto completed her bachelor’s degree in biology at UCLA and her veterinary degree at UC Davis. She has been practicing small animal medicine in Contra Costa County, California since 2002. In 2006, she earned her veterinary acupuncture certification through Colorado State University, and offers this complementary therapy to her patients at Muller Veterinary Hospital and the Canine Rehabilitation Center in Walnut Creek.

NG: Thank you so much for joining our veterinarian interview series. To start out with, if you could describe yourself, what you do, and how you first heard of the Assisi device and started using it.

JY: I’m a small animal veterinarian and I’ve been in practice for about ten years. I do mainly general practice and I’ve been practicing animal acupuncture for the last 5 or 6 years. We have have a rehabilitation center in our hospital, so I get to see a lot of referrals from other hospitals for arthritis, neurological problems, post-operative back surgeries, rehab for orthopedic surgeries, etc..

We started using the Assisi loop a few years ago and have been getting good results. We use the bulk of the loops for conditions like degenerative joint disease and post-operative healing. We’ve also used some on a couple of chronic skin non-healing issues, and I’ve prescribed it a lot for back pain.

I used one on my own cat who has lumbosacral disease. That experience is really what convinced me that it could be a helpful adjunct to the treatments we have available. She did not respond to any of the medications I tried or acupuncture, but she did improve with the assisi loop.

NG: So how can you sense improvement? How can you tell the animal is doing better?

JY: We rely on feedback from owners. In the case where I was watching my own pet, I measured her mobility and vocalization. Prior to the loop, her sacral disease made her scream constantly, so it was easy to see that she was in horrible acute pain. After using the loop she was able to jump without screaming and I could tell that she was feeling better. She would also hold her tail up, whereas she wouldn’t do that before being treated.

NG: So these are things that the owner who is around the animal and knows its behavior can sense?

JY: Exactly. It’s mainly noticing behavior changes and an increased ability to move. Pain or difficulty moving often manifests when the animal is transitioning from a sitting position or laying down position to a standing position. When the loop is helping, owners notice the pet is doing that more easily or is more willing to move around. Or the dog is able to go for a walk longer than it used to be able to. Other people seem to notice–especially when I’m treating back disease–that the dog is initially really hunched or kyphotic (hunchbacked) and that treating the back seems to relax and straighten out the muscles around that kyphotic area.

NG: And what about those cases with the skin disease that you mentioned?

JY: One was a mast cell tumor surgery where we had to remove really wide margins of the skin and the site wasn’t healing for a really long time post-operatively. So we decided to try the loop. I think that helped–it took a while, but eventually the skin did heal up and close over and we were able to close that defect.

That’s the only example I can think of off the top of my head. I would love to try some on lick granulomas [sores caused by compulsive self-licking] or hygromas [swelling on or near a dogs elbow] that just never heal. I haven’t had anyone take me up on that yet but I think it’s a promising area.

NG: When do you tend to use the Assisi loop instead of animal acupuncture or other alternative therapies?

JY: I find a lot of animals either, number one, don’t tolerate needles very well, or, two, the owner has a hard time getting them in for a treatment as frequently as a I need them to. The Assisi loop is a good alternative for a lot of those patients.

Some animals just don’t handle the stress of acupuncture treatments. I’ve found in general that if the pet gets nice and relaxed and accepts the treatment, it tends to be more effective. But if they’re stressed and panting and struggling and associating the treatment with something painful or unpleasant, it’s not as effective. The stress response overrides the body’s positive response to the needles. So for those pets I offer a loop–of course, only if the owner is willing to do the treatments everyday for the amount of time that they need to.

And then we also have clients coming from a fair distance. They’re driving an hour or more to get here for rehab. For animal acupuncture to work best you need to come at least once a week and for some of them that’s really difficult. Oftentimes the loop is the best option in this situation. I’ve had good luck with that.

NG: When you see animals for acupuncture what are you usually treating them for?

JY: Because we have the rehab center here I see a lot of referrals–back surgeries, animals that are in pain or paraplegic, paraparetic or ataxic. In other words, patients who are just not bouncing back after surgery. They’re not walking, they’re uncomfortable, they’re incontinent. For most of those dogs acupuncture works great; but again, there are those few who just hate the needles or hate being here, and we have to try something else.

Through general practice I’ve used the loop on a lot of soft tissue pain. Many active dogs tend to strain their psoas (a deep set muscle used for running and jumping) or their hip flexors. I feel that oftentimes animal acupuncture falls short at dealing with generalized muscle strain discomfort. But probably 60-70% of the dogs I’ve used the loop on for that improve pretty significantly. And I’ve had a lot better luck treating elbow arthritis with the loop than acupuncture. That’s one case where I usually tell people, let’s try the loop first.

NG: When you talk to your clients about using pulsed electromagnetic therapy (PEMF), how do people respond? Do they ask if it’s magnetic therapy?

I get a variety of questions. Some clients just say, “OK, that sounds really weird.” My response is, “You know what, take a look at some literature and look it up online.” There’s quite a bit of information out there. I usually tell them people use the technology too, which can increase their confidence.

But I have had people ask, “Yeah, is it the same thing as wearing those magnets or having the magnet beds?” And then I’ve had some people say be really excited about trying it. So its a really wide range depending on the clientele’s experience, background and how they tend to approach these problems.

NG: Do you recommend Assisi to other vets?

Yes! It’s nice that it’s non invasive and it doesn’t hurt the animals at all. People can administer it at home, they don’t have to drive their pet here for it. And, actually, over the course of months is ends up being fairly inexpensive. It’s a lot less expensive than animal acupuncture as well if you plan on continuing with it long-term (laughs).

Animal acupuncture veterinarian


Canine Heartworm Disease Prevention

By Dr. Erin Troy DVM, CCRP

We are all struggling right now with the right choice of  heartworm prevention for each dog.  There have been supply issues with established products as well new products that we may be unfamiliar with and it makes it all very confusing.

Let’s start first with the basics that can clear up some misunderstandings.  According to Dr Mark Kittleson DVM PhD DACVIM ( Cardiology) at UC Davis, all heartworm preventatives are from the macrocyclic lactone family. This  family is further divided into avermectins, which includes ivermectin as in Heartgard Plus, and milbemycin which is in Interceptor, Sentinel and Trifexis.  Even more important to know is that the amount of ivermectin in Heartgard Plus is not now nor ever has been toxic to ANY breed of dog regardless of MDR1 status.  The dose of ivermectin in Heartgard Plus,  6-12mcg/kg,  is far too low to cause a toxicity.  Ivermectin toxicity  occurs at a dose of 50mcg/kg in the MDR1 mutant dogs and at a dose of  > 100mcg/kg in non- mutant dogs. Keeping this in mind, Heartgard Plus is a safe option for heartworm prevention in any dog. There are occasions where ivermectin can be prescribed at much higher doses than is present in Heartgard Plus and this would not be done in a dog suspected or confirmed sensitive to ivermectin .    If you are still not convinced that you want to put your dog on an ivermectin containing product, then  the milbemycin-containing products such as Trifexis, Sentinel and Interceptor would be another option that is just as safe for monthly protection.  (Sentinel and Interceptor are not currently in production as of the writing of this article).

I hope that this helps put your mind at ease and makes it easier for you to make the right choice for your dog.

(This article can also be found on

Muller Veterinary Hospital in the Community

Our own Dr. Erin Troy participated in an event this past weekend where  Food Express in Mill Valley donated resuscitation kits specifically designed for pets to Marin County fire departments.  A month-long fundraiser by the Mill Valley Pet Food Express, as well as the Whole Foods on East Blithedale Avenue in Mill Valley, resulted in the donation of 44 kits, according to Pet Food Express officials.

Prior to the donation, most of the county’s fire departments were not equipped with the kits.  Marin County fire departments will put the kits on their fire engines, according to officials.  Each kit includes three sizes of oxygen masks, oxygen supply lines, a rescue leash, decals and instructions on how to use the equipment. 

Dr. Troy and Muller Veterinary Hospital designed the kits and have been providing them to various fire departments throughout the country.  In addition, Dr. Troy is a FEMA instructor and has participated in training dog handlers in the field on canine first aid and other canine medical emergencies, in order to enable the handlers to be self sufficient when on site at a national or international disaster!