Vaccinations have worked to decrease the incidence of acute viral disease, but many pet owners and some veterinarians have begun to question both the need for annual, life-long re-vaccination, as well as the long term consequences of vaccination in general. Continue…
Thank you for your interest in Dr. Jeff’s practice. He offers both preventive care as well as management of chronic diseases.
This practice emphasizes working through symptoms rather than working against them (e.g. with ANTI-inflammatories). Symptoms are clues that your pets’ bodies give us to help them stay and get well. Homeopathic medicines, optimizing lifestyle and clinical nutrition are the main therapeutic modalities used.
In this practice, symptoms are embraced and will never be suppressed with “routine” drugs or prevented with vaccines. In addition, you will be asked to feed a fresh and unprocessed (not necessarily raw) food to help your pets heal using their natural Vitality.
The best time to begin holistic preventive care is before your pets get sick and ideally when they are puppies or kittens. However, since you may not start until later in life, problems may have already arisen (and been suppressed). These can take longer up to months and years of treatment to make significant progress. Patience and perseverance are directly related to successful treatment outcomes.
Large part of Dr. Jeff’s practice is management of chronic and degenerative disorders, such as recurrent ear and skin “infections”, arthritis, allergies, metabolic/endocrine imbalances and cancer. In these cases, a diagnostic workup may be recommended because appropriate test results can sometimes help quantify the disease process.
Ascertaining the degree of structural pathology (if any) will help me determine a prognosis and treatment plan. Length of treatment will depend upon the duration and depth of the condition and number of and response to prior suppressions. Most acute situations can be properly resolved over a few days or weeks, whereas lifelong problems can take 1-3 years or more.
During treatment, you will be asked to gradually discontinue (when possible) conventional drugs such as antibiotics and steroids. This will help your pet’s body heal naturally. Using any “anti”-drug (e.g. anti-biotic or anti-inflammatory) during homeopathic treatment is like trying to drive your car with the brakes on. If other symptoms appear during treatment (or if older, previous conditions return) you will be expected to contact Dr. Jeff for an appropriate response, rather than use drugs that you may have used before. Dr. Jeff Feinman’s bio is here.
HOW MUCH WILL IT COST?
Holistic Actions! membership
The first thing to know is that you may not need a private appointment as many of Dr. Jeff’s practice resources and support are also available to Holistic Actions! (HA!) student-member-clients. Holistic Actions! membership costs $27 per month and includes 1 hour weekly live online group support during Pet Health webinars, one 15min monthly guidance call with Dr. Jeff or other faculty member for an additional cost of $27, unlimited forum support. The usual private hourly rate is $240 so these 4+hours of monthly support would otherwise cost $960.
If you still prefer to individualize your pet privately, initial evaluations typically last 1-2 hours. Older and more complicated cases may need 2-3 hours and Dr. Jeff will help you determine appointment length once he reviews your new client application. Most phone or Skype rechecks last around 20-30 minutes. In office appointments for examination and updates are ~45 minutes.
Appointments are billed in 5 minute increments. A current credit card or valid PayPal address will be kept on file, and payment is expected at the time services are rendered (no billing). Dr. Jeff and Amy work with all of the pet insurance companies, including Pet Plan and Embrace, which are among those that cover veterinary homeopathic treatment.
There is a $25 missed appointment charge if your appointment is not canceled 24 hours in advance. Due to the length of new patient initial evaluations, there is a $50.00 non-refundable deposit that will be applied to your first visit.
You can also prepay part or all of your appointment and they will then be credited to your account.
Healthy-pet routine care costs the same as going to the conventional veterinary clinic and it will save you money. A complete healthy pet annual consultation usually lasts ~30 minutes and are extremely important to maintain your pet’s quality of life and longevity. Maintaining optimal health, prevents serious dis-ease later in life (and dramatically reduces future veterinary costs).
If you have not spoken with Dr. Jeff to “fine-tune” your pet in the past year, you are considered to be a new client of the practice.
If Dr. Jeff’s practice sounds like a good fit for you and your pets, click the button below and follow the steps to sign up.
What some clients have to say
“Thank you for being such an extraordinary doctor and person. If all doctors of people and animals were as dedicated as you, there would be a great deal less suffering in the world and a whole lot more happiness.”
K.K., Wilton, CT
“I have visited numerous veterinarians over the years and I have never met anyone quite like you. You not only calm my animals but you also calm me as well. Medically speaking you are unsurpassed.”
D.M., Westport, CT
“The fact that Rosie actually enjoyed going to see you is a testament to your loving care, your kindness and gentleness. We know that the quality of her life was the best it could ever be thanks to gentle homeopathic care.”
V & J.S., Easton, CT
“We have noticed a marked improvement in our dog’s energy level, alertness and mood. You have taken such good care of him for the past 14 years, and I have no doubt that he’s made it to 15 with a wonderful quality of life – in no small part – because of your skill, knowledge and humanity. We will be forever grateful.”
C & T.Q., Westport, CT
“We have had several veterinarians prior to you, and not once have we experienced the wonderful services and care that you offer.”
R.V., Westport, CT
“Thank you for the excellent care you gave to my dog throughout his life. You always made sure that you were available and reachable during all of his crises. This sets you apart…”
D.A., Bridgeport, CT
“You are everything we hoped for in a vet. Your willingness to research, try and your patience and skill are what we want for our dogs.”
L.S., Greenwich, CT & Belgium
“Thank you, thank you, thank you! Every extra day has been an absolute gift. Its especially satisfying to not have destroyed his body or quality of life in the process of keeping him alive.”
J.B., Milford, CT
“Thanks for your incredibly professional and expert care. I am very fortunate that my dog has such a fantastic holistic doctor who not only helps him but also cares for his family.”
V.F., New Canaan, CT
“You are the best vet anyone could ask for. Your gentle manner, patient explanations, accessibility and responsiveness have provided a lot of reassurance over the years.”
V.G., Westport, CT
Whether you call these patients geriatric or (as some feline practitioners insist) “mature,” special considerations are required in evaluating, examining, hospitalizing, and generally caring for older felines. However, veterinarians must understand that old age is not a disease, it is a stage of life.
None of us would be happy with our physicians if we went to their offices com- plaining about an ache or pain, lump or bump and were told, “You are just getting old, and there’s nothing we can do about that.” Like humans, cats do develop problems associated with advancing age.1 We veterinarians must be aware of these common problems so that we can recognize and treat them specifically and enhance our feline patients’ longevity as well as their health in their “golden years.”1 The objectives of a managed program of feline geriatric health care include recognizing and controlling health risk factors, detecting preclinical disease, correcting or delaying the progres- sion of existing disorders, and improving or restoring residual function.
Aging is obviously time dependent. However, various tissues age at different rates, depending on their cell and organ type.1 Some types of cells (e.g., nerve tissue), have little or slow regenerative capacity. Other tissues (e.g., epithelial cells) general- ly have a good regenerative response. Kidneys have a great reserve capacity, as does the liver. Myocardium is much less forgiving of injury. Environmental effects, including husbandry (diet, housing, medical care), also have a great impact on longevity. Feral tomcats have an average life span of 3 years, whereas castrated male housecats can live well into their late teens or early 20s with proper care.
Genetics may also play a role in feline longevity, although this has not been well documented. Some highly inbred cats may be more likely to have heritable defects in organ development or function or immune system defects that may limit longevity.2
Owners often ask us to compare “cat years” to “human years.” A figure that is commonly used is 7 cat years for each calendar year. However, this rule of thumb is not completely accu- rate. Feline development through puberty to young adulthood is accomplished over a period of about 18 to 24 months, rather than 21 years as in humans. Thus, the cat’s first calendar year is more like 16 cat years, and the cat’s second calendar year is more like 5 to 7 cat years (up to an equivalent age of 21 to 23 years in humans). After that, add about 4 cat years for each calendar year of cat life. Thus, an 8-year-old cat is like a 46-year-old person. A 10-year-old cat would be 54, a 15-year-old cat 74, and a 20-year-old cat would be 94 cat years of age. Experts differ as to when one would consider an aging cat to be “geri- atric,” but you can select your own cut-off based on this comparison to the equivalent age in humans.
MORBIDITY AND MORTALITY
The feline patient population is getting older as advances in animal health care and nutrition as well as lifestyle changes (more indoor-only cats) have enhanced longevity. Surveys indicate that the segment of “geriatric” patients in most practices approaches 10% to 20% of the practice population. It is likely that this “graying” of the feline patient population will continue.
The most common causes of death in aged cats include renal failure, cancer, and infectious disease.2 In contrast, the most frequent causes of death among old dogs are cardiac failure, cancer, and renal failure.
Common chronic diseases of aged cats include hyperthyroidism, inflammatory bowel disease, renal insufficiency, diabetes mellitus, dental disease, and feline immunodeficiency virus (FIV) infection.2–5 All of these recognized disease conditions provide oppor- tunities for veterinary management that will improve the health of affected patients and improve the quali- ty of life as well as prolonging life.
Each veterinarian and practice should develop a logical approach to evaluation of the geriatric cat so that abnormalities can be detected in an early, treat- able stage. In addition to being consistent with the practice philosophy and appropriate health care objectives, each geriatric-care program should be evaluated—from the cat owner’s perspective—to be affordable, within the owner’s ability to comply with recommendations, and consistent with the owner’s philosophy of the level of care they want for their pet.6–8
Each clinician should decide if a thorough annual examination and evaluation is sufficient or if it would be best to recommend examination as frequently as every 6 months for apparently healthy mature feline patients. Some feline practitioners recommend blood pressure evaluation as part of this examination. However, obtaining accurate measurements of feline blood pressure is often problematic. I do not believe that essential hypertension (hypertension without underlying disease, such as renal insufficiency or hyperthyroidism) is sufficiently common in cats to warrant this additional patient stress and owner expense.9–12 For patients that are already receiving medical care for chronic problems, reevaluation should obviously be scheduled as indicated by the specific condition and the patient’s response to management.
If you plan to include laboratory evaluation as part of the routine yearly evaluation for healthy geriatric patients, the following are recommended:
- Complete blood count
- Serum biochemistry profile with electrolytes
- Complete urinalysis (collected by cystocentesis because bacterial urinary tract infection, although uncommon in cats, is more likely in older patients)
- Serum total thyroxine
An alternative to this complete laboratory evaluation might include the following:
- Urine specific gravity and dipstick chemistry evaluation
- Packed cell volume and total protein
- Blood urea nitrogen and creatinine
- Alanine aminotransferase, serum alkaline phosphatase, and γ-glutamyl transferase
Other tests should be considered for selected patients. Feline leukemia virus (FeLV) antigen and FIV antibody tests are always recommended for sick patients and should be considered for healthy ani- mals that are outdoor or indoor/outdoor pets with possible exposure to these retroviruses. Fecal exam- ination for parasites may also be more important for cats with outdoor exposure. Thoracic radiographs and further cardiac evaluation (electrocardiography, echocardiography) may be recommended for cats with apparent pulmonary signs, cardiac murmurs, or arrhythmia.
Each clinician should decide if a thorough annual Older animals may have some age-related deterioration of the immune system that makes them more susceptible to infectious diseases or allows infectious diseases (e.g., FIP, FIV) that have been kept in check by the immune system to cause clinical signs. However, routine yearly revaccination policies are currently undergoing reexamination in light of concerns about vaccine-associated sarcoma in cats. In addition, new information about the duration of immunity actually provided by our biologic products is becoming available.
At present, most progressive practitioners recognize that yearly revaccination recommendations are not based on good science. Consequently, they have extended revaccination intervals for adult cats. In addition, we must be selective about which vaccines are really necessary for each particular patient. Just because a vaccine is available does not mean that it should be used in every patient—regardless of age, health status, and environment.
Older animals (like older humans) tend to get less exercise as they age. This is particularly true of cats, which generally have a more sedentary lifestyle than dogs have. Diminished exercise reduces muscle tone and bone and joint strength and causes a tendency toward obesity.13
Geriatric animals also have a decreased thirst response. Therefore, they are more likely to become dehydrated with illness or even during routine hospi- talization or boarding. Dehydration can obviously compromise already marginally functioning body organs and compound deficiencies in renal function.
Taste sensation is reduced in older cats. This can lead to anorexia—again, often associated with illness or a change in surroundings. Feeding highly aromat- ic diets and warming food to body temperature before serving improves palatability.
Cataracts are uncommon in cats, but some degree of visual impairment occurs with age-associated nuclear sclerosis and retinal degeneration.14 Hearing loss is usually gradual and may not be noticed by owners until the cat becomes completely deaf. Both visually and hearing-impaired cats can and often do function quite normally in a protected environment, such as the home. However, they should not be allowed outdoors unsupervised because they would be at risk for potentially fatal encounters with such environmental hazards as dogs and motor vehicles.
Older cats typically spend less time grooming. Also, the skin and haircoat tend to become drier with age.15 Owners should be advised to brush mature cats fre- quently, thus helping to remove debris and improve the distribution of natural oils on the skin and in the haircoat. If necessary, the cat can be bathed with mild hypoallergenic, nondrying shampoo. Longhaired cats may have more problems with hair mats as they age, and the haircoat may need to be clipped to make it easier for the owner to groom the cat.
Musculoskeletal disease (e.g., degenerative joint disease, osteoarthritis) is generally less severe in cats than in dogs because of cats’ light weight and limber physique. However, it is surprising how often degenerative joint disease is discovered as an inci- dental finding on feline radiographs. Sometimes, degenerative joint disease may be a cause of the cat’s “slowing down with age.” In these cases, treat- ment may markedly improve the cat’s mobility and general well being.
Oral cavity disorders (including periodontitis, gin- givitis, stomatitis, dental disease, oral ulcers, or oral cavity tumors) are often overlooked as the cause of significant morbidity in geriatric cats.16 It is remarkable how often appropriate treatment for these oral problems leads to a marked improvement in quality of life and activity. The common signs of oral cavity dis- ease include inappetence, weight loss, halitosis, chattering teeth, abnormal chewing and/or swallow- ing behavior, decreased grooming, or nasal discharge (usually unilateral). Infection often accompa- nies oral cavity disease and may result in intermittent bacteremia or septicemia. This may in turn lead to disorders in other body systems (including hyper- globulinemia due to immune stimulation, immune- complex renal disease, chronic interstitial nephritis, hepatitis, and possibly cardiovascular disease).
Apparent senility does occur in cats. Associated behavior changes include confusion, aimless wander- ing around the house, or getting “stuck” in a corner or under a piece of furniture—the cat is apparently unable to figure out how to get out.17 In others, the changes may include aggression or changes in elimi- nation behavior (usually breaks in housetraining). It is very important to perform a thorough physical exami- nation and laboratory workup to eliminate possible medical problems (e.g., primary central nervous sys- tem disease or neoplasia, hepatoencephalopathy, or urinary tract infection) before assuming that these changes are due to senile dementia.18
Impaired thermoregulation is another central ner- vous system change that may occur in older cats. Affected animals may be more heat or cold seeking, depending on the season and ambient temperature. Body temperature must be monitored closely during and following anesthetic procedures and if the animal is hospitalized.19 53
There are differences of opinion as to whether a specific, specialized diet is necessary or recom- mended for geriatric cats.20 Clearly, animals with spe- cific medical problems that may be helped by special diets (e.g., renal disease [restricted protein and phosphorus], inflammatory bowel disease [select protein, limited antigen], diabetes mellitus [high fiber]) should be fed the most appropriate diet for their condition.21,22 Acidifying diets are not recommended unless there is a documented medical reason for their use. But what about the apparently healthy geriatric patient?
The best diets for older patients should be well balanced, nutritionally complete, highly palatable, highly digestible, and replete with potassium and taurine. Excesses of mineral and protein should be avoid- ed.20,22,23 Several commercially available products fulfill these criteria. Supplements should not be neces- sary with these products unless specific deficiencies (e.g., hypokalemia) are detected.
Some people routinely feed older cats restricted-protein diets (i.e., those designed for animals with renal insufficiency) in the belief that these diets will prevent or slow the development of renal failure. However, recent studies suggest that lower-protein diets do not protect the kidneys and are not beneficial until renal insufficiency has developed.24
In addition to the normal species-related vagaries in drug handling, age-related changes affect the absorption, distribution, and metabolism of various drugs in geriatric cats.25 Decreased gastric secretion of hydrochloric acid may affect the absorption of some drugs that require an acid environment. Decreased intestinal blood flow may reduce the amount of drug absorbed from the intestinal tract. Faster gastric emptying (decreased gastric emptying time) can reduce the amount of contact time for some drugs absorbed from the stomach.
Changes in body mass affect drug distribution. As an animal ages, the percentage of body fat tends to increase and lean body mass tends to decrease. Consequently, dose adjustments may be required if a drug dose is based on lean body mass. Changes in serum proteins and protein binding may affect drug availability and elimination kinetics.
Decreased cardiac output increases circulation time, may reduce blood flow to certain organs or tis- sues, and further alters drug metabolism or pharma- cokinetics. Reductions in liver mass and function can decrease the rate of metabolic conversion of a drug to either active or inactive metabolites. Alterations in renal blood flow and glomerular filtration rate can reduce the rate of clearance of unmodified drug or metabolites from the body. The hepatic and renal changes generally result in a decrease in first-pass drug metabolism and tend to result in higher drug lev- els in the body. Finally, because older patients are likely to have more than one problem as they age, veterinarians need to be aware of the effects of polypharmacy and the potential for adverse drug interactions.25
Despite the veterinarian’s best efforts, there often comes a time when the veterinarian must help the owner make the difficult decision to end the patient’s life.26 This is a heavy responsibility, and none of us should take it lightly. In addition to gently alleviating the patient’s suffering, we must be sensitive to the bond between the pet and its owner. If possible, euthanasia should be performed after regular busi- ness hours, when the clinic is quiet and time is avail- able to perform the procedure calmly, compassion- ately, and gently. Our ability to communicate with the owner and help them through this difficult time is very important.26
The American Association of Feline Practitioners (AAFP) has recently completed a major panel review documenting recommendations and suggestions for practitioners interested in improving the health main- tenance and management of older feline patients. Copies of this document will be published and will be available from the AAFP/Academy of Feline Medicine.
1. Scheitel SM, Fleming KC, Chutka DS, et al: Geriatric health maintenance. Mayo Clin Proc 71:289, 1996.
2. Hoskins JD, McCurnin DM: Geriatric care in the late 1990s. Vet Clin North Am Small Anim Pract 27:1273, 1997.
3. Petersen ME, Becker DV: Radioiodine treatment of 542 cats with hyperthyroidism. JAVMA 207:1422, 1995.
4. Jergens AE: Gastrointestinal disease and its management. Vet Clin North Am Small Anim Pract 27:1373, 1997.
5. JergensAE,MooreFM,HaynesJS,etal:Idiopathicinflamma- tory bowel disease in cogs and cats: 84 cases (1987–1990). JAVMA 201:1603, 1992.
6. SlaterMR,BartonCL,RogersKS,etal:Factorsaffectingtreat- ment decisions and satisfaction of owners of cats with cancer. JAVMA 208:1248, 1996.
7. HadleyEC:Thescienceoftheartofgeriatricmedicine.JAMA 273:1381, 1995.
8. KitchellBE:Cancertherapyforgeriatricdogsandcats.JAAHA 29:41, 1993.
9. Littman MP: Spontaneous systemic hypertension in 24 cats. J Vet Intern Med 8:79, 1994.
10. Henick RA: Systemic hypertension and its management. Vet Clin North Am Small Anim Pract 27:1355, 1997.
11. Kobayashi DL, Peterson ME, Graves TK, et al: Hypertension in cats with chronic renal failure or hyperthyroidism. J Vet Intern Med 4:58, 1990.
12. Haberman CE, Morgan J, Brown SA: Measurement of blood pressure in cats and dogs. Proc Annu ACVIM Forum:688, 1996.
13. Scarlett JM, Donoghue S: Obesity in cats: Prevalence and prognosis. Vet Clin Nutr 3:128, 1996.
14. Glaze MB: Ophthalmic disease and its management. Vet Clin North Am Small Anim Pract 27:1505, 1997.
15. Halliwell REW: Skin diseases of old dogs and cats. Vet Rec 126:389, 1990.
16. Harvey CE: Feline dentistry. Vet Clin North Am Small Anim Pract 22:1265, 1992.
17. Landsberg G, Ruehl W: Geriatric behavioral problems. Vet Clin North Am Small Anim Pract 27:1537, 1997.
18. Bagley RS: Common neurologic diseases of older animals. Vet Clin North Am Small Anim Pract 27:1451, 1997.
19. Haskins SC, Klide AM: Anesthesia for very old patients. Vet Clin North Am Small Anim Pract 22:1265, 1992.
20. Armstrong PJ, Lund EM: Changes in body composition and energy balance with aging. Vet Clin Nutr 3:83, 1996.
21. Dow SW, Fettman MJ: Chronic renal disease and potassium depletion in cats. Semin Vet Med Surg Small Anim 7:198, 1992.
22. Laflamme D: Nutritional management. Vet Clin North Am Small Anim Pract 27:1561, 1997.
23. Dow SW, Fettman MJ, LeCouter RA, et al: Potassium depletion in cats: Renal and dietary influences. JAVMA 191:1569, 1987.
24. Adams LG, Polzin DJ, Osborne CA, et al: Effects of dietary protein and calorie restriction in clinically normal cats and in cats with surgically induced chronic renal failure. Am J Vet Res:1653, 1993.
25. Aucoin DP, Goldston RT, Authement J: Drug therapy in the geriatric pet, in Goldston RT, Hoskins JD (ed): Geriatrics and Gerontology of the Dog and Cat. Philadelphia, WB Saunders, 1995, p 15.
26. Stern M: Psychological elements of attachment to pets and re- sponses to pet loss. JAVMA 209:1707, 1996. 55
Alice M. Wolf, DVM Diplomate, ACVIM (Internal Medicine) and ABVP (Feline Practice) Professor Small Animal Medicine and Surgery College of Veterinary Medicine Texas A&M University College Station, Texas 77843-4474
Waltham Feline Medicine Symposium • TNAVC 1999
Hypothyroidism is the most common endocrine disorder of canines, and up to 80% of cases result from autoimmune (lymphocytic) thyroiditis. Continue…
We all produce new and replacement cells every day, many millions of them each week. All our bones, all our fluids and all our tissues are made of cells and all of these are regularly checked and replaced as required or according to an average life expectancy or utility of each and every type of cell or tissue. Some of these replacements are defective (maybe more in this age than before). We do have however a marvellous Immune system which is constantly alert and checking all new cells, all old cells, all damaged cells, all foreign cells and constantly digesting and recycling them to keep us well and free from all illness including Cancer.
Cancer develops when the Immune System can’t keep up with the job at hand.
NB: There are many factors involved in the development of cancer. It is a process and not really a disease. Prevention is key. Great nutrition, no (or very few and none at a young age) vaccinations and working through (and not suppressing) the symptoms manifest by the body, are critical.–Dr. Jeff