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<channel>
	<title>Levittown Animal Hospital Blog</title>
	
	<link>http://levittownvetblog.com</link>
	<description>Way behind the scenes of a dog &amp; cat hospital -and everything your veterinarian doesn't want you to know</description>
	<lastBuildDate>Mon, 16 Jan 2012 03:16:58 +0000</lastBuildDate>
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		<title>Being the Best</title>
		<link>http://levittownvetblog.com/general/being-the-best/</link>
		<comments>http://levittownvetblog.com/general/being-the-best/#comments</comments>
		<pubDate>Mon, 16 Jan 2012 03:16:57 +0000</pubDate>
		<dc:creator>Dennis Leon, DVM</dc:creator>
				<category><![CDATA[Dr. Leon's Posts]]></category>
		<category><![CDATA[General Musings]]></category>
		<category><![CDATA[Best Animal Hospital]]></category>
		<category><![CDATA[Best of Long Island]]></category>
		<category><![CDATA[Best Veterinarian]]></category>
		<category><![CDATA[Dennis Leon DVM]]></category>
		<category><![CDATA[levittown animal hospital]]></category>
		<category><![CDATA[Mark Nunez DVM]]></category>

		<guid isPermaLink="false">http://levittownvetblog.com/?p=265</guid>
		<description><![CDATA[The 2012 edition of Long Island Press&#8217; Best of LI hit newsstands last  Friday, and results of last Fall&#8217;s voting was finally released to the  general public.  &#8220;Best Pet Hospital,&#8221; &#8220;Best Pet Sitting / Boarding,&#8221; and  &#8220;Best Veterinarian&#8221; were among the hundreds of categories listed in the  newspaper. I am happy [...]]]></description>
			<content:encoded><![CDATA[<div id="attachment_266" class="wp-caption alignleft" style="width: 310px"><a rel="attachment wp-att-266" href="http://levittownvetblog.com/general/being-the-best/attachment/bestof_2012_1st_4c/"><img class="size-medium wp-image-266 " title="Bestof_2012_1st_4c" src="http://levittownvetblog.com/wp-content/uploads/2012/01/Bestof_2012_1st_4c-300x167.jpg" alt="Best Veterinarian Long Island" width="300" height="167" /></a><p class="wp-caption-text">Long Island&#39;s Best Pet Hospital (1st Place) &amp; Best Veterinarian (1st and 3rd Places)</p></div>
<p>The 2012 edition of Long Island Press&#8217; Best of LI hit newsstands last  Friday, and results of last Fall&#8217;s voting was finally released to the  general public.  &#8220;Best Pet Hospital,&#8221; &#8220;Best Pet Sitting / Boarding,&#8221; and  &#8220;Best Veterinarian&#8221; were among the hundreds of categories listed in the  newspaper. I am happy to report that we were listed four times in the  three categories: Levittown Animal Hospital for Best Pet Hospital (First  Place) &amp; Best Pet Sitting / Boarding (Second Place), Dr. Mark Nunez  for Best Veterinarian (Third Place), and myself for Best Veterinarian  (First Place).  <span id="more-265"></span>I&#8217;ve been saying for years that Levittown Animal  Hospital is where everyone wants to bring their pets -some people just  don&#8217;t know it yet.  Now that we&#8217;ve earned the titles of Best Pet  Hospital of Long Island and Best Veterinarians of Long Island, we need  to raise the bar even higher.  Before we merely had something to prove.   Now we have something to live up to.  So what exactly does it take to  be the best veterinary hospital on Long Island? I suppose the answer may  be a little different for everyone.  For me, it&#8217;s actually quite  simple: it means an unwavering dedication to always do the right thing  for our patients.  &#8220;Doing the right thing&#8221; is not just a motto or mantra  at Levittown Animal Hospital -it&#8217;s at the core of our practice  culture.  It is how I learned to practice veterinary medicine and  surgery.  It is the philosophy by which i ground all of my medical  decisions.  It is a standard of care that our entire team must uphold.   Sometimes doing the right thing is actually very straightforward,  inexpensive and easy to figure out.  Oftentimes doing the right thing  can get expensive (for both us and our clients) and complicated -and it  may take some time to plan the best course of action. Sometimes my  clients will not agree with me on what the &#8220;right thing&#8221; is. Either way,  as long as I can remain passionate (perhaps obesessive?) about doing  the right thing for every dog and cat I treat, I am confident I can live  up to my title of Best Veterinarian on Long Island.  And as long as I  can continue to surround myself with Long Island&#8217;s best veterinary team,  the hospital will also remain The Best.<br />
Thanks to everyone who voted.  Your continued trust and support are are a  constant reminder and reward for our efforts to remain at the top of  our game.</p>
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		<title>1 vs 3 year Rabies vaccines -is there really still a debate?</title>
		<link>http://levittownvetblog.com/general/1-3-year-rabies-vaccines-debate/</link>
		<comments>http://levittownvetblog.com/general/1-3-year-rabies-vaccines-debate/#comments</comments>
		<pubDate>Sun, 16 Jan 2011 15:52:39 +0000</pubDate>
		<dc:creator>Dennis Leon, DVM</dc:creator>
				<category><![CDATA[Dr. Leon's Posts]]></category>
		<category><![CDATA[General Musings]]></category>
		<category><![CDATA[1 yr rabies vaccine]]></category>
		<category><![CDATA[3 yr rabies vaccination]]></category>
		<category><![CDATA[dog rabies vaccine]]></category>
		<category><![CDATA[merial imrab]]></category>
		<category><![CDATA[purevax rabies]]></category>
		<category><![CDATA[vaccine related sarcoma]]></category>

		<guid isPermaLink="false">http://levittownvetblog.com/?p=258</guid>
		<description><![CDATA[I was doing some light bedtime internet browsing and came across another veterinarian&#8217;s blog posting about 1yr vs. 3yr rabies vaccinations.  I laughed a little. I cried a little.  So I&#8217;m not accused of any sort of plagiarism, I will refrain from any cutting and pasting, but will merely provide a link to what I [...]]]></description>
			<content:encoded><![CDATA[<p>I was doing some light bedtime internet browsing and came across another veterinarian&#8217;s blog posting about 1yr vs. 3yr rabies vaccinations.  I laughed a little. I cried a little.  So I&#8217;m not accused of any sort of plagiarism, I will refrain from any cutting and pasting, but will merely provide a link to what I read: <a href="http://www.centralvets.com/blog/?p=1" target="_blank">http://www.centralvets.com/blog/?p=1</a></p>
<p>I did cut/paste my comment below. By the time some of you read this I suspect the owner of the other blog will have deleted my response -but I will leave it here for the world to see.<span id="more-258"></span></p>
<p><span style="color: #800000;">wow, that was one of the more interesting rationales for 1 yr rabies vaccination. does anyone reading (or writing) this really think that 3 yr rabies protocols will actually result in an outbreak of rabies here in ny?? let&#8217;s set the record straight with some actual FACTS:</span></p>
<p><span style="color: #800000;">1) yes, rabies vaccination is required by law in NYS. you can read about NY rabies law here: <a href="http://www.health.ny.gov/diseases/communicable/zoonoses/rabies/" target="_blank">http://www.health.ny.gov/diseases/communicable/zoonoses/rabies/<br />
</a><br />
2) yes, giving a 3 yr rabies vaccine to a cat carries with it a five-fold increase in risk of developing a vaccine-related sarcoma (cancer) at the vaccination site. however, this is NOT because it&#8217;s a 3yr vs 1yr vaccine! the difference is that all rabies vaccines approved for 3yrs are adjuvanted vaccines, meaning they contain an additive to stimulate inflammation -basically to help the vaccine be more effective.  as of right now ALL 3yr rabies vaccines are adjuvanted.  MOST 1yr rabies vaccines are also adjuvanted.  as of right now there is only ONE rabies vaccine that is non-adjuvanted (merial&#8217;s purevax rabies). it is for cats only and it is currently only approved for 1 yr.  so that 5-fold increase in cancer risk is actually comparing adjuvanted vaccines to non-adjuvanted vaccines in cats -NOT 1yr vs. 3yr. in fact, if you use an adjuvanted 1yr rabies vaccine (any brand other than purevax) annually, your cat will be at FIFTEEN times the risk of developing a sarcoma (5 times 3).  and, yes, that increased cancer risk comes with all feline adjuvanted vaccines, not just rabies. so ask your veterinarian what they&#8217;re injecting into your cat.</span></p>
<p><span style="color: #800000;">3) jean dodd&#8217;s protocol has been adopted by US veterinary schools. we were using that protocol as far back as 1999 when i was working at the cornell university veterinary teaching hospital. (that&#8217;s the year cornell stopped giving corona virus vaccine to dogs.) i could not find cornell&#8217;s dog vaccine protocol online, but here&#8217;s UC Davis&#8217;: <a href="http://www.vetmed.ucdavis.edu/vmth/small_animal/internal_medicine/vaccination_protocols.cfm" target="_blank">http://www.vetmed.ucdavis.edu/vmth/small_animal/internal_medicine/vaccination_protocols.cfm</a> their current protocol mirrors what i was doing at cornell over 10 years ago.</span></p>
<p><span style="color: #800000;">4) NYS law calls for a dog&#8217;s (or cat&#8217;s) first rabies vaccination to be a 1yr vaccination.  subsequent boosters can be 3 yrs.</span></p>
<p><span style="color: #800000;">5) any one vaccine manufacturer&#8217;s 3yr-labeled rabies vaccine does not contain any more active ingredient than their 1yr-labeled rabies vaccine.  i.e., merial&#8217;s imrab-1 and imrab-3 are the same cocktail with a different label on the vial. just remember that merial&#8217;s 1yr purevax is an entirely different beast.</span></p>
<p><span style="color: #800000;">done with facts. now some real world pragmatism: ask your veterinarian when he/she was last vaccinated against rabies.  ask yourself: who is at greater risk of being exposed to rabies -your dog who sits at home alone most of the time or a veterinarian who handles several hundred dogs and cats (many who are not vaccinated) every month?  THIS IS NOT TO SUGGEST THAT YOU VIOLATE STATE RABIES VACCINE LAW! -but does your dog need to be vaccinated in excess of what the law requires???</span></p>
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		<title>The real cost of healthcare</title>
		<link>http://levittownvetblog.com/general/real-cost-healthcare/</link>
		<comments>http://levittownvetblog.com/general/real-cost-healthcare/#comments</comments>
		<pubDate>Sun, 19 Sep 2010 18:54:45 +0000</pubDate>
		<dc:creator>Dennis Leon, DVM</dc:creator>
				<category><![CDATA[General Musings]]></category>
		<category><![CDATA[dog ear infection]]></category>
		<category><![CDATA[ENT]]></category>
		<category><![CDATA[veterinarian]]></category>
		<category><![CDATA[veterinary cost]]></category>

		<guid isPermaLink="false">http://levittownvetblog.com/?p=246</guid>
		<description><![CDATA[Recently, I had my own appointment with an otolaryngologist (aka ear-nose-throat or &#8220;ENT&#8221; physician).  I was diagnosed with otitis externa (an ear infection) and the doctor prescribed some medicated ear drops which I picked up at a local pharmacy.  This experience struck me as one similar to a scenario I see all the time at [...]]]></description>
			<content:encoded><![CDATA[<div id="attachment_253" class="wp-caption alignleft" style="width: 310px"><a href="http://www.levittownvet.com"><img class="size-medium wp-image-253" title="maserati granturismo" src="http://levittownvetblog.com/wp-content/uploads/2010/09/2008.maserati.granturismo.20214492-E-300x189.jpg" alt="NOT Dr. Leon's car" width="300" height="189" /></a><p class="wp-caption-text">NOT Dr. Leon&#39;s car</p></div>
<p>Recently, I had my own appointment with an otolaryngologist (aka ear-nose-throat or &#8220;ENT&#8221; physician).  I was diagnosed with otitis externa (an ear infection) and the doctor prescribed some medicated ear drops which I picked up at a local pharmacy.  This experience struck me as one similar to a scenario I see all the time at Levittown Animal Hospital.  I see at least one (if not four) ear infections on any given day.  So I decided to compare <span id="more-246"></span>the services we provide our patients (and their associated costs) with my own human appointment.  Here&#8217;s the breakdown.</p>
<p>1) Making the appointment: If you suspect that your dog or cat has an ear infection, we can usually get you an appointment the same day. At most, you would have to wait one day to come in.  When I suspected my own ear infection, I first spoke with another personal physician to get a name of an ENT doctor he trusted.  I called the ENT office for an appointment, and the earliest available slot for a new patient was 10 days away.  That particular day was one I couldn&#8217;t take off from work, so I made an appointment 14 days after the call.</p>
<p>2) The examination: If your dog or cat comes in with the chief concern of an ear infection, he/she still gets a complete nose-to-tail physical examination.  Ears are examined with an otoscope.  If there is any abnormal discharge, a sample is examined microscopically.  My ENT doctor looked at my ears, my nose and my throat.  He did not wear or carry a stethoscope (there&#8217;s no H or C in ENT!).  Abnormal discharge was found deep in my ear canals, but none was collected for further investigation. Cost: At my hospital the exam is $62 and in-house ear cytology is approximately $30. My ENT exam cost me a $40 copay, although without insurance I would have been charged $275.  Speaking of insurance, I pay about $450/month for my plan.  Assuming one doctor visit a month (not sure if I&#8217;ve ever gone to the doctor that often!), that averages out to a cost of $490 for my examination, including the copay.  Yes, I know that&#8217;s an oversimplification, but you get my point.</p>
<p>3) Cleaning: If there is excessive or abnormal discharge found in your dog or cat&#8217;s ears, my technicians or assistants will gently and thoroughly clean it out with a liquid ear cleaner (chosen based on my assessment of the ears and the nature of the discharge).  It is usually a two person job -one person restraining and the other cleaning.  My ENT doctor cleaned my ears himself as I did not require restraint. Or a muzzle.  Cost: About $30 at my hospital.  No additional charge by my ENT doc.</p>
<p>4) Medications:  If an ear infection is confirmed by microscopic exam, an appropriate medication is chosen based on my interpretation of that cytologic exam.  This is all done while the patient&#8217;s ears are being cleaned.  The first dose is typically applied at the hospital by my staff.  The medication is dispensed from our own in-house pharmacy.  Most of the time, we will also dispense an appropriate ear cleaning solution for at-home use.  My ENT doctor diagnosed an ear infection and prescribed an antibiotic-containing (a &#8220;big gun,&#8221; ciprofloxacin, no less!) drop without the supportive evidence of a cytology or culture.  I had the prescription filled at my local pharmacy.  Cost: Ear drops and ointments sold at my hospital range from about $20 to $45, depending on what the patient needs.  Ear cleaning solutions range from $5 to 20.  My CiproDex otic drops cost me a $30 pharmacy copay since it is not available in a generic form.  The same drops sell at a discount internet pharmacy for over $135.</p>
<p>5) Additional testing: Often times, ear infections in dogs and cats are just one part of an overall dermatologic problem.  Sometimes we will run additional tests if we find skin lesions or other evidence of infection outside of the ears.  There are also times when we will suspect an underlying endocrine problem, so we may submit a blood sample to our reference laboratory.  My ENT doc had one of his assistants/nurses perform a hearing test and &#8220;ear function test&#8221; on me. Cost: Skin impression smear and cytology will cost about $30 at my hospital.  General blood screens range in cost from $60 to $160 depending on what tests are of interest for a particular patient.  My ENT doctor charged me an additional $40 on top of my copay for the hearing and ear function tests.  Without insurance, I would have been charged $330.</p>
<p>6) Other observations: While waiting in one of my exam rooms, you may peek out the windows and spot my car parked next to the hospital.  It&#8217;s a 2006 BMW X5 which I bought used last year for $25,000.  While waiting for my ENT doctor in his lobby, I looked out the window and saw his car parked outside.  It was a 2009 Maserati GranTurismo.  Base MSRP $117,500.  Just saying&#8230;</p>
<p>So let&#8217;s add all this up: Appointment right away at my hospital, ear cytology, ear cleaning, meds and flush will run you about $160.  If I have to look at a skin smear and submit a senior blood profile, the total goes up to about $350.  Let&#8217;s say your dogs is overdue for his 3-year Rabies vaccine, needs a nail trim and you brought a stool sample for us to check out also. Now we&#8217;re at $420 for <strong>all </strong>of the above.</p>
<p>Appointment in 10-14 days wth my ENT physician, cleaning, testing, and meds would have cost me $740 if I did not have insurance.  Luckily, I have insurance so my out of pocket costs that day were limited to $110.  But if you factor in just one month of my insurance premium (which I pay for since I am self-employed), that figure gets bolstered to about $560.  And nothing below my neck was even looked at.</p>
<p>Still think veterinarians charge too much?</p>
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		<title>Dnalsi Gnol is Long Island spelled backwards.</title>
		<link>http://levittownvetblog.com/leon/long-island-spelled-backwards/</link>
		<comments>http://levittownvetblog.com/leon/long-island-spelled-backwards/#comments</comments>
		<pubDate>Tue, 15 Jun 2010 18:44:56 +0000</pubDate>
		<dc:creator>Dennis Leon, DVM</dc:creator>
				<category><![CDATA[Dr. Leon's Posts]]></category>
		<category><![CDATA[Rants, Raves and Pet Peeves]]></category>
		<category><![CDATA[animal shelter]]></category>
		<category><![CDATA[laparoscopic spay]]></category>
		<category><![CDATA[minimally invasive surgery]]></category>
		<category><![CDATA[neuter]]></category>
		<category><![CDATA[spay]]></category>
		<category><![CDATA[veterinary medicine]]></category>

		<guid isPermaLink="false">http://levittownvetblog.com/?p=239</guid>
		<description><![CDATA[You would think that one of the wealthiest counties in the country would  also be home to the best of the best veterinary  hospitals in America.  You would think that the pet owners of this  wealthy county would demand the most modern and cutting edge care for  their companions.  Yes, you [...]]]></description>
			<content:encoded><![CDATA[<p><img class="alignleft size-medium wp-image-240" title="Lap ovh web1" src="http://levittownvetblog.com/wp-content/uploads/2010/06/Lap-ovh-web1-300x226.jpg" alt="Lap ovh web1" width="270" height="203" />You would think that one of the wealthiest counties in the country would  also be home to the best of the best veterinary  hospitals in America.  You would think that the pet owners of this  wealthy county would demand the most modern and cutting edge care for  their companions.  Yes, you could think those things <span id="more-239"></span>&#8230;and you&#8217;d be  wrong.  Sure there are a good handful of very good veterinarians here  -doctors who I am proud to call my colleagues -but we are surrounded by a  sea of veterinarians who still give annual Rabies vaccinations to dogs,  think that blood testing before major surgery should be optional, and  think that pain management consists of sending home some pills after the  owner stays up all night with a crying patient.</p>
<p>A conversation with an administrator at a local animal shelter the  other day reminded me just how un-progressive veterinary medicine is  here on Long Island.  First, a little background information: A couple  of years ago, I agreed to perform some spays and neuters for the town  shelter at a reduced rate.  Basically, we were doing them for free.  Our  monetary compensation for these surgeries barely covered the costs of  all the administrative paperwork that goes along with any operation.   Since I refused to lower my standards of care for the shelter animals, I  ended up eating the cost of pre-anesthetic blood testing, pain killers  and intravenous fluids for every single shelter dog and cat that ever  came through here.  In my mind (at the time) it was a small price to pay  for doing the right thing.  The real payoff, however, was the prospect  of gaining a new patient/client.  The new adoptive owners would come to  the hospital to pick up their freshly neutered pet and realize how  wonderful our facility was compared to their current animal hospital of  choice.</p>
<p>So how well did that pan out?  Not so well.  It turned out that more  than 75% of the animals we received from the shelter did not have an  owner yet.  The shelter wanted to get the animals spayed and neutered  before adopting them out.  So we never had an opportunity to meet or  speak with most of these new owners.  In the end, we performed several  hundred surgeries (costing us tens of thousands of dollars in labor,  medication and supplies) and gained &#8230;about eight new clients.  It was  not a mutually beneficial arrangement, so we stopped receiving these  dogs and cats from the shelter.</p>
<p>Fast forward to 2010.  I met with a shelter administrator who want to  know if I would be interested in renewing my contract with the county.   Here is how our conversation went:</p>
<p>&#8220;Actually, I may want to do some dog spays for you this summer.  I&#8217;m  learning how to do laparoscopic spays at the University of Georgia  and&#8230;&#8221;<br />
&#8220;Let me stop you right there.  Another veterinarian approached us with  the same thing last week. We&#8217;re just not interested.&#8221;<br />
&#8220;What do you mean?&#8221;<br />
&#8220;We just don&#8217;t want to get involved with something so new.&#8221;<br />
&#8220;Minimally invasive surgery is hardly new.  This is the new standard of  care in humans and some veterinarians have been doing it like this for  years.&#8221;<br />
&#8220;We just don&#8217;t want to get involved.&#8221;<br />
&#8220;So you&#8217;re turning down an opportunity to get a more progressive, more  expensive, less invasive, less painful surgery done at &#8230;at the same  price to you?&#8221;<br />
&#8220;Well, what&#8217;s involved? Do you still remove the ovaries?&#8221;</p>
<p>At this point it be came very apparent that judgment had been passed on  the procedure without knowing a single thing about it.</p>
<p>&#8220;Yes, both ovaries are still removed.  That&#8217;s what makes a spay a spay.   Typically, the uterus is left in.  This can be done with two or  sometimes one small incision.&#8221;<br />
&#8220;OK. I see&#8230; Well, we talked to our other veterinarians and they all  said that laparoscopic spays were not a good idea for our dogs here.&#8221;<br />
&#8220;Which veterinarians said this?&#8221;<br />
&#8220;I&#8217;m not at liberty to say specifically.  Just the veterinarians who do  our spays for us.&#8221;<br />
&#8220;They&#8217;re wrong. This is just another glaring example of how backwards  veterinarians are around here!&#8221;</p>
<p>Yup, I said that out loud.  What I managed to hold back were my thoughts  of how many swollen, infected and painful surgery sites I have seen on  patients spayed via the shelter over the past few years.  A shameful  display of high-volume, low-cost negligence.</p>
<p>&#8220;Well maybe we&#8217;ll change our minds.  Things may change in six months if  everyone starts to jump on the bandwagon with this laparoscopic  stuff&#8230;&#8221;<br />
&#8220;Unfortunately that will never happen.  You don&#8217;t just decide one day to  start doing laparoscopic surgery.  You need to get sufficient training,  then you need to invest in $10-30,000 of equipment.&#8221;<br />
&#8220;So you just wanted to practice on some shelter dogs?&#8221;<br />
&#8220;For lack of a better word, yes. Every dog I spay for you has a greater  than 50% chance of being  euthanized once you bring her back to the shelter.  I figured you might  want to do whatever it takes to get them up and ready for adoption as  quickly as possible.&#8221;<br />
&#8220;Yeah, well &#8230;we just can&#8217;t let you do that.&#8221;</p>
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		<title>Vaccination vs. Socialization</title>
		<link>http://levittownvetblog.com/general/vaccination-socialization/</link>
		<comments>http://levittownvetblog.com/general/vaccination-socialization/#comments</comments>
		<pubDate>Wed, 26 May 2010 00:24:39 +0000</pubDate>
		<dc:creator>Dennis Leon, DVM</dc:creator>
				<category><![CDATA[Dr. Leon's Posts]]></category>
		<category><![CDATA[General Musings]]></category>
		<category><![CDATA[dog training]]></category>
		<category><![CDATA[levittown animal hospital]]></category>
		<category><![CDATA[puppy kindergarden]]></category>
		<category><![CDATA[puppy socialization]]></category>
		<category><![CDATA[puppy vaccination]]></category>

		<guid isPermaLink="false">http://levittownvetblog.com/?p=230</guid>
		<description><![CDATA[I&#8217;ve made it clear to most people reading this  blog that I don&#8217;t agree with the way most other veterinarians vaccinate  dogs and cats.  They give too many too often, and their entire  preventative care plan revolves around vaccinations.  This awful cycle  begins as soon as puppies are born.  Unfortunately I [...]]]></description>
			<content:encoded><![CDATA[<p style="text-align: justify;"><img class="alignleft size-full wp-image-231" title="pup" src="http://levittownvetblog.com/wp-content/uploads/2010/05/pup.jpg" alt="pup" width="240" height="156" />I&#8217;ve made it clear to most people reading this  blog that I don&#8217;t agree with the way most other veterinarians vaccinate  dogs and cats.  They give too many too often, and their entire  preventative care plan revolves around vaccinations.  This awful cycle  begins as soon as puppies are born.  Unfortunately I have also seen  breeders and puppy stores subscribe to a philosophy of massively  over-vaccinating puppies -starting them as early as 5 weeks of age and  repeating multi-valent vaccines as often as every seven days!  And we  wonder why there are so many dogs with chronic <span id="more-230"></span>kidney disease,  hypothyroidism, and arthritis&#8230;</p>
<p style="text-align: justify;">No situation has bothered me  more than a recent clash between my consulting dog trainers and some  other veterinarians on Long Island.  Responsible owners of several  puppies have enrolled for <a href="http://www.levittownvet.com/services/behavior-services.html" target="_blank">Puppy Kindergarden</a> (socialization) classes  -but their veterinarians have advised them not to bring their puppies  until they are &#8220;fully vaccinated.&#8221;  Perhaps these other veterinarians  are afraid of losing their clients to me (the puppy classes are at my  facility).  More likely, these veterinarians have just proven that they  simply do not understand the importance of early socialization or the  real-world risks of infectious disease transmission between healthy  dogs.</p>
<p style="text-align: justify;">Here are the facts:</p>
<ul>
<li> Behavior problems are the #1  reason why dogs are surrendered to animal shelters.</li>
<li> This, in  turn, makes behavioral issues the number one cause of death for dogs  under three years of age.</li>
<li> The overwhelming majority of these  behavior problems can be either corrected or prevented in the first  place.</li>
<li> The socialization period of dogs ends at around 12-14 weeks  of age.</li>
<li> Most puppies will not be &#8220;fully vaccinated&#8221; until they  reach 16 weeks of age.</li>
<li> The risk of death from Parvo or Distemper  infection is far less than the risk of death due to a behavior problem.</li>
</ul>
<p style="text-align: justify;">Properly  socializing puppies and protecting them from infectious disease do not  have to mutually exclusive.  Can I guarantee that no puppy will ever get  sick at on of my classes? Of course not.  But this is not just a random  gathering of puppies at a local dog park.  All puppies that enroll in  our puppy classes are carefully screened to minimize the spread of  disease among classmates:</p>
<ul>
<li> New puppies must have spent at least 14  days in the home of their new owner.</li>
<li>Puppies must have received at  least one round of Distemper-Adenovirus-Parvo vaccine following a  complete physical examination by a veterinarian.</li>
<li> Puppies must have  received an intranasal vaccination for Bordetella-Parainfluenza.</li>
<li> Puppies must have a documented fecal examination with a negative result.</li>
<li> Puppies must be free of any obvious clinical signs of infectious  disease, including coughing and sneezing.</li>
</ul>
<p style="text-align: justify;">If veterinarians  continue to ignore the facts and insist on a complete vaccination series  before puppies are allowed out of a home quarantine &#8230;they will be  directly responsible for increasing the population of shelter dogs.   It&#8217;s time to live up to our Veterinary Oath and actually use our  scientific knowledge and skills for the benefit of society through the  protection of animal health, and the relief of animal suffering&#8230;</p>
<p style="text-align: justify;">I&#8217;m not alone in this fight against antiquated vaccination vs.  socialization viewpoint.  Here are a couple of expert links:<br />
<a href="http://www.vet.purdue.edu/animalbehavior/forms/pc_letter_vacc.pdf" target="_blank">http://www.vet.purdue.edu/animalbehavior/forms/pc_letter_vacc.pdf</a><br />
<a href="http://www.avsabonline.org/avsabonline/images/stories/Position_Statements/puppy%20socialization.pdf" target="_blank">http://www.avsabonline.org/avsabonline/images/stories/Position_Statements/puppy%20socialization.pdf</a></p>
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		<title>Can’t buy me love</title>
		<link>http://levittownvetblog.com/general/buy-love/</link>
		<comments>http://levittownvetblog.com/general/buy-love/#comments</comments>
		<pubDate>Fri, 30 Apr 2010 03:26:16 +0000</pubDate>
		<dc:creator>Dennis Leon, DVM</dc:creator>
				<category><![CDATA[Dr. Leon's Posts]]></category>
		<category><![CDATA[General Musings]]></category>
		<category><![CDATA[animal hospital]]></category>
		<category><![CDATA[cushing's disease]]></category>
		<category><![CDATA[hyperadrenocorticism]]></category>
		<category><![CDATA[veterinarian]]></category>

		<guid isPermaLink="false">http://levittownvetblog.com/?p=222</guid>
		<description><![CDATA[Hi everyone! I know I haven&#8217;t written in a while -that wasn&#8217;t by choice.  I&#8217;ve just been terribly busy.  Since I last updated this blog, my hospital passed it&#8217;s AAHA accreditation evaluation -a distinction held by less than 15% of animal hospitals in the U.S.  We are also about to start a major construction project, [...]]]></description>
			<content:encoded><![CDATA[<p><img class="alignleft size-medium wp-image-223" title="Insane Business Man" src="http://levittownvetblog.com/wp-content/uploads/2010/04/frustrated-200x300.jpg" alt="Insane Business Man" width="200" height="300" />Hi everyone! I know I haven&#8217;t written in a while -that wasn&#8217;t by choice.  I&#8217;ve just been terribly busy.  Since I last updated this blog, my hospital passed it&#8217;s AAHA accreditation evaluation -a distinction held by less than 15% of animal hospitals in the U.S.  We are also about to start a major construction project, demolishing and rebuilding the hospital&#8217;s outdoor dog runs that date back to the mid-60&#8217;s.  So what prompted me to sit down with my laptop and write tonight?  A frustrating conversation with a client, of course!<span id="more-222"></span></p>
<p>Here are some highlights of the owner&#8217;s rant:</p>
<p>&#8220;I brought my dogs to you because I thought you&#8217;d be better than my last vet.  You did a good job with my other dog, but I&#8217;m questioning you about this one!&#8221;</p>
<p>&#8220;How much is it gonna cost for you to look at my dog?  You already took $1000 from me and now I&#8217;m broke.&#8221;</p>
<p>&#8220;So you&#8217;ll be able to look at my dog and tell me what&#8217;s wrong, right?&#8221;</p>
<p>&#8220;My wife worked for a doctor and she told me that those tests you charged so much for only cost about $10.  It&#8217;s ridiculous that you mark it up so much! You don&#8217;t need to charge me for any additional tests you run.&#8221;</p>
<p>&#8220;Doesn&#8217;t the fact that I already spent $1000 there mean anything?&#8221;</p>
<p>Here are my responses, directed to only to this owner in particular, but to all veterinary clients out there:</p>
<p>1) Question me all you want.  A good veterinarian doesn&#8217;t mind being questioned.  I have always welcomed second opinions from a specialist to confirm my diagnosis.</p>
<p>2) I did not &#8220;take&#8221; $100o from anyone.  I did perform a number of important and informative diagnostic tests.  Costs were discussed and consent forms were signed along the way.  I charged a fair amount for the procedures done and have spent a fair amount of time explaining and interpreting all of the results with the owner.</p>
<p>3) It&#8217;s certainly possible that I can reach a diagnosis for the dog&#8217;s current condition based on physical examination findings.  However, the physical exam is often just one piece of the puzzle.</p>
<p>4) My laboratory bill would be much much smaller if all of my tests only cost me $10!  I will readily admit that there can be a substantial markup on some diagnostic blood tests, but not the 10x markup that this client was suggesting.  Besides, the charge for any individual test is not based solely on the wholesale cost of the test.  If a client wants to figure out what tests need to be run, draw their pet&#8217;s own blood samples, ship them to the lab, and then interpret all the results &#8230;then I could just have a small fixed markup on the test itself.  The fact is, clients don&#8217;t pay for the test per se.  They pay for the sample collection and interpretation.  Otherwise, it&#8217;s just a bunch of meaningless numbers.</p>
<p>5) I appreciate any and all business from my clients.  I have told my staff in the past &#8220;Treat each client as if they are giving you your paycheck -because they are.&#8221;  It doesn&#8217;t matter if you spent $100 or $1000, my commitment is to the well-being of the patient.  However, money previously spent at the hospital is for services already rendered.  It can&#8217;t be used to &#8220;buy&#8221; any freebies or discounts on future services.  If I discount a client&#8217;s next bill by $100 because she spent $1000 at the hospital last month &#8230;doesn&#8217;t that just mean that I over-charged her by $100 last month?  Am I crazy for thinking this way?</p>
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		<title>Score one for the good guys.</title>
		<link>http://levittownvetblog.com/general/score-good-guys/</link>
		<comments>http://levittownvetblog.com/general/score-good-guys/#comments</comments>
		<pubDate>Fri, 29 Jan 2010 00:18:56 +0000</pubDate>
		<dc:creator>Dennis Leon, DVM</dc:creator>
				<category><![CDATA[Dr. Leon's Posts]]></category>
		<category><![CDATA[General Musings]]></category>
		<category><![CDATA[animal hospital]]></category>
		<category><![CDATA[pet lemon law]]></category>
		<category><![CDATA[puppies]]></category>
		<category><![CDATA[puppy store]]></category>

		<guid isPermaLink="false">http://levittownvetblog.com/?p=217</guid>
		<description><![CDATA[
The following article was sent to me by a client this morning.  Good to finally hear that action is being taken against some of these people&#8230;

Cuomo Busts Puppy Salesmen

By BARBARA LEONARD
MINEOLA (CN) &#8211; Queens-based pet dealers use bait-and-switch tactics to sell unfit dogs, and violate charities law by &#8220;purport(ing) to engage in animal rescue activities,&#8221; [...]]]></description>
			<content:encoded><![CDATA[<p><img class="size-thumbnail wp-image-218 alignleft" title="lemon dog" src="http://levittownvetblog.com/wp-content/uploads/2010/01/lemon-dog-150x150.jpg" alt="lemon dog" width="150" height="150" /></p>
<p>The following article was sent to me by a client this morning.  Good to finally hear that action is being taken against some of these people&#8230;</p>
<div id="C1R1_Headline">
<h5>Cuomo Busts Puppy Salesmen</h5>
</div>
<p>By BARBARA LEONARD</p>
<p>MINEOLA (CN) &#8211; Queens-based pet dealers use bait-and-switch tactics to sell unfit dogs, and violate <span id="more-217"></span>charities law by &#8220;purport(ing) to engage in animal rescue activities,&#8221; New York Attorney General Andrew Cuomo says.</p>
<p>Cuomo says the husband and wife&#8217;s two businesses, Imported Quality Guard Dogs and the Animal Rescue Unit, &#8220;engage in deceptive business practices and false advertising&#8221; and violate &#8220;the Pet Lemon Law.&#8221;</p>
<p>Defendants Robin Schulder and her husband, Perry Reich, falsely claim to be dog breeders, make &#8220;numerous misrepresentations&#8221; about their animals, and falsify health records of the dogs, Cuomo says. He adds that Schulder practices as a veterinarian without a license, and makes improper use of the title &#8220;veterinarian technician.&#8221;</p>
<p>Cuomo says his office has received 13 complaints against the couple and their companies. Consumers also have complained to the New York Better Business Bureau, the agriculture department and the American Society for the Prevention of Cruelty to Animals.<br />
The couple operates more than a dozen Web sites that lure consumers with empty promises, such as &#8220;all our babies are born in our home,&#8221; according to the complaint.</p>
<p>The sites list puppies with pictures, names, weight, sex, age, price and availability, but Schulder delivers a &#8220;markedly different&#8221; dog, according to the complaint.</p>
<p>Despite their claims, Cuomo says, the couple resells dogs they bought from third parties.</p>
<p>&#8220;Numerous customers purchased animals that suffered from illnesses ranging from parvo, coccidian, mange, acute respiratory infection, pneumonia and life-threatening hypoglycemia,&#8221; according to the complaint.</p>
<p>Some consumers pay up to $3,000 in veterinary bills &#8220;trying to nurse the animals back to health,&#8221; but one dog died and two had to be euthanized because of severe medical issues, according to the attorney general.</p>
<p>Cuomo says the couple delivers dogs with visible defects, including deformed limbs and blindness, as well as signs of illness such as coughing, sneezing, bloody stool or vomiting.</p>
<p>When consumers demand reimbursement for veterinary care or try to return a puppy, Cuomo says, Schulder becomes verbally abusive, &#8220;lashing out at them with vicious obscenities, and blaming them for their dogs&#8217; illnesses or death.&#8221;</p>
<p>Cuomo says that Schulder once answered the door holding a large kitchen knife, and when a veterinarian diagnosed a puppy with congenital blindness, Schulder insisted that the consumer had dropped the puppy on its head.</p>
<p>Cuomo adds that one of their Web sites claims: &#8220;&#8216;Some of our puppies are imported from our family-owned kennel in Europe.&#8217; This is an outright lie. Respondents do not have a family-owned kennel in Europe.&#8221;</p>
<p>They claim their &#8220;No-Kill Animal Shelter&#8221; has rescued dogs throughout New York&#8217;s five boroughs and has &#8220;over 2,000 supporters and donators,&#8221; but Cuomo says they &#8220;have been unable, however, to produce any records whatsoever identifying any dogs they have rescued, and admit that their &#8216;animal rescue charity,&#8217; the Animal Rescue Unit Inc., is inactive.&#8221;</p>
<p>Cuomo seeks an injunction, accounting, restitution and civil penalties.</p>
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		<title>Can we be everything for everyone?</title>
		<link>http://levittownvetblog.com/general/can-we-be-everything-for-everyone/</link>
		<comments>http://levittownvetblog.com/general/can-we-be-everything-for-everyone/#comments</comments>
		<pubDate>Sat, 16 Jan 2010 01:27:56 +0000</pubDate>
		<dc:creator>Dennis Leon, DVM</dc:creator>
				<category><![CDATA[Dr. Leon's Posts]]></category>
		<category><![CDATA[General Musings]]></category>
		<category><![CDATA[dog trainer]]></category>
		<category><![CDATA[veterinarian]]></category>

		<guid isPermaLink="false">http://levittownvetblog.com/?p=214</guid>
		<description><![CDATA[I had this conversation with a friend of mine last week.  He owns a local dog training company.  No, that’s an understatement. He owns and operates the largest dog training company in the New York Tri-State area.  Since the collapse of the economy, his business has suffered –not because dog don’t need to be trained, [...]]]></description>
			<content:encoded><![CDATA[<p>I had this conversation with a friend of mine last week.  He owns a local dog training company.  No, that’s an understatement. He owns and operates the largest dog training company in the New York Tri-State area.  Since the collapse of the economy, his business has suffered –not because dog don’t need to be trained, but because <span id="more-214"></span>dog owners simply don’t want to spend money for “premium” dog training.</p>
<p>While most dog trainers will charge by the hour or by the lesson, his company charges one price for the life of the dog.  If everything I ever need to know I learned in kindergarten …even kindergarten lasted for more than a handful of 30 minute lessons.  Same thing applies to dogs.  And yet dog owners continue to attempt to rehabilitate their humping, jumping, runaway canines in 4-lessons-for-$150.  But what about the well behaved pooch who just needs some finishing work? Maybe those dogs and their owners really do only need a handful of lessons to get the ball rolling.  So can a premium dog training company offer that as an option without diluting their brand or contradicting the values they preach to their premium training clients?</p>
<p>After our conversation, we agreed it could be done, as long as it was marketed smartly and tactfully.  It worked for other companies: Nobu has Nobu Next Door.  Georgio Armani has Armani Exchange.  Saks Fifth Avenue has Saks Off 5<sup>th</sup>.  Even Porsche once sold the 924.</p>
<p>Could that model ever work for a veterinary hospital?  I sure hope not.  Low-cost veterinary care –unless subsidized by some sort of private or public funding –is often low-quality veterinary care.  Ask any doctor if they can maintain their level of patient care if their operating budget is slashed by 50%.  High profit medical care is only sustainable if there are profits to support it.  Even if doctors donated their time, there are still many other costs to consider: experienced (and well-paid) support staff, medications, laboratory testing, patient monitoring equipment, needles, syringes, fluids, etc…</p>
<p>Let’s look at a simple example of two different veterinarians in the same town who are charging vastly different prices to spay your cat.  One may charge upwards of $275 and the other may quote less than $75.  (These numbers are not entirely made up –I’ve seen this in both the San Francisco Bay are and the New York City Metro area.)  For argument’s sake, let’s assume that both doctors possess the same surgical experience and skills.  What then makes up for the difference?  Can the cheaper veterinarian offer pre-anesthetic blood testing, intravenous fluids, and pain killers at that price?  Is the less expensive hospital utilizing the same level of patient monitors, and are they paying an experienced anesthetist to monitor the cat while the doctor has his hands inside?  On the flip side, how can you know that the more expensive doctor is doing all these things?  The best you can do is ask.</p>
<p>There is indeed a minimum standard of care that every doctor should be providing.  Unfortunately, not everyone agrees on what this minimum level is –and either way, many veterinarians out there don’t make the grade.  Some just don’t care and the rest can’t afford to because they’re not charging enough.</p>
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		<title>Positive Reinforcement of Good Behavior</title>
		<link>http://levittownvetblog.com/general/positive-reinforcement-good-behavior/</link>
		<comments>http://levittownvetblog.com/general/positive-reinforcement-good-behavior/#comments</comments>
		<pubDate>Thu, 17 Dec 2009 00:15:45 +0000</pubDate>
		<dc:creator>Dennis Leon, DVM</dc:creator>
				<category><![CDATA[Dr. Leon's Posts]]></category>
		<category><![CDATA[General Musings]]></category>

		<guid isPermaLink="false">http://levittownvetblog.com/?p=209</guid>
		<description><![CDATA[ While doing end-of-year employee reviews, it occurred to me that I&#8217;m a big hypocrite.  All day long, I tell pet owners to reward good behavior and ignore attention seeking behavior.  Actually, my exact words are usually &#8220;If she gets it right, throw her a party.&#8221;  But I don&#8217;t treat my employees that way, and [...]]]></description>
			<content:encoded><![CDATA[<p><img class="alignnone size-thumbnail wp-image-210" title="pat on back" src="http://levittownvetblog.com/wp-content/uploads/2009/12/pat-on-back-150x150.jpg" alt="pat on back" width="150" height="150" /> While doing end-of-year employee reviews, it occurred to me that I&#8217;m a big hypocrite.  All day long, I tell pet owners to reward good behavior and ignore attention seeking behavior.  Actually, my exact words are usually &#8220;If she gets it right, throw her a party.&#8221;  But I don&#8217;t treat my <span id="more-209"></span>employees that way, and they&#8217;re quick to point that out to me.  I&#8217;m ornery. I&#8217;m gruff. I can be a little rough around the edges at times.  And I am very Very VERY quick to point out that something is wrong.</p>
<p>I suppose I can blame my parents for this.  I never got rewarded for getting a 100 on a math or spelling test.  If I got a 98, I knew I&#8217;d have to answer the question &#8220;Where did the other 2 points go?&#8221;  I was expected to do a good job.  And I was punished if I did poorly.  No, they never beat me -they just gave me more work.  Since my mom&#8217;s an accountant, it was pretty easy for her to whip up a weekend&#8217;s worth of math problems for me.  And I recall some nights of memorizing sections of a dictionary.</p>
<p>Despite all of this, I think I turned out relatively OK.  But I still admittedly have a hard time wrapping my head around praising my staff for doing their job.  Isn&#8217;t that what I pay them to do?  If they didn&#8217;t do a good job, they wouldn&#8217;t be working for me.  About a year and a half ago, I hired a nursing supervisor to help manage my medical staff.  While I was hoping for someone to complement my &#8220;flawed&#8221; management philosophy, I ended up with a fantastic technician who expects perfection from all of her staff.  Surely there is no abundance of warm fuzzies here.</p>
<p>I&#8217;ve also told my staff many times that I HATE the phrase &#8220;Don&#8217;t sweat the small stuff.&#8221;  We get paid to sweat the small stuff so that our clients don&#8217;t have to.  Instead I like the phrase &#8220;The devil is in the details.&#8221; I don&#8217;t run laundromat or a shoe store -small errors and oversights can mean the difference between life and death.  All of my staff needs to understand that every single one of their decisions and actions (or inactions) can affect patient care.  Every action carries a consequence, and some consequences are more significant than others.  So if a receptionist misspells diarrhea, or a kennel assistant checks off the wrong box on a checklist, or a technician reached for prednisolone instead of prednisone &#8230;I will continue to react quickly to point out their mistakes.  If they can&#8217;t handle that, they can certainly try to find a job working for a veterinarian who doesn&#8217;t care.</p>
<p>That being said, I have a pretty happy bunch in the hospital and not very much turnover.  Would it kill me to say &#8220;good job&#8221; more often? Probably not, but it&#8217;s so against my nature to do that.  And wouldn&#8217;t it mean a lot more if I did praise someone when they really went above and beyond the call of duty?</p>
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		<title>The Problem With Being Fat</title>
		<link>http://levittownvetblog.com/general/problem-with-being-fat/</link>
		<comments>http://levittownvetblog.com/general/problem-with-being-fat/#comments</comments>
		<pubDate>Thu, 12 Nov 2009 16:56:41 +0000</pubDate>
		<dc:creator>Dennis Leon, DVM</dc:creator>
				<category><![CDATA[Dr. Leon's Posts]]></category>
		<category><![CDATA[General Musings]]></category>
		<category><![CDATA[cats]]></category>
		<category><![CDATA[dogs]]></category>
		<category><![CDATA[obesity]]></category>
		<category><![CDATA[weight loss]]></category>

		<guid isPermaLink="false">http://levittownvetblog.com/?p=202</guid>
		<description><![CDATA[They say that dental disease is the most commonly diagnosed ailment among companion animals.  While at least 60-75% of my patients have some degree of plaque, tartar, gingivitis, or periodontal disease &#8230;I still think I have a greater percentage of adult dog &#38; cat patients who are overweight or obese.  Yup, I said it.  More [...]]]></description>
			<content:encoded><![CDATA[<p>They say that dental disease is the most commonly diagnosed ailment among companion animals.  While at least 60-75% of my patients have some degree of plaque, tartar, gingivitis, or periodontal disease &#8230;I still think I have a greater percentage of adult dog &amp; cat patients who are overweight or obese.  Yup, I said it.  More than 75% of my patients need to lose weight.  I won&#8217;t begin to guess how many of their owners <span id="more-202"></span>have a hefty BMI.</p>
<p>Here is the problem: Most of the owners of my overweight patients don&#8217;t think their pets are overweight.  It&#8217;s not that they&#8217;re not in denial of the problem (ok, some are) -they&#8217;re completely oblivious to it.  A good portion of the owners think their plump playmates look cute when they&#8217;re chubby (I&#8217;m sure that 1600 pound guy was thinking about how cute he looked while being lifted out of his apartment by a crane).  Another group of owners readily admit to owning a fat dog but still insist on feeding table scraps and treats on top of their expensive low-calorie food (kinda like ordering a Diet Coke with your Big Mac).</p>
<p>Every year, i see at least half a dozen articles in various journals suggesting different techniques to talk to my clients about their pets being overweight.  All of these articles would like me to tiptoe around the issue when the owners themselves are also visibly obese.  I guess I&#8217;m not supposed to offend anyone with my medical diagnoses.   And I guess I&#8217;m a bad person for ignoring all of this advice because here&#8217;s reality as I see it:  My clients pay me for an accurate diagnosis and to be an advocate for their pets.  If I walk into a room and see a 20 pound chihuahua or a 70 pound beagle, I&#8217;m going to say something. Period.  And it&#8217;s going to be blunt.  It doesn&#8217;t matter how big or small the owner is because, honestly, I don&#8217;t care.  They can talk all they want about their weight with their own physicians.  Unless you&#8217;re covered in hair and walking around on all fours, your medical problems are completely out of my jurisdiction.</p>
<p>Once the problem is identified and accepted, then there&#8217;s a basic mathematical issue.  Being 5 lbs overweight may not seem like a big deal, but what if you&#8217;re only supposed to weigh 10 pounds (or 5 pounds!)?  Putting the numbers in perspective: if you have a cat whose ideal weight is 10 pounds, but she actually weighs 15 pounds &#8230;that&#8217;s like a human female being 60+ pounds overweight (if her ideal weight is 120).</p>
<p>So how do we shed the pounds?  Again, I will refer to a very simple equation.  You must burn more calories than you consume in order to lose weight.  If you even eat one more measly calorie than you burn off (via breathing, walking, exercising, etc.), you will never ever ever lose any weight.  Ever.  Of course this is easier said than done, especially considering that obese people/dogs/cats have a harder time feeling satisfied after a meal and have slower metabolisms.  Yes, it&#8217;s a slippery slope.</p>
<p>The saving grace with treating your obese pet is that you don&#8217;t need to deal with any will power issues.  Yes, you may feel issues of guilt for putting your little friend on a diet, but I can&#8217;t help you with that.  And yes, some dogs will begin some very destructive behaviors if they are hungry and &#8220;hunting&#8221; for food in your garbage cans and cupboards -but good training and judicious use of gates and crates will help with that.  But if you just follow the simple feeding guidelines that are given to you by your veterinarian (NOT the chart printed on the back of the food bag), I can practically guarantee success -and your pets will live longer, happier, healthier lives.</p>
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