77 Disaster Preparedness for Pets- Part 1

As I watch the news this week with Hurricane Florence bearing down on the East Coast, I am reminded that September is National Disaster Preparedness Month. And that means planning with pets in mind. It actually started last week, and the theme is Disasters Happen. Prepare now. Learn how.

The first step is to imagine some likely disasters. Up here in North Texas, I think tornadoes, ice storms, power failures, localized flooding, and possible wildfires. There are many similarities to prepare, even though the causes may be different.

The next step is to figure out if you would shelter in place or leave. If you shelter in place, determine which room of your home would be safest. For tornadoes, ideally pick a room with no external windows, on the ground floor, maybe even a bathtub. I recommend having a leash for every dog and a carrier for each cat. If the power goes out, and the sirens wail, and everyone is freaking out, the last thing you want is your pets all loose and stressed out. This might be a great time to purchase some calming pheromone sprays for pets: Feliway for cat and Adaptil for dogs. These are available OTC at pet stores and Amazon. Some pets might want a favorite blanket or toy, just like children.

Some other items to keep in your shelter room are a charged up phone, flashlight, and a battery powered radio. It is a pretty helpless feeling to be hunkered down in a bathroom, in the dark, listening to the sirens, and you have no clue what is going on. Many cities have a Red Alert system, which will call you if there is a local emergency, but you have to subscribe ahead of time. In Lewisville, they call it Citizen Alert.  In a tornado, the cell towers might go down. Keep a battery powered radio handy, and know some local channels. And there are many apps for phones that can get weather and Dallas News, but not necessarily Lewisville news.

Some basic preparations are to make sure your pet’s vaccinations are up to date, you have at least a week or two of important medications, and that they are microchipped. This is not the time to run out of allergy pills, heart medications, or specialty diets. I see quite a few stray dogs and cats after big wind storms here when fences blow down. A tag on a collar or a microchip really helps reconnect Fido and owner.

What if you have to leave? Sometimes it just isn’t safe to stay home. Would you know what to pack? Where to go? When to leave? I am sure there are many people in the Carolinas or Californians near wildfires asking themselves that same question now.

Next week’s blog will be on “Go” bags and preplanning for a bug out.
For more information: https://www.ready.gov/animals

74 The Allergic Cat

Last week I wrote about ragweed, pollen, and allergies, especially in dogs. Cat can develop pollen or food allergies too, but it seems less frequent than dogs. This week, I have seen some indoor and outdoor cats with allergic symptoms. I think I see less feline allergy because most of my cats are indoor only (even though pollen does get into our houses.)

The symptoms of cats with allergies to pollen or food include itchiness, especially the face and ears, licking feet more, generalized tiny bumps, and raised red skin plaques. Some have other signs like sneezing, coughing, wheezing (asthma), and occasional vomiting and diarrhea (especially secondary to hairballs).

Cats can develop asthma just like people, which is a constriction of the tiny airways in the chest. It can be mild to severe. I probably never see the mild ones, but when cats are open mouth breathing and wheezing from an asthma attack, it is an emergency. And of course it isn’t healthy to smoke around cats, especially asthmatic ones.

Cats can also be allergic to flea bites, but we seldom see the actual fleas on cats because most cats are such great groomers. I do see more fleas on chubby patients because it is harder for them to groom themselves. So just because you don’t SEE fleas on Fluffy doesn’t mean she isn’t getting a single flea a day that bites her, which she quickly lick off. Revolution is a great topical product for cats that kills fleas, ear mites & many intestinal parasites.

Cat do occasional have food allergies. The symptoms are often skin related, not just gastrointestinal. They aren’t born with food allergies, but develop slowly over time, even when the food isn’t changed. I usually suspect food allergies if my patient doesn’t respond to steroids.

The treatment for cats is similar to dogs, with a few minor differences. Ideally we try to avoid the trigger, like keep them inside more. We try to remove pollens by bathing them or at least wiping them down with damp washcloths (“lick the cat”). We could try to give them liquid Benadryl, but most owners find that challenging. Apoquel isn’t approved for cats so I usually go straight to steroids, conveniently available in a long term injection. Fortunately, cats don’t have many side effects to an occasional steroid injection, unlike humans and dogs, so it is much safer.

Feline allergies are really a thing, and I don’t mean people that are allergic to cat dander (that’s a different article.) If your cat is grooming more, getting sores, or having respiratory signs, a vet can help. Come see us!

http://www.pethealthnetwork.com/cat-health/cat-diseases-conditions-a-z/what-bothering-your-cat-it-could-be-feline-allergies
https://www.catster.com/cat-health-care/cat-health-care-tips-seasonal-allergies

73 The Itchy Dog

Ragweed season is here already. Ragweed is a problem for many fall allergy sufferers but this year it started really early (in mid-August after the rains), and will generally go until the first frost (average November 15). The mold counts have been high too. Dogs and even cats can be allergic to pollen and mold.

Allergies are nothing to sneeze at, really. Actually, for most dogs the primary symptom is itchiness, especially feet, ears, armpits and rear end. They usually don’t have runny eyes and nose, but a few might. And most “allergies” are to the proteins in pollen, rarely food allergies. For these pets, the immune system has an elevated, inappropriate response to these proteins that are inhaled and absorbed right through the skin. The prime skin cell that reacts is a mast cell, which is loaded with histamine granules, and releases the histamine when the specific proteins are detected by the immune system. Then the histamine triggers the itch. Licking & scratching is a symptom of itchiness.

Symptoms Include licking feet, rubbing face, shaking ears, scratching at armpits or sides, and licking/scooting on their rear. The pattern of allergy itchiness is different than flea bites, which is mostly lower back and backs of thighs. And an allergy dog with even one flea is extra miserable.
Uncontrolled allergies can lead to secondary skin and ear infections, either bacteria like Staph or yeast. If it goes on for weeks, the skin will make extra sebum and smell bad, or get flaky and crusty. Many people mistake this for “dry skin”, and stop bathing their dogs. If the itching and infections go on for longer, the skin may get thickened, turn gray, and wrinkled looking.

As pet parents, we can help these patients. First, I recommend starting with anti-itch medicine, often OTC antihistamines like Benadryl or Zyrtec. If that isn’t working well, I step up to prescription medicines like Apoquel. My last resort is steroids, which have many side effects.

Secondly, I stress cleansing the skin and ears with weekly bathing or wiping, often with gentle shampoos like aloe and oatmeal dog shampoos. If we leave the abnormal sebum on the skin, microorganisms will try to grow in it, so bathing is critical to break the allergy cycle. And washing the bedding and collars is important too. Daily washing of the affected areas ( like feet, face, ears) can help remove topically absorbed pollens and help soothe the itch.

The third component is to try to avoid whatever the allergy is toward. Pollen is hard to avoid, so keeping the pets inside more helps, but pollen gets in homes too. Keeping filters clean helps. Stepping up antihistamines and bathing helps. Many “derm” diets or supplements have higher fatty acids that can help decrease the immune symptoms.

Forth component is to avoid fleas and ticks. The flea population often spikes in mild moist weather like spring and fall. They don’t all die after the summer or winter extremes. And they never die in the house from bad weather outside. So keep allergy dogs on year round flea prevention like Credelio or Trifexis.

Allergies are nothing to sneeze at, but we can manage it so are pets are more comfortable.

For more information: https://pets.webmd.com/dogs/allergies-dogs#1-2

For more information about Apoquel,and the itch cycle.

72 Ears and allergies

This week I have seen a big uptick in my ear cases. We see dogs year round that have ear problems, ear infections, itchy ears, smelly ears, head shaking, but this week was different.

Ear infection doesn’t just happen. Yeast and bacteria don’t come out the dirt, jump in your dog’s ear and cause an infection. There has to be an underlying cause for ear problems. The common triggers are allergies (inhalant pollen or food), wet ears (swimming or bathing), hairy ears, underlying general skin problems (often hormonal like low thyroid), ear conformation ( floppy, or old scar tissue from previous ear infections), foreign bodies (like grass),and rarely parasites like ear mites or ticks. In my practice, it is usually allergies, hair ears, or swimming.

Allergies cause ear infection? Really? Most people either have some seasonal allergies to pollen or mold themselves or know someone who does. Humans experience sneezing, runny noses, itchy nose and eyes, and nasal congestion from the histamines released and can be partially blocked with antihistamines. Dogs also experience allergies to ragweed pollen and mold spores, but have different symptoms. Dogs have more mast cell receptors that release histamine on the skin of their feet, muzzle, ears, and elbow fold, than their membranes of nose and eyes. So when you see a dog frequently licking their feet, it isn’t a foot fetish, they are really itchy and trying to soothe that itch. Those ears when inflamed will make a lot more wax, and if you have a moist, waxy, hairy, folded ear you have the perfect conditions for the normal skin flora of yeast and bacteria ( usually staph) to thrive.

How do you know if your dog has an ear infection? Check Fluffy’s ears when you see head shaking, scratching at ears (or feet), and use all your senses. Look for redness and discharge. Smell for abnormal odors. Many of my clients say they can smell the yeast, because it smells like moldy bread. Listen for a wet squishy sound before you clean then. Feel the ears for warmth because an inflamed ear is often warmer than the other ear or the rest of the skin.

How do you treat ear problems at home? The biggest trick is to catch it early. Check those ears often, especially if Fido has risk factors or is itchy already. Frequent ear washing at home, during/after baths, and after swimming really helps. Using a pet ear cleaning is much better than tap water. They all contain a solution of water, mild acids, and alcohols to help “dry“ the ear when it evaporates. And they smell nicer than a nasty ear. Use ear washes frequently if Spot has ear problems.

What if cleaning isn’t enough? If home care doesn’t stop the head shaking, redness, and tenderness, it is time to come see the vet. We will gently examine the ears, collect samples to look for infection, and prescribe medicine. Occasionally, we will even prescribe pain medicine, because some dogs are truly painful and miserable with ear infections.

How do I prevent the next infection? It is all about managing those causes of ear problems: allergies with antihistamines or stronger prescription medicine like Apoquel, plucking hairy ears, washing weekly at least in allergy season, washing after swimming, and managing underlying skin diseases.

Ear infections can be prevented, treated, and managed. We can help.

For more information:
https://veterinarypartner.vin.com/default.aspx?pid=19239&id=4951507
https://www.petmd.com/blogs/thedailyvet/dr-coates/2014/june/top-five-tips-treating-ear-infections-dogs-and-cats-31848
https://www.petmd.com/dog/slideshows/7-signs-your-pet-has-seasonal-allergies

71 Bring Your Cat to the Vet Day

National Take Your Cat to the Vet Day is August 22.  That is next week.  I would argue EVERY day should be “Take Your Cat to the Vet Day”, but this gives me a chance to wrap up my feline exam & vaccination series.

Today I performed a routine exam and vaccinations on my new nurse’s (Larissa) cat name Dandi.  She has been anxious in the past going to the vet and usually growls.  We know that growling is a sign of fear and anxiety.  She has had a lot of dental work and extractions, so maybe her fear was based on good reasons!  To help avoid anxiety, Larissa gave Dandi a dose a gabapentin this morning on her food before going in the carrier & coming to work.  We scheduled her on a light day, no barking dogs.  She was transferred from carrier to cage while we did our morning cases.

At lunch, we moved Dandi to the cat room, with the pheromone Feliway diffuser, and covered her with a towel that had been sprayed with Feliway.  Dandi never growled, , no dilated pupils, no ears laid back, and seemed comfortable throughout.  We did our whole exam and vaccination without ever triggering fear or anxiety.  Put that in the WIN column!

Dandi is a textbook example of how Fear Free can make a difference.  Let us try it on YOUR cat.  And tell Larissa how cute her cat is.

https://www.catvets.com/public/PDFs/Content-Articles/Cat2VetDayInfographic-2016%20FINAL.2.pdf

https://www.catvets.com/public/PDFs/Content-Articles/Benefits-Routine-Vet-Visits.pdf

https://www.catvets.com/public/PDFs/ClientBrochures/Cat-to-VetHandout.pdf

70 Free Fear Feline Exams

So how do you get a stressed out cat to the vet? My sister-in-law would grab the cat, no carrier, place it in the back of her hatchback car, and drive fast to the vet. Her cat was always anxious, and she had trouble getting her in the carrier. She did what she thought best at the time. Now, in 2018, we have a few tricks to make this easier for cats AND their owners.

Trick #1- CARRIER– Cats will be less stressed in a clean, familiar carrier, either hard sided or the new soft sided kind. Some cats prefer a top opening. For best results, leave it out in house all the time, not just before a trip to the vet. Let Fluffy get used to it, and not just associate it with “going to the vet.” Place treats & catnip in it to make it a happy place. Pheromones like Feliway wipes or spray can help create calming/relaxing atmosphere.

Trick #2- ANTI ANXIETY MEDICATION-Prevet visit medications like RX gabapentin or OTC Feliway pheromones can really help a cat with previous anxiety problems at the vet. I compare it to taking a valium before a visit to the dentist if you are afraid of dentists. It isn’t sedation, but it does help reduce the fear so maybe Tigger won’t have another fearful & anxious experience.
So what is this gabapentin (Neurotin), and how the heck to do I give it to my cat?  Gabapentin is an inexpensive medication originally developed to control seizures in humans. It is also used to control neuropathic pain in humans, dogs, and cats. While it is not labeled for use for anxiety, it is increasingly used for that purpose in human and veterinary medicine. The powder in the capsule does not have a strong taste and is usually well accepted by cats when the capsule is opened and sprinkled over wet food, 90 minutes to three hours before the car trip.
What is Feliway? Feliway is a pheromone (hormone that travels through the air) that goes straight to brain and triggers other hormones. Most people have heard about sex pheromones or fear pheromones. These are calming and marking pheromones. The cats react to them, without drugs, and humans can’t smell them.

Trick #3-THE CAR TRIP– Once in the carrier, the best place for it is on the floor behind the driver. There is less motion & less visual stimulation. You can even cover the carrier with a towel for less stimulation. Some pets respond better to soft music on the radio, not loud Rock or Rap.

Trick #4- THE EXAM– Ask to be scheduled at a time when it isn’t crowded so you can go straight into an exam room. Carry the carrier with 2 hands (don’t swing by the handle) . Don’t place the carrier on the floor- keep at seat or table level. It is great if owner bring a favorite treat or toy from home what we coax them out of carriers with, and use a reward after the exam. Some cats even prefer their own towels from home.

Trick #5 – Chose a Cat Friendly Vet, and one certified in Fear Free practices. Here at Garden Ridge Animal Hospital, we have a “cat room”, use Feliway diffusers , soft yoga mats on tables, spray our towels with Feliway calming pheromones, and handle cats gently, and trying to avoid triggers. We are able to do so much more with cats since we adopted these principals. Most owners are amazed that a few tricks can make such a difference. And often that success builds with each visit, as the cat doesn’t have scary experiences. Because one day, that cat will get sick, need to go the vet, and already be stressed from the illness.

So now you know HOW to set the stage for Fear Free cat visits to the vet. Call us to set up your cat’s annual well check exam, and maybe some vaccines. If you do these steps, YOU will be less stressed.

69 Feline Injection Site Sarcomas

You may have hear or read on the internet that vaccines cause cancer in cats. It is enough to scare any caring cat owner into rethinking about the safety of these lifesaving vaccines. It is true that a rare cat will get a true “allergic” reaction to a vaccine, just like dogs or humans. Vaccines have foreign proteins that we inject into their bodies. But it is also true that injections (any injection) CAN cause a reaction that can lead to a sarcoma in a rare cat. Lots of epidemiological studies have to done in the last 25 years to find out WHAT is causing the inflammation, WHICH vaccines, WHAT manufacturer, and WHY cats might develop this terrible disease

The current thinking is that individual cats may respond to inflammatory changes in a manner that predisposes to sarcoma formation. Current studies to investigate the cytogenetics of injection site sarcomas may provide more information. Up-to-date information regarding research can be obtained from the Vaccine Associated Fibrosarcoma Task Force.
What is the incidence of injection site sarcomas? Most studies agree it is 10-100cats with sarcomas/100,000 cats vaccinated, so about 0.1-1% of vaccines. There does seem to be some regional variation, but they are reported worldwide.

What injections area associated with sarcomas? All vaccines, long acting steroids, subcutaneous fluids, and antibiotic injections
At first vets thought it was only vaccines, and we saw a higher incidence with killed vaccines (Rabies and Feline Leukemia Virus also called FELV) , and especially if aluminum was used as adjuvant. So Garden Ridge Animal Hospital switched to recombinant non -adjuvented FELV and Rabies by Merial like many other vets. Later we saw that all vaccines types made by all the manufacturers have some association. If a cat received all the vaccines in same location, like the neck, there was a higher incidence of sarcomas, so we split them up now. The recommended sites are NOT the neck anymore, but Rabies on Right rear leg, Leukemia on Left rear leg, and FVRCP on the Right foreleg.

Why do cats make sarcomas at injection sites? One theory speculated about a viral helper to FELV, the Feline Sarcoma Virus, but only a few cats with sarcomas test positive for FELV or FIV. Another theory is gene mutation, oncogenes, and mutations in tumor suppressor genes. Approximately 75% of injection sarcomas were found to contain p53 and c-kit oncogene. Approximately one third of tumors contained both p53 and mdm-2, and these tumors were histologically more anaplastic, perhaps explaining the aggressive biologic behavior of some injection site sarcomas.
Any injection can cause local inflammation, usually in first few weeks after the injection. If a bump is present less than 1 month, it should get checked out with a needle biopsy. If the biopsy is “suspicious”, then aggressive surgery is indicated and maybe presurgical radiation therapy. These Injection Site Sarcomas are scary because they are aggressive, large (greater than 4 cm), invasive, and can metastasize to other parts of the body.

There is a lot we still don’t know about Feline Injection Site Sarcomas. I have seen 3 or 4 in my 28 years at Garden Ridge Animal Hospital. One was a cat that I had vaccinated, but not exclusively. But over my 35 years as a vet, I have seen many more cases of Feline Leukemia, Distemper, respiratory infections and even feline Rabies. We also vaccinate less frequently than years ago, and we talk about a risk assessment at our yearly exams. For examine, I don’t recommend FELV vaccine to indoor only adult cats. FVRCP is every three years once they are adults, but Rabies (required by state law and a real threat in Denton county) is still annually with the non-adjuvented Merial Purvax.

I know vaccines save kitty lives and improve quality of life a hundred fold over the risk of Injection Site Sarcomas. If you are still worried, please come in with your cat and we can at least perform a yearly health checkup. Vaccines are always optional, and not the only reason to see a vet.  Our staff is standing by.

For more information
https://www.catvets.com/guidelines/practice-guidelines/feline-vaccination-guidelines

68 Should we vaccinate cats?

The topic of cat vaccination has stirred up quite a controversy in the last few years. Are we over vaccinating? Under vaccinating? Does it cause cancer? How can I get my cat to the vet without stressing him/her out? Why is a yearly exam so important?

Fortunately, this topic has gotten a lot of controlled research, and feline experts came together in 2013 to update the AAFP( American Association of Feline Practitioners) vaccine guidelines.

A quote from Dr Scherk, the editor of the Journal of Feline Medicine and Surgery, regarding her conclusions about feline vaccines is “We’re not over-vaccinating; we’re actually under-vaccinating cats.” Her explanation starts with the many cats that NEVER see a vet until they are very sick, so they aren’t candidates for vaccines then. The other hurtle is that many cat owners have heard about vaccines causing cancer, so they just opt out. Plus cost can be another reason.

The Guidelines recommend we break the different vaccines into 2 categories: Core and Noncore.  Examples of Core are Feline panleukopenia (FPV)(also known as distemper which is not to be confused with dog distemper), Feline herpesvirus-1(FHV-1), and Feline calicivirus (FCV). These are usually combined in the FVRCP vaccine, which is given as a series for kittens, boosted at a year, then every 3 years after that per manufacturer’s recommendation.

Rabies isn’t considered core by AAFP, but every other vet organization considers Rabies a core vaccine, and a legal requirement in the State of Texas. I consider it core vaccine. I have seen a cat with rabies, and we definitely have active rabies in Denton County. Plus the rabies vaccine is a killed viral vaccines, is super safe, not a combination injection, and we use the non-adjuvented Merial Purevax rabies.
I have been vaccinated for rabies and needed a booster when I was pregnant with my daughter, so my pediatrician researched it and concluded it was safe to receive even during pregnancy.

Noncore vaccines Feline leukemia virus (FELV), chlamydophiia felis , Bordetella bronchiseptica, Feline infectious peritonitis ( FIP), and Dermatophyte vaccines. At Garden Ridge Animal Hospital, we only carry FELV in this Noncore category, and we only give it to cats with risk factors like outside cats, cats that fight, or cats in households with some outside cats. We also follow the AAFP recommendation for all kittens to get a series of 2 FELV vaccines, so they have some lifetime protection.

The questions about injection site sarcomas and how to transport cat to the vet require long answers and will be future blog topics.

So my challenge to my cat owners is “are all your cats up to date on their vaccines? Even the old ones that never go outside?” And it not, call the staff at Garden Ridge Animal Hospital at 972-436-2199 and set up an appointment.

For more links on recommendations; https://www.wsava.org/guidelines/vaccination-guidelines

http://www.aavmc.org/data/files/other%20documents/ppphfelineguidelines_proof1.pdf

67 AAHA – Accredited Hospital Day- July 22, 2018

Every year on July 22, the American Animal Hospital Association celebrates hospitals that are accredited. Nationwide, less than 15% of animal hospitals are accredited. Garden Ridge Animal Hospital is Lewisville’s only AAHA Accredited animal hospital. I build it in 1990, with the eventual plan to be accredited. In 2005 we were accredited, and have passed every inspection since then. I had the good fortune to work in two AAHA accredited hospital before opening Garden Ridge. My first experience was with Dr Thomes in Irving, at his hospital on 183. It grew to become VCA Metroplex Animal Hospital, a big 24 hour multi-doctor referral hospital. I worked there as an intern in 1982 and later as one of the night doctors in the winter of 1989/90. After graduation in 1982 until 1989 I worked at Hines North Animal Hospital, which was also AAHA accredited. I remember referring to the AAHA charts of standards as we got ready for inspection. They have standards in anesthesia, dentistry, pain management, patient care, surgery, client service, safety, medical records, laboratory, imaging, and housekeeping. I compare it getting ready for a visit from your loving Mother- in -law. You want everything to be ship shape. The other thing I remember was the constant “raising of the bar” with standards. One time something was optional, and later it was mandatory. The goal is constant improvement.
AAHA motto is The Standard of Veterinary Excellence and its tagline is Champions for Excellent Care. That is the goal for Garden Ridge Animal Hospital, too. Our mission is Quality Care for Quality Lives, for pets, owners and staff. AAHA does more than inspections. It sponsors some awesome Continuing Veterinary Educations, for management and medicine. And they publish lots of training tools and books that help manage a small hospital like mine to the same standards as a large hospital. It also helps us stand out and reach new clients. When I have an existing client that is moving, I always suggest they look for the AAHA Logo in their new locale to find consistently excellent hospitals.
We expect to be celebrating Monday, July 23, after our inspection! Until then, stay cool!! Stay inside & drink lots of water.

https://www.aaha.org/pet_owner/about_aaha/default.aspx

66 Dilated Cardiomyopathy associated with Grain Free Diets

There have been disturbing reports, mostly in Golden Retrievers that are eating grain free, legume (pea) based diets that are developing Dilated Cardiomyopathy. This is a heart muscle disease that causes enlarged hearts, most commonly seen in cats that are eating diets deficient in taurine. Taurine is an amino acid present in most meat and milk. It has been well known that deficiencies in cats can cause dilated cardiomyopathy, but has been rarely seen in dogs until now.

Most of these cases seen by veterinary cardiologist have been on “boutique”, homemade, or raw diets, not the major pet food manufacturers. Some universities are looking for more patterns, but it has been seen most often in Golden Retrievers. https://www.avma.org/News/JAVMANews/Pages/180801e.aspx?utm_source=email-optin&utm_medium=javma-news-180801&utm_campaign=animal-health&utm_term=link&utm_content=pet-diets-heart-disease

I am amazed daily by the number of clients that proudly boast their dog is on a grain free diet. Many think that grain free means no carbohydrates, and that just isn’t the case. To manufacture the kibble, they need some carbohydrates, so the makers use potato, peas, and other legumes instead of wheat, corn, barley and oats. I myself try to eat low carb to manage blood sugar, but I can’t do No carb. I am not gluten intolerant, so I do enjoy my home made sour dough bread in small quantities, especially when it is fresh out of the oven. I have met very few dogs that are gluten intolerant, but there are definitely a few. There are compelling studies for dogs with inflammation in skin or gastrointestinal tracts that benefit from gluten free diets. Gluten is a protein in found in wheat, barley and rye.
I think we need to be careful when we choose pet foods and not buy into fads. Look for the AAFCO label, which means the diet meets all the known standards for nutrients in the diet. And look for a reputable manufacturer. Currently, I am most familiar with and recommend Hills, Purina, Iams/Eukanuba, and Blue since these companies all make good veterinary therapeutic diets. There are probably others that are top notch, but just don’t make therapeutic diets.

To feed grain free or not isn’t black and white. It might be very appropriate for some pets, but we need to watch these new cases of dilated cardiomyopathy in Golden Retrievers that might be related to grain free legume based diets.

https://www.fda.gov/NewsEvents/Newsroom/FDAInBrief/ucm613355.htm

https://www.texvetpets.org/article/grain-free-diets/
https://weethnutrition.wordpress.com/2014/11/04/the-myth-of-the-natural-diet/
https://weethnutrition.wordpress.com/2017/09/03/pet-food-basics-dr-weeths-top-tips-for-feeding-your-new-dog/