The Controversy Between Dilated Cardiomyopathy & Grain Free Diets

Welcome to another episode of The Veterinary Roundtable! In this special feature with only Dr. Duckwall and Dr. King, the ladies discuss Dr. King's new (old) 1977 AKC Dogbook, an intricate cat case, the problem with grain free diets, and more!

Do you have a question for The Veterinary Roundtable? Ask us on any social media platform or email harrison@kingmediamarketing.com!

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TIMESTAMPS
00:00 Intro
Quick Study Tips In Vet School 03:52
Vet Med Shout Outs 12:04
Dr. King's 1977 AKC Dogbook 15:58
Case Collections 18:22
Dilated Cardiomyopathy And Grain Free Diets (Kyle Gilliam) 30:52
Outro 39:26

Transcript

0:00

(upbeat music) Hello everyone and welcome to another episode of the veterinary round table, the podcast where we answer your veterinary related questions while having some fun along the way. If you enjoyed today's episode, be sure to leave us a review on your podcast provider of choice. And if you have any feedback to offer to improve the veterinary round table, let us know.- Let us know.- You might notice the weirdness because it's just, and there's this, like, it's gonna be a tennis match back and forth, back and forth.- This is a vast workout.- Vast like empty space.- Empty space.- Those two do carry a lot of like, weight, conversation with themselves when they come.- But they're small people.- They're small people. We weren't saying that they were large people.- No, no, no, no, no.- But yeah, so it's just stuck while I, yeah.- Which is kinda cool.- The lone troopers, the OG.- The OG.- The consistent ones, the consistent ones, that's right. Exactly.- Well, everyone's sleeping out there'cause we only have 45 Apple podcasts and get, you know what, I'm tired too. I get it. I love to sleep. It's one of my favorite things too.- And you know what's happening is they're listening in the car and they cannot. Right. Safety first.- Safety first.- Safety first.- So maybe that's a factor.- But like, try to do when you park your car.- Oh, there we go. I like it.- Like try to just say, okay, as soon as it's done, I'm hitting it.- Yes.- Okay, so I think that a lot of people listen to the podcast in the car.- Well, probably, isn't that where,- Don't you think that's where I listen to the podcast?- Where do you listen to podcasts?- I don't listen to podcasts.(laughs) So we had to fill out this like fun fact sheet for Charles's work for this thing. And I, number one, I couldn't think of a fun fact about myself.- Oh my gosh, there are tons of fun facts about you.- I mean, they're all like, wow.- I love Jack's pig thought.(laughs)- Hate peanut butter jelly. Like, no. So I was like, it would be hilarious if I'm like, I don't listen to podcasts, but I'm on one.- Did you say that?- But I host one. No, I ended up doing aquariums or scary.- Aquariums are kind of scary.- I hate them.- What if the water like crashes?- Ocean life?- I hate--- Is scary, you're scared of ocean life?- I'm terrified of under ocean life.- That's interesting.- Yeah, I hate aquariums.- I hate them.- You hate aquariums.- I worked at the Indianapolis,- Yeah, no.- Marine aquarium. And it was in the aquarium.- We wouldn't have been friends in that.- I wouldn't have been friends. I couldn't have convinced you to come.- I wouldn't have been able to hang out with you.- That's so interesting. So you put that. I think the podcast one would have been amazing.- I know, I thought so too, but like, then I was like, does that make me look like a hypocrite?- Hmm.- And it still might. Listeners might think I'm a hypocrite, but I don't mind starring in one. I don't mind hosting one, starring like I'm a star. I'm not that commodity.- You are a star.- But I just can't listen to people talk. It makes me sleepy and yeah, it depends. Like I, I don't mind, I've gotten used to listening to podcasts.- Yeah.- So I have a couple that I really like, but it's not every day thing.- Sure.- Because there's so many behavior.- There's so many things going on. Like I don't, you, to actually, I think what it is, to actually like listen, I have to pay attention.- Yeah.- Like if I'm gonna pay attention, then I'm in the car like where I am doing nothing else, right? - Yep.- And I can pay attention. But if I'm like around my house doing stuff, like then I don't hear, I'm listening, but not listening.- Yeah.- Yeah.- And I don't have that much time where I'm doing that activity of listening, not listening.- Makes sense? See, I prefer music, I love music.- Oh, so do I.- And or silence. I really like silence too sometimes. So. - Yeah.- No. I don't know. Maybe I'll try to like, positive reinforce podcasts for myself and like, listen, listen and have a treat at the same time. Okay.(laughs)- Food and.- Yeah. - Attach it to-- But I do have this review, ratings and reviews that I was just given. It's what's that called? Emergence, no, not in emergency. What's on the news when it's like breaking news?- Oh, breaking news.- Breaking news.- Yes.- Do do do do do do do do do do do do do do do do do do do do do do do do.- Okay. Okay, here we go.- Okay.- This is from Trinity, Kisee.- Ooh, nice.- Hopefully I spelled that right, five out of five.- Oh, that's awesome.- Okay. Hello, my name is Trinity. Hello. I'm obsessed with your podcast. I love everything to do with veterinary medicine. The information you all share in this podcast helps me learn so much. I'm currently in undergrad getting a bachelor degree in wildlife sustainability and ecosystem studies with a concentration in Pre-Vet. I hope to one day become a zoo veterinarian.- Ooh.- I was curious how y'all studied in the undergrad and veterinary school. I don't do well with lectures, so it is hard for me to retain the information. I also work full time as a veterinary surgical technician. I am looking for a good way to study so I can remember information for tests. Thank you in advancing. Keep up the amazing work y'all are doing on this podcast.- Oh, that's so nice.- With a hard emoji.- With a hard emoji too. That's really cool.- Thanks for the review. And-- And the question.- A cared question. I mean, first of all, shout out to students. This is amazing because we were talking about this duck wall came to this realization before me, but I don't know why I didn't figure this out. But it seems like we really hit it off with students or people learning in the profession, which I guess when I look back on it, as far as what we talk about, it makes sense.- Yeah, that's awesome.- Because I think we walk people through thought processes and things like that or our thought processes. So that is so cool.- Yeah. And I feel like as an adult when you do it every day, you don't really need to go home and listen to it. That is so true. I don't listen to any veterinary podcast. When I was talking about the podcast, I listened to their not related to veterinary medicine.- Or the TV shows that are out there. Sometimes if there's nothing else on, I'll be like, I wonder how they do their practice. They've got a curiosity and stuff, but you have to have separation too. But we try to mix it up, make it fun, not just be all about like that med.- Yeah.- Okay, so she had a quick question. We should answer it.- Yeah, let's answer it.- How do you study? How did you study?- Well, I felt like I wouldn't cram, but really looking back, like I would try to like relax study, a week or a couple days in advance of a test, but really then I before I'm like close the door to the office, no, Charles don't talk to me, don't look at me. I'll come out for air and food for like 30 minutes and that's it. So I guess my method was, I was very big on colors and charts. I realized that if I, or separated information, some sort of chart pattern that worked for me, and then let's say it was like a certain topic within that class. So, I don't know, in pharmacology, there was flea and tick prevention. So then as I studied, I would highlight and utilize one color for that topic.- Okay.- So green or whatever I wanted to use. So then during the test, I would try to recall in my mind the color, so then I'd go to the chart.- Then you would, then you would busy yourself with all the other information.- Yeah, like that.- Yeah. But it's hard, I think studying in MetSchool is hard because there's so much information. How are you supposed to know what to focus on and whatnot to? Like, yeah, there's the big topics, but sometimes there's detailed questions. So, I mean, honestly, group studying is great or sharing study guides in case you miss something. I personally was more of a solo studyer.- Me too.- There were some things I did in the group, but I know what's up with the air.- I've got some weird allergy thing. Or let's be honest, I have another cold because my child goes, I was going to say that is like your life right now.- Yep. That's okay.- That's all I did. I don't know.- I like that idea. I wish I would have thought of that when I was a student. I'm trying to think is if you don't like listening to lecture, I mean, like, did you guys, because when we were students, like, I'm way far more removed than you from being a student, but like, we did not have digital notes. Like, they have for you guys, right?- Yeah.- So like, you get all the notes ahead of time?- Mm.- Mm.- It just depended on the class and the teacher and everything.- Right.- The lectures weren't recorded either. So yeah, they would maybe piece it into PowerPoints and stuff, but I couldn't study like PowerPoint. I couldn't do PowerPoints.- I mean, we basically took all written notes.- Yeah.- Everything was written notes. We didn't get any notes.- Was it hand cramp up?- Oh yeah.- Was it hand okay?- Oh my God.- But you also were learning it as you were writing it.- Right.- I don't know if you can create, I don't know, I mean, there could be possibilities like for Trinity where if you know somebody else that took the class before you, if you could get their notes, then when you're listening to the lecture, you add to the notes.- Yep.- Like, that's why I was wondering if they gave the students notes anymore or not, but.- Oh yeah. No, you definitely get notes and you even get study guides for some classes too. We had laptops and then you had like touch screen laptops. You could write your notes on the laptop next to the PowerPoint or whatever if you wanted.- There's so many tactics.- I don't know if there's any other way. Didn't she say she didn't want to listen to lecture?- Yeah, she's a hard time focusing, I think. So then, we've got to hear the information or read it somewhere. So textbooks, we had textbooks.- Yeah.- Do you guys have textbooks?- I mean, yeah, we had textbooks. We had to still get and stuff.- Yeah.- They would take that information.- Right.- I just don't know how without listening to the lecture. I mean, maybe you just don't put so much pressure on yourself with doing both listening and taking notes at the same time. Like, maybe you just literally sit and listen.- Yes, and listen. And then, as you study, you relearn it by typing things out or making charts or something like that or writing things. I don't think you can get away with not listening to the lecture, unfortunately.- That's what I was going to say is, I wonder if you could. Because nowadays, you guys all have phones. Could you even record the lecture?- Oh, yeah.- You know what I'm saying? And then, you could go back and then make your notes. You could do a score. You could listen to it on a faster speed. So then, you could just sit in front of it and just absorb it. Just listen to it. I think you'd be surprised would you actually remember when you go and then maybe even just talking about the information. Because I feel like there's a difference between memorizing information, but then having to verbalize and talk about it, the more you can talk about it, the more you just know it then.- Yeah.- And so then, it's so much easier to pull it back out and use it.- Right. Yeah, I know. At least that Purdue, there was study rooms with chalkboards and people just go start writing and talking aloud. They definitely, I mean, they tried to record most of the lectures for us. They're just, you never knew if the microphone wasn't working or the teacher is trying to like, not record it. Anyway, you just got to figure out. Unfortunately, I don't think there's a way that you can just not listen. You just have to figure out the best way to listen. Like I said, don't put too much on remembering everything they're saying and then coming back to it.- Yeah. And then I think in veterinary school, because she's still an undergraduate school in veterinary school, they're going to a lot of the problem-based. And I think some schools are more focused on that than others. So applying to schools that are focused on basically problem-based learning. So you have a, you start day one with a case and it's a cardiology case. And so you're going to end up with less lecturing and more investigative, like learning. And so that type of school, maybe a much better fit when you're applying to veterinary schools than those that are just the traditional lectures that you go to. So that's also something to consider.- Yeah. And I mean, she's a technician, surgery technician right now.- So, you see things, right?- Which is great.- Yeah.- You know stuff that you don't even know, you know?- That's right. I got to give a shout out to Julie Rosta, who listens as well. She is a student. Oh gosh, I'm not going to remember where she's at school, but her mom has been a friend forever because her, all of her children went to school with all of my children. So, yeah. Shout out. Shout out. Thank you for the support.- Yeah.- All the students out there, you guys are amazing.- You can do it.- Yes, you can do it. And if you have friends that aren't students, have them listen to us because we're funny and we're cool.- Exactly. We'll provide at least some humor. That's right. Okay. What are we on to? Case collections, right?- Are we? Well, we should say who we are. Oh, I guess we went through all of that and we didn't even say who we were.- I know. Well, welcome.- Welcome.- Happy March 12th, 2020.- Do you know that March is Women's Month?- I thought there was just one international appreciation.- I don't know. Reading in the AVMA was like, it's Women's Month and I'm thinking all those women that came before me. Yeah. Yeah. So we should have a luncheon.- Yes, a luncheon. That's what--- Every woman loves brunch.- Every woman does love brunch. That is true. I'm Dr. King. I'm Dr. Duckwell.- And there we go.- Okay.- And she's the two of us. It's the two of us, like we said, with our vast empty couch. Shout out one thing you think is doing something right or amazing in the wonderful world in Vet Med industry.- Just wonderful, wide world of veterinary medicine. What is amazing? I'm going to go really broad with innovation.- Okay.- We come up with, there are some really cool meds that have been injected into our industry over the past several years.- Yep.- Even though we're slow to get there. There's still stuff that works great.- Yep. And so, I'm going with innovation.- Yeah, I think that's great.- Okay. I think it's double edged sword for mine.- Okay.- But the human animal bond, just I think over time has changed and morphed and like people want the animals instead of kids nowadays or they treat their animals like human child, like their kids, which is it wrong. But I think the reason why I said it's a double edged sword is because sometimes it's really hard to, I don't know, at least for me, like sometimes make decisions with that emotional, weight and, or honestly, sometimes people are hard to work with because of that blinder on it. I don't know if that's right to say, but no, I think it's true.- I think it's obviously more good than bad. It's not even bad. It's just like it comes with its own challenges.- Well, you're right. I mean, you're dealing with the humans, or you know what I mean, in terms of the human animal bonds, like humans are half the equation. So they do pose a challenge for sure.- But they were put on the start to love, they love us unconditionally, they bring us joy, cuddles.- That's right. There's a lot of great things.- There's a lot of great things.- There's a lot of great things.- Decreasing anxiety.- Yeah. That's right.- And Dwarven really is.- And I love, I freaking love working animals, like working dogs, working horses, like with jobs.- Yes.- Oh my gosh. I love it. I, anytime A.K.C., agility, championship is on TV, I'm on. I'm watching it. I think that's my next life as I want to get a border call in doing agility.- And do agility.- I think it's so cool.- It is very cool.- Or when the cops bring out the dogs, bring out the dogs on the show cops. They're trying to go chase someone down or find the drugs. It's like, it's so cool. I love it. That's very cool.- I guess they have a job.- Speaking of A.K.C.- Oh. Oh.- Some daughter-in-law. And her mother actually, I think as the story goes, I can't see Harrison's face anymore. It got me this book and her mom said she's got to have it. It's orange. And I was like, I do it's orange.- It's beautiful.- And then, and so they got this for me.- It looks like fake almost.- It's, you know?- A.K.C. The complete dog book. Let me tell you.- Oh my gosh.- Let's see what year.- Let's see what year.- I think it's on the size and 82.- Ooh, that was really close.- Really?- Seven, yeah.- Oh, I initially thought of seven, but then I was like, I'm gonna open it and you tell me what dog breed by chance I'm opening two.- Okay.- You're gonna read it?- Oh no.- Okay, go.- Well, you have to give me clues.- Okay, I don't even, okay. This is 1977, remind you.- Oh no. Okay.- It's small.- It has, let's see here. It's been around for four centuries. Let's see here. What else about it? It's got long flowing coat. And...- Lossop, so.- Ooh, that's close.- I'm trying to see where you're at in the book because it looks like your past halfway more.- It's named from the chief of those northwestern islands of Scotland.- Oh, I love Scotland. That as...- I don't have much of this.- Norwick, Terrier, as fat back as he can be traced, formed his native home and in which was found in greatest perfection. He is the only Terrier, distinctively belonging to the northwestern islands that is not common to the whole of Scotland. Those who have the best practical knowledge of the blank of the, okay, I'll tell you this part, those who have the best practical knowledge of the sky mountain that he...- Scottish Terrier.- That's close. It is start with an S. I just gave it away with the name of the mountain.- Skys?- Sky Terrier.- Oh, Sky Terrier. One of the most important breeds at the American Bent shows before the turn of the century. And the rivalry among the leading kennels was exceptionally keen.- So I'm assuming a black and white picture, either?- Yeah, of course.- Yeah, he's got long coat, like he looks like a combination of like a silky Terrier, a sky.- Oh, yes.- A sky, yes.- Well, that's just another clue that I need to go see Scotland because I want to go so badly.- Okay.- You would have thought.- Okay.- Love it. Case collections.- Oh, yeah. Let's talk about this because this is...- Yeah.- I love this case.- So we have a joint case. His name is Toby. He's a four-year-old, neutered male domestic short hair, whom I saw on Thursday, no, Wednesday of last week for an acute urethral obstruction. Okay, he was blocked and he could not urinate. So the history was for about two days, he was eating lethargic, hiding, and then there was vocalization. They haven't seen urine. He had a history of bladder, sorry, urinary issues, I guess, back in December, but he wasn't completely blocked.- Okay.- So, yeah, here we are, initial exam. I just go straight to the belly when they're active like that. He was so uncomfortable any time he moved and his bladder was ginormous. Like, I mean, he's a bigger cat, but like, is that like a canelo?- Okay.- Or maybe that's too big for a canelo, or too small?- No, no, I mean, huge rock hard, painful, classic. So it's pretty emergent because you don't know how long they've been blocked. They don't, you don't know how long the kidneys have been backed up. So in our protocol, we just essentially start to try to get initiate treatment by at least giving pain meds on board while we kind of go through it with owner and expectations and stuff. So she approved on blocking him, which consisted of us, the pain med made him sleepy, but you still need more on top of that. So we put placed an IV catheter and then we gave propylfall, which is an acidation induction med to basically put them in a more unconscious state. And so, depending on how long it takes to relieve the obstruction in the urethra, you may remain a hot to translate over to gas and anesthesia, which we did. We had to intubate and put them on gas for safety.- Did you guys try that coxidial block at all?- So, no. But they say it's so easy, but I find it really hard.- Well, I did on one before. And I felt his space and I feel like I probably could have, but she was financially conscious and so I didn't want to knowing I was going to have to do other things anyway. I didn't want to do that. So it was a tough one to unblock. So we had to do multiple positions and what you do is you get various types of urinary catheters to see what will pass through and then simultaneously someone is pulsing fluid through the urethra because, yeah, there's something lodged there.- You kind of blow it up like a balloon.- Yeah, exactly.- Like on each end so that it might work.- Yeah, the pressure.- And then it relieves the big pressure.- So, had multiple doctors hands on to try to get it done. We did scan his urinary bladder to look for his or stones as their sludge and his was at the time mostly, consists of sludge, just floating, could be blood, could be mucus, whatever. Finally got him unblocked, kept the urinary catheter in overnight. Blood work is also an important thing and also there.- That's what I was going to ask was how bad was it, where is kidneys?- Kidneys were really not that bad. His creatinine was 2.7, his BUN was 40, so it wasn't terrible, but they can get really bad quit.- What was his potassium?- Remember, it's normal, I think.- Oh, that's good.- Yeah. You worry when the potassium gets too high that can create a heart arrhythmia, which then can put them in dire danger.- Right, very risky.- Yeah.- But his ECG was fine, his heart rate and all that. So, that's where the story started. Not ended.- That's right, exactly.- The biggest thing with blocked cats, especially with his history is if you did not pursue getting, like, doing a sistotomy. So, going into the bladder, removing all that crud, the risk is extremely high. He will just re-block within 24 hours. This owner being just financially constrained and obviously concerned actually prompted me on other surgery or other options, I should say, other than just cleaning up the bladder.- Right.- So, I don't know if you want to kind of go into what a PU is and why we do it and stuff like that.- Sure. So, you guys did the sistotomy.- Yep.- And at the same time, since she had asked about, "Hey, is there a way to potentially try and prevent?" That's a strong word, you know? But for the most part, prevent future episodes.- She put, is there anything permanent we can do?- Permanent we can do, yeah. So, then, then, Duc will talk about doing a perineal erythrostomy, which is, we shorten that because we don't like to say that. I wanted to call it a PU. So, and we don't do those very lightly. That's, it's a very barbaric, invasive, yep. Can't go back.- Yep.- Surgery.- And so, but what it does, so in the male cat there, your erythro is so tiny that things get clogged and they're so easily and it doesn't even, it's like sand and debris sometimes. I mean, his was like a, like, the smallest grains of sand, but all just like a sand paste in there, right?- Yeah.- And do like a tube.- Yeah.- And try to ram it into the sandy beach, right? And then you pick the straw up and it would be just everywhere.- Yeah. All caked into the middle of the straw.- Yep.- And that's really hard to dislodge when that happens. And because they are considered a true emergency in veterinary medicine, it's something that we try and like you were mentioning attack quickly. So, I think the PU was the, the right thing to do for this particular cat because he had already had one previous episode. And whenever I'm working on these guys, that's it, right? Like if I'm at the second episode, that's usually when I start talking about that. Certainly by the third episode because now at this point, you've paid for a PU. Like between the first and the second episode, you know, you're at the third episode. So.- Yeah.- And so basically what that is is we widen the erythra. So we pull the, we do a dissection around the pre-puse of the cat and then pull it all the way through and dissect it up into the pelvic canal because further up into the pelvic canal, the erythra is wider. So we amputate the penis and pull that erythra all the way through and tack it down so that you have a wider area for the cat to pee through basically. And so then the hope is that because we don't see this problem in female cats. So then the thought is, okay, well now we can prevent this from happening. The one thing I will say about the surgery is you have to do it the right way. You cannot take a shortcut. You cannot chicken out and when you get into the pelvic canal, not pull the erythra far enough forward. If you do that, you are basically, it's a death sentence for the cat. So it's not something that you should attempt to do without practicing on cadavers without somebody also helping you to learn how to do it because you will want to stab your eyes out. Yeah. Because you'll be like, I can't, I can't go any further up into the pelvic canal. I just can't. There's something I'm going to do something bad. I'm going to, but you have to. You cannot not do it. Yeah. Because it's pointless. It's pointless. Yeah. So, and, but it's an, it's an extensive surgery. It's an invasive surgery and it does come with its own set of complications. Right. So you're not out of the woods, post-op, right? You still have two weeks of normal healing in general, but then you also have this residual pain that the cat was going through, inflammation, spasming of the muscles in their urethra, which can make the opening small or difficult to pee. And then the biggest complication of the surgery is a structure. Yeah. So what happens is essentially that opening, I guess, gets small, still because of scar tissue and inflammation. So Toby underwent both the procedures. He actually had the PU first and then I went in, Dr. Cloud did the PU and then I did the sysautomy. So it was at that point, I was, you know, putting urinary catheters into flush the bladder, flush all the crud out. So we just kind of kept them at time zero and I guess cleaned everything out to start a new. He did pee the next morning, which was amazing. I literally was jumping up and down and it was a Friday. So we set him home because cats can be weird in hospital where they don't want to pee, they don't want to eat, they're scared. And over the weekend he was peeing some, he was eating and we just, you know, you kind of hold your breath for 10 to 12, 14 days because you just, unfortunately, you're just not in the clear. Right. He did come back in yesterday because he had slowed down on his peeing, didn't really want to eat much, seemed uncomfortable. So both Dr. Cloud and I evaluated him and he, we gave more pain meds because one of them had worn off at that point. So we are wondering if he was just uncomfortable and then Dr. Cloud ended up giving him some gas anesthesia to relax him and she was able to release a steady normal stream from his bladder, but we did that because his bladder was pretty full. Like he had not peed and can't, we can't go through the same. He's blocked essentially not peeing and everything. So we re did his medications, his pain meds and realized that the litter, the type of litter may have been a factor for him and then sent him home and just got an update that he's still not acting quite like himself. But we're just going to hope that especially being at the home with the owner, he relaxes and starts peeing. Then we added presence and so to relax is your re-thra. If his bladder was that distended, I mean he could have nerve damage to his bladder, I suppose, as a possibility, but with the values that low, this kidney values that low, I'd put it lower on the, you know what I mean? It seems like he wasn't distended for some extended period of time. So if a cat stays, if their bladder stays stretched for an extended period of time, then they end up with neurologic diseases, what we're talking about. So of their bladder, not of their body, but then they can't, their bladder doesn't operate normally, doesn't can release. Yeah, it can't contract down. His bladder was very angry, very thick. It wasn't as red as I was expecting her bruise, but as I just even gently had to manipulate it, it became more and more angry. So, yeah. He has crossed. I think he just needs a little bit more time, right? Especially since his urine stream. And the drain board looked amazing yesterday. I mean, the whole surgery site looked fantastic. Yeah. So I, yeah, and we were able to, she was able to pass a catheter earlier in the day. I mean, it's just a function of time, I think, and getting him more functional in the bladder. And function of the bladder. I mean, that's the other thing we have to consider. So, I think it's important. Yeah, I think it's important to know that you don't have to do a pu surgery for cat because it gets blocked. Correct. So, let's say in this cat scenario, there was debris. He was a stressed out cat. Diet is like the mainstay treatment or prevention. So it dissolves and keeps, dissolves any crystals, stones, whatever clutter can get in there. It helps the cat drink more water and flush out a system more. If the cat is also having these issues due to anxiety and stress, which he was also, you put them on pro-zac and he was on it. But unfortunately, it just kind of depends on the cat as well, but you don't have to jump into a pu. Usually though, you still need to have a systolic. So, we go in the bladder. Just they'll just get re-blocked exactly as well. Yeah, okay. Okay. Well, fingers crossed. Tobi. We'll give it Tobi update in the next podcast because we'll be out 10 to 14 days at that point. Yep. So, yeah. Go, Tobi. Go. Send good vibes towards Tobi. That's right. Exactly. His bladder. His bladder. That's a very cool case. I love that case. It's got so much great information as far as things that we deal with and manage and everything. Okay. Where we on? Listener questions. Okay. Hey, I love you guys. Thanks for your time. I am seeing only one side of the dog world talking about DCM and grain-free diets. None of them are practicing vets. I would love to hear your perspective. Kyle Gilliam. Okay. Cool. Thanks, Kyle. Yeah. There's been a lot. Well, gosh, now, because we were doing some digging to see if anything had changed. That was 20. Would we say 18? Yeah. 2018 when all that went down. That was five years ago. This COVID was like six years ago. Right? Yeah. 20. Sorry. I can't you see it. It's a time warp with COVID. Okay. So, yeah, five, six years ago when all that came out. Yeah. It started with a study of Golden Retrievers. And essentially, I'm not sure how this, if it was like, hey, we're finding this. Let's do a study on it. I think it was one breeder, wasn't it? Oh. It was like a set of Golden Retrievers where they were getting DCM. DCM. Well, we should back up. Okay. Okay. Yeah. Good point. Dialated cardiomyopathy. Yes. It's a heart disease where your, basically, your heart gets gigantic and the muscle sits out and then they can't, but a little, little, little, little, little, little. Yep. Can't pump blood, the right, like, forward in enough forward force. Yes. To supply you with life, life. Yes. So yeah, it's our poster child breed. A boxer, a doverman. Yeah. That's why I was thinking of doverman, but those are probably the two most common. Yeah. But you think? Yeah, I would think so, for sure. Those are really the two. Those are great days. Okay. Yeah. Okay. Yeah. Archer Spaniels. I don't feel like they have like, no, you're right. I remember, I could picture on a slide show. A car, okay. There we go. Pull that from the depths of whatever. Okay. So those are the breeds that we most commonly see it in. Primary. Yeah. So you can see when these people started showing up with gold retrievers, yeah, with dilated cardiomyopathy. I should be in the DCM. That's what we call DCM, like we call it PU. Yep. DCM. It's like, what? Yeah. Because gold is to have enough of their own issues. They don't need another one. They're the poster child for lymphoma. So, or just, or just kids. Yes. Okay. So, yeah. Yeah. Then they were like, what's going on? This is not normal. So, longs or short, they got to the diet and the grain-free diet or the lagoon-based boutique diets. So, yeah. And then they realized, okay. So here's the other caveat. They're still not a single consensus from cardiologist as far as the metabolism or what is paired with the grain-free, created this disease. Correct. So, the thought, the couple of the thoughts were atorine deficiency. And that is important for the heart and the heart muscle health. Oh, thing, and I got logged out. Okay. And I think that they, what they did was they saw that, okay, these dogs on these specific diets that aren't breeds typically known to have dilated cardiomyopathy are showing up a dilated cardiomyopathy. Why is that? Okay. Well, they substituted beans for meat. And so, they and other things. So that was one tie that they had was, oh, now these dogs, some of them are tarring deficient. But some of them weren't tarring deficient, but still had dilated cardiomyopathy. Yes. So, I think that there's, and the, the congospanials are the ones that are tarring, have like can have the tarring deficiency, I think. But, yeah. I think they're like, well, then why do these, why do these breeds, they're like, well, these that don't normally get it are getting it with this diet, with these boutique diets? Yes. And I think that's where you were going with like, we don't know, there may be some other ingredient in the diet that we don't know about that is causing the effect. Yep. Is what they were thinking as well as is there a genetic component for some of these guys that again, we don't know about. Yeah. So, yeah. It says, so we use VIN a lot, basically our research portal for information, information. It's veterinary information network. Is it, look at that. Yes. Pull that out of my arse. Okay. So, yeah. It says, basically in regards to the food that initially it was suspected to rise from tarring deficiency because many dogs initially reported, we're golden retrievers, which is the breed with tarring metabolism abnormalities. Yes. However, many affected dogs have normal whole blood and serum tarring levels. So, and like measuring the tarring wasn't always accurate. And then in another study, plasma, methionine was lower in normal dogs, fed grain-free diets. So it's unclear. It's unclear. I guess the, the, the consensus is it's unclear. Yeah. No one has decided anything. Yes. But they have advised us in terms of, okay, you have a dog that has dilated cartomap. They, what do you do? So then as far as food. Right. So they say, okay, if you have DCM, your dog has DCM and it's on grain free, take them off it. Take them off it. Right. Well, I mean, here's the thing though, if they've been on grain free and they get DCM, you then just treat it as a dog that has primary DCM, right? So there's no unfortunate like reverse, where there's no reverse. Yeah. Yeah. So we've kind of adopted the philosophy that we just don't recommend grain free because they don't, they can't tell us the time line of, if your dog's on it for this long, you're going to get it or this short of time or something. And people are like, well, can I just supplement twering? And that was an initial thought too, but you have to do touring levels, right? And then in some of these patients, like we were talking, they're not touring deficient, right? So then you're still feeding something that could potentially have a toxic and greeniant exactly. That, so that's what, yeah, I think why we all decided as a group like, let's just make the recommendation that we don't feed it because there's a gazillion other things out there you can feed exactly. Exactly. So that's where I think it's kind of, why do you think grain got such a bad rap? Is it because of people? No, I think people being like the whole crones and like, let's get out glued and not do what are they called for? And like, they kind of, yeah, and then they trickle that down to because people are doing that. And they want their pets to do that. Well, wasn't it also the thought that grains were the problem for like itchy scallogies, which is totally not the thing, which is not true either. It's actually more so the protein involved. So it's not wrong to assume your dog may have a chicken allergy. It's more appropriate to say that, even though it might not be chicken, then it's the grain, right? Period. Yeah. So, if it longs or short, if they develop DCM regardless of the reason, prognosis isn't great. It's not good less than a year. Yep. And that's because that muscle stretches and then once it stretches, you can't go back it because it just is not contracting. So it's sitting there just wiggling. You cannot make it pump like it's normally supposed to. Yeah. I mean, and so it's really unfortunate. Yeah. I have a higher risk of acute death. So try not to beat around the bush here. It's just better all around. Just don't go near the grain free. It's just not worth it. Yes. Yeah. Until we know more, until we know more, which eventually we will. I'm sure at some point they'll, because I can't imagine that those companies that are selling grain free aren't looking into it because they're not in the business of killing animals. So they want their diets to fulfill those requirements that those dogs live long, long lives, right? The longer you live, the more food you buy. Yep. So they're not in the business of creating diets that injure pets. That's not. Yeah. And we see tons of nutritionists in these corporations or companies that are selling food. I mean, there are veterinary board certified nutritionists working with these companies. Yep. You know, I always giggle when people are like, yeah, that food kills them. That's like, no, that's not what they're, that's just not good business practice. Right. No, it doesn't make sense. Yeah. No. But yeah, I think we'll get more information over time. Hopefully. Yeah. I mean, honestly, in the green scheme of, I don't know, science and studies six years isn't that long. So as far as like creating the, creating it, yeah, exactly. So agree. Yeah. I mean, great question. Great question. Hopefully. Yeah. Hopefully. Yeah. Hopefully. The long of the short. Don't put, yeah, okay. The don't. Oh gosh. Okay. Cool. You want to do that? Sure. Okay. I can find it. Hold on. I know how my glasses are. I know this is really, yeah, treacherous. Thank you so much for tuning into another episode of the veterinary roundtable. Remember sending those questions and leave us a review if you enjoyed this episode or a previous one. We'll see you next time for another episode of the veterinary roundtable. See you. Bye bye.(upbeat music)(upbeat music)