Recognizing and Understanding Pain in Pets
Science has shown that a petís nervous system is very similar to ours. So why is it that when we are in pain, everyone around us knows about it but our dogs and cats rarely declare their discomfort. Dr. Steven Fox, of Norvartis Animal Health will help us understand the signs of pets in pain and discuss new ways that veterinarians have to relieve it.
Novartis Animal Health researches, develops and commercializes leading animal treatments that meet the needs of pet owners, farmers and veterinarians. Headquartered in Basel, Switzerland, and present in almost 40 countries, Novartis Animal Health employs about 2,700 people worldwide. For more information, please visit www.ah.novartis.com
Questions or comments? Email Dr. Cruz at: email@example.com.
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Dr. Bernadine Cruz: You’re listening to “The Pet Doctor” on PetLifeRadio.com. I’m your host, Dr. Bernadine Cruz. Science has shown that a pet’s nervous system is very similar to ours so why is it that when we’re in pain everybody around us knows it but when our dogs and cats are, rarely do they declare their discomfort? Dr. Steven Fox of Novartis Animal Health will help us understand the signs of the pet in pain and discuss new ways that a veterinarian has to relieve them. Since it is the beginning of the year 2008, we’re all making our own resolutions. While some resolutions that we should make for our pets can really make sure that they enjoy the best year possible. So some resolutions that you may want to keep in mind for 2008 for your pet is to take your pet to the veterinarian at least twice a year. It seems kind of crazy “why twice a year?” but since one of our years is about seven of theirs, a lot can change in a short amount of time. You also want to keep your pets up to date on vaccines. Don’t fall into the myth that my pet never leaves the home and doesn’t need its vaccines. They still do. They can pick up diseases at their grooming facility or sometimes just even going for a walk around the block. Stay on top of their dental care. It’s very important. Bad teeth are not just a source of bad smell. It can also be source of infection for the entire body. You’ll also want to take parasite control seriously, both internal as well as external. Flees and ticks can be a year round component of your pet’s life. They can stay in the house even in the midst of winter. You’ll also want to keep track of your pet’s medical history. It doesn’t have to be something fancy. Keep yourself a little notebook. Keep track of what’s going on with your pet’s life so when you go into your veterinarian and your veterinarian asks you, “so, how’s that pet been doing at home?” you can whip out that little book and answer because otherwise we tend to forget. Keep medications on hand that are supposed to be given on a daily basis and when given a medication by your veterinarian when it says “give ‘til gone”, do so. There is a reason why you want to do it. What else can you do to keep your pet in good health for 2008? Keep it thin. We know that chubby pets are at risk for just a myriad of diseases. We know that it also shortens their life about two years so chubby is not necessarily happy. These ideas and more can be found on a great website, DrPhilZeltzman.com. He is a veterinarian, a board certified surgeon that puts out a great newsletter that comes out on a weekly basis. You can access this by going to DrPhilZeltzman.com. Dr. PhilZeltzman.com or just check on our website and you can get the address there. So we’ll be right back after a few words from our sponsors and we’ll be talking about pets in pain. Stay tuned.
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Welcome back to the Pet Doctor on PetLifeRadio with Dr. Bernadine Cruz.
The doctor is in and will see you now.
Dr. Bernadine Cruz: My guest today is Dr. Steven Fox of Novartis Animal Health and Dr. Fox, I know that pets are wired basically the same way that people are so why don’t they show pain?
Dr. Steven Fox: Well, they do. I think that it is difficult for us often times to interpret what they’re telling us. It is interesting that in man, pain is what the patient says it is where in animals pain is what the assessor says it is and so some of us are much better at taking the cues that the animals are giving us than are others but by and large that they are expressing pain in some . . . and usually it is a change from normal and that is usually the most common indication that an animal is in pain and of course that is perceived more frequently and more accurately by the owner than is the veterinarian. The veterinarian, as you know Bernadine, is very good at the technical aspects but they don’t know the idiosyncrasies of that particular pet and what is a little bit abnormal for that pet and it’s the pet owner that can give the insight to the veterinarian to fill that total picture.
Dr. Bernadine Cruz: You’re so right Dr. Fox because so many times when an animal comes into the veterinary hospital and it says “really Doc, it was doing it at home but it’s not doing it here” and my usual response is “it’s somewhat like the car that you take to the mechanic or the child you take to the pediatrician; it never makes the noise, it never seems to have the problem and, yes, the pet owner knows the animal so well. What are some of the common ways that a pet owner will notice that something is different, that their pet may be in pain?
Dr. Steven Fox: Well, of course, any kind of behavioral…some of them with severe pain that when you handle them they become somewhat aggressive and they might want to bite. That is kind of at the far end but there could be other subtle things like the animal’s reluctance to eat or particularly with osteoarthritis, reluctance to say jump up on a sofa or a bed or a couch or posturing to toilet sometime is painful with animals that have joint anomalies associated with osteoarthritis so it is a change from the normal that you see that should alarm you that something is not quite right.
Dr. Bernadine Cruz: Do cats display pain differently than dogs?
Dr. Steven Fox: Well, they do and diagnosing lethargy in a cat is kind of like the old “when is yogurt sour?” because cats tend to be very quiet and reserved except of course they’re nocturnal and they like to move around a lot. My three cats move around a lot in nighttimes but. . .
Dr. Bernadine Cruz: Right when you’re trying to go to sleep.
Dr. Steven Fox: That’s right, that’s right and whereas dogs oftentimes. . . and we use this as a cue-off in times with osteoarthritis, they don’t feel well and therefore maybe they are eating a lot and not exercising much and therefore may be putting on weight. Now in contrast, oftentimes you might see a weight loss in cats because frequently we’ll put their food up on an elevated surface, kind of like a washing machine or dryer, something like that, and because they are painful, they won’t jump up and eat as frequently so where in the dog we might see an increase in weight as a cue particularly for osteoarthritis, in the cat we see exactly the opposite and it makes sense when you think about what the cause and affect is that you wouldn’t think that they would be so diverse but oftentimes it is because of the way that we rear or keep the animal.
Dr. Bernadine Cruz: I have to admit that I had an old boy kitty myself, Zachary, and the first time I realized that he was having some problems himself with osteoarthritis is one evening he’d always jump on the bed to sleep with me and this one evening he was scratching on the side of the side of the bedcovers and I looked over the edge and said “come on, jump on up” and then I realized he couldn’t because, you’re right, cats disguise their signs of discomfort so well, I guess it somewhat goes back to survival of the fittest; if you look weak out in the environment you’re going to be the first one picked off by the hunter.
Dr. Steven Fox: That’s right and again particularly, well, depending on how affectionate, if you will, you are with your pet, often times, I know my dogs, I have two golden retrievers, when they’re not feeling well they tend to come to me for some kind of a comfort whereas cats tend to be more solitary and they tend to want to be kind of unto themselves and so they’ll kind of go off in a corner or hide under something or like to be in a box or some place where they can be secluded so they do show a marked difference, one species to another.
Dr. Bernadine Cruz: Pain management right now really seems to be a hot topic in veterinary medicine. Why wasn’t it really addressed in the profession, say, 10-15 years ago? I know when I graduated from veterinary school they always said, well, it’s okay for them to have a little bit of pain. For instance, after they have had surgery, we don’t want them to move around much, we want them to be a little painful so they’ll stay quiet. Why have things changed?
Dr. Steven Fox: Well, there’s lots of explanations for that, Bernadine, principal to which is our increased knowledge base. You know it, to that point, it was only about 20 years ago that they were doing open heart surgery on infants, babies, and they were not giving them pain management at all because at that time the mindset was that they didn’t believe that babies actually, particularly at that age, actually felt pain. Well, we know different now. We have come a long way in our understanding of animal physiology and, interestingly enough, many species, as you said at the intro are very, very similar so we can kind of talk about pain as one science that transcends a lot of different animals and species but we also have better pharmaceutical agents available to us. We have better drugs. We know how they work. We have a better understanding of how to apply them and so whereas for the example you gave, it used to be the mandate that we would let animals feel a little bit of pain because it was good, it would impede their activity, particularly in the orthopedic setting where maybe then they wouldn’t distract a fracture. Well, now that’s very poorly accepted in veterinary medicine. We have come to implement internal fixation. The whole concept is get the animal moving earlier so that we can get more muscle activity and the increased blood flow and therefore faster healing and so now we have medication, we have understanding to keep those animals pain free so that indeed they can enhance their recovery timeframe.
Dr. Bernadine Cruz: Besides the obvious that pain hurts, what are some of the adverse side effects to the whole body when a pet’s in pain?
Dr. Steven Fox: Boy there is almost no end of unrolling those. Pain can affect the endocrine system. It can affect a lot of our physiology and so it can affect blood pressure or immunological response to other problems. We can have, of course, a change in heart rates and respiratory rates. It just, to kind of summarize, it’s a whole body concept and the consequences of pain are very far reaching. We now know that our central nervous system, our very, very complex central nervous system can transition into a state of chronic pain that can be self perpetuating and so, we used to think that the nervous system was hardwired, like a light switch, you flip the switch, the light comes on, how easy is that? But, in fact, the nervous system is more like a smart computer where we have an input that goes to the computer. There are a lot of changes that occur and the output changes and so it is so once you get into a state of chronic pain, it can be self perpetuating and it can extremely difficult to treat and so that gives us all the more reason why we should treat pain early and effectively so that we don’t get into that chronic pain state.
Dr. Bernadine Cruz: If a person doesn’t believe that their pet is in pain and that’s a situation I run into so frequently in my office; an owner comes in with a pet, it obviously is an older pet who’s having a hard time getting up and down, I say “you know, your pet looks like it’s in pain” “oh, no, it’s not in pain, it’s not saying anything, it’s not doing anything”; how do you convince that person that, yes, your pet’s in pain?
Dr. Steven Fox: Well, we go back to kind of an analogy you made earlier which is, in the past, we really didn’t treat pain effectively and why was it, well, because we didn’t have the knowledge base. We now are smarter and to your point, I practiced referral orthopedic surgery for fifteen years and similar to your observation, I would have a pet owner come in with a dog that’s only using three legs and I would say “boy, your dog is obviously very painful” in response, they would say “oh, I don’t think he’s painful” and then I would say “then why don’t you think he’s using his leg? If he’s not painful, he would be using his leg” and so I think that often times, the lay public associates pain only with vocalization and they tend to think that the dog or the animal is only painful if they’re howling or barking or screaming or something like that and in fact they have far more sophisticated expressions of their discomfort than just that verbalization and going back to lameness, usually an animal is lame for only one of two reasons. One is either it cannot move a limb or it refuses to use a limb and it may refuse to use a limb because of pain, on the other hand, it may not be able to use a limb because it may have some musculous pilital anomaly like muscle contracture or a contracted tendon or joint capsule or something. So therefore, you kind of need to look for, well, is it not using the limb because it is painful or is it not using the limb because it can’t or is it a combination of the two, and then approach it that way and that’s the way that most veterinarians approach lamenesses.
Dr. Bernadine Cruz: One of the things I am so happy with, since I have been a veterinarian now for over 20 years, is there is now so many different pain medications; ways that I can treat pain for cats as well as dogs. I know clients are always wondering “oh, they see this new medication that’s come out for dogs or a cat going “huh, is this just really a medication that they tried to use for people and it kind of washed out, it didn’t make it through FDA so now we’re using it on animals. Could you address that?
Dr. Steven Fox: Well, in some cases that’s true. When you look at the pharmaceutical industry, particularly if you’re a stockholder, you’d appreciate that the biggest return on research investments, and, incidentally, to bring a drug to market takes about 12 to 15 years and costs somewhere in the vicinity of $75 to $100 million so it’s not a trivial pursuit to discover and bring to market a new drug. Oftentimes, when pharmaceutical companies do that, they are focusing on the biggest return which is human use and in that process they’ll start using that drug in rodents, mice and rats, and then they’ll progress to say dogs or cats or monkeys and then to man and so forth and oftentimes they’ll find that some of those products don’t work as well or have some adverse side effect in a particular species but not another. Consequently you may find that you have a very good molecule but it just happens to be not real good for people for whatever reason but it showed excellent results with no toxicity or minimal toxicity in say a cat or a dog. In that case then it’s the idea product for that particular species. It’s not very often that major pharmaceutical companies strive to find a specific product for a pet although that does occur. The important thing is that when you use a product you should insure that it has an FDA label for use in that particular species and therein lies some problems. I think oftentimes pet owners will say “well, my dog for example, may have a lameness or something, I’ll just give it an aspirin”. Incidentally, aspirin is not approved for use in dogs and it can be quite dangerous so for those who. . .
Dr. Bernadine Cruz: That’s a medication that veterinarians have been using for so many years and I’m glad you brought it up because so many times you’ll say, “ah, my vet from thirty years ago used to recommend aspirin, so why can’t I give it; what’s wrong with it?”
Dr. Steven Fox: And to that point, they may not have been wrong in using it but, again, I go back to my earlier point which is, we now have better products, safer products, we know more about aspirin than we ever did and, of course, years ago we used what was available to us because that was all that was available to us. Now we have much better products that have gone through greater screens, if you will, for their efficacy, how well they work and how safe they are and we have much, much better choices and we also now know, and this has only been revealed within say the last 5 to 7 years, that aspirin can be problematic to both people and pets. As a matter of fact, the American Medical Association cites that in the year 2000, 15,600 people died from toxicity from aspirin and aspirin-like products so they’re not necessarily benign and if you’re going to reach for those kinds of products, you should always check with your veterinarian first to see that they condone in that particular dog that it’s the appropriate product as a first choice.
Dr. Bernadine Cruz: Can it make a difference, we’re talking about aspirin for instance, we used to use it in dogs, we now know there’s sulfur alternatives, can there be a difference in the way dogs will react from one pain medication to another dog in the same family, for instance, can we use one medication, “Oh, I have a Labrador at home who’s lame and now it’s friend at home who is a golden retriever also has a lameness, can I safely use one medication on the other?
Dr. Steven Fox: Possibly. I think as a population, as we look at dogs in general, there are comparative studies that have shown that some products have better efficacy and possible safety than others, in a whole population of dogs, now, that’s taking again a population of dogs, but just like you and me, there will be differences in our response to different drugs. For example, I might have some kind of painful anomaly and I get a better response from say ibuprofen than I do from say naproxen; Aleve. On the other hand, you may find exactly the contrary. You may find that the best product for you is say Aleve rather than ibuprofen and naproxen so there is great difference from animal to animal despite the fact that they’re the same species and may even be the same breed. So I think one might take their initial clue from studies that show, in the population, how they respond to a particular drug and if that particular animal does not respond as you would expect then you might want to transition or switch to a different one to see if in fact there is a bit of idiosyncratic difference between the two individuals.
Dr. Bernadine Cruz: Well, you’ve been listening to Dr. Steven Fox of Novartis Animal Health. I’m Dr. Bernadine Cruz and this is “The Pet Doctor” on PetLifeRadio. We’re going to take a short break and come back and talk about dogs in particular, one of the most common reasons for them to experience pain to frequently not being treated for it, and that’s arthritis. We’ll be right back after this break.
Announcer: Please have a seat in the waiting room. The doctor will be with you shortly; right after these messages.
Announcer: Welcome back to “The Pet Doctor” on PetLifeRadio with Dr. Bernadine Cruz. The doctor is in and will see you now.
Dr. Bernadine Cruz: We’re speaking right now to Dr. Steven Fox and Dr. Fox, thank you so much for telling us about how people can recognize their pet’s in pain but I do know that about 1 in 5 adult dogs suffer with osteoarthritis and less than half of them are being treated because many times people don’t realize that dog has a problem. What are some of the signs that a person can recognize, look for, if they think their pet may have arthritis?
Dr. Steven Fox: Well, there are some risk factors that will come into play here. Of course, those are rather obvious. Osteoarthritis tends to be more prevalent in older dogs. It tends to be more prevalent in dogs that are overweight and there tends to be a little overrepresentation in females compared to males. So, once again, if you see that your dog is slowing down or is showing some of the indications we mentioned earlier; discomfort when it postures to toilet or reluctance to jump up on things or would rather sit than stand and just basically slow down and less interested, those are some of the basic cues that you might have. Now, when one says, “how can I really insure that my animal is painful? What are the scales or how can I rank it or how can I actually judge that that’s the case?” Well, one, of course, again, is change from normal but the cardinal sign of whether an animal is in pain is whether or not it responds to a pain reliever and therefore, if you think that your animal is slowing down because of some anomaly like osteoarthritis, take them for a test drive with some of these newer products and see if, in fact, they are improved. I think commonly pet owners will tend to say, “Well, my dog’s just old and therefore it slows down” but I can tell you as an aging American, I’m getting older and I’d like to think that I’m not slowing down so I don’t think that age is a disease and so if you’re having that slowing down in your pet then consult with your veterinarian to see if it’s more than just so called old age; that they might have an underlying osteoarthritis because it is, as you mentioned, quite common; about 1 in 4.
Dr. Bernadine Cruz: What are some of the treatments that are now available because I totally agree with you. I have clients come in who say that a pet’s not painful. I’ll put them on a week’s trial, just humor me, try. . . One of the things I’ll use most commonly are the non-steroidal anti-inflammatories and after a week’s time, you tell me if the dog is better or not and the majority of the time they go, “Oh, my goodness, I didn’t realize that it was uncomfortable.” So besides the non-steroidals, what else is there for people to use for their pets in pain?
Dr. Steven Fox: We have just, I say we, at Novartis, within the last year, put out a very informative, interactive CD and we’ve put a lot of literature out addressing the concept of multi-modal approach to osteoarthritis; multi-modal being the term being given when we put a cocktail together to treat the animal or different modalities to treat the animal. So our approach is one, if you could envision the triangle with three corners, one corner being these non-steroidals as you mentioned and that there are a variety of good ones on the market now for pets. Another corner of that would be chondro-protectants, these are usually injectables. Adequan is an example of that. The third corner would be adjunctive drugs. These are many of the drugs that are being used in human medicine for chronic pain such as mantadine, gabapentin, tramadol and so forth. Then if you overlied that triangle with another triangle that’s inverted; one corner being exercise and weight management, another corner of being these new omega-3 fatty acid diets that many of the pet food industries have on the market, and then the final corner being physical rehabilitation and that would include things as simple as leash walking to things that are more complex such as underwater treadmill activity. So here you have six very specific areas all of which independently can make a difference but if they’re implemented collectively it can be very, very powerful and one of the great attributes of using a multi-model approach is that then the component that is the drug can be administered at very, very, very lowest drugs and therefore have minimal potential for side effects. So, I think most people in the know these days would be very strong proponents of multi-model management of osteoarthritis.
Dr. Bernadine Cruz: Dr. Fox, something you didn’t mention and I know people use this for themselves, they use it for their cats and dogs, is going to be things like glucosamine and conjointin sulfate, does that really make a difference once a pet has the arthritis?
Dr. Steven Fox: It can. However, the science is very weak. This has been an area of contentious discussion for many, many years and if you search the human literature, there are very, very few studies that actually show a positive response. One such study was funded by the National Institute of Health and published in the New England Journal of Medicine only about a year and a half ago, a very rigorous study, I think fourteen different institutions, $18 million study that actually showed there was no effect of glucosamine, no effect of chondroitin, put collectively the two together there was a response however in that study the only group that responded to the two together showed no response to the very powerful drug Celebrex so the end result of that study was, you could say, inconclusive but the scientific community, by and large, says that they did not do anything but my personal opinion is that these products can make a positive impact on some animals but it’s… the science is rather weak and the short side of this is that it is an arena open for Charlatans in that there is virtually nobody regulating this area of nutraceuticals, they don’t have to be sanctioned by the FDA so if you and I, Bernadine, want to sweep the floor of our shed and put it in a jar and sell it as a nutraceutical, virtually there is nobody who can prevent us from doing that and therefore, if you feel that you would like to use a nutrceutical, find one that research data has shown to be very favorable and use that product at that dose and that has, in fact, quality assurance assuring that what is in that jar is what the label says is in the jar. And so it is regrettably an area of buyer beware and it has relatively thin science compared to the drugs. Those are not truly drugs. A nutraceutical is defined as a product that’s given orally to try to enhance the wellbeing of the animal; it’s not classified as a drug.
Dr. Bernadine Cruz: Now Dr. Fox, I know that you work for Novartis Animal Health and they don’t produce pet food but many of the pet foods now, this goes along with your buyer beware, are being touted as being joint diets. Do you have a feeling about those?
Dr. Steven Fox: I do. I think that there are some, at the risk of naming products here, I know for example that Hills JD, the Iams Senior Plus, the JM from Purina; these are all diets that are focused on what’s called EPA. That’s a very long term; eicosapentaenoic acid that is derived from both omega-3 and omega-6 fatty acids. That is the active agent in these diets. They enhance the integrity of the cartilage and they prevent enzymes from the disease process that degrade the cartilage so the science is very strong in those diets however, they also, almost all of them, contain a glucosamine and a chondroitin and it is my personal opinion that those are in there for marketing. There is no data that has supported the efficacy or the usefulness of those components; it’s the EPA in those diets that you should be looking for.
Dr. Bernadine Cruz: So they may not hurt, the glucosamine, but they may not help but it helps the owner feel better about pulling it off the shelf and feeding it to their pet. In your multi-model diagram of the six various areas, one of those points of the triangle being the non-steroidal anti-inflammatories, I know people are oftentimes very concerned about using any medication for long term use and we know with arthritis it’s not going to be cured; we’re just going to control the signs. Are INSAIDs really safe for long term use?
Dr. Steven Fox: I would say that they are although I think that there is a risk benefit for any drug put in any animal, ourselves included. For that reason, if you’re going to have your pet on long term therapy with INSAIDs or this would apply to yourself, you and me, you should be routinely going to your physician, in this case the veterinarian to insure that the animal is not having any underlying problems with it such as liver or kidney function response that would be adverse and that’s why it is important that if you have a dog on long term… and many of these drugs that we’re talking about, many of these INSAIDs, have been given to animals for as long as 8 to 10 years. I had a golden retriever that was on an INSAID for about 8 years without complications so, indeed they are, but it’s important that you monitor the animals response because, you see, you may have them on the drug but the animal may change because as the animal gets older, its physiological systems, its kidneys, its liver, its GI tract is changing according to its increasing age and therefore, it may be changing in the way that it handles these drugs that are being administered.
Dr. Bernadine Cruz: What are some of the potential side effects that a person could see if their pet was on an INSAID for instance?
Dr. Steven Fox: Well, the most common side effect from INSAIDs, the adverse side effects are exactly what we see in humans. They’re associated with the GI or gastrointestinal tract, so mostly one might see such things as vomiting or diarrhea and that would be a first clue to; one, immediately discontinue administering the drug and two, call your veterinarian to take a look and see if in fact they think that this is associated with the particular drug administration. The animal could have other anomalies. Maybe a coronavirus is going through the neighborhood or maybe it has a parvo exposure or a variety of other things, maybe a diet change, so it is imperative that you get the assistance of the veterinarian. But I also think it is important to discontinue the drug at the first indication that you might see and then get your advisement as soon as possible from your veterinarian.
Dr. Bernadine Cruz: Great idea. In general, what can a pet owner do working with their veterinarian to make sure that they benefit the most from an INSAID or any medical drug treatment that’s being offered by the veterinarian?
Dr. Steven Fox: Well, I think that… I recall a time when, I think at McDonald’s, if they didn’t serve you within a certain period of time you got a free order of fries or something. I go around the country advocating to veterinarians that any time that they prescribe a drug that the owner should have addressed to them: what is this drug supposed to do; what is the appropriate dose and dosing interval; what would be potential side effects and if I see a potential side effect, what should I do? Now, those four points should be answered for every single prescription that a pet owner has and if your veterinarian clinic, i.e., the veterinarian and/or the staff, is not addressing those questions, you should ask them. You should ask those questions so you have a confidence in what you’re giving your pet and what is the safest way to administer it. I think that’s always a good… and it’s a good rule of thumb for us when we go to our physician and ask the same questions.
Dr. Bernadine Cruz: I think… yes, very definitely now whenever you and I go to our pharmacies to pick up a prescription that’s a new prescription seems like you’re taken aside the pharmacist will say, “Okay, do you have any questions? This is how you take it” whether or not you can take it with food and I think that’s so important because too many times you tell a person to give it… and I remember a client of mine… give it until gone and in my mind that meant until the product was gone and in their mind it was until the signs were gone so it’s like…. hmmm, communication is so definitely important.
Dr. Steven Fox: That’s right and for that reason it is very helpful for veterinarians, for the veterinarians that are in your listening audience, that they not only give that information verbally to the pet owner, but also in writing because, as you know, oftentimes people will come into the veterinarian and they have distractions as well. The dog is not behaving or they have children with them that are distracting and maybe don’t hear everything you would like for them to hear and therefore it is important that the information be available to the pet owner both in writing and verbally. And it’s important maybe that you might even have that on your website.
Dr. Bernadine Cruz: That’s a very good idea. Ask those questions. I know that there’s various areas like computers that I am very challenged with and I sometimes feel a little bit embarrassed to say, “excuse me, could you explain that one more time?” and I’m sure there are times my own clients really don’t understand, so ask. Questions are great. We’ll frequently at my own hospital call a day or so later. “Hi, how are you doing? How is the pet doing? Any problems giving them medications? Are you seeing anything that’s different going on that you didn’t expect?” So, keep those lines of communication open. If people had more questions about arthritis and pain relief in particular, Dr. Fox, is there some place that you recommend that they look on the internet for instance?
Dr. Steven Fox: Well, we at Novartis have a website, it’s PetWellness.com, which talks about some of our products which are focused toward the wellbeing of animals and we also have a very strong technical support group so we have a group of 25 veterinarians and if you had a question, you could call our technical service group at Novartis and we’d try to answer it as best we possibly can in the most scientific and evidence based manner that we can and I think that’s true of most pharmaceutical, pet pharmaceutical companies, that they will try to help consumers, pet owners, learn as much as they possibly can about how to best manage their pet’s illnesses.
Dr. Bernadine Cruz: Well, Dr. Steven Fox of Novartis Animal Health, thank you so much for being with us today. You’re listening to Dr. Bernadine Cruz on “The Pet Doctor” on PetLifeRadio.com. If you have any questions regarding your pet’s health, the best person to ask is your pet’s personal doctor; your veterinarian. You can also ask me by contacting me at the “The Pet Doctor” at PetLifeRadio.com. Please check back next week when I’ll address more of your issues concerning you and your pet’s health and remember, it’s your pet. Health matters. Thanks for listening.
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