Dr. Angie Krause (00:00)
Welcome back to Tails of Truth, where we tell the truth about veterinary medicine. I'm Dr. Angie, and this is my co-host and veterinary nurse extraordinaire JoJo. And today we are answering listener questions.

JoJo (00:13)
We did this, months ago and it was wildly popular because people have questions. And so, well, that's so true. She's not read a single one of these. So I'm glad I'm not you. When we say unscripted, it's so true. Okay. Should we just jump into them? It's, just a variety.

Dr. Angie Krause (00:18)
And I'm answering all of these cold. I haven't seen it. I don't know. I hope it works out. Yeah.

JoJo (00:35)
questions that came and I'm going to name where we got these questions from just so know all the avenues where we exist. So there you go. Totally why not? Okay, you ready? Question number one. Sounds like a dating show. Didn't it? Like the one? Yeah, mean that's where it's coming from. Okay, question number one, Angie. At Simona on Instagram.

Dr. Angie Krause (00:41)
⁓ yes! Little plug.

That was the last, that my dating life was our last episode. Yeah.

JoJo (01:00)
wants to know what do you think of Fembendazole treatment for soft tissue sarcoma cancers.

Dr. Angie Krause (01:07)
⁓ this is a hard one because I think this is a moment where the internet has really sensationalized a dewormer, you know, with ivermectin curing whatever COVID cancer. And now, fembendazole, which is another dewormer, is being sensationalized as like an anti-cancer treatment. And we just don't have the evidence to support that.

And I've seen a lot of people do it and at no time have I ever thought, I bet this dog or cat's doing so much better because of the fembendazole And so while I think it's probably not harmful depending on the dose, I don't think it's helpful. So unfortunately, I'm so sorry. I even checked in with Brooke Fowler about this. Who's a veterinary oncologist. Yeah.

JoJo (01:48)
I think.

Oh, you did. Okay. Yeah.

Because it is gaining some traction. I think they are doing some studies on it now, but I don't know. Yeah, I was just going to say I didn't know. I don't know who they studies are. Studies can be used really loosely. We've kind of talked about that before. So for now it's a mid like you use it, but it's not probably doing anything.

Dr. Angie Krause (02:01)
Who's they, though?

Right.

I don't even know if I could say to use it. Yeah, because people are using it like every day, which is, you I know.

JoJo (02:18)
Yeah, that's fair.

Okay, well can

we offer her something? What could she be doing for a soft tissue sarcoma?

Dr. Angie Krause (02:27)
Soft tissue sarcoma, depending on where it is, and it's, first of all, I would see, you know, I think we would need more information. But I, for cancer patients, like broadly, I like to use mushrooms and CBD. Those would my top two choices, but it kind of depends on how aggressive it is and where it is.

JoJo (02:48)
Okay. Okay. Si Mona, that's Dr. Angie's answer on that. And that's going to disappoint a lot of people because it is, I, I don't know if it's where I'm, where I exist in social land, but I see a lot of it.

Dr. Angie Krause (02:49)
Yeah.

I'm sorry.

I know, I know. You know what? I am used to disappointing people.

JoJo (03:04)
Yeah, that's true. disappoint. Okay, well, we're also going to win some people here. I know it. Okay, this one comes from CJ CJ at YouTube. Does using any of the drugs to calm our kitties prior to transport to the vet in any way skew lab results such as blood work. And this comes from our spicy kitty episode that we did.

Dr. Angie Krause (03:06)
Yeah. Womp womp.

JoJo (03:29)
and using gabapentin and trazodone as a pre-visit sedation protocol.

Dr. Angie Krause (03:29)
⁓

Nope, it won't skew blood work.

JoJo (03:35)
How about blood pressure?

Dr. Angie Krause (03:36)
maybe. That is a maybe. Yeah, with the gabapentin. I actually haven't looked into trazodone. I mean, I think that's a delicate conversation to have with your veterinarian and like, why are you checking pressures? I would have to know more about the kitty, but it's not going to affect blood work at all. So yeah, it's gonna make everyone's life easier.

JoJo (03:38)
Mm-hmm.

but still use.

Mm-hmm.

Perfect, okay.

Yeah, there you go. There's a win. Thumbs up. I'm gonna be like mid thumbs up, thumbs down. Okay, another YouTube question from Felicia Calloway. My four year old pittie which I love a pittie is hungry all the time. I have worked with my vet when it comes to his food, dry food and raw food doesn't agree with him. I gently cook his food and add supplements. I rotate proteins every two weeks. And for the past two years, he's gotten a clean bill of health from the vet.

Dr. Angie Krause (03:58)
Yes.

Mm-hmm.

Okay.

JoJo (04:25)
except for being five pounds overweight. When I rescued him, he was recovering from a hospitalization from something that had left him unresponsive for several minutes. He has seizures due to this. He's also was recovering from Lyme's disease. Is there something I can add to his diet that will help him feel fuller and keep him at a healthy weight?

Dr. Angie Krause (04:42)
Okay, well, I have limited knowledge about this dog, but I would make sure that we don't have a thyroid problem. And I know we have a clean bill of health, but sometimes it's hard to know what that means. Like, does it mean that your veterinarian did a physical exam and says everything's good except for these five pounds? Or does it mean that we've done lab work? Does your dog have Cushing's disease? Do we have chemistries? I think I would want to see chemistries be normal, like especially liver enzymes. And I would want

to see a normal T4 and free T4. And so we could rule out those kind of hormonal imbalances. And then some dogs just really struggle. we've seen that, like Jojo and I have seen that in practice too, where there is some acceptance of like, maybe I'm not going to be able to cut enough calories and my dog's always going to be a little bit overweight. So there's that. But I mean, fiber is really king here.

Like anything you can do, like green beans, carrots, to just add more bulk to the diet to make your dog feel fuller longer.

JoJo (05:44)
answer. Great. So rule out, rule out anything medical would be your first one. And if you've done that already, Felicia, then it sounds like add in some bulk with veggies. And possible your dog might be five pounds overweight. Like

Dr. Angie Krause (05:57)
Yep.

Yeah, I mean, we've definitely had patients

where it's like, know, they're exercising, you know, they're counting calories, you know, they're doing it and their their dog still overweight. And I mean, that happens with people too. And sometimes, I mean, there's a whole subset of medicine that's just for weight loss that we don't have in veterinary medicine. So we have no obesity specialists. And I'm not one.

JoJo (06:22)
No, no obesity specialist.

Okay, next up at Cecilia, this is from Facebook. So you guys, have you heard YouTube, Instagram, Facebook? We exist in these channels, in these spaces. She asked, hello, is Kan Essentials Four Marvels for Cushing's disease helpful? I'll start there, she has a second part to her question.

Dr. Angie Krause (06:45)
Yeah,

I mean it can be. So that's Si Miao San which is a Chinese herb that is supposed to, from a Chinese perspective, of ⁓ clean up spleen chi deficiency and dampness, which is a bunch of metaphorical diagnoses. I have found that Si Miao San by itself is often not enough. I have to make some diet changes depending. I'd have to know a little bit more about your dog, ⁓ but.

it's often not enough, but you could try it. There's no harm in it. And it's an herb that you can use long-term safely.

JoJo (07:15)
and she'll need to get it through her veterinarian to get the Kan essentials or can you get that somewhere else?

Dr. Angie Krause (07:19)
I don't know.

I don't know. feel like everything's available online now.

JoJo (07:23)
I don't trust

anything. A lot of people will grab it on Amazon and like, Ooh, I don't know. Don't do it. Even if it says Kan essentials, unless it's some kind of vetted supplier, which then I don't think it's supposed to be on there anyhow. So start with your vet.

Dr. Angie Krause (07:26)
I wouldn't buy anything on Amazon now. Yeah.

Right. Yeah.

Right, yeah.

We can help you get some if you need some.

JoJo (07:41)
Yeah, her second part of the question is, what test does my dog need to be diagnosed with Cushing's and how else can I help?

Dr. Angie Krause (07:47)
this is so good. Okay, if I had everything I wanted, I would have an abdominal, well, first of all, we start with chemistries, complete blood count, urinalysis, T4, and then we move on to an abdominal ultrasound. And then I like to do an ACTH stimulation test. And that's usually, it's like when you have all of that information, you feel pretty good about it. Sometimes you feel pretty good.

JoJo (07:49)
Yeah.

Dr. Angie Krause (08:13)
just with your chemistry and your ⁓ maybe just an ultrasound or an ACTH stem test alone. ⁓ But those would be the three I would do. And if you need to cut out something for cost, because it's kind of an expensive workup, I would cut out the ultrasound and just do the ACTH stimulation test.

JoJo (08:28)
Mm-hmm.

Yeah, I was going to ask you, can you expand on it? What are they looking for in the chemistries?

Dr. Angie Krause (08:36)
yeah, we're looking for, there's a particular liver enzyme, Alkphos, that gets really elevated. And usually other liver enzymes don't get elevated with Cushings And then maybe the urine will be dilute, won't have a lot of concentration. So that's what we'll be looking for there.

JoJo (08:55)
and then the abdominal ultrasound, what would that show?

Dr. Angie Krause (08:58)
So the abdominal ultrasound, get to actually visualize the adrenals and then you get to visualize the liver sometimes, looks like it has a certain appearance when it looks like it's under the influence of too many steroids. And then the ACTH stimulation test, you're basically testing how much the adrenals are putting out, which in Cushing's disease, the adrenals are putting out way too much cortisol, too many steroids.

JoJo (09:24)
And symptomatically, what is she seeing? If somebody's suspicious that their dog might have cushing, she's obviously suspicious that something's happening.

Dr. Angie Krause (09:31)
Yeah, drinking more, urinating more, eating more, like hungry all the time, like getting into everything, eating inanimate objects, panting all the time. They'll kind of get this like pot belly appearance. Their hair will start to thin out. Their skin will start to get thinner. I'd say those are the main ones.

JoJo (09:49)
Okay.

All right. I already like this. I feel like you're very quick to get to like very clear answers. Okay. ⁓ If we have like four more. Okay. Deanna on Facebook. I believe she's talking about a kitty. Picky eater or kidney disease perhaps that has not been diagnosed. Blood work didn't show anything. urine analysis was not done.

Dr. Angie Krause (09:57)
Yes.

Nice.

Mm-hmm.

JoJo (10:13)
but continued weight loss, although not drastic. Very picky about food. I call him a kibble addict. 10 years old. ⁓ sorry, she. She picks at the food. I have three kinds of kibble out for her to choose from. She will eat tuna, but canned food she walks away from. But it's been a gradual decline in weight. I just noticed she runs to eat, but then she isn't happy with what she's offered. Doesn't that sound so classic?

Dr. Angie Krause (10:35)
Like it's classic inflammatory balances. Like that cat is kind of nauseated, runs up to the bowl and is like, ⁓ I really want to eat because I'm hungry. yeah, but it's like, yeah. So it's time for some blood work. Well, OK, we did blood work. It's time for abdominal ultrasound. Yeah.

JoJo (10:44)
It's like that moment, yeah.

Okay.

And she just needs to keep offering. Well, possibly because she talked to her vet about nausea, so Cerenia and see if that might get her eating because you don't want her losing weight.

Dr. Angie Krause (11:01)
Yes, I'm sure I knew it would begin.

No, I don't like it when my senior cats are losing weight.

JoJo (11:09)
Okay, abdominal ultrasound. Keep offering the foods. If she's willing to eat kibble, you just leave the kibble now.

Dr. Angie Krause (11:10)
Yeah, it's time for that abdominal ultrasound.

Yeah, mean, whatever she wants to eat, but we got to get that abdominal ultrasound and then we can treat. Or if you don't have the money, sometimes we'll just trial treat with steroids. Yeah, because if you're in Vegas betting about what's happening with this kitty, you're betting on inflammatory bowel disease. Yeah, so.

JoJo (11:24)
Okay.

All right, okay.

Diane also on Facebook has a 12 year old male cat just diagnosed with kidney disease because blood work showed increased creatinine was at 2.7, phosphorus was at 5.4. She's giving fluids every three days. He was previously eating canned food but became very fussy. I was given prescription food, dry and wet. He will eat the dry but not the canned.

I've tried several different foods and he refuses them. Any food you would recommend besides prescription food? And just, can I start before you answer? We have entire episodes, two full episodes on cats with kidney disease and what to feed. ⁓

Dr. Angie Krause (12:03)
I mean...

Yeah.

And we have a course, an online course.

JoJo (12:14)
Yep, but I also want to hear your answer.

Dr. Angie Krause (12:16)
Yeah.

Let's see. If your cat has a creatinine of 2.7 and won't eat a kidney diet, then you just feed them whatever they'll eat. It's 2.7 is not that high. And so I would just feed them whatever they want to eat at this point. Now, ideally in later stages of kidney disease, we're protein restricting and that's what those diets are doing. But not all cats are going to accept those

protein restricted diets, they don't taste as good, they're not as palatable. you feed your cat wet food if you can, and if you can't feed them wet food, you feed them kibble. You feed them what they'll eat.

JoJo (12:52)
Is there anything that she needs to be concerned about with the phosphorus where it's at? When do you change diet based on phosphorus? Or do you not?

Dr. Angie Krause (12:58)
⁓

yeah, mean the renal diets are low phosphorus, but by the time the phosphorus starts creeping up, having a restricted phosphorus diet isn't enough. You often have to bind it in the gut too. So you'll start adding a phosphorus binder. And so I'd have to look at the reference range. I don't think five is high. It seems like five is probably still in the reference range. And so I don't think it's time to bind it yet.

JoJo (13:24)
Yeah, those binders seem like they're hard to get in. If you have a choosy kitty on top of it, just hard. Okay, but she's giving fluids every three days, so she's already on top of it. She's doing good things. Okay. ⁓ well this next question is also about phosphorus diet. didn't. ⁓ Emily on YouTube, do you recommend a low phosphorus diet for senior cats, even if their lab showed normal kidney function?

Dr. Angie Krause (13:28)
They're hard to get in. because they're...

Yeah. Yeah, she's helping.

JoJo (13:52)
That's question number one. should it? Okay. I feed my 13 year old raw with a completer. I mostly use meat with bones, but have been advised to use boneless meat and a completer that replaces a calcium source to reduce the phosphorus. So she's wanting to hear your thoughts on that.

Dr. Angie Krause (13:54)
No.

I think I would have to see more of the practices, like what the balancer is, who made the balancer, is it AAFCOBalanced?

JoJo (14:18)
I actually believe

she scheduled a consultation. I think she's on your consultation schedule now that I see her name. So you'll get to have all that conversation in depth.

Dr. Angie Krause (14:23)
great. Okay.

Yes. Okay, we're gonna dive in.

JoJo (14:28)
Yeah, high level though, she doesn't need a low phosphorus diet for senior cats, for normal kidney function.

Dr. Angie Krause (14:33)
I mean, yeah,

I love those senior cats that have normal kidney function. I'm like, good for you. It's like the women that are like 80 years old and like still lifting weights and running marathons. And you're like, nice.

JoJo (14:37)
Yeah.

huh. Yes. I want to be her. Okay.

Which yeah, I love this because I see all these avenues in which people are reaching you and then they're making their way to your calendar. And you know, you used to do these Instagram lives, but it's just, have better, we have better places. This podcast can go into so much more depth.

Dr. Angie Krause (15:02)
Yes, yes, the Instagram lives and I'm in the clinic so much more than I'm time to do the lives.

JoJo (15:06)
Yeah,

that's true. I know those lives are hard. Okay, Mandy on Facebook. Okay, this is a patient that you must see in clinic. So the patient's name is Larimer and he's due for his rabies booster, but I don't feel comfortable giving it to him because he's had a reaction with the last one that he was given. At almost 12, I feel very strongly that he's protected from all his previous boosters. I have been

deep diving into the research and have been heartbroken to read too many stories about dogs becoming severely ill and even dying after the rabies booster, especially in their senior years. Then there's this new mRNA vaccine that is being used now. We were supposed to go to Romero's Canine Club and Tap House this weekend, but their insurance likely requires a vaccine and may not accept hiders or exemption letters. I'd love to hear your thoughts.

Dr. Angie Krause (15:58)
Oh my gosh, I have so many thoughts on this. Is this our last question?

JoJo (16:01)
⁓ yes. Well, there's one more, but it's really simple, but you could go into this one.

Dr. Angie Krause (16:03)
Okay, just okay. Okay.

Okay. Well, first of all, I know, I know you're talking about, ⁓ I know this dog and, anytime a dog or cat has had a reaction to a vaccine, the worry is that the next time we give the vaccine, the reaction is going to be worse. And I think it's difficult to know. First of all, what, what is a vaccine reaction is not really defined. And I think that's.

frustrating for a lot of people because we think of anaphylactic reactions where the face gets big and you know, basically you like it's a hypersensitivity reaction. But dogs and cats can have other reactions like maybe they get a urinary tract infection or maybe they're vomiting for three or four days or like they can just come in so many different forms. And I think

Veterinary medicine is kind of quick to dismiss anything that's not anaphylaxis. And I think it leaves pet parents feeling really invalidated and mistrustful because veterinarians will say, ⁓ I I gave that vaccine and I know your dog vomited for three or four days, but it had nothing to do with the vaccine. Like when we do that, we just distance ourselves from our clients.

And because you're like, wait, what do you mean it had nothing to do with the vaccine and especially dogs or cats that like never have vomiting or anything like that. It's just, it becomes problematic. So I just want to acknowledge that. And so I always try.

JoJo (17:32)
Well, on top

of that, we end up not reporting it, right? Because when we don't believe it, then that data is not getting to the manufacturers of these vaccines.

Dr. Angie Krause (17:35)
and then we end up not reporting it.

Right. Like I'll, I just report everything that I see that I'm like, Ooh, could that be? And then I let the vaccine manufacturers decide what, what they do with all that information and how they assess it. Because I just think we have to start reporting more. so in this case, it sounds like she doesn't want to do another vaccine and, ⁓ you know, that has its own problems.

to have your dog not be up to date on a rabies vaccine here in Boulder County. We do have rabies in bats and skunks every once in a while at Coyote. And so it puts, kind of puts everybody at risk. And so if you don't want to give the booster, then you could do a titer test where we check the level of antibodies. So the amount of protection your dog has, and that can be helpful.

I use that especially in dogs with autoimmune disease, but the problem is, is not everyone thinks that's like a valid form of protection because on some level it's only telling us our protection in that moment. It doesn't tell us our protection. It's a timestamp. so I, yeah, so in this situation where she's, you know, wants to be in this social situation and they won't allow it, then that's really hard.

JoJo (18:41)
at the time stamp.

Dr. Angie Krause (18:54)
I don't know that I have like the answer. think you just have to decide, you know, what you want to do.

JoJo (19:00)
Right. Yeah,

there's a cost to either decision. So it's kind of weighing, like, the risk assessment. Like, what is your risk level in terms of which one feels harder? Which one can you live with? I mean, that's really, there's consequences to both.

Dr. Angie Krause (19:04)
Right.

I know. Because it's possible we

vaccinate this dog and nothing's going to happen and it's going to be fine. But it's also possible. I would say that I have not seen a lot of reactions to rabies vaccines. I have not.

JoJo (19:29)
What about this new technology that she's talking about with the rabies vaccine?

Dr. Angie Krause (19:31)
I don't know

who has that technology. I have not used a single vaccine that has that technology. ⁓ I still use BI, which used to be Mariel, and it's the same technology that we've been using.

JoJo (19:49)
Yeah, so maybe

that's the compromise is depending on the vaccine technology. And also I don't, I don't know where she's seen the severely ill and dying senior dogs, but that's a scary rabbit hole to be in. And that would be terrifying.

Dr. Angie Krause (20:03)
It's scary. Like if you get online and you look for something, you're going to find it. And I think some of these dogs probably are having a vaccine reaction, but a lot of them probably aren't. And I hate to be the veterinarian saying that because I do think we have a problem with invalidating people, but a senior dogs also just get really sick suddenly and die. Like that also happens. Maybe it's, you know,

Correlation and causation. So just because two things happen together doesn't mean that they are related. Doesn't mean one caused the other. But I also don't want to just invalidate everyone's experiences. But I join these groups on Facebook that like, know, Apoquel killed my dog or whatever. Cause I lurk in there. I'm like, what's going on? Because in clinical practice, someone who's giving these vaccines every day, I just don't, I don't see this.

JoJo (20:55)
right

and even if they were all if you're finding the

Dr. Angie Krause (20:59)
But

JoJo (21:00)
the group. So there's an abundance of dogs in this group that are having that experience, but that group is what percentage of this group, right? So what is the actual percentage? But if you're only seeing, ⁓ it's just, it would be terrifying if you're only seeing the death and severely ill.

Dr. Angie Krause (21:08)
Right.

Yeah, well those groups scare me because I'm like, my gosh, what have I missed? And then I have to remember like, you actually do this for a living. ⁓ you know, I don't know, like that those groups are hard and I never want to invalidate anyone. And so I don't want to go in there and validate people, but I think probably it's a it's a correlation and causation problem.

JoJo (21:19)
Yeah, totally. Yeah.

Okay, really, it sounds like the two of you need to have a deeper conversation and land what feels good for her.

Dr. Angie Krause (21:43)
Absolutely. We need to talk about our options, talk it out. And she's totally fun to hang out with too. And I love her dog so much.

JoJo (21:52)
I bet. Yeah.

Okay. I mean, there's one more question. Well, the last question on here is a really easy one. It's at C. Caritha on TikTok.

Dr. Angie Krause (21:57)
Okay. Is that it? Yeah, let's do it.

JoJo (22:05)
What kind of probiotics should she give her cat?

Dr. Angie Krause (22:08)
Vis biome without knowing anything more. I'm gonna guess it's

JoJo (22:09)
Yeah, that's your favorite. I know. And we don't even carry

that one. We carry probiotics, but we don't carry vis biome.

Dr. Angie Krause (22:16)
Yeah, I mean, the only reason why we don't carry is because it needs to ship refrigerated. And I think you would kill me. I think you would quit. You would be like, no. I mean, I love the probiotics we use too. And I usually circulate probiotics. so without knowing more about her cat, like I'm assuming her cat has diarrhea. So I'm like, okay, if your cat has diarrhea, start with his biome. It's also really expensive.

JoJo (22:24)
I was just gonna tell you I would kill you. Let's not. Can we just not?

Dr. Angie Krause (22:42)
And so we carry a couple other probiotics. And what I like to do is go through different probiotics and do a jar of Vis biome and then do a jar of the RX biotic and, you know, just cycle through. Yeah.

JoJo (22:53)
Okay.

And by the way, you can get Vis Biome on at Vis biome vet, or you can email me. I can get you a link too so either way we can get it for you. So that I just won't ship it to y'all have somebody else ship it to you. Period. So

Dr. Angie Krause (23:00)
Yeah.

Yes. know

JoJo would not do that. Shipping is stressful right now. I just want to say that like trusting USPS right now is getting a little dicey. So I can't imagine if we had something that needed to arrive refrigerated.

JoJo (23:12)
Okay.

Right no, I don't want to disappoint people Once it's out of my hands. It's out of my hands. I Do not have control of USPS

Dr. Angie Krause (23:26)
No, no, well...

If you

want to ask me more questions and if you want to just hang out with me in the same format, it looks exactly like this. You can go to boulderholisticvet.com and you can click book a consult. And if you see that I don't have any times open, you can just call us or text us or email us and say, hey, I want to get on your calendar. Or if the times I have open don't work.

you can reach out to us and we'll figure something out and we will collect all your records if you want us to. I'll review them and we'll get together and I'll help you make a plan.

JoJo (24:09)
Alrighty, see you next time.

Dr. Angie Krause (24:11)
See you next time.

Bye.