RawPetMedics Tuesday Live: April Q&A

And we're live. That's not too bad.

Oh, it's just me. Oh, proper order. Okay, okay. Nick is still away, of course, sunning himself. I was gonna say getting a tan, but he's definitely not getting that. Um, yeah, he played an April Fool's Day joke on us there last week, um, and he said that it seems like my complaints are, uh, are striking home in the hotel he's staying in. And the management company contacted them the very next day and said, would you do a tour of our hotels worldwide and see if the quality is up there? And on first reading, I have to admit, I read it going, there's no way that would happen. You give out to them about something and then they award you with the— and then I realized April Fool's Day because I was playing my own April Fool's Day at that time. But yeah, very, very naughty, Nick. I'm sure he's listening here. I'm sure him and the family are gathered around a log fire on the beach just listening to us tonight. Um, anything exciting happening with you, Bren?

Uh, I have been up in, uh, my woodland working hard to take care of the dendron. Yeah, yeah. So this is my green project. So anybody who wants to support us, wants planting trees, I've got 1,000 trees to plant. If you want to come and help, uh, give us a shout. Okay, we've got to do that.

But, uh, do you own a forest or are you putting in a forest?

A forest? Yeah, it's only 5 acres.

Oh, Vegas, cool. And like, how do you— like, is it a bit of land that you think wouldn't be much use for anything else, and so you're popping—

oh yeah, look, this is in the Lake District, so it's on a fairly sort of steep hillside, um, and we've just had a plant, um, disease, uh, notification served on us to take out all of the larch, not because we've got the disease but as a preventative. Yeah, so unfortunately, really sadly, we've lost about 400 trees. Oh, uh, so they're currently laying on the forest floor, uh, and, uh, we are, um, about to have to replant. So you have to plant roughly 3 saplings for every tree that's gone, uh, just because you're going to get some attrition from the deer and squirrels and stuff. So we've got red squirrels, so it's great. Uh, we've got a guy who takes out the grays. Um, I've still yet to— he keeps offering them to feed to my dogs. So that's, you know, every time I go up there I get a squirrel.

Not an easy thing to skin, but this isn't a very pleasant conversation, but we're all raw feeders here, so tough. But there was a girl, there was a girl, lady that was helping a while ago, and she was feeding squirrel to her dog because her dog had such chronic food intolerances. And she was just showing her how she does it. It was just like, you know, you just pull his jacket off and it's like, oh my God, that's how— I mean, she could skin a squirrel in seconds. I can't imagine how you would even start doing that.

What a loss of good fiber?

Has nothing to do with—

That's what my dogs would say.

Yeah, I'm not sure, I'm not sure they'd eat the whole thing. I think that's a very furry cheeseburger. I'm pretty sure they'd—

Really?

Yeah, I think so.

Right, okay, we've got to stop you right there. Now we're referring to cheeseburgers already, okay? And we have to officially apologize for last week, slight mistake that we made, okay? So currently, um, so Pets at Home quite a while ago sold 3 referral practices to Lineus, which are associated with Mars Corporation. Last week we made a slight error, didn't we, Conor, in the middle of our rant, because there was a horrible poster placed up that is actually available in many other vets, other veterinary brands apply, I think, and It was, yeah, tantamount to misleading, I think, because it was all about calories and not about nutrition and, you know, associating weight loss with calories. And we made in that desperation a slight error that actually Pets at Home were owned by Mars Corporation. They're not, okay? They are independent of, as a big organization, and they are not associated with the Mars Corporation. So we do apologize officially, and I'm sorry for some of you guys that may have seen the video disappear off Facebook. That's what what happens when we get it slightly wrong. So we put it back up and we've made the appropriate edits and hopefully you can now see it. So we do apologize.

We were off air for about 3 days. I'm sorry. I'm sorry. To be clear, I didn't say the words didn't come out of my mouth that Pets at Home were linked to Mars Inc. I said, did I actually say Pets at Home? Oh no, I totally meant to say Vets for Pets and that was wrong too. OK, so before I dig it any deeper, a little bit of some bit was sold to someone, but not there's Okay, they're all still independent. I apologize, I'm very sorry.

Also, thanks Rowena. I, I know that's, that's— so we're safe for now.

Absolutely, for now. Yeah, uh, listen, before, before we go any further, listen, Karen, uh, our right-hand woman in here, Karen Reid, had to put down her beloved, uh, Newton. Uh, he went to sleep there yesterday, and that was just a shocker. My God, I think I was as affected as that as anybody close to Karen, and I only met the dog once. She was so profoundly attached to this dog, aren't we all? But, you know, 16 years hand-feeding your dog many times a day, and it's just like, you know, unbelievably beautiful little dog. And that big dog, what am I saying? But anyway, so poor old Karen, I wouldn't even say she's listening tonight. But, um, yeah, so very sorry to hear that news. And, um, you know, uh, hopefully Karen is good to herself over the next few days. Yeah, totally, totally. So, um, look guys, we are Raw Pet Medics. We're missing one, there's only two of us tonight, and tonight is, um, uh, FAQs. So questions that come into our various places, one place is patreon.com/RAWPETMEDICS. You can post your questions there and we do try to get back to those questions as they come up anyway, but as they mount up, we queue them for the end of each month. And so that's where we get most of the questions from. And we're also going to pull a couple of doozies from the Facebook page that popped up over the last 2 or 3 days. And we got 1 or 2 direct into me as well, which we're going to call up as well. So if we can get to 5 or 6, Bren is going to be fielding all the veterinary questions alone, but he's well able. So Do you know where you wanted to start, Brian? What's at the top of your list?

I think I would love to start because you know a bit about this, and actually it was one of the earliest questions. Okay, people are worried about these little babies. Okay, so lots of stuff said that they're toxic, they're horrible, you shouldn't be going anywhere near them for fresh food feeders. What's your view?

Any problem with avocado meat? I mean, it's just fantastic. I never saw a particular issue with that. Isn't it one of the only vegetables out there that has fat in it? So I kind of thought that sounds pretty good, or a particular type of fat. I mean, there's plenty of veg oils and stuff, but yeah, so I don't think that's the problem. I think the problem is obviously the hardy stuff on the outside, but particularly the nut on the inside, and that is squash ball size, and everybody knows squash balls are stone cold killers. So that's probably what people are worried about. Bren, is there something in there I'm missing? Is there something in the meat?

Yeah. So don't feed them the skin either. That's actually not so great. That's where quite a lot of that— well, as with all fruits and veg, they tend to stick stuff in the skins to try and keep the pests out. Okay. So there's lots of stuff in there that, you know, can be off-putting, but the flesh is fine. Okay, really is. Do you know what the most dangerous thing about these things are? Is when you stick the knife butt into there and I sliced right— I don't know whether you can actually see. Do you, can you see? You probably can't see, can you, the scar?

No, no.

I've actually sliced all the way through here, okay, down to the bone, uh, with a very large carving knife because I stuck it in the butt and then you twist to take the stone out and I went straight through my Oh, that's not good.

Don't do that. Don't do that at home, guys.

So I've still got a numb bit, so don't do that. That's the only bit. But great if you can scoop out the flesh with a teaspoon, save you trying to peel it. Okay, dogs love it.

Yeah, definitely. The temptation is that we give the dogs kind of the older bits that we weren't eating, and the problem is with old veggies when they go brown, that oxidizing bit, that actually doesn't work out for doggies. So while you might kind of say, ah, leftover bits of dinner and stuff, if your avocado, as avocados tend to do, I'm not ripe enough, I'm not ripe enough, I'm not ripe, I'm rotten. You have to be absolutely perfect with an avocado. You know, 10 past 4, open the avocados!

Where do you keep them?

They're not happy anywhere. Avocados are not happy anywhere. Apparently they only like being flown from A to B and around the world. But there's a great video of how you get a stone out of an avocado. You won't believe it, it's so simple. So this is how chefs do it apparently. And so you chop the avocado in half, okay, and one half is going to have the stone in it. And you put your fingers around the stone. So the stone is there and you put your fingers around and you push with your thumb from the back and the stone just goes boop and it pops out. So you just hold the fruit and you're pushing it back and the stone just pops out. And I was like, I couldn't believe it.

Mate, you're 25 years too late. You're the one with that.

I was just going to say, I thought you were going to say everyone knew that. I said, well, you didn't, Bren. Okay, so that's our tiles.

25 years too late. Hopefully we're saving thumbs of youngsters out there right now.

There you go. This is how we do it. What's the good— what is the good fat in avocado? It's the fact that it has unsaturated fat.

Yes.

What's the— what's so fancy about avocado compared to other veg? It's the type of fat that it has, isn't it?

It is. And it's also the fact that it's within the flesh of the fruit. Okay. So what you've got effectively is high levels of omega. It's a bit like olive. Okay. And you get all of the fact that the polyphenols, the greens and stuff that are in there, actually staying as an antioxidant. So it keeps those fats from oxidizing. Okay, so that's what's brilliant about the avocado compared to seed oils, which often these days are extracted with chemicals. They're put through a special process, a little bit like refining oils, which gives you then fractions. But in that process, you're oxidizing those double bonds, those unsaturated areas of the fat. And so you're not even just hydrogenating them and making a saturated fat, you're actually making an oxidized fat by adding oxygen into that. So, oh, something I forgot to say, actually. Do you know what? I bet you haven't pressed record.

I am recording. Are you not recording?

I am now, but that's the avocado anyway. So Pete's gonna have your guts for gardens for not reminding me.

He's gonna lose his mind. Oh my God. Um, I don't know what to say about that. Sorry about that, Pete. Um, so look, look, I've got one here, Bren. This is a serious case, okay? So, okay, it's actually a client that I was talking to, um, and this dog was a bloat case and GDV had the actual flip. So this did, you know, bloat with torsion. So bloat is where your dog kind of fills up with gas and, you know, often relieves it with a belch or a fart and it can be quite noticeable. So it's not just your dog's farting, that's not bloat. You will see it in your dog, you'll notice that it's a gassy issue and they build up and it's particularly alarming for deep-chested dogs because this bloat can for some reason in some dogs it can fill up their stomach and when it fills up their stomach, this gas like a balloon from the inside and a little twist can appear at the top and the bottom, Bren, or just on one end.

Top and bottom.

Top and bottom.

It becomes a closed sack.

A closed sack of air that keeps and it's— Not air. No, no, well, no, not air. Okay, fair enough. Carbon dioxide, I suppose, if you want to be particular. Same thing.

Yeah.

No?

Fermentation. Yes, so it's fermentation. So what we find is that it is the gases that have been sampled from those sacks are not equivalent levels of gases of nitrogen and oxygen and carbon dioxide that you would associate with normal air. They are actually levels of sometimes methane, hydrogen, you've got carbon dioxide and no significant levels of nitrogen, etc., in there. It is fermentation gas. So that's stuff that you would—

from the intestines.

Yeah. So any— so the bacteria have got hold usually of high starch material and are causing that fermentation process to expand gas into the stomach.

Yeah. We used to think bloat was caused by, you know, aerophagia, air coming into the mouth. So we'd high feed stations. They used to be associated with bloat. Well, that's because Great Danes suffer an awful lot of bloat and they have high feed stations. But that's a correlation. Correlation and not a causation. And so we're not really thinking about the air coming in and exercise doesn't seem to be playing an issue in it anyway either. A lot more of the cases, over 80% of them happen after an hour, well after. And the reason that hour is so important is, and particularly in this question that we have coming up, is because the food then eventually hits the intestines after 40 minutes, 50 minutes, an hour. And once they hit the intestines, you grow this wrong bacterial group and they get to farting and producing bacterial ferment gases and that travels up in some of these dogs and then they're not quite sure why that flip happens, what the spark is, is it the ligament that holds the stomach to the liver, is it whatever is in this dog but it can flip and it can cause— it's enormously dangerous, very painful and often fatal in a lot of breeds, particularly some breeds are just shockingly high death rate from it very quickly. Anyway, sorry, sorry, the question is—

the fact that it cuts off the blood supply too so when it twists supply that comes from top and bottom, okay, to feed the stomach lining. As soon as you are twisting that, okay, then, and then the gas expands, not only have you got a twist in those vessels, but as the gas expands, it then closes down on that twist, so it actually obstructs the blood vessel and blood flow to the stomach. So you end up with a stomach that suddenly becomes not just hypoxic, but it just dies, and then effectively it can rupture much very easily. So yeah, super horrid to happen. You need to get it treated super quick, decompress them. So your vet may even stick a large needle into the stomach through the abdominal wall just to deflate them to try and allow perfusion back whilst they sort out the rest of untwisting it. And sometimes operating, if they can get a tube down the throat, that's great. They will put that into the stomach and get gases out, that can give them vital, you know, time to get the operation done.

I feel like, you know, when the dog's got bloat, it's kind of like Violet Beauregard in Willy Wonka where they have to squish her, you know, to get all the juice out of the blueberry. Do you remember that? It's not quite the way it is. No, is that a bad analogy?

No, this is—

Don't squeeze it, don't! Yeah, please don't listen to me. I'm not a vet. But look, guys, here's the question. Okay, so this couple were on and We've actually done a whole night on bloat, guys. If you think we're just dancing over the issue, we've already covered this topic a lot, but that was just a rehab. So this person had the operation, it was a Weimaraner, Otto, great name. But anyway, had the issue and after he's had the flip, it's so terrifying. You'll never sleep another night's sleep if you experience that with your dog. And you can actually staple the stomach to the liver, Bren? Is it hepato—

No, you staple it to the abdominal wall.

So you're basically, once you've untwisted it, You can—

so you can create various sleeves to actually fasten that through the muscle of the stomach wall. Okay. You can suture it, you can staple it. There's various options. But once it's untwisted, you stick it to the stomach wall so that it can't flip again.

Yeah. Okay. And so they had this and— but so the dogs now, they realize that, you know, they're trying to avoid some of the things that cause this. A lot of the papers, 2 or 3 papers point their fingers at kibble, at high starch, high soluble fiber diets. Things that feed the wrong bacteria down the gut. So you want something that the bacteria want to eat and you don't grow the wrong bacteria. We believe raw dog food is going to be the answer and don't go mad on the veggies and don't be piling in carbs. So a basic normal raw dog food diet, it's not— for most cases, believe me, that is the solution. For this particular case, this dog keeps on bloating no matter what we feed. We've gone extremely plain. We've tried, say, raw lamb, complete raw dog foods. We've tried cooked versions of that, a cooked lamb version, a cooked beef version. We have been through it and they've been very diligent. And I was like, no, at 45 minutes, 50 minutes, once that food hits the gut, he swells like a cartoon and it's reliable on the clock. Then he belches and farts it all away and then builds up again and then he'll let it go again. And that will be that. And it's like, how is this happening on every food? We've tried probiotics.

So not instant, not instant.

An hour after eating food, 45 minutes, an hour on the button. And it was like, here it comes and he starts to fill up. And they said like, we can't not be around for 2 hours after feeding the dog every single meal. He's on 2 meals a day. Where do you go now? What can possibly be done? Like, what am I missing here?

Okay, so a couple of things. One, check the microbiome. So if there's a way of getting to pet biome, animal biome, there's a couple of options. It's worth just checking some poop samples. Checking what's going on. I presume he's been firm and he's not had diarrhea, but, you know, it's worth just checking. There's a few methanobacterium, okay, that can cause some problems with normal gut function. It is possible that we have an issue with the pylorus. That's the exit from the stomach, and that can be if there's either sympathetic excess because of inflammatory process, or there is an interference with the vagus nerve from the operation. So it's really hard, but the innervation to the gut comes down the vagus nerve, the parasympathetic nerve from the brainstem. Okay, nerve 10, that helps with normal gut function. It's a two-way street, but it's really important with normal gut motility and getting things moving in the right direction. And if there's some damage because of the original twist that's happened, okay, we've talked about how necrotic that tissue can become, or indeed from the surgery, from where they've had to staple, you know, and cut, and they may have had to reset some area of the stomach, etc. Those are things to consider, that there may be interruption to the parasympathetic structure going through. Okay, so normal propulsion needs to be checked. So they can do that by visualising through X-rays how quickly the stomach empties. Okay, a test at home may be to simply liquefy the food and see actually if the food goes through without that level of gas and it's flowing very quickly, then it may be that it's just going straight into the small intestine. There's very little stuff that needs to happen in the stomach. You can even make a raw soup with your raw food. Just reduce any solid bone material obviously out of that. It would just have to go in as ground bone in some of the premades, etc. Just add water. See if it goes through, get it out the other end. You can do a TLI B12 folate, which will give you an idea of level of wall inflammation and bacterial overgrowth.

Sorry for stopping you there, Bren, but Julia and Tristan are both on here, so that saves me having to hide up any of who they are. They're the owners of the dog, and Tristan says he has had his solid stool. Yeah, we knew that. Full foal biopsy of his intestinal wall. And he clearly has a lot of inflammation found on the biopsies.

Yeah, so honestly, obviously I can't go into specifics because against Royal College guidelines, I'm giving you a general thing of what to expect for, you know, dogs which suddenly continue to bloat massively afterwards. And there's certain other investigations that can do. Obviously, we would be very specific and individualize the information and care for Oto's particular case if we were in front of him and doing all of these other things. But general things to talk about to the vets that you're with is looking at bacterial types. You know, using things like a Trantol can be really useful to reduce some of those fermenting bacteria. If you know for sure it's fermenting bacteria, if you're finding that he's actually positively aerophagic as well, may even— and this is one of the reasons for looking at how well he's emptying his esophagus, how well he's emptying his stomach, is looking at is he having problems with that parasympathetic nerve? And that could mean that because of what's happening in the esophagus, he's actually swallowing air. In this case, it's moved back to that consideration. Is he aerophagic as well? But when you're saying it's happening about an hour after eating, I still am convinced it's fermentation. Some bacterial checks need to be done. We need to consider how we would reduce fermentation. You've talked about making sure that you're reducing some of the starches and sort of prebiotics. And this is really, really useful for people out there that have gone, okay, I understand my dog has an issue with dysbiosis and I've tried all of these prebiotics and probiotics. And they get worse. Okay, that is an indicator to you that there is a bacterial overgrowth and you will need to use something like a Trantil first to clear the way, to reduce things. Okay, now your conventional vet may say, we're going to use a 6-week course of antibiotic. You know, that's your choice if you go conventional. But ultimately then you have to be really strong with your good probiotics and prebiotics after that so you don't get the overfermentation problem going on.

Julia says just a total span on the works. Sometimes it happens 4 or 5 hours after food. Sound, Julia, thanks. That makes it even more complicated.

Just to confuse me, you want to throw me curveballs in there.

I think a very, a very immediate cheap option is going to be try a Trantle. I mean, when you go to the website, it says you're— it's bloating relief. It's what we do. I mean, give a Trantle a go. That's horse chestnuts kind of product, isn't it? A Trantle is not what that's—

yeah, it's a, it's a It's one of the heartwoods, uh, of, um, uh, South American tree alongside, um, which is ground up alongside, um, chestnut. I think there's peppermint in there and, um, uh, what's the other one that come— will come to me.

Anyway, Penny Vandermeule says, um, uh, that's a chiropractor visit with her dog, uh, has sorted out the dog's gut. The L6 is not related to gut one, is it? L6 is pancreatitis as well. And so, and then what about acupuncture, Brent? So they're saying if this is a vagal nerve thing, can you affect these things from the outside with pins?

So what you need to be aware of is that some of the back issues that we get interrupt the parasympathetic because of the overdrive of sympathetic innervation. Okay, so if you've got any inflammation, stimulation, entrapment of nerve, then you can get sympathetic overdrive and that will actually interfere with your normal parasympathetic things. It's the same as people and dogs that get super stressed, you know, having an issue with their normal gut motility. You know, the sympathetic is all about stopping normal function and getting you ready for, you know, the attack or the to run, you know, the— so all of that side of things. So, you know, we need to decrease some of the sympathetic drivers in those situations and then review how we do that. So that's why acupuncture has all sorts of other things. You know, it doesn't necessarily mean it needs to be specific points down the back that relate to the gut. It can, in that sense, it can be other areas. So it might be large intestine sort of meridian coming up through that we might be using. It might be small intestine meridian running up the outside of the arm that they're using and stimulating. It could be stomach meridian down the shin that they're using. There's all sorts of other remote areas that we may look at. Okay, so there's other things. Good to have a consultation with an acupuncturist, okay, who can go through specifics for your pet as to what's happening with their heat, damp, all of those aspects too, because that can have an effect.

Yeah, sounds good. Brian, do you want to move on? Do you want to do another question? What else is on your list?

Yeah, so we've got the Patreon, uh, one, uh, we've got liver disease. Um, this is from a vet nurse. Okay, so yeah, um, has a 10-kilo Frenchie with epilepsy. Um, she's on a few drugs, so phenobarbitone, zonisamide. Zonisamide is the one that I told people about, it's linked to the sulfonamide drugs, so you've got to be aware of autoimmune disease. Okay, it's an antibiotic, normally sulfonamide drugs. It's one of the ones that can overstimulate your immune system and cause some autoimmune disease. So be careful with that one. Lavateracetam, that's easy for me to say. Her last two blood tests showing raised alkphos, which is going to be raised pretty much if you've got any inflammatory issue going on. Okay, so we've got to be aware it's not just liver. Low albumin, however, and total protein suggests that the liver is not managing to produce the protein or we're losing excess protein out in the gut or kidneys. And it looks like low calcium as well. So we need to just double-check your nutrients going in are appropriate. Okay, give her Epitor supplements, plus she's fed Poppy's Picnic, so I would hope— but it's cookable raw— I would hope they've got their mix right. But you can give them a ring and double-check if they've got the nutritionals for you, for you specifically. Poppy's Picnic should be pretty good at picking up the phone, so give them a call and double-check your nutritionals. He won't eat raw, pure raw, so it's got to be cooked or lightly cooked. Wanted information on natural liver support that we mentioned in the webinar. So there's a few things that you can use that are available from your own vet. Okay, so the VetPro and NutriVet range. Have products which have some Boswellia and Cardus marianus, which is milk thistle, in them. You can also get Denamarin and a few other milk thistle derivatives, okay, which, you know, are available through every single veterinary wholesaler. So, you know, you can ask your vet about those pretty much around the world now. You know, it's renowned for being great for liver support. Now, there are some other options out there from a complementary point of view that we can give. Celadonium, Cardus marianus, Taraxacum mixes. Okay, so these are things again, speak to your holistic vet about options that are specific to your case in this particular thing. But yeah, we need to rule out, are we losing protein through the urine? So that's urine test needs to be done. We need to rule out, because 800 isn't massive, okay, in the grand scheme of things for alkaline phosphatase. And I would say that, yeah, check your nutritionals going in, make sure your protein levels are appropriate, just check that there's nothing else going on in the gut that's maybe upsetting things as well. You can get a liver function test. So rather than just relying on those three aspects, is actually take them in, get some bloods done for just the liver enzymes, feed them, and an hour later take the bloods again. They get sent off and we can look at the function of the liver too. Okay, so that's worth looking at.

You do the tests of the wee. Can you just have those kits at home and does that cost too much or do you have to go to the vets for that?

For the For the urine, you can, well, you can do dip tests. They're not as accurate as some of the actual protein creatinine ratios that they would do. So basically, if the urine dilutes, there's some ratios that you need to look at to actually get specific levels of microalbumin and protein within the urine. So I mean, certainly if you do a dip test and the protein level comes up really high on the dip test, then I would definitely say you're a high candidate to go and get the other things. By the time you've bought 100 strips, it probably is just as cheap to go and get that test done.

Yeah.

By your local vet.

So Fiona Murray is always on here and related to livers, she just said that any experience of seeing high ALT with all other bloods within normal range? No symptoms at all, otherwise healthy, young, raw-fed dog, 3 years, no conventional meds, only puppy shots. She's ticking all the boxes and yet ALT is up. That's not the first time I've heard that actually. Why would ALT be up?

So right, okay, just this is something that I've come across reasonably commonly and it's— so we need to know specifics about that ALT. Okay, we create a range for our blood results. Excuse me. And we call this a bell-shaped curve. So this— any population usually fits within a bell-shaped curve. Okay, so it's the one that goes like that. Okay, what that means is that underneath that curve is the entirety of any population in normal distribution. Okay, so you expect there's going to be those at the bottom end, those at the top end, and everything in between, but the average, okay, the peak of the bell, okay, is going to be where the majority of the population is. So what do they do? They, in order to try and hone in the parameters of your blood test for the population, they chop off the top 10% and the bottom 10%, which gives you the middle 8% of any population. That fits within the curve, the majority, so 80% of the population are going to be in there. So they use that parameters. That bell-shaped curve moves dependent on breed, dependent on, um, other elements, stress, diet, yeah, all of those things. So that curve can move around. So what we sometimes find is that if we do our bloods in early age, it can be really useful as a reference point for your dog. Okay, so doing a wellness profile can be really useful for your dog whilst they're healthy, because then if we redo them when they're sick and that particular blood parameter has moved significantly, then we know that that is significant for your dog. So what we might end up with is a dog that moves from the lower end of the normal population to the upper end of normal population, and if the vet isn't on it, they won't see that as being out of the normal range. Okay, so we need to say, right, what we need to look at is that trend for the ALT. Has it gone up? If it's just over the normal range, i.e., it's within 50 points or so of the normal range, that may still be in the normal distribution for your dog. It may have been one of those outliers that was at the top end of the population.

Yeah.

So if your dog is perfectly healthy and it falls in that top end of that range, just outside, my advice is to monitor. So give all of the liver support by all means, if you wish, but take another sample in 2 weeks' time. Don't get super anxious about going in for biopsies and everything else. If it's outside of that and/or when you've retaken it, it's getting much worse, scan, check that there's no little lumps or bumps, there's no areas of infection that have got in there, because ALT is associated with the cell wall of the liver cells. Cells, and often if there's any disruption to those cell walls, the ALT will go up.

Okay. Okay.

Unlike the alkaline phosphatase, which goes up at the blink of an eye, which is not necessarily associated with the cell disturbance.

There's a— look, just having a glance at a couple of little forums here, but high ALT readings in raw-fed dogs now and again, it's popping up as a question here, and somebody was saying, oh, toxins, it can be high in toxins is what their veterinary nutritionist told them. And so raw fed, of course, you know, that's where you're going to get all your toxins from, isn't it? Fresh food. But, you know, it is worth thinking that, like, you know, it's so often circulates your liver, you know, when you consider what it does. It's so often something that you may be putting in, except that I know Fiona and that I know that dog is on one very natural lifestyle. It is worth thinking, well, maybe you would simplify the diet greatly, cut out any sort of treats that come from— no offense pet stores, but you need to know what it is. So you'd say, okay guys, just do 2 or 3 weeks on lamb, 2 or 3 weeks on, you know, duck. 2 separate diets. So when you do the ALT readings, you can at least— if you did 2 different readings, I'd have no idea what the cost of this is, but you might say, okay, it would be interesting to see. And also different suppliers, you might just vary it around because you want to lop off the low-hanging fruit and say, okay, maybe I'll stop feeding intensively reared poultry for the moment and try grass-fed beef for a while, or grass-fed and at least then you're removing any sort of concern that non-organic poultry might be an issue.

And look, if you're doing all of this and the direction is in the wrong direction, i.e., you're getting a worsening, as I said, when you're monitoring that, that's where the advice changes to please scan them, check their gallbladders, okay, that you've got normal gallbladder emptying, that you've not got a biliary mucosal forming, which is where you get really thick, sludgy mucus being produced by the outside of the gallbladder, almost as a protection from the strong chemicals within the bile. And if that becomes excessive, it almost gums up the works and stops normal bile being able to eject from the liver, and you'll disturb the liver. Okay, now there's also other, you know, if you've got an infection where you've got a small abscess that's formed within the liver, if you've got a lot of worms migrating from the gut, they go through the liver before they then go through the diaphragm into the lungs, out into the airways, coughed up, swallowed, and then back in. So there are other reasons like parasites that we need to also consider. So you've got to double-check, is there any evidence of parasites within their stools? I'm sure knowing Fiona, she's thought of all of this, but I'm saying for the general people out there, just so that you're aware of the different things that could be going on to cause that liver disturbance. But scan, scan, scan. Check if you've got enzymes going in the wrong direction, Absolutely. Get an ultrasound scan done by somebody who is proficient at ultrasounds. Okay, not just at, you know, just the local vet who's maybe using it for pregnancies, etc. There are some great vets out there. Ask your vet, are they really good at ultrasound? What's the quality of their machine?

And don't forget about a second opinion. You know, vets are as good as they are. Some people have a penchant for skin, some have a penchant for guts, some are dry, some are raw, you know, and so there's nothing wrong with a second opinion and lots of vets do second opinions. I'm not sure if you do them, Bren, but I know some vets do, like Judy Morgan. Judy Morgan, you can send your blood work if you had questionable blood work that you just wanted a second opinion on, you can go and get a second opinion from the likes of Dr. Judy Morgan and it's cool, that is a very cost-effective way of just putting your mind at ease and if she says, oh listen, I would agree that that's what I would feel just looking at the blood work. It's not an in-depth look of what's going on in the background. It's like, this is what I feel, or when I'm looking at the blood work. So that's a pretty cool service, and it's quite cheap, guys. And Ben, I have to ask this question because I promised her I would. There's a pet owner here in dire straits, okay? I got this email before I came on, and I've already been talking to them. I've already been trying to help them out. Very tricky case, and the very capable owners, and we are doing okay, not brilliant. So the dog was in a terrible state gut-wise, shocking guts, just absolutely shocking. And the dog was emaciated and, you know, wasting away quite literally. And so terrible. Then we get the dog onto real food and we go through this very careful exclusion diet. We actually started on cooked food and very plain, and it seemed to be working. The dog started putting on weight first time and you're hallelujah, you feel great. And then it's like, it's not working. And it's like, okay, we'll try something else. And it's not working. It's not working. So What's happening in this dog is that the dog is holding down food and for the first time in a year producing nice stools. The course, the supplements we put the dog on, we put her 2 or 3 weeks on S. boulardii soil-based probiotics because I thought maybe some stubborn little horrible SIBO or some weird little protozoan someone has missed. The dog's been tested up the yin yang and then 2 or 3 weeks on good quality probiotics. And so that with the diet seemed to work and then we celebrated too early and now we're in a position where no matter what we try, we could be feeding bloody starfish to the dog. And he would eat it for 2, 3, 4 days, put on like half a kilo so quickly because he's so underweight, and then he would poo it off in 24 hours. And this dog is— he has been through a number of vets. They cannot find what this is. I am at an absolute loss myself. What could I possibly say? That's, you know, you know what I know, Ben, at this stage, but you have all the other veterinary stuff going on. So what else, what else could— where did they go? They're very, very worried about the long-term prognosis of this dog?

So the first thing that would strike me there is the waxing and waning of the disease. Okay. And so for me, that usually means there's an inflammatory process that's going on that the dog is fighting constantly. Now, that could even get as far as an immune-mediated disease if it's left going, but it may still just be an inflammatory process. You know the book, and I'm sure you've followed some of the instructions on Toxic by Neil Nathan, that actually some of these protozoal diseases, some of the spirochetes like Lyme's disease, can cause those chronic, um, I was thinking that. So, um, I actually, do you know what, he's almost looked like he's asked me to get props ready for tonight. There are two great things that you might want to think about if you are trying to deal with that chronic inflammatory process. One is to think about appropriate mushrooms. Okay. Everything from cordyceps to turkey tail to reishi to maitake, you know, they're all in there. Okay. The other is something which is an amino acid, a methylated amino acid DMG, dimethylglycine. Okay.

Okay.

In the States, that's under the VetriScience brand. Okay. There are some human equivalents, but as I've said before, watch out for the human supplements. They can have anything from 0 to 500% of what they put on the bottle and not always what they put on the bottle. Okay. So just be aware, look for pharmaceutically graded. Okay. Or veterinary-specific supplements.

What's DMG for, Ben?

So that is an immune modulator. So I have used this for stimulating immune systems where they have viral disease that's not resolving, even FIV in cats, so feline immunodeficiency virus, all the way through to immune modulating autoimmune disease, so where they're overactive with their immune systems. So it actually seems to act as a controller for T helper cells. Okay, it helps their apparently methylation on of their ADP to ATP.

Okay, so what about like, I can't help but think I blame everything but what I can't help but think about something like Lyme disease because of the peaking and troughing of it and the unpredictable, the reliable kind of, you know, I can't help but thinking of something like that. And what do vets do for Lyme disease? I imagine if anything, if I mean human GPs are pretty poor at Lyme disease, what do vets do to find out if it's going on in dogs? Lyme disease.

So one thing to do, so look at the PCR and antibody levels in combination for Lyme's. Okay. But in chronic inflammation, the body has an amazing way of walling this off and actually creating more inflammation than there is active infectious material. The other part then is as you support the immune system, okay, what you may find is that you need to repeat that test because the Lyme's disease reemerges as we resolve some of the inflammation. Okay, that's the thing, the key thing. Do not take the first test as absolute. Now, I have used in some cases bioresonance to detect Lyme disease. Now, some people don't like bioresonance. It's a different way of electromagnetically detecting disease states. I have then used remedies to treat Lyme and had good effects with those. So worst case scenario, if you're really stuck, consider finding somebody who's got a good bioresonance machine and actually getting the Lyme disease checked that way. But I would say conventional vets will talk about PCR and antibody testing, then resolve some of the inflammatory process and then review what's happening with their Lyme. So don't just take it as a one-off.

Yeah, I wonder, is that worth a shot? Because, and that, like, you know, we could do something like— the vets have already done this, I'm sure. I know they have. But you could send them off for biome. But the thing is, in this sort of dog, I know what that results of that biome was going to say. It's going to be catastrophic. It's going to be all over the place because he's going to be, you know, the poop is just, is just shocking. So I kind of sometimes think that that's could be £300 you could spend somewhere else because sometimes like, okay, we know the biome is a disaster. I don't think a fecal transplant would be worth a shot. I didn't recommend autogenous probiotics. I didn't think that was worth spending too much money. But I mean, you'll try anything, but these people are shattered at this stage. It's like you're spending an absolute fortune and you're not getting anywhere. It's so demoralizing. We have a number of other questions, Bren. You said that one of the questions— we won't move to Patreon tonight because you're going to put something up on Patreon tonight about the blood readings. Raw-fed dogs have slightly different blood readings, uh, and I think most of us know, we've alluded to this a number of times, but the question was, can we move them from American units to UK units? Did you say you were going to prepare something like that and pop it up on Patreon?

Yeah, so, so it's really interesting, and thanks for all of the guys that joining us from the States, but, um, kindly Gene Dodds has sorted out some raw fed parameters, and most of the units that are published on there are in the US units. So the ones that the vets over in the US like to use. Okay, now strangely enough, you know, they still talk about miles and inches and feet and everything like, just like we do in the UK. But for some reason, we followed the rest of Europe when it comes to laboratory tests and the units that we use, often in millimoles per liter and things like that. And that is the bit that is difficult for some people when they're looking at lab results in the UK and Europe to what's being said in the US and converting that. So there is a conversion that you can do. And so I think what we'll probably do is produce a little table of normals from Gene Dodd's work into the European standards so that you've got reference ranges there.

Yeah, sounds cool. So that, that will move that apart. And that means we can spend another 5 or 10 minutes because we've got a savage amount of questions on the Facebook page.

We've got to do this.

Which one is that?

We've got to talk about chocolate.

Oh, that's a cool little thing.

We've got Easter. We've got Easter coming.

Okay.

Conor, you need to very quickly go on the internet and find the chocolate calculator.

Okay.

For your dogs. Now look, guys, we're all coming to Easter in the UK. We are terrible over here at indulging ourselves in chocolate. For one reason or another, we like to spend 5 times the amount on chocolate as you normally would by buying them in egg shapes. And that chocolate toxicity is something that we're conscious that actually you can find yourself in a situation where they've scavenged the kids' eggs from under the tree. Or worse still, they've eaten your chocolate. So in those circumstances, what we would say, please contact your vet. I'm going to give you some rough guidance now. Okay. And the important things to remember while Conor's trying to look stuff up and actually come back on live, there are calculators out there. VetsNow do one, TVM do one. There are a number out there, so you can go online. But if you're at all worried in that anxiety moment, please will you contact your vet, give them a call. They should at least give you some guidance over the phone. Okay, now I know many people out there that have said, well, I've fed my dog chocolate for years and they're absolutely fine. Some of the symptoms that chocolate toxicity can give palpitations, fainting, distress, hyperactivity. You'll end up with all sorts of hypersalivation, distress, that they can actually even go into high palpitations and faint and sometimes even pass away if they're particularly old. They may even seize. So please be aware of that. Now, there are some really useful useful weight calculators. And on this particular one, there's 4 categories. And that is because within the 4 categories, we have milk chocolate, pretty dire in the UK and probably pretty dire in the US as well as the level of actual chocolate in there. I like to call it Vegelate in that there's more vegetable oil.

What's your problem with than there is.

Well, actually, it's fat in a bar with a little bit of brown coloring. That's what it is. I like my 100% Ecuador chocolate. That's super bitter.

Oh God. So you don't like Easter eggs? I don't trust anyone that says that.

I find them sickly after a while. It's sugar and fat.

Yeah, like after 4 or 5 of them. But you're not supposed to eat that much. You know, you're supposed to take Take the top off, fill it full of Baileys.

Lovely. Are you eating Cream Eggs?

Oh yeah, sorry.

4 or 5 Cream Eggs in one go with fondant icing. He's there. To you guys out there, he advocates all year, low sugar, don't do anything horrible. And then come Easter, he's eating Capri's Cream Eggs full of sugar.

I love them. I used to work at a petrol station and I hate them because they're tin foil, so the barcodes used to always get crinkled up, so you could never scan them properly. And that's the only reason, that's my only problem with them. Besides that, delicious. Eat cream eggs, they're delicious.

So are you a nibbler? Are you down in one, or are you a—

I can crack it by half like an avocado.

Lick out the innards.

Yeah, a little bit of licking, a little bit of weirdness. And but no, essentially in two bites, I'm a stuffer. I—

God, you've not done the tongue action then.

I just posted on the Facebook page, for some reason I cut myself off. I posted a calculator, a chocolate calculator on the Facebook page. Do you want to finish your bit, Brandon? I've cut you off, sorry.

Yeah, no, that's absolutely fine. So what you're looking at for a 12 kilo dog, they can pretty much get through. The cutoff point generally is that they will start to show symptoms around about about, let me guess this, double check that I'm right on this one. Yeah, around about the 200-gram bar. So the big Dairy Milk bars, a 12-kilo dog can just about cope with one of those. So not too hard with milk chocolate. As soon as you get into dark chocolate, okay, so we're talking, that's the 80%, not the 100% stuff that I like, but the dark chocolate, the 80%, 75 to 80% cocoa solids, okay, then pretty much you've got to start being alarmed if your 12-kilo dog is eating around about 65 grams, okay, of that. So a massive difference, you know. Did you realize that milk chocolate's down as low as 14% cocoa solids? Okay, it's really, really low in cocoa solids and cocoa butter stuff. So that theobromine, okay, that causes all of those reactions that I was talking about before Connor joined us again, um, is in the cocoa solids. So as soon as you start to use unsweetened chocolate that's for cooking, or even worse, the cocoa powder that you might use for drinking chocolate, chocolate, okay, absolutely minimal levels that you can be expecting your, you know, if you're up to sort of 30 grams, so that's an ounce, just over an ounce, okay, of the sort of unsweetened cooking chocolate, or even down as low as, again, this is for a 12-kilo, so half an ounce of cocoa powder, your dog may, for 12 kilos, may start to show theobromine toxicity symptoms. Okay, so easiest thing, down to the vets. They'll make them sick with an emetic, something that will make some apomorphine, okay, which will make them feel pretty grim very quickly. And be sick. Now, loads back in the '80s, we didn't have access to this, and we used to talk about, and you'll find it online, people talking about washing soda, milk and mustard, all of these things to try and make them sick, putting fingers down throats. Please don't get bitten. Okay? Don't waste your time putting all of these horrible things in if they've taken cocoa powder or a toxic level of chocolate from what I've just said, please, please, please take them to the vets, get them to give some apomorphine, make them sick as soon as. I will never get out of my memory the smell of chocolate orange vomit from a little tiny toy poodle that decided to eat not just the egg but also the chocolate orange that came with it in an Easter egg packet. And yeah, it's, it just, it's, I've never looked at chocolate oranges in the same light since then for some reason.

I'm just sitting there thinking about chocolate orange. I just sent you a picture, Bren. I mean, it's just, it's a phenomenal vomiting picture. It's, I mean, it's okay for people listening to our podcast, guys, if you listen on the podcast and you're listening on Apple Podcasts, I just noticed we've only got 5 or 6 reviews. Please, if you're listening to us on podcast, give us a review. Stop what you're doing immediately and give us a review. It's actually, I don't know if anybody's listening now after an hour on podcast. That's a long walking the dogs. But give us our reviews, so please give us the 5-star at least. I think we deserve that if you can, so that helps us get up the ranking. So wherever you listen to us on podcasts, you're not going to see this image of this poor boxer who clearly has had something given to him, but he looks like a cartoon character getting sick. I'm just, oh my God, he clearly needed— look, there's a couple other questions, like, you know, we're at an hour here and that's kind of the maximum you need to be doing, but Someone was saying, and there was a couple of questions regarding the different bones and that go into raw dog food, which I love talking about, but without getting too—

well, we're going to do that. We've got, because of next week being Easter, we're going to record something special for you. We'll do a few more Q&As. We're going to post those next week so that you guys can actually get something in our week off as Nick is still away, and we're going to answer to some more of those questions there. So please bear with us. We'll get those done. I'm just going to leave you with this wonderful picture that Connor has. I hope you're not eating your tea, guys. Okay. Because this is pretty grim. I'm just going to, I'm going to make it super dramatic by hiding our pictures. Connor can still voiceover, but here we go. That, look at that. That is Charlie and the Chocolate Factory.

It's just like, I just can't believe that.

So much, so much. I've got to even hide the writing. That's just like, oh my word. Oh, thank God for this. I don't want, I don't want to hear that people are having to deal with that on Easter Sunday.

No, poor old doggy. Oh, there you go, guys. Get your eggs up off the ground, guys. They are going to find them and they are going to eat them.

Um, yeah.

All right. So listen, we, well, yeah, we're going to take next week off, guys, but we are going to leave something in place. And so don't worry, we will be there anyway. And so thanks for joining us again. You'll find us on patreon.com/rollpetmedics. Buy some cup of tea or coffee, it really helps us do this. We love doing this. And so yes, it'll be, it'll be a week off next week with Something Up, and then hopefully into the next— I was gonna say next month, we're already in April, bloody hell. Yeah, and on, on with our list of bits and pieces that just seems to be getting longer and shorter. So, uh, yeah, any recommendations you want, guys, you can always pop them into Patreon. We're always listening. So, um, you know, yeah, thanks for being here tonight. It was great. Cheers, Bren. You fielded a lot of those questions. Appreciate it. It was great.

No problem. Take care, guys.