14 March 2018

Knowledge is power ~ what I learned as a result of Tilly's cancer that could help other dog-owners to make more informed choices for their best friends.

On Saturday 10th February, I had to make the decision that every dedicated dog owner dreads. Although I'd had a couple of months to prepare myself for it, I wasn't ready, and to add insult to injury it didn't happen how I'd planned it; how I'd wanted it to happen. I know that it wasn't what Tilly wanted either, but within the realms of the limited choices laid out before us at the time, it was the only decision that wouldn't have involved prolonged or unnecessary suffering for her. However, the point of this post isn't to discuss the right time to say goodbye to a beloved canine companion, nor how to cope with the devastating loss. It's about imparting the knowledge that I gained throughout the last eight months or so of Tilly's life, which might just help other dog-owners to make better, more informed choices for their best friends.

Although Tilly was officially diagnosed with gastric adenocarcinoma on 3rd January 2018, her symptoms had preceded this by about seven months. In June 2017, she developed a slight, intermittent tremor whilst resting; mostly in her hind legs, but sometimes the rest of her body would tense up for a couple of seconds and then release, as though she was shivering from cold. I filmed a couple of these episodes and took the clips and her along to the vet who advised, despite my concern that it might be abdominal pain, that it was probably nerve degeneration due to her age. Then, during July and August, she started vomiting – infrequently at first, maybe once every two to three weeks, and only during the early hours of the morning on an empty stomach. Another trip to the vet in September brought another 'nothing to worry about', but by November, the early morning vomiting had increased to a couple of times a week. I was 100% certain that she didn't have a gastro-intestinal blockage, and dietary changes had brought no improvement. The vet we saw mid-November time didn't seem overly concerned that she was vomiting a couple of times a week, or that her tremor had worsened, but I knew that something was seriously wrong. She had never been a 'sicky' dog. In fact, throughout her entire life with us prior to summer 2017, she hadn't vomited once. The first few times that it happened, she seemed genuinely surprised.

I wasn't happy that her symptoms kept being dismissed as 'due to age' and 'nothing to worry about' and asked for blood tests. Although these returned a supposedly clear result, during the first week of December she vomitted four times. We returned to the surgery and saw a different vet, who had recently seen another, very similar case. The vet had performed exploratory surgery, removed a benign tumour from the pyloric area of the dog's stomach, and the dog had made a full recovery. However, I wasn't prepared to put Tilly under the knife on the off-chance that the outcome would be the same. Instead, I opted for an ultrasound scan referral, and a week or so later, my worst fears were confirmed – a highly suspicious mass, approximately 6cm by 2cm, situated within the lining of the inner curvature of the gastric fundus.

In the midst of that awful moment, I knew that I had made the right choice with the ultrasound referral, because had I opted for exploratory surgery at my veterinary practice, it would have undoubtedly ended with Tilly having to be put to sleep on the operating table. And despite the vomiting, she still seemed bright, happy, and interested in living. I asked the ultrasonographer whether blood tests could indicate a cancer diagnosis, but was told no. I later discovered, through my own online research, that there is a blood test indicator for cancer – the Neutrophil-to-Lymphocyte Ratio (NLR) – and if this had been common knowledge in general veterinary practice, maybe, just maybe, Tilly's cancer could have been diagnosed early enough for surgery to have been a viable option. The same could also be said about her 'shivering' episodes. However, at the time, we were where we were.

The ultrasonographer recommended referral to a veterinary hospital that could offer us a combined soft tissue surgery and oncology appointment, and a fortnight later, a squashed cell preparation and endoscopic biopies provided a definitive diagnosis: gastric adenocarcinoma – a highly aggressive cancer that is unresponsive to chemotherapy, and due to a combination of tumour location and size, removal and resection to prolong life with any degree of quality was no longer an option. Prognosis with palliative care was 1-2 months.

Between the ultrasound and soft tissue/oncology appointments, I was able to reduce the frequency of her vomiting with Ranitidine (an antacid) and Metoclopramide (an anti-emetic). She seemed brighter, and she was eating well. But the diagnosis also threw a spanner in the works in the form of Tramadol. In recent years, Tramadol has become the 'go to' pain relief drug for dogs suffering a variety of types of pain, from arthritis to cancer. For carcinoma cancers, it is recommended that Tramadol is given alongside meloxicam.Tilly had had meloxicam in the form of Loxicom some years previously and for an extended period of time, so I was fairly confident that this wouldn't cause her any issues. However, she didn't seem to be doing well on Tramadol. Her vomiting increased again, and she seemed to be in more pain, not less. It would have been easy to put this down to the cancer worsening her symptoms, but a small amount of online digging unearthed some interesting research-based facts about Tramadol and dogs; the main one being that dogs do not possess the necessary receptors for Tramadol to work as a painkiller. Furthermore, the drug still has to be metabolised by the liver, and dogs, as humans, may suffer nasty side effects including nausea, vomiting and abdominal cramps.
So I stopped the Tramadol. After a couple of days she seemed much brighter, more coordinated, and noticeably more comfortable; and I felt mortified that I had been giving her something, albeit on veterinary advice, that had not only been making her ill and causing her pain, but had been giving her liver yet another set of chemicals to deal with. The Ranitidine also seemed to have begun to correlate with vomiting episodes, so I stopped this too. During December it had worked well to reduce her stomach acid production, but I felt that it had served its purpose for the time-being. I continued to give her Loxicom and Metoclopramide, and for a few weeks she seemed to be doing better. We also tried veterinary acupuncture to see if it would reduce the frequency of her vomiting, which it did seem to do on a short-term basis as she always had at least one vomit-free day post treatment. She continued to eat well – even regaining the weight that she had lost during December. Her vomiting was occuring only when her stomach was empty, and she was still enjoying fuss, walks, and barking at the postman.

It was on the 9th of February that she took a turn for the worse and her vomiting suddenly spiralled out of control. Although she still managed not to throw up any food, she refused to eat from lunchtime onwards, and despite continuing to drink, she was becoming dehydrated. That night, she slept in my arms for what I knew would be the last time. Come the morning, the whites of her eyes were showing the faintest yellow tinge, and her blood pressure had dropped. I made the call, but despite being assured previously that whenever the time came, day or night, a practice vet would be available to her put to sleep at home, I was told that a home visit was not possible until Tuesday, which was three days away. However, if I could get her to the surgery by close of business at 12.30pm, a vet would do it there. I felt angry and cheated, but I couldn't allow my girl to suffer. I told her what was going to happen and we got a taxi to the surgery so that I didn't have to drive. She literally clung to me for the entire journey – her claws gripping my legs as she lay across my lap. She never laid across my lap. I knew what to expect when we got there – I've had other dogs put to sleep – but what I didn't need to hear from the vet was that he had to use twice the anaesthetic for a dog of Tilly's size, and that she was a strong little dog; a fighter. Not only did this add to the pain of letting her go, it added doubt to my decision to put her to sleep. Over a month on, the 'what ifs' are still haunting me.

And so, to the point of this post – knowledge. Whilst I do not advocate going against veterinary advice, I do encourage dog-owners to question it – particularly if it could cause, or appears to be causing, a dog more harm than good. Veterinary professionals aren't always up-to-date with the latest research, and importantly, no vet will ever know your dog as well as you do. 

Hind-leg tremor and/or shivering, as though cold. I know now that Tilly's tremoring was not due to age-related nerve degeneration, and that my initial, gut feeling that it was abdominal discomfort, was correct. I know this because lowering her stomach acid production with Ranitidine eased it considerably. Gastric adenocarcinoma causes ulceration of the stomach lining. When the stomach is empty, stomach acid and/or bile reflux will cause irritation and burning. If your dog is shivering on and off as though cold but is clearly not cold – particularly if this occurs a few hours after eating or whilst resting – it could be an indictation of abdominal discomfort; not necessarily of cancer, but of some kind of upper gastro-intestinal tract irritiation such as heartburn, acid reflux, gastritis or pancreatitis, that warrants further investigation. The same goes for early morning vomiting, known as bilious vomiting syndrome. This occurs on an empty stomach as a result of bile refluxing into the stomach and causing irritation. Despite being suggested as a fairly common, benign affliction in older dogs, it could be an indication that something more sinister is going on, and shouldn't be dismissed as being due to age. 

Neutrophil-to-Lymphocyte Ratio (NLR) (Uribe-Querol and Rosales, 2015). It is true that there aren't any blood tests that will diagnose cancer in dogs; however, research suggests that the Neutrophil-to-Lymphocyte Ratio (NLR) may serve as a prognostic factor for cancer. Extrapolation of Tilly's blood results from November produces an NLR of 5:1 – this is the ratio that has been found to indicate cancer. 

The NLR cannot be used to specify cancer type, rather, it is a biomarker for various tumors including some lung cancers, hepatocellular carcinoma, nasopharyngeal carcinoma, colorectal cancer, melanoma, breast cancer and gastric cancer. My advice is to always ask for a copy of your dog's blood results, even if your vet tells you that everything is nomal. A full blood count will specify the levels of neutrophils (NEU) and lymphocytes (LYM) in your dog's blood. If NEU is five times higher than LYM, this may indicate that your dog has cancer, and in which case, depending on your dog's symptoms, the early use of non-invasive diagnostic techniques such as ultrasound, MRI and x-rays may be able to detect where this is, and perhaps buy your dog some valuable time in getting it diagnosed and treated.

Tramadol. It doesn't work as a painkiller in dogs (Budsberg et al, 2018). Tramadol is an opioid-like drug, but unlike true opioid drugs that act as mu-opioid receptor agonists, the analgesic effect of Tramadol is due to the drug's metabolites blocking M1 opioid receptors (Minami et al, 2015). Whilst humans and cats have M1 receptors, dogs do not. Dogs are still subject to the serotonin and norepinephrine effects of Tramadol, which cause mild sedation; however, sedation is not pain relief. Effective painkillers for dogs, particularly when opiate-based pain relief is required, include morphine patches if a dog cannot take oral medication or is already suffering with abdominal discomfort or liver disease, and Pardale-V – a non-prescription analgesic that contains codeine, which has been specifically formulated for dogs. I wasn't aware that morphine patches existed for dogs until the end of Tilly's life, by which time it was too late. Given the terminal nature and symptoms of her illness, I feel that we should have been offered this option much sooner. Tilly had a reasonable-to-good quality of life right up until the end, but if we had been able to use morphine patches instead of oral pain relief, I believe that her quality of life would have been further improved. 

Meloxicam – Metacam vs Loxicom. Meloxicam is a NSAID medication – a non-steroidal anti-inflammatory drug. More specifically, it is a COX-2 inhibitor, which has been shown to slow the growth of adenocarcinoma tumours. Meloxicam is the active ingredient in both Metacam and Loxicom, but the two medications are not the same in other respects. The difference is in the excipients – substances that are formulated alongside the active ingredient of a medication, and are included for the purposes of long-term stabilization and other factors, such as palatability. I'm sure that most dog owners are aware that a substance called xylitol, a sweetener often used in chewing gum, is highly toxic to dogs. What I'm also certain of is that most dog owners are unaware that Metacam – the brand of meloxicam favoured by the majority of vets and prescribed for a wide range of inflammatory conditions – contains xylitol. Loxicom on the other hand, does not. I realise that the amount of xylitol in Metacam is probably small, but why include it in a medication formulated for use in dogs when there are plenty of other, dog-safe sweeteners available? I don't know whether the xylitol content of Metacam poses a health-risk to dogs who take it on a longterm basis, but what I do know is that based on ingredients, Loxicom appears to be the safer option. 

Euthanasia – advice for vets for dealing with clients. Please don't say that a dog needed more anaesthetic than would normally be required to end its life. It is a totally unnecessary thing to tell someone. It's also unprofessional. It provides zero comfort to the newly bereaved and worse, it may cause a client to further question what has certainly been an impossibly difficult decision to make. What a client needs to hear is that their dog seems ready to go, and if you have to use more anaesthetic than normal, keep that information to yourself. And unless you truly offer an unconditional, any time 'at home' euthanasia service, please don't mislead clients into thinking that this is an option.

If this blogpost has given the impression that I'm unhappy with the treatment that we received from the veterinary professionals involved in Tilly's care, this was not my intention. Everyone that we came into contact with was kind and caring, and I truly believe that they all had Tilly's best interests at heart. However, it was a lack of knowledge about the presentation of abdominal discomfort and gastric adenocarcinoma, NLR as a progostic factor for cancer, and the (in)effectiveness of Tramadol as a painkiller, that steered the course of Tilly's treatment along a particular path. This path could have been different. The possibility exists that had her symptoms been viewed differently and taken more seriously, and had the cancer been detected early enough, she may still be with us ... and so, if any of the knowledge that I have gained during the course of Tilly's illness enables just one dog and owner to have more time together, then something good will have come out of our experience. 

In loving memory of my beautiful, brave Tillybean.


Budsberg, S., Torres, B., Kleine, S., Sandberg, G. and Berjeski, A. (2018) Lack of effectiveness of tramadol hydrochloride for the treatment of pain and joint dysfunction in dogs with chronic osteoarthritis. Journal of the American Veterinary Medical Association, 252: 427-432.

Minami, K., Sudo, Y., Miyano, K., Murphy, R. and Uezono, Y. (2015) ยต-Opioid receptor activation by tramadol and O-desmethyltramadol (M1). Journal of Anaethesia, 29 (3): 475-479.

Uribe-Querol, E. and Rosales, C. (2015) Neutrophils in Cancer: Two Sides of the Same Coin. Journal of Immunology Research. 


European Drugs Encyclopedia

11 January 2012

Feeding for health and longevity: Raw vs. kibble vs. calories

In May last year I changed the dogs' teatime meal to a commercially prepared, 'ready-made' raw food diet.  At the time and for a long time beforehand, I believed that raw was the best way to feed a dog, but six months down the line, the diet wasn't working out well for Tilly.  I had to stop and re-evaluate my thoughts about raw feeding being the healthy option, and question what the domestic dog's 'species-appropriate' diet really should be. 

Dogs are carnivores, there is no doubting this, but carnivores fall into different types.  There are true or ‘obligate carnivores’ – animals that depend solely on the nutrients found in animal matter for their survival.  While they may consume small amounts of plant matter, they lack the physiology required for the efficient digestion of plants.  All felids including the domestic cat are obligate carnivores, requiring a diet consisting of primarily animal flesh, bones and organs. 

Dogs and other canids are ‘facultative carnivores’.  ‘Facultative’ means contingent, optional, or not required – in other words, while the primary diet of dogs is meat, dogs are actually capable of surviving without it.  Studies of the wolves of Yellowstone National Park in the USA reveal that even when prey animals are in plentiful supply, on average, the wolves only eat fresh prey every 2-3 days.  This can drop to only a few times per month during the winter, with the rest of the diet being made up of carrion (sometimes only frozen hide and bones) and whatever pickable, edible vegetation happens to be available.  In the wild, wolves don’t eat much, not even much of their primary food – fresh, raw prey – and they will go for days without eating anything at all. 

Dogs are also scavenger carnivores, meaning that although the meat that they would naturally consume may well be raw, it may not necessarily be fresh.  The decomposing flesh of carrion is in essence partly digested, with bacteria having already done some of the ‘eating’.

Being a carnivore, the dog’s dentition is geared towards a diet of flesh and bone.  Each side of an adult dog's upper jaw has 3 incisor teeth, 1 large canine tooth, 4 premolars and 2 molar teeth, and the lower jaw has 3 incisors, 1 canine tooth, 4 premolar and 3 molar teeth. 

The number and types of teeth reflect those of a ‘mesocarnivore’.  The earliest Carnivora family of Miacidae, of which Miacis, the earliest known ancestor of the domestic dog was a member, were mesocarnivores.  Modern day mesocarnivores include wolves, coyotes, foxes, civets and skunks, as well as dogs. 

Beyond the teeth, the dog’s gastro-intestinal system is that of a carnivore, being much shorter in proportion and in comparison with the GI tracts of herbivores.  The overall length of the canine GI tract (from mouth to anus) is about 5 times the dog’s total body length, whereas the length of the herbivorous equine GI tract is about 15 times the horse’s total body length.  The human GI tract is 10 times longer than the length of the body. 

The natural diet of a mesocarnivore would ideally consist of 50-70% animal and 30-50% plant matterIn comparison, the diet of ‘hypercarnivores’ (e.g. cats, eagles, sharks, salmon) consists of more than 70% animal, and that of ‘hyopcarnivores’ (e.g. Black bear, raccoon) less than 30% animal.  While virtually all animals display omnivorous feeding behaviour according to conditions such as food supply, etc, animals generally prefer one class of food or another, for which their digestive processes are optimised accordingly.  The classification ‘omnivore’ refers to the adaptations and main food source of a species in general.  The main food source of an omnivore is variety in itself – pigs for example are true omnivores – but a plant-eating carnivore or a meat-eating herbivore is neither individually nor as a whole species omnivorous.  It may surprise you to learn that humans are not omnivores either, and neither are we carnivores or herbivores.  Like all of our primate ‘cousins’ we actually belong to a class of plant-eaters called ‘frugivores’, or fruit-eaters.  Just as carnivores can and do eat plant matter, frugivores (also herbivores, nectarivores, florivores and granivores) can and do eat meat.  The dog is a facultative carnivore, a scavenger carnivore and a mesocarnivore, NOT an omnivore. 

Being a mesocarnivore, the dog’s diet would ideally consist of 30-50% plant matter, but unlike herbivores, dogs lack the bacteria in their gut that produce the enzyme ‘cellulase’ and therefore the ability to break down cellulose – the major component in the rigid cell walls in plants.  Certainly, when some cellulose-rich foods are fed, they are still intact and recognisable within the dog’s faeces, for example, sweetcorn kernels, and grass (as anyone who has had the displeasure of removing grass-dangley-poops from their dog’s bottom will know).  For herbivores, the result of the digestion of cellulose is glucose, which is how they obtain their energy.

Dogs also lack the salivary enzyme ‘amylase’ needed to digest starchy plant matter found in cereals, grains and fibrous vegetables.  Coupled with the fact that dogs also lack grinding molars, the lack of salivary amylase is often used to uphold the theory that dogs are carnivores and therefore should not be fed plant matter at all, however, grinding molars and amylase are not needed for the digestion of ‘softer’ plant material composed mainly of water and simple sugars, such as fruit.  What is also often omitted in the ‘Prey Model’ of feeding is that although dogs lack salivary amylase, amylase is produced in the pancreas, so the digestion of starch-rich plant matter is possible once this has passed into the dog’s small intestine.

Contrary to popular belief, wolves do not eat the stomach contents of large, herbivorous prey animals.  Stomach acid is highly corrosive and would burn the mouth and oesophagus if eaten (and also corrode tooth enamel).  Occasionally, wolves will eat the stomach wall of large herbivorous prey animals, but only after shaking out the stomach contents.  The stomach contents of smaller prey animals such as rabbits, mice and birds is eaten, but only as a result of the entire animal being consumed – claws, fur, beak, feathers and all.

So … based on the domestic dog’s carnivore types (facultative, scavenger and mesocarnivore) and given its likely evolutionary route and self-domestication from the small Asiatic (Arabian) wolf, it could be concluded that the most ideal, most natural, most appropriate doggy diet ideally should consist of 50-70% small, raw, whole prey (flesh, bones, organs, fur, feathers, etc) including mammals, birds (and their eggs), reptiles and invertebrates such as worms and insects, and scavenged carrion (this could include fish and large animals), and a 30-50% mix of the stomach/intestinal contents of small herbivorous and omnivorous prey (e.g. rabbits, squirrels, mice, birds), ripe fruits and berries and various other ‘pickable’ plants and botanicals.  However, the latest DNA evidence suggests that the dog began to branch away from the wolf between 100,000 and 135,000 years ago.  We also know that around 15,000 years ago, at the end of the last ice-age, dogs became the domesticated canines that we know and love today.  During this time, and particularly so during the past 3,000 years of intentional, selective breeding, numerous anatomical and behavioural changes have taken place as a direct result of the domestic dog’s strategy of life, to stay near humans for the best chance of survival (which includes eating our food). 

The dog has not been a wolf for many thousands of years, and numerous features of the dog’s anatomy including skull, teeth, skeleton and GI tract differ significantly from those of wolves both of the past, and of the present.  This means that according to the domestic dog’s strategy of life – to stay near humans for the best chance of survival – the 50-70% animal part of the ‘dog as mesocarnivore’ diet should also include table scraps such as cooked meat and dairy (milk, yoghurt, cheese, etc) and the non-animal part, raw, cooked and partially cooked vegetables, cereals and grains, as well as a smorgasbord of excreted poop from humans and the local domestic and wild animal populations.  This gives a whole new perspective on ‘natural feeding’, and one that implies that popular raw diet formulae such as Prey Model, Natural Raw Diet, Raw Meaty Bones and BARF (Bones and Raw Food, Biologically Appropriate Raw Food) are all flawed in some way or another. 

What to feed is a personal choice that we make for our dogs based on what we believe to be the best.  There is no scientific research to support the claimed, nutritional benefits of raw feeding, only anecdotes and testimonials, however, there is scientific evidence to the contrary both in nutritional analysis studies of raw food diets for dogs and in veterinary case studies of cats and adult dogs and puppies fed various raw diet formulae.  Certainly in six months of feeding a commercially prepared, 'ready made' raw food diet to my dogs, both of whom were in great, general health to begin with anyway, I have seen no obvious beneficial health changes but instead the opposite, when throughout October and November Tilly began to suffer worsening, nightly abdominal discomfort that upon switching her back to her breakfast kibble (Acana) for her teatime meal, ceased completely.  Wanting to ensure that she was back to good health I had her blood tested, and although symptom-free at the time of these tests, she tested positive for pancreatitis.  Two months on since stopping the raw food and her blood lipase level is still double the norm, but I'm hoping that this will continue to drop now that I have switched her onto a bland, low-fat wet food (Chappie).  I am very thankful that my dogs sleep next to my bed, otherwise I would be none-the-wiser to her nightly discomfort and the seriousness of what was developing.  I am also thankful that I am not so far up my own bottom not to be able to change my long-held belief that raw just has to best, or to delude myself that Tilly's symptoms of digestive upset after 6 months of raw feeding must either be normal, or due to something other than the food.  However, I have seen the apparent health benefits of raw feeding in a client dog who had a multitude of infected tick bites on its head that despite several months of antibiotic treatment had failed to clear up.  After only four days on a raw food diet, the tick bites were no longer infected, and a fortnight later there was no evidence that the bites had ever been there.  I don’t think that this was coincidence and I do think that the healing was directly connected to nutrition.  Protein is needed for cell development and repair.  Amino acids are the building blocks of proteins.  Amino acids are critical to life and have many functions in metabolism.  Some protein sources contain higher levels of certain amino acids than do others, and some protein sources contain a broader range of amino acids than do others.  Cooking alters the molecular structure of protein, which may make assimilation difficult, and the cheaper commercial kibbles use lower quality protein sources in their formulae.  Before switching to a raw food diet the dog was being fed what I consider to be a low quality kibble (high in cereal, low in meat, and a minimum level of vitamin D).  I think that the raw food gave him a much needed protein and vitamin D super-boost, which finally enabled his body to repair the damage, and quickly too.  Many of the raw feeding anecdotes are along similar lines – "dog with chronic illness gets well when fed a raw food diet".  Maybe it would be more appropriate to use raw feeding as medicine for dogs, not as the primary diet, and like any course of medicine to stop giving it once the illness has been cured.  

And perhaps there is nothing wrong with long-term raw feeding if the nutrition truly is balanced, complete, and doesn't contain excessive amounts of fat, however, laboratory analyses of five raw diets including two that are commercially produced have shown up nutritional shortfalls in a wide range of minerals including iron, zinc, potassium, manganese, calcium and phosphorous, as well as vitamin E, and nutritional excesses including vitamin D and magnesium.  Similarly, whether homemade, canned or kibbled, there is nothing wrong with feeding a cooked diet that is nutritionally balanced and complete (according to AAFCO) and includes a small proportion of cereal or grain.  But whatever the diet, quality of the ingredients is important, and by quality I mean ‘additive free’.  Many raw-fed dogs are fed fatty, domestically raised animals that have been pumped full antibiotics, hormones and vaccines, and while raw animal flesh, bone and organs are worthy of inclusion into the dog’s diet, feeding fatty, ‘adulterated’ raw meat really is not the healthy option.  Feeding a raw diet that does not consist of between 30-50% digestible plant matter is, in my opinion, not dog-appropriate, and the practise of supplementing a raw or home-cooked diet with probiotic bacteria, digestive enzymes and/or vitamin/mineral/amino-acid rich ‘super-foods’ when the nutritional content of the diet itself has not been thoroughly analysed, is questionable both in benefit and ‘appropriateness’.

Adding supplements also suggests that the dog can’t get enough nutrition from a raw-food diet.  ‘Ah but …’ say many raw-feeders, ‘… in the wild, dogs and wolves would eat all of the carcass, so the nutrition would be balanced and complete.’  So disregarding the fact that dogs are not wolves and have not been living ‘in the wild’ for a very long time, let me get this right – the eating of the ‘non-meat’ parts of a raw carcass makes a meal balanced and complete, but commercially produced pet foods that may contain these ‘derivative’ parts (e.g. hair, hooves, feathers, beaks, sinews, tracheae, guts, eyes, snouts, bum-holes, etc) should be avoided like the plague because they are inferior, junk ingredients?  The fact is that predators will selectively eat for nutritional value, for the best balance of protein, fat and other nutrients, but this has nothing to do with eating an entire carcass, it has to do with having a much, much wider menu from which to self-select.  Self-selection as well as a huge variety of different foods is what today's feeding practices lack, regardless of whether or not the food given is raw or whole.  The dog's choice of what to eat, how much to eat, and when to eat it, is limited.  We decide for them.  The dog's natural feeding practice is 'buffet-style', but we take away this choice to feed naturally.  We prohibit the dog's natural inclination to self-select for balanced nutrition.    

I’m not suggesting that all kibbles are nutritionally 'complete'.  They may be complete as per AAFCO standards and balanced in the nutritients that they actually contain as in there are no excesses or no deficiencies of those ingredients, but some may be lacking in certain vitamins, protein amino-acids and nutrients essential for optimum health simply because there is no legal requirement for pet food manufacturers to include them, or they are included at minimum levels that aren’t sufficient for some dogs to remain in gleaming health (e.g. those with digestion or assimilation problems or chronic illness).  But at least the commercial kibbles aren’t pretending to be something that they are not, and supplementing a commercial kibble diet with a weekly portion of oily fish, the occasional whole, raw egg, a raw, lean, meaty lamb rib (as a meal replacement), a carrot, a broccoli stalk, a handful of blueberries or a few mg of ‘super-greens’ now and again is more likely to enhance overall nutrition than unbalance it.  Incidentally, the past and present feeding practices of captive wolves show that they live longer and remain healthier when fed commercial dog food.  No word of a lie.  According to the leading specialists in wolf husbandry and medicine, feeding commercial dog food, not raw prey, is the recommended practice.  To provide enrichment for the wolves and bait for husbandry purposes raw meat and bones are fed, but not as the main diet. 

But whatever diet choice we make for our dogs, whether that be raw or cooked, commercially produced or home prepared, fresh on the bone, canned, pouched or kibbled, expensive or cheap, one thing is absolutely certain - overfeeding reduces lifespan.  Overfeeding is perhaps the biggest error that pet owners make – even those who feed to manufacturers’ recommended guidelines and according to ‘ideal’ breed weight.  More than 60 years of scientific research shows us that calorie restriction is the only nutritional intervention that consistently extends the lifespan of animals.  For example, in a controlled study of 48 Labradors, feeding 25% less food than the calorie requirement for ideal body weight saw an average lifespan increase of around 2 years.  In addition, compared to the control dogs who were fed to maintain ‘ideal’ body weight, the food restricted dogs weighed less, had lower body fat content, lower serum triglycerides, triiodothyronine, insulin and glucose concentrations, and the onset of the signs of chronic disease was delayed.

Calculating the ideal daily energy requirement for a dog is a little complicated, but not difficult.  First, we need to know the dog’s ‘ideal’ weight.  The standard guideline is to be able to easily feel the ribs beneath the coat, see a definite waist when viewed from above, and an abdominal tuck when viewed from the side.  We also need to know the Metabolic Energy value (kcal/kg) of the food that we feed.  This information is usually easy to find on the packet label of commercially produced, complete kibbles and some canned and pouched foods.  The final piece of information that we need to calculate daily energy requirement is the dog’s age, sexual status and activity level.  Tilly’s ‘ideal’ weight by eye and feel is around 14 kg.  She is between 5 and 7 years old, spayed, and typically active. 

According to the dog food calculator (picture left), this gives me two category choices – ‘typical’ and ‘senior, neutered, inactive’.  She is neutered, but she is neither senior nor inactive, so ‘typical’ more accurately describes her. 

I feed her Chappie original canned, which has a Metabolic Energy value of 850 kcal/kg.  The resulting calculation is that she requires 796 calories per day and I should be feeding her 940 grams of Chappie per day, however, to follow the 25% food restriction diet to increase lifespan, a further calculation is needed. 

To calculate 25% of 796, we need to divide 796 by 100 (7.96) and then multiply this by 25 (199).  This gives a reduced daily calorie intake of 597 (796 – 199). 

We know that 940 grams contains 796 calories, so to reduce this by 25% we divide 940 grams by 100, which gives 9.4 grams (1% of 940 grams), and then multiply 9.4 grams by 25 to give 235 grams.  940 grams minus 235 grams is 705 grams.  So actually, Tilly requires 705 grams of Chappie per day. 
Beau’s ‘ideal’ weight by eye and feel is 32 kg.  He’s 3 years old, neutered, and very lazy, so even though he’s a young dog, I place him in the ‘senior, neutered, inactive’ category.  I feed him Acana Grasslands kibble, which has a Metabolic Energy value of 3750 kcal/kg.  According to the dog food calculator, this works out at 1211 calories and 320 grams of Acana Grasslands per day.  To feed for increased lifespan, this is reduced to 908 calories and 240 grams of Acana Grasslands per day.  If I went by Acana’s daily recommendation for an inactive, 32 kg dog, I would be feeding him 320 grams per day – 80 grams more than is needed.  Beau’s ‘feeding for increased lifespan’ weight is around 31 kg.  Feeding for increased lifespan drops the ‘ideal’ weight by 1 kilo – that’s a whole kilo of excess fat!  Visually, the difference in my dogs between ‘ideal’ and ‘increased lifespan’ weights is that the ribcage is more defined, with the outline of the last three ribs visible beneath the coat (picture right).
It is much, much harder to calculate how much raw food to feed because meats, vegetables, plants, etc, differ greatly in their individual Metabolic Energy values.  The general guide to feeding raw food is around 2% of the dog’s ideal body weight per day.  For Tilly this works out at 300 grams per day in which to pack 796 calories (her ‘ideal’ weight calorie count).  To feed for increased lifespan, we need to reduce the calories to 597, but to feed for variety, the quantity of food fed per day will fluctuate greatly in order to provide the correct calorie count per meal.  For example, there are around 85 calories in 100 g of raw tripe, which means that an all tripe day for Tilly weighs in at 705 g, but if fed according to the 2% rule would provide her with a meagre 238 calories.  Raw lamb ribs are around 284 kcal per 100g, so an all lamb rib day for Tilly weighs in at 210 g, but feeding lamb ribs according to the 2% rule would provide her with 796 calories (and a huge quantity of fat).  Because the Metabolic Energy values of different foods is so inconsistent, realistically, the best way to feed a raw food or home-cooked diet is by calorie content, not by weight, whilst trying to keep the overall quantity of the meal at around 2% of the dog’s bodyweight.  That way, meals that combine meat, bone, offal, fish, egg, dairy and veg, fruit, grain, cereal, herbs based on the mesocarnivore 50-70:30-50 animal:plant ratio of the human-food-eating domestic dog could be made without overloading or starving the body with such wildly fluctuating daily calorie intakes and meal weights, although the ratios per meal would need to differ from dog to dog to accommodate individual calorie needs.      

But calories are only a part of the story.  Even if increased lifespan calorie counts for an individual dog can be achieved at around 2% of bodyweight per meal formula per day, the levels of protein, fat, vitamins and minerals will continue to remain inconsistent across each meal.  This could have three possible outcomes:

  1. over time the inconsistencies balance themselves out
  2. over time the inconsistencies saturate the body’s organs and tissues with excess waste (toxaemia)
  3. over time the inconsistencies leave the body deficient in some way (malnourishment)
It’s tricky enough even with all the right information to get the long-term balance right with a home-prepared diet, and while it may be safe to assume that the producers of commercial ‘complete’ raw food diets have taken care of this for us, the full nutritional content with nutrient levels, along with Metabolic Energy values, are unavailable.  Some list the % values for moisture, protein, fat, ash and fibre.  Some also list vitamin, mineral and amino-acid content, but none list the levels of these nutrients and so do not provide enough information to know for sure that according to the 2% rule (or thereabouts) the food contains a complete and balanced compliment of vitamins, minerals and other essential nutrients.  If feeding only one meal variety that contains just one meat source (e.g. chicken only) and the same vegetable/fruit/‘other’ combination and meat:plant ratio as other meal varieties, this WILL give rise to nutritional deficiency or excess over time, unless the formula has been adjusted accordingly for balance (which to my knowledge, none have).  Even feeding a range of meal varieties is no guarantee of balance because they each tend to be made to the same meat:plant ratio and the same combination of 'plant', with the type of meat being the only element that changes.

My own journey into raw feeding has turned out to be nothing more than a detour, and even though I truly believed that raw was the best way to feed my dogs and to some extent still do, somewhat of a learning curve too.  I’m neither for raw nor against it, but until the commercial, ready-made raw food diet producers can supply complete and balanced nutrition along with full analyses and Metabolic Energy values of their meals and they can achieve this with a fat content of 4% or lower, I will continue to feed Chappie (Tilly) and Acana (Beau) as the primary diet – with the occasional added extra (fish fillet, handful of blueberries, chunk of apple, etc) for variety and to boost basic nutrition. 

I want my dogs to remain healthy and to live as long as possible, and the scientific evidence shows that reducing the daily calories of a commercially produced, complete and balanced kibble by 25%  allows for an average increased lifespan of two years.  Quality and appropriateness of ingredients is important.  Complete and balanced nutrition is also important – but ultimately, it’s reducing the calories that counts in the longevity stakes. 

Less really does mean more – more years, and better health for longer. 


Bibliography & Resources

Wolves: Behavior, Ecology, and Conservation.
L. David Mech and Luigi Boitani.

Canine Behavior: A Guide for Veterinarians.
Bonnie V. Beaver.

The domestic dog: Its evolution, behaviour and interactions with people.
J Serpell.

Dog Food Calculator
Mike Sagman.
Dog Food Advisor: Saving Good Dogs from Bad Food.

Nutritional analysis of 5 types of “Raw Food Diets.”
L. Freeman, K. Michel.

Daniel P. Schlesinger, Daniel J. Joffe.

Richard D. Kealy, PhD; Dennis F. Lawler, DVM; Joan M. Ballam, MS; Sandra L. Mantz; Darryl N. Biery, DVM, DACVR; Elizabeth H. Greeley, PhD; George Lust, PhD; Mariangela Segre, DSc; Gail K. Smith, DVM, PhD, DACVS; Howard D. Stowe, DVM, PhD.

Dr Brennan McKenzie, MA, VMD.

Predators Hunt for a Balanced Diet
Science Daily


Tilly update, 10th February ~ Re-test for cPL has confirmed that finally, this has decreased to a normal level again.  The bad news is that proximal inflammation/damage to her small intestine as a result of the pancreatitis has left her with a folate (vitamin B9) deficiency, so I am working to increase this via dietary supplementation.  I will be re-testing cPL and folate levels again in a month's time to see whether we have continued, normal cPL, and an increase in folate.

7 January 2012

Nail trimming can be fun!

Nail trimming is an incredibly stressful experience for many dogs and their owners, but it doesn't have to be that way.  It is completely possible to train a dog to accept having its nails trimmed or filed, and if done correctly it can take as little as 5 minutes to completely desensitise the dog to the experience, however, handler timing is of the utmost importance and in my experience, most people's timing is too poor to bring about an effective and lasting result. 

Another way to keep on top of the task of nail trimming is to clip just one sliver from just one nail per day, which if carried out with confidence can be over and done with before the dog even realises its nail has been trimmed. 

Lots of walking on concrete or tarmac helps to keep the nails short, but even though I do around 20 minutes of brisk walking/jogging on pavements with my dogs every day, this isn't quite enough to keep their nails at the perfect length, so they still need some extra attention every so often. 

The method that I use is the most fun way to trim nails.  It requires no clippers, no file, no treats, is completely 'hands-off' and 100% effective. 

Are you dying to know what I do?  Okay then, I'll tell you ...

We play 10 minutes of fetch along the concrete path in the garden.  That's it.

Here's the result ...

... Tilly's nails, perfectly filed. 

Throw the fetch-toy so that your dog has to turn to run and fetch it from alternate sides ~ this ensure that the hind nails wear evenly.  If your dog is a really frantic fetcher, throw the ball and make her wait, before releasing her to fetch it ~ that way she'll be facing in the right direction and won't need to turn, so she won't wear the hind nails down quicker than the fore nails.  Certainly with Tilly, her hind nails stay pretty short anyway, so it's the nails of her front paws that need a bit of an extra trim now and again.  If you don't have a concrete path or similar area at home, use a concrete or tarmac footpath or cycle path instead (not right next to a road, obviously!)

For dogs with joint problems this method may not be suitable, but for fit and healthy dogs that need a pedicure just once in a while, it really is the most fun that a nail-trim can be.  It gets a big 'paws up' from my two anyway! 

23 November 2011


A standard 6-foot leash and flat collar is universally accepted as the norm for walking and training dogs, but for large or powerful dogs, such basic equipment offers the handler very little in the way of effective restraint or ease of control. 

With pet stores stocking a huge range of leads, collars and other equipment that claim to resolve unruly on-leash behaviour, deciding what to choose for the best is a confusing and daunting prospect.  As well being an effective tool for the facilitation of training of desirable behaviour, training equipment should not cause the dog physical or emotional distress when used as the design intends, and so with manufacturers using words like ‘gentle’, ‘natural’, ‘kind’, ‘comfort’ and ‘easy’ to describe their products, it’s reasonable to assume that these training aids are humane.  Head-collars are a popular choice to control various on-leash behaviours, from plain old pulling to aggression, but in my experience of speaking with clients and watching dogs being walked, I have yet to meet a single dog that appears to enjoy wearing the type of head-collar known as a ‘muzzle-clamping head-collar’.  Muzzle-clampers include the Halti, Gentle Leader, Cannycollar and GenCon.  Dogs are just miserable wearing these, and many learn to fear the sight of them.  This is because muzzle-clamping head-collars, as the name suggests, are designed to tighten around the dog’s muzzle and head in some way, which the manufacturers describe as producing ‘calming pressure’.  However, because all of these popular head-collar brands when under tension fit so tightly around the dog’s head, the ‘calming pressure’ that the manufacturer told you about is actually felt as pain, which is why, for the dog whose only crime is to pull on the leash, these head-collars work to stop pulling behaviour ~ dog pulls, feels pain around its head, backs off, leash goes slack.  The ‘learning theory’ terminology for this training sequence is ‘positive punishment’ (+P) followed by ‘negative reinforcement’ (-R), and when wearing the head-collar the dog learns that in order to avoid pain, it needs to not move too far away from its handler’s side.  In addition to painful pressure, muzzle-clamping head-collars can make nervous dogs and those who experience frustration on-leash feel even more trapped than they do already, which can exacerbate fear, active-defence behaviour and aggression.  I know this, because I have worked with and rehabilitated such dogs.

If we look at the dog’s natural reflexes, it is a fact of physiology that dogs move INTO physical pressure, not away from it.  Moving INTO pressure is why dogs pull against a taught leash, pull away when we try and hug them close, and generally resist being pushed and pulled about.  This is due to the ‘opposition reflex’ (thigmotaxis, stereotaxis) whereby physical force applied to a dog in one direction elicits thigmotaxic reflexes that cause the dog to increase its efforts in the opposite direction to the force applied.  Dogs also move into pressure when they are stressed.  They lean against walls and push themselves into corners.  This provides feedback to the brain to calm the body down.  This is why anxiety wraps and ‘thundershirts’ are effective at reducing fear ~ the consistent, gentle pressure all over the dog’s body continually feeds back to the brain and so regulates the stress response.  Just as dogs naturally move into pressure, moving away from pain is also a reflexive behaviour, and this is why dogs are so uncomfortable wearing muzzle-clamping head-collars ~ leash tightens, dog feels pain around its head, dog moves away from pain.  If it really was ‘calming pressure’, the dog would pull into the head-collar, not draw away from it.

The manufacturer of one of these muzzle-clamping head-collars claims that the reason why dogs do not pull when wearing their brand of head-collar is because the pressure from the strap behind the ears causes the dog to move back into it, so essentially, the dog continually ‘pulls backwards’ and so walks forwards on a loose leash. However, this manufacturer also says that to achieve this, the correct fit requires the noseband to be loose and the headband to sit snugly just behind the ears, which actually is impossible. The noseband HAS to be tight in order for the headband to fit snugly. It is impossible for the noseband to be loose and the headband be tight. It is impossible for the noseband to be loose and the headband remain in the correct position behind the dog’ ears. In fact in order to get the headband to fit snugly and remain in the correct position, the noseband has to be so tight that the dog’s mouth is completely clamped shut, and the noseband drawn back along the muzzle so far that it rides up into the dog’s eyes. The picture left shows a Boxer wearing one of these head-collars, incorrectly fitted, despite this being the manufacturers own picture! The noseband does indeed have some slack in it, but as you can see the headband is sitting half way down the dog’s neck, several inches from its ears. The first time that this dog swipes at the head-collar noseband with a paw, it will slide straight off its face.

Other common claims by manufacturers of muzzle-clamping head-collars is that the pressure of the noseband mimics the ‘calming’ action of the dominant, parent dog’s jaws around its subordinate, youngster’s muzzle, and that the pressure of the headband and noseband correspond with natural acupressure points on the dog’s head and face. It is true that a wild wolf mother uses the ‘muzzle-grasp’ as a way to elicit passive submission from her very young cubs, but even if all dog-puppies learnt and understood this piece of dominance language (which many do not), it would naturally be an ‘on-off’ grasp, not a sustained grasp, so the continual ‘grasp’ of a muzzle-clamping head-collar is in fact most unnatural (bearing in mind that the noseband of at least one of the popular brands has to be a tight fit in order for the head-collar to remain on the dog’s face). It is also true that acupressure points exist along the dog’s muzzle-flaps and around the ears that when massaged, do produce a calming effect, but what I see are dogs who are far from ‘calm’ when wearing muzzle-clamping head-collars. I see many who are very shut down, sometimes to the point of being unable to move at all, whilst others simply are avoiding the pain of pulling. And then there are those who face-scrape, and twist and thrash about. I have yet to see a dog looking relaxed because the head-collar is massaging its acupressure points.

To some extent, the sensation of a band around the muzzle can help to regulate emotional arousal by sending feedback via touch receptors to the limbic system, the emotional control centre of the brain (the mouth is directly connected to the limbic system), but the noseband has to be nonrestrictive and bring gentle awareness to the mouth area with a light touch (not painful pressure) such as that from the elasticated 'calming band'. 
This effect is lost though when a dog’s defence mechanisms kick-in and kick-back against the restraint and feeling of being trapped when the noseband is too tight, or when it applies enough force to close the dog’s mouth.   

So although muzzle-clamping head-collars are marketed as ‘gentle’, ‘kind’ and ‘natural’, I consider them to be highly aversive as training tools go.  This is why I neither use nor recommend their use under any circumstances.  They clearly cause distress to the dog even when fitted and used correctly, never mind incorrectly, and for the dog who twists and flips and thrashes about whilst wearing one there is always the potential for it to do serious damage to its neck.  However, not all head-collars are bad news.  The reason why a head-collar can be a good choice for walking an unruly dog is the control over the dog’s head that a head-collar provides ~ control the head, and the body follows ~ but we can effectively control animals much larger and considerably more powerful than even the biggest dog with ‘non-muzzle-clamping’ or ‘fixed action’ type head-collars, i.e. those that do not clamp the animal’s mouth shut and tighten around head when the animal pulls.  There simply is no need to use a head-collar that tightens around a dog’s head, causing pain and adding to the anxiety or frustration that a leash-reactive dog is already under. 

What I recommend and use to train large and powerful dogs that display over-emotional behaviour on-leash is a non-muzzle-clamping, fixed-action head-collar, in combination with a neck collar and double-ended, 6’ leash.  First, the head-collar.  'Dogmatic', and George Grayson’s 'Dogalter' (available at B&M stores), are non-muzzle-clamping, fixed-action head-collars with the point of control beneath the dog’s chin:

Dogmatic head-collar

These brands of head-collars do not tighten around the dog’s face but instead provide a non-clamping, secure fit, and allow the handler to gently and effectively turn the dog’s head away from whatever is causing it to over-react without causing the dog to feel pain.  Dogs who have previously been made to wear Haltis, Gentle Leaders and the like, seem to have no problem accepting and wearing a non-muzzle-clamping head-collar ~ no turning tail and hiding at the sight of it, no scraping faces along the ground, no thrashing and twisting.  Even dogs who have never worn any type of head-collar before can be desensitised to wearing a fixed-action head-collar in a matter of minutes, with no backsliding after.  Dogs seem to like wearing these head-collars, which suggests to me that their design and use does not cause physical or emotional distress.

Next, the collar.  A flat, buckle collar is fine to use to walk the dog who rarely pulls on the leash, but for hardened pullers or those who lunge, all that forward motion is concentrated into a single pressure point, encouraging the dog to pull harder and potentially causing damage to the windpipe (picture right).

For hardened pullers and lungers, my neck collar of choice is the ‘limited-action slip-collar’ (also referred to as martingale-style collar).  Unfortunately and incorrectly, this design has also picked up the names ‘half-check’ and ‘half-choke’.  ‘Checking’ or ‘choking’ the dog was never the collar’s intended use, and it should never, ever be used in this way.  When fitted correctly, the limited-action slip-collar remains loose around the dog’s neck when the leash is slack, and when the leash tightens, is designed to apply consistent, non-choking, even pressure all the way around the dog’s neck.  The collar cannot continue to tighten because the action is limited to the correct fit of the collar, i.e. precisely the circumference of the dog’s neck, so when the sliding part of the collar is drawn up, that’s it, the collar fits snugly around the dog’s neck with no further tightening.  This has three benefits ~ 1. The dog cannot back out of the collar, 2. The pressure is not concentrated into a single point so the power of the opposition reflex is diminished, and 3. Using the leash to apply ‘pulsating pressure’ by alternately closing and releasing the collar, stimulates receptors along the inner walls of the carotid sinuses (major blood vessels situated either side of the dog’s windpipe) that send a signal to the brain to lower heart-rate and blood-pressure, which naturally helps to de-arouse the dog and therefore help him to control his emotions:

The closing and releasing of the collar should be just that ~ absolutely NO yanking, snapping, popping or jerking.  The collar should never be used to 'check' or 'correct' behaviour, but rather to apply light, pulsating on-off pressure when the dog is aroused and needs physical help to calm down.  If when you close and release the collar you end up 'rocking' your dog back and forth, you are being too heavy handed.  Your dog should not visibly move when you are working the collar.  I do not recommend all-chain limited-action slip-collars under any circumstances.  The main part of the collar should be made of webbing or soft leather of an appropriate width for the size of the dog.  The sliding part can be chain, as this part of the collar is only ever in contact with the dog's neck when the collar is loose.  When tightened, only the webbing/leather section is in contact with the dog's neck.  Limited-action slip-collars also come as an all-webbing version, with the sliding part as well as the main part of the collar being made of webbing.  Finally, the leash.  The double-ended leash has a trigger hook at each end.  When used in conjunction with a fixed-action head-collar and a limited-action slip-collar, the larger of the two trigger hooks is attached to the slip-collar sliding ring, and the smaller trigger hook to the head-collar control ring.  This gives the handler two points of control, and allows for the slip-collar and head-collar to be used independently of one another.  Most of the time the dog will trot along with barely any tension on either end of the leash because the design of both head-collar and slip-collar allows for the feeling of free movement, but when needed, the dog’s head can be turned towards the handler by applying finger-tip pressure to the head-collar end of the leash, and the stress-reducing action of the slip-collar can be activated by applying pulsing pressure with the collar end of the leash.

I am 5’3” tall and weigh a little under 60kgs.  I work with dogs, often large and powerful ones, who display a range of potentially dangerous on-leash behaviour issues.  I have used the fixed-action head-collar/limited-action slip-collar/leash combo for training Rottweilers, Mastiffs and Great Danes with complete control every time, and with no stress to the dog.  What’s equally important is that my clients can see that their dogs are so much more relaxed in a non-muzzle-clamping head-collar, and feeling in control themselves with the head-collar/slip-collar/leash combo, perhaps for the first time in years, they are able at last to start enjoying walks with their dogs and finally get down to the business of safely and successfully resolving their dogs’ various on-leash issues.

As a dog learns to be less emotional and engage in alternative, acceptable on-leash behaviour, the leash can be attached to the collar alone, while the head-collar is still worn to provide backup control for potentially tricky, beyond-handler-control situations when the small trigger hook can be unclipped from the leash and attached to the head-collar ring in seconds, allowing the handler to remain in control and so deal effectively with the situation.

Of course it’s not the head-collar/slip-collar/leash combo itself that resolves on-leash behaviour issues.  Good on-leash behaviour comes through providing a dog with the right training, and that’s where the guidance of an experienced dog professional comes in.  What the head-collar/slip-collar/leash combo does provide is a truly gentle and effective way of handling a powerful dog, and puts the dog’s owner back in control, both physically and emotionally.  It’s not so much a case of ‘control the head and the body will follow’ but rather ‘relax the brain and the body will relax also’ ~ handler’s and dog’s!