Category Archives: Cases & Recs

Kidney Failure in Young(“ish”) Cats

Kidney Failure in Young(“ish”) Cats

See also:  Kidney Results

When you get blood work back on a pet (Cat), it’s about nine years old and it shows kidney failure it’s not always clear what’s going on. There’s another test or two that you’d run on a dog and there are some tests you could run on a cat. Actually, there are ways to spend thousands. Or, treat the treatable? Give this a listen.

The above does not constitute advice or replace the necessary input of your regular veterinarian within the confines of a VCPR. The above is as much a ‘document’ for the benefit of a particular client I sent to this, as it is to others who may face the same situation.

Old Dog Tremors – Is it Normal For My Dog’s Leg To Tremor?

Old Dog Tremors – Is it Normal For My Dog’s Leg To Tremor?

Commonly we will see one or two limbs on a dog that simply tremor.
Key elements of a “Don’t Worry About It” response are:
1) Pet seems unaware
2) Happens upon some excitement
3) Pet acts perfectly normal in every other respect
4) It’s not constant at all. Maybe daily.

So, if (in the video) there was thunder, or if the dog was looking around terrified, then you know the tremor is “a thing”.

If the dog is just resting and looking at the TV then it’s ‘nothing’.

(Video formats correctly when played.)




The Covid Protocols

Symptoms of Pet Illness or Irregularity

To know what’s going on with your pet when I look at it, the following will be REALLY important. And if forms aren’t ‘your thing’ it’s okay, you can call 770 977 5377 and the staff member will collect any and all descriptive of the problem.

This form is ABSOLUTELY only for the use of Johnson Veterinary Services brick-and-mortar customers who are bringing a pet for care.

This form is ABSOLUTELY only for the use of Johnson Veterinary Services brick-and-mortar customers who are bringing a pet for care. This form will be ignored for online consultation.

This "all-in-one-form" attempts to collect everything from dermatology, to gastroenterology, to neurology and everything in between.
You can be descriptive
You can be descriptive

Azo and Cranberries for Dogs

Folks sometimes call the office looking for something they can do for their dog til it can get seen, or over the weekend, or just IN CONJUNCTION with a standard treatment.

And they ask about AZO, AZO Standard. Which is FINE to ask about except it turns out, the compound in AZO STANDARD is toxic to dogs.

Azo Cranberry, on the other hand, can be soothing, and it makes it harder for bacteria and inflammation to occupy the bladder and urethra.

Currently, Azo Cranberry isn’t made with Xylitol (it’s been years since manufacturers used Xylitol in anything that was possibly going to be used for dogs and cats. They’ve gone to sorbitol for the most part but MAKE NO ASSUMPTIONS and look. Xylitol can be toxic to dogs.

These are Azo Cranberry gummie chews and perhaps they'd be better taken by pets? The tablets may be better suited to embedding in peanut butter, cheese or your favorite form of pill disguise. 

This is the tablet version. You can use "the adult dose" per 50 pounds of dog. That means if the 12 to adult dose is 2 tabs twice a day, go with that. If you're treating a little dog, consider quarters to halves. Still, the margin of safety on 'pure cranberry' is high. 
When treating dogs up to 120 pounds consider increasing the dose by 50% (Means 3 tabs instead of two)

I would add, that if some dog-breeder message board is running off telling people to use "just any" Azo, or they're recommending another Azo, (for example the one with the extra chemistry in it) AND you try it, AND it works and doesn't wreck your dog's kidneys or mentation, please let me know. That is COMMONLY a way I learn new things, is treating things the breeder message boards cause, SOMETIMES for better, SOMETIMES for worse. 

To wit: 
"Phenazopyridine hydrochloride in dogs
Phenazopyridine, found in products such as Pyridium, is an OTC medication used to urinary tract infections and other urinary problems. This medication may be toxic to pets and should never be administered to animals. ... Presumptive hepatotoxicity and rhabdomyolysis secondary to phenazopyridine toxicity in a dog."

Zoe D. Can Walk Now!

So, there is an elderly Chihuahua named Zoe who was brought in because she could not walk. Fortunately for her, she could still feel her feet and she was able to move her legs but deterioration in her neck vertebrae have caused her legs to be very weak and her nerves are not very strong. Prior to medication, she even had trouble holding her continence.

Her parents were very dedicated and found her a cart made for dogs that suffered with paresis in all four legs. This cart holds her up securely enough to make her want to move around, and she is able to maneuver the cart with what strength she has left in her legs so that she can participate with the family on the main floor of the house.

I’ve met this dog, she is not in the least bit unhappy. That is the reason I think, that it is worth the investment that they made in allowing her to be mobile again. I think if she was “broken” and her spirit had departed, it would have been better to let her go. But as it were, she has a new lease on life.

Reverse sneeze, or snorting in dogs

I’ve been waiting for a long time to get a video of a dog performing the “reverse sneeze” and I finally got it. This dog is doing a classic reverse sneeze, except the pace is a little bit slower than some dogs that may be younger.

What’s happening is that air is moving inward through the nose being pulled by the dog who is trying to dislodge his epiglottis from the opening of the Soft palate.

A dogs soft palate is very much like yours in the roof of the mouth and further back where you have a uvula or a little “punching bag“ dogs don’t have that.

At the opening of the wind pipe or trachea, there is a little triangular piece of tissue called the epiglottis and that sticks out behind the soft palate. Normally they never touch. But then, during allergy season, or after a lot of coughing, or during the winter with dry heat and the cold, the soft palate may swell and become irritated. When the soft palate is more swollen, the epiglottis can get trapped behind it and then the dog has to do the reverse sneeze to free it up.

The dog is not choking, anytime they wanted to they could open their mouth’s and breeze easily through their mouth. It is not a sign of heart disease, it is purely a function of airway swelling and irritation. Some dogs do it all the time because they’re soft palate is elongated, “made that way” and sometimes is so bad that it requires surgery.

The majority of these dogs go on an anti-histamine and an anti-inflammatory and quickly resume normal breathing and health.

Consequences of Atkins style, or ultra low carb feeding

Weight loss in dogs by feeding Atkins style is extraordinary, nothing short of exciting, when dogs are not given carbohydrates for a while their appetite planes down as they are no longer on the blood sugar roller coaster. Weight peels off of them and it’s just fat weight so it is very healthy.
My two-year-old dog Ajax just got too ripped. I didn’t like it when his ribs appeared and his flanks would ripple so I put him on the average American carbohydrate-based diet and his ribs have disappeared now now I limit the quantity so he does not get fat which is very easy on carbohydrate-based diet‘s. The following recording discusses Atkins feeding and will illuminate how to do that and diets to satisfy that goal.

DHEA 2019


So there are hormone systems in the body which involve testosterone in males and estrogen in females. Those hormones are vital in the performance of the young male or young female dog or cat, reproductively, as well as for strength, endurance, overall health, muscle mass bone density fitness. Very solid studies have demonstrated that sex-hormones a protective for many cancers, decreasing the odds of cancer in people and animals (when present) by 8-10%.

In people these crucial hormones are produced in the “gonads” which are the testicles or the ovaries.

People and animals also synthesize DHEA in their gonads. Humans (not animals) can also produce DHEA in their adrenal gland and that matters as you will soon see.
But let’s stick a pin in that.
Science has discovered another hormone called “DHEA” which functions at the cellular level very much the way our sex hormones affect us. High levels of DHEA in male tissue can elicit some of the same changes as testosterone. In females high levels of DHEA may function beneficially as estrogen. In humans, DHEA is produced in the adrenal glands at a certain basic level.

In the dog however, DHEA is produced ONLY in the gonad.

So here’s the thing, in a dog or cat when you spayed or neutered them, you are removing their sex hormones as well as their DHEA because they do not produce DHEA in their adrenal gland. The “adrenal” is the gland we leave behind when we performed ‘gonadectomy’ for a pet.
So your animal has no hormonal support of any kind, for its lifetime, not even DHEA. And there is a price to be paid (long-term) for that.
So a recent “fad – bandwagon” in television / Youtube Vet practice is administering DHEA to animals hoping to appreciate some of the benefits of hormones support on those animals. And in fact the results are initially encouraging.

This is the DHEA that I take on the daily. It has the Keto-7 metabolite and regular DHEA for a total of 125mg

However, when you put DHEA into an animal system, you are giving a signal for tissue building, and the activation of a lot of activity,  metabolically. In other words the body suddenly needs the building blocks for the processes that the DHEA is calling up. Sadly there is not a limitless supply of these building blocks and so certain enzyme systems such as nADP and nADPH are exhausted with time, as
DHEA is given. Does it matter in a year? Probably not.

But for long-term use of DHEA, or high dose DHEA, research has been done to determine what enzymes and compounds become deficient metabolically in animals given DHEA; and research is forging ahead to try to bring a product (of a safer nature) to market in 2019. In the meantime supplement of high-dose DHEA to dogs should be endeavored only when the benefits outweigh the negative side effect of metabolite exhaustion.
In my opinion any dogs that is ill, very old, suffering a deteriorating quality-of-life, have little to lose in the effort to gather the benefits of DHEA therapy versus the eventual exhaustion of certain metabolic
processes. Anti-cancer benefit have been noted with DHEA supplementation, research on that is continuing.
Weight Dose Times Per Day
< 10 lb give 5 to 10 mg – 1-2x daily
10-20 lb give 25mg – 1x daily
20-30 lb give 25mg – 2x daily
30-50 lb give 50mg – 2x daily
50-80+ lb give 100mg 2x daily

Some dogs experience agitation. (That’s been 2-3 cases in as many years. Which is why MORNING dosing is good.
Some dogs can have a very untoward reaction to DHEA. That is uncommon, but it looks like this: Fever, joint pain, skin rash and even sores around the mouth and eyes. That’s CRAZY rare and may not even happen in dogs. It happens in people sometimes, and they don’t know why. (Stevens-Johnson Syndrome)

Obtaining DHEA can be simple, but there are caveats. For this to be even worth it, you might want to get a pharmaceutical grade DHEA which are available on and here are the names of two
laboratories that will produce and sell pharmaceutical grade: “Douglas Labs” and “Pure Encapsulations”. Both are commonly relied upon by medical professionals in the human field.
As with any promising nutritional supplement, the FDA has not had time to evaluate the many assertions made about DHEA, and we know there are some karri = a reckoning risks in terms of a reaction among certain dogs as well as eventual deleterious effects latently and possibly sub clinically. In the meantime the benefits probably outweigh those risks. If your pet is weak, very old, sick, or experiencing a deterioration in quality-of-life, which is the reason this information is being provided for you and this recommendation is being made.

What follows is my 2019 Review of DHEA and canines, felines. It’s based on case experience and has some revised dosing and precautions.
canine dhea impact

© 2018 Dr Erik Johnson –


Pancreatitis Case Communication

When bloodwork reveals pancreatitis.

That’s serious inflammation (sometimes even infection) of the dog or cat’s pancreas. It can be life threatening if it drags on or becomes chronic. The pancreas can lose enough integrity to result in diabetes and exocrine pancreatic insufficiency. If the inflammation is serious enough, the belly may even suffer peritonitis.

In some cases, infection is suspected when a pet is anemic. (Low iron, lacking red cells) or the white cells are elevated.

Pancreatitis is painful and “Tramadol” pain reliever is a “good idea”.

Management of Pancreatitis

The KEY element in pancreatitis is LOW or NO FAT in the diet from here on out.

Starting now:

  1. No food for 48 hours.
  2. Only water, not even broth.
  3. After 48 hours — Fat free or VERY low fat food(s)

Rice is fat free.

A diet of eggs, and non-starch vegetables works.
So you can consider: (Low starch low fat home cooking)

Or, you can use Hill’s Low Fat ‘i/D’ diet which is super digestible and very low fat. We have excellent luck resolving pancreatitis with that. I’d go through a 30 pound bag and then MAYBE consider going back to another low fat brand.


If a dog or cat with pancreatitis gets a piece of pizza, they will go RIGHT back to “square one” with the pancreatitis.

If the pet is diagnosed with pancreatitis and the hematocrit is low, or the white cells are high, vets may be a little worried that a dog or cat may have blood in the abdomen from the pancreas. A tap would tell.

But what would we do with that information BESIDES:

  1. Low fat feeding
  2. after a 48 hour fast
  3. Tramadol
  4. Antibiotics

What REALLY Kills Dogs? (Longevity threats)

What are the BIG Threats to Longevity in Dogs?

I’d like to do an article that describes “what really kills dogs“, or “What gets in the way of dog and cat longevity?”
There’s just so much stuff out there. With the advent of the Interwebs, veryone can sell advertising! 15 or 20 years ago it was just the major networks that could make money from a Nabisco ad. But now, anyone with Internet access, and enough of an audience can make money from advertisements running on their channel or web site. I’m fine with that.
The problem is that you have to have people (traffic) in your channel or website for those ads to make any difference, and so what you see is a lot of embellishment and hysteria and headline-grabbing and sensationalism; basically, which has been going on since the start of mankind.
Since EVERYTHING with dogs and cats is an overwhelming crisis, nowadays, how do you know what’s real?
I publish my longevity articles understanding that nobody’s really going to look at my stuff, and this has been borne out over and over again, because I don’t know how to trick Google into putting me at the top of the rankings and I’m not going to use headlines like “The president is dead“ to get people to click on my channel.

Don’t you think it’s funny that when Google started it was their job to be the best search engine there is. But now, instead of doing a good job of finding good information, they sit back and let the content provider come to THEM. It’s not about finding good content for them. It’s about content providers “toeing the line” and creating pages that Google “likes” whether there’s actually good content or not.

So what I’m going to do is write a quiet little article on pet longevity, what’s really killing cats and dogs based on experience in a suburban small animal practice.

Because it’s not dog food. And it’s not spay and neuter. And it’s not shots. Not hardly!

First, I’m going to brainstorm all the reasons dogs and cats died this last year.

  1. Extreme age and infirmity 75
  2. Cancer 35
  3. Complications from obesity 30
  4. Kidney failure 15
  5. Complications from Oral infections 7
  6. Biting and safety 6
  7. Hit by car and accident 6
  8. Heart disease 5
  9. Unexpected unexplained 3

There’s some overlap but not much. #2 is sometimes part of #1 and #4 and #8 find their root in #5.

Keep in mind that this is simply the number of cases that are subjectively assigned to a particular cause of death, from one little small animal practice in Marietta Georgia.
I think it sheds a lot of light on the reason people leave my clinic without a dog or cat (aka: pet expires or is put down).

What are the BIG Threats to Longevity in Dogs?

I noticed that a preponderance of animals face the end of life simply because they wear out. Their overall condition becomes so aged and infirm that quality-of-life is robbed from them.
As a distant second, lots of pets cross the rainbow bridge because of cancer, and a LOT of them have shortened longevity from  complications from malignant obesity.

Many a day I will be putting asleep putting an animal to sleep that is considerably overweight and can’t get up. These dogs have carried the weight most of their lives, and into old age and then as their joints stiffen and their muscles weaken, they get down and cannot get up.
They pee on themselves, and in the house, and there is no dignity, and we put them down.

That is a commentary on overweight in dogs as they move into their twilight years. “Overweight past eight” – just doesn’t go well for them.

Longevity in dogs
Besides YEARS, “down in the back legs” and “peeing himself” would be a second place.

On the other hand, it’s never too late to start, putting them on Atkins diet which is essentially Paleo. Ultra low-carb feeding getting the carbohydrate fraction down to 10% or less eating eggs and non-starch vegetables with a little pumpkin stirred in for soluble fiber.

And, administering DHEA to these pets to shave her weight off of them. This can add as many as three years to the longevity of some of the larger patients, as their physical abilities deteriorate with age.

This is a pseudo-hormone that can restore many of the metabolic benefits of the sex hormones like testosterone and estrogen to the dog, increasing resistance to cancer, and aiding in the metabolic acceleration of weight loss.

Establishing thyroid status
Many older animals are hypo thyroid and when that is corrected, they get a new lease on their metabolism, a big boost to longevity  and weight loss is remarkable.

Feeding ultra low-carb, once known as Atkins, achieved amazing weight loss, suppression of the ravenous appetite after several months, and extraordinary benefits to overall health.
I will never mention feeding dogs Atkin’s style, without simultaneously mentioning that when people feed their dog Atkin’s style, but also give carbohydrate treats and table food on the side, that will kill the dog! Atkins style feeding is high protein and significant amounts of fat, and if given with carbohydrates, the fat is deposited and the animals become PONDEROUS.

longevity compromised by weight?
Is it his AGE or his weight? He gets put down because it’s so sad to watch him struggle with his arthritis.

It is difficult to contemplate the extension of life through weight loss if pain remains. Who wants to extend a painful life?

Allow me to take a moment to describe an “arthritis diagnostic” regimen that I am very fond of.

We take an animal in reasonable health, we put them on three medications to ameliorate arthritis in order to see how much of an impact arthritis is actually having on the dog.

Let me explain that:

If you put a dog on medicines for

  • pain
  • inflammation
  • nerve pinching
  • bone-on-bone grinding

…and you don’t see any difference in the dog, it suggests that these issues don’t manifest in the dog. That he doesn’t need those medicines.

However, if you use a comprehensive panel of medications for a week that address most causes of discomfort in elderly dogs and it’s “the best week of his life“ then you know you have a candidate for long-range arthritis management. You can’t tell a dog in back pain, it does NOT cause limping, right? How can you tell if they have a sore neck? They can’t tell you and it doesn’t cause a limp.
But when they respond to empirical arthritis / nerve pain medications “tried for a week” – these are exciting cases.

Quite often, it’s not necessary to use all three of those medications all the time once you know that arthritis is a factor and can be controlled, you can reduce the amounts and frequency of certain medications and still get excellent results.

The key is the initial diagnosis based on therapeutic response.

The initial cocktail does not include a painkiller. No narcotics, as I do not want to mask the pain, in this protocol I want to alleviate it.

We use Deramax, methocarbamol, and gabapentin. Depending on the pet, we may also use a stomach protectant like famotidine or omeprazole.

After the first week, if the Pet is doing very well we may continue to manage him or her using the following protocols:

Perpetual low-dose gabapentin, perpetual low dose methocarbamol, and “as needed“ Deramax. There is economy and safety in that message.

Some people are so crazy about the way their dog is feeling on the three medications given every day, that they decide to stay with that, and it is perfectly OK.

Most vets will bother you every six months for blood work to check to make sure nothing is happening with the kidneys and liver on the nonsteroidal anti-inflammatory.