DEAR READERS: I am concerned that the ubiquity of pet insurance providers, aligned with the corporate consolidation of companion animal veterinary practices, could lead to overtreatment, unwarranted and costly diagnostics and exclusive promotion and sale of particular manufactured pet foods. Some critics call this a one-size-fits-all medical assembly line.

I was recently solicited by a public relations firm to write about pet health insurance, the communication stating: “I’d like to offer you a story idea about the true cost of pet care. We love our pets and spare little or no cost to keep them healthy, but that can rack up quite a bill. For example, a report from Healthy Paws Pet Insurance about the cost of caring for pets shows that the most common illness for dogs and cats is stomach issues, which can lead to these costs: digital X-rays: $150 to $400; endoscopy: $800 to $1,000; biopsy: up to $1,500; ultrasound: $300 to $500; CT scan: $3,000. Total: up to $6,400 -- for stomach issues!”

Yet this “most common illness for dogs and cats” can be prevented, and often effectively treated, simply by providing biologically appropriate, healthful diets rather than feeding many of the manufactured cat and dog foods on the market and often sold by veterinarians that can cause “nutrigenic” (diet-associated) diseases.

The world’s largest pet food manufacturer, candy company Mars Inc., recently acquired VCA Antech Animal Hospitals -- with 780 animal hospitals in 43 states. This is coupled with the acquisition of some 900 Banfield Pet Hospitals in 2007 and of BluePearl, the nation’s biggest chain of companion animal specialty and emergency care clinics -- with 53 locations in the U.S -- in 2015. With Banfield’s Optimal Wellness Plans, Mars may next become a player in marketing its own pet health insurance plans.

While such corporate consolidation of veterinary hospitals may have limited benefits for pet owners, an estimated 85 to 95 percent of veterinary hospitals are still owned independently, some merging to create their own collaborative private corporations to reap the benefits of economies of scale and increased profitability by pooling equipment and other capital expenses and integrating specialist referral services. It is my hope that companion animal health care will not go the way of the increasingly profit-driven and dysfunctional human health care industry, where monopolistic drug companies inflate prescription drug prices (as they do also with veterinary medicines) and where diagnostic errors and medical mistakes lead to more than 250,000 deaths each year in hospitals, according to a 2016 Johns Hopkins University study.

Visit veterinarymedicine.dvm360.com for veterinarians’ views on whether corporatization of their services means better or worse patient care and client satisfaction.

Owners of companion animals must accept responsibility for their animals’ health with annual wellness appointments with veterinarians who embrace the principles of preventive and alternative, integrative medicine, as advocated by the American Holistic Veterinary Association.

DEAR DR. FOX: My question is regarding my rescued Jindo dog, Angie, who has been in the family for 10 years now and is 12 years old. I am a very gentle and patient owner, and I let her walk me for as long as she wants. She enjoys being off the leash with her doggie friends.

When frightened by lawn mowers or an aggressive dog (she was brutally attacked by two off-leash dogs), she has twice bitten me. These are serious bites, drawing lots of blood. She has no clue. I treated the wounds myself, so I would not have problems. The vet put her on a daily dose of fluoxetine, and she has not bitten me since she has been on the medication.

Why did this little Jindo girl bite me twice? -- I.H., Arlington, Virginia

DEAR I.H.: What you experienced was a fear-biter's defensive behavior being redirected. Quite often, when two dogs who live together are barking at another dog on the other side of their fence, one of the two dogs may lunge at and mock-attack the companion, and in some instances actually bite and start a fight. This is also seen in cats who are upset by a cat outside.

Experienced animal handlers are aware of such redirected or "spill-over" aggression and take precautions when a situation could arise where redirected aggression may be triggered.

It is not rational behavior, and in that panicked state, the animal cannot be reasoned with until he or she calms down. The medication your veterinarian prescribed essentially dampens the panic reaction, which is more likely to occur in animals suffering from post-traumatic stress disorder and specific phobias.

(Send all mail to animaldocfox@gmail.com or to Dr. Michael Fox in care of Andrews McMeel Syndication, 1130 Walnut St., Kansas City, MO 64106. The volume of mail received prohibits personal replies, but questions and comments of general interest will be discussed in future columns.

Visit Dr. Fox's website at DrFoxVet.net.)

DEAR DR. FOX: My 2 1/2-year-old cat has spent most of her life indoors. She makes the usual chattering noise when she sees a bird, is very interested in watching the squirrels, goes from window to window to watch a bunny hopping by, doesn't care much about dogs sniffing around and she rarely mews, but chirps.

My son and I were astounded when, while looking out the window, she spotted a cat and started howling and hissing. So, here's the question: How did she know it was a cat and that howling was the way to go? -- J.S., Moorhead, Minnesota

DEAR J.S.: You seem to be asking how your cat knows that it was a cat outside and not some other creature. Animals have self-awareness, and one cat seeing another outside most often perceives the other cat as a threatening invader of territory, but not a rabbit or dog.

Your cat, like most, has a significant repertoire of vocal sounds for different situations to express her emotional states and cognition. When you live with more than one cat, you may find that one does most of the "talking" and that some varieties, such as Siamese, are very vocal indeed.

You may also see how cats do recognize and respond to each other's different vocal sounds. One of my cats would generally ignore the other, who was twittering and chirping at birds and squirrels on the other side of the window, but would come running to see when a low growl-yowl was given at a free-roaming cat or a less intense vocalization at a raccoon or groundhog.

Your cat could have heard the other cat giving threatening calls and smelled the cat's spray, which free-roaming cats often do around the homes of other cats. This can be very distressing for in-home cats and in many instances can make them start to spray indoors, become house-soilers and even attack each other.

MILLENIALS TOP PET OWNERSHIP

Pet ownership is up, according to the American Pet Products Association’s 2017-2018 National Pet Owners Survey. It reports 68 percent of American households now own a pet, accounting for 84.6 million pet-owning households, up from 79.7 million pet-owning households in 2015. Millennial pet ownership surpassed that of baby boomers by 3 percentage points, and the younger segment includes more than 50 percent of reptile, small-animal and saltwater-fish owners.

I would urge people of all ages not to purchase reptiles or other exotic warm-blooded animals that cannot be provided a proper habitat in unstimulating environments that are facsimiles of their true natures, analogous to zombies. Like many wild bird species, these exotic reptiles are part of a lucrative worldwide industry that causes many to die before they get into the pet stores for uninformed consumers to buy on impulse.

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(Send all mail to animaldocfox@gmail.com or to Dr. Michael Fox in care of Andrews McMeel Syndication, 1130 Walnut St., Kansas City, MO 64106. The volume of mail received prohibits personal replies, but questions and comments of general interest will be discussed in future columns.

Visit Dr. Fox's website at DrFoxVet.net.)

DEAR DR. FOX: The other day, my husband was reading your column and when he was finished he threw the paper down and started to cry. He looked at me and said, “Well, it’s pertinent.” I picked it up and read it, and then I began to cry. The subject you wrote about was happening to us right then.

Our beloved 16-year-old cat, Gracie, was terminal, and it was only a matter of time until she would be gone. Your column dealt with a man who had two cats and lost one. The surviving cat suffered with grief for a long time, so when the situation arose again, this time he took the surviving cat with him when the other cat was euthanized.

After reading this advice in your column we decided to take our Koko with us when Gracie was euthanized. Koko had been through this several years ago when his brother, Kiki, died. Koko was depressed after, and we made sure that we touched, petted and played with him extra to help him get over the loss -- and us, too.

Koko did not like being there, but after we got home, he went into a basket that was always Gracie’s. As soon as Gracie took it over, Koko never went into it until she was gone. It’s been only four days now, but he is taking over some other things that were Gracie’s alone. We are heartsick that we lost our very special kitty, even though she had been lucky as she had an ectopic ureter that was diagnosed when she was 2. She dealt with it very well, so did we, so to have 16 years with her was amazing. -- D.H. and J.H., Estero, Florida

DEAR D.H. and J.H.: You have my sympathy; I understand how devastating the loss of an animal companion can be. I am very glad that one of the issues in my newspaper column coincided with your situation and you found it helpful.

Koko's behavior is interesting in that he clearly accommodated or deferred to Gracie when she was alive. Being conscious that she is now gone, he is essentially filling in some of the spaces that she formerly occupied, both physically and psychologically.

Behavioral and neurological sciences have helped advance our understanding and appreciation of animals' consciousness and emotions. Such evidence that warm-blooded animals are more like us than they are different deflates the erroneous belief in human superiority. It forces us out of anthropocentrism to face the realities of animal use and abuse around the world. For instance, consider the suffering of billions of animals raised for human consumption and used for experiments to find cures for human disease.

For the views of some of history's deepest thinkers and social reformers, I would highly recommend a book by an old colleague and dear friend in Germany, Johanna Wothke. She is the founder and director of Pro Animale, an organization that has set up 25 animal shelters across Europe and Turkey and rescued thousands of dogs, cats, equines and abused and neglected farm animals. Her philosophy is captured in the book's title, "Memento," a derivative of the Latin "memento mori," which suggests being mindful of your death. Such mindfulness, she contends, can move us all to examine how we live in relation to the lives and eventual deaths of others, and lead us along the "paths of suffering and the destruction of our fellow creatures -- the animals -- as caused by us humans."

People in America can support her international animal rescue work and learn more by purchasing copies of "Memento" through email at proanimale-sw@t-online.de.

EXERCISE HELPS DOGS WITH INFLAMMATORY BOWEL DISEASE

Two veterinarians in Taiwan have documented the benefits of an exercise regimen in addition to standard prednisolone treatment in small-breed dogs living a sedentary life and suffering from chronic diarrhea. This was after other dietary treatments (hydrolyzed and hypoallergenic elimination diets) and various supplements either failed or only partially improved their inflammatory bowel disease (IBD). Although this was a small study inspired in part by the clinical improvement in human patients suffering from IBD who are able to participate in a regular exercise program, it offers a safe and potentially effective additional therapeutic approach to this all-too-common canine condition.

Living a sedentary life, rarely aroused and often being trained to evacuate inside, especially when living in high-rise apartments, could lead to longer retention times of fecal material prior to evacuation. This may cause inflammation of the bowels, exacerbated by various dietary ingredients and their metabolites with further possible health problems due to bacterial endotoxins. Physical activity may help improve circulation and help alleviate and prevent lymphangiectasia, the accumulation of lymph in the bowels seen in some forms of canine IBD.

Mental arousal with physical activity may increase peristaltic tonus of the bowel’s smooth muscles that may become flaccid with a placid temperament and an unstimulating indoor environment. Megacolon and fecal impaction, commonly seen in under-stimulated and under-active indoor cats, and weak urinary bladder tonus with urine retention and consequential cystitis may also be related to a lack of arousal and physical activity.

So walk more with your dogs and play more with your cats, some of whom may also enjoy outdoor walks in a harness or on a leash!

(Send all mail to animaldocfox@gmail.com or to Dr. Michael Fox in care of Andrews McMeel Syndication, 1130 Walnut St., Kansas City, MO 64106. The volume of mail received prohibits personal replies, but questions and comments of general interest will be discussed in future columns.

Visit Dr. Fox's website at DrFoxVet.net.)