## Medicine By the Numbers

March 26, 2014

Dr. Ann Hohenhaus

We all rely on numbers to help us make decisions. The stock market is above 16,000; time to sell. Your chance of winning the Powerball Jackpot with a two dollar ticket is one in 175 million, but it’s only two dollars so you buy yet another losing ticket. One in four Americans dies of heart disease every year; more exercise and less butter for you. In my line of work, veterinary medicine, quoting numbers is not nearly as easy.

I have been struggling with a particularly complicated cancer case the past few weeks. After hours of discussion and many more of pondering the options, a clear plan has emerged for this patient. And then the client asked the number one question: “What are the chances my pet will benefit from this procedure?” Having never been much of a math whiz or very successful at gambling, explaining the concept of odds is difficult. The odds of A versus B are calculated from a large group of patients with the same disease. But when I am talking about Fluffy or Fido, it becomes harder to predict the outcome for an individual patient. In some ways it’s a 50-50 coin toss. Your pet gets better or it doesn’t. Because medicine rarely has 100% certainty, no doctor, human or animal, will ever guarantee a 100% chance of success. Even with a 99.9% chance of success, there will be some patients who do not have the desired outcome after the test, treatment or surgery is completed.

An article in last week’s New York Times ‘Science Section’ written by a physician, numbers and their connection to disease appear again. Dr. Abigail Zuger writes about using a reasoned numerical approach (“30 percent of people with your problem of X will develop Y”). Yet, she writes, “many studies (and all casinos and lotteries) illustrate how abysmal is the average person’s understanding of risk when couched in mathematical terms.” Her patients have a hard time grasping the importance of risk factors on their future health or as she calls them “pre-diseases.”

If two medical professionals have difficulty using numbers in their daily practice, then how can people or pet owners make well-informed decisions on healthcare matters?

1. Preventing disease is much easier (and cheaper) than correcting a problem. If your veterinarian gives you numbers on preventing disease, pay close attention. For example, obesity quadruples your dog’s risk of cruciate ligament rupture. Getting your dog’s weight down saves money two ways – you buy less food and your dog doesn’t need an expensive reconstructive knee surgery.
2. There are actually some medical conditions that doctors can predict the outcome with reasonable certainty; for example, diabetes. Without administration of insulin, which is deficient in dogs and cats with diabetes, your pet will die of high blood sugar within days.
3. Since not all diseases come with certainty of outcome like diabetes, think about quality of life. If your pet’s current problem is decreasing their quality of life, consider a treatment to improve it. Keep in mind this is where numbers can become overwhelming and sometimes a decision is made based on your heart rather than your head.

## Pot for Pets

January 21, 2014

Photo: Fox News

The New York Times recently announced that via executive action, New York Governor Andrew Cuomo will relax the laws governing medical marijuana use in the state. New York State has some of the most restrictive and punitive laws regarding illegal drug usage, hold-overs from the Rockefeller era drug laws of the 1970s, and many feel these changes are long overdue. What does this mean for pets?

Increased Toxicity Cases
Veterinarians in New York State will need to be prepared to treat more dogs with marijuana intoxication if the experience in Colorado holds true here. Colorado is a state where medical marijuana is legal. Veterinarians in Colorado studied the number of dogs experiencing inadvertent toxicity from ingestion of marijuana. These researchers found a four-fold increase in the number of dogs treated for marijuana ingestion over a five year period. The increase paralleled the increase in the number of registered users of medical marijuana in Colorado. Pet Poison Helpline reports an increase in calls about canine marijuana intoxication as well.

Dog OD
Ingestion of marijuana, marijuana containing foods or inhalation of marijuana smoke can affect dogs; they become glassy eyed, uncoordinated, and may be very sleepy. These dogs need intravenous fluids to maintain hydration and warming blankets to maintain their body temperature. Often, dogs intoxicated by marijuana dribble urine. Some dogs become hyperactive. Severely affected dogs may seizure or become comatose requiring ventilator treatment until they regain the ability to breathe. Dogs typically recover in one to three days. Sadly, the study of Colorado cases of marijuana reports the death of two dogs ingesting baked goods made with medical grade tetrahydrocannabinol (THC) butter.

Iguana Intoxication!
Although dogs are the most commonly affected by marijuana intoxication, I found a report of three intoxicated iguanas. The iguanas had clinical signs similar to intoxicated dogs – seizures, stomach upset and one even required antiseizure medication. All three recovered fully.

Veterinary Medical Marijuana
So with marijuana legalized in some states for medicinal purposes, is medical marijuana for Fluffy and Fido next? Despite the obvious risks outlined above, some pet owners have taken marijuana for pets into their own hands.

Currently marijuana belongs to the group of drugs most tightly regulated by the Food and Drug Administration. Even though I have a license to prescribe some controlled substances, marijuana is not on the list of those I can prescribe. This tight regulation also restricts research with marijuana. Research is needed to help veterinarians understand what conditions the drug helps and how to use the drug safely and efficaciously in veterinary patients. So for now, I don’t know how to appropriately dose THC in my patients and I can’t do it legally.

1. Keep marijuana and medical marijuana products out of reach of your pets.

2. Call animal poison control if you think your pet has eaten marijuana:

• ASPCA Animal Poison Control (888) 426-4435
• Pet Poison Helpline (800) 213-6680

3. Tell the animal ER what your pet ate. Making the ER veterinarians play a guessing game about your pet’s condition can delay appropriate treatment.

## Neutering: Not Just Doggie Birth Control

December 4, 2013

Dexter, a new dachshund patient of mine, was in last week for another round of puppy shots. He will soon be six months old and it was time for me to discuss the next step in his preventive health care plan: neutering.

Neutering meets the guidelines
The American Veterinary Medical Association has developed guidelines for responsible pet ownership. One of the guidelines obligates pet owners to control their pet’s reproduction through spaying and neutering; subsequently helping to control pet overpopulation in their community. Neutering is the common term for castration of a male dog or cat and spaying refers to removal of the ovaries and uterus, or in some cases just the uterus or ovaries, of a female pet.

Lifesaving responsibility
Pet overpopulation is a serious issue in the United States today. According to the Humane Society of the United States, over four million unwanted pets are destroyed annually. For every puppy or kitten prevented by neutering an adult pet, there is one less homeless and unwanted puppy or kitten euthanized in an animal shelter.

Surgical removal of the testicles is the current standard of care for neutering in both dogs and cats. This surgery renders a male dog or cat unable to reproduce and also removes the major source of the male hormone, testosterone. Removing the source of testosterone eliminates mating behavior in males and also plays a role in eliminating other unwanted behaviors. In both the dog and cat, neutering involves a small skin incision through which the testicles are removed. Cats typically go home the same day, but dogs may stay overnight to recover from anesthesia and for incisional monitoring.

A new method
The New York Times Well Blog recently reported on a new method of non-surgical, chemical castration, called Zeuterin. Zeuterin neutering uses zinc gluconate and arginine injected into a dog’s testicles as a less invasive method of castration. Dogs still produce a small amount of testosterone, but are unable to sire a litter of puppies. Veterinarians must be trained to use the Zeuterin method of neutering, but especially for shelters and rescue groups, the method has great appeal.

My recommendation
Dexter’s owners were concerned about the surgery. They asked if he could just have a vasectomy instead of the traditional neutering surgery. Because my job is to make the best medical recommendations for the specific health concerns of each of one my patients, I recommended the traditional surgery for Dexter. It provides him with the greatest number of health benefits. The surgery prevents unwanted litters of puppies and also prevents prostatic disease, testosterone-induced tumors and behaviors linked to testosterone production. Because a vasectomy or Zeuterin neutering are methods of birth control only, they do not offer the added advantage of decreased levels of testosterone on behavior and disease.

## Choosing a Veterinary Hospital

July 31, 2013

Is there a new puppy in your family? Has the backyard cat installed himself on your family room sofa? Have you inherited grandma’s piano and her parrot? If so, you won’t want to leave the important decision regarding the choice of your new pet’s healthcare provider to chance. Here are some tips for choosing the right veterinarian and veterinary hospital for your pet.

Location, location, location
In Sunday’s New York Times, healthcare reporter Elizabeth Rosenthal, talks about choosing a hospital for your own care. She writes, “Indeed, with thousands of good hospitals across the nation, the best selling point for routine medical care may simply be convenience…” Whether or not you agree with her point of view regarding your personal healthcare, proximity may be a consideration in choosing a primary care veterinarian. A new puppy will need several rounds of vaccines and a spay or neuter surgery requiring transporting the pet to and from the hospital on multiple occasions. But if you have a parrot, the closest veterinary hospital may not have a veterinarian with expertise in avian medicine and you will need to choose a clinic providing bird care, not necessarily the closest clinic.

Proximity plays an even more important role in the selection of an emergency hospital. When your pet is hit by a car and in shock, has serious bleeding or can’t breathe, time is of the essence and the closest animal ER is the best ER for your pet.

Assessing hospital quality
If you personally needed a heart valve replacement, for example, you might look for data on outcome for valve replacement surgery at the various hospitals in your area. In New York State we have the New York State Hospital Report Card. You could also search the doctor ratings on the website of your healthcare provider. Since this type of information is lacking for veterinary hospitals, you might turn to online sources to read the opinion of pet owners who have posted their experiences. I must admit, to me, these online reviews can often seem more like rants and may not provide the objective information you need to guide your pet healthcare decision making process.

A better method of assessing hospital quality would be to look for a hospital accredited by the American Animal Hospital Association (AAHA). Their website also allows you to search for the AAHA accredited hospital nearest you. Choosing an AAHA accredited hospital assures pet owners that the hospital they select has the staff, equipment, medical procedures and facilities that AAHA believes are vital for delivering high-quality pet care. The Animal Medical Center has been AAHA accredited since 1976, and to maintain our accreditation we voluntarily receive triennial evaluations on over 900 standards of small animal hospital care.

Finding the right specialist
The easiest way to find a specialist for your pet is for your primary care veterinarian to recommend one she works with on a regular basis. This will ensure a good line of communication and seamless medical care. If your veterinarian doesn’t have a recommendation:

• Search the website of the type of specialist you are looking for, e.g. veterinary cardiology, veterinary surgery or veterinary dentistry.
• For a cutting edge therapy, you might have to travel a good distance to find the specialist your pet needs. Use a scientific search engine like PubMed or Google Scholar. Search for the procedure your pet needs. When the search identifies a particular hospital where the procedure is commonly performed or a veterinarian who is a frequent author of scientific articles on the procedure, focus your search on this clinic or veterinarian. Examples of this type of procedure include repair to a ruptured ligament in the knee or image modulated radiation therapy.

Quick tips on finding the right veterinary hospital

• Know where the closest animal ER is and keep its address and phone number in your GPS device, cell phone and on the refrigerator list so you are prepared for an emergency.
• Don’t be afraid to visit potential veterinary hospitals before booking an appointment. Find out if their clinic schedule matches your availability. Ask the receptionist about their preventive healthcare protocols.
• In case your pet develops an unusual medical condition or requires specialized surgery, ask your trusted primary care veterinarian about the network of specialists they recommend.

## Exocrine Pancreatic Insufficiency: Cats Get it Too!

December 28, 2012

Recently, I highlighted a common pancreatic disorder in dogs, pancreatitis. The following day, the New York Times “Well Pet” blog wrote about a much less common, but equally serious pancreatic disorder, exocrine pancreatic insufficiency (EPI). The article focuses on EPI in dogs, but cats also can suffer from this disease.

Pancreatic function

The pancreas has two main functions: first to produce the hormone insulin to control blood sugar and second to produce digestive enzymes. Production of insulin is the pancreas’ endocrine function and production of digestive enzymes is an exocrine function. Deficiency of insulin is called diabetes.

Deficiency of the digestive enzymes has a much more descriptive name – exocrine pancreatic insufficiency.

What a cat with EPI looks like

The classic cat with EPI is skinny, greasy, and has bad diarrhea. The absence of digestive enzymes prevents the gastrointestinal tract from breaking food down into it components, and if they are not broken down, the nutrients cannot be absorbed. If your cat has this disorder, he will eat lots of food and lose weight rapidly. Cats with EPI are greasy because they cannot digest fats without pancreatic enzymes and all the undigested fat in their stool gives them nasty diarrhea.

The causes of feline EPI

This disorder is thought to be inherited in certain dog breeds, most commonly German shepherds. Cats never want to be like dogs. Exocrine pancreatic insufficiency in cats does not appear to have a genetic component and is more likely to be the result of chronic damage to the pancreas from long standing pancreatitis. These cats may also be diabetic if the pancreatic damage is severe enough to prevent production of both digestive enzymes and insulin.

Testing the skinny cat

When I see a cat with weight loss, I commonly collect blood for what The Animal Medical Center (AMC) calls a GI panel. This quartet of tests looks at the digestive function of the pancreas and small intestine. One of the tests measures trypsin-like immunoreactivity and is the diagnostic test of choice for feline EPI. Another important test on this panel measures vitamin B12 or cobalamin. A study of feline EPI cases at The AMC and Purdue University found all cats with EPI were deficient in this important vitamin.

Replacement therapy

Once lost, the pancreas do not typically regain exocrine pancreatic function. Management of EPI requires lifelong supplementation with pancreatic enzymes and vitamin B12. Vitamin B12 supplementation is simple: a small injection given under the skin once a week. Pancreatic enzymes come as a powder and are sprinkled on the food. This is where cats can be challenging since many cats refuse food that has been embellished. Raw pancreas (which contains the digestive enzymes) has been recommended, but I haven’t tried it on any patients, yet. The good news is our study of feline EPI showed most cats will respond to therapy.

Resources on pancreatic disease

Exocrine Pancreatic Insufficiency

Pancreatitis

Texas A&M University

WebMD

IDEXX Laboratories

## Healthy Pets Make Happy Homes: National Pet Week 2012

May 7, 2012

May 6-12, 2012 is National Pet Week and the theme chosen by the Auxiliary to the American Veterinary Medical Association is “Healthy Pets Make Happy Homes.”

Each year the Auxiliary sponsors a poster contest around the year’s theme. This year’s winner, Stephanie Jensen, depicts a whimsical home filled with children and happy family pets. While the painting is charming and deserving of accolades, the scene made me think hard about pets and families.

Just the right number of pets makes a happy home

Ms. Jensen’s painting shows a home containing every imaginable pet, but when adding pets to your family, each addition requires careful consideration. For those of us who love pets, it is difficult to resist adding another foundling to our brood. But if we continually increase our home’s pet population, at some point, the number of pets we have will exceed the resources we have to care for them. By resources I am not talking just about financial resources, but space, time, and energy as well. My current feline foster family of seven makes me very happy every morning when I peek in and see all those little cats snoozing in their fur bed. Since the family will be adopted once the kittens are self-sufficient, I can handle caring for seven cats for several weeks, but I could not do this on a forever basis and still work full time!

Children and pets, happy together

In addition to showing many different pets, Ms. Jensen’s painting shows children and their pets. The benefits of pets for children were recently the topic of a New York Times blog by pediatrician Perri Klass.

As a pediatrician, she reports commonly asked questions about children and pets, because of the widely held belief that pets are good for children’s social and emotional health. She also says that, until now, there has been little good scientific research on the benefits of pets for children. Some recent studies suggest a variety of positive outcomes associated with children and pets:

Pets can also pose health risks to young children, and parents should take steps to protect their children from pet-related illness, especially bites.

The pets depicted in Ms. Jensen’s painting look very healthy. To keep your pet healthy and your home happy, provide your cat and dog with a good preventive healthcare program and visit their veterinarian annually.

How do you keep your family and pets happy and healthy? Share your stories in the comments section below.

Photo: Stockbyte

## The Importance of Portion Control for Pets

January 9, 2012

In my last blog I wrote about Pusuke, the world’s oldest dog and the role of breed and size in dog longevity. Every pet owner dreams of having their beloved cat or dog with them for many, many years. But do you know you could be doing something which might decrease your pet’s longevity? That something is overfeeding.

Every living creature needs food to survive. But research has shown overweight and obese pets do not live as long as their thinner counterparts. Maintaining your pet at an ideal body condition score will help to lengthen its life.

Ideal body condition score
Your veterinarian may have talked to you about your pet’s ideal body condition score (BCS). Body condition assessment is used by veterinarians to quantify under and overweight pets. It serves the same purpose as the BMI your doctor calculates for you. At The Animal Medical Center, we record the body condition score of each pet we examine using a separate system for dogs and cats.

Portion size matters
Portion control is critical to maintaining an ideal body condition. An article in the New York Times about kitchen scales made me think of another worthwhile use for your kitchen scale: weighing pet food. It is so easy to be too generous when you use a scoop or cup to serve up a portion of dry food nuggets. When I prescribe a cup of food, I mean a level cup, not the heaping one I suspect pet owners are serving. Not all cups are created equal and some cups have the measuring line just below the top of the cup – allowing you to feed more than the cup you think you are feeding. Now, I prescribe pet food in grams – easily weighed on your kitchen scale. Busy pet owners might want to premeasure pet food servings into plastic bags or storage boxes, kind of like Weight Watchers or Jenny Craig meal plans for people. This will make it quick and easy to feed your pet easy at the end of a busy workday.

The kitchen scale can also be used to measure canned food by putting the feeding bowl on the scale using the tare button. The kitchen scale should be used if your pet’s daily portion is a little more or less than an easily measured amount like a ½ can at each meal.

Portion control will go a long way toward keeping your pet at their ideal body condition and healthy for a long time. If you need help deciding on the best kitchen scale for your kitchen, try Cook’s Illustrated.

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This may also be found in the “Tales from the Pet Clinic” blog on WebMD.com.

For over a century, The Animal Medical Center has been a national leader in animal health care, known for its expertise, innovation and success in providing routine, specialty and emergency medical care for companion animals. Thanks in part to the enduring generosity of donors, The AMC is also known for its outstanding teaching, research and compassionate community funds. Please help us to continue these efforts. Send your contribution to: The Animal Medical Center, 510 East 62nd Street, New York, NY 10065. For more information, visit www.amcny.org. To make an appointment, please call 212.838.7053.

## Cats Are Medically Underserved

October 31, 2011

In my last post I wrote about how little attention has recently been paid to the cat in the articles published in The New York Times. Although I believe in fair and balanced reporting, the lack of newsprint devoted to the cat only hurts their feelings, not their health. As a cat owner, you might not be able to influence the editorial staff at The New York Times, but you can protect your cat’s health.

Over the past decade, veterinarians have noticed an alarming trend. Cats see a veterinarian half as often as dogs do. Just like dogs, cats can get sick and do need annual examinations by their veterinarians. Without regular medical care, your cat misses the opportunity to undergo screening tests to find disease before it becomes untreatable. Cats also need preventive healthcare, such as vaccinations and parasite prevention. I find three particular trends in feline health care particularly disturbing.

1. Rabies in cats is increasing.
In a recently published survey in the Journal of the American Veterinary Medical Association of rabies cases in the United States, the occurrence of rabies declined in all wildlife and domestic dogs, but in cats, rabies increased. Rabies presents a double whammy: it is fatal in cats and poses a huge health risk for the cat’s family members. The good news is rabies is safely and easily prevented by a vaccination which can be given when your cat visits her veterinarian.

2. Feline diabetes is on the rise.
The Banfield State of Pet Health 2010 report documented a 16% increase of diabetes in cats and a much higher occurrence of diabetes in cats than in dogs. The epidemic of diabetes in cats is likely linked to the increase in pet obesity. Annual wellness examinations will include measuring your cat’s body weight, and if your pussy cat is getting a little porky a weight reduction diet can be developed to help keep her from developing diabetes.

3. Dental disease has increased 10% in cats over the past 5 years.
A study from France reports in the Journal of Veterinary Dentistry that cats have a high rate of fractured teeth with retained roots, periodontal disease and bone loss around teeth. Every cat studied had periodontal inflammation. Cat owners can help prevent dental and periodontal disease in their cats with regular tooth brushing. Annual wellness examinations by your cat’s veterinarian can identify dental problems early, and teeth cleaning using special equipment is done with your cat under general anesthesia.

Photo: Dr. Philip Fox

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This may also be found in the “Tales from the Pet Clinic” blog on WebMD.com.

For over a century, The Animal Medical Center has been a national leader in animal health care, known for its expertise, innovation and success in providing routine, specialty and emergency medical care for companion animals. Thanks in part to the enduring generosity of donors, The AMC is also known for its outstanding teaching, research and compassionate community funds. Please help us to continue these efforts. Send your contribution to: The Animal Medical Center, 510 East 62nd Street, New York, NY 10065. For more information, visit www.amcny.org. To make an appointment, please call 212.838.7053.

## Has The New York Times Gone to the Dogs

October 26, 2011

At first I wasn’t sure, but I noticed a suspicious increase in dog-related articles in the October 8, Op-Ed section of The New York Times. That Sunday alone, the Gray Lady published at least three fascinating articles prominently featuring dogs.

The first was an article on the replacement of German Shepherds by Belgian Malinois as the West Rhine-Westphalia police dog.

Another article written by a woman with memory loss from a traumatic brain injury recounted her inability to recognize her friends and how she learned to rely on her dog to recognize and greet people she once knew.

And yet a third article described a behavioral study of the interaction between dogs and sheep.

Two more dog articles last week!
I was sure the increase in dog related articles was a phenomenon when dogs were featured in the Weekend Arts section with a book review of New York Times Executive Editor, Jill Abramson’s The Puppy Diaries and in the Metropolitan section with an article on two Labrador Retrievers, Bonnie and Clyde, who reside in Mayor Michael Bloomberg’s townhouse, but belong to his girlfriend, Diana Taylor.

This weekend the cover of the Book section has a color illustration of Rin Tin Tin and a review of his new biography.

Why is it always about dogs?
It really isn’t all about dogs, just mostly about dogs. Thank goodness for Gail Collins of the Op-Ed section who wrote one of the Times’ articles about cats last month.

However, both recent Times’ articles on cats are actually about the same cat, Willow: lost in Colorado, found in New York City.

Why shouldn’t the New York Times write about dogs, they are the most popular pet after all?
Not true. Current data says the 72 million pet cats outnumber the 62 million pet dogs living in the United States today! I suspect since cats have been branded as independent and aloof, nobody thinks they deserve more than one mention per month on the Op-Ed page, making the species journalistically underserved.

Did you know cats are medically under served too? Check “Fur the Love of Pets” on Monday and find out why.

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This may also be found in the “Tales from the Pet Clinic” blog on WebMD.com.

For over a century, The Animal Medical Center has been a national leader in animal health care, known for its expertise, innovation and success in providing routine, specialty and emergency medical care for companion animals. Thanks in part to the enduring generosity of donors, The AMC is also known for its outstanding teaching, research and compassionate community funds. Please help us to continue these efforts. Send your contribution to: The Animal Medical Center, 510 East 62nd Street, New York, NY 10065. For more information, visit www.amcny.org. To make an appointment, please call 212.838.7053.

## Pedigree vs. Muttigree

October 8, 2009

Being a New Yorker, I read the New York Times and being a veterinarian, I read about pets. So when the New York Times started a new online column, “The Puppy Diaries,” I was compelled to read it. “The Puppy Diaries” is a weekly series about the challenges and satisfactions of raising a puppy through its first year of life.

The puppy star of “The Puppy Diaries” is Scout, a Golden Retriever. The first column generated over 100 reader comments, many criticizing the author’s decision to purchase a purebred dog rather than rescue a mixed breed mutt or adopt a dog from a shelter. Being a lover of dogs in general, and no breed in particular, this criticism swirled in my mind since the first column. I couldn’t decide who was right, the supporters of purebred dogs or the supporters of mutts. Both would bring happiness, companionship and challenges to their family.

I cannot think of an exact parallel, but I did think of some similar situations. Take for example, blue jeans. One can purchase wildly expensive designer jeans or much cheaper no-name jeans. Both types provide coverage and comfort, but owners of the designer jeans swear they are better and those with no-name jeans would never think of spending a large sum on blue jeans. The same is true for other apparel, such as shoes, scarves and handbags. Possibly a better example is children. Some families have children of their own and complete their family by adopting even when they could have more children of their own. Some families adopt, because they want to provide a good home for a child without one.

Similar reasoning may explain prospective dog owner’s choices. Some families, like Scout’s family, want the experience of raising a puppy and other families prefer to skip the puppy stage and adopt an older dog. Because of the dependable characteristics (size, personality and coat) of purebred dogs, selection of a particular purebred dog may be required. (Think Obama here, whose children required a hypoallergenic dog.) A mutt may fit better into a family wanting to share life with a canine companion.

Be it shoes, children or dogs, it is all about what you like, what is best for your family and how you chose to spend your money.

In the end, I think the two sides, mutts and purebreds, will need to agree to disagree on this topic. But in our disagreement, let’s not lose sight of what’s important. All pets should have a loving home, nutritious food, quality healthcare and an education so they become good members of society. Hey, but isn’t that true for humans and canines, alike?

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For nearly a century, The Animal Medical Center has been a national leader in animal health care, known for its expertise, innovation and success in providing routine, specialty and emergency medical care for companion animals. Thanks in part to the enduring generosity of donors, The AMC is also known for its outstanding teaching, research and compassionate community funds. Please help us to continue these efforts.  Send your contribution to: The Animal Medical Center, 510 East 62nd Street, New York, NY 10065. For more information, visit www.amcny.org. To make an appointment, please call 212.838.7053.