May 17 -23, 2015 is National Bite Prevention Week. The United States has 70 million dogs, all of them wonderful companions, but any dog can bite. Animal bites are a serious problem, affecting 4.7 million people per year, most of them children. Senior citizens are the second most common age group affected by bite injuries.
Preventing Bite Injuries
The best defense against dog bite injuries is prevention. Responsible dog owners follow these general guidelines to prevent their dog from becoming a biter:
Train your dog. Obedience trained dogs are less likely to bite.
Keep your dog in control and on a leash when walking on the street or in the park.
Leave your sick dog home. Sick dogs a prone to biting because, just like you, they are cranky when they are sick.
Neuter your male dog. Unneutered male dogs are more often involved in bite incidents than neutered ones.
Supervise all children-dog interactions.
Teach your children how to safely interact with dogs.
Invest in Insurance
If, despite your best efforts, your dog bites a person, you may be fined for having a dangerous dog, in violation of a local ordinance for having a dog off leash or other violations. There is also the potential for the person bitten to bring a lawsuit against you. Check your homeowner’s or renter’s insurance policy to make sure it includes coverage for the family dog. According to the Insurance Information Institute, one third of all homeowner insurance claims paid in 2013 were for dog bite injuries. New York State had the highest average cost per claim, at $43,122.
Keep Rabies Vaccination Up to Date
Should your dog become involved in a bite incident, provide the injured party with a copy of your dog’s rabies vaccination certificate as soon as possible. Their physician will need to know this information when determining what treatments are necessary for the bite injury. If the injured party needs emergency medical care, the ER may be required to report the bite to the local health department. Officials from the health department will monitor your dog’s health and as long as the rabies vaccination is up to date, may put your dog under home quarantine for a specified period of time.
Teaching Children Safe Dog Interaction
Join us on May 30, 2015 from 10am-1pm for AMC’s annual PAW Day: Pet And Wellness fun at Carl Schurz Park on E. 84th Street and East End Avenue in Manhattan. This event is family friendly, including your furry friends! At PAW Day, specially trained dogs will be available for children to practice safe dog interactions. The event features a stuffed animal veterinary clinic, Clifford the Big Red Dog, face painting and a whole lot more.
With the help of veterinarians and physicians, public health officials monitor human and animal populations for signs of infectious diseases. City and state public health officials investigate outbreaks of disease to protect the health of their citizens. In New York City, veterinarians are required to report cases of diseases like monkeypox, plague, rabies and leptospirosis to city officials. Last winter, the NYC Department of Health and Mental Hygiene issued a summary of leptospirosis reporting in NYC dogs. That report contained information important to NYC dogs and their humans.
A Five Borough Disease
Between 2006 and 2013, 116 cases of leptospirosis have been diagnosed in NYC. Any dog can contract leptospirosis. The largest number of cases (45) was in dogs living in Manhattan. Brooklyn was the runner up borough with 35 cases, but leptospirosis was diagnosed in dogs residing in all five boroughs. The report included dogs from 3 months to 13 years and dogs of a variety of different breeds.
Spring is the Time
When evaluating the leptospirosis cases, a clear pattern of infection can be seen. Cases are seen all year round, but the number jumps up in May and stays up all summer and fall. The peaks and valleys of cases occurs because leptospirosis spreads via the urine of infected animals, and in the cold months, the rodents, raccoons and possums carrying leptospira bacteria are less active. The leptospira bacteria can be found in standing puddles of water, but in the winter, cases dramatically decrease because the cold temperatures kill off the bacteria before it can infect dogs.
And You Too!
Leptospirosis falls into the category of zoonotic disease, diseases shared by animal and man. During the same time period as the 116 dogs with leptospirosis were identified, only eight human cases were reported. These human cases were believed to be from rodent exposure and none were thought to be from exposure to a sick dog.
Protecting Your Dog Against Leptospirosis
Dogs in NYC are at risk for leptospirosis.
Talk to your veterinarian about leptospirosis vaccination to determine if it is right for your dog.
Control rodents, which are the major source of leptospirosis in NYC.
Don’t let your dog drink from puddles of water on the street or in the park.
Molly is a cute fluff ball of a Ganaraskan. Although her name sounds like she belongs in a Tolkien novel, the Ganaraskan is a modern dog breed, developed only a few decades ago in Canada near the Ganaraska River in Ontario. The originators of this breed set out to develop the ideal therapy dog from English Cocker, Bichon Frise, Poodle and Miniature Schnauzer stock. Molly is typical of the breed – curly coated, anxious to please and weighing just about 20 pounds. But Molly is anything but typical; she is a legend in her own time a survivor of a major cardiac procedure necessary to save her life.
An Early Beginning of a Legend
Molly’s story starts when she is just a young pup and is diagnosed with a heart murmur at ten weeks of age. An echocardiogram did not identify a cause for the murmur and since the murmur was not very loud, no treatment was prescribed. Two years later, Molly came to The Animal Medical Center for evaluation of a fractured tooth. Dr. Stephen Riback, one of The AMC’s dentists, heard the murmur and recommended an echocardiogram.
The “Heart” of the Problem
The echocardiogram, performed by one of The AMC’s board certified cardiologists, Dr. Dennis Trafny, revealed an enlarged heart and a 4mm (1/8 inch) wide abnormal blood vessel known as a patent ductus arteriosus (PDA). Normal before birth, the PDA typically closes shortly thereafter. In Molly, the PDA did not close, allowing blood to traverse between two major blood vessels, the aorta and the pulmonary artery. The abnormal blood flow caused the heart murmur. But the murmur was just a harbinger of a future, more serious problem – the potential risk of heart failure if the abnormal blood flow was not halted.
The first technique available to veterinary cardiologists for repairing PDA’s in dogs required a thoracic surgery to ligate the PDA vessel using suture material. The incision scar was the size of your hand on the dog’s chest. Now, veterinary cardiologists use fluoroscopy, a special video x-ray machine, to guide a special catheter with a disc occluder up through a blood vessel in the leg, into the heart and right to the site of the PDA. When the disc occluder was deployed on both sides of Molly’s PDA, it corrected the abnormal blood flow. All it took was an incision the size of your fingertip on the inside of her leg and a highly skilled team of AMC veterinarians and medical staff.
Screen Legend – A Movie of Blood Flow
The video clips of Molly’s procedure come from The AMC’s fluoroscopy machine. It is a special x-ray machine which makes a video x-ray of a procedure. In the first video clip, before the PDA was occluded, the rapidly moving black material is a special contrast agent administered intravenously to highlight the PDA. The contrast agent should all stay in the big blood vessel (aorta), but instead it circulates throughout the lungs and the blood vessels highlighted by the contrast agent represent blood vessels in the lungs.
In the second video clip, you can see the PDA has been closed off with a disc occluder. It blocks the blood flow through the PDA. You see the blood does not circulate abnormally through the lungs like in the first video.
Two weeks following surgery, Molly’s cardiac size decreased by 25% and she is doing well today. She is no longer at risk for developing heart failure and is expected to live a long, full life!
If you liked Molly’s story, you might want to hear other stories of medical triumphs at the 7th Annual Living Legends Luncheon on May 12th. Learn more about this event.
For the last few months, veterinarians and dog owners in the Chicago area and other Midwestern states have been faced with an outbreak of canine influenza. Over 1,100 dogs have been diagnosed with the virus and sadly, some have died. First identified in an outbreak of what was believed to be “kennel cough” in greyhounds, the canine influenza virus was initially described in 2005. Canine influenza virus is just one of the causes of “kennel cough” which is really a general term for canine upper respiratory tract infections.
The canine influenza virus reported in 2005 is an H3N8 strain of the virus which has been documented nationwide. The current Chicago outbreak is caused by an H3N2 virus, which is the virus circulating in Asian dogs. Exactly how the Asian strain came to the Windy City is not currently known. Canine influenza seems to be moving east and cases have now been confirmed in the state of Indiana. Just yesterday, dog flu was diagnosed in Iowa.
Dog to Dog Transmission Canine flu is transmitted from dog to dog and dogs can transmit it prior to showing symptoms of the virus. That feature of the disease is probably responsible for its rapid transmission within a population. Inanimate objects, leashes, collars, bowls and bedding used by an infected dog could be a source of infection for other dogs coming in contact with those objects. Petting a sick dog and then petting a healthy dog can also spread the infection.
Clinical Signs of Canine Influenza
The clinical signs of canine influenza run the gamut of respiratory disease. Twenty percent of dogs infected with the virus will never show any signs, but still can infect other dogs. Most dogs develop what we might think of as a cold– sneezing, runny nose and a cough. Dogs with the flu feel out of sorts with a fever and a poor appetite. About ten percent of infected dogs will develop a serious complication of influenza – bacterial pneumonia.
What precautions should dog owners take?
Avoid doggie day care, the boarding kennel, the dog park, obedience classes and any other areas where dogs congregate. The canine flu spreads most rapidly in situations where many dogs come in contact with each other or with infected dogs’ coughs and sneezes.
Wash your hands well. The canine influenza virus can live on human hands for 12 hours, unless they are washed with soap and water.
Talk to your veterinarian about the canine influenza vaccine. The available vaccine is for the typical H3N8 virus. Because the virus in this outbreak is H3N2, we don’t know if the flu vaccine will protect dogs against this new virus, but it is being recommended in the Chicago area. The canine flu vaccine is like the human flu vaccine; it lessens signs of flu and shortens their duration, but does not prevent the disease.
If your dog contracts the flu, wash bedding, dishes, leashes and clothing which can transmit the virus for up to 24-48 hours after coming in contact with a sick dog.
Keep your cat away from your sick dog since the H3N2 strain can be transmitted to cats. The H3N8 strain is not believed to infect cats.
Hairball Awareness Day is April 25th. Most of us become aware of hairballs in the middle of the night, either when we hear that characteristic yacking sound made by a cat about to deposit a hairball on the sheets or as we inadvertently step on a cold, slimy furball deposited on the darkened bedroom floor.
Even though cat families believe hairballs are a common problem, a survey of British cats found most had never vomited a hairball – at least that their family discovered. Intuitively, the same study found long haired cats were more likely to vomit hairballs than short haired cats.
Why do cats get hairballs?
Cats may spend as much as 25% of their waking hours grooming. When a cat grooms, the barbs on her tongue act as a comb and brush. The shed hairs get caught in the barbs and are swallowed. In normal cats, ingested hair is excreted in the stool. Because most ingested hair is excreted in the feces, an uptick in the frequency of hairball production suggests a problem in your cat.
Can hairballs indicate a medical problem?
The simple answer is yes. Formation of hairballs suggests a cat is suffering from excessive hair ingestion or is not excreting ingested hair normally. Excessive hair ingestion can result from overzealous grooming behavior leading to hairball formation. Excessive grooming is a clinical sign of several feline health concerns such as fleas, itching due to allergies, an overactive thyroid gland, food sensitivity or stress.
Decreased grooming behavior is frequently a sign of illness in cats. If the illness progresses, hair mats develop. Once the cat resumes grooming, hairballs may form and you may also notice increased hair in your cat’s stool.
An increase in the frequency of hairball vomiting may also signal some sort of gastrointestinal problem preventing normal passage of hair out in the stool. My patient Sunshine developed an intestinal obstruction from a hairball when intestinal lymphoma disrupted her ability to pass hair in her stool.
Cat families often talk about “coughing” up a hairball, but if your cat is coughing, that is a completely different problem that should be brought to your veterinarian’s attention.
What can cat families do to minimize hairballs?
Control loose hair with regular brushing. Don’t just smooth over the top coat, but use a deshedding tool to remove dead undercoat. Many cat resist brushing, so start with short grooming sessions and use rewards liberally.
Feed commercially available food, treats and supplements formulated to improve intestinal motility and facilitate hair excretion.
AMC’s dermatologist, Dr. Mark Macina, examines a patient
Spring officially arrived nearly three weeks ago, but the onset of allergy season may not arrive too soon this year, given our harsh winter. But once it warms up, pollen, dust mites, fleas, grass, weeds and mold will kick off allergy season in pets.
Clinical Signs of Allergies
Does your dog rub his face along the front of your sofa or scratch incessantly? Has your cat scratched all the fur off her head and made is scabby? Are you constantly putting in ear drops or giving antibiotics to treat skin infections? All these represent clinical signs of allergies in pets.
Control Parasites
One of the top causes of canine and feline allergic skin disease stems from an allergic reaction to flea saliva. A flea bites your dog or cat, setting off an allergic reaction. This disease presents a double-whammy to your pet: discomfort from fleas crawling all over its skin and the discomfort of being itchy. Fortunately, numerous options for control of fleas are available and your choice of product can be tailored to your pet’s exact needs.
Modify the Diet
Food allergies are typically an ongoing problem, not seasonal like pollen, grass or flea saliva allergies. Veterinarians think the allergen in food is the protein source contained in the diet, but it may be other ingredients as well. The standard method for determining if food is the cause of skin disease is a food elimination trial. Elimination diets contain a limited number of ingredients and protein sources not typically found in common pet food and not previously fed to your pet. Novel protein sources include bison, herring or rabbit. Some elimination diets avoid common carbohydrate sources and include potatoes or oats, rather than corn or soy. An elimination diet requires determination on the part of the pet owner, as the skin improves slowly in response to a diet change. Patience is required to tough out a month or more of strict diet control.
Administer Immunotherapy
Immunotherapy, a medical word for allergy shots, involves specialized testing to determine whether it is pollen, dust mites, fleas, grass, weeds or mold revving up your pet’s itch-scratch pathway. Once the cause of the allergy is determined, a custom allergy vaccine can be developed for your pet. You learn to give the injections at home one to two times per week. These injections contain minute amounts of the offending antigen (pollen, dust mites, fleas, grass, weeds or mold) which trains your pet’s immune system to be tolerant of these agents.
Quell the Immune System with Drugs
A variety of drugs can be used to turn off the allergic reaction underlying the itch-scratch cycle in your pet. The most well-known, but not necessarily the most effective in pets, is antihistamines. Steroids can be very effective and rapidly reduce the clinical signs of allergies, but have unpleasant side effects, such as increasing water drinking, urination and appetite, as well as increasing the risk of infection. Another effective drug for allergy management is cyclosporine, although cost is a concern. New to the market, oclacitinib, inhibits the cells initiating the itch-scratch cycle by attacking allergies at the cellular level.
When I started my career as a veterinarian, the options for flea and tick control were limited, smelly and messy. I dispensed cans of spray, bottles of dip, and cartons of powder, but hardly ever prescribed a flea collar. Back then, the collars were not that effective and some thought the only way a flea collar killed a flea was by squashing it when you put the collar on your pet. Thirty years later, the options for pet owners to prevent ectoparasite infestations are infinitely better and way more numerous.
Better flea and tick control has resulted in healthier pets. I used to routinely see dogs and cats crawling with fleas from head to toe. Many developed flea allergic dermatitis, often complicated by a superficial skin infection. While we still see allergies in pets, flea allergic dermatitis is much less common and pets are much more comfortable, thanks to these new products.
Top Spot Products
The big revolution in flea and tick prevention started when top spot products were introduced. These are the little tubes of liquid that come in multipacks for monthly application to the nape of your pet’s neck. The product then distributes throughout the haircoat and kills fleas and ticks when they come in contact with the medicine on your pet’s hair. They also come with stickers for your calendar or an app for your mobile device to remind you when to apply the medication. Many of the manufacturers of these products have videos on their website demonstrating proper application of the product.
Oral Flea and Tick Prevention
Oral products can be active against only fleas or prevent multiple species of ticks as well. Most oral products come as tasty chew treats and are administered monthly; although long lasting products are also available. Not all oral products start working instantly. If your pet has a flea infestation because you missed a dose, check with your veterinarian about a rapidly acting oral product for quick flea takedown.
Long Lasting Collars
Unlike the early flea collars, today’s models last for months at a time. Depending on which collar your veterinarian prescribes, modern flea collars may be active against a single species of tick or fleas and multiple species of ticks. If you choose a collar, check the label carefully as some collars may take a week to reach full strength on your pet.
Choosing What’s Right for Your Pet
When selecting from this array of products, consider the following criteria:
Talk with your veterinarian about the types of parasites in your area. Selecting a product with a profile that fits your area’s parasite population is critical.
Top spot products often repel as well as kill fleas and ticks. If you live in a geographic locale with high numbers of fleas and ticks, you might want this added protection.
Certain collars and oral preventatives last for months at a time. If you are busy and forgetful, one of these products might be a good choice.
Not all top spot preparations and collars are waterproof. If your dog is a swimmer, choose a waterproof product or consider an oral flea and tick preventative.
If you have a puppy or kitten, make sure the product you select is safe for the newest family member. Some products are not labeled for pets < 6-12 weeks of age.
Use dog products for dogs and cat products for cats. Never switch, or you may need a trip to the animal ER.
One part of The Animal Medical Center’s tripartite mission involves advancing the practice of veterinary medicine through research. Many types of research exist: scientific, historical, social science and economic are just a few examples. The AMC participates in a specific type of scientific investigation called clinical research.
Studying Healthcare
Clinical research asks and attempts to answer questions related to healthcare delivery, and in the case of The AMC, animal healthcare. At various times, the veterinarians at The AMC have studied the impact of new medications, treatment protocols, diagnostic tests and therapeutic devices on canine and feline patients. Clinical research is distinct from, but seeks to improve, clinical care.
Institutional Review Board
Research involving living patients, human or veterinary, happens only after an institutional review board studies and approves the research protocol. This process assures the safety of the patients involved in the project. The review board also evaluates the patient consent document. To ensure the pet’s family understands their family member is part of a research protocol, they must read and sign documents about the planned treatment’s risks and benefits. In any clinical study, a pet owner may withdraw their pet from the study at their discretion.
Abstract Presentation
Another component of conducting research is presentation of the findings to a group of your scientific peers. At The AMC, resident research projects are presented to the entire hospital community. The audience can ask questions and make suggestions to clarify or improve the interpretation of the results. At this year’s Resident Research Seminar, five residents presented their work to the AMC community. They addressed topics such as using MRI and CT scanning for dogs with prolapsed spinal discs, vitamin D levels in ICU patients, blood clotting abnormalities as a result of severe trauma, comparison of continuous infusion versus intermittent diuretic infusion for the treatment of heart failure, and iron supplementation in cats with cancer. The results from the studies help AMC veterinarians to improve patient care and when published, influence the care of pets everywhere.
Publish or Perish
The final step in any research project is to publish the results in a peer reviewed journal. Peer reviewed means just what it says. Expert veterinarians review the manuscript for bias in research methodology, statistical analysis and conclusions. They recommend changes to improve the final publication and once those changes are made, approve the final manuscript, which is ultimately published for all interested in the topic to read.
Recent Publications
Here are summaries of some recent AMC resident research project publications:
Smiley, a blind Golden Retriever therapy dog and former puppy mill rescue, recently became an internet sensation. Born without eyes, Smiley bonded with a deaf Great Dane after he was rescued from the puppy mill. According to reports, the relationship drew Smiley out of his shell and turned him into a confident therapy dog, sharing his smile at schools, nursing homes and libraries.
Forms of Blindness
Smiley was born without eyes – medically known as ocular agenesis, but blindness in pets takes many forms. High blood pressure, especially in cats with kidney disease, causes blindness. The increased blood pressure causes vision loss from retinal detachment and intraocular hemorrhage. Chronic herpes infection in a cat’s eye can cause corneal ulcers that are painful, difficult to heal and which can lead to blindness. A lack of tear production or dry eye predisposes dogs to corneal ulcers and scarring, and if left untreated, blindness. Both dogs and cats develop glaucoma, a painful swelling of the eye. If the swelling cannot be controlled, glaucoma can rob pets of their vision.
AMC TO THE RESCUE Helps
Doc, a mixed breed puppy, had developed glaucoma, a painful increase of fluid inside the eyeball that damages or destroys vision. Doc came to see The AMC’s board certified ophthalmologist, Dr. Alexandra van der Woerdt, through a joint effort between AMC TO THE RESCUE and Doc’s rescue group, Louie’s Legacy. AMC TO THE RESCUE funds specialty care to rescued pets whose medical conditions form a barrier to their adoption, preventing them from finding a forever home.
Dr. van der Woerdt determined Doc’s vision could not be saved, and because his eyes were painful, she outlined three options to make him pain free. First, surgical enucleation, or total removal of the eye; second, chemical ablation, where a substance is placed into the eye to destroy the fluid-producing tissue, lowering the pressure inside the eye; and finally, placement of an intraocular prosthesis. This device maintains blinking eyeball shape, but removes the “insides” of the eye so fluid is no longer produced and the eye is no longer painful. Doc underwent surgical enucleation of both eyes.
New Family and a New Name
Doc is now Zach, the name bestowed by his new family who adopted him shortly after the enucleation surgery. A new name is fitting since Zach is a new dog because he no longer suffers from painful eyes. Zach’s new family says, “He is doing super well. He loves to wrestle at the dog park and can navigate around our house and neighborhood with ease. Most people don’t even notice that he is blind!”
AMC TO THE RESCUE is proud to have helped turn one more unadoptable rescue dog into a beloved family pet. For more information about this vital Community Fund, or to donate, please visit our website.
This week, March 15-21, 2015, is National Poison Prevention Week. I am using this week’s blog to alert dog owners of a new toxin found in our homes – nicotine. Nicotine has been around a long time, but the new nicotine substitutes, designed to help people stop smoking, are poisoning dogs. A recent article in the press highlights the dangers of nicotine from e-cigarettes.
Sources of Nicotine
If you smoke around your pet, she will develop an increased concentration of nicotine in their blood stream, but the increases will not reach toxic levels. Ingestion of an e-cigarette or the super concentrated nicotine liquid used to refill the e-cigarette can cause serious and even fatal toxicity. Due to their indiscriminate eating behavior, dogs may help themselves to nicotine-containing gum or candies from your bag or backpack. Another source of nicotine toxicity is discarded nicotine patches snatched from the bathroom trash basket. Cats can also develop nicotine toxicity, but are more likely to find a discarded patch inadvertently stuck to their fur after you have removed it from your skin. Cats will ingest the nicotine while trying to remove the sticky patch by grooming.
Signs of Nicotine Toxicity
If your pet ingests one of these nicotine products, she will show signs in less than an hour and possibly in minutes if the dose is high. Common clinical signs include: vomiting, diarrhea, agitation, elevations in heart and respiration rate, depression, tremors, ataxia, weakness, seizures, blue gums, coma, and cardiac arrest. Just one e-cigarette cartridge can make a big dog really sick and can be lethal in a small dog.
Prevent Pet Poisoning
If your pet ingests nicotine-containing products, go immediately to the nearest animal ER.
New York City, and other cities are about to get green. Not green with envy or ecologically green, but St. Patrick’s Day green. Many of us will don green hats or a sweater with an embroidered shamrock emblazoned on the front. Pets wearing St. Patrick’s Day finery are adorable, but some of the other St. Paddy’s Day traditions can be downright dangerous for pets.
Green Beer and Irish Whiskey
For those hosting a St. Patrick’s Day party, monitor the coffee table and other low surfaces for unfinished alcoholic beverages. Your dog might decide to take a nip or two of these available beverages in honor of the Irish saint, but because dogs are smaller than we are and are not used to drinking alcohol, they can quickly develop alcohol poisoning.
Another tip to avoid a pet crisis during your St. Patrick’s Day party: give Fluffy and Fido their own party space away from your guests. Their own space will protect them against unwanted escape as your guests arrive or depart. But just to be safe, be sure your pets are wearing their collars and name tags under their St. Paddy’s Day garb.
Shamrock Plants
The shamrock, or white clover, is a plant traditionally associated with the Emerald Isle and St. Patrick. History suggests the Irish wore shamrocks on their clothing to honor St. Patrick on his feast day. Today, shamrock plants can be found in your neighborhood grocery store and brighten up window sills at this gloomy time of year. Shamrocks contain oxalate which, if the plant is eaten, is irritating to the intestinal tract. Pet familes should find decorations other than live shamrock plants for the St. Paddy’s holiday season.
Irish Soda Bread
Out of financial necessity, the Irish popularized soda bread. Irish soda bread uses inexpensive ingredients like flour, sour milk and a bit of sugar. Today this tasty, raisin loaded loaf appeals to everyone, including your dog. But keep your loaf away from your dog, since ingestion of even a few raisins or currants can permanently damage your dog’s kidneys.
Green Foil Wrapped Chocolate Shamrocks
Leprechauns often leave foil wrapped chocolate shamrocks as gifts in honor of the patron saint of Ireland. They intend for the chocolate to be eaten by humans. Dogs will happily consume the chocolate and the foil wrapping, leading to an upset stomach. If a large number of these chocolate treats are consumed, dogs can become excitable and develop a very elevated heart rate. Find some shamrock shaped dog biscuits if you are looking for a special dog treat.
If you are wearin’ the green be safe and have a happy St. Patrick’s Day!
The two x-rays seen below are from the same canine patient, taken one month apart. The one on the left shows two bladder stones. On the right you can see the stones are no longer present in the bladder. How did this magic happen? Surgery? Laser therapy? Antibiotics? Food? Magic wand?
Canine x-rays. Left image indicates 2 bladder stones. (Click to enlarge.)
Surgery?
Nope. Surgery may be the fastest and most common treatment for bladder stones, but for this lucky duck dog surgery was not necessary. Bladder surgery is performed under general anesthesia. The surgeon makes an incision in the abdomen near the back legs and finds the bladder just inside the body wall. Because the bladder is a hollow organ, it will collapse when the surgeon makes an incision in the bladder wall. Special sutures are placed in the bladder to hold it up and keep it open while the stones are scooped out of the bladder with a bladder stone spoon.
Bladder spoons (click to enlarge)
PCCL?
Huh? This acronym stands for per cutaneous cystolithotomy. Using laparoscopy equipment, a pinhole incision is made in the bladder. A small camera is threaded into the bladder and its magnifying properties are used to visualize the tiniest stones. Using this non-invasive method, stones are busted up using the laser and then easily removed.
Laser therapy?
Guess again. For dogs of the right size with not too many stones, non-invasive bladder stone removal is possible. Stones can be fragmented using a special laser which is passed up the urethra and into the bladder. Once the stones are broken into small enough pieces, they are either flushed out of the bladder or removed with a special stone-removing basket which is passed up the urethra and into the bladder to gather up the stone fragments.
Antibiotics?
Yes, but only in part. I can hear you saying, “Wait a minute, this makes no sense. Stones are hard chunks of mineral. Antibiotics treat bacterial infections, they do not dissolve stone.” But, this dog’s urinalysis showed an infection in addition to the stones. The infection played a role in the development of the stones and without treating the infection, the stones will not disappear.
Diet?
Stones form in the bladder as a sequel to infection and also because there are too many minerals in the urine. Drinking more water dilutes the minerals and helps dissolve the stones. Taking advantage of that information, a diet was formulated to promote water drinking in dogs fed the special stone dissolving diet. The diet is also low in magnesium and phosphorus, the building blocks of a type of bladder stone called struvite. This diet does not work in every type of bladder stone, only the struvite ones. Antibiotics are necessary since as the stone dissolves, it releases bacteria, and thus the dog needs antibiotics until the stones are completely gone. Antibiotics alone will not dissolve the stone and diet won’t work unless the infection is controlled, so the correct answer for the magical disappearance of the bladder stones in this dog is diet AND antibiotics.
Signs of bladder stones
Dogs with bladder stones urinate more frequently than is normal, have accidents in the house and blood in their urine. If you see any signs like this, be sure to have your dog evaluated immediately by your veterinarian. View a prior blog post on bladder stones to see diagnostic images of stones.
In February, we celebrate Valentine’s Day with flowers and candy hearts. February also focuses on another type of heart – the one beating inside your chest! This is American Heart Month, raising awareness of heart disease. Both dogs and cats get heart disease, but the common type in each species is different. Cats’ hearts have pump problems and dogs’ hearts have valve problems. Although the problems are different, the outcome for both pump and valve problems is heart failure, or inadequate delivery of blood throughout the body for normal function to continue.
Poor pumping = heart disease in cats ❤
The heart is a sophisticated muscle, but it still performs the basic muscle function – contract and relax. When the heart relaxes, the pumping chambers fill. The next muscular contraction expels the blood from the heart into the blood vessels. When the heart muscle is diseased, it can do one of two things – get thicker or thinner. Both are bad. A thick heart pumps less blood with each beat since the thick muscle occupies space inside the heart where the blood to be pumped normally collects. When the heart is thin, the muscles are weak and do not adequately pump blood. Thick or thin, neither heart pumps blood well.
Leaky valves = heart disease in dogs ❤
A normal dog heart consists of four chambers, and the flow of blood between chambers is controlled by little valves. Normal valves remind me of alabaster: translucent and white, but unlike alabaster, they are flexible. Especially in small dogs, the valves degenerate as a dog ages, becoming thick and lumpy and inflexible. The distortion of their shape prevents them from closing normally. Abnormal valves leak and blood is not pumped efficiently through the rest of the heart and blood vessels. Over time, the portion of blood leaking out of the heart chambers increases and blood pumped to vital organs decreases.
Congestive heart failure ❤
Even though the underlying heart problem in dogs and cats is different, the result is often the same. Poor pumping in cats and leaky valves in dogs can lead to congestive heart failure. These disparate problems both decrease the blood flow to vital organs, such as the kidneys. To compensate, the kidneys retain fluid and when the fluid reaches a critical level, it floods into the lungs, causing pulmonary edema. Acute congestive heart failure is a common reason for admission to the hospital from The Animal Medical Center’s ER. Congestive heart failure can be treated with medications to remove fluid, help the heart pump more vigorously and dilate the blood vessels, allowing them to hold more fluid.
Keeping your pet’s heart healthy ❤
I know you want to keep your pet out of the animal ER, so here are some tips for being heart healthy:
Keep your pet at an ideal body weight. Obesity increases stress on the heart and it has other negative effects on health as well.
Exercise daily with your pet. Folks who walk their dog daily have better heart health themselves.
Ask your primary care veterinarian if a consultation with a board certified cardiologist could benefit your pet. Changes in heart valves and muscles cannot typically be reversed; new medications can prolong good quality of life in both dogs and cats with heart disease.
Confusion about prescriptions reigned in my clinic this past week. I spent a lot of time explaining the intricacies of brand name versus generic drugs. There was a lot of confusion about refills as well. So, I am reprising a condensed version of my discussions about drugs for the benefit of all.
Brand name drugs are the easiest to recognize because the label on the box has ® or possibly™ after a bold-faced drug name like Benadryl® or Motrin®. Drugs recently approved by the Food and Drug Administration (FDA) cannot be made as generic drugs until the patent or exclusivity expires. The FDA approves everything surrounding the manufacture, quality control and packaging of brand name drugs. This process assures the consumer the product is both safe and efficacious. Drugs for animals are approved by the FDA’s Center for Veterinary Medicine.
The box, carton or tube of generic drug appears more utilitarian than the brand name drug, but the medication inside is a copy of the brand name drug, which is the same as the brand name drug in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use. Generic drugs meet the same rigid standards as the brand name drug. All generic drugs approved by FDA have the same high quality, strength, purity and shelf life as brand name drugs. The generic drug manufacturing, packaging and testing must pass the same quality standards as those of brand name drugs.
Specialist veterinarians like those of us at The Animal Medical Center use compounded medications every day to provide drugs in formulations our patients will agree to take. Most commonly, we have medications flavored with beef and turkey or have bad tasting powdered medications put in gelatin capsules to hide their nasty taste. But compounded medications should not be confused with generic medications. Compounded medicines do not have the FDA assurance of safety and efficacy because they do not undergo FDA-mandated quality control testing. In most cases, the absorption properties and the shelf life of compounded medications are unstudied and may differ from brand name or generic medications. Because different compounding pharmacies use different “recipes” to create your pet’s specialized medication, the same prescription may not have the same effect when compounded by a different pharmacist. While the lack of FDA oversight may be a negative, if compounding helps you to get your pet to take its medications, compounding becomes positive.
When I call or fax a prescription to a pharmacy for a medication that a dog or cat will take for a long time, I will pre-authorize refills. The number of refills remaining on a prescription is indicated on the label of the medication bottle. In the sample label shown here, the red circle highlights the number of refills available without the need to call your veterinarian. You simply call the pharmacy and ask for one of the refills. The next prescription label will indicate only 4 available refills. I often choose the number of refills to coincide with an anticipated recheck examination since you need to call my office to get more refills, you can also set up the recheck appointment at the same time.
Understanding medications is critical to their successful use. The FDA Center for Veterinary Medicine has a wealth of information on their website for the pet owing public.
This coming weekend begins the multi-day canine spectacular known as the Westminster Kennel Club (WKC) Dog Show. The annual event is the second oldest continuous sporting event in the United States, ranking number two to the Kentucky Derby, one year its senior. Dog lovers can spend Valentine’s Day watching the second annual Master’s Agility Competition at Westminster or meeting over 100 different purebred dogs at the AKC Meet the Breeds show. The WKC Show takes place Monday and Tuesday, February 16 and 17. Daytime events are at Piers 92 and 94 (711 12th Avenue at 55th Street). The evening events, Best of Group and Best in Show, can be seen at Madison Square Garden where the Show has been held for 139 years.
Every Year Beau-tee-ful Dogs!
Nothing new here. The WKC Show will feature nearly 3,000 gorgeous dogs, at least one dog representing each of the American Kennel Club’s (AKC) 184 registered breeds. Leading the pack in terms of numbers are America’s family dogs, the Golden Retriever with 58 entries and Labrador Retrievers with 56. The breed represented by the fewest number of entrants is the Norwegian Lundehund with one ‘lone wolf’ entrant. These truly are rare dogs; I checked The Animal Medical Center’s (AMC) 57,638 dog registrations and found only three Norwegian Lundehunds. This Norse breed features six toes on each foot and a neck so flexible, the top of their head can touch their back, both advantageous adaptations for hunting puffins on the icy slopes of Norway. Like most Artic breeds, they have a thick coat to help them withstand frigid temperatures.
New Breeds at the Show
The list of 184 AKC breeds includes two breeds newly recognized by the American Kennel Club that will be seen at Westminster for the first time: the Coton de Tulear in the Non-Sporting Group and the Wirehaired Vizsla in the Sporting Group. The veterinarians at The AMC know the Coton well as they are popular pets in NYC and we have 145 of them as patients. Since the Wirehaired Vizsla was not imported to the United States until the 1970s, they are not well known. Seeing the Wirehaired Vizslas at the WKC Show will be a special treat since none of these Hungarian hunting dogs have been seen as patients at The AMC.
New Arrivals for 2016
We already know that next year there will be four new breeds ready for participation in the 2016 WKC Show: the Spanish Water Dog, the Cirneco dell’Etna, the Bergamasco and the Boerboel. Except for the Spanish Water Dog, the list appears to be more like a spelling bee challenge than names of dogs!
As Always, The AMC Will Be There
The AMC’s veterinarians will be in attendance for emergency care at both the Piers and the Garden from Saturday until the 2015 Best in Show is named. The AMC will also have an information booth at Meet the Breeds on Saturday (Booth #131 Pier 92) and at the WKC Show on Monday and Tuesday (#44 Pier 94). Please stop by and say hello.
While it is not unusual for a pet to have an accident in The Animal Medical Center waiting room or while standing on an examination table, my reaction to that accident may be considered unusual. As the embarrassed pet family is grabbing for a paper towel or a tissue to mop up, I blurt out “stop” so I can get a syringe to collect the urine for analysis in the laboratory.
18 Tests in One Tube At The Animal Medical Center, a urinalysis tests 18 different parameters from just a teaspoon of urine. Some of the parameters are assessed visually, like color and clarity. A special dipstick measures six values simultaneously – especially important here are glucose and ketones – indicators of potential diabetes. The urine is spun in a centrifuge and the material that collects on the bottom of the test tube is specially stained and evaluated under the microscope. Finally, a drop or two of urine is placed on a refractometer, a device that measures the specific gravity and assesses how concentrated the urine is.
A Snapshot of Your Pet’s Health The results from tests performed on that teaspoon of urine I have collected off the table or floor gives me a whole lot of information about your pet’s health. The finding of red and white blood cells and bacteria when the urine is evaluated under the microscope suggests a urinary tract infection. Observation of crystals in the urine is common and may not represent disease, but if your pet has bladder stones, the presence of crystals gives a hint as to the type of stones, and knowing the type of stone makes treatment more specific and successful. For example, the presence of ammonium biurate crystals in a dog with bladder stones suggests the presence of an abnormal liver blood vessel, and the presence of struvite crystals in a dog with a urinary tract infection and bladder stones suggests struvite stones. In addition to filtering the blood to remove waste products from the body, the kidneys help maintain the body’s water balance. Drink too much and they excrete the excess, drink too little and they hang on to every molecule of water they can. When the kidneys don’t work well, they lose the ability to dilute and concentrate the urine. Measurement of a urine specific gravity, part of a routine urine test, helps veterinarians assess the kidney’s ability to dilute and concentrate and is a partial measure of kidney health.
So much information from something you, the pet owner thought was just an accident. No wonder I am crazy about getting that urine sample from your pet.
One of @amcny’s Twitter followers posted the question that is the title of this post. This person also asked, “Should the high end of the normal range of creatinine be 2.4?” These are very good questions, especially for cat families since cats are seven times more likely to have kidney disease than dogs. I am devoting this week’s blog to the answers.
Kidney Tests
A standard panel of blood tests includes measurement of blood urea nitrogen and creatinine. These tests are commonly used to evaluate kidney function, but the results can be abnormal with dehydration, intestinal bleeding and a high protein diet. When combined with a physical examination and an analysis of the pet’s urine, they become a more powerful assessment of how well the kidneys work.
For many years, when veterinarians discovered elevations in blood tests to measure kidney function, we talked with pet families about chronic renal failure or CRF, and before that we talked about chronic interstitial nephritis or CIN. Today we more commonly use the term chronic kidney disease or CKD. As time passed, the name has changed to more correctly reflect our understanding of the disease. Chronic interstitial nephritis comes from microscopic evaluation of a kidney biopsy, something most pets never have. Chronic renal failure was a confusing term to pet owners who were unfamiliar with the medical term for kidney – renal. Failure was a misnomer since the abnormal blood tests indicate decreased function, but not necessarily an absence of function or failure. Thus, renal became kidney and failure was swapped out for disease.
If There is Chronic, There is Also Acute
In medicine, if a disease has the modifier “chronic” you can bet there is also an ”acute” form of the same disease. Acute renal failure has a very abrupt onset in a decline of kidney function and is caused by a variety of disorders including leptospirosis, antifreeze ingestion and lily intoxication. Some pets with acute renal failure completely recover; others improve but continue to have chronic kidney disease and sadly, others don’t make it. The term chronic indicates a long term process that may or may not get worse, but one that, with treatment, can achieve a good quality of life.
Is 2.4 the High End of Normal Range for Creatinine?
Normal range is another term largely gone from the veterinary lexicon because normal depends on the age, sex and even breed of the dogs or cats used for comparison. Now we use the term “reference range or reference interval.” The upper end of the reference range is variable from lab to lab, based on testing methodology, equipment and the exact animals used to develop it. Perhaps more important than the exact reference range from the lab is what is normal for your pet, i.e. what was the creatinine last year and the year before and is the number trending upwards? When that happens, it suggests decreased kidney function and suggests more testing may be indicated.
Since New Year’s has passed, I suspect many pet families are hard at work on their list of resolutions. Weight loss is a common human New Year’s resolution and since estimates of overweight and obese pets range from 25-40%, I suspect it is on the list of many pet families as well. If you have a Labrador Retriever, Beagle, Cocker Spaniel, Basset Hound, Dachshund or Sheltie, breeds at high risk for obesity, weight loss is probably perpetually on your to do list.
Here are my tips to help your pet keep its resolve when it comes to weight loss:
Many pet owners don’t recognize chubbiness in their favorite furry friend. Have your veterinarian assess your pet’s body condition score. This will help determine if weight loss is necessary.
Pet Body Condition Score Chart
Using your pet’s body condition score, decide how much weight loss is necessary and have your veterinarian calculate the number of calories required daily to attain that weight. Ask if a weight loss food would be nutritionally better than simply cutting back on the current daily portion.
Determine how many calories are in each can, bag or box of your pet’s food and calculate exactly how many ounces, grams or portions of a can are required to meet your pet’s daily calorie allotment. Then feed that number of calories – no more, no less.
Limit treats to 10% of the calculated daily calorie allotment AND include treats in the daily calorie total. Treats can look deceptively calorie free and help to pack on the pounds. A small Milk Bone biscuit contains 20 calories and a Bully Stix has up to 22 calories per inch. A six inch stick could be nearly 25% of your 30 pound dog’s calorie allotment for the day.
May 17 -23, 2015 is National Bite Prevention Week. The United States has 70 million dogs, all of them wonderful companions, but any dog can bite. Animal bites are a serious problem, affecting 4.7 million people per year, most of them children. Senior citizens are the second most common age group affected by bite injuries.
Posted by Fur the Love of Pets 
Fur the Love of Pets 