Pet and Wellness Fun this Saturday, May 18, 2013

Looking for a fun, outdoor activity for the whole family this weekend? Join us at The AMC’s Annual PAW (Pet and Wellness) Day celebration in Carl Schurz Park (84^th Street and East End Avenue, 10am – 1pm), where every family member, including the furry ones, will find special activities designed just for them.

Doggy massages and more
Members of The AMC’s Tina Santi Flaherty Rehabilitation & Fitness Service will teach two sessions on how to relax your dog with yoga and massage. Veterinary staff from The AMC will provide free screenings for canine high blood pressure (hypertension), tooth brushing lessons, obesity assessment and many other hands-on health activities.

There will also be two sessions entitled, “Pet First Aid for the Pet Owner,” presented by one of The AMC’s board certified emergency and critical care veterinarians. Other specialist veterinarians from The AMC will be on hand to answer questions about pet health and disease. They will distribute pamphlets and fliers as well as free samples of treats and pet products.

Kid’s stuff
This year, PAW Day will feature a dog well known to children – Clifford, the Big Red Dog, from the PBS series of the same name. Another PAW Day highlight for children will be the stuffed animal veterinary clinic. Children may bring their favorite stuffed animal for a veterinary examination and treatment or adopt an animal at the event. Children attending PAW Day can also purchase a veterinary kit and receive instruction on examination techniques by the highly trained AMC veterinarians.

Over 400,000 children receive medical treatment each year for dog bite injuries. Since children are the most common victims of dog bites, every parent should be concerned with teaching their child how to safely interact with dogs. Children attending PAW Day can practice the four steps of being safe around dogs with friendly dog volunteers who will be on-hand. If children are shy around dogs, they can still learn about safe interactions with dogs at the coloring book station, which will be in a dog free zone.

PAW Day is free and open to the public, so stop by and say hello to your favorite AMC veterinarian! Check out The AMC’s website for additional information about the event: www.amcny.org/pawday2013. 

Household Cleaning Products: A Pet Danger

X-ray of a cat that has eaten a metal mesh scouring pad

It’s spring cleaning time, but if you have pets please clean cautiously since some of the most common cleaning agents can be toxic to your pet. Birds are especially sensitive to the fumes from household cleaning agents.

Chlorine bleach has an extremely wide spectrum of activity against common bacteria and viruses. Its low cost makes bleach an attractive disinfectant and laundry additive. Bleach disinfects by oxidizing cell membranes, rupturing and killing cells. Bleach has the same effect on the gastrointestinal tract if your pet drinks undiluted bleach or chews on the bleach container. A splash of bleach into the eye of a curious pet can cause tearing, irritation and even an ulcer.

Some websites recommend the use of phenol-containing pine scented cleaners as a deterrent for cats who urinate outside their litter boxes. If you use these products, you may no longer have a healthy cat and the litter box issues will seem insignificant. When walking across your freshly mopped kitchen floor, your cats get phenol on their feet. Phenol is caustic to the delicate paw pads. Then, when cats groom, they ingest the cleaner which damages their liver and kidneys. When compared to dogs, cats are extremely susceptible to phenol toxicity since their liver lacks an important enzyme for metabolism of phenol.

Although not technically toxic, steel wool and metal mesh scouring pads can cause intestinal obstruction if consumed by your pet. At first glance these products do not have much culinary appeal, but when encrusted with steak bits from the grill or some scrambled eggs from the frying pan, a scouring pad becomes a tasty treat for your dog or cat. As you can see in the x-ray, the scouring pad unravels and prevents food from normally passing though the intestine. The sharp strands can also slice into the intestinal wall. Emergency surgery is required for removal.

Quaternary ammonium compounds are disinfectants with a broad spectrum of antimicrobial activity against bacteria, viruses and fungus. These compounds are popular cleaning agents colloquially called “quats.” Serious injury can result to both pets and people if they inadvertently come in contact with quats. Caustic burns, convulsions, low blood pressure and even death occur following ingestion or contact with the skin.

The AMC Emergency and Critical Care staff recently teamed up to save the life of a young Yorkshire Terrier with severe oral swelling and respiratory distress from ingestion of quaternary ammonium. Read his story: Yorkie Ingests Deadly Poison and Survives.

Not sure if a product is pet-safe? Download the material safety data sheet for any product you might purchase to prevent bringing a dangerous product home.

A Busy Night in the ER: Pet Toxicities

Every morning around 5am, the veterinary staff at The Animal Medical Center receives an email listing the cases admitted to the hospital overnight. I found last Sunday’s list particularly intriguing. Four dogs were admitted to the hospital suffering from ingestion of a variety of toxic agents. All four dogs ultimately recovered, but there are some important lessons to be learned from these cases.

High time to avoid marijuana

Despite his bold name, Tiger is a tiny Chihuahua. He came to The AMC’s ER in the middle of the night for being wobbly and weak. The veterinarians used a special drug test kit on his urine and found he had been exposed to marijuana. Small dogs like Tiger can easily become intoxicated by ingesting marijuana or. They develop clinical signs similar to humans, but in serious cases, signs may progress to seizures and even coma. Veterinarians in Colorado, one of the states where medical marijuana is legal, report an increase in canine marijuana toxicity in their animal ERs.

Just say no to human drugs

Charlie, a cute Yorkshire terrier, landed in the ER for one of the most common intoxications: ingestion of a human medication. His owners thought he was painful and administered just a sliver of a naproxen tablet. Naproxen alone is enough to cause a gastric ulcer as well as damage his kidneys, but Charlie was also taking a steroid medication. Steroids plus naproxen are a ‘one, two punch’ to the stomach lining and Charlie vomited a dozen times on the way to The AMC. After two nights in the hospital, Charlie was much better and was released.

Chocolates are no treat

Bibi, a chocolate colored standard poodle, gave herself an abnormal heart rhythm by eating one half of a giant dark chocolate bar. Chocolate contains theobromine, a stimulant related to caffeine. The ER staff administered activated charcoal to help decrease the absorption of the theobromine. The darker the chocolate, the greater the concentration of theobromine in the chocolate. The theobromine is responsible for the hyperactivity, vomiting and abnormal heart rhythms. Like most dogs, Bibi has quite a sweet tooth. This is not the first time she has eaten chocolate, but the first time she consumed enough to require medical attention.

A sugar-free spree

Rocky, a German shepherd was the least sick of the overnight admissions, thanks to the quick response by his family and the ER staff. He had chowed down on some sugar-free gum containing xylitol. Dogs react much differently to xylitol than we do. Just a few pieces of gum are enough to drop a dog’s blood sugar to dangerously low levels and also cause liver failure. Because his family saw him eat the gum and the ER staff forced him to vomit, the gum did not cause any problems for Rocky other than a night away from home and some lost sleep.

Keeping your pet safe from toxins

• The only medications your pet should receive should be those prescribed by your veterinarian. Although we often prescribe human medications, the doses used in pets may be vastly different than those used in humans, so never give your pet human medications without the approval of your veterinarian.
• Educate yourself about substances potentially toxic to your pets.
• If you must keep products which can be toxic to your pet in your home, put them away in a cabinet with a tight latch to avoid inadvertent exposure.

What’s New for Fleas and Ticks?

Ticks have been around forever. Even the ancient Roman author, Pliny the Elder (23-79 A.D.) was vexed by these creatures. He is reported to have said, “Ticks: the foulest and nastiest creatures that be.” Ancient Rome must not have had fleas, or Pliny would have included them on his nasty creature list as well. Besides being nasty, fleas and ticks spread disease to you and your pets.

A new kind of collar

Collars to prevent flea and tick infestations have been around a long time, but their effectiveness has been limited. A veterinary school professor of mine said, “The only fleas killed by a flea collar are those squashed when the collar is put around the pet’s neck.” Polymer technology has advanced flea collars from a dusty plastic strap to a timed release medical device, and in the newest version even repels ticks before they attach. For additional information on year-round flea and tick control, check with the Companion Animal Parasite Council.

A new way to remove ticks

One of my most frequent calls is from an owner who finds a tick attached to their dog or cat and wants to know how to get rid of the nasty critter. The internet is rife with misinformation on how to remove ticks – nail polish remover, smoking matches and petroleum jelly. All of these are bad ideas. Either grasp the tick firmly with tweezers or a tick removing device and pull the tick, head included, out of the skin. This is easier said than done in a wiggly dog with a teeny tiny embedded deer tick. Now, there is a way that will make pet owners ecstatic with an easier way! A new a non-toxic product has been designed and produced to loosen the tick’s grip on the skin and allow it to be lifted off your pet with a cotton ball or moistened pad.

A new method to decrease ticks in the environment

Currently under investigation for the control of Lyme disease are bait boxes for mice. This clever study aims to attack Lyme disease where it starts, with the deer ticks that feed on the reservoir host of the Lyme disease bacteria: the white footed mouse. Bait boxes are placed outdoors. Mice enter the box and a mouse sized dose of fipronyl gets rubbed on their back. Fipronyl is an Environmental Protection Agency registered product found in several top spot tick and flea preventative medications for dogs and cats. When applied to mice, it kills ticks, decreasing the number of ticks which can bite you and your family.

Do you still want more information about ticks? The Connecticut Agricultural Experiment Station has an exhaustive tick handbook available online.

Confused about flea and tick preventatives for your dog and cat? Make an appointment with your veterinarian to find the right prescription for your pets. Follow their directions exactly, because reactions to flea and tick products are most commonly due to improper use of these products.

Avoiding the Knife: Preventing Pet Surgeries

At The Animal Medical Center, our board certified surgeons and neurologists perform approximately 1,500 surgeries each year. A recently released pet insurance study completed in 2012 listed the top ten surgery claims for both dogs and cats:

Survey attributed to VPI Pet Insurance 2012

Since none of us want our pets to be subjected to the difficulties most surgeries pose, I will devote this blog to suggestions on how to avoid some of the most common canine and feline surgeries.

Tooth extractions

Topping the surgery list for cats and coming in at number three for dogs were tooth extractions. Keeping your pets’ teeth healthy means daily brushing and annual dental cleanings. The American Veterinary Dental College website provides good information about home dental care in dogs and cats. Remember, doggy breath often means periodontal disease, so if your pet has smelly breath, see your veterinarian for treatment before extractions become necessary.

Skin abscess, inflammation and pressure ulcers

This list of skin conditions ranks number two as a reason for surgery in both dogs and cats. Pressure ulcers generally occur in older dogs with limited mobility. Padding, padding and more padding will help prevent pressure ulcers on their elbows and thighs. Investigate orthopedic beds for your dog and try to keep him from laying on hard surfaces like the bathroom tile floor which can aggravate pressure sores. Promote mobility in your dog through regular exercise and management of arthritis with diet and medications.

Feline bite wounds

When I was a veterinarian in a more suburban area, we treated cat bite wounds on a daily basis. Preventing cat bite injuries is as simple as keeping your cat indoors. Cat bites not only cause wounds which can become abscesses, but cat bites transmit the feline immunodeficiency virus and possibly blood parasites as well. Priceless is how I define the value of keeping your cat indoors and healthy.

Aural hematoma

The tenth most common surgery in dogs was to repair an aural (ear) hematoma. Cats can develop aural hematomas too, just not as commonly as dogs. This condition is essentially a blood blister inside the ear flap. Blood accumulates in the ear flap when your dog incessantly shakes his head or scratches her ears. Usually, the shaking and scratching is in response to an allergy or an ear infection. If you see this behavior, check inside the ear for redness or discharge. See your veterinarian immediately to treat the cause of the shaking and scratching to prevent the development of an aural hematoma.

While some surgeries are unavoidable, these are prime examples of how a visit to your veterinarian for routine preventive care can help your pet avoid surgery.

Drug Fright: Scary Medication Labels

Everyone has heard them: the rapid fire voiceovers on television advertisements for medications. They sound something like this, “Do not use this medication if you have serious heart disease, suicidal thoughts, liver problems or hangnails. Ask your doctor if this drug is right for you.” If you fast forward through commercials on your DVR and have missed the voiceover, then perhaps you have opened a bag from your pharmacy and found the accordion pleated paper, printed in size two font, containing drug information, warnings, contraindications, precautions, adverse reactions and risks.

Here is a portion of one for a commonly used human medication:

1. General: Urticaria, drug rash, anaphylactic shock, photosensitivity, excessive perspiration, chills, dryness of mouth, nose, and throat
2. Cardiovascular System: Hypotension, headache, palpitations, tachycardia, extrasystoles
3. Hematologic System: Hemolytic anemia, thrombocytopenia, agranulocytosis
4. Nervous System: Sedation, sleepiness, dizziness, disturbed coordination, fatigue, confusion, restlessness, excitation, nervousness, tremor, irritability, insomnia, euphoria, paresthesia, blurred vision, diplopia, vertigo, tinnitus, acute labyrinthitis, neuritis, convulsions
5. Gl System: Epigastric distress, anorexia, nausea, vomiting, diarrhea, constipation
6. GU System: Urinary frequency, difficult urination, urinary retention, early menses
7. Respiratory System: Thickening of bronchial secretions, tightness of chest or throat and wheezing, nasal stuffiness

Here is a portion of a drug label for a canine chemotherapy agent:

Anorexia, lethargy, vomiting, lameness, weight loss, blood in stool/GI bleed/hemorrhagic diarrhea, musculoskeletal disorder, dehydration, dermatitis, pruritus tachypnea, localized pain, nausea, general pain, polydipsia, pyrexia, flatulence, pigmentation disorder, neutropenia, thrombocytopenia, increased alanine, aminotransferase, hypoalbuminemia, decreased hematocrit, hyperbilirubinemia, increased creatinine, urinary tract infection.

The United States Food and Drug Administration has strict regulations governing drug labels. Drug labels should be accurate and not promotional. The list of possible side effects is comprehensive to help prescribers, like me, alert their patients, like your pet, to possible problems that might arise while the medication is being taken. Without this critical information, you might keep giving a medication that is actually making your pet worse. The information on a drug label helps me to weigh the risk of not treating a disease with benefits of a medication used to treat the disease.

The warning labels for both the commonly used human drug and the canine chemotherapy agent sound moderately frightening and yet these drugs are critical to improving a patient’s quality or quantity of life. What the drug labels can’t substitute for is experience. Once your veterinarian or physician has used a drug on many patients, we know what to expect and what to tell you to expect. Reading the drug label is a good thing since it helps you to recognize any adverse reactions to medications early. Not giving a drug to your sick pet because the drug label is frightening is foolish, unless you tell your veterinarian about your concerns and together you decide the best course of action for your pet. Remember, we love to talk about sick pets and about medications; it’s what we do every day!

Oh, by the way, the human drug with the seven body system long list of adverse effects was Benadryl.

Anemia Tails: Dog and Cat Anemia

According to VetLearn, a company focused on continuing education for veterinarians and veterinary technicians, one of the top ten articles they published in 2012 was on anemia in dogs and cats. If an article on anemia tops your veterinarian’s reading list, then your pets are perplexing anemia cases. I would guess you have questions about anemia too.

Anemia: definition

Although the causes of anemia are complex, the definition is simple: if your pet is anemic, she doesn’t have the normal number of red blood cells speeding through her blood vessels carrying oxygen and nutrients to cells and removing cellular waste products. Without adequate oxygen, your usually peppy pup or cavorting cat acts dull and tired.

Liver and onions cause anemia?

You may think liver is a cure for anemia: not true. Last week we saw a cute wiener dog named Klauss. He came to The Animal Medical Center with dark brown urine. Although, Klauss didn’t seem sick to his owner, the color of the urine was frightening, provoking a trip to The AMC ER. The ER doctors found his urine contained a large amount of bilirubin, a breakdown product of red blood cells. They also found Klauss was anemic. Upon further questioning, the family reported of a raid on the trash can containing the leftovers of a of liver and onion dinner. Onions and garlic can damage the red blood cells of both dogs and cats, causing them to rupture and resulting in anemia. Klauss only needs to avoid eating onions and his body will shortly make new red blood cells.

Ironclad diagnosis

We take better care of our pets than ourselves, providing them with nutritious food while we snack out of the pantry. Because of their high level of nutrition, iron deficiency is rare in our furry friends. My patient Jackie, a Labrador with a jaw tumor, has developed a rare case of iron deficiency anemia. Three weeks ago, her tumor eroded a blood vessel and caused a major hemorrhage. When she lost blood, she also lost iron. On her most recent blood count, the red blood cells were tiny. The small size is a result of inadequate iron which keeps them from growing to normal size. An injection of iron will easily fix Jackie’s anemia.

Strange, but true

Hatshepsut, an Egyptian Mau cat, was not acting right. Because of a waning appetite, she came to the hospital for an evaluation. The radiologist saw an intestinal tract full of kitty litter when he reviewed her x-rays. Hatshepsut has a strange but true sign of anemia-pica – an appetite for eating non-food substances. Kitty litter is common, but I have seen dogs with anemia spend all day licking the grout between the bathroom tiles. The presence of kitty litter in the intestine made me suspect anemia, and a blood test confirmed it.

In conclusion

• Blood loss, red blood cell destruction and faulty bone marrows are all causes of anemia. 
• Is your pet tired, eating strange items or just not feeling well in general? See your veterinarian for a blood count. 
• Does your pet’s skin or urine have a funny color? Take a urine sample to the veterinary clinic for testing. 
• Does your pet’s stool have funny color? Take a sample for analysis.

Thiamine Deficiency in Cats: Q & A for Cat Families

Last week the Food and Drug Administration reported a voluntary cat food recall. The recall was voluntary because routine testing performed by the food manufacturer identified an inadequate amount of thiamine in the cat food. No sick cats had been reported following consumption of the food, but thiamine deficiency in cats can be a serious problem and the company was exercising an abundance of caution.

What is thiamine?

Thiamine is a member of the B vitamin group and is also known as vitamin B1. The liver heart and kidneys are the organs with the highest levels of thiamine. Thiamine and all the B vitamins play a critical role in energy metabolism throughout the body. Thiamine interacts with other B vitamins to improve the efficiency of energy metabolism.

How does thiamine deficiency occur in cats?

1. Decreased intake. Processing decreases thiamine and additional thiamine is added after processing to be sure our pets’ food has adequate levels.
2. Destruction by an enzyme known as thiaminase. This enzyme is found in raw fish, shellfish and microorganisms. If you feed your cat raw fish or shellfish, the enzyme could deplete the natural thiamine and lead to thiamine deficiency. Cooking destroys the enzyme.
3. Increased excretion. All the B vitamins, including thiamine, are water soluble and if your cat consumes more B vitamins than they need, the excess is excreted in the urine. Cats with chronic kidney disease may lose more B vitamins than usual through their diseased kidneys.

How would I know if my cat was thiamine deficient?

If your cat became thiamine deficient, you might notice a decrease in appetite or an increase in drooling. If you have a kitten, it might not grow as expected. The nervous system is most severely affected by thiamine deficiency and you might see weakness, stumbling or convulsions. The handful of cats I have seen with thiamine deficiency held their chins to their chest, or in doctor’s terms had “ventral neck flexion.”

Thiamine deficiency sounds bad. Can it be treated?

Here is the best part of the blog. YES! A simple injection of thiamine under the skin should have a thiamine deficient cat on the road to recovery in a day or so. Thiamine is extremely safe and if your cat’s illness is not caused by thiamine deficiency, the kidneys will filter the excess thiamine and excrete it in the urine with no adverse effects for your cat.

In addition to the FDA website, The AMC website posts food recalls and here is another site that posts information about pet food recalls. If your cat is sick, be sure to tell your veterinarian the brand and flavor of food your cat is eating. If your pet eats a food that is recalled, check with your veterinarian for advice on how best to manage your cat and its diet.

A Good Day @The AMC!

I had an especially good day at The Animal Medical Center one day last week and so did everyone else. Our hard work was rewarded with positive outcomes for many wonderful pets.

A cancer check up

Becky

Becky, a graceful Golden Retriever, had an appointment for a follow up on her thyroid tumor which was surgically removed nearly a year ago. After surgery, she received a total of four chemotherapy treatments. I administered two drugs, doxorubicin and carboplatin, using an alternating treatment protocol. Now she needed a new chest x-ray since the lungs are where thyroid tumors spread most commonly. It was a tense wait for everyone, her owner and her oncology team, but we were rewarded when the radiology report indicated her tumor had not spread.

A happy heart

The cardiologists saw a Boxer who suffers from a form of heart disease found commonly in this dog breed. In Boxers, fat replaces the normal heart muscle and causes abnormal heart beats which can lead to sudden death. This disease, known as arrhythmogenic right ventricular cardiomyopathy, was first diagnosed by cardiologists working at The AMC and studying Boxers with heart problems. This particular Boxer and her cardiologist were having a good day, like I was. At first she had 22,000 abnormal heart beats measured using a continuous heart monitor called a Holter monitor. Initial results indicated treatment with heart medications decreased the number of abnormal beats to only 51 abnormal beats in over 110,000 beats counted in a 24 hour period!

Renal medicine rejoices over urine

Since every pet urinates, you might think urine would not be a cause for celebration, but The AMC’s Renal Medicine & Dialysis Service does. When kidneys suffer from serious infection or obstruction, they can actually completely stop making even the smallest drop of urine. Using dialysis, AMC’s kidney specialists can replace the filtration function of the kidneys and prevent serious illness from a buildup of toxins in the bloodstream. But until the kidneys start to heal, cats and dogs may not urinate for days. The first time a dialysis patient urinates, an average day becomes a great day since we know the kidneys are finally getting better.

Surgeons perform less surgery and are glad

Henry was diagnosed with a lung tumor. Because his doctors made an early diagnosis, his tumor was small making it amenable to a minimally invasive removal. The surgeons used a thorascope – a device with a tiny camera attached. The camera was inserted into Henry’s chest through a small incision. Its progress toward the tumor was viewed on a large screen monitor. Once the exact location of the tumor was identified, a second small incision was made through which the lung tumor was removed using a surgical stapler. Because of the minimally invasive approach, Henry was discharged from the hospital the next day rather than several days later, which is typical when traditional surgery is used.

Even though these stories are about different pets, different diseases and different veterinary specialists, they share a common theme, improving the health of pets so they spend as little time as possible @The AMC and spend more time at home with their families enjoying life.

Tripawds Awareness Day

Jill

Sunday was Tripawds Awareness Day on the cleverly chosen date of 3/3. To celebrate tripawds, I thought I would tell you about a triplet of tripawd patients.

Every veterinarian has dog and cat patients with only three legs, or as one website calls them, tripawds. Because I am a cancer specialist, my tripawd patients all have a malignant tumor as the cause of their amputation, but other veterinarians perform amputations to treat a variety of diseases and injuries. One common cause of amputation in cats is a serious fracture that cannot be repaired. Infections of the bone cannot always be cured by antibiotic therapy and if the infection starts to cause pain, an amputation controls both pain and infection. When hit by a car, dogs and cats may suffer nerve damage to their front leg, sometimes resulting in paralysis. The paralyzed limb may drag on the ground and develop sores. Amputation resolves this problem once veterinarians have determined there is no hope of the limb regaining function.

Handsome Lester

Lester, a refined gentleman of a dog, came to The Animal Medical Center nearly two years ago. He has the black tongue of a Chow Chow, the coat of a Samoyed and sadly, osteosarcoma. Osteosarcoma is the most common bone tumor in dogs and in my practice is the most common cause of amputation. Because amputation treats the tumor in the bone but does not treat the little tumors lurking elsewhere, like the lungs, Lester received chemotherapy intravenously for a few months after surgery. Then Lester exceeded our expectations and was tumor-free for over one year. Late last summer, chest x-rays picked up new tumors in his lungs. Thanks to an oral chemotherapy drug, tripawd Lester continues to exceed our expectations with a great quality of life – walking on the beach with his naughty brother Nicholi.

Long live Ajax

Ajax, a 10 year old tripawd Labrador, appeared in an earlier blog when he had two simultaneous tumors, a thymoma near his heart and a soft tissue sarcoma on his hind leg. The sarcoma attached itself to his leg bone and could not be removed without losing the functionality of his leg. Ajax’s soft tissue sarcomas behaved very differently than Lester’s osteosarcoma. Amputation was the only treatment required to cure him of this tumor and he has survived nearly three years since the surgery.

Cheerful Jill

Jill’s family desperately tried to save her leg. They let several pathologists study her toe biopsy and we were hopeful surgical removal of the toe would be all the treatment she needed. Several months after the toe amputation, Jill’s family found a hard mass on the back of her leg, and a biopsy indicated the giant cell osteosarcoma of the toe had recurred. Since the possibility of amputation was discussed during the evaluation of the toe biopsy, Jill’s family was not surprised at the recommendation for an amputation once the tumor had returned. We also recommended chemotherapy, the same drugs we used successfully in Lester. To hear more about Jill and her adventures, read her blog on Tripawds.com.

Want more information about tripawd dogs? 

• In addition to the Tripawds website, there is also Canine Amputees. Their page of links is excellent.
• Watch a video of a pair of bi-paws and their new rolling front legs.

Staphylococcal Infections: They’re Not All Superbugs

Last week I saw two patients with Staph infections. Finding a Staph infection is not unusual; veterinarians see Staph infections every day because Staphylococcus bacteria are normal inhabitants of the skin of dogs. Staph infections start like this: your dog scratches, breaks the skin and the Staph slip in and cause an itchy infection in the hair follicle called pyoderma. Staphylococcus psuedintermedius is one of the resident bacteria in the skin of dogs and a common cause of pyoderma. Staphylococcus aureus is the analogous human bacteria. When either of these bacteria acquires resistance to an antibiotic called methicillin, they have been branded “superbugs,” and in medical terms are called methicillin resistant Staphylococcus psuedintermedius (MRSP) or Staphylococcus aureus (MRSA). Just because they have the name superbug, doesn’t mean the infections caused by these bugs are not treatable; they are not successfully treated with the typical antibiotics we use for a “normal” Staph infection.

Hospital bug

Originally, MRSA/MRSP infections occurred in hospitalized human or animal patients, but recently MRSA infections have been found in patients who have never been in the hospital. This type of MRSA/MRSP infection is often called community acquired. Hospital acquired methicillin resistant infections can readily be transmitted from patient to patient in the hospital, and preventing transmission is one reason veterinarians and physicians wash and sanitize their hands between patients.

Infections with methicillin resistant bacteria may be becoming more widespread. Recently reports indicate wild rats can be carriers of MRSP and a baby alpaca was found to be colonized with MRSA. Obviously, these animals did not acquire the infection in the hospital.

Pets with the superbug

In studies testing a large number of dogs and cats for MRSP, less than one percent of animals screened carried these bacteria. This week’s first patient with MRSP developed a bladder infection confirmed via a urine culture to be MRSP. Neither she nor anyone in her family has been hospitalized, but she has recently completed a course of chemotherapy for a mast cell tumor and possibly the infection is related to those treatments. Happily, the test results indicated a common antibiotic will be effective in treating the infection.

People to pets?

The healthy pets living with humans infected with MRSA have been tested and some found to carry the MRSA which appears to be the same in both the pet and the human. In this interesting study, dogs, cats and even a hamster living with a human infected with MRSA were found to carry MRSA.

Whether the pets were the source of the infection or simply accidently infected by the human is unknown. Nevertheless, this study shows pets could be a source of infection or reinfection for their human family members.

Last week’s second patient with a Staphylococcus psuedintermedius infection did not have a methicillin resistant one, but she could have. Angel is a therapy dog who visits hospitals. Because of her occupational risk, we tested her to protect not only her health, but the health of those under her care.

What can a pet owner do?

If your veterinarian recommends a culture of your pet’s skin or urine, I strongly recommend you agree to the test to help determine the best course of treatment and to identify MRSA/MRSP early.

If you have a therapy pet, follow the guidelines set out by your therapy pet group to protect your pet, yourself and your patients.

If your pet has an infection, tell your veterinarian if someone in your family has recently been hospitalized or diagnosed with MRSA. This information is critical when we submit tests to the lab and prescribe antibiotics.

Scarlett’s Diet

Scarlett on the treadmill

Last week Scarlett, a ruby Cavalier King Charles Spaniel, had an urgent visit to The Animal Medical Center to see her cardiologist. Since she has been diagnosed with early stage heart valve disease, a condition common in Cavaliers, her family is always concerned about her breathing, which, on that day, was heavier than normal.

The cardiologist says…

Her cardiologist found her lungs to be clear, her pulses strong and her respiratory rate to be normal. Using his stethoscope, he heard a heart murmur, but Scarlett always has a heart murmur because she has leaky heart valves. After determining her heart was not the problem, he then honed in on what her problem was: a two pound weight gain between August and February. For this little Cavalier, a two pound weight gain was equal to 12 pounds in a 120 pound person. The extra weight she is now carrying on her small dog frame puts extra pressure on her diaphragm and contributed to her heavy breathing.

Scarlett, the scavenger

Scarlett’s dog sister, Jackie is a patient of mine. Due to her jaw tumor, she has become a bit of a messy eater. Scarlett believes neatness counts and has been tidying up the kitchen floor after her Jackie eats dinner. The extra calories from Jackie’s fallout have resulted in Scarlett’s weight gain and probably her episode of snorting and heavy breathing.

Diet time

To get Scarlett back to ideal body condition, she has been pulled off clean-up duty after Jackie’s dinner. I recommended her family purchase a kitchen scale to weigh each serving of Scarlett’s food. Families can cheat on their dog’s portion more easily with a measuring cup than with a scale. Scarlett already eats a light food, so I calculated how many calories a day she needs and translated those calories to ounces of her brand of dog food. No weight loss plan would be complete without some little treat every day. Scarlett’s favorite is chicken. I allotted 10% of her daily calories to broiled chicken breast and the other 90% to her light kibble.

In addition to decreasing her calories, we have increased her exercise. Scarlett comes twice a week to work out on the treadmill at The AMC’s Tina Santi Flaherty Rehabilitation & Fitness Service. When the beaches open this summer, Scarlett will have a waistline as tiny as that of another flirty redhead, her namesake, Scarlett O’Hara!

Lessons from Scarlett

• Review what ideal body condition looks like for both cats and dogs. This will help you recognize weight gain in your pet early.
• Monitor your pet’s food intake and recognize other sources of calories in their diet such as the other pet’s enticing food bowl, food dropped from the high chair or the nice lady next door who cannot resist giving your dog 10 extra treats per day.
• Get your veterinarian’s recommendation on the amount to feed your dog for successful weight loss. All dog foods do not have the same number of calories per cup or can. Even foods promoted as weight loss diets have a wide range of calorie content per cup or can.

Reflections from the Westminster Kennel Club Dog Show 2013

Every year when the Westminster Kennel Club (WKC) dog show comes to New York City, The AMC goes to the dogs. The Animal Medical Center sets up a vendor booth in the middle of the benching area, which was held this year at Pier 92/94 overlooking the Hudson River, instead of the usual location in the outer ring basement of Madison Square Garden. The new space was so much more spacious than the old space and everyone I talked to hope this new location would be the start of a new tradition.

Only a few cat questions

Not surprisingly, the majority of veterinary questions were asked about dogs. A few slightly embarrassed people walked up to the booth and sheepishly asked permission to have a cat question answered. This reluctance of cat owners to ask cat health questions mirrors one of the current feline healthcare issues: cat owners are providing less healthcare for their cats than dog owners provide for their dogs.

Food, food, food

One of the most frequent topics discussed with pet owners at The AMC booth was pet food which has also been a common topic here at Fur the Love of Pets.

At the dog show, several pet owners asked, Which is better, dry or canned food?” Some cat owners had heard the myth: dry food is bad for your cat and others heard dogs should have a mixture of dry and canned food. Both of these are pet food myths. If you have a healthy dog, cat, puppy or kitten, my guidelines for choosing a pet food include:

• Food that carries the AAFCO nutritional adequacy label
• Matching your pets life-stage and species, (i.e. puppy food for a puppy)
• Food that is easy for you to obtain
• Food that your pet likes

The choice between canned and dry belongs to you and your pet; however, dogs and cats with medical conditions may benefit from a particular type of food.

Intersection of animal and human health

One of the visitors at our booth was a physician. We chatted a bit about the similarities between veterinary and human medicine. This too has been a common theme in my blogs. Pets and their people share infections like Salmonella, get similar cancers, such as melanoma, and everyone gets sick with the flu. The physician was surprised to find out The AMC staff consists of 92 veterinarians, 30 who are board certified specialists and five who hold two certifications.

Thanks

Possibly the best part of staffing The AMC booth was talking with the grateful pet owners who came to say thank you to The AMC. Those kind words and smiling faces are what makes my job, and the job of every veterinarian worthwhile – every day.

Brush Up on Your Bicuspids: A Dog and Cat Tooth Tour

February is National Pet Dental Health Month. According to the American Veterinary Dental College, your pet needs daily toothbrushing and annual dental cleanings to keep their pearly whites white. Just like your visit to the dentist, where x-rays are taken to find periodontal disease or tooth abscesses, x-rays are a critical component of an annual dental cleaning for your dog or cat. Since most pet owners don’t get a chance to see their pet’s dental x-rays, I thought I would show you some from The Animal Medical Center.

Above, you see Spanky the cat’s six normal front teeth (incisors) flanked by his big fangs, also called canine teeth, even though he is a cat. Based on x-rays, the rest of Spanky’s teeth were normal and he did not have to have any teeth extracted during his annual dental cleaning.

 

In this x-ray you see one of Rhett Butler’s big molars. Both roots are surrounded by a dark area, instead of normal white bone. The dark area represents a periapical tooth root abscess which was the cause of his reluctance to eat and his swollen face. Once the tooth was extracted and he was treated with antibiotics, he recovered quickly.

Here you see dental x-rays of the right jaw of two different cats – Spanky on the left and Willie on the right. At first glance, the two look the same. If you look closely you will notice the third tooth in Willie’s x-ray appears moth eaten, especially on the left side of the tooth. The appearance is characteristic of a feline odontoclastic resorptive lesion (FORLS) or root resorption. Teeth with root resorptions need to be extracted as they can be painful and are prone to fracturing. The American Veterinary Dental College recommends cats affected by FORLS should be evaluated twice annually to detect and treat these lesions early.

Despite daily tooth brushing by her owner, Pippa has developed periodontal disease. You can see a pocket of bone loss around the two adjoining teeth. Both teeth had to be extracted during her annual dental cleaning.

Since I shared pictures of pets’ pearly whites, you might want to share yours!

On Flickr: http://www.flickr.com/groups/pearlywhitepets

On Facebook: http://www.facebook.com/events/121936134646100/

On Twitter: Use the hashtag #pearlywhitepets

Dog’s Heart Takes A Lickin’ But Keeps On Tickin’

Chad

Just in time for Valentine’s Day, February is American Heart Month. In 2012, The Animal Medical Center’s spokes-cat was Sidney, who developed fainting episodes which led to the diagnosis of a heart muscle abnormality, a condition common in cats.

This year, we have a spokes-dog who does not want to be outdone by last year’s spokes-cat. This dog has not one, but two types of heart problems at the same time!

An accidental tumor

Chad is a rescued, older male dachshund. After he found a forever home, he needed some dental work. Because his regular veterinarian heard a heart murmur, an echocardiogram was ordered as part of the pre-dental evaluation. Echocardiograms evaluate the heart noninvasively using sound waves. The test showed Chad’s heart murmur was due to leaky valves. Leaky valves are the most common cause of a heart murmur in a dog.

In Chad’s case, the test surprisingly found a tumor near the base of the heart and he came to The Animal Medical Center in March of 2012 for further evaluation.

Magnetic resonance imaging

Heart tumors are quite uncommon; one study showed heart tumors occur in less than 0.2% of all dogs. The two most common types are often hard to distinguish using an echocardiogram. To image the heart, we use a special type of MRI. The MRI showed the tumor was located in the heart wall and could not be removed surgically. We started chemotherapy and between treatments, when he was feeling well, his teeth were cleaned. Chemotherapy finished in November 2012 and an echocardiogram showed the tumor was smaller.

Heart problem number two

In January 2013, Chad’s leaky valves worsened causing heart failure, a buildup of fluid in his lungs. The AMC’s Emergency Service treated him with diuretics (water pills), oxygen and other medications to decrease the fluid in his lungs. The Cardiology Service prescribed medications to keep his broken heart working and the fluid from building up again in his lungs. After two days in the ICU, his heart was ticking well and he went home to his anxiously waiting family.

Is your dog coughing? It might be heart failure. Our friends at the Washington State College of Veterinary Medicine have a nice list of the causes of coughing in dogs.

Still worried your dog might have heart failure? Review the clinical signs and see your veterinarian if you think your dog has heart failure.

Get Well Tuxedo Stan: Political Cat Suffers from Renal Lymphoma

Disclaimer: I am not Stan’s veterinarian and I have not reviewed his medical information nor talked to his doctors. Since lymphoma is the most common tumor of cats, all veterinary oncologists have a good deal of experience in managing this disease.

There are many talented cats who blog. Because I am partial to black and white “tuxedo” cats, Tuxedo Stan from Halifax, Nova Scotia is one of my favorites. Stan believes in taking a political stand. He based his 2012 mayoral campaign platform on the plight of stray cats in Halifax. His politics garnered him endorsements from Ellen DeGeneres and Anderson Cooper.

Early last week Stan announced he was hospitalized at the Atlantic Veterinary College (AVC) on Prince Edward Island for the treatment of the most common type of feline kidney cancer, lymphoma. His most recent tweets indicate he has been released and has returned home.

Lymphoma

Lymphoma is the most common type of cancer seen in cats, approximately one third of all tumors in cats are lymphoma. Stan’s case is a bit unusual since these days most cats with lymphoma suffer from the intestinal form of the disease and, based on his tweets, Stan’s tumor affects his kidneys. During an examination, veterinarians can palpate (feel) large and irregular kidneys. Some, but not all cats with lymphoma of the kidneys have increased values on their kidney blood tests because the tumor cells disrupt normal kidney function. Successful treatment can bring the blood test levels back to normal.

Shaved tummy

In one of his tweets, Stan asked for a sweater because his tummy was cold. He does live in Canada after all. Stan’s abdominal organs were most likely evaluated using abdominal ultrasound. An abdominal x-ray shows the outlines of organs, but an ultrasound lets veterinarians see both the outline and the internal structure of organs as well. Stan’s tummy was cold because we need to shave the fur in order for the ultrasound probe to contact the skin and produce a clear image of the abdominal organs.

Diagnostic test

When oncologists at The Animal Medical Center find a kidney tumor using ultrasound we typically perform a fine needle aspirate to determine the type of kidney tumor, and I suspect Stan had the same or a similar procedure. The radiologist uses the ultrasound images to guide a very thin needle into the tumor. A syringe attached to the needle is used to aspirate (suction) some of the cells out of the tumor. Once the cells are in the needle, the syringe is detached and air is put into the syringe. The syringe and needle are reattached and the air is used to push the cells onto a microscope slide. The slide is stained and evaluated by a specially trained veterinarian called a pathologist. Sometimes these tests are sent to a central laboratory, but because the diagnosis was so rapid, I suspect Stan’s tumor cells were evaluated by a staff pathologist who works at AVC.

Treatment = Chemotherapy

The mainstay of treatment for lymphoma is chemotherapy. At The Animal Medical Center, we typically use a multidrug treatment protocol and rotate drugs on a weekly basis. This protocol attacks tumors using chemotherapy drugs with different mechanisms of action and different toxicity profiles. Administration of chemotherapy drugs to cats requires them to cooperate while the treatment is given intravenously as an outpatient. I hope Stan will give us an update about his ongoing treatments.

Here is more information on signs of cancer in cats.

If you prefer feline social media in 140 characters or less, you might want to use this list to find tweeting cats.

Photo: @TuxedoStan

Neutering: Not Just Doggie Birth Control

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, 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 4 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.

The traditional surgery

Surgical removal of the testicles is the current standard of care 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 dog 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.

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 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.

Plan Ahead for International Pet Travel

With the holidays over and summer not yet here, now is a good time to think about advanced planning for the upcoming trip you and your pet will be taking. If you haven’t thought about taking a trip with your pet, think again. Millions of Americans travel with their pets both locally and internationally and according to an August 2012 TripAdvisor.com survey, 49% of the pet owning public have plans to travel with their pets.

Get some ID

Entrance into many countries requires your pet to have a permanent form of identification. The best form is a microchip placed by your veterinarian. Even if you don’t plan to travel anytime soon, every pet should have a microchip to help get them back home if they are lost. If your pet already has a microchip, double check and make sure the registration information is paid and up to date. Inaccurate information in the microchip database prevents animal rescue groups from contacting you when they find your pet.

Do your homework

Research the pet entry requirements for your destination. Every country is different. As a start, review the information provided by the United States Department of Agriculture.

Their website contains both general information and some country-specific information about pet travel.

You should also locate information on pet travel on the website of the country you plan to visit. Although you and your pet are simply going on vacation, the information about pet entry requirements may be found under import/export regulations. If you cannot find the information or you need further clarification, call the country’s consulate or embassy. The United States Department of State has a listing.

If you find conflicting information about entry requirements, the destination country holds the trump card, so rely on their website and embassy.

Pack the paper

Not newspaper, but your pet’s papers. According to TripAdvisor.com, only 45% of pet owners travel with health certificates and rabies documentation. I find this surprising. Keeping your pet’s vaccinations up to date and keeping their vaccination certificates on file will help streamline obtaining critical travel documents. Bring copies with you and ask your veterinarian for a summary of your pet’s medical conditions and medications.

Important reminders

• Start early. Some countries require your pet to have a special rabies blood test performed. Only certain laboratories perform this test and timing is critical.
• Even though you may have started preparing early for your trip, certain travel documents must be signed only days before departure. Allow time in your schedule to finalize any of your pet’s travel documents.
• Some countries require your pet’s health papers be signed by a USDA accredited veterinarian. Not all veterinarians are accredited, so check with your veterinarian well in advance of your trip to make sure you have an appointment with one who can sign the travel papers.

Constipation in Cats

Topaz
Photo: Dr. Philip Fox

Topaz’s family called me from his Christmas vacation in Florida. They were concerned because they found this older gentleman of a cat straining in his litter box, but not producing any stool. Since I was here at The Animal Medical Center and he was 1,000 miles away, I suggested a safe treatment of canned pumpkin mixed into his food until he returned home and could come visit me a couple of days later.

Complicated constipation

I was anxious to see Topaz when he returned because cats with constipation can be difficult to manage, and there is often an underlying problem causing constipation. I thought the problem might be as simple as dehydration from traveling and being in a strange environment. But Topaz’s family said he was drinking water, in fact, drinking a lot of water.

Too much water

Excessive water consumption in a patient gives some very specific clues to the underlying problem, which may include kidney problems or diabetes.

I checked Topaz’s urine, but it did not contain sugar like a typical diabetic patient. The urine sample was submitted to the laboratory and they reported white blood cells were present, suggesting an infection. Based on this finding, I asked the laboratory to test the urine for the presence of bacteria.

A blockage?

Sometimes constipation is not a medical problem but due to an intestinal blockage. A fractured pelvis, tumors of the colon, or pelvis impinging on the pelvic canal can all prevent normal fecal passage. This possibility forced me to perform a rectal examination, much to Topaz’s chagrin. He was happy since it was normal and because I promised not to do that to him again.

Blood tests tell the story

In addition to testing the urine, I also submitted blood to the laboratory. Routine blood tests screen for a wide variety of common conditions such as anemia, infection, liver problems and kidney disease.

Topaz’s tests showed a mild anemia and elevations in tests indicating a kidney problem. Kidney disease is common in older cats and often leads to dehydration and constipation. Because of the white blood cells in his urine, I was suspicious that the cause of Topaz’s kidney problem was an infection.

Treatment

Topaz got an injection of a long-acting antibiotic, and since his family is experienced with sick cats, they already know how to give fluids under the skin to keep him hydrated and help flush any infection out of his kidneys.

After a few days of home health care, Topaz has fully recovered.

Topaz’s story demonstrates how early intervention can help achieve a positive outcome for your pet and highlights some important reasons to take your cat (or dog) to the veterinarian, including:

• Increased water consumption
• Increased urination
• Constipation

Books for Pet Lovers

If you are like me, you received gift cards during the holidays. What better way to spend them than on books about dogs and cats. Here are a few titles that are currently sitting on my nightstand:

Dogs: Man’s best friend

The Divinity of Dogs: True Stories of Miracles Inspired by Man’s Best Friend is a collection of stories about life changing dogs. Each section of stories has a title: “Love,” “Comfort and Forgiveness,” etc., but for me they all ring true to the wonderful role dogs play in our lives. Some stories, no more than two pages long, will provoke hours of thought about the special gifts of dogs.

Spoiler alert: get out the tissues! When I attended the author’s book reading, the hors d’oeuvre trays should have had tissues instead of napkins. These stories touch the very depth of your soul and remind you why you love dogs, and more importantly why we can’t live without dogs.

Dog: Detective’s best partner

A Fistful of Collars is another installment in the Chet and Bernie mystery series. Chet, the narrator of the book, partners with Bernie, a private detective. Chet is a dog with an opinion. He relishes dinner at the local rib joint, thinks shoe polish is tangy, and muses over words like “collar.” He doesn’t understand why Bernie always talks about collaring perps when they never seem to wear anything around their necks, but instead end up wearing orange jumpsuits! For dog lovers, this book offers a fresh perspective into a dog’s mind.

New kitten and puppy tips

My friend and former AMC colleague, Dr. Jason Nicholas, aka The Preventive Vet has two new titles being released early this spring: 101 Tips for Puppies and 101 Tips for Kittens. I have read the proofs of these attractive and informative books and think they are a must read for new pet families. Beautifully illustrated, even children will like these books and they can be used as a way to actively involve children in the caring of the new family member.

Cooking fun

The Organic Dog Biscuit Cookbook is not on my nightstand, but is on my kitchen shelf. It contains over 100 “tail wagging” recipes. I made the Great Dane Candy Canes as Christmas gifts for a few select dogs. The ingredient list includes brown rice flour, oat flour, Parmesan cheese, egg and tomato paste. These biscuits proved very popular, and Marley, the dog with an office across the hall, comes by and sits by my desk every day, hoping for a sample from the test batch. Dog owners like them too as they are really cute done up as holiday treats. I think cats would like the Going All the Way Upstream treats, which contain salmon. Testing these treats on some hungry cats will be my next cooking project.