The [Veterinary] World is Flat

February 26, 2014

digital x-raysThe title of this blog takes its name from author and New York Times columnist, Thomas Friedman’s bestselling book, The World is Flat: A Brief History of the Twenty-First Century. The book’s thesis explains globalization in the 21st century as a result of wide accessibility to personal computers and fiber optic cables which make communication via email and information gathering via the internet nearly instantaneous. This form of globalization renders geographic divisions between countries irrelevant.

Friedman describes “ten flatteners” including: the collapse of the Berlin Wall, Netscape and workflow software. My own observations of the world of veterinary medicine indicate that it is not much different than the global economy Friedman describes in his book. Paying tribute to the Pulitzer Prize winner Friedman, here are my veterinary flatteners.

A New Workflow
Digital radiography has changed the workflow of daily veterinary practice. In the pre-computer days, each x-ray was a piece of film, not easily copied and very easily misplaced. Now The AMC and many other veterinary hospitals have switched to using digital radiography, using a machine that looks like a regular x-ray machine but which takes digital images similar to those taken with your smart phone. These x-rays can’t be lost because the images are stored in a picture archiving and communication system (PACS). The image files are very large, but can be transported by burning them onto a CD or transferring them through any number of file sharing systems.

Electronic Medical Records
As it has revolutionized the global economy, the personal computer is revolutionizing veterinary practice. Electronic medical records systems (EMRS) allow rapid dissemination of medical information between specialists and primary care veterinarians. I can write a letter to a patient’s primary care veterinarian after I have completed my consultation with their patient. Through the magic of the EMRS, I can have the letter in that veterinarian’s inbox for his/her review before the pet has returned home.

Board Certification
Twenty-five years ago when I started the process of becoming a board certified veterinary oncologist, there were only about 25 veterinary oncologists in the world. The American College of Veterinary Internal Medicine now has certified over 300 oncology diplomates and there is a European College of Veterinary Internal Medicine which certifies oncologists as well. Board certified specialists all over the world form a healthcare network that trades patients back and forth when pet owners relocate or go on vacation, just as I described in a previous blog: “Clea’s International Healthcare Team.” Since veterinary oncologists and other specialists have expanded their reach worldwide, specialist veterinary care no longer has geographic boundaries.

Multinational Veterinary Companies
Specialists are not the only international flatteners. Because international companies provide veterinary products and services, veterinary specialists can access information about pets seen by a veterinarian practicing on a different continent! Take for example my patient Gigi. She came to The AMC from Kuwait, but because the biopsy of her tumor was sent to the European branch of the same laboratory used by The AMC, I was able to ask additional questions about the biopsy result. The biopsy sample was retrieved from storage and then reviewed by a pathologist in Europe. The answers to my questions were sent via email.

Real Time Communication
The internet has changed the face of veterinary education. Today, veterinarians no longer have to travel to earn continuing education credits necessary to maintain their licenses. Continuing education comes to them though their computers. This year, the keynote speaker addresses at the annual Veterinary Cancer Society Meeting were streamed live to members unable to attend. Additionally, several internet based companies offer on-demand veterinary continuing education opportunities.

The veterinary world is indeed flat and that means your pet can get excellent veterinary care from a veterinarian in your neighborhood or from a specialist somewhere a long way from home!


Pot for Pets

January 21, 2014
pot for pets image

Photo: Fox News

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

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

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

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

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

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

If your pet inadvertently ingests marijuana or a THC containing product:

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

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

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

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


AMC Resident Research Abstract Presentations

January 15, 2014

veterinary researchJust before Christmas, The Animal Medical Center held its annual residents research abstract presentations. As part of their specialty training, residents are expected to design, execute and report on research in their area of clinical specialty, and this mini-conference provided a forum for exchange of the knowledge gained from research between members of The AMC medical staff. The AMC performs a very specific type of research – clinical research. This means we study diagnostic testing, new treatments and procedures in the patients we care for as part of our effort to improve the health and well-being of our patients. We do not test or treat any animal for the sake of “research.”

Caspary Research Institute
Research at The AMC is not new; when The AMC moved uptown in the 1960’s from Lafayette Street to its present location, a decision was made to locate the new veterinary research institute right in the middle of the Upper East Side’s strong human-focused biomedical community. The AMC became the fifth biomedical institution in the neighborhood, joining The Rockefeller University, Cornell University Medical College, Sloan-Kettering Institute and Memorial Hospital for Cancer and Allied Diseases. Early architectural drawings of the AMC building show a sign on the north side of the building saying, “Caspary Research Institute.” When The AMC opened on 62nd Street, research and patient care were its main focus areas.

Short and Sweet
From a research point of view, an abstract is a very short presentation – 12 minutes, followed by a 3 minute question and answer period. Resident research abstract presentations are commonly preliminary reports which allow discussion of data and help formulate the interpretation of results prior to the writing of a manuscript for publication. Because the information presented was preliminary, I have a few interesting tidbits to report.

Lookalike Medicines
One study evaluated treatment of cognitive dysfunction in dogs with an anti-seizure medication compared to dogs treated with a placebo. In order to help veterinarians and owners make an unbiased assessment of patient response to the actual medication, our colleagues at Best Pet Rx Pharmacy made every dog’s medication look exactly the same. No one could tell which dogs were getting the medication being studied and which dogs were getting placebo pills. This is called double blind study design. Double blind because two people, the patient and the researcher, don’t know the treatment group assignment because it is hidden by the look-a-like pills.

Challenge of Science
Most research projects do not proceed exactly as planned. A study of ICU patients was designed to follow the effects of treatment on dogs with low blood protein (hypoalbuminemia). Dogs were to have a blood sample prior to treatment and 48 hours later. The study did not meet the enrollment target. Why? Despite an impression that dogs stayed in ICU longer than 48 hours, most dogs did not stay that long and fewer dogs than projected entered the study. Of course, we were happy your dogs went home earlier than expected, which was a scientific finding on its own.

Changing Protocol
The AMC’s ICU patients often need to be fed intravenously. We use a commercially available product called Procalamine. This product provides amino acids, the building blocks of protein and glycerin, as a source of glucose for energy. One emergency critical care resident studied patients receiving Procalamine as part of their treatment protocol. Patients receiving Procalamine through a catheter in their leg had more inflammation of the blood vessel than patients who get Procalamine through other, larger blood vessels. Although the directions for Procalamine indicate it can be given in the legs, we now will try and avoid this whenever the patient’s condition allows it.

Helping Pets Everywhere
These types of studies enable AMC veterinarians to improve the level of care for your pet. Through the publications that will result from these and other studies performed here, the knowledge will improve the care of pets everywhere.


National Veterinary Technician Week 2013

October 15, 2013
Christina and a patient in ICU.

Christina and a patient in ICU.

This week, October 13-19, is National Veterinary Technician Week when we honor veterinary technicians or nurses for their role as critical members of the veterinary healthcare team. The technicians at The Animal Medical Center are a unique group in many ways.

A whole lotta’ techs
The AMC employs 75 technicians, each and every one licensed by the State of New York. These critical veterinary team members provide exceptional care to your pets no matter if it is high noon or 3 o’clock in the morning. The lowest number of technicians on duty in the hospital at any time during a 24 hour cycle is at 3 am when there are eight licensed veterinary technicians on the premises. These multi-tasking technicians run lab tests, take x-rays and provide compassionate patient care 24/7.

Trish and a canine patient.

Trish and a canine patient.

Big skill set
Because The AMC is a specialty hospital, our technicians learn specialized skills to support the veterinarians and patients on their team. We have technicians trained to perform hemodialysis, administer chemotherapy, prep patients for surgical procedures and assist in the operating room. Technicians maintain our delicate equipment like endoscopes and cage-side laboratory equipment to keep us ready for any emergency situation. Some of our long term technicians have worked in multiple areas throughout the hospital and have multidisciplinary skills, including care of exotic pets, plus administering radiation treatments or evaluating intraocular pressure and blood pressure!

Frankie assists Dr. Quesenberry with an examination of a swan

Frankie assists Dr. Quesenberry with an examination of a swan

Lifelong learning
Continuing education is required to maintain a veterinary technician license in New York State. To facilitate continuing education credits for our technicians, The AMC sponsors lectures on topics important to technicians, such as diabetes and heatstroke, through our Partners in Practice lecture series, and welcomes the participation of technicians from other veterinary practices as well. On a national level, the numbers of specialty certified technicians is small, but growing. The AMC is leading the pack with some of the first North American Veterinary Technician Academy (NAVTA) certified specialty technicians in the country. We currently have a total of five NAVTA certified technician in emergency critical care and anesthesia. The Tina Santi Flaherty Rehabilitation & Fitness Service has two technicians certified as Canine Rehabilitation Assistants and more in training.

A heartfelt thank you to vet techs everywhere
On behalf of veterinarians and the patients who benefit from the skills and knowledge of our technician team members, thank you for your hard work and dedication. Pets and vets need techs because we can’t do it without you.


Choosing a Veterinary Hospital

July 31, 2013

Exotics1Is there a new puppy in your family? Has the backyard cat installed himself on your family room sofa? Have you inherited grandma’s piano and her parrot? If so, you won’t want to leave the important decision regarding the choice of your new pet’s healthcare provider to chance. Here are some tips for choosing the right veterinarian and veterinary hospital for your pet.

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

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

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

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

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

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

Quick tips on finding the right veterinary hospital

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

International Health Papers: How to Avoid a Justin Bieber Epic Fail

May 21, 2013
Justin Bieber and Mally

Justin Bieber and Mally

International travel with pets is a complicated affair. Each country has its own set of rules about vaccinations, blood tests, deworming and microchipping. For island countries free of rabies, an elaborate scheme of testing and vaccination is required to prevent a dog or cat from introducing the disease to the country.

Some families handle the international health paper requirements better than others. Take for example Justin Bieber and his pet Chapuchin monkey, Mally. Passports are required for band members on the Believe Tour to enter a foreign country, and Mally the monkey needed special health papers to enter Germany. The problem was, proper papers were lacking and Mally’s concert touring days prematurely ended. Apparently, Mally remains overseas.

Here’s a better story of a family that did their homework regarding international pet travel. Today I saw a cute dog named Avatar, in need of an international health certificate. One of the requirements for entry into her home country is a health certificate signed by an accredited veterinarian. Not every veterinarian is accredited by the United States Department of Agriculture (USDA), but this family knew to ask for an accredited veterinarian because they had carefully researched this information.

Avatar came to my office with a pile of papers carefully detailing all her vaccinations. I need this information to be sure she meets the entry requirements and to document vaccinations on the international health certificate. Another requirement for Avatar’s destination country is vaccination against leptospirosis. Leptospirosis is an infectious disease caused by a bacteria spread in the urine of wild animals. Happily, the paperwork indicated a vaccination against leptospirosis and I quickly checked off that requirement.

Avatar’s destination country did not require a microchip, but documentation of a microchip is a common requirement for entry into many countries. Some countries also have their own import paperwork, but Avatar’s accepted the USDA form. Once I signed off on my part of the health certificate, Avatar had another stop: the USDA area office at JFK Airport, where she received the endorsement of their New York area veterinarian.

How can you avoid a Bieber epic fail when traveling internationally with your pet?

  • Start early to ensue you have enough time for required testing or vaccination protocols.
  • Do your homework. Start with the USDA’s Animal and Plant Health Inspection Service website and the website of your destination country for pet import requirements.
  • If you need the signature of an accredited veterinarian like me, check to see if your veterinarian is accredited or ask for a recommendation.
  • Keep your pet up to date on vaccinations and other preventive health care measures to avoid any delays in getting your pet’s international health certificate.

Household Cleaning Products: A Pet Danger

May 8, 2013
X-ray of a cat that has eaten a metal mesh scouring pad

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.


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