Adrenal Gland Yin and Yang

March 5, 2014

puppy-yinyangLast week was a big week for adrenal gland disorders at The Animal Medical Center. Not one, but three dogs were admitted by The Animal Medical Center’s 24-hour Emergency Service with a diagnosis of Addison’s disease, or hypoactivity of the adrenal gland. Additionally, I evaluated two of my patients for adrenal gland hyperactivity, or Cushing’s disease.

Small but Mighty
Adrenal glands are tiny organs, one sits atop of each kidney. The normal width of a dog’s adrenal gland is less than half an inch. In cats, adrenal glands are half that size. Small compared to the liver or kidneys, these glands are powerhouses pumping out an array of hormones critical to maintaining normal homeostasis. Because the adrenal glands produce so many different hormones, either condition hypo- or hyperactivity can cause a wide variety of serious clinical signs. The hormone most important in Cushing’s and Addison’s disease is cortisol.

Poodle Problem
Two of last week’s ER patients with Addison’s disease were poodles. This was no coincidence. Addison’s disease is inherited in the Standard Poodle and also the Portuguese Water Dog, Nova Scotia Duck Tolling Retriever and the Bearded Collie. Cats very rarely develop Addison’s disease. What is strange about the dogs at AMC is the diagnosis of Addison’s disease in three dogs in one week, since the prevalence of the disease in dogs is thought to be 0.6-0.28% of all dogs. Dogs with Addison’s disease have vague, nonspecific clinical signs such as vomiting and diarrhea. One reason your veterinarian performs blood tests when your dog has vomiting and diarrhea is to identify the characteristically low blood concentrations of sodium and chloride and the high concentration of potassium, classic for a diagnosis of Addison’s disease. The consequences of missing a diagnosis of Addison’s disease are dire. Dogs become progressively dehydrated and the potassium climbs to levels which can stop the heart from beating. The AMC ER has a machine which can test blood concentrations of sodium and potassium in minutes, speeding the diagnosis of Addison’s disease.

Too Much Water; Too Much Pressure
The adrenal glands of dogs with Cushing’s disease produce too much of the hormone cortisol, either because of an adrenal tumor or because the pituitary gland in the brain forgets to tell the adrenal glands to stop producing cortisol. The two patients I evaluated for Cushing’s disease had different medical problems. One dog had an increased amount of protein in her urine, high blood pressure, and an elevated liver test. All three disorders are known to occur as a result of Cushing’s disease. The other dog was drinking too much water and having accidents in the house — two more signs of Cushing’s disease. Neither dog had hair loss, but it is another common problem we see in dogs with an overactive adrenal gland. Cushing’s disease, like Addison’s disease, is rare in cats.

Giving and Taking Away
Treatment for these two opposite diseases is opposite! For Addison’s disease we give hormones, and for Cushing’s disease we take the hormones away by suppressing the adrenal glands. Dogs with Addison’s disease respond rapidly to either oral or injectable forms of the missing adrenal hormones. Treatment of dogs with Cushing’s disease takes a month or two, while oral medications are adjusted to individualize the dose for each dog.

Recognizing the Yin and Yang of Adrenal Gland Disease in Your Dog
Even though Cushing’s disease is more commonly seen than Addison’s disease, both diseases can be readily diagnosed with blood tests. Your veterinarian will suggest testing if your dog is showing the following signs:

Cushing’s Disease

  • Excessive drinking and urinating
  • Hair loss on the trunk
  • Elevated liver tests
  • High blood pressure
  • Protein in the urine
  • Pot-bellied appearance

Addison’s Disease

  • Waxing/waning vomiting and diarrhea
  • Poor appetite
  • Weight loss
  • Anemia
  • High blood potassium
  • Low blood sodium and chloride

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!


When Life Gives You Lemons, You Need a Buddy

February 20, 2014

gray tabbyTracy and her 14 year old grey tabby, Baller, have experienced a few bumps in the road this past year. In April, Tracy noticed Baller, named after a rap song, was defecating outside his litter box. He also had diarrhea, but he didn’t seem very sick since he was eating well and was his usual playful self. Her neighborhood veterinarian examined Baller and found two pounds of weight loss. Tracy thought she could breathe easier when she heard the blood tests were normal, but an abdominal ultrasound revealed Baller had colon cancer.

Minimally Invasive Testing
Tracy brought Baller to The Animal Medical Center for a consultation with one of our board certified oncologists. Baller’s oncologist, Dr. Maria Camps, explained the most common type of cancer in cats is lymphoma, and recommended a minimally invasive approach to diagnosis since lymphoma is treated with chemotherapy, not surgery. Ultrasonography was used to direct a small needle into the colon tumor and retrieve cells from the tumor. Within hours, Tracy found out she and Baller were facing an uphill battle against lymphoma. The anticipated survival time for a cat with lymphoma treated with chemotherapy is less than one year.

Chemotherapy Helps
Dr. Camps actually gave Tracy so much hope, and Dr. Mollica, Baller’s regular veterinarian and a former AMC intern, was also very supportive. These two veterinarians really gave Tracy that extra oomph she needed to continue Baller’s treatment. Ms. Koch says, “I knew the chemo was working almost immediately. Right after his first treatment he was feeling better again. He is one to make it known when he has issues by hiding under the bed, not eating and not able to use the bathroom. But, it was amazing that right after his first treatment he was back to his normal routine. I thought it [the chemotherapy] would help a bit, but I didn’t realize how much better it would make him feel. He was like a whole new cat, which makes me sad because who knows how long he was feeling bad before he really started to show it.”

About one third of the way through his prescribed course of chemotherapy, and just when Baller’s cancer seemed to be in control, a roadblock obstructed the path to further cancer treatments; Tracy was laid off.

Buddy Fund Helps Out
This is where the Buddy Fund comes in to assist Tracy and Baller. The Buddy Fund, one of AMC’s Community Funds, was established to provide financial support for AMC patients with cancer whose owners could otherwise not afford to treat their four-footed family members. The name of the Buddy Fund has a double meaning. The original donors to the fund had a very special cat named Buddy and the fund acts as a “buddy” to owners of pets with cancer. Baller’s oncologist recommended him for the fund because he was responding exceptionally well to the prescribed course of chemotherapy. Discontinuation of treatment would put him at high risk for relapse of his cancer.

Thanks to the Buddy Fund and its generous supporters, Baller completed his chemotherapy protocol just before Thanksgiving and without missing a single treatment. At his most recent follow up appointment he was given a thumbs up because no tumors were detected during the examination. Going forward, Baller will continue to be monitored for tumor recurrence. As the one year anniversary of his diagnosis approaches, everyone has their fingers crossed for Baller. Tracy looks forward to a time when she is employed again and can be a “buddy” to another deserving cat through a contribution to AMC’s Buddy Fund.


Heart Healthy Tests for Pets

February 13, 2014

In addition to being National Pet Dental Health Month, February is American Heart Month. Veterinary patients suffer from heart disease, although coronary artery disease, which is common in people, doesn’t occur in dogs and cats. Even so, cardiologists at The Animal Medical Center use a variety of diagnostic tests to determine if their patients have heart problems requiring treatment.

Auscultation
The stethoscope has been around since the early 1800s when it was invented by French physician René Laennec. Every veterinarian has a stethoscope and they use their stethoscopes to determine the heart rate, heart rhythm and heart sounds. Abnormal heart sounds, also known as murmurs, may be “innocent” or of no concern. Innocent murmurs are most commonly heard in pediatric patients. In adult dogs and cats, the development of a heart murmur typically indicates leaky heart valves. If your veterinarian hears a heart murmur, consultation with a board certified veterinary cardiologist for additional testing may be recommended by your primary care veterinarian.

Electrocardiogram
An electrocardiogram measures the electrical impulses produced by the heart. The recording is a graphic representation of the heart’s rate and rhythm. The normal heart rate varies depending on whether your pet is a dog or cat. Cats have a higher heart rate than dogs, and small dogs tend to have a higher heart rate than large dogs. A normal heart beats regularly. Heartbeats that occur at irregular intervals, called an arrhythmia, indicate heart disease and often land a pet in the animal ICU for emergency treatment by a veterinary cardiologist to correct the abnormal rhythm. Pets with serious abnormal rhythms may be very weak, faint and in rare cases, die suddenly.

This chest x-ray of a cat shows an enlarged heart and fluffy white patches in the lungs typical of pulmonary edema.

This chest x-ray of a cat shows an enlarged heart and fluffy white patches in the lungs typical of pulmonary edema.

Chest X-rays
Radiographs or x-rays show the size of your pet’s heart and the surrounding lungs. Enlarged hearts can occur with diseases of the heart muscle or as a result of leaky heart valves. When the valves are extremely leaky or the heart muscle becomes very weak, heart failure occurs. Heart failure allows fluid to build up in the lungs. This buildup of fluid, called pulmonary edema, can be seen on an x-ray as fluffy white patches in the normally black lungs.

Echocardiogram
An echocardiogram uses sound waves to create a real-time moving image of the heart as it beats inside the chest. The sound waves are created and recorded via a probe placed on the chest over the heart. As the probe is moved, different parts of the heart come into view. The computer inside the echocardiography machine is able to precisely measure the thickness of the heart walls, the valves and measure the rate of blood flow throughout the heart given your pet’s cardiologist an exact measure of how well all components of the heart are functioning. An echocardiogram is used to diagnose nearly all forms of dog and cat heart disease, including the most common form of heart disease in dogs, leaky valves, and in cats, heart muscle disorders.

Brain Natiuretic Peptide (BNP)
If your veterinarian recommends a BNP test as part of a cardiac evaluation, she has not lost her mind. Although the name seems just plain wrong for a heart test, BNP is actually a small hormone produced by the heart. Production increases when the heart muscle is excessively stretched, as in cases of heart failure. Sometimes the clinical signs of heart failure overlap with the signs other diseases causing breathing difficulties, including heart failure and pneumonia. This blood test provides a non-invasive method to help differentiate between cardiac and non-cardiac causes of respiratory problems. This test is most useful when combined with the other tests mentioned previously.

What can you do to have a heart healthy pet?

  • Keep in mind no test is perfect. It may take a battery of tests to determine your pet’s cardiac condition.
  • Excessive coughing or breathing difficulty in your pet should be evaluated immediately by a veterinarian.
  • Packing on the pounds puts extra stress on the heart. Keep your pet in ideal condition.

Dog Breeds in the News

February 5, 2014

For pet lovers, there has been exciting news about dog breeds recently. In less than a month, the American Kennel Club (AKC) will introduce three new breeds at the upcoming Westminster Kennel Club (WKC) Dog Show in New York City. The WKC Show, February 8-11, 2014, will allow dogs of any breed or no breed at all to enter their new agility competition, which will be held on Saturday before the big show. Finally, both The Animal Medical Center and Pets Best Insurance announced their top ten dog breeds, based on the number of pets we care for and they insure.

rat terrier

Rat Terrier

Old Dogs, New Club
The Portuguese Podengo PequenoChinook and Rat Terrier are new only to the AKC dog show ring. One of the most ancient of dog breeds, the Portugese Podengo Pequeno, came to Portugal from Asia Minor around 1000 B.C. This lively hound is related to other ancient breeds such as the Pharaoh Hound and the Basenji. The Rat Terrier is a home grown breed developed early in the 19th century from European terriers imported by immigrants to the United States. The Chinook is another American breed, most famous as the State Dog of New Hampshire, where the breed was developed. For more on these new AKC breeds, listen to David Frei, the voice of Westminster, on NPR. 

And the Top Dog is…
A comparison of the top ten breeds seen at The AMC, insured by Pets Best Insurance and holding AKC registrations shows some interesting trends:

top 10 dog breeds 2013

The Labrador Retriever, Dachshund and Yorkshire Terrier made all three top ten lists. The mixed breed dog topped both The AMC and Pets Best lists. No surprise here, since AKC does not include mixed breed dogs in their registration. Also on two of the three lists were several small breed dogs, such as the Chihuahua, Shih Tzu and the Maltese Terrier, possibly influenced by the dogs of Paris Hilton or Halle Berry. The ever steady German Shepherd Dog and the much maligned Pit Bull Terrier also made two of the three lists. Unique to the AMC list were the Cavalier King Charles Spaniel and the Pomeranian, probably reflecting apartment dwellers selection of a small dog.

Seeing Fewer Spots
Breed popularity comes and goes with popular culture. The movie 101 Dalmations sparked a national craze for the spotted dogs. In 2005, the Dalmatian ranked number 47 in the list of dog breeds seen at The AMC. This past year, Dalmatians dropped in the ranking to 100 as dog owners fell in love with different breeds, for example the French Bulldog.

A Rising Star Among the Breeds
According to Pets Best Insurance, a number of breeds have gained popularity in recent years. In their database, the French Bulldog has seen the most dramatic rise. In 2006, the French Bulldog was the 55th most popular dog breed enrolled with Pets Best. By 2013, this small, muscular pooch soared up the list to become the 19th most popular breed. While Pets Best insures pets nationwide, The AMC’s New York City-based practice reflects the same meteoric rise in the popularity of the French Bulldog. In 2005, Frenchies ranked 30th and our veterinarians cared for 120 individual Frenchies. In 2013, the number of these dogs seen at The AMC has increased 2.5 times to 275 individual dogs.

See More Dog Breeds and Visit the AMC Booth
Like we do every year, The AMC will have a booth in the benching area of the WKC Show on February 10th and 11th. We would love to have you stop by and visit us. You can find us in Booth 16 at Piers 92/94, right alongside the Hudson River at 55th Street and 12th Avenue.

This year, AMC veterinarians have a new role at the 138th WKC show, that of Official Show Veterinarian. Several of our veterinarians will be on site at the Piers and Madison Square Garden, which showcases the main ring events, on both nights to triage any emergencies that could arise.

If you are not a fan of purebred dogs, this year there will be mixes, mutts and Heinz 57 type dogs at the Masters Agility Championship at the WKC Show.

We hope to see you all there!


Dental DOs and DON’Ts

January 31, 2014

dog having teeth brushedBecause February is National Pet Dental Health Month, I spoke to all three of The AMC’s veterinary dentists to get a list of dental DOs and DON’Ts for my readers. A big shout-out to Drs. Dan CarmichaelDjango Martel and Stephen Riback for their help in compiling this list.

Dental DON’Ts – Bones, doggie breath and furry tennis balls
Our three dentists spend much of their time repairing fractured teeth. They blame hard nylon “bones” as a major cause of fractured teeth in dogs. According to Dr. Riback, “Any bone you think might break your tooth if you bit down on it is not one you should give to your dog.”

Don’t tolerate doggie breath in your dog (or cat). Bad breath in your Bassett, Bichon or Burmese is not normal and is very likely a sign of periodontal disease. Stinky breath in your pet means it’s time to schedule a dental cleaning with your pet’s veterinarian.

Although tennis balls are on your dog’s DO list, the tennis ball fur is very abrasive to teeth, making furry tennis balls a DON’T in the mind of veterinary dentists.

Dental DOs – Toothbrushing, VOHC, dental cleaning with anesthesia
Topping the list of dental DOs is daily toothbrushing for your dog and cat. If your pet won’t tolerate brushing, you can use special dental wipes to clean the teeth. DO select oral hygiene products like toothpaste, tartar reducing diets and treats based on the products recommended by the Veterinary Oral Health Council (VOHC).

DO choose tartar control products and dental wipes containing hexametaphosphate, a product that research has shown to decrease tartar buildup on teeth.

The final DO is to make a call now for an appointment to see your pet’s veterinarian to discuss a complete dental cleaning while your pet is under general anesthesia.

Veterinary Dental Resources

Follow @amcny on Twitter to be a part of our National Pet Dental Health Month #TweetTooth campaign to promote healthy pet dental hygiene!


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.


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