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.