AAHA Certification: The AMC Takes the Test to Meet Veterinary Practice Standards of Excellence

July 30, 2014

AAHAlogoDedicatedThe Animal Medical Center undergoes a triennial accreditation evaluation by the American Animal Hospital Association (AAHA). The AAHA is an industry leader that sets the standards for small animal hospitals in North America, standards which are often emulated internationally. For example, in Japan, the Japanese Animal Hospital Association (JAHA) serves a similar role to AAHA in the United States. Recently, AAHA has added new accreditation categories for referral hospitals and university hospitals.

The Benchmarks
Over 900 different standards are assessed during the accreditation evaluation. The standards focus on the quality of care in the areas of: anesthesia, contagious diseases, dentistry, pain management, patient care, surgery and emergency care. The standards are grouped into 20 large categories covering quality of care in diverse areas such as contagious disease, dentistry, diagnostic imaging, emergency and critical care, and pain management. Mandatory standards detail 46 critical/crucial hospital functions required of every AAHA accredited hospital. These “deal breaker” standards include the requirement that dentistry is performed under general anesthesia with tracheal intubation, and all patient care is provided under the supervision of a licensed veterinarian. The standards require hospitals to provide diagnostic services (x-ray and laboratory) facilitating quick and accurate diagnosis of your pet’s illness. Accredited hospitals must dispense medications so treatment can begin immediately.

The focus of the benchmarks is not just on patient care, but on how the veterinary team interacts to achieve high quality patient care. Standards pet owners might not expect as part of the evaluation process include an assessment of confidentiality, security and integrity of medical records, fire safety, diagnostic image archiving, continuing education, and referral standards. While not exactly medical standards, these functions are clearly critical to an accredited hospital’s ability to provide top-notch patient care.

Exam Prep
The AMC is continuously prepping to meet the AAHA accreditation standards. Our accreditation team reviews the benchmarks and educates the staff regarding their responsibilities in implementing each standard. When a new standard is issued, the appropriate hospital team writes our policy to ensure the new standards are met. That policy is then distributed to the implementation teams. Each new standard improves the quality and safety of The AMC’s patient care.

A Pop Quiz
On-site examiners perform a full-day thorough and comprehensive review of the hospital. Preparing for an AAHA evaluation is like preparing for a pop quiz; they can ask questions about any of the 900+ standards and they don’t have to give you a heads-up as to which ones are on the quiz. The examiners speak with a variety of staff and review hospital policies to ensure standards are met. If any deficiencies are identified, they suggest methods of improvement.

Perfect Scores
The accreditation process is rigorous and encompasses all aspects of pet healthcare. Only 15% of all veterinary hospitals meet these stringent quality standards. The AMC is proud to say it has been an AAHA accredited hospital since 1976 and passed its most recent evaluation with flying colors. We achieved a perfect score in six of the 20 categories of standards. All of the standards ultimately affect the care pets receive at The AMC, but most important to pet owners are the A pluses The AMC received for management of contagious diseases and emergency and critical care medicine. Overall, we received a solid A, or 94%, which does not mean we got six questions wrong. We scored 30,250 out of a possible 32,310 points! No wonder it took weeks to prepare for this evaluation.

Standards Met
For over 100 years, The AMC has been a leader in veterinary teaching, research and exceptional clinical care. The AAHA is another leader in veterinary medicine whose opinions and stance are relied upon for setting high hospital standards. Achieving AAHA certification is just one way we continue to provide the highest quality of medicine and surgery to nearly 40,000 patients every year.


July is Sarcoma Awareness Month

July 23, 2014
The wrist of a dog diagnosed with osteosarcoma.

The wrist of a dog diagnosed with osteosarcoma.

Both veterinary and human oncologists talk about three big families of cancer: carcinomas, sarcomas and tumors of the blood and lymphatic system. Carcinomas frequently originate from glands – like breast or prostate carcinomas. The most well-known tumors of the blood and immune system are leukemia and lymphoma. Sarcoma is a form of cancer arising from bones, tendons, muscles, nerves, joints, blood vessels and fat. Over 13,000 Americans were diagnosed with sarcoma in 2013. Sarcomas are rare in adults, but represent 15% of all childhood cancers.

Pets Get Sarcomas Too
Cancer registries for pets exist, but recording the types of cancer pets have is not mandatory as it is for human cancer diagnoses. Some information about the occurrence of sarcomas in pets has been published. In a survey of Greek dogs with skin cancer, 40% of the tumors were sarcomas, the two most common were mast cell tumors and fibrosarcoma. A study of American dogs found the mast cell tumor was the most common malignant tumor on this side of the Atlantic as well. An Italian tumor registry based out of Genoa found sarcomas occurred more commonly as a dog aged. Breed also influences the development of sarcomas. A survey of flat coated retrievers in the United Kingdom found 55% of malignant tumors and 26% of all tumors in this breed were sarcomas.

Common Dog Tumors with the Last Name Sarcoma
Osteosarcoma (bone sarcoma) is ten times more common in dogs than in humans. Large and giant breed dogs have a greater risk of developing osteosarcoma. In dogs, the tumor destroys the bone (see the above photograph) and to control pain, amputation is often recommended; although limb-sparing surgery and radiation therapy are also used to control pain. Coupling surgery or radiation with systemic chemotherapy helps to control the spread of osteosarcoma and thus prolongs survival.

Hemangiosarcoma is a tumor of blood vessels. Because the vessels are cancerous, they rupture easily and dogs with hemangiosarcoma frequently end up in the animal ER with catastrophic hemorrhage from a ruptured tumor in their spleen, liver or heart.

Soft tissue sarcomas include tumors whose name is a mouthful like hemangiopericytoma, or that sound like a more benign tumor, such as the nerve sheath tumor. Soft tissue sarcomas are a mixed group of tumors frequently of the skin and often lumped together because of a similar clinical course. These tumors send tentacles of tumor out into the surrounding tissue, making complete removal challenging. Successful surgical removal of a soft tissue sarcoma requires a much bigger incision than most dog owners expect in order to remove the tentacles. If residual tumor is left behind, these tumors commonly recur and may require radiation therapy to control.

Cat Tumors with the Same Last Name

An injection site sarcoma in a cat just prior to surgical removal.

An injection site sarcoma in a cat just prior to surgical removal.

An injection site sarcoma is a very specific type of sarcoma, most commonly found in cats where injections are administered, such as a vaccination or insulin injection. When these tumors develop on the nape of the neck (as in the photograph on the right) or on the hip, they are very difficult to completely remove and they recur much more frequently than soft tissue sarcomas of dogs. Most patients need follow up with radiation therapy, and because 25-40% of these tumors metastasize, chemotherapy as well.

Raising Sarcoma Awareness

  • Osteosarcoma causes bone pain and limping. Don’t assume your limping dog has a bum knee or weak ankles. Have your limping pet seen by your veterinarian.
  • Soft tissue sarcomas and injection site sarcomas often start as a skin lump. See your veterinarian for any lump that is enlarging over a month, is larger than 2 cm (3/4 inch) in diameter, or has been present for more than 3 months.
  • Sarcomas can often be diagnosed based on a fine needle aspirate. Help your veterinarian take the best care possible of your pet and allow this simple procedure if it is recommended.

What Causes Bloat in Dogs?

July 16, 2014
An x-ray of a dog taken from the right side, showing the gas-filled stomach typical of a dog with bloat.

An x-ray of a dog taken from the right side, showing the gas-filled stomach typical of a dog with bloat.

A few weeks ago, social media couldn’t stop talking about the risks of giving ice water to dogs, based on a blog written by a pet owner. As the story goes, a dog owner gave a bowl of ice water to her overheated dog. When the dog later arrived at an emergency clinic, the ER veterinarian admonished her for giving ice water, blaming it for causing the dog’s bloated stomach. Multiple veterinarians took to Twitter, Facebook and traditional media to debunk this urban legend.

What is bloat?
Bloat is the colloquial name for one of two canine stomach disorders: gastric dilatation (GD), where the stomach fills with gas; and gastric dilatation and volvulus (GDV), where the gas-filled stomach then twists on itself. Both can cause shock because the distended, gas-filled stomach obstructs blood flow. Gastric dilatation can be relieved by pumping the stomach, but GDV requires emergency surgery to untwist the stomach and save the dog’s life.

So if ice water doesn’t cause bloat, what does?
Urban legend still prevails here. Hot food, cold food, big kibble, little kibble, too much food, too much exercise, too many carbohydrates, and stress have all been touted as causes of bloat, but remain unsubstantiated. Scientific studies have repeatedly shown that breed is a risk factor for developing bloat. Large and giant breed dogs with deep chests and narrow waists, like the Weimaraner, St. Bernard, Gordon setter, Irish setter, Rottweiler and Standard poodle, but even Chihuahua’s can experience bloat. Dogs with a littermate that has experienced bloat also have an increased risk of developing the disorder themselves. The risk of bloat increases as a dog ages. One study showed the presence of a foreign object in the stomach predisposed dogs to bloat. Nervous dogs, food gulpers and dogs fed once daily also may have an increased likelihood of bloat, and dogs engaging in a moderate amount of exercise are less likely to bloat. More bloat cases seem to occur in November, December and January, but they occur all year round, so dog owners must always monitor their dog for abdominal distension and nonproductive retching, which are two of the common signs of bloat.

Can bloat be prevented?
Families with one of the at-risk breeds previously mentioned or other large or giant breed dogs should discuss prophylactic gastropexy with their veterinarian. I recommend my patients of these breeds have their stomachs tacked in place at the time of neutering. This surgery can be done using minimally invasive techniques. This surgery does not prevent gastric dilatation, but has been determined to be cost-effective in preventing GDV.

Since once daily feeding and gulping food have been associated with bloat, divide your dog’s food into two daily portions and feed the food in a feeding toy or a specially designed go slow bowl. Be sure your dog gets daily exercise and maintains a healthy body weight.

 


High Rise Syndrome in Cats

July 9, 2014
Cat peeks out an open high rise window

Cat peeks out an open high rise window

Warmer weather ushers in “high rise” season: the time of year when The Animal Medical Center’s ER sees an uptick in the number of cats injured as a result of an accidental fall from their apartment windows. Dogs also fall from apartment windows or terraces, but not as often as cats.

Not Just in New York
In the early 1980s, The AMC was the first to report on what was dubbed “high rise syndrome” in cats. Over a five month period, we treated 132 cats that had fallen out of a building and 90% of these cats survived. High rise syndrome is not unique to New York City. Recently, a study of Croatian cats found most cats who fell were less than a year old and those who fell more than five stories had more serious injuries. In a study of Viennese cats published last year, inflammation of the pancreas was a common sequel to the trauma of falling from a building.

Triad of Injuries
High rise cats seen at The AMC suffer from a common triad of injuries: chest trauma, head/facial injuries and limb fractures. Prince Michael, Sox and Tyra are three recent AMC high rise patients who have this classic set of high rise injuries. Prince Michael was only 12 weeks old when he fell four stories from his West Side apartment window. He must have landed on his chin and chest. He fractured one of his upper fangs, abraded his chin and suffered lung bruises. The fracture of the tooth opened the pulp cavity, or central blood vessel supplying the tooth, and to prevent an infection from moving up through the open pulp cavity, the tooth was extracted a couple of weeks after his fall.

Sox, a four year old cat, fell five stories onto his head and was badly scraped up. The force of the fall caused a tear in his lungs, allowing air to leak out and into the space between his lungs and ribs. The accumulation of air prevented his lungs from expanding and he was experiencing respiratory distress when he arrived at The AMC. Our ER doctors removed the excess air, restoring his ability to breathe. The fall also fractured the roof of his mouth and a back leg. Once the lungs were healed, AMC surgeons repaired the roof of his mouth and splinted the leg.

Current Record Holder

Fractured humerus

Fractured humerus

So far in the 2014 high rise season, the highest fall seen at The AMC has been 17 stories. Tyra, a six month old kitten, suffered a fractured hip socket and lung bruising. Fortunately, Tyra’s orthopedist recommended cage rest and not corrective surgery. Most people wouldn’t think lungs could get bruised, but the impact from a fall can bruise the lungs, the same way you can bruise your elbow if you fall off your bike. When lungs become bruised, they cannot exchange oxygen well and Tyra required oxygen cage therapy until the lung bruises resolved. Happily, Tyra was discharged three days after her fall.

High Rise Syndrome is Preventable
Although all three of these cats were fortunate enough to eventually go home, not all high rise cats survive. Take these steps to keep your cat safe:

  • Keep window screens tightly in place
  • Close windows if you don’t have screens
  • Prevent falls by keeping your pet off open terraces and balconies

Protect Your Pet Against Summertime Hazards

July 2, 2014

The Hunt for Huckleberry: Finding Your Lost Pet

June 25, 2014
Huckleberry

Huckleberry

A couple of evenings ago, I received a frantic phone call from one of my cat-owning clients. Their young cat, Huckleberry, had been missing for a couple of hours and had not come to the kitchen at his appointed dinner hour.

Search Everywhere
When my clients discovered him missing, they took immediate action: opened all the room and closet doors in their apartment in case Huckleberry had accidently been shut in or out of his favorite hiding places, checked the dryer for a cat toasting in a pile of warm, clean, fluffy towels and looked in the hallway outside their apartment door. They even went so far as to disassemble some electronic devices. But, no Huckleberry.

Alert the Veterinary Community
I emailed the front desk and the Emergency Service at The Animal Medical Center alerting them to a possible “injured stray cat” meeting Huckleberry’s description. The front desk in turn emailed Huckleberry’s photo and microchip number to all of the 24 hour emergency hospitals in our area and gave Huckleberry’s home phone number in case a good Samaritan found him and took him to a local animal emergency room.

Use Social Media
Next, I tweeted Huckleberry’s photo, giving his New York City neighborhood and The AMC’s phone number in case someone recognized the little guy on the street looking for a way home. If I had a “do over” I would use a neighborhood hashtag and would have tagged some neighborhood and cat Twitter handles. Still, over 5,000 people got the tweet.

A Happy Ending
This story has a happy ending. After ten hours of searching, Huckleberry was discovered, hungry and in serious need of a litterbox, in his apartment building’s freight elevator. His family speculates the curious cat hopped a ride with a repairman earlier in the day.

I hope none of my readers ever have to search for a missing pet, but the hunt for Huckleberry brings up some important points and ideas for finding lost pets:

  • Be sure your pet has a microchip and the information in the microchip database is up to date.
  • Keep a current photo of your pet readily accessible for making “lost/missing” posters, emailing and posting on social media.
  • Use social media such as Twitter, Facebook and Instagram to broadcast photographs of your missing pet. The wider you broadcast, the greater your chance of finding your pet.
  • If you live in an apartment building with security cameras, ask the building staff if you can review the security tapes for clues to your pet’s whereabouts.
  • Check strange places like inside a box spring or an electronic device with an open area inside the case.

Fifty Years of Postgraduate Education: A Look Back

June 18, 2014

50 years of postgraduate educationThe next two weeks at The Animal Medical Center mark an important milestone for the institution, veterinary medicine and pets everywhere. On June 24th, we are celebrating the graduation of the 50th class of veterinary interns. Earlier this week, we welcomed the 51st intern class at our annual White Coat Ceremony.

Over the past 50 years, more than 1,200 veterinarians have completed a formal internship at The AMC and many have gone on to become leaders in our profession. Today, AMC-trained veterinarians work in all facets of veterinary medicine including teaching, research and clinical practice. The first intern class graduated in 1965 and consisted of three men and one woman. The members of this class embody the mission of The AMC: teaching, research and clinical service. Dr. Daryl Biery retired as a professor of radiology from The University of Pennsylvania, Dr. Stephen Ettinger is best known for his Textbook of Veterinary Internal Medicine, now in its seventh edition, and Dr. William DeHoff founded MedVet, a specialty hospital which was just named “Hospital of the Year” by the American Animal Hospital Association. The first class was also the smallest class to graduate. The largest class graduated 31 years later and had 35 members.

Training the Leaders of Tomorrow
Currently there are over 50 AMC-trained veterinarians who are members of the faculty at colleges of veterinary medicine throughout the world, and another 30 who have retired from their faculty positions. These numbers do not include a handful of AMC-trained veterinarians who serve as veterinary academic leaders such as deans, associate deans and program administrators, such as Dr. Mark StetterDr. Rodney PageDr. Claudia KirkDr. Robert Mason, and Dr. Joseph Taboada. I would venture to say nearly every AMC alumnus has, at one time or another, helped to train a future veterinarian when they have taken a young aspiring veterinarian under their wing and into their practice.

Discovering Knowledge for the Future
Part of The AMC’s mission is the discovery of new knowledge through research into naturally occurring disease. This month’s scientific publications in veterinary medicine highlight that mission through the publications of AMC alumni. In the current issues of the Journal of the American Veterinary Medical Association, the Journal of the American Animal Hospital Association and the Journal of Veterinary Internal Medicine, there are eight publications by AMC-trained veterinarians. These topics include the equine athlete, canine urinary tract infections, polyarthropathy, and the minimum clinical database. There are two articles each on feline hypertrophic cardiomyopathy and lymphoma. In the past, AMC alumni were instrumental in identifying feline taurine deficiency cardiomyopathy, West Nile Virus infections in the United States, hepatic copper toxicosis in Bedlington terriers and techniques to repair kneecaps in dogs.

Saving Animals Every Day
The accomplishments listed above are noteworthy, groundbreaking and important to the veterinary profession, however most graduates of AMC training programs are like me, providing medical, surgical and preventive healthcare for animals of all species, day in and day out. Some of us are specialists and others are your favorite neighborhood veterinarian, but we all love to celebrate a new puppy, reflect on the life of a 19 year old cat, piece together a fractured bone, or put cancer into remission.

So, happy 50th birthday to AMC’s Postgraduate Education program, congratulations to this year’s graduating class and welcome to the incoming class of interns. Click here to see an extensive list of the accomplishments of AMC alumni.


Keep Your Kitties Safe from these 10 Potential Toxins

June 11, 2014

Is Your Dog Down in the Dumps?

May 29, 2014

depressed dogRecently, I answered questions from a New York Times science writer who inquired about depression in dogs for an article she was writing. The short article received a lot of attention, so I decided to expand on the topic for my readers.

Dogs Have Feelings Too
Depression is a specific psychiatric diagnosis in humans. If you look at the National Institutes of Health (NIH) definition of depression, many of the symptoms of depression cannot be applied to dogs, since they revolve around feelings. While we believe dogs have feelings, they cannot articulate sadness, helplessness, pessimism or suicidal thoughts as would humans suffering from clinical depression.

Yet, there are some signs of depression in dogs similar to those experienced by humans. Their owners may notice abrupt changes in behavior including irritability, loss of interest in activities, decreased energy and changes in appetite, all of which may signify depression. Dog owners frequently report these symptoms in their dog when a child in the family goes away to college, a favorite human or animal family member dies or the family moves to a new home. But because these are non-specific findings, they could be attributed to medical conditions as well. So it is wise to bring your pet to a veterinarian whenever you see behavioral changes in order to rule out illness.

Depression Means Two Things
Because veterinarians use the term “depression” in a different way than physicians do about their patients, some pet owners may misunderstand a diagnosis of depression. Veterinarians use “depressed” to describe one of five levels of consciousness in their four-legged patients:

  1. Normal. Of course there are many variations of normal between pets of the same breed. Veterinarians will require input from owners to determine if the pet is behaving in its normal manner.
  2. Depressed, dull, quiet. These pets prefer to sleep and have responses to stimuli that are appropriate. Animals diagnosed with a disease may be dull quiet, or depressed. A thorough examination of a pet with these signs and symptoms is required to rule out behavior resulting from a change in environment or illness.
  3. Disoriented, demented. This is similar to a dull animal, but responses to stimuli are inappropriate. Pets may be hyperactive, hysterical or irritable.
  4. Stuporous, obtunded. These pets do not respond to normal stimuli but will respond to strong, noxious stimuli such as a toe pinch.
  5. Comatose. These pets are unresponsive to all stimuli.

Not Just Depression
The NIH says depression in humans is often associated with other mental health disorders such as anxiety, post traumatic stress disorder (PTSD), phobias and obsessive compulsive disorders. Veterinarians do diagnose obsessive compulsive disorders, PTSD, aggression, separation anxiety, and noise phobia (commonly fear of thunderstorms) in dogs and urine spraying and predatory aggression in cats. These disorders are commonly treated with antidepressants and behavioral modification therapy, suggesting depression may also be associated with these other mental health disorders in pets.

Antidepressants for Your Dog and Cat
Some of the antidepressants veterinarians use in pets include:

  • Clomipramine [Clomicalm®] is approved by the FDA for treatment of separation anxiety in dogs.
  • Fluoxetine [Reconcile®] is approved by the FDA for treatment of separation anxiety in dogs and contains the same active ingredient as Prozac®.
  • Selegiline (L-deprenyl) [Anipryl®] is approved by the FDA for treatment of cognitive dysfunction in dogs.
  • Nortriptyline, amitriptyline [Elavil®] and doxepin are not FDA approved for use in dogs or cats, but are frequently prescribed by veterinarians “off-label.”

If your pooch is punky or your cat is catatonic, it is important to find out the cause. Have them checked by their veterinarian immediately.


10 Warning Signs of Cancer in Pets

May 21, 2014

Is a Cat Bite Worse than a Dog Bite?

May 14, 2014

The feline dental arcade on the left shows the sharp fangs responsible for serious injury from cat bites. The photo on the right shows the blunter, less tapered fangs of a dog.

cat and dog teeth

Feline and canine teeth

May 18-24 is Dog Bite Prevention Week. Once again the cat is ignored, possibly since cat bites are less common than dog bites. But cat bites are a serious problem and should not be disregarded. In New York City, 17% of animal bites injuries seen in emergency rooms are from cats and over 70% from dogs.

Animal bites are a significant public health issue. Every year 4.5 million Americans are bitten by dogs and 150,000 of these people require medical attention. Children ages five to nine and males, regardless of age, are more commonly involved in dog bite incidents than adults and females. Dog bite injuries to children less than four years of age typically involve a bite to the head.

Cats, being a completely different beast than dogs, cause different types of bite injuries than dogs do. Dog bites may look worse, because their teeth are larger, but the slender, sharp fangs of a cat penetrate deeply into the tissues. Cat bites are more likely to introduce bacteria deep into the wound, causing serious infection and damage to tendons and ligaments. In a recent Mayo Clinic study, one third of patients bitten on the hand by a cat were hospitalized and two thirds of those patients needed surgery to treat the bite injury. Middle-aged women were the most common victims of cat bites to the hand.

Because children love dogs, teaching them safe behavior around dogs is important. Using common sense and a little practice of appropriate behavior around dogs, children can safely interact with dogs. This Saturday, May 17th, The Animal Medical Center is hosting PAW Day, its annual pet health fair for families and their pets, from 10:00am – 1:00pm in Carl Schurz Park at 84th Street and East End Avenue, where your child can practice interacting with dogs. This free community awareness event will include a children’s area with Clifford the Big Red Dog, face painting, pet safety information, a stuffed animal vet clinic and much more!

 

PAW Day banner


Bad Back, Good Friends

May 7, 2014
Tiko

Tiko

Tiko (right) first came to The Animal Medical Center after Reynaldo noticed his little buddy was not quite right. Over two days, Tiko lost control of his hind legs, and was referred to The AMC by our neighbors at the Humane Society. Tiko was first seen in The AMC’s ER by Dr. Carly Tichner and she immediately recognized the clinical signs of an intervertebral disc extrusion, colloquially known as a slipped disc. By the time Tiko came to the ER, the slipped disc was not only pressing on his spinal cord and affecting his ability to walk, it was pressing on the nerves giving sensation to his skin. The loss of sensation along a very well defined line in the skin helped Dr. Tichner determine the slipped disc occurred somewhere between the third thoracic vertebra and the third lumbar vertebrae.

Time is of the Essence
The longer a slipped disc goes uncorrected, the greater the damage to the spinal cord and if too much times goes by before the disc pressing on the spinal cord is removed, paralysis can be permanent. The AMC’s second year neurology resident, Dr. Vanessa Biegen, and staff neurologist, Dr. JP McCue, immediately took over Tiko’s case management and within 3 hours of his arrival at The AMC, had the little fellow in The AMC’s MRI machine, and shortly thereafter, onto the operating table to remove the slipped disc. As Dr. Tichner accurately predicted, the MRI identified a slipped disc between the eleventh and twelfth thoracic vertebrae! During the 75 minute surgery, Drs. Biegen and McCue found severe compression and hemorrhage of the spinal cord as a result of the slipped disc.

A Tail Wag = Good News
On afternoon rounds the day after surgery, Tiko wagged his tail for his neurologists and when they examined him, they found he had regained partial ability to move his hind legs! Within 8 weeks, Tiko was 90% back to his old self. To protect his back, Tiko has a new lifestyle – less roughhousing, more resting in his new favorite indoor dog house but according to his family he is once again the totally happy-go-lucky, loving and healthy little guy that he has always been, thanks to the dedicated doctors and staff at The AMC.

Grateful Words
Tiko’s successful surgery and recovery were possible because of the generosity of those who support the Neurology Patient Assistance Fund. Those ill or injured animals like Tiko who benefit from the fund must qualify medically and the pet family must qualify financially to receive this Community Fund-sponsored care. Tiko’s owner summed up his AMC experience this way, “It was definitely one of the toughest weeks I have ever been through, but everyone at The AMC was absolutely amazing. I was immediately impressed and reassured by everyone’s genuine concern for Tiko and knew that he would make it through and be okay. I feel extremely fortunate to have had access to the level of treatment and care provided by The AMC and to have been accepted by the community funds program.”


How Do Dogs’ Noses Work?

April 30, 2014
dog nose

Photo: Mark Watson

Dog noses have been in the news lately. Not just because dogs can sniff out a cracker crumb between the sofa cushions or because dogs smell the new bag of bacon strips through the closed pantry door, but because dog noses are being put to work in a very serious way.

For hundreds of years, dogs, like the Bloodhound, have been employed as search and rescue workers to find missing people after being given a whiff of the missing person’s clothing. Now medical sniffer dogs are being trained to diagnose cancer, detect low blood sugar and predict an epileptic seizure. Several features of dogs’ noses make their sense of smell better than our own.

Bigger is Better
CT scan of a dog's noseCompared to the size of their face, dogs have big noses – well most of them do. And, a bigger nose means they have more area for smell receptors. Inside the nasal passages, the dog has ruffles of tissue called turbinates which increase the surface area that accommodates their smell receptors. Compared to our 5 million, dogs have 300 million receptors on their nasal turbinates. The CT scan on the right shows the ruffles of tissue inside a dog’s nasal passages, and if you watch our video, you can see what turbinates actually look like when a rhinoscopy (nasal endoscopy) is performed.

Bidirectional Smelling
Take a look at your dog’s nose. Notice the nostrils have slits on the sides and the openings are a bit more to the side than directly out front. These features give your dog’s sense of smell directionality. New smells come in from the front and old smells go out through the side slits with exhalation, allowing new smells to constantly bathe the smell receptors.

More Brain Power
Because dogs’ sense of smell is their most highly developed sense, they devote an enormous amount of brain power to the act of smelling. Compared to our rudimentary sense of smell, there is 40 times more canine brain power dedicated to smelling, which allows dogs to differentiate 30,000 to 100,000 different smells. Our repertoire of smells is only 4,000 to 10,000 different smells.

For more about these scent-sitive dogs, watch my interview on Fox5 News with Liz Dahlem.


Hairball Awareness Day 2014

April 23, 2014

This Friday, April 25, 2014 is Hairball Awareness Day. Most of us think of hairballs left for us by our pet cats as an annoyance, found typically between the bedroom and the bathroom. Their peak occurrence is somewhere around 3am and appear only when you have bare feet. As annoying as hairballs are to us, to pets they can actually cause a surgical emergency. Here to prove it is my patient Toby.

Toby clipped

Toby after having his fur clipped

Toby is an eight year old long-haired cat, but in this photo you can see he has been clipped, thanks to a hairball emergency. The second photo shows him with a full coat. Toby’s story starts with a voice change and trouble breathing. In addition, his owner noticed Toby had not been eating well and was not grooming himself. A visit to The Animal Medical Center emergency room found a tumor on his larynx. Ultimately Toby’s diagnosis was lymphoma of the larynx, readily explaining his voice change and respiratory difficulties. Because the tumor was also obstructing the opening to his esophagus, a soft food diet was prescribed, instead of his normal crunchy hairball prevention formula.

Toby at home

Toby at home

A few days later, Toby started chemotherapy. Within days he could meow, was breathing and eating well and resumed his normal grooming routine. But just before his fourth chemotherapy treatment, Toby vomited up a six inch long hairball and initially seemed to be fine, however, on the day of his chemotherapy appointment, he vomited twice and we began to worry about a hairball obstruction since Toby seemed painful when we examined his abdomen. An abdominal ultrasound confirmed the presence of a hairball obstruction. Surgeons at The AMC discovered a hairball blocking his small intestine and removed it. Toby recovered uneventfully and resumed chemotherapy once he recovered from surgery.

Today, Toby is back on his hairball prevention diet, has completed chemotherapy and is enjoying a complete remission of his cancer. Whenever we sedate him to evaluate his larynx, we clip his fur to prevent another hairball emergency.

How to avoid a hairball crisis in your pet:

  • Feed your pet food or treats designed to move hairballs efficiently through the intestine.
  • Brush, brush and brush your pet daily.
  • Use a deshedding tool to efficiently remove loose hairs before your pet swallows them.
  • Use caution when removing hair mats as scissors can cut the underlying skin if the mat is tightly adhered.
  • Consider a professional grooming if your pet is severely matted.

Dogs Get Cirrhosis? Cats Get Lung Cancer?

April 9, 2014

cat and dogFrom a medical perspective, we are not that different from our pets. Humans, dogs and cats have many diseases in common and the treatments for these diseases are often strikingly similar. Diabetes in pets is treated with a special diet and insulin injections; radioactive iodine therapy is used to treat feline hyperthyroidism; and dogs with heart disease receive diuretics (water pills) and ACE inhibitors. Despite these similarities, disease in our pets is not always the same as it is in humans.

Dogs Get Cirrhosis?
In people, cirrhosis of the liver is most often associated with alcoholism, or hepatitis virus infection. Since dogs don’t drink (or they shouldn’t) and the hepatitis virus is a human virus which does not infect dogs, how do dogs get cirrhosis? The diagnosis of cirrhosis does not imply a cause and the cause in dogs differs from humans. Cirrhosis is a liver disorder in which the liver loses its normal structure and function as a result of chronic inflammation. Inflammation, in turn, causes replacement of normal liver cells with scar tissue and destroying their function. If enough of the liver is damaged, dogs show signs of liver failure: jaundice, accumulation of abdominal fluid (ascites) and a bleeding tendency. Labrador Retrievers, Cocker Spaniels and West Highland White Terriers are breeds with an increased risk for developing liver inflammation and cirrhosis. The inciting cause of the inflammation in dogs remains a mystery.

Lung Cancer in Nonsmokers?
The number one cause of lung cancer in humans is cigarette smoking. Since pets don’t smoke, why do they get lung cancer? Veterinarians don’t know exactly. Studies evaluating the impact of the home environment on dogs with lung cancer did not find an association with either living in an urban or a rural environment. We know secondhand smoke affects pets, increasing their risk of lymphoma and oral squamous cell carcinoma, but secondhand smoke has not yet been linked to lung cancer in dogs and cats. If you smoke, don’t do so near your pet; better yet, quit.

But What About Heart Attacks?
Heart attacks, a leading cause of sudden death in the United States, occur when the blood flow to the heart is abruptly blocked. Most heart attacks are the result of high cholesterol and blockage of the coronary arteries which supply blood to the heart muscle. Dogs and cats do not develop coronary artery disease as a result of high cholesterol, and thus do not have heart attacks like their human companions. However, since heart attacks often cause sudden death, grieving families frequently blame a heart attack when their pet dies unexpectedly. Heart disease in pets can be a cause of sudden death due to abnormal heart rhythms, ruptured heart valves and bleeding tumors of the heart.

To read more on disease affecting pets and people, read some of our previous blog posts.


Making a Specialist Visit Special

April 2, 2014
A French bulldog is examined by AMC's Ophthalmologist

A French bulldog is examined by AMC’s Ophthalmologist

Your pet needs a second opinion from a board certified veterinary specialist and your veterinarian has helped you set up the appointment with the right specialist. You know this is going to be different than seeing the familiar veterinarian you have trusted with your pet’s care since you brought him home from the shelter in a cardboard carrier. How can you make this nerve-wracking experience efficient and affect the best possible outcome for you and your pet?

Look at a consultation with a veterinary specialist at The Animal Medical Center or another specialty hospital like you do any other meeting. If you are running a meeting at your office, you will be sure the right people are invited to attend the meeting; the meeting will have an agenda agreed upon in advance; it will have a start and stop time and meeting attendees will be assigned tasks to complete after the meeting is over. All of these points also describe your appointment with a veterinary specialist.

The Right Attendees
I am a veterinarian and my job is to take care of sick pets. To me, your pet is a critical participant in the specialist consultation. While your role of transporting your pet to the appointment and being its spokesperson is also crucial, I really need to examine your pet and see first-hand the problems that need correcting. You would be surprised at how many people come to see me without their pet. If you choose to leave your pet at home and fly solo at a consultation with me, I can guarantee one of your tasks after the meeting will be to bring your pet to The AMC for an examination.

Specialist Agenda
A veterinary specialist has been trained to approach patients with a basic agenda:

  • Ask about the past history and review any documentation from the primary care veterinarian
  • Perform a physical examination
  • Make a list of possible diagnoses
  • Create a list of tests to determine which diagnosis is the correct one
  • Interpret the test results once they become available

Pet owners can streamline that agenda by having medical records, x-rays and blood tests sent in advance of the scheduled consultation.

Pet Owner Agenda
Simply put, the pet owner agenda for a specialist consult revolves around one of three issues: making a diagnosis, treating a disease or improving the quality of life. For some pet owners there may be other issues that are equally important, such as having the pet attend a family function. If there is an important issue for you and your pet, be sure to let the specialist know what it is and how you feel this issue might impact the recommended diagnostic and therapeutic plan.

The To-Do List
At the end of the consultation, the specialist or a member of their team will explain the plan for your pet. It might be to give medications or schedule a follow up test at your veterinarian’s office. Following the plan exactly and scheduling tests or treatments on time will help get your pet back on its feet as soon as possible. And having a healthy pet is what makes any visit to the veterinarian’s office special.


Medicine By the Numbers

March 26, 2014
Dr. Ann Hohenhaus

Dr. Ann Hohenhaus

We all rely on numbers to help us make decisions. The stock market is above 16,000; time to sell. Your chance of winning the Powerball Jackpot with a two dollar ticket is one in 175 million, but it’s only two dollars so you buy yet another losing ticket. One in four Americans dies of heart disease every year; more exercise and less butter for you. In my line of work, veterinary medicine, quoting numbers is not nearly as easy.

I have been struggling with a particularly complicated cancer case the past few weeks. After hours of discussion and many more of pondering the options, a clear plan has emerged for this patient. And then the client asked the number one question: “What are the chances my pet will benefit from this procedure?” Having never been much of a math whiz or very successful at gambling, explaining the concept of odds is difficult. The odds of A versus B are calculated from a large group of patients with the same disease. But when I am talking about Fluffy or Fido, it becomes harder to predict the outcome for an individual patient. In some ways it’s a 50-50 coin toss. Your pet gets better or it doesn’t. Because medicine rarely has 100% certainty, no doctor, human or animal, will ever guarantee a 100% chance of success. Even with a 99.9% chance of success, there will be some patients who do not have the desired outcome after the test, treatment or surgery is completed.

An article in last week’s New York Times ‘Science Section’ written by a physician, numbers and their connection to disease appear again. Dr. Abigail Zuger writes about using a reasoned numerical approach (“30 percent of people with your problem of X will develop Y”). Yet, she writes, “many studies (and all casinos and lotteries) illustrate how abysmal is the average person’s understanding of risk when couched in mathematical terms.” Her patients have a hard time grasping the importance of risk factors on their future health or as she calls them “pre-diseases.”

If two medical professionals have difficulty using numbers in their daily practice, then how can people or pet owners make well-informed decisions on healthcare matters?

  1. Preventing disease is much easier (and cheaper) than correcting a problem. If your veterinarian gives you numbers on preventing disease, pay close attention. For example, obesity quadruples your dog’s risk of cruciate ligament rupture. Getting your dog’s weight down saves money two ways – you buy less food and your dog doesn’t need an expensive reconstructive knee surgery.
  2. There are actually some medical conditions that doctors can predict the outcome with reasonable certainty; for example, diabetes. Without administration of insulin, which is deficient in dogs and cats with diabetes, your pet will die of high blood sugar within days.
  3. Since not all diseases come with certainty of outcome like diabetes, think about quality of life. If your pet’s current problem is decreasing their quality of life, consider a treatment to improve it. Keep in mind this is where numbers can become overwhelming and sometimes a decision is made based on your heart rather than your head.

Canine and Feline Heartworms: The Long and Skinny for Pet Owners

March 21, 2014
Photo: American Heartworm Society

Photo: American Heartworm Society

Just in time for spring, the American Heartworm Society has released its updated 2014 Canine and Feline Guidelines for treatment and prevention of heartworm disease. We always think about heartworms in the spring because they are spread by mosquitoes that become active at this time of year. These days, with global warming and urban heat islands, mosquitoes have expanded their season and their territory; the American Heartworm Society has amended its guidelines to provide up-to-date recommendations for your dog and cat 

Treat Your Dog Year-Round with a Heartworm Preventative
This recommendation is designed to offer your dog maximum protection against heartworms, with minimal effort on your part. Heartworm disease is a serious and life-threatening illness in dogs. Although treatment of the disease can be successful, it is far more prudent for pet owners to administer a medication that is safe and simple than to treat a dog that has contracted the disease. Here at The AMC in NYC, where we have experienced a more severe winter than in recent years, there is clearly not a mosquito around to spread heartworms. However, I have recently signed many health certificates for travel to warmer, mosquito filled climates. If these patients are on year round heartworm medication, their families have one less travel worry in preparation for a trip down south.

Get Your Dog an Annual Heartworm Test
Most cases of canine heartworms can be diagnosed using less than a teaspoon of blood and an in-clinic test. Annual heartworm screening can detect infections early, before the cardiopulmonary system has been damaged due to the presence of heartworms within the heart and the blood vessels of the lungs. Early diagnosis gives your dog the best chance of recovering from a heartworm infection.

Don’t Think of Your Cat as a Small Dog When it Comes to Heartworms
Cats are susceptible to heartworm infection, but less so than dogs and they tend to have fewer worms than dogs do; however, given the small size of cats, a few worms is enough to cause serious heart and lung disease. Heartworms persist in cats for 2-3 years and then they die. When adult heartworms die, that is when they are most dangerous for your cat. Dead heartworms can cause blood clots to form in the lungs which can be fatal. Prevention of heartworm infection in cats is critical since the Heartworm Society reports there is no treatment that prolongs survival of cats diagnosed with adult heartworms. Cats can take a monthly heartworm preventative, just like dogs do.

Follow These Simple Rules

  1. Test your dog annually for heartworms. Any dog over 7 months of age is old enough to have contracted the disease.
  2. Talk to your veterinarian about which type of heartworm preventative—pills, topical or injectable—is best for your pet’s lifestyle.
  3. Give heartworm preventative on schedule. A late dose can result in heartworm infection.
  4. Avoid taking your pet out at dusk and dawn when mosquitoes are most active, and keep them away from standing water where mosquitoes breed or tall grass where they reside.

Want more information about heartworms? Read these previous posts:


Medication Mix-Ups

March 13, 2014
animal poison control image

Photo: aspca.org

Next week is Poison Prevention Week. According to ASPCA Animal Poison Control, the number one cause of poisoning in pets is prescription and over the counter drugs. The poisoning occurs because pets inadvertently consume either pet or human medications. To help raise awareness of potential sources of pet poisoning, here are some recent issues with medications reported to the veterinarians at The Animal Medical Center.

Name Swap
Most drugs have a brand name like Lasix® or Amoxi-tabs® and a corresponding generic name like furosemide or amoxicillin. I will admit I may use the brand name when speaking with pet owners but write a prescription for the generic medication because the generic brand is typically less expensive, though equally as effective. This dual naming system often creates confusion for the pet owner sometimes resulting in double medicating the pet. Oreo has heart failure and is being treated with Lasix. A second prescription of the same medication from a specialist said furosemide. The owner administered the new medication along with the old medication because she didn’t know the two were the same drug. Fortunately, the error was recognized and no harm came to Oreo.

Rainbow Roulette
Please keep in mind that your veterinarian usually doesn’t see the pills dispensed to your pet. Because I don’t see the pills, your description of “the oblong blue one” doesn’t help me determine the medication prescribed. Also keep in mind that generic medicines can be the same drug, but manufactured in different colors. If a medicine is dispensed and does not look like the last prescription for the same medicine, don’t hesitate to ask the pharmacist or someone at your veterinarian’s office to be sure the correct medication was dispensed.

A Pill for You and a Pill for Me
Last week one of our cat patients was inadvertently given one of her owner’s medications. Both pill bottles were sitting side by side on the counter. Even worse, the medication contained Tylenol® (acetaminophen), a human drug which is very toxic to cats. The owner quickly recognized the problem and successfully induced vomiting, but it could have been a disaster for the cat.

Yes, We Mean Three Times a Day
Three times a day does not mean, put all three pills in the food and hope your pet eats a bite of food containing a pill every eight hours. Don’t count on your pet to count the hours between doses. Give each pill separately at the prescribed intervals to avoid over- or under-dosing your pet.

Words to the Wise

  • Ask the prescribing veterinarian what each medication prescribed for your pet is meant to treat. If there are multiple medications to treat the same problem, ask if they are duplicate medications with different names on the labels.
  • If you see more than one veterinarian for your pets multiple problems, take all the medication bottles with you to each visit. Be sure each veterinarian knows what the other has prescribed.
  • Do not talk about the color of the pills with your veterinarian. We prefer the names of the medication to be read off the bottle. Even badly pronounced drug names are better than a description like “the white one, a little smaller than a dime.”
  • To avoid a medication mix-ups, store your medications in a different location than you store Fluffy’s.
  • Keep the toll free number of an animal poison hotline handy for an emergency:

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


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

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