Avoiding the Knife: Preventing Pet Surgeries

April 11, 2013

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

Top-10-Canine-Conditions-large

Survey attributed to VPI Pet Insurance 2012

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

Tooth extractions

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

Skin abscess, inflammation and pressure ulcers

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

Feline bite wounds

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

Aural hematoma

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

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


Understanding Feline Diabetes

November 2, 2012

Cat receiving insulin. Photo: Sugarpet.net

According to the American Diabetes Association, November is American Diabetes Month. Due to obesity, diabetes is on the rise in people and, unfortunately, the same is true for our feline companions. The theme for American Diabetes Month 2012 is “A Day in the Life of Diabetes” and I will detail some of the daily routine of a diabetic cat and his owner, me.

Symba was the cat who came to me shortly after I graduated from veterinary school. He became acutely ill while I was traveling, and my colleagues at The Animal Medical Center diagnosed him with pancreatitis and diabetes. Pancreatitis, inflammation of the pancreas, destroys the ability of that organ to make insulin, and without insulin the result is diabetes. Recurrent pancreatitis and obesity commonly play a role in feline diabetes.

Giving insulin
When Symba came home from the hospital, I had to give insulin injections twice a day. Easy for me, but an aspect of managing diabetes most families with a newly diagnosed diabetic cat initially worry about. In a recent international survey on the quality of life for cats with diabetes, 221 cat owners reported few difficulties in administering insulin, but they did not like adhering to the required rigid schedule of injections.

Twice daily insulin administration gives your cat the best chance of achieving remission of diabetes. Remission means no more insulin injections – good for you and your cat. Twice daily insulin injections did work for Symba. He went into remission which lasted over a year.

Scary hypoglycemia
The feline diabetes quality of life survey found cat owners worried about hypoglycemia, also known as low blood sugar. Low blood sugar deprives critical organs of the sugar they need for fuel. Early signs of hypoglycemia include muscle tremors, lethargy, weakness, and staggering. A seizure or coma means the blood sugar is seriously low and a trip to the animal ER is necessary.

Monitoring blood sugar levels or urine sugar levels will help your cat avoid a hypoglycemic crisis. At the first signs of hypoglycemia, feeding a meal may avert a crisis. Although cat owners involved in the quality of life study worried about hypoglycemia, in actuality it rarely happened. When Symba developed hypoglycemia, I gave him the corn syrup I had in the kitchen cabinet just for this purpose. Maple syrup or honey work too. The good thing about a hypoglycemic crisis is it may mean your cat requires less insulin and might be going into diabetic remission.

Boarding barrier
When I traveled, my colleagues at The AMC took care of Symba at the hospital, but the feline diabetes quality of life participants ranked finding a friend, family member, or boarding facility to take care of their diabetic cat one of their major challenges. Advance planning will help remove some of the stress associated with leaving your cat behind while you travel.

Good quality of life
Despite the challenges to cat and owner, 94% of cat owners rated their diabetic cat’s life as good, fairly good or as good as it could be. When asked if they would treat another cat for diabetes, a resounding 90% said yes.

Prevent diabetes in your cat by keeping her in ideal body condition. Control food intake and provide opportunities to exercise.

To help support diabetes research, CVS pharmacies are donating one dollar for every photo depicting a day in the life of diabetes that is posted on the American Diabetes Association Facebook page.

So start uploading!


The Compounding Pharmacy Problem: What Pet Owners Should Know

October 10, 2012

A rare form of human meningitis has recently been in the news. The outbreak, believed to stem from fungal contamination of a medication compounded to treat back pain, has resulted in several fatalities. The manufacturer of the implicated medication is not a big pharma or an overseas company; the medication was produced by a compounding pharmacy in Massachusetts. The Food and Drug administration has identified fungal organisms in a sealed vial of methylprednisone acetate produced by the compounding pharmacy.

Pets not affected

This outbreak is unusual since the fungi involved, aspergillus and exserohilum, live in soil and water. Exactly how they came to contaminate the medication is under intense investigation. Since veterinarians don’t treat back pain in dogs and cats with steroids like methlyprednisone acetate injected around the spinal cord, there are no reports of fungal meningitis in pets, but veterinarians do use compounded medications, and understanding their role in managing disease in your pet is important.

Compounding defined

Compounding is the alteration of the original drug dosage form for the purposes of ease of administration or because the original dosage form is unsuitable for the purpose intended. Translated for the pet owner, compounding is flavoring a medication to hide the bad taste, dissolving pills into a liquid to facilitate administration, or putting multiple medications into one capsule to help a pet owner comply with a multidrug treatment protocol. Without a good compounding pharmacy, my job would be impossible.

Compounding dangers

Compounding is not regulated by the FDA because it is a process initiated by prescription and on a case-by-case basis. In veterinary medicine, compounding rules have been stretched in an attempt to create cheaper medications. Some compounding pharmacies offer expensive medications at unbelievably low prices. I suspect these cheaper products are being produced by what is known as bulk compounding from raw materials. Just last week, I had to advise a pet owner against using the compounding pharmacy’s cheaper “house” brand of an expensive medication. That medication is not currently available as a less expensive generic. Although I am sympathetic to the financial burden of treating a pet with cancer, my overriding concern is for the patient and the efficacy and safety of the prescribed treatments. Prescribing an approved medication provides some assurance of efficacy and safety for my patients.

Medication safety

Listen to your veterinarian. If they believe a particular medication is better, ask why. If they are concerned about the safety and efficacy of a compounded medication, I recommend trying to make the standard formulation work for your pet.

Learn more about safely medicating your pet.


Let’s Move: Simple Activities to Get Your Cats Moving

September 20, 2012

First Lady Michelle Obama believes in physical activity as a way to combat childhood obesity in America. Her program, Let’s Move, aims to raise a healthier generation of kids.

Americans are also raising a generation of obese cats because most cats now live indoors. Research has shown that cats living in apartments and inactive cats have the highest risk of becoming obese. Cats with a bowl full of food available at all times are more likely to be obese when compared to cats fed at specific meal times. Many cat owners are unable to recognize obesity in their pet, so there is little early intervention. Here are my suggestions for simple, inexpensive cat activities to get your feline friend moving as part of a healthy cat lifestyle.

Going up, going down

One of the features lacking in most apartments, which may contribute to cat inactivity, is stairs. Using stairs is a good way to build strong muscles in your kitten or cat. My apartment doesn’t have stairs, but I have a step stool which I use to get to the top shelves in my kitchen. Some days I put the step stool out with a favorite treat or toy on top to encourage my kitten to move. The photograph shows my kitten playing on the step stool.

Cats recycle

Kittens don’t need expensive toys; in fact they find trash to be treasure. One of the favorites in my house is an empty toilet paper, paper towel or wrapping paper roll. They can chew, scratch and roll the tubes to their hearts’ delight and the toys are easily replaced when completely destroyed. Another great toy is a wide, sturdy ribbon. I saved one from a gift and tied it to the kitchen drawer handle. I pull the drawer out four or five inches so the ribbon flutters in a breeze. My kittens love to jump up and bat the ribbon and at the same time get excellent exercise.

Cats like shopping [bags]

A shopping day means a bonanza for your cat. Maybe they get a cute new toy, but what they are most excited about is the pile of shopping bags you bring home. My kittens adore a large shopping bag with a small cardboard box slipped inside. The box supports part of the bag where the kittens play king of the hill. The box also creates a space inside the bag for hiding, resting and planning a surprise attack on my ankles. If given a choice, they like bags with stiff paper loop handles which they slip through like children with a hula hoop. The photograph shows how I set up the bag and box and how much my kitten likes playing in it!

Do you have a favorite kitten or cat activity? Write back and let everyone else know how you keep your cat moving.


Demystifying General Anesthesia: Part II, General Anesthesia

September 11, 2012

In my previous blog, I wrote about the steps leading up to general anesthesia designed to minimize anesthetic risk. This blog continues with medications used prior to the anesthetic agent and concludes with recommendations for pet owners.

Premedications

Successful anesthesia is not just about the main inhaled or injected anesthetic agent. Most times, several drugs are administered in the hours or minutes prior to induction of anesthesia. These drugs reduce the amount of anesthetic agent required, calm the patient, and make the process better for everyone involved. If postoperative pain is anticipated, pain management may be initiated during this period.

Induction and anesthesia maintenance drugs

After the premedications take effect, administration of an agent to induce anesthesia begins. Sometimes the same drug is used to maintain anesthesia for the procedure; other times a second maintenance agent is administered. Typically a breathing tube is secured in place to allow free passage of oxygen and anesthetic gas into the lungs and carbon dioxide out. The breathing tube has a little expandable balloon cuff which acts as a safety feature. The cuff is expanded to prevent aspiration of saliva or stomach contents into the lungs during the procedure.

Emergency preparedness

Nearly every veterinary hospital has a poster of drug doses to be used in emergency situations. At The AMC, we calculate the exact dose of a long list of emergency medications for every patient undergoing anesthesia. The paper stays with the pet throughout the anesthetic procedure. Emergency equipment is also available in the anesthesia area, including tracheal suction and defibrillators. During every procedure, heart rate, respirations, blood pressure, and blood oxygen level are recorded every few minutes, so if a negative trend is occurring it can by recognized and corrected immediately.

Recovery period

The most critical time in anesthesia is the three hours following discontinuation as this is when the most anesthetic-related deaths occur. Pets are carefully monitored until they are fully awake, once again able to swallow and ambulate normally. Here is a description of Spencer in The AMC’s recovery room.

The pet owner’s role

In addition to asking questions about the procedure and understanding the precautions your pet’s veterinary team is taking to safeguard your pet, you have other important roles. Following your veterinarian’s directions about withholding food and water before the procedure are critical in safeguarding your pet’s health. A full stomach could result in vomiting, leading to aspiration pneumonia.

In most hospitals, you will be asked to sign an informed consent document only when you understand the procedure, its risks, and have had the opportunity to ask questions of the veterinary staff. Finally, if your veterinarian recommends your pet stay overnight and recover under their supervision, listen and heed their advice. On the few occasions I have given in to client pressure and released a pet before I wanted to, both the client and I regretted it. Leaving your pet overnight allows the team to adjust the pain medications, while taking her home means she waits until morning if the prescription needs adjustment.


Feeding Frenzy: Tips for Choosing the Right Pet Food

September 4, 2012

If I had to venture a guess as to the most fretted over issue for pet owners, it would be finding the right food for their pet. Grocery store and pet shop shelves abound with bags, boxes, and cans. No wonder the decision is difficult. Here are my tips to streamline the selection process:

1. Check the label

The American Association of Feed Control Officials (AAFCO) develops regulations regarding the nutritional adequacy of pet food. If the label says “complete and balanced” for your pet’s life stage (puppy, kitten, adult, senior), then you know it meets the AAFCO regulations and is a food worth a trial run. If the AAFCO statement of nutritional adequacy statement is missing from the label, this is definitely not the right food for your pet.

2. Look at your pet

Not every complete and balanced food is right for your pet. If the food you feed results in a dull coat, vomiting after every meal, or diarrhea, start over and select an alternative food. As your pet matures, switch her food to one formulated for her current life stage. With so many options on the store shelves, there is guaranteed to be a food to meet the needs of every pet and pet family.

3. Variety is the spice of life

If you feed your kitten or puppy food of the same flavor every day, you risk raising a finicky eater. Try alternating the chicken flavor of your pet’s favorite brand of food with the beef or tuna flavor. If you feed both canned and dry food, select foods from two different pet food companies. Familiarity with two different textures and tastes may come in handy if one food is taken off the market, is recalled, or if your pet develops an illness requiring a switch to a special diet.

4. Change cautiously

When a diet change becomes necessary due to life stage change, illness, or family preference, plan ahead to prevent problems. An acute diet change often results in complete rejection of the new diet or gastrointestinal upset. Gradual introduction of a new food increases your chance of success in gaining your pet’s acceptance of what you want her to eat. Place a second bowl containing a bite or two of the new food next to the old food. Don’t expect instant success and consider a sniff or a lick on the first day a triumph. If she starts finishing the bite of new food, gradually decrease the portion of the old food while increasing the serving size of the new food. The total transition should take a month.

5. Check with your veterinarian

This is the most important tip. Your veterinarian should serve as your primary resource for pet nutrition information. We see dozens of pets every week and have a good idea of what foods result in healthy, happy pets. Because your veterinarian knows the health of your pet, she will also know if a prescription diet should be part of the therapy for your dog or cat’s illness.


When Are Two Intestinal Tumors Better Than One?

August 13, 2012

This is the fifth in a series of blogs about pets with intestinal diseases.

Otra is a tortoiseshell cat with an unusual name and an unusual medical condition. The unusual name came about when her new family brought her home. They decided to take a couple of days to pick a suitable name. A temporary name of Otra Gata was chosen because Otra was the second cat in the household and otra gata is Spanish for “other cat.” Otra knew it was the right name for her and immediately responded to it when she was called, so it stuck.

Otra first came to see me nearly two years ago with a diagnosis of lymphoma, a commonly diagnosed malignancy of feline patients.

Otra’s health problems started when she was ten years old, just after her family moved to The Animal Medical Center’s neighborhood. They noticed she appeared thin. Otra first met with an internal medicine specialist who eliminated diseases of the thyroid, kidneys, and diabetes as the cause of her weight loss. An abdominal ultrasound honed in on the problem: an inch-and-a-half-long mass of the small intestine. Ultrasound guidance directed a needle into the mass and obtained enough tumor cells for examination under the microscope. The diagnosis: lymphoma.

Cat chemo

Chemotherapy drugs used to treat lymphoma in cats are the same drugs used to treat lymphoma in humans. Otra began treatment just before Christmas and finished six months later. She felt well, acted normally, and was in complete remission. The chemotherapy treatment dissolved the tumor and it could no longer be identified by ultrasound. For the next year, Otra stopped by for weigh-ins and the occasional examination, but mostly we were happy to see her and to see her doing so well.

Thin again

About 18 months after her initial diagnosis of lymphoma, we noticed her weight dropping and an elevation in her heart rate. Blood tests revealed her thyroid was overactive, an everyday diagnosis in geriatric cats. More ominous was the presence of a small mass in her intestine, a half-inch in diameter. We all feared the lymphoma had returned and repeated the ultrasound-guided aspirate. The results were surprising: no lymphoma cells were seen.

A week or so later, the mass was surgically removed from her intestine. The biopsy did not find lymphoma, but a different type of intestinal tumor, adenocarcinoma.

Strange, but true

Otra’s case is doubly unusual. First, a one-and-a-half year remission from lymphoma is very uncommon in cats. Second, two different intestinal tumors in one cat is also uncommon, although Otra’s two different tumors are the number one and two most common intestinal tumors found in cats. This tidbit of information comes from a 40-year review of over 1,100 feline patients with intestinal cancer. In this recently published study, over 600 cats had a diagnosis of lymphoma and just over half that number had the second most common tumor, intestinal adenocarcinoma.

How can two tumors be better?

If Otra’s lymphoma had relapsed, it would have indicated to me the tumor cells had become very clever and developed pathways to avoid the toxic effects of chemotherapy. Treatment would not have been very successful and I would have not been able to offer a very optimistic prognosis. For intestinal adenocarcinoma, the most important aspect of treatment, surgical removal of the tumor, has already been completed and Otra is nearly normal, except for having to wear the dreaded cone to protect the incision.

Because of her quick recovery and the occurrence of a second treatable tumor, we anticipate many more happy months for her and her family.


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