Joan Rivers’ tragic death last week dominated social media and made many ask questions about the safety of endoscopy, pet owners included. Joan Rivers was an unabashed dog lover. And so using one of her signature lines, “Can we talk?” this blog talks about veterinary endoscopy and how veterinarians at The Animal Medical Center safely and successfully use endoscopy every day to diagnose and treat a variety of conditions.
What is Endoscopy?
Endoscopy is a compound word created from endo, which is Greek for within, and the common suffix -scopy or -scope found on many English words: telescope, periscope and microscopy. Once again, scope comes from the Greek word ‘skopein,’ meaning to look. The word endoscopy is generic and describes multiple medical procedures, including esophagoscopy, gastroscopy, laparoscopy (WARNING: This video was taken during an actual laparoscopy where a liver biopsy was performed. Weak-kneed readers should not view this video) colonoscopy, cystoscopy, nasopharyngoscopy, and bronchoscopy. What these procedures all have in common is the use of a piece of medical equipment containing a tiny lens or video camera and specially designed minimally invasive equipment to look inside the body and correct problems with few to no surgical incisions.
What is an Endoscope?
An endoscope appears to be a simple, long tube, but it is actually a very high tech device. The endoscope requires a light source to illuminate the inside of the body. The light source is very powerful since the tip inside the patient can be two to three feet away from the scope’s other end. Endoscopes can be flexible for snaking down the twists and turns of the airways or intestines, or it can be a rigid stainless steel tube. Flexible endoscopes use fiberoptics for transmitting the internal images along the length of the scope to a video monitor for the entire medical team to view. Rigid scopes use a series of lenses and the image is viewed through an eyepiece or on a monitor. Biopsy forceps, scissors and grabbers thread down the endoscope via a separate channel to facilitate biopsy and retrieval of accidentally ingested objects or bladder stones.
Why is Anesthesia Required?
Because of the nature of our patients, anesthesia is a necessity for any endoscopic procedure in a veterinary patient. Your dog or cat must hold perfectly still to allow precise placement of the endoscopic device. Because endoscopy equipment facilitates collection of biopsy samples, general anesthesia manages any pain associated with the procedure. Bronchoscopy, esophagoscopy and gastroscopy require the endoscope to be threaded though the mouth into the lungs, esophagus or stomach. Think what your pet’s chompers do to their favorite toy. Imagine what those same chompers could do to our delicate fiberoptic endoscope. Anesthesia is a must; however many precautions are taken before and during anesthesia by your pet’s medical team to ensure a safe endoscopic procedure.
Why Would My Pet Need Endoscopy?
AMC veterinarians use endoscopy every day to diagnose and treat patients. Our internal medicine team biopsies the nose, stomach, small intestine and colon endoscopically. Ditto for the retrieval of accidently swallowed bones, balls and socks. Orthopedic surgeons use arthroscopsy to identify and repair torn cartilage inside joints. Surgeons avoid putting your pet through major surgery by using laparoscopic and thorascopic procedures in treating diseases of the abdomen and chest. Our interventional radiology team can correct misplaced ureters and remove bladder stones via minimally invasive cystoscopy.
Anytime you hear someone say your favorite fur baby has a medical problem and needs a procedure, I know your heart flutters for a moment. Now that you know more about these diverse and life saving types of endoscopy, I’m sure you realize your veterinarian has ordered a sophisticated and medically advanced procedure for your pet.
We all want to save money, but when it comes to our pets, we strive to give them the best of everything. Here are five tips to help you save money on your pet’s medical expenses and still provide your favorite fur baby with top-notch treatment.
- Be an educated pet owner.
Start by visiting your local library for a basic book on pet care. Check with your neighborhood veterinarian or animal rescue group to see if they offer classes in pet care. Familiarize yourself with the common signs of illness in your pet. For example, review this slide show about the 10 warning signs of cancer in pets and consider subscribing to our Fur the Love of Pets blog to have pet health information delivered to your inbox weekly.
- Don’t skimp on preventive care.
An annual visit to your pet’s veterinarian is worth its weight in gold. During a routine physical examination, your veterinarian can assess your pet’s risk of contracting a contagious disease, such as parvovirus or Lyme disease, and administer vaccinations or parasite preventatives to protect your pet. Subtle changes in body weight or the ability to ambulate identified during an examination may indicate the need for additional testing, medications to alleviate pain, or a diet adjustment. Without an annual examination, your pet’s undetected illness can spiral out of control and might cost much more than an annual veterinary visit.
- Don’t ignore signs of disease such as vomiting, weight loss or inactivity.
If I had dollar for every time I heard a pet owner attribute signs of disease to something other than disease, I would be rich. Here are just a few examples: “He’s not moving around much anymore, but he is older.” Diagnosis: arthritis. “I think she’s losing weight, but I am feeding her the light food.” Diagnosis: intestinal lymphoma. “He vomits every day, but that’s normal for cats, right?” Diagnosis: chronic kidney disease. Don’t miss an opportunity to be proactive and keep your pet healthy and pain-free by quickly recognizing signs of disease.
- Create a safe, but enriched environment for your pet.
One of the most common reasons for pet admissions to The AMC Emergency Service results from hazards in the home. In the month of August alone, AMC emergency and critical care veterinarians treated pets for ingestion of human foods toxic to pets, such as xylitol and chocolate; rat poison intoxication; and consumption of human prescription and recreational drugs, especially marijuana. Falls from open windows without screens commonly result in feline ER visits and hospitalization for shock and broken bones. In addition to pet-proofing your home, protect your pet by creating activities to keep Fluffy and Fido busy during the day using feeding toys, a cat tree or mechanized toys. There are many ways to create an enriched backyard for your dog. Some of these ideas can be adapted for indoor cats as well.
- Invest in pet insurance.
Purchasing the right pet insurance requires you to invest some of your time into researching the best policy for your family and your pet. The strength of some policies lies in the area of preventive care. These policies cover annual wellness visits and medications to prevent fleas, ticks and heartworms. Other policies lean towards covering catastrophic medical care, such as emergency surgery or hospitalization for diseases like heart failure or kidney disease. Purebred dog and cat aficionados should scrutinize potential policies carefully for any breed related exclusions. As you review policies, keep in mind some charge additional fees to cover expensive treatments such as chemotherapy.
So now you are an educated, proactive pet owner with a pet safe home and a well insured pet, I’ll bet that makes both you and your pet sleep better at night.
Practicing in an urban setting, we don’t see too many pets with worms, partly because the city lifestyle reduces exposure to fleas and vermin which transmit worms and partly because I follow the Companion Animal Parasite Council and recommend year round heartworm prevention. Those medications control many common intestinal parasites. Here is information about some of the less common worms veterinarians see in pets.
The photograph on the right came in with one of my patients the other day. The owner was concerned about the rice grains she was seeing on the dog’s bedding and was worried her dog was not digesting the rice in the lamb and rice dog food. What she thought were rice grains were actually tapeworm segments. Dogs become infected with tapeworms when they ingest a flea or eat a small mammal containing tapeworm eggs. Inside the dog’s intestine, a tapeworm consists of hundreds of little segments which are connected to form a worm. Segments break off and can be found moving around near the anus or on your dog’s bedding. Safe dewormers are available to eradicate tapeworms from your dog, but protecting your dog against fleas and limiting their access to vermin will also prevent them from acquiring tapeworms.
Even though NYC is urban, we have lots of raccoons. I saw three youngsters washing their hands in a Central Park pond about two weeks ago. Raccoons carry a roundworm in their intestine (Baylisascaris procyonis) and shed roundworm eggs in their feces. Raccoon roundworm eggs are very hardy and remain infective in the soil for years after being shed in the stool.
The New York City Department of Health and Mental Hygiene advises New Yorkers to avoid raccoon latrines (the area where raccoons repeatedly defecate) and to wash their hands if they come in contact with raccoon feces. Children are especially susceptible to infections with the raccoon roundworm.
Most pet owners think of worms as living in the intestine, but there are worms that live in other organs as well. Dogs can be infected with two different species of tracheal worms, Crenosoma vulpis and Filaroides osleri. F. osleri induces the formation of wart-like lesions in the trachea and bronchi of infected dogs, causing a hard, dry cough. Dr. Kelly Gisselman, an AMC trained ACVIM certified small animal internal medicine specialist, recently posted a YouTube video of a worm she spied while performing a bronchoscopy on a young dog with a cough. Deworming completely resolved the cough which had been going on for a year and a half! Since the worm did not induce the formation of wart-like lesions, we suspect it is C. vulpis.
Protecting Your Pets and Your Family Against Weird Worms
- Check out the Companion Animal Parasite Council’s website for more information on pet parasites.
- Wash hands thoroughly with soap and water after being outdoors and before eating.
- Administer year round monthly heartworm prevention. Those effective against dog roundworms will also treat raccoon roundworms.
- Use medications to prevent fleas which carry the infective form of the tapeworm.
- Clean up raccoon feces on your property, but wear gloves and wash your hands after doing so.
- Put trash in tightly covered containers and don’t put food out for wildlife that may carry weird worms.
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 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.
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.