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.

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.


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.

When Life Gives You Lemons, You Need a Buddy

February 20, 2014

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

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

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

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

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

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


Dog Breeds in the News

February 5, 2014

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

rat terrier

Rat Terrier

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

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

top 10 dog breeds 2013

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

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

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

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

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

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

We hope to see you all there!


Dental DOs and DON’Ts

January 31, 2014

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

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

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

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

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

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

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

Veterinary Dental Resources

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


Pot for Pets

January 21, 2014
pot for pets image

Photo: Fox News

The New York Times recently announced that via executive action, New York Governor Andrew Cuomo will relax the laws governing medical marijuana use in the state. New York State has some of the most restrictive and punitive laws regarding illegal drug usage, hold-overs from the Rockefeller era drug laws of the 1970s, and many feel these changes are long overdue. What does this mean for pets?

Increased Toxicity Cases
Veterinarians in New York State will need to be prepared to treat more dogs with marijuana intoxication if the experience in Colorado holds true here. Colorado is a state where medical marijuana is legal. Veterinarians in Colorado studied the number of dogs experiencing inadvertent toxicity from ingestion of marijuana. These researchers found a four-fold increase in the number of dogs treated for marijuana ingestion over a five year period. The increase paralleled the increase in the number of registered users of medical marijuana in Colorado. Pet Poison Helpline reports an increase in calls about canine marijuana intoxication as well.

Dog OD
Ingestion of marijuana, marijuana containing foods or inhalation of marijuana smoke can affect dogs; they become glassy eyed, uncoordinated, and may be very sleepy. These dogs need intravenous fluids to maintain hydration and warming blankets to maintain their body temperature. Often, dogs intoxicated by marijuana dribble urine. Some dogs become hyperactive. Severely affected dogs may seizure or become comatose requiring ventilator treatment until they regain the ability to breathe. Dogs typically recover in one to three days. Sadly, the study of Colorado cases of marijuana reports the death of two dogs ingesting baked goods made with medical grade tetrahydrocannabinol (THC) butter.

Iguana Intoxication!
Although dogs are the most commonly affected by marijuana intoxication, I found a report of three intoxicated iguanas. The iguanas had clinical signs similar to intoxicated dogs – seizures, stomach upset and one even required antiseizure medication. All three recovered fully.

Veterinary Medical Marijuana
So with marijuana legalized in some states for medicinal purposes, is medical marijuana for Fluffy and Fido next? Despite the obvious risks outlined above, some pet owners have taken marijuana for pets into their own hands.

Currently marijuana belongs to the group of drugs most tightly regulated by the Food and Drug Administration. Even though I have a license to prescribe some controlled substances, marijuana is not on the list of those I can prescribe. This tight regulation also restricts research with marijuana. Research is needed to help veterinarians understand what conditions the drug helps and how to use the drug safely and efficaciously in veterinary patients. So for now, I don’t know how to appropriately dose THC in my patients and I can’t do it legally.

If your pet inadvertently ingests marijuana or a THC containing product:

1. Keep marijuana and medical marijuana products out of reach of your pets.

2. Call animal poison control if you think your pet has eaten marijuana:

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

3. Tell the animal ER what your pet ate. Making the ER veterinarians play a guessing game about your pet’s condition can delay appropriate treatment.


CT Versus MRI: Battle of the Big Machines

January 8, 2014

Veterinarians at The Animal Medical Center depend on high tech equipment to make diagnoses and monitor treatment success. Two commonly used pieces of high tech equipment are the CAT scan or CT (Computed Tomography) and MRI (Magnetic Resonance Imaging). Often, if I recommend a CT, pet owners will ask if an MRI would be better. I checked with one of AMC’s board certified radiologists, Dr. Anthony Fischetti, to help dispel any myths about which test is the best. He says “both are equally as good, but which test is used depends on the body part being imaged and the type of resolution required to optimally image that body part.”

Big Machines at AMC
Computed tomography was introduced to human medicine in the 1970s. The AMC acquired its first CT scanner about 10 years later and is currently using its third scanner, a high-powered 64-slice CT scanner. Magnetic resonance imaging became commercially available in the 1980s and The AMC installed its first MRI machine in 2002 and upgraded that machine in 2006 for a more powerful model. To give you a comparison of the frequency of use of these tests, in 2007, a total of 73 million CT scans were performed on humans. In 2013, 700 CT scans and 600 MRI exams were performed – just at The AMC!

CT reconstruction of the skull of a dog with a jaw tumor

CT reconstruction of the skull of a dog with a jaw tumor

Starting at the Top
Imaging the head is a particularly good example of why we need both a CT scanner and an MRI machine at The AMC. The brain is composed of soft tissue and the boney skull is clearly hard tissue. When our neurologists want an image of the brain to determine the cause of seizures, they choose an MRI because it produces images with exquisite detail of soft tissues comprising the brain. An MRI can show minute changes in both types of brain tissue, the grey and white matter. But if an internal medicine specialist suspects the cause of a bloody nose to be a tumor in the nasal passages, they choose a CT scan, not only for its speed, but for its ability to show changes in the bones composing the nose and nasal passages. Because computed tomography is part computer, the images it creates are easily manipulated into a variety of views and even three dimensional reconstructions. The image you see to the right shows a reconstruction of the skull of a dog with a jaw tumor.

CT Goes with the Flow
CT scan is a form of x-ray and can detect a special contrast agent when the agent is administered intravenously. Using an intravenous contrast agent during a CT scan (CT angiography) helps veterinarians identify abnormal blood vessels in the liver – a common congenital disorder in small breed dogs – or determine, prior to surgery, if a tumor has breached a major blood vessel. Armed with this information, surgeons can better plan their approach before they get to the operating room.

MRI image of a  heart tumor in a dog using a contrast agent

MRI image of a heart tumor in a dog using a contrast agent

MRI has a Heart
MRI also uses intravenous contrast agents to differentiate various soft tissues in the body. The MRI image you see on the right shows a tumor of the heart in a dog following administration of a contrast agent.

Your Pet and the Big Machines
Here are some tips for pet owners whose pets require a CT scan or MRI:

  1. Expect blood tests and possibly a chest x-ray to be done before the scan. Testing helps veterinarians determine safe anesthetic protocols for your pet.
  2. Unlike when you or I receive an MRI or CT scan, you should anticipate that anesthesia will be administered to your pet. You know how hard it is to get a clear photograph of your wiggly pet. We need them to be perfectly still for imaging so that we can obtain an accurate scan.
  3. Know that it may take up to 24 hours for the radiologist to issue a final report on the scan. Waiting is hard, but reviewing images takes time and should not be rushed.

Clea’s International Healthcare Team: Partnering for Cancer Care

December 18, 2013
Clea

Clea, French fashionista poodle

Last spring, I was contacted by a New York City veterinarian who often refers patients to me for second opinions. This time, his request was a bit different. One of his patients, a French poodle named Clea, was in France and had been diagnosed with melanoma of the tongue by a French veterinary oral surgeon. Clea’s owner wanted her treated with the DNA melanoma vaccine, a treatment not available in France. She and Clea would return to New York City, but she needed a local veterinary oncologist, so I was asked to help. Of course, I said yes.

Transatlantic medical information
Within minutes of saying yes, my email box filled with photos of Clea’s tumor, a biopsy report and photographs of the actual tumor cells under the microscope. Clea’s owner contacted me and arranged two appointments for Clea, one with me and one with our radiation oncologist, Dr. Rachel St-Vincent.

Treatment of melanoma of the oral cavity in a dog involves controlling the oral tumor using surgery or radiation therapy and using a vaccine to induce an immune response against the tumor in hopes of preventing spread of the tumor, especially to the lungs. The vaccine is not available in France, necessitating a trip home for the melanoma vaccine. Clea stayed with friends for eight weeks while she received four treatments of radiation and four doses of melanoma vaccine. When treatment was completed, she returned to France and her French veterinary team.

The French team

Clea's veterinary team

Clea’s veterinary team at Clinique Vétérinaire Advetia (www.advetia.fr)

Even though Clea has both an American and a French team of veterinarians, we all speak the same language – veterinary medicine. The French oral surgeon, Dr. Phillipe Hennet, trained in the United States and holds a certification by the American Veterinary Dental College. When new tumors showed up in Clea’s lungs, he referred Clea to an American trained board certified small animal internal medicine specialist at his clinic, Dr. Suzy Valentin. She and I conferred via email to initiate the next step of treatment.

Back in the USA
Clea was back in New York City a few weeks ago and Dr. Valentin wanted another chest x-ray. Clea arrived at The AMC with a report by a French radiologist (in French) and a CD containing her lung CT scan from a month prior. The AMC has a radiologist, Dr. Alexandre Le Rouxwho happens to be French. Looking for a translator, I took the written report and the images to him. To my surprise, the trail of veterinarians caring for Clea came full circle when Dr. Le Roux announced he knew Clea’s French radiologist!

Treatment success
For older pets like Clea, quality of life is possibly more important than quantity. I think Clea’s international healthcare team has achieved success based on this note from her owner: “So Clea is doing well. She is eating twice a day and loves the beef stew from the restaurant across the street. Dog food is definitely part of her past….”


Holiday Gifts for the Naughty and Nice Pets on Your List

December 11, 2013

cat bunk bedA room with a view
What kitten wouldn’t want to find a bunk bed and playroom under the tree with her name on it? The top bunk is perfect for a perching cat or a cat nap, and the bottom bunk for a game of hide-and-seek with a catnip mouse or jingle ball.

Put some socks in his stocking
Do you have a nice, but mobility-impaired older dog? Put Woodrow Wear Power Paws on all four feet and watch these gripper slippers give traction on slippery tile or wood floors. These stylish dog socks come in a rainbow of colors and holiday designs.

Cat walking vest
Going to Grandma’s for the holiday? In addition to checking to be sure Fluffy’s microchip information is current in the registry, consider a SturdiPet™ walking vest from Sturdi Products. It is attractive and snug fitting and unlike many harnesses for cats, this one really stays on and keeps your cat comfortably restrained while you travel in the car or on the airplane to your holiday destination.

Waist watching
The peek-a-boo pet latch is a gift for your naughty dog. Using this latch on the door of the room where you keep the cat litter box will keep your dog from “snacking” in the cat box. The other use for this clever product is to keep an overweight pet out of the food bowl of a more slender pet.

Holiday hairdo
Everyone, your pet included, wants to look their best and smell nice to ring in 2014. What better way to have a coat that shines like the Times Square ball than to have a gift of dog toiletries under the tree for Sparky. Burt’s Bees, the folks with the beeswax based lip balm, now have a new line of natural pet products. Additionally, Wahl, the sponsors of America’s Dirtiest Dog contest, has cleaned up shelter dogs and can clean up your dog as well!

Rest and relaxation
After all the holiday activities, you and your pet will need some rest. Body Glove Pet will introduce a neoprene mat for use in crates or on hard floors, just after the first of the year. Neoprene is the material in wetsuits, so this product will be sturdy, washable and comfortable for a long winter’s rest.

And something for you too!
Need a calendar for 2014 and want to support a good animal cause? Here are just a few listings of calendars from a variety of animal organizations, including The Animal Medical Center!


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