Dogs, cats and blood pressure

September 17, 2012

When you visit the doctor, before our physician comes into an examination room, a nurse measures our weight, temperature and blood pressure. When your pet goes to the veterinarian, the nurse comes in to take his weight and temperature, but not blood pressure. Does this mean blood pressure is not important in dogs and cats?

Blood pressure measurement is important in our pets, but in a different way than in humans. As many as one-in-four Americans suffers from high blood pressure and most may not even know it. Hypertension, aptly named the silent killer causes heart attacks, strokes and kidney disease.

Smoking, drinking and obesity increase our risk of developing hypertension. Some of us are prone to developing hypertension even without smoking, drinking or eating too much due to a predisposition in our genetic profile. Pets become hypertensive from completely different medical conditions.

Pets have different risks

Genetics is the first point where we and our pets differ with regard to hypertension. Inherited hypertension is extremely rare in dogs and cats and because dogs and cats do not drink alcohol or use tobacco; these are not risk factors either. Obesity causes serious medical problems in pets, but not hypertension.

What causes pet hypertension?

The number one cause of hypertension in pets is one form or other of kidney disease. The normal kidney plays a critical role in controlling blood pressure. A diseased kidney can no longer perform well as a blood pressure regulator. Since we see more kidney disease in cats, we see more hypertension in cats, but I have a nice Wirehair Fox Terrier patient who has hypertension as a consequence of kidney disease. Hyperthyroidism, exclusively a feline disease, is another cause of hypertension. Finally, some rare tumors of the adrenal gland can cause hypertension, and I have seen only a small handful of pets with this type of hypertension.

Consequences of pet hypertension

Untreated hypertension causes serious problems in pets: strokes, heart enlargement and damage to the eye causing blindness. Controlling hypertension decreases the risk of these disorders.

Treatment is the same for everyone

If you have hypertension, your doctor has recommended lifestyle changes such as quitting smoking and losing weight. You will be prescribed drugs to decrease blood pressure and you may even be asked to monitor your blood pressure at home since some patients get nervous at the doctor’s office and suffer from “white coat” hypertension.

If your pet has hypertension, your veterinarian will recommend lifestyle changes such as a special kidney-friendly food. A common drug used to treat pets with hypertension is amlodipine, a drug also used in people with hypertension. Other treatments will be needed to manage kidney disease or an overactive thyroid gland. Finally, your veterinarian may ask you to monitor your pet’s blood pressure at home since pets also get white coat hypertension. The procedure is not very difficult and The Animal Medical Center has blood pressure monitors to lend pet owners for home monitoring. If you pet has hypertension, ask if home monitoring is necessary.


Failing Feline Kidneys: No Need to Think the Worst

June 12, 2012

This is the second in a series of blogs about our fabulous felines written for Adopt-A-Cat Month.

Maggie is available for adoption (more info below)

An annual visit to your cat’s veterinarian will result in blood tests being submitted to a veterinary laboratory to test for a variety of diseases such as hyperthyroidism and chronic kidney disease. To the typical cat owner, a diagnosis of kidney disease sounds ominous, but it’s not always as bad as it sounds. Take for example my nephew cat BeeDee. He had a rough start in life, abandoned as a kitten at The Animal Medical Center following a head trauma incident. My sister adopted him and he lived a good life, twenty-one years to be exact, despite having been diagnosed with chronic kidney disease at age eighteen.

Kidney disease: The diagnosis

Estimates suggest one to three percent of cats will develop kidney disease during their lifetime and one in twelve geriatric cats has kidney disease. The diagnosis of chronic kidney disease in a cat like BeeDee is based on elevations in two blood tests: blood urea nitrogen, commonly abbreviated BUN, and creatinine plus evaluation of urine-specific gravity. In chronic kidney disease, the urine-specific gravity is neither concentrated nor dilute; it falls in a middle range known as isothenuric because the impaired kidneys no longer have the ability to concentrate or dilute the urine. Creatinine and BUN can be elevated in disorders other than chronic kidney disease such as a kidney infection or dehydration. Taking a urine sample from your cat to his annual examination will win you a gold star from your veterinarian and allow the urine to be tested to determine if chronic kidney disease is likely. For suggestions on how to collect feline urine, click here.

Severity scoring

The International Renal Interest Society (IRIS) developed guidelines to grade the severity of chronic kidney disease in cats and dogs. The IRIS guidelines rank kidney disease from stage I to stage IV as the creatinine increases. Since as many as twenty percent of cats with chronic kidney disease have hypertension, your cat’s veterinarian will recommend blood pressure monitoring. Blood pressure, urine protein level, and organ damage from hypertension all play a role in IRIS staging. As your cat’s stage increases, so does the need for treatment.

A low score wins!

A study of 211 cats with chronic kidney disease, performed at The AMC, showed IRIS stage based only on creatinine levels in the blood correlated with the cat’s longevity. Cats diagnosed with Stage IIb had a creatinine >2.3 mg/dl, stage III greater than 2.8 mg/dl and stage IV greater than 5 mg/dl. Those cats with IRIS stage II kidney disease survived on average over 1000 days, stage III cats nearly 800 days and stage IV cats only about 100 days.

If your cat’s diagnosis is low IRIS stage chronic kidney disease, try not to worry. Treatment can help keep your cat around for years to come. I can’t guarantee your cat will do as well as my nephew cat and live to the ripe old age of 21 – but you never know!

Maggie is available for adoption in NYC through Petfinder.


Kidneys on Our Minds

March 6, 2012

The news has been full of stories about kidneys recently. The Oregon Zoo’s male black rhinoceros, Pete, sadly succumbed to kidney disease and the Seattle Times reported the Woodland Park Zoo’s male Sumatran tiger, Rakata, was euthanized, like Pete, for kidney failure.

The FDA continues to warn dog owners about the dangers of imported chicken jerky treats. Reports indicate they are associated with a rare kidney disorder called Fanconi-like syndrome.

Because The AMC understands the prevalence and serious nature of kidney disease and has a world-renowned specialist on staff who deals specifically with the kidney function of dogs and cats, we have become the U.S. hub for treatment in the northeast. In fact, The Animal Medical Center recently hosted more than 150 national and international attendees at the Advanced Renal Therapies Symposium 2012 (ARTS 2012) –the only veterinary conference devoted entirely to disease of the kidney.

All kidney diseases are not the same

Even though kidney dysfunction is a common thread in the illnesses of Pete, Rakata, and dogs eating chicken jerky treats from China, the underlying disorders are quite different. Pete suffered from hemochromatosis, a disorder common to black rhinos and one where excessive amounts of iron are stored in the body, damaging internal organs such as the kidneys and liver. Zookeepers treated Pete by changing his diet and monitoring his response using blood tests. In dogs and cats with kidney disease, a diet change is one of the most important therapeutic tools veterinarians have to treat the disease.

Tigers are just like your cat

Rakata, the tiger, had kidney disease associated with old age, very similar to what veterinarians at The AMC diagnose in our geriatric feline patients. The kidneys gradually lose their normal functions of conserving water for the body and filtering out waste products of protein metabolism. Initially, the cat owner sees increased urine production, increased drinking, and when the disease progresses, cat owners may notice weight loss and a bad smell coming from their cat. This smell comes from a combination of accumulated toxins and the oral ulcers commonly seen in kidney failure. In pet cats with chronic kidney disease, veterinarians prescribe fluids, special diets, and medications to lower phosphorus, treat anemia and manage kidney failure-induced gastric ulcers.

Jerky and leaky kidneys

Fanconi-like syndrome is a strange kidney disorder where sugar (glucose) is found in the dog’s urine even though the dog is not diabetic. An unknown component of the chicken jerky treats seems to be damaging the kidneys, causing them to leak not only glucose, but amino acids, protein and electrolytes as well. If owners continue feeding the chicken jerky treats, the kidneys can be permanently damaged. Early elimination of the chicken jerky treats from the diet appears to reverse this disorder. This is a preventable form of kidney disease–simply avoid feeding your dog chicken jerky treats manufactured in China.

Fixing kidneys

With all these types of kidney disease, it is not surprising The AMC would host a conference like ARTS 2012, focused on better treatments for kidney disease. When this conference started in 2006, The AMC had only intermittent hemodialysis. We now have continuous renal replacement therapy, charcoal perfusion for removing substances toxic to the kidneys, and are investigating stem cell therapy for cats with IRIS Stage III kidney disease.

Let’s hope all these efforts are successful and we won’t have to think about kidney disease again. If you can’t avoid thinking about kidneys or have a pet with kidney disease, contact our renal medicine specialists for more information about their services or the recent ARTS Symposium at 212-329-8618.

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This may also be found in the Tales from the Pet Clinic blog on WebMD.com.

For over a century, The Animal Medical Center has been a national leader in animal health care, known for its expertise, innovation and success in providing routine, specialty and emergency medical care for companion animals. Thanks in part to the enduring generosity of donors, The AMC is also known for its outstanding teaching, research and compassionate community funds. Please help us to continue these efforts. Send your contribution to: The Animal Medical Center, 510 East 62nd Street, New York, NY 10065. For more information, visit www.amcny.org. To make an appointment, please call 212.838.7053.


Low Cost Lifesavers

December 26, 2011

Wynston, courtesy of his family

Pet owners frequently ask their pet’s veterinarian, “What can I do to keep my pet healthy as long as possible?” I probably give the same answers as my colleagues across the country:

  • Take your pet to the veterinarian regularly
  • Keep your pet in ideal body condition
  • Feed a complete and balanced diet
  • Brush your pet’s teeth daily
  • Exercise your pet regularly
  • Pet proof your home

This week, the answers to this question came from a couple of The AMC’s pet owners. Through careful attention to their pet’s health, they may actually have saved their pet’s lives.

Wynston’s Tumor

Wynston’s upper front teeth with a red circle around the tumor.

Wynston’s owner does brush his teeth every day. But she doesn’t just brush his teeth; she looks at his mouth too. A couple of weeks ago, she noticed a redness around one of his upper front teeth which is easily seen in the photo.

His regular veterinarian performed a biopsy of the area and discovered a benign plasma cell tumor. Even though it is benign, if not treated, it will become larger and impede his ability to eat. Because the tumor is so small, Wynston is an excellent candidate for strontium radiation therapy.

Strontium works only on small, superficial tumors, and if Wynston’s owner had not been looking in the mouth regularly, the tumor might have become too large to use this type of treatment. We anticipate the tumor can be controlled without a surgical procedure. The cost of a doggie tooth brush and peanut flavored tooth paste: $4.99.

The cost of the lifesaving look at Wynston’s gums, $0.

Tito’s Kidneys
Tito lives in a multi cat household. Because of a diet change, his owner started monitoring his weight on a baby scale because the “hold your cat and weigh yourself” method is not sensitive enough to detect weight loss in cats. Even though all the cats in the family seemed to be eating the new food, Tito kept losing weight, while the other cats gained weight on the new food. A visit to The AMC discovered kidney disease and an abscess on one of Tito’s kidneys. If his owner had not been closely monitoring his weight, the kidney damage might have been greater and Tito might have required a major hospitalization.

The cost of the lifesaving baby scale, $25-125.

Marty’s Heart
Marty the Beagle has a myriad of problems, including lung and heart disease. Right now his cough is really bad, but his owner is sure the cough is not his heart failure flaring up again. Why? Recent research has shown if a dog’s respiratory rate is normal, heart failure is not the problem. Marty’s cardiologist instructed his owner to count his respirations every day. When his rate is normal, she knows Marty does not need to be rushed to the animal ER for heart failure. Both she and Marty feel better and the cost of this lifesaver, $0.

What low cost lifesavers have you discovered for your pet. Let us know!

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This may also be found in the “Tales from the Pet Clinic” blog on WebMD.com.

For over a century, The Animal Medical Center has been a national leader in animal health care, known for its expertise, innovation and success in providing routine, specialty and emergency medical care for companion animals. Thanks in part to the enduring generosity of donors, The AMC is also known for its outstanding teaching, research and compassionate community funds. Please help us to continue these efforts. Send your contribution to: The Animal Medical Center, 510 East 62nd Street, New York, NY 10065. For more information, visit www.amcny.org. To make an appointment, please call 212.838.7053.


You Learn Something New Everyday…About Pet Food

May 5, 2011

Pet food is important to pet lovers since we all want to feed our pets a diet which will help to keep them healthy family members for as long as possible. Many veterinarians at The Animal Medical Center prescribe special diets as part of the treatment for medical conditions. Research into various disease states has resulted in the development of “prescription diets” to meet the nutritional needs of pets while treating a medical condition.

Heart diets have lower sodium, joint diets contain ingredients to promote healthy joints and other diets are easily digestible for pets with gastrointestinal problems. These diets are an important part of many medical interventions. In fact, kidney-friendly diets have been shown to prolong survival in pets with kidney disease.

One of my patients, a French bulldog being treated for allergies, eats a Royal Canin novel protein diet composed of duck and potatoes. He has responded well to this diet and scratches much less when than when he was eating a regular dog food. His owner called me a day or so ago because the bag design had changed. The label said the food was the same, but when the bag was opened the nuggets were a different color.

I called the veterinary hotline staffed by customer service representatives of Royal Canin to check and be sure the food was really the same inside the bag since the outside had changed. The very helpful staff confirmed the food is being made in the same plant and the only change to the recipe was an increase in some vitamins to improve coat health. They also mentioned other consumers had called because of the color change in the food. According to the representative to whom I spoke, there is seasonal variation in the color of the duck meat and potatoes used to formulate the diet. This most recent batch was lighter than usual.

If you have a question about your pet’s food, check the label on the bag. Most pet food companies have a consumer hotline and, as I found out, they can be very helpful. Or call your veterinarian. They are a wealth of information and already know your pet’s medical issues. For tough nutritional issues, your veterinarian may suggest you consult a board certified veterinary nutritionist.

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This may also be found in the “Tales from the Pet Clinic” blog on WebMD.com.

For over a century, The Animal Medical Center has been a national leader in animal health care, known for its expertise, innovation and success in providing routine, specialty and emergency medical care for companion animals. Thanks in part to the enduring generosity of donors, The AMC is also known for its outstanding teaching, research and compassionate community funds. Please help us to continue these efforts. Send your contribution to: The Animal Medical Center, 510 East 62nd Street, New York, NY 10065. For more information, visit www.amcny.org. To make an appointment, please call 212.838.7053.


Take the Kidney Kwiz in Honor of World Kidney Day

March 9, 2011

World Kidney Day (March 10, 2011) serves to remind us how important early detection and treatment of kidney disease is in our pets. Estimates indicate 0.5-1.5% of dogs and 1-3% of cats seen in veterinary clinics suffer from kidney disorders. The Animal Medical Center’s Renal Medicine Service, headed by Dr. Cathy Langston, has developed a Kidney Kwiz to test your knowledge about your pet’s kidneys and how veterinarians manage kidney disease. To test your Kidney IQ, read the blog below and click on the link to the Kwiz at the end of the blog. Good luck to all.

Cats, dogs, birds and small mammal pets all have 2 kidneys. The kidneys are multitasking organs. It is common knowledge that kidneys clean the blood of the waste products of daily metabolism, but did you know they also maintain normal water balance in the body? Hence, one sign of kidney disease in pets is an increase in water consumption. Much less well known is the kidneys help to regulate blood pressure and produce hormones to simulate red blood cell production in the bone marrow, preventing anemia.

One test to help detect kidney disease is evaluation of a urine sample. Your veterinarian will love you if you collect a urine sample from your pet and take it to you pet’s routine physical examination. If your pet is diagnosed with kidney disease, your veterinarian will want to monitor blood pressure and also will prescribe a kidney friendly diet. High blood pressure (hypertension) is common in pets with kidney disease, 20% of cats with kidney disease and 75% of dogs have hypertension. Kidney disease in dogs and cats can be treated. The most important treatment you as a pet owner can give to your pet with kidney disease is to follow your veterinarian’s prescription for feeding a kidney friendly diet. Kidney friendly diets are designed to decrease the workload on the kidneys and have been proven to lessen clinical signs and prolong survival in pets with moderate to advanced stage kidney disease.

Are you ready to take the Kidney Kwiz?

This blog may also be found in the “Tales from the Pet Clinic” blog from WebMD.

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For over a century, The Animal Medical Center has been a national leader in animal health care, known for its expertise, innovation and success in providing routine, specialty and emergency medical care for companion animals. Thanks in part to the enduring generosity of donors, The AMC is also known for its outstanding teaching, research and compassionate community funds. Please help us to continue these efforts. Send your contribution to: The Animal Medical Center, 510 East 62nd Street, New York, NY 10065. For more information, visit www.amcny.org. To make an appointment, please call 212.838.7053.


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