Treatment of Allergies in Pets

April 15, 2015
AMC's dermatologist, Dr. Mark Macina, examines a patient

AMC’s dermatologist, Dr. Mark Macina, examines a patient

Spring officially arrived nearly three weeks ago, but the onset of allergy season may not arrive too soon this year, given our harsh winter. But once it warms up, pollen, dust mites, fleas, grass, weeds and mold will kick off allergy season in pets.

Clinical Signs of Allergies
Does your dog rub his face along the front of your sofa or scratch incessantly? Has your cat scratched all the fur off her head and made is scabby? Are you constantly putting in ear drops or giving antibiotics to treat skin infections? All these represent clinical signs of allergies in pets.

Control Parasites
One of the top causes of canine and feline allergic skin disease stems from an allergic reaction to flea saliva. A flea bites your dog or cat, setting off an allergic reaction. This disease presents a double-whammy to your pet: discomfort from fleas crawling all over its skin and the discomfort of being itchy. Fortunately, numerous options for control of fleas are available and your choice of product can be tailored to your pet’s exact needs.

Modify the Diet
Food allergies are typically an ongoing problem, not seasonal like pollen, grass or flea saliva allergies. Veterinarians think the allergen in food is the protein source contained in the diet, but it may be other ingredients as well. The standard method for determining if food is the cause of skin disease is a food elimination trial. Elimination diets contain a limited number of ingredients and protein sources not typically found in common pet food and not previously fed to your pet. Novel protein sources include bison, herring or rabbit. Some elimination diets avoid common carbohydrate sources and include potatoes or oats, rather than corn or soy. An elimination diet requires determination on the part of the pet owner, as the skin improves slowly in response to a diet change. Patience is required to tough out a month or more of strict diet control.

Administer Immunotherapy
Immunotherapy, a medical word for allergy shots, involves specialized testing to determine whether it is pollen, dust mites, fleas, grass, weeds or mold revving up your pet’s itch-scratch pathway. Once the cause of the allergy is determined, a custom allergy vaccine can be developed for your pet. You learn to give the injections at home one to two times per week. These injections contain minute amounts of the offending antigen (pollen, dust mites, fleas, grass, weeds or mold) which trains your pet’s immune system to be tolerant of these agents.

Quell the Immune System with Drugs
A variety of drugs can be used to turn off the allergic reaction underlying the itch-scratch cycle in your pet. The most well-known, but not necessarily the most effective in pets, is antihistamines. Steroids can be very effective and rapidly reduce the clinical signs of allergies, but have unpleasant side effects, such as increasing water drinking, urination and appetite, as well as increasing the risk of infection. Another effective drug for allergy management is cyclosporine, although cost is a concern. New to the market, oclacitinib, inhibits the cells initiating the itch-scratch cycle by attacking allergies at the cellular level.

With so many options to manage pet allergies, no pet should have their summer fun spoiled by constant itching and scratching. Watch The AMC’s Dr. Mark Macina talk about managing allergies in pets.


Nicotine Intoxication: A Danger for Pets of Smokers

March 19, 2015
Nicotine Poisoning

Photo: Petzine.org

This week, March 15-21, 2015, is National Poison Prevention Week. I am using this week’s blog to alert dog owners of a new toxin found in our homes – nicotine. Nicotine has been around a long time, but the new nicotine substitutes, designed to help people stop smoking, are poisoning dogs. A recent article in the press highlights the dangers of nicotine from e-cigarettes.

Sources of Nicotine
If you smoke around your pet, she will develop an increased concentration of nicotine in their blood stream, but the increases will not reach toxic levels. Ingestion of an e-cigarette or the super concentrated nicotine liquid used to refill the e-cigarette can cause serious and even fatal toxicity. Due to their indiscriminate eating behavior, dogs may help themselves to nicotine-containing gum or candies from your bag or backpack. Another source of nicotine toxicity is discarded nicotine patches snatched from the bathroom trash basket. Cats can also develop nicotine toxicity, but are more likely to find a discarded patch inadvertently stuck to their fur after you have removed it from your skin. Cats will ingest the nicotine while trying to remove the sticky patch by grooming.

Signs of Nicotine Toxicity
If your pet ingests one of these nicotine products, she will show signs in less than an hour and possibly in minutes if the dose is high. Common clinical signs include: vomiting, diarrhea, agitation, elevations in heart and respiration rate, depression, tremors, ataxia, weakness, seizures, blue gums, coma, and cardiac arrest. Just one e-cigarette cartridge can make a big dog really sick and can be lethal in a small dog.

Prevent Pet Poisoning


Bladder Stones: Now You See Them, Now You Don’t

March 4, 2015

The two x-rays seen below are from the same canine patient, taken one month apart. The one on the left shows two bladder stones. On the right you can see the stones are no longer present in the bladder. How did this magic happen? Surgery? Laser therapy? Antibiotics? Food? Magic wand?

canine bladder stones

Canine x-rays. Left image indicates 2 bladder stones. (Click to enlarge.)

Surgery?
Nope. Surgery may be the fastest and most common treatment for bladder stones, but for this lucky duck dog surgery was not necessary. Bladder surgery is performed under general anesthesia. The surgeon makes an incision in the abdomen near the back legs and finds the bladder just inside the body wall. Because the bladder is a hollow organ, it will collapse when the surgeon makes an incision in the bladder wall. Special sutures are placed in the bladder to hold it up and keep it open while the stones are scooped out of the bladder with a bladder stone spoon.

Bladder spoons

Bladder spoons (click to enlarge)

PCCL?
Huh? This acronym stands for per cutaneous cystolithotomy. Using laparoscopy equipment, a pinhole incision is made in the bladder. A small camera is threaded into the bladder and its magnifying properties are used to visualize the tiniest stones. Using this non-invasive method, stones are busted up using the laser and then easily removed.

Laser therapy?
Guess again. For dogs of the right size with not too many stones, non-invasive bladder stone removal is possible. Stones can be fragmented using a special laser which is passed up the urethra and into the bladder. Once the stones are broken into small enough pieces, they are either flushed out of the bladder or removed with a special stone-removing basket which is passed up the urethra and into the bladder to gather up the stone fragments.

Antibiotics?
Yes, but only in part. I can hear you saying, “Wait a minute, this makes no sense. Stones are hard chunks of mineral. Antibiotics treat bacterial infections, they do not dissolve stone.” But, this dog’s urinalysis showed an infection in addition to the stones. The infection played a role in the development of the stones and without treating the infection, the stones will not disappear.

Diet?
Stones form in the bladder as a sequel to infection and also because there are too many minerals in the urine. Drinking more water dilutes the minerals and helps dissolve the stones. Taking advantage of that information, a diet was formulated to promote water drinking in dogs fed the special stone dissolving diet. The diet is also low in magnesium and phosphorus, the building blocks of a type of bladder stone called struvite. This diet does not work in every type of bladder stone, only the struvite ones. Antibiotics are necessary since as the stone dissolves, it releases bacteria, and thus the dog needs antibiotics until the stones are completely gone. Antibiotics alone will not dissolve the stone and diet won’t work unless the infection is controlled, so the correct answer for the magical disappearance of the bladder stones in this dog is diet AND antibiotics.

Signs of bladder stones
Dogs with bladder stones urinate more frequently than is normal, have accidents in the house and blood in their urine. If you see any signs like this, be sure to have your dog evaluated immediately by your veterinarian. View a prior blog post on bladder stones to see diagnostic images of stones.


Pumps and Valves: February is American Heart Month <3

February 25, 2015

heart monthIn February, we celebrate Valentine’s Day with flowers and candy hearts. February also focuses on another type of heart – the one beating inside your chest! This is American Heart Month, raising awareness of heart disease. Both dogs and cats get heart disease, but the common type in each species is different. Cats’ hearts have pump problems and dogs’ hearts have valve problems. Although the problems are different, the outcome for both pump and valve problems is heart failure, or inadequate delivery of blood throughout the body for normal function to continue.

Poor pumping = heart disease in cats ❤
The heart is a sophisticated muscle, but it still performs the basic muscle function – contract and relax. When the heart relaxes, the pumping chambers fill. The next muscular contraction expels the blood from the heart into the blood vessels. When the heart muscle is diseased, it can do one of two things – get thicker or thinner. Both are bad. A thick heart pumps less blood with each beat since the thick muscle occupies space inside the heart where the blood to be pumped normally collects. When the heart is thin, the muscles are weak and do not adequately pump blood. Thick or thin, neither heart pumps blood well.

Leaky valves = heart disease in dogs ❤
A normal dog heart consists of four chambers, and the flow of blood between chambers is controlled by little valves. Normal valves remind me of alabaster: translucent and white, but unlike alabaster, they are flexible. Especially in small dogs, the valves degenerate as a dog ages, becoming thick and lumpy and inflexible. The distortion of their shape prevents them from closing normally. Abnormal valves leak and blood is not pumped efficiently through the rest of the heart and blood vessels. Over time, the portion of blood leaking out of the heart chambers increases and blood pumped to vital organs decreases.

Congestive heart failure ❤
Even though the underlying heart problem in dogs and cats is different, the result is often the same. Poor pumping in cats and leaky valves in dogs can lead to congestive heart failure. These disparate problems both decrease the blood flow to vital organs, such as the kidneys. To compensate, the kidneys retain fluid and when the fluid reaches a critical level, it floods into the lungs, causing pulmonary edema. Acute congestive heart failure is a common reason for admission to the hospital from The Animal Medical Center’s ER. Congestive heart failure can be treated with medications to remove fluid, help the heart pump more vigorously and dilate the blood vessels, allowing them to hold more fluid.

Keeping your pet’s heart healthy ❤
I know you want to keep your pet out of the animal ER, so here are some tips for being heart healthy:

  • Keep your pet at an ideal body weight. Obesity increases stress on the heart and it has other negative effects on health as well.
  • Exercise daily with your pet. Folks who walk their dog daily have better heart health themselves.
  • Ask your primary care veterinarian if a consultation with a board certified cardiologist could benefit your pet. Changes in heart valves and muscles cannot typically be reversed; new medications can prolong good quality of life in both dogs and cats with heart disease.

Brand Name, Generic, Compounded or Refilled: A Prescription Primer

February 18, 2015

Confusion about prescriptions reigned in my clinic this past week. I spent a lot of time explaining the intricacies of brand name versus generic drugs. There was a lot of confusion about refills as well. So, I am reprising a condensed version of my discussions about drugs for the benefit of all.

motrinBrand name drugs are the easiest to recognize because the label on the box has ® or possibly™ after a bold-faced drug name like Benadryl® or Motrin®. Drugs recently approved by the Food and Drug Administration (FDA) cannot be made as generic drugs until the patent or exclusivity expires. The FDA approves everything surrounding the manufacture, quality control and packaging of brand name drugs. This process assures the consumer the product is both safe and efficacious. Drugs for animals are approved by the FDA’s Center for Veterinary Medicine.

ibuprofenThe box, carton or tube of generic drug appears more utilitarian than the brand name drug, but the medication inside is a copy of the brand name drug, which is the same as the brand name drug in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use. Generic drugs meet the same rigid standards as the brand name drug. All generic drugs approved by FDA have the same high quality, strength, purity and shelf life as brand name drugs. The generic drug manufacturing, packaging and testing must pass the same quality standards as those of brand name drugs.

Specialist veterinarians like those of us at The Animal Medical Center use compounded medications every day to provide drugs in formulations our patients will agree to take. Most commonly, we have medications flavored with beef and turkey or have bad tasting powdered medications put in gelatin capsules to hide their nasty taste. But compounded medications should not be confused with generic medications. Compounded medicines do not have the FDA assurance of safety and efficacy because they do not undergo FDA-mandated quality control testing. In most cases, the absorption properties and the shelf life of compounded medications are unstudied and may differ from brand name or generic medications. Because different compounding pharmacies use different “recipes” to create your pet’s specialized medication, the same prescription may not have the same effect when compounded by a different pharmacist. While the lack of FDA oversight may be a negative, if compounding helps you to get your pet to take its medications, compounding becomes positive.

animal medical center prescriptionWhen I call or fax a prescription to a pharmacy for a medication that a dog or cat will take for a long time, I will pre-authorize refills. The number of refills remaining on a prescription is indicated on the label of the medication bottle. In the sample label shown here, the red circle highlights the number of refills available without the need to call your veterinarian. You simply call the pharmacy and ask for one of the refills. The next prescription label will indicate only 4 available refills. I often choose the number of refills to coincide with an anticipated recheck examination since you need to call my office to get more refills, you can also set up the recheck appointment at the same time.

Understanding medications is critical to their successful use. The FDA Center for Veterinary Medicine has a wealth of information on their website for the pet owing public.


Hound’s Tooth and Cat’s Teeth: A Photo Blog in Honor of National Pet Dental Health Month

February 4, 2015

Why Your Veterinarian Goes Crazy for a Urine Sample from Your Pet

January 28, 2015

pet urine sampleWhile it is not unusual for a pet to have an accident in The Animal Medical Center waiting room or while standing on an examination table, my reaction to that accident may be considered unusual. As the embarrassed pet family is grabbing for a paper towel or a tissue to mop up, I blurt out “stop” so I can get a syringe to collect the urine for analysis in the laboratory.

18 Tests in One Tube
At The Animal Medical Center, a urinalysis tests 18 different parameters from just a teaspoon of urine. Some of the parameters are assessed visually, like color and clarity. A special dipstick measures six values simultaneously – especially important here are glucose and ketones – indicators of potential diabetes. The urine is spun in a centrifuge and the material that collects on the bottom of the test tube is specially stained and evaluated under the microscope. Finally, a drop or two of urine is placed on a refractometer, a device that measures the specific gravity and assesses how concentrated the urine is.

A Snapshot of Your Pet’s Health
The results from tests performed on that teaspoon of urine I have collected off the table or floor gives me a whole lot of information about your pet’s health. The finding of red and white blood cells and bacteria when the urine is evaluated under the microscope suggests a urinary tract infection. Observation of crystals in the urine is common and may not represent disease, but if your pet has bladder stones, the presence of crystals gives a hint as to the type of stones, and knowing the type of stone makes treatment more specific and successful. For example, the presence of ammonium biurate crystals in a dog with bladder stones suggests the presence of an abnormal liver blood vessel, and the presence of struvite crystals in a dog with a urinary tract infection and bladder stones suggests struvite stones. In addition to filtering the blood to remove waste products from the body, the kidneys help maintain the body’s water balance. Drink too much and they excrete the excess, drink too little and they hang on to every molecule of water they can. When the kidneys don’t work well, they lose the ability to dilute and concentrate the urine. Measurement of a urine specific gravity, part of a routine urine test, helps veterinarians assess the kidney’s ability to dilute and concentrate and is a partial measure of kidney health.

So much information from something you, the pet owner thought was just an accident. No wonder I am crazy about getting that urine sample from your pet.


Baby, It’s Cold Outside: Winter Tips for Pet Owners

January 21, 2015

Is Chronic Kidney Disease the Same as Chronic Renal Failure?

January 14, 2015

chronic renal failure chronic kidney disease

One of @amcny’s Twitter followers posted the question that is the title of this post. This person also asked, “Should the high end of the normal range of creatinine be 2.4?” These are very good questions, especially for cat families since cats are seven times more likely to have kidney disease than dogs. I am devoting this week’s blog to the answers.

Kidney Tests
A standard panel of blood tests includes measurement of blood urea nitrogen and creatinine. These tests are commonly used to evaluate kidney function, but the results can be abnormal with dehydration, intestinal bleeding and a high protein diet. When combined with a physical examination and an analysis of the pet’s urine, they become a more powerful assessment of how well the kidneys work.

For many years, when veterinarians discovered elevations in blood tests to measure kidney function, we talked with pet families about chronic renal failure or CRF, and before that we talked about chronic interstitial nephritis or CIN. Today we more commonly use the term chronic kidney disease or CKD. As time passed, the name has changed to more correctly reflect our understanding of the disease. Chronic interstitial nephritis comes from microscopic evaluation of a kidney biopsy, something most pets never have. Chronic renal failure was a confusing term to pet owners who were unfamiliar with the medical term for kidney – renal. Failure was a misnomer since the abnormal blood tests indicate decreased function, but not necessarily an absence of function or failure. Thus, renal became kidney and failure was swapped out for disease.

If There is Chronic, There is Also Acute
In medicine, if a disease has the modifier “chronic” you can bet there is also an ”acute” form of the same disease. Acute renal failure has a very abrupt onset in a decline of kidney function and is caused by a variety of disorders including leptospirosis, antifreeze ingestion and lily intoxication. Some pets with acute renal failure completely recover; others improve but continue to have chronic kidney disease and sadly, others don’t make it. The term chronic indicates a long term process that may or may not get worse, but one that, with treatment, can achieve a good quality of life.

Is 2.4 the High End of Normal Range for Creatinine?
Normal range is another term largely gone from the veterinary lexicon because normal depends on the age, sex and even breed of the dogs or cats used for comparison. Now we use the term “reference range or reference interval.” The upper end of the reference range is variable from lab to lab, based on testing methodology, equipment and the exact animals used to develop it. Perhaps more important than the exact reference range from the lab is what is normal for your pet, i.e. what was the creatinine last year and the year before and is the number trending upwards? When that happens, it suggests decreased kidney function and suggests more testing may be indicated.

Thank you to our Twitter follower for asking such important questions. If you are interested in more information about what blood tests tell your veterinarian about your pet’s health, read this recent blog on blood testsLearn more about feline kidney disease.


Five Tips for Keeping Your Pet’s Weight Loss Resolution

January 7, 2015

Since New Year’s has passed, I suspect many pet families are hard at work on their list of resolutions. Weight loss is a common human New Year’s resolution and since estimates of overweight and obese pets range from 25-40%, I suspect it is on the list of many pet families as well. If you have a Labrador Retriever, Beagle, Cocker Spaniel, Basset Hound, Dachshund or Sheltie, breeds at high risk for obesity, weight loss is probably perpetually on your to do list.

Here are my tips to help your pet keep its resolve when it comes to weight loss:

  1. Many pet owners don’t recognize chubbiness in their favorite furry friend. Have your veterinarian assess your pet’s body condition score. This will help determine if weight loss is necessary.

    weight loss for pets

    Pet Body Condition Score Chart

  2. Using your pet’s body condition score, decide how much weight loss is necessary and have your veterinarian calculate the number of calories required daily to attain that weight. Ask if a weight loss food would be nutritionally better than simply cutting back on the current daily portion.
  3. Determine how many calories are in each can, bag or box of your pet’s food and calculate exactly how many ounces, grams or portions of a can are required to meet your pet’s daily calorie allotment. Then feed that number of calories – no more, no less.
  4. Limit treats to 10% of the calculated daily calorie allotment AND include treats in the daily calorie total. Treats can look deceptively calorie free and help to pack on the pounds. A small Milk Bone biscuit contains 20 calories and a Bully Stix has up to 22 calories per inch. A six inch stick could be nearly 25% of your 30 pound dog’s calorie allotment for the day.
  5. Keep your pet active. Throw a ball. Use the laser pointer with your cat. Exercise with your pet. Scientific research has shown exercising your dog is good for those on both ends of the leash.

Here are more weight loss suggestions for pets.

Let’s clink our glasses of no calorie seltzer water to a healthy, happy and thinner 2015 for the whole family!


Veterinary Year in Review: 2014

December 31, 2014

The AMC Gives Not Just at Christmas, but All Year

December 24, 2014

For over 100 years, The Animal Medical Center has held fast to the mission of community service embraced by our founder, Ellin Prince Speyer. In 1910, Mrs. Speyer and her organization, the New York Women’s League for Animals, established a dispensary and out-patient clinic for all animals whose owners could not afford to pay for medical treatment. The clinic treated 6,028 animals in the first full year. To this day, in addition to caring for New York City pets 24/7, The Animal Medical Center continues to give back to the community.

AMC TO THE RESCUEAMC TO THE RESCUE
Because The AMC’s main mission lies in promoting the health and well-being of companion animals through advanced treatment, research and education, we recently created a new Community Fund, AMC TO THE RESCUE, to provide subsidized specialty care to animals currently cared for by rescue groups. Through AMC TO THE RESCUE, we have provided a means for needy animals to receive care from one of our 30 board certified veterinary specialists. Since its inception in 2013, 20 dogs, 15 cats and one rabbit have received medical care supported by AMC TO THE RESCUE, which has led to the adoption of many of these pets into a forever home. Without the specialty care provided by The AMC’s board certified ophthalmologist, neurologist, internist, dentist, cardiologist, soft tissue and orthopedic surgeons, these pets might be spending yet another holiday as homeless and unadoptable rescue animals.

AMC at the WKC showThe Westminster Kennel Club Dog Show
Veterinarians from The AMC volunteered their time to manage minor health issues and triage emergencies for the dogs competing at the 2014 Westminster Kennel Club Dog Show from the start of the First Annual Masters Agility Championship until the moment GCH After All Painting the Sky captured the 138th Westminster Kennel Club Best in Show. Our doctors happily donated their time and skills to ensure the health and welfare of these beautiful animals.

Animal Medical Center Doggy Dash at the NYC Triathlon
For the past seven years The Animal Medical Center has been the title sponsor of the Animal Medical Center Doggy Dash. Doggy Dash gives a runner and their best canine friend the chance to compete in tandem over a 5 mile course through Central Park, finishing at the NYC Triathlon finish line. Twenty-nine dogs and their human runners participated in 2014. To ensure the health and safety of the canine participants, seven AMC veterinarians and four licensed veterinary technicians volunteered to perform the pre-race health certification and monitor canine participants on the hot and steamy day of the race.

AMC trains first respondersEmergency Medical Training for NYC First Responders
A new program for 2014, involving AMC veterinary volunteers, was a canine first aid and critical care workshop for first responders. AMC veterinarians and technicians provided training using canine dummies and cadavers to teach such practices as venipuncture, catheter placement, intubation, CPR, oxygen administration, and treatment of dogs in shock. Thirty-two medical operations personnel, including men and women from the FBI, undercover agents, fire department EMTs, paramedics, physicians, and even an Air Force para-rescue jumper benefited from the expertise and time of AMC volunteer instructors.

Partnering with Angel On A Leash
The AMC and Angel On A Leash are both champions of the human-animal bond and its role in enhancing human health and quality of life, believing in the positive role of therapy dogs in health care facilities, schools, rehabilitation, hospice, extended care, correctional facilities, and crisis intervention. Because of our shared missions, The AMC and Angel On A Leash again worked together this past September on the Ronald McDonald House Family Fun Walk held in Carl Schurz Park.

Giving Tuesday
On #GivingTuesday, the global day dedicated to giving back, the staff of The AMC gave not of time, but of money when they participated in a raffle. The proceeds, nearly $1,000, were donated to SAVE – Seniors’ Animal Veterinary Effort – a community fund supporting pet care for New York City seniors’ pets.

The AMC wishes you and yours the best of the holiday season and a 2015 filled with healthy and happy pets.


What do Blood Tests Tell Your Veterinarian?

December 18, 2014

bloodwork vialsVeterinarians at The Animal Medical Center must say “Let’s send some blood to the lab” about 100 times a day. But what are we looking for in all those tubes of blood with the colorful stoppers?

CBC = Complete Blood Count
Your dog’s or cat’s blood contains at least four types of white blood cells, red blood cells and blood clotting cells, called platelets. A complete blood count analyzes what cells are present, how many cells of each type make up the blood sample, and identifies any unusual cells present. For example, the presence of increased numbers of immature white blood cells, called band neutrophils or bands for short, indicate a serious infection. Last week, one of my patients had an elevated total white blood cell count and 1,236 bands per microliter of blood; normal is less than 300. An abdominal ultrasound determined she had a gallbladder infection.

In addition to assessing the types and numbers of white blood cells, the CBC measures the number of red blood cells and several different features of them as well. A lack of red blood cells is called anemia, and too many red blood cells suggests a rare hematologic disorder called polycythemia. Size is a critical diagnostic feature of red blood cells – too big and we look for an increase in baby red blood cells responding to bleeding or anemia; too small and we worry about iron deficiency. The amount of hemoglobin (oxygen carrying protein) is measured as well. If there is too little hemoglobin, we worry about iron deficiency, and red blood cells are so smart they never synthesize too much hemoglobin. If the lab report indicates the hemoglobin is elevated, we scrutinize the sample for possible errors.

Chem Panel = Serum Biochemical Profile
The CBC looks at the whole blood sample in pretty much the same form as it circulates in the bloodstream. Serum is the liquid portion of the blood without the blood cells. Serum is produced in the lab by spinning the blood in a centrifuge and using a pipette to remove the liquid portion. The serum sample is used to run a serum biochemical profile, a series of 20 or so tests that come in a panel.

The chem panel can be divided up into several different organ systems. Some tests increase with liver disease like the alanine amino transferase, or bilirubin. When a patient has a kidney problem, we often see elevations in blood urea nitrogen and creatinine. Then there is a group of tests that analyzes the concentration of chemical elements like calcium, phosphorus, sodium, potassium and chloride in the blood. These analytes are important for cellular function and can be abnormal in a wide variety of diseases, like adrenal gland diseases, kidney disease and urinary blockage. Typically a chem panel includes measurement of the protein level in the blood. Protein is affected by a wide variety of conditions and is usually interpreted in concert with the other abnormalities found in the panel. Finally, the chem panel measures blood sugar when looking for diabetes or low blood sugar.

The Combination is Critical
Submission of a CBC and chem panel is so routine that it is test #1 in The AMC’s lab ordering system! When paired, these two tests become a powerful tool for veterinarians to assess the health of your pet or to direct further testing to identify the cause of your pet’s illness.

Fun Things Blood Tests Can Tell Us
Blood tests don’t only tell us about disease, but also can give us other little tidbits about your pet:

  • If you have a mixed breed dog, a blood test analyzing your dog’s DNA can tell you about his parents and what breeds are in his genetic makeup.
  • Avian specialists use a blood test to tell if your bird is a boy or girl.
  • A blood test can also be used to predict the birth of a litter of puppies. A rise in blood progesterone to 2-3 micrograms/ml occurs 63 to 65 days prior to whelping – the dog word for birth of puppies.

Bigger is Better and a Lid Doesn’t Matter When it Comes to Cat Bathrooms

December 10, 2014

kitten in litter boxWho among us doesn’t covet a nice bathroom? Our homes today have more bathrooms and larger, more elaborate bathrooms than ever before. According to houzz.com, the average bathroom remodel in New York City costs $32,000, and features granite counter tops, porcelain tile and high end fixtures. Our feline companions are no different. They express definite likes and dislikes when it comes to their litter box. Provide them with a substandard bathroom and they will refuse to use it and instead will use the corner of your dining room rug as their new and more spacious bathroom! In the feline world, this problem is so serious that a 2001 research study reported inappropriate elimination as a top reason cats are relinquished to animal shelters.

What cats care about in their litter box
Bigger boxes are better
In a study published earlier this year in the Journal of Veterinary Behavior, cats were offered the choice of using a standard size litter box or a large plastic box greater than 33 inches in length. The number of urine and fecal “deposits” in each box were recorded and compared. Results determined cats like litter boxes larger than the standard ones available in pet stores.

More boxes are preferable 
Litter box issues are more common in multi-cat households. To avoid competition and territorial behavior towards litter boxes, which leads to inappropriate urination, provide your cats with multiple litter boxes.

Stinky boxes are bad
Even if you scoop daily and completely change the litter weekly, that box can get stinky. Veterinarians tested cats use of litter sprayed with a commercially available litter box odor eliminator. Cats clearly found the sprayed boxes more attractive an preferred their use over unsprayed boxes.

What cats don’t care about in their litter box
Our mothers admonished us to close the lid of the toilet during their attempts to teach us manners. Cats don’t care about a lid on their litter box. A 2013 study of cats to determine their preference for a covered or uncovered litter box found no preference in the style of box in most cats, although as any cat owner will attest to, some persnickety cats did choose an uncovered box over a lidded one or vice versa.

Seems to me that cats should care about the type of litter in their box, but I couldn’t find any research to support that theory. One study did show, the longer cats scratched in the litter box, the less likely they were to inappropriately eliminate. Scientists interpreted that finding to mean lots of scratching at the litter means a cat likes the litter in their box and they will be less likely to eliminate on the dining room rug.

Cat bathroom remodeling tips
Thankfully, remodeling a feline bathroom is much less costly than remodeling your bathroom. First, feline behavior experts believe in simple math when it comes to the number of litter boxes: number of cats + 1 = the number of litter boxes you should have. You don’t like to wait in line to use the restroom, and clearly cats feel the same way. Second, when purchasing additional litter boxes, consider upgrading to a larger box, such as an under-the-bed box or gift wrap storage box without its lid.

Finally, cats fully believe that they are gods and that “cleanliness is next to godliness.” Research has shown that daily scooping of cat waste from the litter box and weekly litter changes can resolve urine spray behavior in cats.

Remember: inappropriate elimination may be a sign of illness, so check with your veterinarian if your cat suddenly stops using her litter box.


Holiday Gifts for Pets

December 3, 2014

Sharing Turkey Day Dinner with Your Pets

November 26, 2014

Happy ThanksgivingThanksgiving is all about food and family. Many of us consider our pets family members and want to include them in the holiday celebration, but menu selection for pets can be tricky. For example, dogs love chocolate, but it will cause vomiting, diarrhea and hyperactivity if Fido indulges his passion with a few foil wrapped chocolate turkeys. Your cat may find the raw turkey trimmings sitting on the counter a tasty treat. Raw poultry can be teeming with organisms such Salmonella or E. coli and give Fluffy a nasty case of food poisoning. So here are simple suggestions for taking food from your holiday table and creating a healthy and safe buffet for the family pets. More difficult will be figuring out if seating Fido next to Grandpa and Fluffy next to Uncle Ray will provoke a family fracas!

Doggie dishes
When choosing Thanksgiving food for your dog’s dish, stay away from high fat dishes, such as gravy or sausage stuffing, which can provoke an episode of painful pancreatitis. Steer clear of raisins and grapes, whether in a fruit salad or stuffing, as these delicious fruits can cause serious kidney problems. A spoonful each of nice white meat turkey, sweet potatoes or mashed potatoes minus the butter, sour cream, nuts, and marshmallows would be safe turkey day fare for your dog. Fruit often appeals to dogs, and while recreating grandma’s apple crumb pie, save a couple of apple slices for your dog.

Reptile recipes
If you have a vegetarian reptile, such as an iguana, bearded dragon or a tortoise, the Thanksgiving side dishes provide an opportunity to share the bounty of the season.  Winter greens such as collards and mustard greens make a tasty holiday treat. While you’re setting aside the greens for your special scaled friend, save some raw squash, yams and even a few fresh or boiled cranberries to create a colorful and healthy reptile dinner. In addition to the vegetables and fruit, your turtles might like a bit of white or dark meat turkey added to their plate.

Kitty cuisine
Because cats think of you as their servant, dishing up what you believe to be a special holiday meal without asking their permission may result in rejection of your best culinary efforts. Perhaps just serve up the turkey flavor of your cat’s favorite canned cat food and call it a day in the kitchen! If you must cook for your kitty, consider simmering the giblets from the turkey until they are cooked through. Once they are cooled, mince them finely for a feline Thanksgiving Day indulgence.

Pocket pet provisions
If you have a small mammal, such as a rabbit or guinea pig, save some salad fixings, like lettuce leaves and carrot pieces, to make Thanksgiving extra special. While you are making the pie, save a small piece of apple before it is mixed with sugar and cinnamon as a rabbit dessert. The family ferret can feast on small bits of plain turkey meat without gravy or seasonings.

Bird buffet
Before you add the butter, sugar or marshmallows to the steamed or boiled sweet potatoes, save a small portion for your bird’s Thanksgiving dinner. If you garnish your vegetable dishes with pecans, walnuts or slivered almonds, they too can be added to your bird’s holiday fare. Selections from the vegetable side dishes, such as carrot pieces, green beans and Brussels sprouts, make a tasty and healthy addition to your bird’s plate, but be sure to set them aside before butter or salt is added!

The Animal Medical Center wishes a happy Thanksgiving to all! “Bone” Appétit.


Keeping Your Senior Pet Healthy

November 19, 2014

senior petsSince November is National Adopt a Senior Pet Month, this image posted on Twitter by @PetLiving caught my eye. Adopting a grey muzzle pet bypasses the need to housebreak, train and socialize your pet, all necessary tasks when you adopt a puppy or kitten. The text accompanying this photo highlights just two of the health issues, loss of vision and hearing, that you might expect when you adopt a senior pet.

Do you have a senior pet?
A dog or cat is considered a “senior” when he or she is in the last 25 percent of the breed’s expected lifespan. So a Great Dane with a life expectancy of 8 years might be a senior at 6 years. Conversely, a miniature poodle with an expected lifespan of 15 years might not be a senior until 11 or 12 years. The lifespan of cats remains more consistent across breeds than in dogs, and cats over 10 years of age are considered seniors.

Keeping your senior cat healthy
Essential to keeping your senior cat healthy are regular preventive care visits to the veterinarian. Over the past 10 or so years, the frequency feline patients see their veterinarian has dropped to less than one time per year. Without routine care, small problems become big ones. Take for example feline teeth. In a British study of over 140,000 cats, nearly 15 percent suffered from periodontal disease.

Periodontal disease is a painful condition which can be nipped in the bud by routine dental prophylaxis. Wait too long to have your cat’s teeth treated and the need for multiple extractions increases. Preventive health care visits allow your cat’s veterinarian to perform blood tests which can reveal kidney disease at a time when dietary therapy can be effective. Routine visits to your cat’s veterinarian also help to keep tabs on your cat’s weight. Overweight cats have a greater risk of developing diabetes and bladder problems.

Keeping your senior dog healthy
Three critical factors in keeping your senior dog healthy are preventing obesity, promoting mobility and monitoring for cancer.  A multi-year study of Labrador retrievers demonstrated the negative impact of obesity on longevity. Dogs fed a restricted amount of food lived nearly two years longer than dogs fed a higher number of calories.

Keeping your senior dog in lean body condition is directly tied to maintaining mobility. Overweight senior dogs with creaky joints have a much more difficult time getting around than their slimmer counterparts. More time sitting on the sofa translates to a decline in muscle strength and turns into a dog that can barely walk. During your twice yearly senior pet checkup, your veterinarian has in her pharmacy a variety of medications to keep your senior dog moving comfortably. Experts estimate that almost 50 percent of all dogs over the age of 10 will develop cancer, making this a significant problem in the senior dog. You can easily monitor for skin cancers by simply doing a through belly rub and petting your dog from nose to tail. If you find any lumps or bumps, bring them to the attention of your veterinarian immediately.

Better medical treatment means pets can live longer and healthier than ever before. Don’t assume your senior pet is just slowing down as a normal part of aging. Slowing down could indicate your pet is developing a disease. That’s why veterinarians recommend your senior pet see them twice yearly. Make an appointment for your senior pet today!


National Pet Cancer Awareness Month: Pet Cancer Treatment Options, Part II

November 12, 2014

dog receiving chemotherapyNovember has been designated National Pet Cancer Awareness Month to raise awareness about the causes, prevention and treatment of dogs and cats with this terrible disease. To raise awareness of the possible treatments for pet cancer, this second part of my two-part blog on cancer treatments for pets discusses three additional treatment therapies: chemotherapy, immunotherapy and targeted therapy. Part I focused on surgery and radiation therapy.

Chemotherapy
Although the use of radiation therapy in humans preceded the use of chemotherapy, chemotherapy was more widely used in pet cancers before radiation therapy. Chemotherapy is administered when a biopsy indicates a tumor has spread or might spread, such as in feline breast cancer.

Chemotherapy can also be administered when a tumor is too widespread for either surgical removal or radiation therapy. At the top of the veterinary list of pet cancers treated with chemotherapy is lymphoma.

Veterinary oncologists treat both dogs and cats for lymphoma using a variety of chemotherapy drugs. Most commonly used is the CHOP protocol. CHOP is an acronym representing the first letter of each chemotherapy drug in the protocol and is repurposed from human oncology. Despite the bad reputation chemotherapy has, both cat and dog owners report a good quality of life in their pets receiving chemotherapy.

Immunotherapy
The concept of harnessing the cancer patient’s own immune system to fight cancer is an idea that has been around a long while. The idea came to fruition when a vaccine to treat melanoma in dogs was approved in 2010.

Dogs suffering from melanoma are given four vaccinations over two months and then boostered every six months. This treatment protocol prolonged survival by 300 days or more in dogs receiving the vaccine. In people with lymphoma, treatment using monoclonal antibodies like Rituxan® has dramatically improved patients’ survival time. In a similar vein, AMC oncologists are currently studying a monoclonal antibody against T cell lymphoma and a monoclonal antibody against B cell lymphoma is also available.

On the horizon for the treatment of lymphoma is a new cancer vaccine for a particular type of lymphoma in dogs called large B cell lymphoma.

Targeted Therapy
In 2009, toceranib phosphate, known as Palladia®, became the first targeted therapy approved for use in dogs diagnosed with mast cell tumors.

A second targeted therapy, mastitinib, known as Kinavet®, has conditional approval for the treatment of the same tumor. Targeted therapies exploit a physiologic abnormality in tumor cells, not present in normal cells. Targeted therapies commonly work by turning on or off a cellular process critical to cancer growth and metastasis, halting tumor growth. In the future, expect to see more targeted drugs used in dogs and cats.

Because cancer is diagnosed in over six million pets each year, you may be faced with this diagnosis in your favorite furry friend. But treatment of cancer in pets is possible. You and your pet have more treatment options and more specially trained veterinarians than ever before to help you achieve a good outcome if your pet is diagnosed with cancer. To find a board certified veterinary cancer specialist in your area, visit the American College of Veterinary Internal Medicine website and use their search function.


National Pet Cancer Awareness Month: Pet Cancer Treatment Options, Part I

November 5, 2014

National Pet Cancer Awareness MonthNovember has been designated National Pet Cancer Awareness Month to raise awareness about the causes, prevention and treatment of dogs and cats with this terrible disease. According to the Morris Animal Foundation, there are six million new pet cancer diagnoses every year. That number of diagnoses translates to millions of pet cancer treatments each year. Traditionally, surgery, chemotherapy and radiation therapy were considered the mainstays of cancer treatment in both people and pets, but recent innovations add immunotherapy and targeted drug therapy to the growing list of cancer treatments for pets.

To raise awareness of the possible treatments for pet cancer, Fur the Love of Pets will feature this two-part blog on cancer treatment options in pets.

Surgery
Surgical removal as a treatment for cancer has been practiced since Roman times. Perhaps because of a lack of surgical skill, coupled with a lack of techniques for general anesthesia, surgery was not particularly effective, if we believe the Roman physician Celsus. He wrote, “After excision, even when a scar has formed, none the less the disease has returned.” Today we know much more about how to treat canine and feline cancer patients with surgery. Tumors such as canine breast cancer, soft tissue sarcomas and mast cell tumors are potentially cured by surgical excision alone. The key to treating many types of tumors with surgery is to remove a wide swath of normal skin and tissue around the tumor to ensure complete removal of the cancer-causing cells. Anyone with a pet treated with surgery for mast cell tumor or soft tissue sarcoma can attest to the fact that the actual incision was much bigger than they anticipated. Current guidelines recommend as much as 3cm (1.25 inches) of normal tissue be removed on all sides of the tumor as part of a cancer surgery.

Surgical treatment of pet cancer recently became highly specialized when the American College of Veterinary Surgeons (ACVS) recognized the Veterinary Society of Surgical Oncologists (VSSO). Members of VSSO have achieved a high level of competence in cancer surgery though their participation in a surgical oncology fellowship following certification by ACVS.

Radiation Therapy
The second cancer treatment to be widely used in humans was radiation therapy. Veterinarians began using radiation therapy in pets in the early 1980s. Board certified veterinary radiation oncologists treat a wide variety of tumors including brain tumors, thyroid tumors and melanoma.

The radiation therapy equipment The AMC currently uses is our third machine since 1989. The first two used cobalt as the radiation source. Now we have a linear accelerator with electron beam capabilities, image modulated radiation therapy and stereotactic radiosurgery – a huge advancement in technology from our first rudimentary cobalt machine. To ensure exact positioning for each treatment, a customized “bed” is created for each patient. View a video of one of our vacuum assisted positioning devices being used in a feline patient.

Want to learn how to recognize signs of cancer in your pet? View our slide show on the “Ten Warning Signs of Cancer in Pets.”

In Part II of this blog, I’ll discuss chemotherapy, immunotherapy and targeted therapy.


Feline Stomatitis: A Pain in the Mouth

October 29, 2014
Stomatitis

Redness and swelling indicative of stomatitis

You can bet with a high degree of certainty that any medical condition ending in -itis is painful. Think appendicitis, neuritis and bronchitis. The suffix –itis means inflammation. Stomatitis means inflammation of the mouth, and in cats, the redness and swelling seen in the photo on the right characterizes feline stomatitis.

Don’t confuse stomatitis with gingivitis
This cat has gingivitis. The thin red line at the tooth-gum junction seen in the second photograph is gingivitis, which is much less painful and much easier to treat than stomatitis. Gingivitis is a mild, localized form of oral inflammation and stomatitis is more widespread.

Gingivitis

Gingivitis in a cat

Causes of stomatitis
A recent research publication reported on over 5,000 cats. Cats with oral disease were more likely to test positive for either feline leukemia virus or feline immunodeficiency virus (FIV). Stomatitis was most strongly associated with FIV infection. An exuberant immune reaction to plaque buildup on the teeth has been suggested as a cause of stomatitis. Feline calici virus infection may be the trigger for the exuberant immune reaction against the plaque.

Recognizing stomatitis in your cat
You might not even know your cat has gingivitis unless you lift their lip and look in their mouth. Recognizing stomatitis in your cat is easier. Cats with stomatitis paw at their face, refuse their favorite cat food, drool and yawn. Sometimes you will notice blood in the drool or your cat screaming when she yawns. Any of these clinical signs should provoke a visit to your cat’s veterinarian.

Treatment of stomatitis
A professional dental cleaning will remove plaque, but in severe cases of stomatitis, teeth cleaning may not be enough to correct the problem on a long-term basis. Antibiotic treatment may also provide a short-term benefit through temporary reduction of bacteria levels in the mouth. If these measures do not resolve stomatitis and your cat is still painful, tooth extraction will likely be the next recommended treatment. How many teeth are extracted depends on the severity and location of the oral inflammation. A routine tooth cleaning and extractions of diseased teeth may cure or control the mild cases, but extraction of all molars and premolars is a common prescription. In some cases, removal of all the teeth, including the fangs and the tiny front teeth called incisors is necessary to control stomatitis. After a post-operative recovery period, cats can eat canned food and have an improved quality of life once the stomatitis has resolved. While this sounds drastic, research has shown 80% of cats have resolution of oral pain with tooth extraction.

Cat owner’s role in preventing stomatitis

  • Train your kitten to accept tooth brushing during kittenhood, and brush daily.  This will help to keep levels of plaque low.
  • Treat your cat with products designed to removed plaque and tartar as recommended by your veterinarian.
  • Take your cat to the veterinarian for annual examination and recommendations about dental cleaning.
  • Keep your cat indoors to protect them against infection with the feline leukemia virus or feline immunodeficiency virus.

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