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.


Veterinary Year in Review: 2014

December 31, 2014

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.


What Does a Vet Tech Do?

October 8, 2014

Five Money Saving Tips to Cut Expenses on Pet Medical Care

September 4, 2014

dog imageWe all want to save money, but when it comes to our pets, we strive to give them the best of everything.  Here are five tips to help you save money on your pet’s medical expenses and still provide your favorite fur baby with top-notch treatment. 

  1. Be an educated pet owner.
    Start by visiting your local library for a basic book on pet care. Check with your neighborhood veterinarian or animal rescue group to see if they offer classes in pet care. Familiarize yourself with the common signs of illness in your pet. For example, review this slide show about the 10 warning signs of cancer in pets and consider subscribing to our Fur the Love of Pets blog to have pet health information delivered to your inbox weekly.
  2. Don’t skimp on preventive care.
    An annual visit to your pet’s veterinarian is worth its weight in gold. During a routine physical examination, your veterinarian can assess your pet’s risk of contracting a contagious disease, such as parvovirus or Lyme disease, and administer vaccinations or parasite preventatives to protect your pet. Subtle changes in body weight or the ability to ambulate identified during an examination may indicate the need for additional testing, medications to alleviate pain, or a diet adjustment. Without an annual examination, your pet’s undetected illness can spiral out of control and might cost much more than an annual veterinary visit.
  3. Don’t ignore signs of disease such as vomiting, weight loss or inactivity.
    If I had dollar for every time I heard a pet owner attribute signs of disease to something other than disease, I would be rich. Here are just a few examples: “He’s not moving around much anymore, but he is older.” Diagnosis: arthritis. “I think she’s losing weight, but I am feeding her the light food.” Diagnosis: intestinal lymphoma. “He vomits every day, but that’s normal for cats, right?” Diagnosis: chronic kidney disease. Don’t miss an opportunity to be proactive and keep your pet healthy and pain-free by quickly recognizing signs of disease.
  4. Create a safe, but enriched environment for your pet.
    One of the most common reasons for pet admissions to The AMC Emergency Service results from hazards in the home. In the month of August alone, AMC emergency and critical care veterinarians treated pets for ingestion of human foods toxic to pets, such as xylitol and chocolate; rat poison intoxication; and consumption of human prescription and recreational drugs, especially marijuanaFalls from open windows without screens commonly result in feline ER visits and hospitalization for shock and broken bones. In addition to pet-proofing your home, protect your pet by creating activities to keep Fluffy and Fido busy during the day using feeding toys, a cat tree or mechanized toys. There are many ways to create an enriched backyard for your dog. Some of these ideas can be adapted for indoor cats as well. 
  5. Invest in pet insurance.
    Purchasing the right pet insurance requires you to invest some of your time into researching the best policy for your family and your pet. The strength of some policies lies in the area of preventive care. These policies cover annual wellness visits and medications to prevent fleas, ticks and heartworms. Other policies lean towards covering catastrophic medical care, such as emergency surgery or hospitalization for diseases like heart failure or kidney disease. Purebred dog and cat aficionados should scrutinize potential policies carefully for any breed related exclusions. As you review policies, keep in mind some charge additional fees to cover expensive treatments such as chemotherapy.

So now you are an educated, proactive pet owner with a pet safe home and a well insured pet, I’ll bet that makes both you and your pet sleep better at night.


SAVE Saves a Bird

August 13, 2014
Scarlett's x-ray

Scarlett’s x-ray shows her stuck egg

As her name suggests, Scarlett is a pet that is red, but not a red setter, a redbone coonhound or a red Abyssinian, she’s an African grey parrot with a red tail. This 25-year-old parrot is also an artist, creating colorful abstract works of art in the bathtub. She was referred to The Animal Medical Center to see Avian and Exotic specialist Dr. Kathy Quesenberry for an egg that wasn’t being laid, an avian condition known as egg binding, putting a damper on her artistic endeavors.

Like many medical problems, egg binding occurs in overweight birds with a sedentary lifestyle or a diet lacking adequate calcium. Medical treatments can be effective in resolving a stuck egg – calcium, fluids, lubrication and keeping the bird warm may cause the egg to pass, if not, then manual or surgical removal of the egg may be necessary. These treatments had been tried in Scarlett, but they were unsuccessful.

IDing an Egg
One of the first steps in treating an egg-bound bird is to pinpoint the egg’s location within the reproductive tract. Because eggshells contain calcium, they can easily be seen using a standard x-ray. In the x-ray image on the right, you can see a thin, egg-shaped structure in Scarlett’s abdomen between her pelvic bones representing Scarlett’s stuck egg.

Avian Endoscopy
The inside of a bird’s vent, called the cloaca, contains multiple openings – one for the intestinal tract, one for the reproductive tract, and two small openings for the urinary tract. Dr. Quesenberry used endoscopy to view inside the vent and was planning to remove the egg at the same time. Endoscopy identified a tear at the end of the oviduct where it entered the cloaca, making surgery urgently necessary.

Scarlett in the tub

Scarlett as a component of her artwork

Bird Spay
During the two and a half hour endoscopy and surgery, Scarlett’s torn oviduct at the cloaca was repaired, and the remainder of her oviduct was removed to prevent another egg binding episode. Unlike mammals, most birds have only a single left oviduct and ovary. Because a bird’s ovary is close to large blood vessels, it cannot be removed safely. A “bird spay,” or salpingectomy, is the procedure of removing most of the oviduct so that an actual shelled egg cannot be formed, even though the ovary still functions normally. Scarlett recovered uneventfully. Two weeks after surgery her sutures were removed and she was given a clean bill of health and she has returned to emulating Jackson Pollack-esque abstract impressionism in her bathtub. The photo seen here shows Scarlett as a component of her own artwork.

Help From an AMC Community Fund
The happy ending to Scarlett’s story would not have been possible without the generosity of those who support The AMC’s Community Funds. Scarlett’s care was covered by the Seniors’ Animal Veterinary Effort (SAVE), which provides free or subsidized general and emergency veterinary services for the pets of the indigent elderly.

To learn about other pets treated through The AMC’s Community Funds, read the heartwarming stories about TikoFrankie, and Baller.

Become a supporter of The AMC’s Community Funds today.


Watch Scarlett at work in her bathtub studio on The AMC’s YouTube channel.


View Scarlett’s virtual art gallery.

Click to play this Smilebox slideshow

AAHA Certification: The AMC Takes the Test to Meet Veterinary Practice Standards of Excellence

July 30, 2014

AAHAlogoDedicatedThe Animal Medical Center undergoes a triennial accreditation evaluation by the American Animal Hospital Association (AAHA). The AAHA is an industry leader that sets the standards for small animal hospitals in North America, standards which are often emulated internationally. For example, in Japan, the Japanese Animal Hospital Association (JAHA) serves a similar role to AAHA in the United States. Recently, AAHA has added new accreditation categories for referral hospitals and university hospitals.

The Benchmarks
Over 900 different standards are assessed during the accreditation evaluation. The standards focus on the quality of care in the areas of: anesthesia, contagious diseases, dentistry, pain management, patient care, surgery and emergency care. The standards are grouped into 20 large categories covering quality of care in diverse areas such as contagious disease, dentistry, diagnostic imaging, emergency and critical care, and pain management. Mandatory standards detail 46 critical/crucial hospital functions required of every AAHA accredited hospital. These “deal breaker” standards include the requirement that dentistry is performed under general anesthesia with tracheal intubation, and all patient care is provided under the supervision of a licensed veterinarian. The standards require hospitals to provide diagnostic services (x-ray and laboratory) facilitating quick and accurate diagnosis of your pet’s illness. Accredited hospitals must dispense medications so treatment can begin immediately.

The focus of the benchmarks is not just on patient care, but on how the veterinary team interacts to achieve high quality patient care. Standards pet owners might not expect as part of the evaluation process include an assessment of confidentiality, security and integrity of medical records, fire safety, diagnostic image archiving, continuing education, and referral standards. While not exactly medical standards, these functions are clearly critical to an accredited hospital’s ability to provide top-notch patient care.

Exam Prep
The AMC is continuously prepping to meet the AAHA accreditation standards. Our accreditation team reviews the benchmarks and educates the staff regarding their responsibilities in implementing each standard. When a new standard is issued, the appropriate hospital team writes our policy to ensure the new standards are met. That policy is then distributed to the implementation teams. Each new standard improves the quality and safety of The AMC’s patient care.

A Pop Quiz
On-site examiners perform a full-day thorough and comprehensive review of the hospital. Preparing for an AAHA evaluation is like preparing for a pop quiz; they can ask questions about any of the 900+ standards and they don’t have to give you a heads-up as to which ones are on the quiz. The examiners speak with a variety of staff and review hospital policies to ensure standards are met. If any deficiencies are identified, they suggest methods of improvement.

Perfect Scores
The accreditation process is rigorous and encompasses all aspects of pet healthcare. Only 15% of all veterinary hospitals meet these stringent quality standards. The AMC is proud to say it has been an AAHA accredited hospital since 1976 and passed its most recent evaluation with flying colors. We achieved a perfect score in six of the 20 categories of standards. All of the standards ultimately affect the care pets receive at The AMC, but most important to pet owners are the A pluses The AMC received for management of contagious diseases and emergency and critical care medicine. Overall, we received a solid A, or 94%, which does not mean we got six questions wrong. We scored 30,250 out of a possible 32,310 points! No wonder it took weeks to prepare for this evaluation.

Standards Met
For over 100 years, The AMC has been a leader in veterinary teaching, research and exceptional clinical care. The AAHA is another leader in veterinary medicine whose opinions and stance are relied upon for setting high hospital standards. Achieving AAHA certification is just one way we continue to provide the highest quality of medicine and surgery to nearly 40,000 patients every year.


Rat-Bite Fever and Pet Rats: How Concerned Should We Be?

April 16, 2014
Photo: freeinfosociety.com

Photo: freeinfosociety.com

The recent report of a 10-year-old boy that died from rat-bite fever in San Diego has raised concerns about the risk of contracting this disease from pet rats. The family of the child is suing Petco, where they bought a pet rat two weeks before the boy died after a 48-hour illness characterized by flu-like symptoms. This incident has brought into discussion the rare but real risk of this zoonotic disease, which is caused by two different bacteria that are carried by rats. The type of rat-bite fever that is most common in North America is caused by Streptobacillus moniliformis. Another form of rat-bite fever is caused by Spirillum minus and occurs primarily in Asia. Rats can carry both bacteria as part of the normal flora of their respiratory tract. Because of this, rats do not usually exhibit any outward signs of illness from these bacteria. People are infected with the bacteria through rat bites or exposure to urine, feces or saliva of rats that carry the organism.

Illness after the bite of a rat has been described for thousands of years in Asia in poor populations that are exposed to wild rats. With the increased use of large numbers of laboratory rats in the last century, this disease has been seen most often in laboratory animal workers in the US, as well as in poor populations. However, the growth of the pet industry and the increased popularity of fancy pet rats in the last 30 years have shifted the disease incidence so that now more than 50% of the cases in the United States are seen in children. Rat-bite fever is not a reportable disease in the US, so the actual number of cases that occur annually is unknown. However, the incidence of the disease in the US is very low, and death from rat-bite fever is also rare. The cases that are known are those that are documented in the medical literature. To complicate matters, the clinical signs of rat-bite fever in people are nonspecific, and the tests to isolate or identify the organisms involved are not routine. Often, a history of exposure to a rat, in combination with the clinical signs, is the clue that doctors use to suspect rat-bite fever in patients, and then diagnosis is based on specific testing methods. If the disease is suspected or diagnosed, treatment with antibiotics is curative in most cases. A good review of this disease is available – see Rat Bite Fever and Streptobacillus moniliformis.

So what is the risk of this disease if you or your children have a pet rat? Fancy rats are very popular as easy to maintain, social and gentle pets. They are common children’s pets but also have an avid following among adults who can’t afford or don’t have the lifestyle suitable for a dog or cat. Fancy rats are widely available from both pet stores and private breeders in different colors, sizes and conformations. However, few, if any of the pet rats sold are tested for the bacteria that cause rat-bite fever. The prevalence of the bacteria in rats can vary, from as few as 10% to as many as 100% of rats in a breeding colony or laboratory that are infected. Any pet rat can carry these organisms, but the risk of actually contracting the disease from the rat is very low.

What should you do? As with any animal that carries a risk of zoonotic disease, hand-washing after handling is of utmost importance. Using either soap-and-water or an alcohol-based hand cleanser after handling the pet rat and cleaning the cage is mandatory. Children should be instructed to always wash their hands after playing with the pet and to always tell parents about any bites that occur when handling the pet. Owners of pet rats should immediately report unexplained fevers, illness or rashes to their healthcare provider. Specialized screening tests to see if your pet rat is a carrier of S. moniliformis are available from veterinarians, but make sure you call ahead to see which veterinarians provide this test, as it is not routinely offered.

This blog was written by:
Katherine Quesenberry, DVM, MPH, DABVP (Avian)
Head, Avian and Exotic Pet Service

The Animal Medical Center


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.


The [Veterinary] World is Flat

February 26, 2014

digital x-raysThe title of this blog takes its name from author and New York Times columnist, Thomas Friedman’s bestselling book, The World is Flat: A Brief History of the Twenty-First Century. The book’s thesis explains globalization in the 21st century as a result of wide accessibility to personal computers and fiber optic cables which make communication via email and information gathering via the internet nearly instantaneous. This form of globalization renders geographic divisions between countries irrelevant.

Friedman describes “ten flatteners” including: the collapse of the Berlin Wall, Netscape and workflow software. My own observations of the world of veterinary medicine indicate that it is not much different than the global economy Friedman describes in his book. Paying tribute to the Pulitzer Prize winner Friedman, here are my veterinary flatteners.

A New Workflow
Digital radiography has changed the workflow of daily veterinary practice. In the pre-computer days, each x-ray was a piece of film, not easily copied and very easily misplaced. Now The AMC and many other veterinary hospitals have switched to using digital radiography, using a machine that looks like a regular x-ray machine but which takes digital images similar to those taken with your smart phone. These x-rays can’t be lost because the images are stored in a picture archiving and communication system (PACS). The image files are very large, but can be transported by burning them onto a CD or transferring them through any number of file sharing systems.

Electronic Medical Records
As it has revolutionized the global economy, the personal computer is revolutionizing veterinary practice. Electronic medical records systems (EMRS) allow rapid dissemination of medical information between specialists and primary care veterinarians. I can write a letter to a patient’s primary care veterinarian after I have completed my consultation with their patient. Through the magic of the EMRS, I can have the letter in that veterinarian’s inbox for his/her review before the pet has returned home.

Board Certification
Twenty-five years ago when I started the process of becoming a board certified veterinary oncologist, there were only about 25 veterinary oncologists in the world. The American College of Veterinary Internal Medicine now has certified over 300 oncology diplomates and there is a European College of Veterinary Internal Medicine which certifies oncologists as well. Board certified specialists all over the world form a healthcare network that trades patients back and forth when pet owners relocate or go on vacation, just as I described in a previous blog: “Clea’s International Healthcare Team.” Since veterinary oncologists and other specialists have expanded their reach worldwide, specialist veterinary care no longer has geographic boundaries.

Multinational Veterinary Companies
Specialists are not the only international flatteners. Because international companies provide veterinary products and services, veterinary specialists can access information about pets seen by a veterinarian practicing on a different continent! Take for example my patient Gigi. She came to The AMC from Kuwait, but because the biopsy of her tumor was sent to the European branch of the same laboratory used by The AMC, I was able to ask additional questions about the biopsy result. The biopsy sample was retrieved from storage and then reviewed by a pathologist in Europe. The answers to my questions were sent via email.

Real Time Communication
The internet has changed the face of veterinary education. Today, veterinarians no longer have to travel to earn continuing education credits necessary to maintain their licenses. Continuing education comes to them though their computers. This year, the keynote speaker addresses at the annual Veterinary Cancer Society Meeting were streamed live to members unable to attend. Additionally, several internet based companies offer on-demand veterinary continuing education opportunities.

The veterinary world is indeed flat and that means your pet can get excellent veterinary care from a veterinarian in your neighborhood or from a specialist somewhere a long way from home!


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.


AMC Resident Research Abstract Presentations

January 15, 2014

veterinary researchJust before Christmas, The Animal Medical Center held its annual residents research abstract presentations. As part of their specialty training, residents are expected to design, execute and report on research in their area of clinical specialty, and this mini-conference provided a forum for exchange of the knowledge gained from research between members of The AMC medical staff. The AMC performs a very specific type of research – clinical research. This means we study diagnostic testing, new treatments and procedures in the patients we care for as part of our effort to improve the health and well-being of our patients. We do not test or treat any animal for the sake of “research.”

Caspary Research Institute
Research at The AMC is not new; when The AMC moved uptown in the 1960’s from Lafayette Street to its present location, a decision was made to locate the new veterinary research institute right in the middle of the Upper East Side’s strong human-focused biomedical community. The AMC became the fifth biomedical institution in the neighborhood, joining The Rockefeller University, Cornell University Medical College, Sloan-Kettering Institute and Memorial Hospital for Cancer and Allied Diseases. Early architectural drawings of the AMC building show a sign on the north side of the building saying, “Caspary Research Institute.” When The AMC opened on 62nd Street, research and patient care were its main focus areas.

Short and Sweet
From a research point of view, an abstract is a very short presentation – 12 minutes, followed by a 3 minute question and answer period. Resident research abstract presentations are commonly preliminary reports which allow discussion of data and help formulate the interpretation of results prior to the writing of a manuscript for publication. Because the information presented was preliminary, I have a few interesting tidbits to report.

Lookalike Medicines
One study evaluated treatment of cognitive dysfunction in dogs with an anti-seizure medication compared to dogs treated with a placebo. In order to help veterinarians and owners make an unbiased assessment of patient response to the actual medication, our colleagues at Best Pet Rx Pharmacy made every dog’s medication look exactly the same. No one could tell which dogs were getting the medication being studied and which dogs were getting placebo pills. This is called double blind study design. Double blind because two people, the patient and the researcher, don’t know the treatment group assignment because it is hidden by the look-a-like pills.

Challenge of Science
Most research projects do not proceed exactly as planned. A study of ICU patients was designed to follow the effects of treatment on dogs with low blood protein (hypoalbuminemia). Dogs were to have a blood sample prior to treatment and 48 hours later. The study did not meet the enrollment target. Why? Despite an impression that dogs stayed in ICU longer than 48 hours, most dogs did not stay that long and fewer dogs than projected entered the study. Of course, we were happy your dogs went home earlier than expected, which was a scientific finding on its own.

Changing Protocol
The AMC’s ICU patients often need to be fed intravenously. We use a commercially available product called Procalamine. This product provides amino acids, the building blocks of protein and glycerin, as a source of glucose for energy. One emergency critical care resident studied patients receiving Procalamine as part of their treatment protocol. Patients receiving Procalamine through a catheter in their leg had more inflammation of the blood vessel than patients who get Procalamine through other, larger blood vessels. Although the directions for Procalamine indicate it can be given in the legs, we now will try and avoid this whenever the patient’s condition allows it.

Helping Pets Everywhere
These types of studies enable AMC veterinarians to improve the level of care for your pet. Through the publications that will result from these and other studies performed here, the knowledge will improve the care of pets everywhere.


The Year in Veterinary Medicine

December 31, 2013

year-in-review-revisedAs 2013 comes to a close, we have put together a review of some of the interesting veterinary and animal-related highlights of the past year. We hope some of these tidbits will bring a smile to your face, a tear to your eye or spark some conversation at a holiday party.

January
Several articles reported the veterinary profession turned 150 years old in 2013. A misnomer in reporting, it was the American Veterinary Medical Association which turned 150 years old, celebrating with a traveling Smithsonian exhibition and a commemorative book. (Cavalry horses during Roman times were cared for by practitioners known as veterinarii, suggesting the profession has existed for much longer than 150 years!)

February
The Animal Medical Center created AMC TO THE RESCUE, a new fund to support specialist level treatment of pets that are currently under the care of rescue groups. The goal of the fund is to use AMC specialists to treat correctable medical conditions, making pets, like Frankie, more adoptable into a forever home.

March
In a year without much bipartisan cooperation, two veterinarians, Kurt Schrader, a Democrat, and Ted Yoho, a Republican, joined forces to increase awareness of the role veterinary medicine plays in research, public health, animal health and welfare, food safety, and the economy.

April
Starting in April, therapy dogs were almost continuously in the news. They arrived in Boston to comfort survivors of the Boston Marathon bombing. Later in the month, therapy dogs were called to Texas in the aftermath of a fertilizer plant explosion. Finally, therapy dogs took up residence at LAX to de-stress airline passengers.

May
If April was for dogs, then May was for cats. The Cannes Film Festival is always newsworthy, but this year not because of a Hollywood starlet, but because of a small ginger tom cat who starred in the Coen brothers’ film, Inside Llewyn Davis. Tama, a Japanese calico cat, was credited with saving a cat-themed train station from closure.

June
Therapy dogs made the news again in Michigan for supporting anxious victims of violent crimes during courtroom testimony.

July
Veterinarian Dr. Ernie Ward sits in a hot car with the window cracked for 30 minutes while the temperature climbs to 116 degrees Fahrenheit to demonstrate how dangerous leaving your dog in a parked car can be.

August
Cat DNA, sent to the Veterinary Genetics Laboratory at the University of California, Davis, became key evidence used in a 2012 British murder case. Scientists in the lab identified the hairs on fabric wrapping the body as coming from the murderer’s cat.

September
News of a new and potentially lethal dog virus spread like a contagion on the Internet. But by late fall, veterinary researchers determined circovirus was not a significant threat to canine health.

October
One of the most visible victims of the government shutdown was the National Zoo’s Panda Cam. Sixteen days later when the camera again rolled, one tweet rejoiced that “our long national nightmare is over.”

The Urban Resource Institute (URI) and Purina teamed up to support victims of domestic violence through URIPALS, New York City’s first initiative to allow victims of domestic violence to enter shelters with their pets. Purina donated much-needed welcome kits and educational materials for families entering URI’s largest domestic violence shelter.

November
The Animal Medical Center hosted the Third Annual Zoobiquity Conference, along with UCLA and the Wildlife Conservation Society. The Conference explored the diagnosis and treatment of disease from the perspective of both physicians and veterinarians.

December
Rosie and Clarence, the first two official police comfort dogs, were honored at The AMC’s annual Top Dog Gala. These canine officers received the Top Dog Award for their support of first responders at critical incidents and traumatic events, including the aftermath of the Sandy Hook Elementary School tragedy and the Boston Marathon bombing.

…and, we “Pawse to Remember”
No end of the year retrospective would be complete without acknowledging the passing of those who led notable lives:

  • Tuxedo Stan, former Halifax, Nova Scotia mayoral candidate.
  • Kaiser, a World Trade Center search and rescue dog and 2011 AMC Top Dog Gala honoree.
  • George, who held the Guinness Book of World Record’s title of tallest dog.
  • Barney Bush, the AP reporter-biting former FDOTUS.
  • Brian Griffin, canine family member on Family Guy.

Wishing you and your families the very best this holiday season and a healthy and prosperous New Year!


National Veterinary Technician Week 2013

October 15, 2013
Christina and a patient in ICU.

Christina and a patient in ICU.

This week, October 13-19, is National Veterinary Technician Week when we honor veterinary technicians or nurses for their role as critical members of the veterinary healthcare team. The technicians at The Animal Medical Center are a unique group in many ways.

A whole lotta’ techs
The AMC employs 75 technicians, each and every one licensed by the State of New York. These critical veterinary team members provide exceptional care to your pets no matter if it is high noon or 3 o’clock in the morning. The lowest number of technicians on duty in the hospital at any time during a 24 hour cycle is at 3 am when there are eight licensed veterinary technicians on the premises. These multi-tasking technicians run lab tests, take x-rays and provide compassionate patient care 24/7.

Trish and a canine patient.

Trish and a canine patient.

Big skill set
Because The AMC is a specialty hospital, our technicians learn specialized skills to support the veterinarians and patients on their team. We have technicians trained to perform hemodialysis, administer chemotherapy, prep patients for surgical procedures and assist in the operating room. Technicians maintain our delicate equipment like endoscopes and cage-side laboratory equipment to keep us ready for any emergency situation. Some of our long term technicians have worked in multiple areas throughout the hospital and have multidisciplinary skills, including care of exotic pets, plus administering radiation treatments or evaluating intraocular pressure and blood pressure!

Frankie assists Dr. Quesenberry with an examination of a swan

Frankie assists Dr. Quesenberry with an examination of a swan

Lifelong learning
Continuing education is required to maintain a veterinary technician license in New York State. To facilitate continuing education credits for our technicians, The AMC sponsors lectures on topics important to technicians, such as diabetes and heatstroke, through our Partners in Practice lecture series, and welcomes the participation of technicians from other veterinary practices as well. On a national level, the numbers of specialty certified technicians is small, but growing. The AMC is leading the pack with some of the first North American Veterinary Technician Academy (NAVTA) certified specialty technicians in the country. We currently have a total of five NAVTA certified technician in emergency critical care and anesthesia. The Tina Santi Flaherty Rehabilitation & Fitness Service has two technicians certified as Canine Rehabilitation Assistants and more in training.

A heartfelt thank you to vet techs everywhere
On behalf of veterinarians and the patients who benefit from the skills and knowledge of our technician team members, thank you for your hard work and dedication. Pets and vets need techs because we can’t do it without you.


Pet Insurance: FAQ from The AMC

August 21, 2013

Pet-Insurance2The webmaster at The Animal Medical Center fields questions related to pet health from all over the world. Many of the recurrent questions are related to pet health insurance. Here are the answers to a few of the most common pet health insurance questions.

What insurance policies does The AMC accept?
Pet insurance is different than human insurance. My doctor’s office has negotiated contracts with several insurance companies; therefore, she cares for patients who purchase policies from those companies. The contract in pet insurance is between the pet owner who purchases the policy and the pet insurance company. The AMC provides information and invoices to the pet owner, who in turn submits a claim to their pet’s insurance company and is reimbursed for their expenditures by the insurance company.

What will pet insurance cover?
Coverage depends on the company and the details of the policy. Trupanion policies focus on coverage for illness and recovery rather than preventive healthcare. The ASCPA policy, underwritten by the Hartfield Group, has several different levels of care, two of which include coverage for preventive healthcare.

How much do policies cover?
Commonly, policies state they reimburse 80-90% of customary and usual charges for covered services. Each veterinary hospital sets its fees to reflect their costs of operation. If you live in a city where the cost of living is high, ask if the insurance company has higher “customary and usual charges” for calculating your level of reimbursement. Alternatively, ask a prospective insurer what percentage of submitted claims is paid out to pet owners in your area. Healthy Paws reimburses based on the actual veterinary bill as do a couple of other companies. Some companies have annual or lifetime caps on total payments. Others cap payments for specific conditions.

Can I get pet insurance for all my pets?
All companies insure dogs and cats. Insurance for the other members of Noah’s crew, including birds, reptiles, small mammals, marsupials, amphibians, rodents and lagomorphs is available only through VPI, the oldest pet insurance company in the United States.

What about coverage for pre-existing conditions?
Again, this type of coverage varies from policy to policy. For example, some policies exclude genetic conditions, such as elbow dysplasia and hip dysplasia, from coverage. If your dog has already had a cruciate ligament repaired on the left and the right cruciate ligament ruptures, he will not be covered by all policies as some consider cruciate disease to be a bilateral disease. Pets Best seems to be one exception to this exclusion.

Another point to keep in mind: your veterinarian may recommend therapies not covered by your policy. If she does, your claim would be denied. Before you renew your policy, ask if any illnesses reimbursed in the previous policy cycle will be excluded as pre-existing conditions once your renew.

Surprising coverage
I found several interesting features of the policies I reviewed. Pet’s Best lists coverage for some groundbreaking treatments, like stem cell therapy for feline kidney disease. I found a 13 page list of medications covered by one plan, and another with coverage for boarding if you are hospitalized and need to board your pet.

Employee Benefit?
A recent news article highlighted increasing numbers of companies offering pet insurance as an employee benefit. Check with your human resource department before you select a policy for your favorite fur person.

Final word: Read the policy carefully
I found at least one policy that does not cover two common (and costly) problems of older dogs and cats: heart disease and diabetes. Cancer is another group of diseases which are not covered by all policies; although many policies can be upgraded to cover cancer diagnosis and treatment.


Choosing a Veterinary Hospital

July 31, 2013

Exotics1Is there a new puppy in your family? Has the backyard cat installed himself on your family room sofa? Have you inherited grandma’s piano and her parrot? If so, you won’t want to leave the important decision regarding the choice of your new pet’s healthcare provider to chance. Here are some tips for choosing the right veterinarian and veterinary hospital for your pet.

Location, location, location
In Sunday’s New York Times, healthcare reporter Elizabeth Rosenthal, talks about choosing a hospital for your own care. She writes, “Indeed, with thousands of good hospitals across the nation, the best selling point for routine medical care may simply be convenience…” Whether or not you agree with her point of view regarding your personal healthcare, proximity may be a consideration in choosing a primary care veterinarian. A new puppy will need several rounds of vaccines and a spay or neuter surgery requiring transporting the pet to and from the hospital on multiple occasions. But if you have a parrot, the closest veterinary hospital may not have a veterinarian with expertise in avian medicine and you will need to choose a clinic providing bird care, not necessarily the closest clinic.

Proximity plays an even more important role in the selection of an emergency hospital. When your pet is hit by a car and in shock, has serious bleeding or can’t breathe, time is of the essence and the closest animal ER is the best ER for your pet.

Assessing hospital quality
If you personally needed a heart valve replacement, for example, you might look for data on outcome for valve replacement surgery at the various hospitals in your area. In New York State we have the New York State Hospital Report Card. You could also search the doctor ratings on the website of your healthcare provider. Since this type of information is lacking for veterinary hospitals, you might turn to online sources to read the opinion of pet owners who have posted their experiences. I must admit, to me, these online reviews can often seem more like rants and may not provide the objective information you need to guide your pet healthcare decision making process.

A better method of assessing hospital quality would be to look for a hospital accredited by the American Animal Hospital Association (AAHA). Their website also allows you to search for the AAHA accredited hospital nearest you. Choosing an AAHA accredited hospital assures pet owners that the hospital they select has the staff, equipment, medical procedures and facilities that AAHA believes are vital for delivering high-quality pet care. The Animal Medical Center has been AAHA accredited since 1976, and to maintain our accreditation we voluntarily receive triennial evaluations on over 900 standards of small animal hospital care.

Finding the right specialist
The easiest way to find a specialist for your pet is for your primary care veterinarian to recommend one she works with on a regular basis. This will ensure a good line of communication and seamless medical care. If your veterinarian doesn’t have a recommendation:

  • Search the website of the type of specialist you are looking for, e.g. veterinary cardiology, veterinary surgery or veterinary dentistry.
  • For a cutting edge therapy, you might have to travel a good distance to find the specialist your pet needs. Use a scientific search engine like PubMed or Google Scholar. Search for the procedure your pet needs. When the search identifies a particular hospital where the procedure is commonly performed or a veterinarian who is a frequent author of scientific articles on the procedure, focus your search on this clinic or veterinarian. Examples of this type of procedure include repair to a ruptured ligament in the knee or image modulated radiation therapy.

Quick tips on finding the right veterinary hospital

  • Know where the closest animal ER is and keep its address and phone number in your GPS device, cell phone and on the refrigerator list so you are prepared for an emergency.
  • Don’t be afraid to visit potential veterinary hospitals before booking an appointment. Find out if their clinic schedule matches your availability. Ask the receptionist about their preventive healthcare protocols.
  • In case your pet develops an unusual medical condition or requires specialized surgery, ask your trusted primary care veterinarian about the network of specialists they recommend.

International Health Papers: How to Avoid a Justin Bieber Epic Fail

May 21, 2013
Justin Bieber and Mally

Justin Bieber and Mally

International travel with pets is a complicated affair. Each country has its own set of rules about vaccinations, blood tests, deworming and microchipping. For island countries free of rabies, an elaborate scheme of testing and vaccination is required to prevent a dog or cat from introducing the disease to the country.

Some families handle the international health paper requirements better than others. Take for example Justin Bieber and his pet Chapuchin monkey, Mally. Passports are required for band members on the Believe Tour to enter a foreign country, and Mally the monkey needed special health papers to enter Germany. The problem was, proper papers were lacking and Mally’s concert touring days prematurely ended. Apparently, Mally remains overseas.

Here’s a better story of a family that did their homework regarding international pet travel. Today I saw a cute dog named Avatar, in need of an international health certificate. One of the requirements for entry into her home country is a health certificate signed by an accredited veterinarian. Not every veterinarian is accredited by the United States Department of Agriculture (USDA), but this family knew to ask for an accredited veterinarian because they had carefully researched this information.

Avatar came to my office with a pile of papers carefully detailing all her vaccinations. I need this information to be sure she meets the entry requirements and to document vaccinations on the international health certificate. Another requirement for Avatar’s destination country is vaccination against leptospirosis. Leptospirosis is an infectious disease caused by a bacteria spread in the urine of wild animals. Happily, the paperwork indicated a vaccination against leptospirosis and I quickly checked off that requirement.

Avatar’s destination country did not require a microchip, but documentation of a microchip is a common requirement for entry into many countries. Some countries also have their own import paperwork, but Avatar’s accepted the USDA form. Once I signed off on my part of the health certificate, Avatar had another stop: the USDA area office at JFK Airport, where she received the endorsement of their New York area veterinarian.

How can you avoid a Bieber epic fail when traveling internationally with your pet?

  • Start early to ensue you have enough time for required testing or vaccination protocols.
  • Do your homework. Start with the USDA’s Animal and Plant Health Inspection Service website and the website of your destination country for pet import requirements.
  • If you need the signature of an accredited veterinarian like me, check to see if your veterinarian is accredited or ask for a recommendation.
  • Keep your pet up to date on vaccinations and other preventive health care measures to avoid any delays in getting your pet’s international health certificate.

Household Cleaning Products: A Pet Danger

May 8, 2013
X-ray of a cat that has eaten a metal mesh scouring pad

X-ray of a cat that has eaten a metal mesh scouring pad

It’s spring cleaning time, but if you have pets please clean cautiously since some of the most common cleaning agents can be toxic to your pet. Birds are especially sensitive to the fumes from household cleaning agents.

Chlorine bleach has an extremely wide spectrum of activity against common bacteria and viruses. Its low cost makes bleach an attractive disinfectant and laundry additive. Bleach disinfects by oxidizing cell membranes, rupturing and killing cells. Bleach has the same effect on the gastrointestinal tract if your pet drinks undiluted bleach or chews on the bleach container. A splash of bleach into the eye of a curious pet can cause tearing, irritation and even an ulcer.

Some websites recommend the use of phenol-containing pine scented cleaners as a deterrent for cats who urinate outside their litter boxes. If you use these products, you may no longer have a healthy cat and the litter box issues will seem insignificant. When walking across your freshly mopped kitchen floor, your cats get phenol on their feet. Phenol is caustic to the delicate paw pads. Then, when cats groom, they ingest the cleaner which damages their liver and kidneys. When compared to dogs, cats are extremely susceptible to phenol toxicity since their liver lacks an important enzyme for metabolism of phenol.

Although not technically toxic, steel wool and metal mesh scouring pads can cause intestinal obstruction if consumed by your pet. At first glance these products do not have much culinary appeal, but when encrusted with steak bits from the grill or some scrambled eggs from the frying pan, a scouring pad becomes a tasty treat for your dog or cat. As you can see in the x-ray, the scouring pad unravels and prevents food from normally passing though the intestine. The sharp strands can also slice into the intestinal wall. Emergency surgery is required for removal.

Quaternary ammonium compounds are disinfectants with a broad spectrum of antimicrobial activity against bacteria, viruses and fungus. These compounds are popular cleaning agents colloquially called “quats.” Serious injury can result to both pets and people if they inadvertently come in contact with quats. Caustic burns, convulsions, low blood pressure and even death occur following ingestion or contact with the skin.

The AMC Emergency and Critical Care staff recently teamed up to save the life of a young Yorkshire Terrier with severe oral swelling and respiratory distress from ingestion of quaternary ammonium. Read his story: Yorkie Ingests Deadly Poison and Survives.

Not sure if a product is pet-safe? Download the material safety data sheet for any product you might purchase to prevent bringing a dangerous product home.


Resolve to Be a Responsible Pet Owner

January 2, 2013

woman with dog2It’s that time of year again; the time when we make New Year’s resolutions. I seem to make the same ones every year: eat healthier, exercise more, be kinder. My suggestion for 2013 is for every pet owner to be a responsible one. To achieve that goal, the American Veterinary Medical Association has developed a list of guidelines for responsible pet ownership.

Fur the Love of Pets believes this is a good list for pet owners to review before making their 2013 list of resolutions:

Commit

As the holidays approached, I received several tweets discouraging pets as holiday gifts since a pet is a lifetime commitment and acquiring one should not be an impulsive decision. You must choose the right pet for your lifestyle and should have as many pets you can comfortably care for, both physically and financially.

Good pet care involves more than food and water. A successful pet parent provides exercise, a stimulating environment and training.

Invest

Having a pet requires an investment of both time and money. Preventive healthcare saves money in the long run and helps prevent costly emergency visits.

Although vaccinations are part of a preventive healthcare program, the rabies vaccine protects human health as well.

Identify

Every pet should have both permanent and temporary identification. Permanent identification should preferably be a microchip, but a tattoo is a viable alternative. A collar with tags is a good temporary and immediate method of letting people know where your pet belongs if he should become lost.

Limit

Help decrease the nation’s pet overpopulation problem by spaying or neutering your pet. Preventing unwanted litters limits the number of animals entering shelters each year.

Prepare

Prepare for your pet’s future like you prepare for your family’s future. Assemble a “go bag” for your pet. Include your pet in estate planning; don’t assume your family is prepared to add your pet to their household and make provisions for your pet in case you can no longer be the primary caretaker.


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