Shedding Light on Feline Hairballs

April 22, 2015

Feline HairballsHairball Awareness Day is April 25th. Most of us become aware of hairballs in the middle of the night, either when we hear that characteristic yacking sound made by a cat about to deposit a hairball on the sheets or as we inadvertently step on a cold, slimy furball deposited on the darkened bedroom floor.

Even though cat families believe hairballs are a common problem, a survey of British cats found most had never vomited a hairball – at least that their family discovered. Intuitively, the same study found long haired cats were more likely to vomit hairballs than short haired cats.

Why do cats get hairballs?
Cats may spend as much as 25% of their waking hours grooming. When a cat grooms, the barbs on her tongue act as a comb and brush. The shed hairs get caught in the barbs and are swallowed. In normal cats, ingested hair is excreted in the stool. Because most ingested hair is excreted in the feces, an uptick in the frequency of hairball production suggests a problem in your cat.

Can hairballs indicate a medical problem?
The simple answer is yes. Formation of hairballs suggests a cat is suffering from excessive hair ingestion or is not excreting ingested hair normally. Excessive hair ingestion can result from overzealous grooming behavior leading to hairball formation. Excessive grooming is a clinical sign of several feline health concerns such as fleas, itching due to allergies, an overactive thyroid gland, food sensitivity or stress.

Decreased grooming behavior is frequently a sign of illness in cats. If the illness progresses, hair mats develop. Once the cat resumes grooming, hairballs may form and you may also notice increased hair in your cat’s stool.

An increase in the frequency of hairball vomiting may also signal some sort of gastrointestinal problem preventing normal passage of hair out in the stool. My patient Sunshine developed an intestinal obstruction from a hairball when intestinal lymphoma disrupted her ability to pass hair in her stool.

Cat families often talk about “coughing” up a hairball, but if your cat is coughing, that is a completely different problem that should be brought to your veterinarian’s attention.

What can cat families do to minimize hairballs?

  • Control loose hair with regular brushing. Don’t just smooth over the top coat, but use a deshedding tool to remove dead undercoat. Many cat resist brushing, so start with short grooming sessions and use rewards liberally.
  • Feed commercially available food, treats and supplements formulated to improve intestinal motility and facilitate hair excretion.
  • Consider a lion cut to decrease the amount of hair ingested. Check out a photo of my patient Toby who tangled with a nasty hairball and now routinely gets clipped.
  • An increase in hairball vomiting can be a sign of illness. Report any increase to your cat’s veterinarian.
  • Ask to your veterinarian about medications that might help facilitate hair movement through the intestinal track.

Blindness in Pets

March 25, 2015
Smiley

Smiley

Smiley, a blind Golden Retriever therapy dog and former puppy mill rescue, recently became an internet sensation. Born without eyes, Smiley bonded with a deaf Great Dane after he was rescued from the puppy mill. According to reports, the relationship drew Smiley out of his shell and turned him into a confident therapy dog, sharing his smile at schools, nursing homes and libraries.

Forms of Blindness
Smiley was born without eyes – medically known as ocular agenesis, but blindness in pets takes many forms. High blood pressure, especially in cats with kidney disease, causes blindness. The increased blood pressure causes vision loss from retinal detachment and intraocular hemorrhage. Chronic herpes infection in a cat’s eye can cause corneal ulcers that are painful, difficult to heal and which can lead to blindness. A lack of tear production or dry eye predisposes dogs to corneal ulcers and scarring, and if left untreated, blindness. Both dogs and cats develop glaucoma, a painful swelling of the eye. If the swelling cannot be controlled, glaucoma can rob pets of their vision.

AMC TO THE RESCUE Helps
Doc, a mixed breed puppy, had developed glaucoma, a painful increase of fluid inside the eyeball that damages or destroys vision. Doc came to see The AMC’s board certified ophthalmologist, Dr. Alexandra van der Woerdt, through a joint effort between AMC TO THE RESCUE and Doc’s rescue group, Louie’s Legacy. AMC TO THE RESCUE funds specialty care to rescued pets whose medical conditions form a barrier to their adoption, preventing them from finding a forever home.

Dr. van der Woerdt determined Doc’s vision could not be saved, and because his eyes were painful, she outlined three options to make him pain free. First, surgical enucleation, or total removal of the eye; second, chemical ablation, where a substance is placed into the eye to destroy the fluid-producing tissue, lowering the pressure inside the eye; and finally, placement of an intraocular prosthesis. This device maintains blinking eyeball shape, but removes the “insides” of the eye so fluid is no longer produced and the eye is no longer painful. Doc underwent surgical enucleation of both eyes.

New Family and a New Name
Doc is now Zach, the name bestowed by his new family who adopted him shortly after the enucleation surgery. A new name is fitting since Zach is a new dog because he no longer suffers from painful eyes. Zach’s new family says, “He is doing super well. He loves to wrestle at the dog park and can navigate around our house and neighborhood with ease. Most people don’t even notice that he is blind!”

AMC TO THE RESCUE is proud to have helped turn one more unadoptable rescue dog into a beloved family pet. For more information about this vital Community Fund, or to donate, please visit our website.


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.


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.


Holiday Gifts for Pets

December 3, 2014

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.


What Does a Vet Tech Do?

October 8, 2014

Pet Picnic Perils

August 27, 2014

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


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!


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.


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