Treatment of Allergies in Pets

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

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

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

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

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

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

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

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

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


Flea and Tick Prevention: 2015 Update

April 8, 2015
Photo: Vetstreet.com

Photo: Vetstreet.com

When I started my career as a veterinarian, the options for flea and tick control were limited, smelly and messy. I dispensed cans of spray, bottles of dip, and cartons of powder, but hardly ever prescribed a flea collar. Back then, the collars were not that effective and some thought the only way a flea collar killed a flea was by squashing it when you put the collar on your pet. Thirty years later, the options for pet owners to prevent ectoparasite infestations are infinitely better and way more numerous.

Better flea and tick control has resulted in healthier pets. I used to routinely see dogs and cats crawling with fleas from head to toe. Many developed flea allergic dermatitis, often complicated by a superficial skin infection. While we still see allergies in pets, flea allergic dermatitis is much less common and pets are much more comfortable, thanks to these new products.

Top Spot Products
The big revolution in flea and tick prevention started when top spot products were introduced. These are the little tubes of liquid that come in multipacks for monthly application to the nape of your pet’s neck. The product then distributes throughout the haircoat and kills fleas and ticks when they come in contact with the medicine on your pet’s hair. They also come with stickers for your calendar or an app for your mobile device to remind you when to apply the medication. Many of the manufacturers of these products have videos on their website demonstrating proper application of the product.

Oral Flea and Tick Prevention
Oral products can be active against only fleas or prevent multiple species of ticks as well. Most oral products come as tasty chew treats and are administered monthly; although long lasting products are also available. Not all oral products start working instantly. If your pet has a flea infestation because you missed a dose, check with your veterinarian about a rapidly acting oral product for quick flea takedown.

Long Lasting Collars
Unlike the early flea collars, today’s models last for months at a time. Depending on which collar your veterinarian prescribes, modern flea collars may be active against a single species of tick or fleas and multiple species of ticks. If you choose a collar, check the label carefully as some collars may take a week to reach full strength on your pet.

Choosing What’s Right for Your Pet
When selecting from this array of products, consider the following criteria:

  1. Talk with your veterinarian about the types of parasites in your area. Selecting a product with a profile that fits your area’s parasite population is critical.
  2. Top spot products often repel as well as kill fleas and ticks. If you live in a geographic locale with high numbers of fleas and ticks, you might want this added protection.
  3. Certain collars and oral preventatives last for months at a time. If you are busy and forgetful, one of these products might be a good choice.
  4. Not all top spot preparations and collars are waterproof. If your dog is a swimmer, choose a waterproof product or consider an oral flea and tick preventative.
  5. If you have a puppy or kitten, make sure the product you select is safe for the newest family member. Some products are not labeled for pets < 6-12 weeks of age.
  6. Use dog products for dogs and cat products for cats. Never switch, or you may need a trip to the animal ER.

Clinical Research at The Animal Medical Center

April 1, 2015

veterinary researchOne part of The Animal Medical Center’s tripartite mission involves advancing the practice of veterinary medicine through research. Many types of research exist: scientific, historical, social science and economic are just a few examples. The AMC participates in a specific type of scientific investigation called clinical research.

Studying Healthcare
Clinical research asks and attempts to answer questions related to healthcare delivery, and in the case of The AMC, animal healthcare. At various times, the veterinarians at The AMC have studied the impact of new medications, treatment protocols, diagnostic tests and therapeutic devices on canine and feline patients. Clinical research is distinct from, but seeks to improve, clinical care.

Institutional Review Board
Research involving living patients, human or veterinary, happens only after an institutional review board studies and approves the research protocol. This process assures the safety of the patients involved in the project. The review board also evaluates the patient consent document. To ensure the pet’s family understands their family member is part of a research protocol, they must read and sign documents about the planned treatment’s risks and benefits. In any clinical study, a pet owner may withdraw their pet from the study at their discretion.

Abstract Presentation
Another component of conducting research is presentation of the findings to a group of your scientific peers. At The AMC, resident research projects are presented to the entire hospital community. The audience can ask questions and make suggestions to clarify or improve the interpretation of the results. At this year’s Resident Research Seminar, five residents presented their work to the AMC community. They addressed topics such as using MRI and CT scanning for dogs with prolapsed spinal discs, vitamin D levels in ICU patients, blood clotting abnormalities as a result of severe trauma, comparison of continuous infusion versus intermittent diuretic infusion for the treatment of heart failure, and iron supplementation in cats with cancer. The results from the studies help AMC veterinarians to improve patient care and when published, influence the care of pets everywhere.

Publish or Perish
The final step in any research project is to publish the results in a peer reviewed journal. Peer reviewed means just what it says. Expert veterinarians review the manuscript for bias in research methodology, statistical analysis and conclusions. They recommend changes to improve the final publication and once those changes are made, approve the final manuscript, which is ultimately published for all interested in the topic to read.

Recent Publications
Here are summaries of some recent AMC resident research project publications:


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


Erin Go Daugh!!! St. Patrick’s Day for Pets

March 12, 2015

St. Patrick's Day for PetsNew York City, and other cities are about to get green. Not green with envy or ecologically green, but St. Patrick’s Day green. Many of us will don green hats or a sweater with an embroidered shamrock emblazoned on the front. Pets wearing St. Patrick’s Day finery are adorable, but some of the other St. Paddy’s Day traditions can be downright dangerous for pets.

Green Beer and Irish Whiskey
For those hosting a St. Patrick’s Day party, monitor the coffee table and other low surfaces for unfinished alcoholic beverages. Your dog might decide to take a nip or two of these available beverages in honor of the Irish saint, but because dogs are smaller than we are and are not used to drinking alcohol, they can quickly develop alcohol poisoning.

Another tip to avoid a pet crisis during your St. Patrick’s Day party: give Fluffy and Fido their own party space away from your guests. Their own space will protect them against unwanted escape as your guests arrive or depart. But just to be safe, be sure your pets are wearing their collars and name tags under their St. Paddy’s Day garb.

Shamrock Plants
The shamrock, or white clover, is a plant traditionally associated with the Emerald Isle and St. Patrick. History suggests the Irish wore shamrocks on their clothing to honor St. Patrick on his feast day. Today, shamrock plants can be found in your neighborhood grocery store and brighten up window sills at this gloomy time of year. Shamrocks contain oxalate which, if the plant is eaten, is irritating to the intestinal tract. Pet familes should find decorations other than live shamrock plants for the St. Paddy’s holiday season.

Irish Soda Bread
Out of financial necessity, the Irish popularized soda bread. Irish soda bread uses inexpensive ingredients like flour, sour milk and a bit of sugar. Today this tasty, raisin loaded loaf appeals to everyone, including your dog. But keep your loaf away from your dog, since ingestion of even a few raisins or currants can permanently damage your dog’s kidneys.

Green Foil Wrapped Chocolate Shamrocks
Leprechauns often leave foil wrapped chocolate shamrocks as gifts in honor of the patron saint of Ireland. They intend for the chocolate to be eaten by humans. Dogs will happily consume the chocolate and the foil wrapping, leading to an upset stomach. If a large number of these chocolate treats are consumed, dogs can become excitable and develop a very elevated heart rate. Find some shamrock shaped dog biscuits if you are looking for a special dog treat.

If you are wearin’ the green be safe and have a happy St. Patrick’s Day!


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.


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