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.


Pumps and Valves: February is American Heart Month <3

February 25, 2015

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

Poor pumping = heart disease in cats <3
The heart is a sophisticated muscle, but it still performs the basic muscle function – contract and relax. When the heart relaxes, the pumping chambers fill. The next muscular contraction expels the blood from the heart into the blood vessels. When the heart muscle is diseased, it can do one of two things – get thicker or thinner. Both are bad. A thick heart pumps less blood with each beat since the thick muscle occupies space inside the heart where the blood to be pumped normally collects. When the heart is thin, the muscles are weak and do not adequately pump blood. Thick or thin, neither heart pumps blood well.

Leaky valves = heart disease in dogs <3
A normal dog heart consists of four chambers, and the flow of blood between chambers is controlled by little valves. Normal valves remind me of alabaster: translucent and white, but unlike alabaster, they are flexible. Especially in small dogs, the valves degenerate as a dog ages, becoming thick and lumpy and inflexible. The distortion of their shape prevents them from closing normally. Abnormal valves leak and blood is not pumped efficiently through the rest of the heart and blood vessels. Over time, the portion of blood leaking out of the heart chambers increases and blood pumped to vital organs decreases.

Congestive heart failure <3
Even though the underlying heart problem in dogs and cats is different, the result is often the same. Poor pumping in cats and leaky valves in dogs can lead to congestive heart failure. These disparate problems both decrease the blood flow to vital organs, such as the kidneys. To compensate, the kidneys retain fluid and when the fluid reaches a critical level, it floods into the lungs, causing pulmonary edema. Acute congestive heart failure is a common reason for admission to the hospital from The Animal Medical Center’s ER. Congestive heart failure can be treated with medications to remove fluid, help the heart pump more vigorously and dilate the blood vessels, allowing them to hold more fluid.

Keeping your pet’s heart healthy <3
I know you want to keep your pet out of the animal ER, so here are some tips for being heart healthy:

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

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

February 18, 2015

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

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

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

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

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

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


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