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.

Is Your Dog Down in the Dumps?

May 29, 2014

depressed dogRecently, I answered questions from a New York Times science writer who inquired about depression in dogs for an article she was writing. The short article received a lot of attention, so I decided to expand on the topic for my readers.

Dogs Have Feelings Too
Depression is a specific psychiatric diagnosis in humans. If you look at the National Institutes of Health (NIH) definition of depression, many of the symptoms of depression cannot be applied to dogs, since they revolve around feelings. While we believe dogs have feelings, they cannot articulate sadness, helplessness, pessimism or suicidal thoughts as would humans suffering from clinical depression.

Yet, there are some signs of depression in dogs similar to those experienced by humans. Their owners may notice abrupt changes in behavior including irritability, loss of interest in activities, decreased energy and changes in appetite, all of which may signify depression. Dog owners frequently report these symptoms in their dog when a child in the family goes away to college, a favorite human or animal family member dies or the family moves to a new home. But because these are non-specific findings, they could be attributed to medical conditions as well. So it is wise to bring your pet to a veterinarian whenever you see behavioral changes in order to rule out illness.

Depression Means Two Things
Because veterinarians use the term “depression” in a different way than physicians do about their patients, some pet owners may misunderstand a diagnosis of depression. Veterinarians use “depressed” to describe one of five levels of consciousness in their four-legged patients:

  1. Normal. Of course there are many variations of normal between pets of the same breed. Veterinarians will require input from owners to determine if the pet is behaving in its normal manner.
  2. Depressed, dull, quiet. These pets prefer to sleep and have responses to stimuli that are appropriate. Animals diagnosed with a disease may be dull quiet, or depressed. A thorough examination of a pet with these signs and symptoms is required to rule out behavior resulting from a change in environment or illness.
  3. Disoriented, demented. This is similar to a dull animal, but responses to stimuli are inappropriate. Pets may be hyperactive, hysterical or irritable.
  4. Stuporous, obtunded. These pets do not respond to normal stimuli but will respond to strong, noxious stimuli such as a toe pinch.
  5. Comatose. These pets are unresponsive to all stimuli.

Not Just Depression
The NIH says depression in humans is often associated with other mental health disorders such as anxiety, post traumatic stress disorder (PTSD), phobias and obsessive compulsive disorders. Veterinarians do diagnose obsessive compulsive disorders, PTSD, aggression, separation anxiety, and noise phobia (commonly fear of thunderstorms) in dogs and urine spraying and predatory aggression in cats. These disorders are commonly treated with antidepressants and behavioral modification therapy, suggesting depression may also be associated with these other mental health disorders in pets.

Antidepressants for Your Dog and Cat
Some of the antidepressants veterinarians use in pets include:

  • Clomipramine [Clomicalm®] is approved by the FDA for treatment of separation anxiety in dogs.
  • Fluoxetine [Reconcile®] is approved by the FDA for treatment of separation anxiety in dogs and contains the same active ingredient as Prozac®.
  • Selegiline (L-deprenyl) [Anipryl®] is approved by the FDA for treatment of cognitive dysfunction in dogs.
  • Nortriptyline, amitriptyline [Elavil®] and doxepin are not FDA approved for use in dogs or cats, but are frequently prescribed by veterinarians “off-label.”

If your pooch is punky or your cat is catatonic, it is important to find out the cause. Have them checked by their veterinarian immediately.

Drug Fright: Scary Medication Labels

April 3, 2013

Everyone has heard them: the rapid fire voiceovers on television advertisements for medications. They sound something like this, “Do not use this medication if you have serious heart disease, suicidal thoughts, liver problems or hangnails. Ask your doctor if this drug is right for you.” If you fast forward through commercials on your DVR and have missed the voiceover, then perhaps you have opened a bag from your pharmacy and found the accordion pleated paper, printed in size two font, containing drug information, warnings, contraindications, precautions, adverse reactions and risks.

Here is a portion of one for a commonly used human medication:

  1. General: Urticaria, drug rash, anaphylactic shock, photosensitivity, excessive perspiration, chills, dryness of mouth, nose, and throat
  2. Cardiovascular System: Hypotension, headache, palpitations, tachycardia, extrasystoles
  3. Hematologic System: Hemolytic anemia, thrombocytopenia, agranulocytosis
  4. Nervous System: Sedation, sleepiness, dizziness, disturbed coordination, fatigue, confusion, restlessness, excitation, nervousness, tremor, irritability, insomnia, euphoria, paresthesia, blurred vision, diplopia, vertigo, tinnitus, acute labyrinthitis, neuritis, convulsions
  5. Gl System: Epigastric distress, anorexia, nausea, vomiting, diarrhea, constipation
  6. GU System: Urinary frequency, difficult urination, urinary retention, early menses
  7. Respiratory System: Thickening of bronchial secretions, tightness of chest or throat and wheezing, nasal stuffiness

Here is a portion of a drug label for a canine chemotherapy agent:

Anorexia, lethargy, vomiting, lameness, weight loss, blood in stool/GI bleed/hemorrhagic diarrhea, musculoskeletal disorder, dehydration, dermatitis, pruritus tachypnea, localized pain, nausea, general pain, polydipsia, pyrexia, flatulence, pigmentation disorder, neutropenia, thrombocytopenia, increased alanine, aminotransferase, hypoalbuminemia, decreased hematocrit, hyperbilirubinemia, increased creatinine, urinary tract infection.

The United States Food and Drug Administration has strict regulations governing drug labels. Drug labels should be accurate and not promotional. The list of possible side effects is comprehensive to help prescribers, like me, alert their patients, like your pet, to possible problems that might arise while the medication is being taken. Without this critical information, you might keep giving a medication that is actually making your pet worse. The information on a drug label helps me to weigh the risk of not treating a disease with benefits of a medication used to treat the disease.

The warning labels for both the commonly used human drug and the canine chemotherapy agent sound moderately frightening and yet these drugs are critical to improving a patient’s quality or quantity of life. What the drug labels can’t substitute for is experience. Once your veterinarian or physician has used a drug on many patients, we know what to expect and what to tell you to expect. Reading the drug label is a good thing since it helps you to recognize any adverse reactions to medications early. Not giving a drug to your sick pet because the drug label is frightening is foolish, unless you tell your veterinarian about your concerns and together you decide the best course of action for your pet. Remember, we love to talk about sick pets and about medications; it’s what we do every day!

Oh, by the way, the human drug with the seven body system long list of adverse effects was Benadryl.

Thiamine Deficiency in Cats: Q & A for Cat Families

March 20, 2013

kittens-in-bedLast week the Food and Drug Administration reported a voluntary cat food recall. The recall was voluntary because routine testing performed by the food manufacturer identified an inadequate amount of thiamine in the cat food. No sick cats had been reported following consumption of the food, but thiamine deficiency in cats can be a serious problem and the company was exercising an abundance of caution.

What is thiamine?

Thiamine is a member of the B vitamin group and is also known as vitamin B1. The liver heart and kidneys are the organs with the highest levels of thiamine. Thiamine and all the B vitamins play a critical role in energy metabolism throughout the body. Thiamine interacts with other B vitamins to improve the efficiency of energy metabolism.

How does thiamine deficiency occur in cats?

  1. Decreased intake. Processing decreases thiamine and additional thiamine is added after processing to be sure our pets’ food has adequate levels.
  2. Destruction by an enzyme known as thiaminase. This enzyme is found in raw fish, shellfish and microorganisms. If you feed your cat raw fish or shellfish, the enzyme could deplete the natural thiamine and lead to thiamine deficiency. Cooking destroys the enzyme.
  3. Increased excretion. All the B vitamins, including thiamine, are water soluble and if your cat consumes more B vitamins than they need, the excess is excreted in the urine. Cats with chronic kidney disease may lose more B vitamins than usual through their diseased kidneys.

How would I know if my cat was thiamine deficient?

If your cat became thiamine deficient, you might notice a decrease in appetite or an increase in drooling. If you have a kitten, it might not grow as expected. The nervous system is most severely affected by thiamine deficiency and you might see weakness, stumbling or convulsions. The handful of cats I have seen with thiamine deficiency held their chins to their chest, or in doctor’s terms had “ventral neck flexion.”

Thiamine deficiency sounds bad. Can it be treated?

Here is the best part of the blog. YES! A simple injection of thiamine under the skin should have a thiamine deficient cat on the road to recovery in a day or so. Thiamine is extremely safe and if your cat’s illness is not caused by thiamine deficiency, the kidneys will filter the excess thiamine and excrete it in the urine with no adverse effects for your cat.

In addition to the FDA website, The AMC website posts food recalls and here is another site that posts information about pet food recalls. If your cat is sick, be sure to tell your veterinarian the brand and flavor of food your cat is eating. If your pet eats a food that is recalled, check with your veterinarian for advice on how best to manage your cat and its diet.

The Compounding Pharmacy Problem: What Pet Owners Should Know

October 10, 2012

A rare form of human meningitis has recently been in the news. The outbreak, believed to stem from fungal contamination of a medication compounded to treat back pain, has resulted in several fatalities. The manufacturer of the implicated medication is not a big pharma or an overseas company; the medication was produced by a compounding pharmacy in Massachusetts. The Food and Drug administration has identified fungal organisms in a sealed vial of methylprednisone acetate produced by the compounding pharmacy.

Pets not affected

This outbreak is unusual since the fungi involved, aspergillus and exserohilum, live in soil and water. Exactly how they came to contaminate the medication is under intense investigation. Since veterinarians don’t treat back pain in dogs and cats with steroids like methlyprednisone acetate injected around the spinal cord, there are no reports of fungal meningitis in pets, but veterinarians do use compounded medications, and understanding their role in managing disease in your pet is important.

Compounding defined

Compounding is the alteration of the original drug dosage form for the purposes of ease of administration or because the original dosage form is unsuitable for the purpose intended. Translated for the pet owner, compounding is flavoring a medication to hide the bad taste, dissolving pills into a liquid to facilitate administration, or putting multiple medications into one capsule to help a pet owner comply with a multidrug treatment protocol. Without a good compounding pharmacy, my job would be impossible.

Compounding dangers

Compounding is not regulated by the FDA because it is a process initiated by prescription and on a case-by-case basis. In veterinary medicine, compounding rules have been stretched in an attempt to create cheaper medications. Some compounding pharmacies offer expensive medications at unbelievably low prices. I suspect these cheaper products are being produced by what is known as bulk compounding from raw materials. Just last week, I had to advise a pet owner against using the compounding pharmacy’s cheaper “house” brand of an expensive medication. That medication is not currently available as a less expensive generic. Although I am sympathetic to the financial burden of treating a pet with cancer, my overriding concern is for the patient and the efficacy and safety of the prescribed treatments. Prescribing an approved medication provides some assurance of efficacy and safety for my patients.

Medication safety

Listen to your veterinarian. If they believe a particular medication is better, ask why. If they are concerned about the safety and efficacy of a compounded medication, I recommend trying to make the standard formulation work for your pet.

Learn more about safely medicating your pet.

Protect Your Pet, Skip the Jerky Treats

September 27, 2012

Recently, the Food and Drug Administration (FDA) issued an update to its ongoing investigation of animal illnesses linked to jerky style pet treats.

One of The Animal Medical Center’s own, Dr. Richard Goldstein, Chief Medical Officer, has been serving as an advisor to the FDA and the American Veterinary Medical Association since the investigation into this issue began in 2007. Dr. Goldstein is internationally recognized for his work during the massive pet food recall related to melamine contamination in 2006.

The FDA has logged an estimated 2,200 reports of pet illnesses related to these jerky pet treats, and Dr. Goldstein was instrumental in first establishing the link between the jerky treats and kidney disease in dogs.

Now, the FDA investigation has taken a new direction. In consultation with NASA, the FDA has expanded its investigation into byproducts of irradiation, which is part of the process used to make jerky treats.

To help keep your pets safe, Dr. Goldstein suggests the following:

  • Immediately eliminate all imported jerky treats from your cats’ or dogs’ diets. Feed them a commercially prepared diet which carries the “AAFCO” (Association of American Feed Control Officials) adequacy statement to ensure it provides all the nutritional requirements your pet needs to stay healthy and strong.
  • If your pet’s jerky treats do not list a country of origin, call the company’s toll free number listed on the bag or box to confirm the country of manufacture.
  • Make your own jerky treats.
  • If you choose to feed your pet a commercial jerky pet treat product, watch for any signs of illness: decreased appetite, decreased activity, vomiting, diarrhea (sometimes with blood), increased water consumption, and/or increased urination.
  • If any of these symptoms occur, stop feeding your pet the treats and see your veterinarian immediately. Take a sample of your pet’s urine to the veterinary visit.
  • Blood tests performed by your veterinarian can help determine if the jerky treats are causing a problem. The tests may indicate kidney disease (increased blood urea nitrogen and creatinine) and increased liver enzymes. Urine tests may indicate Fanconi like syndrome (glucose in the urine).
  • Although most pets appear to recover, some reports to the FDA have involved dogs and a cat that have died.
  • If your pet is diagnosed with a jerky treat-related illness, report that illness to the FDA’s Safety Reporting Portal or call the FDA Consumer Complaint Coordinators.

Pet Medications: 6 Tips to Keep Pets Safe

August 30, 2012

All of us want to give the best and safest medications to our pets. Here are my tips to make sure your pet gets the medications he needs.

1. Approved is easy

Some of the work of selecting safe medications for your pet has already been done for you. The United States Food and Drug Administration (FDA) approves medications for use in pets by a similar process used for human drugs. Animal vaccines receive approval from the United States Department of Agriculture and treatments to prevent ectoparasites, also known as flea and tick preventatives, by the Environmental Protection Agency. Approved medications help you ensure you are administering drugs that have met standards for both safety and efficacy.

2. Don’t play veterinarian and give your own medications to your pet.

Certain human medications can be lethal to pets. For example, acetaminophen (a common brand is Tylenol) in cats, ibuprofen (a common brand is Advil) in dogs. The leading phone call to animal poison control experts is about accidental or owner administered human medications.

3. Human pharmacies

Like nearly all veterinarians, I too prescribe human medications for my patients. I do this for convenience when the pet owner is far from The Animal Medical Center or because there is not a veterinary-approved version of the drug. Human medications are most often a solution for dogs over 40 or 50 pounds, since tablet and pill sizes are too big for cats and little dogs. So if it is Saturday night and your veterinarian tells you to come to the clinic to pick up medication, it is because nothing but a doggie drug or kitty capsule will do.

4. Legal drugs

The law requires all veterinarians to prescribe medications only in the context of a valid veterinarian-client-patient relationship. Translated from the legalese, the statement means I have to examine your pet in order to prescribe a medication. This is all about safety –Fluffy’s safety. Although you are sure she has the same skin condition as last year, I need to be sure you are correct in order to prescribe the medication with the best chance of fixing the problem with the least risk of an adverse reaction.

5. Custom compounding

Veterinarians rely on compounding pharmacies to convert pills and tablets into chicken-flavored liquids, to place multiple medications into a single capsule to simplify medicating the pet with bear trap-like jaws, or to scale down a large tablet for a tiny terrier. Regulations govern compounding like they do for any prescription. Prescriptions for compounded medications can only be written on a case-by-case basis and must be made specifically for an individual pet. Compounded medications may mean the difference between therapeutic success and failure, but because compounded products are not regulated, products may be of variable quality as demonstrated in a recent scientific study of compounded trilostane. Using a pharmacy certified by the Pharmacy Compounding Accreditation Board assures you of a compounding pharmacy that adheres to established principles, policies and standards.

6. Internet pharmacies

The challenge in using an internet pharmacy is finding the right one. Although the prices offered by electronic drug stores are attractive, high-quality service may be lacking. Red flags in online reviews include companies who fill email boxes with spam, distribute counterfeit products, or never ship product at all. I spoke with the CEO of PetCare Rx, Jonathan Shapiro, about how his company ensures the quality of medications they ship. “PetCare Rx purchases product directly from the manufacturer or veterinary purchasing groups to protect our customers from counterfeit products. Consumers should look for an internet pharmacy accredited by the Veterinary Verified Internet Pharmacy Practice Sites (Vet-VIPPS). This accreditation ensures the pharmacy complies with regulations and laws governing pharmacy practice.”

Salmonella in Pets and Humans

May 17, 2012

On April 6, 2012, the United States Food and Drug Administration announced a voluntary recall of Diamond Naturals Lamb Meal and Rice dry dog food. Since the initial recall, several other brands of food manufactured in a South Carolina plant have been voluntarily recalled for possible Salmonella contamination. Voluntary recalls of pet food are not uncommon, but this recall is unusual. Illness in humans, not dogs, prompted the recall.

Outbreak investigation

Scientists at the Centers for Disease Control checked the genetic fingerprint of the Salmonella found in the dog food against a national database of foodborne infections and found people infected with an identical bacterium. Because the Salmonella isolated from the dog food and the people is a rare type, the humans were interviewed to determine if there was a common source of infection. These interviews revealed many of the infected people had been exposed to dogs and the brand of dog food included in the initial recall. Subsequent recalls have all involved food manufactured in the same facility.

Why did people get sick?

This medical mystery seemed backwards to me. I could understand if my dog and I both got sick from some food I slipped her at the table, but I would suspect hardly any of us grab a handful of tan nuggets from our dog’s bowl as a quick snack.

So to help me understand, I called my sister, Mary Hohenhaus, MD, FACP, who is also a board certified internist (but for people) with Brigham and Women’s Physicians Organization in Boston.

The other Dr. Hohenhaus says:

Salmonella bacteria are a leading cause of infectious gastroenteritis in humans – more than a million cases in the U.S. each year. Symptoms include diarrhea, cramping, and fever starting anywhere from 12 to 72 hours after exposure.

Catching Salmonella is easy only if the bacteria can find their way into your mouth. I use a scoop to measure out dry food for my cat, but I could just as easily grab a handful of kibble for Sam’s bowl – and if the next thing I did was grab a handful of grapes for my breakfast, I could be in trouble.

Food and water contaminated with animal feces are a common source of Salmonella infection. Outbreaks have been associated with meat, eggs, dairy products, and fresh produce, as well as processed foods. Pet birds and reptiles can carry Salmonella without appearing ill. Feces from infected humans are another source.

Many infections are mild and don’t come to medical attention. Most people get better within a week just with extra fluids and rest. Children, the elderly, and people whose immune systems don’t work well are more likely to have severe cases of Salmonella, where the bacteria enter the bloodstream. These people need intravenous fluids, antibiotics and close monitoring in a hospital.

This current outbreak is a good reminder that Salmonella can show up in some surprising and unexpected places. It also reminds us that contaminated foods look, smell, and taste perfectly normal. The best protection against Salmonella and many other infections is common sense: keep your hands clean (and out of your mouth) and practice food safety.

When should you wash? After using the toilet, before preparing food, and any time your hands are visibly soiled are a must. Don’t forget to wash after playing with pets, not just after poop-scooping. A pocket-sized bottle of hand sanitizer is a great addition to your daily walk with Fido.

In the kitchen, wash utensils and work surfaces thoroughly after handling raw meat and eggs and before preparing produce – especially important if fruits and vegetables will be served raw. Thoroughly cook meat and eggs, and be sure to serve hot foods hot and cold foods cold. For more information click here.

This Dr. Hohenhaus is worried about dogs

Although the Salmonella cases making the news are human, dogs can also contract Salmonella after eating tainted food. Veterinarians in New York City are required to report certain diseases to the Department of Health and Mental Hygiene just like physicians are. We report zoonotic diseases, diseases transmitted between animal and humans, which include: Salmonellosis, tuberculosis, Rocky Mountain spotted fever, and leptospirosis.

I contacted one of my colleagues at the New York City Department of Health and Mental Hygiene, Dr. Sally Slavinski, Assistant Director Zoonotic, Influenza and Vector-borne Disease Unit, and she says no canine cases associated with this recall have been reported to the DHMH. I do have veterinary colleagues out of state who have seen a smattering of dogs they believe contracted Salmonellosis from the recalled foods.

Prevention in pets

For tips on preventing foodborne infections in your pets, click here.

Urine Dribbling: Plugging the Leaking Dog

December 14, 2011

Willa came to The AMC today. Her owner was worried she might have diabetes because the dog bed was smelly and soaked with urine the last couple of mornings. Dogs with diabetes (and cats too!) will drink and urinate excessively, often having accidents in the house. When I questioned Willa’s owner, the “accidents” only happened when the dog was sleeping and there was no increase in water consumption or urinations. A quick test of the urine the owner brought with her dog determined diabetes was not the problem.

Causes of Urine Dribbling
Simple and complex disorders can lead to urination abnormalities in dogs. Infections, bladder stones and hormone problems are common causes of urine leakage and can readily be identified with routine blood tests, analysis of urine and x-rays. The x-ray to the right shows a dog with four large stones in its bladder. In some cases, a special diet will dissolve bladder stones. In this case, surgical removal of the stones resolved the urine dribbling.

In Willa’s case, testing showed no urinary tract infection, no stones and no blood test abnormalities. Because she is an older spayed female dog, I thought she might have “urethral incompetence.” Large breed, older, spayed female dogs are at risk for developing this condition, which may be related to a lack of estrogen in spayed female dogs and occasionally neutered males.

Treatments for Urine Dribbling
Commonly it is treated with medications including drugs to tighten the urethra (known as α-blockers), such as phenylpropanolamine, ephedrine or pseudoephedrine, or with estrogen replacement therapy using diethylstilbestrol. Recently, the Food and Drug Administration approved estriol for use in dogs.

If your dog resists taking medications, specialists at The Animal Medical Center can inject collagen into the urethral wall using special noninvasive endoscopic equipment to help narrow the urethral lumen and prevent urine dribbling. For refractory cases, AMC specialists also use a hydraulic urethral occluder.

Willa quickly responded to treatment with estrogen and once again has a dry bed in the morning. With all these options available to plug the leak, no dog should have to suffer with a stinky, wet bed.


This may also be found in the “Tales from the Pet Clinic” blog on

For over a century, The Animal Medical Center has been a national leader in animal health care, known for its expertise, innovation and success in providing routine, specialty and emergency medical care for companion animals. Thanks in part to the enduring generosity of donors, The AMC is also known for its outstanding teaching, research and compassionate community funds. Please help us to continue these efforts. Send your contribution to: The Animal Medical Center, 510 East 62nd Street, New York, NY 10065. For more information, visit To make an appointment, please call 212.838.7053.

The Danger of Xylitol to Your Dog and Ferret

September 26, 2011

My regular trip to the grocery store this week brought a health risk for dogs and ferrets to the forefront of my mind.

As I was standing in the checkout line, I noticed a number of hard candies and mints with xylitol on the label. Xylitol may help keep us slim and protect our teeth, but it is deadly for our dogs and ferrets. The Animal Medical Center’s Emergency Service has seen several dogs suffering from xylitol-induced illness. The danger is serious enough to have caused the FDA to issue a warning to pet owners because xylitol poisoning is on the rise.

Xylitol is an organic compound and a naturally occurring sugar alcohol used as a low calorie sweetener. Chewing gum and candies are commonly sweetened with xylitol. Recipes abound on the Internet for home baked treats using the sweetner as an ingredient. Medical products such as throat lozenges, cough syrup, children’s multivitamins, toothpaste and mouthwash contain xylitol because it helps prevent tooth decay.

When a dog or ferret consumes xylitol, blood sugar drops dangerously low (hypoglycemia) and can result in seizures. Even if the hypoglycemia is reversed with administration of intravenous sugar (glucose), there is still the potential for development of liver failure and death.

If your dog inadvertently ingests one of the many xylitol-containing foods, medications or any other potentially toxic substance, go to an animal emergency room immediately as the drop in blood sugar occurs very quickly. Take the package, bag or box containing the xylitol product with you. The information on the package will help when your veterinarian contacts one of the animal poison control services included in the links below. These services are open 24 hours a day to advise pet owners and veterinarians on optimal management for pet poisonings.

For more information on other foods toxic to pets, visit:

Fur the Love of Pets: Kitchen Catastrophies

ASPCA: Poison Control

MSPCA Angell Poision Control Hotline

Pet Poison Helpline


This may also be found in the “Tales from the Pet Clinic” blog on

For over a century, The Animal Medical Center has been a national leader in animal health care, known for its expertise, innovation and success in providing routine, specialty and emergency medical care for companion animals. Thanks in part to the enduring generosity of donors, The AMC is also known for its outstanding teaching, research and compassionate community funds. Please help us to continue these efforts. Send your contribution to: The Animal Medical Center, 510 East 62nd Street, New York, NY 10065. For more information, visit To make an appointment, please call 212.838.7053.

Traditional Chinese Medicine and Cancer Therapy for Your Pet

March 3, 2011

My inspiration for today’s blog post comes from two wonderful patients of The Animal Medical Center, Baby and Basil, who benefited from both traditional Chinese medicine and Western chemotherapy during the management of their cancer and inspired me to research the topic further.

Basil/Photo: Dr. Steven Chiros

Traditional Chinese medicine is an alternative medical system different from our more familiar Western medical system. Traditional Chinese medicine is based in the Taoist religion and encompasses acupuncture, herbal therapy, mind-body therapy and Chinese massage, Tui-na. Although these treatment modalities have been used to treat diseases for five millennia, their use is not widespread in the Western world.

Despite this, there are people in the West seeking traditional Chinese medicine for themselves and requesting the same for their pets.

Some traditional Chinese therapies have been used in pets. Acupuncture is one of them. According to the Leukemia and Lymphoma Society, acupuncture has been shown to be safe in human cancer patients and may help to ameliorate treatment associated nausea.

The AMC’s acupuncturist, Steven Chiros, DVM, CVA used acupuncture to help decrease Basil’s nausea, improve her appetite and increase her energy. The photo of Basil shows an acupuncture treatment in progress. In addition to acupuncture, Basil received two Chinese herbal formulas. Basil’s owner reported a significant improvement from the two therapies. Based on its safety in humans with cancer and experience with acupuncture in my patients, I do not hesitate to have my patients see AMC’s acupuncture specialist.

Baby/Photo: Leo Weinberger

Baby was a cat with intestinal cancer whose Chinese medicine practitioner referred him to The AMC for treatment with Western medicine chemotherapy in addition to the traditional Chinese therapies. Baby received an herbal antioxoidant, coenzyme Q and other herbal therapies as well as well as traditional chemotherapy. The use of Chinese herbal therapies in cancer patients is not as straightforward as the use of acupuncture.

Herbal therapies must be carefully selected in pets on chemotherapy. Strong evidence exists indicating St. John’s wort (Hypericum perforata) extract decreases blood levels of various anticancer agents in human cancer patients and this herb should not be used in conjunction with chemotherapy. Other herbs, such as ginko, may decrease the ability of the blood to clot, resulting in excessive hemorrhage during surgery.

Investigation of natural compounds active against cancer is currently an area of enormous interest. Between 1981 and 2002, 62% of cancer drugs approved by the FDA were of natural origin. Today, the National Cancer Institute Office of Cancer Complementary and Alternative Medicine is funding studies on tumeric (Curcuma longa), a spice commonly used in African and Asian cultures, often as a component of curry powder, and in traditional Chinese medicine.

In the November issue of the American Journal of Veterinary Research, a laboratory study showed the carotenoid lycopene slowed growth and killed canine bone tumor cells grown in cell cultures. Even more promising was the fact that lycopene did not interfere with chemotherapy drug effects on the tumor cells. These are hopeful findings, not yet ready to be translated to use in clinical patients.

Right now, what is critical to treatment success is an open dialogue between your veterinarian and your traditional Chinese medicine practitioner. Be sure to tell them you are giving your pet herbs or they are undergoing chemotherapy.

This blog may also be found in the “Tales from the Pet Clinic” blog from WebMD.


For over a century, The Animal Medical Center has been a national leader in animal health care, known for its expertise, innovation and success in providing routine, specialty and emergency medical care for companion animals. Thanks in part to the enduring generosity of donors, The AMC is also known for its outstanding teaching, research and compassionate community funds. Please help us to continue these efforts. Send your contribution to: The Animal Medical Center, 510 East 62nd Street, New York, NY 10065. For more information, visit To make an appointment, please call 212.838.7053.

Diatomaceous Earth for Pest Prevention

October 4, 2010

In the past month, The Animal Medical Center has received several inquiries about the use of diatomaceous earth (DE) as a flea preventative. I knew DE was used in swimming pool and fish tank filters, in cat litter and in laboratory studies but I hadn’t heard of using it against fleas. I found some interesting information to share with you.

Diatomaceous earth is composed of the fossilized silica skeletons of a unicellular organism known as a diatom. Diatomaceous earth crumbles easily and has the texture of pumice. Many websites recommending natural and organic medications suggest a host of medical uses for DE. Although DE is GRAS (Generally Recognized as Safe) by the FDA and some forms of DE are considered food grade, there are no FDA approved DE compounds for the treatment of diseases or for parasite control.  

Food and Drug Administration approval of a medication assures the consumer and the prescribing veterinarian that the product meets certain safety and efficacy standards.  In the case of flea and tick preventative medications, FDA approval means the medications are tested for safety in both dogs and cats if the medication is approved for use in both species. The manufacturer also has to prove to the FDA that the medication works against the parasite(s) the label says it kills or prevents. Without FDA approval, I don’t have enough information on the dosage, efficacy or safety of a medication to know how much to give, if the product works, or if it will hurt my patient.

Pet owners wishing to avoid chemical flea control don’t have very effective options. Keeping the pet inside and away from other animals will decrease exposure, but in apartment buildings the little critters can travel between apartments in the hallway carpet. Daily vacuuming of your apartment and disposing of the bag will help to decrease the numbers of fleas and eggs in the environment. Finally, using a flea comb daily will decrease fleas and eggs on your pet.
For nearly a century, The Animal Medical Center has been a national leader in animal health care, known for its expertise, innovation and success in providing routine, specialty and emergency medical care for companion animals. Thanks in part to the enduring generosity of donors, The AMC is also known for its outstanding teaching, research and compassionate community funds. Please help us to continue these efforts. Send your contribution to: The Animal Medical Center, 510 East 62nd Street, New York, NY 10065. For more information, visit To make an appointment, please call 212.838.7053.

Pet Food Recalls

June 10, 2010

Yesterday, the Iams Company voluntarily recalled Iams ProActive Health canned cat and kitten food – all varieties of 3 oz & 5.5 oz cans (date on the bottom of the can is 09/2011 to 06/2012). The Iams Company quality assurance team identified a deficiency of vitamin B1, also called thiamine, in this line of cat food. Cats can easily become thiamine deficient. If your cat is eating any of the recalled foods and appears sick in any way, please see your veterinarian immediately. Thiamine deficiency can easily be treated if recognized early. For more information, visit the Iams website.

The Food and Drug Administration (FDA) regulates pet food. Regulations indicate pet food should be sanitary, safe for consumption and truthfully labeled. Unlike FDA approved medications for your pet, food does not have to undergo a pre-market approval process. The FDA regulates pet food labels in two ways. First, pet food must be correctly identified: what’s in it, who makes it, where is it made. Second, the FDA reviews specific health claims of pet food such as “promotes urinary tract health” or “prevents dental tartar.”

A recall can be one of three different types. The most common is a voluntary recall, and this recall is just that type. During a voluntary recall, the manufacturer realizes the food or medication is in some way unsafe and issues a recall. Distributors are alerted to remove unsold product from stores. As a service to consumers, a press release is posted on the FDA website. Less commonly, the FDA can request a recall if their investigation identifies a safety issue with a food or medication. And finally, the FDA has statutory power to mandate a recall.

Pets and humans share a common environment, food and often the same diseases. A human food recall could affect our pets if they were sharing our hamburger that gets recalled. A pet food recall can directly affect us as well. Recalled food can be risky for those handling the food, not just those eating it. For example, pet foods are at risk for being contaminated by a bacterium called Salmonella. Pets eating the food can get sick, and humans who prepare the food for their pet without properly washing their hands after handling the contaminated food could contract Salmonellosis too. Since humans are not eating this food, this particular recall is of consequence only to our cats. The recalled cat food poses no safety issues for the humans in the family.

Here are some suggestions to protect yourself and your pet against food-borne illnesses. Always wash your hands thoroughly after handling any food, especially raw meat. Wash your pet’s food and water bowls daily in hot, soapy water to remove any microorganisms. If your pet’s food smells strange or looks different than it usually does, discard it. Proper storage will protect food against spoiling. Opened wet food should be refrigerated and dry food should be stored in a tightly closed container at less than 80oF to preserve freshness. And finally, always save the label from the food you are feeding as a resource in case the food your pet is eating undergoes a recall.


For nearly a century, The Animal Medical Center has been a national leader in animal health care, known for its expertise, innovation and success in providing routine, specialty and emergency medical care for companion animals. Thanks in part to the enduring generosity of donors, The AMC is also known for its outstanding teaching, research and compassionate community funds. Please help us to continue these efforts. Send your contribution to: The Animal Medical Center, 510 East 62nd Street, New York, NY 10065. For more information, visit To make an appointment, please call 212.838.7053.

Big News in Cancer Treatment for Dogs!

July 21, 2009


Just last month, veterinary oncology had a first and as a board certified veterinary oncologist, this news just made my day. Until now, all chemotherapy agents administered to dogs were human drugs adapted for use by veterinarians. In June, the Food and Drug Administration’s Center for Veterinary Medicine approved the use of Palladia® (toceranib phosphate) which was specifically developed for use in dogs and has safety and efficacy data from canine studies backing its use. Palladia is licensed for the treatment of recurrent mast cell tumors.

mast-cell-tumorVeterinary oncologists have effective therapies for some dogs with mast cell tumors.  These treatments include surgery, human chemotherapy agents and radiation therapy.  But not all dogs have tumors amenable to surgical removal, not all tumors are in a location where radiation therapy can be safely administered and currently available chemotherapy agents do not cure every dog. So the first drug specifically developed for canine mast cell tumors is big news. 

Mast cell tumors are one of the most common skin tumors in dogs and are one of the most important cancers veterinary oncologists treat. Some dogs are unlucky enough to have multiple mast cell tumors or a mast cell tumor that keeps coming back in the same location. So a drug to help manage this common tumor is big news, redux.

Palladia belongs to a class of drugs known as tyrosine kinase inhibitors. The presence of abnormal tyrosine kinases in tumors results in the proliferation of tumor cells and the growth of new blood vessels to the tumor. These blood vessels provide nutrients to the growing tumor. Inhibition of tyrosine kinases by drugs like Pallada (or for humans, Gleevec®, another tyrosine kinase inhibitor) stops both cell proliferation and new blood vessel growth. Without nutrients and without cell proliferation the tumor shrinks. More big news.

Pfizer Animal Health is working with veterinary specialists to help them use Palladia effectively and safely. It is currently available from board certified veterinary specialists in oncology, internal medicine and dermatology. To find the specialist nearest you go to for oncologists and internists and at for dermatologists. Pricing for Palladia has not yet been announced.

Click here to download an information sheet about Palladia from The AMC.

The Oncology Team at The Animal Medical Center

At The Animal Medical Center, specialists certified by the American College of Veterinary Internal Medicine in the sub-specialty of Oncology and the American College of Veterinary Radiology in the sub-specialty of Radiation Oncology provide dedicated care for pets with cancer Monday through Saturday.  We take a team approach to cancer care, collaborating with specialists in the fields of diagnostic imaging, pathology, surgery and internal medicine to create a customized plan for the care of your pets .

You can reach The AMC Oncology staff by email or phone:

• Ann Hohenhaus, DVM, DACVIM (Oncology, Small Animal Internal Medicine)    
(212) 329-8612,   
• Nicole Leibman, DVM, DACVIM (Oncology)
(212) 329-8696,   
• John Farrelly, DVM, DACVR (Radiation Oncology), DACVIM (Oncology)
(212) 329-8794,  
• Andrea Flory, DVM, DACVIM (Oncology)
(212) 329-8687,

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