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:


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.


Feeding Your Pet for Optimal Health

September 17, 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.


Managing your Pet’s Medications: The Importance of Compliance

August 22, 2011

On a daily basis, the veterinarians at The Animal Medical Center prescribe pills, capsules and tablets to cure, control and prevent diseases. We have pockets full of prescribing information, access dosing online and carefully follow guidelines to use medications safely and wisely.

Correct prescribing by the veterinarian is critical to medication success, but the other half, administering medications as prescribed is equally important. Pet owners, upset by the illness of their pet often misunderstand directions or adjust medication dosing without consulting their pet’s veterinary healthcare team. If you think no one would do this, here is summary of this week’s medication conversations.

Becky
Poor Becky had major dental surgery this week, including eight extractions and resulting in a prescription for pain medications. Becky, a dachshund, belongs to an employee of The AMC and I stopped by her office the next day to check on the dog. It just happened to be medication time and Becky’s owner was worried Becky was painful (highly likely given eight extractions) and she though she would give only half the prescribed dose of pain medications. I reassured her the amount prescribed had been carefully calculated for Becky’s size and pain level and that the entire dose should be given.

Montana
Montana is getting chemotherapy and also some antinausea pills. When I reviewed his prescriptions, his owner reported she was giving half a pill twice daily rather than one pill once daily. She thought the antinausea effect would last longer if she gave the pill more often. The problem with this logic is the antinausea medicine stays around a long time, hence the once a day dosing recommended by the manufacturer. By giving half a dose, Montana may not have gotten a high enough level of antinausea medicine in the bloodstream to have a full effect.

Harvey
Finally, there’s Harvey and his chemo pills. He started a new regimen and I called a couple days later to see how it was going. Harvey felt great. I should have listened to my inner doctor voice saying, “Hmm, seems too good to be true.” Turns out his owner made an honest mistake, misread the label and was giving only one pill instead of two. Now he is on the correct dosage and is feeling better than ever since his tumor is shrinking.

Medication Pointers

  • Read the label. Read it again and if you have questions, call your veterinarian’s office.
  • Give the medication as prescribed on the label. Don’t adjust the amount, frequency or duration of administration without talking to your veterinarian.
  • If you are having trouble administering medications, stop by your veterinarian’s office for a lesson in administration.
  • If the medication schedule does not fit with your schedule, ask your veterinarian if there is an alternative drug with a different schedule.
  • If your pet won’t take a pill, ask if the medication comes in a liquid or can be formulated into a liquid to ease administration.
  • If you think your pet is having a bad reaction to the medication, stop the medication and call your veterinarian immediately. For after hours trips to the animal ER, be sure to take all the medications with you and show them to the ER staff.

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

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 www.amcny.org. To make an appointment, please call 212.838.7053.


Acknowledge Miracles

January 24, 2011

The tragedy in Tucson is on everyone’s mind. Since I am very medical and not very political, I was captivated by a quote in the New York Times last week attributed to one of the neurosurgeons caring for Congresswomen Gabrielle Giffords. Dr. G. Michael Lemole, Jr. had been asked if Ms. Gifford’s recovery was miraculous. His reply indicates a doctor of great insight. He said, “Miracles happen every day, and in medicine, we like to attribute them to what we do or what others do around us. A lot of medicine is outside our control. We are wise to acknowledge miracles.”

Herbie in the hospital

Sick Herbie in AMC ICU with EKG monitor and hemodialysis catheter.

I want to acknowledge one of the Animal Medical Center’s miracles, Herbie. Herbie was a 3 month old, formerly bouncy Labrador retriever when he first came to The AMC. He came to us because of a critical illness involving his liver and kidneys, ultimately diagnosed as leptospirosis. Leptospirosis is a systemic bacterial disease of dogs, humans and wildlife. The bacteria can injury the kidneys so severely that hemodialysis is required to replace the normal function of the kidneys, while antibiotics eradicate the infection. If diagnosed early, and treated intensively, recovery is possible. Like Congresswoman Giffords, Herbie was on the critical list and was given a 10% chance of survival.

Intensive is the only word to describe Herbie’s treatment. In addition to hemodialysis, a pivotal decision was made by Dr. Buriko of the AMC’s ICU staff to perform an emergency, middle of the night surgery to correct an intestinal problem brought on by the severe vomiting and diarrhea from leptospirosis. Following surgery, he required a red blood cell transfusion to replace cells lost in surgery and in his stool. He also received a canine albumen transfusion to replace lost protein in his blood stream.

Herbie’s treatment was not just medical. His family believes AMC’s “human touch” made all the difference in their Labrador’s miraculous recovery. He had visits from Dr. Currao’s puppy who reminded Herbie life as a puppy was worth living. The ICU staff sat with him, encouraging him to eat homemade chicken. Herbie was one of those cases the ICU staff knew would recover faster if him family visited and his dedicated family complied, visiting him twice a day.

Herbie after treatment

Miracle Herbie at home last week.

Three weeks after he was admitted to the intensive care unit, Herbie was discharged to his family. At a follow up visit just before Christmas, Herbie’s kidney tests, which were five times the normal value at admission, were nearly normal. His family reports he is a cuter, friskier and smarter puppy than before he was stricken with leptospirosis. A miracle indeed.

This blog may also be found in the “Tales from the Pet Clinic” blog from WebMD.
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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 www.amcny.org. To make an appointment, please call 212.838.7053.


Measuring Your Pet’s Medication

November 8, 2010

Medical professionals, veterinarians included, speak to each other in our own language, more difficult to understand than either ancient Latin or Greek. This language is confusing to pet owners and often results in question about medication administration.

This weekend was a case in point. An owner called while she was out of town on vacation. I had completely confused her with my instructions on how much medication to administer. She was hours away and unable to drop by The Animal Medical Center for a refresher course. In giving instructions, I forgot pet owners are not always well versed in scientific weights and measures and the sight of an oral dosing syringe can induce paralysis in even the most educated client. Here are the definitions for some of the most confusing terms.

Milliliter (ml) is a measure of volume and a liquid medication dose is commonly given in milliliters. A milliliter is the same as a cc (cubic centimeter). But a milliliter does not tell how much medication is being given. Medication is typically measured in milligrams (mg). For example, a tablet of the antibiotic amoxicillin contains a set number of milligrams, but the milligrams contained in a milliliter of amoxicillin depend on the particular antibiotic brand’s strength. In other words, all liquid medications are not created equal. Veterinarians will always talk about how many milligrams your pet needs when you want to know is how many milliliters to squirt down the throat of your dog who has its teeth clamped shut and has just slipped under your king sized bed.

A diabetic pet presents a special set of challenges, one of which is how much insulin to give. Based on the comments above, the careful reader would surmise insulin is given in milliliters – it is a liquid medication after all. But no, it is given in units and double no, 1 unit does not equal a milliliter. If you have U 100 insulin, 100 units = 1 milliliter. If you have U 40 insulin, 40 units = 1 milliliter. To complicate matters more, each insulin needs its own special syringe matched to the type of insulin, ie, U 100 syringes for U 100 insulin. Understanding these seemingly trivial differences means success or failure in treating your diabetic pet.

Decimal points are another prescription predicament. The numbers 5.0, 0.5 and .05 are 100 fold different and yet when they appear on a prescription label they can be confusing. Proper prescriptions use zeros to highlight a decimal point. Numbers should have a leading zero before any decimal point, ie 0.5 is correct. Numbers should not have a trailing zero, ie 5.0 is incorrect. These differences highlight how carefully pet owners should read a medication label before administering a new medication.

Finally, because of the obesity epidemic in pets, veterinarians are making pet owners more conscious of how much pets eat. One cup is easy to understand, but calories per cup vary dramatically. One cup of Eukanuba puppy food contains 503 kcal and one cup of their weight control product for large breed dogs contains 272 kcal. Some foods list kcal per kg (kilogram) of food. Converting kilograms (a measure of weight) to cups (a measure of volume) requires advanced math, or a scale from your local cookware shop.

So when it comes to medicating your pet, ask lots of questions and don’t be afraid to call your veterinarian’s office for clarification, because a microgram of prevention is worth a milligram of cure.

Have you ever encountered problems with your pet’s medication dosing? Tell us your story by commenting below!

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

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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 www.amcny.org. To make an appointment, please call 212.838.7053.


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