Making Difficult Decisions for Your Pet

June 7, 2010

Making certain decisions for your pet can be pretty simple. Yes, I give heartworm medication every month, because the drug is effective and much safer than treating my dog for heartworms. Yes, I know spaying my dog prevents mammary gland cancer and unwanted puppies. Yes, I keep my cat indoors to protect against cat fights, automobiles and feline leukemia virus infection. There are some decisions, however, that do not come so easily.

Recently, I spent time with a dog-owning family facing one of these tough decisions. The dog was older, but age should never be the sole criteria used to guide decision-making. The dog was in reasonably good shape until he collapsed earlier that day. Emergency evaluation discovered a life-threatening problem requiring an emergency surgery. It doesn’t get tougher than that — you’ve got your back against the wall and the clock is already ticking. Luckily for these owners and their dog, there was a surgical procedure to correct the problem, but (and there is always a “but” in these situations) the procedure was not without risks and no veterinarian could guarantee a positive outcome for the dog. Scientific research into this disease had identified four factors which decrease a dog’s chance of surviving the procedure. Unfortunately, this dog had three of the four factors. Does this information mean the dog should not be taken to the operating room? Not necessarily.

Just to illustrate the point, let me tell you about a cat and its owner I saw this week. Four years ago this cat experienced congestive heart failure, meaning his heart muscle was too weak to pump blood and fluid built up in his lungs. Sounds bad, and usually it is. Once a cat experiences congestive heart failure, the typical survival time is about one year. So why is this cat still alive four years later? Is the scientifically collected data wrong? Data gives probabilities about an outcome in a population of patients with a particular condition but cannot predict how a condition will affect an individual patient. Statistics will never tell the whole story since each pet is an individual and may respond better (or worse) than the typical pet with this condition. This lucky cat defied the odds and lived to tell about it.

So what is a pet owner to do in situations like this? First, listen to your veterinarian. Ask questions about the quality of life after the procedure, the length of hospitalization and the follow up care required. Some pets have the personality to cope with many trips to the hospital for follow up care, others do not. Some families have the time and energy to nurse a pet back to health; others do not. Only your family can determine what is right for you and your pet. Sometimes your veterinarian will give you grim statistics, but if your heart tells you not to quit or if you know your pet is not a quitter, then go forward with an informed and realistic expectation of the outcome of the procedure.

By the way, the dog with the three or four bad factors was discharged from the hospital three days after surgery. Go figure.

Sometimes, even after you speak with your veterinarian, you are still confused about what to do. Maybe your friends and family are giving you conflicting advice. Perhaps you have concerns you feel are too private to share with most people. You may need more time to talk things through than your veterinarian can give you. The Animal Medical Center is the only hospital in the tri-state area with a full-time counseling department. Trained social workers can speak with you by appointment, on the phone or during your pet’s visit to help you sort through your options, figure out what questions to ask, and help you decide what is right for you and your family.

If after careful consideration you decide not to pursue treatment and have chosen to let your loved one go, the Counseling staff will be with you through our pet loss services, including The AMC’s Pet Loss Support Group. To reach a counselor, call 212.329.8680. There is no charge for counseling services.

For more information about our counseling services, visit www.amcny.org/counseling. To contribute to the Counseling/Human-Animal Bond Program, visit www.amcny.org/contribute and ask that your donation go to support those services or consider joining our partnership with Margo Feiden Galleries.

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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.


Stem Cell Therapy for Arthritic Pets

June 1, 2009

arthritic-dog

Arthritis is an important disease in geriatric dogs and is also becoming more widely recognized in cats. Estimates indicate as many as one in five dogs will suffer from arthritis as they age. This is the second in a two-part series on arthritis. The first blog covered the standard therapies for treatment of arthritis. This blog features expert information from Dr. Pamela Schwartz, Diplomate American College of Veterinary Surgery, of The AMC’s Surgery Department. She has an interest in the use of stem cells for the treatment of canine arthritis.

Stem cells are purified mesenchymal stem cells harvested from subcutaneous (under the skin) fat in dogs. These stem cells are not the controversial embryonic stem cells we hear about on the evening news, but they do possess the ability to develop into any cell in the body. In animal models, researchers have shown these stem cells have the ability to develop into cartilage cells if they are injected into the appropriate environment. Once they are injected into an inflamed, arthritic joint, they will turn into new cartilage cells to help repair the damage caused by osteoarthritis. 

osteoarthritisEvery dog is not a candidate for stem cell therapy. Stem cell therapy is currently indicated for osteoarthritis and is not considered applicable to other chronic medical or neurological conditions. Dogs with cancer are not good candidates for this treatment. If there is a surgically repairable disease (i.e., ligament tear), we recommend surgery and reserve the use of stem cells for the future. 

Owners interested in having their dog evaluated for stem cell therapy must have a consultation with a stem cell credentialed veterinarian (The AMC currently has five stem cell credentialed doctors, including Dr. Schwartz). The evaluation includes a physical examination, blood work and chest radiographs.

stem-cell-injectionIf the dog is found to be a good candidate for stem cell therapy, an outpatient “fat harvest” will be scheduled. During the harvest, a small incision is made in either the groin, behind the shoulder blade, or into the abdomen. The dog is discharged from the hospital the same evening and the harvested fat is shipped overnight for processing. Forty-eight hours later, when the stem cells arrive back at AMC, the stem cells are injected into the affected joints while the dog is under sedation. Multiple joints may be injected on the same day and we’ve seen good results in arthritis of the hips, knees and elbows. 

Following stem cell therapy, the degree of lameness is reevaluated 30, 60 and 90 days after the injection. During these visits, both the owners and the vets will evaluate the degree of lameness to assess the dog’s improvement. We are pleased with the results we have seen in the patients we have treated with stem cells. They can go for longer walks, jump on and off the bed again and have a more comfortable life. 

For further information about stem cell therapy at The AMC or to schedule a consultation, please call Dr. Pamela Schwartz at 212.329.8756.

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The Department of Surgery at The AMC
The surgeons at The AMC, who are certified by the American College of Veterinary Surgery, provide seven-day-per-week expertise, state-of-the-art surgical techniques and emergency surgical care.  We also offer specialty services such as veterinary dentistry, rehabilitation and pet fitness services, orthopedics and soft-tissue surgery.  Our surgeons work closely with internal medicine, oncology, radiology, critical care and pathology specialists to coordinate testing and to determine the least invasive and effective procedures necessary to optimize patient outcomes.

Orthopedic Surgery
• Marc E. Havig, DVM, DACVS
212.329.8709
marc.havig@amcny.org
• Pamela Schwartz, DVM, DACVS
212.329.8756
pamela.schwartz@amcny.org
• Jason Syrcle, DVM
212.329.8809
jason.syrcle@amcny.org

Soft Tissue Surgery
• Janet Kovak McClaran, DVM, DACVS
212.329.8710
janet.kovak@amcny.org
• Pamela Schwartz, DVM, DACVS
212.329.8756
pamela.schwartz@amcny.org
• Jason Syrcle, DVM
212.329.8809
jason.syrcle@amcny.org


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