Everyday Medicine: Hospital Wards

AMC hospital ward

“Everyday Medicine” is an intermittent series of blog posts highlighting tests, treatments, and procedures common in daily Animal Medical Center practice. Some past examples of this type of blog post include physical examination and vomiting or regurgitation. Today’s post focuses on the types of hospital wards your pet would stay in at AMC.

If you have been unlucky enough to be hospitalized, you know a human hospital is divided into a variety of different wards,usually by types of diseases: maternity ward, surgery ward, cardiac care, pediatric, and so on. AMC is also divided into wards, but a little bit differently since dogs and cats don’t have heart attacks and puppies and kittens are usually born at home. Even with the different types of hospital wards, AMC still has veterinarians and nurses on duty 24/7. Overnight there are always at least two veterinarians in the hospital.

ICU-Intensive Care Unit  

In the ICU, you will find no more than the 21 sickest patients in the hospital, because that is the number of cages available in our ICU.  These are patients that need constant monitoring because they have unstable vital signs.

The types of patients hospitalized in ICU include those requiring oxygen therapy for pneumonia or heart failure, glucose monitoring for diabetes, seizure watches, and any patient who is so sick they are recumbent and require intensive nursing care. Each patient in ICU has a service directing their care and also a nurse assigned for treatments and monitoring.

SCU-Special Care Unit

In a human hospital AMC’s SCU might be called a step-down ward. When patients recover enough to leave ICU, but are not quite ready to go home, they transfer to SCU. SCU is also home to patients admitted for the day for a procedure or following surgery when ICU-level care is not indicated.

ER-Emergency Room Ward

AMC’s ER is only a short-term stay ward. Pets evaluated by AMC’s Emergency and Critical Care staff are typically treated and discharged or hospitalized in ICU or SCU. A few may stay in the ER for several hours. Those pets landing a spot in ER might be a dog with a difficult birth, a pet with a laceration that requires anesthesia for repair, or an acutely ill animal waiting for blood tests or diagnostic imaging results to direct the treatment plan.

Avian and Exotic Pet Ward

In some ways, the avian and exotic pet ward is our most specialized ward.  This ward has “hospital beds” to accommodate birds, bunnies, reptiles, and other small mammals.  The ward has auxiliary heating since some exotic pets need a warmer environment than dogs and cats, and the cabinets and shelved are stocked with medications and equipment not found elsewhere in the hospital.

Isolation Ward

Like any isolation ward, AMC hosts pet with contagious diseases.  The most common diseases requiring isolation procedures include parvovirus and both canine and feline upper respiratory infections.

Designed to protect other pets from contracting an infectious disease, the isolation ward has restricted entry, a requirement for staff to wear protective gear, and a ventilation system that prevents contaminated air from circulating in the hospital. Cameras connect the patients to their nursing staff.

I hope your pet never needs our ICU, SCU, ER, avian and exotic pet or isolation wards, but if they do, you now know how carefully they will be cared for while they are with us.

Veterinary Nursing in Action

Zyna

October 14-20 is the annual celebration of National Veterinary Technician Week. In New York State, we call these animal healthcare professionals licensed veterinary technicians (LVT), but in other municipalities they are known as certified veterinary technicians, veterinary technologists, or registered veterinary technicians. No matter what their exact title is, these critical members of the veterinary healthcare team function as registered nurses do in human medicine. For a general description of the role of veterinary technicians, you can read a prior blog post.

The Animal Medical Center employs 90+ LVTs who support and enhance patient care working side-by-side with the veterinary staff. Space doesn’t allow me to describe the role of every LVT at AMC, so as part of our weeklong celebration of veterinary technicians, I will highlight just a couple of exceptional veterinary nurses in action.

Recovery
AMC’s Surgery Service has a cadre of LVTs focusing on pets recovering from general anesthesia. They work in a specially outfitted area right off the surgery preparation area. Once an anesthetic procedure is completed, the pet is moved into recovery and stays there on a soft mattress under a heating blanket until the anesthetic has worn off enough that they can again stand and walk normally. Xyna is a member of the recovery tech team. She is new to AMC and a recent graduate of SUNY Canton’s accredited LVT program. Like all LVTs, she was trained in recovery techniques, but never thought she could have a full-time job, supervising anesthetic recovery. When I visited recovery to speak with Xyna, under her care was a pug with a hip dislocation, a schnauzer fresh out of the CT scanner, and a cat recovering from a spleen removal surgery.

Radiation Therapy (RT)
One of AMC’s most experienced LVTs, Corrado, works in RT. After 17 years at AMC and about the same amount of time working as a tech for private practices and a guide dog school, he has seen it all from the tech perspective. His AMC career started in the blood bank and as backup for hemodialysis procedures. His next stop was CT/MRI where he was responsible for operation of the big machines and patient anesthesia.

Currently, Corrado operates our third big machine, the Varian linear accelerator and also serves as RT patient anesthetist. Even though all patients receiving radiation therapy do so under general anesthesia, these pets recover in their cages in the radiation therapy suite rather than in the surgical recovery area.

Want to learn more about veterinary nurses? Read these previous blog posts from National Vet Tech Week 2013 and 2012. And when you are done, don’t forget to say “thanks” to the veterinary nurses this week, and every week.

Should I Adopt an Older Dog?

Adopt a dog

October is Adopt a Dog Month or Adopt a Shelter Dog Month. Either way, I hope your family is thinking about whether or not adopting a dog is the right move. Keep in mind, adopting a dog at the wrong time or without considering its impact on your family is always a bad idea. Adopting a puppy, with her big eyes and fluffy coat, is easy until the little devil comes home. Adopting an adult dog, may circumvent some of the puppy-raising challenges puppy families face.

Advantages of a Grown-Up Dog
In my mind, adopting an adult dog bypasses one of the biggest challenges of having a puppy: housebreaking. Adult dog adopters shouldn’t expect perfection from the new arrival, but after a few days, most housebroken dogs will realize how they go “out.”

Teething is another puppy milestone avoided by adopting an adult dog. Last week, one of my teething puppy patients ate some shoe trees, a bottle of Zantac, and a box of tissues after letting himself into the bedroom. Other puppy patients have eaten woodwork, chair legs, and shoes. Once a dog hits about one year of age, their indiscriminate chewing tends to subside.

Last spring, one of my mature clients got a new puppy. Both of his aged dogs had died over the winter. The new puppy was delightful, except for the stubborn Giardia infection. In a moment of diarrhea-related frustration and puppy induced exhaustion, he asked me to find her a new family. Now that the diarrhea is cleared up and she is approaching her first birthday as a much calmer grown-up dog, there is no chance of him giving her up, but this vignette shows how trying puppies can be.

Points to Consider When You Adopt Any Dog
Puppies require a series of visits to the veterinarian for vaccinations and other preventive health care procedures. While these medical expenditures will not be necessary in an adult dog that is already well vaccinated and spayed or neutered, all pets need medical care. Your family needs to consider not only the cost of preventive care but how you will manage a catastrophic illness or injury. Other ongoing costs to include in budget planning are food, treats, grooming, boarding, and the inevitable wardrobe of seasonal collars, leashes, and bandanas you just can’t resist at your local pet emporium.

Adopting is Not for Everyone
Some families need the predictability of a purebred dog. Certain breeds are easier for people with allergies, making the decision to have a purebred dog a medical decision. Those of us living in apartment buildings face restrictions on dog size and breed. A cute puppy with an unknown family tree may result in a lovely pet that exceeds the size limit set by the building’s board of directors. Who needs that kind of heartbreak?

Did this blog post make your choice between a puppy and a dog easier or more difficult? Whatever your decision, consider adopting, not shopping.

Immune Mediated Neutropenia

Schnauzer

I recently wrote about the concept of immune disease; those disorders where the immune system goes haywire and attacks normal cells in the body. In more recent blog posts, I wrote about two important immune diseases: immune mediated hemolytic anemia (IMHA) and immune mediated thrombocytopenia (ITP or IMTP).  Today’s blog post focuses on a third immune disorder of blood cells: immune mediated neutropenia.

Neutrophils Fight Infection
Neutrophils are the first responders of the immune system. When you get a splinter in your finger, neutrophils rush to the site to start cleaning up bacteria and other nasties. The accumulation of neutrophils in a focal site is known as an abscess. Without neutrophils, the immune system cannot inactivate infectious agents, and patients run the risk of developing a life-threatening systemic infection.

Immune Mediated Neutropenia
Neutropenia is just a fancy way to say a low neutrophil count. Similar to dogs and cats with IMHA and IMT, the immune system of pets with immune mediated neutropenia destroys blood cells, specifically, neutrophils.

Recognizing Immune Mediated Neutropenia
Immune mediated neutropenia is much less common than either IMHA or IMT and is less common in cats than in dogs. A recent study found dogs with immune mediated neutropenia saw their veterinarian because of poor appetite, lethargy or fever, which are all very non-specific clinical findings. A complete blood count is required to identify a low neutrophil count, but if neutropenia is identified, your veterinarian will recommend a battery of tests to evaluate your dog or cat’s low neutrophil count. In addition to immune mediated destruction, low neutrophil counts can result from an infectious disease like ehrlichiosis, a fungal disease such as histoplasmosis or a bone marrow disorder.

Treatment of Immune Mediated Neutropenia
Like the other immune blood cell disorders, initial treatment of dogs and cats with immune mediated neutropenia involves suppressing the immune system with steroids. According to recent research, most dogs with immune mediated neutropenia responded quickly to steroid administration, while a few required additional immunosuppressive agents to correct the neutropenia. While I hope your dog or cat never gets immune mediated neutropenia, the majority of pets diagnosed with this disorder survive for an extended period of time.

Medical Machines: Infusion Pumps

Fluid Pumps

“Medical Machines” is a new series of blog posts highlighting the equipment AMC veterinarians use to provide state-of-the-art care to thousands of pets annually. These machines save lives, but pet families rarely ever have the opportunity to see them up close and personal. This series will give readers a glimpse into the equipment AMC veterinarians rely on every day.

The machine for today is an infusion pump, sometimes called a fluid pump.

Not Just for Fluid
Infusion pumps, fluid pumps, and IV pumps are commonly used terms to describe a device which delivers a precise volume of liquid over an exact period of time. The pump can be used to administer a wide variety of liquids including intravenous fluids, antibiotics, or pain medications. Pumps are also used to deliver liquid feeding solutions into the stomach or intestine and for blood transfusions. Pumps free the nursing staff from monitoring fluid delivery rates for more important duties. If the infusion rate varies from the setting, the pump beeps to alert the nursing staff of a problem.

How They Work
AMC has two types of pumps: peristaltic and syringe pumps. In the peristaltic pump, the tubing for the fluid fits between rollers which compress the tubing as they roll. This rolling action forces the liquid through the tubing. Peristaltic pumps are commonly used for IV fluids. AMC also uses syringe pumps. A syringe loaded with medication is placed in a slot on the pump and a motorized screw turns to push the syringe plunger at a controlled rate to deliver the fluid. Syringe pumps are commonly used for very small patients or for very small volume infusions. Above, you can see a puppy receiving a blood transfusion via syringe pump.

A Machine of Major Importance
Infusion pumps don’t really impress like a CT scanner or linear accelerator.
But what pumps lack in size, they compensate for in sheer numbers. Our best estimate is that AMC has over 200 peristaltic pumps and at least 50 syringe pumps. Our ICU has enough peristaltic pumps for each patient to have two at all times, plus some extras. Our animal ER has about 10 peristaltic pumps which they use to deliver fluids at a very high rate in patients with shock.

In researching infusion pumps for this blog post, one of our senior nurses who remembers a time before infusion pumps remarked, “Infusion pumps revolutionized patient care at AMC. We no longer had to stand by each patient’s IV line counting the number of drips per minute; we simply set the pump to the correct rate and were then free to take care of the patients, not the fluid infusion.”

Infusion pumps are one of AMC’s most valuable medical machines.

Cleaning Up Eye Goop

dog eyes

Last week I took calls from pet families on SiriusXM “Doctor Radio,” which is broadcast from NYU Langone Medical Center. Although I answered numerous calls during the one hour show, one question stood out in my mind for its pure practicality: “What products are safe for me to use around my pet’s eyes?”

Dirty Eyes
Pet families have many reasons to want to clean their pet’s eyes. The first might be a bit of debris, twig, or other foreign object that has found its way into your pet’s eye causing discomfort and possibly an injury. During allergy season, itchy eyes cause pets to rub their face with their paws or on furniture. The resulting ocular discharge adheres to the fur around the eyes and can even lead to dermatitis in that area. Some dogs develop tear staining around their eyes when bacteria reproduce in the moist fur. The brown staining is unsightly but not a health concern.

Flushing the Eye
To remove debris, a twig, or other foreign object that has found its way into your pet’s eye, sterile saline used by contact lens wearers is easily obtained and safe for pet eyes. In fact, you should keep an unopened bottle in your pet first aid kit for use in an emergency.

Cleaning the Fur
When ocular discharge adheres to the periocular fur, warm water and a washcloth or gauze pads can be used to moisten and wipe away the discharge. If more than warm water is required to clean the area, one drop of no-more-tears baby shampoo in a cup of warm water makes an eye-safe cleaning solution. This solution can also be used to remove the bacteria causing brown tear staining, which is especially noticeable on white dogs. Daily washing around the eyes also decreases pollen on the face, a major cause of allergic conjunctivitis. For those on the go with their pet, little packets containing individual eyelid wipes can be found in the eye section of the drug store, and work well in pets.

Have more questions about eyes? Read about common eye conditions, your dog and cat’s third eyelid, and dry eye.

Coping with the Grief of Pet Loss

pet loss

Recently, one of my friend’s dogs developed cancer. Although I am not her veterinarian, she and I had a long talk about the grim prognosis and the treatment options. A few weeks later, after her beloved dog had crossed the Rainbow Bridge, I overheard a mutual friend, who is not a pet person, saying something like, “You have to stop thinking about her; you can always get another dog.”

Changing Attitudes Toward Pet Loss
The comment above was crushing to my friend and would be to any pet lover who has recently lost a pet. Sadly, comments like this one are not uncommon coming from someone lacking personal experience in the grief associated with the loss of a beloved pet. A recent Scientific American article highlighted the intensity of the loss experienced by pet families. Not only has the family lost a companion, but their daily routine changes, social interactions decrease, leaving them rudderless. The typical social norms applied when a parent or other human family member dies do not always apply to a pet’s death. Because you cannot always depend on your friends for comfort after the death of a pet, here are some suggestions to cope with your grief.

Find a Pet Loss Support Group
For some bereaved pet owners, their family can serve as their pet loss support group. For those without family support, I Googled “pet loss support group” and found a myriad of different services. Some groups, like the one at AMC, meet in person. Other pet loss services are virtual. There are also individual counseling sessions available. For those who are inconsolable after the death of their pet, a number of pet loss hotlines are open to provide an immediate resource. Here is a list of pet loss hotlines and their telephone numbers.

Read Books
A quick search of Amazon.com found several books which might be helpful in the period after a pet’s death. The authors Mary and Herb Montgomery have written several books on pet loss. A Special Place for Charlee: A Child’s Companion Through Pet Loss helps parents guide their child through the grief process. One interesting book is A 30 Day Guide to Healing from the Loss of Your Pet by Gael Ross. This book is part workbook, part journal and was written to facilitate the healing process after the death of a beloved pet. These are by no means the only books on pet loss and you will know when you find the book that speaks to you.

Make a Memory
While your pet was alive, you made thousands of memories. Make a scrapbook, a Facebook video, or a photo collage featuring your pet. Read a couple previous blogs for other ideas to honor or memorialize your pet. Remember it is ok to feel sad and recognize that some days will be better than others.

The Animal Medical Center’s Usdan Institute for Animal Health Education is helping those who have recently lost pets remember them and celebrate the lives they’ve lived on Thursday, September 13, 2018. Register today!

Veterinary Neurological Conditions

AMC's neurology team

The Animal Medical Center has 36 board certified specialists in 17 different specialties. Neurology is a critical specialty at AMC and we are lucky to have three experienced specialists in veterinary neurology who are available to AMC patients seven days a week. The Neurology Service also trains the next generation of veterinary neurologists and currently has three residents in training. Many readers might not be familiar with common neurologic disorders of dogs and cats, so I will highlight them in this blog post.

Top Neurologic Conditions
The most common problems managed by AMC’s Neurology Service include seizures in dogs and cats, disc problems in the backs of dogs, and vestibular disease. A seizure occurs because the electrical system of the brain goes haywire. Seizures occur in all breeds of dogs and cats. Intervertebral disc disease has clear breed predictions. If you have a French bulldog, a dachshund, or a cocker spaniel, your dog is at increased risk of developing a slipped disc. All dog owners should be aware of the problem of slipped discs in dogs and seek emergency care if their dog suddenly can’t walk. When the disc slips out of its normal place, the disc pushes on the spinal cord causing pain and affecting the nerves controlling the back legs. Vestibular disease may also result in the sudden inability to walk, but dogs tend not to be painful, just very dizzy and often nauseous.

Intersection of Medicine and Neurology
Certain medical conditions can mimic neurologic ones. For example, a low blood sugar level deprives the brain of necessary fuel and can result in a seizure that is different than a seizure caused by epilepsy or a brain tumor. Fainting might look like a seizure or an episode of vertigo, but in cats, fainting is commonly caused by heart disease. Pet owners might think shaking is a neurologic condition, but the causes of shaking in dogs include hormone disorders, low calcium levels post-partum, and ingestion of toxic substances.

Neurology Diagnostic Tools
AMC has both a CT scanner and an MRI. Neurology typically uses the MRI to diagnose disorders of the brain and spinal cord. Dogs with back problems have an MRI, often in the middle of the night, before surgery to remove an out of place intravertebral disc. An MRI scan is also the test of choice in patients with seizures. Neurologists may also perform a spinal tap in seizure patients to evaluate the fluid around the brain to determine the cause of the seizures.

If you have a pet with a neurologic condition or want to learn more about veterinary neurology, tune in to “Ask the Vet” on SiriusXM Stars channel 109 on Friday, September 7 at 1pm EDT to hear an interview with AMC’s chief neurologist Dr. Chad West.

Everyday Medicine: Is it Vomiting or Regurgitation?

megaesophagus

“Everyday Medicine” is an intermittent series of blog posts highlighting tests, treatments, and procedures common in daily Animal Medical Center practice. Some past examples of this type of blog post include “Cytology” and “Packed Cell Volume.” Today’s post focuses on the question: Is it vomiting or regurgitation?

Veterinarians Ask a Lot of Questions
The first part of any patient visit to the veterinarian is a Q&A called history taking. We ask the pet family questions about their pet’s health. You know the drill – How is his appetite? Do you send him to the boarding kennel? Do you have other pets? We adapt the questions to the situation. In the animal ER, the Q&A will be truncated and may only be, “Where did he get hit by the car?” rather than a lengthy set of questions about diet and exercise. In dogs or cats with vomiting, we often probe further to differentiate vomiting from regurgitation.

Vomiting
You know the sound of vomiting. First you hear a horrible gagging sound right before you find the big spot on the carpet. Always on the carpet because no self-respecting pet would vomit on the linoleum where clean-up is easy. Vomiting is an active process and you see contraction of the abdominal muscles a split second before the stomach empties.

Regurgitation
Until I went to veterinary school, I thought regurgitation was a more sophisticated word for vomiting. Not true. Regurgitation does not have the forceful expulsion of food from the stomach typical of vomiting. The food seems to fall out of the mouth rather than exploding from the stomach. Regurgitated food never makes it to the stomach because of poor esophageal function, and if undigested food seems to fall out of your pet’s mouth, he may be regurgitating. Regurgitation is much less common than vomiting and is associated with a disorder called megaesophagus.

Does the Answer Matter?
The short answer is yes. If a veterinarian can determine a patient is regurgitating rather than vomiting, then she will follow a different path of diagnostic testing. If your veterinarian suspects vomiting, an abdominal x-ray is commonly obtained. Because regurgitation suggests esophageal dysfunction, a chest x-ray will be part of the initial testing to see if the esophagus appears abnormally filled with air. Special movie x-rays called fluoroscopy can be used to identify esophageal dysfunction typical of megaesophagus.

To learn more about megaesophagus, watch this video interview by Insider.

National Bring Your Cat to the Vet Day

Bring Your Cat to the Vet Day

Even though it is the dog days of summer, Wednesday, August 22nd is National Bring Your Cat to the Vet Day. Only half of American cats see a veterinarian on a routine basis. The lack of medical care means feline health concerns remain unaddressed until the condition is severe and more difficult to treat. #Cat2VetDay is a gentle reminder to cat families that their favorite feline deserves preventive health care just like the family dog.

Barriers to Vet Visits
A survey of cat owners, conducted by the pet food company Royal Canin, identified four common excuses cat families use for skipping cat checkups. The barriers include:

  1. Difficulty getting your cat to the veterinarian – read “My cat hates its carrier.”
  2. Belief in the urban myth that cats need less veterinary care than dogs.
  3. Reluctance to ask for time off work to make a trip to the veterinarian.
  4. Cost of veterinary care.

Overcoming Barrier #1
This is the easiest barrier to overcome. First, leave the carrier out all the time, fill it with a soft, comfy fleece bed and a catnip toy or two, and usually the problem solves itself.


If your cat is really difficult about the carrier, check with your veterinarian about safe, effective and cost-conscious drugs to use when transporting your cat.

Overcoming Barrier #2
The fact that you are reading this post is overcoming the dangerous myth that cats require less health care than dogs. Because sick cats can hide their illness until they are nearly dead, it is easy to see how this myth has been perpetuated. Undoing the myth is a challenge and part of the reason for Bring Your Cat to the Vet Day.

Overcoming Barrier #3
Since over 30% of American households have a feline member, there is a good chance your boss has a cat and will understand if you need to leave early for a veterinary visit. If your boss is not feline-friendly, then look for a cat clinic with evening or weekend hours.

Overcoming Barrier #4
A routine preventive health care visit for your cat is designed to identify problems before they become big expensive ones or require an animal ER visit. To help manage pet health care costs, check with your employer’s human resources office to see if pet health insurance is an option in your benefits package. If not, consider purchasing a policy after reviewing these insurance FAQs answered by AMC’s Usdan Institute for Animal Health Education.

Celebrate #Cat2VetDay by using the steps above as a road map to getting your cat to see their veterinarian annually. Check out these additional resources to help make your cat’s veterinary visits a positive experience for everyone.