Should I give CBD supplements to my pet?

CBD in PetsThere’s a huge interest in cannabis products for pets. Based on the queries from my patients, most of the interest is in CBD-containing supplements. While the internet and local pet stores may have well-stocked shelves of CBD chew treats, oils and creams, pet owners should exercise caution if they chose to administer such products to their favorite fur person.

Marijuana basics

The marijuana plant contains nearly 500 different organic compounds, but the two most important are tetrahydrocannabinol (THC), the psychoactive cannabinoid, and cannabidiol (CBD). CBD is touted as safer because it does not have the euphoric effects of THC in humans, but CBD does affect the nervous system, and its mechanisms are largely a mystery to scientists. Additionally, CBD’s effect on cats and dogs remains poorly studied.

The Drug Enforcement Agency classifies marijuana or extracts from the plant as Schedule 1 controlled drugs. This classification prevents veterinarians from prescribing medical marijuana and also restricts our ability to research the drug’s effects in different diseases. Despite its Schedule 1 classification, CBD containing products can be purchased in stores and online.

Hemp

Some products on pet store shelves contain “CBD from hemp.” Industrial hemp is legal; however, the Drug Enforcement Agency has issued a clarification that while they indeed recognize industrial hemp research and its products as legal, this protection does not extend to CBD products, which remain illegal, regardless of the source of the CBD. Recent legislation may ease the use of CBD from hemp, but until the federal regulations are written, prescribing CBD appears to be off limits to veterinarians like me.

What is the dose?

Despite the huge interest, there isn’t a correspondingly large body of scientifically collected information on the impact of CBD in pets. Most of the information veterinarians have available to them comes from emergency room studies of pets accidentally ingesting marijuana. This means I, and my colleagues, cannot be very helpful to you regarding dosing your pet with CBD products, because of a lack of information.

The lack of information regarding dosage is compounded by the fact that many CBD-containing products don’t contain the amount of active ingredient indicated on the label. The FDA has quantified CBD levels in some products and found many did not contain the advertised levels of CBD. Some “CBD” products contain very little CBD, while others contain more. For these reasons, the FDA cautions consumers regarding the purchase and use of CBD products as the effects may be unpredictable in their pets.

More information soon

Although information about optimal dosing of CBD and the diseases most amenable to CBD therapy are lacking, more information may be coming. According to a recent article in the American Animal Hospital Association’s Trends Magazine, approximately a dozen studies of CBD products are underway in dogs, cats, horses, monkeys and birds. When the results of those studies become available, pet owners and veterinarians will have much better information on which to base therapeutic decisions for their pets and patients. Until then, the many unanswered questions regarding CBD continues to limit its utility in pets.

Making your cat live to be 100!

This photo is my patient, Jake, celebrating his 18th birthday which is approximately 86 in cat years.  But Jake is not my longest-lived patient, Sparky, an orange gentleman at 18 and a half takes that prize.  Weezer, a stripey spring chicken is the runner up at nearly 16 years.  What do these three elderly cats tell us about aging in our feline companions?

Many diseases, one cat

Research stemming from a Swedish pet insurance database indicates that cats like Jake represent the typical older feline patient.  In the Scandinavian cohort of cats, cancer, kidney disease and intestinal disease increase in frequency as cats age. Medically speaking, Jake has intestinal lymphoma, recurrent kidney infections, heart disease, pancreatitis and an occasional flare up of diabetes, all of which are currently under control.  Older cats, with a myriad of medical conditions, need a plethora of carefully titrated drugs to keep their problems well controlled.   From my veterinary viewpoint, these cases are incredibly challenging because one disease may need a medication like steroids while another disease like diabetes can flare up with steroid therapy.

Intestinal lymphoma

One diagnosis common to all three of these cats is cancer.  Jake, Sparky and Weezer all have lymphoma and for that matter, the same form of lymphoma, gastrointestinal small cell lymphoma.  This little fact should give you hope since all three cats have exceeded the reported average lifespan of cats which is 14 years, despite a diagnosis which is expected to send their owners into a blue funk.  Gastrointestinal small cell lymphoma has become the most common form of lymphoma diagnosed in cats and carries a good prognosis when treated early.  The take home message here is if your cat has a cancer diagnosis, despair should not be your first emotion.

Good news, cats are living longer

Sparky, Weezer and Jake reflect a new trend in cat lifespans.  Information from the Swedish pet insurance database I mentioned above suggests that cats are living longer.  For example, between 1998 and 2002, 58% of Birman cats lived on average 12.5 years and between 2003 and 2006 68% of Birman cats lived 12.5 years.  An increase in longevity was seen across the spectrum of cats including other purebreds and domestic cats.  The reason for this increase is currently a mystery.

How can you get your cat to live like Weezer, Sparky and Jake?

To have a geriatric cat, you first need your young cat to be healthy. Some very simple lifestyle modifications will help that happen.  Neutering has been shown to be associated with an increased lifespan.  Since trauma is a big killer of young cats, make your cats indoor ones.

Another killer of young cats is infectious disease.   Keeping your cat indoors will help protect your favorite fur person against contracting an infectious disease like FeLV and FIV, but vaccinations are another important component of protection against infectious disease.

Finally, feeding the right food will also help your cat grow old, but not too much, since overweight cats have a truncated lifespan.

Everyday Medicine: Blood Pressure

pet blood pressure

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 “The Highs and Lows of Blood Sugar” and “The Third Eyelid.” Today’s post focuses on blood pressure.

Blood Pressure Definition
Everyone has had their blood pressure taken at the doctor’s office and we all know high blood pressure, or hypertension, is bad. But what does that Velcro covered cuff really measure? The cuff measures the pressure the circulating blood exerts on the walls of the blood vessel. When your blood pressure is taken, the nurse reports a number over a number. The top number (systolic blood pressure) is the pressure on the vessel walls when the heart pumps and the diastolic blood pressure or bottom number is the pressure when the heart relaxes. The blood pressure monitors veterinarians use in the clinic for dogs and cats usually measure only the top number, or systolic pressure.

Causes of High Blood Pressure
The most common cause of hypertension in both dogs and cats is chronic kidney disease. The International Renal Interest Society recommends all pets with kidney disease have their blood pressure measured as part of a clinical evaluation. Hypertensive pets should be treated with antihypertensive agents to protect their eyes, heart, brain and kidneys from damage due to high blood pressure.

Hyperthyroidism is another known cause of hypertension, most commonly in cats. Successful treatment of hyperthyroidism typically resolves the hypertension without administration of antihypertensive medications.

Causes of Low Blood Pressure
Low blood pressure is a common problem in AMC’s ER patients. Many ER patients have fluid loss. For example, vomiting and diarrhea-producing dehydration decrease the amount of fluid in the blood vessels, as does hemorrhage. Both dehydration and hemorrhage can result in low blood pressure. A severe systemic infection often leads to low blood pressure through a complex series of physiologic events. Since so many emergency situations lead to low blood pressure, an intravenous catheter and administration of intravenous fluids is typically one of the first emergency therapies administered in an animal ER.

If your pet has recently been anesthetized, he probably has a clipped spot on one of his front legs. That spot identifies the location of an intravenous catheter placement. General anesthesia decreases blood pressure. Veterinarians monitor blood pressure during anesthesia and give intravenous fluids during anesthetic procedures to help maintain blood pressure within a normal range.

Pets with hypertension have frequent blood pressure measurements taken while their veterinarians adjust medications to normalize blood pressure. Blood pressure medication must be titrated to the proper amount to prevent low blood pressure or hypotension. Hypotension makes pets weak and may negatively impact their kidney function.

If your pet is making a trip to the veterinarian soon, don’t be surprised if one of the nurses brings out a petite blood pressure cuff and places it around your pet’s wrist, since blood pressure is an important medical test.

Purging Your Pet’s Closet

pet closet

A common recurrent theme in magazines like Real Simple, Good Housekeeping, and Glamour is closet organization. These publications recommend purging closets seasonally to prevent accumulation of unwanted clothing and accessories. Many of us with pets have a small cabinet or closet devoted to our pet’s belongings. Taking a cue from these glossies, I am going to give some tips for cleaning out your pet’s closet.

If He Won’t Wear it, Recycle it
When you get to the back of your pet’s closet and find that really ugly sweater from Aunt Sally your dog has never worn or his favorite raincoat from when he was a puppy, but it no longer fits, cut the cord and send these unused items to a textile recycling center. Ditto for worn leashes and collars which present a safety hazard for your pet. In New York City, greenmarkets collect unwanted clothing, shoes and other fabric items for recycling.

Rid the Closet of Expired Medications
I am quite confident that when you clear out the closet you will find expired pet medications. Why? Because many of my clients call asking if they can use a medication for their pet found in the back of the closet. First thing I ask them is to tell me the expiration date on the box and usually that medication expired many months prior. The expiration date of medications is printed on the pharmacy label or the box. If you have outdated medication, use the United States Food and Drug Administration (FDA) guidelines to dispose of the drugs properly.

Toss the Expired Food
Before you replace any dog or cat food in the closet, check the expiration date on the bag or can and if outdated, dispose of it. Opened bags of dry food that have not been sealed tightly are likely to be stale or even rancid. Dispose of them as well.

No Need to Store Bones
Board certified veterinary dentists at the Animal Medical Center caution all dog owners against using natural bones or synthetic bones made of nylon as dog chew toys. Both types of bone are the cause of tooth fractures. When a tooth fractures and exposes the pulp cavity, either extraction or a costly restoration is needed. Avoid an emergency trip to the veterinary dentist by choosing tooth-friendly toys such as those made of hard rubber or fabric.

What? You Still Have Jerky Treats?
Between 2007 and December 31, 2015, the FDA has received approximately 5,200 complaints of illnesses associated with consumption of chicken, duck, or sweet potato jerky treats from pet owners. The cause of these illnesses is unknown. Since jerky treats are not a required part of your pet’s diet, veterinarians recommend selecting other types of treats for your pet. If you are feeding jerky treats and your pet becomes ill, tell your veterinarian about the jerky treat ingestion. If you believe your pet has become ill from consuming a jerky treat, please provide the FDA with valuable information by reporting it electronically through their Safety Reporting Portal or your local FDA Consumer Complaint Coordinator.

Once you have that closet cleaned, spend some quality time with your pet and play with all the fun toys you re-discovered while cleaning out your pet’s closet.

Immune Mediated Hemolytic Anemia

I recently wrote about the concept of immune disease – those disorders where the immune system goes haywire and attacks normal cells in the body. Immune mediated hemolytic anemia, better known by its acronym IMHA, is one of these types of diseases. It is most common in dogs, but occasionally we see IMHA in cats.

Defining IMHA
Let’s break this complicated term into its component parts to help explain the disease process. I defined immune mediated in the previous blog, but in the context of IMHA, the immune system targets red blood cells, resulting in their destruction at a rate faster than the body can replace them. Anemia is simply a lower than normal number of red blood cells which, in IMHA, occurs because of rapid destruction of healthy red blood cells. Red blood cells can be thought of like a little teeny bag containing hemoglobin, the red oxygen-carrying protein. Hemolysis is the rupture of the membrane holding the hemoglobin inside the red blood cell. The red hemoglobin leaks out of the ruptured red blood cell and into the bloodstream and urine. The sample in the photograph is a urine sample from a dog with IMHA. It is red because of the release of hemoglobin into the bloodstream and excretion in the urine.

Recognizing IMHA
As a pet owner, you might recognize lethargy and weakness because your pet does not have enough blood cells to carry adequate oxygen throughout their body. You may also see discolored urine and feces. If you look carefully, your pet’s gums will be pale compared to their normal pink color. But sometimes it takes a battery of tests to the lab to determine that IMHA is the diagnosis.

Causes of Hemolytic Anemia
IMHA is not the only cause of hemolytic anemia. Certain dogs have a genetic defect that makes their red blood cells weak and prone to rupture. For some unexplainable reason, dogs, especially puppies like to eat coins. Pennies contain zinc, which damages red blood cells and causes hemolysis. Blood parasites, transmitted by ectoparasites, are another cause of hemolysis. Occasionally hemolysis is the result of an undiagnosed cancer. With this lengthy list of causes, it is no surprise your pet will need a battery of tests to determine a diagnosis of IMHA.

Treatment Can Be Tough Going
Treatment of IMHA involves suppressing the immune system with drugs like prednisone and azathioprine. When anemia is severe enough, blood transfusion is required. Because dogs with IMHA are critically ill, they are most often hospitalized for several days in AMC’s intensive care unit where their condition can be monitored minute by minute. The first two weeks after a diagnosis of IMHA are the most perilous. But if a dog makes it through the first two weeks, they are likely to live for many more months with ongoing therapy.

In a future blog, I will tackle another hematology disorder, immune mediated thrombocytopenia.

Top Tick Stories 2017

Increase in Lyme Disease Cases for 2017
According to the Companion Animal Parasite Council, canine Lyme disease is expected to expand beyond its traditional geographic boundaries in 2017. In states like New York where the disease is endemic, the number of cases will increase, thanks to a bumper crop of white footed mice, the efficient vectors of the Lyme disease-carrying Ixodes scapularis tick. Because humans and dogs can contract Lyme disease, it is going to be a tough season for all.

Powassan Virus Makes its Mark in 2017
This rare tick-borne virus made NYC metro news this spring when a young Connecticut child was diagnosed with Powassan virus disease. In our area, this virus is spread by the same tick vector as Lyme disease. Powassan virus, first identified in Canada, causes neurologic signs and can be fatal. Fortunately, the Connecticut child recovered without major long-term effects. To date, there is no information indicating dogs and cats can be affected by this virus, but without tick prophylaxis, your pet could inadvertently expose your family to ticks carrying this deadly virus. Preventing ticks on your pet makes your family safer.

Forecasting Lyme Disease
One bright spot in the nasty tick predictions for 2017 is how dogs are impacting Lyme disease forecasting. Though very complicated math,

scientists determined results of pet dog blood tests for Lyme disease in past years can forecast the occurrence of the disease in the upcoming year. This helps to alert veterinarians about the geographic expansion of Lyme disease into new areas, helping us to better prevent and diagnose the disease. Since we share outdoor activities with our dogs, the information also helps physicians to diagnose Lyme disease early.

News to Use
The continuous geographic expansion of tick-borne diseases makes protecting ourselves and our pets from tick attachment more important than ever. A three-pronged approach is necessary: manage the environment, prevent tick attachment, and remove ticks promptly and completely.

  1. To reduce tick habitat, keep grass and bushes in your yard trimmed and clean up dead leaves and branches.
  2. Talk to your veterinarian about what tick prevention products work in your locale and would be best for your pet. Collars, pills and top spot preventatives are all very effective.
  3. Check yourself and your dog for ticks after spending time outdoors. Use tweezers or a specially designed tick remover tool to remove both the body and the head of the attached tick.

Resources for National Dog Bite Prevention Week 2017

This year, National Dog Bite Prevention Week® has moved from May to April, and will remain a signature April event in the future. Sponsors of National Dog Bite Prevention Week moved the event up in the calendar in an attempt to educate the public and prevent more bite injuries. Bites occur most commonly in children, and more bite injuries occur in the summer months. The exact reason for these phenomena are unknown, but perhaps because children and dogs are frequently together outdoors in the warmer months or maybe dogs are cranky, just like the rest of us are when the weather is hot and sticky.

The Coalition
Dog bite injury affects many facets of society and the coalition sponsoring the event reflects that. The coalition includes the American Veterinary Medical Association, United States Postal Service, State Farm Insurance, American Humane, Insurance Information Institute, and Positively®, Victoria Stilwell. Each one of these organizations brings valuable information from their perspective about dog bite prevention. I have summarized some of those resources below.

American Veterinary Medical Association
Doggie Do’s and Don’ts: Dog Safety and You, the AVMA bilingual coloring book. You can download a copy for free for your child or order enough for a whole classroom of children.

State Farm Insurance
Insurance companies pay millions of dollars each year for dog bite claims and have a vested interest in decreasing the annual number of dog bites. State Farm’s website provides information about preventing and responding to a bite incident. The site also has several other dog safety related articles of interest to pet families.

American Humane 
If you are a teacher looking for a lesson plan about animals, check the website of American Humane. Although not directly focused on dog bite prevention, these prefabricated plans have been devised for students 5-7 years of age and run 45 minutes in length. The plan includes worksheets and coloring pages which can easily be reproduced for classroom use.

Positively, Victoria Stilwell
This British television dog trainer and promoter of positive re-enforcement methods of dog training has recorded a podcast with tips to stop dogs from biting. Download the podcast and make listening to it a family activity.

A Few Personal Favorites
Dog bite prevention information is not limited to coalition members. The American Academy of Pediatrics has a podcast on bite prevention.

Dogs participating in obedience training are less likely to bite and I recommend all puppies and dogs successfully complete an obedience training course. One of the many courses available is the Canine Good Citizen program sponsored by the American Kennel Club.

Finally, for the most updated information on bite prevention, tune into the National Dog Bite Prevention Week coalition’s press conference on Thursday, April 6, featuring:
• Demonstrations by veterinary specialists on dog bite prevention
• Release of the number of postal carriers bitten in 2016
• Announcement of the average cost of dog bite claims nationally in 2016, as well as the top 10 states with the largest number of dog bite claims in the U.S.

Why Your Dog Smells “Doggy”

dog smell

Ask a veterinarian what is one of the best smells in the world and many will answer without a moment’s hesitation: puppy breath. Hardly anyone can resist the fresh scent of a new puppy, kind of like the smell of a new car. But, as your dog grows up, he loses that delightful smell and sometimes can smell, well, a bit like a dog. Doggy smells may indicate a problem needing more than just a dog deodorant. Consider the following problems if you whiff the dog smell.

Hound Halitosis
While your dog is always kissable, a bad case of hound halitosis may make you want to avoid a smooch from your pooch. Doggy breath is not normal and is a sign of tooth or gum disease. Daily brushing and special dental products can help. But your dog may need a professional cleaning to eliminate the smell. Keep in mind, bad breath has been included as one of the 10 warning signs of pet cancer. A serious case of bad breath should send you and your dog to the veterinarian’s office pronto.

Stinky Ears
First you notice your dog scratching at his head and then you catch a stench wafting from his ears. Ear infections are one of the most common reasons dogs see their veterinarian and frequently are associated with a bad smell. Flip up the ear flap. If your dog winches, has a red flap or gook coming from the ear canal, you may be dealing with an ear infection as the source of the unpleasant doggy smell. Both bacteria and yeast can be at the root of stinky ears. Your veterinarian can do testing to identify the culprit and prescribe the appropriate medication.

Reeking Rumps
The anal sacs sit on the right and left sides between the layers of muscles making up the anal sphincter. Each one has a duct traveling out from the sac to the skin. Why dogs (and cats too) have this anatomic structure is somewhat of a mystery. Why about 10% of dogs have recurrent impactions and infections of the anal glands is also a mystery. There is no question however, that the smell of anal sac secretions can clear out large areas of a veterinary clinic and send the assistants running for room deodorizer. When your dog slides his rump on the floor or licks that area excessively, he may be trying to telling you he has an anal gland problem.

If your Fido is a bit fragrant don’t worry, a trip to veterinarian can have him smelling as fresh as a bunch of daisies.

Everyday Medicine: Pulse Oximetry

pulse oximetry

Everyday medicine is an intermittent series of blog posts highlighting tests, treatments and procedures commonly used at AMC. Some past examples of this type of blog post include “What are Vital Signs” or “Five Reasons Veterinarians Love Fluid Therapy.” Today’s blog post will tackle the topic of pulse oximetry, a common monitoring tool used at AMC.

In the last publication of Everyday Medicine, I wrote about oxygen therapy and how veterinary patients depend on this vital element. Today, I am writing about a non-invasive method we use to monitor oxygen therapy, pulse oximetry.

The Device
A pulse oximeter is a portable device with two main parts: 1) a box that contains the software and a display panel, and 2) a sensor which attaches on one end to the box and on the other end to your pet. In people, the sensor is often attached to a finger, toe or ear lobe, but the hairy nature of paws and the thick pads make toes a less than ideal location in pets. Veterinarians typically attach the probe to the tongue or cheek, or the web of skin between the toes in anesthetized patients. In conscious patients, we use the ear flap.

The Measurement
The pulse oximeter measures how much oxygen is attached to the hemoglobin molecules within the red blood cells. The machine display reports the percent of the hemoglobin molecules that have oxygen attached to them, a value called the oxygen saturation. In a normal dog or cat, we expect the oxygen saturation to be near 100%. When oxygen saturation is less than approximately 94%, oxygen therapy is administered.

The Clinical Application
I bet AMC veterinarians use the pulse oximeter a couple of dozen times a day in a variety of situations. The most common use is as a monitoring tool for pets undergoing general anesthesia. Oxygen gas is used as part of the anesthetic protocol. If the pulse oximeter indicates the oxygen saturation is falling in an anesthetized pet, it is a clue for veterinarians and veterinary technicians monitoring the pet to adjust the anesthetic and oxygen levels. In pets with diseases affecting the lungs, like pneumonia or asthma, the pulse oximeter can assess the impact of oxygen therapy and also improvements in the pet’s underlying disease following administration of antibiotics or anti-inflammatory drugs.

Simple and indispensable, the pulse oximeter is an essential device for the daily practice of veterinary medicine.

Everyday Medicine: What are Vital Signs?

animal medical centerEveryday medicine will be an intermittent series of blog posts highlighting tests, treatments and procedures commonly used at the AMC.  Some past examples of this type of blog post include “Spenser’s Recovery After Surgery” or “Five Reasons Veterinarians Love Fluid Therapy.”

Today’s blog post will tackle the topic of vital signs, a common term used by our Emergency and Critical Care Service.

Triage
When a patient checks into the AMC ER, a call for triage is made. The nurse or veterinarian assessing the patient will speak briefly with the client about the problem and collect the patient’s vital signs. The vital signs will be compared to normal and used to determine if the pet can be considered stable. This information is used to prioritize the patients waiting to be seen in the animal ER based on severity of their illness.

Vital Signs
Pulse, respiratory rate, temperature and blood pressure are considered vital signs.  A stable patient has normal vital signs. A normal pulse is easy to feel on the inside of the hind legs and should be regular with a rate around 100-120 beats per minute. Auscultation with a stethoscope may be used to help confirm an irregular heartbeat. Respiratory rate can easily be counted just by observation. A respiratory rate above 40 breaths per minute is abnormal. The third vital sign, body temperature, hovers around 100oF in dogs and cats but is not considered a fever until it reaches 102.5oF. In critically ill patients, a low body temperature may be just as serious as a high one. Technically, blood pressure is not a vital sign, but it is commonly measured in the animal ER, and like vital signs, if too low or too high, a patient can be considered unstable.

Follow-Up Testing and Treatment
The ER veterinarians may order follow-up tests if the vital signs are abnormal.  An irregular heartbeat will provoke an EKG. An elevated respiratory rate is further investigated by auscultation with a stethoscope and possibly a chest x-ray. To follow up on an elevated body temperature, a blood count is commonly submitted to the lab. Administration of intravenous fluids helps to bring blood pressure up or fever down.

Beyond Vital Signs
In the animal ER, other parameters are assessed to help determine if a patient is stable. Gums are checked for moistness and the skin rebound is observed. Dry gums and a slow skin rebound are signs of dehydration. Gum color is checked as an indicator of anemia and can be quickly monitored via a packed cell volume, or PCV, to determine the presence or absence of anemia. The patient’s level of consciousness is also assessed and even if the vital signs are normal, if a patient is unresponsive, they will be deemed unstable.

An experienced ER veterinarian can make an assessment of whether or not a patient is stable in just a few minutes. If your pet visits the animal ER and they are deemed stable, you might be unhappy because of the wait, but you should be relieved that your pet is stable and does not need to immediately whisked away for rapid intervention because of unstable vital signs.