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.

Making the Most of Your Pet’s Microchip

microchip

The annual Check the Chip Day is Wednesday, August 15th. This pet health event reminds pet families to have the microchip in their pet checked by the staff in their veterinarian’s office to be sure it is working, as well as to update any information in the microchip database which links your pet’s microchip number to your contact information.

Microchip Basics
A microchip provides a permanent method of identifying your pet; it is not a GPS device. A microchip is about the size of a grain of rice. A veterinarian implants the chip under the skin over the shoulders. The microchip has no battery or moving parts, but emits a unique radiofrequency code and is designed to last for up to 20 years. Animal shelters and veterinary offices have microchip scanners to “read” the chip. Watch Nugget get his microchip scanned below. A microchip is typically a prerequisite for international pet travel.

And Also a Collar and Tag
A microchip is essential because many pets are not wearing a collar when they are separated from their family. But a collar with an ID tag displaying your phone number will get your pet home faster since anyone can read an ID tag, but only some have access to a microchip scanner. You might also consider putting your pet’s microchip number on their collar, but some folks choose to keep that information private.

The Power of a Chip
One of my patients escaped out the window when a workman inadvertently left the window open after doing repairs. Despite canvassing their neighborhood and following other suggestions for finding a lost pet, Sneezy was nowhere to be found. The little guy was MIA for two months until someone in the neighborhood noticed a scrawny, but very friendly cat they had not seen before. The kind neighbors scooped him up and delivered him to the local shelter. It took all of about ten minutes for the shelter staff to scan Sneezy, find his microchip and contact his jubilant family.

To make your lost pet story have a happy ending like Sneezy’s, be sure your pet’s microchip registration is up to date. If you only know the chip number, look up the company online. Also check the information on your pet’s ID tags and replace them if the information is out of date. If you want to keep your pet’s microchip information handy, download and print out this postcard from AMC’s Usdan Institute and keep it with his/her records.

Suffocation Risks for Pets

pet suffocation

Last week I noticed a recall on a pet water dispenser from the popular furniture and home accessories giant IKEA. Although I can’t quite wrap my head around how two pets could get their head caught in a water dispenser and die, IKEA is doing the right thing by recalling the product and refunding the cost of the water dispenser to prevent more tragic deaths.

Most pet owners would think suffocation is an uncommon cause of pet death, but Prevent Pet Suffocation and The Preventive Vet would argue otherwise.

Dangerous Bags
The bags supplied with snack food, pet food and treats, and breakfast cereal pose a serious risk to your pet. Even your average zipper bag can be lethal if your pet’s head becomes trapped in a bag which is impervious to air. As your pet tries to get the last chip crumb from the taco chip bag, every breath forms a tightening seal around your pet’s head, preventing her from getting oxygen. It takes only a few minutes for hypoxia and suffocation to occur.

Any Pet is At Risk
The IKEA recall warns about a danger to small dogs and cats, and the memorials to pets lost to bag suffocation show no boundaries. Most of the tributes are photographs of dogs, but all types and sizes: dogs with flat and pointy noses, big and little dogs. There are even a few cats who have succumbed to this preventable death.

Protecting Your Pet Against Suffocation

  • Don’t leave bagged food on the counter or anywhere your pet might get access to a bag
  • When disposing of empty chip, cereal, and zipper bags, cut off the closed end to open the bag and allow airflow if your pet finds the bag in the trash
  • Consider transferring food to plastic containers rather than storing them in bags
  • Be extra vigilant when you and your pet visit friends who might have bagged food unsafely stored
  • Use trash cans with locking lids
  • Alert your guests to the risk of bagged food or empty food bags
  • Sign up for pet product recalls and follow the manufacturer’s recommendations if you own a product that is recalled. A couple of suggestions are @AVMARecallWatch on Twitter and PetMD Recalls.

Distemper in Pets

canine distemper

This week, the New York City Department of Health and Mental Hygiene issued a veterinary alert about canine distemper virus infections in Central Park raccoons and both Fox 5 News and ABC 7 News visited Animal Medical Center to talk about the story.

An alert from the Health Department about sick raccoons dying from a dog virus may seem a bit outside their normal purview, but the alert is important to dog families and humans alike.

What is Distemper?
Although named canine distemper virus, this virus can affect a wide number of species, hence the sick raccoons in Central Park. Canine distemper occurs worldwide, especially in regions of the world where vaccination is uncommon. Veterinarians in the United States rarely diagnose canine distemper since the vaccine is very effective. In the United States, stray dogs are those most likely to be unvaccinated and ultimately diagnosed with canine distemper.

Recognizing Canine Distemper
Canine distemper virus infection has a wide range of clinical signs. Early in the disease, dogs have runny noses and red eyes, with some vomiting and diarrhea. Severe cases may develop pneumonia. As the disease progresses, dogs and raccoons exhibit neurologic signs like paralysis, twitching, and a wobbly gait. A strange type of seizure called a “chewing gum” fit is common. Some dogs appear to recover from distemper only to develop neurologic signs months to years later. This syndrome is called old dog encephalitis.

Why Are Officials Concerned?
Because distemper has a wide range of clinical signs, this disease can resemble other important infections, most notably rabies. The rabies virus circulates in NYC in cats, raccoons, and this week in a fox.

Both rabies and canine distemper can cause neurologic signs, making it difficult to differentiate the two diseases without specialized testing. New York City has recently experienced a dog flu outbreak.

To further complicate the picture, early distemper may resemble canine influenza and also “kennel cough.”

Protecting Your Dog
Veterinarians consider distemper vaccine a “core” vaccine. Core vaccines are those veterinarians recommend for every dog. Current best practice for distemper vaccination is a series of puppy shots, a booster around one year of age, and then triennial boosters. Check with your veterinarian to confirm your dog is up to date on his distemper vaccine. Distemper virus is transmitted via bodily fluids from an infected animal. If you are walking your dog, avoid contact with raccoons and consider keeping your dog on-leash to prevent him from coming in contact with urine or feces from an infected raccoon or the remains of a deceased raccoon.

Diet-Related Canine Heart Disease

dog diets

Last week, the United States Food and Drug Administration (FDA) announced an investigation into diet-related heart disease in dogs.

I suspect most dog families would be surprised to learn diet may play a role in the development of heart disease in their favorite fur baby. Here is a summary of the FDA announcement.

Heart Disease in Dogs
Veterinarians diagnose three main types of heart disease in dogs. The most common is degeneration of the valves between the chambers of the heart, leading to congestive heart failure. The least common form is congenital heart abnormalities. This form of heart disease might be considered a birth defect. The third form of canine heart disease is an abnormality of the heart muscle called dilated cardiomyopathy (DCM).

Dilated Cardiomyopathy
Canine DCM is a disease of a dog’s heart muscle and results in an enlarged heart that can easily be seen with a chest x-ray. The enlargement is due to thinning of the heart muscle, making the pumping action of the heart ineffective. The heart valves become leaky, leading to a buildup of fluids in the chest and abdomen. Like heart valve disease, DCM often results in congestive heart failure. Breeds that are typically more frequently affected by DCM include large and giant breed dogs, such as Great Danes, Boxers, Newfoundlands, Irish Wolfhounds, Saint Bernards, and Doberman Pinschers. There are also two small breed dogs prone to DCM, American and English Cocker Spaniels. The underlying cause of DCM is not truly known, but is thought to have a genetic component because of the strong breed associations. If caught early, heart function may improve in some cases that are not linked to genetics.

This Type is Different
The FDA initiated the investigation last week because the dogs recently identified with DCM are breeds not appearing on the list above. The cases that have been reported to the FDA have included Golden and Labrador Retrievers, Whippets, a Shih Tzu, a Bulldog, and Miniature Schnauzers, as well as mixed breed dogs. The other common finding in the recently diagnosed dogs is their diet. When the families of the dogs recently diagnosed with DCM were interviewed, they reported their dog’s diet contained potatoes or multiple legumes such as peas, lentils, other “pulses” (seeds of legumes), and their protein, starch and fiber derivatives early in the ingredient list, indicating that they are main ingredients. Early reports from the veterinary cardiology community indicate that the dogs consistently ate these foods as their primary source of nutrition for time periods ranging from months to years. High levels of legumes or potatoes appear to be more common in diets labeled as “grain-free,” but it is not yet known how these ingredients are linked to cases of DCM.

If You Are Worried About Your Dog or Your Dog’s Diet
Check with your dog’s veterinarian before changing his diet. The FDA encourages pet owners and veterinary professionals to report cases of DCM in dogs suspected of having a link to diet by using the electronic Safety Reporting Portal or calling their state’s FDA Consumer Complaint Coordinators. Please see “How to Report a Pet Food Complaint” for additional instructions.