Having a Heart to Heart Talk with Yourself About Your Pet’s Cancer Diagnosis

Cure Pet Cancer

November is National Pet Cancer Awareness Month. One in every four dogs and one in every five cats will develop cancer in their lifetime and @amcny is doing its part to raise pet cancer awareness by tweeting to #CurePetCancer to raise awareness.

Since cancer diagnoses are common in pets, many of my readers will face the difficult task of choosing cancer treatment decisions for their pet. Here is a list of questions you should ask yourself as you work through that decision-making process.

What kind of cancer specialist does my pet need?
Veterinary cancer specialists are not all the same. At AMC, we have three different types of cancer experts for pets: those that focus on administering chemotherapy, some who specialize in delivering radiation therapy, and the third type have special training in surgical oncology. We all know the basics of cancer treatment principals, but have different strengths within that core information. Your pet may need a consultation with one of us or all of us, depending on the type of cancer that has been diagnosed. The answer to this question lies in the biopsy because the type of tumor your pet has dictates the treatment options.

What kind of treatment is the oncologist recommending and is it right for my pet?
There are three main treatments for cancer: surgery, radiation and chemotherapy. Not every treatment is appropriate for every type of cancer and based on the biopsy, an oncologist will discuss what options are available to your pet and the expected outcome for each treatment option. Chemotherapy and radiation therapy require multiple treatments over several weeks to months. Surgery typically requires only a few visits to the hospital and has the highest chance of curing certain cancers. Cancer is most common in older pets and the grey muzzle set is also most likely to have other medical conditions which have to be taken into consideration in making the decision to pursue cancer treatment.

Do I have the resources to undertake the recommended treatment?
This question isn’t just about money, although cancer treatment can be costly. Another consideration when making the decision to treat your pet’s cancer is your time. Sometimes a trip to the surgical oncologist is all that is needed and other times 20+ trips are required for a course of chemotherapy. Be sure you understand what is required for the recommended treatment protocol. Your emotional resources count too. Maybe you are also caring for a seriously ill human family member and cancer treatment for the pet is more than you can handle. Or maybe it is the other way around and you can’t bear to lose two family members at once.

What is the prognosis for my pet with and without treatment?
This is a loaded question. The question is fair, but pet families who choose not to treat their pet’s cancer don’t often consult with an oncologist. That means oncologists, like me, don’t always have a good handle on the prognosis without treating many types of cancer.

If you have decided to make an appointment for a consultation with a veterinary cancer specialist, read about fancy cancer words that we try to keep out of our conversation with you, but sometimes accidentally slip into a conversation about treating your pet. Being prepared for a visit with a specialist will help to make sure all your questions are answered.

Diabetes: Pets and People

Stone - Diabetes

November is American Diabetes Month. To highlight how veterinarians care for pets with diabetes, I thought I would tell the story of one of my patients, a fluffy, grey and white cat named Stone.

Stone is a youngster, just under two years of age. He came to see me because his owner had noticed weight loss and excessive drinking. Weight loss and excessive drinking are common clinical signs of diabetes, but Stone was much younger than the typical cat with diabetes. Hyperthyroidism can also cause weight loss and increased drinking, but typically occurs in older cats.

Another cause of weight loss and excessive drinking is chronic kidney disease, but again, typically in older cats. I wasn’t really sure what was wrong with Stone until the blood tests showed sugar in his urine and an elevated blood sugar.

Dogs and cats have different forms of diabetes. Dogs commonly have Type I diabetes, which is a total lack of insulin production by the pancreas. Cats have Type II diabetes which occurs most commonly in middle to older overweight cats. Unlike humans with Type II diabetes, cats require insulin injections where humans can often manage Type II diabetes with oral medications and diet. Strangely, with weight loss, insulin therapy, and a special diet, some diabetic cats will become normoglycemic again and no longer require insulin. This happened to my own cat and he stopped needing insulin for a year. Then became permanently diabetic and required insulin for the rest of his life. I think chronic inflammation of the pancreas (known as pancreatitis) was the likely cause of the diabetes.

Stone was in to see me just a few days ago. On twice daily insulin therapy, he has gained back some of the weight he lost and is eating his special diabetes diet with gusto. Blood tests indicate his blood sugar is well controlled and his owner notes it is getting harder for her to test his urine to measure the urine sugar level. I am suspicious he may be heading for a period of diabetic remission.

To help my readers understand the similarities between their own diabetes and that of their pets, I included a table below with a comparison of the common features of the disease.

Comparison of diabetes between people and their pets:

  Cat Dog Human
Occurrence 0.58% of cats 0.35% of dogs 9.4% of Americans
Type I diabetes No Yes Yes
Type II diabetes Yes No More than 90% of diabetes
Diabetic retinopathy No Rare Yes
Diabetic nephropathy No No Yes
Association with pancreatitis Yes Yes No
Oral treatments No No Yes
Insulin injections Yes Yes Yes
Spontaneous remission resolution Yes No No
Diabetic cataracts Rare Yes Yes
Linked to obesity Yes Yes Yes

Going Viral: AMC’s One Health Day Event

One Health Day

November 3, 2018, marks the third annual One Health Day, a global campaign celebrating the need for a One Health approach to address shared health threats at the human-animal-environment interface. The One Health concept uses a transdisciplinary approach to recognizing and caring for the interconnected health of humans, animals, plants, and our shared environment. To celebrate One Health Day 2018, AMC will host a panel discussion with three New York City-based One Health experts; each panelist is a veterinarian AND an expert in a different One Health arena.

A Public Health Veterinarian
Sally Slavinski DVM, MPH, Diplomate ACVPM has an impressive list of letters after her name. Dr. Slavinski is a veterinarian with specialty training in public health. As the Assistant Director Zoonotic, Influenza and Vector-borne Disease Unit in New York City’s Department of Health and Mental Hygiene’s Bureau of Communicable Disease, Sally stands at the juncture between animal and human disease in New York City. When you hear a warning about rabies in Central Park raccoons and the risk to your dog and yourself, Sally is behind that alert. She will provide attendees an overview of her role at the health department, explain the role of epidemiology and disease surveillance, and highlight the relationship between the Department of Health and Mental Hygiene and the animal health community.

A Veterinarian and Environmental Health 
Ellen P. Carlin, DVM works for EcoHealth Alliance as a Senior Health and Policy Specialist. She is also a Research Associate at the Smithsonian Conservation Biology Institute and holds positions at Columbia University National Center for Disaster Preparedness and Cornell University’s College of Veterinary Medicine. Her role on the panel is to discuss the often forgotten third point of the One Health triad, environmental ecological health. Dr. Carlin will discuss her role and contributions to understanding environmental elements of disease transmission, particularly in the context of disease transmitted between animals and humans.

A Wild Animal Veterinarian, Human and Environmental Health
Paul P. Calle, VMD, Diplomate ACZM & ECZM (Zoo Health Management) is the Chief Veterinarian and Vice President for Health Programs and the Director, Zoological Health Program at the Wildlife Conservation Society (WCS), lovingly known to New Yorkers as the Bronx Zoo. The WCS does more than care for the animals in the NYC zoos; the WCS is instrumental in working on international health issues such as West Nile Virus, Ebola, and Avian Influenza. Diseases like these become global issues due to loss of animal habitats as a result of expansion of the human population and transport of disease vectors and causative agents by traveling humans.

Your pet, your world and you: expand your knowledge about all three by spending an evening with these three fascinating experts at AMC’s annual One Health Day on November 1st, 2018 from 6:30-8:30 pm. Register for free today!

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.

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.