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.

Sharing Turkey Day Dinner with Your Pets

Thanksgiving is all about food and family. Many of us consider our pets family members and want to include them in the holiday celebration, but menu selection for pets can be tricky. For example, dogs love chocolate, but it will cause vomiting, diarrhea and hyperactivity if Fido indulges his passion with a few foil wrapped chocolate turkeys. Your cat may find the raw turkey trimmings sitting on the counter a tasty treat. Raw poultry can be teeming with organisms such Salmonella or E. coli and give Fluffy a nasty case of food poisoning. So here are simple suggestions for taking food from your holiday table and creating a healthy and safe buffet for the family pets. More difficult will be figuring out if seating Fido next to Grandpa and Fluffy next to Uncle Ray will provoke a family fracas!

Doggie dishes
When choosing Thanksgiving food for your dog’s dish, stay away from high fat dishes, such as gravy or sausage stuffing, which can provoke an episode of painful pancreatitis. Steer clear of raisins and grapes, whether in a fruit salad or stuffing, as these delicious fruits can cause serious kidney problems. A spoonful each of nice white meat turkey, sweet potatoes or mashed potatoes minus the butter, sour cream, nuts, and marshmallows would be safe turkey day fare for your dog. Fruit often appeals to dogs, and while recreating grandma’s apple crumb pie, save a couple of apple slices for your dog.

Reptile recipes
If you have a vegetarian reptile, such as an iguana, bearded dragon or a tortoise, the Thanksgiving side dishes provide an opportunity to share the bounty of the season. Winter greens such as collards and mustard greens make a tasty holiday treat. While you’re setting aside the greens for your special scaled friend, save some raw squash, yams and even a few fresh or boiled cranberries to create a colorful and healthy reptile dinner. In addition to the vegetables and fruit, your turtles might like a bit of white or dark meat turkey added to their plate.

Kitty cuisine
Because cats think of you as their servant, dishing up what you believe to be a special holiday meal without asking their permission may result in rejection of your best culinary efforts. Perhaps just serve up the turkey flavor of your cat’s favorite canned cat food and call it a day in the kitchen! If you must cook for your kitty, consider simmering the giblets from the turkey until they are cooked through. Once they are cooled, mince them finely for a feline Thanksgiving Day indulgence.

Pocket pet provisions
If you have a small mammal, such as a rabbit or guinea pig, save some salad fixings, like lettuce leaves and carrot pieces, to make Thanksgiving extra special. While you are making the pie, save a small piece of apple before it is mixed with sugar and cinnamon as a rabbit dessert. The family ferret can feast on small bits of plain turkey meat without gravy or seasonings.

Bird buffet
Before you add the butter, sugar or marshmallows to the steamed or boiled sweet potatoes, save a small portion for your bird’s Thanksgiving dinner. If you garnish your vegetable dishes with pecans, walnuts or slivered almonds, they too can be added to your bird’s holiday fare. Selections from the vegetable side dishes, such as carrot pieces, green beans and Brussels sprouts, make a tasty and healthy addition to your bird’s plate, but be sure to set them aside before butter or salt is added!

The Animal Medical Center wishes a happy Thanksgiving to all! “Bone” Appétit.

SAVE Saves a Bird

As her name suggests, Scarlett is a pet that is red, but not a red setter, a redbone coonhound or a red Abyssinian, she’s an African grey parrot with a red tail. This 25-year-old parrot is also an artist, creating colorful abstract works of art in the bathtub. She was referred to The Animal Medical Center to see Avian and Exotic specialist Dr. Kathy Quesenberry for an egg that wasn’t being laid, an avian condition known as egg binding, putting a damper on her artistic endeavors.

Like many medical problems, egg binding occurs in overweight birds with a sedentary lifestyle or a diet lacking adequate calcium. Medical treatments can be effective in resolving a stuck egg – calcium, fluids, lubrication and keeping the bird warm may cause the egg to pass, if not, then manual or surgical removal of the egg may be necessary. These treatments had been tried in Scarlett, but they were unsuccessful.

IDing an Egg
One of the first steps in treating an egg-bound bird is to pinpoint the egg’s location within the reproductive tract. Because eggshells contain calcium, they can easily be seen using a standard x-ray. In the x-ray image on the right, you can see a thin, egg-shaped structure in Scarlett’s abdomen between her pelvic bones representing Scarlett’s stuck egg.

Avian Endoscopy
The inside of a bird’s vent, called the cloaca, contains multiple openings – one for the intestinal tract, one for the reproductive tract, and two small openings for the urinary tract. Dr. Quesenberry used endoscopy to view inside the vent and was planning to remove the egg at the same time. Endoscopy identified a tear at the end of the oviduct where it entered the cloaca, making surgery urgently necessary.

Bird Spay
During the two and a half hour endoscopy and surgery, Scarlett’s torn oviduct at the cloaca was repaired, and the remainder of her oviduct was removed to prevent another egg binding episode. Unlike mammals, most birds have only a single left oviduct and ovary. Because a bird’s ovary is close to large blood vessels, it cannot be removed safely. A “bird spay,” or salpingectomy, is the procedure of removing most of the oviduct so that an actual shelled egg cannot be formed, even though the ovary still functions normally. Scarlett recovered uneventfully. Two weeks after surgery her sutures were removed and she was given a clean bill of health and she has returned to emulating Jackson Pollack-esque abstract impressionism in her bathtub. The photo seen here shows Scarlett as a component of her own artwork.

Help From an AMC Community Fund
The happy ending to Scarlett’s story would not have been possible without the generosity of those who support The AMC’s Community Funds. Scarlett’s care was covered by the Seniors’ Animal Veterinary Effort (SAVE), which provides free or subsidized general and emergency veterinary services for the pets of the indigent elderly.

To learn about other pets treated through The AMC’s Community Funds, read the heartwarming stories about Tiko, Frankie, and Baller.

Become a supporter of The AMC’s Community Funds today.


Watch Scarlett at work in her bathtub studio on The AMC’s YouTube channel.


View Scarlett’s virtual art gallery.

Click to play this Smilebox slideshow

AAHA Certification: The AMC Takes the Test to Meet Veterinary Practice Standards of Excellence

The Animal Medical Center undergoes a triennial accreditation evaluation by the American Animal Hospital Association (AAHA). The AAHA is an industry leader that sets the standards for small animal hospitals in North America, standards which are often emulated internationally. For example, in Japan, the Japanese Animal Hospital Association (JAHA) serves a similar role to AAHA in the United States. Recently, AAHA has added new accreditation categories for referral hospitals and university hospitals.

The Benchmarks
Over 900 different standards are assessed during the accreditation evaluation. The standards focus on the quality of care in the areas of: anesthesia, contagious diseases, dentistry, pain management, patient care, surgery and emergency care. The standards are grouped into 20 large categories covering quality of care in diverse areas such as contagious disease, dentistry, diagnostic imaging, emergency and critical care, and pain management. Mandatory standards detail 46 critical/crucial hospital functions required of every AAHA accredited hospital. These “deal breaker” standards include the requirement that dentistry is performed under general anesthesia with tracheal intubation, and all patient care is provided under the supervision of a licensed veterinarian. The standards require hospitals to provide diagnostic services (x-ray and laboratory) facilitating quick and accurate diagnosis of your pet’s illness. Accredited hospitals must dispense medications so treatment can begin immediately.

The focus of the benchmarks is not just on patient care, but on how the veterinary team interacts to achieve high quality patient care. Standards pet owners might not expect as part of the evaluation process include an assessment of confidentiality, security and integrity of medical records, fire safety, diagnostic image archiving, continuing education, and referral standards. While not exactly medical standards, these functions are clearly critical to an accredited hospital’s ability to provide top-notch patient care.

Exam Prep
The AMC is continuously prepping to meet the AAHA accreditation standards. Our accreditation team reviews the benchmarks and educates the staff regarding their responsibilities in implementing each standard. When a new standard is issued, the appropriate hospital team writes our policy to ensure the new standards are met. That policy is then distributed to the implementation teams. Each new standard improves the quality and safety of The AMC’s patient care.

A Pop Quiz
On-site examiners perform a full-day thorough and comprehensive review of the hospital. Preparing for an AAHA evaluation is like preparing for a pop quiz; they can ask questions about any of the 900+ standards and they don’t have to give you a heads-up as to which ones are on the quiz. The examiners speak with a variety of staff and review hospital policies to ensure standards are met. If any deficiencies are identified, they suggest methods of improvement.

Perfect Scores
The accreditation process is rigorous and encompasses all aspects of pet healthcare. Only 15% of all veterinary hospitals meet these stringent quality standards. The AMC is proud to say it has been an AAHA accredited hospital since 1976 and passed its most recent evaluation with flying colors. We achieved a perfect score in six of the 20 categories of standards. All of the standards ultimately affect the care pets receive at The AMC, but most important to pet owners are the A pluses The AMC received for management of contagious diseases and emergency and critical care medicine. Overall, we received a solid A, or 94%, which does not mean we got six questions wrong. We scored 30,250 out of a possible 32,310 points! No wonder it took weeks to prepare for this evaluation.

Standards Met
For over 100 years, The AMC has been a leader in veterinary teaching, research and exceptional clinical care. The AAHA is another leader in veterinary medicine whose opinions and stance are relied upon for setting high hospital standards. Achieving AAHA certification is just one way we continue to provide the highest quality of medicine and surgery to nearly 40,000 patients every year.

Rat-Bite Fever and Pet Rats: How Concerned Should We Be?

The recent report of a 10-year-old boy that died from rat-bite fever in San Diego has raised concerns about the risk of contracting this disease from pet rats. The family of the child is suing Petco, where they bought a pet rat two weeks before the boy died after a 48-hour illness characterized by flu-like symptoms. This incident has brought into discussion the rare but real risk of this zoonotic disease, which is caused by two different bacteria that are carried by rats. The type of rat-bite fever that is most common in North America is caused by Streptobacillus moniliformis. Another form of rat-bite fever is caused by Spirillum minus and occurs primarily in Asia. Rats can carry both bacteria as part of the normal flora of their respiratory tract. Because of this, rats do not usually exhibit any outward signs of illness from these bacteria. People are infected with the bacteria through rat bites or exposure to urine, feces or saliva of rats that carry the organism.

Illness after the bite of a rat has been described for thousands of years in Asia in poor populations that are exposed to wild rats. With the increased use of large numbers of laboratory rats in the last century, this disease has been seen most often in laboratory animal workers in the US, as well as in poor populations. However, the growth of the pet industry and the increased popularity of fancy pet rats in the last 30 years have shifted the disease incidence so that now more than 50% of the cases in the United States are seen in children. Rat-bite fever is not a reportable disease in the US, so the actual number of cases that occur annually is unknown. However, the incidence of the disease in the US is very low, and death from rat-bite fever is also rare. The cases that are known are those that are documented in the medical literature. To complicate matters, the clinical signs of rat-bite fever in people are nonspecific, and the tests to isolate or identify the organisms involved are not routine. Often, a history of exposure to a rat, in combination with the clinical signs, is the clue that doctors use to suspect rat-bite fever in patients, and then diagnosis is based on specific testing methods. If the disease is suspected or diagnosed, treatment with antibiotics is curative in most cases. A good review of this disease is available – see Rat Bite Fever and Streptobacillus moniliformis.

So what is the risk of this disease if you or your children have a pet rat? Fancy rats are very popular as easy to maintain, social and gentle pets. They are common children’s pets but also have an avid following among adults who can’t afford or don’t have the lifestyle suitable for a dog or cat. Fancy rats are widely available from both pet stores and private breeders in different colors, sizes and conformations. However, few, if any of the pet rats sold are tested for the bacteria that cause rat-bite fever. The prevalence of the bacteria in rats can vary, from as few as 10% to as many as 100% of rats in a breeding colony or laboratory that are infected. Any pet rat can carry these organisms, but the risk of actually contracting the disease from the rat is very low.

What should you do? As with any animal that carries a risk of zoonotic disease, hand-washing after handling is of utmost importance. Using either soap-and-water or an alcohol-based hand cleanser after handling the pet rat and cleaning the cage is mandatory. Children should be instructed to always wash their hands after playing with the pet and to always tell parents about any bites that occur when handling the pet. Owners of pet rats should immediately report unexplained fevers, illness or rashes to their healthcare provider. Specialized screening tests to see if your pet rat is a carrier of S. moniliformis are available from veterinarians, but make sure you call ahead to see which veterinarians provide this test, as it is not routinely offered.

This blog was written by:
Katherine Quesenberry, DVM, MPH, DABVP (Avian)
Head, Avian and Exotic Pet Service

The Animal Medical Center

The [Veterinary] World is Flat

The title of this blog takes its name from author and New York Times columnist, Thomas Friedman’s bestselling book, The World is Flat: A Brief History of the Twenty-First Century. The book’s thesis explains globalization in the 21st century as a result of wide accessibility to personal computers and fiber optic cables which make communication via email and information gathering via the internet nearly instantaneous. This form of globalization renders geographic divisions between countries irrelevant.

Friedman describes “ten flatteners” including: the collapse of the Berlin Wall, Netscape and workflow software. My own observations of the world of veterinary medicine indicate that it is not much different than the global economy Friedman describes in his book. Paying tribute to the Pulitzer Prize winner Friedman, here are my veterinary flatteners.

A New Workflow
Digital radiography has changed the workflow of daily veterinary practice. In the pre-computer days, each x-ray was a piece of film, not easily copied and very easily misplaced. Now The AMC and many other veterinary hospitals have switched to using digital radiography, using a machine that looks like a regular x-ray machine but which takes digital images similar to those taken with your smart phone. These x-rays can’t be lost because the images are stored in a picture archiving and communication system (PACS). The image files are very large, but can be transported by burning them onto a CD or transferring them through any number of file sharing systems.

Electronic Medical Records
As it has revolutionized the global economy, the personal computer is revolutionizing veterinary practice. Electronic medical records systems (EMRS) allow rapid dissemination of medical information between specialists and primary care veterinarians. I can write a letter to a patient’s primary care veterinarian after I have completed my consultation with their patient. Through the magic of the EMRS, I can have the letter in that veterinarian’s inbox for his/her review before the pet has returned home.

Board Certification
Twenty-five years ago when I started the process of becoming a board certified veterinary oncologist, there were only about 25 veterinary oncologists in the world. The American College of Veterinary Internal Medicine now has certified over 300 oncology diplomates and there is a European College of Veterinary Internal Medicine which certifies oncologists as well. Board certified specialists all over the world form a healthcare network that trades patients back and forth when pet owners relocate or go on vacation, just as I described in a previous blog: “Clea’s International Healthcare Team.” Since veterinary oncologists and other specialists have expanded their reach worldwide, specialist veterinary care no longer has geographic boundaries.

Multinational Veterinary Companies
Specialists are not the only international flatteners. Because international companies provide veterinary products and services, veterinary specialists can access information about pets seen by a veterinarian practicing on a different continent! Take for example my patient Gigi. She came to The AMC from Kuwait, but because the biopsy of her tumor was sent to the European branch of the same laboratory used by The AMC, I was able to ask additional questions about the biopsy result. The biopsy sample was retrieved from storage and then reviewed by a pathologist in Europe. The answers to my questions were sent via email.

Real Time Communication
The internet has changed the face of veterinary education. Today, veterinarians no longer have to travel to earn continuing education credits necessary to maintain their licenses. Continuing education comes to them though their computers. This year, the keynote speaker addresses at the annual Veterinary Cancer Society Meeting were streamed live to members unable to attend. Additionally, several internet based companies offer on-demand veterinary continuing education opportunities.

The veterinary world is indeed flat and that means your pet can get excellent veterinary care from a veterinarian in your neighborhood or from a specialist somewhere a long way from home!

AMC Resident Research Abstract Presentations

Just before Christmas, The Animal Medical Center held its annual residents research abstract presentations. As part of their specialty training, residents are expected to design, execute and report on research in their area of clinical specialty, and this mini-conference provided a forum for exchange of the knowledge gained from research between members of The AMC medical staff. The AMC performs a very specific type of research – clinical research. This means we study diagnostic testing, new treatments and procedures in the patients we care for as part of our effort to improve the health and well-being of our patients. We do not test or treat any animal for the sake of “research.”

Caspary Research Institute
Research at The AMC is not new; when The AMC moved uptown in the 1960’s from Lafayette Street to its present location, a decision was made to locate the new veterinary research institute right in the middle of the Upper East Side’s strong human-focused biomedical community. The AMC became the fifth biomedical institution in the neighborhood, joining The Rockefeller University, Cornell University Medical College, Sloan-Kettering Institute and Memorial Hospital for Cancer and Allied Diseases. Early architectural drawings of the AMC building show a sign on the north side of the building saying, “Caspary Research Institute.” When The AMC opened on 62nd Street, research and patient care were its main focus areas.

Short and Sweet
From a research point of view, an abstract is a very short presentation – 12 minutes, followed by a 3 minute question and answer period. Resident research abstract presentations are commonly preliminary reports which allow discussion of data and help formulate the interpretation of results prior to the writing of a manuscript for publication. Because the information presented was preliminary, I have a few interesting tidbits to report.

Lookalike Medicines
One study evaluated treatment of cognitive dysfunction in dogs with an anti-seizure medication compared to dogs treated with a placebo. In order to help veterinarians and owners make an unbiased assessment of patient response to the actual medication, our colleagues at Best Pet Rx Pharmacy made every dog’s medication look exactly the same. No one could tell which dogs were getting the medication being studied and which dogs were getting placebo pills. This is called double blind study design. Double blind because two people, the patient and the researcher, don’t know the treatment group assignment because it is hidden by the look-a-like pills.

Challenge of Science
Most research projects do not proceed exactly as planned. A study of ICU patients was designed to follow the effects of treatment on dogs with low blood protein (hypoalbuminemia). Dogs were to have a blood sample prior to treatment and 48 hours later. The study did not meet the enrollment target. Why? Despite an impression that dogs stayed in ICU longer than 48 hours, most dogs did not stay that long and fewer dogs than projected entered the study. Of course, we were happy your dogs went home earlier than expected, which was a scientific finding on its own.

Changing Protocol
The AMC’s ICU patients often need to be fed intravenously. We use a commercially available product called Procalamine. This product provides amino acids, the building blocks of protein and glycerin, as a source of glucose for energy. One emergency critical care resident studied patients receiving Procalamine as part of their treatment protocol. Patients receiving Procalamine through a catheter in their leg had more inflammation of the blood vessel than patients who get Procalamine through other, larger blood vessels. Although the directions for Procalamine indicate it can be given in the legs, we now will try and avoid this whenever the patient’s condition allows it.

Helping Pets Everywhere
These types of studies enable AMC veterinarians to improve the level of care for your pet. Through the publications that will result from these and other studies performed here, the knowledge will improve the care of pets everywhere.

Flu Season 2013 is Upon Us

Influenza was in the news and on my mind last week. First a new strain of avian influenza was reported to have infected humans. Then, I got my annual flu shot and finally reader comments on an article about canine influenza clearly showed the article was misconstrued by its readers, making me think it was time to write the hard facts about influenza.

Not like avian influenza
Canine influenza is significantly different than avian influenza. Compared to avian influenza virus, the canine influenza virus is relatively new. It was identified in 2004 by researchers in Florida who were studying an outbreak of respiratory disease and pneumonia in greyhounds. Based on research published, the virus appears to have emerged in racing greyhounds in approximately 1999. Subsequently, all dogs, greyhound or not, have been shown to be susceptible to infection by the canine influenza virus. But don’t worry, Fido’s virus does not appear to affect you or the family parrot.

Not like human influenza
Canine influenza is also very different than the human flu virus. I (and millions of other Americans) get a flu shot in the fall because flu infections predictably spike in the fall and peter out in the spring, only to return again in the fall. Canine influenza is non-seasonal, occurring anytime of the year. Check with your veterinarian to see if your dog is at risk for the flu and should be vaccinated against it.

Flu virus similarities
Flu viruses are usually contagious and spread rapidly in a susceptible population. Children typically bring the flu home from school and infect their parents. Dogs tend to contract the flu in places where there are many dogs in close contact. In a dog’s world, places of close contact include puppy kindergarten, dog parks, doggie day care, shelters and boarding kennels. If your dog visits any of these types of facilities, check on their vaccination policy.

We cover our face when we sneeze to protect others from our viruses and we wash our hands to prevent transmitting viruses on door knobs and other surfaces. As clever as dogs are, they do neither of these things to prevent transmitting canine influenza to their dog friends. If your dog is coughing or sneezing, keep her away from other dogs until your veterinarian gives the all clear sign.

Be flu safe
Right now, flu activity is low in the United States. To keep track of human flu, check the Centers for Disease Control’s flu map.

Get your flu shot today! If you are sick, who will take care of your dog or cat?