Taking Medical Photos of Your Pet

The smartphone has revolutionized much of life today. Not only can we stay in constant contact with family and friends, but we can also listen to music, watch sporting events, and record life’s important moments in photographs and video. In a previous blog post, I suggested how you could use your smartphone to keep your pet healthy.

Smartphones have also revolutionized veterinary care via apps, access to scientific journals, and rapid communication with pet families. Your smartphone has improved my ability to care for your pet when you use it to send me images to keep me abreast of changes in your pet. Some photos are more helpful than others. Here are my suggestions to help you take the best medical photos possible.

Focus
Below is a very crisp, clear photograph of a healing incision. The photographer owner was concerned the incision was red on one end of the incision. I agreed with her assessment, but it was not severe enough for a trip to the ER, and the over the next two days the skin around the incision became normal again.

crisp photo

Compare the previous photo to this one. You can see it is out of focus and because it was out of focus I could not determine what the owner was trying to convey using this image.

fuzzy incision

Zoom In, Zoom Out
Sometimes, two photos would be helpful. The first photo should show where the problem is on the body, and the second should be closer in to show what the area in question actually looks like. On left is a photo of the elbow of a pug. The wider scope of the photo helps me see where the lesion is and how big it is. On the right is a close-up and I can readily see a bald patch without infection or swelling. If you send me only the second photo, I am at a loss as to the location of the abnormality.

zoom photo

Title Your Photo
Sometimes you are so worried about your pet, you snap a photo and send it to me without a label or caption. Without more information, I am at a loss as to what I am looking at or how I should respond. For example, the heading in the email said “Rosie today”. I couldn’t figure out what I was looking at. Turns out the photo was an out of focus close up of a stool sample with a fleck of blood on it. If the title was “Rosie’s poop today”, I could have grasped the owner’s concern.

And because a picture is worth 1,000 words, you can tell me a lot more about your pet with one well taken photograph rather than a very long email. So get clicking and start sending, but focus, title and frame those photos!

Finding the Right Sitter for Your Pet

pet sitter

In my last blog post, I wrote how smart devices like automatic feeders and pet cams make pet families lives easier. Technology is a poor substitute for a human being who watches over your pet while you are away on a business trip or vacation. Since I recommended a human pet sitter and not a robotic one, I thought I should give my readers some guidelines for selecting the right pet sitter.

Sleepaway Camp or Stay-cation
One of the first decisions you should make about care for your pet is where your pet will be taken care of: at home, at someone else’s home, or at a boarding facility. Each of these options has its pluses and minuses. A stay-cation might be great for your sedentary, octogenarian cat, but a puppy who needs exercise and training might be very bored and potentially destructive if left alone except for daily walks during your two-week vacation. If you have a dog who is the life of the party, a boarding facility will provide the perfect opportunity for a sleep away stay. The introverted dog will probably find a week at a friend’s house more to his liking.

Credentials and Qualifications
The pet-loving neighbor kid might be a good person to feed your young, healthy cat while you are away for a couple of days; on the other hand, the neighbor kid is definitely not qualified if your cat needs medications while you are away. The skill level required of a pet sitter increases dramatically when medications are involved. Your veterinarian’s office will likely know of an experienced veterinary technician or assistant who can both feed your pet and administer medications while you are away. Some veterinary hospitals will also do “medical boarding” which can be a good solution to the pet care problem. If you use a boarding facility, check on their policies regarding medication administration. Don’t forget to alert the boarding facility if any heartworm or flea/tick preventive medications are due while you are away.

God Forbid, an Emergency
Another point of inquiry is how the facility handles medical emergencies. If the boarding facility uses an emergency clinic, be sure the boarding facility knows who your pet’s regular veterinarian is and also notify your regular veterinarian regarding your pet’s boarding schedule. It wouldn’t hurt to make a quick one-pager on your pet’s current medications, health concerns and your contact information while you are away. You might also consider designating a medical proxy to make decisions in the event you cannot be reached at a critical moment.

With a bit of advanced planning, both you and your pet can have a wonderful time away even if you are apart.

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

Paw-o-ween: Halloween Animal Myths

Halloween dog

Halloween is a mystical holiday, full of supernatural creatures with magical powers. The spirits inhabiting All Hallows Eve and the Day of the Dead, have given us some animal myths. In this blog post, I dig deeper into the myths and determine if they are fact or fiction.

Chicken Halloween Costumes are the New Trend
Halloween spending in the United States is expected to top $9 billion in 2018, many of the dollars spent on costumes. Two weeks ago, I saw a post on Facebook with chickens in Halloween costumes. The idea seemed over the top, but harmless until I received an email entitled, “CDC calls foul on Halloween costumes for backyard chickens.” The CDC warns chicken owners not festoon their fowl for Halloween amid an outbreak of drug-resistant Salmonella. The CDC also says people should not cuddle chickens and should sanitize surfaces that have come into contact with raw poultry in order to protect themselves and their family against Salmonella from their feathered family members.

For tips on raising backyard poultry safely, read the CDC backyard poultry guidelines.

Black Cats are Bad Luck
This legend apparently started in England. Charles I had a black cat so prized, it was given its own security guard. The cat took ill and died the day Charles I was arrested. Across the pond in America, around the time of the Salem witch trials, black cats were thought to be witches in disguise, to carry demons, or to possess special powers and abilities. The rational person believes this is a total myth, but probably doesn’t know cats and also dogs with black coats are less likely to be adopted from a shelter than those dogs and cats with brown, white or multicolored coats. Animal protection organizations report black cats are often mistreated around Halloween. So, in fact, this is not a myth, a black cat is unlucky, but to himself not to us!

Pumpkin is Good for Pets
If you are one of the millions of pet owners feeding pumpkin to your pet, you know it makes a world of difference to your constipated cat or dog with fiber responsive intestinal disease. All this happens safely, inexpensively, and without drug therapy. Leading up to Halloween, every NYC farmer’s market, bodega, and grocery store is loaded with pumpkins for carving into Jack-o-lanterns. After the trick-or-treaters have come and gone, the pumpkins will linger on the front porches and stoops of our neighborhoods becoming moldy and rotten. Pet families should be sure to throw away the spent pumpkins before one of your pets decides to nibble on the decorative gourd and induce a bout of gastrointestinal upset.

Wishing all our readers a happy and safe Howl-o-ween!

Should I Adopt an Older Dog?

Adopt a dog

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

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

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

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

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

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

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

Immune Mediated Neutropenia

Schnauzer

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

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

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

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

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

Medical Machines: Infusion Pumps

Fluid Pumps

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

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

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

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

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

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

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

Cleaning Up Eye Goop

dog eyes

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

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

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

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

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

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.

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.