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.

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.

Immune Mediated Thrombocytopenia

immune mediated thrombocytopenia

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 a more recent blog, I wrote about one of the important canine immune diseases, immune mediated hemolytic anemia (IMHA). Today’s blog post focuses on a disease similar to IMHA, immune mediated thrombocytopenia (ITP or IMTP).

Defining ITP
The cell targeted by the out of control immune system in ITP is the platelet or blood clotting cell. The platelet is a powerhouse of coagulation. Under the microscope, a platelet is the smallest of the blood cells, yet the sticky platelet provides the first level of defense against hemorrhage. Platelets are in a large part responsible for the formation of a scab when you cut your skin while chopping vegetables or scrape your knee in a bike accident. Dogs, and the rare cat, with ITP can’t form a blood clot if nicked by the groomer because the immune system has destroyed their platelets. The lack of platelets can also result in spontaneous hemorrhage.

Recognizing ITP
You, as the healthcare advocate for your pet, may be the first one to recognize clinical signs of ITP. The hallmark of a low platelet count is little pinpoint hemorrhages on the skin, in the mouth or on the whites of the eyes. Hemorrhage may occur internally making the stool dark like tar or the urine bloody. One of my patients with ITP recently relapsed and came to the ER with a bloody nose. But, not every pet with a low platelet count or bleeding has ITP.

Causes of ITP
There are many other causes of low platelets that must be investigated before a diagnosis of ITP is made. Infectious disease tops the list of potential diagnoses for low platelets. Diseases transmitted by ticks top the list. Ehrlichiosis, Rocky Mountain spotted fever and Anaplasmosis may resemble ITP, but some readily available laboratory testing can quickly identify these diseases. Cancer, especially lymphoma or hemangiosarcoma can cause low platelet counts. Occasionally a reaction to a drug like an antibiotic can cause ITP. When a veterinarian cannot find an underlying cause of a low platelet count and a diagnostic evaluation is unremarkable, by the process of elimination, the diagnosis is ITP.

Treatment of ITP
Even though the blood cell affected in ITP is different than in IMHA, the treatment is similar since the overactive immune system needs to be suppressed to prevent more platelets from being destroyed. The first line therapy involves the use of drugs like prednisone to suppress the immune system. A chemotherapy drug, vincristine, when administered to dogs with ITP increases platelet release from the bone marrow and helps normalize their platelet count faster and shortens hospital stay. Dogs are often hospitalized for several days in case hemorrhage is severe enough to warrant blood transfusion. Most dogs recover from ITP, but some require additional drugs to suppress the immune system long term.

Other diseases affecting the immune system include polyarthritis and a variety of immune mediated skin diseases which will be the topic of a future blog post.

Heatstroke

heatstroke

It’s that time of year when the Animal Medical Center’s ER prepares to see dogs and cats with heatstroke. Heatstroke occurs when the ambient temperature overwhelms the body’s cooling mechanisms. Both heat and humidity contribute to the development of heatstroke. When humidity is high, pets cannot cool themselves by panting, a form of evaporative cooling. When the air is full of water, evaporation from panting occurs slowly and cannot keep the body temperature in a safe range.

Too Hot
The normal body temperature of dogs and cats is 100-102°F. AMC’s ER does not become concerned when a fever is as high as 104 or 105°F. Heatstroke is a body temperature 106-108°F. When the body gets that hot, multiple organs begin to fail.

Hot Pets
While heatstroke can happen to any pet, certain dogs are at greater risk. Snub-nosed dogs are unable to use evaporative cooling via panting as well as dogs with longer noses, and thus are a greater risk of developing heatstroke. Dark-coated dogs, golden retrievers, Labrador retrievers, overweight dogs, and those not acclimated to the heat are also at increased risk.

Heatstroke Symptoms
Hot skin, vomiting, panting, distress collapse, incoordination, and loss of consciousness are all indicators of heatstroke. If your pet is developing heatstroke, you will notice nonstop panting, hot, red skin and weakness. This may progress to incoordination, collapse and loss of consciousness. At the first hint of heatstroke, head to your local animal ER.

Head to the Animal ER
If you suspect heatstroke, go immediately to the closest animal ER, do not delay. Experts say trying to cool your pet off on your own wastes valuable time. But, if on your way out the door you can grab ice packs or frozen food from your freezer, put the frozen food on your pet in the car on the way to the ER.

Heat Injury
The extent of illness may not be apparent upon arrival in the ER. Heatstroke is a multi-organ system disorder. Pets experience circulatory shock from fluid loss from panting. Heat damages normal tissues like the brain and other vital organs. Damaged brain neurons cannot be replaced and may result in cognitive decline following an episode of heatstroke. Abnormalities in blood clotting and kidney function may not become apparent until hours after arrival in the ER.

Tips to Prevent Heatstroke
Preventing heatstroke is critical since data indicates half of pets suffering from heatstroke don’t recover.

1. Don’t exercise in heat of the day, only early or late. Heatstroke occurs most often in the afternoon.
2. Don’t leave pet in a hot car, even with the windows cracked. In one study, a hot car was the number one cause of heatstroke.
3. Provide access to cold water. Consider choosing a water bowl designed to keep water cool or add ice cubes to the bowl.
4. Provide shade with an umbrella or a covered kennel.
5. Try out a cooling jacket or mat.

Click for more suggestions on keeping your dog cool during the hot summer months.

Fun Feline Facts

cats playing

For my final blog post of Adopt A [Shelter] Cat Month, I am going to be less medical and more fun. To that end, I am going to share with you my latest collection of fun feline facts.

Purring Pussycats
One of the most endearing qualities of cats is their ability to purr. In my mind, there is nothing better than a cat on my lap, snuggled in and purring away. Everyone can recognize purring, but I suspect few can define it. In Mammal Review, purring is defined as a continuous sound produced on alternating (pulmonic) egressive (breathing out) and ingressive (breathing in) airstream. Purring results from neural oscillation – neurons which turn on and off rapidly causing rhythmic contraction of the laryngeal muscles 20-30 times per second. Based on the above definition of purring, not all felines can purr. Those that do not purr are those that roar: the lion, tiger, jaguar, and leopard. All other felidae can purr.

Are Right-Handed Cats Nicer?
This is really two fun facts rolled into one. First, did you even consider your cat could be right or left handed? Probably not. But in a recent study in the International Journal of Neuroscience, female cats exhibited right handedness more than males when tested with a food reaching test. About 10% of all cats were ambidextrous. Although an ambidextrous cat might sound intriguing, a behavioral study found ambidextrous cats less affectionate and more aggressive than righty or lefty cats. Strongly right or left-pawed cats were determined to be more confident and affectionate than those with weaker paw preference.

Are Cats or Dogs Smarter?
The answer to this question is open to a great deal of bias depending on your affinity for felines or canines. Scientists have tried to answer this question with data rather than their heart. In a study published in Frontiers in Neuroanatomy, researchers found dogs possess about 530 million neurons in the cortex, while cats have about 250 million. Neurons in the brain often go unused, so just having more neurons does not necessarily make dogs smarter. In fact, when you think about cats, they are phenomenal hunters and can easily out hunt humans with their neuron-loaded brains. So the number of neurons in the cat brain is not necessarily related to intelligence; the answer may lie in the function of each of those neurons. This quote from Dr. Brian Hare at the Duke University Canine Cognition Center answers the question thoughtfully. “Asking which species is smarter is like asking if a hammer is a better tool than a screwdriver. Each tool is designed for a specific problem, so of course it depends on the problem we are trying to solve.”

Are you coming late to Adopt A [Shelter] Cat Month? Did you miss the first three feline-focused blog posts? Catch up here:

  • Lifestyle Factors Related to Feline Obesity
  • Explaining the FVRCP in Feline Vaccines
  • Alternatives to Catnip

Lifestyle Factors Related to Feline Obesity

Buster Brown

June is Adopt-A-Cat Month and every blog post in June will focus on some aspect of our furry feline friends. Today’s topic is obesity.

I saw one of my favorite patients the other day. Okay, I admit, all my patients are my favorite. Buster Brown is a mink-coated Tonkinese cat, just a bit over one year of age. Because he is young and healthy, I haven’t seen him since before he was neutered and was a bit shocked when I put him on the scale. He had gained three pounds during the five months since I had last seen him. When his family saw the numbers on the scale, they asked, “How did this happen?” Below, I have outlined a few of the contributing factors to feline obesity that cat families can use to keep their furry friend at an ideal body condition.

But My Cat is Big-Boned
You are right, the significance of weight gain depends somewhat on the size of your cat. A slinky Siamese can gain less weight and still have a good body condition than the king of cats, the Maine Coon, but adding three pounds is probably too much for just about any cat. When I assessed Buster B’s body condition score, a scale which looks at a cat’s distribution of fat in various parts of the body, he scored 8/9, which is considered obese for a cat of his size.

Fixing Him, Even Though He’s Not Broken
Although Buster B is extremely handsome, he is a pet and was not going to make babies. Thus, he was neutered before he had a chance to start spraying urine on the furniture or drapes. Male cats that have not been “fixed” have very stinky urine and for that reason, pet cats are typically neutered. Neutering is a known risk factor for obesity in cats and portion control is a good practice after neutering. Decreasing a cat’s food intake by approximately one-third after neutering surgery is a good rule of thumb to prevent unwanted weight gain.

He Likes Crunchies and I Hate Those Smelly Cans in the Fridge
I am with you on this point. Cats like what they like and I find those little cans of congealed salmon and tuna pate revolting sitting next to my kale and organic chicken breasts. But, a diet of more than 50% dry food has been shown to be associated with obesity. If you feed your cat dry food fed free choice, without regard for portion control, your kitty can pack on the pounds. Ditto for treats; limit how many your cat consumes per day since snacking predisposes cats to obesity.

Kitty Gymnasium
In a recent scientific study published in Preventive Veterinary Medicine, risk factors for obesity in cats at two years of age were identified. Cats kept indoors were more likely to be overweight or obese. I suspect this is related to exercise or the lack of it in a confined space like your apartment. While research indicating cat calisthenics helps to keep weight off is lacking, exercising your cat with a laser light, fishing pole toy or encouraging them to run up and down the stairs can’t hurt. Better yet, provide a cat tree for climbing as cats love to be up high.

One third to one-half of American cats are considered overweight or obese. Be proactive and keep your kitty slim and trim by controlling his food portions, including some canned food in his diet, and making sure he gets plenty of exercise.

Canine Influenza Q&A 2018

dog flu

Recently the Gothamist, an online New York City-centric news site, reported on a canine influenza outbreak centered in the borough of Brooklyn; although veterinarians expect the outbreak to expand to other boroughs. Compared to diseases like rabies and distemper, canine influenza is a relatively new disease, first described in 2005. Because many dogs have never been exposed to canine influenza, they have no immunity and the disease can spread like wildfire through entire neighborhoods. Drawing on prior blog posts, I will answer common questions about canine influenza.

What causes canine influenza?
Canine influenza is a viral disease, and two different strains of canine flu virus have been described – the original H3N8 and H3N2, first described in 2015.

What are the symptoms of canine influenza?
Canine influenza causes an upper respiratory illness with runny eyes, sneezing, and a runny nose. Most dogs with the flu have a cough. If the flu causes a fever, dogs typically are not very energetic. Occasionally, dog flu progresses to pneumonia which can be life-threatening. This list of clinical signs is not specific for canine influenza and could be due to a bacterial infection or allergies.

How do dogs get the flu?
Dog flu spreads when the virus is coughed or sneezed into the environment or onto an uninfected dog. Keeping your dog away from other dogs will help to protect them against contracting canine influenza. Humans can transport the virus on their hands or clothing. The virus is wily because dogs can transmit the virus before showing clinical signs and continue to shed the virus after clinical signs have resolved. This means a dog that looks healthy could give the flu to your dog.

Can dogs get flu shots?
Humans get flu shots in the fall because influenza in humans is seasonal. Since I am writing about canine influenza in May, you have probably guessed canine influenza is not seasonal and can occur any time of the year. The canine influenza virus does not change annually like the human flu virus and vaccines against both H3N8 and H3N2 are available from veterinarians year round.

All of us at the Animal Medical Center wish the flu-stricken dogs in Brooklyn a speedy recovery and hope all healthy dogs stay that way!