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.

Keeping Your Senior Pet Healthy

Since November is National Adopt a Senior Pet Month, this image posted on Twitter by @PetLiving caught my eye. Adopting a grey muzzle pet bypasses the need to housebreak, train and socialize your pet, all necessary tasks when you adopt a puppy or kitten. The text accompanying this photo highlights just two of the health issues, loss of vision and hearing, that you might expect when you adopt a senior pet.

Do you have a senior pet?
A dog or cat is considered a “senior” when he or she is in the last 25 percent of the breed’s expected lifespan. So a Great Dane with a life expectancy of 8 years might be a senior at 6 years. Conversely, a miniature poodle with an expected lifespan of 15 years might not be a senior until 11 or 12 years. The lifespan of cats remains more consistent across breeds than in dogs, and cats over 10 years of age are considered seniors.

Keeping your senior cat healthy
Essential to keeping your senior cat healthy are regular preventive care visits to the veterinarian. Over the past 10 or so years, the frequency feline patients see their veterinarian has dropped to less than one time per year. Without routine care, small problems become big ones. Take for example feline teeth. In a British study of over 140,000 cats, nearly 15 percent suffered from periodontal disease.

Periodontal disease is a painful condition which can be nipped in the bud by routine dental prophylaxis. Wait too long to have your cat’s teeth treated and the need for multiple extractions increases. Preventive health care visits allow your cat’s veterinarian to perform blood tests which can reveal kidney disease at a time when dietary therapy can be effective. Routine visits to your cat’s veterinarian also help to keep tabs on your cat’s weight. Overweight cats have a greater risk of developing diabetes and bladder problems.

Keeping your senior dog healthy
Three critical factors in keeping your senior dog healthy are preventing obesity, promoting mobility and monitoring for cancer. A multi-year study of Labrador retrievers demonstrated the negative impact of obesity on longevity. Dogs fed a restricted amount of food lived nearly two years longer than dogs fed a higher number of calories.

Keeping your senior dog in lean body condition is directly tied to maintaining mobility. Overweight senior dogs with creaky joints have a much more difficult time getting around than their slimmer counterparts. More time sitting on the sofa translates to a decline in muscle strength and turns into a dog that can barely walk. During your twice yearly senior pet checkup, your veterinarian has in her pharmacy a variety of medications to keep your senior dog moving comfortably. Experts estimate that almost 50 percent of all dogs over the age of 10 will develop cancer, making this a significant problem in the senior dog. You can easily monitor for skin cancers by simply doing a through belly rub and petting your dog from nose to tail. If you find any lumps or bumps, bring them to the attention of your veterinarian immediately.

Better medical treatment means pets can live longer and healthier than ever before. Don’t assume your senior pet is just slowing down as a normal part of aging. Slowing down could indicate your pet is developing a disease. That’s why veterinarians recommend your senior pet see them twice yearly. Make an appointment for your senior pet today!

Making a Specialist Visit Special

Your pet needs a second opinion from a board certified veterinary specialist and your veterinarian has helped you set up the appointment with the right specialist. You know this is going to be different than seeing the familiar veterinarian you have trusted with your pet’s care since you brought him home from the shelter in a cardboard carrier. How can you make this nerve-wracking experience efficient and affect the best possible outcome for you and your pet?

Look at a consultation with a veterinary specialist at The Animal Medical Center or another specialty hospital like you do any other meeting. If you are running a meeting at your office, you will be sure the right people are invited to attend the meeting; the meeting will have an agenda agreed upon in advance; it will have a start and stop time and meeting attendees will be assigned tasks to complete after the meeting is over. All of these points also describe your appointment with a veterinary specialist.

The Right Attendees
I am a veterinarian and my job is to take care of sick pets. To me, your pet is a critical participant in the specialist consultation. While your role of transporting your pet to the appointment and being its spokesperson is also crucial, I really need to examine your pet and see first-hand the problems that need correcting. You would be surprised at how many people come to see me without their pet. If you choose to leave your pet at home and fly solo at a consultation with me, I can guarantee one of your tasks after the meeting will be to bring your pet to The AMC for an examination.

Specialist Agenda
A veterinary specialist has been trained to approach patients with a basic agenda:

  • Ask about the past history and review any documentation from the primary care veterinarian
  • Perform a physical examination
  • Make a list of possible diagnoses
  • Create a list of tests to determine which diagnosis is the correct one
  • Interpret the test results once they become available

Pet owners can streamline that agenda by having medical records, x-rays and blood tests sent in advance of the scheduled consultation.

Pet Owner Agenda
Simply put, the pet owner agenda for a specialist consult revolves around one of three issues: making a diagnosis, treating a disease or improving the quality of life. For some pet owners there may be other issues that are equally important, such as having the pet attend a family function. If there is an important issue for you and your pet, be sure to let the specialist know what it is and how you feel this issue might impact the recommended diagnostic and therapeutic plan.

The To-Do List
At the end of the consultation, the specialist or a member of their team will explain the plan for your pet. It might be to give medications or schedule a follow up test at your veterinarian’s office. Following the plan exactly and scheduling tests or treatments on time will help get your pet back on its feet as soon as possible. And having a healthy pet is what makes any visit to the veterinarian’s office special.

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.

Pet Insurance: FAQ from The AMC

The webmaster at The Animal Medical Center fields questions related to pet health from all over the world. Many of the recurrent questions are related to pet health insurance. Here are the answers to a few of the most common pet health insurance questions.

What insurance policies does The AMC accept?
Pet insurance is different than human insurance. My doctor’s office has negotiated contracts with several insurance companies; therefore, she cares for patients who purchase policies from those companies. The contract in pet insurance is between the pet owner who purchases the policy and the pet insurance company. The AMC provides information and invoices to the pet owner, who in turn submits a claim to their pet’s insurance company and is reimbursed for their expenditures by the insurance company.

What will pet insurance cover?
Coverage depends on the company and the details of the policy. Trupanion policies focus on coverage for illness and recovery rather than preventive healthcare. The ASCPA policy, underwritten by the Hartfield Group, has several different levels of care, two of which include coverage for preventive healthcare.

How much do policies cover?
Commonly, policies state they reimburse 80-90% of customary and usual charges for covered services. Each veterinary hospital sets its fees to reflect their costs of operation. If you live in a city where the cost of living is high, ask if the insurance company has higher “customary and usual charges” for calculating your level of reimbursement. Alternatively, ask a prospective insurer what percentage of submitted claims is paid out to pet owners in your area. Healthy Paws reimburses based on the actual veterinary bill as do a couple of other companies. Some companies have annual or lifetime caps on total payments. Others cap payments for specific conditions.

Can I get pet insurance for all my pets?
All companies insure dogs and cats. Insurance for the other members of Noah’s crew, including birds, reptiles, small mammals, marsupials, amphibians, rodents and lagomorphs is available only through VPI, the oldest pet insurance company in the United States.

What about coverage for pre-existing conditions?
Again, this type of coverage varies from policy to policy. For example, some policies exclude genetic conditions, such as elbow dysplasia and hip dysplasia, from coverage. If your dog has already had a cruciate ligament repaired on the left and the right cruciate ligament ruptures, he will not be covered by all policies as some consider cruciate disease to be a bilateral disease. Pets Best seems to be one exception to this exclusion.

Another point to keep in mind: your veterinarian may recommend therapies not covered by your policy. If she does, your claim would be denied. Before you renew your policy, ask if any illnesses reimbursed in the previous policy cycle will be excluded as pre-existing conditions once your renew.

Surprising coverage
I found several interesting features of the policies I reviewed. Pet’s Best lists coverage for some groundbreaking treatments, like stem cell therapy for feline kidney disease. I found a 13 page list of medications covered by one plan, and another with coverage for boarding if you are hospitalized and need to board your pet.

Employee Benefit?
A recent news article highlighted increasing numbers of companies offering pet insurance as an employee benefit. Check with your human resource department before you select a policy for your favorite fur person.

Final word: Read the policy carefully
I found at least one policy that does not cover two common (and costly) problems of older dogs and cats: heart disease and diabetes. Cancer is another group of diseases which are not covered by all policies; although many policies can be upgraded to cover cancer diagnosis and treatment.

Choosing a Veterinary Hospital

Is there a new puppy in your family? Has the backyard cat installed himself on your family room sofa? Have you inherited grandma’s piano and her parrot? If so, you won’t want to leave the important decision regarding the choice of your new pet’s healthcare provider to chance. Here are some tips for choosing the right veterinarian and veterinary hospital for your pet.

Location, location, location
In Sunday’s New York Times, healthcare reporter Elizabeth Rosenthal, talks about choosing a hospital for your own care. She writes, “Indeed, with thousands of good hospitals across the nation, the best selling point for routine medical care may simply be convenience…” Whether or not you agree with her point of view regarding your personal healthcare, proximity may be a consideration in choosing a primary care veterinarian. A new puppy will need several rounds of vaccines and a spay or neuter surgery requiring transporting the pet to and from the hospital on multiple occasions. But if you have a parrot, the closest veterinary hospital may not have a veterinarian with expertise in avian medicine and you will need to choose a clinic providing bird care, not necessarily the closest clinic.

Proximity plays an even more important role in the selection of an emergency hospital. When your pet is hit by a car and in shock, has serious bleeding or can’t breathe, time is of the essence and the closest animal ER is the best ER for your pet.

Assessing hospital quality
If you personally needed a heart valve replacement, for example, you might look for data on outcome for valve replacement surgery at the various hospitals in your area. In New York State we have the New York State Hospital Report Card. You could also search the doctor ratings on the website of your healthcare provider. Since this type of information is lacking for veterinary hospitals, you might turn to online sources to read the opinion of pet owners who have posted their experiences. I must admit, to me, these online reviews can often seem more like rants and may not provide the objective information you need to guide your pet healthcare decision making process.

A better method of assessing hospital quality would be to look for a hospital accredited by the American Animal Hospital Association (AAHA). Their website also allows you to search for the AAHA accredited hospital nearest you. Choosing an AAHA accredited hospital assures pet owners that the hospital they select has the staff, equipment, medical procedures and facilities that AAHA believes are vital for delivering high-quality pet care. The Animal Medical Center has been AAHA accredited since 1976, and to maintain our accreditation we voluntarily receive triennial evaluations on over 900 standards of small animal hospital care.

Finding the right specialist
The easiest way to find a specialist for your pet is for your primary care veterinarian to recommend one she works with on a regular basis. This will ensure a good line of communication and seamless medical care. If your veterinarian doesn’t have a recommendation:

  • Search the website of the type of specialist you are looking for, e.g. veterinary cardiology, veterinary surgery or veterinary dentistry.
  • For a cutting edge therapy, you might have to travel a good distance to find the specialist your pet needs. Use a scientific search engine like PubMed or Google Scholar. Search for the procedure your pet needs. When the search identifies a particular hospital where the procedure is commonly performed or a veterinarian who is a frequent author of scientific articles on the procedure, focus your search on this clinic or veterinarian. Examples of this type of procedure include repair to a ruptured ligament in the knee or image modulated radiation therapy.

Quick tips on finding the right veterinary hospital

  • Know where the closest animal ER is and keep its address and phone number in your GPS device, cell phone and on the refrigerator list so you are prepared for an emergency.
  • Don’t be afraid to visit potential veterinary hospitals before booking an appointment. Find out if their clinic schedule matches your availability. Ask the receptionist about their preventive healthcare protocols.
  • In case your pet develops an unusual medical condition or requires specialized surgery, ask your trusted primary care veterinarian about the network of specialists they recommend.

International Health Papers: How to Avoid a Justin Bieber Epic Fail

International travel with pets is a complicated affair. Each country has its own set of rules about vaccinations, blood tests, deworming and microchipping. For island countries free of rabies, an elaborate scheme of testing and vaccination is required to prevent a dog or cat from introducing the disease to the country.

Some families handle the international health paper requirements better than others. Take for example Justin Bieber and his pet Chapuchin monkey, Mally. Passports are required for band members on the Believe Tour to enter a foreign country, and Mally the monkey needed special health papers to enter Germany. The problem was, proper papers were lacking and Mally’s concert touring days prematurely ended. Apparently, Mally remains overseas.

Here’s a better story of a family that did their homework regarding international pet travel. Today I saw a cute dog named Avatar, in need of an international health certificate. One of the requirements for entry into her home country is a health certificate signed by an accredited veterinarian. Not every veterinarian is accredited by the United States Department of Agriculture (USDA), but this family knew to ask for an accredited veterinarian because they had carefully researched this information.

Avatar came to my office with a pile of papers carefully detailing all her vaccinations. I need this information to be sure she meets the entry requirements and to document vaccinations on the international health certificate. Another requirement for Avatar’s destination country is vaccination against leptospirosis. Leptospirosis is an infectious disease caused by a bacteria spread in the urine of wild animals. Happily, the paperwork indicated a vaccination against leptospirosis and I quickly checked off that requirement.

Avatar’s destination country did not require a microchip, but documentation of a microchip is a common requirement for entry into many countries. Some countries also have their own import paperwork, but Avatar’s accepted the USDA form. Once I signed off on my part of the health certificate, Avatar had another stop: the USDA area office at JFK Airport, where she received the endorsement of their New York area veterinarian.

How can you avoid a Bieber epic fail when traveling internationally with your pet?

  • Start early to ensue you have enough time for required testing or vaccination protocols.
  • Do your homework. Start with the USDA’s Animal and Plant Health Inspection Service website and the website of your destination country for pet import requirements.
  • If you need the signature of an accredited veterinarian like me, check to see if your veterinarian is accredited or ask for a recommendation.
  • Keep your pet up to date on vaccinations and other preventive health care measures to avoid any delays in getting your pet’s international health certificate.