Immune Mediated Disease

immune mediated disease

The body’s immune system is a host defense system in both people and pets. But I bet you don’t often think about your own immune system. There are several reasons the immune system is harder to wrap your head around than other body systems.

  1. You hardly know the immune system is there unless it doesn’t work. The immune system’s job is to protect you against invading organisms that might make you sick. If it is working well, you feel great. If it doesn’t work, you get the flu or the chickenpox.
  2. The immune system is all over your body. The respiratory system seems so obvious. You have a nose, a windpipe and lungs. They control respiration. Bet you can’t describe the location of the cells of your immune system, but they are strewn about in the lymph nodes, spleen, lungs, intestines, and are circulating in your blood stream.
  3. The immune system can cause serious diseases when immune cells start attacking normal cells. These diseases are classified as autoimmune diseases or immune mediated diseases.

Autoimmune Disease
An autoimmune disease is a disease where a hyperactive immune system attacks normal cells as if they were foreign organisms. A diagnosis of autoimmune disease is made when the antibody produced by the abnormal immune function can be identified in the laboratory. Examples of this in people are gluten sensitivity due to an antibody induced by dietary gluten against intestinal cells, or Type 1 diabetes where the immune system makes an antibody that attacks insulin-producing pancreatic cells. Autoimmune diseases are thought to exist in veterinary patients, but tests to confirm the diagnosis are lacking.

Immune Mediated Disease
Immune mediated disease is a disease of unknown cause, but one which is thought to be modulated by an aberrant immune response. Unlike autoimmune diseases, the antibody causing this group of diseases has not been identified. This classification describes several important dog and cat diseases. In dogs and cats, immune mediated hemolytic anemia is an example of an immune mediated disease. Dogs also suffer from immune mediated thrombocytopenia and immune mediated polyarthritis. These diseases target red blood cells, platelets and joints, respectively.

Treatment of Immune Mediated Disease
The key to treatment of immune mediated diseases is to halt the immune reaction underlying the disorder. Veterinarians use immunosuppressive medications to turn off the cells of the immune system. The first line therapy in immune mediated hemolytic anemia, thrombocytopenia and polyarthritis is prednisolone/prednisone, which is a steroid medication. Prednisolone/prednisone receives top billing because it works quickly and is inexpensive. But prednisolone/prednisone is not enough in some cases and a second immunosuppressive agent such as azathioprine, cyclosporine or mycophenylate can be added. Increasing the number of immunosuppressive agents runs the risk of turning off the immune system completely, increasing the risk for a serious infection. Dogs and cats on immunosuppressive agents need close monitoring. Once the immune disease is controlled, the medications are slowly withdrawn and the patient is carefully monitored for relapse.

In future blogs, I will discuss the specifics of some common immune mediated diseases in pets.

Resources for Injured Pets and Urban Wildlife


When people need information about animals, their veterinarian is typically the first phone call they make. Recently, I got just such a call from a friend with an injured seagull in their Boston backyard. Given the increasing interface between urban and rural, issues with wildlife in the backyard are on the uptick. Sick or injured stray dogs and cats are an ongoing issue in all municipalities. The question about the injured seagull raised important points about who to contact about an injured animal and I have outlined some helpful information below.

Baby Birds
This time of year, homeowners frequently find fledglings that look lost, but if left alone, will be cared for by attentive bird parents until the youngsters learn to fly solo. Nestlings that have been blown from their nest in a rain or windstorm may need some human help to get back in their nest so their parents can resume raising the wayward birds. Most baby birds blown from the nest land very close to the tree where their nest is located. A sharp eye can find where the baby belongs. The Cornell Laboratory of Ornithology wrote an article about what to do with a baby bird and the Audubon Society has a video on the same topic.

Stray Dogs and Cats
Each municipality has its own protocol for controlling stray dogs and cats. In New York City, stray dogs, orphaned kittens, and abandoned pets can be reported by calling 311 or they can be taken to any of the city shelters.
You can report a found or lost dog online as well.

Injured Wild Animals
This blog post started with a call about an injured wild bird and the photo accompanying the blog is an injured Woodcock AMC took care of until he or she was released to a wildlife rehabilitator. Calling a wildlife rehabilitator is exactly what I told my friend to do. In New York State, the Department of Environmental Conservation has a list of licensed wildlife rehabilitators and AMC often works with Wildlife in Need of Rescue and Rehabilitation. Here in NYC, we are lucky enough to have the Wild Bird Fund, a local organization to help with injured birds.

If you can’t find a list of wildlife rehabilitators in your state, your veterinarian might keep those numbers at the front desk for occasions like this. The website of your municipality is a good resource for information about wildlife. In New York City, an injured wild animal in a city park can be reported to authorities via If a wild animal (raccoon, skunk or fox) is acting strangely and could potentially be rabid, the situation is kicked up a notch because of the public health concern. In New York City, if you identify a potentially rabid animal, call 911 immediately to alert the authorities to the danger. If you or your pet has been in contact with that animal, reach out to your physician or veterinarian for further instructions.

While we all love a bit of nature close by, an injured or lost animal deserves the special care it needs, just like your favorite cat or dog.

How Global Warming Affects Your Pet

global warmingThis year, 2016, is on track to be one of the warmest on record. While not everyone ascribes to the global warming theory, those that do will be concerned about the impact of climate change on their pets’ well-being.

Expansion of Disease Vectors
Some diseases, like canine influenza, are transmitted from one dog to another. Diseases like heartworms and Lyme disease require a vector. A vector is a small organism responsible for transmitting a disease. Mosquitoes transmit heartworms via their bite and ticks transmit Lyme disease the same way. Global warming could increase the number of disease vectors if the warmer environment sends vector reproduction into overdrive. Global warming can also expand the range of vector as they move north with the warmer weather. The net is an explosion of vector-borne disease in pets.

Habitat Changes
Another factor potentially affecting vector and the diseases they carry is habitat changes resulting from changes in climate. Populations of vectors are kept in check by larger animals such as birds, bats and large insects. Climate changes can modify the number of vector predators and if the modification results in a decrease in predators, the vectors will increase. An increase in vectors is likely to result in an increase in the disease they transmit.

Feline Overpopulation
In female cats, the mating season is tied to the longer days of springtime; however some experts report a feral kitten and cat population explosion that appears to coincide with higher environmental temperatures. The cause of the population explosion is unclear. Does the warmer weather increase the number of kittens born or do more kittens survive because winter is more temperate? If more kittens survive winter and become adults, there are then more cats to reproduce the following spring, setting up a vicious cycle of feline overpopulation.

Pets and Natural Disasters
One feature of global warming is an increase in natural disasters like flooding, landslides and forest fires. When these natural disasters displace humans, pets suffer. Following Hurricane Katrina, many pets were separated from their families and never reclaimed. As a direct result of Katrina, when many folks would not evacuate because their pets were not welcome in storm shelters, an animal facility was built at a Louisiana state prison. Now, pets displaced by the recent flooding in Baton Rouge whose families have moved to shelters which cannot accommodate them are being moved to the prison facility. Inmate trustees will care for them until they can be reunited with their families. But not every locale has such a good system for managing displaced pets during a crisis and an increase in natural disasters will result in more homeless pets.

Changes in Human Behavior
Higher ambient temperatures change our behavior, which in turn impacts our pets. When the temperature soars in the summer, we keep our pets inside, avoiding heatstroke and heat exhaustion. But the lack of exercise can result in obesity and the lack of mental stimulation in boredom and behavior disorders like separation anxiety.

Like the potential impact of global warming on humans, the effect on pets may be significant and may directly impact their health. Just another really good reason to support measures to decrease our carbon footprints and pawprints!

Feeding Your Cat for Optimal Health

cats eating AMCNYJune is the ASPCA’s Adopt a Shelter Cat Month and I am hoping many families will be welcoming a new furry feline into their home this month. To help new cat owners learn about the needs of cats, this month’s blogs are dedicated to feline topics – this week to nutrition.

Use a Reliable Source of Information About Feline Nutrition
Your veterinarian’s website, the website of a college of veterinary medicine, or an organization like the World Small Animal Veterinary Association’s (WSAVA) Global Nutrition Committee are excellent sources of information about feline nutrition. The WSAVA has a feline specific set of guidelines for internet based nutritional information, or the American Academy of Veterinary Nutrition’s resource page.

cat body conditionFeed to Maintain an Ideal Body Condition
Veterinarians discuss ideal body condition rather than a specific ideal weight since some slinky Siamese cats should weigh five pounds and a beefy Maine Coon cat, 15 pounds. The image on the right shows a cat with an ideal body condition. Notice you can see a waistline when looking at your cat from the top and a can feel the ribs if you put your hands on the cat. The loss of a waistline means your cat should lose weight and visualization of the ribs suggests more food is in order.

Feed a Complete and Balanced Diet
A “complete and balanced” diet will say exactly that on the pet food label. The label also indicates the life stage for which the food is appropriate: kitten, puppy, adult, senior. Obviously you should choose the appropriate one for your pet. Some pet foods and treats are not complete and balanced and the label will indicate these foods are “intended for intermittent or supplemental feeding only.” Occasionally, treats are formulated to be “complete and balanced” and that will be indicated on the label, as well. Veterinarians define supplemental feeding as less than 10% of the daily calorie requirement.

Think Twice About Feeding Raw Food
Being totally honest, I am nervous about the safety of raw food diets, specifically raw animal protein sources. Raw fruits, vegetables and vegetable protein sources are usually safe when eaten raw. We cook protein, specifically meat, to protect against certain food borne illnesses, like Salmonella, Campylobacter and Toxoplasma. Raw food must be handled carefully, since it poses a significant health risk to both pets and humans, especially children and immunocompromised individuals. After handling raw food diets, hands and food preparation surfaces and cat bowls must be washed with hot soapy water or in the dishwasher to avoid spreading any infectious agents. Raw diets may not be appropriate in homes with small children and immunocompromised individuals. Here is more on protecting your pets against foodborne illness.

Feed Carbs…Or Not
I am bringing this up because it is currently an area of great controversy in feline nutrition. There are proponents of zero carbs and proponents of carbs for cats. The former argue cats are strict carnivores and the latter provide data indicating cats can utilize the nutrients provided by grains and starches. Some veterinary research indicates treatment of feline diabetes requires a high fiber (high carbohydrate diet) and others a high protein diet. Since the currently available data is conflicting, I suggest cat owners rely on the expert advice of their veterinarian for recommendations on the optimal food for your individual cat, including dietary carbohydrate content.

Giving Indoor Cats Outdoor Time

adopt a shelter cat monthJune is the ASPCA’s Adopt a Shelter Cat Month and I am hoping many cats will get a forever home during this month. In a prior blog, I made a case for making your cat an indoor animal for safety reasons. But to help all the new cat owners get ready for their new furry friend and to inspire current cat owners to enrich their cat’s lives, I have some suggestions on how to safely bring the great outdoors to your indoor cat.

Cat Harness and Leash
The simple method of giving your indoor cat outdoor time is a leash and harness. Notice, I did not say a collar because cats can slip out of a collar and also many harnesses. One snug, but comfortable looking harness is the Kitty Holster, made of cotton and with a top zipper closure, it appears very secure for a walk outdoors with your cat.

Cat Gazebo
Using the search words “cat gazebo” or “cat enclosure,” I found a number of outdoor play spaces that can easily and quickly be set up in your backyard or on your deck. I would choose a cat tent with a roof or canopy to provide shade on a sunny day. Because cats love to climb, I would also select one with a built in perch or two. Some cat gazebos are very elaborate and become an integral part of your outdoor living room.

cat connectorCat Connector
While nearly all of the products I identified to bring your indoor cat outdoors require you to transport your cat to the structure, I did find one system where your cat can have free access to her outdoor space. Using a connector kit that looks something like a dryer hose, the cat can exit the house via the tube installed into a window and end up in the outdoor cat condo, giving your cat total independence.

Cat Run
Another search term that identified some nice outdoor spaces for cats was “cat run.” Cat runs come in both vertical and horizontal versions which can be zipped together to form a large outdoor space for more than one cat at a time. The cat runs I found collapse into a small carrying case, making them portable for a traveling cat.

cat solariumCat Solarium
Fitting into a window like a window air conditioning unit, the cat solarium creates a cat sized bay window hovering over your yard. The windows on three sides give your cat a panoramic view of the great outdoors.

Bring Your Cat Closer to the Outdoors
If you don’t have a yard for a cat gazebo or your persnickety condo board won’t allow a solarium, consider bringing your cat closer to nature with a window hammock, a carpet covered window sill extender or a hanging window basket cat perch.

Whether you choose a solarium, a gazebo or just a window hammock, your cat will now be able to safely enjoy the great outdoors.

4 Tips to Get Your Pet Ready for Spring

levingston-puppy-1_3.jpgSpring arrived just this past weekend.  With vernal equinox comes a desire to shape up and be healthier for the coming summer months. Why not include your pet in your springtime health improvement plan?  Here are four tips to help you meet that goal.

  1. Exercise your pet’s body
    Take advantage of the increased number of daylight hours by spending time outdoors exercising with your pet.  Even indoor cats can enjoy outdoor time wearing a harness and leash. Exercise has several health benefits. First, exercise helps keep your pet in tip top condition, and we know pets with ideal body condition have less disease and live longer than those who are overweight. The other benefit of exercise with your dog is for you! Dog owners are healthier than non-dog owners, in part because they get more exercise.
  2. Exercise your pet’s mind
    Some of the time you spend with your pet should exercise their minds to keep them mentally fit. Play games like hide and seek with their favorite toy or create your own feeding puzzle from a tennis ball and some dog treats. Slice an opening along the tennis ball seam. Make the opening big enough to insert a few dog treats. Watch your dog figure out how to flatten the ball and make the treats fall out. To make a cat feeding toy, use an empty plastic water bottle with a screw top lid. Cut little holes in the plastic bottle which are big enough to let your cat’s dry food fall out when the bottle is rolled on the floor. Put a few morsels of dry food in the bottle, cap it, and this low cost toy will keep your cat mentally engaged. If your cat or dog inhales their food, a feeding toy is one method of slowing food consumption so they feel full sooner and eat less.
  3. Take good care of your pet’s teeth
    In pet owner surveys, tooth and gum disease is listed as one of the top health concerns for dogs and cats. Keeping your pet’s mouth healthy involves a multi-pronged approach of daily brushing, annual cleaning and tooth-safe toys. Ignoring dental care can lead to tartar build up, periodontal disease and tooth loss. Your veterinarian will examine your dog or cat’s teeth during an annual examination and recommend appropriate dental care. But of course your veterinarian can only make recommendations if you make an appointment for an annual exam.
  4. Prevent disease
    You may think this is your veterinarian’s job, but I am only the first stop for disease prevention. The Companion Animal Parasite Council recommends preventative medications for all pets against heartworm, intestinal parasites, fleas, and ticks. I can prescribe these medications but if you don’t give them on schedule, your pet is at risk for contracting heartworm disease, intestinal worms and diseases carried by ticks, such as Lyme disease. Most preventive medications have smartphone apps to remind you when it is time to give them. Check the package for the product’s web address and set up regular reminders.

For me, the arrival of spring signals my favorite season of the year. By following these easy tips, it should be your favorite time of the year too since you can enjoy it knowing your pet is healthier.

City Safety for Urban Dogs

Every morning at about 5 am, veterinarians from the Animal Medical Center’s Emergency Service send out a list of all pets admitted to the hospital overnight. Not too long ago, one admission caught my attention: a small dog admitted because his paw got caught in an escalator. Ultimately he recovered, but not before three toes on that paw were amputated because the damage inflicted by the escalator was so severe.

This sad story made me wonder about other uniquely urban hazards that might impact the health of your dog.

What Goes Up, Must Come Down
Because the urban landscape is vertical, not horizontal, in addition to escalators, we have elevators. I can always tell if I am riding an elevator with a suburban dog. Once the cab starts to move, the dog crouches down and starts shaking.  But that is only a minor annoyance. Strangulation can occur when your dog’s leash gets caught in the elevator doors as they close. Once the cab starts moving, the ensnared leash causes the collar to become tight around your dog’s neck and can cause serious injury or death. Never drop the leash while your dog enters or exits the elevator cab.

Yes, We Have Rats
As a matter of fact, I saw a couple of rats in broad daylight last Sunday morning on my walk in Central Park. To control vermin, park staff places rodenticide in areas frequented by rats, but those areas may also be frequented by dogs.

If dogs consume rat poison they can become extremely ill. Two types of rat poison are commonly used in NYC. One type inhibits blood clotting. Dogs eating enough of this type of poison bleed internally. The other type of rat poison causes an elevation in blood calcium. Prolonged elevation in blood calcium can cause kidney damage. Recent research also found NYC rats carry diseases like leptospirosis that can strike dogs as well.

Shopping is Not Always Fun
In New York City, many stores welcome dogs while their humans shop. A frequent sight in stores with shopping carts is a small dog in the kiddy seat of the cart. Another recent overnight admission at AMC was an elderly dog who fell out of a shopping cart and became paralyzed. Fortunately, the paralysis was temporary.Make sure your dog is secure in the shopping cart while you are browsing the aisles.

Dogs Can Fall Too
Although most common in cats, dogs do fall out of windows and off of balconies. Serious injury can occur, which in dogs can include fractured legs and spinal trauma. Always use window screens, and if you are lucky enough to have a balcony or terrace, make sure it is pet proof.

City living with pets can be great, especially once you know how to avoid urban hazards.

Conversations About Research at AMC

On September 21st, the Animal Medical Center hosted its annual “Cocktails and Conversation” event, which this year featured some of the AMC staff veterinarians involved in clinical research. Each researcher spoke about their current project and how the results of the study will benefit pets. Here are some of the highlights.

Cancer Research at AMC
During the entire month of October we are celebrating the opening of the Cancer Institute at the Animal Medical Center and, as part of this celebration, all blogs this month focus on some aspect of cancer in pets. At “Cocktails and Conversation,” Dr. Nicole Leibman, chief of the Cancer Institute at the AMC, spoke about several clinical trials in progress at AMC for dogs with lymphoma. Lymphoma is the most common type of cancer treated by oncologists at AMC, and better treatments which offer longer survivals are desperately needed. The lymphoma clinical trials investigate harnessing the immune system of the patient to help clear the tumor cells from the body. Similar drugs are available for human patients with lymphoma. These trials involved collaboration between veterinary oncologists around the country to accrue enough canine patients to make a determination about the effectiveness of the treatment.

Complementary and Alternative Medicine
Dr. Leilani Alvarez, head of AMC’s Tina Santi Flaherty Rehabilitation & Fitness Service, is currently completing a blinded, placebo controlled trial of a medical device called the Assisi Loop. This type of trial is considered the pinnacle of clinical trial design. The Assisi Loop emits electromagnetic waves and treats musculoskeletal disease. To eliminate bias on the part of pet owners and veterinarians observing response to treatment with the Assisi Loop, the company provided functional loops and some nonfunctional loops. The nonfunctional loops look just like the real deal, but they don’t emit any electromagnetic waves, hence they are considered a placebo treatment. Because no one knows which loops work, the study is considered to be “blinded.” When the results of the study become available, the functionality of the loops will be unveiled and any treatment benefit determined without confounding observer bias.

Studying Teeth and Gums
New and better treatments for old diseases like gum disease are as important in pets as in people. Dr. Django Martel of AMC’s Dentistry Service competed successfully for funding from the American Kennel Club’s Canine Health Foundation. This prestigious recognition allows Dr. Martel to study three different treatments for gum disease in dogs: deep dental cleaning of under the gumline and application of two different antibiotic gels under the gumline after cleaning. Veterinary technicians measuring the impact of treatment are blinded to treatment groups of each patient to ensure an accurate determination of the results can be made. This study is still undergoing patient enrollment and interested pet owners can read more on AMC’s website about our clinical trials

New Insights Into Collapsing Trachea
Tracheal collapse occurs commonly in small breed dogs and results in multiple hospital stays when respiratory distress occurs. Dr. Chick Weisse, head of AMC’s Interventional Radiology Service, discussed his work with the non-invasive placement of tracheal stents to hold open the area of tracheal collapse and improve respirations. Because of AMC’s enormous caseload, he now recognizes different patterns of tracheal collapse in dogs and can implement new and more advanced treatment for dogs suffering from this debilitating condition.

If you are interested in participating in a clinical trial at AMC, you can view an up-to-date list on our website