Does Menopause Occur in Animals?

 

Killer the iguanaLast week, at the Animal Medical Center, our Avian and Exotic Pet Service examined a geriatric female iguana named Killer. One of her problems was osteoporosis, a disease of the bony skeleton common in post-menopausal women. Given that Killer is an older lady, her family asked a reasonable question, “Is my iguana post-menopausal?”

A Different Type of Reproductive Cycle
Like female humans, female dogs, cats and farm animals have a reproductive cycle, meaning periods of fertility alternating with periods of reproductive quiescence. In dogs, cats and farm animals this cycle is called the estrus cycle. An estrus cycle is not a menstrual cycle and thus dogs, cats and farm animals cannot have menopause; however, as these species age, fertility clearly wanes. 

Reptile Reproduction
Even though some say turtles are ageless, female painted turtles experience a severe drop off in fertility as they age. Female painted turtles over 20 years of age continue to lay large numbers of eggs, but fewer of those eggs hatch, a situation quite different from menopause in women.

Our Closest Relatives
Chimpanzees, our closest relatives, live about 40 years in the wild. A recent study showed female chimps continue to give birth throughout their entire lifespan. A recent study of wild female chimpanzees compared their reproductive senescence to that of humans. The study found that unlike women, the chimps’ reproductive aging paralleled that of their body and chimps do not have an extended post reproductive lifespan analogous to menopause.

Back to Iguanas with Osteoporosis
Killer, the iguana that prompted this discussion, has osteoporosis. In humans, falling estrogen levels resulting from menopause contribute to the development of osteoporosis. In iguanas, the cause of osteoporosis differs. Pet iguanas of any age can develop a nutritional deficiency of calcium leading to osteoporosis, often termed metabolic bone disease in reptiles. Iguanas require a diet with adequate calcium, balanced with an appropriate amount of phosphorus and sunshine which allows them to make vitamin D in their skin. The ultraviolet light from sunshine can also be provided by a special light source. Not equivalent at all to post-menopausal women.

If you have an iguana or another species of captive reptile, be sure you are feeding an appropriate diet and providing adequate ultraviolet light. AMC’s Avian and Exotic Pet Service has developed a list of resources for owners of reptiles which is very informative.

Pumps and Valves: February is American Heart Month <3

In February, we celebrate Valentine’s Day with flowers and candy hearts. February also focuses on another type of heart – the one beating inside your chest! This is American Heart Month, raising awareness of heart disease. Both dogs and cats get heart disease, but the common type in each species is different. Cats’ hearts have pump problems and dogs’ hearts have valve problems. Although the problems are different, the outcome for both pump and valve problems is heart failure, or inadequate delivery of blood throughout the body for normal function to continue.

Poor pumping = heart disease in cats <3
The heart is a sophisticated muscle, but it still performs the basic muscle function – contract and relax. When the heart relaxes, the pumping chambers fill. The next muscular contraction expels the blood from the heart into the blood vessels. When the heart muscle is diseased, it can do one of two things – get thicker or thinner. Both are bad. A thick heart pumps less blood with each beat since the thick muscle occupies space inside the heart where the blood to be pumped normally collects. When the heart is thin, the muscles are weak and do not adequately pump blood. Thick or thin, neither heart pumps blood well.

Leaky valves = heart disease in dogs <3
A normal dog heart consists of four chambers, and the flow of blood between chambers is controlled by little valves. Normal valves remind me of alabaster: translucent and white, but unlike alabaster, they are flexible. Especially in small dogs, the valves degenerate as a dog ages, becoming thick and lumpy and inflexible. The distortion of their shape prevents them from closing normally. Abnormal valves leak and blood is not pumped efficiently through the rest of the heart and blood vessels. Over time, the portion of blood leaking out of the heart chambers increases and blood pumped to vital organs decreases.

Congestive heart failure <3
Even though the underlying heart problem in dogs and cats is different, the result is often the same. Poor pumping in cats and leaky valves in dogs can lead to congestive heart failure. These disparate problems both decrease the blood flow to vital organs, such as the kidneys. To compensate, the kidneys retain fluid and when the fluid reaches a critical level, it floods into the lungs, causing pulmonary edema. Acute congestive heart failure is a common reason for admission to the hospital from The Animal Medical Center’s ER. Congestive heart failure can be treated with medications to remove fluid, help the heart pump more vigorously and dilate the blood vessels, allowing them to hold more fluid.

Keeping your pet’s heart healthy <3
I know you want to keep your pet out of the animal ER, so here are some tips for being heart healthy:

  • Keep your pet at an ideal body weight. Obesity increases stress on the heart and it has other negative effects on health as well.
  • Exercise daily with your pet. Folks who walk their dog daily have better heart health themselves.
  • Ask your primary care veterinarian if a consultation with a board certified cardiologist could benefit your pet. Changes in heart valves and muscles cannot typically be reversed; new medications can prolong good quality of life in both dogs and cats with heart disease.

Brand Name, Generic, Compounded or Refilled: A Prescription Primer

Confusion about prescriptions reigned in my clinic this past week. I spent a lot of time explaining the intricacies of brand name versus generic drugs. There was a lot of confusion about refills as well. So, I am reprising a condensed version of my discussions about drugs for the benefit of all.

Brand name drugs are the easiest to recognize because the label on the box has ® or possibly™ after a bold-faced drug name like Benadryl® or Motrin®. Drugs recently approved by the Food and Drug Administration (FDA) cannot be made as generic drugs until the patent or exclusivity expires. The FDA approves everything surrounding the manufacture, quality control and packaging of brand name drugs. This process assures the consumer the product is both safe and efficacious. Drugs for animals are approved by the FDA’s Center for Veterinary Medicine.

The box, carton or tube of generic drug appears more utilitarian than the brand name drug, but the medication inside is a copy of the brand name drug, which is the same as the brand name drug in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use. Generic drugs meet the same rigid standards as the brand name drug. All generic drugs approved by FDA have the same high quality, strength, purity and shelf life as brand name drugs. The generic drug manufacturing, packaging and testing must pass the same quality standards as those of brand name drugs.

Specialist veterinarians like those of us at The Animal Medical Center use compounded medications every day to provide drugs in formulations our patients will agree to take. Most commonly, we have medications flavored with beef and turkey or have bad tasting powdered medications put in gelatin capsules to hide their nasty taste. But compounded medications should not be confused with generic medications. Compounded medicines do not have the FDA assurance of safety and efficacy because they do not undergo FDA-mandated quality control testing. In most cases, the absorption properties and the shelf life of compounded medications are unstudied and may differ from brand name or generic medications. Because different compounding pharmacies use different “recipes” to create your pet’s specialized medication, the same prescription may not have the same effect when compounded by a different pharmacist. While the lack of FDA oversight may be a negative, if compounding helps you to get your pet to take its medications, compounding becomes positive.

When I call or fax a prescription to a pharmacy for a medication that a dog or cat will take for a long time, I will pre-authorize refills. The number of refills remaining on a prescription is indicated on the label of the medication bottle. In the sample label shown here, the red circle highlights the number of refills available without the need to call your veterinarian. You simply call the pharmacy and ask for one of the refills. The next prescription label will indicate only 4 available refills. I often choose the number of refills to coincide with an anticipated recheck examination since you need to call my office to get more refills, you can also set up the recheck appointment at the same time.

Understanding medications is critical to their successful use. The FDA Center for Veterinary Medicine has a wealth of information on their website for the pet owing public.

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.

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!

Pot for Pets

The New York Times recently announced that via executive action, New York Governor Andrew Cuomo will relax the laws governing medical marijuana use in the state. New York State has some of the most restrictive and punitive laws regarding illegal drug usage, hold-overs from the Rockefeller era drug laws of the 1970s, and many feel these changes are long overdue. What does this mean for pets?

Increased Toxicity Cases Veterinarians in New York State will need to be prepared to treat more dogs with marijuana intoxication if the experience in Colorado holds true here. Colorado is a state where medical marijuana is legal. Veterinarians in Colorado studied the number of dogs experiencing inadvertent toxicity from ingestion of marijuana. These researchers found a four-fold increase in the number of dogs treated for marijuana ingestion over a five year period. The increase paralleled the increase in the number of registered users of medical marijuana in Colorado. Pet Poison Helpline reports an increase in calls about canine marijuana intoxication as well.

Dog OD Ingestion of marijuana, marijuana containing foods or inhalation of marijuana smoke can affect dogs; they become glassy eyed, uncoordinated, and may be very sleepy. These dogs need intravenous fluids to maintain hydration and warming blankets to maintain their body temperature. Often, dogs intoxicated by marijuana dribble urine. Some dogs become hyperactive. Severely affected dogs may seizure or become comatose requiring ventilator treatment until they regain the ability to breathe. Dogs typically recover in one to three days. Sadly, the study of Colorado cases of marijuana reports the death of two dogs ingesting baked goods made with medical grade tetrahydrocannabinol (THC) butter.

Iguana Intoxication! Although dogs are the most commonly affected by marijuana intoxication, I found a report of three intoxicated iguanas. The iguanas had clinical signs similar to intoxicated dogs – seizures, stomach upset and one even required antiseizure medication. All three recovered fully.

Veterinary Medical Marijuana So with marijuana legalized in some states for medicinal purposes, is medical marijuana for Fluffy and Fido next? Despite the obvious risks outlined above, some pet owners have taken marijuana for pets into their own hands. Currently marijuana belongs to the group of drugs most tightly regulated by the Food and Drug Administration. Even though I have a license to prescribe some controlled substances, marijuana is not on the list of those I can prescribe. This tight regulation also restricts research with marijuana. Research is needed to help veterinarians understand what conditions the drug helps and how to use the drug safely and efficaciously in veterinary patients. So for now, I don’t know how to appropriately dose THC in my patients and I can’t do it legally.

If your pet inadvertently ingests marijuana or a THC containing product:

1. Keep marijuana and medical marijuana products out of reach of your pets.

2. Call animal poison control if you think your pet has eaten marijuana:

  • ASPCA Animal Poison Control (888) 426-4435
  • Pet Poison Helpline (800) 213-6680

3. Tell the animal ER what your pet ate. Making the ER veterinarians play a guessing game about your pet’s condition can delay appropriate treatment.