Veterinary Neurological Conditions

AMC's neurology team

The Animal Medical Center has 36 board certified specialists in 17 different specialties. Neurology is a critical specialty at AMC and we are lucky to have three experienced specialists in veterinary neurology who are available to AMC patients seven days a week. The Neurology Service also trains the next generation of veterinary neurologists and currently has three residents in training. Many readers might not be familiar with common neurologic disorders of dogs and cats, so I will highlight them in this blog post.

Top Neurologic Conditions
The most common problems managed by AMC’s Neurology Service include seizures in dogs and cats, disc problems in the backs of dogs, and vestibular disease. A seizure occurs because the electrical system of the brain goes haywire. Seizures occur in all breeds of dogs and cats. Intervertebral disc disease has clear breed predictions. If you have a French bulldog, a dachshund, or a cocker spaniel, your dog is at increased risk of developing a slipped disc. All dog owners should be aware of the problem of slipped discs in dogs and seek emergency care if their dog suddenly can’t walk. When the disc slips out of its normal place, the disc pushes on the spinal cord causing pain and affecting the nerves controlling the back legs. Vestibular disease may also result in the sudden inability to walk, but dogs tend not to be painful, just very dizzy and often nauseous.

Intersection of Medicine and Neurology
Certain medical conditions can mimic neurologic ones. For example, a low blood sugar level deprives the brain of necessary fuel and can result in a seizure that is different than a seizure caused by epilepsy or a brain tumor. Fainting might look like a seizure or an episode of vertigo, but in cats, fainting is commonly caused by heart disease. Pet owners might think shaking is a neurologic condition, but the causes of shaking in dogs include hormone disorders, low calcium levels post-partum, and ingestion of toxic substances.

Neurology Diagnostic Tools
AMC has both a CT scanner and an MRI. Neurology typically uses the MRI to diagnose disorders of the brain and spinal cord. Dogs with back problems have an MRI, often in the middle of the night, before surgery to remove an out of place intravertebral disc. An MRI scan is also the test of choice in patients with seizures. Neurologists may also perform a spinal tap in seizure patients to evaluate the fluid around the brain to determine the cause of the seizures.

If you have a pet with a neurologic condition or want to learn more about veterinary neurology, tune in to “Ask the Vet” on SiriusXM Stars channel 109 on Friday, September 7 at 1pm EDT to hear an interview with AMC’s chief neurologist Dr. Chad West.

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.

Proteinuria in Pets

proteinuria

When your pet has an annual physical examination, your veterinarian will often request a urine sample. Once you collect the sample, your veterinarian will have the urine analyzed in the laboratory. Urinalysis is a test which assesses nearly 20 different parameters. This blog post will focus on one particular parameter of the urinalysis, protein.

Protein is Not Normal
In a normal dog or cat, very little protein passes through the kidneys and into the urine. When a routine urinalysis identifies an increase in urine protein, a number of tests are performed to determine the source of the protein. If the source is thought to be the kidneys, a follow-up test called a urine protein creatinine ratio is performed. This ratio helps us determine if the protein in the urine is elevated to a level where medical intervention is needed. Multiple assessments of a pet’s protein creatinine ratio may be necessary before a diagnosis of excessive protein in the urine is made. The condition where excessive protein is lost in the urine is called proteinuria.

Causes of Proteinuria
Chronic kidney disease is probably the most common cause of proteinuria, but veterinarians see it in pets with other chronic diseases as well. Diabetes, Lyme disease, and Cushing’s disease have all been associated with increased urine protein levels. But a bladder infection or fever might cause increased protein in the urine. The key to determining the cause of proteinuria is a complete diagnostic evaluation which will include blood tests, blood pressure measurement, and possibly even an ultrasound.

Protein is a Problem
Proteinuria is problematic on several levels. Protein in the urine signals a problem with the kidneys. The leakage of protein though the kidneys damages the kidneys and decreases their ability to remove waste products from the body, leading to kidney failure. Loss of protein in the urine can deplete the protein in the body, putting the patient at risk for swelling of the limbs and blood clots. High blood pressure has also been associated with protein loss in the urine. In both dogs and cats with chronic kidney disease, proteinuria correlates with an increased risk of death from chronic kidney disease when compared to patients without proteinuria.

Treating Proteinuria
Once a diagnosis of proteinuria has been established, any underlying disorders, such as Lyme disease, will be treated. Successful treatment can resolve the proteinuria. If the cause of the proteinuria is chronic kidney disease, then lifelong treatment will be required. Non-drug interventions include a kidney-friendly diet and anti-inflammatory supplements like fish oil. Angiotensin converting enzyme (ACE) inhibitors like enalapril or benazepril, and newer medications like telmisartan (an angiotensive receptor II blocker) are administered to decrease protein loss. If pets have high blood pressure, antihypertensive medications will be prescribed and blood pressure monitored. Some pets with serious protein loss need medications to prevent formation of blood clots.

Help Keep Your Pet Healthy
You are part of your pet’s healthcare team. Your efforts in collecting a urine sample helps veterinarians like me take better care of your pet. Better care means you and your pet can have more healthy and happy years together.

Why the Animal ER is the Right Place in an Emergency

pet emergency

I suspect every veterinarian hears this at least once a week, “But I want you to see my pet, not the ER.” Yet sometimes the animal ER is just the place your sick pet needs to be. I get it, I would rather see my regular physician than someone I don’t know in the ER. And yes, I hate the thought of a long wait in the ER. But think about it, if you are waiting in the ER, you should count your blessings because it means you are not the sickest patient; you are just an impatient patient.

Here are four really good reasons the ER handles urgent and emergent cases best.

1. The ER Sees it All
A specialist like me is really good at managing a limited number of medical conditions. The ER staff sees everything, and one of their best skills is determining what the problem is and what type of veterinarian is best to handle the emergency situation. Take for example a cute terrier who didn’t want to go to the ER. His family thought he should see a board certified neurologist. Begrudgingly, he came to the ER. In about a second, the ER veterinarian recognized this terrier had inflamed joints and transferred the cute terrier to an internal medicine specialist. Specialists worry we won’t pick up on a disease we rarely see as quickly as our ER colleagues will.

2. The Animal ER has Different Equipment
Each work area in a hospital like the Animal Medical Center is organized to promote efficiency. Case in point: my work area in The Cancer Institute has a machine to count blood cells. The AMC ER does not. This is because nearly all my patients need a blood count, but those in the AMC ER don’t. But the ER has equipment commonly used to manage emergencies not available in The Cancer Institute. With the right equipment, the animal ER is better able to manage urgently ill pets than specialists working in other areas of the hospital. Keep in mind, your urgently ill pet may not have the luxury of time in an emergency for the essential pieces of equipment to be assembled outside of the ER.

3. ER Veterinarians Have Different Training
ER veterinarians are trained to recognize and react to life-threatening abnormalities like low oxygen, massive bleeding, or severe trauma. The ability to recognize and react are critical skills in emergency situations. Internal medicine specialists are trained to evaluate a sick patient and make a diagnosis and then manage long-term care. Not emergency skills at all. Pets with emergencies benefit from the skill and rapid care provided in the animal ER.

4. The Animal ER Can Prioritize the Most Critical Patients
The veterinarians in your neighborhood and at a specialty hospital like AMC use a schedule of appointments to manage care for pets. Appointments control the flow of patients throughout the day to avoid overcrowding the clinic and allow pet families to budget their time. An emergency visit in the middle of appointments derails the entire schedule and disrupts the scheduled patients. Properly prioritizing a pet with an emergency is tricky when you have a full day of scheduled appointments. The animal ER has no appointments, which allows them to prioritize the most critical patients and save lives.

Experience, equipment, training, and the ability to prioritize sick pets by their medical needs makes the animal ER a great place for your pet’s emergency visit. Not sure what an emergency is? AMC’s board certified emergency and critical care specialists have provided a list to help pet owners recognize an emergency.

Everyday Medicine: Cytology

cytology

“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 “The Highs and Lows of Blood Sugar” and “Blood Pressure.” Today’s post focuses on cytology.

Cytology is a very common exam room test performed by veterinarians. The test involves taking a sample – a swab of ear gook, a bit of diarrhea, or a few cells from a skin mass – and smearing a thin layer of the sample on a microscope slide. The slide might be dipped into a series of jars containing pink and blue dye. The dye colors the sample and helps differentiate the various cells and organisms in the sample when the slide is viewed under a microscope lens. Or, the slide might have a few drops of saline added in a procedure called a “wet mount.” In either case, the slide is then examined under a microscope to help facilitate a diagnosis.

Ear Gook
Every case of ear gook is not the same and veterinarians commonly use cytology to tell the difference between the types of ear infections. Black or brown discharge is common in ear infections and the presence of black discharge doesn’t tell us what the cause of the infection is. In cats, ear mites are really common causes of black discharge, especially in stray cats and kittens. Ear mites are not so common a cause of black discharge in dogs. Veterinarians mostly diagnose bacterial and yeast ear infections in dogs.

Yuck! Diarrhea
Diarrhea makes the pet patient uncomfortable and the pet family’s house a mess, so a quick fix is in order. A quick fix requires a quick diagnostic test like cytology. Using a “wet mount preparation” of a fresh fecal sample and a microscope, veterinarians can identify the eggs of roundworms, hookworms, tapeworms, and whipworms as well as protozoal organisms like coccidia, and Giardia. A second fecal sample may also be submitted to an outside veterinary laboratory for even more specialized testing.

Skin Masses
Another very common reason for exam room cytology is for the assessment of a skin lump. Keep in mind, a skin lump does not always mean cancer. Skin lumps can be abscesses, fluid filled cysts, benign fatty tumors, and yes, sometimes cancer. Knowing right now that I am dealing with an abscess means your cat gets the antibiotics she needs immediately. But, not every cytology sample can be evaluated in the exam room. Some samples must be sent to a laboratory where a veterinary specialist called a pathologist will interpret the cytology. Other samples indicate a biopsy is needed.

To learn more about lumps on your dog, review our previous blog post, “Will That Be One Lump or Two?

The Difference Between Diagnostic Radiology, Radiation Therapy and Interventional Radiology

radiation therapy

At first glance, these three disciplines within veterinary medicine seem pretty much the same, but at the Animal Medical Center, diagnostic radiology, radiation therapy, and interventional radiology represent three different groups of veterinarians with three very different sets of background and training. What ties these three disparate groups together is their use of radiation to diagnose and treat disease.

Diagnostic Radiology
These days you are more likely to find a Department of Diagnostic Imaging in a hospital than a Radiology Department. Radiology is an older term, used when x-rays were the only testing modality using radiation available in medicine. Today, AMC’s Diagnostic Imaging Service uses not only traditional x-rays but also ultrasound, computed tomography (CT) scans, and magnetic resonance imaging (MRI) in the diagnostic evaluation of patients. AMC’s Diagnostic Imaging Service also has a fluoroscopy unit, which is like a video x-ray. This machine allows us to watch bodily functions like blood flow or swallowing in real time. To see an example of fluoroscopy, read about Molly the Ganaraskan. Every veterinarian at AMC depends on our diagnostic imaging team for their expertise in imaging sick pets and helping us to make an accurate diagnosis.

Radiation Therapy
A very accurate description, AMC’s Radiation Oncology Service uses radiation to treat tumors. Specifically, we have a linear accelerator (linac), a giant machine that creates various types of radiation depending on patient needs. Our state-of-the-art linac can make electrons for superficial treatments, produce high energy pinpoint beams for stereotactic radiosurgery, and stereotactic body radiation therapy. Diagnostic Imaging’s CT scanner interfaces with Radiation Oncology’s 3-D computer planning system. The interface allows the linac’s multileaf collimator to sculpt the radiation beam to precisely target the tumor being treated. The veterinarians working in radiation therapy have training in both the physics of radiation as well as the management of cancer.

Interventional Radiology
Specialists in interventional radiology use minimally invasive techniques to make image-guided diagnoses and also deploy high tech treatments for a variety of diseases. Using a range of techniques which rely on the use of images generated by diagnostic radiology equipment such as fluoroscopy, ultrasound, CT scan, or MRI imaging, the interventional radiologist precisely targets various organs with treatments such as stents, occluders and medications. Watch a video where AMC’s interventional radiology team uses fluoroscopy to close off abnormal blood vessels in the liver. The veterinarians in our Interventional Radiology Service have diverse backgrounds in surgery, internal medicine plus specialized training to use minimally invasive equipment.

Linked together by their use of radiation as a diagnostic and therapeutic tool, diagnostic radiology, radiation therapy and interventional radiology are just a few of the highly trained specialists at AMC working to make sick pets healthy again.

Antibiotics: Precious Medical Resources

antibiotics

November 13-19 is World Antibiotic Awareness Week. I can’t believe any of my readers need to be made aware of the importance of antibiotics in both veterinary and human medicine, but we all need to be aware of how to protect these precious medical resources.

Antibiotics have been around for less than 100 years and yet as a class of drugs, their discovery revolutionized the practice of medicine. Sir Alexander Fleming discovered penicillin, the first antibiotic, in 1928, and in 1945 won the Nobel Prize in Medicine for his discovery. Since then, dozens of antibiotics have been identified in nature or synthesized in the laboratory. Even though antibiotics save millions of people and pets every year, misuse and abuse are rendering them less effective every day. Antibiotic use should be reserved for patients who are likely to benefit from their administration and not be prescribed just because you or your pets are feeling sick. For some diseases, antibiotic treatment would be a poor therapeutic choice.

Good Uses of Antibiotics
Antibiotics are especially effective in treating bacterial infections. Common bacterial infections in pets include skin, ear and urinary tract infections. Veterinarians base their selection of an antibiotic on several factors: the location of the infection and the typical bacteria causing that type of infection. Additionally, a sample taken from the site of infection can be observed under the microscope and the antibiotic can be chosen based on the type of bacteria seen. The best indicator of correct antibiotic choice is to sample the infection, grow the causative bacteria in the laboratory and actually test which antibiotic best kills the bacteria. This takes a few days and usually we make an educated guess about which antibiotic is likely to work and prescribe that until the laboratory gives more specific results.

How AMC Uses Antibiotics
Antibiotics are some of the most commonly prescribed medications in veterinary medicine. I checked with our systems administration and for the past three years running, and probably in 2017 as well, AMC veterinarians have written over 7,000 antibiotic prescriptions per year, or 20 antibiotic prescriptions per day. This number does not include antibiotic ointments for eyes, antibiotic drops for ears, and any topical antibiotic creams. The most frequently prescribed antibiotics will be familiar to many pet owners as I suspect they are commonly used by many veterinarians: Clavamox®, Convenia®, Simplicef™ and Baytril®. Since skin disease is one of the most common reasons pets are seen by veterinarians, the antibiotics on the list are no surprise; they all are good antibiotic choices for the treatment of skin disease. The top four antibiotics prescribed by AMC veterinarians comprise over half of all the antibiotic prescriptions at AMC and should convince you how important a role antibiotics play in making your pet better.

What Antibiotics Can’t Do
Bold face name antibiotics like amoxicillin, Keflex® and the eponymous Z-pack® treat a variety of different bacterial infections. If your pet has a viral infection like feline herpes virus or canine influenza virus infection, no antibiotic will help. Viruses need to run their course in order for your pet to feel better. Using antibiotics in viral diseases only creates antibiotic resistant bacteria without improving your pet’s health.

Bad Ideas When it Comes to Antibiotic Therapy

  1. Don’t use your dog’s antibiotic for your cat, or vice versa. While not wasting this precious medical resource seems reasonable, the differences in canine and feline metabolism prevent safe swapping of antibiotics between pets of different species.
  2. Don’t use antibiotics prescribed for one pet on another, even if they are both the same species. Veterinarians carefully select the antibiotic based on the type of infection being treated and the size of the patient and you may end up doing more harm than good.
  3. Keep to the prescribed medication schedule and finish every last one of the pills. Tedious, I know, but if you are having trouble keeping to a medication schedule, confess to your veterinarian. There is a good chance a different treatment plan can be implemented.
  4. Dispose of unused antibiotics appropriately. Check the Food and Drug Administration for guidance.

Everyday Medicine: Blood Pressure

pet blood pressure

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 “The Highs and Lows of Blood Sugar” and “The Third Eyelid.” Today’s post focuses on blood pressure.

Blood Pressure Definition
Everyone has had their blood pressure taken at the doctor’s office and we all know high blood pressure, or hypertension, is bad. But what does that Velcro covered cuff really measure? The cuff measures the pressure the circulating blood exerts on the walls of the blood vessel. When your blood pressure is taken, the nurse reports a number over a number. The top number (systolic blood pressure) is the pressure on the vessel walls when the heart pumps and the diastolic blood pressure or bottom number is the pressure when the heart relaxes. The blood pressure monitors veterinarians use in the clinic for dogs and cats usually measure only the top number, or systolic pressure.

Causes of High Blood Pressure
The most common cause of hypertension in both dogs and cats is chronic kidney disease. The International Renal Interest Society recommends all pets with kidney disease have their blood pressure measured as part of a clinical evaluation. Hypertensive pets should be treated with antihypertensive agents to protect their eyes, heart, brain and kidneys from damage due to high blood pressure.

Hyperthyroidism is another known cause of hypertension, most commonly in cats. Successful treatment of hyperthyroidism typically resolves the hypertension without administration of antihypertensive medications.

Causes of Low Blood Pressure
Low blood pressure is a common problem in AMC’s ER patients. Many ER patients have fluid loss. For example, vomiting and diarrhea-producing dehydration decrease the amount of fluid in the blood vessels, as does hemorrhage. Both dehydration and hemorrhage can result in low blood pressure. A severe systemic infection often leads to low blood pressure through a complex series of physiologic events. Since so many emergency situations lead to low blood pressure, an intravenous catheter and administration of intravenous fluids is typically one of the first emergency therapies administered in an animal ER.

If your pet has recently been anesthetized, he probably has a clipped spot on one of his front legs. That spot identifies the location of an intravenous catheter placement. General anesthesia decreases blood pressure. Veterinarians monitor blood pressure during anesthesia and give intravenous fluids during anesthetic procedures to help maintain blood pressure within a normal range.

Pets with hypertension have frequent blood pressure measurements taken while their veterinarians adjust medications to normalize blood pressure. Blood pressure medication must be titrated to the proper amount to prevent low blood pressure or hypotension. Hypotension makes pets weak and may negatively impact their kidney function.

If your pet is making a trip to the veterinarian soon, don’t be surprised if one of the nurses brings out a petite blood pressure cuff and places it around your pet’s wrist, since blood pressure is an important medical test.

The Horrors of Halloween: The Pet Version

halloween pets

When witches go riding, and black cats are seen. The moon laughs and whispers, ‘tis near Halloween. – 19th century postcard

Although black cats are one of the spooky creatures connected with Halloween, many cats and dogs may not be as excited about Halloween as their families are. Halloween has become one of America’s premier holidays, and according to the National Retail Foundation, the total spending for the holiday in 2017 is expected to reach $9.1 billion. But have pets fallen under the magical spell of Halloween like their families have? Candy, costumes, witches and wizards can make Halloween downright frightful for pets.

Tricks Not Treats
About one-third of the money spent on Halloween goes towards the purchase of candy. But the trick or treat bags should be off-limits for pets. Chocolate contains theobromine, a substance similar to caffeine. The amount is lowest in white chocolate and highest in dark chocolate, but any chocolate consumption is risky in pets because chocolate causes vomiting, diarrhea and hyperactivity. Some health conscious spirits distribute little boxes of raisins as an alternative to candy. But when dogs consume raisins, these healthy little snacks become tricks, not treats, and can damage your dog’s kidneys. If your dog eats sugar-free Halloween treats containing xylitol, expect a hair-raising trip to the animal ER because xylitol can be lethal in dogs.

Keep the candy cauldron out of your pet’s reach to prevent grave consequences.

Creepy Costumes
Most pets rush to the door when the doorbell rings, but the appearance of ghosts, goblins and the Grim Reaper at your door screaming “Trick or Treat” may be your pet’s version of a zombie apocalypse. Keep your pet safely confined and well away from the front door to prevent an accidental escape when unexpected apparitions startle your pet.

Of the 179 million Americans celebrating Halloween, 28 million will purchase a costume for their pet. Not all pets think dressing up is bloody good fun. Hazardous hats and tight tu-tus may turn your pet’s Halloween into a nightmare. Do a costume trial run before the big night to prevent Halloween from becoming a bad dream.

Which Witch is Pet Safe?
To create a haunting aura on Halloween, half of Americans plan to decorate their homes this year, although not all decorations are pet safe. Jack-O-Lanterns add to the eerie atmosphere of Halloween night, but the candle inside can easily set a curious cat or dog’s fur on fire. Use battery operated flickering lights in place of the traditional candles in your carved pumpkin. I love to decorate with fake cobwebs and plastic spiders. If you have cats, I don’t recommend using this scary décor since cats love to eat anything that is stringy. Strings can easily lodge in your cat’s intestine causing a blockage.

All of us at the Animal Medical Center wish you and your pets a safe and fun Howl-oween.

Purging Your Pet’s Closet

pet closet

A common recurrent theme in magazines like Real Simple, Good Housekeeping, and Glamour is closet organization. These publications recommend purging closets seasonally to prevent accumulation of unwanted clothing and accessories. Many of us with pets have a small cabinet or closet devoted to our pet’s belongings. Taking a cue from these glossies, I am going to give some tips for cleaning out your pet’s closet.

If He Won’t Wear it, Recycle it
When you get to the back of your pet’s closet and find that really ugly sweater from Aunt Sally your dog has never worn or his favorite raincoat from when he was a puppy, but it no longer fits, cut the cord and send these unused items to a textile recycling center. Ditto for worn leashes and collars which present a safety hazard for your pet. In New York City, greenmarkets collect unwanted clothing, shoes and other fabric items for recycling.

Rid the Closet of Expired Medications
I am quite confident that when you clear out the closet you will find expired pet medications. Why? Because many of my clients call asking if they can use a medication for their pet found in the back of the closet. First thing I ask them is to tell me the expiration date on the box and usually that medication expired many months prior. The expiration date of medications is printed on the pharmacy label or the box. If you have outdated medication, use the United States Food and Drug Administration (FDA) guidelines to dispose of the drugs properly.

Toss the Expired Food
Before you replace any dog or cat food in the closet, check the expiration date on the bag or can and if outdated, dispose of it. Opened bags of dry food that have not been sealed tightly are likely to be stale or even rancid. Dispose of them as well.

No Need to Store Bones
Board certified veterinary dentists at the Animal Medical Center caution all dog owners against using natural bones or synthetic bones made of nylon as dog chew toys. Both types of bone are the cause of tooth fractures. When a tooth fractures and exposes the pulp cavity, either extraction or a costly restoration is needed. Avoid an emergency trip to the veterinary dentist by choosing tooth-friendly toys such as those made of hard rubber or fabric.

What? You Still Have Jerky Treats?
Between 2007 and December 31, 2015, the FDA has received approximately 5,200 complaints of illnesses associated with consumption of chicken, duck, or sweet potato jerky treats from pet owners. The cause of these illnesses is unknown. Since jerky treats are not a required part of your pet’s diet, veterinarians recommend selecting other types of treats for your pet. If you are feeding jerky treats and your pet becomes ill, tell your veterinarian about the jerky treat ingestion. If you believe your pet has become ill from consuming a jerky treat, please provide the FDA with valuable information by reporting it electronically through their Safety Reporting Portal or your local FDA Consumer Complaint Coordinator.

Once you have that closet cleaned, spend some quality time with your pet and play with all the fun toys you re-discovered while cleaning out your pet’s closet.