Tales from the Pet Clinic

By Ann Hohenhaus, DVM

At the booth

In the exhibit area at Westminster Kennel Club, The Animal Medical Center joins Angels on a Leash, Take the Lead, the ASPCA, and others to answer medical questions from show attendees. Old friends often stop by to thank us for care we have given to a beloved dog. One dog lover told the story of her Afghan Hound, which fell off a ledge a the Brooklyn library, puncturing a lung and fracturing both front legs. She reported the ER staff at AMC repaired both legs with metal rods and fixed the puncture, restoring the dog to full health.

Another visitor to the booth was a veterinary colleague from out of town. On the way into the show ring, her Labrador Retriever was bitten by a dog on the way out of the show ring dashing the dog’s changes of a ribbon. We called The AMC and arranged for her dog to get first aid on its way home to have the ear repaired. The ill-behaved dog was banished from competition.

Benched!

In most sporting events, one of the worst things an athlete can hear from the coach is: “you’re benched.” Not so at the Westminster Kennel Club Show. Benched is what all the dogs are in this ‘bench show.” The benching area, just off the ring in the basement of Madison Square Garden, has endeared the show to New Yorkers who come by the thousands. Benched dogs spend all day with their handlers, meeting the adoring public and getting petted so much it seems their meticulously groomed coats could be rubbed off. For a photo album of the great dogs I got to meet in the benching area click here.

What’s in a name?

While in the benching area I struck up a conversation with Darby Canyon Gracie’s Fellini, a Spinone Italiano. I inquired about his name, which was listed on his crate as Rico. The woman sitting with Rico explained her name was Grace and all her dogs have Grace in their names. Because he is of Italian descent, the Fellini part of Rico’s name comes from the famous Italian director Frederico Fellini and Frederico has been truncated to Rico, which is the call name of this handsome creature.

And the winner is…….

A member of The AMC family! Palacegarden Malachy the winning Pekingese and now Best in Show is co-owned by Professor Iris Love, a member of AMC’s’ board of trustees and lover of dogs in general. Malachy’s physical attributes make great copy. The LA Times called him a bobbing pompom, MSNBC described him as the love child of Chewbacca and an Ewok, and the person in the office next to mine reported Malachy made appearances on the morning shows sitting on a blue tuffet like Miss Muffett!

Watch a composite video of Malachy and his winning performances at the Garden:

By Ann Hohenhaus, DVM

We all know food provides the energy and nutrients each of us, including our pets, need every day. But as a veterinarian, food is more important than just providing nutrients; it is an integral component of disease and recovery.

Food and disease

Food is also related to common illnesses veterinarians diagnose on a regular basis. Take for example Jack, the cat lost at JFK, who succumbed to hepatic lipidosis, a disease provoked by inadequate food intake and treated by feeding!

Excess food intake often results in obesity. Obese animals live shorter lives and have more medical problems, including arthritis, bladder problems, and respiratory disease.

Food as medicine

Veterinarians have been using specially formulated diets as a component of medical therapy since the 1940’s.

“Prescription” diets are now manufactured by several pet food companies. These diets are available by prescription only since the nutrients have been modified to address certain nutritional differences in pets with a variety of diseases, so they are not appropriate for every pet. Take for example the reduced protein diets used in dogs and cats with liver problems. Too much protein can cause seizures in these patients. Protein-restricted diets are commonly prescribed to minimize the protein-induced seizures. For pets with suspected food allergies, diets have been formulated with novel ingredients to facilitate diet elimination trials. The exotic ingredient list for these diets – kangaroo, rabbit, duck, peas, and sweet potato – help veterinarians to eliminate common causes of food allergies, like beef, chicken, corn, and wheat, while maintaining a convenient source of nutrition for your pet. Specially formulated kidney friendly diets are one of the most important types of therapeutic diets and have been shown to minimize clinical signs of severe kidney failure (uremia) while maximizing survival in both dogs and cats with kidney disease.

For The Animal Medical Center’s brochure on feeding pets with kidney disease, click here.

Food and insurance

Can you believe food just got more important? The Trupanion Pet Insurance Company recently expanded coverage to include veterinarian prescribed diets.

Here is the coverage as listed in the sample policy:

Therapeutic Pet Food

(1) Therapeutic Pet Food – We will cover the incremental cost of therapeutic pet food when recommended and dispensed by your veterinarian in the treatment of injuries or symptomatic illnesses covered by this policy for up to two months of feeding. If you continue to feed your pet the veterinarian recommended therapeutic pet food as a long-term replacement diet, you will be eligible for a discount to your monthly premium. This coverage is not for routine/preventive care.

This is great news for pets and pet owners. Clearly, Trupanion understands the importance of food and I hope other pet insurance companies will recognize it too!

By Ann Hohenhaus, DVM

In my last post I wrote about rodenticides and the dangers they pose if ingested by our animal companions. This post will describe the clinical signs and treatment of dogs with rodenticide intoxication, including both anticoagulant and vitamin D poisons.

The photograph shows a hemorrhage in the retina from rodenticide poisoning.

Anticoagulant rodenticides

Ingestion of this type of rat poison by dogs typically causes internal hemorrhage, anemia, and, in the worst cases, death. If your dog has ingested this type of poison, you might notice a bloody nose, blood in the stool or urine, and a general lack of energy from anemia due to blood loss. Many dog owners do not realize rat poison has been placed by their landlord or an exterminator until an emergency room veterinarian suspects rodenticide intoxication. A blood test showing abnormal blood clotting can confirm the diagnosis.

Anticoagulant rodenticide intoxication can be successfully treated. The antidote is vitamin K, but not the type of vitamin K available in a health food store; a prescription is required. Severely ill dogs will require hospitalization, blood transfusions, and close monitoring in an intensive care unit. The good news is, most will recover.

Vitamin D analogues

Minor elevations in blood calcium caused by ingestion of vitamin D analogue rat poisons will cause your pet to increase its drinking and urination. If the exposure to vitamin D analogue rat poison is prolonged or the amount ingested large, kidney damage, seizures, and death can occur.

For veterinarians, making a diagnosis of vitamin D rodenticide intoxication can be challenging. An increase in drinking and urination is not specific for vitamin D rodenticide intoxication and is a common finding in several disorders, including diabetes, kidney failure and pyometra.

Routine bloodwork can readily identify elevated calcium levels, but like an increase in drinking and urination, elevation of calcium levels is nonspecific and occurs in several disorders, including kidney failure, lymphoma, and an overactive parathyroid gland. A dog with elevated calcium levels often needs an extensive medical evaluation to determine if rodenticide intoxication is causing the elevation in calcium levels.

Treatment of vitamin D rodenticide intoxication can be equally as challenging and require administration of several different treatments to bring the calcium down. Hospitalization is frequently required for administration of intravenous fluids and diuretics. The hormone calcitonin has also been used to lower dangerously high calcium levels and steroids may also be used to increase calcium excretion in the urine.

An ounce of prevention is worth a pound of cure, and in the case of rodenticides, cautious use could save your pet’s life. The Environmental Protection Agency has a very useful consumer website on rodenticides and their safe use in homes with pets. It may be worth your pet’s life to check it out.

By Ann Hohenhaus, DVM

Right next door to The Animal Medical Center is Twenty-four Sycamores Playground.  A typical New York City playground, it contains swings, a sprinkler, basketball court, and rat poison. There was rat poison application posted on the entry gate about a week ago.

Doggy danger

Since dogs are not allowed in the playground, the sign was directed at the parents of children playing in the park, but dog owners should be vigilant in any area where rat poison warning signs are posted since ingestion of rat poison can be lethal for dogs. The poison danger does not lie solely in urban environments and, according to the Pet Poison Hotline, rodenticides were the number three cause of poisoning in pets in 2011.

Two main types of rat bait poison

The toxic substance placed in Twenty-four Sycamores Playground was bomadialone, a second generation anticoagulant rodenticide. Another common second generation anticoagulant rodenticide is 1,3 indandione. The first generation anticoagulant rodenticide Coumadin, or warfarin, has largely been retired as rat bait and put to a much better medical use – protecting humans against dangerous blood clots. Anticoagulant rodenticides block the function of a critical enzyme required for blood clotting. The other class of commonly used rodenticides is the vitamin D analogues, erogocalciferol and cholecalciferol which cause fatal elevations in blood calcium since vitamin D’s normal function is to increase absorption of calcium by the body.

Kitty katastrophy

Perhaps because of their finicky dining style, anticoagulant rodenticide intoxication remains a rare diagnosis in cats.  If you think your cat has been nibbling on some anticoagulant rat poison, your veterinarian can test a blood sample to determine if you cat’s blood is clotting abnormally. You should watch for external bleeding, blood in the urine, or dark tarry stool indicative of bleeding in the upper intestinal tract. Cats can be saved, but most require a blood transfusion as a life-saving intervention in addition to supplementation with vitamin K, the antidote.

Veterinarians have reported a few cats treated for ingestion of vitamin D analogue rodenticides.

Not all cats recover. Treatment consists of fluids, diuretics, and other medications to help promote excretion of excess calcium.

Avoid using rat poisons around your pets. For suggestions on how to control rats without rat poisons, check out the New York City Rat Information Portal.

By Ann Hohenhaus, DVM

Abyssinian kittens Elizabeth Barbara and Moby came to The AMC for a spa day of sorts. You can watch a video of Elizabeth in the tub here. Readers of Tales from the Pet Clinic know these kittens from their debut in the “ABC’s of Feline DNA.”

When their owner called to alert me of a dark spot near Elizabeth’s ear, I was concerned one of these rambunctious kittens had gotten burned. But because kittens are prone to a fungal infection known as ringworm, I sent a hair sample to the lab for testing. About two days before the result came back from the lab, Moby developed a similar lesion on his ear and then I knew it was ringworm. At that time I prescribed a topical antifungal cream called ketoconazole, and when the lab confirmed the result it was time for a bath.

Dermatophytosis

Ringworm is the most common infectious and contagious skin disease in cats and gets its name from the characteristic ring lesion seen in humans. WebMD has a slideshow demonstrating the appearance of the characteristic skin lesions.

Dermatophytosis is the scientific name for ringworm, which in cats is typically caused by the organism Microsporum canis. This fungus requires a break in the skin to cause infection. The photograph doesn’t show the marks, but Elizabeth had punctures around the base of her ear about the same width as the space between Moby’s fangs. Because their immune system is not fully mature, kittens more commonly contract ringworm than adult cats.

Scabby, scaly kittens

The clinical hallmarks of ringworm in cats are hair loss, hair breakage, scaling, and crusting of the skin. Infected cats may be very itchy. Like Moby and Elizabeth, most lesions occur on the face, ears, and paws. In some cats, ringworm lesions spread all over the body.

The gift of ringworm

We will never know where these kittens came into contact with M. canis, since it is ubiquitous within the environment and also carried on the fur of cats. We do know they gave the infection to their family. One of the first things I did when I suspected ringworm was to ask the family if they had any skin lesions and to warn them about the possibility. I also wrote down what I though the kittens might have on my prescription pad so the human dermatologist could call me if need be. Communication between veterinarians and physicians is critical in cases of zoonotic disease – diseases passed between animals and man.

The spa day

A bath is part of the treatment for ringworm. Additionally, oral and topical antifungals are often used. This is no flowery, bubbly soak. We rinse ringworm patients with lime sulfur dip, which is more like “taking the cure” at Saratoga Springs than spending a day at Elizabeth Arden. Lime sulfur carries the pungent odor of rotten eggs and on the day of the bath, someone commented the bathing area smelled like a chemistry lab where the experiment had gone badly. The smell may have been bad, but the bath went well and the hair is already growing back in on Moby’s and Elizabeth’s ears.

By Ann Hohenhaus, DVM

To promote good oral healthcare for cats and dogs, February has been designated National Pet Dental Health Month. I want to be sure pet owners are aware of some of the veterinary resources available to help keep pet mouths healthy.

Your primary care veterinarian

The first place to start to keep your pet’s mouth clean and healthy is your veterinarian’s office. An oral examination is part of an annual (or biannual if you have an older pet) examination. A quick look in your pet’s mouth will quickly reveal how effective tooth brushing is in keeping tartar under control. Your veterinarian can recommend special food and products to keep teeth healthy and also choose the right time for a full dental cleaning. Keep in mind rabbits also have dental problems from over grown teeth. Your veterinarian needs to see those bunny choppers once or twice a year if you have an older rabbit.

Board certified veterinary dentists

The American Veterinary Dental College (AVDC) is the nationally recognized certification body for veterinary dentists. In addition to earning a doctor of veterinary medicine degree, a board certified veterinary dentist has completed specialized training in veterinary dentistry under the guidance of a board certified mentor and successfully completed a certification examination. Your neighborhood veterinarian can provide routine dental care, but for big problems of teeth and gums, these highly trained veterinarians are the experts your pet needs. The AVDC also sponsors the Veterinary Oral Health Council (VOHC).

Seal of approval

The Veterinary Oral Health Council exists to recognize products that meet pre-set standards of plaque and calculus (tartar) retardation in dogs and cats. The Council is recognized worldwide through endorsements by organizations such as the British Veterinary Dental Association and the Australian Veterinary Dental Society.

Manufacturers of products designed to decrease plaque and tartar on the teeth can voluntarily submit their clinical studies performed according to VOHC standards. If the products meet the requirements, the VOHC awards a seal of approval. Pet owners will be happy to know some are their favorite products are on this list, including dental chews from Friskees and Greenies, and foods from Iams, Hills, Purina and Royal Canin. Regular use of products with the VOHC seal will decrease the severity of plaque and tartar in pets. For a list of products bearing the VOHC seal, click here.

Looking for more information?

In honor of National Pet Dental Health Month, the folks at Greenies and Trone Research have teamed up to demystify common misunderstandings about pet oral health.

The AMC website also has information about dental care in pets.

A question many pet owners have about dental cleanings in pets is related to the required anesthesia, the topic of a blog last year.

And finally, WebMD also has dental information resources for the pet owner. Check them out here!

By Ann Hohenhaus, DVM, DACVIM

The staff of The Animal Medical Center was saddened to read of the passing of one of its most distinguished canine patients, Uncle Chichi.

A resident of Manhattan’s West Village neighborhood, Uncle Chichi was a philanthropist. Because of an appearance on “Good Morning America,” he garnered a donation of 10,000 servings of Spot’s Stew for the John Ancrum Society for the Prevention of Cruelty to Animals in Charleston, SC, the organization that found him his forever home 24 years ago. That’s right, 24 years ago. Uncle Chichi was one of those centenarian miniature poodles I wrote about in “How Old is Old, in Dog Years.”

Any dog living over 24 years is guaranteed to become a connoisseur of veterinarians, and Uncle Chichi was no exception. He arrived at The Animal Medical Center with a pathology report in French stamped with an official-looking Swiss stamp. His family had noticed a black mass on his lower lip while traveling and a veterinarian in Geneva, Switzerland diagnosed mélanome. The attached translation said melanoma.

Melanoma is a common tumor managed by the veterinarians at The AMC. The lip mass was surgically removed by AMC board-certified soft tissue surgeon, Dr. Janet Kovak McClaran. Uncle Chichi’s board-certified oncologist, Dr. Maria Camps,

prescribed the state-of-the-art canine melanoma vaccine and administered four doses.  This vaccine has prolonged the survival of many grateful dogs suffering from melanoma, but Uncle Chichi’s melanoma defied the statistics and spread to his lungs. As the tumors in his lungs worsened, Uncle Chichi’s cough worsened. A molecularly targeted chemotherapy agent, Palladia, and a cough suppressant were prescribed and relieved the constant coughing. But then the seizures started. Uncle Chichi came to The AMC ER and they diagnosed spread of the melanoma to his brain.

The typical dog with a melanoma treated with the vaccine lives over 400 days. Uncle Chichi lived just over half that time. Although we wish it would have been longer, The AMC is proud to have contributed to such a well-lived and long life. Uncle Chichi will be missed by many, including those of us who knew him here at The AMC.

By Ann Hohenhaus, DVM, DACVIM

In my last blog, I wrote about some of the situations that cause stress in pets. Today I will share my suggestions for relieving their stress.

Natural remedies

In addition to having adequate litter boxes and feeding special diets to control stress- related diarrhea mentioned in my last blog, the concerned pet owner can respond with environmental enrichment, exercise, and natural destressors, such as pheremones. When I have hospitalized feline patients at The AMC, I like to give them a cardboard box in their cage for hiding. I spray the box with Feliway, a feline pheromone, which signals comfort and reassurance to the cat.

Dogs have their own pheromone for stressful situations, called DAP. I find spraying it on a bandana and placing it around the dog’s neck often calms a dog stressed by travel or a clinic visit.

The popularity of lavender in candles, soaps and lotions is in part due to its natural stress reductions properties. One of my patients, a nervous terrier named Fred, benefitted from lavender oil daubed on the tips of his ears at the beginning of a clinic visit. This simple, safe stress buster immediately stopped Fred’s shaking and calmed him enough that he would snooze while I spoke with his family.

An intriguing new product is Pet Naturals of Vermont’s Calming for Pets treats for cats and dogs. This product contains natural ingredients to support stress reduction and comes in a variety of sizes to fit your pet. Last week I tried some on my patients who enthusiastically give these bone-shaped treats an all paws up rating.

Environmental enrichment

Providing an enriched environment helps to combat stress and is one way of providing activities other than lying on a sofa.

Challenge your pet with puzzle toys for feeding. Food puzzle toys will amuse your pet and will simultaneously help to control their weight by slowing their rate of eating. These puzzles are available for both dogs and cats at nearly every pet emporium.

Water fountains provide entertainment for your cat or dog and will encourage adequate water consumption for those pets with medical conditions requiring increased water intake.

Fresh air and sunshine improve everyone’s mood, cats included. If taking your pet outside is difficult, make sure it has a safe perch on a window ledge or piece of furniture so it can look beyond the four walls. Cats love to perch and if you do not have a good view from your windows, try a cat tower to add perching opportunities to your home.

What are your suggestions for decreasing stress in your pet? Please share them in the comments below or with the members of the Healthy Pets community.

By Ann Hohenhaus, DVM, DACVIM

People talk a lot about the stress in their lives: their job, their mortgage, their spouse; but do pets have stress? And if they have stress, how can you manage it?

Cat stressors

Since this blog is titled “Pet Stress,” you can guess I believe pet stress exists. I actually see it on a daily basis. The photo at left shows a good example of cat stress. Donovan, the new kitten, is trying to be friends with Delbert, the established top cat in the household. Donovan has snuggled into the chair. Delbert is giving him the cold shoulder and is unwilling to even make eye contact with the little invader. The addition of a new pet can be very stressful to the current one.

To decrease stress when a new cat is added to the household, the number of litter boxes should equal the number of cats, plus one. Cats like privacy and an inadequate number of litter boxes can result in inappropriate urinations and defecations. Some cats even wait outside the box to attack the other cat as he exits the preferred litter box.

Stress colitis

Dogs may respond to stressful events by developing acute diarrhea. The AMC’s emergency room staff saw a lot of this over the holidays in response to houseguests, following parties, or after a stay at the boarding kennel. I have one dog patient who always struggles with diarrhea while he is in New York City and the minute he decamps to the country house, the diarrhea is better. I think New York City is a great place to live; obviously he doesn’t agree with me, but he does eat the special food I prescribe which nicely prevents the diarrhea flare-ups.

Other stressors

Just like a new pet in the household can be stressful, a new baby, new boyfriend or a new home can cause stress in your pet. Change can be difficult for them too: a change in food, schedule, or the absence of a favorite family member, including another pet, can upset pets.  Your behavior is also a pet stressor. Door slamming, yelling, angry voices and other loud noises can send your pet under the bed or provoke an accident in the house due to stress.

If you think your pet is experiencing stress, talk to your veterinarian first and if the clinical signs you’re seeing are not related to a medical condition, check back here next week for suggestions on destressing your pet.

By Ann Hohenhaus, DVM, DACVIM

I must admit, diapers for a pet seemed way over the top to me. But recently some of my patients have convinced me otherwise. Their use of diapers is only part of the medical management required to keep them active and happy members of their family. Here are their stories.

One of the obvious uses for a diaper is on a female dog in heat. If your dog comes into heat unexpectedly or if you are waiting a heat cycle before breeding her, a diaper may be a good solution. The diaper protects the furniture, rugs and floors from staining while your female dog is in heat. Don’t count on the diaper as a form of contraception, as a male dog will find a way around the diaper and you may find an unexpected litter of puppies. Always keep a female in heat away, crated or in a separate room from an unneutered male dog.

Sophie

Sophie is another example of how helpful a doggie diaper can be. She has several medical problems which we keep in check with regular visits and a strict medication regimen. Sophie’s bladder capacity is limited since she had surgery last spring to remove a bladder tumor. Her Cushing’s disease and elevated calcium level cause her to drink more water and consequently produce more urine. This combination of problems make her use of wee-wee pads unreliable, so she wears a diaper when her owners are not home. Sophie is happy, energetic and a vital member of the family.

Spenser

Spenser only needed a diaper for a few weeks after his bladder surgery. Surgical manipulation of the bladder made it painful for his bladder to hold much urine and it was difficult for him to wait between walks. Even though his owner walked him extra times following surgery, the diaper prevented embarrassing accidents until his bladder recovered and he could hold urine normally again.

Pumpkin

I even have a cat patient who occasionally wears a diaper. Even though he is a neutered male cat, Pumpkin has a bad habit of spraying urine on the living room drapes. When his family wants everyone to be together in the living room, Pumpkin wears stud pants, a special form of cat diaper to prevent urine spray on the drapes. The female form of cat diapers are sometimes called queen panties since female cats are referred to as queens.

If you are looking for diapers for your pet, Sophie recommends these as they come in cute prints.

I found this series of videos showing how to convert baby diapers to pet diapers, which might be a good solution in an emergency.

Have you ever used diapers on your pet? Do you think they’re helpful or unnecessary? Share your thoughts in the comments below or in our Pet Health community.