http://www.petmd.com/blogs/thedailyvet/rss en Regular Exams Can Save More than Your Pet's Life http://www.petmd.com/blogs/thedailyvet/drjintile/2014/july/regular-exams-can-save-more-your-pets-life-31887  
There’s a great deal of evidence to support the benefit of preventative medicine for people. One study indicated that over half of the deaths in the United States in the year 2000 were due to preventable “behaviors and exposures.” This included deaths from cardiovascular disease, chronic respiratory disease, unintentional injuries, diabetes, and infectious diseases.
 
It would seem, therefore, that preventative medicine would be our best defense against illness. Yet, nary a few months go by before another study is published indicating that preventative exams, lab tests, or diagnostic procedures are no longer being recommended as they provide no apparent benefit to patients.
 
As an example, the results of a recent meta-analysis of 52 different studies indicated annual pelvic exams were “unnecessary” for women.  Results showed the exams provided no benefit for diagnosing women with ovarian cancer, uterine cancer, or vaginal infections early enough to save a woman’s life or preserve her fertility.
 
When I heard the results on our local news station early one morning, I immediately reacted with anxiety, anger, and concern, shouting irrationally at the television screen, while my husband stood bewildered at my outburst.  When the media puts forth such medical information without a supporting net for the fallout, I can’t help but bristle in response.
 
When you examine the “bones” of the study, the American College of Physicians essentially is saying, skip the pelvic exam, but you still need to routinely test for cervical cancer. 
 
Although the conclusion I read into it was, “You still need to see your doctor regularly for preventative testing,” the media’s take was skewed towards, “Skip the exam and question your doctor if they suggest performing one.”
 
My first concern was that women would hear the results and interpret them to mean “You don’t need to make an appointment for an annual exam anymore — it doesn’t do anything.” 
 
I then wondered how the perception of the results of such studies translated to veterinary medicine.  If the (inaccurate) message put forth is that preventative care is unnecessary and unhelpful for people, how can veterinarians ever attempt to convince owners of the importance of preventative health care for animals?
 
I am certain that one of the main reasons we are unable to cure the majority of our veterinary cancer patients is because we diagnose and initiate treatment when their disease burden has become large.
 
Animals are hard-wired to hide signs of illness or pain and will often begin to give an indication that they are sick only after their disease is quite advanced. Even the most astute and loving pet owner can easily miss the very early signs of disease.
 
Regular physical exams and a better ability to screen patients for risk factors indicating predispositions to cancers would lead to earlier diagnosis and a better chance for cure. We could also test breeding animals for susceptibilities to cancers and remove them from the breeding programs.
 
Prevention of disease could ultimately be less costly than diagnostics and treatment instituted at advanced stages. A 2007 study by the American Veterinary Medical Association (www.avma.org) supports this concern. 
 
This study showed that although there was a consistent rise in spending on veterinary care for pets over a five year period, the actual number of veterinary visits per pet during that same time frame declined.
 
Many interpreted the results to mean that owners were spending more money only once their pets were sick, rather than on their routine visits that could have prevented the larger expenses in the long run.
 
Lastly, bringing pets in for more wellness exams will force veterinarians to place more emphasis on the lost art of the physical exam. One of my best mentors in veterinary school drilled into students that 90 percent of success in obtaining a diagnosis comes from the history given by the pet owner, and the physical exam. Despite this, veterinarians consistently seem to rely much more significantly on the results of labwork or imaging tests to tell them what’s wrong with pets.
 
Think about it this way: If one year in the life of your pet equals seven years of your own life, and you skip your pet’s yearly checkup, it’s the equivalence of missing seven years of preventative care for yourself.
 
Imagine not going to the doctor or dentist for seven years.  Would you not be surprised to learn you had “issues” with high blood pressure, were slowly gaining weight, or had a “bit” of dental disease by that time? How then can anyone be surprised when diseases are detected at such advanced stages in pets when routine care is avoided? And how can we be surprised when treatment options are limited and cure rates are low?
 
Keep up with the wellness visits for your pets — they really are an invaluable aspect of their overall health! And you may just be able to afford your companion with a chance for a cure they would not have had if you had waited until they were actually sick from their disease.
 

Dr. Joanne Intile
 
Image: Ermolaev Alexander / Shutterstock
 
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What Congress' Passing of the Veterinary Mobility Act Means for You and Your Pets http://www.petmd.com/blogs/thedailyvet/patrick-mahaney/2014/july/what-congress-passing-veterinary-mobility-act-means-31893  
What is the Veterinary Medicine Mobility Act?
 
The Veterinary Medicine Mobility Act (H.R.. 1528/S. 1171) modifies “the Controlled Substances Act and Drug Enforcement Administration policy that currently prohibits veterinarians from transporting controlled substances to administer and treat patients outside of the registered location.”
 
Controlled substances include “narcotics, depressants, and stimulants manufactured for legitimate medical uses, are subject to abuse, and have therefore been brought under legal control” so that these drugs “are readily available for medical use, while preventing their distribution for illicit sale and abuse.”
 
Controlled substances are categorized from Schedule I-V. Schedule I drugs have no known medicinal use in veterinary medicine, including heroin and marijuana (yet, such could change regarding cannabis in the future, see: Veterinary marijuana?). Schedule II-V include a variety of pain-relieving, sedating, anti-anxiety, muscle-relaxing, muscle-building, and life-ending drugs that veterinarians use for our patients.
 
Predating the Veterinary Medicine Mobility Act, the “Drug Enforcement Administration’s (DEA) interpretation of provisions within the Controlled Substances Act (CSA) and resulting federal regulations make it illegal for registrants to transport controlled substances for use outside of a registered location.”
 
Why is the Veterinary Medicine Mobility Act Important to Veterinary Practice?
 
The Veterinary Medicine Mobility Act permits veterinarians to transport controlled substances for use outside of their location of registration (i.e., typically a hospital or clinic setting).
 
As a mobile practitioner in Los Angeles, there’s definitely an occasional need to use controlled drugs in my house-call practice. Although I do not sedate my patients to the degree where surgery could be performed on a house-call basis, I need to give sedating and pain relieving drugs for dogs or cats who:

have severe pain that isn’t being controlled by oral pain medications — Pets having pain from trauma, fractures, surgery, cancer, and those having advanced metabolic diseases (kidney liver failure, pancreatitis, etc.) are candidates for injectable pain-relieving drugs.


require sedation for minor procedures — Some animals aren’t cooperative enough to undergo manual restraint for routine procedures like nail trim, bandage placement, wound care, etc. Sedation helps ensure that the task at hand can effectively be performed to a desirable level and that our patients are less likely to self-injure by struggling during the procedure.


need to have their life ended through euthanasia — Having a beloved pet put to sleep at home is much more desirable to the majority of my clients as compared to bringing their sick animal into the hospital for the procedure. Home euthanasia permits the client to welcome family and friends for support during the process and ensures the pet’s final experiences occurs in a comfortable and familiar setting.

 
Although I don’t practice on large animals or wildlife, veterinarians that do need to be able to transport drugs to an off-site location. After all, animals weighing hundreds to thousands of pounds aren’t good candidates to be readily transported, or they may have ailments requiring immediate care in the field. Additionally, veterinarians may be called into action to “remove or translocate dangerous wildlife (e.g., bears, cougars) or rescue trapped wildlife (e.g., deer trapped in a fence).”
 
Without the ability to legally transport controlled substances to perform procedures, we veterinarians wouldn’t legally be able to provide such drugs to help improve the quality of life of our patients for fear of potentially compromising our ability to practice by violating established legal guidelines, coming under scrutiny from our state’s Veterinary Medical Board (VMB), and potentially losing our licenses to practice.
 
What’s Next for the Veterinary Medicine Mobility Act?
 
Now that the Veterinary Medicine Mobility Act has passed in the U.S. House, it now must move further up the chain of command and eventually be signed by the President.
 
Although the bill is moving in the right direction, veterinarians should still do their part in ensuring the further passage of the bill by contacting their representatives and asking for partnership in cosponsoring and voting for the The Veterinary Medicine Mobility Act (H.R. 1528/S. 1171).
 
You can also follow and send Tweets to the American Veterinary Medical Association at @AVMAVets, and the U.S. House of Representatives at @HouseFloor.
 
The ultimate passing of this bill will be a step in the right direction to benefit practicing veterinarians and the clients and patients we so dutifully serve.
 

Dr. Patrick Mahaney
 
Image: nednapa / Shutterstock
 
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How to Get Your Cat to Take Medicine http://www.petmd.com/blogs/thedailyvet/lorieahuston/2014/july/how-get-your-cat-take-medicine-31886  
Before you attempt to medicate your cat, get all your supplies together. Have the medication handy, along with a treat to make the experience more pleasant for your cat, and a towel for wrapping your cat if necessary.
 
To give a liquid medication, place your cat on a flat surface, facing away from you with his hindquarters against your body. You should already have the medication drawn up into a dosing syringe. Use your free hand to tilt your cat’s head up slightly. Place the tip of syringe in the back corner of your cat’s mouth, squirting the medication in the space between the cheek and gums. Be sure to reward your cat with a favorite treat afterward.
 
To give a pill or capsule, hold your cat in the same position you would to give a liquid. Using one hand, steady your cat’s head and tilt it slightly upward. Grasp the pill or capsule between your thumb and forefinger of the opposite hand. Use your middle finger to open your cat’s mouth and slide the pill down the center of the tongue to the back of the mouth.
 
Alternatively, you can use a pill gun (a device used to hold the pill or capsule and place it in the mouth), again placing the medication on the tongue at the back of your cat’s mouth.  Continue to hold your cat’s head in a slightly tilted position with the mouth closed until you see your cat swallow. Follow the pilling procedure with a treat for your cat.
 
If your cat struggles and attempts to scratch, wrap a thick towel around your cat’s neck and front legs to protect yourself from your cat’s claws.
 
If medicating your cat is difficult, you may try hiding your cat’s medication in food. Liquid medication can be mixed in with wet food or with gravy or tuna juice. Check with your veterinarian first though, to be sure that this will not affect the efficacy of the medication.
 
For pills or capsules, you can purchase pill pockets which can be used to hide a pill or capsule inside. The pill pocket with the medication inside is then offered as a treat. Alternatively, you can try making your own pill pocket by wrapping the pill or capsule in a bit of cheese or inside of a ball of canned food.
However, many cats will simply nibble around the medication, rather than actually taking the medication. If your cat does this, you will need to either manually medicate your cat or find another alternative.
 
In many situations, there may be other alternatives available. Many medications can be compounded, producing a liquid with a pleasant flavor. There are special compounding pharmacies that can do this if your veterinarian is unable to formulate the flavored medication in the hospital.
 
Some medications are also available as a transdermal gel. This special medicated gel is able to be absorbed through the skin rather than requiring oral administration. Typically, these medications are applied to the inside of the tip of the ear.  Methimazole, a medication frequently used to treat hyperthyroidism in cats, is frequently dosed as a transdermal gel.
 
Transdermal patches are another alternative that may be an option with some medications. These are patches with medication embedded in them that are affixed directly to the skin. The medication is then released from the patch through the skin in a time-released manner. Fentanyl, a potent pain reliever, is often dosed as a patch.
 
Unfortunately, not all medications lend themselves well to transdermal applications. However, your veterinarian will be able to help you choose a medication delivery system that is manageable for you and can also demonstrate how to go about medicating your cat.
 
Have you found a tip that is useful in medicating your cat? Please share it with us in the comments.
 

Dr. Lorie Huston
 
Image: Yellowj / Shutterstock
 
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Puppy Strangles — A Potentially Devastating Skin Disease http://www.petmd.com/blogs/thedailyvet/dr-coates/2014/july/puppy-strangles-%E2%80%94-potentially-devastating-skin-disease-31885  
Puppy strangles is an odd disease. First of all, it tends to only affect puppies younger than four months of age, and for all the world it looks like it should be caused by a bacterial infection. Affected puppies develop some combination of the following symptoms:

facial swelling
papules (small, solid, raised masses) around the face and ears
pustules (small pockets of pus) around the face and ears that usually rupture and crust over
enlarged lymph nodes behind the jaw that may rupture and drain
fever
poor appetite
lethargy
joint pain (less common)

 
To confuse matters, bacteria are often present when samples are taken from the skin, but these infections develop as a result of puppy strangles; they are not its cause. This explains why antibiotic therapy alone is rarely successful in eradicating the disease.
 
Puppy strangles appears to primarily be an immune-mediated disease. Genetics seems to play a role since it is diagnosed more frequently in some breeds (golden retrievers, Gordon setters, miniature dachshunds, and Siberian huskies) and family lines than in others.
 
Immunosuppression (usually with prednisone) is the cornerstone of treatment for puppy strangles, which is a little scary when we’re talking about treating a puppy with an immature immune system who is already at higher than average risk for a laundry list of infectious diseases. Many veterinarians will put puppies suffering from strangles on broad spectrum antibiotics to prevent (or treat) secondary bacterial infections. This is one of the few times that I think combination treatment with prednisone and an antibiotic makes sense.
 
When a veterinarian suspects that a puppy is suffering from strangles, he or she will usually want to run a handful of tests before prescribing prednisone or other immunosuppressive drugs. Deep skin scrapings to look for the mites that cause demodectic mange, skin cytology (a microscopic examination of cells), and a fungal culture for ringworm are always a good idea since immunosuppression in the face of an infectious disease can be catastrophic. Skin biopsies and other tests may also be needed to reach a definitive diagnosis.
 
I’ve seen a handful of puppy strangles cases in my career. It is not all that common but can lead to devastating scarring and even death if it is not treated appropriately and in a timely manner. Get your canine bundle of joy to the veterinarian ASAP if you have reason to suspect that he or she is developing puppy strangles.
 

Dr. Jennifer Coates
 
Image: Sue McDonald / Shutterstock
 
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The Incredible High-Diving Horses of Yesteryear http://www.petmd.com/blogs/thedailyvet/aobriendvm/2014/july/incredible-high-diving-horses-yesteryear-31874  
There are a few different variations of how Carver came to this diving horse idea. Other parts of Carver’s biography are fuzzy as well, but include time spent training as a sharp shooter and taking part in the famous Buffalo Bill Wild West show. The most widely cited account of Carver’s equestrian ingenuity details how he jumped a horse off either an embankment or bridge in Nebraska into the river below. Soon, Carver’s business partner, Al Floyd Carver, built a mobile ramp and tower and the diving horse traveling show was born.
 
In an era rich with entertainment in the form of traveling sideshows and circuses, the diving horses were a big hit. Unique to be sure, these shows offered paying customers a small piece of everything you could want in entertainment: danger, suspense, and the appearance of the human-animal bond. In the early 1900s, Carver’s show became a permanent fixture at Atlantic City’s Steel Pier.
 
If this story sounds a little familiar to some of you, it might be because of a Disney film called Wild Hearts Can’t be Broken, released in 1991. This film chronicles the true story of a young girl named Sonora Webster, who was a rider in Carver’s show. Tragically, in 1931, Sonora was blinded after an accident on the pier caused her horse to dive unexpectedly off-balance. Sonora hit the water with her eyes open and the force of the impact detached her retinas. A story of perseverance, Sonora continued to dive blind in the act for another eleven years and married Carver’s business partner.
 
Carver’s act continued at the Steel Pier until the 1970s — a very respectable tenure for something born in the previous century. Pressure mounting from various animal welfare groups finally closed the show. Atlantic City attempted to resurrect the show again at Steel Pier a few years ago, but it was again halted on grounds of animal welfare.
 
Although Sonora always maintained their horses were treated humanely, one must wonder: Is it in a horse’s nature to willingly climb atop a forty foot structure and then leap into water below? Granted, it is not in a horse’s nature to allow a human on its back either, and yet we are able to quite easily train a horse to accept that. Is a horse trainable enough to willingly dive?
 
Accusations arose during the show’s timeline that cattle prods and other methods of force were used to force the horses up the ramp and then off the pier. However, even if these aren’t true, there were horses that died over the course of the show’s lifetime, either from injuries sustained during a last-minute panic prior to jumping into the water, or to drowning.
 
I bring up this niche of equestrian history not to be a downer and debate animal welfare, but to share a glimpse into the past. Horses have had such a huge impact on human development and entertainment over the millennia that I find it interesting when something rather unique — Diving horses? Who would’ve thought? — blips on the radar. Being a horse lover myself, I am continually amazed at what the equine species endures.
 

Dr. Anna O'Brien
 
Image: Archive image of a diving horse with human rider
 
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Raw Diets and Hyperthyroidism in Dogs http://www.petmd.com/blogs/thedailyvet/ken-tudor/2014/july/raw-diets-and-hyperthyroidism-dogs-31873  
What is Hyperthyroidism?
 
All animals have thyroid glands. The glands are located next to the trachea (wind pipe) just below the larynx (voice box). These glands secrete thyroid hormone. The amount of thyroid hormone in the blood regulates body metabolism. Decreased levels slow metabolism and increased levels speed up metabolism. Heart rate, body temperature, chemical reactions, food utilization, or storage are all dependent on the level of thyroid hormone in the bloodstream.
 
Animals with hyperthyroidism secrete excess hormone, causing a constant state of metabolic hyperactivity. They often lose weight, have fast heart rates, and ravenous appetites. Side effects also include increased water consumption, increased urination, and vomiting. Long term, this hyper metabolic state can result in heart and kidney failure.
 
Cat owners are all too familiar with this condition. Over-active, microscopic benign tumors in the thyroid glands are extremely common in older cats. The condition is so common that a veterinary expert in feline hyperthyroidism once quipped, “It seems that every cat is destined to develop hyperthyroidism at some point in its life.” 
 
What is the Cause of Hyperthyroidism in Dogs Fed Raw Food?
 
Active thyroid hormone secreting tissue is not restricted to the thyroid gland. Research has shown that small, usually microscopic, amounts of active thyroid tissue can be found along the entire trachea, even into the chest. Dogs fed raw animals necks absorb thyroid hormone from attached or residual thyroid gland or thyroid active tissue in the neck. The amount is sufficient to cause symptoms of hyperthyroidism.
 
In the 2012 and 2013 studies, the diets of the sick dogs were confirmed to have included raw neck tissue or thyroid gland contamination of raw products from a slaughtering plant. The new 2014 study (unpublished) confirmed beef necks and thyroid tissue in raw dog treats. All of the dogs in the studies had elevated thyroid hormone levels without evidence of thyroid tumors. Dietary change resulted in a return to normal blood thyroid levels and relief from the symptoms, suggesting that the raw thyroid tissue was the underlying cause.
 
Why Hyperthyroidism in Dogs May Become More Common 
 
The popularity of real food raw diets for dogs is becoming extremely popular. Major ingredients in many of these diets are “meaty bones.” Meaty bones are basically the frame (neck, back, and pelvis) of the chicken or small livestock (rabbits), and necks of large livestock after the majority of the choice muscle has been removed. Chicken necks are a very commonly used meaty bone. The combination of residual meat, ligament, tendon. and bone make them attractive for those choosing to feed a diet that more closely mimics the diet of the wild ancestor of the dog. The high bone content is thought to add adequate calcium, phosphorus, and magnesium, and the necks contribute fat and a small amount of protein to the rest of the diet.
 
These studies suggest that thyroid tissue contamination of raw animal necks or treats containing neck and thyroid tissue can cause hyperthyroidism in dogs. With larger numbers of dogs being fed raw necks we may see more dogs with this condition.
 
Fortunately, the condition is reversible once thyroid tissue is removed from the diet. Those choosing to feed a raw diet containing meaty bones may want to avoid using necks as part of the diet. Evaluation of blood thyroid hormone levels in dogs on these diets would also be advisable.
 

Dr. Ken Tudor
 
Image: V.J. Matthews / Shutterstock
 
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Progress is Slow in New Treatments for Pet Cancers http://www.petmd.com/blogs/thedailyvet/drjintile/2014/july/progress-slow-new-treatments-pet-cancers-31872  
Since the time of publishing this article, a group of medical researchers in Vienna, Austria, have put forth the results of a small study describing a new and different monoclonal antibody for dogs. This antibody reacts with the canine version of a cell-surface protein called epithelial growth factor receptor (EGFR).
 
EGFR is mutated in many forms of cancers in both people and animals and are most often found in epithelial cancers, which are tumors of the linings of different organs/tissues. Examples of epithelial tumors include mammary tumors, skin tumors, and lung tumors. Mutations in EGFR can lead to unregulated cell division and growth (e.g., formation of tumors) and can also help cancer cells figure out how to invade into other tissues and spread throughout the body (i.e., metastasize).
 
There are a variety of anti-EGFR monoclonal antibodies available for humans with cancer. One such "human drug" is called Cetuximab ®, which is structurally very similar to the newly developed canine anti-EGFR monoclonal antibody. Cetuximab ® is used to treat people with metastatic colorectal cancer, metastatic non-small cell lung cancer, and different forms of head and neck cancers.
 
Currently, veterinary patients with epithelial cancers (including those mentioned above treated with Cetuximab ®) have little treatment options beyond aggressive surgery and radiation therapy. Conventional injectable and/or oral chemotherapy protocols, though recommended, often lack evidence-based results to suggest that their use substantially changes outcomes in pets.  
 
Researchers showed the newly developed antibody was able to bind to the surface of canine cells overexpressing EGFR and that application of the antibody caused significant inhibition of canine tumor cell growth/proliferation. Moreover, the antibody was able to cause significant tumor cell killing via direct stimulation of other immune cells in Petri dishes.   
 
The next step will be establishing the safety and efficacy of the drug “in vivo,” meaning testing whether the results seen in the cells in the laboratory are translatable to live animals. This will usually entail safety trials, followed by efficacy trials, then potentially even larger-scale clinical trials. Each step requires a great deal of time and finances and compliance, which typically translates into a long lag on knowing any further information while the results of such studies are analyzed.
 
It’s interesting to note that while human oncologists have used monoclonal antibodies to treat many different cancers for over 20 years, this form of treatment is in it’s relative infancy for veterinary oncologists.
 
This likely stems from 1) the astronomical costs associated with the development of such drugs, and 2) the major limitations to the current manufacturing and purification processes necessary to mass-produce the antibodies. It’s not unusual for the costs associated with monoclonal antibody therapy to approach over $50,000 U.S.. dollars per year for individuals with cancers. In the veterinary world, this is simply not a realistic option.
 
This latter point is one of my main concerns for when/if monoclonal antibody therapy becomes a potential option for veterinary patients. Whether discussing the previously described treatment for lymphoma or the potential new option for epithelial cancers, we have to consider what measures can be taken to ensure the treatments won’t become cost-prohibitive for owners. How can we ensure all of our patients have access to the drugs? Will this even be possible, given what we know from our human oncology counterparts?
 
It’s also important to keep in mind that in people, drugs such as Cetuximab ® are usually used in conjunction with other forms of chemotherapy, rather than as a single-agent treatment. Therefore, monoclonal antibodies are unlikely to be a “magic bullet” for our patients. Veterinary oncologists will still recommend aggressive surgery, radiation therapy, and even injectable and/or oral chemotherapy, in combination with an immunotherapy option. Again, issues related to cost, owner concerns for their pet's safety and quality of life, and other emotional factors will certainly come into play.
 
The take home message is that progress is certainly being made in our field and exciting new options are likely to be available within the next few years. It can be frustrating to recognize how my profession lags behind the advancements afforded to my human physician counterparts, but as Frederick Douglass said, “If there is no struggle, there is no progress.”
 
When we consider that veterinary oncology is truly still in the infancy of existence, learning about these new options suggests to me that overall, we are doing a pretty good job of progressing despite our struggles — with patients who tend to be much more tolerant of our shortcomings, and a whole lot cuter as a whole.
 

Dr. Joanne Intile
 
Image: Thinkstock
 
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When Pets Complete Chemotherapy Are They Cancer-Free? http://www.petmd.com/blogs/thedailyvet/patrick-mahaney/2014/july/when-pets-complete-chemotherapy-are-they-cancer-free-318  
On June 25, 2014 Cardiff finished his course of University of Wisconsin-Madison Canine Lymphoma Protocol (CHOP) chemotherapy and had a repeat abdominal ultrasound, revealing no evidence of new masses nor any other concerning abnormalities inside his abdomen.
 
So, the milestone has been reached and it’s time to go back to our lives as normal ... so we hope.
 
Is Cardiff Cancer-Free?
 
Cardiff was technically in cancer remission after his exploratory abdominal surgery to remove the mass on his loop of small intestine in December 2013. Post-surgery, and on an ongoing basis, no further cancer cells could be detected as tissue samples collected from an abdominal lymph node, spleen, and liver all tested negative.
 
According to the National Cancer Institute (NCI), cancer remission means “a decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although cancer still may be in the body.”
 
Although I could consider Cardiff’s cancer to be in remission, I still had to take additional steps to ensure a healthy and long life for him.
 
If Cardiff Was Considered in Cancer Remission Why Did He Get Chemotherapy?
 
The biopsy of surgically-removed intestinal mass revealed that Cardiff had T-cell lymphoma, which is a more severe diagnosis with a poorer prognosis as compared to B-cell lymphoma.
 
The recommendation from Cardiff’s veterinary oncologist (Dr. Mary Davis at Veterinary Cancer Group) was to put him through the course of CHOP to kill tumor cells waiting to become new masses.
 
My holistically-minded brain had hesitations about putting Cardiff through chemotherapy. On a seemingly never-ending loop, I asked myself, “If we surgically removed the cancer and strongly feel it's gone, do we really need to put a series of toxic injections or oral medication into his body?” Although we couldn’t detect them, cancer cells may still lurk in Cardiff’s abdomen and chemotherapy would prevent new tumors from forming.
 
I felt convinced that chemotherapy was the right thing to do, but I imparted my Chinese medicine and holistic perspectives via nutraceuticals and herbs to Cardiff’s treatment to help him better tolerate chemotherapy protocol.
 
On non-chemo days and excluding a few days post-chemotherapy, Cardiff received twice daily doses of:
 

Rx Vitamins for Pets Nutrigest

Pre- and probiotics — Probiotics are beneficial bacteria and pre-biotics are the materials on which probiotics grow. 
Digestive tract and immune system supporting ingredients — L-glutamine, Cat’s Claw, ginger, Oregon grape root, garlic, psyllium seed, aloe extract, etc.



Rx Vitamins for Pets

Glucamune — yeast-derived whole β-glucan particles [WGP], or
Immuno Support — plant-derived Arabinogalactans, Shiitake Mushroom Extract [LEM], and Lutein [bioactive carotenoid])



TCVM Herbal Wei Qi Booster teapills — In Chinese medicine, Wei Qi is the energy that protects the body from invading pathogens, irritants, and other undesirable stimuli. Wei Qi Booster is blend of Chinese herbs having anti-cancer, blood-moving, and energy-supporting effects. A teapill is a small, circular, black, “BB” like format that helps mask the herbal aroma and increase palatability with a slightly-sweet coating.

 
As Cardiff exhibited partial anorexia in being pickier about food and generally not eating with great zeal, these products were hand fed in small pockets of Trader Joe’s yogurt cheese, which is lower in lactose than regular-milk cheese, easy to mold around a pill or capsule, and greatly deters any detectable product aroma.
 
When Cardiff was eating more normally, he also benefitted from the anti-inflammatory effects of fish oil in the form of Nordic Naturals Omega-3 Pet. Since he now has a regularly improved appetite post-chemo, Cardiff will soon start on an oral chondroprotectant to benefit the mildly arthritic joints present in his toes and other body parts (after all, he’s a senior a nine years of age).
 
What Are the Next Steps in Monitoring Cardiff for Reemergence of Cancer?
 
Now the hard part is now over and the waiting game begins. Currently, the plan is for Cardiff to have an abdominal ultrasound every two months. Additionally, I perform blood testing every 7 to 14 days just to see if there are any subtle changes that could indicate his cancer is reemerging (alterations in white blood cells, globulins, albumins, T4, etc.).
 
Make sure to check out my Pet-Lebrity News column on Pet360 in early August, as we are having a ninth birthday/chemotherapy completion/cancer fundraiser party. It's likely going to be a star-studded event, so stay tuned to see photos and hear about Cardiff's good time for a good cause.
 

Dr. Patrick Mahaney
 
Image: Cardiff is restrained by Veterinary Cancer Group technicians for his last dose of Vincristine (the one that caused the reaction reported in Unexpected Side Effects of Chemotherapy Treatment)
 
Related Articles:
Unexpected Side Effects of Chemotherapy Treatment
Feeding Your Dog During Chemotherapy Treatment
Can a Veterinarian Treat His Own Pet?
How a Vet Diagnoses and Treats Cancer in His Own Dog
A Veterinarian's Experience with Treating His Dog's Cancer
Top 5 Acupuncture Success Stories
 
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Don't Let Rabbit Fever Strike Your Pet http://www.petmd.com/blogs/thedailyvet/dr-coates/2014/july/tularemia-awareness-critical-prevention-and-treatment-31870  
Tularemia affects many different species of animals including people, dogs, and cats. Infections can develop in a couple of different ways:

handling a sick or dead animal that harbors the bacteria
eating the un- or under-cooked flesh of animals infected with the bacteria, which applies to canine, feline, and human hunters
through the bites of insects, most commonly ticks or deer flies

 
It is also possible to develop tularemia after eating or drinking contaminated food or water or by breathing in airborne bacteria, but these routes of transmission are less common than those mentioned above.
 
The Department of Health and Environment in Larimer County, Colorado, reports that the “typical signs of infection in humans are fever, chills, headache, muscle aches, chest pain, and coughing. If tularemia is caused by the bite of an infected insect or from bacteria entering a cut or scratch, it usually causes a skin ulcer and swollen glands. Eating or drinking food or water containing the bacteria may produce a throat infection, stomach pain, diarrhea and vomiting.”
 
Cats are more susceptible to tularemia than are dogs, with young animals being at higher risk than adults. Mildly infected animals may only suffer from a brief period of poor appetite, lethargy, and a low grade fever that resolves without treatment. More severely affected individuals can suffer from dehydration, draining abscesses, jaundice, ulcers in and around the mouth, eye infections, swollen lymph nodes, enlarged liver and/or spleen, and high fevers.
 
A definitive diagnosis of tularemia is based on a combination of the potential for exposure, the presence of typical clinical signs and changes in basic lab work (e.g., evidence of infection, low platelet counts, and liver involvement), and a specific test for exposure to the bacteria. Treatment with certain types of antibiotics is usually quite effective, as long as it is started in a timely manner. Dogs and cats who are suspected or known to have tularemia need to be isolated, and the people who are treating them should wear gowns, masks, and gloves and take other biosecurity measures to protect themselves and others. Cases of tularemia need to be reported to the appropriate regulatory agencies.
 
The Larimer County Department of Health and Environment makes the following recommendations for the prevention of tularemia in people and pets:

Avoid handling dead [or sick] animals;
Leash your pets when outdoors and keep them away from dead [or sick] animals.
If a dead animal must be moved, avoid direct contact with it. Put on a repellent to protect yourself from its fleas or ticks, and use a shovel to scoop it up. Place it in a plastic bag and dispose in an outdoor trash receptacle. Wash your hands well afterwards.
When outdoors near places where rabbits or rodents are present, wear an insect repellent containing DEET.
Keep pets confined and away from dead [or sick] animals.
Routinely use a tick and flea preventative on pets. Read the label and consult your veterinarian if you are unsure what to use.

 


Dr. Jennifer Coates
 
Image: Nigel Dowsett / Shutterstock
Related articles you might want to read:
Bacterial Infection (Tularemia) in Dogs
Bacterial Infection (Tularemia) in Cats
 
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Is There a Way to Stop Cats From Clawing Furniture? http://www.petmd.com/blogs/thedailyvet/lorieahuston/2014/july/there-way-stop-cats-clawing-furniture-31868  
Cat owners do need to realize that, even though the behavior may be irritating to us, it’s a perfectly normal behavior from the cat’s perspective. Cats claw for many different reasons. They mark their territory that way, using both visual and chemical messages. They also scratch to sharpen their claws, helping to keep those claws in tip-top condition. Clawing is used a means of stretching muscles to keep them healthy and supple as well.
 
Scratching is a basic need for all cats. Your cat is not clawing your furniture out of spite or vindictiveness. He (or she, as the case may be) is clawing because he’s a cat. Fortunately, there are some things that you can do to discourage your cat from using your furniture as a scratching post. Here are some tips.
 

Provide an appropriate scratching surface for your cat. Scratching posts are fine. Cat trees work well also. Some people even wrap table legs in sisal or other fabric for their cat’s use.

There should be both vertical and horizontal scratching surfaces. Some cats prefer one over the other; other cats will use both.

The scratching post or cat tree should be sturdy enough that it won’t tip over while your cat is using it. In some cases, it may be necessary to secure the post to a solid surface, like the wall.

Encourage your cat to use the scratching area by making it as attractive as possible. Tempt your cat by using a favorite toy on or near the scratching surface. If your cat responds to catnip, rub some on the surface. Or place some favorite food or cat treats on or near the scratching area. Do not try to “teach” your cat to use the surface by placing his feet on it though.

If your cat has already chosen a scratching location that is unacceptable to you, make that area as unattractive as you can. Placing a plastic runner over the surface usually deters a cat from scratching a given surface. At the same time, place an acceptable scratching surface (e.g., a scratching post or cat tree) near the location and make this surface as attractive as you are able.

 
Once your cat is regularly using the alternative scratching surface, you can slowly move it (a short distance at a time) to a more acceptable location, if desired. You can also remove the runner or whatever deterrent was used to make the original area unattractive to your cat.
 
Households with more than one cat will require a separate scratching area for each cat. Scratching surfaces are an essential basic need for the feline and your cat may not want to share.
 
There may be additional help in the future in the form of a pheromone product that simulates the pheromone released from glands in your cat’s feet (called the plantar pad glands) during the clawing process. These pheromones are used as a chemical marker and serve as a means for your cat to tell the world that your home is his territory. A recent study funded by a grant from the Winn Feline Foundation looked at a synthetic version of this pheromone (named the feline interdigital semiochemical, or FIS) and found that “the presence of FIS can influence and prime the location for this important feline behavior (scratching). It also gives specific, long lasting information to other cats. Using the semiochemical approach can modify the choice of areas selected spontaneously by cats. In the future, it could be used as a preventative measure for a cat arriving at a new home or control or change inappropriate scratching behavior.”
 

Dr. Lorie Huston
 
Image: ktynzq / Shutterstock
 
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The Amazing and Wondrous Fistulated Cow http://www.petmd.com/blogs/thedailyvet/aobriendvm/2014/july/amazing-and-wondrous-fistulated-cow-31867  
Puns and hyperbole aside, I’d like to tell you about yet another cool cow aspect: Some fellow bovines can have a hole permanently installed from the outside into their rumen. This hole is called a fistula. Usually kept at a veterinary school, large veterinary clinic, or dairy, a fistulated cow is an extra-special cow because she is used to donate her rumen microbes to other sick cows. Here’s how it all works.
 
A cow’s overall health is very much dictated by how healthy her rumen gut bugs, called “microflora,” are. When a cow is sick, her microflora can die, wreaking havoc on her digestive system. Sometime it’s a challenge to re-grow those gastrointestinal bugs. This is where a fistulated cow comes in handy.
 
Surgically speaking, installing a fistula into a cow’s rumen is a relatively simple process. A hole is cut through the right side of the cow’s flank and into the rumen (the rumen is always on the cow’s right side). A rubber ring is inserted and permanently installed. This procedure does not take very long and is performed with the cow standing. The cow’s flank is numbed with local anesthetic and once installed, the fistula causes no pain. And of course it has a cap, to prevent leakage.
 
Then comes the fun part. When a sick cow comes in and needs some healthy rumen microbes, someone lucky gets to put on a shoulder-length glove, undo the lid of the fistula, and sink his or her arm right inside the 50 gallon rumen of the healthy fistulated cow. It’s a crazy experience; it’s very warm and moist, as you might expect, but you also can appreciate the contractions and rumblings of the stomach in action!
 
After you’re done being the rumen tourist, you grab a few large handfuls of ingesta, which is usually liquefied hay and grass. You pull this out, put it in a clean bag that has been sitting in warm water, and then rush over to the sick cow with the goodies.
 
You administer the good microbes to the sick cow via orogastric tube — sort of like force-feeding — and then give her a few days to see if her appetite has improved. Monitoring her manure also helps indicate how her gastrointestinal tract is improving.
 
You may wonder whether there are diseases that can be transmitted from fistulated cow to sick cow. Usually, no. Fistulated cows themselves are pretty healthy and kept out of trouble — they are not bred or milked or stressed, and don’t travel so as to become exposed to contagious diseases. And as far as accidentally spreading “bad” gut microbes, it’s all in numbers — the vast majority of gut microbes in a healthy cow are good, keeping the bad ones in check.
 
Another cool thing about fistulated cows is that their ingesta can be used for other ruminant species, too. Goats and sheep in need of some microbial boosts for their guts can take a dose or two from a fistulated cow, and I’ve used cow ingesta to help sick alpacas, too.
 
I fondly remember the fistulated cow at vet school. Her name was Buttercup and all the senior vet students who rotated in on their large animal clinic rotation and assigned her daily care doted on her. She was spoiled — big time.
 
Needless to say, fistulated cows are worth their weight in gold. One fistulated cow in a geographical area often ends up helping out animals from different counties and sometimes even states! This raises the question: Does a fistulated cow ever run out of ingesta? I think you’d have to borrow pretty heavily to run into trouble in that regard. Besides, you can use your arm as a gauge — finding yourself digging deep? Just offer her more feed! Her rumen levels should be up by the next morning.
 

Dr. Anna O'Brien
 
Image: smereka / Shutterstock
 
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How to Prevent Your Pet from Starting a Fire http://www.petmd.com/blogs/thedailyvet/ken-tudor/2014/july/how-prevent-your-pet-starting-fire-31866  
Annually, pets are responsible for starting 1,000 house fires. To celebrate Pet Fire Safety Day, I would like to share information from the American Kennel Club and ADT Security Services that might save your pet’s life.
 
Prevention is a Priority
 

Extinguish open flames — Like moths drawn to light, pets tend to be curious about flames and will be attracted to candles, lanterns, stoves and open fires like the fireplace or BBQ. To avoid problems make sure all sources of fire are completely extinguished and do not pose a threat.

Remove or protect stove knobs — Pets accidentally turning on stove knobs is the leading reason for pet started house fires, according to the National Fire Protection Association. Remove or protect stove knobs from activation while you are away.

Flameless candles — Although not as aromatic as regular candles, the light bulbs in flameless candles are unlikely to start a fire if knocked over by your pet.

Water bowls on wooden decks — Like starting a fire with a magnifying glass, the reflection of light through glass bowls can generate enough heat to ignite a wooden deck. Stainless steel or ceramic water dishes cannot focus light in the same way .

Inspect and pet proof — Be alert to loose electrical wires, appliances, and other hazards within your pet’s reach.

 
Safety in Case of Fire
 

Confine young pets — Puppies are notoriously curious and capable of finding trouble. Confining them to crates or pens while you are away will help reduce the risk of them causing a fire. The confined area should be near an entrance for easy access in case of fire.

Keep pets near entrances — Firefighters can easily find and rescue pets that are near entrances. To ensure quick, safe transport, collars, leashes, and carriers should be near these same entrances. Have emergency kits with your pet’s medical information and a supply of medications that they regularly need close together. Know your pet’s safe hiding places and restrict access to them in your absence so they can’t flee there in fear and make it difficult for firefighters to find them.

Monitored alert service — Battery operated smoke alarms will not only scare your pet but won’t alert anyone to a fire if you are not there. Monitored smoke detectors alert a monitoring system that can then alert both you and the nearest fire station.

Pet Alert window clings — These static clings alert firefighters that pets are inside. Indicating the number of pets on these clings can help save critical time for firefighters. Free window clings are available online from the ASPCA or can be purchased at pet supply stores. They should be placed so they are readily seen by firefighters.

Plan an escape route — Plan a safe escape route and have leashes and carriers easily accessible. Practice fire drills so your pet is familiar with the routine in case of fire. Pet friendly work places should also have a designated escape plan for workers and their pets. They also should perform routine fire drills so the plan is familiar to both workers and pets.

Outdoor pets — Housing and pens for outside animals should be located clear of brush, bushes, or other vegetation that could act as fuel for a fire. Outdoor pets should wear or have implanted identification in case they flee your yard or property during a fire.

 

Dr. Ken Tudor
 
Image: yevgeniy11 / Shutterstock
 
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Heartbreak of Losing a Pet Can Be Cushioned With Planning http://www.petmd.com/blogs/thedailyvet/drjintile/2014/july/heartbreak-losing-pet-can-be-cushioned-planning-31864  
Yes, this is a heavy way to start an article. But reality tempers the excitement of picking out a new puppy or kitten, or adopting an older dog or cat, with the knowledge that the animal’s expected lifespan will, in all likelihood, be far shorter than your own. A major consideration for pet ownership is what can be done to ensure that a good quality of life is provided during all stages of its existence.
 
The loss of a pet can be unbearable for owners whose attachment far supersedes what would be considered a “typical” healthy human-animal bond. Those cases require professional help when it comes to the complications surrounding euthanasia and death. Fortunately, there are health care providers specifically trained in dealing with supporting exceptional cases of grief related to pet loss.
 
What I encounter far more frequently are owners who, despite a rational understanding that their pets are not immortal, become overcome with fear and anxiety once faced with the diagnosis of a terminal disease.
 
Even though owners may be able to comprehend that their pet has a fatal disease, the tension surrounding the details of the actual “process” off loss can be overwhelming. A more frightening concept for most people is the actual act of euthanasia itself. The word “Euthanasia” literally translates to “The good death.” It is simultaneously the most humbling and powerful aspect of my job.
 
The perception of what transpires during euthanasia of a pet can be clouded by experiences with the deaths of relatives or friends, or even from sensational images put forth by the media. I cringe each time a television show depicts death as some remarkably dramatic flat lining of an EKG or theatrical intake of a last breath. In reality, the passing is marked with much less spectacle.
 
As difficult as it is to discuss the subject, I thought it would be helpful to provide factual information for pet owners to think about prior to the difficult choice of euthanasia and allow some opportunity for learning and discussion about an otherwise unmentionable topic.
 
The first step for most owners is deciding where to have the euthanasia take place. For some, the decision may unfortunately need to be made on a more urgent basis, but for many other situations we are able to somewhat plan the process.
 
Most euthanasia occurs in a veterinary hospital, however some veterinarians will travel to an owner’s home in order to provide an additional layer of comfort during this difficult time. This can be a very helpful service for very sick or frail animals, or for owners who are incapable of transporting their pets to the vet and would otherwise be limited in their abilities.
 
Owners must then decide whether they will be present or not during the euthanasia. This is often a difficult choice for many pet owners and I urge owners to think about this particular aspect of “the plan” ahead of time. From personal experience, I know that the answer to this question can be different for each individual pet and is dependent on many different unique emotional aspects. Take this time to consider the right choice not only for yourself, but also for your pet.
 
Although the specifics of euthanasia can vary with facility and from doctor preference, in most cases a small intravenous catheter is placed into a vein located on the lower part of one of the limbs. The catheter will be taped in place temporarily. This is to facilitate the administration of the euthanasia solution, a drug called sodium pentobarbital.
 
This drug is a barbiturate medication that at “routine” doses can be used as an anesthetic/sedative, but at the high doses used for euthanasia will be fatal. The drug will cause unconsciousness within the first 5-10 seconds of administration. During this time period, there is also a drop in blood pressure, along with cessation of breathing, and cardiac arrest. This occurs within 10-30 seconds of administration. There is a surprisingly brief amount of time from the initiation of injection to the passing of the patient.
 
Many times we also administer a sedative prior to injecting the actual euthanasia solution. This is to make sure the pets are calm and quiet and able to relax in their owners' arms or near them on the floor in a comfortable and kind environment.
 
Once the euthanasia solution is injected, I will take my stethoscope and listen for a heartbeat. Once I’ve confirmed the heartbeat has stopped I will let my owners know their pet has passed.
 
Some owners will elect to take their pets home for burial. Most owners elect for private cremation of their pet, with their ashes being returned to them.
 
Veterinary hospitals typically have a contract with a local pet cemetery that provides this service. The cemetery may also offer special options for owners including viewings, witnessing the cremation, and burials with plots similar to those available for humans. Owners are encouraged to contact their veterinarians for further details, or even to search on their own for a cemetery better suited to their personal needs.
 
In most situations, owners will need to return to the veterinary hospital to pick up their pet’s ashes once they return. This can often be a very difficult thing for owners to face as they are returning to the place they will associate with the loss of their beloved companion. If needed, ask a friend or family member to either accompany you or act in your place at this time.
 
Educating yourself on what to expect at the end of life might just be the first step in coming to terms with a terminal diagnosis for your pet. Doing so doesn’t make you heartless or uncaring. On the contrary, I find it represents a commitment to one of the major responsibilities of pet ownership.
 
The process is certainly emotionally taxing and painful, but with a small amount of exploration in advance, can also be demystified, allowing for a calm and peaceful closure for owners dedicated to their pets' care.
 
It’s the final gift we can give to our companions, who never ask for anything in return.
 

Dr. Joanne Intile
 
Image: Marco Saracco / Shutterstock
 
 
Related posts you might also be interested in:
The Decision to Euthanize a Pet: A Vet's Perspective
Euthanasia... What To Expect
In-Home Euthanasia
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Don't Overlook Rats as Pets http://www.petmd.com/blogs/thedailyvet/dr-coates/2014/july/dont-overlook-rats-pets-31863  
The hamsters and gerbils were always up for biting, the guinea pigs sat there looking cute but didn’t do much else, and the rabbits seemed hell bent on finding new and improved ways of committing suicide. I tried to be fairly honest about the strengths and weakness of all these “small fuzzies” as pets, which probably accounts for the fact that I was one of the worst salespeople on the staff.
 
We had some albino rats in the store too, but they were sold as feeder rats to reptile owners. I’m sad to say I didn’t give them much thought… until our supplier sent us some “fancy” rats by accident. Fancy rats and albino “lab” rats are the same species, Rattus norvegicus, but the fancy varieties have been bred for looks. The group we got into the store were lovely — soft brown eyes with fawn and cream coloring. I couldn’t help but spend a little time getting to know them. What charmers! They were very social with each other and people. They never nipped once and always seemed happy when I stopped by for a visit. Surreptitiously, I sold them all as pets by sidling up to customers who were looking at the other small fuzzies, whispering, “Psst, have you considered a rat?”
 
Well, what goes around comes around. My daughter and her best friend recently waged a concerted campaign to become guinea pig owners. After her friend’s mom caved under the pressure, it became increasingly hard to come up with good reasons why my daughter couldn’t have one also. And then came salvation — a coworker needed to find a home for her pet rats (her husband had developed allergies). After a brief discussion during which I waxed poetic over the virtues of rats and brought up the movie Ratatouille multiple times, I had her convinced that adopting these rats was the only sensible thing to do… so now we’ve added two female rats to our zoo.
 
Oreo is black and white and a real go-getter. She’s always on the move and loves to explore. Cinnamon is tan and cream colored and more of a snuggler. Together they have already provided us with hours of entertainment. We even went so far as setting up their very own swimming pool to see if they like the water (Cinnamon does, Oreo doesn’t). The only “person” they’ve bitten so far is our dog Apollo, who insists on sticking his enormously long tongue into their cage, so who can really blame them.
 
Once again I’m in a position to promote rats as pets. In addition to their friendly nature, they are a great size — small enough to be housed comfortably in cages but large enough that they aren’t overly fragile. They also tend to live longer than hamsters and gerbils but not so long as guinea pigs or rabbits, which is a good compromise if you aren’t ready for a decade long commitment to a new pet but want a decent amount of time with your neat new fuzzy friend.


Dr. Jennifer Coates
 
Image: Anna Hoychuk / Shutterstock
 
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Cleft Palate in Dogs Awareness http://www.petmd.com/blogs/thedailyvet/patrick-mahaney/2014/july/cleft-palate-dogs-awareness-31862  
According to the JOSH Facebook page: “The breeder took Josh into the shelter to be put to sleep at 48 hours because of a cleft palate. Rescued by LNPB and Hand raised by Me … Tina Marie Lythgoe.”
 
Since then, Josh has overcome adversity and matured into an adolescent pooch having a unique lifestyle. In the petition to have Josh appear on the cover of Modern Dog magazine, we learn some interesting facts about this cute pup.
 
Age: 5 months
Nicknames: wolfie! bad boy! wild child!
Likes: cats,birds
Dislikes: He likes everything!
Favorite Foods: His puppy food
Favorite Pastimes: Playing at our grooming shop
 
You can cast your vote for Josh through July 2nd by clicking this link: Meet: Josh
 
What I love seeing is the outpouring of photos and kind words on JOSH’s Facebook page from other owners who have dogs that are affected by cleft palate, including Giget, a Chihuahua, and Treble, who also looks like a Chihuahua (or mix). There are also well wishes from pet lovers worldwide who are interested in seeing Josh continue to thrive.
 
Additionally, Josh also has some unusual furry friends in his household. His Facebook page shares photos of a visiting opossum, with the caption, “Opogogio my brother ... He lost his mom when he was a baby ... He snuggles like a cat and he plays with toys like a dog ❤️JOSH”
 
What I find very interesting about Josh is that he’s has been able to thrive to the age of five months despite his medical condition. Having a cleft palate leaves an affected puppy, kitten, or other species especially prone to a variety of health concerns, including:

Nasal discharge
Cough
Difficulty nursing
Weight loss — resulting from inability to consume enough calories
Failure to thrive — due to insufficient hydration and calorie consumption or susceptibility to health problems
Aspiration pneumonia — inflammation and malfunction of the lungs caused by inhalation of liquid and food into the respiratory tract (trachea) instead of going down the  esophagus
Breathing problems — associated with aspiration and pneumonia
Inappetence (anorexia) — decreased appetite, which can be related to diseases occurring as a result of the cleft palate, like pneumonia or others
Other

 
The exact reason why a puppy or kitten is born with a cleft palate is typically unknown, but the condition has been correlated with exposure of the embryo to chemicals capable of causing harmful developmental changes (teratogens) including:

Griseofulvicin (Fulvicin) — An anti-fungal medication that is used to treat Dermatophytosis (ringworm)
Vitamins A and D — Vitamin D supplementation during pregnancy. Safety considerations in the design and interpretation of clinical trials indicates that “some animal studies have suggested the potential for dose-dependent fetal toxicities (for example, growth impairment, skeletal malformations and cardiovascular anomalies) associated with excess Vitamin D supplementation. While The American Journal of Clinical Nutrition reports “craniofacial … malformations” (those affecting the head and face) occurring in animals exposed to high Vitamin A intake during embryonic development

 
There are some breeds in which cleft palate is more common, including “beagles, Cocker Spaniels, dachshunds, German shepherds, Labrador retrievers, schnauzers, Shetland sheepdogs, and brachycephalic (short-nosed) breeds.” Although the West Highland White Terrier (Westie) isn’t listed here, Josh is a Westie mix and could always have one of these other breeds or a completely different breed or mixed breed in his genetic makeup.
 
Josh’s cleft palate may be able to be repaired via surgery. The typical recommendation is to wait at until at least three to four months of age, and multiple surgeries may be needed. Performing surgery to fix the cleft palate is neither simple or inexpensive and often requires the skills of a board certified veterinary surgeon.
 
I hope that Josh continues to thrive in life despite his conformational abnormality. Additionally, I’m voting for him to appear on the cover of Modern Dog magazine to help educate the world about cleft palates and to serve as an inspiration to others who have pets facing similar issues.
 

Dr. Patrick Mahaney
 
Image: From Josh's Facebook page
 
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The Parasites That Plague Our Cats http://www.petmd.com/blogs/thedailyvet/lorieahuston/2014/july/fleas-ticks-heartworms-and-your-cat-31861  
Cats and Fleas
 
Fleas are one of the most common parasites we find on cats. Here’s what you need to know about them.
 

Fleas survive on a blood diet. Because these parasites ingest your cat’s blood, anemia is a potential complication.
Some cats develop an allergy to the bite of the flea. Flea allergy dermatitis (FAD) is one of the most common allergies diagnosed in cats. Because the allergy is a reaction to a substance in the flea’s saliva, it takes only one flea bite to cause an allergic reaction. FAD results in itchiness, hair loss, skin sores, irritated skin, and discomfort for your cat.
Fleas can also carry diseases. Some of these diseases can be quite dangerous for your cat, but others are actually more dangerous for you and your family.
Fleas also carry parasites, such as tapeworms, that can be easily passed to any flea-infested cat.
Indoor cats are not safe from fleas. Fleas can find their way indoors quite easily. They often hitchhike on people coming into your home or on other pets that do go outdoors.
Fleas can survive and can resurface during the winter under the right circumstances, even in cold climates.
Once your cat is infested with fleas, getting rid of the infestation is difficult. Fleas live only a portion of their life on your pet. Their eggs and larvae develop in your pet’s environment, which in most cases is your home. Once an infestation is established, the environment will need to be treated as well as the pet and it may take months to completely eradicate the infestation. Prevention is much easier and safer for your cat.
All pets in the household must receive adequate flea protection to effectively control fleas.

 
Cats and Ticks
 
Ticks are less frequently seen on cats but are still seen on a regular basis, particularly for those cats that spend time outdoors.
 

Ticks are most likely to attach to the area around the face, head, ears, and neck.
Ticks attach to your cat’s skin via their mouthparts and feed on your cat’s blood while attached. They do not, however, embed their bodies under your cat’s skin.
Ticks do not jump, fly, or run. They tend to be slow moving but will position themselves in grass and on vegetation where they can latch on to passing hosts. Once on the host, they will crawl to an area where they can feed.
While ticks tend to more of a problem for cats that spend time outdoors, it is not impossible for a tick to hitch-hike indoors on a person or another pet, only to find and feed on your cat. There is also one particular species of tick that can establish a stable population indoors and infest your home, posing a threat to people and pets alike.
Ticks can survive and can resurface during the winter under the right circumstances, even in cold climates.
Ticks can carry diseases that may be passed on to your cat. One of the most serious of these diseases is cytauxzoonsosis, a disease that is often fatal for an infected cat.
Using a product that repels and/or kills ticks is preferable, particularly if your cat is at risk.
Checking your cat for ticks on a regular basis, and removing any ticks found as soon as possible, is also a good idea.

 
Cats and Heartworms
 
At one point in time, we believed that only dogs could be infected with heartworms and that cats were immune. We now know that is far from true.
 

Your cat can become infected with heartworms through the bite of a mosquito.
Even indoor cats can become infected with heartworms.
While dogs infected with heartworms often harbor large numbers of heartworms, cat typically have only a few. This does not make the parasite less dangerous for your cat but does make diagnosis of heartworm disease more challenging.
In cats, heartworm disease tends to manifest as a respiratory disease. It often mimics feline asthma.
Sudden death is one of the recognized symptoms of feline heartworm disease. Death may occur so suddenly that there is no chance to do anything medically to stabilize or save the affected cat.
There is no safe or effective cure for cats infected with heartworms. The medication used to treat dogs for heartworms (Immiticide) is not safe for cats.
Cats with heartworm disease are usually treated symptomatically.
Heartworms can be prevented. There are numerous medications that are both safe and effective in protecting your cat from heartworms.

 
Heartworm preventive medication should be considered as part of a comprehensive preventive health care plan for all cats, as should flea and tick control. Your veterinarian is your best source of information regarding which parasite products are best suited to your cat.
 

Dr. Lorie Huston
 
Image: Stokkete / Shutterstock
 
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Pig Virus Continues to Threaten Pig Herds http://www.petmd.com/blogs/thedailyvet/aobriendvm/2014/july/porcine-epidemic-diarrhea-virus-update-31860  
The virus that causes PED is part of the swine enteric coronavirus diseases (SECD). While PEDv was first documented in the U.S. in April 2013, another virus of the same family, called porcine delta coronavirus (PDCov), has also popped up. Both viruses cause diarrhea and associated weight loss. Both can result in significant mortality, primarily in young pigs. 
 
Since its initial outbreak over a year ago, PEDv has killed roughly 10 percent of the pigs in the U.S. — that’s an estimated seven million pigs, according to a Reuters report in early June. What’s more, officials still don’t know where it came from. While there is speculation that its origin is from China, since all strains identified from the U.S. outbreaks are closely related to a strain from China, the where and why and how of its transcontinental travel remain a mystery, something unnerving to officials whose job it is to keep foreign animal diseases, well, foreign.
 
On June 5, 2014, the USDA issued a Federal Order. This Federal Order requires all producers, veterinarians, and diagnostic laboratories to report all new cases of PEDv and PDCoV. Secondly, this order requires hog operations to work with a veterinarian to develop a management plan to address the disease and prevent its spread in their herds. Both parts of this Federal Order are aimed at tracking the diseases and helping prevent their continual spread.
 
As a veterinarian — and large animal veterinarians are mostly affected by this — certain diseases (e.g., diseases the government is trying to eradicate, have already been eradicated, are foreign animal diseases, or dangerous zoonotic diseases) are reportable, which means that if you see it in a patient, you call your state veterinarian and report it. This means you’re suddenly playing with the big boys. This means that now, PEDv has been elevated to Big Boy status. Sort of exciting.
 
On June 16, the USDA announced issuance of a conditional license for a vaccine that may aid in the control of PED, making it the first of its kind. You may have noticed two things in that last sentence: the word “conditional” and the word “may.” Conditional licenses are issued sometimes when a disease threat is heavy and the need is severe. Such a vaccine has been proved to be safe, but how well it works (called its efficacy) has yet to be completely determined.
 
There’s a possibility that a conditional vaccine may not actually work well at all and after this is proven from actual use data, it will be removed from the market. This happened fairly recently with the conditional approval of a vaccine in horses against a protozoa that causes spinal damage (a disease called equine protozoa myelitis). This was extremely disappointing in the equine veterinary world because there is a great need for such a vaccine in the U.S. Think of a conditional license as a way to get something safe on the market fast when there is a need, using real world data to gather the rest of the efficacy data. This is why the USDA’s statement on June 16 says “may aid in the control.” They don’t know yet. But they have to try something.
 
One thing to keep in mind is that PEDv is not transmissible to humans or other animals and can’t be transmitted through eating meat from an infected animal. So we humans remain safe, at least in terms of PEDv. Watch this epidemic closely if you have an interest in the pork industry or epidemiology, as things are continuing to develop on an almost daily basis. 
 

Dr. Anna O'Brien
 
Image: Dmitry Kalinovsky / Shutterstock
 
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Preventing Obesity in Cats: A Feeding Strategy http://www.petmd.com/blogs/thedailyvet/ken-tudor/2014/june/preventing-obesity-cats-feeding-strategy-31745  
Inter-cat dynamics and differences in eating and meal preferences complicate a one-size-fits-all weight loss solution. Prevention of obesity is important for both cats and dogs, but is paramount with cats. Following is a feeding strategy to maintain optimum weight in our feline friends.
 
Feed the TOTAL household calorie count. This strategy requires that the daily calorie requirement of each cat is calculated and a total for the entire household is determined. For the average 9-10 pound (ideal weight) cat, that is about 250-300 calories per day. For larger framed cats the requirements are different. Your vet can help. For those with science calculators the formula is:
 
[100 x (Ideal body weight in lbs./2.2)0.67] = Daily Calorie Requirement
 
Once the total household calorie requirement is determined, the calorie density of the food is the next math step. Cat food makers are not required to disclose the calorie content of their food on the label. If it is not available, you may have to consult the company website. Once that information is found the total amount of food is calculated to meet the calorie needs of the total household. Are you frustrated yet?
 
Example: All dry, kibble, free feeding a 3 average-cat household. The food contains 375 calories per cup. The household needs 750-900 calories per day. Let’s split the difference and assume 825 calories per day. The total amount of food for the household is:
 
825 calories divided by 375 calories per cup = 2.2 or about 2 and 1/3 cups of food per day
 
The rule of thumb is to have 1-2 more feeding stations than the number of cats, widely separated throughout the house or apartment. Ideally the stations should be placed in out of the way areas that require effort to access. By dividing our 2.33 cups of food we need five feeding stations with just under ½ cup of food. No other food is offered and the body condition score of each cat is monitored to ensure that all cats are competing successfully for adequate calories.
 
If a combination of canned and dry food is preferred, the wet calories are subtracted from the household total and the amount of dry food is re-calculated for the feeding stations. Those preferring scheduled feeding of canned only, or canned plus dry, need to calculate the needs of each cat per meal. Recent research suggests that multiple scheduled or random multiple meals increase a cat's activity level and leads to more calorie expenditure and overweight prevention.
 
The same researchers also documented higher activity levels when cats were offered dry kibble with the addition of water. However, the longer moistened food is left available for free feeding, the less likely it is to be consumed. Damn finicky cats.  
 
Some cat owners will also find that extremely dominant or submissive cats make this strategy very difficult to ensure all cats are getting their nutritional needs. Separate, isolated feeding alternatives for the dominant or submissive eater are necessary in these types of environments.
 

Dr. Ken Tudor
 
Image: Tom Thai / Flickr
 
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Top Five Tips for Treating Ear Infections in Dogs and Cats http://www.petmd.com/blogs/thedailyvet/dr-coates/2014/june/top-five-tips-treating-ear-infections-dogs-and-cats-31848  
Owners often want a quick (and inexpensive) fix, and doctors can be unwilling to put in the time necessary to thoroughly explain the complexities behind many ear infections. To help remedy this situation, here are a few tips for treating ear infections in dogs and cats.
 
1. Ear infections typically develop as a result of another problem.
 
In most cases, a pet’s ear infection should be viewed as a symptom of another, underlying condition. Allergies to ingredients in the pet’s food and/or environmental triggers like pollen, molds, and dust mites are most common, but anatomical abnormalities, masses, or foreign material within the ear, chronically damp ears, and hormonal disorders are also possible.
 
2. Ear mites are rarely to blame, except in kittens.
 
Almost every case of ear mites that I’ve diagnosed has been in a kitten. Puppies can also get ear mites, but if you have an adult dog or cat that has not been in contact with kittens or puppies with ear mites, the chances that he or she has mites is very small. Bacterial and/or yeast infections are much more likely.
 
3. Clean the ears properly.
 
Getting the “gunk” out of a pet’s ears is an essential part of treatment. In severe cases, a veterinarian may need to sedate the dog or cat to thoroughly flush out the ears down to the level of the ear drum. Examining the ear drum after cleaning is important because infections that involve structures behind the ear drum require more aggressive treatment and certain topical medications can cause deafness when used on pets with ruptured ear drums.
 
At home, owners should completely fill the ear canal until it overflows with the cleaner prescribed by a veterinarian, fold the pinna (ear flap) over the canal, gently massage until a “squishy” noise is heard, and then stand back and let the dog or cat shake his or her head vigorously. The centrifugal forces generated by head shaking will bring deeper material to the surface where it can be wiped away. Do not dig down into the pet’s ear canal with cotton swabs or other objects as this will simply push the material deeper and possibly lead to a rupture of the ear drum.
 
4. The longer an ear infection goes without treatment, the harder it is to get rid of.
 
Chronic ear infections can lead to permanent alterations in the anatomy of a dog or cat’s ears, making future infections more likely and more difficult to treat. Consult with a veterinarian quickly when a pet develops the typical signs of an ear infection: head shaking, scratching at the ears, and/or discharge and a foul odor from the ears.
 
5. Ear infections will keep coming back unless the underlying problem is dealt with.
 
Healthy adult pets with “normal” ear anatomy almost never get ear infections. It is reasonable to treat the first infection that a dog or cat gets as a random event, but if the infection returns or fails to promptly resolve with appropriate therapy, a search for the underlying cause should commence.
 

Dr. Jennifer Coates
 
Image: Ermolaev Alexander / Shutterstock
 
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Lack of Specialized Information Can Lead to Pet's Early Death http://www.petmd.com/blogs/thedailyvet/drjintile/2014/june/lack-specialized-information-can-lead-pets-early-death-31847  
This was the third conference I’ve attended this year. Each time, I’ve returned feeling renewed and invigorated about being an oncologist. I’ve felt more confident in my career path and my knowledge base. I’ve felt assured I’m doing the best job I can do, and that I have been adequately adhering to my responsibility to keep current in my field. Sadly, within just a few short days of arriving home from each occasion, I’ve found my enthusiasm become re-routed as I tackle events that completely question my faith in the public’s perception of veterinary specialty medicine.
 
I’d barely arrived home when my husband excitedly told me the wine store near where we lived was having it’s grand opening that afternoon. Though I am an avid lover of animals, I also really enjoy wine, so I was equally enthusiastic about the event.
 
Within a few minutes of our arrival at the store, we met two gentlemen who struck up a conversation with us about a baseball game we all were watching on the large flat-screen TV. My husband and I have an unwritten rule that we will not voluntarily bring up our profession in social situations unless asked directly, as inevitably the tides of conversation will change and then simply become monopolized by animal talk. So we happily discussed the game, the wine store, and things to do around the area with our newfound friends.
 
But, as is so often the case, it somehow came up in conversation that we were both vets, and immediately the topics shifted from discussing pitching stats and the merits of beer flavored with Old Bay to questions about our new friends' pets, breed specific illnesses, and then once they found out I was an oncologist, stories of their dogs who were previously diagnosed with various tumors and their outcomes.
 
I listened intently as one owner recounted the events surrounding the death of his older Golden retriever. He accurately recounted how his dog became acutely weak and inappetant one morning, with no premonitory signs of illness. His owner knew enough to know the behavior wasn’t normal, but figured his dog had contracted a stomach bug or ate something he shouldn’t have. He diligently brought him to his primary care veterinarian for evaluation that same day. That’s when the story took a disheartening turn for me.
 
Turns out his dog’s signs were not due to a simple virus, but rather a bleeding tumor along his spleen. Given the age, breed, and presentation of his pet, the most likely diagnosis was an aggressive tumor called hemangiosarcoma (see Cancer: Imagining the Worst, and the Best). However, other possibilities existed. The only way to know would be to perform an immediate life-saving surgery and remove the spleen and submit the tissue for biopsy.
 
The owner recalled the story with the following chain of events: 1) The primary care veterinarian diagnosed his dog with a bleeding tumor that had a > 90% chance of being a type of cancer; 2) The dog would live only three months with an immediate life saving surgery; 3) The life saving surgery needed to be done at a specialty veterinary hospital and would cost no less than $10,000; and 4) The dog had a less than 50% chance of surviving the surgery. He ultimately elected for humane euthanasia.
 
As he told the events of his pet’s death to me, I could feel myself struggling between a strong sense of sadness over the sudden loss of his beloved companion and a growing sense of frustration and anger towards the misconceptions he had about what may have been the outcome for his dog.
 
Yes, there is a strong likelihood of a diagnosis of splenic hemangiosarcoma, but I will stand by my conviction that so many dogs are euthanized prior to surgery that we actually do not know the true prevalence of benign vs. malignant splenic tumors.
 
Yes, if the diagnosis is splenic hemangiosarcoma, the prognosis is considered very guarded with surgery alone, but chemotherapy following surgery can be effective in prolonging survival.
 
Yes, the surgery is expensive, but the cost likely would range between about one-third to half the amount quoted by the primary veterinarian.
 
And yes, though the dog was quite ill at the time of diagnosis, the survival rate for splenectomy surgery is far higher than 50%.
 
At the time, I silently agreed with the owner as he told the story, as nothing I would say or do could change the events of what transpired with his dog. But I made a mental note that although I am only one small voice for my profession, I have the potential to be a proverbially powerful one. Therefore I put forth two main suggestions for our profession at this time:
 
1) I sincerely urge owners to seek referral to a specialist when offered, but also consider asking for a referral when they want to learn more about their pet's health.
 
2) Likewise, I urge primary care veterinarians to discuss cases with your local specialists to be sure, as frontline consultants, you are providing the most accurate information to owners.
 
In the triad of owner, primary care veterinarian, and specialists, don’t we owe to it to the one thing we all share in common? The voiceless companions dependent on our care would never ask for anything more than this.
 

Dr. Joanne Intile
 
Image: Thinkstock
 
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