The Human-Animal Research Connection

While many people are aware that human medical research is done on animals, they may not realize that there is quite a bit of research in human medicine that benefits animals as well.

In fact, many of the drugs we use in animals are human medications. There are some companies that work exclusively on developing drugs FOR animals but the truth is that money drives all of this. The cost to get ONE drug approved in a dog is expensive (don't even ask about humans!),  so many times, they won't bother to get it "approved" in cats, goats, ferrets, etc. We have to use it and discuss it amongst ourselves and come up with acceptable doses and timing intervals. It's true. A drug company rarely pays for the necessary testing to get a drug approved for a cat, let alone a goat or a ferret. 


We, as veterinarians, use a lot of medications "off-label" and we are fortunate that we are able to do so. You probably don't even know the number of times your animal has benefited from this! 

In addition there are many drugs we veterinarians have used with great success in animals, that have been pulled from the human market due to problems (which we do not see in our animal patients.)  We are left to our wonderful compounding pharmacies to continue to supply these drugs to us. The drug companies are not going to keep it around for mere kitties (for example) because they will not make much money on them!

A prime example is a drug called Propulsid or Cisapride, a drug WE have used in veterinary patients, namely cats, with much success for issues associated with megacolon (and thus a constipation issue). In people, it was used for heartburn and they were having so many cardiac issues, they pulled this drug, not concerned that CATS benefited from it with NO cardiac effects. This is ONLY ONE example of many...

It works both ways though and the sooner we can communicate better among all the groups involved, the better off we will all be.

As a recent article out of Tufts School of Veterinary Medicine on how veterinary medicine affects the human medical device industry reports:

"... a recent design for a total elbow replacement device for dogs, the TATE elbow (named after the dog of inventor-veterinarian Dr. Randy Acker), introduced a “cartridge” concept that is being applied to development of joint prostheses for humans. A modified hip prosthesis that was developed for dogs who suffer from hip disease is being introduced in Europe for humans."

There has been for some time an effort to share knowledge among health care providers and scientists of all disciplines and it's called the One Health Initiative.  How they aim to achieve their mission statement makes sense to me:

One Health (formerly called One Medicine) is dedicated to improving the lives of all species—human and animal—through the integration of human medicine, veterinary medicine and environmental science. 

One Health shall be achieved through:

• 1. Joint educational efforts between human medical, veterinary medical schools, and schools of public health and the environment;
• 2. Joint communication efforts in journals, at conferences, and via allied health networks;
• 3. Joint efforts in clinical care through the assessment, treatment and prevention of cross-species disease transmission;
• 4. Joint cross-species disease surveillance and control efforts in public health;
• 5. Joint efforts in better understanding of cross-species disease transmission through comparative medicine and environmental research;
• 6. Joint efforts in the development and evaluation of new diagnostic methods, medicines and vaccines for the prevention and control of diseases across species and;
• 7. Joint efforts to inform and educate political leaders and the public sector through accurate media publications

BBQ (and Pancreatitis) Season

Since this is the unofficial start of summer and for many, parties and BBQ's, I thought it was a good time to remind people the dangers of feeding "party" foods to your pet.

This generally applies to dogs, since cats have a much MORE discriminating palate, though there are a few oddball kitties out there.


First of all, let me say that just because Fido has eaten X in the past, does NOT mean, that this time around, X won't cause some serious gastrointestinal upset. I've seen it MANY times. Think of how maybe YOU could eat certain things in your younger days but now can't. Same thing applies.  And it could depend on quantity too.


Pancreatitis CAN happen for other reasons (infections, inflammatory processes we can't always identify, trauma, cancers, and a few other things). However, one of the BIGGEST and most preventable reasons for it is caused by people feeding all sorts of table foods to their dogs or THE dog getting into the trash (tempted by partially eaten food, food wrappers, etc).

The biggest culprits are the fatty and greasy foods (bacon, hot dogs, etc). I've also seen dogs get VERY sick from eating the BBQ drippings off the grill. 


What can happen can vary from something minor - like a little vomiting and/or diarrhea (gastroenteritis) - to something MUCH more serious - pancreatitis. If this does happen, do NOT wait - see your vet. YOU cannot tell which one it is. We can determine this based on the exam and some blood work (and possibly some other tests).  IF your dog is diagnosed with pancreatitis, they will be admitted to the hospital. This IS a serious condition and I have lost dogs to it. They can go downhill quickly too.


Fortunately, with IV fluids and some supportive care (antibiotics, antiemetics, and pain meds - pancreatic diseases = PAIN!!), most of them WILL get through it. It won't be inexpensive either, so consider that before you think "aww he's so cute and it's just a little piece of ...."


Another quick warning - corn on the cob: the cobs ARE very tempting to eat for some dogs (notably Labs and Beagles but any dog can get into trouble) so keep them out of reach - or you will be spending your summer vacation money on exploratory surgery and foreign body removal. 

Common Human Medications That Your Pet May Ingest

Almost weekly, a pet owner calls in with a concern because the dog or cat ingested "x" medication that belongs to the owner. Sometimes I know what potential problems there could be, but often not - especially because there are SO many drugs, so many NEW drugs and the dose for an animal (think about the size and physiological differences in cats versus dogs - chihuahuas to Great Danes!) versus the average human can obviously vary quite a bit! 


There are so many human medications, I am not even sure how   physicians keep up with them. Fortunately, we have a PDR (a Physicians Desk Reference) too and access to some great veterinary toxicologists through several hotlines.  


I just read an article I thought was worth sharing that details what a few top selling human meds are and how they affect your pet should he/she ingest them. Fortunately, in most cases, they are NOT a problem.  These drugs include: Lipitor, Nexium, Plavix, Advair Diskus and Abilify. Who knew?  The last two are apparently the BIG concerns.  Amazingly, Plavix has a wide margin of safety in pets, so generally no worries about them bleeding out on this one! 


Top Prescription Drugs and Your Pets

Breed of the Week: Golden Retrievers

Last week, I discussed another very popular family dog, the Labrador Retriever. Golden Retrievers share many of the same qualities and medical problems, with some key differences.

1.Like Labs, they are very energetic dogs, though I think Labs have them beat in this department even if it's a slight lead. Unlike Labs, they do NOT tend to eat nearly as many inappropriate things.


2. They also have a propensity for becoming obese (seems like it would be easier for me to tell you breeds that DO NOT!).


3. They also have issues with hip and elbow dysplasia, as well as congenital eye problems (all of which should be screened for prior to breeding).


4. They too have skin and ear issues. In Goldens we frequently see what are commonly referred to as "hot spots" - an area on the skin (generally by the ears, on the neck, or on the sides of the back leg up by the hip) of moist dermatitis. They can quickly get pretty nasty and smelly. These conditions are often precipitated by allergies. 


5. Unlike Labs, Goldens have a much higher incidence of cancer - particularly of the spleen. I've also seen a fairly high number of aggressive oral cancers in this breed, as well as lymphoma. 


6. They can inherit a congenital heart condition called subaortic stenosis that can be serious. Breeders have dogs screened for this with echocardiography.


7. Hypothyroidism (a low functioning thyroid gland) has been reported to occur in up to 25% of these dogs at SOME point in their lives. Breeders also screen dogs for this condition as well by running a very comprehensive thyroid profile. 


8. As with any large breed dog, they often develop arthritis later in life.


Most of these sweet dogs live anywhere from 10-12 years, but in my experience cancer is what knocks most of them down younger. Hopefully the continuing research into genetic and environmental factors will help us vastly reduce the incidence (and who knows, maybe even eliminate it!).

I Shouldn't Even HAVE To Say This!

I don't know why EVERY year, people have to be told this and EVERY year, pets still die unnecessary deaths because their owners left them in a car, on a warm (not necessarily swelteringly hot) day for a "few minutes."


The past few days it's been hot and humid. Generally, unless you are taking the pet somewhere (the vet, groomer, dog park), you should leave them at home. Make sure the air conditioner is running and they are getting adequate air flow.


Note: a pet with his head hanging out the window makes me cringe for several reasons: ear/eye irritation (and possible eye trauma) is UNAVOIDABLE and some will be tempted to jump out at a stop or parked position. I've seen that scenario a few times (with major trauma involved) when working at an emergency clinic.


AND when you take them someplace, make sure they are properly restrained. I have seen a dog that was the victim of a rollover accident because she was loose in the back seat. She was a Golden Retriever. They DO make crates or even harness/seat belt combos for dogs of ALL sizes. She had numerous pieces of window glass embedded in her face. It could've been much worse.

The AVMA has a great page on this including this table which shows the air temperature outside versus inside your vehicle. In just a few minutes the temperature can rise 19 degrees or more (even with a "cracked" window!). Don't do it!!! And if I see a dog in a car on a warm day, I WILL (and have) called the police. 

Estimated Vehicle Interior Air Temperature v. Elapsed Time

Elapsed time	Outside Air Temperature (F)
	70	75	80	85	90	95
0 minutes	70	75	80	85	90	95
10 minutes	89	94	99	104	109	114
20 minutes	99	104	109	114	119	124
30 minutes	104	109	114	119	124	129
40 minutes	108	113	118	123	128	133
50 minutes	111	116	121	126	131	136
60 minutes	113	118	123	128	133	138
> 1 hour	115	120	125	130	135	140

Courtesy Jan Null, CCM; Department of Geosciences, San Francisco State University

Paw Pad Injuries

Throughout the year, I'll see dogs with varying degrees of injuries to their digital or metacarpal/metatarsal pads:

The top 5 pads on each foot are the most commonly injured since the other ones don't touch the ground.

These injuries usually occur when the dog has been running on an abrasive surface, such as hot pavement or even ice.  They can be minor to severe. They can also occur with chemical or other burns and from being hit by a car and drug on pavement.


I recall one dog that had severely abraded pads on ALL four limbs and it was a Great Dane. The dog had been doing laps running around the owner's pool on concrete. This dog had torn off the top layer on each pad and was in a lot of pain. He didn't know which leg to put most of his weight on because none of them felt good. 

Obviously a SEVERE case!

Generally, even if there is flap of that top "black" layer hanging off, these do not hold sutures well. There is not adequate blood flow to promote healing so it's better just to debride any tissue we can and put the dog on pain meds, antibiotics and maybe get them bandaged or a bootie for the foot (depending on how we think the dog will tolerate one of these). It WILL heal but will take weeks to do so by granulating in from the inside out.  

Foster Kittens

It's really nice when someone takes in a kitten or litter of kittens  to foster until they are old enough to be adopted out.


Those that do, need to remember that this is not a problem or loss free scenario.  


Today we saw a sweet young lady who had taken in a kitten from a litter of 4. Three of these had ultimately died. The kitten she brought us was already in a weakened state. We call this "failure to thrive." 


Unfortunately, despite all efforts, it can happen.There can be issues with temperature and diet, potential infectious agents AND genetic/congenital issues.


So this dehydrated kitten was given subcutaneous fluids and antibiotics. The owner was shown how to do this at home as well. Sadly, this kitten did NOT make it.  


There was obviously more going on than we were aware of at the time. Sometimes DESPITE all that is done for them, they do NOT make it. It IS important to keep the environmental temperature up with these little guys and to feed frequent meals (every 3-4 hours) of kitten replacement formula. Once they are close to 5-6 weeks we can introduce softened kitten food to them. Still, it is always a gamble with these little ones..but you never know who will make it!

A Virus That May Have Jumped from Dogs to Humans

...centuries ago though..so don't worry! I found this news story today and thought it was interesting (science nerd that I am!).

Researchers Find Cousin of Hepatitis C Virus in Dogs

Might lead to better understanding and treatment of human version of the disease

MONDAY, May 23 (HealthDay News) -- Researchers report that they've discovered a virus similar to the human hepatitis C virus in dogs, a finding that might provide insight into how the germ evolved in people and perhaps lead to better treatments.

About 200 million people around the world are thought to suffer from hepatitis C, including an estimated 3.2 million chronically infected people in the United States. Many don't know they're infected with the liver-damaging virus that causes the disease, which means they can spread it to others without realizing it.

The new findings suggest that hepatitis C may have "jumped" from dogs to humans more than five centuries ago, the researchers said.

The rest of the article is here:

http://consumer.healthday.com/Article.asp?AID=653157

Unless You Are Pregnant, A Swollen Belly is NOT A Good Thing!

Lately it seems as all I've been seeing are complex and sad medical cases, some of which lead to euthanasia. Oh sure, there's an occasional cute puppy or kitten thrown in there. 


The only "plus" is that I've been rockin it big time on my diagnosing these cases AND have been told so by people I work for - and publicly in a staff meeting too! 


The irony is that I prefer surgery to medicine (it was the opposite when I FIRST got out of vet school because frankly, vet school doesn't do a great job of preparing you for surgery..normal, everyday surgeries!). 


Today was no exception to the pattern.  The one case that stood out was the 11 yr old Boston who came in because she was not eating and her "belly was looking bigger." This happened in the past week or so according to the owners.


Well, generally in a dog this age, it's either fluid or a mass.
NEITHER of those is a good thing because the underlying cause is generally not fixable and often even if its something we can treat with medicine or surgery, we are only able to buy a short amount of time.


On the exam, I also found a heart murmur that was never diagnosed, partially because the dog hadn't been seen in quite a while. Yes, I'm going to REPEAT myself about the importance of annual (more frequently in senior pets) physicals! Sometimes when we see stuff, it's progressed too far! 


So my suspicion was that this dog was in right sided heart failure - which was confirmed by x-rays and analysis of the fluid in the abdomen. The kidneys are also shutting down on this poor little girl. 


Honestly, it is TIME. The dog is not eating. The owners, however, aren't "there" yet. So we put her on some cardiac medications and hope that she improves enough to eat. The question is will they make the decision or not? I don't know. Some people just CANNOT do it. Or they wait too long and the animal ends up in a state of crisis at 3am. Neither is a good scenario.  Most of them do NOT just die in their sleep.

A Common Problem During Warmer Months

Some of the common things we hear when diagnosing flea allergy dermatitis or recommend monthly flea prevention:

-he can't have fleas, he never goes out

-I've never seen fleas on him

-I use a topical product, you know, from Wal Mart

-I used it for 1 or 2 months and they still have fleas 

-do I have to treat ALL the pets in the house?

5 facts about flea allergy dermatitis

Your pet can’t stop itching, but why? Here’s a look at flea allergy dermatitis (FAD), a condition your pet could be suffering from, even if you’ve taken all the standard precautions against fleas. Read through the information, then consult with your veterinarian to find the best treatment option for your pet.

1. FAD is common.

According to the Companion Animal Parasite Council (CAPC), flea allergy derma- titis accounts for about 50 percent of all canine and feline dermatological cases reported to veterinarians. Watch for scratching around the tail base, rear, and groin in dogs, and scratching or crusty bumps around your cat’s neck. Cats with FAD also tend to lick constantly, often to the point of exposing bare skin.

2. FAD can affect your pet even if you’ve administered a topical or oral parasite preventive.

Most of the more popular parasite preventives work great for the average pet, particularly when used year-round. But they’re not magic. When a flea jumps on your pet, the preventive doesn’t kill it instantly— there’s always a bit of a delay. If your pet suffers from FAD, a few bites over time can result in hours of scratching or licking.

3. Fleas aren’t always present with FAD.

You can search and search and come up empty. Your veterinarian may not even be able to spot a flea on

your pet. Fleas are fast, and some pets have thick coats. The fleas don’t want to be spotted, so even a thorough search can overlook them. And all it takes is a quick walk near a nest of fleas to expose your pet to a whole new batch.

4. Your other pets won’t necessarily itch. 

Not all pets are affected with FAD. So even if you’ve admin- stered parasite preventives to all of your pets and they all spend the same amount of time out- doors, one might spend all day scratching his itchy coat while the other remains unaffected.

5. Even indoor cats can suffer from FAD.

Fleas don’t just nest outdoors. Your other pets could carry them into the house, or they could sneak in with your human guests. As long as they have a warm place to thrive, they pose a threat to your pets.

Common treatment options for FAD include a 10- to 14-day dose of a mild steroid, along with a vigilant protocol for flea control. Most pets will find relief from itching within one to two days. Talk to your vet- erinarian to find what will work best for your pet.

Source: Dr. Carlo Vitale, San Francisco Veterinary Specialists

Breed of the Week: Labrador Retrievers

My last appointment of the day was something like this:

Yes - very, VERY cute!


Labrador Retrievers are pretty well known to most people, even non-pet owners. This is because they are, and have been for some time, one of the top breeds in numbers and families that own them. Along with Golden Retrievers (which we will discuss at another time), they are wonderful and fun family dogs. They are usually great with other pets and children.


As the name implies, they are retrieving dogs used by hunters to go after waterfowl or pheasant. They also make excellent police, search and rescue, seeing eye and field trial dogs.  Most people have them as companions (sometimes in addition to a "job.")

Since we see such a large number of them, I can tell you what the most common problems are (health and behaviorally).


1. They ARE generally very energetic dogs - usually well beyond their puppy year. Owners need to be prepared for this. I strongly recommend a large yard, doggie daycare, etc and always obedience training (for ANY breed!!).  


2. Most of them will eat just about anything. I always warn new Lab owners of how frequently these dogs end up in surgery for foreign bodies of EVERY description - food and non food items. 


3. Obesity is one of the top medical problems - leading of course to many other medical issues as well. They are very food motivated and will eat the whole bag of dog food if you put it in front of them, so you need to really monitor the weight.


4. Hip dysplasia, elbow dysplasia - these are congenital problems that are screened for by REPUTABLE breeders.  


5. Skin issues/allergies - very common - affects the ears most often - chronic ear infections are what we often see.


6. PRA or Progressive Retinal Atrophy. Another disease we have genetic testing for so breeders can avoid mating dogs that will produce offspring with the problem. The retina in these dogs just starts to lose function and they go blind.


7. Arthritis is common as they get older - esp if there is extra weight on them.


8. Lumps and bumps - most labs get lipomas (or benign fatty growths) as they get older. Have your vet check out any lump you find though! 

They are very good at finding trouble!

Red Flags or Don't Ignore a Cough in an Older Dog

Sometimes I take for granted what is a "red flag" for me. When someone comes in with an older patient that is coughing, my first thoughts on why are NOT good ones. 


People often think in terms of what happens in humans - and they are partially correct. Only they don't think of their 10 yr old large breed dog AS an 80-90yr old person. They are thinking that he's coughing for the same reason as a 20-30yr old might - allergies, an upper respiratory, etc. Nothing major.  


Certainly at this time of year, we do (and are) seeing a lot of allergy related problems in dogs (all sorts of skin issues and eye and ear problems). However, coughing is generally not a typical "allergy" symptom in a dog. 


A patient I recently saw had been coughing for more than a few months but had been doing pretty good otherwise. The dog was bright and alert and eating. She was just a little slower and had some arthritis - not a surprise given her age, breed and previous history of cruciate ligament damage and subsequent surgery. 


No matter what, this patient needed a chest x-ray. However, I was even MORE inclined to do it when I heard muffled (not real clear) heart sounds on both sides of her chest. Unfortunately, I was correct and she does have masses in her lungs. We can buy her some time though with steroids but long term prognosis is poor.  


Any change in an older pet's behavior (no matter how minor it seems) warrants a physical exam and possibly some diagnostics by your veterinarian. Actually, "senior" pets really should routinely be examined every 6 months and have blood work done at least once a year (more if there is something we are watching). It is amazing what CAN be picked up early on. 

Sometimes It Just Sucks

While the loss of a patient is never easy, every veterinarian (even if they are not willing to admit it) is affected more deeply by some cases versus others. 


Obviously, one of the hardest ones are the unexpected deaths - especially in a young patients.  


The kitty I mentioned the other day - 2 yrs old with pneumonia - died DESPITE us doing all that we could for her. It's cases like these that I would love to be able to necropsy because I do not know why THIS cat didn't respond to therapy that has helped many other cats. She didn't even get improvement for a short period after one or two medications was used, an O2 cage, etc. Was more going on (ie was THERE cancer underlying??)? Was it some weird or resistant pathogen? I don't know. The only way TO KNOW is to get tissue samples and send them to the lab.  


In any case, the other hard part of this is not knowing if this whole thing was started by treatment of another medical condition. Some medications we use suppress the immune system to a degree. In a young, otherwise healthy cat, no one would balk at using these types of drugs. But then something like this happens, leaving those who did the initial treatment wondering. I know 1)I would done the same thing and 2) I would be feeling the same way. 


No one wins here - pet, client, vets. 

Does Your City Bite?

No, no, I don't mean the weather or the lack of great restaurants. I mean, how likely is a US Postal Carrier to get bit by a dog in YOUR town?


I found this interesting article with the top 10:


1. Houston - 62
2. Columbus, OH, and San Diego, CA - 45 each
3. Los Angeles, CA - 44
4. Louisville, KY - 40
5. San Antonio, TX, and St. Louis, MO - 39 each
6. Cleveland, OH, and Phoenix, AZ - 38 each
7. Minneapolis, MN, and Portland, OR - 35 each
8. Denver, CO, and Philadelphia, PA - 31 each
9. Sacramento, CA - 30
10. Seattle, WA - 28


I don't see any pattern here or in the expanded list - they are ALL over the country. There doesn't seem to be JUST colder weather cities or hot weather towns at the top or bottom. It's pretty well mixed up. 


If you click the link to the full article below, you will find there is a link to an expanded list of 25 top cities.

Read more: http://www.sfgate.com/cgi-bin/blogs/pets/detail?entry_id=88952#ixzz1MkhzQXOS

More from the Front Lines

Today was another crazy day in general small animal practice. See above graphic for complete listing of what that entails!


The morning started off with a 2 yr old cat in respiratory distress. Her chest x-ray initially had me thinking she had cancer but I was so happy to see her white blood cell count significantly elevated, indicating it was most likely pneumonia. Serious but better than the big "C." Still, she's not out of the woods and it will be a few days before we know how she'll respond to therapy.


Then I had to explain to an owner that their dog was not going to recover from kidney failure secondary to Lyme disease (what we term "Lyme nephritis.") This was hard because the dog was a young adult. Unfortunately, she had never been vaccinated for Lyme. This is why we (and I, personally) urge vaccination - we see far too much in this area to NOT do it. 
Sadly, the owners will have to make that difficult decision in the next days to weeks. 


This afternoon, I honestly think almost every appointment I saw was either: skin issues or vomiting/diarrhea. These ARE two of the most common reasons people bring pets in (esp dogs).  There are so many things that can cause dermatologic or gastrointestinal issues. Some of these patients just needed medication, others more of an extensive work-up. Unfortunately for one, it does appear that she has a mass in her abdomen compressing (and possibly involving) her stomach.