A lot of people with pet allergies assume they can never have or be around pets again, but this week, Dr. Andy comes to the rescue with 5 simple tips to help (non-severe) allergy sufferers keep on lovin’ pets!
There are a ton of options out there when it comes to dog food, and not all of them are created equal. This week, Dr. Andy shares 5 things you can’t afford to get wrong when it comes to feeding your pooch.
I messed up. I missed a tumor in my own veterinary technician’s dog. How did I let this happen? How did I fail Smokey and Amanda?
Smokey was my inspiration for a new cancer awareness program called See Something, Do Something. I am on a mission to help us all detect tumors earlier – whether you are a veterinarian, veterinary team member, or a pet owner.
At the time, Smokey was a 10-year-old white Pit Bull that belonged to one of my technicians, Amanda. I adored them both. Smokey was one of those amazing, soulful dogs that spread sunshine with every wag of his tail. Everyone who met Smokey loved him. He was Amanda’s once-in-a-lifetime-dog.
I had aspirated over 10 skin masses on Smokey over the years, and the masses had always been benign fatty lipomas. [An aspirate is when we poke things with a small needle and then look at the cells and fluid we get out under a microscope.]
When Amanda mentioned she was bringing Smokey in to check out a new mass a few weeks earlier, we all expected it to be the routine: a quick aspirate, fat on the microscope slides, give a treat to Smokey, collect some wags and kisses, and on his way.
The first day Amanda brought Smokey in, the clinic was so busy that we never got to Smokey’s aspirate. But none of us were worried because we assumed it was just another benign lipoma.
When Smokey returned the following week, I examined the 5 cm mass that was deeply attached to the underlying tissue on his left flank area. As I did my aspirate, I could see blood collecting in my needle and syringe. I immediately knew this was not a lipoma. I aspirated the mass in a few more areas, and we submitted the slides to the lab for cytology.
I told Amanda that my clinical hunch was a tumor. Tears welled up in her eyes.
As veterinary professionals, we deal with cancer in dogs and cats every day but nothing can prepare you when it is YOUR pet. I could see Amanda’s mind start to race and shut down at the same time. I gave her a huge hug, and we waited anxiously overnight for Smokey’s cytology results.
The cytology came back as a soft tissue sarcoma. Soft tissue sarcomas, or STS, are malignant
(cancerous) and develop in a variety of connective tissues. They can be found all over the body, from head to trunk to paws. The majority of these tumors are aggressive locally, which means they dig into the neighboring tissues. They are also prone to come back if they are not removed with wide margins.
The good news is that the low and intermediate grade versions of these tumors typically don’t metastasize, or spread. Low and intermediate grades of soft tissue sarcomas are very treatable. So surgery can be curative if the mass can be removed completely.
For Smokey, the next step was a biopsy to confirm the tumor type and help our soft tissue surgeon appropriately plan his surgery. I ran blood and urine tests, and ordered chest X-rays and an abdominal ultrasound to make sure the cancer hadn’t spread – all clear!
On surgery day, Smokey had a CT scan to get a better idea of the size of the tumor. These cancers are famous for having tentacle-like projections that can extend for centimeters away from the mass. If we leave the tumor tentacles, the tumor will likely regrow.
To avoid those tentacles, these tumors generally require 3-centimeter margins (more than an inch) around the tumor and a plane of tissue underneath the tumor. Smokey’s tumor thus required a really big surgery: for a 5-centimeter tumor, the incision should be at least 11 cm (or 4.3 inches).
Smokey’s surgery went well. He spent 2 days in our ICU recovering, and we anxiously waited for his biopsy report. The biopsy report confirmed GREAT NEWS: a low-grade (grade 1) hemangiopericytoma with wide, clean margins. He did not need more treatment – no post-operative radiation or chemotherapy. I just recommended regular monitoring of the scar and periodic chest X-rays.
Even though Smokey’s surgery had a happy ending, his malignant tumor really hit me hard. In hindsight, if we had aspirated this earlier when the mass was smaller, his surgery would have been simpler. How could I, a cancer specialist, have missed this tumor? And did I misguide Amanda?
Were there guidelines I had forgotten? I pulled out cancer books, journals, and cancer notes from my medical oncology residency. No, there are no guidelines for veterinarians or pet owners for when to aspirate or biopsy a mass on a dog or cat. The recommendations for doing an aspirate include generalities – “recommend if a mass is changing in size or appearance, or bothering the patient.“
Owners are often told to “keep an eye on it.” But what does that mean? Keep an eye on it for how long? How much can it grow before we should do something?
I hear all too often that a mass does not look or feel malignant. The pet owner should just monitor the mass and wait until it is bothering the pet. This is not good enough!
When tumors grow, what could have been removed with a simple surgery may now require a bigger surgery and radiation or chemotherapy afterwards. Even worse, the tumor may become too big to be removed or treated at all.
No one, not even a cancer specialist like me, can look at a mass and know what it is. We must do better. We must find tumors earlier when they are small. We must aspirate them. That’s where See Something, Do Something comes in.
See Something, Do Something:
See something – if your dog or cat has a mass that is the size of a pea (1 cm) and has been there 1 month,
Do something. Go to your vet and get it aspirated (or biopsied)
Do not get complacent like I did. Even after many benign aspirates, the next one can be malignant (like Smokey’s was).
See Something, Do Something. Why wait? Aspirate.
About Sue Ettinger, DVM, DACVIM (Oncology)
Dr Sue Cancer Vet
Dr. Sue Ettinger, ACVIM (Oncology), is a boarded veterinary medical cancer specialist. She attended Cornell University College of Veterinary Medicine. As a Diplomate of the American College of Veterinary Internal Medicine (Oncology), and she is 1 of approximately 300 board-certified veterinary specialists in medical oncology in North America. Dr. Ettinger is currently the head of the Oncology Department at the Animal Specialty Center in Yonkers NY.
Also known as Dr Sue Cancer Vet, she is a book author, radio co-host, and Certified Veterinary Journalist. Dr. Sue is the co-author of the Second Edition of The Dog Cancer Survival Guide, and she co-hosts The Pet Cancer Vet, an internet radio show on radiopetlady.com. From 2011 to 2014, Dr. Sue was a regular contributor to the blog, www.dogcancerblog.com. She lives in Westchester NY with her husband, a veterinary internist, their two sons, their goofy black Labrador, Matilda, and their dog-loving orange cat, Jeter.
Dr. Sue is passionate about raising cancer awareness, and she has developed See Something, Do SomethingTM to promote early cancer detection and diagnosis. The sooner we determine whether a mass is cancerous and should be removed, the better for our pets. Most skin and subcutaneous tumors can be cured if diagnosed early when masses are small. Early detection saves lives.
She can be found on social media at www.facebook.com/DrSueCancerVet and @DrSueCancerVet on Twitter.
By: Tasha McNerney BS, CVT
Recently I had the privilege of running the anesthesia on my friend/coworker’s dog, Maggie, undergoing surgery to repair an ACL tear. The anesthesia itself was uneventful and – dare I say it? – even boring.
(Side note 1: It’s a good thing when the anesthetic event is boring; that means no complications to get your heart racing!)
(Side note 2: I’m allowed to say it was boring after the fact, and if you were in that room for 5 hours staring at that perfect ECG, you might say the same thing too)
The epidural even went in so beautifully I joked about taking pictures for a textbook I’m putting together. Everything about this case was textbook: from the induction, epidural, intra-op monitoring parameters to the smooth recovery from anesthesia. I figured everything was going to go smoothly in this case, including the recovery period, so we set Maggie up for the usual post op analgesic regime that every ACL repair gets (fentanyl patch and tramadol tablets). I thought I wouldn’t hear much from Maggie and her owner.
And that’s when Maggie reminded us that not every patient reads the pain management handbook and some people’s (or dog’s, in this case) pain tolerance is different than others.
[tweetthis]Maggie reminded us not every patient reads the pain management handbook -[/tweetthis]
Maggie’s owner called me 48 hours after her procedure and said that Maggie seemed to be in a lot of pain, not wanting to get up from sitting, and toe touching on the rear leg. I knew the fentanyl patch had been in place for about 72 hours at that point, so it should have still been in her system. Also, she was on tramadol, so that seems to be a pretty good combination, right? Unfortunately, while we were effectively using an opioid analgesic (the fentanyl, which is related to morphine), there were other ways the body experiences pain (pain pathways) that were NOT being treated in Maggie, and we had to re-evaluate our usual plan.
Taking the Power Ranger Approach to Pain and Healing
We had Maggie come back over to the clinic to start low level laser therapy every other day. Low-level laser therapy is an alternative method of treatment where the injured body part is exposed to lasers of low intensity, which stimulate the cells and tissues and quicken the healing process.
The increased blood circulation to the area also quickens the healing process. We also put Maggie back on her previous doses of carprofen (a non-steroidal anti-inflammatory or “NSAID”) to help with the inflammation. I asked Maggie’s owner how she felt about the tramadol and fentanyl combination and she replied that Maggie had used tramadol in the past for stiffness and it had appeared to be ineffective. So, we took the tramadol away and added in a medication called gabapentin.
The beauty of gabapentin is that it works on the neuropathic aspect of pain (i.e. “nerve pain”). It also works beautifully together with NSAIDs. Gabapentin helps to control nerve pain, thus helping to prevent the “wind-up phenomenon” that can lead to chronic maladaptive pain. Often patients develop chronic pain conditions as a result of ineffective pain management therapy in the post op period.
So, we took Maggie’s previous pain management plan, which was only covering one or two of the ways she might be experiencing pain and expanded her analgesic plan to cover three different pain pathways.
I like to think of the analgesic plan and the therapies as Power Rangers. One Power Ranger battling one pain pathway is usually not enough to control the pain monster, however multiple Power Rangers can work together and combine their powers (pathways) to totally defeat that pain monster.
[tweetthis]Taking the Power Ranger Approach to Pain and Healing -[/tweetthis]
Maggie’s owner called me the next day (only 24 hours later) to say she was noticing a huge improvement. She was now trying to keep Maggie from jumping up on the bed and zooming around the house when the mailman visited. Just tweaking her pain management protocol resulted in a dramatic difference in the quality of her recovery.
Often as with many other facets of veterinary medicine, we find ourselves relying on a “cookbook” approach to post-operative pain management. We get so used to every patient doing “just fine” with carprofen and tramadol that we often don’t look to see what works best for each patient as an individual. So, take the time to follow up with your patients. If that pain management plan isn’t defeating the pain monster, re-assess and start a new plan. Your patients will bounce back faster and your clients will know you truly care about the health and comfort of your pet.
And, if you are a pet owner: trust your instinct. If your pet seems unusually uncomfortable, talk to your veterinarian. Together you can come up with a pain management plan that gets your best friend back in action sooner.
[tweetthis]If you are a pet owner: trust your instinct #painmanagement[/tweetthis]
**Hopkins, J. T., McLoda, T. A., Seegmiller, J. G., & David Baxter, G. (2004). Low-Level Laser Therapy Facilitates Superficial Wound Healing in Humans: A Triple-Blind, Sham-Controlled Study. Journal of Athletic Training, 39(3), 223–229.
· If you would like to find a pet pain specialist in your area, or learn more about preventing animal pain, check out the International Veterinary Academy of Pain Management at www.ivapm.org
· If you want to hear and see more from Tasha McNerney BS, CVT check out her video series on veterinary technician career development for Firstline magazine called “Coffee on the Couch”. Each episode Tasha interviews technicians in different career fields and explores the secrets of their success. Check out the first episode here: http://veterinaryteam.dvm360.com/coffee-couch-conversation-with-veterinary-technician-mary-berg
About Tasha McNerney BS, CVT
Tasha McNerney attended Michigan State University and obtained a bachelor’s of science in 2002 majoring in wildlife biology. After graduation she worked in the field of wildlife rehabilitation in the Florida Keys working with shore birds specifically.
In 2003 Tasha moved to the Philadelphia area and began her veterinary technician training at Manor College in Jenkintown, PA.
Tasha has worked at Rau Animal Hospital in Glenside, PA for ten years as an O.R. / Anesthesia technician. Her areas of interest include sighthound and brachycephalic anesthesia as well as pain management. Tasha has been a featured speaker on various anesthesia and pain management topics at conferences such Atlantic Coast Veterinary Conference, Wild West Veterinary Conference and the American Veterinary Medical Association. Tasha has authored several articles for the NAVTA journal, Firstline magazine, and “Fetch” a blog dedicated to pet parents. Tasha was also a contributing author for the new “Pain Management for Veterinary Technicians” textbook. Tasha is currently working on obtaining her CVPP and VTS (Anesthesia)
In 2013 Tasha created the Facebook group Veterinary Anesthesia Nerds, which has over 4,000 members participating in education and exchange of ideas in all aspects of veterinary anesthesia and pain management.
Since pets can’t just speak up and tell us when they’re experiencing pain, we have to keep a lookout for clues. This week, Dr. Andy shares 8 subtle signs that your fur baby may be struggling.
By: Meg Pierson
I have an actor friend with tremendous talent and a love of literature. One day while we were walking together after a Shakespeare in the Park performance, she revealed a long-time dream of hers. She does not currently own a dog but one day she wants to have a basset hound and name it August.
I’m not doing the name justice here: she pronounces it “Au-GOOS-t,” with the “t” just barely included. She went on to describe the birth/adoption announcements she would send out, to let her friends know that the day had arrived: her long-awaited basset hound was finally snuggled beside her.
Can we all pause and agree that basset hounds are adorable [see beach basset above]? I’m not expressing too much breed bias but there is nothing more endearing to me than a floppy-eared, baleful little basset hound staring up at you, wondering if you’re going to share that piece of cheese you’re eating (the answer is always YES, but only a portion). But when you add the name “August” to it, the dog becomes charmingly dignified. Suddenly, he’s a German ambassador and everything he does, from tripping over his own ears to enjoying yet another classic hound nap in the sun, becomes stately. It’s glorious.
In my world, names are one of the best parts about getting anything. I’ve named every one of my cars and even got to name my family’s wheaten terrier when I was 13 (I chose Duncan after the good king in Macbeth; I was a pretentious little tyke).
Doggyloot.com just revealed the top ten names for dogs in 2014. Please allow me to break down the top three of both genders.
1. Max (boy) and Bella (girl)
Both these names require the dog to live up to pretty high standards, and pave the way for unparalleled sibling rivalry. The British English Dictionary defines “max” as: “The most significant, highest, furthest, or greatest thing.” If you have more than one dog, I’d suggest naming your tallest dog Max, so the name can be in reference to his height, not his character. Unless you name your other dog Awesome, so they can be equals.
Bella is a wonderful name for a dog who isn’t actually beautiful. Let’s give that adorably funky shelter dog you just rescued a chance to be what it has never been considered before! Many attribute the rise in this name to the popularity of the Twilight book series but I have faith; I think it’s because we’re all just really big fans of Bela Fleck, not a book series about shimmering, moody teens who like to suck blood (c’mon, what teenager DOESN’T?).
2. Buddy (boy) and Molly (girl)
OK, real talk – I only call a person “buddy” when I’m getting annoyed with someone or I’m trying to make sure a guy knows he’s in the friend zone. In my world, this name has one purpose: to passively show the recipient you’re done playing and in about five minutes they can expect a cold shoulder that would rival a house cat’s ritual of ignoring people.
You could name both of these Jack Russells Molly – but I guess that’s confusing.
I’ve never met a Molly that I disliked. And if you’re in your late twenties like I am, you’ll probably remember Molly the American Girl doll. She’s a patriotic firecracker from the Second World War era and her glasses are awesome. Who doesn’t want a Jack Russell named after a resourceful tweenager who loves her country?
3. Rocky (boy) and Lucy (girl)
I’ve never seen the movie Rocky, but I can tell you that the only reason I’d name my dog after it is to be “that girl.” You know, the one that cooks a great steak, flipping LOVES football (PACKERS!!!), AND can do a great cartwheel. Currently, only one of these statements about me is true. I’ll let you decide which one.
Everyone wants a song they can sing to their dog. My family has a dog named “Blueberry” and I can’t tell you how many renditions I’ve sung of “Blueberry Hill.” So why not name your dog after “Lucy in the Sky with Diamonds” by The Beatles?
You can and should see the whole list of names – maybe your pet’s name is on there! I love to see how people pick names for their pets. Whether you come up with a moniker before meeting the dog or wait to be inspired, your pooch has a story and a character all his own. And every time I meet a new dog, it’s fun to see how the name helps define their character.
Visit the Doggyloot Blog here!
Meg began her stage career in 2004 with Clemson University’s improv comedy group. During her time at Clemson, she trained in Atlanta, Chicago, and Chapel Hill and performed across the Southeast. Meg has performed with the Upstate Shakespeare Festival, Greenville Little Theater, and two regional improv companies. Currently she works as an actor, production assistant, and comedic writer for Cone of Shame. She has appeared in and provided voice over work for a number of videos for IDEXX, Vetstreet, and DVM360. Meg performs regularly as a founding member with Alchemy Comedy in Greenville, South Carolina, and teaches improv courses.