Monday, May 24, 2010

Pain Management

One of the many things I am very proud to say we do well at Friendship is attend to our patients’ pain. When I had Westin spayed in 1996 I was given the option to provide her with pain medication at an addition cost to the procedure. I was then and fourteen years later still am appalled that someone would not consider pain medication to be essential with intra-abdominal surgery. It seems like that was a long time ago but just last month I encountered a dog that had surgery at another clinic and was not sent home with any pain medication.

It was long thought in veterinary medicine that we did not need to address pain in our patients’ because “animals feel less pain than humans”, “pain is beneficial because it limits activity” and “analgesia hides clinical deterioration”. These rationales are now known to be false and in fact pain can take a tremendous toll on our patients.

Without providing proper pain management we put our patients at risk for delayed wound healing, increased risk of sepsis, prolonged convalescence, increased metabolic demand and cardiovascular stress. Studies in humans suggest that improperly controlled acute pain may precipitate a chronic pain syndrome that can be very difficult to control. Above all else, we have an ethical obligation to provide humane care to our patients.

Friendship provides our patients with multi-modal pain management before, during and after a painful event be it surgery, trauma or illness. We are also aggressive with controlling chronic pain such as that seen with arthritis. This consists of opioid drugs, non-steroidal anti-inflammatories, local anesthetic, constant rate infusions and the therapeutic K-laser.

Animals are very good at hiding pain and it is up to both veterinarians and owners to make sure that they are kept as comfortable as possible.

Tuesday, May 11, 2010

Brighton and the new baby

My good friends Whitney and John recently welcomed their baby girl Tyler Elizabeth into the world. They were concerned about the reaction of their first child--Brighton, a four-year-old Cavalier King Charles Spaniel. In order to get Brighton comfortable with the drastic changes in the household that usually accompany a new baby, we started working on a few things well before Whitney’s due date.

Our goal was to anticipate the changes the new baby would make to Brighton’s schedule, and then start introducing those changes five or six months before the baby was due. That way, Brighton would have plenty of time to get accustomed to his new routine, and there wouldn’t be so much to adjust to once Tyler arrived on the scene.

Brighton's owners set up a schedule that they hoped to maintain once baby Tyler arrived. Each day included at least ten minutes of uninterrupted "Brighton time" that would happen no matter what was going on with the baby.

Another key technique was to take the empty baby stroller along on Brighton’s walks. This allowed the dog to get used to the strange new contraption. It was also a chance to practice loose-leash walking techniques so Brighton wouldn't pull while on leash. Making sure that Brighton would behave well on walks with the baby meant that he could be included in as many future family outings as possible.

Whitney created a beautiful nursery in preparation for baby Tyler. She and John always left the nursery door open so Brighton could explore the area and get used to the unfamiliar smells of baby powder and diapers. Though he was encouraged to investigate, Brighton was never allowed to sleep on any of the baby's furniture or belongings, because these would be off-limits once Tyler was home.

Once Tyler was born but still in the hospital with her mom, John brought home some of the clothes the baby had worn and left these around the house for Brighton to smell. This gave Brighton a chance to get acquainted with all the smells of a newborn baby, so he wouldn’t besurprised when Tyler came home.

When Whitney and Tyler were released from the hospital, John waited outside their home with the baby while Whitney went in to greet Brighton. Once Brighton calmed down from the excitement of not seeing Whitney for three days, John and Whitney set up a formal meeting of baby and dog. Whitney sat on the couch with Tyler, and John brought Brighton in on a leash. Whitney and John praised and petted Brighton while he approached and sniffed Tyler.

Whitney and John are lucky: since Brighton is an exceptionally well-behaved and sweet dog, he accepted his new sister without missing a beat.

But not all dogs are as laid-back as Brighton. If a dog shows any signs of aggression, excitement or excessive interest in a baby, the dog should be kept on a leash at all times when the baby is present. When only one adult is home, the dog should be kept in a separate room, without any access to the baby. Remember that even a non-aggressive dog may become overly exuberant and cause injury by jumping up on a baby.

A new baby is a big change in any household, but with thoughtful planning the transition can be made as smooth as possible for your furry family members.

Tuesday, May 4, 2010

Canine Cancer Awareness

In an effort to raise awareness about canine cancer Friendship has partnered with Morris Animal Foundation, Blue Buffalo Food and Petco in an event this Saturday. We will be at the Petco on Connecticut Avenue from 10 am to 2 pm to answer your questions and concerns regarding cancer in pets.
As a pet owner who lost a dog to not one, but three types of cancer--lymphoma, melanoma and hemangiosarcoma--I know firsthand how devastating, confusing and overwhelming this diagnosis can be. The only possible shred of good news is that you have the warm, caring embrace of the Oncology Department at Friendship available to you.

Dr. Chand Khanna--who may just be the most amazing person I have ever met--leads this team of dedicated doctors and veterinary technicians. In addition to being double board-certified in internal medicine and oncology, Dr. Khanna runs multiple labs at the National Institutes of Health and founded Animal Clinical Investigation. Through these organizations he performs ground-breaking research in both animal and human cancer. Equally important, he is a personable, compassionate and caring individual. His entire team--including doctors Tony Rusk, Alexandra Sahora and Kristen Weishaar; his assistant Tracey; and the veterinary technicians JT, Rebecca and Amy--understands what a scary time this is for your and your pet.
Managing cancer is complex, expensive and at times confusing (even for me with Westin). Dr. Khanna and his team will go out of their way to answer all your questions and concerns and are always available to the emergency doctors at Friendship if something happens after hours. They do their very best to make treating your pet’s cancer as comfortable as possible for both you and your beloved pal.

Though most cancers in companion animals are, unfortunately, not yet curable, many are now treatable thanks to devoted doctors like Chand Khanna and organizations like the Morris Animal Foundation. We are making great advances in managing cancer in our beloved pets and one day we will find a cure. I treasured each day I had with Westin and consider myself blessed that she had Dr. Khanna and the oncology service at Friendship looking after her.