Showing posts with label Referral. Show all posts
Showing posts with label Referral. Show all posts

Wednesday, May 7, 2014

Frank's Big Scare


I apologize that it has been awhile since my last post, April was a crazy month and I am still recovering from it.  The 8th Annual Fashion forPaws Runway Show was on April 12th and it was a huge success.  The event raised over $425,000 that will directly provide care and medical attention for the 43,000 animals that the Washington Humane Society cares for each year.  Frank was a star of course and I was honored to speak at the event this year as Executive Committee Chair.

Our delight in the Fashion for Paws afterglow was put out quickly when Frank became sick a few days after the event.  I first noticed that he was eating a bit slower than usual and he seemed tired out on our walks.  When he didn’t get up for his treat one morning I knew something was really wrong and we rushed him right into Friendship.

Dr. Calabro who is one of Friendship’s two amazing critical care specialists examined Frank and found him to have a low grade fever and back pain.  Screening bloodwork was submitted and he was started on intravenous fluids and pain medication.  Friendship’s radiologist Dr. Hankin performed radiographs and an abdominal ultrasound to rule out an infection of the vertebrae called discospondolytits as well as look for any additional underlying abnormalities.  Thankfully these were all normal.  We also submitted tick titers to make sure this wasn’t from an infectious cause such as Lyme disease or Ehrlichiosis. 

Being a good dog for his IV fluids
His bloodwork came back with a slightly elevated white blood cell count indicating systemic inflammation.  Additionally his platelet count was low; platelets are the blood cells that are responsible for clotting blood.  The decreased platelets could be from an infection destroying his platelets or again systemic inflammation.  We added doxycycline to his treatment and he spent the night in the hospital.  If his symptoms were due to a tick borne infection it should resolve quickly on the doxycycline.

The next day his fever had come down a bit, he was eating well and seemed to be feeling better so we took him home.  Over the next day he was fine but still acting very quiet and not himself.  I brought him back to the hospital about 36 hours after discharge to have his bloodwork rechecked.  Friendship’s other criticalist, Dr. Gonzales took a look at him and found that in addition to back pain he was now painful in his neck and multiple joints.  The follow up bloodwork showed that his platelets had not improved at all and his white cell cont was now higher.

At this point my husband and I were beside ourselves worrying. Frank is only 4 years old, how could he get this sick so quickly and how could we not know what was wrong with him.  Our next step was to have Friendship’s orthopedic surgeon Dr. Glassman evaluate his joint pain and take samples of joint fluid to see if there was evidence of infection or inflammation in his joints.  Frank had to be sedated for the joint tap procedures, as it is painful to enter the joint and collect the samples.  Analysis of the joint fluid did not show any abnormalities so we returned to looking at his neck and back pain as the primary problem.

Waiting in Dr. Talrico's exam room
The next day we headed out to Southpaws for a neurology consult with the amazing Dr. Talrico.  The very first day Frank was sick Dr. Calabro discussed his case with Dr. Talrico who thought it sounded like a textbook case of Steroid-Responsive Meningitis-Arteritis (SRMA). The cause of SRMA is unknown but it is auto-immune in origin meaning that for some reason the body creates inflammatory cells that attack the central nervous system.  After a complete neurologic exam Dr. Talrico recommended a CSF tap that would hopefully confirm her suspicion of SRMA.  For this Frank was put under general anesthesia and a needed was passed between the vertebrae in his neck to collect the fluid that surrounds his spinal cord.  He recovered well from the procedure and we headed home to wait for the analysis of the spinal fluid.

Here is where medicine can get frustrating; the results from the CSF tap were suggestive of SRMA but not definitive.  Unfortunately we can do all the testing in world and still not have an exact answer of what is causing the problem.  In this situation it is critical to work with a doctor that you trust and has experience with the suspected disease process.  Veterinary medicine is often a puzzle; you have to take the history, exam findings, test results and response to treatment and piece them all together to get an answer.

 Dr. Talrico felt given his clinical signs and the results from all of his testing that we caught the disease very early in its progress.  This was actually good news because it meant with aggressive treatment Frank has a much better prognosis for complete remission with no future relapses.  We started steroids that day and within a few days he was feeling much better and his platelet count was almost back up to normal.

This is not a disease he will ever be cured of and it always has to be in the back of our minds as he can relapse at any time.  Frank cannot ever be vaccinated again as this could over-stimulate his immune system resulting in a relapse.  I am most worried about not being able to vaccinate him against leptospirosis.  I can monitor his immune protection against rabies, distemper and parvo viruses with titers but not with leptospirosis.

My family is so thankful for all the amazing care Frank received during this ordeal and that he is back to his normal crazy/loving/adorable/playful self.  Drs. Calabro, Gonzales, Galssman, Romsland, Hankin and Talrico are brilliant veterinarians and dedicated themselves to helping me figure out what was going on with Frank.  All of the technicians that took care of him while he was in the hospital were gentle and caring.  I am lucky to count all of these wonderful people as my friends and am grateful for Friendship and the excellent care that is available to all of us here in DC.  So go home tonight and give your pets a big hug and a kiss, each day we have with them is truly a gift that should be treasured.

He has a new haircut to even out all his shaved areas and is feeling much better!



Tuesday, February 14, 2012

Dr. Bush and Puck the Corgi


Puck a few days after surgery

I have written multiple posts about how much I admire and respect neurologist extraordinaire Dr. Bill Bush; you can then imagine how thrilled I was when he started seeing appointments at Friendship on Thursdays.  We are so lucky to have such an amazing neurologist right in the hospital that we can refer clients to. 

I think the story of Puck the Corgi illustrates just how gifted a clinician Dr. Bush is and the cutting edge treatment options he has available to his patients.  Puck presented to Friendship after having multiple seizures for the first time in his ten years of age.  Dr. Bush evaluated Puck and immediately suspected that he had a brain tumor, he literally pointed to Puck’s forehead and said, “There is something going on right here”. 

Sure enough an MRI at Bush Veterinary Neurology Service (BVNS) in Leesburg confirmed that Puck had a tumor in the olfactory-frontal lobe of his brain.  Puck immediately went to surgery for a transfrontal craniotomy to have the tumor removed.  A post-operative MRI showed that Dr. Bush and his resident Dr. Hague were able to remove the entire tumor.  Puck recovered quickly and was back home in a few days.


Initial MRI - tumor is white area above red arrow
MRI post-op, no more tumor!

Here is where it gets really cool!  The tumor was submitted to the Ohlfest Brain Tumor Laboratory at the University of Minnesota where they are performing groundbreaking research in treatment of brain tumors for both dogs and humans.  They were able to use Puck’s tumor to create a vaccine that will be administered under his skin to target and kill any remaining tumor cells.

Four months after surgery Puck is doing great and even updates his fans on his very own Twitter feed @puckthecorgi.  Visit BVNS’s website for more amazing stories of dogs and cats that Dr. Bush and his team have helped.  Remember he is available for consults at Friendship on Thursdays, visit our website for more information.

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.

Wednesday, February 24, 2010

Sparkle and Dr. Bush


A few years ago, when I was in the midst of my internship year at Friendship, my rat terrier Sparkle suddenly developed severe neck pain. She hid under the bed and would scream anytime I touched her. She was six years old at the time, and had previously been one hundred percent healthy. Needless to say, I was completely freaked out and immediately started imagining all the horrible diseases that could be causing her discomfort.


It was this episode that solidified my opinion of Dr. Bush -- of Bush Veterinary Neurology Services (BVNS), -- as my all-time favorite specialist in the area. I called him very upset and he instantly squeezed me into his schedule, which was already jam-packed. Prior to these events, I had frequently spoken with him on the phone because he allowed the doctors at Friendship to call his cell phone whenever we had questions on cases with neurologic issues.

The fact that Dr. Bush permits Friendship veterinarians to call him at any time of day or night shows how dedicated he is. We have amazing specialists in DC but, besides Dr. Bush, I don’t know of a single one who will answer a cell phone at one in the morning to discuss a case. Not only that, but I have never called with a patient in need of a neurologist and been told Dr. Bush and his colleagues are unable to see the referral. It is such a comforting feeling to know I can assure my client that without a doubt their pet will be seen by a neurologist within the next twenty-four hours or less.

Sparkle’s neck pain resolved with medical management and she has not had an issue since. (It is possible that, being the neurotic pet owner that I am, I may have overreacted!) Regardless, I have been a dedicated fan of Dr. Bush ever since, and refer all of my patients that need the attention of a neurologist to BVNS.


Since my visit with Sparkle over three years ago, BVNS has grown tremendously. Dr. Bush now has two board-certified neurologists and three veterinarians who are completing advanced training to become neurologists. In addition, he has an MRI located at his clinic, ensuring that his patients can have advanced imaging when they need it rather than rely on an outside service.

Taking your pet to see a neurologist is rarely a desirable event as it is usually precipitated by a scary event such as seizures or paralysis. Here in DC, we are lucky to have the doctors at BVNS to turn to when neurologic disease strikes one of our pets.

Thursday, September 10, 2009

Lymphoma


Lymphoma is the most common cancer that we diagnose in cats and dogs. Cancer is never good news, of course, but if there is a bright side, it’s that Lymphoma is by far the most treatable. It does however behave very differently in cats and dogs.


In dogs we usually see an enlargement in one or more of the peripheral lymph nodes such as those located under the jaw or on the back of the hind legs. In many cases, the patient won’t even feel sick at the time of diagnosis. In other cases, the patient will show general signs of weight loss, lethargy and anorexia.

Diagnosis is typically relatively non-invasive and done by sticking a needle into a lymph node to obtain cells. (This is called a fine needle aspirate.) Lymphoma can also present in the gastrointestinal organs such as the liver, spleen, small intestines or lymph nodes, lymph nodes in the chest, or sites such as the skin, nervous system and eyes.

Cats, on the other hand, are afflicted most frequently with gastrointestinal lymphoma, although they can also get the same organ involvement listed above for dogs. They present with general maladies such as decreased appetite, weight loss, frequent vomiting or diarrhea.

With cats, I recommend bloodwork first in order to rule out any underlying issues with kidney disease or hyperthyroidism. If the bloodwork is unremarkable then lymphoma or inflammatory bowel disease are at the top of my list of suspects.

Cats are not as easy as dogs to diagnose. The next step is an ultrasound, done by our internist Dr. McConnell, to visualize the abdominal organs. We often see thickening of the small intestinal walls, enlarged lymph nodes in the abdomen, changes in the liver or spleen. If possible, Dr. McConnell will do an ultrasound-guided fine-needle aspirate of everything except the small intestine. If it looks like the small intestine is involved endoscopy is recommended to obtain pieces of the stomach and small intestine to differentiate between lymphoma and inflammatory bowel disease.

Once lymphoma is diagnosed in both dogs and cats, we refer people to an oncologist for further diagnostics and treatment. It is necessary to stage the disease in order to figure out how far it has progressed and which specific type of lymphoma it is. The most frequent sites of metastasis are the lungs and liver. Therefore x-rays of the chest are taken and an ultrasound (if one was not done already) is performed to look for evidence that the cancer has spread.

Once the oncologist has determined exactly what they are dealing with, it is time to discuss treatment options and prognosis. If this is something you ever have to go through with your own animal, an oncologist will explain what treatments are available and what you can expect.

The most important thing to keep in mind when treating cancer in animals is that our goal is not to cure. Instead, we want to prolong the animal’s life while maintaining a good quality of life. People are blasted with chemotherapy drugs to try and kill all of the cancer. This is why people get so sick. With animals, we administer lower doses of drugs with the intent to kill as many of the cancer cells as possible without making the patient feel bad.

Having a pet diagnosed with any kind of cancer is scary and overwhelming, I hope this provides you with some helpful information.

Tuesday, September 8, 2009

So your pet has cancer - Now what?


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 Stuart, 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.

Tuesday, July 28, 2009

Cardiology

We all know that our pets have huge hearts filled with unconditional love--but what does it mean when your veterinarian tells you your pet has a heart murmur?

It could mean nothing or it could indicate that there is heart disease present. The only way to know is with an ultrasound of the heart called an echocardiogram. This procedure takes around 30 minutes and is done by a board certified cardiologist. Usually sedation is not necessary and you are with your pet the entire time. The doctor will image the heart and see if there is disease present such as thickening of the heart wall or abnormalities with the valves.

I often have people ask me “even if there is something wrong what are we going to do about it anyway?” While heart surgery is not commonly performed on animals, we can treat with medications that will help the heart work better and prolong your pet’s quality of life. On Wednesdays at Friendship we have Dr. Braz-Ruivo seeing appointments; he is not only a delight to work with but also an excellent cardiologist. If you would like to schedule an appointment please call (301) 809-8800.

Thursday, July 9, 2009

Vomiting Kitty

A few weeks ago, I noticed that one of my cats had begun vomiting at least one a day. After a couple of days of observation--and one morning of being woken up to the sound of vomiting--I determined that it was my cat Breaker.

All cat people know that cats vomit from time to time, and there are about a million things that can cause it. But when a kitty starts vomiting more than once a week, it warrants further investigation. I started by giving Pepcid AC to Breaker once a day, to help settle his stomach by decreasing the amount of stomach acid produced. Unfortunately, despite the Pepcid, I continued to find frequent piles of kitty puke around the house.

It was time for some veterinary detective work: My first step was to run bloodwork to check for the most common cat ailments: kidney disease, hyperthyroidism and liver disease. I also submitted a feline heartworm test. The good news was that the bloodwork was unremarkable and Breaker tested negative for heartworm disease.

My next step was schedule an abdominal ultrasound to look for signs of pancreatitis, inflammatory bowel disease (IBD), and lymphoma. Luckily for Breaker, Friendship’s internist Dr. McConnell happens to be an absolute genius with this diagnostic test.

The ultrasound is non-invasive and, other than a little abdominal pressure, not painful. It allows us to view the internal architecture of the abdominal organs. Where x-rays show shapes and shadows, ultrasound lets us assess such things as the layers in the intestinal wall, and see if the gall bladder is distended or the bladder wall is thicker than it should be.

I was relieved to see that Breaker’s pancreas did not appear inflamed, his abdominal lymph nodes were normal sized and his intestinal wall looked just like it should. Because ultrasound is not one hundred percent diagnostic, I still didn’t have an exact answer as to why my poor kitty was vomiting. Still, it was good to know that pancreatitis, IBD, and lymphoma were much less likely.

To further rule out pancreatitis, we submitted a blood test to the vet school at Texas A&M to check Breaker’s pancreatic values. These turned out to be normal. At the same time, we decided to see if a change in diet would help. Success! I’m pleased to report that I switched Breaker to a prescription diet, and he hasn’t vomited once.

My plan now is to monitor him at home and continue with the new diet. If he starts vomiting again the next step would be endoscopy, which is the least invasive way to collect biopsy samples of the stomach and small intestine. This would then allow us to distinguish between inflammatory bowl disease and lymphoma. Let us hope for no more kitty vomit from Breaker.

Tuesday, March 10, 2009

Westin's Continuing Battle with Cancer


My dog Westin was diagnosed last week with a very aggressive type of cancer in her liver called hemangiosarcoma. This is a cancer of the blood vessels, it has a tendency to spread quickly and can be very difficult to treat. As with her two previous diagnoses of lymphoma and melanoma, the Oncology Department at Friendship has been amazing.


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 Esther Chon; his assistant Cindy; and the veterinary technicians Stuart, Tracey 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. Westin has responded unbelievably well to her previous treatments. I know the next course of chemotherapy may be difficult for her but she is still a happy, active dog and I know she wants to keep trying. I treasure each day with her and consider myself blessed that she has Dr. Khanna and the Oncology Department at Friendship looking after her.

Tuesday, February 3, 2009

Advanced Veterinary Dentistry and Oral Surgery


At Friendship we do routine dental cleaning, have advanced imaging with digital radiography and perform extractions if necessary. Sometimes more advanced techniques such as a root canal, complicated jaw fracture or aggressive surgical excision of oral cancer are required. For this we usually refer outside of the hospital to any of the veterinary dentistry specialists.

Unfortunately, I have personal experience with aggressive oral surgery, because my dog Westin was diagnosed with oral melanoma in April 2008. In my opinion, Dr. Mark Smith and Dr. Kendall Taney at the Center for Veterinary Dentistry and Oral Surgery are gods in the world of veterinary dentistry. Not only were they sympathetic and caring but the surgery they performed on Westin was amazing. The type of tumor she had required wide surgical margins to make sure all of the cells were removed and given the location there was not a lot of extra tissue in the mouth to work with. Performing cutting edge techniques, they excised the entire tumor while barely leaving a scar. I cannot thank them enough for helping me with Westin and, when necessary, I send my clients to them with the utmost confidence in their abilities.

Pictured above are the photos of Westin after surgery. You can barely see the incision on her muzzle. Amazing!

Wednesday, January 21, 2009

So your pet has cancer, now what?

As a pet owner whose own dog has not one, but two types of cancer--lymphoma and melanoma--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 Esther Chon; his assistant Cindy; and the veterinary technicians Stuart, Tracey 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. Westin has responded unbelievably well to her treatments but I know some day she will not be able to fight anymore. I treasure each day with her and consider myself blessed that she has Dr. Khanna and the oncology service at Friendship looking after her.