It’s getting towards the end of the year. That means lots of top ten lists and product reccs in advance of the holidays. This list, over at FastCompany magazine’s website, took things a little further by including whiz-bang veterinary products and services along with pricey niceties like GPS collars and pet-dedicated flights. Nestled among these was Vet-Stem’s product: stem cell therapy for the dog that has everything...even osteoarthritis.
It seems stem cell therapy for ailing pets continues to gain momentum as as way to treat painful joints not amenable to surgical intervention or when surgery is deemed too invasive or stressful. Its success in the equine world for the same indications means that there’s reason to believe it’ll work for pets. Problem is, the literature is still sketchy.
Part of the problem is that we have only a very rudimentary understanding of how stem cells––harvested from a patient’s own fat and injected back into joints––can help reduce the pain and swelling located there. It makes some sense from a 30,000 foot vantage point...but not so much at the nit-picky cellular level.
But the larger problem lies in the lack of evidence on behalf of the product's efficacy. While a reasonable cluster of these exists for the equine community, only two canine studies have thus far been conducted. And I’m less than impressed. Though peer-reviewed, both were undertaken by the company that holds the patent on the process (Vet-Stem): One on the efficacy of the procedure in canine elbows included only 14 patients, while the hip disease study boasted little better with a sample size of 21. Each found the statistics as favoring the procedure...but not by a wide margin.
And still clients clamor for it. Even upon learning that stem cell therapy is an expensive, hit-or-miss prospect with very little research to back up its success in dog joints, they demand it.
And why shouldn’t they? If the alternatives don’t sound appetizing and the risk of the procedure (a two-step anesthetic process for fat collection and subsequent joint injection) seems more about their wallets than its inherent dangers to their pets, I can see why Fluffy’s owners might prefer it to a full-on hip replacement. But then, we know a whole lot more about hip replacements than we do about stem cells.
Which gets me to wondering...why is the state of veterinary research in such sad shape that we have to rely on companies to fund their own studies? I understand the economics that lie beneath, but I can’t help think there has to be a better way.
For example: With as many canine patients receiving stem cell therapy for their joints, how is it that they’ve not been tracked and monitored and their anonymous data compiled by an independent source? After all, owner reluctance would almost certainly prove no barrier.
While I certainly understand the high price of conducting prospective studies, it would seem that veterinarians, owners and the company would all have a stake in furthering research and share the burden to varying degrees. I mean, how hard is it to creatively organize a decent trial...with a reasonable sample sizes...with acceptable control groups (e.g., dogs who receive NSAIDs instead of stem cells)?
It’s a problem that dogs human medicine along with our side of things. And yet it’s rare that creative solutions arise to tackle even the seemingly simple task of compiling outcome data retrospectively. And why? In my opinion it’s largely because medicine prefers to outsource the study of emerging therapies like this one to the capitalist projects perceived to have most to gain from their outcome. But this represents a catch-22, doesn’t it? Who among us would wholly respect clinical data when it’s compiled by the most financially invested party?
In Vet-Stem’s case it’s their downfall in my eyes. But it needn’t be their undoing. What would it take to require that company-certified (yet independent) clinicians collect key data points in exchange for certification? That’s how Penn-HIP works. That’s the kind of initiative some vaccine companies take before they widely distribute their biologicals.
To my way of seeing things, our veterinary research needs to get lots more creative before we can get to where we’re going with a minimum of R&D outlays that serve only to raise the price of the product at the expense of the data’s credibility. Maybe what the veterinary industry needs is the occasional workings of a practical brain to dot their DVM/VMD ranks with a dash of simple strategic thinking. Maybe then veterinarians like me would be more willing to recommend the potentially masterful bit of veterinary innovation Vet-Stem offers.
Every veterinarian gets this line. It pumps our egos and fills us with the kind of joy only animals can add to working lives otherwise filled with fearful animals who run the other way once they catch wind of us. Never mind that these animals who “simply adore” us often fall into this category, too.
“No, really. Everywhere else they’ve had to muzzle her. She must really love you.”
OK, I’ll buy it. But just barely. And only because I truly want to believe they like me better than others. After all, who among us is immune to this kind of compliment? Being “chosen” by an animal as trustworthy and likable––no, “lovable”––is undoubtedly the ultimate kind of appreciation.
All egotistical veterinary leanings aside, I do believe it’s true. Animals do like some humans over others. One of my sister’s dogs is a perfect example:
A rottie-malamute mix, he’s so wolf-like and aloof you’d never know he truly liked you except for his willingness to greet you with his modest tail wags and upturned face. But when he doesn’t like you, you know it right away. He barks and growls. It doesn’t happen often but I’ve seen it. And it’s scary. Good thing he’s immaculately trained and stands down on a quick command.
The strange thing is, we have no idea what makes him so capable of distrusting certain random individuals who seem perfectly nice to us. A smell? A sign of fear? A hesitation? When I saw it happen it was in response to a serious dog lover. Weird.
Occasionally, I can also recognize a true “click” with some of my patients. Though they mostly live in abject terror of my presence, they will sometimes pull on their leash to get to me, ignoring all others along their path. I even have a couple of kitties who love their hospital stays, their owners swearing up and down that they love to lie in their carriers when at home, seemingly begging for a vet visit.
Like other veterinarians I know in this area, I have clients that charter flights from the Bahamas to bring their pets to me. They’ll drive a couple of hours to see us. Because they claim that one of their pets will see no one else. Gotta believe it’s true or else they wouldn’t go to these lengths.
“I wish she’d see Dr. X in West Palm. He’s so much closer, but she won’t go there.”
Is it our clients who are crazy? Or is their pet's behavior truly the result of basic affinities our pets will inevitably feel? As the occasional object of pet devotion and witness to the pros and cons of their emotional behavior, I’m certainly capable of believing it’s the latter.
Yesterday’s email inbox ding-dinged repeatedly with email alerts from a variety of sources, all urging me to look into the recent American Veterinary Medical Association advisory on H1N1. The Internet is abuzz with the news: One Iowa cat was confirmed to have been infected with H1N1.
Here’s the content of the AVMA’s message:
November 4, 2009 – A 13-year old cat in Iowa developed signs of a respiratory infection after several people in the household were ill. Preliminary testing was positive for 2009 H1N1 on October 29, and the results were confirmed on November 2. This is the first report of a cat infected with H1N1. The cat has recovered from its illness.
To date, this is the first cat confirmed infected with the 2009 H1N1 virus. Two ferrets, one in Oregon and one in Nebraska, have also recently been confirmed infected with the 2009 H1N1 virus. The Nebraska ferret died, but the Oregon ferret has recovered. To date, there is no evidence that the ferrets or the cat passed the virus to people.
The American Veterinary Medical Association and American Association of Feline Practitioners are reminding pet owners that many viruses can pass between people and animals, so this was not an altogether unexpected event. We are advising pet owners to monitor their pets’ health very closely, no matter what type of animal, and visit a veterinarian if there are any signs of illness.
For more information, view the AVMA’s press release on the Iowa case or visit the AVMA’s H1N1 resources Web page.
Needless to say, this is not welcome news. Though we’d always allowed for the possibility of transmission to and from our household pets, the reality of a confirmed feline case promises to make this flu season even more difficult than it’s already shaping up to be:
more clients will call with fear-based H1N1 questions panicked pet owners might kick Fluffy out of the house for the season some might even seize this opportunity to relinquish their pets to shelters...or worse.
I’m not looking forward to it. Because when I consider how much time it takes my GP to address H1N1 concerns (I was there three hours this week and consequently managed to get a good taste of what their daily H1N1 workload is like), I’ll be worrying for my personal sanity along with my patients’ health. More so when I read statements like this one from a Purdue vet school prof (as reported by ABC):
"This could be a thing that just fizzles out but it also has the potential for huge impact," said Tony Johnson, a clinical assistant professor at the Purdue University School of Veterinary Medicine. "We have these little fuzzy things living in our house that could be vectors for nasty diseases."
All fear-mongering aside, this case does not represent a fundamental change in how we should deal with this virus. I’m still with the CDC on all their major points:
wash your hands with soap...frequently if you’re out and about or if anyone in your household is sick cough into your elbow, not your hands (please!) stay home if you’re sick get vaccinated!!
To which I’ll add: if you’re sick, wash your hands before handling or feeding your pets. Don’t cough in their direction. Treat them as you would anyone else who might be exposed to your illness. Refrain from kisses, for example, until 24 hours after your fever subsides. And if your pet does get sick, take her to a veterinarian for testing.
It’s just basic stuff, really. Nonetheless, I’ll allow that knowing our pets can become infected––which means they will likely be able to infect us, regardless of the soothing spin the AVMA wants to put on it––is a big deal. But it hasn’t yet proved it’ll change the game so much as it will the players...more of them. And that’s where I worry.
Zyrtec (cetirizine) is an antihistamine approved for use in humans to treat allergy symptoms. In veterinary medicine it’s used in both cats and dogs for the same indication...and more.
For dogs, I’ll turn to Zyrtec when Benadryl (diphenhydramine) fails. Usually, these are the itchy dogs: the hot spot-ridden, flea allergic, food allergic and/or atopic (inhalant allergic). Except in older dogs whose kidney function I carefully screen before embarking on a course, Zyrtec has proved incredibly safe and moderately effective. The ability to buy it OTC and dose it only once daily for some dogs––not to mention its less drowse-inducing action––has enlisted my fandom.
The only drawback? Its brand name version is more expensive, meaning it tends to be pricier than drugs like Benadryl. And for a drug that sometimes has to be administered for weeks on end, that’s no small factor. Luckily, it's off patent now and you can purchase generics for significantly less than the prettily packaged stuff.
Moderate dog success notwithstanding, where Zyrtec really shines is in my kitty patients. Though it doesn’t work for all itchy cats, it does seem to help quite a bit––far more than Benadryl’s diphenhydramine and significantly more than chlorpheniramine (my former go-to antihistamine for cats).
The dermatologists on VIN (the Veterinary Information Network) seem to agree: Good, safe stuff for cats, this Zyrtec. Probably more effective than the alternatives. And definitely easier because, for cats, we now know that once-a day dosing is perfectly appropriate.
The best news for felines, however, is not just that Zyrtec seems to help for their itchiness, but also that it may help treat eosinophilic diseases.
What’s that, you ask? They’re a collection of [typically] skin, airway and intestinal diseases cats suffer much more frequently than dogs. They can cause stomatitis (oral inflammation), rodent ulcers (unsightly upper lip lesions), eosinophilic plaques (crusty sores), intestinal ulceration and diarrhea, bronchitis and tracheitis and asthma, among other problems.
Lately, it’s been determined that a significant percentage of cats affected by these eosinophilic diseases respond well to Zyrtec. Complete remission of symptoms is actually possible for some once this drug is initiated. So far, this seems to be true for all eosinophilic cases save those of the respiratory variety. (Who knows why.)
A recent case demonstrates the possibilities: A cat remanded to lifelong use of prednisone for her eosinophilic skin disease (manifested primarily in her ears and intestines) was weaned off this harsh, immunosuppressive steroid while Zyrtec was initiated.
I expressed tremendous concern that all the symptoms would almost certainly return, though perhaps at a more manageable level than before the steroid usage. Yet six months later there’s no sign of a break in her remission. No diarrhea. No ear lesions. Nothing. The cat is more playful and happy than she’s ever been.
Though this case is undoubtedly not the norm, the shocking success of it speaks to the need to study this drug in more detail. Currently, most of the evidence in favor of its use comes from the dermatologic community. Too bad the now-vast supply of it is primarily anecdotal.
Luckily, the human medical community has been active in amassing literature on Zyrtec and eosinophilic diseases, leading the veterinary community to begin more aggressively employing it in the hopes that one of the most frustrating feline disease complexes we see in cats can be successfully addressed.
It’s not unusual for landlords and condo associations to be picky about pets in ways that aren’t always best for the people who love them. Pet limits on species type, their weights and their numbers are standard fare when you live in small-box, close-quarter housing. And we all get that. You can’t exactly expect neighbors to get along when someone wants to run a rescue out of his 800 sf efficiency on the top floor of a highrise.
But consider that sometimes these rules and regs go too far. So much so that they often neglect to consider the pets themselves and, consequently, what’s in everyone’s best interest––human and animal. Because, much like fences, good pets make good neighbors. And you won’t find good pets in abundance where the regulations aren’t geared to the ultimate goal: satisfying the behavioral needs of our companion animals.
I raise this topic on the heels of a recent round of condo association discussions that took place at a friend’s fancy waterfront digs. Based on the actions (or rather, inactions) of neighbors who would allow indiscriminate poopings in public spaces (sans scooping), his condo association voted to limit the number of pets in each unit to just one animal.
Grandfather clauses notwithstanding, this didn’t make my friend happy. His two pets need one another, he claims. Any two future pets would not be immune from this need. His busy schedule (and that of most modernized humans) means that keeping a minimum of two pets is essential to their behavioral well-being. He asserts that basic animal welfare principles back him up:
Pets need company. And it’s unreasonable to expect that owners live as homebodies to meet their pets needs. Not within the context of our culture. Not when the concept of conspecific housing is a basic tenet of animal welfare for so many pack or pride-based species.
In other words, such a limitation is unfair to the animals. Moreover, he rightly contends, the unintended consequences of maintaining solitary pets will make a significant dent to the comfort of the community when it recognizes that separation anxiety, much more common to solitary pets, will likely present a noise problem when pets voice their dismay at their isolation.
I wholly agree with my friend. Especially since it’s clear to me that altering a two pet rule to just one will make very little difference to the stool volume in the area as long as those who would flout condo laws on scooping continue to do so. Sometimes you just can’t regulate neighborliness.
As with so many onerous pet rules in our society, it’s the owners’ behavior that deserves to be individually addressed––especially when blanket rules would adversely affect animal welfare as a whole.
