Dear Dr. Hershey,
What are some of the best advancements you’ve seen in veterinary medicine recently?
Brad from St. Louis Park
I received this very thought provoking question and it took me a while to narrow down what I thought were “game changers” in the world of veterinary medicine. This list is definitely debatable. If you were to ask 10 different veterinarians, you would certainly not find agreement. But here goes, my top five treatments that have changed the world for animals recently.
1. Pimobendan: This heart medication helps the heart pump better in cats and dogs with congestive heart failure. A recent article in the Journal of the American Veterinary Medical Association (JAVMA, Sept 1, 2014), showed that Pimobendan increased survival times in cats with congestive heart failure quite significantly. In this study, the median survival time for cats receiving Pimobendan was 626 days, compared with 103 days in the control group. What an amazing difference! In my clinical experience, I have found that both cats and dogs that receive Pimobendan remain stable for a longer period of time and have an improved quality of life.
2. Apoquel: This allergy medication is both a blessing and a curse. For cats and dogs with allergies, relief has often been difficult to find. For the lucky ones, antihistamines like Benadryl are enough to help stop the itching. There are other animals however, that truly suffer from this disease. Their skin is constantly inflamed and they often will have secondary yeast or bacterial infections.
The typical treatment options we are steroids (lots of side effects), allergy shots (can take months to start working), cyclosporine (takes weeks to start working) or very frequent shampooing and topical cream application. Recently, the veterinary world received Apoquel. This allergy medication works immediately with less side effects then steroids. (Of course, it’s not side effect free. Most veterinarians recommend checking blood cells and liver and kidney values every three to six months). The kicker, however, is that it is only made in one factory and France, so it is very difficult to get!
3. Homemade diets: Manufactured pet foods have made pet ownership incredibly convenient. Most animals do great on the wide assortment of pre-packaged, balanced, affordable diets that are available over the counter.
There are some patients however, that just do not tolerate a manufactured diet. These are the pets that despite many trials of limited ingredient or hypoallergenic packaged foods still have chronic skin or ear problems, vomit, or have diarrhea, or just plain don’t feel good because of a constant belly ache. For these patients, a homemade diet can turn their life around. It is very important that if you plan on cooking a food for your pet, that you ensure that their food is balanced with the essential nutrients they need. This is especially true for cats that lack certain enzymes in their liver for building essential amino acids if it is not provided in their food. I recommend the website balanceit.com. This website was started by a veterinary nutritionist. The recipes are simple, and you can purchase the supplements through their website to add to the diet made at home.
4. Acupuncture: Although acupuncture itself is not new, its use in animals has increased dramatically over the past five to 10 years. The reason I think acupuncture has taken so long to be accepted as a treatment tool for animals and western medicine in general, is because we still don’t understand why it works for some patients and not others.
I have had patients in such severe neck pain that they literally can’t move, get up and walk out of the clinic after an acupuncture treatment. I have also had the experience that acupuncture did nothing, or worse, seemed to make the pet more tired and sore after procedure. I have been trained in medical acupuncture, so I attempt to choose needle placement sites based on my knowledge of anatomy and nerve function. Yet I still can only report about a 30 percent success rate. For those patients that are acupuncture responders, however, this treatment can mean getting off of other medications and a return to a normal quality of life.
5. Multi-pronged approach to arthritis management: Arthritis in dogs and cats is incredibly common. The good news is that we have gotten so much smarter about managing arthritis pain in our patients.
The key is to not assume one treatment will fix everything. Pets with arthritis pain need to have nutritional counseling, moderate exercise (never to the point of increased lameness), massage and gentle stretching, acupuncture and a combination of medications that make sense for the patient’s condition. I often use an anti-inflammatory (like Rimadyl for dogs and with caution, Metcam for cats), gabapentin (which acts in the central nervous system to help turn off chronic pain pathways), tramadol (an opioid like drug) and Adequan injections (which help promote cartilage growth). On the onset, it can seem like a lot, however using a smaller amount of several different medications is often better tolerated with less side effects then trying to use just one.
Dr. Teresa Hershey is a veterinarian at Westgate Pet Clinic in Linden Hills. Email her your pet questions at firstname.lastname@example.org.