Pets Benefit with Access to State-of-the-Art Research Studies

This entry is article 1 of 7 in the December 2014 issue

Background

Bolt, an eight-year-old German Shepherd was diagnosed in Fall 2012 with perianal fistulas (a painful opening in the skin surrounding the anus). Anal fistulas are very common in this breed of dogs and can be extremely painful.

Leading up to Bolt’s development of these fistulas, owner Paul Higgins describes Bolt’s long history of recurrent skin infections and was referred by his primary care veterinarian at Eastham Vets to a dermatology specialist at VCA in Weymouth. Dr. Loren Cohen was successful in managing Bolt’s skin conditions with cyclosporine; however, a couple years later he developed anal fistulas, which were not resolving. Dr. Cohen had heard about a clinical trial that was being conducted at Cummings School of Veterinary Medicine at Tufts University to treat anal fistulas and suggested that owner Paul Higgins meet faculty member and principal investigator, Lluis Ferrer DVM, PhD, DECVD. Cummings School is a committed part of the One Health initiative that links the human, animal, environmental and research worlds together. “One of our missions is to offer trials that are on the cutting edge of medical advancement, for both animals and humans,” says Dr. Ferrer.

Clinical Trial

The study that Bolt participated in employed the injection of human mesenchymal stem cells into and around the fistulas. The goals of this treatment are to diminish or heal the existing fistulas and either reduce or eliminate the use of certain immunomodulatory agents(a class of drugs) to control the fistulas. Side effects from these drugs, specifically GI upset, made this a less than ideal form of treatment for pets with anal fistulas.

In April 2014 Paul Higgins participated in a brief interview with Cummings School to determine if Bolt would be eligible for the study. Shortly thereafter, Bolt met Dr. Ferrer in North Grafton for an assessment, where it was confirmed that he met all the criteria to participate. Paul joked that he was so proud to have his baby get accepted to Cummings. “It was not without apprehension. We went online and while the information was very technical, I got the general gist of it. When you hear they are going to inject human stem cells into your pet, and anytime you have to subject your pet to sedation, there are worries,” said Paul.

Treatment

Less than two weeks later, Paul and his wife Christina brought Bolt for the procedure “We were a bit tentative, but from the minute we got there they put our fears at ease. Tufts’ reputation is top notch. They explained everything and we knew immediately we were doing the right thing,” continued Paul.

Dr. Lluis Ferrer administered the stem cells which were supplied as part of a partnership with Advanced Cell Technology of Marlborough, Massachusetts.

Paul speaks graciously about his ongoing communication with Diane Welsh Cummings School’s clinical trial coordinator, who called as soon as Bolt woke up to let them know all had gone well, and also recalled how accommodating they were in scheduling Bolt’s post-procedure appointments.

Outcome

The clinical trial treatment proved to be successful in healing Bolt’s fistulas. Bolt was monitored for six months, at one week, and monthly post injection. At six months post injection, the fistulas had dissipated and not returned. While the Higgins’ are pleased to have participated in this cutting edge treatment approach, Bolt is not alone with the positive outcome and relief he experienced. The clinical trial was comprised of six patients – 4 German Shepherds, 1 Australian Shepherd and 1 Australian Terrier. All have had their fistulas resolve and the medication decreased. While Bolt is continuing to receive the cyclosporine, it is being used to treat his skin allergies. Dr. Ferrer and his team are very pleased with these positive results and the potential for translation to human medicine. “This study has shown not only to be beneficial to our canine patients, but this research also has implications in helping human patients with Crohn’s disease with similar manifestations and it also has added valuable knowledge about the therapeutic use of stem cells, explains Dr. Ferrer.

Effects of anti-angiogenic therapy on mouth cancer (oral squamous cell carcinoma) in cats

This entry is article 5 of 7 in the December 2014 issue

The cancer that most commonly affects the mouth of cats is called oral squamous cell carcinoma (OSCC). This cancer is common and responds poorly to treatment. The average life expectancy for cats diagnosed with this cancer is approximately six-months. Cats may exhibit a number of problems as a result of OSCC, including a swelling in the head/throat, lack of appetite, difficulty eating or swallowing, decreased grooming behavior, excessive salivation, foul odor of breath, change in voice or difficulty vocalizing. The purpose of this study is to determine if a drug called “Anginex” would provide a safe and effective means of treating OSCC in cats. Anginex is a small protein that interferes with the ability of a tumor to make and maintain its blood supply, a process known as angiogenesis. Cancer drugs that target the blood supply of a tumor are called “anti-angiogenic” agents. Because tumors need a blood supply to grow beyond a microscopic size, inhibiting angiogenesis prevents tumors from growing and can cause tumors to shrink. Anginex has been used in mice experimentally. We have also performed a pilot study in cats with OSCC. The current clinical study in which we are enrolling cats investigates Amginex’s effectiveness on the tumor and its blood vessels and oxygen levels.

For more information regarding this study please visit: http://sites.tufts.edu/vetclinicaltrials/

Evaluating hypercoagulability (abnormal blood coagulation that increases the risk of blood clots) in dogs with brachycephalic airway syndrome: similarity to human obstructive sleep apnea.

This entry is article 7 of 7 in the December 2014 issue

The primary purpose of this study is to determine whether English Bulldogs are more hypercoagulable (an abnormality of the clotting process that increases the risk of developing blood clots within blood vessels) than non-brachycephalic dogs by running a series of coagulation tests. We are also interested in determining if C-reactive protein, a marker of inflammation and cardiovascular risk, is elevated in English Bulldogs as it is in humans with obstructive sleep apnea.

For more information regarding this study please visit: http://sites.tufts.edu/vetclinicaltrials/

Congenital Heart Defects Study: Investigating Patent Ductus Arteriosus (PDA) in Pembroke Welsh Corgis

This entry is article 6 of 7 in the December 2014 issue

Congenital heart defects occur in a variety of dog breeds, with the most common being the patent ductus arteriosus (PDA). Although this is a correctable disorder in most puppies, it requires surgery or a catheter-based procedure which can be expensive and is not without risk. Therefore, determining the genetic cause of PDA in dogs would be highly desirable so that dogs could be screened and the genetic mutation could be eventually bred out of the canine population. Corgis are a breed at increased risk for PDA’s so the goal of this study is to evaluate Corgis with and without PDA’s in order to identify the gene mutation for this heart problem.

For more information regarding this study please visit: http://sites.tufts.edu/vetclinicaltrials/

The evaluation of a palliative radiation therapy in conjunction with an oral anticancer agent (Palladia®) for the treatment of measurable cancerous tumors in dogs

This entry is article 3 of 7 in the December 2014 issue

Carcinomas are a common form of malignancy in both dogs and humans. As a category of cancer, carcinomas tend to be both locally invasive as well as carry a high risk of local metastasis (spread to nearby tissues). In cases diagnosed in early stages, long term survival is often possible with a combination of surgery, definitive radiation therapy, and conventional chemotherapy but such combined therapy is often cost prohibitive for many clients. Furthermore, surgery may not be an option for some patients. Therapy is often limited to palliative (relief of pain and symptoms)radiation therapy (PRT) +/- conventional chemotherapy. The purpose of this study is to evaluate therapy with toceranib (Palladia®), an oral anticancer agent, in combination with palliative radiation therapy for tolerability, toxicity and efficacy in a population of dogs with measurable carcinomas.

For more information regarding this study please visit: http://sites.tufts.edu/vetclinicaltrials/

Clinical Studies Provide Hope for Pet Owners

This entry is article 2 of 7 in the December 2014 issue

Many of you may be familiar with clinical trials used in treating human disease. In a similar way, veterinary clinical studies are being conducted to assess promising new treatments, drugs or procedures in animals. As in human health, participation in veterinary clinical trials is on a volunteer basis.

As an academic veterinary medical center, the faculty and staff at Cummings School of Veterinary Medicine are constantly exploring new scientific breakthroughs that have the potential to improve quality of life for your pet by providing them with diagnostics and treatments that are still exploratory and otherwise not available. This may take the form of a drug, a newly developed medical device or procedure, or a behavioral change, such as diet.

Participation in a clinical study is completely voluntarily and may offer several benefits. Clinical studies not only provide access to cutting edge approaches but also provide hope when there are few other options for treatment and may offer your pet a better quality of life or even additional years to live. In addition to the direct benefits your pet may experience, by participating in a clinical study your pet is ultimately contributing to the understanding of disease and the advancement of medicine, benefiting pets in years to come. You may be wondering how safe it is to participate in a clinical study. Rest assure that clinical studies are only made available after initial studies have determined that the treatment is safe and has potential to be more effective than current mechanisms of treatment.

Cummings School of Veterinary Medicine offers numerous clinical studies for clients of the Foster Hospital for Small Animals, Hospital for Large Animals, Tufts Ambulatory Service and Tufts VETS. Your pet will receive care from a highly specialized support team including a Principal Investigator (PI), a co-PI and a dedicated veterinary technician, who will monitor your pet’s health very closely.

Your care team at Foster Hospital can provide you with additional information on enrolling in any of our current clinical studies or feel free to ask your primary veterinarian if there may be a study appropriate for your pet’s disease or condition. You may also find details on clinical trials underway at: http://sites.tufts.edu/vetclinicaltrials/

Diabetes in Your Pet

This entry is article 3 of 5 in the November 2014 issue

What is diabetes?

In veterinary medicine, there are two types of diabetes mellitus: Type I DM and Type II DM. Type I occurs when the body doesn’t make enough insulin, a hormone that is produced by the pancreas. This form of diabetes requires lifelong insulin injections. In Type II DM, the body does not use insulin properly, a condition referred to as insulin resistance. Initially, the pancreas makes extra insulin to make up for this; however, over time it is not able to keep up and make enough insulin to maintain normal blood glucose levels. This form of diabetes also requires insulin injections and monitoring of blood glucose levels. The good news is that both types of diabetes are manageable and, if detected early, pets with diabetes can live a normal life.

Are there certain dogs or cat that are more susceptible?

  • Type I DM is most commonly seen in dogs; more typically dogs 7-9 years of age.
  • Female dogs seem to be more likely to develop diabetes.
  • Some breeds of dogs may run a greater risk, including Australian Terriers, Schnauzers, Samoyeds, Fox Terriers, Keeshonds, Bichon Frises, Finnish Spitz, Cairn Terriers, and Poodles.
  • Type II DM is the more common form of diabetes seen in cats; more typically seen in older cats, 8-13 years of age.
  • Male cats and breeds such as Burmese are over-represented.

Treatment

Treatment for diabetes differs between dogs and cats. For dogs, treatment requires twice a day injections of insulin and careful blood work monitoring. For cats, weight control in overweight cats is a big part of managing cats with diabetes, but like dogs they also benefit from insulin therapy. While some cats may go into a state of remission for a period of time and not require insulin, many of these cats often will later relapse as their disease progresses. Nutritional management in both dogs and cats is helpful in maintaining steady blood sugar levels.

Signs of Diabetes

The signs of diabetes can develop very gradually, but signs to be aware of include:

  • Increased thirst (pet may be emptying his water dish more frequently)
  • Excessive urination, urinating outside the litterbox or inappropriate urination Weight loss
  • Increased appetite
  • Blindness (seen primarily in dogs, but cats can also develop blindness from diabetic cataracts)
  • Tiredness and lack of energy
  • Urinary tract infections
  • Weakness in rear limbs (cats only)
  • Weight loss

If your pet is exhibiting any of these common signs, we encourage you to seek advice from your veterinarian as soon as possible. Your veterinarian is your resource on diabetes and can provide you with appropriate preventive tips and help in the management of the disease if your pet is diagnosed with diabetes. With the support of your primary care veterinarian, the prognosis is positive. The sooner it is diagnosed, the sooner you can begin treatment and get your pet on the road to an active and healthy life.

Holidays are Around the Corner: Watching Your Pet’s Waistline

This entry is article 2 of 5 in the November 2014 issue

Pet obesity is a growing health concern. Overweight cats have an increased risk of diabetes, liver problems and joint problems. Similarly, obese dogs are prone to diabetes, develop more orthopedic problems and arthritis. They may also develop respiratory distress and are more susceptible to heat stroke.

Keep these things in mind to prevent your pet’s waistline from expanding and to keep your pet safe:

  • Maintain a routine. Keep to a schedule of several small meals a day and make sure you are feeding your pet from a pet bowl or dish. It may be helpful to have a check off list to ensure a pet is not fed twice.
  • Provide opportunities for physical activity. While the days are getting cooler and the weather not always cooperating, taking a longer walk or more frequent walks with your dog can benefit both of you. For cat owners, encourage activity by getting him/her to run and play. Toys that encourage your cat to chase are helpful or include stairs in your pet’s playtime by getting the cat to run up and down the stairs. Whatever you choose, HAVE FUN!
  • Watch the snacks and treats. Take note of the number of calories and the nutritional content in your pet’s treats. Think about whether that single dog cookie, decorated like a reindeer or the cat treat decorated like a mouse, is worth the extra calories. Too many treats, especially high-calorie treats, can result in your pet gaining extra weight during the holidays.
  • Follow this simple rule: “Humans get human food and pets get pet food.” This can often be difficult when you have friends or family visiting. When they see a cute little face begging for food, it’s hard to resist. Remind your guests not to feed your pet and if they want to, provide them with some appropriate pet treats to share. The one exception is vegetables: celery, zucchini, carrots, and green beans can make great low calorie snacks as an alternative to fatty meats or dangerous bones.
  • Watch the crumbs. Pay attention to any foods that may “accidently” fall into your pets feeding area. Keep your pets away from the table and be conscious of where you’re leaving unattended plates of food, and remember to secure the trash.
  • Some foods can be dangerous.
    • Turkey and other bones can cause intestinal blockages and other problems for your pet’s digestive system.
    • Fatty, spicy and other rich foods can cause indigestion, sickness and diarrhea – and more serious conditions from gastroenteritis to pancreatitis
    • Onions or other alliums (i.e., garlic, leeks, scallions), in small quantities may be alright, but larger quantities can lead to toxic anemia. Be careful of turkey stuffing, which often contains onions.
    • Remember the risks of feeding your pets chocolate or anything sweetened with sugar substitute, xylitol.
    • If you pet does ingest anything toxic, call your veterinarian or poison control immediately.

We all want healthy companion pets. By following these simple tips, you’ll be assured that you are doing everything possible to help your pet during a time that is just as tempting for them as it is for you.

Quick Action and Teamwork Lead to Happy Ending

This entry is article 5 of 5 in the November 2014 issue

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Background

When Oliver, a 4-1/2-month-old golden retriever puppy arrived at Foster Hospital for Small Animals at Cummings School of Veterinary Medical Center at Tufts University, he had been vomiting for two days after breaking into the trash can. “You could tell he wanted to lie down, but couldn’t; he was stretching out his neck looking very uncomfortable,” owner Carrie Alward recalled. She knew something was not right and brought Oliver to a local emergency clinic. The x-ray was inconclusive, but they suspected he had acquired a gastrointestinal infection, and sent Oliver home that evening. After 36 hours with no improvement, Carrie brought him to Foster Hospital in search of a second medical opinion and was hopeful that specialists from Tufts would collaborate to diagnose and ultimately treat her Oliver. Emergency room veterinarian, Dr. Tiffany Jagodich was immediately concerned with the seriousness of Oliver’s illness. She started him on intravenous fluids and medications (pain relief, antacids, and anti-vomiting medications) and transitioned him to the ICU for ongoing treatment and further diagnostic tests, where he was placed in the care of Dr. Scott Taylor.

“Oliver was in extreme pain and unable to rest, remaining standing in a hunched position. He was one very sad puppy,” recalls Dr. Taylor. Standard imaging techniques, including x-rays and ultrasound were again inconclusive. Foster Hospital’s ICU staff, however, recommended and discussed additional diagnostic options with Carrie Alward. Ultimately, the doctors and Alward family decided to pursue a CT scan for Oliver, which would require anesthesia. This more advanced diagnostic test revealed a bamboo skewer (teriyaki stick) vertically piercing from Oliver’s stomach through his esophagus and into the muscles under his spine. It’s no wonder that Oliver was so uncomfortable. Carrie received a call from Dr. Taylor who described the dire situation — one that would require surgery. Although the doctors were hopeful that they could successfully remove the skewer and repair the internal damage that it had done, the Alward family was also prepared for the worst.

Oliver’s case is a true testament to the teamwork and collaboration that happen every day at Foster Hospital for Small Animals. Drs. John Berg and Harpreet Singh, soft tissue surgery specialists, in conjunction with radiologists Drs. Dominique Pennink, Trisha Oura and Josh Hobbs, and board-certified anesthesiologist Dr. Lois Wetmore were consulted by the ICU team to discuss the best approach and management for this very precarious injury. In the end, it was the collaboration and joint care of the entire team of veterinary specialists under one roof that would ultimately save Oliver’s life.

Multiple procedures were required — first abdominal surgery, followed by thoracic surgery and then incision repair to both his stomach and esophagus. A portion of his lung was also removed and a specialized feeding tube placed in his stomach to bypass the esophagus during his recovery. This was a very complicated procedure, one that required the skilled expertise of veterinary specialists with advanced training in surgery and anesthesia. . In spite of the potential risk of complications, Oliver had an excellent recovery while being intensively managed by Dr. Kristina DePaula during this ICU stay. Nutritionist Dr. Lily Johnson was also consulted during the recovery period to ensure Oliver’s nutrient requirements were met.

Oliver was discharged on a Sunday, four days after his surgery, and continued to receive stomach tube feedings. When the tube was removed 15 days later, Dr. Johnson instructed Carrie on how to transition to regular feedings and the best foods to provide a growing puppy. This was not Carrie’s first encounter with Foster Hospital. The team had previously cared for another of Carrie’s doggie’s, who had suffered with bone cancer and she speaks of how wonderful they were then. This time was no different. “The Tufts team of doctors and staff held my hand through the entire process. Dr. Depaula, in particular, was there for me and for Oliver, explaining everything so that I understood exactly what to expect” recalled Carrie. “It’s frustrating that they didn’t do more thorough diagnostic testing when I brought Oliver to the local emergency clinic for the initial evaluation,” said Carrie, disappointed that she hadn’t first taken him to Tufts.

Not only does she sing the praises of the Foster Hospital’s team of veterinarians and staff who provided such compassionate care for her sweet Oliver and saved his life, but she will also shout from the rooftops the importance of keeping barbecue skewers out of the trash. Now two months later, “Oliver is thriving, growing and doing everything he should be doing…just like his brothers and sisters are,” according to Carrie.