Ask the Vet
Ask the Vet
How Internal Medicine Helps Your Pets with Dr. Dennis Slade
In this episode of Ask the Vet, Dr. Ann Hohenhaus speaks with Dr. Dennis Slade, Department Head of Internal Medicine at the Schwarzman Animal Medical Center, about what veterinary internal medicine really means, and how specialists like him help pets with complicated or chronic health issues.
Topics include:
· What veterinary internal medicine treats
· How AMC’s collaborative care model improves patient outcomes
· The surprising things pets swallow and how endoscopy helps get them out
· How veterinarians address multiple diseases in the same patient
· Ways pet owners can prepare for a specialist visit
· The future of veterinary medicine, from artificial intelligence to microbiome research
Also on this month’s show:
· Viral trending animal story about twin eastern box turtles successfully separated after hatching conjoined in Virginia
· Animal news including the dogs guarding endangered penguins, “gifted word learner” dogs that understand toy categories, and the rats trained to detect landmines and tuberculosis
· Pet Health Listener Q&A: Managing pets with both heart and kidney disease, preventing feline stomatitis after calicivirus infection, and understanding inflammatory bowel disease in dogs
Do you have a pet question for Dr. Hohenhaus? Email askthevet@amcny.org to have your question answered on Ask the Vet's Listener Q&A.
We want to remind our listeners that this program is for informational and educational purposes only, and not intended to substitute for professional veterinary medical advice, diagnosis and treatment. The Animal Medical Center does not recommend or endorse any products or services advertised by Sirius XM. Welcome to Ask the Vet with Dr. Ann Hohenhaus. This is the place to talk about your pets and get advice for the top veterinarian from the Animal Medical Center in NYC. Hear from the leading authorities on animals and ask your questions. Now here's your host, Dr. Ann Hohenhaus. Hello everyone and welcome to the October Ask the Vet, the podcast for people who love their pets and want the latest in animal health and news. I'm your host this month and every month I'm Dr. Ann Hohenhaus. senior veterinarian and Director of Health Information here at the Schwarzman Animal Medical Center in New York. And that's where we're broadcasting from today. We're going to talk about internal medicine today, a specialty that focuses on diagnosing and managing complex and chronic conditions in pets. Here at AMC, our internal medicine team works closely with primary care veterinarians and our other AMC services from cardio to surgery to oncology to provide pets with comprehensive health care. To help us explore this topic, I will be joined today by my colleague, Doctor Dennis Slade, head of AMC's internal medicine service. I look forward to speaking with him about what internal medicine encompasses, when pets may benefit from seeing a specialist, and how collaboration at AMC makes a difference in patient care. Remember, the Schwarzman Animal Medical Center is the only level one veterinary trauma center in New York City, and we have 115 years of being the very best place for your pet. If you're seeking advice on maintaining your pet's health. I'm here to help. Just send me your questions to ask the vet email, which is cleverly ask the vet at AMCNY dot org, and I'll answer your questions on next month's show. If you didn't catch that or didn't have a pen or pencil, you can get it during the break. And I'll give it a couple of more times during today's show. And now it's time for our trending animal of the month. It's time for the internet's most talked about animal. Veterinarians in Virginia recently faced a case unlike anything they'd seen before, from a single egg to eastern box, turtles hatched, connected at the yolk sac. Now, most of the time, you don't see turtles hatching. But in this case, the mother turtle was already under the care of Southwest Virginia Wildlife Center in Roanoke, and she was being treated for an ear abscess. So staff were closely watching as the nest began to hatch. And when this pair of twin turtles struggled, veterinarians performed a delicate surgery to separate their yolk sacs. Each hatchling weighed barely three grams, about half the size of their siblings. Now I'm thinking that three grams doesn't mean much to my listeners, but for reference, a raisin is about a gram. So that tells you that these little turtles were about the size of three raisins combined. So back to the turtle story for recovery. The tiny turtles were placed in makeshift cradles, which were shot glasses lined with damp paper towels that kept them stable and upright. Conjoined twins are extremely rare in turtles, estimated to be about 1% of all hatchlings, and that, surprisingly, most of them don't survive. These two little guys remain fragile, but with care for monitoring, the critical milestone will be whether they can begin feeding on their own and continue to grow. And if they do, they May 1st day make it back into the wild. Now I'm excited to introduce today's guest, my colleague Doctor Dennis Slade. Doctor Slade is board certified in small animal internal medicine and is the head of the Internal Medicine service here at the Schwarzman Animal Medical Center. Doctor Slade earned his veterinary degree from Cornell University and completed his residency in internal medicine at the University of Pennsylvania. Over the course of his career, Doctor Slade has cared for pets with a wide range of complex conditions, including liver and kidney disease, endocrine disorders, and gastrointestinal problems. At AMC. He leads our internal medicine team, working closely with colleagues in other specialties to provide pets with comprehensive and collaborative care. So, Dennis, thanks so much for joining me today here on Ask the Vet. Oh, it's a pleasure to be here. And I'm so excited. So I always like to find out what kind of pets my guests have. So can you tell me about what little creatures you have at home and then are there any of these pets that have really influenced your pathway in veterinary medicine? Absolutely. Well, my wife and I always keep a menagerie of hard luck rescue animals. So there is usually room in the inn for one more. But currently we have two small dogs. One is a little angry fluff named, Ruthie, who's about six years old. And then our newest addition is about a three year old scruffy dog named George. And I'm also, I'm a proud owner of a about 16, 17 year old, old timer cat named pooch. So, which is Italian for stinky, which was the best description of him when we adopted him? But throughout the years, I've had many animals and, if I look back, I think one of the the very seminal moments that really concretized my wish to become a vet was a cat that I had as a child who actually got shot, by the, in the neighborhood. And it was through that process of finding him and in a state of distress and really wanting to learn everything that I can do to help and save him really solidified my, my wishes to, to continue this on as a profession. What kind of cat was it? He was just he was just an orange cat. And, sadly, just an orange cat. Orange cats are the best. Oh, well, my parents said just an orange cat, but, we called him, Willie for, actually, for embarrassingly long time before we realized, that he was actually a wilhemina. So also, was a learning issue for me. As I started my veterinary journey. But, you know, there were a lot of, a lot of cats that start out as Willie and become Wilhelmina or vice versa. Very difficult, especially in baby cats, to tell the difference. Sometimes my fosters I have to look at and look at again, and then go back to the SPCA and say, guys, I think that this might be a girl, but I'm not 100% sure, you know, because they're tiny. So you're not alone in that mistake at all. So since we're talking about internal medicine today, I think that, the listeners who might want to know what internal medicine is, because my regular doctor, who I see for routine health care, is an internal medicine person, but she's not quite the same as how we define internal medicine at AMC. Yeah. So it's it can be challenging to to try to explain to our clientele or the role that we inhabit. And so, as you had mentioned in your introduction, internal medicine, specialists primary role is in the diagnosis management. And often multidisciplinary treatments, across other specialists, of conditions that we see in animals across all of the, of the spectrum of age. Probably dealing with a lot of elder care as well. But we are the people that try to figure out what's going on, to try to get, our patients where they need to be. If it's with another specialist and often are trying to cross coordinate care across several specialties. I often joke that I'm the cruise director of my patients because I need to interact with, often a surgical service or a cardiologist in order to optimize, great health care for and health care outcomes. So, I have to say that the my introduction and your comments focus on elderly pets, but the reality is you guys see a fair number of young pets who come in and you see them because of of your skills with endoscopes. You want to talk about why why, someone might see you even with a young pet only. And mostly because of of your endoscopy skills. Sure. So that's a that's a fair point. It's not just older animals that we take care of. It's animals across the spectrum of age. But part of being an internist is utilizing a lot of the diagnostic tools that we have available for us. And that will include endoscopy, cystoscopy, bronchoscopy, really anything, that involves putting a scope, be it rigid or flexible, inside an animal, for a diagnostic or a therapeutic outcome. And so, yes, for young animals, it's not uncommon that we get called to retrieve foreign bodies, something that a naughty dog has eaten, like a pair of socks, two rubber bands or hair ties and cats. And even helping out sometimes our colleagues and exotics with, removing screws or other piece of hardware from chickens or exotic birds. So, the hair tie thing in cat is just stunning to me. One of my oncology friends was teaching a class at a university and physical exam, and she took her own cat in because, well, that's that's what happens to your pets when when you're a teacher is they become teaching pets. And the students said, we feel this mass from we don't know what it is. And so she said, well, I thought it was probably going to be the kidney. And it wasn't the kidney, it was the cat's stomach. And when they radiograph the cat or did an X-ray in the cat, there was the classic appearance of hair ties. Now this friend's daughter was an ice skater and the daughter kept saying, mom, I need more hair ties, I need more hair ties. And it turns out that the daughter was not losing the hair ties, but in fact, the cat was consuming the hair ties faster than the mother. My friend could purchase hair ties and so they had to take all the hair ties out of the cat. But that is not unusual for us at all, is to see a cat with a stomach full of hair ties, which I mean one. Okay, fine. But I mean like lots of hair ties. So note to our listeners is if if you're blaming your daughter for losing her hair ties, think again. And check with the cat. Because the cat may be eating hair ties, missing things end up in pets very, very commonly. So what's the craziest thing you've taken out of a pet? I have taken out all sorts of clothing materials from socks and shirts and underwear. I have removed, rings, including wedding rings and engagement rings. Hopefully repairing a relationship that otherwise might have gone awry if I wasn't able to recover it. Razor blades, fish hooks. Boy, you can see so many different things. I'm always surprised at what I pull out. And I think one, incident that I really remember was, knowing that a Great Dane had ingested something and you could see on the X-rays that there was definitely something abnormal. And with, the endoscopy, I got a hint of what it was, and people were in the room watching me, and I was able to remove it headfirst and like a magician pulling a rabbit out of the hat, it was indeed a rabbit. And I said, Tad, as I pulled it out of the mouth and everyone clapped. So you never know what you're going to get into. Oh, do you mean a stuffed rabbit? Like a toy rabbit? I was going to be a real rabbit. And then to observe about a great day. So if you're missing something and the pet's not quite right, please confess to the doctor that you see that you're missing half a ball. The favored bunny toy that the pet has. Because they will somehow some pets will eat almost anything, that that they happen to come in contact with. Okay, that was fun. But we digress. So one of the things that I think our listeners might want to know is when would I make an appointment to see someone like you, Doctor Slade? How do I know my pet needs an internal medicine specialist? Also, a great question. I think that there's, the most common route to see me is through a referral. And so that is working with your local veterinarian, your general practitioner who does the majority of the heavy lifting of basic care and preventive care. But if we get to a point where we are, concerned about one or more diseases, but haven't really diagnosed the problem yet, or if we feel that we need advanced testing to to sort things out or we have, uncovered one or more diseases that we need a little bit of help in managing. That's when we would come to see me so. Or my peers. So again, we manage a lot of complex conditions, often coexisting in the same patients. And we play that role to work with the primary care veterinarian or your general practitioner. And there are some cases that we will manage primarily. And again, these are usually very critically ill patients to try to get them through that period of, of of illness, to try to get them into a more stable position where then we can continue to, to share, management of the case. Some cases will come to us primarily or directly through our emergency service if they are very sick and fit that the type of criteria that I had discussed. So I think that's an important thing, for listeners to understand is if your vet says you regular vet says go see an internal medicine specialist, they they've made an assessment that that's important. But if your pet's really sick and you think you need to go to the ER, then the ER will help sort through that urgent situation and say, oh no, your pet's sick because it is bloated and it needs a surgeon, not Doctor Slade or one of his colleagues. And if the pet has chronic vomiting and diarrhea then they might say, oh, you need the internal medicine service because they're the ones who are going to sort through the many causes of vomiting or diarrhea. So just like Dennis, how did you describe yourself not as the oh, the cruise director. So er is also kind of like a cruise director and none of us like to go to the ER. Meaning I've been to the ER a number of times myself. But the reality I don't, I don't like to go because it's all strangers. It's not doctors that I know, but the reality is the er is a really good cruise director for that emergent pet, and we'll direct them to the right group within the hospital where, whether it's Dennis's group or the surgical group or some other group. So as much as we all cringe at the thought of VR, they are really good cruise directors in figuring out what direction that pet needs to go. And it might be Dennis. And so Dennis and the internal medicine team see both outpatients and hospitalized patients. So you might get to Dennis not knowing you're getting to Dennis. So what's the most common kind of condition that you and the internal medicine team treat. So I would say the most common is probably still a quite a lengthy list. But the types of conditions that we manage will include endocrine diseases, which can range from thyroid conditions to adrenal gland conditions to, pancreatic conditions. We also will deal with chronic diseases of the GI tract, chronic respiratory or lung disease, including bronchitis and asthma. We will deal with, chronic kidney disease or really even acute kidney disease. So if they are kidney issues, liver issues, urinary issues, the fact of the matter is we probably have our hands in several pots. Really, any organ is fair game. For a type of condition that medicine will help manage primarily or co-manage with other specialists. So I think the easy way for the listeners to grasp what internal medicine takes care of is, if you look at one of those kind of diagrams of the inside of an animal with the skin off of it, anything you see on the inside of the animal is what the internal medicine people take care of, which is probably why it's called internal medicine, because it was on the outside, it would be called dermatology. Right. So so think about that is, if you think your pet has a problem on the inside, it should go to internal medicine. So talk about how you are different but complementary to the primary care veterinarian or the vet in the neighborhood or your regular vet. However, people define that veterinarian. So I think that our roles are both integral but overlapping. Which is to say that within my specialty, I am not practicing a lot of general wellness, preventive and primary care. However, I rely on the general practitioners to help execute some of the long term plans that I may recommend for cases that we share. As well as I rely on the primary clinician or the general practitioner to also help gate keep for me trying to, send the patients that are appropriate for my skill set and for example, making sure that a lameness isn't an orthopedic issue where I am not as robust in my skill set, but it might be an immune mediated joint issue. So it's really important for me to work hand in glove with the the primary care team in the community to make sure that we are really maximizing, our, our skill sets, respectively. So then to accomplish your goal of managing these complex patients, we've talked a little bit about the tools that you rely on, which is endoscopy, bronchoscopy. But also there's other diagnostic things that you use. So do you want to talk a little bit about the tests that and other diagnostic things that internal medicine will use? Sure. So there's still a lot of blood work and urinalysis and blood testing that we will utilize, including, sometimes more esoteric tests to screen for infectious diseases or to evaluate, for endocrine dysfunction. And so there are some, still a lot of our bread and butter will be diagnostic tests that involve blood or urine screening. But we also rely heavily on imaging modalities, including X-rays, ultrasounds of of the belly or the chest, CT scans, MRI's, as ways to better understand what is happening in our patients. And then in terms of more, let's say more invasive, procedures, we had mentioned scoping as a broad category of, of, of diagnostic tests, but we will also utilize, procedures like bone marrow aspirate. So if we need to sample the bone marrow joint taps to evaluate joint fluid, lung washes, again, to evaluate, for certain pulmonary diseases, and depending on what each individual internist does, sometimes we also delve into the world of laparoscopic biopsies. If we have advanced training in that. So it really is quite a number of procedures and technologies that we need to be aware of in order to make the best diagnostic and treatment decisions for our patients. Also throw in fluoroscopy, which is moving X-rays. So we have quite a tool chest to choose from. Well, and I think at AMC we have a I don't know maybe I'm thinking we have a bigger than average tool chest here. Yeah. We're very lucky to have both a CT and an MRI. We have endoscopy doesn't involve just one endoscope. How many do you think we have? Closet full of about 8 to 10. Yeah. So because the one of the things about veterinary medicine that's so different than human medicine is our canine patients, not so much cats. Cats are much more uniform, but dogs can range from 2 to 200 pounds. And so there's no species that has that degree of variation. And here at AMC we see dogs that range from 2 to 200 pounds. So, even though a lot of people think New York City would have all small dogs, we see a good number of large dogs. And so we have to be prepared to take care of all those different sized animals, because we never know what's going to walk through the door. Actually. So internal medicine involves chronic and complicated conditions. So how do you help owners navigate through what can be sometimes a long and emotionally stressful diagnostic process? I think that, it is really important that internists are able to communicate well with owners, to try to bring them up to speed with what we think is happening. Likely outcomes with likely plans put into place. And part of that discussion is under a larger category of what we call goals of care. And that's an honest discussion about what resources we have available, be it emotional, financial or otherwise, which allows us to make decisions for the well-being of, of the patient, hearing owner's goals about what does or would not constitute a good quality of life for their patient, and trying to figure out the most appropriate action steps. Because internal medicine is often predicated on multiple steps of testing, retesting, evaluating response to therapy, they can be very long and intensive relationships. And so you really have to be able to communicate well both ways and hear and listen well, and build trust with our clients, because everybody that comes in to see me is worried because their their pet is sick or unwell or has the potential to be unwell. And so that automatically sets a different paradigm than, what if I were seeing, a vaccine appointment or a healthy pet recheck? The stakes are often very high emotionally, and I think it is our job to be advocates for our patients in the best way that we can. And for my perspective, being an advocate is not always getting the answer to everything. And my perspective. Being an advocate for the patient is doing the best we can for that patient and that owner with what resources we have. So in that answer, I heard some advice that would be great for pet owners. And how I heard it was if I was going to see Doctor Dennis Slade, I would need to have certain things that I thought about in advance so that I could help Doctor Slade help my pet the best. And I heard things like, know what it is that you want for your pet? What are your goals for that pet? And if a client thinks about those goals in advance, that's going to help you do your job right? If they can articulate those goals, absolutely. And that is often an evolving conversation along the the journey that we have together and reassessing what our goals are checking in. How are we doing at home... We started this journey thinking one thing, but here is the reality of how our pet is feeling. Is this, good enough? For quality of life? Are we worried that our quality of life is becoming diminished? How can we try to improve this? So much of internal medicine is communications, and I think it is really, of course, every every specialty needs to be excellent communicators. But because we deal with a lot of unknown and a lot of variability, and even if you make the diagnosis, it does not guarantee that the outcome will be what you expect. There really just needs to be a lot of empathy and compassion and advocacy on my end. As well as a client's end, to, to make sure that we are both on the same team, which is usually the case, and that team is being an advocate for the patient or pet, in front of us. So what else? If I'm make an appointment with you? What? What would you tell me? You would like me to come prepared with that would make that the best make this the most special specialist visit they could have in addition to showing up with their goals, that that would be one thing. Showing up with your goals, making sure that any records are sent ahead in advance. Often we will need to go through months, if not years of medical records to make sure we have a sense of what's been going on historically. And, well, we can get this information most of the time on our own. Sometimes we really rely on donors to help close any gaps that we have remaining. I think it's important to come with a and a framework of listening, these are appointments that generally take a longer period of time. And so if, if I walk into an appointment and a client is saying I need to leave in 15 minutes, it's often not going to be as productive as it should be. With the advent of technologies that help with transcription of medical notes or using phones to record conversations or jotting down notes, often we will need to repeat main points that we've discussed, and I don't expect owners to absorb it all and retain it all at once. So having a mechanism that you can reflect on the notes that you have taken is important. And there needs to be, again, that open dialog of what our goals are and it does not always mean, finances, but because we have so many resources at our disposal, it helps me figure out the best way to advocate for that patient if I know what an owner is. Rough budget is if I know what their relative risk aversion, is in terms of doing more invasive diagnostics, is that something we can do or we really can't do? Sometimes that even comes down to an open discussion of any religious or ethical beliefs that might help me understand how I can be an advocate for for the patient in front of me. That's a great list. And we'll call that the making a specialist visit specialist, because that that I think if pet owners came with that, it really would be such a worthwhile thing. So we just have another minute or so left. Can you talk about where you see veterinary medicine going over the next 10 to 15 years? Absolutely. I think that, I'm very excited to see where technology helps augment our skill sets. And so there's a lot of discussion about how we can utilize AI to make us better doctors, whether that's from data collection systems. So we can do better research to helping to make our days more efficient with note taking to AI programs that might help us pick out changes in blood work or on imaging, in patterns that we may not see. I think that the role of AI is really ripe ground and fertile ground for growth in so many professions, but particularly in veterinary medicine and internal medicine. As part of that, we have newer technologies that are being unfurled every day from better understanding of, genetic tests to allow us to understand the microbiome. All of the bacteria and viruses and fungi that make up our normal gut population or even populations within our nasal passages or, so much, so much is being looked at how the role of our, our microbiome may affect every other organ system. And I think we've only scratched the surface of how, for example, gut health may rely, or affect cardiac health and brain health and so on and so forth. And I'm really excited to see not just how the technology helps us over the next years, but each generation. As an educator, I am always really, kept on my toes with training young vets because there's just no end to the curiosity and the questions and the drive that I see and some of our younger generations to help, really advance the practice of medicine and our sphere. So those are the things that I look forward to. So I think that that is a great note on which to end this conversation, but I'm just going to give you a little hint that stay tuned, because I have a surprise for you during the question and answer period. If you'd like to learn more about AMC's internal medicine service and the care available for pets with complex medical needs, you can visit our website at amcny.org backslash internal medicine. One word. Thanks so much, Dennis, and I look forward to seeing around the hospital like we do almost every day. Absolutely. It's been a pleasure. I know that keeping your pet healthy is very important to you. And with that said, I hope that you will reach out to me if you have a question about your pet's health, I'll respond to your question on next month's Ask the Vet podcast. And all you have to do is email me at Ask the Vet One Word at amcny.org. We have a short break coming up, but stay tuned because we've convinced Doctor Slade to stay and answer the questions today, which are all about internal medicine. Okay, we're back with Dr. Ann Hohenhaus on ask the Vet. So thanks everyone for joining us again here on asks the Vet. And now it's time for our listener questions. And I am absolutely thrilled to have Doctor Dennis Slade here, who's stayed on from our first segment. And he's going to answer the questions today. Lucky they're not questions about surgery. The first question we have is from Jennifer F in Manhattan. And Jennifer says, my dog was just diagnosed with heart disease and kidney disease. Note to listeners that this is the kind of complex problem that Doctor Slade was alluding to earlier in the show. And so Jennifer's question says, how can one be treated without making the other worse? Well, that's a really great question. And that's often a very real, every day challenge in general. Why we care is that the treatments for both kidney disease and heart disease are often diametrically opposed. And what I mean by that is with kidney disease, we want to make sure that our patient is adequately hydrated, so that we have good and ample blood flow to the kidney, especially if it's failing and not doing as good of a job as it should in filtering and helping get rid of waste products. Whereas with heart disease, we worry that too much fluid in our, in our body, causes the heart to have a harder time, handling too much of a blood supply effectively circulating, and that can lead to congestive heart failure. And so the treatments for congestive heart failure are to actually dehydrate you, to give less blood volume for your, your, your heart to pump with. So the good news is, is that for many patients, we can manage with a middle ground and keep both the kidney and the heart happy. The challenge becomes, if we are really in a state of extremity, in, in the, in, in terms of congestive heart failure, or if we have a significant and rapid decline in kidney function, and that's when it becomes really a balancing act. And it's often predicated by what is going to be the best to set of decisions for that patient's comfort. And that can be a really challenging condition. But thankfully, we try to avoid that clash. That can often happen for as long as possible. And there are some newer drugs and medications that we are using, and even more on the horizon that might help in the treatment of both kidney and heart disease. So it's one of the things that we're looking forward to as technology advances. Okay. So our next question is from Maria in New Jersey. And Maria says my cat has calicivirus and I know that can be linked to stomatitis. How can I help lower the risk of stomatitis developing. And he also had a nasal polyp removed. Could that come back? And is there anything I can do to reduce the chances of the nasal polyp coming back. So that's a that's a like four questions. And what that. Yeah. Tell me if you want me to give you one at a time. Well as far as calicivirus is concerned and this is a fairly common virus that many cats have exposure to and will often get sick from. But get over this infection. It usually manifests as upper respiratory signs. So in addition to fever and lethargy, we can have oral ulcers and lingual or tongue ulcers as well. Now, chronic stomatitis or inflammation of the the mouth tissue can be linked to calicivirus. But not every animal that has calicivirus will go on to develop really severe forms of stomatitis. Unfortunately, there is a limited role for treatments with antivirals for calicivirus. And there are some medications that help modulate the immune system that may be effective in very severe or chronic offender cases. But because there is so much complexity in why some cats develop stomatitis, it's not just viral disease. It's, I think, brushing your cat's teeth and trying to maintain a good oral environment is key to try to prevent these types of relapses. Nasal pharyngeal polyps or nasal polyps is an adjacent issue. And we can see benign growths that can develop from the inner ear of cats that are often associated or thought to be associated with chronic viral disease. But even that has not been proven definitively. The good news about nasal polyps is that they can be removed non surgically most of the time, but there is a chance that they can come back. If we do have a cat that has chronically recurrent nasal polyps, there are some more definitive treatments which are surgical. But but in my experience, thankfully we're able to give a lot of relief for cats that may have very congested nasal passages, with, polyp removal, which is something that we can do. And this fits right in with what Doctor Slade was talking about before, because oftentimes they will use their endoscopes to help them facilitate removal of these polyps, or at least seeing where the polyp is and where it's coming from. So this is definitely another one in the purview of internal medicine. And our last question is as well. And this question comes from David C in Brooklyn. And David says my six year old lab has had bouts of vomiting and diarrhea off and on for nearly a year. So fits right in with what Doctor Slade talks about as chronic. We've tried diet changes, parasite treatments and even medications and that helped for a while. But the symptoms always come back. And now she's losing weight. Yikes. Our veterinarian mentioned inflammatory bowel disease. How is that diagnosis confirmed and what does treatment usually involve long term. Great. Well, I'm glad that I have about an hour and a half to answer this question. But it is also a very common reason why pet me, which is for chronic GI issues. The short answer is that we still have a lot to learn about why some cats and dogs develop chronic GI inflammation, but I think their most evidence points towards that complicated interplay between the immune system of the gut, the food that's passing through, and the bacterial or GI biome, which I mentioned before. Very complicated dance between communications of all of these three players. And we worry that with some of our inflammatory diseases, there's a loss of the normal communication between these, these parts of the story in very short answer, inflammatory bowel disease, which should be really reclassified or recalled chronic and to rapacity and to RA apathy meaning problem with the GI tract. And we're dealing with chronic GI issues. Can often be divided into food responsive categories, categories that require steroids or medications to modulate the immune system, and as well as patients that respond to changes or manipulation of the gut biome with the use of medications like antibiotics, but also prebiotics and probiotics. In order to make a diagnosis, we do have to rule out all other causes of vomiting and diarrhea, which can be an expansive list. And so it's a discussion with an owner of how much testing to do that. We also need a biopsy to prove that we're dealing with an inflammatory process. And so this is a longer conversation that often is, tackled in multiple parts with a veterinarian and may not be accomplished at one visit. And it speaks towards the need for relationship building with our clients, because we may try a couple of things at first, and then maybe something works and that's great. But if it doesn't work, we need to have a game plan of how to move the move to the next step. So chronic interrupt pathway or chronic GI disease is a very common issue and would be a reason to see an internist. So that's our last question for today. And I want to thank Doctor Slade so much for staying and answering these questions from the internal medicine perspective. It's been a pleasure. And now it's time for the animal news. It's time for animal headlines the biggest animal news from across the world. I just returned from a trip to Australia, and one story I heard there really stayed with me on Middle Island, off the coast of Warrnambool, which is amazingly spelled Warrnambool in southern Victoria. There's a colony of little penguins on this island, and the colony was on the verge of collapse, so that by 2005 only ten breeding pairs of these little penguins were left. And what happened was that when the tide went out, foxes could cross over to the island on land and would get onto the island and raid the penguin nests and eat the penguin babies and eggs. So the Warrnambool City Council worked with local partners and tried a very bold experiment involving dogs. They brought these big white dogs called Maremma dogs, which are livestock guardian dogs, and they kind of look like Great Pyrenees because I've never seen one of these dogs except in pictures. Normally these dogs protect sheep from wolves, but they trained these dogs to guard these little penguins. The presence was enough to keep the predators away. And since then, the Middle Island Penguin Project has become a model for conservation. Credited with reviving this colony to several hundred birds and helping other seabirds that nest nearby. So this unlikely partnership between giant dogs and tiny penguins. But it's one that changed the future of this island. Our next story is about dogs and children and language. So researchers at Overseas Lorand University discovered that some dogs understand their toys in ways we associate with young children. They studied what are known as gifted word learners. These are dogs that seem to already know lots of names of toys and other items, and during play sessions, the dogs were shown the difference between tug toys and fetch toys, and later they would be given a brand new object and were asked to bring a tug toy or a fetch toy. And amazingly, many of the dogs got this right on the first try. Even with toys they'd never seen before, showing that the dogs weren't just memorizing words, they were actually categorizing objects based on how they use those objects. This is a rare skill seen only in a handful of dogs worldwide, but it offers a fascinating insight into the world of canine intelligence. And she says that some pets may process language in ways that are surprisingly similar to how we learn languages as children. But the last story is actually my favorite story, because I'm from New York City and we much maligned rats here in New York City because we we have a rat problem. We also have a rat czar. And this story is from Africa in Tanzania, the nonprofit of Popo has been training African giant pouched rats for two extraordinary jobs detecting land mines and diagnosing tuberculosis for mine detection. The rats light weight means they can safely move across minefields without setting off explosives. They're trained to sniff out TNT and scratch at the ground to alert their handlers. And over the years, these hero rats have helped clear millions of square meters of land mines in countries such as Mozambique, Angola and Cambodia, returning once dangerous ground to local communities. This same species of rats can also work in the lab by quickly sniffing human samples. They can identify tuberculosis cases that traditional tests often missed, and that speeds up the diagnosis and treatment for patients infected with TB. Since 2007, if proposed, rats have helped identify tens of thousands of additional TB patients. Now we have a short break coming up, but please remember that if you have a question you want me to answer on next month's, ask the Vet podcast, you can email me at Ask the Vet at amcny.org. Stay tuned because we have AMC news. When we come back from our break, we're back with Dr. Ann Hohenhaus on Ask the vet. Hi and welcome back to Ask the Vet. We have important information from AMC's Usdan Institute. Halloween is just around the corner. And today in oncology at AMC, our pumpkins and ghosts all got put up all over our office, so we're in the festive mood already here. The Usdan Institute for Animal Health Education keeps an eye on some of the issues that pop up at this time of year. We see a lot of pets in our E.R. because they get into the goodie bag or the candy bowl and chocolate and candy containing the artificial sweetener xylitol are both very toxic to dogs and cats. Even wrappers can cause problems if swallowed, and pets can choke or have intestinal blockages because of it. Costumes are really cute on pets, but they can be an area where your good intentions sometimes backfire. They can restrict a pet's breathing, vision, or movement and become quickly unsafe. It's not just food and costumes we worry about this time of year. Halloween itself can be overwhelming for pets. Doorbell ringing visitors in masks. Strange, spooky decorations can really stress some pets out. So we often advise families to set up a quiet room away from the front door, away from the trick or treaters with their pets, bed and toys so the pet feels safe and secure. And this also limits escapes because escapes out the front door are more common on busy nights like Halloween. Wouldn't be a bad idea sometime between now and Halloween. You double check your pet's ID tags on their collar, and be sure your microchip information is up to date. And finally, take a look at your decorations. Not from how fun and cute they are, but from your pet's point of view. A flickering candle may seem fun to sniff or pull out, but it's a serious burn hazard. Dangling cords or light strings can seem like a chew toy to a cat, but they can get a shock or a burn. If they bite into those and motion activated skeletons and witches that light up and shriek to a pet. That can be confusing because pets don't like surprises. Sometimes a shriek or a sudden light up of a Halloween decoration can send the pet rushing out the door or knocking things over. So what feels fun and festive to us can be scary for pets. So just keep those things in mind and keep your pet safe this Halloween. Eye health is just as important for pets as it is for people. And with today's advances in ophthalmology, there are more ways than ever to help your pet's vision. Tune in on Wednesday, October 29th. 6 p.m. Eastern Time for a free webinar with Doctor Alexander van der Woerdt service Head of Veterinary Ophthalmology at AMC. Drawing on her experience, doctor. We'll talk about the five most common eye conditions she sees in pets. How to recognize them early, and treatments that can protect your pet's vision and their quality of life as usual. This event is free, but you have to register so that we can send the zoom link to you in advance. You can register at amcny.org backslash events. I'd like to take this moment to thank Doctor Dennis Slade for joining me today. If you're interested in learning more about internal medicine at AMC, then go to amcny.org backslash Internal Medicine. Don't forget, I'd be happy to answer questions about your pets well-being or health on next month's show. Just email me at Ask the Vet at AMC and y.org, and I'll answer questions on next month's show. Ask the vet podcast can be accessed on the SIRIUS app, across all major podcast platforms and on AMC's website. This is all thanks to AMC's long standing partnership with Sirius XM. To follow us on social media. Our handle on Facebook is the Animal Medical Center on X, or Twitter and Instagram at @amcny. Please take a moment to like and give the Ask the Vet podcast a review. And don't forget to subscribe so you get every new episode the minute it drops. I hope you'll all join me again next month for another episode of Ask the Vet. Happy Halloween to everyone!