Specialized pet care now mirrors human medicine

Treatment options wide-ranging for pet owners

CINCINNATI - When Robin Lefevre decided to add pets to her life, she adopted two cats -- brother and sister -- Jack and Lucy.

"They're so cute and so much fun," she said. "They're just a joy to have."

However, things quickly changed as Lucy entered her eighth month of life.  

"She was extremely lethargic," Lefevre said.  "When I would go feed them, she wouldn't come and eat."

Soon, Lucy began vomiting, so Lefevre took her to the the Animal Hospital on Mount Lookout Square. Dr. Kevin Rebrovich did a thorough examination, but had bad news.

"She was on her last legs when she came in here for the very first time," he said. "She was going to die."

The case perplexed Dr. Rebrovich because his workup wasn't able to pinpoint a specific diagnosis. He called in internal medicine specialist Dr. Jenny Wells of Med-Vet.


In March of 2012, Dr. Paul Levitas of the Animal Hospital on Mount Lookout Square removed a lobe from the liver of George, the Golden Retriever belonging to me and my wife.

That was due to a diagnosis of liver cancer in the then 12-year-old dog. The surgery was successful and it was determined that the cancer had not spread throughout George's body.

However, in April he became sluggish and erratic in his eating patterns. Dr. Rebrovich ordered blood tests that showed George was anemic and rare spindle cells were present in his body.  An ultrasound revealed a fluid buildup in his abdomen.

Since we wanted to explore every possible treatment option, Dr. Levitas and Dr. Rebrovich referred us for a consultation with Dr. Karina Valerius at Med-Vet.

MED-VET MEDICAL & CANCER CENTER FOR PETS

That's the sort of partnering that occurs every day between a pet owner's regular veterinarian and the specialists at Med-Vet Medical & Cancer Center for Pets on Red Bank Road in Fairfax.

Med-Vet treats over 60,000 dogs and cats a year from offices in Columbus, Cincinnati, Dayton, Mandeville and New Orleans.

The facilities provide specialty practices for in-depth care plus year-round emergency care.

The Fairfax facility opened in October of 2012, after Med-Vet acquired the former Red Bank Emergency Veterinary Center. The new office has 29,000 square feet of space for diagnosis and treatment of pets with a wide range of services.

Med-Vet Medical Director Dr. Amy Snyder said the facility's offerings reflect a response to the demands of the community.

"Even though you think our client is at the end of the leash, really, our client is the referring veterinarian," she said. "We've really tried to add specialties and offerings in regard to what they're asking for."

Dr. Levitas said referrals are made to board-certified specialists if his team needs assistance in treating a pet.

"We feel like we can handle just about anything, but the things that we can't, at least we have the confidence that we will refer out and hopefully they can find the answer," he said. "They may not always, but if they can't, maybe nobody can."

According to Dr. Snyder, veterinary medicine is becoming more and more like human medicine in terms of the offerings that are provided.

"We have the ability now to treat radiation patients, ophthalmology surgery offerings, cardiology interventional procedures such as pacemakers and and oblations, plus surgical options of hip replacements and all kinds of orthopedic procedures," she said.

For example, Dr. Snyder pointed to a cat with a heart murmur.

"Back in the day, your vet may have picked up on that, but nothing was done except monitoring each year," she said. "Now, you have the option to come in, see a veterinary cardiologist and have all the diagnostics done to tell if there's something you need to do or not."

Heart disease in pets is as common as heart disease in humans, according to Med-Vet cardiologist Dr. Kathy Wright.  

"We can really help those animals by working with family veterinarians to improve their cardiac care," she said.

One way of doing that is with a procedure called an oblation. Med-Vet is the only facility in North America where it's currently being performed.

Cases are referred to Fairfax from all over the country, including Alaska, Washington, Oregon, Pennsylvania, Florida, Tennessee and New Mexico.

Dr. Wright pointed to the case of a 1-year-old dog from Philadelphia, which was in congestive heart failure due to a rhythm disturbance. The problem was so severe that the dog couldn't exercise or play with the members of his owner family.

"We went in with catheters through the veins in his neck and his legs and we mapped out where this abnormal circuit was," she said. "We were able to deliver radio frequency energy to that area, destroy that abnormal connection and now he's running and playing and completely off all medications."

Med-Vet is the only private cancer center for pets in Ohio and among just a few across the country. The medical oncologists know that some cancers are curable, while others are not.

They employ state-of-the-art therapeutic and clinical treatments for leukemia, mast cell tumors and other cancers that can

lead to remission and a better quality-of-life.

One of the newest pieces of equipment installed at Med-Vet is for radiation oncology. It's identical to the machines used to treat humans.

Radiation oncologist Dr. Heather Lasher said CT scans diagnose a tumor and define the extent of the disease.  That information is loaded into a computerized treatment plan to create a three-dimensional model to eliminate the tumor.

"We can pinpoint our dose a lot more accurately," she said. "We can kind of come down on an area really to maximize the dose to tumor tissue and protect normal structures."

Dr. Lasher cited one complicated case where a dog had a tumor in his jaw. The owners decided on a full course of radiation treatment and he's now fully healed.

"It's a real privilege to work in this facility elbow-to-elbow with colleagues that have the intelligence, skill and technical capability that we have here," she said.  "The opportunities we have in medicine and technology right now that didn't exist years ago is absolutely amazing.

Surgery is performed for various cancers plus orthopedics like hip replacements, knee surgery and ACL tears. Dogs hit by cars often need surgery for pelvic fractures, long-bone breaks and spine problems.

Dr. Karl Maritato performs many of those operations each week and said he goes to great lengths to do whatever is needed to help pets get better. That includes a special focus in hard cases, since he and his wife have six pets of their own.

"I think of the pet, but I also think about who I'm trying to get it back to -- the person that's waiting on the other end two days from now when that dog goes home," he said.  "There's nothing worse than having to tell someone you couldn't be successful."

GEORGE'S CASE

George came to live with us in 2001 after we adopted him at the SPCA on Colerain Avenue in Northside. He had a beautiful reddish-brown coat and a mission in life to love everyone he met.

He was tough enough to recover from serious injuries after being hit by a car in 2007.  He had fractured ribs, his spleen had to be removed, his kidneys were bruised and he lost one of his canine teeth.

It was during a routine blood test in 2012 that elevated liver levels were discovered in George, who was 12 at the time. Liver cancer was suspected.  An ultrasound confirmed the diagnosis and Dr. Levitas surgically removed one of the lobes of George's liver. 

It was quite a relief to find out that Dr. Levitas couldn't find any evidence that cancerous cells had spread throughout his body.

Things were back to normal until April of this year.

George wasn't eating properly and seemed more sluggish than usual.  We took him back to the Animal Hospital on Mount Lookout Square for an appointment with Dr. Kevin Rebrovich.

A blood test again showed elevated liver levels and evidence of anemia. Dr. Rebrovich ordered an ultrasound to get more information on the status of the liver and other organs.

The test showed the presence of rare spindle cells that might be cancerous and a fluid building up in George's abdomen. We discussed treatment possibilities that included another surgery, chemotherapy or steroids.

At our request, Dr. Rebrovich reviewed the findings with Dr. Levitas. They determined that there was no way to know if a second surgery would be successful and recommended a consultation at Med-Vet.

Dr. Karina Valerius did an oncology workup and confirmed the findings of Dr. Levitas and Dr. Rebrovich.  Treatment options were clearly laid out for us. They included surgery, aggressive chemotherapy and milder chemotherapy plus steroids.

Because George was 13 years old at the time and because we didn't want to put him through the pain of surgery and the possible sickness from chemotherapy, we decided not to pursue treatments and keep him as comfortable as possible.

Within a few days, he stopped eating and began vomiting.  

Our decision was tough to make for a pet that had become such an integral member of our family, but on April 30, George was put down. We did it for him, not for us.

The cost of treatments wasn't a factor in our decision. However, we decided we couldn't put him through tough treatments that might only extend his life a few months. 

LUCY'S CASE

Because she often traveled in her job, Robin Lefevre wanted low maintenance pets that could be on their own for short periods of time.

That's why she chose to adopt the pair of cats, Jack and Lucy.

When Lucy's health started failing, Lefevre's low maintenance pets suddenly became very high maintenance.

The first visit to the Animal Hospital on Mount Lookout Square was shocking for Lefevre with Dr. Kevin Rebrovich saying that Lucy needed prompt emergency care or she would die.

Dr. Rebrovich immediately called internal medicine specialist Dr. Jenny Wells at Med-Vet.

"When we reached a point where between the hours it would take to support her and the actual invasiveness of technology that comes with the diagnostics that were beyond our reach here, having Med-Vet to help out was what saved her

life," he said.

Dr. Wells quickly ordered a full workup on Lucy, complete with X-rays, an abdominal ultrasound and an array of infectious disease testing all looking for an underlying cause of her sickness.

"When she was transferred to me, she was fairly anemic and her bone marrow didn't seem to be responding appropriately," she said. "We did a bone marrow aspirate and biopsy."

The results of those tests ruled out things like feline leukemia.  However, they pointed to what turned out to be the final diagnosis -- immune-mediated anemia at the level of the bone marrow.

Lucy underwent two blood transfusions and received immunio-suppressive medications. The treatments worked.  Her red blood cell counts are normal.  The anemia is in complete remission.

"She was so young, you couldn't give up on her," Dr. Wells said. "To take such a sick kitty at such a young age and turn her around like this is why we do this job."

Plus, Dr. Wells pointed to Lefevre's determination to Lucy's well-being.

"It was such a relief to know that I made the right decision," Lefevre said. "Lucy had been through so much, so I was happy that she was feeling better."

The situation was win-win-win-win for Lefevre, Lucy, Dr. Rebrovich and Dr. Wells.

"She hasn't just gone to Med-Vet," said Dr. Rebrovich.  "She came here for a lot of her re-checks, but Dr. Wells was always available by phone. That's the great thing about Med-Vet is their communication with us."

TREATMENT OPTIONS AND COSTS

 

Americans spend billions on feeding and caring for pets every year. Costs for treatment between a regular veterinarian and Med-Vet specialists can range between hundreds to thousands of dollars, depending upon the options a pet owner chooses.

"We give bare minimum options up to the highest standard of care," said Dr. Snyder.  "We also work closely with the referring vet that sent use the case to see if there's anything they can do at their practice to limit the cost for clients."

Dr. Snyder pointed out that every case is different. An option chosen by one client may be very realistic, but the same choice for another client may be a hardship. It all depends upon the quality-of-life a pet owner seeks for their dog or cat.

"While cataract surgery may be an expensive endeavor, you're going to restore vision in that dog for the rest of their life, which definitely impacts client and pet," she said.  "Same with things like total hip replacement  or completely curative treatments for cancer."

The age of the pet may be a key factor in a treatment decision, according to Dr. Lasher, who with her husband considers their pets their children. Perhaps a younger dog with a tumor may get a more aggressive treatment for long-term control than an older pet.

"Maybe we have a client that's more focused on quality-of-life for an older pet," she said. "Maybe the tumor has a much worse prognosis, so we're just focused on shrinking the tumor and making the pet feel more comfortable, keep them eating and buy the owner extra time with that pet."

"I think everyone has different priorities and a different financial status in their life," she added.  

Dr. Snyder said every case is different and Med-Vet has client testimonials that some of the treatments have changed lives because of the bond a family has with its pet.

"We recently had a case where the son had leukemia and his dog was his best buddy in the world," she said.  "For them treating a fracture of whatever the condition is for that companion animal is really impactful for the family."

She added, "I think it's case-to-case, but the clients definitely make the decision.  So, we support their choices."

THE FUTURE

What does the future hold for Med-Vet?

Dr. Snyder said the biggest goal is to get better at what the facility is currently doing.

"I don't see a lot more expansion for us at this time, other than just honing our skills and continuing to improve our services to pets and clients," she said.

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