LGVMA's GOOD NEWS!
originally printed in April 1999 issue

Healthy Pets Healthy People

As reported in previous newsletters, the LGVMA is an active supporter of the Healthy Pets Healthy People project, an effort to provide a resource guide for both veterinarians and physicians when dealing with immuno- compromised pet owners. PAWS-San Francisco is currently hosting Dr. Anthony Calo as an HPHP intern.

HPHP Intern offers fresh viewpoint

To gain a better under standing of the awareness clinicians have when dealing with immuno- compromised clients, I had to chance to talk with Dr. Sheri Ross, a resident in small animal internal medicine at the University of Minnesota. A graduate of the University of Prince Edward Island’s (PEI) Atlantic Veterinary College, Dr. Ross completed a small animal internship at the University of Minnesota before entering a joint residency and Ph.D. program there.

According to Dr. Ross, the importance of the human animal bond was stressed at PEI through a program in which students were required to take care of the teaching dogs used for practicing physical exams and other routine procedures. Each term students were assigned to a dog and were responsible for all aspects of its care including its social and emotional well-being. Students were permitted to participate in animal visitation programs at local hospitals and nursing homes.

Dr. Ross spoke of a dog in her care named Lester. She had formed a special relationship with him, and even brought him home with her most nights so that he did not have to stay in a kennel. Her relationship with Lester was made even stronger by one particular occasion when they visited the burn patient’s ward at a children’s hospital. Lester’s kindness and gentle behavior with the children made a lasting impression on Dr. Ross about the important role animals play in the healing process.

Dr. Ross also reported that there were no organized programs during her school years dealing with the immunocompromised client. As certain infectious diseases such as toxoplasmosis were discussed, the zoonotic potential was mentioned but with no particular attention given to owners who are HIV-positive or are undergoing chemotherapy. She also stated that because there was less of a problem with infectious and parasitic diseases in her area, they were not emphasized as much as they could have been.

Dr. Ross spoke with a special fondness about a client who was referred to the university by a local veterinarian. The cat had originally been seen for weight loss and increased appetite and was diagnosed with hyperthyroidism. When she met the client to discuss treatment options at the university, Dr. Ross first noticed a large, bright pink flamingo tattoo on his arm. More importantly, she quickly saw the strength of the bond between the small, fluffy cat and the client, who repeatedly stated he wanted the best treatment plan for his cat.

At that point, she discussed the pros and cons of I-131, which required a stay in an isolation ward for at least four weeks versus daily treatment with oral methamizole. He then asked which one she would recommend. She emphasized that both are effective, but that the I-131 would be her treatment of choice for long-term resolution. The client told her that he would prefer to go with that option, but because of the long-term isolation period, that he would probably not be able to see his cat again because he had AIDS and was diagnosed with active pneumocystis.

With this information, Dr. Ross suggested going with the methamizole so that the client could maintain daily interaction with his cat. The client’s main concern was that after he died, his roommate could not continue the daily schedule. Despite the poor short-term prognosis his own physician had given him, the client decided on the I-131 therapy.

He told her that his birthday was that weekend and he would like to take the cat home to celebrate his last birthday with him before the therapy was initiated. Dr. Ross said of the client “The owner had a great attitude – this is what happened and I am going to take care of it the best I can. He was a very open person. When we talked about his final birthday he was sad about it, but not mad.”

The owner took the cat home with him to celebrate his birthday and to have the weekend to say goodbye. That Monday morning, he brought the cat in for the treatment. He obviously had a hard time saying goodbye to his cat. He was shaking as he continually told him that he loved him and that he was his best buddy. He left a favorite T-shirt with the cat and a bright pink stuffed flamingo, along with numerous toys and catnip. He also told her that the cat loved dance music if there was a radio in the ward. It was a difficult moment for both Dr. Ross and the senior student on the case. Dr. Ross had a very close friend who was dying from AIDS-related complications at the same time she was getting to know this client.

Dr. Ross kept in close contact with the owner while the cat was in the I-131 ward. During the first week, he was even sneaked into the ward to visit. She later found out the technician actually sneaked him down about four more times to see the cat. During the hospitalization, the cat remained happy, friendly, and active. Largely, Dr. Ross attributed this to the strong bond between the owner and the cat: “It was a very special relationship.”

The cat was released to the owner after four weeks in the hospital. Even though Dr. Ross noticed a significant decline in the owner’s condition, he was extremely happy about their reunion. He took him home with the comfort of knowing that the problem was completely resolved.

Two months later the cat returned for a follow-up T4 level and exam, but the roommate brought him in. The owner was not there. Even though the owner was not brought up in conversation, it was evident to Dr. Ross that he had died. She felt sad, but there was also a sense of calmness. She had given the owner the peace of mind that the cat would continue to do well in the new situation with the roommate. She had also given herself peace with the knowledge that she helped the owner maintain one of his most important relationships up to the very end.

The topic of current awareness of clinicians was also discussed with Dr. Ross. She feels that the level of awareness and sensitivity to the immunocompromised clients is definitely dependent on the individual clinician. “Fortunately, most of the younger doctors are comfortable dealing with he subject. Older clinicians, will warn clients that are older or that have babies about zoonotic potential, but never stop to consider the client that is HIV-positive or has AIDS.” She also feels that many physicians lack the necessary knowledge of zoonotic diseases. She has had more than one client receiving chemotherapy or was HIV-positive that was told by their physician that they should give up their cats. There is a definite need for improvement in the way in which awareness and sensitivity is handled in the curriculum of veterinary schools. Dr. Ross feels that more emphasis needs to be placed on the zoonotic potential when infectious diseases are being discussed. She also feels that the ethics classes should include dealing with all groups of clients, especially those with special needs, such as the HIV/AIDS community: “It is the responsibility of our profession to be knowledgeable about this. We should be able to provide referrals to AIDS organizations, help find funding, and provide standard procedures in order to help a client who is willing to share his or her HIV status with us, and who may need extra help and support.”

—Anthony Calo, DVM