Hemodialysis for Pets


Yes, it’s true. Dogs and cats are able to benefit from hemodialysis just as people are. The use of hemodialysis in veterinary medicine is a little different compared to people but the basic principles are the same. Here we will explain the basics of hemodialysis as well as the indications for this treatment in dogs and cats.

What is the normal function of the kidney?
The kidneys (there are usually two – left and right) are organs located in the abdomen. Their primary job is to filter the blood, removing by-products of metabolism and toxins from the body. Kidneys also participate in the following:

  • Keeping blood electrolyte and mineral concentrations in the normal range
  • Red blood cell production
  • Blood pressure control
  • Regulation of water content in the body

Hemodialysis 2What is hemodialysis?
Hemodialysis is the movement of blood through a filter and cleaning the blood of toxins that build up in the body when the kidneys are not working effectively. The filter is located outside of the body and the blood is moved through a blood circuit.

Is a special catheter used?
The use of a hemodialysis catheter facilitates the movement of blood outside of the body. This catheter is larger than regular intravenous catheters allowing high flow rates of blood. In most pets, placement of the hemodialysis catheter is in the right jugular vein. A majority of dogs and cats will have placement of the catheter under general anesthesia. X-rays confirm proper placement of the catheter. Sterility is of utmost importance to reduce the risk of infection. The hemodialysis doctors place these catheters with the same sterility as a surgeon uses when performing surgery.

Why would my pet need hemodialysis?
Many of us have had a family member or friend treated with hemodialysis, or have seen movies or TV programs showing people getting hemodialysis. Hemodialysis conjures an image of people living the rest of their life hooked up to a machine. In this situation, these people have end-stage kidney disease caused by chronic illness such as diabetes or high blood pressure. As these people have no hope of regaining normal kidney function, they will remain dependent on hemodialysis for the remainder of their lives. Some people may be candidates for a transplant but for most, hemodialysis (or chronic peritoneal dialysis) remains the only option.

In veterinary medicine, cost and considerations of quality of life for pets limit the use of hemodialysis for treatment of chronic kidney disease. Most often, veterinarians use hemodialysis to treat acute kidney disease. Acute kidney disease differs from chronic kidney disease for many reasons. Of these differences, reversibility of the underlying process is the most important, especially when we are recommending hemodialysis to treat a patient with acute kidney disease. Long-standing damage to the kidney leading to loss of the normal kidney function of filtering the blood leads to illness. Various diseases can lead to chronic damage of the kidney tissue. In response to this damage, scar tissue builds up, leading to irreversible loss of kidney function. These chronically damaged kidneys have little to no ability to repair themselves.

Acute kidney disease differs in that there is a chance of repair and return to normal function. Acute insults to the kidney can lead to acute kidney injury. The insult could be an infection (e.g. leptospirosis), a toxin (e.g. ethylene glycol, non-steroidal anti-inflammatory drugs), and/or decreased blood flow, to name a few. Once damaged, the kidney’s function declines and the pet starts to feel sick. Treatment of the underlying disease can eliminate the ongoing damage. The kidney then has a chance at repairing itself and function returning to normal or near normal. Repair of the organ tissue can take days to months, leaving the kidney function abnormal during that time. Many patients with acute kidney damage will respond to supportive care and treatment of the underlying disease and there is no need for hemodialysis. These treatments may include intravenous fluids, antibiotics, and anti-vomiting medications. When the degree of damage is enough to cause marked accumulations of toxins in the body and/or the loss of the ability to make urine, and supportive treatments are not leading to improvement of kidney function, hemodialysis is a treatment consideration.

Hemodialysis1If my pet needs hemodialysis, how long does treatment last?
Hemodialysis does not fix the kidneys. It merely filters the toxins from the blood, making the pet feel better and allowing their kidneys time to heal. The speed at which the kidneys heal vary and depend on the underlying cause as well as variations between individual pets. In the beginning, a pet may need daily treatments. When the patient stabilizes, treatments may be every 2-3 days. When kidney function is improved or the patient is making urine, dialysis ceases and traditional medical treatments continue until the patient goes home. Kidney recovery can take between 2-6 weeks (sometimes months) and patients may need dialysis treatments for 2-4 weeks. In some cases, we can treat pets on an outpatient basis, having them come in every 2 days for treatment. We find most patients only need dialysis for the first 1-2 weeks.
Individual treatment sessions last between 4-12 hours depending in the cause of the kidney dysfunction. Treatment times depend on a number of factors. The initial treatments typically last the longest and become shorter during the course of hospitalization.

How will my pet receive nutrition during treatments?
Most patients with kidney injury or disease will have poor appetites, and as nutrition is very important, many pets will have a feeding tube placed at the time of the hemodialysis catheter placement. An esophagostomy tube is commonly used. Placement of the esophagostomy tube occurs with the patient under general anesthesia. The advantage of an esophagostomy tube is that we can feed a complete, balanced diet that promotes recovery.

Can hemodialysis treat diseases other than kidney disease?
The answer is a resounding, YES! Removal of toxins from the blood can occur with the combined techniques of hemodialysis and hemoperfusion. Hemoperfusion utilizes a special charcoal filter that binds toxins, removing them from the blood. Hemoperfusion has been used successfully to treat toxicities in both dogs and cats.

What is the prognosis?
The prognosis for recovery from acute kidney damage in dogs and cats treated with hemodialysis depends on the cause, extent of renal damage, concurrent disease, and presence of multiple organ system involvement. Based on the published studies, global survival for dogs with severe acute uremia is approximately 50 percent. Survival from infectious (60 percent), hemodynamic and metabolic etiologies (40 percent) was greater than survival from toxic causes (20 percent). The outcome for dogs with acute leptospirosis is especially favorable with 80-90 percent survival with either severe (dialysis-dependent) or milder forms (medically manageable) of acute renal failure (ARF). Reported global survival for cats requiring hemodialysis is 56 percent. Overall, hemodialysis substantially increases the global survival for both dogs and cats with severe acute kidney damage beyond what would be expected with conventional management.

What about chronic kidney disease?
Dogs and cats with chronic kidney disease can undergo long-term hemodialysis. This is similar to people who get hemodialysis 3 times a week for the remainder of their lives. Veterinary patients can experience a very good quality of life. Patients have been treated chronically and still go hiking with their human companions and live amazing lives. We must remember, however, that this is a huge commitment, from an emotional and financial point of view. Not all pets are good candidates. A hemodialysis doctor will perform a detailed review of the case and they will determine if your pet is a candidate for chronic hemodialysis.

Summary
Hemodialysis can be a life-saving procedure for patients with acute kidney injury, allowing patients greater chance of survival. For patients with a treatable underlying disease, hemodialysis is a reasonable consideration for any pet experiencing severe acute kidney disease.

Learn more about Hemodialysis at NorthStar VETS.

Benjamin Davidson, BVSc, MANZCVSc, DACVECC
Benjamin-DavidsonDr. Davidson graduated from the University of Queensland School of Veterinary Science in 1998. He obtained experience as an emergency veterinarian for five years before starting a residency in small animal emergency and critical care at the Cummings School of Veterinary Medicine at Tufts University in 2003. He completed his residency in 2006 and became board certified in emergency and critical care the same year. Dr. Davidson then took on a role as a senior clinician at BluePearl Veterinary Partners in New York City, where he headed the critical care service for ten years. He then headed the critical care and hemodialysis services at BluePearl in Paramus, NJ. Board certified and proficient in all fields of veterinary emergency and critical care, Dr. Davidson’s professional interests include mechanical ventilation, trauma, sepsis and extracorporeal methods of organ support, including hemodialysis, ultrafiltration and membrane oxygenation. Dr. Davidson has authored articles and textbook chapters on the topics of critical care, and routinely lectures to veterinarians.


The information presented on this web site is not intended to take the place of your family veterinarian’s advice and is not intended to diagnose, treat, cure or prevent any disease. Discuss this information with your own veterinarian to determine what is right for your pet. All information is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical conditions. We can not and do not give you medical advice via this blog. The information contained in this online site and emails is presented in summary form only and intended to provide broad understanding and knowledge. The information should not be considered complete and should not be used in place of a visit, call, consultation or advice of your veterinarian. We do not recommend the self-management of your pet’s health problems.

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From the Client Perspective: Living with IMHA


Ethan joined my family from Glen Highland Farm Rescue on December 26, 2009. I was his 4th home in his short time on this earth of 10 months. No one could figure out how to effectively communicate with him. He was quirky and anxious. But we took a chance on each other and I think he has taught me more than I have taught him.

Ethan5I was looking for my next competition dog and I thought Ethan could be it. We did enter the show arena in agility, herding, and lure coursing, but his insecurities would get the better of him and he would “act out.” What people didn’t realize was that he wasn’t giving me a hard time, he was having a hard time. I decided it was best for us to focus on him being comfortable in his own skin. He may not have won any big titles or events, but he is a champion in my eyes.

Those who know the story of Ethan know how difficult life was for him, as he was presented with challenges daily. Fear of other dogs, reactivity to motion, cars, bicycles, lights, sounds, ceiling fans – you name it. Together we learned how to conquer his fears, and Ethan finally allowed himself to be happy and content. That’s when we faced his next big battle – IMHA.

In August of 2018, Ethan started to urinate blood and seemed mopey. I knew something was wrong. My other border collie, Shane, was dying of gastric carcinoma, and now Ethan was on the brink of death with a disease I knew nothing about. It was then that I met with Dr. Tammy Anderson of the NorthStar VETS Internal Medicine team. She had previously treated another dog for me. I remembered her being knowledgeable and compassionate. I was terrified at the prospect of losing two precious border collies both within the same week.

Ethan1Immune-mediated hemolytic anemia (IMHA) is a condition where the body’s immune system attacks and removes its own red blood cells, leading to severe anemia, an unhealthy yellow coloring of the tissues called jaundice, as well as an assortment of life-threatening complications. Mortality from this condition is high, so veterinarians take an aggressive approach. Multiple blood transfusions and immune-suppressive drugs are needed.

Dr. Anderson promised that she would do all that she could. It was very touch-and-go for a while, but Ethan made it through his first transfusion and eventually became stable enough to be discharged. I believe Dr. Anderson and I spoke several times a week for the first two months after his diagnosis, as she wanted to closely monitor his care.

Ethan4A few weeks after his discharge, we took Ethan kayaking down the Delaware River. I sent Dr. Anderson videos and pictures, as I didn’t want to just share the bad, but I wanted to share the good as well. At the end of each call or visit, she would tell me “Enjoy him.” That truly touched my heart, as her sentiment was genuine.

Over the next few months, we battled skin infections, fluctuating PCV numbers and elevated liver enzymes. And then in February 2019, the biggest fear of IMHA dogs came true – Ethan crashed. A transfusion would be more difficult now, as he would have to be cross-typed and matched. Ethan rejected the first transfusion and things were looking dim. Dr. Anderson was just as upset and concerned as I was. We spoke frankly, and Dr. Anderson took the time to explain everything thoroughly and with compassion.

Ethan6We made a joint decision to try one more time. If it didn’t work, we at least would know that we tried our best. The second transfusion worked! But we both knew Ethan was very fragile now. We then tried several different types of medication and that seemed to work. Our weekly/bi-weekly visits continued and Ethan became like “Norm” from the show “Cheers.” Ethan would walk into the hospital and EVERYONE knew his name. This made him light up! He gets showered with attention and cookies whenever he goes into the back for his tests and bloodwork.

Ethan2The staff at NorthStar has been wonderful with Ethan and have made us both feel at home. Several months went by until June of 2019 when Ethan got infected elbow hygromas and was septic. Again, Dr. Anderson pulled off yet another miracle and Ethan survived this as well. All throughout Ethan’s ordeals, Dr. Anderson remained genuinely concerned, knowledgeable, compassionate, but also grounded in reality. We told Ethan that he needed a new hobby, and jokingly said that he is on the “I’m Not Dead Yet” Tour. We are hoping the tour continues for the next few years! We have had a few more scares, such as bilateral calcium deposits and bizarre bony growths in his carpus, but Ethan continued to improve every week. He was an IMHA warrior.

Ethan3Today, as of February 2020, Ethan is off prednisone and we are slowly continuing to taper him off the other immunosuppressants. He has gained weight, his coat has come back in full, and is lush and curly. He is active playing ball, running in the yard, and that spark is back in his eyes. We truly appreciate all that NorthStar VETS and Dr. Tammy Anderson have done for us. This has certainly been an emotional rollercoaster, but the one thing that has remained steadfast is Dr. Anderson’s devotion to her patient’s care.

Learn more about the Internal Medicine service at NorthStar VETS

Tammy Anderson, DVM, DACVIMTammy Anderson, DVM, DACVIM
Dr. Anderson is a New Jersey native who received her veterinary medical degree from Ohio State University in 1995. She completed her small animal internship at Michigan State University in 1996, and her residency in small animal internal medicine at the University of Tennessee in 1999. She remained at UT as an assistant professor of small animal medicine until 2001, when she returned to New Jersey and entered private practice. Dr. Anderson joined NorthStar VETS in 2004.

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Meet the NorthStar VETS Team: Dominick Valenzano, DVM


Dominick Valenzano, DVM is a doctor in the Surgery service at NorthStar VETS. In this video, he talks about leaving engineering to get into veterinary medicine, the types of cases he sees, and what drew him to NorthStar VETS to start his career.

How Dr. Valenzano got into Veterinary Medicine
We caught up with Dr. Valenzano, who was checking on a patient. Dr. Valenzano is a doctor on the Surgery team at NorthStar VETS and he originally planned to be an engineer before finding his passion for veterinary medicine. “When I was an undergraduate, I was studying Engineering at the University of Maryland, and while I was there, i got a job at a veterinary clinic as an assistant. I ended up loving the job so much that I switched my major around and after that I ended up going to veterinary school at Cornell University. After graduating veterinary school, I did a one-year internship at the University of Pennsylvania and then following that, a three-year residency in Surgery at Cornell University.”

“I first heard about NorthStar VETS from another employee who works here. They spoke very highly of the hospital, that it was a very collaborative hospital with a lot of great resources. I interviewed a few months after that and then accepted the job several months after that.”

The Types of Cases Dr. Valenzano Sees
NorthStar VETS sees a wide variety of unique cases each week. “So far, a typical week has been balancing several appointments and cases with other emergencies that come up that are more urgent and need to be dealt with quickly. Those could be anything from orthopedic cases such as trauma (like fractures), to cruciate tears, and a wide variety of soft-tissue cases both emergent and elective.”

What Dr. Valenzano Loves about NorthStar VETS
NorthStar VETS has more than 45 doctors working in 15 different specialties, and all of them work together to provide world class care to their patients. “What I’ve really appreciated about NorthStar VETS is the tremendous amount of support and collaboration that you can find here. There are so many different specialties and highly-trained technicians that makes everything that you need to do much easier.”

Dr. Valenzano really enjoys working with clients and helping to keep pets healthy. “I think that they see all the hard work we do, and when you are able to have a lot of really great outcomes, it keeps you motivated to want to keep coming back in.”

Learn more about the Surgery service at NorthStar VETS.

Dominick Valenzano, DVM (practice limited to surgery)
Dr. Valenzano grew up in central New Jersey and is excited to join the NorthStar VETS surgery team. Dr. Valenzano obtained his Bachelor of Science in Bioengineering from the University of Maryland in 2011. During his undergraduate studies, he worked as a veterinary technician which inspired him to go to veterinary school. He graduated from Cornell University?EUR(TM)s Veterinary School in 2015 and then completed a rotating internship at Ryan Veterinary Hospital at the University of Pennsylvania. After his internship, he completed his three-year residency program at Cornell University Hospital for Animals in 2019. His surgical interests include minimally invasive surgery, orthopedic surgery, and cardiothoracic surgery. He is trained in the tibial plateau leveling osteotomy (TPLO) for cranial cruciate ligament disease.

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Cool Case Maggie


Maggie03Maggie, a 10-year-old Yorkshire Terrier, presented to NorthStar VETS for acute respiratory distress and cyanosis (turning blue), noticed by the pet-sitter while the owners were returning home from vacation. She had a history of tracheal collapse, but before this episode, she had been doing pretty well. Upon arrival, she had a honking cough and was significantly dyspneic (trouble breathing). She was successfully stabilized by the Emergency team with oxygen therapy and sedation.

Maggie's collapsed tracheaChest X-rays revealed severe collapse of her cervical trachea (as seen in the image). We gave her a few days of attempted medical management; however, she continued to have very noisy breathing, coughing and episodes of cyanosis when taken out of the oxygen cage. Because of the severity of the collapse and her episode, it was elected to manage her condition with a tracheal stent placement.

Tracheal collapse is a condition from cartilage weakness in the trachea that causes the normally open, “C-shaped” cartilage rings to collapse down partially or completely. When this happens, it causes a honking cough and does not allow air to normally pass through it. It is an irreversible and progressive condition common in small-breed dogs, especially Yorkies like Maggie.

It can be managed medically or surgically. Medical management involves cough suppressants, anti-histamines, intermittent steroids, keeping the dogs trim and using harnesses, not collars. In most cases, we can successfully manage their clinical signs and coughing with these treatment options. When the case is more severe, or if it causes life-threatening signs, as in Maggie’s case, we opt for a procedural intervention. This is done by placing a nitinol, meshwork stent inside the tracheal lumen to give it support and keep it open. It does not eliminate the cough completely, but usually improves it significantly and prevents the life-threatening respiratory episodes.

Maggie's tracheal stentUnderstanding the risks of this respiratory procedure, Maggie’s owners decided to move forward with the stent placement. She was placed under general anesthesia and the size of the stent was chosen based on measurements taken via fluoroscopy. The endotracheal tube (tube used to delivery oxygen and anesthetic gas) was removed and the stent was deployed in her trachea covering the collapse area and keeping it nice and open (as seen in the image).
She recovered beautifully, and for the first time since we met her, she was able to breathe quietly and be with us outside of the oxygen cage. She was immediately happy, alert and wanting to eat! It was truly a night-and-day difference.

Maggie went home the next day breathing normally. Months later, Maggie is at home and doing extremely well. She coughs occasionally, which is expected for dogs with tracheal stents, but it is minimal and has not led to any further respiratory distress episodes. We love hearing how well she is doing at home and that she is enjoying time with her family!

Learn more about the Interventional Radiology service at NorthStar VETS.

Melanie Puchot, DVM, DACVIM
Melanie Puchot, DVM, DACVIMDr. Melanie Puchot is a Texas native who received her veterinary degree from Texas A&M University College of Veterinary Medicine in 2013. After graduation, she completed a small animal rotating internship at Cornell University in Ithaca, NY. She then returned to Texas A&M University and completed a 3-year residency in small animal internal medicine in 2017. She has a special interest in endocrinology, nephrology and interventional endoscopy / radiology. Dr. Puchot is excited to join the team at NorthStar VETS.


The information presented on this web site is not intended to take the place of your family veterinarian’s advice and is not intended to diagnose, treat, cure or prevent any disease. Discuss this information with your own veterinarian to determine what is right for your pet. All information is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical conditions. We can not and do not give you medical advice via this blog. The information contained in this online site and emails is presented in summary form only and intended to provide broad understanding and knowledge. The information should not be considered complete and should not be used in place of a visit, call, consultation or advice of your veterinarian. We do not recommend the self-management of your pet’s health problems.

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Meet the NorthStar VETS Team: Dylan Fry, DVM, DACVIM (Neurology)


Dylan Fry, DVM, DACVIM (Neurology) is a doctor in the Neurology service at NorthStar VETS. In this video, he talks about how his days on a dairy farm got him into veterinary medicine, the types of cases he sees, and what drew him to NorthStar VETS to start his career.

How Dr. Fry got into Veterinary Medicine
We caught up with Dr. Fry, who was checking on a patient. Dr. Fry is a Neurologist at NorthStar VETS and was first inspired to become a veterinarian from growing up on a dairy farm. “My Uncle is a veterinarian as well, so that was a big impact. It wasn’t until after I finished undergrad at Cornell University that I decided to go back to vet school later on. I went to Cornell for undergrad and then once I decided I wanted to go to vet school, I came back to Cornell and had a great experience there for all eight years. Since vet school, I narrowed my path toward Neurology. I’ve done a specialty internship, practiced emergency medicine along the way to broaden my experience, and then started a residency at Tufts University for four years there.”

After passing board certification, Dr. Fry came to join the team at NorthStar VETS. “I had heard about NorthStar VETS early on, even before starting my residency, so it was always on the radar as a great hospital. When it came time to pick a place that I wanted to practice, I definitely had it in consideration. The biggest things that drew me were the camaraderie among the doctors (everyone seems to get along really well here and it’s a great team), state-of-the-art facilities, and everyone practices really good medicine.”

The Types of Cases Dr. Fry Sees
As a Neurologist and Neurosurgeon at NorthStar VETS, Dr. Fry sees a wide variety of cases. “I primarily see patients that are dogs or cats, and any disease relating to the brain, spine or musculature. Sometimes, those are diseases that need medical management or surgery, and we do quite a bit of MRIs here, which is our main diagnostic tool to diagnose these diseases.”

What Dr. Fry Loves about NorthStar VETS
Dr. Fry is looking forward to helping you and your pets. “It’s been great so far. I like working with the people here. It’s been a very warm welcome and we all get along very well, and the clients and patients have been great, too. I’m looking forward to more time and more experience here.”

Learn more about the Neurology service at NorthStar VETS.

Dylan Fry, DVM, DACVIM (Neurology)
Dr. Dylan Fry received his veterinary degree from Cornell University College of Veterinary Medicine in 2013. After graduation, he completed a small animal rotating internship at Red Bank Veterinary Hospital and then worked as an emergency clinician at Massachusetts Veterinary Referral Hospital. He then pursued a 1-year specialty internship followed by a 3-year residency in neurology and neurosurgery at the Cummings School of Veterinary Medicine at Tufts University. Dr. Fry enjoys all aspects of veterinary neurology, particularly brain and spinal surgery, seizure management, and autoimmune inflammatory diseases.

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Meet the NorthStar VETS Team: Chelsea Bogart, DVM


Chelsea Bogart, DVM is a doctor in the Emergency and Critical Care service at NorthStar VETS. In this video, she talks about how she got into veterinary medicine, the types of cases she sees, and the kind of pets she has at home.

How Animals Brought Dr. Bogart into Veterinary Medicine
We caught up with Dr. Bogart, who was checking on a patient. Dr. Bogart works with Emergency cases and grew up with a lot of pets around that inspired her to become a veterinarian. “I went to undergrad at UMass Amherst in western Massachusetts, and then I went all the way to California for veterinary school. I went to Western University of Health Sciences and that’s where I earned my doctorate. After that, I was living in Austin, Texas with my husband, who is a college professor. He got a job at Rowan University, which led us out here. I have a classmate who works at NorthStar VETS, and that’s how I found NorthStar VETS.” She went on to talk about the rescue pets she has at home. “Both of my dogs are L.A. street dogs I found when I was in veterinary school. I have one that’s an Australian Shepherd mix, and one that’s a Chihuahua/Dachshund, so he’s extra sassy. I also have two senior cats that I’ve had since I was a teenager.”

The Types of Cases Dr. Bogart Sees
Dr. Bogart works in Emergency and Critical Care, and sees a wide variety of cases each week. “We see a lot of trauma cases, we see a lot of vomiting and diarrhea, gastroenteritis, and things like that. We see puppies with dietary indiscretion getting into things they shouldn’t. Those are probably the most common things we see coming through Emergency every day. Pets do really well with supportive care. I think it’s really rewarding to see a pet that came in sick and by the end of the shift have it be bouncing back and showing significant improvement.”

Many pets come into the Emergency department in dire situations, and Dr. Bogart enjoys seeing the dramatic improvements in her patients. “I saw a Chihuahua puppy, and I’m a Chihuahua Mom, so they’re already my number one. It came in having had a lot of vomiting and diarrhea, it was very dehydrated. Actually, on presentation, was close to passing away, but we intervened very quickly. We started fluids, antibiotics, and pain medication. In the next eight hours when I left at the end of my shift, he was bouncing around and giving kisses. It was really sweet and rewarding to see him make that improvement.”

What Dr. Bogart Loves about NorthStar VETS
Dr. Bogart has only been at NorthStar VETS for a few months, and she looks forward to helping more pets and their families in the future. “I think it’s a really wonderful environment in which to work, which is one of the most important things. Plus, I think the quality of medicine is really high which is excellent!”

Learn more about the Emegency and Critical Care service at NorthStar VETS.

Chelsea Bogart, DVM
Dr. Bogart grew up in Deerfield, Massachusetts and earned her Bachelor of Science degree in Animal Science from the University of Massachusetts in 2012. Following graduation, she moved to California where she earned her Doctorate of Veterinary Medicine from Western University of Health Sciences. She completed a rotating internship in San Diego, CA and then moved to Austin Texas, where she worked full time as an emergency veterinarian.

Dr. Bogart recently relocated from Texas to New Jersey and joined the emergency team at NorthStar VETS. Her clinical interests include toxicology, neurology, and wound management. In her free time she enjoys hiking, cooking, watching sports, and spending time with her husband as well as their two rescue dogs and two senior cats.

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Cool Case Rosey


Rosey is a happy and playful 10-month-old Bichon mix that was recently adopted by her family as an emotional support dog. She was a healthy puppy with no previous medical history.

Rosey was brought in to see Dr. Nancy Vail-Archer, Emergency clinician and Medical Director of the NorthStar VETS hospital in Maple Shade, for a sudden onset of vomiting followed by collapse. Her family reported that she was perfectly normal earlier that morning. They were very concerned and unable to think of what could have happened to make Rosey so ill.

RoseyOn presentation, she was stuporous (poorly responsive) with miotic pupils (constricted pupils). Rosey was hypersalivating (drooling excessively), tetraparetic (unable to use all four of her limbs), she was vocalizing and highly sensitive to any stimulation. Further examination revealed that Rosey was unable to swallow due to an impaired gag reflex. Given her young age, rapid onset of signs and clinical presentation, a toxin exposure was high on the list of differential diagnoses.

Many of her clinical signs were consistent with a baclofen toxicosis. Baclofen is a common medication that acts on the central nervous system to provide muscle relaxation. The drug rapidly crosses the blood-brain barrier (travels from the blood stream into the brain) resulting in suppression of the central nervous system. Further discussions with her family revealed that baclofen was in the home and could not be ruled out as a potential cause. The treatment for a baclofen toxicosis can be intensive, but with aggressive supportive care, the prognosis is often good for recovery. Severe muscle relaxation can result in an inability to breathe, and may necessitate intubation and mechanical ventilation.

Rosey was treated with IV fluids, antinausea medications and medications to help reduce the toxic effects of the baclofen. Cotton balls were placed in her ears to help reduce stimulation. A particularly important treatment was the use of Intralipid emulsion (ILE). ILE will help to capture the toxicant and carry it to organs that can detoxify and/or excrete the toxicant. Additional nursing staff was called in to provide one-on-one supportive care for Rosey. Over the next 24 hours Rosey gradually became more responsive and fully recovered by her 3rd day in the hospital. We are happy to know that Rosey is at home and is back to being a playful puppy!

Learn more about the Emergency and Critical Care service at NorthStar VETS.

Nancy Vail-Archer, DVM – Medical Director, Maple Shade
Nancy Vail-Archer, DVM - Medical Director, Maple ShadeDr. Vail-Archer returned to her hometown of Bordentown, New Jersey along with her two dogs, Ricky and Saba, when she joined NorthStar VETS in 2007. She completed her undergraduate studies at Rutgers University where she earned a degree in biological sciences, and her interest in research and medicine led her to Princeton University where she worked as a research assistant. She completed her veterinary studies at Ross University School of Veterinary Medicine, with a year of clinical training at the University of Missouri College of Veterinary Medicine. She completed a 13-month rotating internship at Fifth Avenue Veterinary Specialists in New York City and has a special interest in emergency and critical care medicine. Outside of veterinary medicine, Dr. Vail-Archer enjoys running, skiing and scuba diving.


The information presented on this web site is not intended to take the place of your family veterinarian’s advice and is not intended to diagnose, treat, cure or prevent any disease. Discuss this information with your own veterinarian to determine what is right for your pet. All information is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical conditions. We can not and do not give you medical advice via this blog. The information contained in this online site and emails is presented in summary form only and intended to provide broad understanding and knowledge. The information should not be considered complete and should not be used in place of a visit, call, consultation or advice of your veterinarian. We do not recommend the self-management of your pet’s health problems.

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Cool Case Pearl


Pearl, a 2 year old English Bulldog, presented to NorthStar VETS with a chronic history of diarrhea and weight loss. In fact, she continued to lose weight despite many treatment options. To reach a definitive diagnosis, Pearl had biopsies of her gastrointestinal tract. Biopsies were consistent with a condition called inflammatory bowel disease (IBD).

Inflammatory bowel disease is a chronic inflammatory condition of the gastrointestinal tract. Although the etiology in many cases of IBD is unknown, there are several factors which may contribute to this condition including parasites, bacterial disease, immune mediated response, and food hypersensitivity, among others. Regardless of the cause, IBD can many times be controlled with more traditional treatments. These treatments include treating the bacterial or parasitic disease, specific diets, and steroids to calm the immune system.

Dr. Wylie examines Pearl

Dr. Wylie examines Pearl

Unfortunately, in Pearl’s case, she did not respond to the more traditional treatments. Pearl continued to lose weight and the diarrhea was persistent. At this point, Dr. Wylie and the team at NorthStar VETS looked to more nontraditional methods. This nontraditional method included a fecal transplant.

A fecal transplant involves taking a donor’s stool (from a healthy dog), once they have passed the necessary screening tests, and making it into a slurry. The slurry is then transplanted into the patient’s gastrointestinal tract either across the scope via endoscopy or as a retention enema. This has been extensively used as a treatment option in human medicine, but it has been a fairly newer concept in veterinary medicine. This type of procedure can be used to help patients with inflammatory bowel disease or bacterial imbalance (dysbiosis).

Arya was the donor for Pearl

Arya was the donor for Pearl

In Pearl’s case, the transplant was performed via retention enema, and the donor was Dr. Wylie’s own dog, Arya! The transplant seemed to work very well. In fact, Pearl’s stool was normal that night. She did have a week where she had some diarrhea, but ever since, Pearl’s stool has been completely normal!

It is important to note that even though results can be seen as quickly as 24-48 hours, some patients can take a little bit longer to respond. Others may not respond at all. Fecal transplants can be used as needed. Luckily, Pearl has only needed one transplant and has been doing great since.

Learn more about the Internal Medicine service at NorthStar VETS.

Stacie Wylie, DVM, DACVIM
Stacie Wylie, DVM, DACVIMDr. Stacey Wylie is a Pennsylvania native who received her undergraduate degree from Millersville University in 2009. She earned her veterinary degree from Michigan State University College of Veterinary Medicine in 2013. After graduation, she completed a small animal rotating internship at Oradell Animal Hospital in Paramus, NJ. She then returned to Michigan State University and completed a 3-year residency in small animal internal medicine in 2017, receiving Resident of the Year in both 2016 and 2017. Dr. Wylie is excited to be part of the NorthStar VETS team. She loves all things medicine, but her special interests include renal, hepatobiliary, gastrointestinal, and respiratory diseases as well as endoscopy and feline medicine.

She currently resides with her husband, their 3 cats (Aeris, Yuffie, and Leon) and adorable pittie mix (Arya). Outside of work, she enjoys spending quality time with her family and friends, playing ice hockey and volleyball, reading, and playing video games. She is also a passionate MSU Spartan and Philadelphia Flyers fan.

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Harmful Algal Blooms Persist in NJ


On August 20, NorthStar VETS posted a warning to pet parents about toxic algal blooms in NJ waters. This update is to inform pet parents that of the 21 bodies of water affected by harmful algal blooms (HABs) in July and August, 15 continue to be affected in September.

To err on the side of caution, please keep pets away from water that is green, scummy or smells bad. Toxin-producing cyanobacteria are not just dangerous for dogs, they can be fatal! We urge all pet parents to avoid exposure to bodies of water with algal blooms.

For the latest news story, visit NJ.com.

For more information on these harmful blue green algal blooms, visit EPA.gov.

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From the Client Perspective: Tucker


Heather searched Petfinder every day for over a year looking for just the right dog. It wasn’t until an ordinary Saturday morning that she was headed to Costco, that an “Adoption Day” sign outside of PetSmart reeled her in. She saw Tucker immediately and fell in love. His big ears and sweet, lovable personality stole her heart. She stood there holding him for over two hours when the people running the adoption said, “Ma’am, you’re going to have to make a decision, we have to hit the road in about 15 minutes.” They only accepted cash so Heather bolted across the parking lot, hit up an ATM and minutes later, Tucker was hers.

At home, Tucker proved to be an extraordinarily sweet dog with a passion for the outdoors. Squirrels, rabbits and deer were daily visitors and Tucker could chase them all day. Heather said the hardest thing about training Tucker was that he wasn’t food motivated, “he learned how to open the front door as a pup and would run around the block for hours! Neighbors would bring out an entire rotisserie chicken and he still wouldn’t come. He thought it was all just a fun game!” Life with Tucker was great as the next nine years went by, and now they’ve added Adam, Heather’s fiance, to their family. Tucker is a part of everything that they do.

One day after work, Heather and Adam came home and found Tucker upstairs laying on the bed having trouble breathing. “His tail was wagging, but he was working so hard to get air.” They took him outside for a walk hoping they were overreacting, but his breathing was still restricted. His nostrils were flaring, the rise and fall of his chest was off, and he was coughing intermittently. Heather and Adam knew something was wrong. “We stayed awake the entire night watching over him. We knew our vet’s office opened up at 9am, so at 8:30am we began calling every three minutes until someone answered.”

Tucker-Enjoying-Life“We explained what was happening and they told us to come in right away,” Heather said. “We took a video of Tucker’s breathing to show the doctors and after listening to his chest, they took him back for an X-ray.” The doctor came out a few minutes later and said, “I’m so sorry, there is something in his chest.” Heather and Adam were devastated. Their vet recommended that they bring him to NorthStar VETS. Heather called to to let them know they were on their way. The family of three got back into their car and made the trip to Robbinsville. “I was sobbing the entire way,” said Heather.

Air was escaping into Tucker's chest, creating a life-threatening situation.

Air was escaping into Tucker’s chest, creating a life-threatening situation.

Tucker had his chest tapped, which means that air was removed from his chest allowing the organs to sit properly again.

Tucker had his chest tapped, which means that air was removed from his chest allowing the organs to sit properly again.

When they arrived at NorthStar VETS, they were greeted at the front desk and a technician was out within seconds to get treatment started. “Everyone was warm and reassuring to us, which gave a sense of comfort that we brought him to the best possible place.” Heather and Adam were taken to an exam room for privacy as they were visibly upset. Dr. Laura Tasker of the Emergency and Critical Care team came in and explained what had happened. Tucker had a pneumothorax, which is a dangerous condition where air escapes from the lungs and fills the chest cavity. Dr. Tasker calmly explained that a chest tap was necessary, which is a procedure where they remove the air with a needle, to give him some relief and allow the organs to re-expand. Heather said, “Dr. Tasker was so patient and kind. You could immediately feel her love of animals and knew that she wanted what was best for Tucker.” Heather and Adam trusted her and agreed to the chest tap.

Dr. Tasker returned to the exam room and said that the procedure went well but that unfortunately, she was concerned that it would happen again. She reviewed the potential causes of a pneumothorax. These range in severity from cancer to tiny blisters that form on the lungs called blebs or bulla. She reviewed the corresponding treatments, recovery times and life expectancies associated with each. Heather and Adam were devastated about the possibilities. They asked a ton of questions to better understand and Dr. Tasker stayed with them as if she was family. “She was better than any human doctor I’ve ever had. I could feel her heart hurting for us, so I trusted her expertise and opinions.”

Tucker-Drop-OffDr. Tasker called them into another room to review the before and after X-rays. She explained that Tucker had to be admitted overnight and that a CT scan the next morning would diagnose the cause and provide better direction with what options Tucker had.

Before they left for the night, a technician brought Tucker to them again. “It was an emotional moment for us,” said Heather, “we weren’t sure if it would be the last time we saw him.”

The next morning, Heather and Adam received a call from Dr. Steven Berkowitz of the Emergency and Critical Care team. Dr. Berkowitz said that he did well overnight and that they should expect a call from the surgeon at noon to discuss the CT results. He advised that it would be ideal to make a decision quickly. Tucker would be under anesthesia and that if he needed surgery, which was highly likely, they wanted to limit the risks of sedation. “Our number one priority was quality and longevity of life” Heather recalled.

Dr. Barri Sarowitz of the NorthStar VETS Surgery team called Heather and Adam a few hours later and explained that there was no mass or cancer, which was a huge relief. She said that it was blebs on his lungs and that they had to open Tucker’s chest to find and remove the source of the leak. The surgeon allowed them a few minutes to discuss it privately and only a few minutes later Heather and Adam called back and said, “do the surgery.”

About five painstaking hours later, the doctor called and said that the surgery went well and that he had come out of the anesthesia. The surgeons removed two lung lobes where the air was leaking into the chest. They said they would keep him for at least a night or two to recover. Heather and Adam were so relieved, “it felt like the first breath we had taken in days,” Heather said.

Tucker stayed in the Intensive Care Unit with Dr. Berkowitz for continued monitoring. “Dr. Berkowitz called us regularly with updates. We knew Tucker was being well taken care of by the way Dr. Berkowitz talked about him. He explained his personality and details of what he was doing, which every dog mom knows is so important to hear.”

They kept close tabs which Heather said, “the doctors and staff didn’t seem to mind at all. They all were so kind.” Heather said that she will never forget the call she received from Dr. Berkowitz only two days after his surgery. “I was at Bed Bath and Beyond and when I saw the number, I was so hopeful it was the good news we were waiting for. He called to say that it was time to take him home! I told Dr. Berkowitz that I loved him and for sure, did a little dance right there in the aisle!”

Tucker-Going-HomeWhen Heather and Adam got to NorthStar VETS, Dr. Berkowitz came out to greet them. He went over the medications Tucker would be on and gave instructions for caring for him at home post-surgery. “Dr. Berkowitz was so wonderful. He felt like family and was so patient with all of my questions. He let us know exactly what to expect which was really helpful. Tucker came out a few minutes later and we were headed home to be a family again.”

Today, Tucker is getting back to normal at home. “We’ve made accommodations for him,” said Heather. “We’ve been sleeping with our mattress on the floor so Tucker can still be with us at night. We’re still trying to keep him from getting too much activity, which is truly the hardest part. He’s going for walks again and loves laying in the grass in his t-shirts! We’re so grateful to the team at NorthStar VETS for their expertise, compassion and for allowing us to continue our life with Tucker!”

Tucker-at-HomeTucker-WalkTucker-T-shirtTucker-Resting

Learn more about the Emergency and Critical Care service at NorthStar VETS.


Laura Tasker, DVM, CVMALaura Tasker, DVM, CVMA
Dr. Tasker earned her bachelor of science degree in animal science from the University of Delaware. She continued her veterinary studies at Ross University School of Veterinary Medicine, with a year of clinical training at Colorado State University College of Veterinary Medicine. She completed an internship in emergency and critical care at the Veterinary Specialty and Emergency Center in Levittown, Pennsylvania. Her professional interests include trauma stabilization, wound care, and metabolic diseases. She is certified in both large and small animal veterinary acupuncture, and has a particular interest in pain management. Outside of NorthStar VETS, Dr. Tasker enjoys spending time with her family and friends, playing with her Australian Shepherd, and all things horses.

Steven Berkowitz, DVM (practice limited to emergency and critical care)Steven Berkowitz, DVM (practice limited to emergency and critical care)
Dr. Steven Berkowitz attended St. Georges University and did his clinical year at the University of Illinois. Berkowitz joined NorthStar VETS after serving as the Chief of Emergency and Critical Care at another specialty hospital. Prior to that, he completed a three-year residency in Emergency and Critical Care medicine at the Oradell Animal Hospital in Paramus, NJ. His residency was completed at one of only a few recognized veterinary trauma centers in the United States. Prior to his residency, he was a staff Emergency Veterinarian at Animal Specialty Center in Yonkers, NY as well as serving as an emergency doctor at Animal Emergency and Referral Associates in Fairfield, NJ for 3 years. Dr. Berkowitz can be seen on seasons 5 and 6 of “Animal Precinct” on Animal Planet, which was filmed during his internship at The Bergh Memorial Animal Hospital of the ASPCA in New York City.
Dr. Berkowitz has special interest in the management of metabolic and endocrine derangements, trauma, as well as management of the septic patient.

Barri Sarowitz, VMD, DACVSBarri Sarowitz, VMD, DACVS
Having grown up in south Jersey, Dr. Sarowitz is excited to join the surgery team at NorthStar VETS. Dr. Sarowitz obtained her Bachelor of Arts in Biology from Cornell University in 2007. She moved to Philadelphia and worked as a veterinary technician for a year before completing veterinary school at the University of Pennsylvania in 2012. After graduating, Dr. Sarowitz completed a rotating internship at Red Bank Veterinary Hospital in Tinton Falls, NJ. Following her internship, she completed a three-year residency in surgery at Red Bank Veterinary Hospital in 2016. Her surgical interests include surgical oncology, minimally invasive surgery, cardiothoracic surgery, and wound management. She is trained in the tibial plateau leveling osteotomy (TPLO) and lateral extracapsular suture techniques for cranial cruciate ligament disease. Outside of work, she enjoys hiking, traveling, and football.

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