Veterinary Hospice in 2012

We wanted to wish all our friends and followers a Happy New Year.

Lap of Love had a lot happen in 2012 - here is a recap:

It all started in January -  Drs. Dani McVety and Mary Gardner were asked to present the topics of Veterinary Hospice and Euthanasia at the North American Veterinary Conference (NAVC) in Orlando. Their sessions were attended by technicians, practice managers and veterinarians.

We also had the coolest booth in the exhibit hall.

Veterinary Oncologist Dr. Karri Miller joined the team to offer phone consultations to pet parents around the world dealing with cancer.  Learn More    And Jodi Ziskin joined to offer nutritional phone consultations: Learn More

At the start of 2012 - we had 11 locations... but this year we were blessed to find 11 wonderful veterinarians to double the size of Lap of Love and help families in the following locations:

Miami, Florida - Dr. Ursula Dell
Philadelphia, Pennsylvania - Dr. Brad Bates
St. Louis, MO - Dr. Dawnetta Woodruff
Houston, Texas - Drs. Charles Jameson and Cheryl Maguire
Dallas, Texas - Dr. Holly Kiernicki
Boston, Massachusetts - Dr. David Rousseau
St. Augustine, Florida - Dr. Danielle Churchill
Greensboro, North Carolina - Dr. Sara Fletcher
Naples, Florida - Dr. Suzaane Brough
Atlanta, Georgia - Dr. Courtney Culbertson
Annapolis, Maryland - Dr. Melanie Cohen

Two of our veterinarians moved locations.
Dr. Juliana Lyles moved to Chicago, Illinois  & Dr. Nicole Sabo moved to Connecticut.

Twelve additional veterinarians joined in existing areas such as South Florida, Tampa, Knoxville, Orlando, Charlotte and Jacksonville.    We now have 40 of the most compassionate veterinarians helping families in 22 locations and 13 states.  WOW!

We published 60 blog posts (including this one), 5 newsletters and some Lap of Love vets were even interviewed for news stations.

Photo courtesy of Sun Sentinel

Lap of Love also had articles published in veterinary journals and other non-vet magazines - all to help increase the awareness of veterinary hospice and options available.

In November, Drs. Gardner, McVety and Lyles attended the 2nd Annual International Association of Animal Hospice and Palliative Care (IAAHPC) in Denver to learn about new trends in veterinary hospice and share some of their ideas with fellow veterinarians.

We added two wonderful artists to our shopping site that create personalized items to help remember our loved ones:

Tile Art by Paul Gold:  See More

 

Art Glass by Babs:  See More

A beautiful song was created for us by Zach Ziskin and a video was made for it as well:  Click here to watch.   But have tissues present!   You can also purchase the song for your personal use. Learn More

And lastly - to help families remember their pets, we developed our Pet Memorial site where parents can upload pictures, stories and memorials for their pets plus they can send that to friends and family members so that they can light candles in memory of those pets and post a message.  Learn More

In summary - it has been a year full of new colleagues and FULL of wodnerful, awesome families that love their pets just as much as we do. We have shared tears, stories, smiles, photos, memories and bonds with so many of our clients.  Many people may question how we can do what we do... but I think all of our families know... we have to - there is no other way.

With warm wishes for a wonderful new year.  We will think fondly of those we lost in 2012 and cherish those we still have.

Mary Gardner, DVM
www.lapoflove.com

Here are some favorite pics throughout the year:

 

Cognitive Dysfunction in Pets, by Dr. Cheryl Maguire

Photo (c) Pavel Horak
(Click to see original on Flickr)

I must admit that I have a soft spot for senior pets. Nothing is more comfortable or dependable than the relationships we have with the dogs and cats who have shared our lives for years. But as our pets age, we may start to notice things that are concerning to us. At night, our dogs may pace and pant and our cats may howl. Our pets may sleep longer than usual, seem disoriented or disinterested or hide. These behaviors may trouble us but then we may think, “Isn’t this part of the normal aging process?” The answer to that is yes and no.

Like humans, as pets age their senses become diminished and the body slows down as a normal part of the degenerative process but we do not have to sit back idly and accept the changes. Instead, we can help our pets have a better quality of life even as they advance into their golden years. I am going to briefly discuss Cognitive Dysfunction Syndrome as well as touch on some of the many things that can be done to alleviate it.

Cognitive Dysfunction is a syndrome that affects both cats and dogs as they age. The symptoms will vary in degree and form but usually include disorientation, disruption of sleeping patterns, problems with house soiling and changes in appetite and interest in life. Most importantly, other disease processes must first be ruled out and, if needed, treated by your veterinarian since many conditions common in geriatric pets overlap with Cognitive Dysfunction.

Once Cognitive Dysfunction has been identified in your pet and other conditions have been ruled out there are several approaches that can be taken to ameliorate the symptoms. To get the best results you should use several of these suggestions together. But, the first thing is to review what medications your pet is currently receiving with your veterinarian. Some medications such as sedatives, anxiety medications and steroids can actually exacerbate the symptoms of Cognitive Dysfunction. Other medications like non-Steroidal anti-inflammatory (NSAID) drugs can help alleviate them.

Asses your pet’s diet and the quantity of food they are consuming. Research has shown that animals and humans that consume a calorie restricted diet experience fewer problems with senility and Alzheimer’s Disease. On the other hand, a pet that is too thin and not as interested in food as they were in the past may benefit from appetite stimulants. There is at least one commercially made food on the market that is made specifically for older dogs showing symptoms of Cognitive Dysfunction. In general your pet should be fed a low carbohydrate food that contains good quality protein source.

There are many categories of supplements that can be added to the pet’s diet to improve the symptoms seen with Cognitive Dysfunction. Fish oil supplements containing at least 300mg of DHA, CoEnzymeQ10, Gingko, SAMe, as well as vitamin and nutraceutical products made specifically for Cognitive Dysfunction can be administered along with diet changes. Melatonin can be given at night to help with sleep disturbances.

One of the most important aspects of helping senior pets with Cognitive Dysfunction is stimulating their senses and providing daily exercise. Include your senior pet in daily activities as much as they will tolerate. Groom them gently, talk to them, take them on short walks even if it is just around the house or yard. Feed them interesting small meals and allow them to interact with other pets in the home. Bring them out of the closet and out from under the bed or if necessary, bring the family members to them. But, keep these seniors involved with their families and mentally stimulated.

The best way to help your senior pet that is exhibiting symptoms of Cognitive Dysfunction is to visit your veterinarian and discuss the options for your pet’s individual situation. The most successful strategy is to implement as many of the different options available as possible. You should start to see an improvement in your senior pet within two weeks of implementing any of these methods. Some pets respond even sooner. In the very least do not give up hope and accept the negative effects of the aging process without giving some of the options discussed a try.

Lap of Love Pet Memorial Site

Lap of Love is proud to announce their new Pet Memorial site to help families honor the lives of those they loved!   The site allows pet parents to submit a memorial about their pet, write a story (like how they got their pet, their favorite things), attach multiple pictures and even send an email to friends and families about the post.  Those people can then submit messages and light virtual candles for that pet.

Here is how it works.

1) Go to www.lapoflove.com

2) In the upper left menu bar - click the tab 'Pet Memorials'

3) Click 'Submit A Memorial' button  (or use the search options to see existing memorials)

4) Fill out the information on the form and hit submit!  Your memorial will be posted immediately and an email will be sent to you and whomever you choose, with a link to your pet's memorial. 

5) People can come to your pet's site and post comments/light a candle.  See Jasper's page below:

If you have any questions - please contact Dr. Mary Gardner at drmary@lapoflove.com

Lymphoma by Dr. Dana Lewis

Cancer is a fascinating disease. No, really. It is amazing how our genes can betray us on their own, or due to us abusing them by choice (smoking, sun worshipping, etc.) or inadvertently (all the other stuff our bodies are exposed to). If you want to read an excellent book, I recommend The Emperor of All Maladies, by Siddhartha Mukherjee. It is a biography of cancer and is really amazing.

lymphoma cells in a RBC background
from a bone marrow biopsy.
Source: Nature.com

Lymphoma, also called lymphosarcoma, is a highly malignant tumor of the lymph system. It is the most common form of cancer in both humans and small animals. Dogs, cats, and young ferrets are hard hit by this cancer.

What is Cancer?

We do not know how pets and people get cancer most of the time. Cancer starts with a cell that has mutated due to genes turning on or off, and growth starts to run amok. These cells are being born in our bodies all the time and we have an assortment of mechanisms to destroy them before they get out of hand. Sometimes these cancer cells escape destruction and cancer grows. It begins to divide quickly and without control. The organ where the abnormal cells live may be destroyed as the cancer cells take over. Other tissues may become invaded as the tumor cells grow into them. Cancer cells break away from the primary tumor and travel via blood or lymph vessels to other areas of the body. Wherever these cells lodge, they can start new tumors. This form of cancer spread is called metastasis.

What is the Lymph System?

The lymph system is a network of vessels that intersect with the blood stream and direct foreign material and organisms (bacteria, viruses, etc.) to the lymph nodes that then process this debris. The lymph nodes are full of the cells of the immune system. There are many different types of immune-related cells; some produce antibodies, some circulate and destroy the foreign materials they encounter, some regulate the activity of other cells. Lymphocytes, a type of white blood cell, are the primary cells of the lymph system. The spleen and liver are also heavily involved with the lymph system. Lymphoma can occur anywhere in the body.

What is Lymphoma?

lymphocytes smeared out
from a node aspirate.
Source: BiomedicalCentral.com

When lymphocytes become cancerous within a lymph node, the node swells and hardens. Malignant lymphocytes readily travel through the lymph vessels to nearby lymph nodes. Soon all the nodes are enlarged. Ultimately, the bone marrow where are blood cells are formed becomes obliterated with these abnormal cells, the immune system is destroyed, and severe anemia, organ failure, and/or infection usually claim the victim's life. (Leukemia is another type of white blood cell cancer with circulating blood cells-these can be immature lymphocytes or other white cell lines. Leukemias are usually detected from a blood sample while lymphomas are detected from taking a sample from a node or biopsy of other affected tissues. However, lymphoma is also the most common cancerous cause of hypercalcemia (high blood calcium levels) in dogs, so that may be detected on bloodwork).

Dog with swollen lymph nodes.
Source: NCSU College of Veterinary Medicine

The typical dog lymphoma patient is a middle-aged dog who goes to the veterinarian because one or more lumps have been found. In dogs, the most common lymphoma form is the multicentric form, where all the lymph nodes of the body seem to enlarge at once. Certain breeds of dogs are more likely to develop lymphoma, especially the Golden Retriever, but also the Boxer, Scottish Terrier, Basset Hound, Airedale Terrier, Chow Chow, German Shepherd, Poodle, St. Bernard, Bulldog, Beagle, Rottweiler. While multicentric lymphoma can occur in cats, the most common feline form of lymphoma is currently intestinal. This was not always the case. Years ago, prior to the widespread use of the feline leukemia vaccine, the mediastinal form (a tumor in the chest cavity) was the predominant lymphoma form and the leading cause of lymphoma was the feline leukemia virus. Now the virus has become less common, thanks to more cats living indoors, effective vaccination, and readily available testing procedures. The average intestinal lymphoma patient is an elderly cat with a history of vomiting, diarrhea, weight loss, appetite loss or any combination thereof. A mass may develop with intestinal lymphoma or the tumor may be more infiltrative. A mass can potentially cause obstruction in the intestine and lead to a crisis that must be promptly resolved surgically. Cigarette smoke in the home has been found to double a cat's risk of developing lymphoma.

WITHOUT TREATMENT, ANIMALS WITH LYMPHOMA ARE EXPECTED TO LIVE 4-8 WEEKS FROM THE TIME OF DIAGNOSIS.

Many patients are not feeling particularly sick at the time of diagnosis. It may be tempting to hold off on treatment until the pet seems more ill. Waiting can drastically reduce the chance for long-term survival; better remission quality is obtained if the patient is treated while still feeling healthy.

What is Remission?

Remission is the state in which symptoms have been abated, the tumor cells are undetectable for the moment, and the patient doesn’t appear to have cancer. Prolonged remission is the goal of cancer therapy which, for most lymphoma cases, means chemotherapy. How long a remission lasts depends on what protocol is used and a number of other factors. Numerous protocols are available and there is one to fit every budget and every schedule.

What is Cure?

Cure is the permanent removal of all traces of tumor such that no further treatment is needed. In effect, it is a permanent state of remission. While this is a possibility for your pet, it is more constructive and realistic to focus on increasing quality time. With lymphoma, remission is likely but cure is not.

Chemotherapy

Chemotherapy means therapy using medication (as opposed to surgery or radiation, which can also play a role in lymphoma therapy). The word chemotherapy conjures images of people losing their hair and suffering chronic overwhelming nausea. It is unfortunate that many pets (and probably people, too) do not receive chemotherapy based upon these unpleasant images that poorly represent the current state of treatment. Decades of research has gone into patient comfort, minimizing side effects, and maximizing response. There is a lot of research going on to tailor therapy to the specific genes that are out of control, and several chemotherapeutic agents on the market for other cancers that target specific gene activity, and which greatly minimizes side effects.

Only 7% of pet patients require hospitalization due to side effects of chemotherapy. 75% of lymphoma patients go into remission with chemotherapy protocols beyond prednisone alone. In cats, protocols using multiple drugs yield much better results, but high grade lymphoma, FeLV+ cats, and cats with lymphoma in the kidneys have a poorer response to therapy with median survival of 6-9 months. Low grade intestinal lymphoma cats can live for years while on chemotherapy. The median survival time for most dogs on chemotherapy (again not just prednisone) is approximately one year with 25% of dogs surviving two years. T-cell lymphoma is less responsive to medication than B-cell lymphoma. Luckily, B-cell lymphoma accounts for 75% of canine lymphoma. Several facilities also are doing bone marrow transplants with their chemotherapy dogs who have gone into remission and are appropriate candidates. This can be curative in about 30% of dog patients.

Blog written by:
Dr. Dana Lewis

Posted by Dr. Mary Gardner

Read more or contact Dr. Dana:
Dana Lewis, DVM
Lap of Love Veterinary Hospice
Raleigh, North Carolina
drdana@lapoflove.com  |  www.lapoflove.com

Dr. Dana assists families with Pet Hospice and Euthanasia in the Raleigh North Carolina area (Raleigh, Durham, Chapel Hill and the greater Triangle, as well as Wake, Durham, Orange, and Chatham counties.

So, do our pets go to heaven? By Dr. Laura Allison

This question has been pondered by many. An answer never confirmed. The human- animal bond has developed so profoundly that it is no wonder why we seek to find the truth. This question, even if not discussed publicly, weighs heavily on our minds, especially at the moment when we must make the most difficult decision to mercifully let go of our beloved pets.

There is much debate on this topic, whether from a religious perspective or philosophical one. If you ask most pet parents if they believe their pets go to Heaven, the vote is unanimously yes. Ask a theologian, and you may receive a different answer. My perspective is simply this: our pets are sentient beings full of love, what is closer to Heaven than this?

There are many references from people who have had a near death experience. Many report they have seen their beloved pets in the light or on a ladder leading upward toward a light. Hallucination, I think not. It is up to each of us to make our own decision.

Below are excerpts from the book, Beyond the Light, which documents such experiences. Copyright Beyond the Light, originally in hardcover, Birch Lane Press, New York City (reprinted as a paperback through Avon Books, New York City, 1995 - ISBN: 0-380-72540-1).

I found that both adults and children occasionally report being greeted on The Other Side by animals, especially if favored pets have previously died. But it is the children who describe an animal heaven, some even insisting that they must go through it before they can reach the Heaven where people are. Adult cases can be equally compelling.

Several years before his death, Bryce Bond, a famous New York City media personality turned parapsychologist, shared with me the story of what happened to him when he once collapsed after a violent allergic reaction to pine nuts and was rushed to a hospital. He remembered suddenly passing through a long tunnel toward a brilliant light, and then (pages 13-14, paperback version, "BEYOND THE LIGHT"):

"I hear a bark, and racing toward me is a dog I once had, a black poodle named Pepe. When I see him, I feel an emotional floodgate open. Tears fill my eyes. He jumps into my arms, licking my face. As I hold him, he is real, more real than I had ever experienced him. I can smell him, feel him, hear his breathing, and sense his great joy at being with me again.

"I feel the presence of my dog around me as I ponder those two questions. Then I hear barking, and other dogs appear I once had. “

The following near-death experience appears in P.M.H. Atwater's book, Childrenof the New Millennium (now out of print - see The New Children and Near-Death

“From the light came two dogs of mine. One was a collie named Mimi who had died three years previously from an infection, and the other was a boxer named Sam who had died two years before after being hit by a car. The dogs came running and jumped on me and kissed my face with their tongues. Their tongues weren't wet, and I felt no weight when they jumped on me. The dogs seemed to glow from a light that was inside them. “

Looking to the spiritual, below are verses found in the Bible that may make the case.

The Old Testament:

Ecclesiastes 3:18-21: “As for humans, God tests them so that they may see that they are like the animals. Surely the fate of human beings is like that of the animals; the same fate awaits them both: As one dies, so dies the other. All have the same breath (literally “spirit“); humans have no advantage over animals. Everything is meaningless. All go to the same place; all come from dust, and to dust all return. Who knows if the human spirit rises upward and if the spirit of the animal goes down into the earth?”

Genesis 9:9-10: “I now establish my covenant with you and with your descendants after you; and with every living creature that was with you—the birds, the livestock and all the wild animals, all those that came out of the ark with you—every living creature on earth.”

Genesis 9:16: “Whenever the rainbow appears in the clouds, I will see it and remember the everlasting covenant between God and all living creatures of every kind on the earth.”

Hosea 2:18: “In that day I will make a covenant for them with the beasts of the field, the birds in the sky and the creatures that move along the ground. Bow and sword and battle will abolish from the land, so that all may lie down in safety.” 

The New Testament:

Luke 3:6: "all flesh will see the salvation of God."

Luke 12:6: “Are not five sparrows sold for two pennies? Yet not one of them is forgotten by God.”

Revelation 5:13: "Then I heard every creature in heaven and on earth and under the earth and on the sea, and all that is in them, singing: 'To him who sits on the throne and to the Lamb be praise and honor and glory and power, forever and ever!' "

Regardless of one’s faith, most of us would agree that we will see our pets again. With all that our pets give us in a lifetime; friendship, unconditional love and devotion, surely they will live on long after they have left us.

Blog by Dr. Laura Allison

Posted by Dr. Mary Gardner

Read more or contact Dr. Allison:
Laura Allison, DVM

Lap of Love Veterinary Hospice
(954) 778-8908
Pompano Beach, FL
drallison@lapoflove.com  |  www.lapoflove.com

Dr. Allison services Broward County, including Pompano Beach, Lighthouse Point, Hillsboro Beach, Deerfield Beach, Coconut Creek, Oakland Park, Wilton Manors, Coral Springs, Tamarac, Plantation, Sunrise, Lauderhill, Oakland Park, Ft. Lauderdale, Aventura, Miramar, Hollywood, Davie, Pembroke Pines, Cooper City, and Weston.

Thanksgiving Food Dangers for Dogs and Cats

I know we all like to share some of our Thanksgiving goodies to our dogs and cats - but please be careful because there are some things that are extremely dangerous for our furry family members.  Plus, veterinarians see an increase in post-Thanksgiving pancreatitis in dogs because of overfeeding (especially fatty foods).

The Reader's Digest posted this great article (Keep pet safety on the mind while cooking Thanksgiving dinner) that talks about some of those dangerous items:

http://www.rd.com/home/thanksgiving-foods-that-are-toxic-to-cats-and-dogs/

Herbie (the cat) and Angel (the dog) wish you a Happy Thanksgiving! 

Blog posted by:
Vet Mary Gardner
Lap of Love Veterinary Hospice & In Home Pet Euthanasia
Serving Broward and Palm Beach counties in Southern Florida
www.lapoflove.com

Warning to Owners: Don't give these sweets to your dogs! by Dr. Laura Devlin Bacon

Xylitol poisoning in pets is very serious.

Xylitol, a sugar substitute used in many products, including sugar-free gum and mints, chewable vitamins, oral-care products and baked goods, can be highly fatal to your dog if ingested. Xylitol is a popular sweetener in Europe and Japan, and its use as a sweetener in the United States has grown rapidly over the last few years. While xylitol consumption is considered safe in people, dogs are different story altogether.

Xylitol’s ability to cause low blood sugar in dogs has been known for almost 40 years. However, a recent study has found that xylitol also can cause acute liver failure in man’s best friend. The ASPCA Animal Poison Control Center (APCC) has released its findings from a study of eight dogs that developed liver failure and blood clotting disorders after ingesting xylitol. These dogs had accidentally eaten a variety of products containing xylitol, including cookies, gum, cupcakes, xylitol powder, and muffins. Five of the eight dogs were euthanized or died because of liver failure.

The molecular structure of xylitol

While xylitol causes little-to-no insulin release in people, it does cause a rapid and profound insulin release in dogs. As early as 30 minutes and up to 12 hours after eating xylitol, a dog’s blood sugar can plummet, causing lethargy, vomiting, collapse, seizures, and even death. In addition, some dogs will develop decreased blood potassium and phosphorous levels and increased liver enzymes. In severe cases, massive liver damage, liver failure, and loss of blood clotting abilities can occur, leading to death. The lowest estimated dose of xylitol associated with liver failure is 1 gram per pound – that’s about 5 sticks of gum per 1 pound of dog. However, blood sugar abnormalities can occur with a much smaller amount. Any xylitol ingestion by a dog should be considered potentially life-threatening.

Pet owners: if you are diabetic or watching your diets by using xylitol-sweetened products, please keep them out of the reach of your pets. If your dog consumes even the smallest amount of a xylitol-containing product, it is crucial to seek veterinary treatment immediately. Your dog will need to be hospitalized for at least 24 hours and monitored so that care can be given should his or her blood sugar drop. In addition, supportive care may be needed for the next 72 hours for possible liver damage. Rapid, aggressive treatment is the best way to increase your dog’s chance of surviving this deadly treat.

Laura Devlin Bacon, DVM, DABVP
Canine and Feline Practice

Read more or contact Dr. Bacon:
Laura Devlin Bacon, DVM DABVP
Lap of Love Veterinary Hospice
Knoxville, Tennessee
drlaura@lapoflove.com
www.lapoflove.com

Dr. Bacon services the Greater Knoxville Area, including Farragut, Lenoir City, Oak Ridge, Clinton, Luttrell, Maryville, Sevierville, and Dandridge.

Blog posted by Vet Mary Gardner

Is my dog fat? By Dr. Dawnetta Woodruff

"Is my dog fat?" 

 As a veterinarian, this is a question I hear in the exam room almost every single day. Often, people are caught off guard when the scale reads 10lb instead of 8lbs like last year... or 85lbs instead of 75lbs. A few extra pounds over the course of a year may not sound like much... but lets do the math. For an 8lb dog, gaining 2lbs over the course of a year is a 25% increase in weight.

Lets put that in more terms that are easier to grasp... For a person, that would be the same as weighing in at 160lbs this year, and 200lbs next year! If you or I gained 40lbs in a year, we would be very concerned! We would notice that none of our clothes fit, we would be short of breath going up and down stairs, and we would have a lot less energy - and we would be at risk for health problems like heart disease, joint problems, diabetes, and stroke. For our pets, the health risks are just as real, even though the number of pounds gained is much smaller.

So now that we know a few pounds CAN be a big deal for our 4-legged family members, how can we answer the "Is my dog fat?" question? And how can we keep a closer eye on our pets weight at home, in between yearly vet visits? The answer is not in the number itself, but rather in your pets Body Condition Score, or BCS (see chart below). The BCS is a system used to evaluate your pets weight, taking their frame size into account. The scale ranges from 1-9 with 1 being "emaciated" and 9 being "severely obese" - a score of 4-5 is considered "ideal." So what exactly do these numbers mean? Lets take a closer look...

1. Ribs, lumbar vertebrae, pelvic bones and all bony prominences evident from a distance. No discernible body fat. Obvious loss of muscle mass.
2. Ribs, lumbar vertebrae and pelvic bones easily visible. No palpable fat. Some evidence of other bony prominence. Minimal loss of muscle mass.
3. Ribs easily palpated and may be visible with no palpable fat. Tops of lumbar vertebrae visible. Pelvic bones becoming prominent. Obvious waist.
4. Ribs easily palpable, with minimal fat covering. Waist easily noted, viewed from above. Abdominal tuck evident.
5. Ribs palpable without excess fat covering. Waist observed behind ribs when viewed from above. Abdomen tucked up when viewed.
6. Ribs palpable with slight excess fat covering. Waist is discernible viewed from above but is not prominent. Abdominal tuck apparent.
7. Ribs palpable with difficulty; heavy fat cover. Noticeable fat deposits over lumbar area and base of tail. Waist absent or barely visible. Abdominal tuck may be present.
8. Ribs not palpable under very heavy fat cover, or palpable only with significant pressure. Heavy fat deposits over lumbar area and base of tail. Waist absent. No abdominal tuck. Obvious abdominal distension may be present.
9. Massive fat deposits over thorax, spine and base of tail. Waist and abdominal tuck absent. Fat deposits on neck and limbs. Obvious abdominal distention.

Image courtesy of Nestle Purina company

At first, this scoring system may seem a big confusing. If so, its time to have a conversation with your veterinarian at Fido's next checkup! They can explain the system to you, and help you evaluate his or her individual score. Using this knowledge, together you can decide the answer to the question "Is my dog fat?" And if the answer is yes, you can form a plan of action to help your pet get to a healthier weight. Usually, I cannot give someone an exact answer to the question "How many pounds does Coco need to lose?" Rather, I can let them know their Coco's BCS, and give them a goal BCS. Using this information, we can determine approximately how much their pet may need to lose - but often, my answer is something along the lines of "Coco is currently a BCS of 8. I would like her to lose 8-10lbs, and then we will re-evaluate her BCS to determine how much more weight she may need to lose." Obesity is a definite concern for our pets, and just as with people, the solution is not simple and the goal often cannot be reached in a few weeks or even a few months. If your 4-legged family member has been gaining weight for 2-3 years, remember, it may take 1-2 years to lose that same amount of weight! Be diligent, talk with your vet often, and come up with a plan that works for all three of you!

If you would like more information regarding obesity in our pets, you may enjoy a previous Lap of Love blog written by Dr. Dana Lewis.

Blog Written by:
Dr. Dawnetta Woodruff
Click here for Dr. Dawnetta's Bio and Contact information
Dr. Dawnetta assists families with in home hospice and euthanasia in Missouri & Illinois areas including:

• MISSOURI - Serving St Louis and portions of the St Louis Metro: South County / Fenton / Chesterfield / Kirkwood / Webster Groves / Town & Country / Ellisville 
• ILLINOIS - Serving Monroe County and portions of Randolph & St Clair counties: Waterloo / Columbia / Smithton / Millstadt / Belleville / Fairview Heights / O'Fallon 

Blog posted by Vet Mary Gardner

The dangers of dog and cat collars, by Dr. David Rousseau

Photo by Akyra
(Click to see original.)

Fall has come to New England, and we hopefully don’t have to worry about cars overheating with dogs trapped inside. But as I passed a car parked under a shady tree with a dog in the cargo area just this week, I was reminded of another danger of dogs in the car…collars. I have no idea how many dogs are injured by collars each year. I do know that as a practicing vet, I always warned my clients of the potential dangers.

Collars serve many purposes for our furry friends. Fashion, control, restraint, training, identification…these are great purposes for collars. But collars can be dangerous.

Many years before I was a veterinarian, I worked with in a restaurant with a cook who wanted a German shepherd puppy desperately. She was thrilled when she finally purchased the beautiful purebred dog, and she was enamored of that gorgeous puppy. She even brought it to work and left it in her truck, uncrated but collared. She could visit it and take it out throughout the evenings. One night, as the shift drew to a close, we heard the most horrific scream from the kitchen. We all raced through the swinging doors, and we were greeted with the unimaginable. There stood my sobbing friend with her lifeless puppy in her arms. The puppy had fallen from the front seat and the collar caught on the handle of the window crank. I will never forget that tragic night, and have told that story a million times as a reminder. No collars in the unattended vehicle. And never, ever leave a choke collar on!

If you are going to leave your dog in the car, even for a few minutes, take off the collar. Most collars have a heavy duty snap, so they are easy to on and off. Consider purchasing one for just such car rides. The same goes for crating. I have seen dogs trapped by tag on a collar to the outside of a crate. While the outcome was not grim, the puppy had been trapped for some time. It could have been a tragedy. No collars in the crate.

As just mentioned, collar tags can increase the risk of problems. Name tags, rabies tags, identification tags…the jingle through the house can be a sweet and reassuring sound. But they can be hazardous. A good friend who lives in the country, and is an experienced dog owner, had her young Springer Spaniel out walking off leash. The rabies tag was dangling from the collar. The dog ducked under the electric horse fence, and she managed to somehow catch the slightly opened “s” hook on the live wire. She instantly went into panic mode, biting wildly and screaming madly as her mother tried to get her collar off. Her mother got severely bitten in the panic, and required hospitalization. Be sure all tags are safely secured so they cannot get trapped, and use an easy off collar if your dog is off leash to avoid them ever getting trapped.

Collars and tags are a necessary and useful part of dog life, but we humans have to be very mindful of the dangers they can pose. Being aware and taking precautions are the key to using them safely.

Blog Written by:
Dr. David Rousseau
Click here for Dr. David's Bio and Contact information
Dr. David assists families with in home hospice and euthanasia in the greater Boston, Mass area including
~ Cape Anne ~ The North Shore  ~ Beverly ~ Manchester-by-the-sea ~ Gloucester ~ Hamilton ~ Wenham ~ Rockport
~ Ipswich ~ Salem ~ Danvers

Blog posted by Vet Mary Gardner

Rabbit Care, by Dr. Michelle Bellville

Photo by Jaime.
(Click to see original.)

Thinking about getting a small furry friend?

Rabbits are cool little animals with great personalities. They can be potty trained and can even live peacefully sharing a house with cats and dogs. These creatures can range in size from dwarf breeds that weigh only a few pounds to Flemish giants that easily weigh over 20 pounds! They have extremely powerful rear legs that help them jump, and all sizes of these animals are at risk of breaking their backs if mishandled. They are ‘hind gut fermenters,’ meaning that they use bacteria in their large intestine (behind the stomach, or ‘gut’) to help digest the fiber they eat. Other examples of hind gut fermenters are horses and rhinoceros! ‘Foregut fermenters’ are animals like cows and giraffe that use bacteria in their stomach to digest the fiber they eat. As gross as this sounds, rabbits consume some of their own feces – special fecal pellets called cecotropes – in order to get all the nutrients they need. You will probably never see them do this, as they usually consume cecotropes at night or early morning. This is an important reason to make sure your rabbit’s cage does not have a wire/mesh bottom that would allow for waste to drop where your rabbit can’t reach.

Photo by Asaciel
(Click to see original.)

Just like horses, rabbits need access to food all day, and one of the most common problems requiring medical care are gastro-intestinal related issues. Also like horses, rabbits cannot vomit and need to eat predominantly hay and grasses. Contrary to popular belief, rabbit pellets are meant to be a minor portion of the daily diet, with unlimited access to hay and measured amounts of fresh chopped veggies as the major portion. Young rabbits can have alfalfa hay and pellets, but as rabbits mature, the hay and pellets offered should be something other than alfalfa. Timothy pellets are very common, and you can vary the hay with timothy, orchard grass, botanical, meadow, and oat hay. Fresh chopped veggies should be dark leafy greens, root veggies, and herbs. The list for greens/herbs is quite long, but include things like dandelion greens, kale, arugula, spring mix, turnip greens, bok choy, fennel, basil, mint, and cilantro. Offer these at 1 packed cup per 2 pounds body weight. Veggies include things like carrots, broccoli, edible flowers, celery, bell peppers, cabbage, and squash and should be offered at 1 tablespoon per 2 pounds of body weight per day. Rabbits LOVE fruit and can have this special treat in small quantities (no more than 1 teaspoon per 2 pounds body weight per day).

Having a solid handle on a great diet for your rabbit will make it easy keeping a rabbit happy and healthy for a long time! Check out www.rabbit.org for great information on rabbit care, and don’t forget to have your rabbit examined yearly by an exotics trained veterinarian!

Blog by:
Dr. Michelle Bellville
www.lapoflove.com
Click Here for Dr. Michelle's Bio/Contact Information

Dr. Bellville assists families in the Orlando Florida area with In Home Hospice and Euthanasia. She is also available to assist families with 'exotic' species like birds, hamsters, rabbits, etc with all end of like care. 

Medication Nightmares: or why you shouldn't give medication to your pet without talking to a vet first, by Dr. Dana Lewis

Always ask your veterinarian before administering any medications, supplements, herbal remedies, etc. to your pet. Here are some common household meds you might think are safe but they are NOT.

Aspirin: While dogs can be given aspirin with caution, this can cause major GI ulceration if given inappropriately, and also disrupt clotting leading to your pet hemorrhaging. It is a huge NO-NO in cats. They cannot metabolize it fast enough. Signs of aspirin toxicosis may include fever, rapid breathing, vomiting, melena (black digested blood in stool), abdominal pain, seizures, and coma.

Pepto-Bismol and Kaopectate: Again, proceed with caution in dogs, and a huge NO in cats as this product contains bismuth subsalicylate which is an equivalent to ASPIRIN!

Ibuprofen (Advil): I don’t recommend it in dogs due to great risk for GI ulcers and kidney failure. And never in cats.

Acetaminophen (Tylenol): The active ingredient in Tylenol® and other commonly used over- the-counter medications, such as Percocet®, aspirin-free Excedrin®, and various sinus, cold, and flu medications, is acetaminophen. Lots of human doctors no longer recommend this for people. We don’t use it in our house. I would never give it to a pet: Can cause liver failure in dogs, in cats it will KILL them. Yes, kill them. One tablet. Bad news, Causes damage to red blood cells and liver failure.

Topical steroid creams: If ingested, and pet is on an NSAID it increases the risk of GI ulcers. Also, even if pet is not on an NSAID, chronic consumption or absorption through the skin can cause iatrogenic Cushing’s disease. (iatrogenic means caused by you, and Cushing’s disease is when you have too much cortisol in your body and you become more prone to infection, poor wound healing, liver damage, thin coat and thin skin, loss of muscle mass, and a bunch of other problems.) Also, some topical steroids are in combo with calcipotriene which can cause elevated blood calcium that can result in kidney failure, heart failure, and possibly death. 

Garlic: not only does it not work on fleas, as a member of the onion family it is toxic to red blood cells and destroys them.

Imodium (loperamide): Some collies and other breeds cannot metabolize this drug properly (the same dogs who cannot metabolize ivermectin). It causes neurotoxicity (dog becomes depressed/confused/comatose).

Benadryl and other antihistamines: Can cause hyperexcitability, increased heart rate, fever, and seizures.

Expectorants and antihistamines (many have pseudoephedrine): Pseudoephedrine causes tremors, elevated heart rate and/or blood pressure. It doesn’t take much to kill a pet.

Desitin and some other diaper creams: Contain zinc and ingestion can lead to zinc toxicosis which causes destruction of red blood cells.

Holistic stuff to prevent heartworms: not only do they not prevent heartworm disease they aren’t safe. Stick with what the veterinarians recommend.

Hydrogen Peroxide: Kills healthy skin cells and can cause aspiration pneumonia if in the process of administering it orally it gets into the lungs.

So please do not let your pet become a statistic as a result of the medicine cabinet.

Blog written by:
Dr. Dana Lewis

Dr. Dana assists families with Pet Hospice and Euthanasia in the Raleigh North Carolina area (Raleigh, Durham, Chapel Hill and the greater Triangle, as well as Wake, Durham, Orange, and Chatham counties.)

Click here for Dr. Dana's bio link

DrDana@LapofLove.com

www.lapoflove.com

Caring Beyond A Cure – A Look At Veterinary Hospice

By Dr. Mary Gardner

November 3rd 2012 is National Veterinary Hospice Awareness day so I thought it was appropriate to post a blog on what veterinary hospice is. It can mean a lot of things to many people.

If you have ever cared for a geriatric or terminally ill pet, then you know what it’s like to hear those dreaded words, ‘There is nothing more we can do’ ; or even worse if your veterinarian simply says, ‘Call me when it’s time…you will know when that is.’ However this does not mean that euthanasia is the only option available to you. Pet Hospice is an emerging field in veterinary medicine and is a unique approach to your pet’s end-of-life needs. It focuses on maintaining comfort and quality of life for of your pet, not at finding a cure for his or her disease.

As a veterinarian that solely practices in-home hospice and euthanasia, I have been given the unique privilege to help families during what I believe is the most important time they have with their pet. So often a pet owner who has just heard that their pet has a terminal illness needs time: Time to think, time to adjust, and time to make decisions. Veterinary hospice care supports both pet and family during this time.

The first and most important step in hospice care is educating yourself about your pet’s medical condition.

You need to know what to expect in those last few months, weeks, days, and/or hours in order to make the best decision for you, your pet, and your family.

The second step is making sure your pet is treated palliatively. This means your pet is being medically treated for comfort or anxiety. Veterinary hospice is not about giving them such high doses of strong medication that they can’t function; it’s about making sure they feel good throughout the day and have a comfortable full night’s sleep.

The third step in hospice care is evaluating Quality of Life. This can be very subjective terminology and is highly dependent on the disease process your pet is experiencing, your pet’s personality, and your personal beliefs. Determining quality of life is made easy when you have a scale and diary to help guide you. There are many Quality of Life scales available online. After giving your pet a ‘grade’ you can determine where they are in terms of their condition and if medical intervention or even euthanasia is appropriate.

Hospice is not synonymous with euthanasia, although euthanasia should be discussed and can be a part of a hospice program. We all wish for a peaceful natural passing but it is not always that simple, fast or painless. As pet parents we are responsible for making sure our pets do not suffer – even if that means we have to suffer a little ourselves and make tough decisions.

For more information on hospice – visit our site: www.lapoflove.com


Blog by:
Vet Mary Gardner
Dr. Mary is one of the Lap of Love Veterinary Hospice founders and has helped hundreds of families in South Florida with end of life care for their pets.

Beginning life with an exotic pet, by Dr. Michelle Bellville

Did you know that guinea pigs get scurvy? How about the fact that pet lizards can lose so much calcium in their bones that they bend? Did you know that birds can get arteriosclerosis, heart disease, and hypertension like humans? A little rabbit may be a sweet Easter present for your son or daughter, but do you know what it needs to eat to decrease chances of illness, obesity, and dental abscesses?

Each one of these creatures deserves to have a long, healthy life like our typical dog and cat companions, yet many are passing away young or silently living a suboptimal life. I remember having hamsters, guinea pigs, and rabbits as a child and I realize now how much I truly didn’t know. These animals I kept really deserved better of me. No one ever told me I needed to be educated in how to keep these animals, so I never looked.

Petrie, a fat tailed gecko and
my first exotic pet.

At 13 years old, my mom allowed me to get a fat tailed gecko I named Petrie. I did my research – found out how to keep her the best I could, and spent the next 13 years with her. One of the exotics veterinarians at University of Florida commented that she was one of the oldest fat tails they had ever seen!

Before you buy a pocket pet, reptile, or bird, do your research: buy a book on care of that animal or go to one of the recommended websites below so that you can be an educated future owner! If you are already sharing your life and home with one of these amazing creatures, make sure they get their yearly check-up by an exotics- trained veterinarian – they can help you take a critical look at the husbandry (home environment, food, daily routine, etc) of your pet to see if or where changes should be made!

• For rabbits: www.rabbit.org has great resources
• For reptiles: check out the Advanced Vivarium Series (AVS) books – individual species guides
• For general bird care: Birds for Dummies or The Complete Idiot’s Guide to Bird Care & Training.

Blog by:
Dr. Michelle Bellville
www.lapoflove.com
Click Here for Dr. Michelle's Bio/Contact Information

Dr. Bellville assists families in the Orlando Florida area with In Home Hospice and Euthanasia. She is also available to assist families with 'exotic' species like birds, hamsters, rabbits, etc with all end of like care. 

Halloween Dangers for Pets, by Dr. Mosley

 1. Food Hazards
Different types of chocolate contain various levels of fat, caffeine and the substances methylxanthines. In general, the darker and richer the chocolate (i.e., baker’s chocolate), the higher the risk of toxicity. Depending on the type and amount of chocolate ingested, dogs might experience vomiting, diarrhea, urination, hyperactivity, heart arrhythmias, tremors and seizures. Also, be aware of the wrappers that the candy leaves behind. The sweet smell is still on them, which will attract your pet! This can be very dangerous, not only is it a choking hazard, but it can cause damage to the organs! If you do suspect your pet has ingested something toxic, please call your veterinarian.

2. Popular Halloween Plants 
Pumpkins and decorative corn are considered to be relatively nontoxic, but they can produce stomach upset in pets who nibble on them. Also, be careful with carved pumpkins if you choose to add a candle. Pets can easily knock a lit pumpkin over and cause a fire. Curious kittens and wagging tails especially run the risk of getting burned or singed by candle flames.

3. Wires and cords 
From electric lights and other decorations should be kept out of reach of your pets. If chewed, your pet might suffer cuts or burns, or receive a possibly life-threatening electrical shock. This one is a year-round rule- but especially important during Halloween and Christmas!!

4. Costumes 
Please don’t put your dog or cat in a costume UNLESS you know he or she loves it. Here are a few tips when considering a costume for your pet:

• A pet in costume should NEVER be left alone and unsupervised. If left alone in costume, your pet may chew it up and ingest it. This could cause intestinal obstruction if more than small shreds of material are consumed.
• Tight elastics on the costumes can get lost in the pet’s hair, potentially causing owners to overlook them, leading to swelling and pain in the area of the elastic.
• If the costumed pet escapes or is frightened away while trick-or-treating, the costume could entangle the pet on trees, fences, etc.

5. Stress caused by Trick-or-Treaters 
Continual doorbell ringing and people at the door (in costume, no less!) can be stressful for a pet. Some pets may experience stress-related diarrhea or potentially injure themselves if crated or otherwise contained. Keep your pet in a quiet and safe place on Halloween. Some animals may also become unexpectedly aggressive or fearful, even normally friendly pets.

6. Keep your pets indoors 
Please keep your pets inside on Halloween night, especially black cats and dogs. Animals are at risk for cruel treatment by some Halloween pranksters. Many adoption agencies and humane societies will not allow adoption of black cats around Halloween for this reason. Please use caution when taking your dog outside. If you have any outdoor pets, consider keeping them inside for the few days surrounding Halloween.

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Read more or contact Dr. Mosley:
Tiffany Mosley, DVM
Lap of Love Veterinary Hospice
Jacksonville, FL
drtiffany@lapoflove.com  |  www.lapoflove.com

Dr. Mosley services towns in and around Jacksonville with a focus on the Mandarin & Orange Park areas as well as the beaches.

Too numerous to count, by Dr. Cheryl Maguire

October is Adopt a Shelter Dog Month and just so happens to be the month that I am revisiting my shelter roots. Just over 27 years ago, I began my life working with animals as a kennel attendant at a shelter in Southern California. I was very young but full of energy and optimism. I eagerly bottle-fed kittens and puppies, hand-fed orphaned baby birds, cleaned kennels and weeded the exercise yards all because I loved animals and felt that the work was so important.

Because that particular shelter I started out in was what would now be labeled a “boutique” shelter I was protected from the harsher realities of the large municipal shelters. Still, I was initiated into the world of neglect, pet-overpopulation, disposable pets, the pit bull controversy just to name a few of the problems plaguing shelters then and now. I moved on in life and with my career eventually becoming a veterinarian. Along the way I continued to volunteer or work at shelters wherever I lived.

It has been two years since I left the world of shelter medicine after burning out from a full- time job at a high profile shelter that left me mentally and emotionally spent. Fast-forward to this month when I find myself once again on the front lines of shelter medicine. I’m no tender- hearted rookie, I am a realistic veteran, but what I have seen in the past few weeks has been nothing short of discouraging.

Twenty-seven years ago mandatory sterilization of shelter animals was not wide-spread the way it is today. Prepubertal neuter and spay was not practiced and was even considered detrimental. There were no trap-neuter-release programs for feral cats. There were very few rescue groups and those that were active did not have such luxuries as cell phones, the internet and social media to facilitate communication to help pets in need. We now have all of these programs and amenities at our disposal today and what is the result? Tragically, not much has changed as far as the unfortunate animals are concerned.

The shelter that I have spent the past two weeks at is overflowing with dogs and cats. Nice dogs and cats. Oh, and not just Labrador retriever and German Shepherds cross breeds. There are plenty of purebred dogs there. Just in one week I saw the following breeds come across the door: Anatolian Shepherd, Bull Terrier, Pembroke Welsh Corgi, Bichon Frise, Cocker Spaniel one each of these breeds and too numerous to count of the following: Boxers, Poodles, Chihuahuas, German Shepherds, Schnauzers, Dachshunds, Beagles, Labrador Retrievers, Siberian Huskies, Malamutes and of course Pitbulls….not just mixes of these breeds but purebred examples of each breed mentioned. All in one week!

I am depressed and discouraged because I had hoped that something had changed. That perhaps all of the young puppies and feral cats that I had spayed over the years had made a difference. Sadly, they have not. Please adopt a shelter dog. Do not buy a dog. I am tired of watching nice dogs and cats die senselessly. This madness has got to end. 


Lap of Love Veterinary Hospice

Lyme Nephropathy in Dogs

by Brad Bates, VMD

Lyme Nephropathy, just the sound of this disease makes me cringe….

This is a disease of the kidneys (from greek, nephros – kidney; opathy- disease or disorder of) with Lyme infection being the underlying cause. Lyme disease is caused by a special type of bacterium, Borrelia burgdorferi. Ixodes-type ticks, like the well-known ‘deer tick,’ spread this organism.

In dogs, Lyme disease tends to be either asymptomatic (most dogs, with 90- 95% showing no clinical signs at the time of diagnosis), or cause a transient fever, lethargy, anorexia and limping. Limping in lyme-infected dogs classically shifts from one leg to the other. It is believed that clinical signs of lyme disease, including limping, is a result of the body’s immune response to the organism. Symptoms usually take a few months from the time of infection to develop.

Most Lyme positive dogs that are clinical for the infection will get better rather quickly on antibiotics, with doxycycline being most veterinarian’s first choice. The infection is usually not cleared, even with treatment, but will usually be kept under control by the dog’s immune system once treated.

A much more serious disease process has been reported, thankfully much more rarely- Lyme Nephropathy. This disease is not completely understood, but it has been found to have an immune basis. The body’s own immune system is needed for the destruction of the kidneys. What happens is the immune system develops antibodies to the organism and these antibodies attach to the organism or pieces of the organism. The antibodies can form immune ‘complexes’ that can attach to regular tissues in the body - one place being the kidneys. This leads to activation of the rest of the immune system, where the body thinks it is clearing an infection and instead damages its own tissues. This process can be likened to laser-guided missile attacks, where the immune complexes are the lasers and the missiles are the immune system components. But in this case, it would be considered ‘friendly fire.’

Dogs with Lyme Nephropathy show signs of anorexia, lethargy, fever and some will even vomit. Kidney levels are often elevated, or elevate later in the course of the disease. The classic hallmark sign of this disease is loss of blood proteins in the urine- called proteinuria. Many will lose enough proteins that their blood work will show low albumin (the major blood protein), leading to leakage of blood fluids from the vessels into the tissues- causing the patient to develop swellings of the tissues called edema.

Most dogs with Lyme Nephropathy have a very poor prognosis, with most succumbing to the disease rather quickly after clinical signs develop despite therapy.

Prevention

The best way to prevent this infection is to administer monthly tick preventatives to your dog. The topical products, Frontline and Advantix, being the most common and two of the most reliable preventatives on the market. Others are available through veterinary clinics. It is important to follow all the directions and precautions of these products.

The lyme vaccine is controversial at this time, and people seeking this vaccine should speak with their veterinarian at length about its use and benefits/side effects. At the least, every dog receiving this vaccine should first be tested for lyme exposure.

If your dog is exposed to Lyme it is very important to follow your veterinarian’s recommendation. Guidelines recommend routine blood work at the time of diagnosis and at least yearly to check kidney values and other parameters such as white blood cells and platelets. Other tick-borne infections can also be spread by the same ticks that spread Lyme disease and some are more difficult to diagnose on routine screening, but may still cause changes on blood work. Urine should be checked at the time of diagnosis and at least every 6-12 months to check for protein loss. If there is protein in the sample, your veterinarian may want to check for an infection with a urine culture, or for bladder stones using an x-ray of the abdomen. If no other causes of protein in the urine are seen, the level of protein should be quantified with a specific test (called urine protein creatinine ratio, or UPC). This can determine if the protein loss is significant and how severe it is, as well as help guide treatment in the future.

As I first stated, just the sound of this disease makes me cringe…and as I write this blog I think about my patient currently being treated for possible Lyme Nephropathy. I just hope she is not one of the unlucky few, and I hope by following simple preventative measures other dogs can be spared this horrible disease.

Read more or contact Dr. Bates:
Brad Bates, DVM DABVP
Lap of Love Veterinary Hospice
Philadelphia, PA
drbrad@lapoflove.com  |  www.lapoflove.com

(267) 317-8110

Dr. Bates services the Greater Philadelphia area with providing families with in home hospice and euthanasia options. (All areas around Philly including Rittenhouse, Center City, Art Museum, Queen village, Washington Square, Graduate Hospital, Society Hill, Italian Market, Logan Square, Bella Vista, Old City, West Philadelphia, South Philadelphia, University City, Fishtown, Northern liberties, Fairmount, Manayunk, Conshohocken, Roxborough, Drexel Hill, Media, Villanova, Swarthmore, New Hope, Langhorne, Bryn Mawr, and Gladwyne).