Veterinary Vertex
Veterinary Vertex is a weekly podcast that takes you behind the scenes of the clinical and research discoveries published in the Journal of the American Veterinary Medical Association (JAVMA) and the American Journal of Veterinary Research (AJVR). Tune in to learn about cutting-edge veterinary research and gain in-depth insights you won’t find anywhere else. Come away with knowledge you can put to use in your own practice – along with a healthy dose of inspiration to remind you what you love about veterinary medicine.
Veterinary Vertex
The Hidden Link: Pica and Chronic Enteropathy
What if your pet's habit of eating socks, furniture stuffing, or other non-food items isn't simply bad behavior, but actually a cry for help? Dr. Julianna Perez's groundbreaking research reveals that pica – the consumption of non-food items – may be a clinical sign of chronic enteropathy in dogs and cats.
The discovery began in emergency rooms, where veterinarians noticed dogs returning repeatedly for foreign body obstructions. When they removed these objects surgically, they observed abnormal intestinal tissue with blunted villi, erosions, and ulcerations. This led Dr. Perez to systematically collect biopsies during these surgeries, with astonishing results: 99% of animals with pica showed evidence of chronic enteropathy, primarily lymphoplasmacytic enteritis.
Most surprising was the severity of inflammation found in these pets, despite many showing only subtle clinical signs that owners often dismissed as normal – occasional vomiting, picky eating, or mild digestive issues. The research challenges the common assumption that pica is primarily behavioral, suggesting that in adult animals over two years old, it should be considered a medical condition until proven otherwise.
"Pica is not because animals are misbehaved," emphasizes Dr. Perez, whose work was inspired by a heartbreaking case of a service dog that died after multiple foreign body obstructions. The study found mixed breeds (particularly doodles), pit bulls, and retrievers commonly affected, though all breeds can develop this condition.
For veterinarians, this research highlights the importance of taking biopsies during foreign body surgeries and looking beyond the immediate obstruction to investigate underlying causes. For pet owners, recognizing repeated pica as a potential medical issue could prevent dangerous obstructions and potentially save lives.
Listen as Dr. Perez shares her findings, discusses future research directions exploring nutritional and molecular aspects of pica, and offers practical advice for both veterinarians and pet owners dealing with this challenging condition.
JAVMA article: https://doi.org/10.2460/javma.25.02.0079
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Speaker 2:You are listening to Veterinary Vertex, a podcast of the AVMA Journals. In this episode, we chat about pica as a clinical sign of a chronic enteropathy in dogs and cats, with our guest, juliana Perez.
Speaker 3:Welcome listeners. I'm Editor-in-Chief Lisa Fortier, and I'm joined by Associate Editor Sarah Wright. Today we have a fabulous former Cornell student, juliana, joining us, and thanks so much for taking time out of your busy schedule to be with us here today. Thanks for having me here.
Speaker 4:I really appreciate it. Just talking about all the research and all the work that's gone into this, I really appreciate it.
Speaker 2:Of course, let's dive right in so before we started recording or chatting earlier, how important of a topic as this is, so we're really excited to chat with you more about this today, and your article states how a significant number of animals with pica and foreign bodies demonstrated evidence of a chronic enteropathy. Please share with our listeners the background on this article.
Speaker 4:So essentially background on, it was as the cases we were seeing coming in through the ER. We work really close with an ER in the medicine department over here in Arizona and started to notice that a lot of these dogs coming in for pica would be repeated episodes of pica, not just one, two, three. There was one that had about six different foreign body instances. So we started noticing that as we were pulling out the foreign bodies going through the intestinal tract it was extremely abnormal. They would have like blunted villi, you know, erosions, ulcerations, all that stuff when we were pulling out from the stomach. So kind of over time started to notice as we noticed that, started taking biopsies and the idea kind of came from well, if these dogs with pica are having these abnormalities further down in the intestinal tract, maybe there could be a cause to the pica. So what we started doing was taking biopsies on every single dog or cat that had pica and eventually we found that 99% of them had evidence of a chronic enteropathy.
Speaker 4:Hard to say, you know, is it inflammatory bowel disease? Is it, you know, another type of like malabsorption type of thing? But a lot of them had characteristic findings of lymphoplasm, acidic enteritis or eosinophilic, neutrophilic, all of that stuff. And it was interesting that we found that in the intestinal tract and plus sometimes in the stomach as well, a lot of times in the stomach as well, but more so in the intestinal tract. And so there was kind of an argument where, well, if it's in the stomach because of the object rolling around, why is it in the intestinal tract? So then we started to kind of collect these cases and eventually got to the point where I was able to publish enough of them. There was enough evidence to show that and eventually we got it after some hard work and cases that came in through the ER.
Speaker 2:Yeah, super cool topic and really glad too that you guys were taking them samples as well while you're in there retrieving the objects. I mean, what's another five, 10 minutes getting samples?
Speaker 4:And it's, you know, going later on, a lot of the times we find if they're a referral from another clinic or for any reason and they've had open abdominal surgery or you know other foreign bodies might as well get the information while you're in there. It's just less invasive in the future, less costly to the owner, less surgical procedures in the future of that animal. So, um, we ended up doing it and it's, it wasn't too bad that a lot of them did well after the fact and stuff like that. So, um, it's, I'm pretty proud of it. It's a really good topic to do and, uh, hopefully I can expand a little bit more on the topic too as you should be.
Speaker 2:Yes. What are some of the important take-home messages from this article?
Speaker 4:PICA is not because animals are misbehaved. I would say in my paper we kind of classify in asking behaviorists the cutoff for behavioral PICA was about two years of age. I did have a lot of animals that were like one and a half, 2.1 month or 1.95 months things like that and I was able to clarify with a couple of behaviorists that that's kind of the age. They find that that pica behavior because of adolescence goes away. And so I would say pica is not because if they're older than two years of age it's not because they're bad animals or because, you know, maybe environmental enrichment sure that could be a part of it. But I do think a big part of it is a clinical sign of a chronic enteropathy and if you address it a lot of the times it goes away, if not improves quite a bit with therapy. So that's kind of the big home takeaway.
Speaker 3:Well, I look forward to my daughter's dogs growing out of it. I've lost four pair of cheaters in as many weeks and at the last pair, like she's very stealth and I can hear the crunch and like I don't care about them. Right, but I do care about the chunk of the lens that she might swallow.
Speaker 4:yeah, oh my gosh, no, my cat she's. She used to chew on cords and, uh, she eventually grew out of it eventually. But you always get worried. It's like, oh, there's a missing cord, you know my iphone, or something like that. So I, I understand completely. But, um, I think that's the biggest, the big home takeaway is it's a sign of a clinical, of a clinical enteropathy, or chronic enteropathy would be my biggest thing.
Speaker 3:Yeah, it's a Bernadudo highly likely.
Speaker 4:Yeah, those. I love doodles. Honestly, that's what I want. I'm looking for a doodle like a rescue or anything like that, but they're. They were the most common breed, the mixed breeds they call them in our population and it's funny because they're so common in Arizona and Scottsdale, so common. Like my physical therapist has one, my friends have them, so yeah, super common. And then I think the second one, pit bulls, goldens, labradors, those guys. But it's fine, you deal with it and you get it treated, managed and they do fine. A lot of their animals did fine, but they're trouble.
Speaker 3:It is such a cool topic for you know, veterinarians and trainers and everybody owners right. What sparked your interest in pursuing this as a research project?
Speaker 4:So when I was an intern I was over at Angel Memorial Boston and I had this case. It was a military veteran and his dog. It was a service dog and the dog ended up having three foreign body obstructions, ended up getting surgery every single time. I unfortunately got the dog at the fourth time and they went in. There were so many adhesions and the guy was not educated on training and basket muzzles, treatment therapy, things like that and the dog ended up getting an enterotomy adhesions everywhere and unfortunately the dog ended up dying because they did de-kiss because of how bad it was.
Speaker 4:So I think that really triggered my inspiration for this topic and avoiding so many cases coming in for chronic interrupt the other signs were it. My biggest thing was how could I help all these animals and how could we avoid death in the future, because it's such a common thing and unfortunately I'm not a surgeon, right, I don't cut things. I see things on a referral basis for internal issues and so what could I do to kind of help this? And that was the biggest case. I think it will always stay with me and it's just so heartbreaking. You know, you see an adult crying for and the dog was five years old, so that's the toughest thing and I think that's really kind of sparked my interest in GI disease and noticing this is kind of the biggest thing, really just kind of tug at the heartstrings. But that was the biggest inspiration for this and really just what else could I do to help without cutting things open, because that's not what I do. So that was kind of the big thing for me.
Speaker 3:Sounds like a tough and inspiring case. It is, yeah.
Speaker 4:Sad and just, yeah, it's just, it's tough. And we see a lot of these and you know they'll go to surgery and a lot of them end up dying because, you know, either because they did this they go septic or it's just it's sad, and then they're all young. They're all young, that's the thing. They're not like, they're 10, 12, you know, a lot of them are like four, five, six, seven, and it's like you just wish you could have done more, I think. And that's kind of where I'm at with this topic. So the more awareness, the better.
Speaker 3:In my mind, just to kind of help veterinarians recognize this disease and help animals in the future really is my goal. Yeah, sarah, asked you a little bit earlier what some of the most salient points of the article, but every time we do a study we are surprised by things, which then engenders more research. What were some of the surprising findings from this article?
Speaker 4:Yeah, I think the most surprising finding was that. I think the fact that they all had evidence of lymphoplasmocytic enteritis, even though a lot of the dogs weren't nuances, little clinical signs, you know they would puke a couple times a month and the owner would say, you know, that's normal for them, you know. Or picky appetite that's a really common one, we find or having GERD signs, things like that, and the signs were not too bad. So eventually we got to the point where when we got that lymphoplasm acidic enteritis, that to me says that this is severe chronicity and a lot of them would be severe. So I think that was the most interesting finding that I came out because I didn't think we were going to find, you know, severe or moderate lymphoplasm acidic enteritis Me. I thought maybe you know, maybe some mild changes, some, you know, a little bit of fibrosis, nothing.
Speaker 4:I think that was the biggest interesting finding and just kind of following the severity of helicobacter associated with the stomach severity was not an interesting finding but a lot of people that do gastroenterology research, it kind of fits with that as well. So I thought that was interesting too, given that a lot of the times in those research articles you'll see, you know they're vomiting or they're losing weight, things like that. Not a lot of these animals had the weight loss or the vomiting, it was more so the pica, the picky appetite, the GERD-like signs, things like that. So I thought that was the more interesting ones that I took from the paper. When we got all the stats crunched and all the interesting findings from the paper and stuff.
Speaker 2:Sounds like a good educational topic for both pet owners and veterinarians alike. Right? No, that's my goal. So, that being said, what are the next steps for research in FICA?
Speaker 4:I yeah, I mean, I think so for me it's good that you know biopsies are great and I think so for me it's good that you know biopsies are great. We got that. I would like to find because I think there's more. So at the molecular level, for me I would like to see you know, are there any other micronutrients that they're missing? Are there any iron metabolites in these samples, potentially that they could be missing?
Speaker 4:A lot of the research I found in human medicine where you know people that were pregnant, people that are common, that they could be missing. A lot of the research I found in human medicine where you know people that were pregnant, people that are common, that they're anemic, things like that. But a lot of my animals weren't pregnant, anemic, these behavioral issues, they were kind of beyond that. So I'd like to go more into kind of the molecular level nutrients, things like that, to kind of see I'm looking.
Speaker 4:Got a new job in California so I'm trying to go and kind of talk to where I'm going to next to see are there opportunities for me to kind of look more into it To see you know, are there any other things that maybe we're just not getting the whole clinical picture, because that's not available to us. Maybe there are human hospitals that potentially do do this and maybe I can incorporate that into my next future sample population, things like that. But that's the biggest thing I'm interested in to see Because, yeah, they may be nauseous, they may not feel good, but it's not as black and white and I think there's more to it. I think that we're just not seeing, and that's kind of my next goal for my next kind of adventure in research for me.
Speaker 2:Very cool. Well, we look forward to hopefully seeing more of your future work too. So AI is a really hot topic. We've seen this a lot and definitely it's even becoming more popular, I think, too, as a research topic in veterinary medicine and scholarly publishing. Do you see a role for AI in the area of research that you're pursuing?
Speaker 4:on. But really for the, I think for the details getting details from a lot of the records, getting details from referral vets, things like that a number crunching, I think that would be super helpful. I think that's kind of where the role of AI that I see it in I'm kind of like it makes me a little uncomfortable for AI to, you know, maybe diagnose things and interpret things, because I think AI misses that human quality that we can look at the clinical picture, we can look at the little nuanced things, the trends of things. So I would say, keep AI to the number crunching, the detail association. I'm a millennials kid so I'm very less AI, the better, I think, for that regard. But it is neat, right, it is super, it has its place, totally for it. You know, I have colleagues that are younger than myself and they're doing the records with like GPT and all these things. So more power to them. I'm all school, I use paper all day.
Speaker 2:Yeah, one of my best school classmates. Actually, over the weekend she posted a really funny video that she had made at her clinic where she was like I'd like to see AI try to replace like this, and it was her and a technician working to like restrain the fractious cat and then like pill the fractious cat and they had him like in the quote, unquote, panini press. You know he makes more efficient but not replacing us.
Speaker 4:Right, right, no, that's great, yeah, no there's a lot of that and it has its place, I think one day, but I don't know.
Speaker 2:I'm still hesitant. For those of you just joining us, we're discussing pica as a clinical sign of a chronic enteropathy, and dogs and cats with our guest Juliana, and my chronic enteropathy cat decided to join us. You can see her ear here. You're watching the video.
Speaker 3:Hey, giuliani, we talked briefly. Like Cornell grad went to Boston. Angel, you've got a lot of training and all that adds up, but getting across the finish line with getting the article all the way to publication, is a whole nother beast. How did all that training help you write this article and get it all the way across?
Speaker 4:Yeah, gosh, that's a great question. I think the biggest thing is the perseverance. I got a lot of people that kind of told me you know, this is not, it's not realistic, it's not an ideal topic, it's not something that me people will argue with. You know, the experts like Kenny Simpson or Marks over at Davis, things like that, and you know I think it's more so the perseverance and really like, doing all of these internships, doing all of these, the residency unit, I mean things like that, I think really kind of pushed me to doing working harder it. It helped, obviously, getting my, my credentialing in as well, because I needed that. But I really think the biggest point was you know, what can I prove to these big gurus? That that I can prove and and see, you know, hey, like yeah, I'm a young grad, but I think there's other things we're missing, not just like diet related, not just you know what I mean, all of these things.
Speaker 3:I can't wait to see Simmo and say, hey, you're a big guru, it's out on Veterinary Vertex.
Speaker 4:Right, right, no, no, yeah, he's, he's. Yeah, I had him as a teacher too, and man he was, he was a he's a very big guru in the GI world. So, yeah, I mean him, stanley Marks, all those guys, and what could I prove? And that's what I like, you know, I like what could I prove that people don't think is the typical, what is the norm?
Speaker 2:You know, I like to prove people wrong and that's just kind of who I am as a person and that's just kind of what the goal was yeah, we have a lot of these like myth buster episodes, I feel like on the podcast, where people are like looking at things that always traditionally like been thought and they have the evidence to show either otherwise or to validate what we've been doing. So, right, those were episodes. All right, juliana. So this next set of questions is going to be really important for our listeners. We're gonna take all the great information you shared with us today. Try to boil it down to like one take-home message that people need to know. What is one piece of information the veterinarian should know about pica and dogs and cats?
Speaker 4:That at a certain age it is not a behavioral problem, it's evidence of a chronic neuropathy. I would say that's the biggest take-home and really pay attention to that, because they do it for a reason, it's not just because, would be my biggest take-home message.
Speaker 2:And on the other side of the relationship, what's one thing that clients should know?
Speaker 4:I think clients should be cognizant of really kind of keeping an eye on their pets, the biggest thing being that they can become obstructed and I think that's kind of the biggest takeaway for owners and really recognizing that they do it once, maybe behavioral if they're a certain age, but if they're older and they keep doing it, I would think that's when you should really get it addressed.
Speaker 3:That's really nice and concise. Thanks again. Great to see you again. Yeah, nice to see you too. Thank you so much for your time. I appreciate it. Yeah, we always like to end with a kind of a fun question, and for you, we'd like to know what is your favorite animal fact.
Speaker 4:Yes, so my favorite animal fact a group of flamingos is called a flamboyance. I thought that was the funniest thing ever and I think that's kind of my fun fact to people.
Speaker 2:I love that. The local zoo here, brookville Zoo, chicago. They started doing these like flamingo walks they call them where they have the flamingos come out in like a kind of like a group and they walk around a portion of the zoo and the visitors get to like see them up close, which is really cool and engaging. But the first thing I thought of when you said that fact- I was like oh, flamingo walk no, I love it.
Speaker 4:When I was little they used to have a little petting area and you could pet the flamingos they're. They're very aggressive though, so I got bit so I wouldn't recommend it. So I was like seven so, and then I got bit by an emu, like a couple years later. So birds, yeah, snowbirds, no, thanks yeah, but that's my interesting, uh, animal fact very nice, I love that.
Speaker 2:Yeah, we are at the beach with some friends this weekend and I have a friend who's terrified of any kind of bird oh yeah, there was like a bird that was encroaching on her because she's yeah, lisa's raising her hand lisa's like me too when she was having a snack and the birds were like walking over. So I was like, all right, here we go having a snack and the birds were like walking over. So I was like, all right, here we go. Animal science 101. I was walking with my arms outstretched to make myself bigger, to get them to move. So bird herder that's great.
Speaker 4:No, my mom has a cockatoo and the cockatoo, uh, it's bit me a few times. So I'm like no more. No more birds for me. I'm good, I'll stay away. I'm good. Cats and dogs precious cats, I love them, they're good, but birds I'm I'm good, I'll stay away. I'm good with cats and dogs precious cats, I love them, they're good, but birds, I'm done, I'm done, so I love that.
Speaker 2:We need people like you. Well, thank you so much, juliana. We appreciate you being here and sharing your insight, too, about your article with our listeners.
Speaker 4:Yeah, thank you guys so much for inviting me and thank you for showing interest in my paper. It means a lot, honestly it does, and it's just it's nice to kind of get this topic kind of out there. Not even the recognition about the paper, it's really for the, you know, the animals and what we can do different to kind of reduce death, reduce this comorbidities and treat them. So I think I really appreciate your guys's time.
Speaker 2:Of course, and to our listeners. You can read Juliana's article in Javma. I'm Sarah Wright with Lisa Fortier. Be on the lookout for next week's episode and don't forget to leave us a rating interview on Apple Podcasts or whatever platform you listen to.
