GENERAL PET ARTICLES

Diabetes Mellitus Part II – What Causes Diabetes?

In the previous article, we briefly described the role that insulin plays in delivering glucose to the cells of the body. Diabetes is characterized by the cells’ inability to utilize glucose for...

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In the previous article, we briefly described the role that insulin plays in delivering glucose to the cells of the body. Diabetes is characterized by the cells’ inability to utilize glucose for energy and the subsequent high blood concentrations of unused glucose. This inability is caused by either or both a deficiency in the production of insulin, or insulin that for some reason is unrecognized by the cells. Cells cannot utilize glucose without insulin, and the insulin must be recognized by the cells in order to deliver glucose. In this section, we will discuss the possible causes of Diabetes Mellitus.

The cause of diabetes in a specific patient is not always known; however, we are aware of certain risk factors that can contribute to the development of this disease.

Type I Diabetes, the most common form in dogs, is caused by insufficient production of insulin. Insulin is made by specialized cells, called beta cells, in an organ called the pancreas. The amount of insulin produced is directly related to the amount of glucose in the bloodstream. When food is consumed, beta cells are triggered by an increase in blood-glucose levels to begin producing insulin. The insulin then delivers the glucose to all of the cells in the body to be used as fuel.

Damage to the beta cells, either from chronic pancreatitis or an auto-immune disorder where the body’s defenses attack its own cells, can reduce insulin production. Pancreatitis can be triggered by certain drugs, infection, shock or trauma, diets high in fat, and obesity. Some breeds like Schnauzers are predisposed to chronic pancreatitis which makes them more likely to develop diabetes.

Patients with Type II Diabetes may have normal or even elevated levels of insulin, but the cells in the body reject it during the transfer of glucose. This is called insulin resistance. Cats are more likely to develop this form of diabetes. Obesity is a common trigger of this type of diabetes. The relationship of obesity to insulin resistance is known, but the mechanism is not completely understood. A condition called hyperadrenocorticism, or Cushing’s Disease, can be a contributing cause of insulin resistance – and thus – diabetes. Cushing’s can make controlling diabetes very difficult. Somewhat common in dogs, Cushing’s is rare in cats; however, more than 80% of Cushinoid cats develop concurrent Type II Diabetes.

It is important to realize the link between obesity and diabetes since this is a contributing factor that we, as pet owners, can control. Obese pets are more likely to develop pancreatitis, leading to Type I Diabetes; and, they are more likely to develop insulin resistance, or Type II Diabetes. Appropriate diets and healthy feeding regimens can significantly reduce the pet’s chance of becoming diabetic.

In Part III, we will discuss the diagnosis and management of diabetes.

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Diabetes Mellitus Part Iv – Giving Insulin And At-home Monitoring

Many diabetic pets will be prescribed insulin injections that you will give at home once or twice daily. It is very important that you are comfortable and confident with this responsibility. The...

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Many diabetic pets will be prescribed insulin injections that you will give at home once or twice daily. It is very important that you are comfortable and confident with this responsibility. The veterinarian and support staff will train you in the measurement and injection of insulin, and this video will help to ensure that you are administering the injections properly. Pets are generally very adaptable to receiving these injections, especially if you associate the process with a treat that the pet particularly enjoys.

At-home monitoring will involve observation of symptoms and side-effects of poorly managed diabetes, as well as possibly using a glucometer to periodically measure blood-glucose. Your veterinarian may supply you with a glucometer and testing supplies that are specifically calibrated for dogs and cats. Human glucometers are not designed for animals and should not be used.

Insulin is given by subcutaneous injection. This is the method whereby the drug is injected beneath the skin in an area over the shoulder blades ensuring a slow and consistent absorption rate. Giving the insulin by another technique, such as intravenous or in the muscle, could result in rapid drops in blood-glucose leading to hypoglycemia – or dangerously low glucose levels.

Insulin is measured in units, and syringes are calibrated for the number of units of insulin contained in each milliliter of solution. The concentration, denoted in units per ml, is listed on the package label. Most insulin comes in 40, 80, or 100 units per ml and the package label and syringes are usually color coded to match. Be sure that the syringes and insulin label match. You will see a “U-100”, for example, on each. Using a “U-40” syringe with “U-100” insulin would mean that you are delivering two and a half times more insulin than prescribed and could cause an overdose. The opposite combination would mean that not enough insulin was being given, resulting in poorly controlled blood-glucose levels.

Insulin also is labeled by the duration of effect and the source of the insulin. For example lente (L) and ultra lente (UL) signify long-acting and ultra long-acting. Do not substitute one brand or type of insulin for another without first consulting the veterinarian. Insulin can be obtained without a prescription; however, many pharmacies will require a doctor’s order to ensure that the correct type is sent home.

Insulin should never be vigorously shaken. Foaming of the solution may dilute the injection with tiny air bubbles. Instead, roll the bottle between the palms to ensure that the crystalloid solution is thoroughly mixed. It should be stored under refrigeration at all times; if it is accidentally left in the car, or allowed to freeze, you should contact your veterinarian before using the insulin.

To draw up the insulin into the syringe, hold the vial inverted in your less-dominant hand. Remove the cap from the needle and syringe, hold the syringe with your dominant hand, and draw back an amount of air equivalent to the amount of insulin you will need. Insert the needle into the vial, and inject the air. Draw back more insulin than you will need, and gently tap any air bubbles to the top of the syringe. Push excess air and insulin back into the vial, stopping exactly at the number of units you will be giving. Remove the needle from the vial.

It is extremely important to keep the needle sterile at all times. If you touch anything with the needle, including the side of the vial, your fingers, the table surface, etc, you may introduce bacteria under the skin and cause an abscess to form.

To give the insulin injection to your pet, use your less-dominant hand to grasp the skin over the shoulder blades on either side of the spine. Lift the skin gently, and form a triangular “tent” by poking your index finger of your dominant hand between and slightly below your thumb and fingers. Remove the cap from the syringe and needle, and inject the needle through the skin parallel to the body. You should not contact the muscle layer, but be sure the needle passes all the way through the skin. Depress the plunger until all of the insulin is administered. Insulin should always be administered in this region, but the injections should not be given in the exact same location each time lest scar tissue may form. It is important to give insulin properly to ensure consistent absorption.

Wetting the hair and skin with an alcohol-soaked cotton ball may help to better visualize the working area, but is not necessary. Dispose of used needles and syringes in a sharps container that you can obtain from your veterinarian or pharmacy. Keep the sharps container, insulin, and syringes out of childrens’ reach.

Always give the insulin at the same times everyday. If you forget to give a dose, that is okay. A pet can do just fine skipping a dose. Just give the next dose when it is due. A pet should not, however, receive accidental repeated doses; nor should the doses be given closer together than prescribed. If you can not remember if you gave the insulin already, or if someone in the house may have already dosed the pet, err on the side of caution and skip the injection.

Too much insulin is always a problem!

You should always make sure that the pet seems normal before giving a scheduled dose of insulin. If it seems unusually lethargic, has recently missed a meal or vomited, or otherwise doesn’t seem normal, then skip the dose of insulin and consult your veterinarian before proceeding. Even a weekend without insulin is safer than an overdose. Chronically elevated blood-glucose is what is detrimental to the health of the pet, not a short-term shortage of insulin.

Using a glucometer to monitor the diabetic pet’s blood-glucose at home is a good method to avoid over- and under-dosing of insulin. Your veterinarian will show you how to use a specific type of glucometer and give you instructions on when it should be performed. The doctor may ask you to report glucose readings so that he or she can adjust the insulin dosage accordingly. You should never change the dosage without first consulting the vet, no matter the results of the test. A glucometer is especially useful to assess whether an animal is becoming hypoglycemic if it seems lethargic. A blood-glucose reading of less than 40 is cause for concern, and steps to raise the blood-sugar level should be taken.

If hypoglycemia occurs, or if you suspect hypoglycemia and do not have a glucometer to verify this, DO NOT GIVE INSULIN! Hypoglycemia may appear as lethargy, vomiting, seizures, or even coma. When a diabetic pet seems like something is wrong, it is never for a lack of insulin. You will only drive the glucose lower if you give a subsequent or larger dose.

Instead, correct the hypoglycemia by giving oral food or sugar. Never give anything orally to an unconscious animal. It is a good idea to offer cats a treat or canned food that they especially enjoy; If they will not eat, you can syringe honey or Karo syrup into their mouth. This is true for dogs as well. An emergency supply of honey or syrup should be kept where everyone in the family can find it.

Once again, symptoms of hypoglycemia – low blood-sugar, or insulin overdose – sometimes called insulin shock, are lethargy, vomiting, seizures, and coma. If the hypoglycemic status is not corrected, this can lead to death. If you find your pet unconscious, take it immediately to your veterinarian or emergency pet hospital.

With all precautions understood, giving insulin to your diabetic pet can be safely accomplished at home. Without treatment, a pet with diabetes will have a poor quality of life and a drastically shortened lifespan.

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Diagnostic Tests – Quick Reference

This is a quick explanation of abbreviations and terminology used for common diagnostic tests ordered by the veterinarian.  It does not attempt to describe every scenario in which the tests might be performed.  In parentheses is the primary purpose of the test.


Ab-antibody test for exposure to a...

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This is a quick explanation of abbreviations and terminology used for common diagnostic tests ordered by the veterinarian.  It does not attempt to describe every scenario in which the tests might be performed.  In parentheses is the primary purpose of the test.


Ab-antibody test for exposure to a particular antigen

ACT-activated clotting time (bleeding disorders)
ACTH-adrenocorticotropic hormone (adrenal gland function)
Ag-antigen test for proteins specific to a disease causing organism or virus
Alb-albumin (liver, kidney and intestinal disorders)
Alk-Phos, ALP alkaline phosphatase (liver and adrenal disorders)
Allergy Testing intradermal or blood antibody test for allergen hypersensitivity
ALT-alanine aminotransferase (liver disorder)
Amyl-amylase enzyme – non specific (pancreatitis)
ANA-antinuclear antibody (systemic lupus erythematosus)
Anaplasmosis Anaplasma spp. (tick-borne rickettsial disease)
APTT-activated partial thromboplastin time (blood clotting ability)
AST-aspartate aminotransferase (muscle and liver disorders)
Band band cell – type of white blood cell
Baso basophil – type of white blood cell
Bile Acids digestive acids produced in the liver and stored in the gall bladder (liver function)
Bili bilirubin (bile pigment responsible for jaundice from liver disease or RBC destruction)
BP-blood pressure measurement
BUN-blood urea nitrogen (kidney and liver function)
Bx biopsy
C & S aerobic / anaerobic bacterial culture and antibiotic sensitivity test (infection, drug selection)
Ca+2 calcium ion – unbound calcium (parathyroid gland function)
CBC-complete blood count (all circulating cells)
Chol cholesterol (liver, thyroid disorders)
CK, CPK creatine [phospho]kinase (muscle disease, heart disease)
Cl- chloride ion – unbound chloride (hydration, blood pH)
CO2-carbon dioxide (blood pH)
Contrast Radiograph x-ray image using injected radiopaque contrast media
Cortisol hormone produced by the adrenal glands (adrenal gland function)
Coomb’s anti- red blood cell antibody test (immune-mediated hemolytic anemia)
Crea creatinine (kidney function)
CRT-capillary refill time (blood pressure, tissue perfusion)
DTM-dermatophyte test medium (ringworm – dermatophytosis)
EEG-electroencephalogram (brain function, epilepsy)
Ehrlichia Ehrlichia spp. (tick-borne rickettsial disease)
EKG, ECG-electrok[c]ardiogram (electrical heart activity, heart arryhthmia)
Eos eosinophil – type of white blood cell
Fecal,flotation,direct intestinal parasite exam
FeLV Feline Leukemia Virus test
FIA Feline Infectious Anemia: aka Feline Hemotrophic Mycoplasma, Haemobartonella felis test
FIV Feline Immunodeficiency Virus test
Fluorescein Stain fluorescein stain uptake of cornea (corneal ulceration)
fT4, fT4ed, freeT4ed thyroxine hormone unbound by protein measured by equilibrium dialysis (thyroid function)
GGT gamma-glutamyltranferase (liver disorders)
Glob globulin (liver, immune system)
Glu blood or urine glucose (diabetes mellitus)
Gran granulocytes – subgroup of white blood cells
Hb, Hgb hemoglobin – iron rich protein bound to red blood cells that carries oxygen (anemia, red cell mass)
HCO3- bicarbonate ion (blood pH)
HCT, PCV, MHCT hematocrit, packed-cell volume, microhematocrit (hemoconcentration, dehydration, anemia)
K+ potassium ion – unbound potassium (kidney disorders, adrenal gland disorders)
Lipa lipase enzyme – non specific (pancreatitis)
LYME Borrelia spp. (tick-borne rickettsial disease)
Lymph lymphocyte – type of white blood cell
MCHC mean corpuscular hemoglobin concentration (anemia, iron deficiency)
MCV mean corpuscular volume – average red cell size (anemia, iron deficiency)
Mg+2 magnesium ion – unbound magnesium (diabetes, parathyroid function, malnutrition)
MHCT, HCT, PCV microhematocrit, hematocrit, packed-cell volume (hemoconcentration, dehydration, anemia)
MIC minimum inhibitory concentration – part of the C&S that determines antimicrobial selection
Mono monocyte – type of white blood cell
MRI magnetic resonance imaging (advanced tissue imaging)
Na+ sodium ion – unbound sodium (dehydration, adrenal gland disease)
nRBC nucleated red blood cell – immature red blood cell (bone marrow damage, lead toxicity)
PCV, HCT, MHCT packed-cell volume, hematocrit, microhematocrit (hemoconcentration, dehydration, anemia)
PE physical examination
pH urine pH (urinary tract infection, urolithiasis)
Phos phosphorus (kidney disorders, ketoacidosis, parathyroid function)
PLI pancreatic lipase immunoreactivity (pancreatitis)
PLT platelet – cells involved in clotting (bleeding disorders)
PT prothrombin time (bleeding disorders)
PTH parathyroid hormone, parathormone (parathyroid function)
Radiograph x-ray image
RBC red blood cell count (anemia)
REL Rocky Mountain Spotted Fever / Ehrlichia / Lyme combination test
Retic reticulocyte – immature red blood cell (regenerative vs. non-regenerative anemia)
RMSF Rocky Mountain Spotted Fever
SAP serum alkaline phosphatase (liver disorders)
Schirmer Tear Test tear production test (keratoconjunctivitis sicca – dry eye,)
Seg segmented neutrophil – type of white blood cell
USG Urine specific gravity (urine concentration, kidney function)
spec cPL specific canine pancreatic lipase (pancreatitis) –replaces the PLI test
spec fPL specific feline pancreatic lipase (pancreatitis) –replaces the PLI test
T4 thyroxine hormone – total (thyroid gland function)
TLI trypsin-like immunoreactivity (exocrine pancreatic insufficiency)
TP total protein (hydration, liver disorders)
TPR temperature / pulse / respirations (physical exam vital signs)
Trig triglycerides (fat metabolism, liver disorders)
TSH thyroid stimulating hormone (thyroid gland function)
UA urinalysis (kidney function, urinary tract infection, diabetes)
Urine Cortisol-Crea Ratio urine cortisol-creatine ratio (screening test for adrenal gland disease)
Urine Protein-Crea Ratio urine protein-creatinine ratio (kidney disorders)
VWF VonWillebrands factor (bleeding disorder)
WBC white blood cell count (infection, inflammation, bone marrow suppression)

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Dry Eye (KCS)

Keratoconjunctivitis Sicca (KCS) is commonly called dry eye. Certain breeds are more susceptible to KCS because of the anatomy of their eyes. Dogs and cats with short noses and bulging eyes are over...

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Keratoconjunctivitis Sicca (KCS) is commonly called dry eye. Certain breeds are more susceptible to KCS because of the anatomy of their eyes. Dogs and cats with short noses and bulging eyes are over represented with dry eye. KCS is a condition or a symptom of reduced tear production. Tears lubricate the cornea, the clear layer that covers the eye, as well as wash away contaminates and carry nutrients and oxygen to the outer surface of the eye. Kerato refers to the cornea. Conjunctiva is the pink fleshy tissue on the under side of the eyelids. “Itis” means inflammation. And, sicca means dry. So, KCS simply means dry, inflamed eyes. Symptoms of KCS include a stringy mucous discharge, pain and rubbing at the eyes, and the hair around the eyes being matted. Untreated dry eye can lead to corneal ulceration and scarring, reduced vision, and even eye loss.

Tear film is composed of three layers: a mucous portion, an aqueous (watery) portion and a lipid (fat) portion. In KCS, the inability to clear mucous from the eye due to the absence of the aqueous tear portion of the film and increased mucous production in response to irritation give the characteristic dry appearance to the cornea. The aqueous portion carries essential components necessary for corneal health including oxygen, moisture, and nutrients and rinses the surface free of debris. Without the aqueous portion of tear film, irritants and bacteria collect in the mucoid discharge and the cornea is deprived of oxygen leading to damage and infection. Without normal lubrication, the formation of blood vessels and pigmentation on the cornea develop leading to vision loss with chronic KCS. Ulceration can occur, and infection can become established. In severe cases, the eye can rupture and atrophy (shrink). Complete eye loss is possible.

KCS is easily diagnosed. A calibrated absorbent strip of paper called a Schirmer Tear Test Strip is held against the eyeball for sixty seconds. Tears will wet the strip and the moisture line will climb along millimeter graduation marks on the paper. Normal tear production will measure fifteen millimeters or more in one minute. Any lower measurement is considered abnormal. Eleven to fourteen millimeters is borderline for KCS. Six to ten millimeters is diagnostic. And five or less is severe dry eye. Other ophthalmic tests may be performed during an eye exam to detect corneal ulceration (fluorescein stain uptake test) and glaucoma (tonometry).

Causes of KCS can include feline Herpes virus, canine distemper, Sulfa-based antibiotic use, trauma to the lacrimal glands, and cherry-eye surgery. The most common cause of KCS however, is an immune-mediated condition that causes destruction of the tear-producing glands. The treatment of choice for this condition is the use of cyclosporine in a topical ophthalmic medication (Optimmune). Cyclosporine is an immunosuppressive drug that stimulates tear production thereby reversing the effects of KCS. It is applied topically to the eye once or twice daily on an ongoing basis. Adjunct treatments may include artificial tears, antibiotics, and pilocarpine – a cholinergic drug that may increase tear production.

80% of animals with KCS will respond to some degree to cyclosporine treatment. It is most effective for immune-mediated disease. The severity of the reduced tear production and amount of eye damage that has already occurred will determine the amount of improvement to be expected.

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Endoscopic Procedures

An endoscope is a tube of lenses that carries an image from inside the animal’s body to the doctor’s eye or a television monitor. Endoscopy allows a veterinarian to visualize internal organs, joints, ...

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An endoscope is a tube of lenses that carries an image from inside the animal’s body to the doctor’s eye or a television monitor. Endoscopy allows a veterinarian to visualize internal organs, joints, and the inner lining of the stomach and intestines. Surgical exploration, biopsy, and repair can be performed with the aid of an endoscope. It reduces the need to make large incisions to accommodate the surgeon’s hands. Instead, tiny forceps and other surgical instruments are guided by the scope, reducing the risk of complications and speeding healing times.

There are many sizes and varieties of endoscopes, but there are two basic types: flexible and rigid. Which one the surgeon uses is a matter of preference and depends on the surgery.

The kinds of procedures that may be performed using an endoscope are numerous. A biopsy of the stomach wall or colon is obtainable without the need for a laparotomy, or opening of the abdominal cavity. A very small incision through the abdominal wall however, will allow a surgeon using a scope to biopsy the liver and other organs easily. A smaller incision means less chance of introducing infection. Arthroscopy is a surgical method of using a very small scope to visualize the inside of the joints. Exploration of the thorax is possible without artificial respiration.

Ultimately, the endoscope is a remarkable advancement in surgical technique. It reduces the size of incisions, minimizing bleeding and risk of infection. It speeds healing times greatly, allowing pets to return to normal activity much more quickly than after conventional surgery. The use of an endoscope also reduces pain associated with surgery since less trauma is caused to body tissues during the procedures. There are situations where the use of an endoscope is not ideal, but usually the endoscope offers superior results to the scalpel.

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Exocrine Pancreatic Insufficiency

The pancreas is a relatively small, yet vital organ that lies along the base of the stomach and the upper portion of the small intestine called the duodenum. It serves two primary metabolic purposes: ...

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The pancreas is a relatively small, yet vital organ that lies along the base of the stomach and the upper portion of the small intestine called the duodenum. It serves two primary metabolic purposes: its endocrine function regulates blood-glucose release and uptake, and its exocrine function produces digestive enzymes that are released through the pancreatic ducts into the duodenum. The enzymes aid in breaking down common dietary constituents such as fat, protein, and carbohydrates into lesser molecules that can be absorbed through the intestinal wall into the bloodstream. There are not two distinct sections of the pancreas responsible for these functions; rather, the endocrine and exocrine related cells are diffused throughout the entire organ. Pancreatic endocrine dysfunction can lead to diabetes mellitus or hypoglycemia (low blood sugar levels); whereas exocrine pancreatic insufficiency (EPI) causes malabsorption of nutrients. Symptoms of EPI include persistent diarrhea, weight loss despite an increased appetite, and referred problems with other organ systems due to malnutrition.

Exocrine pancreatic insufficiency is caused by destruction of the related cells within the pancreas and can stem from several causes. In acinar atrophy, the acinar cells in the pancreas that store digestive enzymes become shriveled and dysfunctional. This condition is the most common cause of EPI in dogs. It is thought to have a genetic determinant, and breeds predisposed include Rough-Coated Collies and German Shepherd. Acinar atrophy can occur at any age, but generally develops in young adults.

Another cause of EPI in dogs and cats is chronic pancreatitis. Pancreatitis simply means inflammation of the organ, but does not suggest a reason. Pancreatitis may indiscriminately affect both the endocrine and exocrine functions of the pancreas, and it may lead to diabetes and EPI concurrently. Usually, symptoms of EPI do not occur until 90% or more of the enzyme-producing cells have been damaged. Miniature Schnauzers are at an increased risk of developing chronic pancreatitis.

Pancreatitis can become chronic after an acute episode. It may be caused by dietary indiscretion or occasionally, a bacterial infection of the pancreas. A fatty meal like meat trimmings or drippings may trigger the onset of illness. Vomiting and diarrhea are the primary symptoms, except in cats, which may have a relatively silent form of the disease. The most common cause of EPI in cats is due to chronic pancreatitis.

Pancreatic cancer is the rarest cause of EPI, yet carries the gravest prognosis. The cancer may be isolated in the pancreas or may have metastasized or spread from another organ system.

The digestive enzymes that are deficient in animals with exocrine pancreatic insufficiency include amylase, lipase, protease, and trypsin. Each serves to help breakdown specific components in the diet so that they may be absorbed and utilized for energy, growth, and tissue repair. Gray, greasy diarrhea results from maldigestion of the nutrients; and the animal will begin to lose weight despite a compensatory increased appetite. Poor hair-coat health evident as dry, flaky skin and increased shedding is a common secondary symptom to malnutrition.

After ruling out other possible causes of diarrhea, a diagnosis of EPI is confirmed with a blood test called a trypsin-like immunoreactivity test, or TLI. This test measures the blood level of the digestive enzyme trypsin, which is normally detectable in very small amounts in healthy animals. Dogs and cats with EPI will have virtually no measurable blood levels of the enzyme.

The treatment for EPI must include addressing any underlying cause for pancreatic changes. Then, dietary supplementation of the digestive enzymes is used to help aid digestion and absorption of nutrients. There are specific products formulated for dogs and cats (Pancrezyme, Viokase-V) available as powders that are mixed with the pet’s food. Tablet forms do not seem to work as consistently as powders. In addition, an antacid may be given to help reduce the stomach’s acid production and increase the available enzyme entering the intestinal tract. Furthermore, a low fiber, low to moderate fat, highly digestible food will help the pet absorb more nutrients and as a result, gain weight. There are “prescription” type diets that your veterinarian will recommend.

Adjunct therapies for EPI patients include intestinally active antibiotics to reduce bacterial overgrowth occurring as a result of maldigestion. Probiotics (lactobacillus acidophilus) can help to reestablish the normal bacterial flora in the gut. Cobalamin (vitamin B12) and folate (vitamin B9) supplementation is also required where bacteria have depleted the normal sources of these important vitamins. Cobalamin deficiency is associated with anemia and neuropathy; and even pets on supplementation enzymes may require ongoing B12 injections. Both cobalamin and folate blood tests are usually combined with the TLI test in the diagnostic blood-chemistry panel.

Supplementation will be required for the life of the patient. In most cases, patients respond very well to this treatment.

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Femoral Head Ostectomy

There are many injuries, diseases, and deformities that can affect the hip joints in dogs and cats. Pain and reduced mobility are likely symptoms regardless of whether the problem occurs acutely,...

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There are many injuries, diseases, and deformities that can affect the hip joints in dogs and cats. Pain and reduced mobility are likely symptoms regardless of whether the problem occurs acutely, like a traumatic fracture, or over time, like the arthritic changes seen with hip dysplasia. In some cases, a surgical procedure called a femoral head (and neck) ostectomy, FHO for short, may be an effective treatment option to provide pain relief and improved range of motion.

Specifically, the hip joint is a ball and socket type attachment between the rear leg and the pelvis. The femur (thigh bone) runs vertically through the hind leg and is topped with a neck that points toward the body. At the end of the neck is a smooth ball that fits snugly into a socket in the pelvis called the acetabulum.

During a femoral head ostectomy, the ball and neck portion of the femur are removed, and any irregularities remaining on the femur are removed. This requires disarticulation (separation) of the joint unless the hip is already severely dysplastic or traumatically separated. The muscles that support the limb attach below the neck of the femur and are not affected by an FHO surgery. The joint capsule tissue is then closed if possible, followed by the muscle and subcutaneous tissue. Finally, the skin is closed with sutures that will be removed in a couple of weeks. Usually, there is no need for bandaging; although, an e-collar is recommended to keep the pet from chewing at their sutures.

An FHO is sometimes referred to as a “salvage procedure”; so called because the bone and joint are not restored to their original form and function. Instead, a portion of bone is removed, and a “false” joint, or scar tissue pad, forms in place of the hip joint. The result is alleviation of pain and close to normal function of the limb. This procedure works best on cats and small to medium dogs, but has been performed on animals as large as horses. For large breed dogs, hip replacement is preferred over FHO, and the outcome is generally better.

This is one procedure where activity is not restricted afterward. The growth of the scar tissue pad that forms in place of the joint is dependent on the limb being used. Range of motion exercises should be performed as soon as the pet will tolerate them. These involve gentle flexion and extension of the entire leg in repetitions several times a day. Good pain control will help the pet begin using the limb within a couple of weeks of surgery. If all goes well, it will be difficult to visually discern which leg has received an FHO procedure after complete recovery.

Even though a femoral head ostectomy is sometimes called a salvage procedure, it is actually a very practical and effective remedy for many pets. It is the treatment of choice for Legg-Perthes Disease, a painful and crippling hip problem affecting many toy breeds that results from impaired blood supply to the head of the femur. An FHO can mean relief from chronic pain when conservative treatment has failed or alternative methods of surgical intervention are not possible.

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Food Allergies

Food allergies often cause skin disorders in dogs and cats. They can be complicated by inhalant allergies (atopy) that cause similar symptoms. In cats, food allergies may be an underlying trigger for inflammatory bowel disease. It is often thought that corn and soy, preservatives, and food...

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Food allergies often cause skin disorders in dogs and cats. They can be complicated by inhalant allergies (atopy) that cause similar symptoms. In cats, food allergies may be an underlying trigger for inflammatory bowel disease. It is often thought that corn and soy, preservatives, and food colorings are responsible for food allergies; however, beef, dairy, and wheat are the most common food allergens for dogs. Beef, dairy, and fish are the most common sources of food allergy in cats. These ingredients are hard to avoid in most commercial dog and cat food, even in trace amounts. Typically, food allergies occur by exposure to an ingredient over a long period of time. Prepared hypoallergenic diets are available from veterinarians only, and all other sources of calories including treats and rawhides are eliminated during a food trial.

Other sources of skin problems must be ruled out or resolved before an effective response to hypoallergenic food trials will be seen. Fleas are the number one cause of pruritus (itchy skin) and alopecia (hair loss). They must be absolutely eliminated as a contributing factor. Sarcoptic mange causes insatiable itching and is often difficult to diagnose because the mites can be hard to find on skin tests. Inhalant allergies (atopy) may respond well to steroid therapy; whereas food allergies may respond poorly.

Food allergy induced itching can be differentiated from inhalant allergies in that it is non-seasonal. Usually, allergy symptoms caused by pollens and molds will wax and wane throughout the year. Any distribution of skin involvement may occur, but the ears, rump, limbs, axillae (arm pits) and groin are commonly affected. Cats may develop eosinophillic granuloma complex, crusty oozing lesions around the face and chin. The itch may involve primarily the paws and the ears. Ear infections may be persistent and recurring. Other symptoms of food allergies may include papules (pimple-like bumps), secondary pyoderma (skin infection), and hot spots. Cats may show symptoms of inflammatory bowel disease like chronic or intermittent diarrhea.

There are blood tests and intra-dermal testing methods of diagnosing food allergies. In most experts’ opinions, they are unreliable, and a feeding trial is considered the best diagnostic tool for food allergies.

For severely itchy and infected skin, an animal may be started on oral antibiotics and steroids. Ear infections would be treated appropriately with topical antibiotic / antifungal / anti-inflammatory medications. Measurement of the response to a food trial alone will diagnose and treat the allergy, however. It is important that if your pet is started on a hypoallergenic diet that it cannot eat anything at all except for that one particular food. Basted and impregnated toys and chews may also contain allergens and should be taken away from the pet.

There are two technologies upon which hypoallergenic diets are based: novel protein, novel carbohydrate formulas and hydrolyzed protein formulas. The first type of food avoids all common food ingredients associated with allergies. Instead, a novel protein source such as rabbit or salmon, and a novel carbohydrate source such as potatoes or peas is chosen. This technology assumes that the animal’s immune system has never been exposed to these ingredients. Misuse of novel diets and over-the-counter marketing has caused manufacturers to continually search for even more exotic meats and starches. Such is the case with lamb and rice diets which are ubiquitous these days. Alternatively, a hydrolyzed protein diet usually consists of a soy protein that has been pre-digested enzymatically to a point where the immune system does not recognize it as an allergen. The protein is still of nutritional value, and this type of diet has no potential for misuse. Switching between different over the counter foods is a haphazard method of curing food allergies and at best will achieve limited response.

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Heartworm Disease

Heartworms (Dirofilaria immitis) are blood parasites that are transmitted by mosquitoes in much the same way malaria is spread in people. The adult worms can be 10 to 14 inches long and live inside...

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Heartworms (Dirofilaria immitis) are blood parasites that are transmitted by mosquitoes in much the same way malaria is spread in people. The adult worms can be 10 to 14 inches long and live inside the heart and pulmonary arteries. They cause a restriction in blood flow leading to lung disease and congestive heart failure. Heartworm disease is diagnosed in all 50 United States, with endemic areas along the Atlantic and Gulf coast and along the Mississippi river. Treatment of infection can be relatively straightforward if the disease is caught very early, or it can be very risky if the patient has advanced symptoms. Preventive medication is the safest and easiest way to avoid heartworm infection.

Adult heartworms bear live young called microfilariae. They circulate in the bloodstream where they are picked up by mosquitoes taking a blood meal from the infected animal. Microfilariae can be seen in whole blood under the microscope; however, their numbers are dependent on the number of mating pairs of adults in the heart. A negative test for microfilariae does not mean that the animal does not have heartworms. An occult heartworm infection is one where no microfilariae are present.

Microfilariae cannot develop into adult worms without first living inside the salivary glands of the mosquito and then being transmitted back into a host animal. Once the host is infected, over the next 6 months, they will migrate through tissue to reach the pulmonary arteries and the right side of the heart. The adult worms may live up to 7 years inside the infected animal.

Dogs infected with heartworms may at first exhibit very mild and intermittent symptoms of the disease. As more adult worms invade the heart and pulmonary arteries, and as the disease progresses, coughing, exercise intolerance, inappetence, and lethargy will become more and more persistent. It is common for an infected dog to have more than 30 adult worms inside the heart. Eventually, an untreated dog will succumb to heart failure.

Cats are aberrant hosts of heartworms, meaning that the parasite does not typically infect them, but for some reason infection has occurred. Immunosuppressed cats, such as those with Feline Leukemia, may be more susceptible to heartworms. Symptoms in cats are sometimes mistaken for other feline respiratory diseases such as asthma. Coughing, gagging, rapid open-mouth breathing, and weight loss are common symptoms. In many cases, cats may have fewer than 3 adult heartworms that cause debilitating disease.

The treatment for heartworm disease is currently only approved for use in dogs. There is no protocol for the treatment of cats other than supportive care. Cats may be prescribed bronchodilators and corticosteroids to control symptoms.

Before treatment, a blood chemistry panel is performed to check for kidney and liver problems that may delay or preclude the use of an adulticide, the drug that kills adult heartworms. Also chest x-rays are taken to assess changes in the lungs, vessels, and heart. Severity of the changes and symptoms determines whether a single treatment or a split treatment will be used to kill the adult worms.

The only drug approved is called melarsomine. It is an organically bound arsenical compound that is given by injection in the lumbar muscles of the back. One injection is administered, followed by a second one 24 hours later if the patient tolerates the medication well. In a split treatment, the dog is given the first injection followed by the series of two injections 4 to 6 weeks later. In either case, the dog must be kept confined for several weeks after the injections to avoid complications from treatment.

Complications can include respiratory distress, coughing up blood, liver or kidney inflammation, lethargy, inappetence (refusal to eat), vomiting, and diarrhea.

During the treatment, the doctor may prescribe an antibiotic like doxycycline and an NSAID for pain, since the patient’s back may be sore after the deep muscle injections. Medications for other specific symptoms may also be needed.

Prevention is the best way to avoid heartworm disease and the risk involved with treatment (not to mention the expense). There are a number of safe heartworm preventive medications that your veterinarian can prescribe for your pet.

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Grape and Raisin Toxicity

We all know we shouldn’t give “people food” to our pets. Quality pet food already contains all of the nutrients and calories they need to be healthy. Still, it’s very hard to deny those pitiful eyes begging for just a little morsel from the table. Many of the “harmless” little handouts we share with our pets are in the least unnecessary calories, and may complicate dietary sensitive chronic conditions like heart...

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We all know we shouldn’t give “people food” to our pets. Quality pet food already contains all of the nutrients and calories they need to be healthy. Still, it’s very hard to deny those pitiful eyes begging for just a little morsel from the table. Many of the “harmless” little handouts we share with our pets are in the least unnecessary calories, and may complicate dietary sensitive chronic conditions like heart disease or pancreatitis. What we may not realize however, is that there are certain foods that are certainly healthy for people, but can be quite toxic to our pets. The most widely known food toxin is chocolate. Onions and garlic can also cause illness. In recent years, grapes and raisins have been implicated in food toxicities; some cases of which have caused serious harm or even death.

The responsible chemical toxin in grapes and raisins is unknown. It is speculated that mycotoxin, a fungal by-product, or pesticides might be to blame; however, no consistent evidence exists to prove a direct link. In cases of toxicity, there is no pattern of the variety or origin of the grape or raisin ingested; nor does it seem to depend on seed vs. seedless, skin-on or skin-less, et cetera. It is also difficult to assess how many grapes or raisins an animal can consume before developing a toxic reaction. Many pets may consume a significant quantity without any ill effect, and others become extremely sick or may die. Any ingestion of grapes or raisins should be considered an emergency and be brought to the attention of the veterinarian immediately.

The initial symptoms seen within several hours after grape or raisin ingestion include vomiting followed by diarrhea, lethargy, and increased thirst. From 24 hours to several days later, acute renal failure (kidney failure) may occur. Since the exact toxin is unknown, there is no known antidote available. And, because it is unpredictable how each animal will react to grape or raisin exposure, the best possible prognosis depends upon rapid and successful decontamination of the pet. If significant grape or raisin ingestion has occurred or is highly suspected, vomiting should be induced as soon as possible, followed by administration of activated charcoal to absorb the toxin.

The treatment beyond decontamination is renal (kidney) support with intravenous fluids. An IV catheter is placed, and fluids are administered in order to increase urine excretion of the toxin. Blood chemistry analysis will need to be assessed before, during, and after treatment to determine how much harm, if any, was done to the kidneys. Elevated blood-urea nitrogen, creatinine, phosphorous, and calcium levels are evidence of kidney damage.

Some animals may never have a reaction to grapes or raisins, but it is not worth the risk of permanent kidney damage or death to find out. Do not give these “people treats” to your pets, and keep them out of your pets’ reach to avoid accidental ingestion.

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Diabetes Mellitus Part Iii – Confirming A Diagnosis And Managing The Disease

It should first be said that any disease is easier to treat when detected early in its progression. For the chronically unmanaged diabetic patient, much deterioration in the overall health has...

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It should first be said that any disease is easier to treat when detected early in its progression. For the chronically unmanaged diabetic patient, much deterioration in the overall health has already occurred, making treatment of the disease more difficult. By the time symptoms are obvious, the disease is already well established. Routine wellness exams greatly improve early detection of diseases like diabetes.

Upon presentation of a symptomatic animal, the veterinarian will give the pet a complete physical examination and collect blood and urine for analysis. In addition to diagnosing diabetes, it is very important to rule out complicating factors that may make long-term management of the disease more difficult. A complete blood cell count and chemistry panel, along with a urinalysis is required as a baseline workup. A thyroid panel and urine culture is also commonly needed.

Elevated blood-glucose and glucosuria, or glucose present in the urine, is evidence of diabetes. Other laboratory test results that return outside of the normal range may indicate the deteriorative effects of diabetes, such as dehydration, kidney disease, pancreatitis, and ketoacidosis – a life-threatening emergency condition caused by untreated chronic diabetes.

When Diabetes Mellitus is diagnosed, insulin therapy may be started. Almost all diabetic dogs require insulin injections, as they will have Type I Diabetes – a deficiency in the production of insulin. Some cats may respond well to diet change and oral glucose-controlling drugs, at least initially. Most cats will eventually require insulin injections as well; however, cats may experience transient diabetes, where they require insulin for a period of time and suddenly reverse their diabetic status.

When insulin is given, a pre- and post-injection blood-glucose will be checked to measure the resting level and response. The veterinarian will adjust the dose until a desired effect is seen. This is called a glucose curve.

The veterinarian will then prescribe a dose of insulin for you to give at home on a once or twice daily basis. This dose may be changed frequently by the doctor as the animal shows response to the therapy and its requirements change. The staff will teach you how to properly administer the injections and help you to become comfortable with this responsibility.

A special diet is prescribed for diabetic patients. Since glucose is converted from food, animals will benefit from diets that take the body longer to break down into glucose. This will help to regulate the blood-sugar level and smooth out peaks and troughs that normally occur after and in-between meals. Also, feeding schedules should be kept consistent. The timing of insulin injections to food consumption will directly affect the blood-glucose curve throughout the day. The amount of insulin required will be difficult to assess if feeding schedules are haphazard.

For the proper long-term management of diabetes, blood-glucose is periodically monitored; and ideally, 24-hour glucose curves are established to regulate the glucose within a controlled range. Because stress may artificially elevate blood-sugar levels, your veterinarian may equip and train you to measure glucose at home. A trip to the vet may cause fluctuations in glucose that do not occur when the pet is comfortable at home and make it difficult to predict the proper dose of insulin that is needed. At home monitoring can also reduce the risk of insulin overdose – a life threatening situation that will be discussed in the following section.

In Part IV, we will discuss how to properly administer insulin injections, monitoring of blood-glucose at home, hypoglycemia – or low blood-glucose, and the symptoms of – and procedures to follow in case of insulin shock or overdose.

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Diabetes Mellitus – Quick Reference

When an animal consumes a meal, food is eventually converted to a sugar called glucose. Cells throughout the body require glucose for energy in order to function and survive. However, cells cannot absorb the glucose without some help from a substance called insulin. In healthy animals, insulin is...

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When an animal consumes a meal, food is eventually converted to a sugar called glucose. Cells throughout the body require glucose for energy in order to function and survive. However, cells cannot absorb the glucose without some help from a substance called insulin. In healthy animals, insulin is produced by an organ called the pancreas. Diabetic animals for some reason do not produce enough insulin to allow cells to utilize the glucose, or they develop a resistance to the mechanism of insulin. As a result, the amount of glucose in the bloodstream rises, however the cells cannot function due to a lack of usable fuel.

Diabetics may be treated by supplementing their insulin with injections given once or twice a day. Blood-glucose tests are run to determine the correct amount of insulin needed. If you are using a glucometer to measure blood-glucose values at home, you should report the values to the veterinarian before making any adjustments to the insulin dosage.

Because insulin allows the cells to absorb glucose, if too much insulin is given or if the animal does not consume food regularly, the blood-sugar level can drop rapidly and the cells again become depleted of energy. This is called insulin shock or hypoglycemia. Symptoms include lethargy, immobility, incoherence, and very quickly – death.

If an animal misses a meal, seems lethargic or unwell, it is always better to skip the next insulin injection to avoid causing insulin shock. Monitor the animal closely until the veterinarian can be seen.

If insulin shock does occur or is even suspected, or if an accidental overdose of insulin occurs, try to feed the animal (only if they are conscious) honey or Karo syrup, or anything it will consume to raise blood-sugar levels. Then see the veterinarian or emergency clinic as quickly as possible. Do Not Give More Insulin!

Insulin and Syringes

Insulin is available in several forms and concentrations. Always verify the type and strength of the insulin with the prescription. The strength will be in units. Notice a U-100, U-40, or U-80 on the package. Compare with the syringe. The markings must be the same, e.g. U-100 insulin must be administered with a U-100 syringe.

The Veterinarian will instruct you on the technique of giving insulin injections.

Remember…if you have any questions at all regarding insulin administration, or if you suspect insulin shock, be safe and call the vet!

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Diarrhea

As a pet owner it is often distressing to have a sick or ailing pet. Diarrhea in your pet is one such ailment that can often cause discomfort for the owner as well as the pet by causing accidents...

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As a pet owner it is often distressing to have a sick or ailing pet. Diarrhea in your pet is one such ailment that can often cause discomfort for the owner as well as the pet by causing accidents around the house. Diarrhea is the passage of unformed, loose stools and may appear for many different reasons. This handout will review the causes of diarrhea, treatments for the diarrhea and observations that will be helpful for your veterinarian to diagnose the problem.

Diarrhea occurs when digested food speeds through the digestive tract too quickly and forms loose, watery stools. It is also marked by the decreased absorption of water, electrolytes and other nutrients. The causes of diarrhea are wide ranging. Some animals experience mild diarrhea due to stress, allergies, change in food patterns, or stomach irritants. This stomach irritation can range from mild to severe and may be caused by some form of bacteria, virus, plant or chemical. It is important to remember that while diarrhea by itself is not a disease, it may be a symptom of a larger more complex problem.

Remember that variations in stools occur for many reasons. However, one of the concerning complications of prolonged diarrhea is dehydration. Observe your pet closely and if your pet has experienced diarrhea for two days, seems lethargic, refuses water or has other symptoms, contact your veterinarian immediately.

Before a treatment can be started, the cause of the diarrhea must be determined. There are many different tests that can be performed to determine the many causes of diarrhea. However, initially, a more generalized, cost effective and less invasive approach is often tried first. This approach calls for withholding food for 24 hours while encouraging water consumption. This allows the irritated stomach and bowels to calm down. Then gradually and in small portions, bland foods are offered to the animal. The foods most often recommended are white boiled rice, pasta, chicken broth and skinless chicken breasts. As the animal’s stools return to normal, then small portions of their normal diet may be gradually incorporated with the bland foods.

If this generalized approach does not seem to be calming your pet’s diarrhea distress, then your veterinarian may perform more tests to determine if the diarrhea is a symptom of larger and more far reaching problems. Clinical workups may include blood work, stool samples, urine cultures and food trials. These tests will determine if the diarrhea is simply caused by a bacteria, virus or food allergy or if the distress is a symptom of larger issues, such as cancer.

In order to assist your veterinarian with the proper diagnosis, observe the following details about your pet:

  • How frequently is your pet defecating?

  • What are the consistency, smell and color of the stools?

  • Is your pet exhibiting any other symptoms such as lethargy, vomiting or weight loss?

  • Has there been any change to your pet’s normal routine, food or environment?

  • Does your pet have access to small objects that might have been swallowed?

  • Has your pet escaped your house/yard recently and had access to foreign objects?

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Ear Mites

Ear mites (Otodectes cynotis) are tiny, almost microscopic, parasites that live in the ear canals of our pets. They are very contagious and nearly always found in both ears. Even though ear mites are ...

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Ear mites (Otodectes cynotis) are tiny, almost microscopic, parasites that live in the ear canals of our pets. They are very contagious and nearly always found in both ears. Even though ear mites are a common cause of ear infection, they are often falsely blamed for other bacterial and fungal infections of the ears. They produce large amounts of reddish-black discharge from the ear that resembles coffee grounds. It is important to have any ear problem seen by a veterinarian before over-the-counter ear mite remedies are attempted without success. Ear mites are easy to diagnose, but they can be persistent if not treated properly. Be sure to tell your veterinarian about all animals in the household with which the pet may come into contact. They are not considered contagious to humans.

Ear mites appear as tiny white specks to the naked eye. An otoscope magnifies them to the point that they can be seen moving. Under the microscope, they are spider-like mites with eight legs. The adult males mate continually with deutonymphs, immature mites with no set gender. The deutonymph then molts into a male or female adult. The females will be egg-laden, and the males will seek mates. Eggs hatch in four days, and a six-legged larva emerges which molts into a protonymph and later a deutonymph. The entire bizarre life cycle lasts about three weeks. Adult ear mites live approximately two months on the host animal, and up to twelve weeks in the environment. Fleas may be able to carry eggs and mites from one animal to another, making direct contact unnecessary to transmit ear mites.

There are several treatment options for ear mites. Topical insecticide otic preparations that contain pyrethrin easily kill the mites and larvae but not the eggs. These products must be used for at least the three week life cycle to ensure that all hatching larvae are killed. Some veterinarians prefer a thirty day treatment.

Another treatment for ear mites is a one time treatment with a topical product containing ivermectin or milbemycin. Only about five percent of pets will require retreatment, and the products are very safe. Convenience is weighed against cost with these products when multiple animals in the household must be treated.

An injection of ivermectin can be given weekly for two to four weeks to kill ear mites. This is an extra-label use of the drug, meaning it is not specifically approved by the FDA for this use. It is a very effective treatment; however, certain breeds of dogs may be sensitive to ivermectin. Because it is injected, higher blood levels of the drug are achieved and reactions, while rare, may occur.

There are several “spot-on” topical monthly flea and tick preventives that are labeled for ear mite treatment available today as well. It is imperative that the product label says “safe for use on cats” if it is to be applied to a cat with ear mites.

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Entropion

Entropion describes a condition in which the eyelids roll inward causing the eyelashes to constantly rub on the sclera (white of the eye) and cornea (clear covering of the iris and pupil). This is most often a heritable trait found in purebred dogs; it is somewhat rare in cats but can occur. Entropion causes a significant amount of discomfort and irritation to the delicate tissue of the eye. Untreated, it can lead to a very painful ulceration, secondary infection, and ultimately sight-impairing ...

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Entropion describes a condition in which the eyelids roll inward causing the eyelashes to constantly rub on the sclera (white of the eye) and cornea (clear covering of the iris and pupil). This is most often a heritable trait found in purebred dogs; it is somewhat rare in cats but can occur. Entropion causes a significant amount of discomfort and irritation to the delicate tissue of the eye. Untreated, it can lead to a very painful ulceration, secondary infection, and ultimately sight-impairing scarring of the cornea. Symptomatic entropion almost always requires surgical correction. The procedure should be performed before symptoms become severe and damage to the eye becomes irreversible.

Because of its heritable nature, entropion usually causes the pet to become symptomatic at an early age. Acute onset in a mature animal is more likely to be secondary to injury or tumor formation, where scar tissue or cancer deforms the edge of the eyelid causing it to invert onto the eye. Since entropion may cause damage to the eye itself, the veterinarian will usually run several ophthalmic diagnostic tests during an eye exam even if entropion is visibly obvious. A flourescein stain uptake test is used to reveal corneal sloughing and ulceration which can quickly lead to vision loss if not treated aggressively. A Schirmer tear test may also be performed to make sure that tear production is not reduced which would impede healing.

The surgical treatment for entropion is called “blepharoplasty”. This procedure is performed under a general anesthetic. The affected eyelids are reshaped by removing excess skin above or below the eye. A small wedge is all that is usually required to roll the eyelid back to a normal position. A couple of sutures are placed to close the incision and will most likely be removed after 10 to 14 days. Any infection or irritation resulting from the entropion will be treated with topical ophthalmic medications that the owner will continue at home. Pets are sent home in an Elizabethan collar to prevent them from rubbing out the sutures or causing further self-trauma to the eyes.

If entropion is discovered in a very young animal, it may be possible to preclude blepharoplasty with a simple eyelid “tacking” procedure. Blepharoplasty is generally delayed until after 6 or 8 months of age, after the mature shape of the eyelid is fully realized. None-the-less, entropion should not go untreated, because damage to the cornea is very painful and can quickly progress to permanent vision loss.

There are numerous dog breeds that are predisposed to this condition, and dogs with a history of entropion should not be bred.

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Feeding Tubes

A feeding tube may be needed in cases where a pet cannot or will not eat for an extended period of time. There are basically four kinds of tubes that are selected for different situations. Conditions ...

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A feeding tube may be needed in cases where a pet cannot or will not eat for an extended period of time. There are basically four kinds of tubes that are selected for different situations. Conditions wherein a feeding tube may be used include newborns that are not thriving and need supplemental nutrition, hepatic lipidosis in cats, and fractures and cancers of the jaw. Nutrition and medications can be delivered via the tube directly into the stomach.

The most temporary type of feeding tube is an orogastric tube. This process is performed without anesthesia. A mouth gag is placed between the teeth to prevent the pet from chewing, and a red rubber tube is passed through the mouth, down the esophagus, and into the stomach. Liquefied canned food is drawn into a large syringe and injected through the tube. An entire meal can be delivered in a few seconds. The tube is immediately removed. This method is only used when supplemental feeding will last 1 or 2 days. Complications include vomiting while pulling the tube because of the gag reflex and the risk of aspiration of food into the lungs. This process can be quite stressful to the animal as well.

Another method to deliver calories is to insert a nasogastric feeding tube. This usually does not require anesthesia. A small diameter rubber tube is passed through one nostril, down the esophagus, and into the stomach. Liquefied food can be administered through this tube several times a day. An Elizabethan collar is worn to prevent the pet from removing the tube with a paw. Drawbacks of this method are that the food must be watered down, and thus is not calorie-dense. Also, the tube can be vomited up. When this occurs, the pet will chew off the end of the tube that is hanging out of the mouth, and the owner may not be aware. During the next feeding, liquefied food is squirted into the throat instead of the stomach; and there is a risk of aspiration into the lungs. Sometimes a nasogastric tube is used for a couple of days in order to stabilize an animal before an anesthetic can safely be administered to place a better type of feeding tube.

An esophagostomy / pharyngostomy tube is a better alternative to the nasogastric feeding tube, but it does require anesthesia to place. It is a larger bore tube that can accept blenderized food (more calorie-dense), and it is passed into the esophagus through an incision from the side of the neck. The tube is sutured and bandaged in place and is generally well tolerated. It can be left in place for weeks. This type of tube can also be vomited, so the same risk of aspiration exists as with a nasogastric tube. Also, infection can occur at the incision requiring removal of the feeding tube.

The best type of feeding tube is called a percutaneous endoscopic gastrotomy (PEG) tube. It also requires the pet to be anesthetized for placement. An incision is made through the abdominal wall and directly into the stomach. A balloon-like cuff on the end seals the tube to the stomach wall, preventing leakage of food into the abdomen. Unlike other feeding tubes, it cannot be vomited and the risk of aspiration is much lower. A PEG tube can remain in place for a year or more.

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Flea Allergy Dermatitis

Fleas are the worldwide number one cause of allergic dermatitis in dogs and cats. Symptoms of flea allergy dermatitis (FAD) include scratching, chewing, licking, inflamed skin, and hair loss. Severe...

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Fleas are the worldwide number one cause of allergic dermatitis in dogs and cats. Symptoms of flea allergy dermatitis (FAD) include scratching, chewing, licking, inflamed skin, and hair loss. Severe cases may lead to broken skin called hotspots, and granulomas – raised, edematous, oozing lesions that can cause permanent scarring. Being blood-sucking parasites, fleas can cause anemia if their numbers are great. Fleas can transmit disease to people and pets and can quickly infest a household and yard. The treatment for FAD always begins with removal of the fleas from the animal and its environment. Topical, oral, and injectable antihistamines and corticosteroids, as well as antibiotics for infected skin, may be prescribed to provide relief of symptoms.

Fleas are blood-sucking insect parasites that require an animal host to survive. Female fleas must continually feed during reproduction; therefore, they can consume 150 times their body weight in blood every day. During blood meals, the flea’s saliva is released into the animal’s skin to act as an anticoagulant. The saliva contains histamine-like compounds that are very irritating to the skin.

Flea allergy dermatitis is specifically caused by an allergic reaction to flea saliva. The allergy begins as a local contact allergy, but becomes systemic as the pet is exposed over time. This condition does not require a large number of fleas, only a repeated exposure. In fact, animals with flea allergy dermatitis may not have many fleas on them, usually because they ingest the fleas while licking and biting themselves. As the allergic reaction becomes more severe, redness and hair-loss will occur. Eventually, the skin will become thickened and hyper-pigmented from chronic self-trauma and allergic inflammation. Secondary infection and odor occurs when bacteria and yeast invade and colonize on the damaged skin.

In the past, the methods of removing fleas from the pet included bathing and dipping the animal in insecticides containing pyrethrins. While very effective, pyrethrins do absorb into the blood-stream through the skin and can be toxic to the liver and neurological system. Because animals with FAD may have broken and inflamed skin, they may absorb higher levels than healthy pets. Permethrin, a stronger synthetic insecticide, is extremely toxic to cats. Permethrin containing products are labeled, “for use on dogs only.” Newer topical and oral treatments to kill fleas are safer and fast-acting. Your veterinarian will prescribe the safest, most effective remedy for your pet.

Most animals with FAD will require medication to relieve itching. It is important to stop the self trauma that leads to infected skin. Antihistamines used include diphenhydramine and chlorpheniramine. They are very safe, and doses can be repeated every 8 hours as needed. Corticosteroids are used for more severe symptoms. Prednisolone and triamcinolone come in topical, injectable, and oral forms. Injectables, while very potent and often necessary, can not be removed from the body in the event of side effects.

Shampoos and rinses containing oatmeal and antiseptic ingredients may also be used to provide temporary relief from the symptoms of flea allergy dermatitis.

Regular use of flea preventives is the only way to avoid flea allergy dermatitis.

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Fractures (Broken Bones)

There are three primary classifications of bone fractures with numerous subtypes. All of which will require an individual assessment by the veterinarian to ensure proper healing. While most “simple”...

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There are three primary classifications of bone fractures with numerous subtypes. All of which will require an individual assessment by the veterinarian to ensure proper healing. While most “simple” fractures are not technically an emergency, any animal that is suspected of breaking a bone should be seen quickly by the doctor, at least for the sake of pain control. After an examination and an x-ray, the veterinarian will determine the best course of treatment.

Closed fractures involve a broken bone without a break in the skin. There has been no contamination of the wound, in other words. Unless an organ or artery has been damaged, these fractures can usually wait a few days to be repaired. Open or compound fractures have bone protruding through the skin or a puncture that communicates with the bone. These types of injuries are susceptible to infection, and should be dealt with quickly and aggressively. Bone infections can be especially difficult to treat, and healing of the fracture can be significantly delayed. Epiphyseal (e-pif-uh-see-uhl) fractures occur at the site of a growth plate. Growth plates are the soft, spongy ends of the bone in juvenile animals that allow the bone to elongate as the animal matures. These types of fractures are notorious for healing improperly, causing irregular bone growth or deformity if not repaired properly.

Another type of fracture that would warrant emergency medical treatment would be that of the vertebrae, a broken neck or a broken back. If there is impingement on the spinal cord, the injury could lead to paralysis.

Subtypes of fractures are basically descriptions of the physical break pattern on the bone. Simple fractures describe bones that are broken into 2 or 3 large fragments, whereas comminuted fractures cause shattering of the bone into many tiny pieces. There are also compression fractures, spiral fractures, transverse, oblique, impacted fractures, and so forth…

If a bone in a limb is fractured, the animal will not bear weight on that leg at all. Other fractured bones may not cause such obvious symptoms. An x-ray can reveal even a green-stick fracture – an incomplete break that does not go completely through the bone. It is important to have any pet suspected of a fracture assessed by the veterinarian to ensure that should one exist, it can be repaired correctly so that it will heal properly and not cause complications later in life.

Before attempting to move a pet with a fracture, be sure to securely fasten a muzzle to keep from being bitten. If there is active bleeding, apply firm direct pressure with your hand or a towel. If there is an open wound, lightly wrap it in gauze or cloth to avoid further contamination. If possible, immobilize the animal on a board or stretcher, especially if the back or neck seems to be injured. Do not attempt to splint a broken bone at home. Inappropriately applied homemade splints can actually do more harm than good. Instead, padding the affected bone with a large towel or blanket will help immobilize the fracture and reduce pain. Never give over-the counter pain medications to your pet. They can cause extended bleeding times and many are quite toxic to animals.

In the case of very minor fractures, the veterinarian may be able to apply a splint. In many cases however, surgery may be necessary to properly align and stabilize the bone. In any case, the goal of treatment is to fix the two ends of the fracture so that they cannot move, allowing them time to heal. If the animal becomes too active too soon after surgery, this may cause a separation of the repaired fragments which may result in a non-union – the fractured ends not healing back together.

There are as many surgical repair techniques as there are types of fractures. In general, a surgical-grade stainless steel appliance will be utilized to hold the bone in place while it heals. Kershner wires or bone pins are heavy gauge steel rods that are drilled into the medullary canal, the center hollow portion of a bone where the marrow lies. Bone plates are affixed using screws drilled transversely through the outer walls of the bone. External fixators consist of pins drilled through the skin and bone and are held together by a stainless steel clamp outside the body. Which type of appliance is used is determined by the size of the bone, the location in the body, the complexity of the fracture, and the expected healing time of the injury.

K-wires and bone plates are typically left in place after the fracture completely heals, but in certain circumstances they have to be removed. This is true especially if infection or inflammation develops at the site of repair. External fixators are always removed.

Plaster and gauze or fiberglass casts are not used on dogs and cats for one simple reason: the animal cannot tell the doctor what is going on under the cast. If irritation or infection develops, it will not be revealed until the cast is removed. By that time, disastrous effects may have already occurred.

In general, bones take weeks to heal. During that time, the animal should have restricted activity, and your veterinarian will give you detailed instructions on aftercare.

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Hematoma Of The Ear Flap

Hematoma simply means “blood filled mass”. A hematoma of the ear flap (pinna) is caused by a ruptured vessel leaking blood between the layers of skin covering the inner and outer external portion of...

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Hematoma simply means “blood filled mass”. A hematoma of the ear flap (pinna) is caused by a ruptured vessel leaking blood between the layers of skin covering the inner and outer external portion of the ear. Because the blood cannot escape the body, the ear pinna fills like a pillow or balloon. Dogs and cats can be diagnosed with an aural hematoma. Canine hematomas are usually associated with an ear infection. The pain and irritation causes the dog to shake its head violently, causing a whipping effect of the ear flap. The increased blood pressure in the vessels causes them to rupture. Another cause of a hematoma can be a trauma such as from fight wounds, and this is the more common cause of hematomas in cats. The shorter the ear pinna, the less likely that a whipping action caused the blood vessels to rupture. In any case, an ear infection should be ruled out as an underlying reason for a hematoma.

Surgical repair is usually recommended for aural hematomas. Aspirating the blood with a needle and syringe can deflate the pinna, but this treatment is seldom effective. The hematoma will probably recur, and infection can occur if the hematoma is contaminated. Left untreated, the blood will reabsorb and form scar tissue, causing the ear pinna to shrink and deform. This is sometimes called a cauliflower effect, and can occlude the ear canal leading to increased risk of ear infections.

The window of opportunity to surgically repair an aural hematoma is typically within a week of its occurrence. The pet is administered a general anesthetic after pre-surgical blood work confirms that there are no contraindications precluding surgery. If an ear infection exists, the ear canal may be swabbed to send samples to a reference laboratory for culture and susceptibility testing. This can greatly expedite a successful resolution of the infection. Also, the ear canal may be flushed with antiseptic during anesthesia to facilitate a thorough cleaning before beginning topical treatments at home.

The ear pinna is shaved and prepped before an incision is made through one layer of skin over the length of the hematoma. The blood is drained, and the blood clots that would otherwise form scar tissue are removed. There are variations in technique at this point, but all achieve the same purpose. The Variation would be to tack the two sides of the ear pinna together leaving an opening to drain any residual bleeding that may occur. This will cause the two sides of the ear to scar together so that there will be no “pocket” to fill up with blood in the future. Some veterinarians will suture a piece of plastic to the back of the ear to help hold the pinna straight while healing. Local anesthetic may be infused into the pinna to help with pain control.

An Elizabethan collar is worn during healing to prevent the pet from scratching at the sutures, and sutures are removed after 14 to 21 days. Healing times are generally longer than spay or neuter surgery to ensure that the hematoma does not recur. Oral antibiotics and pain medications are sent home after surgery. Antibacterial / antifungal ear ointments are dispensed in the case of an ear infection.

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Heart Murmurs

During a physical examination, the veterinarian will use a stethoscope to listen for abnormal sounds in the chest. A heart murmur is one such abnormality that is fairly common in dogs and somewhat...

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During a physical examination, the veterinarian will use a stethoscope to listen for abnormal sounds in the chest. A heart murmur is one such abnormality that is fairly common in dogs and somewhat rare in cats. A murmur is an additional “swishing” sound that accompanies the normal heart beat. While no cause for panic, this finding does warrant further investigation to ensure that the heart is healthy.

The dog and cat heart is similar to a human heart in that it utilizes four “passive one-way” valves to regulate the direction of blood flow. The valves are located at the entrances and exits of the two ventricles, the largest two of the four chambers of the heart. They are “one-way” valves, such that they open when blood flows in one direction, but are pushed closed if the blood tries to move in the opposite direction. The valves are “passive” because they do not open and close by any other mechanism besides the force of the blood flow.

The ventricles (larger heart chambers) are surrounded by muscles that contract and relax changing the volume or capacity of the chamber or space therein. As the ventricle relaxes, the capacity increases and blood enters the chamber through the entrance valve. The exit valve is forced closed by the pressure of blood trying to flow into the ventricle through the exit. As the ventricle contracts, the volume of the chamber decreases. The entrance valve is then forced closed, and the exit valve opens to allow blood to flow out of the chamber. Every time the ventricles contract and relax, or “beat”, blood is pumped in one direction to the lungs, organs, and tissues of the body.

A heart murmur occurs when a valve fails to close or open completely. The sound is created by regurgitation – turbulence caused by blood flowing in the reverse direction – or from excessive pressure when blood is accelerated past a narrowly opened valve like water squirting through a pinched hose.

Murmurs are classified as systolic or diastolic – the turbulence occurring after the first beat sound or after the second beat sound – and graded according to the intensity or volume of the turbulence. Furthermore, the location of the murmur, or the loudest point on the chest where the murmur can be ausculted (heard with a stethoscope), can also help predict which heart valve is malfunctioning. Other descriptions of murmurs can include the pitch, the shape (variation in intensity), and the quality of the turbulence.

Heart murmurs may be congenital or acquired. Congenital murmurs exist from birth (although they may not be observed until later) and are evidence of a heart defect that occurred during development. This type of murmur may not be related to the valves at all, and instead may be caused by a small hole between the chambers of the heart where turbulence occurs. When mild and asymptomatic, the murmur is considered innocent or benign, and is not attributable to a pathological (harmful) heart condition. Congenital murmurs should be monitored for changes and reevaluated as necessary.

Acquired murmurs most often occur as a result of underlying or developing disease. Valvular disease and congestive heart failure are relatively common in aging dogs, and a murmur may be the first subtle evidence detected. Anemia is an easy to miss reason for an acquired murmur. The veterinarian may request a cardiac workup including radiographs, EKG, blood-chemistry profile, or an echocardiogram to determine a course of action. Many mild murmurs found in otherwise asymptomatic animals will require no treatment other than observation. Heart disease diagnosed and managed early in its progression carries a much better prognosis than after symptoms begin.

Heart murmurs are rare in cats, and cats with even serious heart disease do not necessarily acquire a murmur. For this reason, a murmur detected in a cat should be evaluated aggressively. A silent killer called Hypertrophic Cardiomyopathy will occasionally reveal itself with a heart murmur; there is otherwise rarely any warning of its impending threat.

Many pets live long and normal lives with heart murmurs. To be safe, any murmur should be thoroughly evaluated by a veterinarian.

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Texas West Animal Health

16367 South FM 4,

Santo, TX 76472

Phone. 940-769-2222

Fax. 866-632-3365

Email. texaswestvet@gmail.com