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Pet of the Month – December 2016 – Smudgey

by admin on December 1st, 2016

Category: Pet of the Month, Tags:

Smudgey is giving us a reproving look from the depths of a buster collar that should prevent him removing his indwelling urinary catheter.

SMUDGEYThe catheter had to be placed under anaesthesia in an emergency procedure to relieve a potentially life-threatening condition called urethral obstruction.

Urethral obstruction is a problem that occurs almost exclusively in male cats. This is because the urethra of a male cat is much longer and much narrower than that of a female cat, and so is more susceptible to becoming blocked.

Urethral blockage is not a common condition, but when it occurs it is painful, the cat will be unable to urinate despite repeated efforts, and it is a life-threatening emergency as it can cause acute kidney failure and death within 2-3 days if not managed appropriately
 

What are the signs of urethral obstruction?

A cat with urethral obstruction will usually show:

  • Repeated attempts to urinate that are unproductive
  • Crying or discomfort when straining to urinate
  • Increased agitation, and there may be some vomiting

Depending on the underlying cause, you may also have noticed some other changes in your cat’s urinating behaviour over the preceding few days such as increased frequency of urination, straining, discomfort or even some blood in the urine.

Contact your vet immediately if you think your cat may have an obstructed urethra, as this is an emergency situation.
 

What causes urethral obstruction?

Several underlying conditions can cause obstruction of the narrow urethra of a male cat, including:

  • A ‘plug’ in the urethra – this is usually an accumulation of proteins, cells, crystals and debris in the bladder that accumulates and lodges in the urethra
  • A small stone (urolith) or an accumulation of very small stones – these form in the bladder but may become lodged in the urethra
  • Swelling and spasm of the urethra – during inflammation of the bladder and urethra, whatever the cause, the inflammation may cause swelling of the wall of the urethra which may contribute to blockage, and in a number of cases the inflammation and irritation causes the muscle around the urethra (the urethral sphincter muscle) to go into spasm – this too can cause obstruction if the cat is not able to relax the muscle.

 

How is urethral blockage managed?

If your cat’s urethra is blocked, the vet will need to relieve the obstruction quickly.

Blood tests may be important to see if there are any significant complications. In particular, cats with a blocked urethra may develop acute kidney failure and may develop very high blood potassium concentrations; these are life-threatening complications that should be checked when possible.

X-rays or ultrasound may be needed to help determine the underlying cause of the obstruction and to help determine the best treatment method.

Under anaesthesia a catheter is passed into the urethra (via the penis) so that fluids can be infused to help flush out the obstruction (or sometimes to push it back into the bladder). These procedures have to be done very carefully to avoid damaging the delicate lining of the urethra.

If the obstruction is caused by spasm of the urethral muscle, simply sedating or anaesthetising the cat may be sufficient to allow easy passage of a catheter into the bladder.
 

What happens after the obstruction is relieved?

Once the obstruction has been relieved, the vet will want to infuse a sterile saline solution into the bladder via the catheter so that all the blood and debris (that will inevitably be present in the bladder) can be washed out. This is usually repeated several times to remove as much debris as possible to reduce the chance of re-obstruction.

Once this has been done, the vet will decide whether the urinary catheter can be removed. If there has been a severe blockage, your vet may want to leave a catheter in for a few days (usually no more than 2-3 days) to ensure urine can be produced while treatment is commenced for the underlying disease and inflammation.
 

What other treatments are given?

Further treatment depends on the underlying cause of the obstruction, the severity of the obstruction, and what (if any) complications have arisen. Any damage to the kidneys may be completely reversible, but cats will often have to receive intravenous fluids for several days if the kidneys have been affected. In addition to intravenous fluids, other drugs commonly used to help manage cats include:

  • Other pain-killing (analgesic) drugs
  • Drugs to help relieve spasm of the urethra (spasmolytics)
  • Anti-inflammatory drugs to relieve the swelling in the urethra

 

Long-term management of the cat with urethral obstruction

In the short-term, while the initial swelling in the urethra settles down, cats may need to be on anti-inflammatory drugs, spasmolytics, and perhaps analgesics for several days and even up to a week or two.

Longer term, management is aimed at the underlying cause of the urethral obstruction. Cases associated with uroliths (stones in the urethra and bladder) will need to be managed with special diets to reduce the risk of their recurrence. Most cats with urethral spasm or urethral plugs are thought to have underlying feline idiopathic cystitis. These cats should be managed with painkillers and the aim of reducing stress.

If repeated episodes of obstruction occur despite appropriate management, in some cases a surgical operation can be performed (called perineal urethrostomy) to help open and widen the narrow end to the urethra. This should not be regarded as a first-line therapy though as it does not deal with the underlying cause, and the surgery can sometimes be associated with complications such as the risk of stricture formation and an increased risk of bacterial urinary tract infections.

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Pet of the Month – November 2016 – Bruce

by admin on November 3rd, 2016

Category: Pet of the Month, Tags:

Poor Bruce! This is not the first time our practice cat has featured in this newsletter. At present Bruce is suffering from pancreatitis and is in our hospital.

Pancreatitis in cats has two forms, acute and chronic, which are usually diagnosed by symptoms and by ruling out other diseases. There are diagnostic tests for pancreatitis, but they are not always accurate, they can be costly, and can be quite invasive for a definitive diagnosis. Pancreatitis can also predispose your cat to other disease processes.

The pancreas is an organ that makes two primary products – digestive enzymes and insulin. Normally the digestive enzymes are released in an inactive form and are not activated until they reach the intestinal tract. This is to prevent the enzymes that are designed to break down food from coming into contact with the delicate pancreatic tissue.

In pancreatitis, for reasons yet unknown to us, these digestive enzymes will become activated while they are still in the pancreas. This results in significant inflammation and irritation to the pancreatic tissue, which can also cascade to other surrounding tissues such as the liver and intestinal tract. This can lead to secondary bacterial infections in the pancreas.

If the activation of the digestive enzymes is significant enough, then your cat can develop acute pancreatitis which can range from mild to severe and life threatening. If the activation of the digestive enzymes remains mild and continues long term, then your cat may develop chronic pancreatitis, which can result in the development of scar tissue in the pancreas, and eventually pancreatic insufficiency and predisposition to diabetes. It has been estimated that 30% or more of cats have chronic pancreatitis, but many may never show symptoms.

 

Acute pancreatitis:

Symptoms - Every cat will have different symptoms, some may have several, and some may have only one.

  • Intense vomiting: Your cat may vomit multiple times over a period of hours or days, and may not be able to keep food down. This needs to be addressed quickly to prevent dehydration.
  • Pain: Your cat may be sitting in a hunched position with their head tucked, or not want to be picked up or touched. Acute pancreatitis is very painful in all mammals.
  • Anorexia:Your cat may be feeling intensely nauseous and painful, so it is unlikely that they will want to eat.
  • Lethargy: Your cat may be extremely tired and lethargic.
  • Diarrhoea: If your cat’s pancreas is so inflamed that it is not secreting digestive enzymes into the small intestine, then any food that your cat does eat may come out as diarrhoea with a very foul odour.

Diagnosis - With acute pancreatitis, we will need to begin treatment immediately. How we treat at this point will be based on the severity of the symptoms and blood sample results.

  • Blood tests: As well as general haematology and biochemistry tests there are pancreas specific tests such as fPLI – this stands for feline pancreatic lipase immunoreactivity which can be elevated in pancreatitis in cats. However, while a positive test can confirm a diagnosis of pancreatitis, a negative test does NOT rule it out. It is possible to have a false positive with this test. The accuracy of this test has been estimated to be between 50-80%. So, while we may use this test to try and confirm a diagnosis of pancreatitis, we will not use it to make an initial diagnosis.
  • Ultrasound: For an experienced ultrasonographer, this can be a good way to diagnose pancreatitis, by finding an enlarged, thickened pancreas on ultrasound. However, this requires a more advanced skill level of ultrasonagraphy than most general practitioners have.
  • Biopsy: This is considered the gold standard for a 99.9% accurate diagnosis. However, this requires exploratory abdominal surgery which is invasive to your already sick cat, and it can take 2-3 days to get the histopathology results, so we do not do this routinely.

Treatment - The goal of treatment for acute pancreatitis is to reduce your cat’s pain and nausea, stabilize any electrolyte abnormalities, treat any secondary infections, and reduce the inflammation until your cat is able to heal.

  • Pain management: This is one of the most important aspects of treating acute pancreatitis. Commonly used drugs are: Buprenorphine. This is a narcotic that has show to have excellent pain control in cats. This is our most common first line pain management for acute pancreatitis.
  • Nausea: We have several anti-nausea medications that we will use in cats with acute pancreatitis. Most commonly used is Cerenia (maropitant). This is a fairly new drug that has quickly become our first line of defense for nausea in cats. This drug not only reduces nausea and vomiting, but it also has anti-inflammatory and anti-pain properties.
  • Reducing gastric acid secretion in the stomach can help an already nauseated cat. We often use omeprazole.
  • Antibiotics: We may use antibiotics to treat any secondary infections.
  • Intravenous fluids: If your cat is having a hard time staying hydrated due to vomiting or not drinking, or if your cat has abnormal electrolytes, then we will start intravenous fluid therapy.
  • Syringe feeding: If is very important that you cat eats. If they are too nauseous to eat, we may syringe feed them a very bland diet or a prescription diet.

Possible long term effects: Acute pancreatitis can lead to destruction of a fair amount of pancreatic tissue. How much tissue is affected can determine what happens next. Some of the more common sequelae are:

  • Scar tissue: After the inflammation subsides, there is a chance of scar tissue developing in the healing process. As long as there is enough healthy tissue remaining, then your cat may never have any additional problems.
  • Chronic pancreatitis: This is what happens when your cat’s pancreas continues to have low grade chronic inflammation. This can result in regular vomiting and anorexia episodes.
  • Pancreatic insufficiency: When too much of your cat’s pancreas that makes digestive enzymes is destroyed, either by severe acute pancreatitis, or by chronic pancreatitis, eventually the pancreas will not be able to make enough enzymes to digest food. Your cat may then have large fluffy diarrhea and an increase in vomiting. This can be treated by giving your cat synthetic digestive enzymes.
  • Type I diabetes: When enough of your cat’s pancreas that makes insulin is destroyed, it will not be able to make enough insulin to counteract the glucose in the body. Your cat may then develop diabetes and will need to be started on insulin injections.

 

Chronic pancreatitis:

The symptoms of chronic pancreatitis are very similar to acute pancreatitis, but on a milder scale. A common pattern we will hear is that your cat will vomit several times a day for a few days, not want to eat, and may act uncomfortable and lethargic, and then a few days later, will be fine until the next episode. These symptoms can also be similar to inflammatory bowel disease, so we may ask you lots of questions about exactly what goes on with each episode, and frequency to try and distinguish between the two.

Diagnosis again is similar to acute pancreatitis, but it can be harder as the blood work will be more likely to look normal, fPLI will only be positive if there is significant inflammation, and ultrasound will be even harder to detect. There is a blood test available that will test for two pancreatic enzymes and two intestinal enzymes to try and differentiate between pancreatitis and inflammatory bowel disease, but if it is negative, it still doesn’t rule either one out for sure.

Treatment most commonly is symptomatic, with pain medications, antibiotics, and anti-nausea medications. For cats who do have routine flare ups of chronic pancreatitis, we may want to treat long term with Cerenia as a preventative. We have a few other preventative treatment options as well if Cerenia is not an option.

While pancreatitis is one of the more painful and potentially nauseating diseases we can see in cats, as you have just read above there are things we can do to decrease its effects and help your cat to feel better.

Bruce Pet of The Month

 

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Pet of the Month – October 2016 – Margot

by admin on October 7th, 2016

Category: Pet of the Month, Tags:

Margot is currently doing really well, recovering from an operation to correct “cherry eye’.

Cherry eye, or prolapse of the gland of the third eyelid, is quite common in small dogs and refers to a pink mass protruding from the animal’s eyelid;. The prolapsed gland itself rarely causes discomfort or damage to the eye, so the repair is mostly cosmetic. Most people choose to repair it, because it can have a very unpleasant appearance.

The gland contributes about 40% of the total tear-production of the eye and it is therefore imperative to aim to preserve the gland if possible as removal can cause a dry eye which can lead to damaged vision. If this does happen, it is controllable with medications, but it is preferable to prevent it. The most common surgical approach is a technique in which the gland is re-positioned using a mucosal pocket, creating a new envelope for the gland to sit within, but taking care to leave a few millimetres on either side to allow tears to drain freely. The unaffected side is often operated on pre-emptively.

Pet of the Month - October 2016 - Margot

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Pet of the Month – September 2016 – Daisy

by admin on September 1st, 2016

Category: Pet of the Month, Tags:

When young Daisy returned from her travels with a wounded and unstable right hock joint her owner brought her to the surgery straight away.  Radiographs revealed the hock joint to be extremely unstable which necessitated a referral to an orthopaedic specialist.

Daisy’s hock was stabilised with an external fixator and bandaged. External fixation consists of inserting two or more pins each in undamaged areas of the bones proximal and distal to the fracture site. The pins are connected by clamps or putty to keep them rigid.

Undaunted by her escapade Daisy managed to escape from an open window on her first night home from the specialist. After a half hour chase she was caught and returned to what had been thought to be a secure enclosure, now with even tighter security. Her hock had to be re-radiographed the next day to check that no damage had been incurred and we are pleased to report that she is making very good progress.

Pet of the month DAISY

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Pet of the Month – August 2016 – Brambie

by admin on August 1st, 2016

Category: Pet of the Month, Tags:

Brambie first visited the practice as a second opinion for recurrent bladder/urination problems. A scan revealed she had bladder stones which had not been picked up by her previous vet.

We surgically removed her bladder stones and are delighted to report that she is doing very well.

Brambie

For your interest we include further information on bladder stones below.

What are the symptoms of struvite bladder stones?

The symptoms of bladder stones are very similar to the symptoms of an uncomplicated bladder infection or cystitis. The most common signs that a dog has bladder stones are hematuria (blood in the urine) and dysuria (straining to urinate). Hematuria occurs because the stones rub against the bladder wall, irritating and damaging the tissue and causing bleeding. Dysuria may result from inflammation and swelling of the bladder walls or the urethra, from muscle spasms, or due to a physical obstruction to urine flow caused by the presence of the stones. Veterinarians assume that the condition is painful, because people with bladder stones experience pain, and because many clients remark about how much better and more active their dog becomes following surgical removal of bladder stones.

Large stones may act almost like a valve or stopcock, causing an intermittent or partial obstruction at the neck of the bladder, the point where the bladder attaches to the urethra. Small stones may flow with the urine into the urethra where they can become lodged and cause an obstruction. If an obstruction occurs, the bladder cannot be emptied fully; if the obstruction is complete, the dog will be unable to urinate at all. If the obstruction is not relieved, the bladder may rupture. A complete obstruction is potentially life threatening and requires immediate emergency treatment.

My dog has struvite bladder stones. What does that mean?

Dogs, like people, can develop a variety of bladder and kidney stones. Bladder stones (uroliths or cystic calculi), are rock-like formations of minerals that form in the urinary bladder, and are more common than kidney stones in dogs. One of the more common urolith in the dog is composed of magnesium ammonium phosphate hexahydrate. The more common name for this type of bladder stone is “struvite bladder stone”.

How did my dog get them?

Normal dog urine is slightly acidic and contains waste products from metabolism including dissolved mineral salts and other compounds. Struvite is a normal component of dog’s urine and will remain dissolved as long as the urine is acidic and is not too concentrated. If the urine becomes exceptionally concentrated or if it becomes alkaline, struvite crystals will precipitate or fall out of solution.

In dogs, struvite bladder stones usually form as a complication of a  bladder infection caused by bacteria that produce an enzyme known as urease.  This enzyme breaks down the urea that is normally present in the urine causing an excess production of ammonia; this ammonia production then causes the urine to become alkaline. Ammonia in the urine also causes bladder inflammation. Under these environmental conditions, struvite crystals will precipitate out of solution and collect around any cells or debris that may have formed in the bladder as a result of inflammation.  Female dogs tend to get these types of bladder infections and stones much more frequently than males, probably because their shorter, wider urethra makes it easier for bacteria to pass up the urethra into the bladder. In some studies, up to 85% of dogs with struvite bladder stones were female.

Other causes of alkaline urine such as certain kidney diseases, long-term use of diuretic drugs or antacids, and other conditions that cause elevated urine pH or elevated levels of urinary phosphorus or ammonia can also predispose a dog to the formation of struvite bladder stones.

How common are struvite bladder stones?

Bladder stones are somewhat common in dogs, and struvite stones are the most common; in clinical studies, up to 26% of all bladder stones were found to contain struvite. Together, struvite and calcium oxalate uroliths have been found to comprise over 85% of all uroliths submitted for laboratory analysis in a recent study. Based on the results of tens of thousands of stone analyses, it has been found that the number of struvite bladder stones has been declining in dogs while the number of calcium oxalate stones has been increasing during the past ten years.  Struvite uroliths were noted to be more common in female dogs and calcium oxalate uroliths in male dogs. Breeds most commonly diagnosed with struvite and calcium oxalate bladder stones included: shih tzu, miniature schnauzer, bichon frisé, lhasa apso, and Yorkshire terrier.

How are struvite bladder stones diagnosed?

In some cases, your veterinarian may be able to palpate (feel) struvite stones in the bladder if the dog is relaxed and the bladder isn’t too painful. However, some stones are too small to be felt this way. Often, bladder stones are diagnosed by means of an x-ray of the bladder, or by means of an ultrasound. Struvite stones are almost always ‘radiodense’, meaning that they can be seen on a plain radiograph. However, sometimes bones or other overlying body parts will interfere with the ability to see bladder stones with regular x-rays, in which case your veterinarian may recommend a contrast study, a specialized technique that uses dye to outline the stones in the bladder, or a bladder ultrasound.

These imaging procedures will identify the presence of a bladder stone, but will not definitively tell your veterinarian the composition of the stone. The only way to be sure that a bladder stone is made of struvite is to have the stone analyzed at a veterinary laboratory.

In some cases, your veterinarian may make an educated guess about the type of stone that is present, based on the radiographic appearance and results of a urinalysis. For example, if x-rays show that there are one or more stones present in the bladder, and the results of the urinalysis show the presence of alkaline urine along with numerous struvite crystals, your veterinarian may make a presumptive diagnosis of struvite bladder stones and recommend treatment accordingly.

How are struvite bladder stones treated?

There are three primary treatment strategies for struvite bladder stones:

1) Feeding a special diet to dissolve the stone(s)

2) Non-surgical removal by urohydropropulsion

3) Surgical removal

1) Feeding a special diet:  The use of special therapeutic diets to dissolve struvite bladder stones is often recommended in cases where the risk of a urinary tract obstruction is relatively low.  These diets typically are restricted in protein, phosphorus and magnesium and are formulated to promote formation of acidic urine (with a pH less than 6.5). This formulation helps dissolve struvite stones that are already present in the urine, and prevents formation of further stones. Dissolution of the stones is further enhanced by increased water intake, which will serve to dilute the urine.

Since most dogs with struvite bladder stones developed them as a result of a bladder infection, the dog will also be placed on antibiotic therapy while the stones are being dissolved. This is important because, as the layers of stone are dissolved, bacteria that have become trapped in the layers of stone are released into the bladder; if left untreated these bacteria can set up another infection.  Some dogs may experience dissolution of struvite stones within two weeks while others may take up to 12 weeks. Your dog will need to have antibiotics during this entire period of time. If your dog is placed on dietary therapy to dissolve the bladder stones, your veterinarian will recommend that a urinalysis and bladder x-rays should be performed approximately every four to six weeks during treatment.

Some bladder stones can be ‘mixed’ or composed of multiple layers of different types of mineral, which may complicate treatment.  If follow-up x-rays show that the stones are no longer dissolving, this may indicate that the stones are mixed, and the treatment plan may need to be adjusted.

2)  Non-surgical removal:   If the bladder stones are very small it may be possible to pass a special catheter into the bladder and then flush the stones out, in a technique called urohydropropulsion. In some cases, this procedure may be performed with the dog under heavy sedation, although general anesthesia is often necessary.  If your veterinarian has a cystoscope, small stones in the bladder or urethra can sometimes be removed with this instrument, thus avoiding the need to cut the abdomen and bladder open. Either of these procedures may also be used to obtain a sample stone for analysis so that your veterinarian can determine if dietary dissolution is feasible.

3)  Surgical removal:   Surgery is indicated in dogs that have a large number of stones in their bladder, if there is an increased risk that the patient will develop  an obstruction in the urinary tract, or if the client wishes to have the problem resolved as quickly as possible. Male dogs are at a much higher risk of developing an obstruction in the urinary tract as a result of bladder stones, so when bladder stones are diagnosed in a male dog, your veterinarian will often strongly recommend surgical removal. Surgery is also indicated if dietary treatment was not successful in eliminating the stones, or If it appears that the stones are composed of a mixture of mineral types. Your veterinarian will discuss the appropriate treatment strategy for your dog, based on your individual situation.

Are there any other treatment options?

In some selected referral centers, another option may be available to treat bladder stones. This option is ultrasonic dissolution, a technique in which high frequency ultrasound waves are used to disrupt or break the stones into tiny particles that can then be flushed out of the bladder. It has the advantage of immediate removal of the offending stones without the need for surgery.  Your veterinarian will discuss this treatment option with you if it is available in your area.

How can I prevent my dog from developing struvite bladder stones in the future?

Dogs that have experienced struvite bladder stones will often be fed a therapeutic diet for life. Diets lower in protein, phosphorus and magnesium and promote acidic urine are recommended.  The preventative diet is NOT the same as the diet that promotes dissolution of the stones. In certain cases, medications to acidify the urine may be required.  In addition, careful routine monitoring of the urine to detect any signs of bacterial infection is also recommended. Bladder x-rays and urinalysis will be performed one month after successful treatment, dietary or surgical, and then every three to six months for life. Dogs displaying any clinical signs of urinary tract infections such as frequent urination, urinating in unusual places, painful urination or the presence of blood in the urine should be evaluated immediately. Keep in mind that the greatest risk factor for developing struvite bladder stones in the dog is a urinary tract infection.

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Pet of the Month – July 2016 – Hedgie!

by admin on July 1st, 2016

Category: Pet of the Month, Tags: Tags: ,

June - Polly

This week’s Pet of the Month is a small hedgehog we have chosen to highlight the fantastic work our vets and nurses do treating wildlife. A few years ago we were very fortunate to have a Wildlife Unit built in our garden funded by The Body Shop and WADARS Animal Rescue. This small hedgehog was brought in to us injured, by a member of the public. We checked him over thoroughly under anaesthetic and cleaned up his wounded leg. He is now starting to eat and recover. We hope he will be moving on to a hedgehog rehabilitation centre shortly and in due course ‘Hedgie’ should be able to return to the countryside.

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Pet of the Month – June 2016 – Polly

by admin on June 1st, 2016

Category: Pet of the Month, Tags:

June - Polly

What is Cushing’s disease and how is steroid produced by the body?

Hyperadrenocorticism or ‘Cushing’s disease’ is caused by excessive production or administration of steroid. It can be classified as pituitary dependent, adrenal dependent, or iatrogenic.

A brief overview of how steroid is produced in the body will help with the understanding of this disease. The pituitary gland is a small gland at the base of the brain that secretes a hormone called ACTH. ACTH causes the adrenal glands to secrete steroid hormone. There are two adrenal glands in animals which are located in the abdomen close to the left and right kidneys. The main steroids produced in response to ACTH secreted by the pituitary gland are glucocorticoids and these have widespread effects on the management of proteins and sugars by the body.

What is the cause of Cushing’s disease?

Approximately 85% of dogs with Cushing’s disease have a very small, typically non-cancerous, growth of the pituitary gland that drives the excessive steroid production (via excessive ACTH production). These dogs have what is called ‘pituitary dependent hyperadrenocorticism’ (abbreviated to ‘PDH’). Approximately 75% of dogs with PDH weigh less than 20kg.

Approximately 15% of dogs have a tumour on one of their adrenal glands that drives the excess steroid production. This is known as ‘adrenal dependent hyperadrenocorticism’ (abbreviated to ‘ADH’). Cancerous and non-cancerous growths occur with equal frequency. Approximately 50% of dogs with ADH weigh greater than 20kg.

What are the signs of Cushing’s disease?

The most common presenting signs in dogs with Cushing’s disease are:

  • increased drinking
  • increased urination
  • increased appetite
  • panting
  • enlargement of the abdomen
  • hair loss

Dogs with Cushing’s disease are usually 6 years of age or older and many different breeds have been reported to be affected including Poodles, various Terrier breeds, Daschunds, Beagles and Labrador Retrievers.

How is a diagnosis of Cushing’s disease made?

The diagnosis of Cushing’s disease can sometimes be difficult, even with blood tests. Blood test results will be interpreted by your vet in light of the history and findings on examination. A blood test taken after the administration of a hormone or drug is necessary to help make the diagnosis. These tests are called the ‘ACTH stimulation test’ and the ‘low dose dexamethasone suppression test’. Normally only one test is necessary; however, occasionally both tests need to be performed. Urine tests are often performed as well.

Once a diagnosis of Cushing’s disease is made, it is useful to know whether the patient has pituitary dependent Cushing’s disease or adrenal dependent Cushing’s disease. The differentiation can be made with further blood testing or with an ultrasound scan of the abdomen. An ultrasound scan of the abdomen is sometimes required to help in achieving a diagnosis of Cushing’s disease.

How are dogs with Cushing’s disease treated?

Dogs with confirmed pituitary dependent Cushing’s disease are managed with an oral drug called trilostane. Trilostane stops the production of steroid and leads to an improvement in clinical signs in most dogs. Trilostane is absorbed better if given with food. Blood testing is necessary after starting treatment to monitor the effect of the drug. Any blood test result will always be interpreted in combination with the clinical signs. The majority of dogs will show a good response to treatment but will require lifelong therapy. Occasionally the small growth on the pituitary gland can grow and cause neurological signs (fits, behaviour change). Scans of the brain are therefore sometimes performed.

Surgical removal of the adrenal gland mass is the treatment of choice for patients with adrenal dependent Cushing’s disease. The outlook depends upon the degree of invasion of the growth into local blood vessels and analysis of the tumour under a microscope. Trilostane can be trialled in those patients for whom surgery is not an option.

‘Iatrogenic’ Cushing’s disease can be caused by the administration of steroid by mouth or topically. It tends to occur in patients on high dose, long term oral steroid (prednisolone) therapy. Treatment involves gradually stopping steroid therapy.

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Pet of the Month – May 2016 – O’Riley!

by admin on May 2nd, 2016

Category: Pet of the Month, Tags:

WINSTON

With O’Riley already suffering from Inflammatory Bowel Disease (IBD) his owners were used to him having the occasional flare ups of IBD causing him to not be his normal bouncy self. But when they noticed he was drinking more, urinating more and having more frequent bouts of vomiting as well they brought him in to  see if anything  else could be contributing to this.

Blood tests showed O’Riley to have higher than normal levels  of urea and creatinine, substances which the kidneys excrete, indicating O’Riley’s kidney function was declining. A urine sample was taken to help confirm the diagnosis  and also to check if he had excess protein in his urine (‘proteinuria’) as animals with kidney disease who develop this will benefit from additional medications. A clinically silent urinary tract infection was detected, a common complaint for animals with kidney disease, which obscured the protein results. This was addressed with a course of antibiotics  before repeating the urine test. O’Riley was found to have proteinuria and started on a medication called an ACE inhibitor. An ultrasound scan of his kidneys was also performed to check for any structural abnormalities and his left kidney was found to be small, a common finding in Chronic Kidney Disease (CKD). A renal diet which restricts the amounts of protein and phosphorus, which the kidneys struggle to excrete in kidney disease, was tried but due to O’Riley’s concurrent IBD this treatment had to be abandoned. His phosphate levels were found to be too high and so an additional medication known as a phosphate binder was started. O’Riley also had regular checks of his blood pressure, as hypertension (high blood pressure) is another common result of CKD. When O’Riley’s blood pressure was found to be elevated he was also started on Amlodipine to help reduce this. Blood tests to check on his kidneys a month later showed improvements with lower levels of urea, creatinine and phosphate.

We are delighted to report that apart from an isolated occasion when his kidney disease made him feel unwell and which a brief stay in our hospital on intravenous fluids helped rectify, six months on O’Riley continues to do well.

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Pet of the Month April 2016 – Winston!

by admin on April 1st, 2016

Category: Pet of the Month, Tags: Tags: , , ,

WINSTON

Young Winston is featured this week as he has fortunately made a swift and complete recovery following treatment for vomiting using an extended course of antacids and a bland diet. Apart from showing off his good looks this article illustrates a common feline problem and the approach taken for pets whose response to treatment is not quite so immediate as his.

You’ve probably witnessed your cat vomiting from time to time without raising too much concern. Vomiting is a protective mechanism that can result from something minor such as overindulgence or access to an irritant, or it can be a sign of a much more serious condition associated with a primary gastrointestinal disorder (e.g. an ingested foreign body) or a systemic disorder (e.g. kidney disease).

What is the difference between your cat vomiting and and your cat regurgitating? Why does it matter?

The oesophagus is a narrow, muscular tube that allows food to pass through on its way to the stomach. In healthy cats, food will move quickly through the oesophagus to the stomach with little to no delay. When you take your cat to your veterinary surgeon because he or she is vomiting, they will ask you questions in attempt to differentiate between vomiting and regurgitation.

Regurgitation is the passive ejection of contents from the oesophagus. The cat will lower its head and food is expelled with little or no effort. The food is usually undigested, may have a tubular shape, and is often covered with a slimy mucus. Cats will also attempt to eat the regurgitated material.

If the muscle of the oesophagus is considered diseased, it will either result in widening of the oesophagus due to loss of muscular tone (called ‘megaoesophagus’), or narrowing of the oesophagus, which acts as an obstruction to material moving down into the stomach (e.g. a stricture, a tumour or a foreign body can all cause narrowing of the oesophagus). A dilated (widened) oesophagus will not effectively, or efficiently, move or push food from the oesophagus into the stomach. This delay can result in regurgitation shortly after eating. The danger of regurgitation is that the contents may also be inhaled into the airways causing pneumonia and a cough. It’s therefore important for your vet to differentiate between vomiting and regurgitation as this will have an impact on deciding which diagnostic tests to perform, and also will help when deciding on the most appropriate treatment options.

Vomiting, on the other hand, is an active process. Cats will often vocalise, be apprehensive and heave/retch to vomit. If food is present in vomit, it is partially digested and can also contain a yellow fluid (bile). Vomiting can be divided down into primary (gastrointestinal) causes, or secondary (non-gastrointestinal) causes.

Primary causes of vomiting are those diseases directly affecting the stomach and upper intestinal tract. Secondary causes are due to diseases lying outside of the gastrointestinal tract and can include neurological disease or accumulation of toxic substances in the blood. Neurological disease and/or toxic substances will stimulate the vomiting centre in the brain and cause the animal to vomit. Additionally, vomiting can be further divided into acute versus chronic causes.

Some common causes for sudden (acute) vomiting in cats include:

  • Diet-related causes (diet change, food intolerance)
  • Gastric or intestinal foreign bodies (eg. toys, hairballs, or where one part of the intestine moves inside another part of the intestine)
  • Gastrointestinal parasites
  • Urinary tract causes: acute kidney failure, ruptured bladder
  • Acute liver failure
  • Pancreatitis
  • Ingestion of toxins or chemicals
  • Viral infections
  • Certain prescribed medications
  • Inner ear/neurological disorders
  • Decompensation of a more chronic disease

Some common causes for chronic vomiting in cats (vomiting greater than 3 weeks duration) include:

  • Gastritis/gastroenteritis (infectious, toxic, dietary indiscretion/intolerance)
  • Hyperthyroidism
  • Inflammatory bowel disease (gastritis, enteritis, colitis)
  • Severe constipation
  • Diabetes (ketoacidosis – this is a form of uncontrolled diabetes)
  • Chronic liver disease
  • Chronic kidney disease
  • Pancreatitis
  • Cancer (gastric/intestinal)
  • Inner ear diseases/neurological disorders
  • Heart worm disease

What should I do if my cat vomits frequently?

An occasional, isolated bout of vomiting is normal. However, frequent vomiting can be a sign of a more serious condition. Your vet will normally ask you a very detailed clinical history and perform a thorough physical examination. This information can help your vet narrow down potential causes from the very long list of possibilities.

The presence of fever, abdominal pain, jaundice, anaemia or abnormal masses in the abdomen will help your vet make a more specific diagnosis. The mouth should be carefully examined as some foreign objects such as string can entangle themselves around the base of the tongue with the rest of the object extending into the stomach or small intestine. A nodule may be palpated in the neck of cats with hyperthyroidism.

Many times, a full physical examination may be normal and unremarkable. At this stage, your vet may choose to adopt trial treatment/supportive care by implementing a brief starvation period, with or without administration of fluid therapy and various medications (e.g. pain relief, anti-nausea medications, antacids) and assess your cat’s response.

Further investigation of vomiting in cats

Depending on response, your vet may need to perform further investigations to differentiate primary from secondary causes of vomiting. Depending on history, clinical examination, and response to trial therapy, further tests may be needed and may include blood tests, urine analysis and faecal examination to rule out possible toxicities, parasites, and metabolic diseases. Further blood tests may include FIV/FeLV (Feline Immunodeficiency Virus and Feline Leukaemia Virus) to assess viral status. Although FIV/FeLV are not common primary causes of vomiting, they may reflect underlying immunosuppression which may make the cat more susceptible to certain diseases. Your vet may also decide to perform tests to assess the pancreatic health (e.g. pancreatitis).

Depending on the case, your vet may then decide to proceed with ‘second tier’ testing. This usually would involve some diagnostic imaging – x-rays and ultrasound – which can be useful in identifying masses, foreign objects, and other gastrointestinal tract problems such as pancreatitis.

Finally, if indicated, further ‘third tier’ testing may be indicated to obtain a biopsy of intestinal tract tissue if cancer or inflammatory bowel disease is suspected. Biopsies can be collected using either minimally invasive procedures (endoscopy and/or laparoscopy) or more invasive procedures (exploratory laparotomy). Endoscopy (a small camera attached to a long flexible tube) is commonly used to visualise the inside of the oesophagus, stomach and first part of the small intestine and to obtain small biopsies called ‘pinch biopsies’. It may also be possible to provide therapeutic interventions with an endoscope. Laparotomy (open surgery) or laparoscopy (‘key hole surgery’) may be considered for those cases where samples of organs lying outside of the stomach/small intestine and full thickness biopsies of intestines are needed.

This information will help your vet to identify the cause, streamline a treatment plan, and also provide you with a prognosis.

What are some treatment options?

The treatment for vomiting depends upon the underlying cause.

Non-specific treatment may include a 12-24 hour fasting period. Fluids may need to be withheld for a short period of time until vomiting has ceased. Water should never be withheld from an animal with known or suspected kidney disease without replacing fluids intravenously or subcutaneously (under the skin).

Water can be reintroduced in small volumes after a 6-12 hour period. You may wish to start with tuna water (not brine) or chicken broth (with NO added onion/garlic or powders) to encourage fluid intake. Gradual increases in volume may commence over the course of the day if vomiting does not recur.

Provided oral fluids have been well-tolerated, small volumes of a bland, high quality protein source (boiled chicken breast, tuna in spring water, turkey breast, boiled white fish) may then be introduced. It’s advisable to start with a teaspoon size portion every 4-6 hours for 1-2 days. Again, if tolerated, gradual increases in food volume may be attempted with the aim to wean back to the original diet over a 3-5 day period. If a cat is bright and alert and has had no previous health problems, episodes of acute vomiting may be managed at home, although veterinary consultation prior to home treatment is strongly advised. In certain situations (e.g. depression, dehydration, or symptoms lasting longer than 12-24 hours), your cat may require fluid therapy or drugs to help control vomiting. You’ll need to see your vet to determine the proper course of action.

What other symptoms should I watch for?

The causes of vomiting are so varied and can be extremely difficult to accurately diagnose. It’s therefore important to monitor for other signs of ill health that may help direct your vet in his/her quest in identifying the underlying cause.

What to watch for:

  • Frequency of vomiting. If your cat vomits once and proceeds to eat regularly and have a normal bowel movement, the vomiting was most likely an isolated incident
  • Diarrhoea
  • Dehydration (sticky gums, weak, sunken eyes, increased ‘skin tenting’)
  • Lethargy
  • Blood in vomit
  • Weight loss
  • Change in appetite and water intake (either increased or decreased)

When is it time to see the vet?

Please see your vet if you notice any of the symptoms mentioned above or if vomiting persists. Depending on your cat’s age, medical history, physical examination findings and particular symptoms, your vet may choose to perform various tests and/or admit your cat for more intensive treatment.

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Pet of the Month – March 2016

by admin on March 2nd, 2016

Category: Pet of the Month, Tags:

MAX

Max developed marked swelling of opposite fore and hind limbs within hours of a muddy walk. Rather uniquely he had emphysema and oedema in his legs. Max was depressed and inappetant and the following day developed skin lesions and a low platelet count was detected on his routine bloods. He was sent to Anderson Moores Veterinary Specialists for fear he had contracted Alabama Rot and he was continued on aggressive fluid therapy, pentoxyphylline, a drug that helps stop vasculitis and general intensive care with frequent monitoring of his platelets and kidney parameters. His urine output was monitored. His feet were maintained in dressings and antibiotics were used for the secondary infections which occurred following the skin lesions and he had opiates for analgesia. Acute Kidney Injury typically develops in 1-10 days so this protocol was continued until he had passed the 10 day mark and then medications were continued until his skin lesions resolved.

Max was home in time for Christmas and we are delighted to report that he has continued to do well.

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