Allergies

Allergies

Allergies are a very real problem in our pets. Dogs and cats manifest allergies differently than humans. Allergies manifest through the skin of dogs and cats whereas humans exhibit more upper respiratory signs. Our pets, therefore, exhibit itching and scratching, redness of feet and belly, shaking the head and ears, and chewing the feet. 

There are three main categories of allergies: atopy (seasonal and environmental), food allergies, and flea reactions. Almost without exception, pets have multiple allergies. Therefore if we suspect a seasonal allergy, a food allergy should be considered as well. 

Atopy is also known as seasonal and environmental allergies. The potential list is truly endless. If the allergen is outdoor and seasonal, then the allergy will occur just a few times a year. If there is an indoor environmental allergen, then the pet may exhibit the allergy throughout the year. The classic clinical signs are face rubbing, feet licking, scratching the flanks and abdomen, and generalized itchiness or redness. Allergens are inhaled as well as absorbed. Therefore the allergens are concentrated in the feet and are a likely reason for excessive foot/pad chewing. For this reason, we describe atopy as "Face and Feet".

Food allergies can also have an endless potential list. One should not assume one allergy over another (i.e. wheat gluten, beef, etc). The classic clinical signs for food allergies are recurrent ear disease and rectal problems (itching, licking, scooting). For this reason, we dub food allergies as "Ears and Rear".

Flea allergies commonly manifest with a thinning hair pattern just over the rump at the base of the tail. Fleas may or may not be seen! Fleas may be in the inguinal region, around the ears, under the neck as so on, but the dermatologic lesion will be at the base of the tail. 

Secondarily the skin will respond to these allergens with redness, hair loss, crusting, scabbing, flakiness, and infection. 

Diagnosing allergies begins with a detailed history and physical examination. Clinical signs and locations of dermatitis often direct us to the type of allergy. Allergies can only be specifically diagnosed through either skin or blood testing. Food allergies can be diagnosed through blood testing or through an extended dietary food trial. Flea allergens are diagnosed through physical examination.

Treatment consists of identifying the underlying allergen and preventing exposure if possible. Antihistamines and steroids are often utilized with varying success. Medicated shampoos and anti-itch medications can aid in relief. Identification and production of an allergen serum can be used to retrain how the body responds to allergens. The only real treatment of food allergy is through a restricted diet. Flea prevention and treatment is the primary method of preventing flea allergies. 

Bladder Stones / Urinary Tract Infections

Bladder Stone / Urinary Tract Infections

One of the more common conditions seen in dogs and cats is urinary tract disease/infection. In dogs, true infections occur more commonly than inflammatory conditions. Research shows that younger cats rarely have true infections but typically have inflammatory conditions. Older cats tend to have true infections as dogs do. The most common clinical signs of a UTI is increased frequency or attempts to urinate but with a minimal production of urine. The urine may appear normal in color or may show discoloration that could represent blood. Diagnosis is through obtaining urine and testing it along a reagent strip.

Urinary tract infections are treated with 1-2 weeks of antibiotics to clear the infection. A two week injectable antibiotic is now available for convenience. Increasing fluid intake will help flush the bladder and relieve discomfort. 

Bladder stones develop as the body inefficiently processes minerals. The composition of the two most common stones are calcium oxylate and magnesium/ammonium/phosphate (struvite). Both stones occur with the same frequency. Struvite stones occur in the face of infections and an alkaline urine environment. Calcium oxylate stones form in a more acidic urine. Struvite stones can be dissolved by removing the bacteria as well as acidifying the urine. Calcium oxylate stones, however, must be surgically removed. Dietary management is the cornerstone preventative therapy. The goal is to reduce the minerals that comprise these stones. 

Bladder stones can possibly be diagnosed through physical examination if the stones are large enough. In all cases, though, radiographs (x-rays) are necessary to determine size and amount as well as to rule out other intrabdominal issues. Although struvite stones can be dissolved, the length of time needed for dissolution may be too excessive. Radiographs alone cannot distinguish struvite from calcium oxylate stones. Once removed, the stones should be submitted to a laboratory to identify the mineral composition of the stones so that an appropriate diet can be instituted. 

Cataracts

Cataracts In Our Pets

Within the structure of the eye lies a lens. The job of the lens is to focus light within the eye which in turn allows vision via the retina.

Cataracts can be defined as an opacity change in the lens, which will present with a cloudy or hazy look. A pets’ medical history and clinical progression is important when diagnosing a cataract. Commonly, cataracts are inherited, can develop slowly, and are considered age appropriate. Diabetes mellitus or trauma to the eye may also elicit cataracts. Dr. Shaun Reynolds explains that upon cataract maturation, “light will ultimately be refracted, which can alter vision.”

There is no medical treatment for cataracts, but with some cataract developments, our doctors may deem it necessary to rule out other potential diseases of the eye with further diagnostic testing(s) and medication(s). When appropriate, your pet may be referred to a board certified veterinary ophthalmologist for surgical cataract removal.

 

Chemotherapy

Chemotherapy for our Pets

Just hearing the word “chemotherapy” conjures frightening emotions. Cancer, in any form, is a terrible disease to battle. In human medicine it may also seem that the treatment of cancer is as bad if not worse than the disease itself. As there are numerous forms of cancer, there are also numerous forms of treatment. In general, cancer is fought by 1) surgically removing a tumor, 2) using radiation to target and remove localized cancer, and 3) providing chemotherapy to treat potentially generalized disease as well as “clean up” any remaining cells. This is true of both human and animal medicine.

Chemotherapy is simply a term that means using chemicals to therapeutically treat a condition. So in theory, any medication used for any disease may be called chemotherapy. However, we save this term for specific treatment of neoplasia, or cancer.

Research is an ongoing effort to find the safest and most efficacious medicines to treat cancer. Historically, the medicines used for cancer have terrible side effects, at least in people. Most of these medicines do not specifically target cancer. They are designed to target any fast growing/dividing cells which neoplasia, or “new growth” typically exhibit. One main reason cancer is so bad is that is grows so rapidly. Chemotherapy attacks any cells that grow rapidly which is great for treating cancer, but is terrible for normal, rapidly dividing cells. Cells that line the stomach and intestines grow quickly so that vomiting and diarrhea are common side effects. People’s hair grows quickly, so our hair falls out.

Pets, fortunately, do quite well with chemotherapy. Although they are very similar in physiology to humans, they do not generally suffer the same intensity of side effects. What vomiting and diarrhea that may occur, simple medicines seem to be very beneficial. Rarely do pets loose hair.

Different chemotherapies do seem to work better on different types of cancer. Therefore before any medication is chosen, it is imperative that the specific cancer is diagnosed through either biopsy or blood testing.

We are fortunate here at Williamson County Animal Hospital that we are able to provide your pets with the best medicine possible, including chemotherapy.

Demodectic Mange

Demodectic mange, or "Red Mange" is a dermatologic skin disorder in which the normal demodectic mites are uninhibited and create multifocal skin lesions. This specific mite normally resides on/in the skin of healthy dogs, cats, and even humans! It is proposed that puppies who develop Demodectic mange have a genetic predisposition to developing the mange. If an adult dog develops this mange, it is speculated that either it is a reoccurrence of mange (if they had it as a puppy) or a condition in which the immune system is weakened which normal keeps these mites in check. Those possible conditions are hypothyroidism, stress, Cushing's disease, kidney or liver dysfunction, or other conditions. As this is considered a heritable trait, pets with this condition should be spayed or neutered. 

The clinical signs of Demodectic mange are hair loss, crusting and scaling (particularly around the eyes and ears), potential itching, and a skin odor. Demodex should always be considered as a possible differential for any puppy with hair loss. 

Diagnosis involves a thorough history and physical examination along with a skin scraping. Unfortunately the skin scrape is not highly sensitive meaning that the mites can be difficult to locate. However once mites are positively identified, therapy can be instituted. 

Therapy involves providing a medicine, commonly ivermectin, to the dog once a day for at least 1-2 months. Collie breeds and collie crosses should use a product such as milbemycin as some collies have a predisposition to ivermectin toxicity. Secondary bacterial skin infections are very common and should be treated with appropriate antibiotics. Patients should be skin scraped monthly until negative results occur. Medicine should continue one month beyond a negative skin scraping. The length of therapy can vary greatly from pet to pet. Some animals only require 1 month of therapy and others may require several months to a year. 

This condition cannot be cured in every case, but it can be successfully managed. It is possible and even likely that this condition will manifest itself years later, especially if another illness or stressful event occurs. 

Diabetes Mellitus

Diabetes mellitus is one of the most common hormonal diseases diagnosed in our dogs and cats. Diabetes is a condition in which the pancreas is unable to produce insulin in sufficient amounts. Without insulin, the body cannot utilize its main energy source, which is glucose (sugar). Therefore the body must use the alternative energy sources fat and protein. As the body breaks these sources down, the animal loses weight which can be significant. Even though the body cannot utilize blood sugar, it remains very high in the blood which leads to excessive drinking and urination. (Remember the more sweet drinks we drink, the thirstier we become.) 

Diagnostically, diabetes can easily be diagnosed with very high blood sugar levels.  Secondary tests such as a urinalysis are often performed to rule out concurrent urinary tract infections and ketoacidosis which is a more severe form of diabetes. 

Dogs and, to a lessor extent, cats will often develop cataracts as a secondary condition. Long term conditions such as neuropathies, liver and kidney issues, etc that are more common in humans do not typically affect our pets simply due to the length of time it takes to create those problems. 

Although we cannot characterize dog and cat diabetes as we do with humans, it is similar. Dogs are more likely to exhibit a Type one, or insulin dependent diabetes much like children. The pancreas of dogs will often either completely stop production of insulin, or it will dramatically decrease its production. Cats are more similar to adult onset diabetes, or Type two (non-insulin dependent) diabetes. Therefore, dogs almost always require insulin injections to control blood sugar. Cats often times require insulin injections but can otherwise be controlled with diets high in fiber and low in simple sugars or carbohydrates. 

The goal of diabetes therapy is to decrease the clinical signs of excessive drinking, excessive urination, excessive appetite, and cataract formation. It is ideal to get the blood sugar into a more normal range, but that is not the primary goal. Unlike people who will check their blood sugar multiple times a day, that is impractical in our pets. We will spot check blood sugar weekly until we feel a good regulation has occurred. Therapy is often required for life in dogs. Dietary management may be all that is required for cats.  

Feline Immumodeficiency Virus (FIV)

FIV is the cat equivalent of HIV in humans. Just as with human transmission of the virus, FIV can be passed through sexual contact but can also be transmitted through other bodily fluids. FIV has been shown to be a very species specific virus and has never been shown to convert to HIV. 

FIV, as the name implies, is a virus that weakens the immune system to the point that the cat cannot effectively fight off even "simple" infections. Eventually, the cat can be classified as having an AIDS like syndrome much as humans with HIV eventually develop AIDS. Also like humans, there is no cure for this virus. Once it is contracted, the virus will persist for life. 

Although there is a vaccination to help prevent contracting the virus, we have concerns about the efficacy. Once the vaccination is given, the cat will produce antibodies that will persist for life. The test necessary for diagnosing FIV looks for presence of antibodies and therefore will always test positive (false positive result). 

Cats with FIV should be isolated from non-infected cats to help prevent spread of the disease. It has been shown that some cats may be more susceptible to the virus as well as some may be less susceptible to contracting FIV. Research is ongoing. 

Cats with FIV should be aggressively treated for any infections or diseases. Infected cats can live for many years with this virus if monitored and treated appropriately. 

Feline Leukemia (FeLv)

Feline Leukemia is a virus that, as the name implies, affects cats. It is one of the most feared viruses among cat owners, yet is one of the easiest viruses to prevent through vaccination. Historically, FeLV was considered a fatal virus, and it was recommended that cats be euthanized to prevent the spread. Fortunately much research has occurred since then. 

SubstandardFullSizeRender.jpg

Cats contract FeLV through contact with bodily fluids (saliva, urine, semen) from an infected cat. Research has shown that nearly 70% or greater cats can rid the virus from their body. The length of time that cats are successful with this clearance is approximately 3 months or less. This is the basis for retesting positive cats. If a cat tests positive for a second time after 3 months, these will likely be unable to clear the virus. These cats will often succumb to their disease within 3 years. If a cat is presented to the hospital due to an illness and it is determined that FeLV is the culprit, these cats could still clear the virus, but prognosis is poor. Those that seem to clear the virus are those that we find the virus incidentally through annual vaccinations/testing. Feline Leukemia positive cats should be isolated from healthy, non-infected cats to prevent transmission of this potentially deadly virus. 

FeLV is a virus that can do "whatever it wants". As the name implies, it can createa leukemia type of cancer. It can create tumors within or on the body or create organ dysfunction. Treatment is directed at the specific condition as the virus cannot be targeted

Feline Lower Urinary Tract Disease

Feline Lower Urinary Tract Disease (FLUTD), or Feline Urologic Syndrome (FUS) is a condition in historically young to middle aged cats that exhibit the classic signs of a urinary tract infection. These signs include frequent trips to the litter box, little to no voiding of urine once in the box, straining, bloody or discolored urine, inappropriate elimination (missing the box or not getting in the box), and discomfort. Research, however, shows that a vast majority of young cats do not have simple true infections. Pathologically the bladder will be thickened and blood present, but bacteria is often not present. Older cats exhibit true bacterial infections. 

This can help to explain why young adult cats have recurrent UTI issues. It is usually due to an underlying behavioral component instead of a bacterial component. Cats manifest behavioral issues much differently than people. Cats could act aggressive, but they typically manifest with signs of urinary tract disease, upper respiratory disease, or hairloss-skin disease. 

Urinary tract disease manifestation occurs due to several potential reasons. Litter box problems have been stressed as main issue. There should be at least one litter box per cat in the household plus one more box. Therefore a 2 cat household should have 3 litter boxes. Boxes should be cleaned out at least daily if not more frequently. Boxes should be opened and not covered since odors could be trapped. Different types (clumping vs non-clumping, fine vs course, deep vs shallow, etc) should be tried. Older cats may find it difficult to physically enter the box if the sides are too tall. Litter boxes should be located in a quite, non-traffic area that is away from the food bowl. If there is inter-cat aggression, each cat should be able to use a litter box in private, away from the anxiety of the other cat. 

Although most cases are not classically bacterial in nature, almost every cat will be treated with antibiotics as the environment of the urinary bladder is still very conducive for infection to begin. Litter box therapy should be instituted. Many cats may be placed on an anti-anxiety medicine such as fluoxetine (Prozac) which has been shown to greatly reduce FLUTD/FUS.  

Glaucoma

Glaucoma

In general, glaucoma is defined as an increased pressure within the eye. Glaucoma may further be categorized as either primary or secondary in nature. Primary glaucoma results from a structural abnormality within the eye that prevents the fluid within the eye from draining/circulating properly. The result is an increase in pressure within the eye. Treatment for the condition is aimed at decreasing the pressure within the eye by use of a variety of topically applied medications/drops. Much more common in the dog, than the cat, several breeds can be over-represented including the American Cocker Spaniel, terrier breeds, Artic Circle breeds (Husky, Samoyed, Norwegian elkhound), miniature poodles, Chow Chow, Shar Pei, Dalmatians, Basset-hound, and rarely Beagles. 

Secondary glaucoma is caused by another primary problem within the eye or body (typically not a structural problem with the eye) that results in an increased pressure within the eye.   Treatment is aimed at not only decreasing the pressure within the eye using similar drops mentioned above, but also finding and correcting the primary cause, whether infectious, inflammatory or even cancerous.

Ginger_Lagrone_WCAH2016_EyePressureCheck.jpg

According to our Dr. Lee Stockstill, the clinical signs of glaucoma can be manifested by anything from an inflamed conjunctiva (tissue around the eyeball) and reddened sclera (the white part of the eye) to a bulging eye with a bluish colored cornea (the outer most part of the eye).

Glaucoma is a serious condition that might easily result in blindness and significant pain. In practice, a tonometer is used to identify glaucoma. Early diagnosis is key to treating this effectively and preventing blindness. 

 

Heartworm Disease

Heartworm disease is a significant and potentially fatal disease of primarily dogs but also cats. It is also one of the most preventable diseases that veterinary medicine has to offer. The disease occurs as worms live within the heart and vessels of the lung leading to heart disease and potentially heart failure. 

The lifecycle of the heartworm (Dirofilaria immitis) is long and complex. EVERY DOG AND CAT, BOTH INDOOR AND OUTDOOR ARE SUSCEPTIBLE. Heartworms are transmitted through mosquitoes. Without the mosquito, it is impossible to contract heartworms. In order to understand the lifecycle, we begin as the mosquito bites an infected dog. As the mosquito is feeding, it takes in the immature stages of the heartworm that is circulating in the animal's blood. These microscopic immature worms must further develop within the mouthparts of the mosquito. Unbeknownst to the mosquito, it finds a new animal to feed on. Once it begins feeding again on the new, uninfected animal, the immature worms are injected into the skin. It then travels in the body for approximately 4-6 months, maturing along the way, and finally reaching its final destination (the heart). Once in the heart, this mature adult worm will mate with another worm to produce more immature stages that circulate in the blood and wait to be taken in by another mosquito. 

Diagnosis is primarily through blood tests which test for the antigen of the adult female worm as well as a drop of blood that harbors the microscopic, swimming immature stages. Radiographs may be performed in attempts to identify the severity of the disease. It is theoretically possible for there to be an infection with all male worms that produce no immature stages, but this is very unlikely. 

Treatment is much safer now than it was even 10 years ago. A product known as Immiticide is injected in the lower back muscles 24 hours apart for 2 injections. This medicine is designed to slowly kill the mature worms over a 2-3 week period. Because of this time frame, IT IS IMPERATIVE THAT YOUR PET STAY CALM AND INACTIVE FOR AT LEAST 4 WEEKS. This is to prevent the premature death of worms that could serve as clots. After 4 weeks of rest, the patient will then receive another medicine to kill the immature stages. Another blood tests will then be performed within 2-3 months after therapy. If your pet is significantly ill with heartworms, your veterinarian may choose to perform and extended therapy. 

Prevention is recommended for both dogs and cats every month of the year. Prevention is directed at killing the immature stages of the heartworm before they can mature into a young adult or adult worm. We perform heartworm test every year on dogs even if they are on the prevention.  

Heart Disease / Failure

Heart disease is a condition in which multiple factors of the heart can be abnormal. The heart can have electrical, structural, or functional abnormalities that manifest in a similar fashion. As in humans, heart disease can be "silent" in that clinical signs may not be present for many months to years. 

The most common clinical signs of heart disease is coughing, fatigue, and weight loss. As this condition is typically chronic in nature, clinical signs usually become more persistent and severe. In order to diagnose heart disease, several tests can be utilized including taking a detailed history, thorough physical examination, ECG, chest and abdominal radiographs, and ultrasound to identify the underlying problem. Secondary tests such as blood evaluation including cardiac biomarkers can be very beneficial. 

The most common abnormality seen with heart disease is a thickening of the internal lining of the heart including heart valves. This leads to the valves being unable to properly close thus allowing blood to go backwards creating an audible murmur.  Hearing a murmur for the first time in an asymptomatic patient does not necessarily warrant full diagnostics and treatment, but a good understanding of heart disease as well as vigilance of clinical signs is needed. 

Heart disease can progress to heart failure which is defined as the heart being unable to effectively pump the blood through the circulatory system. Because of this inability, blood backs up into the body cavities (as with right heart failure) or the lungs (as with left heart failure), or both (with both sided heart failure). Every patient should be treated once diagnosed with failure. This typically includes minimizing stress and oxygen therapy, diuretics, ACE inhibitors, and inodilators. These medications are typically given life long. Heart failure can be well controlled but heart disease is not a curable condition. It is only manageable. 

Heart Murmurs

Heart Murmurs

Anytime your pet is here in the hospital to be seen by a doctor, a physical exam will be performed. This will include a veterinarian using a stethoscope to listen to your pet’s heart and lungs. Any abnormalities heard will be noted and discussed. Sometimes, a heart murmur will be heard and identified.

 

So, your pet has been diagnosed with a heart murmur. What does that mean?

 

A heart murmur is caused by unstable blood flow in the heart, or in other words, by leaky heart valves.  According to our Dr. Louise Barrett, some pets are born with an abnormality in their heart that leads to a heart murmur. More frequently, however, animals develop heart murmurs with age. Not all heart murmurs sound the same or progress the same. You may hear us describe the murmur as a Grade I – VI, with Grade I being a quiet and more minor murmur in comparison to the louder, more readily identified Grades.

 

We try to monitor our pets with murmurs closely and note any significant changes. If your pet has a murmur, we always take that into consideration during procedures and adjust treatment and protocol accordingly. Your veterinarian may recommend additional testing such as radiographs (x-rays), EKG’s, or bloodwork.

 

If your pet is coughing, tiring easily, breathing hard, or losing weight a visit with one of our doctors would be warranted. We can examine them for a progressed murmur and/or possible heart disease. A number of medications are available to manage heart disease and its symptoms.

Hot Spots

Hot Spots

During your pet’s lifetime, he or she may develop a “hot spot,” or acute moist dermatitis. Hot spots can develop quickly on dogs or cats and present as red, inflamed skin. The skin may be moist, warm to the touch, and often hairless.

Typically, hot spots are self-induced by a pet licking or scratching a specific itchy area. Usually these itchy areas are caused by allergies and/or fleas.

To treat, we normally need to clip, clean, and medicate the area topically. An e-collar, or protective collar, will most often be recommended to prevent the continuation of licking and scratching. Additionally, your veterinarian will want to treat the itching and possible infection with medications. One of our various shampoos may also be added to your pets’ treatment plan. The important part of treating hot spots is uncovering the underlying cause of the scratching (i.e. specific allergy or fleas), and preventing future flare ups. We commonly advise further testing for pets who experience chronic hot spots.

Hyperadrenocorticism (Cushing's Syndrome)

Cushing's Syndrome is a hormonal disease that primarily affects dogs. This condition results from the overproduction of the steroid cortisol. Steroids are produced in the adrenal glands that reside near the kidneys. The stimulus for the overproduction of cortisol is a benign tumor of the pituitary gland (80%) at the base of the brain or the adrenal gland (20%). The pituitary gland is a major hormone gland that signals several organs to produce other hormones or do a specific function. For the normal production of cortisol, the pituitary secretes the hormone ACTH that travels to the adrenal gland where cortisol is formed.

If there is a tumor on the pituitary gland, then an excess production of ACTH will occur which signals an increased production of cortisol. There are two adrenal glands that receive ACTH equally. Therefore, both glands will be enlarged. 

If there is a tumor on one of the adrenal glands, then that gland will produce excess cortisol without need of direction from the pituitary gland. In this case, only the affected adrenal gland will be large. The other gland will be small or atrophied. 

As a result of both tumor locations, the body has to deal with excessive steroids. In normal levels, steroids are vital. In excessive or minimal levels, the body can have significant side effects. The most common side effects of excessive steroids are excessive drinking and urination, pot-bellied appearance, thinning hair along the back/trunk, excessive appetite, enlarged liver, and continual panting.

Diagnosis begins with a detailed history and physical examination. Basic blood tests can point us in the direction of Cushing's disease but specific blood tests are required. The two most common tests for diagnosis is an ACTH stimulation test and a Low Dose Dexamethasone suppression (LDDS) test. The ACTH stimulation test is the most specific test that will accurately diagnose ("rule in") the disease in 8 of 10 patients. The LDDS test is more sensitive meaning that it can rule out the disease in over 9 of 10 patients. Your veterinarian will decide which test to run. On occasion, both tests may be performed. Depending on the results, it may be possible to not only diagnose Cushing's but also differentiate between pituitary dependent and adrenal dependent forms. An ultrasound of the abdomen can be performed to identify the size of the adrenal glands which may suggest one form of the disease over the other. 

Treatment involves increasing the patient's quality of life. As the disease is a result of a tumor, medical management can only be supportive. Surgical options are available but rarely selected due to significant complications. Our goals of therapy are to decrease the clinical signs of excessive drinking and urination, increased appetite, pot-bellied appearance, and hair loss. Therapy is typically life long, and routine blood tests will need to be performed regularly.

Hypoadrenocorticism (Addison's Disease)

Hypoadrenocorticism, or Addison's disease, is a hormonal dysfunction due to a lack of production of steroids from the adrenal glands. The adrenal glands are paired organs that are found near both kidneys. They have numerous functions such as secreting the "fight or flight" hormone epinephrine, also known as adrenaline. They also secrete different types of hormones that regulate sodium and potassium levels, facilitate blood pressure regulation, and basic steroid homeostasis. 

Addison's disease occurs when a specific type of steroid is not produced in sufficient quantities. Unlike many diseases that have typical clinical signs, Addison's clinical signs can vary tremendously. A veterinarian must have a suspicion of the disease as basic blood tests are often nonspecific. A detailed history is often the most important part of the diagnostic process. Many dogs with Addison's disease have a cyclical illness in that the patient may exhibit unexplained vomiting or diarrhea for a few days then improve only to begin the illness again within weeks. Weight loss is common as well. Some pets may exhibit mild abdominal pain that warrant x-rays to rule out other causes such as foreign bodies, obstructions, or masses. 

As stated, most basic blood tests are within normal limits. However, a fair amount of patients will have a low sodium to potassium ratio. Since the adrenal gland maintains a specific relationship of sodium to potassium, an underactive gland will allow for sodium to decrease and potassium to increase. Even though the individual levels may still be a "normal" level, the ratio is bad. This often suggests a more specific blood test known as the ACTH stimulation test. The adrenal gland receives its commands from the pituitary gland located at the base of the brain. The pituitary secretes AdrenoCorticoTrophic Hormone or ACTH that tells the adrenal gland to respond. When we administer exogenous ACTH, we are trying to command the adrenal gland to respond. If the gland fails to do so, we then can diagnose hypoadrenocorticism, or Addison's disease.  

Treatment involves replacing the missing hormone. This is accomplished by either injecting a hormone in the muscle once every 3-4 weeks, or by giving a daily tablet. Both forms are given for the life of the pet. Oral prednisone is often given in a very low dose as this hormone is produced in low levels with Addison's disease.

Hyperthyroidism

Hyperthyroidism is a hormonal condition in which the thyroid gland produces too much thyroid hormone. In the small animal world, cats are the most common to get this disease. Even more specifically, older cats are much more common than younger cats. The thyroid gland is responsible for the maintenance of metabolism among other things. A detailed history, physical examination, and blood tests can easily diagnose this condition.

The common clinical signs of hyperthyroidism is excessive weight loss despite an increased appetite and mood changes. Cats will occasionally exhibit excessive thirst and urination. It is not uncommon for a 10 pound cat to lose 3-4 pounds quickly. 

In order to diagnose hyperthyroidism, veterinarians check a total T4 level. A high level is diagnostic. A complete blood count and profile are necessary to rule out other conditions. A careful evaluation of the heart and blood pressure should be performed as hyperthyroid disease often leads to heart disease and hypertension. Once this condition is corrected, it is very important to continue to evaluate kidney function. The kidneys actually benefit from a hyperthyroid condition due to tremendous blood flow to the area. As the blood flow to the kidneys decrease with correction of the thyroid abnormality, the kidneys can decompensate leading to disease. In order to ensure adequate dosing, the thyroid level should be checked at least annually. 

Correcting an overactive thyroid can occur in several different ways. The most common method is a daily medication that slows the overproduction of thyroid hormone. This comes in the form of a tablet or transdermal ear medication. This is a life long therapy. This condition can be cured with more aggressive therapies such as surgery to remove the thyroid glands or iodine-radiation therapy. A new maintenance diet has shown significant promise with correcting this condition. 

Hypothyroidism

Hypothyroidism is a hormonal disorder in which the thyroid gland fails to produce an adequate amount of thyroid hormone. The thyroid gland is responsible for many things such as regulating metabolism of many body systems. Those often affected are the skin/hair coat, gastrointestinal, neurologic, reproductive, and cardiovascular. Hypothyroidism is a condition that typically affects medium to larger breed dogs. Cats rarely get hypothyroidism. Their condition is an over active thyroid gland, or hyperthyroidism.  The most common cause of hypothyroidism is an immune complex targeting the thyroid gland.

Clinical signs of hypothyroidism vary between dogs but more commonly exhibit weight gain (despite a usual lack of appetite), hair loss (especially on their tail--"rat tail"), and mentally dull and lethargic. Due to many other vague clinical signs, hypothyroidism should always been on a differential diagnosis list, especially if weight gain is occurring.

Diagnosis is possible with a clinical suspicion of the disease as well as a thorough history and physical exam. The definitive diagnosis is through blood tests that include the more specific Free T4 as well as Total T4. If diagnosis is not as straightforward as anticipated, a third blood value, the TSH, may be necessary.  

Treatment involves replacing the lacking thyroid hormone with a once or twice a day medicine. Therapy is usually life long. Annual blood tests are necessary to determine the appropriate dosage.

Insulin Therapy

Beginning insulin therapy for your pet can be a very stressful time, both for you and your pet.  Although you likely share the same trepidation as most pet owners, you can learn to do this with ease. Always be sure to follow your veterinarian's instructions.

Always keep the insulin vial in the refrigerator. You may either administer cold insulin or let the vial set out for a few minutes to bring the contents up to room temperature. Do not shake the vial. Insulin is combined with products such as protamine and zinc to delay absorption so that the insulin stays in the body longer. If the product is vigorously shaken, the insulin can become separated from the protamine and zinc and therefore become much less effective. Insulin should be removed from the refrigerator and rolled between the palms of your hand for 10-15 seconds to mix the product. 

Always ensure that you have the correct type of syringe for your insulin product. The cat product ProZinc is a 40 unit/mL concentration that requires a 40 unit/mL syringe. Dogs utilize an insulin that is 100 unit/mL concentration that requires a 100 unit/mL syringe. To draw up the insulin into the syringe, begin with the bottle on a flat surface. Safely remove the syringe cap and lay it to the side. Insert the needle completely into the center hole on the top of the insulin vial. Turn the vial/syringe upside down and aspirate more than needed. You will notice many tiny bubbles that enter the syringe. Push the plunger of the syringe to inject the excess insulin as well as tiny bubbles that has remained at the top. DO NOT RECAP THE SYRINGE AS YOU RISK ACCIDENTALLY POKING YOURSELF.

Insulin can be injected anywhere skin exists. However, the most common and easiest place is the skin over the shoulders. This skin is typically in abundance and seemingly less painful in this area. Grasp the skin where you intend to inject. Hold the syringe like a dart and not like a cigarette. With the latter there is a tendency to depress the plunger while inserting the needle in the skin. Insert the needle completely into the skin. If you are holding the syringe as a dart, regrip and depress the plunger to inject the insulin. If you feel that you wasted some insulin, DO NOT ADMINISTER MORE. Wait until the next dose. Remove the needle from the skin and place the syringe in an approved sharps container. I prefer to give the insulin injection while the pet is eating and otherwise distracted. If you notice the skin is red, administer the injection somewhere else. If the redness does not go away, let us know. 

Intervertebral Disc Disease (IVDD)

Intervertebral Disc Disease (IVDD) is a condition in which the spongy, shock absorbing disc, which resides between every back bone, extrudes and puts pressure on the spinal cord. Depending on the degree of extrusion, the pet may exhibit clinical signs ranging from pain to paralysis. 

IVDD occurs for two main reasons: acute, traumatic extrusion and chronic, degenerative extrusion. In either case, the outcome is often the same. The two most common locations are the mid-lower back and the neck. The scenarios are also very similar. Usually a pet has fallen or jumped off of a normal obstacle and landed "wrong". Depending on the degree of injury, the pet may just appear painful and slow moving. With mid-lower back IVDD, they often arch the back and keep the tail tucked low. With cervical, or neck IVDD, they often keep the head in a low and neutral position. They are very resistant to head and neck manipulation. Neck pain is usually severe.

Diagnosis is possible with a thorough history and physical examination. Radiographs are often performed to not only identify the problem, but also determine the location as well as rule out other potential diseases. Occasionally, more sensitive and advanced imaging such as a CT or MRI may be required.

This condition is potentially progressive if the animal is not kept calm. The progression of IVDD begins with pain, then paresis (unsteady, "drunk" walk, criss crossing feet, etc), then paralysis (with or without maintaining deep/bone pain). Type of treatment is determined by extent of injury. Strictly enforced rest (small room, cage, etc) and anti-inflammatory medication is often all that is required for dogs who exhibit only pain. Dogs exhibiting paresis should be considered a surgical candidate. It is still possible for healing with hospitalization and aggressive steroid use, but these patients are at a significant risk of progressing towards paralysis. Dogs with paralysis should have surgery to remove the damaged disc material from the spinal cord. This type of a procedure should be performed within 24 hours of injury and only with a neurosurgeon for best outcome. 

Preventing IVDD may be possible by preventing obesity. Exercise in an otherwise healthy pet should be encouraged