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. 

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.  

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. 

 

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.

TTA

                                                 Kenai

                                                 Kenai

One of the most common orthopedic conditions that our canine population develop is a torn, or partially torn cranial cruciate ligament, which the equivalent in human anatomy is the anterior cruciate ligament, or ACL. This ligament serves several purposes including preventing the rear leg from hyperextending, preventing excessive internal knee rotation, and preventing the lower leg (tibia) from moving too forward. In essence, the ACL is a major structure that keeps the knee stable. 

Unlike humans, however, the reason for ACL tears in dogs is not primarily traumatic in nature. Degenerative changes occur over months to years that lead to rupture of the ligament with potentially relative ease. This degenerative change is also the reason for the other ACL to tear within 6 months to 2 years in well over 50% of the cases. 

There are several methods of surgical correction. In our experience, the TTA is the superior surgical technique. The theory behind this surgery is to shift the front tibia forward to the point that the patellar ligament (ligament holding the "kneecap") reaches 90 degrees. At this point, all of the forces on the ACL are shifted toward the upper thigh muscles thus relieving pain within the knee itself. This technique is superior to other methods as it allows a quicker return to function, less muscle atrophy, and oftentimes a higher quality of life.

Immediately following surgery, the patient should have their knee iced at least three times   a day for approximately 15 minutes at a time. A homemade icepack can be made by using a gallon freezer bag filled with equal parts of water and rubbing alcohol. Placing this solution in the freezer will create a malleable pack that can conform to the leg. It can be reused multiple times. Another option would be a frozen vegetable pack (such as sweet peas or corn) that can also be conformed to the leg. This should be done for the first week.

It is also ideal for the patient to immediately begin range of motion exercises following surgery. THIS SHOULD ONLY BE DONE IF THE PATIENT IS COMFORTABLE AND NOT PAINFUL. This exercise is accomplished by placing the pet on their side with the affected leg up. With GENTLE and SLOW motion, grasp the foot/ankle with one hand and support the knee with the other hand. Then move the limb as if they were walking normally. Do this procedure 3 times a day for 15-20 reps at a time.  This should be done for the first week.

Weeks 2 and 3 after surgery, stop the cold therapy and use warm heat. A homemade rice sock can be microwaved for 1-2 minutes and applied to the knee for 15 minutes, three times a day. Leash walks can be started slowly by week 2. DO NOT GIVE THEM FREE ROAM OR OFF-LEASH CAPABILITIES. The first week following surgery, the pet should be confined to a small room to limit movement, and especially running or jumping.

By weeks 6-8, your pet can be walked on longer leashes. Weeks 9-10, the pet can have monitored off-leash abilities. We would like to x-ray the pet at 6 and 10 weeks to evaluate healing.