Kidney Disease

Kidney disease, also known as renal insufficiency, is a condition in which the kidneys are not functioning at full capacity. It is common that this condition will eventually lead to kidney failure. The kidneys are responsible for many things. The primary responsibility is to filter the blood of all toxins, reabsorb things such as water, sugar, and protein. Another responsibility of the kidneys is to signal the bone marrow to produce more red blood cells. 

Clinical signs of kidney disease include excessive drinking and urinating, weight loss, vomiting, and loss of appetite. As the kidneys lose its abilities to filter the blood, toxins will begin to build up in the body leading to a condition known as uremia. Anemia sets in once the kidneys can no longer communicate with the bone marrow to produce red blood cells. 

Diagnosis of kidney disease is accomplished with blood and urine tests. The most important values in the blood are BUN (blood urea nitrogen) and Creatinine. The BUN are metabolic waste products that increase once the kidneys are damaged. This is about the earliest indicator for kidney disease. However, it is not very specific for the kidney. Other things such as dehydration will elevate this value. The creatinine is a very specific kidney value but unfortunately is not an early indicator. The kidney function must decrease by 75% before the creatinine value increases. A urinalysis is also beneficial to quantify the ability of the kidneys to concentrate urine as well as see the level of protein loss. 

Treatment includes fluid therapy and dietary management (low protein diet). Keeping the pet hydrated and fed is paramount. Other medications such as Benazepril has been shown to decrease the amount of protein lost through the kidneys. Azodyl is an enteric bacteria that has been shown to decrease BUN. Rarely blood transfusions are needed. Ideally, dialysis would clean the blood, but veterinary medicine is limited in this ability. 

Otitis

Otitis, or ear infection is an unfortunately common condition. There are three types of ear infection based on the location with the external ear canal being the most common. Other than ear mites, primary ear infections (those infections that have no underlying reason) are very infrequent, and rather rare. Secondary ear infections, however, are very common. 

Ear infections typically occur secondary to allergies. Pets' allergies are not typically manifested as human allergies are. We tend to have upper respiratory signs. Pets tend to have skin oriented signs such as itching, scratching, and redness. The ear is a deep, dark, and potentially damp hole in the skin. It should be no surprise that, if the skin is irritated, the ears will often be one of the first things to become infected. 

Your pet has millions of organisms such as bacteria and yeast on their skin including the ears. These organisms live there in a commensal fashion. However, with inflammation, these organisms replicate to the point of infection. Common clinical signs of ear infection are pain, redness, odor, debris (wax, pus, blood), and swelling. 

Diagnosis is rather straightforward through a physical examination. An ear cytology will show the type of organism (bacteria, yeast, or both) as well as differentiate between common organisms and the more resistant bacteria, Pseudomonas. It is also important to discuss the common reasons (i.e. allergies) leading to ear infections. 

The two main types of allergies leading to ear infections are seasonal/environmental allergies and food allergies. With seasonal/environmental allergies, we commonly see face rubbing, ear scratching, paw licking, and general itchiness. For this reason, we often say "Face and Feet". With food allergies, we often also see ear disease as well as rectal itching, scooting, and inflammation. For this reason, we often say "Ears and Rears". A detailed history can often clue us in as to the type. It is very common that pets have both types of allergies. In order to specifically diagnose the allergy, the pet would need an allergy test and/or undergo a long term food trial. 

Treatment consists of thoroughly flushing the ear canal. Once the organism(s) is identified, a topical medication will be administered. Occasionally, an oral medication may be selected. All underlying allergies should be identified and avoided if possible. If your pet has chronic ear disease, the anatomy of the ear may have been changed which will prevent a cure. Therefore identification of the underlying problem should be sought after early.

Pancreatitis

The pancreas is an organ with dual functions. It has both endocrine (hormonal) and exocrine (digestive) functions. Pancreatitis is a condition in which the exocrine, or digestive function of the is compromised. Digestion of food begins in the mouth through saliva and chewing. The food moves into the stomach where further digestion occurs with stomach acid. The much smaller almost liquid food particles empty into the small intestines where the pancreas secretes its own digestive enzymes to further break down food particles. Food is the obvious stimulus for the pancreas. Therefore, certain types of food often stimulates the overproduction of digestive enzymes and inflammation of the pancreas. The usual culprits are pork products followed by beef products. Any greasy or fatty substance can initiate this. This excess enzyme is very irritating to the lining of the upper small intestines which can lead to vomiting and diarrhea that often has blood associated with it. 

Diagnosis occurs with a thorough history and physical examination along with blood tests looking for elevated pancreatic enzymes. Radiographs are beneficial in some cases but are fairly insensitive for the pancreas. It is a valuable test to rule out other possible abdominal conditions. 

Treatment involves dietary management/restriction, fluid therapy, and possible antibiotic therapy. Any vomiting and diarrhea would be addressed as well. Interestingly in dogs, food is restricted for 24-48 hours to give the gut time to heal. In cats, food is encouraged and often forced. 

With chronic pancreatitis, the endocrine function can be slowed. The pancreas is responsible for creating insulin which is the hormone that regulates blood sugar. If this capability is decreased, diabetes mellitus can result. 

In order to prevent pancreatitis, diets low in fats and higher fiber have been shown to be beneficial. It is very important to feed only the recommended food for your pet. 

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.

Upper Respiratory Disease

One of the most common conditions that our cats have is upper respiratory disease. The usual etiology is a virus. The most common URT virus is Feline Viral Rhinotracheitis which is a herpes virus. This virus is said to be ubiquitous in the feline population and has been estimated that close to 80% of cats harbor this virus. Humans have a similar herpes virus that usually manifests as a cold sore or fever blister. Although the human and cat herpes virus is very species specific, they can share some similarities. Just as stress can cause people to break out with fever blisters, stress is typically implicated in leading to a break out with cold-like symptoms in the cat. Once a cat contracts the FVR virus, either from the mother or just casual contact with an infected cat, the virus lives in the nerves of the face and recrudesces during periods of stress. This virus will persist for life. Although this is a virus, secondary bacterial infections can occur which warrant appropriate antibiotic therapy. Occasional steroid therapy may be necessary to help with excess congestion. 

Vaccine therapy is designed to reduce the risk of disease that upper respiratory viruses can lead to. The vaccine includes the FVR virus as well as several other viruses.  We recommend this vaccine for every cat that live in either indoors or outdoors. Those cats that have recurrent upper respiratory disease should receive the vaccine in attempts to lessen the course as well as suppress the virus. The virus typically runs its course within 7-10 days. 

Urinalysis

Performing a urinalysis, or testing your pets’ urine, can give us various indicators about what may be taking place inside your pets’ body.  From a diagnostic standpoint, a urinalysis is a very common and frequent test that we can run in our hospital or send to an outside, specialized laboratory.

So...one of our veterinarians recommends a urinalysis, what exactly does that mean?

The first step required for a urinalysis is capturing the sample. This can be accomplished via three different methods:

1: The owner-friendly method is called the “free catch” method. We routinely use this method in the hospital, as well. Urine can be obtained while your pet is voiding naturally. Sometimes having assistance from another person can be helpful in collecting the sample; one person can walk the pet while the other catches the urine. We offer sterile pans and transfer cups for your convenience.

Ideally, the urine sample will be collected, and the test will begin immediately. When collecting at home, we know that this may not always be possible. As a clinic, we prefer fresh urine collected within the hour.

We recommended collecting the urine in the morning, but refrigeration may be utilized if the urine is collected after our regular hours of operation.  We take storing options and time into account when analyzing the sample, as false positives may develop with time, even with refrigeration.

2: Urine may also be collected in the hospital during a sterile and minimally invasive procedure known as a cystocentesis. With a syringe, a doctor will aspirate urine directly from a full bladder. This process allows for a low risk of bacterial cross-transfer and potential false positives that we may see with the free catch method. Your pet may experience minor discomfort during the aspiration, but no more than receiving a vaccination of having a blood draw.

3: Lastly, if appropriate, a catheter may be placed to allow for sterile and direct urine collection. Again, this method ensures minimal false positives or bacterial transfer.

 

Once urine is available, testing may begin. There are three parts of the testing process.

1: Using a refractometer, the specific gravity of the urine can be determined. This tells us how dilute the urine is.

2: The dipstick portion of the test indicates if leukocytes, bilirubin, urobilinogen, nitrite, ketones, or proteins are present in the urine. It will also tell us if blood, glucose, or an abnormal pH level is present.

3: The third portion of the test involves reading a sediment. Using a microscope, we can visualize any cells, bacteria, casts, or crystals that may be present in the urine.

 

We use the urinalysis process daily. It grants us the ability to diagnose urinary tract infections and determine which medication will be suitable in eliminating the infection.

The urinalysis also helps us focus diagnosis concerning abnormal kidney, liver, or pancreatic functions.

Depending on clinical findings and known symptoms, a doctor may find it necessary to continue diagnostics with a radiograph or bloodwork. For example, when crystals are visualized in the sediment, we are concerned a urolith, or bladder stone, may be present. Taking an x-ray will confirm or deny a bladder stone. Your doctor will discuss further treatment and prevention of urinary crystals and/or stones.