Archive for the ‘Veterinary Diagnostic Procedures’ Category

Glomerular Disease in Dogs

Sunday, April 26th, 2015

Glomerular disease occurs quite commonly in dogs. It affects purebreds and mixed-breeds alike, and can be an inherited disorder in Shar Peis, Soft Coated Wheaten Terriers, Bull Terriers, Dalmatians, Samoyeds, Bernese Mountain Dogs, Doberman Pinschers, Newfoundlands, and English Cocker Spaniels.

Terminology

Veterinarians use a number of different terms interchangeably when describing “glomerular disease”. Here is a sampling of those most commonly used:

  • Glomerulopathy
  • Glomerulonephropathy
  • Glomerulonephritis
  • Protein losing nephropathy

Glomerular function

Each kidney contains millions of glomeruli, microscopic filtration units that interface with the blood vessels that supply the kidneys. I like to think of a glomerulus as a tiny sieve or colander because the size of its pores dictates which substances within the blood are allowed to enter into the fluid that ultimately becomes urine. Normal glomeruli do not allow larger protein molecules such as albumin to pass into the urine.

Causes of glomerular damage

The most common means by which glomeruli are damaged include:

  • Inflammation, particularly that which is immune mediated (autoimmune) in nature
  • A form of scarring referred to as glomerulosclerosis
  • Persistent high pressure blood flow to the kidneys (e.g., elevated blood pressure)
  • Deposition of a protein called amyloid (this is referred to as amyloidosis)

When glomeruli are damaged, they become “leakier,” thus allowing larger protein molecules to filter into the urine. Persistent proteinuria (increased protein within the urine) is a hallmark characteristic of glomerular disease.

Glomerular damage may be present at the very earliest onset of kidney disease, well before there are other measurable laboratory changes or symptoms typically associated with kidney damage. Moreover, compared to dogs with kidney disease and no proteinuria, those with glomerular damage are far more likely to develop significant illness and/or death as a result of their kidney disorder. In other words, glomerular disease, particularly when left untreated, hastens the progression of kidney failure.

Glomerular damage can arise as a primary disease process, or it can occur secondary to another underlying disease. Diseases commonly associated with secondary glomerular injury include:

  • Heartworm disease
  • Pyometra
  • Pancreatitis
  • Infectious diseases (bacterial, fungal, tick-borne)
  • Cancerous diseases
  • Immune mediated (autoimmune) diseases

Symptoms of glomerular disease

In and of itself, protein loss in the urine does not cause any symptoms. Therefore, many dogs with glomerular disease, particularly early on, appear completely normal. When symptoms do arise, they are usually related to one or more of the following:

  • The underlying disease process causing the glomerular damage (see the list above)
  • Kidney failure
  • Complications associated with glomerular damage (high blood pressure, decreased protein in the bloodstream, blood clot formation)

Some common symptoms observed in dogs with glomerular disease include:

  • Vomiting
  • Loss of appetite
  • Lethargy
  • Increased thirst and urine output
  • Weight loss
  • Halitosis (bad breath)

Documentation of excessive protein in the urine

There are four different laboratory tests that can be used to assess protein within the urine. They include:

  • Urinalysis: This provides “semi-quantitative results.” This means that a positive test result gives only a rough idea of how much protein is in the urine. The urinalysis is a very useful first screening test, but it is fraught with false positive results. Additionally, it is not always sensitive enough to detect the very earliest stages of glomerular damage. For these reasons, follow up testing via another methodology (see below) should be performed, either when the urinalysis is positive for protein or when the urinalysis is negative for protein but glomerular damage is suspected (e.g., dogs of breeds with inherited forms of glomerular disease).
  • Urine protein to creatinine ratio: This test helps quantify the amount of protein in the urine. This accomplishes two things. It verifies whether the amount of protein in a urine sample is normal or increased. Secondly, it establishes a baseline to which future samples can be compared. This helps in the monitoring of disease progression.
  • Microalbuminuria testing: This test detects very small amounts of a protein called albumin within the urine, even before proteinuria can be documented via a urinalysis. As such a sensitive test, it is recommended in the following situations:

• The results of other screening tests for proteinuria are negative in a dog with a serious illness, particularly one known to be associated with glomerular disease (see the causes of glomerular disease above).

• As a general health screening test in middle-aged and older dogs.

• As an early-age screening test for dogs with a possible inherited predisposition for glomerular disease.

  • 24-hour urine protein quantification: Back when I was a pup (before urine protein to creatinine ratios and microalbuminuria testing were available) we would house a dog in a “metabolic cage” or place a urinary catheter so as to collect every drop of urine produced over a 24-hour period. The amount of protein in this duration of urine was then measured. This methodology was a pain-in-the-you-know-what for everyone involved, particularly the poor dog. Thank goodness, such testing is now considered antiquated and is rarely if ever used.

Diagnosing glomerular disease

If a dog demonstrates persistent proteinuria (repeatable on multiple tests over the course of a few weeks), a battery of tests is typically recommended to rule out non-glomerular causes of excess protein within the urine such as urinary tract infection, stones, or bleeding. This testing typically includes the following:

  • Complete blood cell count (CBC)
  • Blood chemistry profile
  • Urinalysis
  • Urine culture
  • Abdominal ultrasound or x-rays

Other tests may be recommended for purposes of ruling out heartworm disease, infectious processes, cancer, and other diseases that can cause secondary glomerular damage. Diagnostics may include:

  • Heartworm testing
  • Chest x-rays
  • Abdominal ultrasound
  • Specific screening tests for infectious diseases

A clear-cut diagnosis of glomerular disease requires a kidney biopsy. This can be accomplished via surgery, laparoscopy, or with ultrasound guidance. Whichever methodology is used, collection of a kidney biopsy has the potential to cause significant complications. Thoughtful discussion with a veterinarian about risks and benefits should always precede a kidney biopsy.

Complications commonly caused by glomerular disease

As if glomerular disease isn’t enough to worry about, it is capable of causing a number of serious secondary issues including:

  • Hypertension (high blood pressure): Can cause damage in heart, kidneys, brain, and/or retinas; hypertension promotes proteinuria
  • Hypercoagulability (an increased propensity to form blood clots): Thromboembolism (blood clot) formation can occur within any organ
  • Kidney failure

Treatment of glomerular disease

There are four primary goals when treating canine glomerular disease. How they are implemented will depend, in part, on the dog’s kidney function and degree of proteinuria.

  1. Identify and eliminate the underlying cause of the glomerular damage: Doing so may resolve the proteinuria altogether (the best outcome possible). For example, successful treatment of heartworm disease often eliminates the associated glomerular damage. Unfortunately, in many cases, the underlying cause of the glomerular disease cannot be identified or successfully eliminated.
  1. Attempt to lessen the degree of proteinuria: Doing so is the best bet for slowing the progression of kidney damage and other complications associated with glomerular disease. The mainstays of such therapy include:

• Feeding a diet that is low in quantity, but high in quality in terms of protein content: This decreases the amount of protein filtered by the kidneys.

• Supplementation with omega-3 fatty acids: Their anti-inflammatory effects are thought to be responsible for decreasing proteinuria.

• Administration of an angiotensin-converting-enzyme inhibitor drug (enalapril, benazepril): Alters microscopic blood flow at the level of the kidneys.

• Immunosuppressive drugs: Suppression of the immune system may help diminish glomerular inflammation.

  1. Treatment of glomerular disease complications: Examples of such treatments include administration of medications to control high blood pressure, anticoagulant therapy to help prevent blood clot formation, and daily subcutaneous fluids to manage kidney failure.
  1. Follow up monitoring: Once the diagnosis of glomerular disease is made and treatment is instituted, there will be a need for ongoing monitoring. The results of such monitoring will direct how the dog’s therapy should be adjusted. A typical follow up veterinary visit for a dog with glomerular disease would include:

• Discussion of how the dog is doing at home

• A thorough physical examination

• Blood pressure measurement

• Blood testing to evaluate kidney function

• Urine protein to creatinine ratio

The treatment of glomerular disease can be challenging, and the more experience a veterinarian has with this disease, the better. For this reason, when glomerular disorder is suspected or has been diagnosed in your dog, I strongly encourage consulting with a veterinarian who specializes in small animal internal medicine. To learn more about the treatment of glomerular disease, I invite you to read, “Consensus Recommendations for Standard Therapy of Glomerular Disease in Dogs” prepared by veterinarians who are members of the International Renal Interest Society (IRIS).

Prognosis

The earlier glomerular disease is detected and managed, the greater the likelihood of deterring a negative outcome. Left unchecked, glomerular disease is known to increase the severity and progression of kidney failure.

Canine glomerular disease is often associated with kidney failure which may progress very slowly, very quickly, or anything in between. Some dogs live for several years with glomerular disease. The likelihood of such an outcome is far greater with appropriate treatment and monitoring.

Nephrotic syndrome

Dogs with severe glomerular disease can progress to a condition that is referred to as nephrotic syndrome. This is characterized by the following four abnormalities:

  1. Excess protein loss in the urine
  2. Decreased protein (specifically albumin) within the blood stream
  3. Elevated blood cholesterol level
  4. Presence of edema (accumulation of watery fluid under the skin or within body cavities)

Nephrotic syndrome represents an advanced stage of glomerular disease. In addition to the treatment options mentioned above, measures to manage the edema (fluid drainage, specific medications) may be warranted.

Have you had any experience with glomerular disease in your dogs?

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot and Your Dog’s Best Health.   There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot and Your Dog’s Best Health are available at www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

Pollakiuria: Why is My Pet Urinating More Often Than Normal?

Sunday, March 15th, 2015

Pollakiuria is a fun word to pronounce, but it’s certainly not a fun symptom to deal with. Pollakiuria means increased frequency of urination. Dogs with this symptom ask to go outside more frequently than normal, often round the clock. The well house trained dog may begin leaving puddles in the house and cats with pollakiuria are in and out of the litter box with increased frequency. Some kitties abandon the box altogether choosing other places to urinate.

Pollakiuria caused by lower urinary tract disease

Pollakiuria is most commonly caused by abnormalities within the lower urinary tract, consisting of the bladder and urethra. The urethra is the narrow tube that transports urine from the bladder to the outside world.

Lower urinary tract disease may cause a dog or cat to sense the need to urinate well before their bladder is full, and the puddles produced are quite small. If ever you’ve experienced a bladder infection, no doubt you can relate to this sensation.

Common lower urinary tract maladies that cause pollakiuria include:

  1. Bacterial infection within the bladder, aka bacterial cystitis: common in dogs, relatively uncommon in cats
  2. Stones within the bladder or urethra: common in dogs and cats
  3. Feline idiopathic cystitis (FIC)- an inflammatory condition of unknown cause affecting the bladder and/or urethra: purely cats
  4. Tumors or polyps within the bladder or urethra: relatively common in dogs, less common in cats

Pollakiuria caused by increased thirst

Some diseases causing pollakiuria are associated with increased thirst (polydipsia). Excess water intake and excess urine production (polyuria) go hand in hand. The animal drinks more, therefore the bladder fills more rapidly and frequently, and the puddles produced are quite large. Causes of increased thirst and urine production in dogs and cats include:

1. Hormonal imbalances

  • Diabetes mellitus: dogs and cats
  • Diabetes insipidus: primarily dogs
  • Hyperadrenocorticism (Cushing’s disease): primarily dogs
  • Hyperthyroidism: primarily cats

2. Kidney disease

  • Kidney failure: dogs and cats
  • Pyelonephritis (kidney infection): dogs and cats

3. Liver disease: dogs and cats

4. Pyometra: primarily dogs

5. Medications

  • Cortisone containing products: primarily dogs
  • Anti-seizure medications: dogs and cats
  • Diuretics: dogs and cats

Recognizing pollakiuria

Some pollakiuric pets show overt symptoms (the kitty who urinates in the bathroom sink or the dog who leaves a bedside puddle for you to step in first thing in the morning). Other pets show more subtle symptoms. Be on the lookout for:

  • Increased frequency of urination on walks
  • Increased number of puddles in the litter box
  • A litter box that needs to be changed more frequently
  • Interrupted sleep because your pet is asking to go outside
  • The need to fill the water bowl more frequently than usual

If such symptoms arise, I encourage you to schedule a visit with your veterinarian. Do your best to arrive with a full bladder (your pet’s that is) because testing a urine sample will be an important first step in arriving at a diagnosis. This is best accomplished by taking your kitty’s litter box away a few hours prior to the office visit. Likewise, avoid walking your dog before the visit, and get into the waiting room quickly so as to avoid those many tempting places to urinate just outside the clinic.

Has your pet ever experienced pollakiuria? If so, what was the cause determined to be?

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot and Your Dog’s Best Health.   There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot and Your Dog’s Best Health are available at www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

 

Transitional Cell Carcinoma in Dogs

Sunday, February 22nd, 2015

Transitional cell carcinoma (TCC) is the most common cancerous condition affecting the urinary tract of dogs. Scottish Terriers top the list in terms of breed predisposition.

What is TCC?

TCC is a malignant tumor that most commonly grows within the urinary bladder. It also frequents the urethra, the tube-like structure that drains urine from the bladder to the outside world. TCC can also arise within the prostate gland (males), kidneys, and ureters (the long, narrow tubes that transport urine from the kidneys into the bladder).

TCC arises from transitional epithelial cells that line the inner surface of the urinary tract. In addition to growing inward within the lumen of the bladder and/or urethra, the cancer cells invade locally into the walls of these structures. TCC cells also have the ability to metastasize (spread) to lymph nodes and other distant organs.

This cancerous growth has a propensity for growing within the trigone region of the bladder, the anatomical area where urinary tract plumbing is most complicated. It is here that the urethra and ureters connect into the bladder. It’s no wonder that TCC commonly causes a dog to experience difficulty urinating and, sometimes, even complete urinary tract obstruction.

Causes of TCC

Genetic predisposition and environmental factors likely play a role in most cases of TCC. The genetic basis is strongly suspected because Scottish Terriers have as much as an 18-20 fold higher risk for this disease. Other predisposed breeds include, Shetland Sheepdogs, Beagles, West Highland White Terriers, and Wire Hair Fox Terriers.

Environmental factors that have been incriminated as risk factors for TCC are application of older generation pesticides and insecticides to the animal and exposure to lawn herbicides and pesticides. A study comparing 83 Scottish Terriers with TCC and 83 similarly aged, normal Scotties discovered that the group with cancer had greater exposure to lawns and gardens treated with insecticides and herbicides or herbicides alone. The effect of lawn and garden chemicals on other breeds has not yet been studied.

Smoking is the number one cause of TCC in people. It is not known if exposure to second hand smoke contributes to the occurrence of TCC in dogs.

Symptoms of TCC

The earliest symptoms caused by TCC vary from mild to severe, and often resemble those caused by a urinary tract infection. Such symptoms include:

  • Increased frequency of urination
  • Blood within the urine
  • Straining to urinate
  • Inability to urinate

Straining to have a bowel movement may be observed if the prostate gland becomes enlarged due to infiltration with TCC cells. When a dog becomes completely unable to urinate due to obstruction, systemic symptoms such as lethargy, vomiting, and loss of appetite will arise within 24 hours.

Diagnosis of TCC

TCC is suspected when a mass within the bladder is detected by an imaging study such as abdominal ultrasound. Growth of TCC within the urethra is best detected via endoscopy (a fiberoptic telescope device that allows visualization within the urinary tract).

Collection of tissue samples from the mass that are then processed and examined under the microscope is the only way to make a definitive diagnosis of TCC. Such tissue samples can be collected via surgery or endoscopy, and sometimes by urinary tract catheterization.

Other testing

Many dogs with TCC have a concurrent urinary tract infection, and a urine culture is performed to determine if antibiotic therapy is warranted.

Once TCC has been diagnosed, “staging tests” may be performed. Staging is the process used to determine if the tumor has spread to other sites in the body. Staging is warranted when the additional information these tests provide are important for providing ongoing care. The results of staging tests assist in:

  • Determining the prognosis.
  • Choosing the most appropriate course of treatment.
  • Establishing a baseline set of tumor measurements that will help determine if subsequent treatment is successful.
  • Anticipating which future symptoms may arise.

Staging tests for dogs with TCC may include:

  • Blood and urine testing
  • Radiographs (x-rays) of the chest cavity to look for spread to the lungs and/or lymph nodes
  • Ultrasound of the abdomen to assess changes in the kidneys caused by possible obstruction to urine flow and spread of cancer to abdominal organs and/or lymph nodes

Treatment options

There are several options for treating TCC in dogs. Complete remission (complete elimination) of this cancer is always desirable, but this outcome tends to be the exception rather than the rule. Partial remission (reduction in the overall size of the tumor) and simply arresting growth of the tumor over a prolonged period are far more likely outcomes that usually result in restoring and maintaining an excellent quality of life.

Surgery

For dogs with TCC that has not spread outside of the bladder, complete surgical removal of the mass is the ideal therapy. Unfortunately, even for a highly gifted surgeon, this outcome usually isn’t possible. This is because TCC has a predilection for growing within the trigone region (neck of the bladder) where aggressive surgery would disrupt the delicate urethral and ureteral plumbing located there. Surgical removal works well when the TCC growth is relatively small and is located well away from the trigone.

Medical therapies

The medical options described below tend to be extremely well tolerated by most dogs. These drugs may be used individually, but it is not unusual for them to be used in combination to treat dogs with TCC.

Piroxicam

Piroxicam is an oral non-steroidal anti-inflammatory medication that substantially reduces the size of many TCC tumors. Piroxicam and other nonsteroidal anti-inflammatory medications (e.g., Rimadyl, Deramaxx, Previcox) are referred to as cyclooxygenase (cox) inhibitors. It so happens that TCC cells often produce and use cyclooxygenase, and inhibition of this enzyme can hinder tumor growth.

Piroxicam’s ability to influence the growth of cancer cells was discovered spuriously when the drug was being used to provide pain relief for dogs with cancer. Unexpected cancer remissions were observed. This resulted in a study of 34 dogs with TCC who were treated with piroxicam. The results were as follows:

  • Complete remission (cancer fully gone): 2 dogs
  • Partial remission (cancer reduced in size): 4 dogs
  • Stable disease (no change in cancer size): 18 dogs
  • Cancer increased in size: 10 dogs
  • Average survival time: 181 days

Mitoxantrone

A chemotherapy drug called mitoxantrone has also been used to successfully treat TCC. A study of 48 dogs treated with the combination of piroxicam and mitaxantrone was performed by the Veterinary Cooperative Oncology Group. Results included:

  • Complete remission: 1 dog
  • Partial remission: 16 dogs
  • Stable disease: 22 dogs
  • Cancer increased in size: 9 dogs
  • Average survival time from start of therapy: 250-300 days

Vinblastine

A third drug for the treatment of TCC is vinblastine. This drug is typically used following failure of the other drugs mentioned above. A study using vinblastine to treat 28 dogs with TCC resulted in:

  • Partial remission: 10 dogs
  • Stable disease: 14 dogs
  • Cancer increased in size: 4 dogs
  • Average survival time from first vinblastine treatment: 147 days
  • Average survival time from the time of diagnosis: 299 days

Metronomic therapy

Metronomic chemotherapy refers to long term, low dose, frequent oral administration of a Chemotherapy drug. Metronomic therapy is given with hopes of blocking the formation of new blood vessels within the tumor, thereby inhibiting its growth. This is referred to as an “anti-angiogenic” effect.

A study of metronomic therapy for TCC was performed using a drug called chlorambucil (Leukeran). Of the 31 dogs studied, 29 had failed prior TCC treatment. The results are as follows:

  • Partial remission: 1 dog
  • Stable disease: 20 dogs
  • Progressive disease: 9 dogs
  • Lost to followup: 1 dog
  • Average survival time from start of therapy: 221 days

Radiation therapy

Radiation therapy is an option for control of TCC growth. Unfortunately, applied in suitable dosages, radiation therapy often produces harmful complications affecting the bladder and surrounding organs.

Have you ever cared for a Scottie or any other breed of dog with transitional cell carcinoma?

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot and Your Dog’s Best Health.   There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot and Your Dog’s Best Health are available at www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

Cancer Therapy: Is it the Right Choice for Your Pet?

Sunday, May 12th, 2013

Last week, in honor of Pet Cancer Awareness Month, I provided some pointers for constructively dealing with the diagnosis of cancer. This week I will deliver information about the treatment of cancer and tips for determining if a pet is a good candidate for such therapy.

Treatment Options

The three most common treatment methods used to treat animals with cancer are surgery, chemotherapy, and radiation therapy. Often only one type of therapy is needed to effectively treat the cancer. For example, a small solitary mass might be cured with surgery alone. Not uncommonly, a combination of treatments is most beneficial. Chemotherapy or radiation therapy may be recommended as an adjunct to surgery to destroy any cells that may have spread outside of the surgical incision.

Whether or not various complementary/alternative therapies such as Chinese herbs, homeopathy, or acupuncture are capable of chasing away cancer cells is controversial. Most veterinarians agree that what they do best is help support the patient’s overall health and mitigate any side effects of cancer therapy.

How does your veterinarian know which treatment plan is the best choice for your dog or cat? First, she needs to know which type of cancer she is dealing with. This is accomplished by evaluating a sample of the abnormal cells under a microscope. An experienced pathologist at a commercial veterinary laboratory typically performs this testing. Additionally, determining the stage or grade of the disease (how aggressive and widespread the cancer is) via blood and urine testing and imaging studies allows your vet to know which treatment makes the most sense.

Making the Choice for Your Pet

Diagnosing and staging the cancer is typically the straightforward part. Determining whether or not to treat one’s four-legged family member is often the more challenging piece of the puzzle. If ever you find yourself squaring off with this decision, strongly consider consultation with a veterinarian who specializes in cancer therapy (a board certified oncologist or internist). In no way does such a consultation obligate you to proceed with treatment. Rather, it is an opportunity to gather a bunch of useful information that will assist you in your decision-making process.

Now, here are some important thoughts and questions to consider when the diagnosis is cancer:

Is your pet’s personality well suited to the recommended therapy?

If your dog or cat is a pushover for anyone and everyone who provides an ear scratch and a treat, he may relish weekly chemotherapy appointments. On the other hand, if he turns into a quivering quaking emotional wreck as soon as you turn into the vet clinic parking lot, perhaps he’d be better suited to a chemotherapy protocol that involves appointments spaced farther apart. You may not really know how your dog or cat will respond emotionally until you’ve made the first few visits.

Is your own schedule flexible enough?

Many chemotherapy protocols initially involve once-weekly visits. Rarely are evening or weekend appointments available. If radiation therapy has been recommended, you may need to drive a consider-able distance to a treatment facility. Radiation therapy is typically administered daily, Monday through Friday for three or more consecutive weeks. Many radiation facilities offer the option of boarding their patients during the workweek and then sending them home for weekends.

Is it financially feasible to proceed?

Combination chemotherapy protocols, radiation therapy, and many surgical procedures are “big-ticket” items. Remember, some chemotherapy is almost always better than no chemotherapy. Don’t by shy about discussing your budget. Your veterinarian can use this information to create a treatment protocol for your pet that provides “the most bang for the buck.”

Is treating your pet’s cancer reasonable for you from an emotional point of view?

For those who have experienced the ravages of cancer therapy either for themselves or a loved one, it may be impossible to consider such treatment for a family pet, no matter what reassurances are provided. And that’s perfectly okay. Remember, whether or not to treat your pet’s cancer is always a truly personal choice.

You can call it quits at any time!

When you say, “Yes” to chemotherapy or radiation therapy, all you are really committing to is the very next treatment. If ever you don’t like what you see you can call it quits. Sometimes, simply knowing that this “out clause” exists gives people the wherewithal to give cancer therapy a try.

Focus on the quality rather than the quantity of life.

When I counsel people about the potential pros and cons of cancer treatment, I describe the three goals of therapy as, “Quality of life, quality of life, and quality of life.” There’s no doubt in my mind that we fail our patients miserably when we achieve “quantity” (longer life) only.

Enjoy the “honeymoon.” 

Even when a fabulous response to therapy is achieved, it’s difficult for some people to enjoy this time because their minds are so preoccupied with the underlying diagnosis. Keep in mind that those happy, playful, loving pets of ours don’t simply vanish because they have cancer. Even with their disease, they are wonderfully adept at “living in the moment.” When an animal undergoing cancer therapy behaves in a glum fashion, it’s important to consider that they may be responding to the way their favorite human is feeling. If you opt to treat your pet’s cancer, be prepared to enjoy the honeymoon!

Have you ever said, “Yes” to cancer therapy for one of your pets? If so, were you ultimately glad you did so?

 

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot and Your Dog’s Best Health.   There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot and Your Dog’s Best Health are available at www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

 

 

When the Diagnosis is Cancer

Sunday, May 5th, 2013

The month of May has been declared Pet Cancer Awareness Month. While I’m not altogether sure who determines such things, in honor of this declaration I present to you a good deal of information that I’m certain will be useful should your four-legged family member develop cancer.

Cancer, neoplasia, growth, tumor, malignancy, the big “C”: no matter which word is used, it is the diagnosis we all dread. It’s not that cancer is always associated with a terrible outcome. What is true, however, is that whenever cancer is diagnosed, it is inevitable that lives are going to change. And change such as this isn’t something we relish when it comes to our pets.

If your veterinarian suspects or knows that your pet has cancer, you will be asked to make a number of significant decisions.  Some of them may have to do with diagnostic testing and others will pertain to treatment options. Such decisions can be tough in the best of times. If you’ve just learned your dog or cat has cancer, these decisions can feel downright overwhelming. What can you do to regain some control over the situation? Here are some suggestions.

  • Ask your veterinarian how urgently your decisions must be made. An extra day or two can make a huge difference in terms of settling down emotionally and doing the research needed to deal with the decisions at hand.
  • Do your best to put away preconceived, inaccurate notions of what you imagine your pet’s experience will be like. People often get sick, develop profound fatigue, and lose their hair in response to cancer therapy. It is uncommon for dogs and cats to experience such side effects.
  • Read, “surf,” and ask lots of questions. The more you learn about your pet’s cancer, the more you will feel empowered to make good decisions on their behalf. When researching via the Internet, be sure to surf responsibly.  No sense wasting time on useless information.
  • Take things one step at a time.  Being asked to make decisions for your dog with cancer is akin to climbing a tall mountain. It’s strategically and psychologically important to break your ascent into small manageable increments (and there’s less likelihood of tripping and falling when your eyes are not glued to the summit). Similarly, it is easier when you focus your attention on the medical decisions at hand rather than those that may (or may not) arise later.
  • Follow your own heart. Steer clear of folks intent on convincing you that he is “just a dog” or “just a cat,” and that the appropriate treatment is to “put the poor thing out of his misery.” Likewise, avoid those people who think that all animals must be treated as aggressively as possible for anything and everything. Wear a thick skin around such “influential” people (maybe take a sabbatical from socializing with them). Surround yourself with people who are open-minded and are interested in supporting rather than influencing you. Remember, you know better than anyone else what is right for yourself and your best buddy.

Part two of this blog post (follows in one week) will focus on the treatment of canine and feline cancer and how to decide whether or not therapy makes sense for your pet.

Has one of your four-legged family members ever been diagnosed with cancer? How did you respond?

 

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot and Your Dog’s Best Health.   There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot and Your Dog’s Best Health are available at www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

 

 

Not All Patients Read the Textbook

Sunday, January 6th, 2013

Fannie (in foreground) and Easy

My dear friend Juli is a seasoned veterinary technician. So when her own 16-year-old Cattle Dog named Easy developed bleeding into his belly because of a cancerous growth, Juli had a clear sense about the prognosis. Surgical removal of the tumor would likely buy some good quality time, three to six months on average before the cancer recurred. Post-surgical chemotherapy might expand that time frame just a little bit.

After some serious soul searching and “conversation” with her beloved dog, Juli opted for surgery without chemotherapy. Easy experienced a smooth, uncomplicated recovery. Within just a couple of weeks of surgery he was back to his normal routine of gentle walks, relaxing with Fannie (his little sister), good food, and enjoyment of an excellent quality of life. Every few months thereafter, Juli asked me to ultrasound Easy’s abdomen in order to detect recurrence of his cancer. Over and over again we were pleasantly surprised to nothing out of the ordinary. At the very generous age of 19, Easy succumbed to issues completely unrelated to the malignancy that had been diagnosed three years prior.

How is it possible that Easy’s cancer never recurred when statistics tell us that surgery should not have been curative? The answer is simple- not every patient reads the textbook! For every possible disease, there will always be “outliers”- those patients who fare far better (or far worse) than research statistics predict. Such “surprises” are part and parcel with the treatment of disease, whether treating dogs, cats, humans, or any other species.

Is there a way to predict who these outliers will be? Don’t I wish! With such a crystal ball I could alleviate so much angst for my clients as they wrestle to make good decisions for the animals they love so dearly. For a small percentage of my clients, medical decision making is relatively easy. They may be “numbers people”  who base their decision solely on statistical predictions. They deem the outlier population to be too too small to be statistically significant. And then there are those clients whose decisions are made easier because they have absolute faith that their best buddy will be that outlier. No question, but they will opt to carry on.

Most of my clients struggle a great deal when there is uncertainty about the outcome. They know the prognosis is bleak, but not hopeless. Maybe their pet will be the one who defies the odds. When counseling these clients, in addition to engaging in some serious nose-to-nose “discussion” with their four-legged family member, I recommend that they play out all options to both their best and worst possible outcomes. I advise them to then consider which option provides the outcomes that will likely provide them with the greatest long term peace of mind. Juli did exactly this with Easy. She knew that attempting surgery, no matter the outcome, would provide her with the greatest peace of mind.

No one ever said this role of medical advocate was going to be easy!

Have you been in the position of making a difficult medical decision for your pet? Have you ever cared for a patient who didn’t read the textbook?

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot and Your Dog’s Best Health.   There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot and Your Dog’s Best Health are available at www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

 

Heart Murmurs in Dogs: What Do They Mean?

Sunday, December 16th, 2012

Dr. Nancy’s Dog, Nellie

I recently received the following question from Ardis, a reader who oversees a rescue organization in California:

One of our adopters has an older Beagle with a growth on his gum that is apparently not cancer and is not attached to the bone, but it is really impeding his ability to eat.  The adopter is worried about the anesthesia to have it removed because the Beagle has a significant heart murmur. Do you have any opinions on ways to go for this lovely man and his dog?

This is such a great question and one that I want to answer for all of my readers because heart murmurs in dogs are so darned common. Normally when ausculting a dog’s heart (listening with a stethoscope), one hears a distinctive two beat “lub dub” sound with silence in between these two beats. In dogs with heart murmurs. A swishing sound or what I refer to as a “washing machine” sound is heard between the two “lub dub” beats.

Within the normal heart, blood flows smoothly through all four chambers. When the heart has a structural or functional defect, blood flow becomes turbulent and this turbulence is what creates the audible murmur. Heart murmurs are graded on a scale of I to VI depending on how loud they are. In general, the more turbulent the blood flow, the louder the heart murmur.

Mitral Valve Disease

Far and away the most common cause of canine heart murmurs is chronic degenerative mitral valve disease (aka, endocardiosis, mitral valvular insufficiency, mitral valve regurgitation, mitral valve degeneration). Normal mitral valves consist of two thin leaflets that separate the left atrium from the left ventricle. Their job is to open when the heart is filling with blood and seal tightly when the heart contracts, sending blood out into the body. Degenerative mitral valve disease causes clubbing and thickening of the valve leaflets rendering them unable to form a nice tight seal. As a result, when the heart contracts, some blood is “regurgitated” back into the left atrium. This abnormal blood flow creates an audible heart murmur, loudest over the left side of the dog’s chest.

Degenerative mitral valvular disease is thought to be an inherited condition and small breed dogs are particularly predisposed. In fact, my own little, six-year-old, 11 pound Nellie has mitral valve disease. Cavalier King Charles Spaniels are the “poster dogs” for this disorder- it is rare to find a Cavie over five or six years of age without a mitral murmur.

Thankfully, many dogs with mitral valve disease never develop any symptoms whatsoever. For the unfortunate others, abnormal blood flow increases the workload on the heart, ultimately resulting in heart failure symptoms (coughing, increased respiratory rate, labored breathing, exercise intolerance). Medications can successfully control the symptoms of heart failure for lengthy periods of time in most dogs.

Other Causes of Heart Murmurs

In addition to mitral valve disease, other causes of canine heart murmurs include congenital abnormalities (birth defects such as pulmonic stenosis, aortic stenosis, ventricular septal defects), chronic degenerative tricuspid valve disease (the tricuspid valve separates the right atrium from the right ventricle), and endocarditis (infection of a heart valve).

The best way to determine the cause of a heart murmur is with an ultrasound evaluation of the heart (echocardiogram). This study requires advanced equipment and operator expertise. If cardiac ultrasound has been recommended for your dog, be sure to seek out a veterinarian with specialty training. While ultrasound reveals the underlying cause of the heart murmur, X-rays of the chest cavity are the best way to determine if the dog is experiencing heart failure.

So, back to Ardis’ questions about the Beagle with a heart murmur and the growth on his gum. Here is the response I provided:

Many dogs have heart murmurs that do not, in any way, impair heart function. The best bet is to have this Beagle evaluated with cardiac ultrasound and chest X-rays, ideally performed by a veterinarian with advanced training in cardiology or internal medicine. These tests will allow his adopter to know the cause of his dog’s heart murmur as well as whether or not it will be safe to proceed with anesthesia. Just because a heart murmur is heard does not automatically mean the dog cannot be anesthetized. More information is needed before making this decision.

Does your dog happen to have a heart murmur? If so, please share what you know about it.

Wishing you and your four-legged family members a joyful and healthy holiday season.

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot and Your Dog’s Best Health.   There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot and Your Dog’s Best Health are available at www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

 

 

Cataracts in Dogs and Cats

Monday, August 27th, 2012

While cataracts are less common in dogs and cats than in people, they do occur with relative frequency and are one of the most common causes of blindness. Normally, the pupil of the eye appears black because the lens (located just behind the iris) is crystal clear. A cataract is an opacification within the lens, and when a cataract is “mature” it imparts a grayish, whitish color to the pupil. The opacification prevents normal light transmission to the retina within the back of the eye. A fully opacified lens (a mature cataract) results in blindness.

Some dog breeds are genetically predisposed to cataract formation including: American Cocker Spaniel, Bichon Frise, Australian Shepherd, Miniature Schnauzer, Siberian Husky, Boston Terrier, Labrador Retriever, Golden Retriever, Lhasa Apso, and all varieties of Poodles. Diabetes mellitus and diseases within the eye (inflammation, glaucoma, displacement of the lens) can also cause cataract formation.

The treatment of choice for mature cataracts (those resulting in blindness) is surgical removal of the affected lens(es). This is a delicate procedure, one that should be performed only by a veterinarian who is a specialist in veterinary ophthalmology. Prior to surgery, special testing is performed to insure the retinas are working normally. (If the retina is diseased, removal of the cataract will not restore vision). During surgery, ultrasound is used to break up or emulsify the cataract. The lens material is then aspirated from the eye through a tiny incision. A new lens can then be inserted within the remaining lens capsule to restore normal post-operative vision.

Cataracts typically form gradually, giving the dog or cat time to adapt to their vision loss. While it is tempting to assume that a blind animal’s quality of life would be vastly diminished, rarely is this the case. They are masters at using their other senses to navigate their environment. My point being, there is no reason to despair if cataract surgery is not a feasible option for your blind pet.

Do you have the sense that your best buddy’s pupils are not as black as they used to be? Don’t assume that he or she has cataracts. Lenticular sclerosis is a normal aging process that causes the pupils to appear grayish or cloudy. In fact, this change is evident in most dogs and cats over the age of ten. The good news is that lenticular sclerosis does not interfere with light transmission to the retinas. In other words, this “normal abnormality” does not affect vision and does not require any therapy. Your veterinarian will be able to determine if your pet has cataracts or lenticular sclerosis by performing a thorough eye examination.

Have you cared for a pet with cataracts? Have you cared for a blind pet? Please share your story.

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot and Your Dog’s Best Health.   There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot and Your Dog’s Best Health are available at www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

 

 

Is It Vomiting or Is It Regurgitation?

Sunday, July 22nd, 2012

Boomer, an adorable and effervescent young Cairn Terrier, was recently referred to me for vomiting of three days duration. This mischievous little boy raided the kitchen garbage the day before the vomiting began. Neither blood work nor abdominal X-rays performed by the referring veterinarian provided a diagnosis. When I questioned Boomer’s family, I learned that their dog was bringing up clear fluid after drinking and undigested food after eating. Additionally, none of the retching that dogs typically do right before vomiting had been observed. This history provided some big clues that redirected my thinking. Boomer was likely regurgitating rather than vomiting.

Vomiting occurs when food or liquid is expelled from the stomach or upper small intestine, and is preceded by some audible retching (no different than when you or I are nauseated and hovering over the toilet). The vomited material may consist of clear liquid if it originates from the stomach, yellow or green liquid if it originates from the small intestine, or food that appears undigested or partially digested.

Regurgitation differs from vomiting in that the expelled material almost always originates from within the esophagus- the muscular tube that propels food, water, and saliva from the mouth down into the stomach. The regurgitated material consists of water, saliva, or undigested food that comes spewing forth without any audible retching or warning. Regurgitation typically takes the dog and anyone in close proximity completely by surprise. Because the event is so sudden, the larynx (the opening to the windpipe) doesn’t have time to close, and some of the regurgitated material can be inhaled into the lungs resulting in aspiration pneumonia.

So, why is it important to differentiate whether my patient is regurgitating or vomiting? Here’s the reason. The tests for determining the cause of regurgitation are different than those used to determine the cause of vomiting. And the more wisely diagnostic tests are selected, the more expediently a diagnosis is established (better for my patient as well as my client’s pocket book). Diagnostic testing for regurgitation involves evaluation of the esophagus. Diagnostics for the vomiting patient evaluate the stomach and small intestine and screen for other diseases such as kidney failure, liver disease, and pancreatitis all of which can cause vomiting.

So, what ever happened with Boomer? Given his history, I recommended X-rays of his chest cavity (where the esophagus lives). Low and behold, the images revealed a piece of bone lodged within his esophagus. Using an endoscope (a long telescope device) and some fancy foreign body retrievers I was able to nonsurgically remove Boomer’s foreign body. We treated the resulting esophageal inflammation with medications and counseled his family on preventing their little darling from tampering with the garbage! Thankfully, Boomer experienced a complete recovery.

If ever you have a “vomiting” dog on your hands, carefully think about whether what you are observing is vomiting or regurgitation. Distinguishing the two will help point your veterinarian in the appropriate diagnostic direction.

Has your dog ever been evaluated for vomiting or regurgitation? If so, what was the outcome?

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot and Your Dog’s Best Health.   There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot and Your Dog’s Best Health are available at www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

 

A Primer on Diabetes Insipidus

Sunday, March 4th, 2012

Photo Credit: Susannah Kay

Mention the word diabetes, and one thinks of insulin injections and blood sugar levels. This is because diabetes mellitus (aka, sugar diabetes) is so darned prevalent in people, dogs, and cats. But did you know that there is another version of diabetes, one that has absolutely no impact on blood sugar levels? It is called diabetes insipidus (DI). This form of diabetes is far less common, but as it happens, I diagnosed two patients (one dog and one cat) with DI within the last week. Go figure! As things tend to happen in “threes” I expect my third patient with DI will walk through the door next week!

Diabetes insipudus occurs when the kidneys are unable to conserve water. Under normal circumstances, the kidneys retain some of the water within the bloodstream for use within the body while eliminating the rest within the urine. This nifty little water conservation system is controlled by a hormone called vasopressin (aka, ADH or antidiuretic hormone). Vasopressin is produced within the brain’s hypothalamus. It is then stored and released from the pituitary gland, also within the brain. Now here’s the really cool part. There are sensors in the body that control exactly how much vasopressin is released into the blood stream after detecting exactly how much water the body needs. For example, if you are hiking in Death Valley and it is 110 degrees, your pituitary gland will release lots of vasopressin so that you produce minimal urine. Likewise, if you’ve just chugged a gallon of water, vasopressin release will be turned off thereby allowing your kidneys to “turn on the faucets.”

Diabetes insipidus occurs when vasopression is no longer released from the pituitary gland. Affected dogs and cats produce copious volumes of urine, and all that water loss results in profound thirst. Their dilute urine looks more like water than urine. In addition, affected animals  are prone to urinary accidents, saturation of their litter boxes on a daily basis, and the inability to make it through the night without urinating. Under such circumstances, people are sometimes tempted to restrict their pet’s water intake. This can be disastrous- even with water withheld, massive amounts of urine will continue to be produced and the animal will quickly become dehydrated. Fortunately, most animals with DI who are deprived of water will drive their humans crazy until they relent and fill the water bowl.

The diagnosis or DI is made by first ruling out other diseases that can cause increased thirst and urine output including: kidney disease, liver disease, urinary tract infections, diabetes mellitus and other hormonal imbalances.  The diagnosis is then confirmed based on a positive response to vasopressin therapy.

Trauma, infection, and cancer affecting the region of the hypothalamus/pituitary gland are all potential causes of DI. However, most cases of DI turn out to be idiopathic (an underlying cause cannot be determined). If your dog or cat has DI, your veterinarian will want to perform a thorough neurological examination. If neurological abnormalities are detected, a brain scan (MRI or CT) and collection of spinal fluid for analysis may be recommended.

The treatment for DI is vasopressin replacement therapy. This hormone is available in tablet and nasal spray formulations. The nasal spray must be fitted with an adaptive nozzle that allows application of the liquid as eye drops. Typically, marked reduction in water intake and urine output are observed within a few days to a week after beginning therapy. Other than the need to give daily, lifelong medication, the major drawback of treatment is that vasopressin is pretty darned pricey. It definitely pays to shop around at a number of pharmacies to obtain the best price. Barring no significant underlying brain disease, the prognosis for a patient with DI is excellent, and that’s definitely something that we internists don’t get to say frequently enough!

Have you any experience with diabetes insipidus? If so, please share what you know.

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot and Your Dog’s Best Health.   There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot and Your Dog’s Best Health are available at www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.