Archive for the ‘Veterinary Diagnostic Procedures’ Category

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.

Never a Dull Moment!

Sunday, January 29th, 2012

Having graduated from veterinary school in 1982, this year marks my 30th year practicing veterinary medicine! Wow, that’s a lot of years! What feels most remarkable is that I’ve been able to work at the same profession for so long without becoming bored or complacent. I’m certain the reason is that not a single week goes by without my seeing or experiencing something new and exciting.

Take Dottie, for example. This exuberant 5-year-old spayed female Jack Russell Terrier mix was referred to me because of persistent vomiting despite treatment with a variety of medications. Little Miss Dot continued to eat well and she remained normally active, but her daily vomiting continued. Blood and urine testing were normal as were x-rays of her belly.

Physaloptera worms. Photo Credit vet.ohio-state.edu.

When I examined Dottie, had I not known better I would have thought she was a completely healthy little girl. I performed abdominal ultrasound, the results of which were normal. The next step was endoscopy in which a long telescope device was passed down her esophagus and into her stomach and upper small intestine. Lo and behold, when I entered Dot’s stomach I was greeted by a herd of little white worms! They were crawling every which way and many dove into their burrows within the lining of Dot’s stomach in response to the bright light of the endoscope. No wonder the poor girl was vomiting!

Never before thirty years of practice have I seen stomach worms, aka Physaloptera! I’ve just moved cross-country, so I assumed that I’d just encountered my first case of a disease that must be common in the Carolinas. Not so! Other than as photos in a textbooks, none of my coworkers had ever before seen Physaloptera. There was a crowd of twenty or so people crowded into the endoscopy suite in order to have a look. (I should have charged admission!)

Intestinal worms in dogs and cats are commonplace. Worms living (and burrowing) in the stomach are a rarity and I may have encountered my first and only career case of Physaloptera. These worms are transmitted via insects such as beetles, cockroaches, and crickets. Dogs who eat such critters are subject to developing stomach worms. The eggs of the worm may show up via fecal flotation (the stool sample is examined under the microscope). Veterinarians don’t commonly think of running fecals on patients with vomiting as the only symptom. I certainly won’t be skipping this test in the future! Running a simple fecal flotation is far less expensive and a whole lot easier on the patient than an endoscopic procedure.

Dot received the appropriate deworming medication and her vomiting has completely resolved. Her doting family members are thrilled with the outcome and they are going to do their best to prevent their little girl from snacking on insects in the future.

Do you encounter new and exciting things in your chosen profession? Please do tell!

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.

 

 

Murphy and Ruska

Monday, September 5th, 2011

I refer to my last week at work as the “Murphy and Ruska Show” in honor of two delightful patients who arrived at my doorstep one day apart, each with a life-threatening disorder called pneumothorax. “Pneumo” means air and “thorax” refers to the chest cavity, so “pneumothorax” is air within the chest cavity.  If you’re scratching your head wondering, “Isn’t there supposed to be air in the chest cavity?” here’s what you need to know.  While the lungs are air-filled, the space surrounding the lungs, known as the pleural space, is normally devoid of air.  Pneumothorax refers to the accumulation of air with the pleural space. In order to understand how a pneumothorax causes difficulty breathing, it helps to think of the chest cavity as an empty barrel into which the lung lobes expand as they inflate (like balloons filling with air).  The lungs readily inflate with minimal effort because negative pressure (a vacuum effect) normally exists within the pleural space.  Fill the pleural space with air and the negative pressure is disrupted resulting in more effort required for lung expansion.  Make sense?

Murphy and Ruska were both observed by their families to experience an abrupt onset of labored breathing. Murphy also became subdued, a marked deviation from his normal wiggly-waggly Labrador self and he was unwilling to lie down.  Clever Murphy figured out that lying down makes labored breathing even more of a struggle.  In addition to working extra hard to breathe the normally ravenous Ruska refused her breakfast, a sure sign that this sweet Shepherd was off her game.

Normal Chest

The two most common causes of pneumothorax are penetrating chest cavity wounds that allow external air to enter the pleural space and leakage of air from the surface of a diseased or injured lung lobe.  Pneumothorax is readily diagnosed with a chest x-ray.  Have a look at the accompanying normal and abnormal x-ray images. In both views, the dogs are lying on their sides with their head end to the left and their tail end to the right.  You can see the spines at the top of the images.  Note the heart, the whitish round structure in the middle of the chest cavity. Air shows up black on an x-ray. Now notice how much more black (air) there is surrounding the heart in the pneumothorax image compared to the normal chest. Makes you want to become a radiologist, eh!

Pneumothorax

Murphy and Ruska were referred to me to figure out why they had leaky lung lobes.  The most common cause of pneumothorax is a blunt blow to the chest cavity (hit-by-car trauma is classic) forceful enough to tear a lung lobe and allow leakage of air into the pleural space. Ruska and Murphy were both closely supervised with no known trauma history.  Computed tomography (CT scanning) is my test of choice for solving the mystery of the leaky lung lobe. Murphy’s scan revealed multiple small blisters (aka, blebs or bullae) on his lung lobe surfaces.  Just as in people with this abnormality the blisters are thin-walled and capable of spontaneous rupture allowing air to leak into the pleural space. Fortunately, as was the case with Murphy, most lung blisters are self-sealing within a few days. Worse case scenario, a stubborn leaker can be surgically sealed. Murphy’s family has been forewarned that his multiple blebs will likely mean multiple penumothorax episodes.  They know what to be watching for and will return with Murphy any time, day or night, should his labored breathing recur. Murphy is now home, happy as can be with instructions to be a couch potato for the next two weeks with hopes of avoiding disruption of the body’s “bandaid” on his leaky lung blister.

Ruska’s CT scan documented a small walled off abscess on the surface of one lung lobe.  Given the time of year and where Ruska lives and plays, I’d be willing to bet my first born child that a foxtail plant awn is living within that abscess.  Fortunately, Ruska’s lung lobe leak resolved itself, and the pros and cons of surgically exploring the site versus long-term antibiotic therapy (foxtails shuttle bacteria wherever they migrate) were discussed and are still being considered.  I should be hearing back from Ruska’s mom sometime this week.  For now, this big girl is back home and, like her friend Murphy, she is doing her best to be a cooperative couch potato (easier for a Shepherd than a Lab!).

Our emergency room vets are used to seeing pneumothorax patients because hit-by-car trauma is so prevalent.  As a small animal internist I rarely see them, yet here were two within one week! (I suspect the third is on its way.)  Have you or a loved one (human or canine) experienced a pneumothorax?  Please do tell.

Best wishes for good health,

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
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. 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 is available at Amazon.com, local bookstores, and your favorite online book seller.

The Elephant in the Middle of the Exam Room

Monday, August 1st, 2011

My dual career as an author and a practicing veterinarian provides me with a unique vantage point. Not only am I privy to the issues my veterinary colleagues are stewing about, I also receive a plethora of emails from my readers candidly venting about their experiences as consumers of veterinary medicine.  It’s rare that those on both sides of the exam room table are growling about the same issue, but these days this is certainly the case.

See if you can identify the elephant in the exam room based on the following data that has appeared in current veterinary news feeds along with quotes from recent correspondences with my readers:

– The number of pet visits to veterinary hospitals is dramatically decreasing (DVM Newsmagazine, June 2011), and a special session was held at this year’s conference of the American Veterinary Medical Association to explore ways to increase public awareness about the importance of annual checkups for pets.

– “In my opinion, most of the decline in veterinary visits is primarily due to the bad economy. If you are barely scraping by, you are certainly not going to the vet for a very pricey annual exam, especially if your pet seems fine.”

– While pet spending is up, the market isn’t growing fast enough to support the number of new veterinarians entering the veterinary profession. (DVM Newsmagazine, June 2011) Veterinarian supply is growing faster than pet owner demand. (The Bayer Veterinary Care Usage Study 2011)

– “Sadly there are some veterinarians who see hospitalization fees as a revenue stream and do not inform clients that no one will be supervising the pet they recommend be hospitalized. While one tends to like to think of their vet as a kind, caring person and many are, some are more business than heart.”

– Eighty-nine percent of current veterinary school graduates have student debt.  The average student loan debt of students graduating in 2010 from veterinary school was $133,873 (15% have debt in excess of $200,000) and the average starting salary was $48,674. (Veterinary Information Network News Service, January 4, 2011)

– “My question is why most vets feel the need to worry about money instead of worrying about taking care of the pets.”

– Although the number of households in the United States with cats is increasing, the number of feline visits to veterinary hospitals is decreasing. (Banfield Pet Hospital® State of Pet Health 2011 Report)

– “I’d love to take each of my cats in for dental cleaning on a regular basis and I have two cats that desperately need attention now. For me, it’s a matter of costs. Vets continue to increase their charges and there’s no break for multiple pets. Dental disease is a precursor for renal failure in cats and yet it’s so expensive for cleaning – yet alone extracting any teeth. Then blood work is usually advisable to be on the safe side. It’s a small fortune when you leave the vet’s office for ONE pet. Next you’ve got the cost associated with monthly flea control. You have to draw the line somewhere and hope for the best.”

– Fifty-four percent of cat owners and 47% of dog owners report that they would take their pet to the veterinary hospital more often if each visit were less expensive. (The Bayer Veterinary Care Usage Study 2011)

– “I am not saying veterinarians can’t charge a reasonable fee for their services, but most people can’t afford $300+ bills every time they step into a clinic, per pet, per year, and that is for the healthy ones who are coming in for regular yearly checkups and not for other medical concerns that require medications, further diagnostics, overnight stays, dental cleaning, blood work etc.”

– Fifty three percent of clients believe that veterinary clinic costs are usually much higher than expected. (The Bayer Veterinary Care Usage Study 2011)

– “I am sick and tired of the way veterinarians financially take advantage of people who are emotionally upset about their pets.”

– Twenty-four percent of pet owners believe that routine checkups are unnecessary and 36% believe that vaccinations are the main reason to take their overtly healthy pet in for an office visit. (The Bayer Veterinary Care Usage Study 2011)

– “We have a lot of price gouging going on here at local vets. A dental cleaning has gone from $75 to $300 and up at many places. A lot of the clinics are buying high tech equipment and passing overhead costs on us so they really shouldn’t complain when clients come for less visits.”

Have you identified the common thread amongst these comments and statistics?  No doubt in my mind that the “gripe du jour” is the “M word.”  Perhaps it is more accurate to say that the real issue is too little money.

This blog is not intended to create or perpetuate harsh judgments. Please hear me when I say that I know that not every veterinarian or every person who brings their pet to see the vet is thinking primarily about money.  Clearly, however, money matters are on the minds of many, in fact more so than I’ve witnessed throughout my thirty year career.   Never before have I observed colleagues declare bankruptcy.  Never before have I spent so much time in the exam room trying to help folks figure out how to do more with less.

My goal in presenting this information is to create some understanding about what’s going on in the minds of individuals on both sides of the exam room table.  Blame this money mess state of mind on the diseased economy, veterinary competition, or the expense of going to veterinary school.  Whatever the causes, there is an awful lot of emotion tangled up in the financial aspects of providing and receiving veterinary health care these days.

What are your thoughts? Let’s talk about it and in doing so we will be able to kick that big ole’ elephant out of the middle of the exam room!

Best wishes for good health,

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
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. 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 is available at Amazon.com, local bookstores, and your favorite online book seller.