Category: Avian

Symptoms of Diseases

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Here are 5 basic areas you should observe on a daily basis.

Eating

Watch your pets daily eating habits for :

  • difficulty chewing
  • odor
  • swelling
  • pawing at its muzzle

Since dental disease is so prevalent please follow the link to learn how this can affect your pet’s eating.

Breathing

When your pet is at rest count the number of times it breathes per minute (watch it for 15 seconds and multiply that number by 4). A typical dog or cat breathes 30-40 times per minute, although this can be variable based on breed and external temperature. The important thing to watch for is an increase in its respiratory rate over a period of time. Trend this on a piece of paper weekly so you can see this trend as it gets going. This can be a subtle but very important parameter to measure since an increase here can be for many serious reasons.

Urination

Look for any changes in the following:

  • Urinating more often or in greater amounts than normal
  • Urinating small amounts frequently
  • Straining to urinate
  • Inability to urinate
  • Licking at genitals

In female dogs it can be difficult to assess some of these parameters, so try to pay close attention when she squats to urinate.

Defecation

Any significant change here is important:

  • Continual diarrhea of any type
  • Straining to defecate
  • Licking at anus
  • Scooting
  • Any blood on feces

Walking

Obvious lameness is readily noticed. Also look for a pet that is leaning more towards one leg or the other, tires easily after walking or playing, is slow at getting up after resting, or is reluctant to go up or down any type of elevation like stairs or jumping into a vehicle.

Now that you have observed your pets daily habits lets look at how you can look for problems that are not so apparent by going to our In Home Exam page.

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Diabetes Mellitus (Sugar Diabetes)

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FRUThis page describing diabetes mellitus (DM) is very thorough and will require some study if you want to understand it fully. There is a different kind of diabetes, called diabetes insipidus, which is not the same disease. In general, when most people say a pet or a person has diabetes, or  if they also say sugar diabetes, they are refurring to diabetes mellitus.

Sugar diabetes, more correctly know as diabetes mellitus (DM), is a complex disease that is difficult to control, particularly in cats. Proper treatment requires a commitment on your part, usually for the life of your pet. It is well worth the effot in most cases because response to treatment is usually quite rewarding.

By definition, DM is a persistent hyperglycemia and glycosuria due to an absolute or relative insulin deficiency. By the time you are done with this page you will understand what all of this means.

You will also learn that some of the parameters of DM in animals are similar to humans, and many parameters are not, so be careful of extrapolating any experience you have between the two. DM can occur in many different species like birds and Guinea Pigs, although it is most commonly diagnosed in dogs, and especially cats.

Obesity is a big reason pets get DM. Fat is not just fat, it causes inflammation, leads to the rise of insulin resistance, which means your pet gets DM and does not respond well to insulin treatment. Most obese cats are prone to be what is called prediabetic. It all has to due with a hormone called amylin elevated in the bloodstream of overweight cats.

You can go far in preventing DM by keeping your pet at a normal weight, and feeding your cat a food that is higher in protein and lower in carbohydrates. Routine exams, that include blood panels and urinalyses that both monitor glucose, are important as your pet ages.

It will help if you learn these medical words because they will be used on this page:


Normal Physiology

The ability to use a food source for energy is critical to the success of any species, therefore nature has very sophisticated mechanisms to regulate this process. These mechanisms are extremely complex, and only those mechanisms that relate to diabetes mellitus will be summarized for the sake of simplicity.

In response to a decreasing blood glucose level the appetite center in the brain is stimulated and hunger ensues. A meal is then eaten, which consists of fats, carbohydrates, and proteins, in different percentages. When these fats, carbohydrates, and proteins are broken down by the digestive system and absorbed into the bloodstream, they are used by the body for various functions. The main function of the carbohydrates is eventual conversion to an energy source in the form of glucose, the primary energy source for all cells in the body. Some of this glucose is stored in the liver in the form of glycogen, which is released and converted back to glucose when cells need energy in-between meals.

Carbohydrates can be complex or simple. Complex ones are bread and pasta, simple ones are lactose (the carbohydrate in milk). When these carbohydrates are absorbed in the bloodstream through the intestines they are converted to glucose by the liver. The simple ones, like lactose, are rapidly converted and will immediately raise the blood glucose level. The more complex carbohydrates take longer to be metabolized to glucose by the liver, as a result they raise the blood glucose level more slowly. This point becomes important when treating both hyperglycemia and hypoglycemia.

Once in the bloodstream the glucose that circulates throughout the body is available for use by all cells as their primary energy source. These individual cells cannot absorb this glucose that passes by in the bloodstream unless the hormone insulin is circulating in the bloodstream at the same time. Insulin causes a chemical reaction in the cell wall that allows the glucose to enter the cell. The only cells in the body that do not need insulin to absorb glucose are specific brain cells.

Insulin originates in a group of cells called the islets of langerhams that are located in the pancreas. Insulin comes from the beta cells in the islets. It is secreted into the bloodstream in response to an increase in glucose in the bloodstream, a normal occurrence after a meal is eaten. The higher the glucose level the greater the amount of insulin secreted. Since the absorption of simple carbohydrates will cause a more rapid increase in blood glucose there will be a more rapid increase in insulin secreted. The complex carbohydrates will cause a more gradual rise in the insulin level.  This fact becomes important in feeding a diabetic patient.

The normal physiology is even more complex. Insulin also has a large effect on fat and protein metabolism. In addition, the pancreas also secretes a hormone called glucagon in response to a decreasing blood glucose level. Glucagon originates from the alpha cells in the islets, and its role is to help the liver convert glycogen back to glucose. As can be expected, glucagon will increase the blood glucose level, and counteracts the blood glucose lowering effects of insulin. Insulin and glucagon work in a negative feedback loop that allows for a very refined system to keep the blood glucose level at an optimal level for the energy requirements of each individual cell. The liver is a major part of this loop, acting as a blood glucose buffer to keep the blood glucose at optimum levels. This is a highly refined process that is fine tuned over thousands of years and works extremely well.

In general, brain cells do not need insulin to utilize glucose. A specific area of the brain, called the appetite center (in the hypothalamus), monitors the amount of glucose that circulates in the bloodstream. The lower the blood glucose level in the cells in the appetite center the greater the appetite. Unlike most of the brain cells, the ability of glucose to enter the cells of the appetite center is dependent upon insulin. In diabetes mellitus, with its lack of adequate insulin in the bloodstream, these appetite center cells don’t monitor glucose levels properly, thinking the blood glucose is low. As a result, the pet develops polyphagia to correct for this perceived problem. The additional food that is then eaten further increases the blood glucose level.

The pancreas does more than secrete insulin and glucagon into the bloodstream. It is the primary source of enzymes that are secreted into the small intestines (not bloodstream this time). These enzymes are secreted in response to the presence of food in the digestive tract, and are the primary way that many nutrients are broken down and absorbed by the intestines into the bloodstream. The way these energy sources are acted upon by the enzymes, and how they are eventually utilized by the liver, are also factors that effect the blood glucose level.

To further complicate the picture, epinephrine (adrenaline), cortisol (cortisone) and growth hormone also influence the blood glucose level.

This is a picture of the pancreas of a cat. It is adjacent to the beginning of the small intestine called the duodenum. The pancreas is the pinkish tissue directly under the cylindrical duodenum. For such a small organ it has an important job.

Now that you are an expert at normal physiology, lets learn what happens when the normal mechanisms described above go wrong. This is called pathophysiology. What causes this pathophysiology, leading to a lack of insulin production by the pancreas? It is multi-factorial, and includes:

  • Genetic predisposition
  • Infection
  • Toxins
  • Inflammation

Obesity and a lack of physical activity are predisposing factors, especially in cats.

Pathophysiology

The relative lack of insulin causes the blood glucose to go abnormally high. Normal blood glucose in a dog or cat varies from 80 to 150, but can temporarily go much higher (300-500 or more) in stressful situations. When the blood glucose is consistently high, as seen in diabetes mellitus, several negative effects occur.

Inadequate insulin levels force the cell to perform its functions with alternative sources of energy besides glucose. This causes problems for the organ that is made up of these cells, and eventually will lead to significant disease and the complications that occur in untreated diabetes mellitus.

The cells of the body (except most brain cells) are deprived of their primary source of energy. This means they do not function at optimum efficiency. Since they are starved of glucose they need to rely on other sources of energy, namely fat and amino acids. These are not as good an energy source as glucose in the long run.

To utilize amino acids as an energy source the body needs to break down protein. A large part of this conversion occurs in the protein in muscles cells. As this conversion from protein to amino acids progresses the body loses its muscle mass and weight loss occurs.

Metabolism of fat as an energy source is a normal response when cells do not receive adequate glucose for their energy. In the short term this process is highly advantageous. Fat has twice as much calories as proteins and carbohydrates, so it is a concentrated source of energy in the short run. If the fat metabolism process goes on for a prolonged period of time it becomes detrimental, and leads to the buildup of byproducts from fat metabolism. The main byproduct is a compound called ketones.

The ketones that build up in this process change the pH of the blood, further dehydrate a pet, interfere with other metabolic processes, and cause fatty infiltration of the liver. Ketones also cause vomiting, which leads to further inappetance and additional dehydration and electrolyte imbalance. Further inappetance causes the cells to use even more fat as an energy source, causing an uncontrollable spiral, and sometimes even death. Any diabetic pet presented with ketones in its urine is a medical emergency. These pets have what are termed diabetic ketoacidosis, abbreviated as DKA.

In addition to the liver, the kidneys are another important organ in this disease. The primary role of the kidneys is to filter the blood. As the blood passes through the kidney filters essential nutrients are returned to the bloodstream and waste products are excreted through the urinary system. Glucose is one of the many molecules that is returned to the bloodstream after it has passed through the kidney filters. Once the glucose exceeds 200 mg per deciliter (this varies by species, cats tend to be higher) in the bloodstream though, the kidneys can no longer selectively return all of this glucose back into the bloodstream. This is called “exceeding the renal threshold”, and is a very important part of diabetes mellitus.

As a result, glucose spills into the urinary tract and bladder in excessive quantities. Since glucose attracts water (called the osmotic effect) it pulls fluid out of the pet and causes polyuria. To compensate for this excess urination the pet drinks more water, and now has polydypsia. It now has the symptoms we abbreviate as PU/PD. Eventually it causes dehydration when the pet can’t drink enough water to keep up with the increased urination. In addition, the excess urination pulls important electrolytes out of the bloodstream like sodium and potassium, which leads to lethargy and weakness. The loss of glucose also depletes the body of its primary energy source, so additional weight loss occurs. To further add to a diabetic pet’s woes, the excess glucose that builds up in the bladder feeds bacteria that can cause a urinary tract infection.

Why the pancreas stops secreting adequate levels of insulin is a mystery. There is a strong correlation for diabetes mellitus to occur in cats that previously had an episode of pancreatitis. This makes sense because the pancreas is the source of insulin. Yet, many cats that have diabetes mellitus had no apparent pancreatitis in the past. In some pets the immune system attacks the beta cells in the islets and deposits a compound called amyloid which, makes the beta cells unable to secrete insulin. This amyloid, which contains a protein called amylin, is thought to play a significant role in non-insulin dependent diabetes (your will learn about this soon) because amylin is toxic to the cells in the islets of langerhams.

Another factor involved in non-insulin dependent diabetes is peripheral insulin resistance. This resistance plays a significant role in obese pets, which is a major predisposing role in the development of insulin. Genetics is also involved-genetics cannot be controlled, but obesity can.

Elevated levels of thyroxine, which occurs in feline hyperthyroidism, can also be a factor in insulin resistance.

So what does all of this mean? To summarize all of this pathophysiology:

    • Peripheral insulin resistance, due to obesity and/or the protein amylin found in amyloid, causes chronic stimulation of insulin production in the pancreatic beta cells.
    • Impaired insulin secretion causes insulin and amylin to accumulate in beta cells in the pancreas.
    • The high levels of amylin in the beta cells allows amyloid to deposit, further disrupting the ability of these cells to produce and regulate insulin. As the problem progresses non-insulin dependent diabetes eventually progresses, and at some point in time, the symptoms of diabetes mellitus appear.
      The pancreas can get a tumor called an insulinoma. In this case the pancreas secretes too much insulin and the blood glucose hovers at dangerously low levels. This problem is rare in most animals except for the ferret

Classification

Most people are familiar with the classification scheme used in human medicine. Even though the disease is similar in people and pets, the human classification scheme does not always correlate with diabetes mellitus in cats. Differentiating between Type I and Type II in cats can be difficult.

  • Type I

    Has similarities to insulin dependent or juvenile onset diabetes mellitus. Most commonly occurs in middle aged cats. Insulin is needed to treat the problem. This is also known as insulin dependent diabetes mellitus (IDDM).

  • Type II

    Similar to adult onset or non-insulin dependent in humans. Obesity is a significant risk factor. Insulin is not needed in all cases. Type II cats can become Type I cats when exposed to significant stress. Fortunately, when the stress is resolved they can revert back to Type II. This is also known as non-insulin dependent diabetes mellitus (NIDDM).

    Diabetes can occur secondary to other problems. Some of these problems include hormone imbalances and reactions to medications. A medication called Ovaban, a hormone used to treat numerous cat ailments, can cause diabetes if used excessively.

Symptoms

The classic signs of a cat or dog with diabetes mellitus are PU/PD. These signs of excess drinking and urinating are subtle at the beginning stages of the disease and are easily missed. This is especially true in outdoor cats who do most of their urinating outside, and dogs that urinate outside also.

Other symptoms include weakness, an increase in appetite, occasionally a decrease in appetite, weight loss, lethargy, and rarely, vision problems due to cataracts (this problem is more common in dogs). Cats with a severe liver problem associated with this disease might have icterus (jaundice).

An affected cat might even walk abnormally on the rear legs (called plantigrade posture) due to nerve problems as a consequence of the elevated blood glucose level. It is also known as diabetic neuropathy, and tends to occur as the disease progresses. The best way to prevent it is to keep the blood glucose level as close to normal as possible.

This is what the abnormal (plantigrade) posture looks like

These are also the symptoms of other diseases commonly seen in dogs and cats, and can only be differentiated by diagnostic tests. These other diseases include, but are not limited to, hyperthyroidismkidney diseasecancerliver diseaseCushing’s disease and adverse reaction to medications.

The yellow discoloration to these gums is icterus (jaundice). It is commonly, but not always, caused by liver disease.

Symptoms in dogs typically include:

  • PU/PD
  • lethargy
  • poor appetite
  • vomiting
  • weight loss
  • diarrhea
  • cataract formation

Just like in cats, many dogs with diabetes mellitus were overweight at some time in the recent past.

Dogs with diabetes commonly have other diseases concurrently. They include:

Diagnosis

By the time a diagnosis of diabetes mellitus is made the disease process has usually been present for a significant period of time. When the disease process first started there were no obvious symptoms because of compensatory mechanisms in the body. As diabetes progresses these compensatory mechanisms lose their ability to maintain euglycemia. Eventually, symptoms of PU/PD and weight loss occur and your pet is brought in to be examined. This emphasizes the point that middle aged and older pets should have a routine blood panel and urinalysis every year once they reach 8.

This is a complex disease, and no specific set of symptoms tells us your pet has diabetes mellitus. It is important to follow the tenets of the diagnostic process closely when making a diagnosis of diabetes mellitus, especially since kidney disease and hyperthyroidism have similar symptoms. We will use the diagnostic process as an example of how we make this diagnosis:

Signalment

Typically this disease is seen in obese cats that are middle aged or older, and more commonly in males (the opposite of dogs). Orange cats seem to get DM more often than other colors, but that could be because more of them are male. There is no specific breed predilection in cats.

Dogs are typically middle aged and older, with purebred dogs showing a higher incidence. Common breeds are:

History

The classic signs of PU/PD, polyphagia, and weight loss occur in many cases, but not all. These signs depend on how well entrenched the disease process is before your pet is brought in for an examination. Sometimes the only thing an owner notices are accidents around the house in a previously housebroken cat.

A consistent finding is obesity in the recent past. This predisposes them to DM, and we sometimes call them pre-diabetic if obese enough. These obese cats need to be closely monitored for DM with fasting blood glucose tests, urinalysis, and fructosamine tests. You will learn about these tests in or diagnosis section.

Since this disease occurs in middle aged and older pets there can be other diseases occurring simultaneously. Some cats have a history of vomiting in the recent past, an indication that they might have had an episode of IBD (Inflammatory Bowel Disease) or pancreatitis. Some cats are borderline diabetics that have had a recent illness, stress, or adverse reaction to medication. There might also be blood in the urine or straining to urinate, an indication of a urinary tract infection.

Cats presented in DKA might have a history of abdominal pain and distention, vomiting, inappetance, and lethargy.

Physical Examination

The findings of the physical exam depend on how severe the diabetes is, how long it has been present, what caused it, and if there are any other disease processes occurring simultaneously.

Many cats will have lost weight, yet they still could be obese. There might be dehydration, weakness, lethargy, an enlarged liver on abdominal palpation, and an acetone (juicy fruit) smell to the breath. Hypothermia and shock could be present in advanced cases and those with DKA.

Diagnostic Tests

The primary method of diagnosis is with a fasting blood panel and a urinalysis. The blood panel will reveal hyperglycemia (at least > 200 mg/dl) while the urine sample will reveal glycosuria. Not every case of hyperglycemia means a cat has diabetes mellitus. Cats that recently ate, or those that eat canned foods that are rich in sugar, might have blood glucose levels higher than the normal range. Cats that are stressed from a car ride, on cortisone, are in heat, on phenobarbital medication or hormone medications, might also have hyperglycemia.

Cats are unique in that their stress response can cause a tremendous rise (up to 4x normal) in the blood glucose. This is a common occurrence when we take a blood sample in a cat, and needs to be taken into consideration when we analyze a blood report. This stress induced response is a normal reaction to the release of epinephrine (adrenaline). It is a transitory response and will not persist like the hyperglycemia of diabetes mellitus. These cats sometimes need to adjust to a hospital environment before we are able to determine their true blood glucose level. It is always advised to check the blood sugar in dogs and cats after an 8-12 hour fast to give an accurate representation of the blood glucose level.

Here is a blood glucose report from our lab for a cat that does not have diabetes mellitus. The blood glucose is 317.

This cat has diabetes mellitus, its blood glucose is 390

How do we differentiate them when both are well above the normal range?

Diabetes mellitus is diagnosed when there is a persistent fasting hyperglycemia along with glycosuria, that is consistent with a history of PU/PD and polyphagia.

Other blood tests are sometimes used in this disease. The two more common ones are serum fructosamine and glycosylated hemoglobin. They are used to to distinguish stress induced hyperglycemia from diabetes mellitus, and to also monitor insulin therapy. They give us an indication of what the blood glucose level has been for the preceding weeks.

Fructosamine is formed when glucose reacts with amino acids that make up serum proteins like albumin, which is made by the liver. When the blood glucose is high, fructosamine also increases. Increased levels of fructosamine help confirm a diagnosis of diabetes mellitus, give us an idea of the presence of a persistent hyperglycemia, and help us monitor response to treatment.

Glycated hemoglobin (HbA1c), a tool to diagnose, monitor, and treat diabetes mellitus in people, is just start to get clinical application to dogs and cats with DM. This hemoglobin A1c test gives us a greater timespan to monitor glucose levels, up to 70 days in cats and 110 days in dogs, as opposed to fructosamine which monitors glucose levels for several weeks.  The A1c test is is not affected by daily blood glucose fluctuations, exercise, diet, or the amount of insulin in the bloodstream. As this test is tested for consistency and become standardized and cost effective we will implement its use as another aid to monitor and treat or diabetic patients.

In addition to glucose in the urine and ketones, the urinalysis might indicate that a urinary tract infection is present. This is detected by a change in the pH of the urine, excess white or red blood cells, and bacteria. Even if these are not present a urinary tract infection can still be present. This is why we recommend a urine culture and sensitivity looking for bacteria.

This is a urinalysis from a cat that has diabetes mellitus. Its glucose is 4+. Fortunately, it is negative for ketones, there are no white or red blood cells present, and there are no bacteria visible either.

This cat does not have ketonuria or an infection.

Treatment

The goal of treatment is to resolve the symptoms of poor appetite, lethargy, and PU/PD without inducing hypoglycemia. Dogs tend to be easier to regulate than cats, although preventing cataracts from forming is difficult in the dog.

Some cases of diabetes mellitus in cats are not straightforward. An obese cat can have NIDDM in its normal, unstressed home environment. These cats are secreting insulin but in low levels. As long as they are in a stress-free environment they are able to maintain euglycemia. If they encounter a stressful situation, get sick, or are put on certain medications, their blood glucose will increase. If it goes beyond the renal threshold for glucose, PU/PD will ensue.

These cats are then brought to a veterinarian because of the PU/PD and diagnosed as having diabetes mellitus. They are put on insulin therapy and the problem improves. The problem occurs when these cats are returned to their normal environment and the problem that started the increased blood glucose in the first place (stress, illness, drugs) is now gone. In some of these cases these cats will now become hypoglycemic because they are being given insulin injections when they do not need them. Identifying these cats that have converted from insulin-requiring to non-insuin requiring NIDDM is difficult. This is one of the numerous reasons why diabetic cats should be brought to our hospital every 1- 3 months for a urinalysis and blood glucose curve.

If we start a cat on insulin injections, it’s weight is or becomes normal, and it responds well to insulin injections (especially glargine), we might have a cat in remission, which is our ultimate goal.  In these cases we start lowering the insulin dose slowly, over several weeks to see if it still maintains a normal blood glucose.

Hypoglycemia, blood sugar that is too low, is your primary emergency problem. Symptoms to watch for include:

  • Walking abnormally, like your pet is drunk
  • Running into walls or circling
  • Staring into space
  • Shaking

All diabetic animals, especially cats, need to be closely monitored because urine and blood glucose levels are in a constant state of flux. Because of this you need to be in touch with your pet’s habits and observant of any changes. You also need to have Karo syrup available at all times for dogs and cats in case their blood sugar becomes low and they have problems. If you have no Karo syrup make up some sugar water and rub it on the gums.

Diet

Recent evidence suggests that feeding a high protein diet will help cats with diabetes mellitus.  This higher protein diet mimics what a cat’s physiology has been used to for millenniums. It leads to less release of hormones that affect blood glucose levels. Some cats on high protein diets will need little if any insulin injections. Some cats that are on insulin injections to control their diabetes can actually go off insulin when put on a higher protein diet. The food we recommend is Hill’s M/D.

Dietary therapy might be all that is needed for the obese cat with NIDDM. A cat that is underweight from diabetes mellitus should not be put on a high fiber diet. Since this disease is prevalent in older cats this change in diet might be met with resistance. In these cases mix the higher fiber food with its regular diet to get some advantage of the higher diet. Do not feed foods that contain excess sugar like semi-moist canned foods.

Dogs tend to do well with Hills W/D. The most important thing to remember is consistency. Your dog and cat should be fed the food they like to eat, in the same amount, at the same time every day.

Oral Hypoglycemics

The goal of oral hypoglycemic medication is to minimize glucose absorption by the intestines and to also minimize the conversion of glycogen to glucose by the liver. They also help increase insulin secretion from the pancreas. Oral hypoglycemics need to be used early in the disease before the beta cells are exhausted. Since so many pets are brought to us well past that stage, they do not work as well as in humans.

They are used in cats that are not underweight, have negligible ketones in the urine, no indication of pancreatitis or no history of being on medication that could cause hyperglycemia. In conjunction with diet, oral hypoglycemics can sometimes help us differentiate NIDDM form IDDM. Cats with NIDDM will have significantly lower blood glucose levels when checked several days after initiating this protocol.

Some cats will vomit and might even develop hepatitis from oral hypoglycemics. Giving the medication with food helps minimize vomiting.

The main one used is Glipizide. Due to variable response and potential side effects it is not used often.

Insulin

The thought of giving injections to your pet, especially a cat, can cause panic in some people. Keep in mind it is easier to give insulin injections with the tiny needle that is used, than it is to give a cat a pill. Once we show you how easy it is you will become an expert in no time. If you make it a positive endeavor, feeding around the same time, then a small treat, or a brushing or petting session just after the injection, it will be a positive experience for both of you.

There are many types  of insulin that have been traditionally used to treat IDDM in our hospital over the decades. Unfortunately, the manufacture, Eli Lilly, has discontinued the production of many of its insulin products.


Regular

FastActing- Peaks in 2-4 hours Lasts 5-8 hours


NPH

IntermediateActing- Peaks in 8-12 hours Lasts 18-26 hours


Ultralente

ProlongedActing- Peaks in 16-24 hours Lasts 24-36 hours


This chart gives you a relative idea of their peaks and duration of action. It is important to remember that every dog and cat will react differently and will not necessarily have this same graph.

Regular insulin is used initially to treat a cat or dog if it has DKA. Once the ketoacidotic state has been reduced we use the intermediate or prolonged lasting insulin. Your veterinarian will let you know which one might be most appropriate in your situation. Sometimes we need to try more than one type of insulin. What is just as important as the type of insulin used is the familiarity a doctor has with a specific protocol.

Most pets will need insulin given every 12 hours. This should coincide with a meal. You should decide ahead of time what insulin and feeding schedule works for you and your lifestyle because consistency is of utmost importance. The same thing goes for exercise since this affects insulin. Take your dog for the same type of walk at around the same time every day when possible to increase your chance of a good response to insulin injections.

For many years the insulin used to treat cats was derived from a beef-pork combination (90% beef and 10% pork) that was used in human diabetes mellitus. The pharmaceutical companies are now relying more on human recombinant (genetically engineered) insulin.

The goal of insulin therapy is to mimic naturally secreted insulin from the pancreas as closely as possible. This can be quite difficult in any species, let alone the cat. The dose of insulin and the type of insulin that is effective will vary from cat to cat and dog to dog. Once a proper dose is initially determined at some point in time in the future this dose will probably change.

Initially, insulin is dosed conservatively in order to see an individual dog and cat’s response and to minimize any chance of hypoglycemia. After your pet has been on this initial low dose we like to do a blood glucose curve to assess where we are, then make adjustments in dose accordingly.

There are many different types of insulin used. We will go over the ones most commonly used:

  • Glargine and Detemir- Ultra long acting

    Glargine, a human insulin has been successfully used in many cats. If used early in the course of the disease it is even possible to get a remission of the disease.  Those cats that do go into remission need to be monitored and kept at an ideal body weight or they might have a recurrence of diabetes mellitus.

    Glargine is more expensive than the other insulin’s used. This added expense might be worth it if your cats diabetes problem is actually cured of the problem. One of our doctors will discuss this with you and see if it is appropriate in your situation.

    Glargine has been show to be effective in some cats, although its long term efficacy has not been proven yet in a large number of cats. The same holds true for Detemir. More studies with a large number of diabetic cats over a long period of time are needed.

  • PZI (Protamine Zinc Insulin)- Long acting

    This is one of the more commonly used insulins in cats. It is usually given every 12 hours. We start with a dose of 1-3 units, and adjust as needed.

  • Vetsulin (Lente)- Intermediate acting

    This insulin is approved for use in dogs and cats, and is one of the more common ones used, especially in dogs. Its use in cats is increasing due to good results. It is made from purified porcine insulin which has the same amino acids as canine insulin. Because of this there should be more effective regulation of blood glucose with less risk of anti-insulin antibodies. It is an intermediate acting insulin, and in some dogs once daily dosing is adequate. Cats usually need to be given their injections twice each day.

  • NPH (Neutral Protamine Hadedorn)- Intermediate acting

    This has been the mainstay for treating diabetic dogs over many decades. It is still used, although we have been using Vetsulin much more frequently. It is not used in cats.

Ketoacidotic Diabetes Mellitus

Pets presented with DKA need immediate medical attention. They need regular insulin due to its ability to rapidly lower the blood glucose level. They also need fluids and electrolytes to correct dehydration, electrolyte imbalance, and acidosis (a change in the pH of the bloodstream). If this therapy is initiated too aggressively it might cause more harm than good. Our goal is to return your cat to a relatively stable state within the first 1-2 days after initiating this therapy.

Regulation

Diabetic pets need to be slowly  regulated (the correct dose of insulin needed). Many pets will take 4-8 weeks to find the proper level of insulin Most cats have well entrenched pathology that is not conducive to rapid change. The dose has to be given in small amounts initially to prevent hypoglycemia. It takes several days for a cat to respond to a change in dose. This initial regulation only gives us a starting point for your pet’s insulin dose since there will be numerous mitigating factors that will affect insulin levels when your cat returns home.

Initially we will use a low dose and have you administer the insulin at home at this dose for the next 7 days. After 7 days we will perform a glucose curve in our hospital over 10 hours.  The blood glucose curve will give us an idea of how it is reacting to the type and amount of insulin we are using. Every pet is different, so this trending is needed to understand specifically how your pet will react. This curve will give us an accurate picture of just how high and how low the blood glucose is. This will then allow us to further refine the dose of insulin. We will do this glucose curve every 7 days, refining the dose each time, until we have achieved are desired level.

Any other problem your pet has, especially UTI’s (urinary tract infections) needs to be corrected for insulin injections to lower the blood glucose properly.

Our goal is to get the blood sugar level down to somewhere between 100-250 mg/dl. Some pets are regulated fine even if the blood glucose peaks at greater than 250 mg/dl. It is much better to have a pet that has a slightly high blood glucose level than to try and refine the dose so closely that hypoglycemia is risked.

To monitor your pets blood glucose we take frequent samples. To prevent the constant irritation from obtaining this blood sample we put a catheter into one of your cat’s veins. This eliminates discomfort and also minimizes the stress response.

This cat has jugular catheter — to learn more about catheters click here

 

The first step in the process of running a blood glucose test in our hospital involves taking blood from your pet and putting it on a special strip.

This cat’s blood glucose reading is 63 mg/dl. It is hypoglycemic at this point.

The typical pet eventually needs anywhere from 2-10 units given from once to twice daily. Of course this dose depends on the weight of your pet, the type of insulin used, its diet, its exercise level, and its individual response.

Even though these blood glucose checks are critical, your input as to how well your pet is eating, acting, and how much it is drinking and urinating, are just as important. If your pet is doing well in all these parameters then the blood glucose is being regulated.

Insulin Injections

It is imperative that you administer the precise amount of insulin required since small changes can have dramatic effects. Be consistent and give the insulin the same time and at the same location every day. If your pet is on twice daily insulin injections give each morning and evening dose at the same time every day. Always feed your pet in the morning prior to giving the insulin. If it does not eat its food skip the morning dose of insulin. If it eats only half of its food, give it only half of its insulin dose. Giving a normal dose of insulin to a pet that is not eating greatly increases the risk of hypoglycemia. You must always err on the side of hyperglycemia instead of hypoglycemia.

Most cats eat small bites of their food throughout the day. This might or might not work in a diabetic cat because of the manner in which the insulin that is administered peaks. If it does not work, feed your cat twice each day, feeding part of its daily meal when you give the insulin in the morning. Make sure it has access to this same food when the insulin level is peaking later in the day.

A record should be kept of your pet’s food intake to note any changes. The same thing holds for its water consumption. Marking this on a calendar weekly will give you important trends and give you a good idea if you are on the proper dose of insulin.

The actual administration of insulin is very straightforward. As a matter of fact, it is easier to give insulin injections at home than it is to give SQ (subcutaneous) fluids to cats that have chronic renal failure, a common feline problem. This is because an insulin injection takes 1 second to give, whereas fluids take 5-10 minutes. The technique used to give insulin injections or SQ fluids is the same- click here to view an actual demonstration of the administration of SQ fluids. When you are finished learning the proper technique return here to finish.

You will never be forced into doing something that makes you feel uncomfortable. While your cat is in the hospital with us you can observe how we give the insulin injections. One of our nurses will demonstrate its proper administration when we release your pet from the hospital. You can return to our hospital for assistance in giving the insulin at any time.

In order to simplify the process we will give you an insulin syringe that has been designed to be used with the specific type of insulin your pet requires. You will be giving insulin in a measurement called “units”, and not in ml (milliliters) or cc (cubic centimeters) as is commonly used in most syringes.

 

The use of injections is very simple. If we are using U-40 insulin, then we use a U-40 syringe. If we prescribe 2 units of insulin, draw up the insulin to the 2 mark on the syringe and give the injection. That’s all there is- no calculations are needed on your part.

Some cats require such a low dose of insulin that we have to dilute it for proper administration. A special diluent is needed for this, and diluted insulin should not be used longer than 2 months. A special syringe is sometimes used for dilute insulin.

This is what a U-100 syringe looks like. The needle is very small and sharp so your pet will not feel it during its injection.

Insulin should be kept refrigerated at all times to preserve its freshness. When you purchase it at the pharmacy bring an ice pack with you. Prior to use it should be gently warmed in your hands.  Storing the insulin bottle on its side in the refrigerator will help in mixing.

Gently roll it (never shake it vigorously because excess bubbles will form) between your hands for 1-2 minutes to bring it to the proper temperature for administration.

Make sure you are in a relatively calm location when you give the injection. Hold the insulin bottle upside down and draw out slightly more than the number of units your cat requires. Tap the syringe a few times to remove any air bubbles-this aids in accuracy (a few tiny bubbles are OK). Push the plunger in the syringe slightly forward until you have the exact number of units you need to administer is in the syringe. Put the cap back on the syringe and put the insulin bottle back in the refrigerator. Do not reuse the syringe.

We will show you exactly how to do this in person, and give the first few injections for you until you get your confidence. In this picture you can see we have drawn 6 units into the syringe.

Give the injection in the scruff of the neck just as you would when giving SQ fluids described above. Your pet should not feel anything because the needle is so tiny and sharp. The whole process, from warming the insulin to giving the injections, should only take a couple of minutes. As you get confidence it is recommended to rotate your injection sites. We can shave a section of hair to make this whole process easier.

Improper administration of insulin is one of the most common causes for improper regulation. Please do not hesitate to contact us at any time for assistance in this vital procedure. Unless unavailable, only one person per household should be delegated to giving insulin.

Home Monitoring

The best way to monitor your pets blood glucose at home is to perform the blood glucose yourself. Ears and pads are areas in which a small prick will give sufficient amount of blood to run an in home blood glucose. In some cats this method of obtaining a blood glucose level is preferable to running a glucose curve in the hospital. This is because the stress of the car ride and the obtaining of blood several times while in the hospital can mislead us as to your cats actual blood glucose level.

Some of our clients use a home glucose kit to check their cats. It is easy to do once we show you, and gives a more accurate assessment of blood glucose levels at home than does the glucose in the urine. You only need a few drops of blood for the glucometer.

To use the glucometer you need to find an ear vein. You can see this one running horizontally under our nurses finger.

It is very simple to prick the ear with this machine and get your sample

 After you place a drop of the blood in the green tip the machine will give you a blood glucose reading in a few seconds

Most people prefer to monitor the glucose in their pet’s urine because it is simpler. Monitoring of the glucose in your pets urine will give you at best a rough idea of its blood glucose level. There are significant limitations to home monitoring using urine glucose as a criteria. We do not recommend it.

Urine glucose measurements do not necessarily correlate with blood glucose measurements, the more important of the two. Also, if the blood glucose level is below the renal threshold a negative glucose in the urine cannot differentiate between euglycemia and hypoglycemia. If you note a significant amount of glycosuria consistently for several days your pet needs a blood glucose curve.

One of the ways the urine dipstick can be particularly helpful is in monitoring ketones. Occasional trace ketones is no cause for alarm. Consistent ketonuria in a cat that is not feeling well requires immediate veterinary care.

To help in the urine monitoring process your cat’s normal litter can be replaced with special litter that will not absorb urine. You can also use regular paper, newspaper, or even plastic wrap in the bottom of the cage. There is even a special litter that reacts with the glucose in the urine.

One of the more common urine dipstick kits is the Keto-Diastix. In addition to monitoring glucose it also monitors for ketones.

This is the chart on the Keto-Diastix bottle. The box to the far left is negative, which is the goal. The next box to the right is 100 mg/dl. Its OK to have this urine glucose value on occasion.

On the same bottle there is a chart to monitor for ketones in the urine. Your goal is to have negative with an occasional trace.

What is just as important as urine glucose is your subjective interpretation of how your pet is doing. If the original symptoms are greatly reduced then you are probably giving an accurate dose.

Determining the daily dose of insulin required at home is not an easy task. We have learned over the years that blood glucose determinations are variable, and that in many cases it is your perception at how well you pet is eating, how active it is, and how its drinking and urinating has decreased that is more important.

A more accurate blood test is the fructosamine level, which gives us an average of your pets blood glucose levels of the last 2-3 weeks, and is much less variable than individual blood glucose determinations. The fructosamine test is obtained at our hospital, and should be performed every 3 months after initial regulation.

Do not make any changes in insulin dose unless you talk with one of our doctors. Do not make daily changes in insulin doses either, wait 3 days to determine if the new dose is having any effect.

Warning signs that necessitate an exam and blood glucose curve in the hospital:

  • Lethargy or significant increase or decrease in appetite
  • Significant increase in drinking or urinating
  • (100 mg/dl) or more glycosuria for > 2 days
  • Significant ketones in urine for > 2 days

Long Term Care

It must be understood that in most cases insulin administration does not cure diabetes mellitus, it only controls it.  As you learned above in the physiology section, the body has very sophisticated and refined mechanisms to keep the blood glucose at optimum levels. This can not be replicated easily by giving insulin. The exception to this is the occasional cat diagnosed early in the disease process and is not overweight.  Glargine seems to be the best insulin to increase the chance of remission .

To minimize problems we should monitor your pets’s blood glucose level in the hospital and perform a urinalysis every 3 months. Since cats can exhibit an exaggerated stress response causing a profound hyperglycemia, a glucose curve is necessary to ensure accuracy. Every 6 months we should also perform a complete blood panel to look for changes in other organs caused by the diabetes. A urinalysis at the same time is needed to monitor for a UTI (urinary tract infection).

A further reason to run a complete blood panel every 6 months is to monitor routine age related changes like hyperthyroidism and kidney disease. Diabetes can also predispose your pet to high blood pressure (hypertension).

This long term monitoring is important for another reason. In almost every diabetic pet insulin requirements change, necessitating the need for close monitoring and communication with us. If your pet goes into heat (another reason to spay females and even neuter males) its insulin requirements might change. In some diabetic cats the problem goes away and they no longer have a need for insulin. Giving insulin to these cats can cause hypoglycemia, which if it is severe enough, can lead to seizures.

Complications of Diabetes

  • Hypoglycemia

    One of the more alarming, yet relatively rare side effects to insulin administration, is hypoglycemia. You should be ever vigilant about its appearance and always be ready to treat it at home. Close observation of your pets appetite will go a long way towards preventing this problem.

    Symptoms include shaking, a starry eyed appearance, lethargy, shaking, greatly enlarged pupils, muscle tremors and even seizures. If the problem is serious and persists long enough, coma and even death can occur from depression of the respiratory system. Some pets don’t show any obvious symptoms except subtle behavior changes like sleeping more than usual. Since cats sleep most of the time anyway this can easily be missed.

    In most cases the cause is an overdose of insulin. A common scenario involves a pet that eats significantly less than its normal amount for the day. Hypoglycemia can result if the dose of insulin is not adjusted to take this into account. If your pet is not eating well and you are unsure of its appetite, either give less insulin that day or do not give any at all. A blood glucose test in the hospital will let us know for sure.

    Other causes of hypoglycemia include improper insulin administration resulting in an accidental overdose, along with cats that spontaneously recover from their diabetes and no longer need insulin. This is why close monitoring of the blood sugar level is important, either at home or at our office.

    If the symptoms of hypoglycemia are mild, feed your pet some of its normal food. For many pets this will suffice. If the problem is severe use Karo syrup, a simple carbohydrate. It is readily available at the supermarket and should be kept on hand at all times. Give it in small amounts or rub it on the gums. Pancake syrup, honey, sugar water or any fluid that has high amounts of sugar can be used also. These high carbohydrate remedies only last a short time so you might have to keep on repeating one of them. Also, it is a good idea to have a source of simple carbohydrates in your car or other important locations when traveling or even just going for a walk. It pays to be prepared.

    In the rare case that your pet has a seizure or seems comatose from hypoglycemia, it is imperative that you do not put anything into its mouth, including your fingers.  These pets need to be seen by a veterinarian immediately.

  • Liver Disease

    Cats with diabetes are forced into using an energy source that will eventually cause a fatty infiltration of liver cells. As a result the liver will not function at optimum capacity, a potentially serious problem since the liver is such a vital organ. The liver enzyme test on the blood panel will alert us to this complication. When the diabetes is treated this problem might resolve. Radiography might reveal an enlarged liver (hepatomegaly) due to the fatty infiltration.

    This liver is larger than normal-it is extending towards the right far beyond the margin of the ribs. The 4 white arrows on the bottom outline the lower edge of the wedge shaped and enlarged liver.

    One of the most important disease syndromes associated with a fatty liver is called hepatic lipidosis. It occurs in overweight cats that are exposed to a stress that causes them to stop eating. This lack of appetite can become so severe that a feeding tube needs to be put in.

    Keeping the blood glucose level as close to euglycemia as possible will help minimize this complication. Again, the need for periodic blood glucose monitoring along with a routine blood panel every 3-6 months become obvious.

  • Somogyi Effect (Insulin Induced Hyperglycemia)

    Overdosing the morning dose of insulin can cause hypoglycemia. If the hypoglycemia becomes severe enough (< 60 mg/dl) the body will go through complex compensatory mechanisms to raise the blood glucose level. These mechanisms involve the liver, glucagon and epinephrine. If these mechanisms are unable to raise the blood glucose rapidly enough then the symptoms of hypoglycemia described above might occur.

    When these mechanisms are able to correct the hypoglycemia they can cause the blood glucose level to go quite high later in the day and persist through the night. If the urine glucose is measured just before the morning dose the next day there will be significant glycosuria due to the previous afternoon and evenings hyperglycemia. This will cause many people to increase the insulin amount in the morning dose. This overdosing will again cause hypoglycemia some time during the day, and the cycle will repeat itself.

    This problem is diagnosed by a blood glucose curve in the hospital. A cat with the Somogyi effect will have a blood glucose level that is abnormally low some time during the day. This emphasizes the need for a blood glucose curve to monitor your pet’s problem because only one blood glucose test during the day might miss the hypoglycemia episode that is causing this problem in the first place.

    Insulin antagonism

    Pets that are not regulated in spite of higher than normal insulin doses might have this problem. This problem can mimic improper storage, handling, and administration of insulin.

    There can be many causes to insulin antagonism. Hormones, cortisone, the Somogyi effect, adrenal gland disease, infection, chronic pancreatitis, kidney disease, cancer, anti-insulin antibodies, and even ineffective insulin all could be involved. Cats that get Feline Acromegaly, an excess of growth hormone, can also get insulin resistance.

  • Infections

    Diabetic pets are prone to infections, especially of the urinary tract. These infections makes them more prone to DKA and insulin antagonism. Good dental hygiene is critical also since many pets with diabetes have dental disease. Chronic dental disease can make regulation almost impossible.

  • Cataracts

    Almost all dogs with diabetes mellitus will eventually develop cataracts. The earlier the diagnosis is made the greater chance your dog’s blood glucose can be regulated to stave this off. One of our doctors might refer you to a veterinary ophthalmologist because there can be inflammation associated with this called uveitis. The cataract needs to be removed in this case to prevent pain and further complications. Your dog has to be properly regulated regarding insulin levels before the ophthalmologist can do this surgery.

Boarding a Pet with Diabetes

It is always preferable to keep your diabetic pet in its normal environment. When this is not feasible special precautions need to be taken if your pet is boarded. Cats that board away from home are at an increased risk of becoming unregulated as to their correct insulin amount. They will frequently have a diminished appetite, increasing their chance of hypoglycemia if their insulin dose is not adjusted. Your cat should be boarded only at a facility that is adept at treating this disease and can run a blood glucose curve in case of a problem. One of the more common reasons we board pets at our hospital is because they need this type of medical monitoring for their problem.

A fructosamine test should be performed just prior to boarding for us to get an accurate idea of your pets average blood glucose level.

You should bring your food and your insulin to the boarding facility. A feeding schedule with amounts of food and water consumed and at what times should be provided. Also include a timetable when insulin is given and at what amount.

Since diabetic pets should be monitored with a blood glucose curve periodically this is an ideal time to run this test. Many cats will adapt to their new environment in a short time, which should make their individual blood glucose tests more reliable. When your return to pick up your pet we will review this curve with you and adjust doses as needed.

Summary

It is obvious that this is a complex disease that requires diligence on your part for proper control. Since every pet is different, your doctor will make a custom plan that will work for you and your pet, and will not necessarily follow any pre-established protocol. Be prepared for constantly changing insulin requirements and potential complications. The more consistent you are with feeding the same food, in the same amount, at the same time(s) every day, will add to a successful outcome.

The majority of diabetic pets on insulin therapy have a significantly increased quality of life. This usually makes the time time and monetary commitment necessary for proper regulation well worth the effort.

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Anesthesia

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One of the most important tools available to veterinarians to thoroughly and painlessly treat pets is the advent of modern day anesthetics. These anesthetic agents allow us to sedate and anesthetize a wide variety of animals with negligible chance of serious side effects.

The lack of significant complications from anesthesia is due to a combination of expertise, thorough pre-anesthetic testing, and state of the art anesthetic and monitoring equipment. We are equipped to anesthetize any pet from a finch that weighs 15 grams (it takes 454 grams to make up one pound), to pets that weigh several hundred pounds. We are also particularly proficient in anesthetizing senior pets and pets with medical problems like liver and kidney disease.

The goals of anesthesia are to minimize anxiety and eliminate pain. In addition, from the surgical point of view, anesthesia allows profound muscle relaxation. This is helpful in every surgery because the procedure will go quicker and incisions can be made smaller when the muscles are relaxed. In certain types of surgery like fracture repair, this muscle relaxation is crucial for success.

It is normal for you to have concern if your pet is about to undergo a procedure that requires anesthesia. Because of this fact, we invite you to be a part of our anesthetic team. Your primary responsibility is to let us know of your concern. You will have access to your doctor to discuss any of your concerns and to set up a custom protocol for your pet, taking its specific needs into consideration. Only when you are comfortable with the situation will we proceed any further. Also, to alleviate your concern on the day of actual anesthesia, we will call you immediately after your pet wakes up, if you so desire. Please leave a number where we can reach you on the day of surgery.

We have a short video on monitoring pets during anesthesia. You will need QuickTIme from www.apple.com to be able to view it.

Precautions

One of the best precautions we take to minimize the risk of anesthesia it to perform pre-anesthetic diagnostic tests. A pet can pass its pre anesthetic physical exam and still have significant internal problems, so it is important that we perform more than just a physical exam. This is because animals cannot tell us of their problems, have high pain thresholds in comparison to people, and have defensive mechanisms allowing them to hide symptoms. Pre-anesthetic diagnostic tests are designed to alert us to internal problems that are occurring without any symptoms.

Those pets that have infections (especially tooth infections) are put on antibiotics ahead of time. They make pets feel better, and help support internal organs.

Older pets or those with medical problems are given intravenous (IV) fluids prior to and during the anesthetic procedure. Giving fluids prior to the surgery greatly reduces anesthetic risk. This is particularly important in older pets and those with kidney or liver disease. Most pets that have significant dental disease will also be given IV fluids.


Injectable Anesthesia

Injectable anesthetics are used for many purposes. One of their primary uses is to sedate pets before giving the actual anesthesia (called pre-anesthetic). By sedating ahead of time we dramatically minimize anxiety, cause a smoother recovery, and minimize how much anesthetic we need to administer during the actual procedure. In addition, some injectable anesthetics minimize vomiting, a common problem when waking up from anesthetic.

Little Bit is receiving an intravenous injection of an anesthetic before his teeth cleaning. It is being given through an I.V. catheter in the cephalic vein of the forearm.

Injectable anesthetics are also used to give complete anesthesia for short periods of time. This is used for C-sections and minor surgical procedures. Injectable anesthetics are ideal to sedate a pet for radiographs (x-rays).

As new anesthetic agents evolve, the trend is towards using injectable anesthetics more and more for complete surgical anesthesia. They are very effective, very safe, and allow for rapid recovery from anesthesia. They also protect the environment because there are no anesthetic gases vented into the atmosphere.

The primary anesthetic in this category is called Propofol. It induces anesthesia rapidly, and pets wake up almost immediately.

Gas Anesthesia

The mainstay for general anesthesia is gas anesthesia because it is very safe and highly controllable. We use the safest and most effective gas anesthesia available, called Isoflurane. It is so safe it can be used in creatures as small as tiny birds.

Gas anesthesia requires specialized equipment and training. Several precision components are used to administer and monitor anesthesia:

Oxygen

All pets put under gas anesthesia are given 100% oxygen from the moment they are anesthetized until they wake up, dramatically increasing the safety of the procedure.

We have a special machine in surgery that generates 100% oxygen

As a backup,  oxygen is stored in large tanks under high pressure. The oxygen in the tanks is delivered to the anesthetic machine via special piping throughout the hospital. This allows us to have anesthetic machines in several hospital locations. A pet can be brought into radiology after its surgery and still be kept under gas anesthesia while the surgeon reviews post operative radiographs to ensure everything is in order. This is especially helpful when orthopedic surgery is performed.

Endotracheal Tube

With rare exceptions, oxygen is delivered to your pet by a breathing tube (endotracheal tube) in its windpipe. It is the preferred method to administer oxygen because it is very efficient, will prevent any vomitus from entering the trachea (vomiting rarely happens because of fasting and pre-anesthetic sedation), and allows us to gently inflate the lungs during surgery so that work at maximum efficiency. Besides oxygen, the anesthetic gas (Isoflurane) is also administered through the endotracheal tube. Medications can even be administered via this special tube.

After Little Bit was given an injectable anesthetic a breathing tube was placed in his windpipe and Isoflurane was administered.

We can easily inflate your pet’s lungs by gently squeezing the bag connected to the tube and monitoring the amount of pressure we are exerting with a gauge on the anesthetic machine. Each size and species of pet requires a different sized endotracheal tube. The tube is not removed from your pet until it is literally waking up. This ensures that the swallowing reflex is present and your pet is now safely able to breathe on its own.

This x-ray shows the breathing tube (follow the arrow) as it passes over the tongue and down the trachea (windpipe).

"Chase Summerville" 2/2/98

Vaporizer

An instrument called a precision vaporizer is used to deliver the anesthetic gas within the oxygen. It is a very precise instrument allowing us to make fine adjustments in anesthetic level. Without this vaporizer we would not have the wide safety margin that we currently enjoy.

For most surgeries we administer the anesthetic at a setting of 1-2 %. This small percent of anesthetic, added to the oxygen the pet is breathing, is all that is needed to achieve complete surgical anesthesia. Before the surgical procedure is finished the anesthetic is lowered before it is turned off completely. As the surgeon is finishing the procedure your pet is in the beginning stages of waking up. This is another way we minimize anesthetic risk.

Monitoring

During the procedure your pet will be monitored in several ways. One of the best monitors is the surgeon because he is literally visualizing the blood in the circulatory system. Any change in the blood is readily noticed because pets that are breathing 100% oxygen should have bright red blood.

Also, we have an anesthetist nurse in the room monitoring anesthesia. She monitors oxygen flow and anesthetic settings on the precision vaporizer, along with heart rate and respiratory rate. She also uses several tools to aid her in keeping a close watch on important anesthetic parameters:

All of our patients, especially the smaller ones like this guinea pig, are kept on warm water water blankets to prevent hypothermia before during, and after any anesthetic procedure.

Surgery-GPigWaterBlanket Surgery-GPigWaterBlanket1

 

Anesthetic Monitor

This highly accurate and sensitive monitor gives us detailed information on your pets physiologic status while under anesthesia.

It is calibrated prior to surgery to ensure accuracy

Esophageal Stethoscope

Our anesthetist technician can also use an esophageal stethoscope to listen to the heart. This sensitive instrument is passed into your pet’s esophagus while under anesthesia and placed right at the level of the heart, thus greatly enhancing our ability to hear the heart and detect any problems.

Pulse Oximeter

The portable pulse oximeter is an instrument that measures the oxygen saturation of you pet’s red blood cells (to be more specific, its hemoglobin). It is an extremely sensitive instrument that gives us an indication of problems that may be arising long before your pet suffers any ill effects. In addition to measuring oxygen saturation, it measures heart rate, pulse character, and respiration.

This instrument does its magic by measuring the hemoglobin that is oxygenated and comparing it to the hemoglobin that is not oxygenated. It does this by shining a light on an artery, and then measures how much of this light is absorbed. It gives us an answer in PaO2– the partial atmospheric pressure of oxygen

This pulse oximeter shows a pet with an oxygen saturation of 94%, a heart rate of 157. It is breathing 27 times per minute, and its heart rate is steady.

This is Little Bit having his teeth cleaned under general anesthesia. The pulse oximeter is attached to his rear leg.

The pulse oximeter has several different types of sensors that can be attached in various locations depending on the procedure being performed.The pulse oximeter can also be used on pets that are not anesthetized. It is useful for pets that are having difficulty breathing (dyspnea) from many different causes. It is also used to monitor pets that are in a state of shock. One of the most common reasons for pets to be presented to us in a state of shock is from trauma, especially being hit by a car (HBC).

The esophageal stethoscope and the pulse oximeter can be used simultaneously. In this dog, undergoing a neuter operation, Denise, our nurse anesthetist, is taking a reading with both instruments.

The blue tube on the anesthetic machine suctions exhaled gases from our patient and vents them outside the building. The white particles in the canister absorb exhaled carbon dioxide, and the round gauge measures the pressure at which oxygen is being introduced into the endotracheal tube when the technician inflates the bag.

Techa 1

We have a short Quicktime movie showing a pulse oximeter in action on one of our volunteers. The top number is the oxygen saturation, the bottom number is the heart rate. The vertical bar gives us a clue as to the strength of the heart beat. Click on the link below.

Pulse Oximeter

Capillary Refill Time

To complement these high tech methods of monitoring, our anesthetist technician uses several hands-on techniques as a backup. One of the easiest of these is called capillary refill time (CRT). By pressing on the mucous membranes in the mouth, and noting how long it takes for the blanched area to turn pink again, we get a basic assessment of your pets cardiovascular status. A normal pet’s pink color returns within 2 seconds. This technique is used in other situations besides anesthetic monitoring. It is especially helpful when a pet is in shock or is dehydrated.

Blood Pressure Monitor

We also monitor the blood pressure when pets are under anesthesia for the longer surgical procedures. This is done with our anesthetic monitor. Our hypertension page has a video of the doppler blood pressure monitor in action when we use it in an exam room.

Pain Medication

We complete the anesthetic process by giving your pet a pain injection before it wakes up from the anesthetic. Since the gas anesthesia has a small amount of residual analgesia (ability to kill pain), the pain shot kicks in as the gas anesthetic is wearing off. This allows for a very smooth and pain free recovery. Those of us that have had even minor surgery know how important pain medication is after a procedure. This pain injection will keep your pet calm its first night home from any surgery.

Local Anesthesia

Another excellent way to prevent the pain encountered when your pet first wakes up is to use a long acting local anesthetic at the incision site. We administer it prior to completion of the surgery, and its affects last for 6 hours.

We use the long acting version of this drug which eliminates pain for up to 8 hours.

We even have a local anesthesia patch that is used in some cases to bring long term relief for several days if needed.

Pain Patch

We also use Duragesic patches for general pain control in the more serious cases. It is preferable to apply it 12 hours before the surgery for maximum effect postoperatively. It provides pain relief for 3 days. It is important to make sure that no children or other pets are allowed to contact the patch in any way. Bring your pet back to us for proper removal and disposal.

The patch is applied in different locations depending on the surgery. Wrapped around one of the legs and between the shoulder blades are common locations. One of our nurses is applying it in this picture using gloves to ensure she does not come into contact with the active ingredient.

If we put it on the leg it is covered with a bandage. We will commonly staple the patch to the skin if we put it between the shoulder blades. It will be bandaged for protection and to minimize the chance of contact with other pets and children. Please return in 3 days for us to remove it and dispose of it properly.

To ensure your pets complete safety, it will stay with us for at least several hours after it is awake. We will verify the pain medication is working and there are no ill effects from the anesthetic administered. It will also allow your pet to completely wake up and walk normally in a controlled environment where it cannot hurt itself. Our technical staff monitors your pet post operatively until we are certain it is ready to go home.

Long term pain control at home is also important during the next several days. We will routinely send you home with an anti-inflammatory medication or pain suspension for long term pain control. The two most common medications we use are Rimadyl and Torbutrol suspension.

Laser Surgery

Even though it is not an actual pain medication, using our carbon dioxide laser when indicated during a surgical procedure dramatically minimizes pain because it decreases inflammation, swelling, and cauterizes nerve endings. By using the laser and stopping the pain cascade before it even begins there is a dramatic influence on decreasing post operative pain.

Returning Home after anesthesia

When you bring your pet home after anesthesia it is helpful to follow some common sense suggestions:

Keep contact with other pets and children to a minimum for at least the first 12 hours. Confine it to an area where it cannot hurt itself  because it may not be steady on its feet for up to 24 hours. It might be groggy the first night due to the pain injection it was given.

Use pain medication as prescribed and keep your pet in a warm and quiet area. You can spend time giving unlimited TLC

Even though your pet has probably been fasted for the anesthesia, feed it only a small amount of food and water when first returning home. Give it more later if it eats well and does not vomit (emesis). Most pets return to a normal appetite within 24 hours. If your pet has not fully recovered from the anesthetic by the next day then please call our office.

Please call us in the evening if you have any questions when your pet returns home from surgery or any anesthetic procedure.

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Bird X-Rays

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The first series of radiographs are before we had our digital radiography. As you scroll down and come to the rad’s taken by our digital machine you will see the increase in quality.

This first x-ray is from a normal cockatoo that is laying on its side, with the head towards the right. To see a diagram that labels these structures click here, then return for our x-ray tour of birds.

This is another normal cockatoo, this time it is laying on its back. The important organs have been labeled. Note the hourglass appearance of how the heart and liver connect.

These first two x-rays show a bird that has an abdomen filled with fluid. You cannot identify individual organs when the fluid is this extensive. Unfortunately, this is a serious condition.


This is an x-ray of a bird with an enlarged liver. The hourglass appearance between the heart and liver is not present.

This patient has lead toxicity (click here to learn more about lead toxicity). The arrow points to lead particles in the gizzard (stomach). Do you see the fractured leg also? The next x-ray shows the lead and fracture from a different view.

This same bird is now laying on its back, and emphasizes the importance of analyzing two views of an x-ray. The fracture (arrow) in the tibiotarsal (shin) bone is more apparent now. The other arrow points to the lead particles in the gizzard. Now go back and see if you can find the fracture in the view above (hint-it is in the leg to the left). This type of fracture can be handled with a splint.


Here is another bird with lead particles in the gizzard. You know how to recognize it now without an arrow.

The arrow is pointing to a metallic object that is in the bone marrow of the femur (thigh bone). Can you guess what this object is? The next x-ray shows you a side view of this object.

Birdrad-intraosseus

This is called an intraosseus (IO) catheter. It is used to give fluids, especially during an emergency. Birds have very thin walled veins and sometimes they do not hold up when we need to administer fluids. The IO catheter remedies this problem

The following radiographs are from our new digital radiography machine. You can click on them to enlarge.

Egg bound

Birdrad- egg

Fish hook in crop

Birdrad- fishook

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Barium in crop

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BB in skull

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Hawk with BB’s in wing

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Detail of digital radiography in a normal bird

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Fractured tibiotarsal (shin) bone

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Fish hook in gizzard (ventriculus)

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Heron neck

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Repair of fractured ulna in red tailed hawk. The metal object is an IM (intramdeullary) pin. The fuzziness around the pin is normal healing bone, called callus

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Egg bound bird with egg almost out (in the cloaca)

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Fracture repair using external pins

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Proventricular Dilatation Syndrome (PDS)

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Proventricular Dilatation Syndrome (PDS) , also known as Macaw Wasting Disease (it was first seen in macaws), is a devastating disease of mostly young psittacines. The proventriculus is the chamber of the digestive tract just in front of the ventriculus (gizzard). When it dilates there is an inability of the stomach to digest food. It can be a problem in any psittacine, but is found most commonly in macaws and cockatoos.

Cause

A virus is the most likely cause.

Symptoms

Birds that have this problem are weak, have lost weight, and can have difficulty perching. Many of them will regurgitate and pass undigested seeds in their droppings.

Regurgitation of a mucous like fluid is one of the classic signs of PDS. There might be seeds adhered to the mouth and feathers around the face.

Diagnosis

Young cockatoos and macaws that have symptoms of this disease warrant further diagnostic tests. Other diseases can mimic PDS, so it is important to follow a thorough diagnostic process. Baby birds and those with infections, cancer or toxicities can also have a dilated proventriculus. Sometimes a biopsy of the crop or proventriculus is needed to confirm the diagnosis.

X-rays are a significant aid in making this diagnosis. The chambers of the stomach will show enlargement, which can be outlined with barium. Barium allows us to see the structures of the digestive tract more clearly. It also lets us know if the digestive tract is normal by assessing how long it takes for the barium to pass through to the end.

To understand how we perform a radiographic analysis of this problem it is important to understand the radiographic anatomy of a bird:

This is a normal x-ray of a bird laying on its right side. The head is towards the left. The diagram below explains the structures.

AS- air sac

PV- proventriculus

Vent- ventriculus (gizzard)

S- spleen

H- heart

This bird has PDS. The arrows circle the hugely dilated proventriculus.

We frequently give barium to help in outlining the digestive tract and to look for causes of the dilated proventriculus other than PDS.

In this x-ray the barium filled crop is on the far left (arrow on far left), there is barium in the esophagus (arrow in middle) and the ventriculus has barium in it (arrow on far right). The dilated proventriculus, without any barium in it, can be seen just to the left of the ventriculus.

Treatment

PDS carries a poor prognosis. Medication to minimize vomiting and supportive care with fluids, antibiotics, and feeding small amounts of food at each meal might be helpful temporarily.

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Lead Toxicity

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Lead is a heavy metal and can easily cause a toxicity (called plumbism). Other heavy metals, notably zinc, can also cause toxicity.

Cause

Birds are sometimes drawn to shiny objects, hence they will eat metallic objects that can contain lead. Birds are natural chewers and will chew cage bars and painted walls. In older homes there are sometimes layers of paint below the surface layer that contain lead. Lead particles can build up on the ventriculus (gizzard) and become toxic if in large enough quantity.

Lead is a heavy metal that is poorly absorbed by the intestines. Unfortunately, only a small amount is needed to cause problems. It eventually gets distributed to all body tissues, with particular emphasis on the digestive system, the red blood cells, the bone marrow, the liver and the nervous system.

Sources of lead could include; old paint, old cages, solder, stained glass, curtain weights, foil, fishing weights, batteries, linoleum, plaster, and putty.

Symptoms

Symptoms depend on how much lead is ingested over how long a period of time. The disease is sometimes broken down into acute lead toxicity and chronic lead toxicity.

In the acute version birds might be weak, depressed, produce abnormal droppings, and vomit. Neurologic signs could include walking in circles, twitching, incoordination and even convulsions.

Here is a short video of a bird with neurologic signs that could be caused by lead toxicity

Lead Toxicity Bird

Chronically infected birds can have similar symptoms to acute toxicity. In addition, they might lose weight, be partially or fully paralyzed, and even blind.

Diagnosis

History

In some lead infected birds there is a history of recent chewing of paint on the walls. In some cases the owners did not suspect any exposure to lead.

Physical Exam

The physical exam may or may not reveal significant abnormalities. It all depends on how much lead has been ingested over how long a period of time.

This bird has lead toxicity. It chewed the paint on the floor after the owner did some remodeling in an old home. He is alert and eating well but cannot walk well on his back legs.

Diagnostic Tests

A blood panel might be useful in this disease. In some birds we might see anemia or evidence of liver disease. When we suspect lead toxicity we can run a lead level on the blood.

A blood lead level gives us a more accurate indication if lead toxicity is present

This is from the bird above. His lead level is 0.5 parts per million, far above the normal range of less than 0.06

Some brids can have a zinc toxicity also.

One of the most consistent ways to diagnose lead toxicity is with an x-ray. Lead is a heavy metal and will show up vividly on a radiograph, usually in the ventriculus (gizzard).

This radiograph is also from the above bird. It has normal grit in the gizzard, but if you look closely some of the grit looks brighter than normal. The brighter objects are lead particles, not grit.

Treatment

Birds that are weak, losing weight, or not eating need supportive care. This consists of fluids and supplemental feeding. We will frequently hospitalize them until they regain their strength. If they are having seizures we can put them on anticonvulsant medication.

It is important to try to remove the lead from the ventriculus. Treatment with lubricating agents or even peanut butter will help pull the lead out of the gizzard to be passed in the droppings. On rare occasions, especially if the lead particles in the ventriculus are too large to pass, we will perform surgery to remove them.

Once your bird is stable and we have attempted to remove the lead from its ventriculus we use a class of medications called chelating agents. Their job is to go into the organs, especially the bone, where the lead has accumulated and counteract its affects. It can take several courses of treatment to completely treat your bird. These medications are not without risk, so they are used intermittently to give your bird a rest period in between doses.

We will treat until the lead level in the blood test is back to normal and there is no more radiographic evidence of lead in the ventriculus.

Prevention

It is the nature of birds to be chewers and put metallic objects in their mouth. Minimizing their exposure to lead containing objects is an obvious way to prevent this problem. Also, feeding them a balanced diet (not just seed) will help keep them from looking for nutrients they need and are not receiving in their diets.

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Egg Binding

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Egg Binding is a problem that occurs most often in the smaller female birds. Canaries, lovebirds, cockatiels, budgies (parakeets) and finches are the commonly affected breeds. Egg binding can be a serious problem, and is considered an emergency, requiring delicate and professional care. Unfortunately, some birds can succumb in spite of this care.


Cause

Infection, trauma to the reproductive tract, inadequate nesting area, excessive egg laying, obesity, and nutritional problems are some of the factors involved with this problem. Those birds on all seed diets or those with an inadequate calcium intake are particularly prone. An egg that is too soft can also cause the problem. Some birds are just prone to the problem, and even environmental factors like hypothermia can be involved. Determining the exact cause can be difficult.

Symptoms

Birds that have this problem might exhibit depression, labored breathing, straining, abdominal distention, lack of droppings, whitish droppings only, fluffed appearance, and poor appetite. There might even be a broken bone due to inadequate calcium. These are also the symptoms of other avian diseases. Pressure from a stuck egg can even interfere with nerve function to the legs. Sometimes the only symptom is your bird sitting at the bottom of the cage. Unfortunately, the only symptom in some cases is a dead bird found at the bottom of the cage.

Even a bird that is eating can have serious illness

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Diagnosis

In many egg bound birds there is a history of recent egg laying. Some birds exhibit sexual behavior and even build nests. During physical examination of a bird with a distended abdomen an egg can sometimes be palpated. There are other causes besides egg binding in sick birds with distended abdomens, so it is important to follow a thorough diagnostic process.

X-rays are a significant aid in making this diagnosis, but only if a bird is strong enough. Eggs shells have a high level of calcium, so depending on how well they are developed, might show up vividly on an x-ray. Some eggs are poorly calcified and do not show up well on a radiograph.

It’s not difficult to see the egg on this bird that is laying on its back. The circular whitish material just above the egg is grit in the gizzard (ventriculus).

Treatment

Egg bound birds are very ill and require emergency care. Many are hypothermic and require immediate warming. They can be toxic from the inability to eliminate waste products and dehydrated from poor appetites and weakness, so warm fluids are also administered. If the bird is in shock we will give these fluids via an intraosseus catheter. Calcium is also administered to aid in muscle contractions and hopefully expulsion of the egg on its own. Medications to stimulate the uterus to contract are also used. Whether or not they help depends on the cause of the problem.

If medical therapy does not work we attempt to help in the removal of the stuck egg. Once the bird is more stable we can sometimes gently expel the egg with liberal lubrication and digital pressure. If the egg is adhered to the uterus digital pressure might not work. Inserting a needle with a syringe attached directly into the egg allows us to collapse the egg and make expulsion easier.

This female is being examined with a lubricated speculum to determine the exact nature of her problem. We can deflate the egg by passing the needle through the speculum. The arrow points to a high intensity cool light that allows greater visualization.

Prevention

There are factors involved with this problem that we have no control over. Factors we can control are good nutrition, a clean environment, spaying birds that are predisposed to egg binding or are excessive egg layers, minimizing obesity and stimulating exercise.

Careful daily observation of your pets daily habits will help you recognize the early symptoms of this disease. No matter what the problem, any time your pet bird shows any symptoms of a disease, no matter how subtle, it is considered significant and requires immediate veterinary care. This is because birds are masters at hiding illness, and we are all too often presented with sick birds in advanced stages of disease. Our ability to return these birds to normal health is diminished because proper care has not been given early on in the disease process where it is most beneficial.

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Scaley Face Mites

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Birds are occasionally infected with a mite called Knemidicoptes (if you want to make an effort at pronouncing this word the K is silent). We usually encounter this problem in parakeets (Budgies) at our hospital. This parasite causes extensive crusting and hair loss, fortunately it is readily treatable.

Cause

Scaley face disease is caused by a mite called Knemidicoptes that is spread from bird to bird by contact. Some birds acquire this parasite while young and do not develop symptoms until they are young adults.

Diagnosis

This disease is diagnosed by the character of the lesions and the fact that it has occurred in a Budgie. Microscopic examination by a skin scraping will reveal the mite.

This bird has the telltale lesions of scaley face mites. There is crusting on the neck and face, and a honeycombed appearance to the beak. This is a severe case. In addition, this bird has a growth on its beak.

Lesions also occur in other areas, most noticeably in the vent and on the feet.

Treatment

Years ago the only treatment we had was an ointment that was used to treat pubic lice in people. It was messy and had to be applied daily, but it usually worked. Now we use the drug Ivermectin, given every week or two until the problem is gone, usually within 3-4 weeks.

This is the same bird as above 10 days after its first Ivermectin treatment. We removed the growth on its head a few days before this.

Here he is 2 weeks after his second treatment. He is almost completely healed and feeling a million times better. Hard to believe its the same bird.

He was brought into our clinic and dropped off as part of our wildlife program since he was a stray and was found by one of our clients. He has a great personality, and once we got him looking like this we had no problem finding him a home (with a girlfriend).

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Parrot Fever (Psittacosis)

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Parrot fever has many names, including Chlamydiosis, Psittacosis and Ornithosis. It is called Psittacosis when it occurs in people and psittacine (parrot types) birds, and Ornithosis when it occurs in passerine (pigeons, doves, etc.) birds. Psittacosis is difficult to diagnose, and is a mysterious disease that does not “follow the rules” of typical avian diseases.

Important Regulations

The United States Department of Agriculture regulates the importation of domestic birds in order to protect the domestic poultry industry. These imported birds must be accompanied by a health certificate. Upon admission they are quarantined for 30 days at a special facility and tested for Newcastle disease. During the 30 days they are given food supplemented with medication that will treat Psittacosis. This medicated feed needs to be continued for at least an additional 15 days when the bird is released from quarantine.

State Health Regulations

Psittacosis is a reportable disease. When a positive diagnosis of Psittacosis is made an inspection might occur to determine the cause of the outbreak, number of birds affected, and any human exposure. Depending on the specifics of the situation a quarantine and treatment might be initiated.

Human Health Significance

Humans can get Psittacosis (Chlamydia psittaci) from birds. Cats get Chlamydia psittaci and show evidence of eye problems, but there is no evidence that cats can spread this disease to people. Other species of the Chlamydia bacteria that occur in sheep, goats, and cattle can cause disease in humans, but those diseases are not called Psittacosis.

Exposure is usually due to the inhalation of dried bird droppings that contain the organism, incubation is 6-19 days. Other potential sources of infection are from respiratory secretions and feathers. Symptoms in people range from nothing to severe disease with pneumonia. Typical symptoms include fever, chills, headache, muscle aches and cough. Inflammation of the heart, liver, and nervous system can occur, with even fatal cases reported. With proper treatment most people recover. According to the Centers for Disease Control and Prevention, between 50-100 cases of human Psittacosis are reported each year, with probably many more undiagnosed. Probably due to increased awareness and diagnostic testing, annual incidence of Psittacosis in humans is decreasing.

Cause

Psittacosis is caused by a bacterium called Chlamydia psittaci that is an obligate intracellular parasite. It has been isolated from many birds, especially cockatiels and parakeets. After exposure the incubation period can vary from 3 days to weeks.

Healthy birds can be carriers of Psittacosis, shedding the organism in their droppings intermittently. It is also found in respiratory discharge. Shedding is stimulated in birds by stress like overcrowding, chilling, and shipping. The shed Psittacosis bacteria can remain infectious in the environment for several months.

Symptoms

Birds are masters at hiding any symptoms of illness, especially in Psittacosis. An apparently healthy bird that is singing and eating in the morning can be gravely ill or be found dead by the same afternoon. It is imperative that you tune in to subtle signs of disease in your pet bird, and bring it in for an exam at the first sign of a problem. If you are unsure, it is better to be safe than sorry.

Some birds with Psittacosis do not show any symptoms and can become carriers, shedding the bacterium intermittently, especially when stressed. Others might get a chronic illness or become severely ill and die. Symptoms depend on age at infection, species, virulence of the specific strain of the bacterium, exposure amount, and stress factors.

Typical symptoms, if present, might include a fluffed appearance, poor appetite, weight loss, respiratory disease, and lime green droppings. The droppings might appear to be diarrhea, but in reality they are usually watery urates, the equivalent of bird urine. Some birds have ocular discharge, leading to the term “one eyed cold”. These symptoms occur with many other avian diseases, so it is imperative to follow proper diagnostic parameters when making this diagnosis.

This parrot has a problem as evidenced by its fluffed appearance. It is fluffed because a disease process is preventing it from keeping itself warm, so it is trapping air under its feathers in order to insulate itself. Birds that do this consistently are ill. Psittacosis can cause this, but so can many other bird diseases.

Diagnosis

History

In some cases we have a high degree of suspicion because a bird has been imported into the country illegally. This means it has bypassed the USDA quarantine and treatment facility. These smuggled birds commonly come from Mexico. They can be purchased at swap meets for a low price, so you must be wary of these potential disease carriers.

Physical Exam

The physical exam may or may not reveal significant abnormalities. An exam of a bird gives us limited information compared to dogs and cats. This is because of the unique anatomy and physiology of a bird. Several examples will elucidate this point.

  • A birds body temperature can go well over 107 degrees F and still be normal
  • They do not have external lymph nodes that can be felt during an exam
  • Their heart rate can easily be up to 500 beats per minute, making it almost impossible to detect murmurs and arrythmias
  • They do not have a diaphragm, the muscle of breathing that separates the abdomen from the chest
  • They use air sacs as a major part of their respiratory physiology, as opposed to dogs and cats using only lungs.
  • Their keel bone extends far down over their abdomen, making it impossible to accurately palpate abdominal organs.

Diagnostic Tests

Since a physical exam on birds yields significantly less information compared to a dog or cat, we need to rely more on diagnostic tests.

Taking a blood sample from the small veins of a bird is a refined art. One of our nurses is taking one from the leg vein of a cockatoo.

A blood panel might be perfectly normal, or it might show significant problems. This is a blood panel from a bird positive for Psittacosis on the ELISA test. The arrows point to the significant abnormalities. The white blood cells (WBC count) are elevated, it is anemic (HCT is low), and its liver test (AST) is high. These findings give us an indication that this bird might have Psittacosis, but they can also occur with other avian diseases though.

Another diagnostic test helpful in Psittacosis is radiology because it allows us to visualize internal organs. This radiograph is also from the above bird. It has an enlarged spleen (S), the circular structure in the middle of its coelomic cavity.

If you would like to learn more about reading a bird radiograph click here.

Culture

Culture is used to detect the Chlamydia organism itself, and is one of the most accurate methods of making an accurate diagnosis. It is time consuming, requires special techniques and laboratories, and since shedding of the bacteria can be intermittent, samples need to be collected for several days. Also, it can take up to several weeks before the result is available, which defeats the purpose of the test for many ill birds. Unfortunately, the laboratories that perform this culture are not readily available to us.

Psittacosis tests

Psittacosis tests have been developed to aid us in our diagnosis. No test is perfect or applies to every situation and species. In some cases we will perform several of these tests to increase accuracy:

  • Antibody Tests- These tests check for antibodies made by the immune system when it is exposed to the Chlamydia organism. Birds that are stressed, in poor nutritional state, or have other diseases, might not produce antibodies at all. Also, it is possible for these tests to be negative early in the course of the disease when the immune system has not had enough time to produce antibodies.
    • EBA- Elementary Body Agglutination checks the antibody called IgM (immunoglobulin M), which is found early in the course of the disease. As a result, it is used as a screening tool for healthy birds or if a bird is suspected to be early in the course of the disease. A positive result does not easily differentiate a bird that actively has the disease from a bird that has been exposed in the past and is currently not ill. It only requires a small amount of blood in relation to other blood tests. IFA- Immunofluorescent Antibody checks for IgG (immunoglobulin G) that builds up in the bloodstream later in the course of the disease. It gives a better long term perspective as a result.
  • Antigen Tests- These tests check for the shedding of the Chlamydia organism in the feces. Viable Chlamydia are not needed for a positive diagnosis since they test for antigen or DNA of Chlamydia.
    • ELISA-Enzyme-Linked Immunosorbent Assay is used on ill birds. It was originally developed to detect human Chlamydia. Like the culture, samples should be taken over several days to increase the chance of finding the problem in intermittent shedders. It is an easy test to administer and can be performed as an outpatient basis with immediate results. False negatives and false positives can occur. a bird with a negative on this test still could have Psittacosis. A bird with a positive on this test might have Psittacosis.PCR- Polymerase Chain reaction is another antigen test. It has great promise and might become the test of choice in the future.

Autopsy (Necropsy)

Unfortunately, Psittacosis is sometimes accurately diagnosed only at necropsy.

This dark red organ is the enlarged spleen of a bird that died of Psittacosis.

This air sac is cloudy, an indication of an infection. Psittacosis could be a cause of this.

Treatment

Birds that are suspected of having Psittacosis are immediately isolated. Protective clothing should be worn at all times when treating these suspects. Routine surgical masks might not be adequate to prevent exposure.

Birds that are weak, losing weight, or not eating need supportive care. This consists of fluids and supplemental feeding. We will frequently hospitalize them until they regain their strength. The mainstay of treatment is with the tetracyclines.

There are several different methods to get this medication into a birds system in order to achieve adequate blood levels.

  • Medicated Feed- Medicated foods can be purchased or made up that contain 1% chlortetracycline (CTC). These need to be fed for 45 days. Acceptance is variable, so monitoring of food consumption is imperative. Calcium should not be greater than >7% in this diet because it can interfere with the tetracycline.
  • Oral Doxycycline- This is the drug of choice for oral treatment. It is also used for 45 days, and is given to birds that are cooperative.
  • Injectable Doxycycline- This drug, also know as Vibravenous, is given once every 5-7 days. Treatment is given for at least 6 weeks. Irritation can occur at the injection site, so it must be given under the direction of a veterinarian.

Prevention

Do not purchase a bird that seems ill or you suspect has been brought into this country illegally. New birds should be examined, tested, and quarantined for at least 45 days. During this 45 days these new birds can be treated also.

People with compromised immune systems should not be exposed to birds that might have Psittacosis. Gloves, masks, and protective clothing should be used when cleaning cages and working around birds suspected of this disease.

Clean cages and feeding bowls frequently, and set up housing so droppings, food, and feathers do not contaminate other cages.

Chlamydia psittaci is susceptible to routine disinfectants. Common ones include Lysol, bleach, 70% isopropyl alcohol, and Roccal.

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Prolapsed Cloaca

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Introduction

A cloacal prolapse is a serious problem requiring immediate veterinary care. Trauma to the internal organs that are prolapsed through the opening can seriously affect the bird. It is seen in cockatoos and the smaller breed birds like budgies and cockatiels. It requires immediate replacement of the prolapsed organs.

Cause

Straining due to parasites, abdominal masses or tumors, chronic egg laying, abnormal eggs and poor nutrition are all predisposing factors. Determining the exact cause can be
difficult.

Symptoms

Birds that have this problem might exhibit depression, straining, lack of droppings, fluffed appearance, and poor appetite. Sometimes the only symptom you notice at home is blood in the droppings. These symptoms occur in other diseases, so the diagnostic approach has to be thorough.

Diagnosis

In many prolapsed birds there is a history of recent egg laying. During the physical exam internal organs (intestines or reproductive usually) are apparent at the cloaca. When diagnostic tests are used their main indication is to find the underlying cause to the problem in order to prevent recurrence. These tests include fecal exams for parasites, x-rays for abdominal masses pushing on the abdominal contents, and blood panels to determine general health and organ function.

Treatment

Birds with prolapsed cloaca’s require emergency care. Many are hypothermic and require immediate warming. Others can be dehydrated so warm fluids are also administered. Antibiotics are usually administered to prevent infection in the affected organs.

Once a bird is stabilized the prolapse is replaced back into the abdomen. The sooner the better because internal organs that are exposed to the environment are easily traumatized and infected. Amputation could be needed on infected tissue or tissue that has inadequate blood supply.

In some cases we anesthetize the bird to allow muscle relaxation and subsequent easier replacement of the affected organs. This patient is in a special anesthetic chamber allowing us to safely administer the anesthetic.


This prolapse has been present for several hours. The coloration tells us it is healthy enough to allow replacement back into the abdomen. It will be gently cleansed and flushed with sterile saline. It is an internal organ and requires delicate handling.


The area is lubricated copiously with K-Y jelly and the prolapse is gently manipulated back into the abdomen using Q-tips. This process takes several minutes because the organ is swollen and predisposed to tearing.


After it is replaced special sutures (at the arrows) are used to prevent it from coming out again. They are put in tight enough to keep the organs inside but loose enough to allow droppings to pass. These sutures will be kept in for at least several days to allow the prolapsed tissue to heal.

Prevention

There are factors involved with this problem that we have no control over. Factors we can control are good nutrition, a clean environment, spaying birds that are predisposed to egg binding or are excessive egg layers, minimizing obesity and stimulating exercise.

Careful daily observation of your pets daily habits will help you recognize the early symptoms of this disease. No matter what the problem, any time your pet bird shows any symptoms of a disease, no matter how subtle, it is considered significant and requires immediate veterinary care. This is because birds are masters at hiding illness, and we are all too often presented with sick birds in advanced stages of disease. Our ability to return these birds to normal health is diminished because proper care has not been given early on in the disease process where it is most beneficial.

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