Search Results for: IBD

Inflammatory Bowel Disease (IBD)

Share This!

IBD is an inflammatory condition of the stomach, small intestines, or large intestines (the gastrointestinal (GI) tract).  It is sometimes called Idiopathic IDB. The Idiopathic part means that the cause of the condition is unknown.

IBD tends to be chronic in nature.  It is one of the most common conditions of the gastrointestinal tract diagnosed in pets, especially in cats. Despite its prevalence, it is one of the least understood conditions, especially regarding cause. Some pets respond well to treatment, others do not.

Some cases of IBD involve the liver and pancreas. In this case there are 3 diseases occurring, and we refer to it as Triaditis. This is more difficult to treat than IBD alone.

The usual symptoms of IBD are poor appetite, vomiting, diarrhea, and weight loss.  Cats tend more  towards vomiting, dogs tend towards diarrhea. These symptoms appear in many other diseases, so you cannot assume your pet has IBD from symptoms alone. To learn the process of how we make a diagnosis of a disease when the symptoms are the same as so many other diseases, we have a methodical and detailed approach. It is called the Diagnostic Process.

We discuss the importance of worms (internal parasites) many times in this page in regards to IBD. With the modern medications we have, including flea products that contain medication to kill worms, it behooves you to treat your pets for worms monthly. Not only might it help prevent IBD from appearing at some time in your pet’s life, it will protect you and your children. Our Internal Parasites page has the scoop on all of this.

In spite of its prevalence, many pets are diagnosed with Idiopathic IBD when they do not have it. To standardize what IBD is, the World Small Animal Veterinary Association has listed the following criteria to help make this diagnosis:

The GI symptoms must be present for at least three weeks

Diet change, worming, and medication do not give a significant reduction in symptoms

No other explanations can be found for the symptoms

Biopsies of the intestines show significant inflammation of the interior lining

The resolution of symptoms when put on mediations that modulate the immune system (immunosuppressive).

This criteria means that a pet that responds to just a diet change technically has a Food Responsive Enteropathy. If a pet responds just to antibiotics then it technically has an Antibiotic Responsive Enteropathy.

Graphic photos of surgeries are on this page

Anatomy and Physiology of the Gastrointestinal (GI) Tract

When your pet eats, food from the stomach passes into the small intestine, which is composed of three different sections called the duodenum, jejunum, and ileum.

The majority of nutrient (proteins, carbohydrates, fats) digestion occurs within the small intestines.  The inner lining of the intestines is called the mucosa, and that’s where all the action occurs when it comes to absorbing nutrients. The mucosa has a large surface area because there are microscopic folds called villa.

Ilium-NormalMucosa

This is the lining of the small intestines. The villa are microscopic, so you cannot see them without a microscope.

There are many different types of specialized cells in the lining of the mucosa. Some of these cells specialize in aiding digestion, some are for absorption of these nutrients into the bloodstream, and some are part of the immunes system and defend the body from foreign invaders.

These immune system cells are important for protection due to the constant exposure the GI tract has to outside invaders in the form of oral ingestion of food and its many contaminants. It is these cells that can overreact and cause IBD symptoms.

Surgery-SmallIntestines

These are the small intestines during a routine abdominal surgery. Notice the extensive blood supply, necessary to get those nutrients from the lining of the intestines into the bloodstream, and then off to every cell in the body- amazing!

Ilium-Ingesta

This is what the ingesta looks like as it passes through the small intestines

The pancreas secretes digestive enzymes into the small intestines as the food passes through the duodenum. These enzymes are crucial for digestion of fats, carbohydrates, and proteins. As the food continues down the small intestines the enzymes from the pancreas continue their breakdown of nutrients, which are then absorbed by the mucosa of the jejunum and ileum and make it into the bloodstream.

Pancreas-labeled

This is the pancreas, a small but mighty organ. Our surgeon is holding the duodenum (D), with the pancreas in the center (D).

Pancreas-Normal

Close up view of the architecture on the outside of the pancreas

The gall bladder secretes bile into the duodenum to help in digesting fats. When the liver is a part of IBD the bile can build up in the liver and cause a problem. This is a part of the Triaditis that complicates IBD.

The large intestine is composed of the cecum (our appendix), colon, rectum, and anus. Water, electrolytes (sodium and potassium), sugars, and vitamins are the main nutrients absorbed by the large intestine. Some vitamins are produced in the large intestine also. Nutrients that were not broken down or absorbed well enough within the small intestine are further digested in the large intestine due to microbial fermentation. The large numbers of these good bacteria that are present in the intestines are crucial to normal health.

The human cecum (appendix) has atrophied to the point that it is no longer needed. Our diet does not have the fiber of our ancestors, so this organ is not needed for normal digestion, which is why it can be removed if appendicitis occurs. As a fun anatomical comparison, the cecum of a rabbit is enormous in relation to the rest of its body. That is because it is a hind-gut fermenter, and contains large numbers of bacteria to help digest food that is high in fiber. Our rabbit GI stasis page has radiographs of the cecum along with actual pictures to give you an idea of just how large it is.

Pathophysiology

Allergens cause inflammation of the mucosa, leading to the symptoms associated with IBD. The allergens that cause this inflammation can be anything, with food (especially protein) as the main culprit.  Bacteria and parasites are also allergens that cause inflammation of the mucosa. It is the immune system that over reacts to these antigens that causes the symptoms of IBD. This immune system over reaction is why pets that truly have IBD need medication to suppress the immune system, in addition to dietary changes and antibiotics.

Intesinte-normal lumen

The size of the lumen thorough with the food passes and intestinal wall thickness of a normal small intestine

ThickenedSmallIntestine

You can easily see the smaller lumen and thickened intestinal wall in this pet with IBD

Inflammation of the pancreas is known as pancreatitis. In pancreatitis, the digestive enzymes that would normally be secreted into the duodenum to digest food are now leaking out of the pancreas into the abdomen, causing tremendous inflammation and pain to surrounding organs. Pancreatitis is a serious disease, and usually requires hospitalization, intravenous fluids, and medication. It can be hard to diagnose in cats because they usually become quiet and sit as if content, when in reality they are in pain. A clue is the fact that are not eating well.

Inflammation of the liver in some cases may be associated with IBD, permitting an infection to creep up the bile duct and into the liver. There are many different sources to this infection, ascending from the GI tract or urinary tract.

The pancreas, liver, and intestines are closely associated, and when one has a problem it causes inflammation in one of the other ones. When all three have a problem it is called Triaditis. As you can see, it all gets quite complicated.

Cause

IBD is one of those conditions where the exact cause might never be identified. The most common causes are dietary allergies, infections, and environmental stress. Stress can happen in multiple pet households, during holidays, and in extreme weather.

Dietary allergies are involved with sensitivity to protein in the diet. Sometimes, an inability to absorb nutrients, called a malabsorption syndrome, is involved. Some pets generate an excessive amount of a specific white blood cell called an eosinophil (eosinophil gastroenteritis) in the lining of the GI tract.

Other dietary causes might include artificial coloring, preservatives, and food additives. Differentiation between the above-mentioned causes is difficult, especially since many IBD cases are associated with several concurrent factors.

It is suspected that puppies with a large amount of internal parasites (worms) are setting the stage for IBD later in life. This is another good reason to have your pet checked for internal parasites at least yearly, and wormed frequently when young.

Pancreatitis is highly associated with pets that are overweight, particularly spayed female dogs. Fatty meals are important components of the clinical history for cases involving pancreatitis. As a result, we tend to see this cause of pancreatitis around the holidays when people are celebrating with turkey (and gravy) and other similar foods that their pets’ eat also.

Inflammation of the pancreas can spread to the liver  due to its proximity.  This can inflame the gall bladder, causing bile to backup into the liver. This can lead to Triaditis mentioned earlier.

Inflammation of the liver and biliary system, known as cholangiohepatitis, is most commonly associated with a bacterial infection.  In cases of Triaditis, it is unknown as to whether the liver is the first organ affected, resulting in secondary inflammation of the pancreas and gastrointestinal tract, or if it is the other way around.  It has been hypothesized that bacterial infections may be the initiating cause of cholangiohepatitis, with IBD and pancreatitis following thereafter.

Dietary Induced

Proteins and grains in the food contribute to dietary intolerance. Intolerance occurs when there is an abrupt change in the diet, resulting in an inability for the gastrointestinal tract mucosa and associated cells to adapt accordingly.  When this happens foods are often not digested or absorbed properly.

Maldigestion is a separate condition of the gastrointestinal tract that generally occurs secondary to exocrine pancreatic insufficiency. The endocrine pancreas secretes insulin to regulate the blood glucose level. The exocrine pancreas secretes the digestive enzymes needed to digest food in the intestines. If the pancreas is not secreting enzymes into the small intestines as the food passes, the nutrients will not be broken down and absorbed into the bloodstream. This leads to weight loss and diarrhea, even in a pet that is eating.

Malabsorption is secondary to numerous disease processes such as food allergies and/or intolerance, protein losing diseases of the gastrointestinal mucosal layer, intestinal parasites, antibiotic responsive disease, cancer, IBD, and immune-mediated disease. The exocrine pancreas is secreting the proper digestive enzymes in this cause. It is an inflammation of the inner lining of the intestines (the mucosa) that prevents absorption of the nutrients into the bloodstream.

Intestinal parasites (worms)

There are numerous intestinal parasites known to cause the same symptoms as IBD. They include roundworms, hookworms, whipworms (dogs only), cryptosporidia (protozoa), toxoplasma (protozoa; cats only), coccidia, and giardia.

Some intestinal parasites are known to affect humans as well (zoonotic potential). These include the larvae of roundworms causing organ involvement (visceral larval migrans), or eye involvement (ocular larval migrans), hookworms (skin involvement), giardia (gastrointestinal disorders), coccidia (gastrointestinal disorders especially in immune suppressed individuals), toxoplasma (congenital defects in babies), and cryptosporidia (gastrointestinal disorders).

A fecal examination is often one of the first steps when diagnostics are being evaluated in a pet with a gastrointestinal disease. Our intestinal parasites page has detailed information on these parasites (worms). We sometimes do  a fecal Giardia test since this parasite can be hard to detect.

Cancer – Lymphosarcoma (Lymphoma)

In cats, lymphosarcoma is the most common type of cancer known to affect the gastrointestinal tract. This is not easy to diagnose, since the changes present in IBD are very similar to those in Lymphosarcoma when the pathologist analyzes them under the microscope.

Depending on the type of lymphoma (small, medium or large cell lymphoma), tissue samples must be sent in for further diagnostics in order to definitively differentiate between early cancer and IBD. Proper treatment depends upon a proper diagnosis.

VeryThickenedSmallIntestine

These severely thickened intestines are from cancer

We have a page that shows an exploratory surgery on a cat with intestinal cancer.

Bacterial infection

Although there are no definitive infectious agents that consistently result in IBD, some organisms such as Giardia, Salmonella, Clostridium, and Campylobacter could be a cause. Some of the “good” bacteria, those that are necessary for life, can become imbalanced and cause the symptoms seen in IBD.

Medications

Any medication can disrupt the lining of the intestines. The most common one is antibiotics, since they disrupt the normal GI bacteria (referred to sometimes as flora).

Other causes

Toxicities (plants, chemicals), hyperthyroidism, FIP, FeLV, FIV .

Diagnosis

Signalment

Both dogs and cats are commonly affected by IBD, although it is much more of a problem in cats. IBD can occur at most any age due to the numerous causes of the condition; however, it is usually observed in pets over the age of two .

Triaditis is more commonly diagnosed in middle to older aged cats.  If it is associated with a food allergy, they tend to be young adults to middle aged. Males and females get IBD in equal frequencies.

Addison’s disease, which is common in Standard Poodles, can cause symptoms similar to IBD.

History

Sometimes pets are affected by IBD for many years while appearing apparently healthy in all other aspects. Typical symptoms are  lethargy, poor appetite (anorexia), weight loss, diarrhea and vomiting.

Depending on the inciting cause, the clinical signs may occur intermittently over a long period of time (i.e. dietary allergy) or abruptly and progressively (immune-mediated, infectious, dietary allergy, cancer). If Triaditis is present clinical signs may range from lethargy and decreased appetite to severe vomiting, diarrhea, abdominal pain, and icterus (jaundice) due to liver compromise).

OLYMPUS DIGITAL CAMERA

This pet has severe icterus (also known as jaundice)

Cats can have variable symptoms compared to dog. Cats that have pancreatitis might sit quietly and appear to have no problems. In reality, these cats are painful, which is why they sit like this.

Physical Exam

In both dogs and cats, palpation of the abdomen might reveal painful and thickened bowel loops. This is not a consistent sign, and just because bowel loops are thickened, does not mean there is a problem. Pain may also be associated with palpation of the pancreas or liver in cases of Triaditis.

Lymph nodes deep within the abdomen may be enlarged and palpable as well as painful. Excessive intestinal sounds (called borborygmus ) might be heard on auscultation of the abdomen. In more chronic cases, other subtle signs may be present such as a dull hair coat, mild to moderate dehydration, fever, and overall poor body condition. None of these are consistent findings, and cannot be relied upon for a diagnosis of IBD.

XRays-LymphNode

These lymph nodes, call the sub lumbar, are enlarged on this dog. They are the whitish circles within the red circle. They are due to cancer, but they cannot be palpated.

Diagnostic Tests

Complete blood count, biochemistry panel, and urinalysis, are a starting point for diagnosis. Certain blood values might suggest IBD if in combination with clinical signs. Even “normal values” are clinically diagnostic, as they help to rule out another disease that can cause the same symptoms as IBD. A pet with a perfectly normal blood panel can still have IBD.

Some pets will have a chronic anemia (low red blood cells). Sometimes the white blood cells will be elevated, in other cases the protein will be low (hypoproteinemia). There might also be a low cobalamin level.  Cholangiohepatitis (inflammation of the liver) in cats, when Triaditis is present, may be further suspected if bilirubin (hyprebilirubinemia) or liver enzymes are increased. A bile acids test helps assess the liver in these cases.

LiverTests

The blood panel is very thorough and checks many different organs and systems. This is a few of the many tests, the elevated liver tests are circled, and could be a sign of Triaditis in this case.

A resting cortisol test might also be used to eliminate Addison’s (hypoadrenocortocism) disease

Fecal examination is an important and inexpensive test to rule out internal parasites (worms). We sometimes give worm medication (called anthelmintics) to pets with a negative fecal if they have and GI symptoms. This is because a pet can have internal parasites that do not show up on a fecal exam. Our intestinal parasites page has much more information explaining this.

A fecal exam, checking for internal parasites (worms) is important in every pet with any signs of illness. In this exam, we are checking for eggs (ova) of the parasite. A special test for Giardia is also used. 

Bacterial cultures are also utilized in some cases. The bacteria we are checking for include:

Campylobacter

Salmonella

Cryptosporidium

This is what we want to see when we do a urine culture- no bacterial growth in 48 hours

Abdominal radiographs are often normal in cases of IBD, but are a necessary tool to rule out other causes of similar clinical signs. Survey abdominal radiographs are also indicated prior to ultrasound  as well.

Xray-PenniesInRectum

This dog had chronic diarrhea.  Nobody took a radiograph prior to treatment. The cause was not IBD, it was the pennies stuck in the rectum.

IBDRadiograph-thickened intestines

This cat has IBD, as evidenced in this case by the thickened small intestines at the arrow. This can also be a normal finding, and it can also be a sign of intestinal cancer. The more common intestinal cancers are lymphoma, adenocarcinoma, and mast cell tumors.

Prior to the common use of ultrasonography, barium contrast studies were performed in order to reveal disruptions of the mucosal surface along the gastrointestinal tract.  We are looking for filling defects and ulcers of the mucosa and thickening. Barium has lost some of its significance since ultrasonography tends to be much more sensitive. One very nice “side effect” of giving barium to a pet that might be vomiting is its soothing affect on the lining of the intestines (mucosa) to stop the vomiting.

TLI type tests- serum fPLI (pancreatitis), fasting serum TLI (exocrine pancreatic insufficiency), fasting serum cobalamin and folate (small intestinal function and bacterial overgrowth). These are specialized tests and take several days for the results to come back.

Endoscopy is a useful tool since we can observe the lining of the esophagus, stomach, and duodenum for ulcers, lesions, and foreign bodies, that might not show up on a radiograph. Biopsy samples can be taken, although they are not full thickness, and only take the lining of the small intestines. This can lead to an inaccurate diagnosis.

This is a report from a stomach and intestinal biopsy with the endoscope

The most accurate way to diagnose IBD is to perform an exploratory surgery and take full thickness intestinal biopsy samples. If the blood protein level is low (hypoproteinemia) care must be taken because healing can be delayed.

Samples obtained during surgery are analyzed by a pathologist to help confirm a diagnosis of IBD, and also rule in or rule out the possibility of  intestinal cancer. Sometimes  the pathologist cannot tell the difference between IBD and cancer due to the abundance of inflammatory cells. During surgery, samples of other important organs like the liver and lymph nodes can also be obtained. These samples are very informative, and are taken in many cases.

IntestineBiopsy

Surgery has the major advantage of being able to see and palpate the intestines, along with taking a complete (called full thickness) sample of the intestines. This surgeon is using a scalpel blade to take the sample.

These samples are analyzed by a histopathologist. The report might come back with several different terms describing the IBD in specific medical terms, depending on the cell type:

  • Lymphocytic-plasmacyltic (the most common one)- respond best to diet change, antibiotics, and immunosuppressive drugs.
  • Eosinophilic (2nd most common)- respond best to worming medication, diet change, and sometimes immunosuppressive drugs
  •         Neutrophilic- bacteria is a possible cause, so culture and antibiotics, with no immunosuppressive works best
  • Granulomatous- least common, suggests fungal or intra-cellular pathogen

Ultrasonography of the abdomen is an invaluable diagnostic tool. Prior to the advent of ultrasound, exploratory surgery was needed to make an accurate diagnosis, and that was only after biopsy samples were obtained. Ultrasound is dramatically less invasive and expensive compared to surgery, and the results are obtained immediately in many cases. In the case of IBD it can tell us of thickening of the intestines and gives us a suspicion that IBD is indeed present, but it cannot confirm the diagnosis.

Ultrasound is a big aid in the diagnosis of IBD in its ability to to rule out cancer and foreign bodies as a cause of vomiting. It also gives us an accurate way to biopsy internal organs like lymph nodes.

Ultrasound-Machine

Ultrasound is rapid and painless, and the only invasive part is shaving your pet’s abdomen

UltrasoundReport-IBD

This is a typical report of a pet with IBD. Note how detailed it is, and how organ size is measured. 

Ultrasound can be used to measure wall thickness of various segments of the intestinal tract, which yields supportive evidence in the face of clinical signs. However, it cannot be used to differentiate between IBD and other disease processes that result in significant inflammation of the intestinal wall (i.e. lymphoma). This is where surgery has an advantage since full thickness biopsy samples can be taken for analysis

Ultrasound-SmallIntestine

This is what the small intestines look like during ultrasound while they are being measure for size

Ultrasound-Pancreas1

This is what the pancreas looks like, also being measured

Ultrasound-MesLymphNode

All of the abdominal organs are assessed during an ultrasound. This is what an enlarged abdominal lymph node looks like.

Fine needle aspirate samples may be obtained with the guidance of ultrasonography.  Sometimes this test is diagnostic, sometimes it is not. Even though it is not a perfect test, we sometimes recommend it due to the simplicity in obtaining it.

A hypoallergenic diet trial may be issued for cases of highly suspected dietary allergies or intolerance. In such cases, some pets respond when the diet is altered and no further diagnostics are necessary. You must feed this food, and only this food, to see if this works. Sometimes results are immediate, other times it might take several months to know for sure.

This can be a risk if the diet trial is attempted before numerous other disease processes are not first ruled out, especially cancer and internal organ diseases like Feline Hyperthyroidism.  This delay in diagnosis can affect outcome. If clinical signs do not improve or resolve within the first two weeks of the diet trial, then further diagnostic work-up is indicated.

Treatment

Depending on the severity of disease at presentation, treatment must first begin with stabilizing the pet. What we do to stabilize depends on the severity and duration of symptoms.

Symptomatic

Stabilization generally includes intravenous  fluids to correct dehydration, correct electrolyte imbalance, and improve kidney function. If the protein level is low we might use a fluid called Hetastarch.

Pets that are not eating are assist fed a special diet called A/D to maintain appropriate caloric intake and to prevent further disruption of internal organ function and get the GI tract back to normal. Probiotics to help stimulate the normal bacterial flora might be beneficial.

Vomiting pets are continued on fluids to maintain normal hydration, and given a specific medication called Cerenia (maropitant) to stop the vomiting. This drug has been a tremendous help in alleviating vomiting in pets due to many different causes. We use it for IBD and also for other GI problems like parvo virus and pancreatitis without IBD. Cerenia works on the emetic (vomiting) center of the brain.

Cerenia

We use the injectable version in the hospital, and send home an oral version if needed

Diet

It must be understood that if one of our doctors recommends a dietary change to treat your pet’s IBD that the only food or treat that can be fed to your pet is this new diet. Nothing else can be used as a food source. Feeding other foods is a reason why this dietary change does not work in some cases. When multiple people feed a pet this needs to be communicated to everyone.

Dietary intervention is considered a mainstay for many gastrointestinal cases because a large proportion of cats and dogs with gastrointestinal disease are associated with food-sensitivity. We need to get these pets eating again for the intestines to return to normal function.

Dogs and cats with pancreatitis, which is painful and causes severe illness,  do well initially with a low fat diet in the early stages to get them stronger and get the intestines used to digesting food again.  I/D (Intestinal Diet) has been used by our doctors for well over 35 years, and is the gold standard for pets with GI problems. After the pet is stable we look for a long term food.

PrescriptionDiet-ID

I/D comes in many variations, and our doctors will tell you which one is appropriate for your pet’s specific problem

Hydrolyzed Protein Diet

 It is the protein component of the food that causes the problem in IBD. Hill’s has solved this problem by making a food with a hydrolyzed protein that does not cause a reaction. It is unconditionally guaranteed, and is worth using in every case because it works often, and you can get your money back if it does not work. This is a complete diet and can be fed for the rest of your pet’s life. It is very rewarding when a dog or cat with the signs of IBD improves on only food and does not need medication.

PrescriptionDiet-ZD

The best food we have found overall for dogs and cats with food allergy is called Z/D

Novel Protein Diets

Novel proteins are not manipulated protein sources (as compared to hydrolyzed proteins like Z/D), but are simply new proteins that the pet has never ingested before. Many dogs and cats immune systems have not been exposed to venison, duck, or rabbit. Due to the fact that it takes long-term exposure to a protein before the immune system will react against it, then these novel protein diets are often attempted when the protein source is suspected to be the cause of IBD. The new diet will take at least 2 weeks, and up to 4 weeks, for the symptoms to diminish or resolve.

These foods might contain:

Potato

Duck

Sweet potato

Venison

Salmon

Vitamin supplementation is a critical component of treatment for some individual pets whose IBD stems from a deficiency in cobalamin (vitamin B12), specifically in cats.  Pets that are sick enough to have a low cobalamin level are generally in need of more than just vitamin supplementation, requiring a combination of other medications and dietary alterations.

Immune Modulators

Steroids (corticosteroids) are used in many cases in order to decrease the inflammation. The most common ones include prednisolone or prednisone. Budesonide, is a weaker steroid, that is also used. If the root of IBD or Triaditis is due to an immune-mediated process, then more potent immune system suppressants than steroids are required, such as cyclosporine, chlorambucil, or azathioprine.

Cyclosporine is an immune modulation drug that can suppress the inflammation from IBD.

Chlorambucil (Leukeran) is a chemotherapy drug for treatment of resistant IBD or some forms of cancer

Antibiotics

Antibiotics should be chosen based on bacterial culture and susceptibility when possible, especially in cases of Triaditis. Antibiotics such as Flagyl (metronidazole) are very commonly used for their ability to treat patients with chronic diarrhea. Some pets respond well to this medication only (they have Antibiotic Responsive Enteropathies). Flagyl suppresses the bacteria that are involved with IBD, and also mildly decreases the immune response that is an important component of IBD. Other antibiotics include Tylosin, Amoxicillin, and Fluoroquinolones. Tylosin must be compounded.

Probiotics and Probiotics

These are commonly used to help with the trillions of beneficial bacteria in the GI tract. IBD disrupts these “good” bacteria, and even the antibiotics we use to treat IBD can disrupt the normal GI flora. Make sure there is not a chicken or beef base.

Probiotics have bacteria that are considered to be beneficial to the GI tract. Probiotics have fiber that is fermented for good bacteria.

Liver Support Medication

When the liver is involved (Triaditis) we might also use Actigall (ursodiol) or Denamarin (s-adenosyl methionine)

Denamarin

IBD can be painful, and it is important to keep the pet as comfortable as possible during an acute episode of IBD or severe case of Triaditis. Prednisone, prednisone, and Flagyl decrease inflammation, which helps minimze pain. Specific pain medications are also used.

Stem Cells

Limited studies show promising results

Fecal Transplant

A last resort that can be effective. The feces must be negative for pathogens.

Prognosis

The prognosis depends on many factors. This disease is usually not cured, unless there is a food allergy and we find the right diet for your pet. Most cases are controlled with diet and medication. IBD and it’s associated diseases tend to be a long-term problem that is usually managed successfully. You increase your chance of success by giving medication consistently and bringing your pet to us for exams and diagnostic tests to look for changes that require a change in treatment.

Return to Diseases Page

Continue Reading

Spleen Hematoma

Share This!


This page stresses the importance of routine yearly exams, and close owner observation, on our pets. Large breed dogs can be stoic, and have significant problems brewing without showing any outward signs. When serious symptoms like weight loss and lack of appetite finally show up, the disease process is usually well entrenched, and there is little we can do. We want to see these pets before it gets to that stage.

Pets are masters at hiding illnes, so it can be difficult if they are ill. It might be a good idea to read our short page on symptoms of disease to know what to watch for.

We also have a nice page on teaching you how to do an in-home exam. If you bring your pet to us one of our staff will go over this with you, and do a hands-on demonstration of how to palpate the peripheral lymph nodes. This early warning system is a great way to catch problems early in the course of disease.

History

A beautiful male labrador retriever named Colt came in for a routine Wellness Exam when he was 10 years old. During this exam Colt’s owner told Dr. Palazzolo that Colt vomited on occasion over the last month, but that otherwise he was doing fine. He is a calm dog, and just lays around a lot.

Exam

Colt’s body temperature was normal, and his weight was the same as a previous visit. A pet’s weight is a good idea of how well it is doing, and if it is maintaining its weight that is usually a good sign. In Colt’s problem, this is not the case.

During the physical Dr. P noted a very tense abdomen, so tense that he could not even palpate internal organs. After this was noted, the owner did say that Colt’s abdomen seemed to be distended. The rest of Colt’s thorough physical examination was normal.

The distended abdomen is a significant finding, and warranted a radiograph, in addition to the blood panel which is part of the Wellness Exam.

Diagnostic Tests

ColtRad

You don’t need to be a radiologist to know something is wrong with this abdomen, as evidenced by the large and round whitish structure

NormalAbdDogRad

Here is a normal abdomen for comparison. In this normal radiograph you can see individual organs, unlike the abnormal one above, that looks like it has a beach ball inside of it.

This is a serious finding, and this mass could have many causes, and involve almost any internal organ. Due to its size, shape, location, and the relative lack of symptoms, it was probably the spleen. It could be a benign tumor of the spleen called a hemangioma, a malignant tumor of the spleen called a hemangiosarcoma, or a hematoma of the spleen. A hematoma is a blood filled cavity that is benign.

Its size said it might be a hematoma, which has the best prognosis of the three. To learn much more about spleen tumors please visit our hemangiosarcoma page.

ColtCleanChest

Before we proceed any further we take a radiograph of the chest to make sure there has not been any spread of tumor to the lungs. The white object in the center is Colt’s heart, the dark areas around the heart are the lungs. This is a normal chest radiograph.

You can learn much more about how to read a radiograph if you are interested

Our radiologist, Dr. Ann Reed, performed an ultrasound of the abdomen. This ultrasound lets us know if the mass is actively bleeding, and if there has been any spread of the mass to the right atrium of the heart. If that is the case, the mass is probably a hemangiosarcoma that has already spread. This is not a good prognosis.

ColtUS

Colt’s ultrasound report showing it is probably benign, and consistent with a hemangioma or hematoma

Pre-surgical Preparation

In Colt’s case there was no abdominal bleeding, and the heart was OK. Colt’s blood panel came back normal, so we did a cross match of his blood, and readied a unit of blood for a transfusion in case we needed it during the surgery scheduled for the next day.

Agglutination Crossmatch substrate Crossmatch blood Transfusion kit
BloodCrossMatch2 BloodCrossMatch1 BloodCrossMatch3 spleen-transfusion

Before we do a blood transfusion we do several tests to minimize a transfusion reaction

We were much better prepared for surgery the next morning with all of this information. During the night prior to surgery Colt was given intravenous fluids to stabilize him and make him a better anesthetic risk, and a pain patch was put on. Having the pain medication on board before surgery increases its effectiveness. Colt is now good to go for surgery the next morning.

We have a short page that talks all about how we do surgery at the Long Beach Animal Hospital. You might want to check it out before you see Colt’s surgery.

Graphic and bloody photos of surgery to follow

Colt did great overnight.  We took away his popcorn after the Lassie movie ended (he likes classic movies), and he rested comfortably during the night, monitored by our night crew. He slept well, and dreamed of being a famous movie star like Lassie.

ColtJenn

 Here he is with Jennifer the next morning, keeping an eye on our surgical team as they prepare for his surgery.

KennedyExam

Colt gets some extra petting for being a good boy, by his surgeon, Dr. Kennedy

KennedyExam1

Even though Colt has been thoroughly checked, we always perform a physical exam just prior to inducing anesthesia. An important organ to assess is the heart. If we suspect something is wrong with the heart when we listen to it we will do a pre-anesthetic EKG (electrocardiogram).

If you like heart stuff we have a very detailed page on heart disease in animals. It’s not for the “weak of heart” (pun intended), because it goes into all sorts of anatomy and physiology. If you get through it give yourself a pat on the back, and think of applying to veterinary school!

Propofol

Colt’s anesthesia is initially given by injection. Once he is relaxed we put in a breathing tube and start prepping his abdomen for surgery.

surgery-monitor

This surgical monitor allows us to detect any impending problems, and make adjustments before problems become serious.

Rabbit-femurfx-9

Even though we use these hi-tech machines to monitor important physiologic parameters during surgery, we also use the hands-on approach to make sure we do not miss anything. In this picture our anesthetist is listening to the heart with a stethoscope.

AnesthesiaReport

During the procedure Colt’s vital information is closely monitored and recorded. Our anesthesia page has more details.

Instruments

While Colt is being readied for surgery Dr. K is getting her instruments ready. She will need many clamps to close off the blood supply to the spleen before it can be removed, which required more than one surgical pack.

draping

When Colt is prepped, and under the proper plane of anesthesia, Dr. Kennedy does her draping. This draping is an important part of the surgery, and is doing carefully.

JessicaTerri

It will take more than one pair of hands to get this spleen out, so our surgical assistant, Jessica, stands by waiting for instruction. Terri our anesthetist keeps a close tab on everything.

Incision1

The initial incision is only though the skin. Blood vessels just under the skin are clamped before we go any further.

Incision2

You can see the two clamps that are controlling bleeding in the subcutaneous (SQ) tissue just under the skin. Colt’s spleen is humungous, so it will take a long incision to get a big enough opening to remove it

Incision3

Even though the incision was made as long as possible, the opening was still not big enough to remove the spleen. Dr. K had to make a side incision in the abdomen to facilitate removal.

SpleenBloodSupply

The spleen has an extensive supply of blood vessels that are near the stomach. A large part of this surgery is identifying and ligating these vessels, and doing this without damaging the blood supply to the stomach. These blood vessels are intertwined in tissue that is covering the spleen as the body attempts to wall of this large mass. This is the most meticulous part of the surgery, and Dr. K’s experience and skill at doing this before pays off.

LargeVessel

These blood vessels are large and need to be handled carefully

ClampingVessles

It takes multiple clamps and special suture material to perform this important part of the surgery

JessicaHoldingClamps

Jessica is kept busy holding clamps while Dr. K identifies and continues to ligate the many blood vessels to the spleen

FirstRemovalAttempt

As more of these vessels are ligated Dr. K carefully attempts to get the spleen out of the abdomen. No luck the first time.

Adhesion

An adhesion from the intestines to the spleen was identified and removed. Time to try to get the spleen out again.

SecondRemovalAttempt

 We need to be very careful at this point that we do not rupture the spleen by forcing it out.

FirstRemovalAttempt

With gentle coaxing and manipulating, along with Jessica’s help holding the abdomen open, we almost have it out, but not just yet

ThirdRemovalAttempt

It was time for Dr. P to stop taking photos and assist in surgery. He has removed many spleens in his decades of surgery, and with the help of Dr. K and Jessica, was able to extricate the spleen. Now Dr. K could finish ligating blood vessels (and hopefully Jessica does not need to scratch an itch at her nose)!

JessicaHolding

Here she is doing a great job

FinalCut

The final blood vessel to the spleen is cut while Jessica holds on to the spleen

JessicaHoldingFinal

After almost 2 hours of surgery Colt is now lighter on his feet

FourteenPounds

It’s official, 14.095 pounds!

SpleenHematoma

The vertical and long structure on the left is an enlarged and normal spleen, with the hematoma of this spleen on the right

Lavage

Surgery is nowhere near done. After Dr. K looks for any significant bleeding on the blood vessels she ligated, she flushes the abdomen numerous times with warm saline.

LineaSutures

The long process of putting Colt back together now begins. The most important suture layer is an area called the linea alba. This is where the muscle bellies of the abdomen meet, and is a tendinous area that is very strong. This is where the first and most important layer of sutures is placed.

SkinSutures

After more layers of sutures are placed, and before Dr. K puts in skin staples, Colt now has a bikini scar (OK, maybe not, but once the hair grows back nobody will know his secret)

Local

In addition to the pain patch put on the night before, and the pain injection given during surgery, a long acting local anesthetic is placed at the incision. Now Colt will be comfortable when he wakes up and through the night.

LocalStaples

All of our abdominal surgeries receive therapy laser treatment on their incisions. This aids in both healing and pain control. Notice the staples in Colt’s skin incision.

FirstBandage

Now comes the bandage; the first layer is gauze and telfa pads

SecondBandage

After more pads and gauze are put over the incision, the outer layer is wrapped by Terri while Jennifer and Jessica hold up Colt. They are getting their biceps exercise for the day!

LastBandage

We did the surgery the day after Halloween, so we thought this was an appropriate colored bandage

Trophy

Our dedicated surgical team posing with their trophy. Great job!

Colt was closely monitored for several days, and his red blood cell count was checked to make sure he did not need that blood transfusion. He went home after 2 days and was back to normal in no time. Yea Colt!

HemangiomaReport

Great news on Colt’s histopathology report, confirming it is a hematoma. Colt should make a complete recovery and lead a normal, if not lighter, life.

HemangiomaHisto

Just in case you want to see what a spleen hematoma looks like under the microscope here is your chance

047A8608

Colt with his happy mom two weeks later when he came in for his staples removal

 Case Summary

If you go back to Colt’s initial history the owner stated Colt vomited on occasion over the last month. Looking at the size of this hematoma (a record for Long Beach Animal Hospital), the hematoma was probably brewing over several months. Its a wonder Colt could even eat, and was not vomiting more, with a hematoma of this size in his abdomen. If Colt had not been brought in for his Wellness Exam, this hematoma could have easily ruptured, causing Colt to go into shock. and most likely a rapid death.

 Colt’s weight was the same as a previous visit. It was only because he had such a large mass in his abdomen, and goes to show you cannot go by just one physical parameter to determine health. It also shows you need to be thorough when investigating a medical problem.

The ability to do ultrasound with our highly skilled radiologist, telling us the hematoma was not actively bleeding, allowed us to take the time to prepare Colt for surgery. This made him a much better anesthetic risk, and and allowed him to heal faster with no complications.

The ultrasound told us it was probably a hematoma, and there was no evidence of spread to the heart which would indicate a potential malignant hemagiosarcoma of the spleen. With the blood panel and chest radiographs being normal, it was realistic to proceed with surgery based on the fact that the mass was probably not a malignant cancer.

Now that you have seen a successful hematoma surgery, now might be a good time to learn about hemangiosarcoma, a malignant cancer of the spleen. In this same page you can see another hematoma surgery of a dog with an 8 pound hematoma of the spleen.

Continue Reading

Geriatric Medicine

Share This!

In the past, we may have accepted a declining quality of life for our aging pets as a fact of life beyond our control. Like humans, older dogs and cats are more likely to encounter health problems than younger pets. Thanks to advances in veterinary medicine, pets are living longer than ever before. A 7 year old dog or cat is equivalent to a 50 year old person.

Most humanoids are practicing preventive medicine at this age- routine physical exams, breast exams, prostate exams, blood pressure checkups, blood panels and dietary changes. Dogs and cats need similar preventive medicine at this age. Since they age approximately 7 years for every 1 year of human life, an 8 year old dog or cat is equivalent to a 56 year old person, and a 9 year old dog or cat is equivalent ot a 63 year old person. This rapid yearly increase in equivalent age emphasizes the fact that we need to pay close attention to all dogs and cats as they move beyond 7 years of life.

Just as older people experience a progressive decline in physical condition, so do senior pets. Studies indicate that 36% of senior dogs suffer from osteoarthritis, 18% show signs of Cognitive Dysfunction Syndrome, and the number one diagnosed disease of dogs in all age groups is dental disease.

Compared to humans, old age problems may progress up to 7 times faster in senior pets. Having your senior pet examined only once a year is like a senior person visiting the doctor only once every seven years. That is why, as your pet nears 7 years of age (5 years of age in Giant Breeds), preventive senior exams every 6 months can help assess your pet’s current health, provide a baseline for monitoring changes in the years ahead, and help detect health problems in the early stages, when diseases can be treated more effectively.

Senior Care is “geriatric” medicine for pets. Senior health care implies both preventive and therapeutic approaches to medicine, including nutrition, dental care, and exercise as well as therapy for diseases.

Age Chart

Relative age of Your Dog in “Human Years”
Age Dog’s size in pounds
years 0-20 21-50 51-90 90 +
5 36 37 40 42
6 40 42 45 49
7 44 47 50 56
8 48 51 55 64
9 52 56 61 71
10 56 60 66 78
11 60 65 72 86
12 64 69 77 93
13 68 74 82 101
14 72 78 88 108
15 76 83 93 115
16 80 87 99 123
17 84 92 104
18 88 96 109
19 92 101 115
20 96 105 120
= Senior
= Geriatric

 


Symptoms

Changes in behavior or appearance may be the first indication of a problem. However, these signs may not be apparent in the exam room during your veterinary visit. It is important for you to watch for subtle changes, especially in stoic older pets.

Signs of aging:

Difficulty climbing stairs

Difficulty jumping up

Increased stiffness or limping

Loss of housetraining

Increased thirst

Increased urination

Changes in activity level

Excessive panting

Circling/Repetitive movements

Confusion or disorientation

Excessive barking

Less interaction with family

Decreased responsiveness

Tremors or shaking

Skin and haircoat changes

Changes in sleeping patterns

Less enthusiastic greeting or behavior

Altered appetite

Weight change

Common Health Conditions of Senior Pets

Obesity- As their metabolism slows down it is easy to overfeed. This leads to arthritis, sugar diabetes, liver disease, and heart disease.

Dental– Inflammation of the teeth and gums may lead to pain, infection, tooth loss, bad breath, kidney and heart disease, and, as a result, decrease your pet’s life expectancy.

Hormone (endocrine)- cause a vast array of symptoms that are treatable and sometimes curable.

Cushing’s– Excess production of cortisol (cortisone) by the adrenal glands

Addison’s– The opposite of Cushing’s

Diabetes (sugar) – Excess glucose in the bloodstream due to a lack of insulin

Hyperthyroid– Excess production of thyroid hormone

Hypothyroid– Inadequate amount of thyroid production

Kidney– Failure of this organ can lead to chemical imbalances, anemia, compromised immune function, and blood clotting defects as well as altered mental capacity. Kidney disease is a leading cause of death in geriatric cats.Chronic Urinary Tract Infections can easily occur without you being aware. These are painful, and can predispose your pet to bladder stones.

Liver– Failure can lead to serious disease with chemical imbalances, anemia, compromised immune function, and blood clotting defects as well as altered mental capacity.

Heart– Pets with heart disease can experience difficulty breathing, fatigue, exercise intolerance, and lethargy.

Cancer– Can occur in many different organs. Early detection may improve the prognosis. Many treatments are available and most have few side effects.

Cognitive Dysfunction Syndrome– Similar to senility or Alzheimers in people.

Skin conditions-Hair loss, itching, and skin infections are common

Arthritis-This is painful and debilitating, and can easily sneak up on a pet without you being aware of it.

High Blood Pressure– Usually secondary to a heart problem, kidney problem, or high thyroid problem.

Inflammatory Bowe Disease (IBD)- A common problem in cats as they age.

Epilepsy– These seizures have an unknown origin, and occur in older pets.

Senior Exam

With frequent checkups, at least twice a year, we can screen for common senior diseases. By diagnosing and treating problems earlier, we may be able to slow the disease process and prevent pain and discomfort.

In addition to a complete physical examinationdiagnostic tests can help detect many diseases before your pet displays signs of a condition. Even if results are normal, the findings give you veterinarian a good baseline to identify and monitor changes in your pet’s health as the years progress.

You can do an in-home exam to help catch problems before they become entrenched.

Physical Examination We can check for physical signs of cancer, arthritis, heart and lung disease, dental disease, or cataracts.
Complete Blood Count
(CBC)
This test helps identify infections, anemia, and certain types of cancer as well as problems with bleeding and the immune system.
Serum Chemistry Profile This blood test can help identify diseases of the liver and kidney, and endocrine disorders such as Diabetes or Cushing’s.
Complete Urinalysis A urine sample can help test for kidney diseasediabetes, urinary tract infections, and bladder stones.
Fecal Exam A fecal sample can be checked for internal parasites and bacterial overgrowth.
Other Tests Depending on your pet’s overall health, we may recommend additional tests such as blood pressure measurementradiographselectrocardiography (ECG or EKG),ultrasound, thyroid (hyperthyroid or hypothyroid) or adrenal gland (Cushing’s or addison’s) testing, as well as liver, pancreas, and small intestine function tests.

Here are examples of blood panels and urine samples that caught problems early, and before they became so well entrenched we would have a difficult time treating them.

This pet is anemic

This one has kidney failure

This low Specific Gravity is a sign of a kidney problem 

Senior Nutritional Needs

Nutritional needs of pets change as they get older. Senior dogs should consume fewer calories due to decreased activity and reduced daily energy needs. This is very important because obesity increases the risk of serious diseases, arthritis, diabetes, cardiovascular disease, respiratory disease, and musculoskeletal disorders in older dogs.

Pet foods, specifically for seniors, are now available with fewer calories, limited phosphorous, more protein, balanced fatty acids, antioxidants, vitamins and minerals to meet the specific nutritional needs of senior pets. These foods have optimum amounts of nutrition, and can help in the progression of common diseases like kidney disease.

All cats that are 7 years of age and older should be on Hill’s K/D due to the significant prevalence of this problem.

Many older dogs are obese and arthritic, and the Hill’s food Metabolic and Mobility is a major help for them.

We have much more information about nutrition in animals, and why you should never take the advice of a pet store or groomer on nutrition. It is an interesting read.

 


References:

1. Survey of Veterinarians, 1998. Sponsored by The Iams Company and Pfizer Animal Health.

Developed for Long Beach animal Hospital, by Glenna M Gobar DVM, MPVM, MS, courtesy of Pfizer animal Health; Sept 2001

Return to top of page

Continue Reading

VNA (Veterinary Neuronal Adjustment)

Share This!

We have been using VNA treat a wide variety of diseases in several species since 1995. It has helped many pets, especially older and arthritic ones, lead a high quality life in the face of debilitating disease.

The goal of VNA is to treat the Vertebral Subluxation Complex (VSC). This is a functional defect of a joint which causes neurologic signs, or pain, that might not show up on an X-ray. The effects of VSC can include mobility problems, muscle spasm, neurologic defects and inflammation.

Disease related to the spinal cord has traditionally been treated with a combination of surgery and medication. Through the use of VNA, we now have another treatment modality to treat the spinal cord, thus helping all the organs in the body. VNA is a noninvasive and non-painful way to dramatically minimize the effects of spinal cord dysfunction. In most cases the improvement is so significant that we can diminish the use of medications, sometimes even stopping them altogether. This page will give you a detailed explanation of the use of Veterinary Neuronal Adjustment (VNA) at the Long Beach Animal Hospital.

This treatment method used to be called VOM (Veterinary Orthopedic  Manipulation). You might encounter this name still in the literature.

Spinal Cord Anatomy

The spinal cord is an extremely sensitive and complex part of the nervous system. In essence, it is an extension of the brain. Subtle changes in pressure on the spinal cord itself can cause significant changes in the body. The spinal cord is completely enclosed in bone for protection. To allow for movement, and to allow nerve branches to leave the spinal cord, it is flexible and has openings.

This view of a spinal cord model is an end-on view of how the spinal cord fits into the spinal canal. You can see how the spinal cord is enclosed by bone. If it swells it has no place to expand into, resulting in serious damage to the cord. This swelling can occur when VSC is present.

The above picture greatly simplifies the anatomy of this area. In reality, there are many blood vessels, nerves, muscles, and connective tissue all around the spinal cord.

This diagram shows some of the complexity that is not so apparent in the simplified picture above.

The Nerve Roots (NR) above are the same thing as the Dorsal Nerve Root in the picture below. The Spinal Cord (SC) in the picture above is the semicircular area in the top left of the picture below. When a vertebrae becomes subluxated (misaligned) it affects these nerve roots and ganglia. This leads to the disease we call Vertebral Subluxation Complex (VSC).

As the spinal cord moves from the brain down to the tail it sends out nerve branches (called nerve roots- see picture above) that go to various organs. These branches are part of the Autonomic Nervous System (ANS). The ANS is an extremely complex system of nervous connections that runs the length of the spinal cord. Nerves that branch off from these connections innvervate all the important organs in the body. The ANS performs it magic without your conscious input. Here are a few examples of the many things the ANS does:

  • Dilates your eyes when you are scared
  • Increases your heart rate when you are scared
  • Contracts your stomach and opens your pylorus to allow food to move into the intestines
  • Stimulates your pancreas to secrete digestive enzymes into the small intestines as food moves past
  • Dilates or constricts blood vessels to the internal organs. This becomes an important point when we treat diseases of internal organs like the kidneys.

In this picture you get a feel for the complexity of the ANS. As the nerve roots leave a vertebral segment they form ganglia that innervate the internal organs. This is how the VSC can affect internal organs.

To use this diagram look at the middle of the thoracic vertebrae on the left. Go to the right until you see the Celiac ganglion. A branch of this ganglion innervate the kidneys. When the vertebrae in the middle of the thoracic area have VSC they kidneys can be affected. When treated with VNA the nerves that supply the kidneys with normal blood flow become dilated. This increases blood flow to the kidneys, and helps them if they are diseased.

When the vertebrae in the picture above are misaligned only slightly there can be significant disruption to the spinal cord and the nerve roots as they leave the spinal cord. Correcting this problem is the goal of VNA.

Vertebral Anatomy

The dog has 31 vertebrae:

  • Cervical (neck)- 7
  • Thoracic (chest) – 13
  • Lumbar (lower back) – 7
  • Sacral (pelvis) – 3 (fused)

Let’s go on a tour of this anatomy by looking at overlapping radiographs:

C-1 and C-2 are called the atlas and the axis. The words atlas (holding up the world) and axis (what the world spins on) come from Greek mythology. There can be an instability in this area in large dogs that will cause neurologic problems. The cervical vertebrae are quite flexible, for obvious reasons. VSC can occur in this area.

As the cervical vertebrae become the thoracic vertebrae they go past the shoulder (S). The nerves that come off this cervical-thoracic junction at the shoulder are called the brachial plexus (you cannot see nerves on a plain radiograph). They innervate the front legs on each side. Each of the thoracic vertebrae corresponds to a rib (R) on each side of the chest.

As we continue down the thoracic vertebrae you can visualize how high their dorsal spinal processes are. Also notice how these processes start to get smaller as we get closer to the lumbar vertebrae.

Moving towards the end of the thoracic vertebrae we come to what is termed the thoracolumbar (T-L) junction. It is a very common area to have VSC disease. As we pass into the lumbar vertebrae we have now made our way into the lower back.

The 7 lumbar vertebrae eventually lead into the sacral vertebrae (S). The fused sacral vertebrae are hard to visualize because they are within the pelvis. After the sacrum we are at the tail.

This side view of a spinal cord model shows 2 vertebrae (V) with a normal disk (D) in between. One of the nerve roots (NR) can be seen coming off of the spinal cord (SC). You saw this same picture, from a different angle, at the beginning of this page.

To keep you oriented, this is the same area on a radiograph (at L1-2). The nerve root comes out of the dark structure that looks like a horse’s head. The disk, nerve root, and spinal cord do not show up normally on a radiograph. This is one of the areas on a radiograph we look for VSC, although many times VSC can be present and there are no radiographic changes. If radiographic changes do occur, they can take months to years to become apparent on a radiograph.

VNA Theory

Lets review some of the concepts we illustrated above. alterations in the biomechanical or physiological dynamics of the joints of the vertebral column (called a subluxation because the bones are partially dislocated) cause spinal nerve dysfunction as the nerve roots leave the spinal cord. This is VSC. The dysfunction can lead to mobility problems in the joint, swelling and inflammation in the joint, or spasms of the muscles immediately around the vertebrae. The nerve root that has a dysfunction causes disease in many internal organs that are innervated by a particular nerve root.

The negative forces that caused the dysfunction in the first place are from trauma and environmental toxins. Most pets have had significant trauma to their spinal canal since they were young. It comes in the form of playing with a Frisbee, jumping off or onto something, general play, and excessive running. For some pets, going down stairs might be the biggest predisposing factor to subluxation. We recommend harnesses for most dogs since collars put extra strain on the neck and might predispose to VSC.

In many cases, the changes in the vertebral column that surround the area of nerve dysfunction do not show any changes, and thus are normal on a radiograph. When radiographic changes of this nerve dysfunction are present, they occur long after the problem originated. In some cases the nerve dysfunction from the subluxation can be low-grade or intermittent, taking years to show up on a radiograph.

In VNA we counteract nerve dysfunction by “re-setting” the joint with a gentle and painless force. We are counteracting all of the negative forces that have built up on the spinal canal and its nerve roots over a period of time. The nerves in the area can begin acting normally again, which increases blood flow to internal organs, correcting many diseases. Some of the diseases that are responsive to VNA therapy include:

VNA excels at treating Feline Hyperesthesia. In this disease cats are extremely sensitive on their skin to stimulation, especially the rear quarters. Most cats will lick obsessively when scratched here, others are so sensitive they will go into a seizure.

This cat has a moderate form of hyperesthesia. Click on his picture to see a video of how sensitive he is.

Click on his picture below and watch how we treat him. Notice how relaxed he becomes when he lays down as the treatment starts. Also watch how he starts licking as the vetrostim moves down his back

The nature of this technique allows us to detect disease states before clinical symptoms appear, allowing us to initiate treatment before your pet exhibits clinical signs of disease. This means that we now have at our disposal a tool to determine if your pet is starting to get a disease before the disease becomes well entrenched. This approach is far superior to allowing a disease to become entrenched, and thus is not as easily treated. When treated at this early stage the disease process can be minimized, and sometimes even eliminated. In a sense, VNA is a form of preventive medicine.

The arrow points to vertebral changes that occur secondary to nerve dysfunction. In this radiograph the body is trying to stabilize a subluxated vertebrae by laying down extra bone. Unfortunately, these changes on the radiograph become apparent many months to years after the initial incident that caused the nerve dysfunction. With VNA we now have a diagnostic and treatment capability to prevent these severe boney changes from establishing themselves.

Equipment

Activator (spinal accelerometer)

This devices fires a very fast and concise force to the subluxated vertebrae. It takes at most 4 milliseconds to administer this force. The fast speed of the accelerometer, combined with its small mass, allows us to administer a concise force only to the problem area. Since there is no pain involved, anesthesia is not needed.

This is the manual activator.

The activator is pain-free. This brief movie shows us using it on our hands. Turn up the volume so you can hear the sound it makes.

Activator Movie

The movie shows it in actual use along the lower back of a dog

Using Activator on a Dog

In most pets we use an electric activator because it is much faster, easier on the hands, and has adjustable power settings.

Technique

The first thing we do is try to determine where in the spinal canal nerve dysfunction is occurring. There are several ways to make this determination.

Routine Diagnostic Tests

Every pet that is presented for a problem should have routine tests performed after its examination. These tests usually include a blood panel with thyroid test, a urinalysis, a fecal sample for internal parasites, and radiographs of the spine. You can learn much more about these tests by going to our Diagnostic Tests page.

Not every pet with a disease has a vertebral subluxation causing nerve dysfunction. There can be foreign bodies, infections, and even tumors causing problems.

The white area on this radiograph is a tumor, verifying the importance of taking a radiograph before initiating treatment. This tumor is not treated with VNA.

Neurologic Reflexes

There are several reflexes to help us pinpoint areas of subluxation causing nerve dysfunction:

Panniculus

Animals have a muscle under the skin (the cutaneous trunci muscle) that allows them to flinch their skin, unlike humanoids. This is a great advantage to them when they want to rid their haircoat of pesky insects, but have no hands to scratch with. When the dorsal or lateral process of the bones of the vertebrae from T-3 to L-6 have a dysfunction, the skin in the lower to mid back will flinch, indicating a problem. Sometimes the problem is so apparent that just pushing gently on the spine in this area will cause the skin to flinch. In many cases though, we need to gently stimulate the area with the activator to elicit this response.

This gives you an idea of the relative position of the activator when we test for this response.

To initiate this response we place the activator over the dorsal spinous processes of the vertebrae and look for the response as we set off the activator. We start at the vertebrae of the neck and work all the way back to the pelvic bones, noting areas where there is muscle or skin movement. This movement is also called a “read”. A positive read indicates an area of subluxation. These reads will change when we actually treat the area, which is an indication that we are affecting a cure.

Medications, particularly anti-arthritic medications will make it difficult to interpret reads. If your pet can be taken off these medications without any serious effects it will help make the reads more accurate.

Ear and Facial Reflexes

In the C-2 to T-10 area there is a reflex in animals that shows up as an ear twitch. Sometimes a pet will look like it has this reflex when it is really only reacting to the slight clicking sound of the activator.

Postural Reflexes

When an animal stands it maintains tone to the extensor muscles of the legs. A spinal segment that has a problem will temporarily shut down the signal to these extensor muscles when stimulated, causing a momentary change in posture. This change can be very subtle, and might range from a yawn to a twitch, stumble, collapse, or sign of pain. Sometimes the only indication of this response is a subtle change in posture that is felt by the person holding the pet.

Once we have determined if there is a subluxation, and where it is most likely to be by analyzing our diagnostic tests and checking for reflexes, we initiate treatment. The activator is also used to treat, making the same pass as the initial one where we determined likely areas of subluxation. We pass the activator at least 2 times in most cases, and look for changes in the reads.

We put the activator directly over the dorsal vertebral process you saw in the picture above. There is a significant amount of muscle and tendon (and sometimes fat in obese pets!) surrounding the dorsal vertebral process. On heavy coated pets there is even more to go through to transmit the energy directly to the process.

One of the effects of the vertebral subluxation is muscle spasms in the muscles along the back. If we stimulate this area we can relieve the muscle spasm, causing a return to normal posture and relief of pain and discomfort. Stimulating the muscles over the vertebrae also stimulates nerve centers (called ganglia-remember the pictures above?) that reside along the vertebrae.

The instrument we use to stimulate the muscles and ganglia along the vertebrae is called the VetroStim. Most pets love it because it feels like a massage!

You can see the relative position of the VetroStim when positioned to stimulate muscle around the ganglia

This close-up shows how we position it over the muscle, and not the dorsal process of the vertebrae

In this movie you can see the activator and VetroStim in action. We start at the neck and rapidly move to the lumbar vertebrae. Turn up the volume to hear the sound the machine makes.

Activator and VetroStim use on a Beagle

Pets that have internal problems like urinary incontinence and inflammatory bowel disease are treated at their Somato-Visceral points.

These areas are located near the angle of the jaw on either side.

Several of our clients were so satisfied with their pets outcomes that they starred in a little movie……

We do VNA on a wide variety of animals, including this is Iggie that was not moving its rear legs properly

We have even used it in an egg bound bird to help pass a stuck egg.

Complications

VNA does not work well if your pet has underlying problems. They need to be corrected to get the full advantage of VNA treatment. Three common problems that need correcting are:

Nutrition- your pet needs to be on a food certified by the Association of American Feed Control Officials (AAFCO).

Hypothyroidism can interfere with treatment. If your dog has this problem it needs to be supplemented with thyroid hormone. In many cases treating this problem with VNA can affect a cure down the road.

Hyperthyroidism also poses a problem, and needs to be treated if present. VNA therapy might also affect a cure for this problem.

Treatment Timetable

In most pets we treat at day 1, day 3, day 7, then twice per week,  and then every 1-4 weeks depending on response. At that point we treat monthly for 3 months.

For the typical dog it takes a total of 5-6 adjustments to make a cure, for the cat it takes 4-5. Some pets respond well initially, and seem to be symptom free after only several treatments. These pets are not cured yet, and should be treated until there are no more reads. Our goal is to affect a cure, and then treat only once every 3-6 months to maintain the cure. The Feline Hyperesthesia Syndrome can take up to one year to cure in some cases.

Every pet is an individual, so your exact treatment timetable might be modified by one of our doctors as treatment progresses. It is important not to let your pet jump into the car or from the front seat to back seat on the way home from our office. This can cause an adjustment to fall out of place.

 

Continue Reading

Intestine Tumor in a Cat

Share This!

Tumors are common in cats, especially as they get older. This page describes how we treated an intestinal tumor in an 11 year old cat named Ruby. The format in this page will be different than our other disease pages. In this one we will present it as a case study, and show the diagnostic process that allowed us to make this diagnosis.

We will follow the parameters of the diagnostic process in this case, the same process we use in every diagnosis me make. If you are not familiar with this process click here  for a quick review, then come back to this page and continue the case study. You need to have an understanding of the diagnostic process in order to appreciate the thought process involved in making Ruby’s diagnosis.

This page has graphic surgical pictures.

Signalment

Our patient is an 11 year old spayed female domestic short haired cat named Ruby.

Interpretation of signalment:

Domestic short haired cats have no breed predilection, so this information does not narrow down the list of possible diseases at this point. Since Ruby is spayed there is negligible chance of a reproductive problem like pregnancy or an infected uterus, called a pyometra.

Her age is very important because it brings to mind some of the following diseases:

History

Ruby has been lethargic and not eating for 2 days. She seems painful when picked up and has been vomiting a yellow fluid. Other important parameters like bowel movements, breathing, and urination are normal.

Interpretation of history:

This information is helpful because now we start getting a feel for the extent of Ruby’s problem. It is unusual in that she is vomiting and has not eaten in 2 days, yet her bowel movements and urination are normal. A pet that has these symptoms is almost always dehydrated and would not be having normal bowel movements and urination. This discrepancy in the history is not uncommon in many cases.

Because of the new information we obtained in Ruby’s history, we need to add infection, intestinal foreign body, abscess, liver diseaseFeLVFIVFIPkidney diseasehyperthyroidism, and even poisoning to her potential disease list.

Physical Exam

  • Temperature- 104.3 degrees F
  • Weight 12.75 #
  • Eyes- normal
  • Ears- normal
  • Oral Cavity- normal
  • External Lymph Nodes- normal
  • 8-10% dehydrated
  • Heart- normal
  • Lungs- normal
  • Abdomen- 4 cm x 4 cm mass palpable in the mid abdomen
  • Muscles and Bones- normal
  • Skin- normal
  • Interpretation of exam findings:Our exam findings give us important information. Ruby has a fever (normal cats are usually less than 103 degrees F). She is dehydrated, as was expected from her history. We make a determination of her state of hydration by looking at the color of her gums, checking if her eyes appear sunken, and noting how elastic her skin is when we pull it up and let it go. The fact that she has a mass in her abdomen is one of our most important findings so far.Based on the information we have at this point we can now generate a list of Ruby’s problems:
    • anorexia (not eating)
    • Lethargy
    • Emesis (vomiting)
    • Pyrexia (fever)
    • Dehydration
    • Abdominal mass

Differential Diagnosis

This is one of the most important parts of our diagnostic process. It is a list of the most likely diseases that are causing Ruby’s problem. Based on this list we will perform specific diagnostic tests to narrow the list down to the most likely disease processes occurring. We will also institute treatment based on her problem list and the differential diagnosis. We always initiate symptomatic treatment before our test reports return. This decreases our patients’ discomfort as soon as possible, and allows us to treat the problem earlier which is always an advantage in healing.

  • Infection
  • Intestinal tumor
  • Lymph node cancer
  • Feline viral disease
  • Kidney Disease
  • Liver Disease
  • Splenic disease
  • Pancreatic disease
  • Intestinal inflammation/abscess
  • Intestinal foreign body
  • Stomach disease
  • Constipation
  • Intussusception- A disease where the intestines literally telescope into each other. This obstructs the flow of food through the intestines, and can lead to death of a section of the intestine.

Diagnostic Tests

By running diagnostic tests we rule in or rule out the diseases in our differential diagnosis list above. In Ruby’s case we initially ran a blood panel and took an x-ray.

Blood Panel

The blood panel revealed an elevation in her white blood cells. Tests of the liver, kidney, pancreas, red blood cells, protein, and viruses were all normal.

X-Ray

radiograph was taken of Ruby’s abdomen. The stomach, kidneys, large intestines, and bladder all appeared normal. The liver was slightly enlarged (called hepatomegaly). There was a large soft tissue mass effect in the center of the abdomen.

Here is a normal cat abdomen radiograph- compare it to Ruby’s below. The normal organs are identified:

L- Liver
S- Stomach
K- Kidney
LI- Large intestine
SP- Spleen
SI- Small intestine
BL- Urinary bladder
The white arrow points to sutures from a spay surgery

Here is Ruby’s radiograph. The large white section in the lower center is the problem area. This is where the small intestines (SI) are in the above radiograph. Can you see the liver, stomach, and kidneys?

A tiny needle was inserted into the mass in her abdomen and some cells were removed for analysis by a pathologist. This test is called an aspirate, and the analysis of these cells is called cytology.

Interpretation of diagnostic tests

The normal blood panel, except for the elevated white blood cell count, minimizes the chance of liver, kidney, and feline viral diseases. The x-ray eliminates constipation as a cause to Ruby’s problems. The report from the cells taken from the abdomen indicates there is infected or dying tissue in the abdomen. This is a serious finding and necessitates immediate action.

Based on these test we can now refine our differential diagnosis:

  • Ruptured intestines
  • Intestinal abscess
  • Intestinal cancer
  • Intestinal foreign body
  • Lymph node cancer
  • Pancreatitis
  • Spleen mass
  • Intussusception
  • Liver mass
  • Kidney mass
  • Lymph node mass

A determination had to be made as to the appropriate course of action for Ruby’s condition. This is based on her age, cost, convalescence, and prognosis. These important points are discussed with Ruby’s owner prior to any further treatment. The main decision for her owner at this point is to perform ultrasound versus surgery. Each has its advantages and disadvantages:

Ultrasound advantages

No anesthesia is required and Ruby does not have to undergo the trauma of surgery in her abdomen. Ultrasound is very accurate, the results of the ultrasound are immediate, and biopsies can be obtained accurately. With the ultrasound an expert can literally visualize the internal structures of an organ and make a determination on whether or not it looks healthy.

Here is a typical ultrasound picture on a different case. It is looking at the liver and gall bladder. By looking at the liver closely an experienced doctor can determine if the cells in the liver are abnormal. If they are abnormal the ultrasound is used to guide a special biopsy needle right to the problem area.

Our ultrasound doctor is giving us a demonstration of how the biopsy is obtained.

Only a small amount of tissue is obtained with this method. When analyzed microscopically by a pathologist a significant amount of information can be obtained.

Ultrasound disadvantages

Surgery might be inevitable, so why delay. No treatment can be given with ultrasound, it is for diagnostic purposes only. Delaying prolongs the time it takes to ultimately correct Ruby’s problem and adds additional costs to the bill if we do proceed with a laparotomy.

Exploratory surgery advantages

An exploratory surgery in Ruby’s abdomen is called a laparotomy. It has the advantage of giving us an immediate diagnosis and gives us an opportunity to treat the condition (if the problem is not too far gone). Also, the surgeon can literally see the internal organs in their natural color instead of grey images on an ultrasound screen.

Exploratory surgery disadvantages

It is a an invasive procedure that has risks, including the anesthetic risk. Even though the surgeon can palpate internal organs, he can not look at their internal architecture like the ultrasound does. Also, there is  post operative discomfort and convalescence when a surgery is performed. With modern anesthetics and pain medication we can do almost any surgery in an older pet and not have any problems.

In Ruby’s case a decision was made to perform a laparotomy. We were fairly certain of our diagnosis and the need for surgery, so why prolong the inevitable.

Treatment

Treatment was initiated as soon as Ruby was admitted to the hospital This treatment consisted of intravenous fluids to correct her dehydration and lethargy. She was also given intravenous antibiotics and fed a special food. Her temperature was also closely monitored. Here is a picture of part of her medical record on the day of surgery:

Status BAR means she was bright, alert, and responsive Weight- 12 # 11 ozTemperature- 103 degrees F Appetite- NPO means “nothing per os”. This is a Latin abbreviation for no food given in anticipation of surgery. Urine- NormalBowel movement- noneOur nurses noted that she had vomited during the night and she was scheduled for a laparotomy surgery sometime today. Her treatment consisted of lactated ringers solution. She was given 250 milliliters intravenously every 12 hours. Baytril, her antibiotic, was given at 1.3 milliliters intravenously every 12 hours.

Surgery

The following area contains graphic pictures of an actual surgical procedure performed at the hospital.

Ruby was anesthetized and brought into surgery when she was anesthetically stable. A 7 inch incision was made in her abdomen and her internal organs were assessed.

We suspected Ruby’s problem was with her intestines, so we immediately assessed them. The diseased area was found and brought out through the incision in her abdomen. Not only were the small intestines swollen and discolored, there was a ruptured area of infection and dead tissue. The oval mass in the picture below is a tumor in the small intestines. There is an opening in the center where it is dead and has ruptured into the abdomen.

This section had to be removed without damaging the rest of the intestines. This is a delicate procedure because the intestines have a tremendous blood supply that can easily be injured during surgery. Special clamps (seen in the picture above) are used to separate the diseased tissue from the normal intestines. Once they are in place the blood supply to the diseased part of the intestine is cut off.

In this picture the larger black arrow on the top points to the diseased intestine, while the smaller 4 arrows in the center point to metal clips that have cut off the blood supply to the disease intestine.

After cutting its blood supply the diseased tissue is removed by cutting between the 2 clamps. The clamp on the right (arrow) is on the diseased portion of the small intestine. The clamp on the left (arrow) is a very gentle clamp that keeps any intestinal fluid from spilling out of the cut end of the normal intestine. We are using the scalpel blade to make the actual cut between the 2 hemostats.

The opening of one end of the normal intestines is now visible towards the right immediately after it has been cut. The center of this opening is lined with pink tissue called the mucosa, the white area around it is called the submucosa. The submucosa is thicker than normal, indicating that there might be additional disease in this section and further intestine might need to be removed.

The tedious process of suturing the cut ends of the intestines (called an anastamosis) begins. These sutures are critical if there is to be healing and to prevent leakage of intestinal contents into the abdomen when this pet eats. The first suture is shown being placed as the process is begun.

Part way through the suturing you can see the intestines coming together nicely. The bleeding is a good sign because it is a general indication of healthy small intestine.

When all of the sutures are placed a small amount of sterile saline solution is injected into the anastamosis site to check for leakage.

This is a good overall view of the anastamosted section of intestine (see arrow). You can see how this section of small intestine is more inflamed than the normal section below it.

With the intestinal problem corrected we explore the rest of the abdomen for any other problems. Nature works in complex ways, and just because we found a problem in one area does not mean all the other abdominal organs (including more intestine) are disease free. This picture shows a normal spleen in the top left along with normal intestines on the bottom.

The diseased tissue had ruptured which means there is an infection in the abdomen (this is called peritonitis). To alleviate this infection we flush the abdomen with copious amounts of warm saline solution. This picture shows our suction apparatus removing some of the fluid that was flushed into the abdomen.

Here is Ruby just after surgery. She is a little groggy from the ordeal, but her pain medication has been administered so she is comfortable. She will be monitored closely and given some broth 12 hours after surgery. Within 24 hours after surgery she will be nibbling soft food.

Final Diagnosis

Ruby had a tumor in her small intestine called a Mast Cell Tumor. Compared to most abdominal tumors we diagnose it is a relatively rare form of tumor, and it is seen only in the cat. There is the possibility that it might spread to intestinal lymph nodes or even liver later in its course. It is difficult to say what will happen in the long term, so her prognosis is guarded.

In addition to the surgery we put Ruby on medication to minimize side effects from the tumor. Mast cell tumors have the potential to release a compound called histamine. This can cause a type of allergic reaction and even cause ulcers in the stomach lining. Ruby is on medication to counteract this problem.

Ruby returned to have her stitches removed 2 weeks after the surgery.

Continue Reading