Category: Ferret

Laser Surgery

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We have been using the carbon dioxide laser at the Long Beach Animal Hospital for over 20 years.  We are one of only a handful of animal hospitals in California that have this capability. It is a highly advanced and technical piece of equipment that we never dreamed about having while we were training to be veterinarians. Its one of the ways we offer state-of-the-art care at Long Beach Animal Hospital.

The laser is a high precision instrument 

It is carefully calibrated for each individual surgery

This video shows how we set up one for a dog neuter, and how the laser checks its circuits and calibrates itself.

You get to wear these cool glasses when the laser is on

Dr.P has taught many surgeons how to use the laser. Here he is teaching one of our externs.

GPig-EyeSx-11

Dr. Ridgeway is using the laser on a guinea pig for eye surgery.  He is using magnifying glasses due to the small size of his patient. Small patients cannot tolerate blood loss, so the laser has been a tremendous tool for surgery in animals that only have a few drops of blood in them to begin with.

Laser-Tortoise

Here he is teaching one of our externs on the use of laser in a tortoise. Veterinary students do not get exposed to the laser routinely while in veterinary school, which is one of the reasons they do an externship at our hospital. Our goal is to impart all of our knowledge to them as they start their careers.

Laser Theory

A carbon dioxide laser emits a high energy beam of infrared (invisible to the human eye) radiation in the form of light waves that has many veterinary applications. If you would like to learn more about the mechanics of lasers in general, including safety procedures, how they work, and why we use the carbon dioxide laser as opposed to other lasers, click here.

Graphic photos on this page.

Advantages

There are several advantages to the COlaser surgery:

  1. Pain Reduction

    Your pet will experience significantly less post operative pain in almost every instance. As a matter of fact, the pain reduction is so great that we perform declaws on cats only with a laser beam. This reduction in pain is a result of the unique characteristics of the laser beam as it cuts nerve endings, preventing the raw ends that are characteristic of scalpel blades.

  2. Swelling Reduction

    Whenever an incision is made in tissue with either a scalpel blade or scissors, inflammation is started in the affected tissue. This inflammation is a result of interaction with the circulatory and lymphatic systems. Because the laser beam effectively cauterizes the lymphatic system, there is much less post operative swelling. This makes your pet much more comfortable while it is convalescing from surgery.

  3. Control of Infection

    The laser beam operates at a temperature of over 200 degrees Fahrenheit. This makes it highly effective at killing bacteria that have the potential to cause an infection. This is particularly important in areas where it is difficult to prevent bacteria from contaminating the surgical site. Examples include abscesses and cat declaws.

  4. Minimal Surgical Bleeding

    When an incision is made with a scalpel blade, small blood vessels are cut in the skin and the layer of tissue just under the skin. These blood vessels can ooze throughout the surgery and even postoperatively. Traditionally they are taken care of by clamping them with hemostats, cauterizing, or holding gauze sponges on them until they stop. All of these procedures take time, which means the surgery takes longer and there is more post operative swelling. The laser beam is a highly effective coagulator of small blood vessels. Less bleeding during surgery means less anesthetic time and faster recovery time.

    Even though lasers are used effectively in many surgical procedures they are not used in every surgery. They are especially useful in oral surgery, neuters, growth removals, and amputations of small extremities. We also use it in small animals, especially birds, because of the laser’s great effectiveness at minimizing bleeding.

    The following sections give specific examples of the use of the carbon dioxide laser in our hospital.

    Neuter

    The laser is particularly advantageous in this surgery. Prior to using the laser we used a scalpel blade to make the scrotal incision and throughout the whole procedure. When using the scalpel like this, the scrotum would swell over several days post operatively as small blood vessels oozed. This was obviously very uncomfortable in such a sensitive area. The laser has eliminated this completely.

    Canine-neuter6

The laser is being use to cut through the outer layer of the testicle, called the tunica vaginalis

Canine-neuter7

The testicle is exposed, along with the epididymis and blood supply. Notice the lack of bleeding.

We neuter a wide variety of animal:

Cats

Rabbits

Dogs

Rats

Bladder Surgery

Bladder stones are not uncommon in animals. The bladder is usually inflamed and highly vascular, causing significant bleeding when we incise the bladder to remove a stone. The laser has revolutionized this surgery. This is a very sensitive internal organ, and anytime we can make an incision in such an organ without any bleeding, the healing period is much faster and less painful.

Surgery-CatLaserBladder

Here is the initial incision in a cat with no bleeding from the bladder

Laser-cystotomystone

This is a dog with the stone being removed from the bladder after the laser incision

Our bladder stone page has much more detail, including a movie of removing bladder stones from a dog. We also have pages that show removal of bladder stones in Iguanas and tortoises (you don’t want to miss this tortoise bladder stone page)!

Feline Mammary Tumor

These tend to be malignant and highly vascular, causing substantial time during surgery controlling bleeding, along with considerable bruising after surgery. The laser has revolutionized this surgery.

In the video note how diseased the subcutaneous tissue looks and the total lack of bleeding in this highly vascular area. Also notice as milk is excreted from the gland as the surgery progresses

Our web site has a detailed page on mammary tumors in animals.

Rat Mammary Tumor

Rats get a mammary tumor under the skin very commonly. The laser is huge when it comes to removing them with minimal bleeding, which is important in a small animal.

Surgery-RatMammary-3

Surgery-RatMammary-4

Click here to see the full surgery

Oral Tumor

A tumor that can be encountered in dogs and cats is called sqamous cell carcinoma. These pictures are of a dog that had one on its left jaw, called the mandible. The only way to completely cure this tumor is to remove the jaw on that side, a surgery called a hemimandibulectomy. In this case the owner decided against it, and will have the growth removed as much as possible with the laser, following up with radiation therapy.

The tumor is identified by the white arrow. It had been removed 1 year earlier, but as expected with this type of tumor, has recurred. This time the surgery will be with the laser for maximum comfort for Jackey.

The post operative appearance immediately after it has been removed by the laser. Minimal bleeding and swelling are apparent.

We were able to suture gum tissue over the defect left by the surgery. It is hard to tell in this picture that any surgery was performed at all.

This tumor is in a Tegu

LaserSurgery-IggieJaw

The arrow points to the tumor

LaserSurgery-IggieJaw-2

No sutures, no bleeding, no pain, and no inflammation

Declaws

This is a request from people that want to keep their cats indoors. Prior to a declaw, we advise keeping the nails trimmed short or the administration of Soft Paws on the nails, along with a scratching post. One of our nurses will gladly give you a demonstration of these options.

We prefer you use other options before thinking about laser declaw, and will show you how to gently trim the nails

If this does not work you need to make an appointment to have your cat examined by one of our doctors and determine if it is a candidate for the surgery. We do not do this surgery routinely.

Prior to the introduction of the carbon dioxide laser all declaws were done with a scalpel blade. It is a very precise surgical procedure that our doctors have performed thousands of times. Unfortunately, the post operative period was painful, the feet were bandaged, and most cats had to stay in the hospital for several days. On older cats this surgery was even harder on the pet.

The advent of declaws with the laser surgery has substantially minimized these drawbacks. There is usually no bleeding during the surgery so a tourniquet is no longer used. Most of them can even go home the day of surgery but we prefer to keep them for observation for 1-2 days. Most cats have so little pain or discomfort they are jumping and running before nature has had time to complete the healing process. Always restrict their activity at home for the first few days to prevent this problem.

This cat’s nails have grown into its pads due to the owner’s inability to care for it properly. This is a painful situation and makes him a candidate for a front declaw.

Feline-NecroticNail

Sometimes the problem is even more severe, and the severely infected toe (on the right) needs amputation. This is where the laser shines.

The following pictures are from an actual declaw that we performed at our hospital.

Surgery-CatLaserDeclaw

The nail is gently pulled forward prior to surgery to open up the area behind the nail where the incision with the laser will be. Bone is not cut during the procedure at any time, only tendons and ligaments are cut.

Surgery-CatLaserDeclaw-4

The laser beam (it is invisible to the naked eye) has started the incision at the top of the toe. It will cut through skin and tendons along with ligaments in between the digits.  The nail, with its attached bone (called phalanx 3), is removed.

The surgery is complete with no bleeding, swelling,  or trauma to any bone. The top arrow in this picture points to the bone at the joint of the 2nd knuckle. The bottom arrow points to the intact pad that has not been touched either. A drop of surgical tissue glue will be put on the pad to cover the end of the bone.

The foot immediately after surgery. There is no need for a bandage.

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Fluid Therapy

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Fluid therapy might just be the most important medical therapy we perform on sick animals. Dehydrated pets feel ill, cannot fight disease, do not eat well, and cannot metabolize drugs efficiently. Dehydration decreases the circulation to two very important organs, the liver and the kidney. These organs are then unable to perform vital functions, some of which include detoxifying drugs and removing waste products.

We give fluids to a wide variety of species in addition to dogs and cats. They can be ill, and need fluids for many different reasons.

This guinea pig being examined by one of our externs has a problem with overgrown teeth and cannot eat well. This has caused him to become dehydrated, and in need of supplemental fluids.

Before coming in for treatment this rabbit was painful from a broken leg and not eating well, so it became dehydrated. Supplemental fluids to correct the dehydration, and a splint to take away the bone pain and allow the healing, were needed to get him back to being a normal bunny again. You can see how we treated his fracture here

Yup, we even give fluids to 120 pythons when they are ill or dehydrated. This is probably not something you want to try at home!

Fun Facts

Before we get started on the specifics, lets go over a little background on fluids.

The body weight of a normal dog or cat is about 60% water, puppies and kittens are up to 80% water. These numbers show the importance of a proper fluid balance for normal physiology, especially in puppies and kittens when these animals become dehydrated.

The fluid in the bodies of normal animals resides in 3 areas:

Inside the cells of an individual organ, called the intracellular space. 65% of the total fluid in the body resides in this intracellular space.

In the bloodstream, called the intravascular space. 25% of the total fluid in the body resides in bloodstream.

In the tissue surround the cells, called the interstitial space. 10% of the total fluid in the body resides in the interstitial space.

When the intravascular fluid is low hypovolemia results. Hypovolemia means the body cannot deliver adequate oxygen to the cells, and a pet can go into shock. If not treated death can ensue. We assess this low oxygen problem with an instrument called a Pulse Oximeter, which measures the oxygen saturation of the hemoglobin molecule in the red blood cells. It should be in the 90 percent range.

This pot-bellied pig, with a 92 % oxygen saturation, and a heart rate of 82 beats per minute, is normal

Pets with hypovolemia are very ill and can exhibit some of the follow symptoms:

Elevated heart rate, called tachycardia.

Slow heart rate, called bradycardia. This occurs when your pet is in the act of dying.

Weak peripheral pulses. We detect this on an exam by palpating the femoral pulses while simultaneously listening to the heart.

Prolonged capillary refill time (CRT). For a normal animal this should be under 2 seconds.

This is how we check the CRT. This pet is under anesthesia, a time when we carefully monitor this parameter

Cold extremities

Low blood pressure (hypotension).

Hypothermia (low body temperature)

When the interstitial fluid is low dehydration results. This is not usually life threatening until the dehydration progresses to around 10%, which now causes hypovolemia. Dehydration is detected during an exam when any of the following occurs:

Tacky or dry mucous membranes (the gums)

Skin tenting

Sunken eyes

Elevated BUN or Creatinine on a blood panel

Elevated hematocrit and total protein

blood sample will also give clues to dehydration, especially the total protein level and the hematocrit.

This is the hematocrit test, checking the percentage of red blood cells in the serum, giving us information on the state of your pet’s hydration

After the hematocrit is measured we break the tube in the middle and place the serum on an instrument called a refractometer to check the protein level. In conjunction with the history, exam findings, and hematocrit level, the protein level helps us determine the degree of dehydration.

Hypovolemia and dehydration can occur independently. A dehydrated patient might not be hypovolemic, and a hypovolemic patient might not be dehydrated.

Our doctors decide on how much fluid to give your ill pet based on the following:

The normal (called maintenance) amount of fluid your pet needs every 24 hours to maintain normal physiology (called homeostasis).

For a dog this is 60 ml for each kg of body weight. For a 20 pound dog this is 545 ml (1/2 of a liter, or 30 ounces) per 24 hours.

For a cat this is 45 ml for each kg of body weight. For a 10 pound cat this is 204 ml (0.2 liters or 7 ounces) per 24 hours.

The degree of dehydration of your pet

A 20 pound pet that is 7% dehydrated needs 600ml to correct this dehydration. This is more than pet owners realize, and why proper fluid therapy is so important when we hospitalize your pet.

Ongoing fluid losses like vomiting or diarrhea. As pet that has been burned has tremendous fluid losses due to seepage of serum at the burned skin area. This ongoing loss is subjective, but it needs to be added to the calculation above if your pet continues to have these fluid losses.

Symptoms of Dehydration

Signs of dehydration include lethargy, anorexia (poor appetite), sunken eyes, sticky gums, constipation, and a general feeling of malaise. It is diagnosed based on a history of anorexia, vomiting, diarrhea, or extra fluid loss, in combination with a physical exam and diagnostic tests. During an exam a dehydrated pet will shows signs of dehydration when the problem is greater than 5 %. The page talks about the two primary methods used to give fluids to pets. The first is intravenous, and is performed only by us in the hospital. This is not a treatment method you will do at home.

Types of Fluids

The type of fluids we will be describing are called crystalloids. This are the kinds most people are used to, and are usually lactated ringers solution (LRS) or sodium chloride (NaCL), and variations thereof that we might use in specific situations.

These are some of the ingredients in LRS

Another type of fluid is called a colloid (hetastarch or hydroxyethyl starch). Colloids are used only in specific situations, which are not common. For the remainder of this page we will be referring to crystalloids.

Intravenous (IV) Fluids

I.V. (intravenous) catheters are used extensively in pets that are sick or those pets that are about to be anesthetized. These catheters allow us to administer medication directly into the venous system for rapid distribution to the whole body. Medication given this way acts faster and is more controllable, a significant advantage for an ill pet or in an emergency. IV administration of fluids is critical in pets that are hypovolemic.

Intravenous fluids are important during surgery. We monitor this closely in many ways, especially with the blood pressure.

If your pet is ill and staying in the hospital, or about to undergo anesthesia for any reason, an I.V. catheter to allow fluid administration is one of the most important therapies we can institute, and can literally be life saving.

This dog getting his teeth cleaned was put on IV fluids before the procedure to stabilize the kidneys for the anesthesia. The fluids are continued for the duration of the procedure, and will be administered until this pet is fully awake and its owner is picking it up.  

The placement of the catheter requires technical skill and knowledge, particularly in small or dehydrated pets (the veins in these pets are small and damage easily). Improper placement of the catheter can literally cause more harm than good. Our nurses excel at placing I.V. catheters in all species.

Because the catheter is introduced directly into the venous system, it must be placed in an aseptic (sterile) manner. The hair over the vein is shaved, and special tape is placed over the catheter. 

Comfort is also important when placing the catheter due to the small nature of some of our patients, and the duration the catheter must stay in the vein. This tape and catheter is constantly monitored by our staff for comfort and sterility. After 3-5 days we usually replace the catheter in order to minimize the chance of the catheter causing an infection. 

I.V. catheters are usually placed in one of three veins:

Cephalic Vein-This is by far the most common vein to use. It runs along the top of the foreleg of dogs and cats. The illustration below shows the placement of this catheter in a large dog.

Jugular vein-This vein is in the neck. A catheter placed in this vein allows longer term use and the ability to give larger volumes of medication with different viscosity’s.

Saphenous-This vein is on one of the back legs. It is mostly used when the cephalic vein is unusable, but can be used at any time.

Various other veins are sometimes used, by they are reserved for some of the more unusual species of animals we deal with. In some of these pets like birds, that have minuscule seized veins, we cannot give the necessary emergency fluids intravenously. In these cases we use what is called an intraosseous catheter. This catheter goes directly into the bone marrow, and allows us to give the necessary fluids to a small creature rapidly and effectively. In birds it is put in what is called the tibia tarsal (tiboitarsus) bone. This is equivalent to our tibia or shinbone. It is put in at the knee joint.

This radiograph shows the placement of an intraosseous catheter. It is going down the shaft of the tibiotarsal bone in this bird that came in collapsed and in shock. The bird responded and recovered completely after we administered fluids through this catheter. 

Your pet’s catheter will stay in for the duration of its hospitalization or procedure, and will not be removed until you return to pick up your pet. Your pet may go home with a small piece of tape and cotton where the catheter was. It can be removed several hours later after you return home.

We use many different types of fluids, the most common one being Lactated Ringer’s Solution. The amount of fluids given are calculated and  monitored carefully.  We use a special fluid pump that gives a consistent amount of a period of time.

Each patient receiving fluids has a custom fluid chart outside its cage for close and constant monitoring of the fluids. Our doctors make adjustments in the type and amount of fluids as diagnostic tests like blood panels, and your pet’s response to treatment, are analyzed. 

Subcutaneous (SQ) Fluids

The second method used to administer fluids is subcutaneously (under the skin) between the shoulder blades. The administered fluid slowly absorbs over several hours. In this hospital and on an out-patient basis, this method is used for pets that are not seriously ill, but just need some additional fluids to maintain hydration, fight a fever, or stimulate the appetite.

If your pet needs to be on SQ fluids on a long term basis due to a chronic disease, think of it as bonding time and make it a positive experience

This section on SQ fluids contains  detailed step-by-step descriptions on how to give fluids at home on an ill pet, an older pet, or a pet with kidney disease. When you first read it you might think there is no way I can do all of that. Once you observe us do it in front of you, and then do it yourself, you will realize it is not anywhere is difficult as you think when you read about it the first time.

This video is how we give sq fluids at our hospital. Notice how calm this dog is.

SQ fluids are of special benefit for pets that need long term fluid administration at home, usually older (geriatric) cats or those with kidney disease. This is the animal version of dialysis in people, and it works extremely well. These fluids at home are highly beneficial, and have had cats with chronic kidney disease do well for years with this treatment at home.

If your doctor feels your pet needs SQ fluids at home you will be taught how to administer them by our nursing staff. At first it might seem an impossible notion to give your pet fluids at home. Not only is there the psychological fear of using a needle, or worry about hurting your pet, there is also a worry that your pet will not stay cooperative long enough for the few minutes it takes to give the fluids.

Rest assured that you will not be forced into giving these fluids if you feel uncomfortable, although we have yet to encounter a client that was not able to perform this procedure at home. This is because we have extensive experience in this area, and we teach you at your own individual pace. Only when you feel you are ready will you proceed on your own.

You will be given as many personal demonstrations as necessary, and can return to the hospital at any time for further demonstrations or to make sure you are performing the procedure properly. You are welcome to bring your pet in at any time for assistance in giving the fluids, so do not feel you are on your own. If you are out of town, your house sitter can bring your pet in for these fluids. We consider you part of our nursing team and are willing to give any assistance needed. Before you are given a live demonstration the following basics will help prepare you.

The scariest part of the whole procedure for most people is the actual insertion of the needle into the skin so that the fluids flow under the skin (SQ). You will watch us do this as many times as you need to overcome any fear you might have. When you realize it is not all that difficult by watching us do it, we will hold your hands when it is your turn if needed.

Practicing by inserting a needle into an orange or similar fruit can be helpful. Different sized needles, ranging from 22 gauge to 18 gauge, are used to give SQ fluids. During the demonstration we will show you which one works best for your pet.

The 18 gauge needle, at the top, has the largest diameter. Fluids flow fast through this needle, taking less time to give them. If this size needle is uncomfortable for your pet, we will try the 20 gauge next because it is smaller, although the fluids will flow more slowly. On small pets we might even use the 22 gauge needle. 

During this demonstration you will be told exactly how much fluids to give. For most cats with chronic kidney disease, this is 100ml once or twice daily. The fluid bag has 1000ml (1 liter), so for the average cat you will be able to give these fluids for ten days. This might vary depending on many factors, and your doctor will determine the amount and frequency. Do not change this unless instructed to.

Keep children and other pets away if they are disruptive during the process of giving the SQ fluids at home. Have all of your equipment readily available, usually on the same table as your pet. Depending on the size of your pet, the table should be around waist to chest high. It is helpful to set up one area of your house to give the fluids. Hang the fluid bottle in this room for easy access. It should be at least a few feet above the table for optimum flow. You will be shown how to set this up by one of our staff.

Store the fluid bag at room temperature and cover the bag so no light hits it. We sometimes add medications like vitamins and electrolytes to the bag, and light can affect them.

When you purchase a fluid bag from us it needs to be set up with the IV line. We will show you how to do this in person. You only need to set it up when you purchase a new bag. After that, you give the fluids with a new needle each time, keeping the IV set attached, until the bag is empty.

Never use the needles more than once since they are sterile and very sharp when first opened. Repeated use could cause an infection in your pet, and makes the needles dull, causing discomfort on administration. Needles are inexpensive, so don’t take the chance by re-using them.

When you purchase the bag it comes wrapped in a plastic wrapping. Remove the wrapping at home when you are ready to set it up to give fluids to your pet. After you remove the outer wrapping lay the bag on your table or hang it from a coat hanger. 

Open the sterile IV set and lay it on the table


These are the components of the IV set

The large white end with clear receptacle goes into the fluid bag once the white cap is removed. The clear container above will be filled part way with fluid once attached. 

 At the opposite end of the IV line is a small blue cap. You remove this blue cap when you attach a needle, which you will learn about later. 

The large blue plastic piece in the center allows you to turn the flow on and off, and also adjusts the rate of flow. Make sure the white wheel is in the off position like this when first setting it up. 


Remove the white plug from the bottom of the bag. The cap is in solidly, so you will need to pull hard to remove it.

 You can do this while the bag is hanging, or while it is laying on the table. Discard the white cap, it will not be used again. 

Remove the white cover from the IV set receptacle. It is sterile, so do not touch it to anything at this point. 

Hold the hanging bag steady, or lay it flat while doing this, so you can put it straight in without touching anything else. 

Insert it all of the way into the fluid bag 

Hang the bag, then squeeze the receptacle until the fluid fills half of the receptacle

It should look like this when you are done

Lay the needle next to the end of the IV set that has the blue cap

Remove the clear plastic at the base of the needle by twisting it either direction. The open base of this needle is sterile, so do not touch it to anything until you insert it into the IV line. 

Remove the blue cover at the end of the IV set. Turn the fluids on and let a few seconds of fluids flow through the IV line to remove the air. Let these few drops flow into a small bowel or on to a towel. Do not touch the end of this line to anything. 

A few air bubbles left inside the IV line will not cause any problems 

Insert the needle straight into the opening. Hold you left hand still as you twist clockwise with your right hand to lock it tight

Hang the IV set over the fluid bag. You are now set to give the fluids. 

Every pet reacts differently to the actual giving of the fluids, and they feed off of your emotions, so cool and calm usually works best. If either one of your gets worked up, stop and try again later.

Make sure the location to give the fluids is subdued and calm, with no excessive lighting or noise to alarm your pet. Take your time by bringing your pet to the table and interacting with it by petting it and holding it. You can even feed it while giving the fluids. A towel for restraint, or another person holding the head, might even be appropriate.

Hold your pet to the side, make a small tent of the skin between the shoulder blades, remove the cap over the needle, and rapidly insert the needle between the shoulder blades in one motion.

Insert it all of the way in until the hub touches the skin. Turn on the fluids completely on by moving the white wheel all the way to the top, and give the prescribed amount of fluids. For most pets, this takes only a few minutes of your time daily, a few minutes of your time that will be highly advantageous to your pet. 

When you are finished giving the fluids remove the needle from your pet and cap it. Remove the used needle and place a new sterile needle at the end of the IV set, and hang the IV set over the bag as before. You are now ready to give the fluids again the next time one of our doctors prescribes.

Finally, pat yourself on the back for a job well done, have a seat, and breathe deeply (or get a stiff drink if needed to calm your shaking hands).

Place all used needles in a safe place with no access to children or pets. A sharps container to hold these needles is the best place to put them until disposal. Dispose them according to the guidelines in your community. Here are some local disposal centers for needles. If you are not near one of these areas call us at 562-434-9966 for other locations:

EDCO Recycling and Transfer Center

2755 California Ave.

Signal Hill, CA 90755

562-597-0608

L.A. County Sheriff- Lakewood Station

5130 N. Clarke Ave.

Lakewood, CA 90712

Huntington Beach Collection Center

17121 Nichols Lane

Huntington Beach, CA 92647

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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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Arthritis

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One of the most insidious diseases we encounter in animals is arthritis. It was not long ago that pets were euthanized because they seemed “old” based on their symptoms of poor appetite, decreased activity, and lethargy. In reality they were not “old”, they had arthritis, and acted like they were old because they were painful.

Today we can treat their arthritis and give them a new lease on life and lead a great quality of life for many more years. All animals get arthritis, we most commonly see it in dogs and cats. This page will emphasize it in dogs since it is most prevalent in them. Cats get arthritis also, and we wil discuss how they differ from dogs in this disease.

Many of our pets are stoic, and can have a disease process brewing on the inside yet show no external symptoms. As the disease progresses eventually the symptoms appear, and we are presented with a very ill pet that seemingly became sick overnight. The reality is that the problem was present for a long period of time. It went unnoticed until your pet went rapidly downhill, when the bodies mechanisms for compensating and coping with the disease have become overwhelmed, and your pet is in a debilitating condition. At this point the disease process is so well entrenched that the prognosis for recovery is poor.

This concept applies to arthritis in dogs and cats.With our new digital radiography that gives us much more detail, we are diagnosing it earlier. Coupled with substantially improved treatments, we can successfully treat these arthritic and painful animals, and give them a vastly improved quality of life for many more years.

This digital radiograph of the abdomen shows the tremendous detail we get with digital, and how we can see the internal organs in the abdomen. Click on the photo above if you would like to learn how to read a radiograph (you do know the 5 radiographic densities don’t you?).

What’s even better is the fact that some of these new treatments do not involve the use of drugs. We have a multi-system approach to arthritis due to its chronic and debilitating nature, and the fact we strive for treatment modalities that involve minimal use of long term drugs.

Here is a summary of how we approach this important problem. We will talk about these treatments in more detail later in this page:

If your pet is overweight, a common problem, modifying diet and feeding habits to bring it back to its fighting weight can minimize the symptoms of arthritis. This common sense, inexpensive, and drug free option, seems to escape many people.

Hills-MetabolicMobility

Hill’s makes a prescription diet called Metabolic + Mobility that addresses obesity and arthritis at the same time. It is the food of choice for overweight dogs that that are also arthritic.

Arthritis tends to be a disease of the aging. Older pets have different nutritional needs that need to be addressed. These needs cannot be addressed by going to a pet store and listening to the advice of some amateur nutritionist behind the counter trying to sell you the latest gimmick in dog food marketing. It comes after you discuss your pet’s individual lifestyle needs with your veterinarian, your pet is given a thorough physical exam, and your veterinarian has blood panel and radiographic tests on your pet. Only then will the full picture of your pets needs be understood, leading to a custom treatment protocol specific for your pet.

Chondroprotective agents called neutraceuticals can help in some cases.  These are the chondroitin sulfate- glucosamine products available everywhere, including Trader Joe’s at the checkout stand. They are not a panacea, and its important to take a critical look to see if they are working in your pet’s case. Sometimes the placebo effect seems to be transmitted in our minds to our pets, and we do not have an objective standard to determine if these medications truly help. Fortunately they do not seem to hurt, so we can achieve or first goal of “do no harm” as veterinarians.

NSAID’s  (non-steroidal anti-inflammatory drugs) are a tremendous advancement in the treatment of arthritis. Non-steroidal means they do not contain cortisone, which was one of the primary drugs used to treat arthritis in the recent past. The NSAID’s are better at treating arthritis when used judiciously to maximize their good effects, while minimizing their potential for side effects. Every pet reacts differently, so if one NSAID does not seem to work, we will try another. In cat’s we use this drug sparingly if it all due to their inabiliy to tolerate their use long term. The NSAID’s we use in cats are called Meloxicam, Metacam, or Onsior.

Veterinary Neuronal Adjustment (VNA or VOM) is a tremendous treatment modality that uses the bodies natural healing processes without the use of any drugs. It involves stimulating the autonomic nervous system (specifically the sympathetic branches) and provides substantial pain relief. We have been using VNA at the Long Beach Animal Hospital for over 15 years. This is especially important in cats, since they do not tolerate NSAID’s well for long periods of time.

Therapy Laser brings an additional and highly effective treatment modality that again does not involve the use of drugs. This laser penetrates the hair and skin and goes right to the problem area to decrease inflammatory mediators. We recently updated our equipment to include a new therapy laser called MLS that treats using two different wavelengths.

Acupuncture can also be used to augment all of the above therapies. Dr. Seto and Dr. Yamamoto are both certified in acupuncture in animals. Cats do well with acupuncture.

Stem cell therapy is starting to be used, utilizing your dogs own fat cells. It is still in the early stages, and treatment is not long lasting. If this area of treatment evolves and becomes more practical, we will utilize it.

Exercising your pet in the cooler part of the day, without excess trauma like jumping for long periods of time, will keep your pet flexible, the joins warm and lubricated, and keep its weight under control. If your pet is not afraid of water, letting it swim in a shallow area is a great way to enhance mobility.

In older cats that are prone to arthritis there are several common sense things to do:

Raise the water and food bowls slightly. This is because cats get arthritis in the elbow joint, and elevated bowels allow them to feed with the elbow in extension, which is less painful. It also gives cats with hip and stifle (knee) pain are more comfortable sitting position when feeding.

Have several litter boxes around the house, make sure they do not need to go up the stairs to access them, and if the litter pans have tall sides see if they can be cut down for easy access.

If your cat likes to perch on a window sill or lay on your bed make sure it does not need to jump to access these areas, and set up some steps for easy access.

We will use the words arthritis and osteoarthritis (OA) interchangeably, because they are the same thing in regards to the pain your pet is feeling and how it is treated.

Please be realistic about the fantastic claims that abound on the Internet for cheap treatments that will help your pets arthritis. These treatments have show to be nothing more than effective marketing. This disease is complicated and serious, and needs more than some supplement you purchase online.

What is Arthritis?

Dogs are prone to many different types of bone problems. This page will focus on the arthritis that tends to occur in dogs, especially as they age. Arthritis literally means inflammation of the joint, but the term is used more generally to describe several different processes. These include degenerative joint disease (DJD), infectious joint disease, immune mediated joint disease, and crystal-induced joint diseases. Many people use the term arthritis synonymous with osteoarthritis (OA), a complex, slowly progressive, and degenerative arthritis that is characterized by the gradual development of joint pain, stiffness, and a decreased range of motion.This is the type of arthritis common in older pets, and is increasing as pets live longer.

As we learn more about the subtleties of feline medicine we realize that many cats get significant arthritis especially in their lower back. This problem, also know as feline hypersethesia syndrome, causes tremendous discomfort and decreases the quality of life for many cats.

Anatomy

A normal joint is lined with hyaline cartilage, which is the covering over the end of the bone. It provides an almost frictionless surface for the bones to articulate, and also acts as a shock absorber. Hyaline cartilage is comprised of chondrocytes, proteoglycans, and collagen.

A normal joint is encased in a fibrous structure called the joint capsule. The joint capsule helps stabilize the joint and keeps the cartilage bathed in synovial fluid. Ligaments, which attach bone to bone, also provide joint stability.

This picture is from an actual surgery on the knee of a dog with a ruptured cranial cruciate ligament. The head is on the right, the foot is on the left, so the joint appears horizontal.

Arthritis-StifleJointArrow

The ridge of bone running horizontally at the bottom (arrow) is arthritis. The normal smooth cartilage above it is the normal groove of the knee (stifle) joint. The patella runs along this groove. 

Cause

The cause of this complex and multi factorial disease can be primary or secondary. Primary OA results from normal stresses acting on abnormal cartilage. Secondary OA is more common, and results from abnormal stresses acting on normal cartilage, such as an unstable joint caused by canine hip dysplasia, fragmented coronoid process, ununited anconeal process, patellar luxation, or a ruptured cruciate ligament. Some of the factors that can cause OA include excessive exercise, obesity, poor nutrition, trauma, immune reactions, and genetic predispositions.

The  following radiograph on the top is from a normal shoulder joint. The one on the bottom has an abnormal flap of cartilage at the arrow. This is know as osteochondritis dissecans, and is a primary OA. Without this radiograph we never would have know this limping pet had this problem.

shoulder arthritis

This normal shoulder joint shows no problems
osteochondritis

The white arrow points to a flap of cartilage that has eroded off

These two elbows from the same dog are normal

This elbow from a different dog shows advanced arthritis, probably secondary to elbow dysplasia

Damage to cartilage might occur as one event, or be the culmination of many small events over years. As swelling occurs, and the joint capsule becomes stretched, pain occurs. Your pet will use the joint less because of this pain, leading to muscle atrophy and the inability of the surrounding tendons and muscles to support the joint. As the muscular support of the joint weakens the joint capsule, ligaments, and cartilage become further stressed and stretched, leading to even further pain.

At this point the body releases chemicals called inflammatory mediators, (the therapy laser works on these mediators) which further damage the cartilage and add to even more swelling. It is obvious that this rapidly becomes a vicious cycle leading to debilitating pain. When OA progresses to the point that you notice your pet in discomfort or pain, the damage to the joint might be irreversible.

Diagnosis

Signalment

OA is commonly diagnosed in older dogs and cats. Some breeds are prone to getting it because of the conformation of their joints.

Dogs like Dachshunds have abnormally shaped long bones that might predispose them to OA. This is the wrist, forearm, and elbow of a Doxie. The medical terms are carpal, radius, ulna, and olecranon.

History

It is important to understand the initial symptoms might be subtle. Your pet will be experiencing pain or discomfort, yet it might not show any external signs.

Symptoms are related to joint pain and stiffness. Most owners notice a pet losing its ability to perform normally, such as a reluctance to jump or climb stairs, or even limping. Stiffness after rest that diminishes rapidly as your pet starts moving and warms up is a hallmark sign of OA. Other symptoms of arthritis include lethargy and poor appetite, which are the result of pain.

Initial symptoms are subtle and easily missed. Most dogs show a reluctance to run or move about. Some might not walk as long as usual, stop part way through a walk, or come back from a routine walk and go right to their bed to rest. They might be slow getting up.

Some will be reluctant to go up or down stairs, or might even be limping. As the disease progresses these dogs might be in overt pain and lose their appetite. Some of these symptoms occur in other diseases, notably hip dysplasia and intervertebral disk disease. The are treated in similar ways in some cases, in different  ways in other cases, so a proper diagnosis is imperative.

Dogs that will not go on extended walks, or dogs that pant excessively during a walk could also indicate OA. Symptoms can be worsened by obesity, too much exercise, and by cold or damp conditions.

Cats tend to show different symptoms sometimes. The most common areas for cats to have arthritis are the elbow, knee, hip, and spine. Most cats tuck their forelimbs under their bodies when they rest. If your cat consistently holds its elbow out (in extension) that could be a sign of elbow pain, a common area for arthritis to occur in cats. Cats that are reluctant to jump up to the bed or a window sill could have arthritis.

Other symptoms in cats include unkept fur due to pain when grooming. There could be overgrooming in painful areas leading to hair loss at the joints. Overgrown claws could be a sign it is not moving normally due to pain. At the end of this page is a link to the Feline Musculskeletal Pain Index to help determine if your cat is having a problem.

Physical Exam

In some pets there are no abnormalities detected during a physical exam. Pain or discomfort might be found by palpating a joint or pushing on the mid or lower back. We might feel grinding of joints (crepitus), a swollen joint, abnormal bone formation and roughened bones, or inflammation at the joint. Dogs with longer standing OA might show atrophy of muscles. Range of motion might be limited and cause discomfort or pain. There might also be subtle signs during the neurologic part of the exam.

Cats tend to have less crepitus and range of motion problems, but do have more joint swelling and pain.

Some pets are so distracted during an exam (this happens to us people commonly) that they do not exhibit signs of pain when touched in painful places. This is why we need some basic diagnostic tests.

Diagnostic Tests

Radiography is an important diagnostic test to perform on a dog or cat suspected of having OA. Even though a radiograph can be normal in a pet that has OA, it is a substantial help in verifying the diagnosis and determining the degree of involvement. Cats tend to have less radiographic evidence of arthritis, and might even have more cartilage problems than bone problems in some cases.

There are many diseases that can mimic the symptoms of OA, so a radiograph should be taken on every suspected OA  to eliminate these other causes.

This is a normal dog knee joint radiographically

This one has arthritis. The arrows point to all of the rough edges that are indicative of OA. Compare these rough edges to the smooth edges on the radiograph above. Also, the bone has a stronger whitish appearance, another indication of OA.

This dog was originally suspected of having arthritis based on a history of soreness in the hip area. It would be a mistake to treat this dog with an arthritis supplement and let the undiagnosed problem progress.

Radiographs revealed the true diagnosis was not the assumed arthritis, as can be seen at the arrow at the far left of the radiograph. The white circular area in the bone has the potential to be several different diseases, some of them serious like cancer.  A bone biopsy is need to know for sure.

A close-up view gives you a better idea of this dog’s problem

This form of OA is called spondylosis, which is arthritis of the vertebrae in the spine.
It is very common as pets age and causes substantial discomfort, nerve weakness, and even urinary and bowel incontinence.

The red circles show the sever spondylosis this bulldog has. It is affecting the nerves to the bladder, causing an inability to properly urinate. The hugely distended urinary bladder is the result of this nerve problem, and can be seen as the large whitish area in the center of the radiography. A bladder this large is painful and prone to a chronic infection (UTI or cystitis).

You can learn more about the bones of the spine by going to our intervertebral disk page.

This dog was sore around its rear quarters when petted by the owner. The owners of the dog assumed it was arthritis and treated the problem on their own. When it did not improve the dog was brought to us for a proper diagnosis. Look at the lateral radiograph below of its posterior abdomen and see what you think the cause of the soreness was.

Did you figure out what is going on? Those circular white objects towards the top right of the radiograph are 3 pennies in the rectum! Even though it seems like a safe place to store your money, it was painful and causing this dog’s problem.

This is another dog that was sore in its rear quarters which that owner (and all of his well intentioned friends that love to give advice) assumed was just old dog arthritis. The circle shows the real cause of the problem in this dog’s back end. It is due to enlarged sublumbar lymph nodes from malignant cancer. 

A very important differential when diagnosing OA on a radiograph is a bone tumor. This one is on the femur (thigh bone). This dog had symptoms of muscle atrophy and limping on this leg. If a radiograph had not been taken these symptoms could have easily been mistaken for arthritis. At this stage of the disease amputation is usually the only way to temporarily stop the tumor from spreading.

This is a serious form of cancer, and usually requires amputation 

The other important differential on radiograph like this is a bone infection called osteomyelitis. The fuzzy or roughened edges at the arrows is the infection.

The incorporation of digital radiography into our practice gives us substantially more detail on a radiograph. This is easily seen in the Ferret spine radiograph.

Treatment

Treatment of OA initially includes correction of any underlying primary diseases such as surgical correction of a torn ligament or arthroscopy to remove a cartilage flap. Once any primary disease has been addressed, the goal of treatment is to slow the progression of OA and to keep your pet comfortable. It’s important to realize that there is no cure for OA. The following are the treatment options we find that are most successful, and were mentioned at the beginning of this page.

Nutrition

Most pets with OA will require some adjustment in their lifestyle. Weight management is most important, since obese pets put unnecessary strain on joints, leading to a more rapid progression of the disease. Depending on the degree of obesity your veterinarian might put your overweight pet on Hill’s Metabolic Diet. This is a weight control product with lasting effects and is our first recommendation. We might also use Hill’s W/D (weight diet) or Hill’s R/D (reducing diet).

If your pet is not overweight  we will utilize a food called Hill’s J/D (joint diet). It has added chondroitin sulfate and glucosamine in addition to essential fatty acids and carnitine. These foods are complete and balanced nutrition and can be fed for the rest of your pets life. There is a version for dogs and one for cats. Like all Hill’s foods it highly recommend in almost every case of arthritis unless your pet has some other disease that precludes their use. All Hill’s Prescriptions Diets our doctors recommend are unconditionally guaranteed. We have a detailed page on Nutrition Advice to help clear the air on all the hype that exists on the Internet to get you to put your money into this multi billion dollar a year business.

Omega-3 fatty acids have been shown to improve activity in cats with arthritis. They are included in many health diets already, so added amounts are not needed in most cases.

Exercise

Excessive exercise that leads to pain or discomfort should be avoided, but moderate exercise is recommended. Swimming is an excellent exercise for pets that have OA and aren’t fearful of water. Most pets do best with several short, exercise periods per day rather than fewer extended periods. Each patient will have their own unique program of weight management and exercise, and we can help you individualize one for you and your pet.

There are even veterinarians that specialize in rehabilitative therapy, with specialized swimming pools and therapy methods.

Chondroprotective Agents

These products typically contain precursors of cartilage and joint fluid synthesis. We like to use these medications first since there are negligible side effects and they might be an aid in preventing further deterioration of the cartilage. Hill’s J/D contains adequate amounts of these ingredients. Please remember that if a little is good, a lot is not necessarily better, because you disrupt the nutrient balance that is so important in nutrition.

These products have a positive effect on cartilage matrix synthesis and  an inhibitory effect on the enzymes that break cartilage down. They might require up to 6 weeks of use before OA symptoms are diminished. Unfortunately they do not work in every case, so be realistic and make a careful assessment as to their efficacy.

Adequan

Adequan (polysulfated glycosaminoglycan) is an injectable chondroprotective agent. Adequan incorporates into joint cartilage and inhibits several enzymes that break down cartilage. No studies have been done in animals other than horses and dogs, but it appears to be safe and effective in other species including cats, rabbits, ferrets, and birds.

The intramuscular injections are initially given twice weekly (every 3-4 days) for a month, then given monthly as needed. Adequan seems to be most effective when given in the early stages of OA. 

Dasuquin

Unlike the injectable adequan, Dasuquin and other oral joint supplements are considered nutraceuticals, or nutritional supplements, and do not require FDA approval. Cosequin contains glucosamine and chondroitin sulfate, agents proven to be effective at supporting and protecting joint cartilage.

In addition, Dasuquin contains ASU (avocado/soybean unsaponifiables) that makes the glucosamine and chondroitin sulfate more effective.

There is a Dasuquin made for cats also

NSAID’S

The non-steroidal anti-inflammatories (NSAID’S) are the most commonly used drugs in treating OA in dogs. We also use them in cats, but for a shorter duration. NSAID’s are highly effective and tend to be the drug of choice when we put your pet on actual arthritis medication. They are so effective we even use them for routine post operative pain control in dogs and cats. They have saved many a dog from long term pain, and even euthanasia.

NSAID’S work by inhibiting an enzyme in the inflammatory pathway, thereby providing analgesia (pain relief), antipyrexia (decreased fever) and reduced tissue swelling. The enzyme that is inhibited is  cyclooxygenase (abbreviated COX). This enzyme causes an inflammatory reaction in the joint fluid that surrounds the joint.

A common NSAID is Rimadyl. We use other NSAID’s in addition to this one.

Before we start your pet on NSAID’S we perform an examination and run a baseline blood sample. Every 6 months we will examine your pet and recheck the blood to look for any potential side effects. This will make sure kidney and liver function is adequate.

This pet has kidney disease, and the kidney problem needs to be addressed before we institute NSAID therapy. We would use a lower dose of the NSAID many times in a pet with kidney disease like this to make sure the NSAID is not making the kidney disease worse. 

Using NSAID’S alone is not recommended since the signs of arthritis are masked, leading to a more active dog and a quicker progression of arthritis. NSAID’S, in combination with weight loss and chondroprotective agents, provide cartilage building blocks in addition to pain relief, and may slow the progression of OA.

All NSAID’S carry a small risk of side effects, so careful observation of your pet while on one of these medications is important. If they occur, the most common side effects are vomiting and diarrhea. There might also be kidney and liver problems, and even bleeding. These side effects can be minimized by using the lowest dosage and frequency possible, giving the medication on a full stomach, and giving Pepcid AC  prior.

The best way to minimize the potential for side effects, yet still get the most out of NSAID’s, is to use the lowest effective dose of the NSAID of choice, and combine it with proper diet,  VNA and Companion Laser as additional treatments. You will learn more about these treatments below.

We do not routinely use NSAID’s in cats due to their potential to cause kidney damage. These cats do best with weight loss if they are overweight, J/D diet if they are not overweight, Dasuquin, VNA, and Companion Laser. A new NSAID for cats is called Onsior. It is approved for treatment of pain and inflammation for 3 days, so we use it routinely in our post operative cat patients.

The other primary NSAID we use in cats is called meloxicam (Metacam). It is used only for a few days due to the potential for problems with the kidneys.

VNA (also called VOM in the past)

An additional treatment modality that has yielded great success  for well over the last 20 years is called VNA. It has been a game changer for us in the treatment of arthritis in a wide variety of animals.

It is a non-invasive and non-painful way to stimulate the autonomic nervous system to help correct the problem. Through the use of VNA we can decrease the use of the above medications in almost all cases. By decreasing the use of these medications, we help your pet live a longer and healthier life, while decreasing you medication costs over the life of your pet. Click here to learn more about VNA.

This dog is getting VNA therapy for its arthritic spine

Cats respond very well to VNA treatment. They get what is called the “Feline Hyperesthesia Syndrome. In this syndrome, their lower backs are extremely sensitive, so much so that they start licking compulsively when scratched there, can bite an owner due to pain, and even go into a seizure.

Look how sensitive this cat is when scratched at its rear quarters

As we perform VNA the cat relaxes completely because the sensitivity is diminished

We use VNA in a wide variety of species. This rabbit has GI stasis, and felt much better after this treatment.

Companion Laser Therapy

In the last few years we have added a new and natural way to treat arthritis using the Therapy Laser. This modality has been used to treat people for over 30 years and has recently been approved by the FDA for use in animals. This treatment modality has been a huge boon to our geriatric pets with painful arthritis, especially when used with low dose NSAID’s and VNA.

To learn more about it please click here or on the picture below.

Acupuncture

This can also be used at any time to augment the treatment already being utilized. To learn more about how we use acupuncture follow this link.

Do you see the two acupuncture needles on this pet’s neck?

Miscellaneous Pain Medications

Galliprant

This is a prostaglandin antagonist that helps with pain and inflammation. It is used only in dogs.

Tramadol

This medication is used for pain. It seems to help, but there is controversy on whether it does actually help with pain, with the latest consenus is that it is not helpful. .

Gabapentin

This seizure medication is another useful adjunct as the arthritis progresses.

Brupenorphine

Short term use can be effective for pain control.

Regenerative Medicine

What this is not doing is to generate new and healthly cartilage as is a common misconception. What this treatment does is take a high concentration of growth factors and anti-inflammatories and bring them to an area of relatively poor tissue healing with the chance there will be a reduction on the inflammatory process.

Stem Cell Therapy- (Adipose Derived Stem Cells ( Ad-SCT ))

This promising yet unproven treatment utilizes stem cells from your own dog’s fat cells to alleviate arthritis symptoms. This means there is no chance of rejection, a major advantage of this technique.

Your dog has to be anesthetized for a short time in order to harvest the fat cells. Collection sites can be in many areas depending on your dogs conformation and fat reserves. Once the fat cells are harvested they are shipped overnight to the company that isolates the stem cells with a specialized technique. They are returned usually within 48 hours. We sedate your pet again and inject the stem cells into the affected area.

We will keep you posted as this promising therapy is given better scrutiny to make sure it has no deleterious effects in the long run and actually helps.

Platelet Rich Plasma (PRP)

This is a blood sample from your pet with a high concentration of  platelets without red blood cells (RBC’s) and some white blood cells (WBC’S). These platelets have growth factors and anti-inflammatory properties.

Rehabilitation

This can range from using wobble boards and exercise balls up to underwater treadmills. These can be beneficial, and we would send you to a veteriinary specialist to help determine if this will help in your pet’s case.

Here is the link to the Feline Musculskeletal Pain index. Please print it out and bring it in when we examine your cat.

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Sarcoptic Mange (Scabies)

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Sarcoptic mange (cats get a version called notoedric mange ), commonly know as scabies, is caused by an external parasite called Sarcoptes scabei  that burrows deep into the skin. It commonly occurs in dogs, not so commonly in cats, unless is it notoedric mange), also occurs in foxes, ferrets, rabbits, sheep, goats, cattle, pigs and guinea pigs.

It is contagious to other pets and occurs in many different animals. It causes intense itchiness, especially affecting the ear margins, elbows, and face. People can pick up this disease from their pet and show symptoms of itching, but it goes away by itself in many cases and usually  does not require treatment in most cases (always check with your doctor).

It is important to note that the diagnosis of this skin condition, like most skin conditions, cannot be made just by looking at a pet. Diagnostic tests are mandatory to arrive at a correct diagnosis and achieve a satisfactory outcome to therapy. Stating that an animal looks “mangey” is not the same thing as making a positive diagnosis of mange. Pets that have Ringworm , Demodex. and allergies can look like they have Sarcoptic mange.

 Life Cycle

This ectoparasite spends it life cycle of 14-21 days entirely on the host it has infected.  Overcrowded conditions increase risk for transmission. Stress from many sources can also be a factor.

History

The following history for an itching pet with sarcoptes usually involves:

  • Severe itching that is non-seasonal
  • Recently adopted or boarded pet
  • Multiple pets in the house
  • Humans in the same house that are itching with red lesions on their skin.

 Symptoms

In dogs most of the symptoms involve intense itching at the ear margins, elbows, hocks and abdomen. Less common areas of itching can include the face and feet. This itching will inflame the skin and cause scabs, with a secondary bacterial infection (pyoderma) occurring due to the trauma. Some pets will shake their ears excessively and cause an aural hematoma (swollen ear). These symptoms can mimic those of other skin conditions, so the rules of the diagnostic process should be carefully adhered to.

Other symptoms that might be present sometimes include:

  • Lethargy and depression
  • Lack of appetite
  • Weight loss

Cat mange (notoedres cati)

In cats, sarcoptic mange is caused by a mite called notoedres cati, a microscopic ectoparasite that burrows in to the skin. It is not as itchy, and occurs more often on the face, ears, paws, and tail.

This is a highly magnified view of notoedres cati as it appears under the microscope

This cat has scabies, but you can’t say that for sure just by looking at it

The top of his head shows how irritating the problem is, especially at the ears

Diagnosis

The primary way to diagnose sarcoptic mange is to do a skin scraping where the patches of alopecia occur. Finding these mites, their eggs, or their feces,  under the microscope can be very difficult in this disease. a pet that has the symptoms of Sarcoptic mange and is negative on skin scrapings for the parasite can still have the disease. In these cases we commonly treat for the disease anyway, because the treatment is highly effective.

In rare cases we will do a skin biopsy, which is a great way to rule out other diseases that have similar symptoms.

Other diseases in dogs that mimic scabies include:

  • Folliculitis
  • Malassezia (fungus)
  • Allergies
  • Contact dermatitis
  • Cancer
  • Pemphigus (immune system disease)

Diseases in cats that mimic scabies include:

  • Demodectic mange
  • Otodectic mange
  • Cheyletellia
  • Herpes dermatitis
  • Allergies

Treatment

The usual treatment for Sarcoptic mange is a drug called Ivermectin. It is an injection given weekly for up to 6 weeks. Most pets decrease their scratching rapidly after the first injection. Some dogs, particularly Collies, Shetland Sheepdogs, and Old English Sheepdogs, do not tolerate the medication well. In these pets we use a dip called Lyme Sulfur that is also very effective.

The disadvantage to the dip is the odor it causes and the staining of white coated animals. All pets in a household should be treated regardless of whether they are showing symptoms or not. Pets that have secondary skin infections from the trauma might also be put on antibiotics. Other common treatments include Revolution (selamectin) topical.

Other pets in the same household are commonly treated if they are in close contact. Treating the environment is usually not needed if all pets in the house are treated.

Some pets itch more in the first few days of treatment due to dying mites. These pets can be put on low dose cortisone for a few days in a reducing dose to get over this phase.

This dog has scabies

This is a picture from the dog above 7 days after its first Ivermectin injection

Prevention

Good nutrition and plenty of play and exercise are always important to maintain the proper balance to fight off disease. All pets in a household that has a pet diagnosed with this disease should also be treated.

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Spay Ferret

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If female ferrets go into heat and do not mate or are not spayed, they can develop a severe, and even life threatening anemia. This is because estrogen can cause the bone marrow to stop producing red blood cells. If your female ferret develops an enlarged vulva it should be brought in for an exam immediately to determine if it is in heat or possible has an adrenal gland problem.

This page contains graphic pictures of an actual surgical procedure performed at the hospital. 


Physiology

Female ferrets have a unique reproductive system. Most female mammals have a heat cycle the phase in and out of, whether they mate or not. Ferrets are induced ovulators, and will stay in heat until they mate. While in heat a female ferrets secrete high levels of estrogen. If this hormone stays in the blood for a prolonged period of time, as what occurs when the female does not mate, it will affect the bone marrow. The white blood cells are not produced in adequate numbers, and the ferret becomes much more susceptible to an infection. Also, a serious anemia will arise, and will be life threatening if not corrected. If your ferret is not being bred then it must be spayed or the problem of life threatening bone marrow suppression will present itself when it goes into heat.

Pre-Operative Preparation

Please take away all food and water the morning of surgery (do not fast a ferret for more than 4 hours) and bring your pet to the hospital between 7:30 AM and 9 AM the day of surgery. It will go home in the late afternoon the day of surgery. Please call our office at 4 PM for pickup time, you will be given post operative instructions then.

Anesthesia

Pre-anesthetic preparation is important in every surgery we perform, no matter how routine. All of our spays receive a physical exam prior to surgery. After this exam will we draw a small amount of blood for an in-hospital pre-anesthetic test. When everything is to our satisfaction we will administer a sedative. This will calm the pet down and make the administration of the actual anesthetic, along with post operative recovery, much smoother. Once a pet is anesthetized, prepared for surgery, and had its monitoring equipment hooked up and reading accurately, the surgery can begin.

This is a sterile abdominal surgery, and our surgeon starts the pre-surgical process by using special soap to clean his hands

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While our patient is being anesthetized our surgeon is already in our surgical suite setting up instruments. Our surgeon is ready to start before our patient is at a proper plane of anesthesia. Once the anesthetist gives the green light the surgery starts immediately. We want our surgeon waiting for his patient, not the other way around.  All of this is to minimize anesthetic time.

OVH-rabbit-2

OVH-rabbit-3

We keep a close tab on important physiologic parameters for all of our surgeries. Monitors like this give us an early warning of an impending problem.

This machine monitors:

Temperature

Heart Rate

Heart rhythm

Oxygen saturation

Carbon dioxide level

Respiratory rate

Surgery-Monitor

In addition to our monitoring equipment our anesthetist stays “hands on” in monitoring important physiologic parameters

Rabbit-femurfx-9

Surgery

The first step in the surgical process requires an incision in the skin and muscles of the abdomen. There is a specific anatomical location where the incision in the muscle is made, called the linea alba. An incision here bleeds very little and gives us a strong tendon to hold sutures when we close the incision.

In this picture the skin incision has already been made and we are using a scalpel to incise the linea alba.

A scissors is used to extend the linea alba incision. Now we have access to the abdominal structures.

This incision gives us a full view of the abdomen and its structures. Before we can find the uterus we commonly encounter fat, intestines, spleen, and even urinary bladder.

The uterus needs to be exteriorized from the abdomen for the spay to proceed. In this view one horn of the uterus is exposed. The arrow points to the location of the ovary, buried in fat.

Sutures are placed around the ovary and it is removed form the abdominal cavity along with the rest of the uterine horn.

The same procedure is performed on the other ovary. The black arrows point to the ovaries that were just removed. The blue arrow to the right points to the location where the uterus will be removed from the body. Everything to the left of this blue arrow is removed during the procedure.

This is what remains at the cervix after it has been sutured and the rest of the uterus removed. This small amount of remaining uterus will be placed back into the abdomen.

It is very important that the linea alba is properly resutured. a hernia with actual spillage of abdominal organs can occur if the sutures aren’t placed properly.

When all of the sutures have been placed (in this case they are stainless steel) there is a solid seal in the linea alba. These sutures cause minimal tissue reaction and have tremendous holding ability. They will stay with this pet for the rest of its life, and will even show up on an x-ray of the abdomen.

Several different types of sutures can be put in the skin incision. This type, called subcuticular, makes is difficult for the ferret to chew them out because the sutures are under the skin surface. These sutures will dissolve by themselves, so there is no need to remove them.

At this point in the surgery a pain injection will be given and the patient allowed to wake up slowly. She will be ready to go home late in the afternoon, and by the next day, will resume her normal activity.

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Ferret Insulinoma

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Tumors of the pancreas (insulinoma) can cause excess secretion of insulin, thus lowering the blood glucose (sugar) level to a point that a ferret can become ill. Unfortunately, this is a relatively common problem in middle aged and older ferrets.

Graphic photos on this page.

The end of this page has a short video on surgery to remove nodules from the pancreas.


Symptoms

Some ferrets do not show any symptoms, while others exhibit lethargy and weakness. There might be a decrease in appetite and weight loss. These symptoms might even come and go over a period of months. Some ferrets will have increased salivation and even a glazed appearance to the eyes, and might even collapse or have seizures.

FerretInsulinoma-Waking

Some ferrets are very weak due to their low blood sugar

Diagnosis

Some ferrets are diagnosed as having an insulinoma when an abdominal surgery is being performed for other reasons (adrenal gland diseasespayliver disease). This is especially true for the ferrets that are not showing any symptoms of this disease. For those ferrets that are symptomatic of insulinoma, the diagnosis is made based on history, examination findings, and diagnostic tests.

Our laboratory has a special blood panel for ferrets that are exhibiting signs of insulinoma.The diagnosis of insulinoma is verified by a low blood glucose (sugar) level.

FerretInsulinoma-Glucometer

We use a special instrument to check the blood glucose level that only requires a few drops of blood. If you have ever tried to get blood from a ferret you would understand the importance of being able to do this test with only a few drops of blood

Medical Treatment

Medical therapy can be effective at controlling symptoms, although it can not cure the disease. Food should be fed frequently, and should consist of cat food or ferret food. Stay away from high sugar foods that can stimulate the pancreas to secrete excess amounts of insulin and set the stage for a hypoglycemic (low blood sugar) episode.

Prednisone (cortisone) can be effective at controlling symptoms for several months to several years. It comes in a liquid or pill form, and is usually given twice each day, depending on what your veterinarian determines. It helps raise the blood glucose level without stimulating excess secretion of insulin like foods high in sugar.

Other medications can be used if prednisone is not effective. These drugs are more expensive and have the potential to cause vomiting and appetite loss. Your veterinarian will let you know if they are indicated in your situation.

If your pet has an episode of hypoglycemia it should be given Karo syrup, Nutrical, honey or other foods high in glucose to temporarily raise the blood glucose level. After giving a high sugar food feed it its normal diet to minimize excess secretion of insulin in the long run.

If your pet has collapsed and is unable to swallow, rub a small amount of honey or syrup on its gums. Only use just enough to wet the gums and take care not to be bitten if your ferret is having a seizure. When it regains consciousness feed it its normal diet and bring it to the hospital for an exam and blood glucose check.

Ferrets that are not eating well are also commonly fed Hill’s A/D.

Surgical Treatment

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

Younger ferrets or those that have adrenal gland disease simultaneously are candidates for surgery. Tumor nodules that are found on the pancreas are removed, helping to prolong survival time. In some cases we perform a partial pancreatectomy. In spite of the fact that surgery is performed some of these ferrets will need medical management. Survival time is variable after surgery, ranging from months to years.

Several pecautions must be taken when this surgery is performed. Ferrets can easily become hypothermic due to the anesthesia and the fact that their abdomen will be open during the procedure. They can also become hypoglycemic due to the stress of the procedure. Special precautions are taken to help mitigate these problems.

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This is a sterile abdominal surgery, and our surgeon starts the pre-surgical process by using special soap to clean his hands

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While our patient is being anesthetized our surgeon is already in our surgical suite setting up instruments.

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Our surgeon is ready to start before our patient is completely prepped. Once the anesthetist gives the green light the surgery starts immediately. We want our surgeon waiting for his patient, not the other way around.  All of this is to minimize anesthetic time.

In ferret surgery pay particular attention to low body temperature (hypothermia) and low blood sugar (hypoglycemia). They are placed next to special hot water bottles throughout the procedure.

FerretInsulinoma-Temp

We keep a close tab on body temperature, before, during, and after surgery

Our patients are carefully monitored to detect any abnormality before it becomes a problem. This early warning system is important in such a small animal that is ill and undergoing anesthesia and major surgery.

Surgery-Monitor

This machine monitors:

Temperature

Heart Rate

Heart rhythm

Oxygen saturation

Carbon dioxide level

Respiratory rate

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Our surgeon and anesthetist work closely together

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In addition to our monitoring equipment our anesthetist stays “hands on” in monitoring important physiologic parameters. We use a special stethoscope (called an esophageal stethoscope) that is passed down the esophagus and can give us a clear sound of the heart.

FerretInsulinoma-Scrub

Our patient is carefully clipped and scrubbed

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Our surgeon does the all important draping after the final cleanse of the abdomen

FerretInsulinoma-Drape

 Under these drapes is a hot water blanket and also hot water bottles

FerretInsulinoma-Incision

When our surgeon is comfortable everything is in order he makes his skin incision 

FerretInsulinoma-Linea

There is a special location on the abdominal muscles called the linea alba.  You can see it as this white horizontal line between the muscles.

It is here that our surgeon cuts through the muscle and enters the abdominal cavity without cutting any abdominal muscles. This is a tendon that holds the abdominal muscles together, and is the area that has the best holding strength when we suture the area back together. If it did not have this strength, we would have an abdominal hernia.

FerretInsulinoma-LineaIncision

The scissors is used to make the cut through the linea alba into the abdomen

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 The pancreas is rapidly isolated and a insulinoma nodule is searched for visually and by palpation. Do you see the small nodule on the pancreas?

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The arrow will help you visualize the nodule

Many nodules are gently squeezed out

FerretInsulinoma-NoduleRemoved

This is a typical insulinoma nodule after removal from the pancreas

FerretHisto-Insulinoma

This is the report we receive from our pathologist confirming the diagnosis

FerretInsulinoma-Hemoclips

Sometimes these tumors need to be cut out. These are hemoclips, metal sutures that stop the bleeding of small vessels buried in the fat around the area.

FerretInsulinoma-Tumor

On occasion we encounter a pancreas that has a large tumor

FerretInsulinoma-LargeTumorArrow

The arrow points to the lower left edge of the tumor

After removal of any pancreatic tumors we check the rest of the abdominal organs for any problems. Ferrets are prone to many problems, and if we are doing surgery for a specific problem like insulinoma, we make sure to check the other internal organs.

FerretInsulinoma-Intestines

Our surgeon is carefully palpating the length of the intestines to feel for any abnormalities, especially foreign bodies and cancer.

FerretInsulinoma-Spleen

The spleen is assessed next in this patient. Even though it is large, it is not necessarily diseased. That nodule at the end is not significant.

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The liver is carefully assessed

Missy Miller 4/19/01

This one is cystic

A very important organ to check is the adrenal gland since adrenal gland disease is common in ferrets.

FerretInsulinoma-Kidney

This one is normal so it is difficult to visualize. It is the small pink circle of tissue that lies to the left of the dark brown kidney, which in this picture is surrounded by normal fat. Can you see it?

FerretInsulinoma-AdrenalArrow

The arrow helps identify it

After surgery our little patient is kept cozy warm, watched carefully for hypothermia and hypoglycemia, and monitored closely for pain.
FerretInsulinoma-FAce
This one is a little groggy, but feeling no pain
This short video goes through the important points of surgery to remove nodules from the pancreas and also remove an adrenal tumor. Notice how we use the laser to make the initial incision.

Prognosis

Insulinomas are malignant tumors that will decrease a ferrets life span and compromise its quality of life. This is a serious disease that does not lend itself to a cure or long term control. Longevity after diagnosis varies from weeks to years, and depends on the duration of the problem prior to diagnosis. The sooner we make the diagnosis, the more that can be done to treat the problem and increase a ferret’s quality of life and lifespan.

Return to Ferret Adrenal Diseases Page

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Ferret Adrenal Disease

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Tumors of the adrenal gland in ferrets can cause excess secretion of sex hormones, thus affecting many organs in the body. Unfortunately, this is a relatively common problem in middle aged and older ferrets. Even though most of these tumors are not malignant, they can cause significant disease if left untreated.

This disease goes by several names in addition to the one in the title of this page:

  • ADG- adrenal gland disease
  • AGN- adrenal gland neoplasia
  • ACD- adrenal cortical disease
  • AEE- adrenal associated endocrinopathy
  • FADC- ferret adrenal disease complex

FADC is probably the most accurate description, because as is the case with so many diseases, as we advance our knowledge over the decades, and develop more sophisticated diagnostic tools, we realize that most diseases are much more complex than originally envisioned. It is human nature to try to make things simple so they are easier to understand. This does not apply to most diseases we encounter in animals.

Dogs and cats get a problem similar to this, although it acts and is treated differently. In dogs and cats it is due to an excess secretion of cortisone, not sex hormones. In these species it is called Cushing’s disease.

At the very end of this page is a video of part of a surgery to remove cancerous adrenal glands and cancerous nodules on the pancreas.

This page will show surgical and medical treatment.

This page contains graphic photos from surgery and necropsy of deceased ferrets.

Physiology

This disease involves reproductive hormones. In a normal ferret, a hormone from the hypothalmus in the brain, called gonadotropin-releasing hormone (GnRH),  is released in larger amounts, usually due to an increase in daylight. This causes stimulation of luteinizing hormone (LH) and follicle stimulating hormone (FSH) from the pituitary gland.

These hormones stimulate the release of estrogen and testosterone from the gonads and adrenal glands (important point in neutered pets that have no gonads). A very sensitive negative feedback loop maintains just the right amount of estrogen and testosterone. This sensitive balance is upset in adrenal disease of ferrets.

In the medical treatment section we will discuss a drug called Lupron. This drug binds with receptors on the GnRH molecules and lessens its effects on the pituitary.

Cause

The exact reason this tumor arises is not completely known. It is seen more often in the U.S. than in Great Britain, where different breeding and husbandry practices are utilized. It is speculated that diet, exposure to sunlight, and neutering are all factors, with neutering being the most important one.

Ferrets breed seasonally, causing variation in melatonin release with varying daylight. Less daylight means more melatonin and a thick haircoat. This higher level of melatonin eventually exerts a negative feedback on the release of the sex hormones estrogen and testosterone. When ferrets are spayed and neutered the negative feedback is disrupted, more of these sex hormones are secreted than is normal, and clinical signs develop.

The three main types of adrenal lesion encountered are:

  • Benign nodular hyperplasia that occurs 56% of the time
  • Benign adrenocortical adenoma that occurs 16 % of the time
  • Malignant adrenocortical adenocarcinoma that occurs 26% of the time
  • A combination of the above

Anatomy

The adrenal glands are small glands located just in front of the kidneys. The left gland is embedded in fat just in front of the kidney, the right one is located deeper in the abdomen and under one of the liver lobes. The left adrenal gland is the one affected in almost all cases, which is advantageous surgically as you will learn.

Ferret-AdrenalFat

The arrow points to a normal left adrenal gland of a ferret. It is quite small and buried in fat in front of the kidneys. Click on the photo to enlarge.

Ferret-AdrenalCloseup

A close up to shows how tiny it can be when normal

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Here is another one at the top of the hemostat on the left. This one is inflamed, the with adrenal disease.

Rocky Walker 21218 Ferret Gastric tumor Blood supply to mildly inflamed left adrenal

The tip of this hemostat shows an inflamed adrenal gland. Note the large vein underneath it, called the adrenolumbar vein  This vessel makes this surgery intricate. You can see the adrenolulmbar vein (horizontal blue line) in this picture below the adrenal gland. This is what will be ligated when we show surgery pictures later.

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The adrenal gland to the right of the arrow is very inflamed

necropsy of Ash, the ferret with insulinoma kidney on right adrenal to left of kidney at cranial end

The adrenal gland to the right of the arrow is very inflamed

When a diseased left adrenal gland is not removed surgically it might eventually get extremely enlarged and cause substantial illness. Symptoms of adrenal disease would appear long before the gland gets this large.

The left 2/3 of this picture is a diseased adrenal gland. The right 1/3 of this picture is the kidney, showing just how large this adrenal gland became as this ferret aged. The adrenal gland is so diseased that it is literally rutpturing, as can be seen toward the top left of the gland.

Ferret-LiverCoveringAdrenal

The right adrenal gland is under the right lobe of the liver, adjacent or attached to the vena cava (VC). The vena cava is the major return of all the blood from the back of the body to the heart. The liver has to be pulled away to visualize the adrenal gland, which is why you cannot see the adrenal gland in this photo.

Ferret-AdrenalNormalRIghtVC

When you pull the liver lobe forward you can see the enlarged right adrenal gland to the right of the arrow. You can also see how the adrenal gland is adhered to the vena cava, which makes surgery to remove a diseased right adrenal gland problematic, to say the least.

Ferret-RightAdrenalVC

A different view of the right adrenal gland and its close association to the liver and vena cava (VC)

In this picture we have both right (on the bottom) and left (on the top) adrenal glands of the same ferret. The white arrow in the lower left of this picture points to a normal right adrenal gland. It is very small because it is normal. On the left, above this right adrenal gland, is a lobe of the liver (L) that has to be pulled forward during surgery in order to get access to the right adrenal gland. The posterior vena cava is the large blue vein running horizontally. The abnormal left adrenal gland can be visualized to the left of the arrow on the top right.

Ferret-LargeRtAdrenal6

Sometimes the tumor on the right side gets greatly enlarged. Here is is intertwined with the right kidney and the  vena cava (vertical blue line to the right of the tumor).

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Here is a different angle of this same tumor showing just how large it is

Physiology

These small but very important glands have numerous roles you can learn more about in our Cushing’s page. It gets very detailed, so be prepared to learn some anatomy and physiology before you return back here to learn about adrenal disease in ferrets.

The adrenal tissue in ferrets normally secretes several sex hormones. The important ones are:

  • 17 – OHP (17 alpha hydroxyprogesterone)
  • androstenedione
  • DHEa (dehydroepiandrosterone sulfate)

It is postulated that these hormones are secreted from the adrenal glands after chronic stimulation from follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the pituitary gland. Indoor housing of ferrets, leading to more light than ferrets in the wild, is postulated to also stimulate release of LH, along with gonadotropin releasing hormone (GnRH) from the pituitary gland. The end result of this hormone imbalance is excess secretion of estrogen in females and testosterone in males. This causes the vulva to enlarge in females, and a return to male sexual behavior in the male. The enlarged vulva is easy to see, which might be the reason we diagnose this problem more often in female ferrets.

A special lab in Tennessee can check for excess amounts of these hormones on a blood panel, an important help in the diagnosis of this disease.  A ferret can have normal values on this test, yet still have adrenal gland disease. This is why we always follow the tenets of the diagnostic process.

Symptoms

Hair loss

The most common symptom of adrenal disease in ferrets is hair loss, sometimes with itchiness (pruritis). Itchiness due to adrenal disease an also be present with no hair loss. The hair loss can be seasonal, can come and go, but eventually it progresses to almost complete baldness. The most likely spots for hair loss are the tail area and rear legs. Hair loss in dogs and cats is almost always caused by a different problem. This hair loss occurs in over 80% of the ferrets with this disease.

Do you see the hair loss at the back end of this ferret?

This view gives you a better idea of the extent of the hair loss

She even has a bare tummy

At least she is not as bad as this ferret

Hair loss can be anywhere on the body. This is typical of the hair loss that can occur at the tail

Hair -loss-tail-ferret

Some times we are not sure if we are treating a ferret or a rat!

Sometimes we see enlarged vulvas in spayed females.

This one is slightly swollen. It should not be swollen at all since she is spayed.

This one has more enlargement. Notice the hair loss?

It has been observed that mast cell tumors in ferrets can also cause hair loss.

This is what a mast cell looks like on the neck of a ferret that is ready to undergo laser removal of the tumor

Difficulty urinating (stranguria)

Male ferrets sometimes have difficulty urinating in addition to hair loss. Even if they are neutered there might be a return to normal sexual behavior. There might also be lethargy, a decrease in appetite and weight loss.

In male ferrets cysts can occur in the small amount of prostatic tissue they have. They can also get a bacterial prostatitis causing these symptoms. This can cause difficulty in urination, which can affect the kidneys if it progresses. On rare occasion this problem can progress to complete inability to urinate due to the enlarged prostatic tissue.  Inability to urinate is a medical emergency, and needs immediate attention to save the kidneys and prevent the bladder from rupturing.

distendedbladder

A urinary bladder that is so distended that a pet cannot urinate is diagnosed on palpation during a physical exam. It is confirmed with a radiograph, as in this cat that cannot urinate. If we run a blood panel on this animal we will see what is called post renal azotemia, a sign the kidneys are shutting down. Our kidney page has much more detail on this.

Ferret-DistendedBladderNecropsy

This is the necropsy picture of a severely distened bladder in a ferret that did not make it

When a ferret is presented in this state we have to immediately catheterize them. You can see the tip of the catheter in the lumen of the urinary bladder. The catheter was placed through the tip of the penis, and gently pushed past the pelvic urethra and into the bladder. You can see all of this if you enlarge the photo.

Radiopaque dye was put into the urinary bladder to make sure there was no rupture

Note also the unique shape of the tip of the penis in the ferret. It has a bone in it (just like the dog) called the os penis. The tip of the os penis in the ferret is curved, and the opening is very small, making catheterization difficult.

Stones in the urethra and bladder can also cause stranguria, so we cannot always assume adrenal disease is the cause of a ferret that is straining to urinate or cannot urinate.

Ferret-UrethralStones

These are what stones look like in a ferret urethra

Ferret-BladderStones

The same stones after removal from the urethra

Male ferrets with adrenal disease might also return to typical male sexual behavior or mounting, whether it is a female or a male they are mounting. Aggression can occur, and seems to occur more in ferrets with malignant adrenal disease (adenocarcinoma).

Swollen vulva

In years past, before all ferrets were routinely spayed, an enlarged vulva in a sick ferret was a sign of a ferret that did not mate when it was in heat. Being an induced ovulator, meaning jills would only release eggs from their ovaries when they mated, jills that did not mate would secrete an excess of estrogen for a long period of time.

This excess estrogen was toxic to the bone marrow, and would cause a severe life-threatening anemia that few would survive. The technical term was aplastic anemia. When we had a sick unspayed ferret with an enlarged vulva we would run a blood panel. The anemia would show up as  severely low RBC’s (red blood cells), HGB (hemoglobin) or HCT (hematocrit).

Ferret-SmallMammalProfile

Our lab runs a special blood panel for small mammals like ferrets

Ferret-AdrenalCBC

This ferret has a hematocrit (HCT) of 15.5 %, typical of a ferret with aplastic anemia. It should be at least 43% at this lab.

Now that all ferrets are spayed and neutered upon purchase in the United States, we no longer see this type of anemia. When we have a ferret with an enlarged vulva we know it is most likely due to adrenal disease, especially if hair loss is present also. Retained ovarian tissue form a spay can cause this on rare occasion.

Lethargy and muscle atrophy

Occasional symptoms might include lethargy and muscle atrophy. Abdominal muscle atrophy can also cause the pot-bellied appearance seen in Cushing’s disease of dogs.

Sometimes the muscle atrophy is severe, and is also caused in conjunction with other common ferret diseases, notably cancer in the intestines or lymph nodes. The bulge on the left at the back end of this ferret is the right kidney.

Diagnosis

Signalment

This tends to be a disease of neutered male and female ferrets with an average age of 3 years. It be seen earlier and later than these age groups.

Symptoms

Although enlarged adrenal glands can be palpated during an examination, this is not usually the case. A large number of adrenal tumors are confirmed during routine exploratory surgery, especially if the ferret exhibits the typical pattern of hair loss and an enlarged vulva in the female, or straining to urinate in the male. Exploratory surgery is a common way to verify the diagnosis and correct the problem. During this surgery we routinely check other organs for problems, especially the pancreas for tumor nodules that might be an insulinoma.

Physical Exam

This might reveal pale gums and heart murmur if there is a significant anemia. If the adrenal gland is on the left (most cases), and it is large enough, it might be possible to feel it during abdominal palpation.

We perform a complete physical exam on all our patients. This is particularly important due to their propensity to get other diseases besides adrenal gland disease.

We do a thorough exam since ferrets are prone so several important problems in addition to adrenal gland disease like cancer. Doing this exam is easier said than done for such a wiggle patient, which is why Dr. Kennedy has an assistant help hold.

Adrenal Panel

Sex hormone assays are very helpful in the diagnosis also, particularly to rule out other diseases. Pioneer work on these hormones was done at the University of Tennessee, and it is where we send all of our hormone tests on ferrets. You learned about these hormones in the physiology section above.

A special blood sample can be performed to check hormone levels. This test can be used if the typical symptoms of hair loss and enlarged vulva or urine straining are not particularly prevalent. This sample is sent to a special laboratory that takes several weeks to report their results.

Ferret-AdrenalPanelNormals

This is their results based on 3,000 ferrets  with confirmed adrenal disease, on how much of an increase (the abnormal column) is needed above the normal column to be considered positive for ferret adrenal disease. They also noted that all 3 tests need to be run because on occasion estradiol was normal in a ferret that has adrenal disease.

This is how they report a sample back to us

This adrenal panel needs to be interpreted with regard to time of the year in the northern hemisphere, because even neutered ferrets can have seasonal variations in these hormones. This emphasizes the importance of the diagnostic process in making a diagnosis of this disease, and using clinical signs along with ultrasound, surgery,  and biopsy findings, to confirm a diagnosis.

Radiology

Radiographs are usually unhelpful in this diagnosis since it is difficult to see the adrenal glands. On occasion, due to size or calcification, we can get an indication the adrenal glands are enlarged on a radiograph.

This normal radiograph shows two overlapping kidneys (K) in the middle of the abdomen. The adrenal glands are located just to the left of these glands. They are not routinely visible on radiographs.

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Can you see the the large whitish area on this radiograph that could indicate a greatly enlarged adrenal gland?

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It has been circled for easier visualization

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Can you see it on this view of the same ferret?

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The calcified right adrenal gland has been circled

Ultrasound

Ultrasound is what is needed to visualize the adrenal glands in ferrets, and also dogs and cats in most cases. Ferret adrenal glands can be tiny, which is why we always call our radiologist to perform this test.

Radiologist are specialists in this area, and perform many dozens of ultrasounds on a daily basis. Their skill is extraordinary. Our radiologist, Dr. Ann Reed, is very experienced with ferrets, and is the only one we trust to perform our ultrasounds.

Ferret-AdrenalUS3

Brenda is gently holding this ferret still for an abdominal ultrasound

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This G.E. ultrasound gives us the detail we need to see a very small organ

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Most ferrets enjoy the attention and tummy rub as we gently move the probe on the abdomen

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With ultrasound we can measure the size of the adrenal gland and determine if it is enlarged

Surgical Treatment

These ferrets sometimes come in very ill, and need medical stabilizing before we can proceed further. At this point in the exam we do not know what an individual ferret has, so we correct basic problems like dehydration, hypothermia, negative nitrogen balance, nausea, and hypoglycemia before proceeding further.

Ferret-sickferret

Most ill ferrets are treated with IV fluids to correct dehydration. The IV catheter also allows administration of medication without having to inject into the muscle.

The primary method of treating adrenal disease in ferrets is surgical removal of the gland. The problem can occur on either the right or left adrenal gland (or both). In the overwhelming number of cases the problem is in the left gland only. Eventually, both glands are commonly involved. After surgery to remove the affected gland vulvar swelling decreases and hair growth starts within 1-2 months and returns to normal at 6 months in most cases.

The left gland is much easier to work with because it is in a fat pad above the left kidney. The right gland is much more difficult to approach because it is under a lobe of the liver and is attached to the posterior vena cava, the main vein that returns blood from the back end of the body to the heart. You saw that in the pictures at the beginning of this page.

In most surgeries we remove the diseased left gland, leaving the right gland alone.  Complete removal of both glands can cause serious complications. Sometimes removal of only one of the glands can cause a problem if the remaining gland cannot make up for the loss. If that is the case we might cause something similar to a disease called hypoadrenocorticism.

We take the same precautions in ferret adrenal gland surgery as we do in all pets. First we perform a pre anesthetic blood panel to check the internal organs. If everything is in order we perform a pre-anesthetic physical exam, and then carefully go through our checklist prior to anesthetizing our patient.

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This is a sterile abdominal surgery, and our surgeon starts the pre-surgical process by using special soap to clean his hands

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While our patient is being anesthetized our surgeon is already in our surgical suite setting up instruments. He is ready to start before our patient is at a proper plane of anesthesia. Once the anesthetist gives the green light the surgery starts immediately. We want our surgeon waiting for his patient, not the other way around, in order to minimize anesthetic time.

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Only when everything is in order does our surgeon start the procedure

 In ferret surgery we have to pay particular attention to low body temperature (hypothermia) and low blood sugar (hypoglycemia). They are placed next to special hot water bottles throughout the procedure.

Our patients are carefully monitored to detect any abnormality before it becomes a problem. This early warning system is important in such a small animal that is ill and undergoing anesthesia and major surgery.

Surgery-Monitor

This machine monitors:

Temperature

Heart Rate

Heart rhythm

Oxygen saturation

Carbon dioxide level

Respiratory rate

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In addition to our monitoring equipment our anesthetist stays “hands on” in monitoring important physiologic parameters. We use a special stethoscope (called an esophageal stethoscope) that is passed down the esophagus and can give us a clear sound of the heart.

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Once our patient is draped we are ready to proceed

incision-skin-adrenal-surgery-ferret

We make our incision in a particular location in the center of the abdomen, called the ventral midline. We use a special scalpel made for a small animal like a ferret

incision-linea-adrenal-surgery-ferret

The next layer is a special muscle/tendon layer, called the line albs. It is important that we go through this particular area because this is the area that will be able to hold the sutures we use to sew the muscles back together, and thus prevent a hernia.

incision-linea-adrenal-surgery-ferret

A special surgical scissors is used to extend the incision

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Ferrets are little guys, so their surgical anatomy is small. In some surgical cases we use magnifying loops to help identify structures.

inflamed-adrenal-surgery-ferret

This picture is from an actual surgery. The inflamed left adrenal gland, buried in fat, is in the center of this picture

inflamed-adrenal-surgery-ferret

It is at the tip of this forceps after it has been dissected out of the fat

hemoclips-adrenal-surgery-ferret

Special stainless steel clips, called hemoclips, are used to ligate the blood vessels as we remove the gland

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This is the 1 cm diseased adrenal gland after removal, with some fat still around it

We sometimes use the laser on the larger glands to aid in hemostasis (control of bleeding). This is of great important in such a small animal because large tumors like the can bleed excessively. Our laser has revolutionized some of the surgeries we perform on small animals like a ferret.

 

Ferret-Adrenal6 Ferret-Adrenal5 Ferret-Adrenal4
Cutting Cauterizing Bloodless dissection

During the surgery, and immediately after, we monitor body temperature to prevent hypothermia

We also check the blood sugar level when the procedure is finished and before the ferret is completely awake. Their veins are small and difficult to find, so it is much easier to do it when the ferret is still groggy from the anesthesia.

We test the blood sugar level right in the surgical suite so we can plan our post operative care

Here is our little friend nice and cozy right after her surgery, cuddled in warm blankets. She has been given a pain injection and is being monitored closely.

Alex will keep a close eye on her as the transfers her to recovery

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We continue to monitor temperature and blood glucose as our patient recovers

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This ferret had surgery 12 hours earlier and is doing great. After a night of observation by our staff it will go home in the morning. 

Whenever we perform an exploratory surgery (called a laparotomy) on an animal we check other internal organs for disease. This is especially important in ferrets due to their propensity for having other diseases.

Ferret-Splenectomy1

This is a picture of an enlarged spleen found during a routine adrenal gland surgery

We knew there was an enlarged spleen in this ferret because we could palpate it during an examination. This enlarged spleen was verified by a radiograph.

The black arrows outline the enlarged spleen. A kidney (K) is also visible overlying the spleen

This spleen was biopsied to determine whether this was a normal enlargement, called hypersplenism, or whether it was cause by cancer.

This picture shows cautery of the spleen after a small biopsy was taken

We have a very detailed page on spleen disease if you want to learn more

Another very important organ to check in ferrets is the pancreas due to a disease called insulinoma. In this disease the pancreas secretes too much insulin, the opposite of sugar diabetes (diabetes mellitus).

Ferret-Adrenal8

Our surgeon is carefully palpating the intestines to check for intestinal cancer, and also the pancreas (the peach colored semi-circular area in the center of the intestines) for nodules that could indicate insulinoma

This ferret had a cyst on one of its liver lobes

Now that you know how we perform this surgery lets look at an abbreviated video of a ferret with an adrenal gland tumor and an insulinoma. You will also get a chance to see how we make a bloodless incision with the laser.

Medical Treatment

Some ferrets are not good candidates for surgery, so we will use medical therapy on them. Also, we use this medical therapy after surgery. Medical therapy does not cure the disease, it only controls it. The effectiveness of these therapies varies from ferret to ferret.

There has even been some evidence that using deslorelin in November or December can even prevent the onset of adrenal disease. Much of this information needs to be refined as we learn more about this disease.

Deslorelin

This is a long acting drug that is implanted under the skin. The symptoms of adrenal disease in ferrets start diminishing within a few weeks, and reach maximum effect within 6 week. The injection can last anywhere from 6 months to well over one year before needing an additional injection.

Lupron

One of the best medications used to treat this condition is called Lupron, originally used to treat testicular cancer in men and endometriosis in women. We also use it to treat birds like cockatiels that are excessive egg layers, and can even become egg bound.

Lupron (Leuprolide) is a GnRH analog (remember the physiology section above) that minimizes the secretion of the sex hormones from the adrenal gland. Lupron does this by suppressing the production of FSH and LH from the pituitary gland. This decreases levels of estrogen and testosterone, and symptoms diminish.  It will decrease symptoms but not the size of the tumor.

It is usually given as an injection that lasts several months at least, all depending on the dose. We titrate the dose based on symptoms, age, weight, blood results, body condition score, and client compliance. Some ferrets exhibit a swelling at the injection site. This is of no cause for alarm and will usually resolve.

We have maintained ferrets on Lupron successfully for many years, so it has become a mainstay of our medical management after the left adrenal gland is removed. Long term effects of the chronic use of this drug are unknown. In some cases we also use only medical therapy, particularly if a ferret is not a good surgical candidate due to age or other conditions that are so common in ferrets.

Adrenal tumors are so common in the United States that some veterinarians that work with large numbers of ferrets even use Lupron as a protective plan with the following criteria:

Indoor ferrets that are exposed to unnatural photoperiods- give 1 mg Lupron Depot 4-month every 6-8 months starting at 4-8 months of age.

Outdoor ferrets exposed to natural photoperiods- 1 mg Lupron Depot 4-month annual in Feb or March in North America starting at 4-8 months of age.

Viadur, a 1-year Leuprolide implant is planned for the future.

Miscellaneous drugs with potential

The following medications have been used with varying success on adrenal disease in ferrets. Much more work needs to be done before we can recommend them routinely. There is concern that long term use of them can cause damage to organs like the kidneys. No long terms studies have been performed. They should be used when Lupron is not working, and adrenal profile hormones and ultrasounds should be performed every 3 months to monitor their effects, both good and bad.

Mitotane

This is one of the primary drugs used to treat dogs with Cushing’s. It is sometimes in conjunction with Lupron. It seems to show variable success only with cortical adenomas, and does not help adenocarcinomas. Its seems to work by chemically reducing the size of the affected adrenal gland. If a ferret has insulinoma at the same time, which is not uncommon, mitotane can cause hypoglycemia (low blood sugar) and a ferret can become comatose.

It is sometime used as pulse therapy, and symptoms of hair loss sometimes return after stopping Mitotane. As general rules, this drug, or in combination with Lupron, is only used on older ferrets with both adrenal glands affected and also a poor candidate for surgery due to other diseases occurring at the same time.

Deslorelin

This drug is a synthetic GnRH analog, and is used currently to reduce testosterone in dogs as a contraceptive. When given as a injection it is slow release and has helped reduce the typical symptoms of ferret adrenal disease.

Melatonin

Melatonin inhibits the release of GnRH, suppressing the amount of LH and FSH released into the bloodstream. It theoretically helps regulate hormonal control in a ferrets normal circadian rhythm of light and dark. It is in the form of a long acting injection or daily oral medication.

Melatonin can be used to stimulate hair regrowth, it does not suppress the adrenal tumor. If used prior to a physical exam it can mask symptoms, and cause the adrenal gland to become even larger before surgical removal.

It can cause lethargy, and should not be used in smaller ferrets. Ferrets can develop a tolerance. It should be used as an adjunct to Lupron.

Casodex

This oral drug blocks binding sites to testosterone. It will help minimize symptoms of adrenal disease, especially straining in the male ferret. It needs to be used one week on, one week off, for life. More information is needed before we can recommend this drug.

Arimidex

This oral drugs interferes with the enzyme pathway that converts testosterone to estrogen. It should not be used with Casodex since the two drugs will negate each other.

Prognosis

Most ferrets that have this surgery regain hair growth and do well for years. Even though most adrenal tumors are benign, recurrence can occur. A tumor can appear in the adrenal gland that is not removed at the time of  surgery, and symptoms can recur.

Return to Ferret Adrenal Diseases page

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Ferret Liver Cancer

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Ferret’s are highly prone to several serious diseases. In addition to insulinomas and adrenal gland disease, they are also prone to cancer. This page shows a ferret that has a liver cancer.

Graphic photos from surgery are on this page.

Symptoms

Some ferrets do not show any symptoms while others exhibit lethargy and weakness and a distended abdomen. There might be a decrease in appetite and weight loss. Symptoms alone are not enough to diagnose liver cancer.

Diagnosis

Like most diseases, the diagnosis of liver cancer is made based on history, examination findings, and diagnostic tests. In this specific case an exploratory surgery was performed to verify the diagnosis and determine the extent of the problem. an ultrasound could have been performed also. Since ferrets are prone to so many internal organ diseases, and since exploratory surgeries can be performed rapidly and yield a large amount of information, it is common to perform surgery instead of ultrasound. Some ferrets are diagnosed as having cancer when an abdominal surgery is being performed for other reasons (adrenal gland diseasespayinsulinoma). This is especially true for the ferrets that are not showing any symptoms of this disease.

Blood samples are an aid in the diagnosis and can also be helpful to rule out other important diseases that might be occurring simultaneously. Our laboratory specializes in working with ferrets, and has a special blood panel for them.

We are commonly asked how the heck do you get blood from a ferret. They are certainly one of the more difficult patients to obtain blood from. This is where the expertise of our nursing staff comes into play. a very small needle is used because the veins are so fragile. This ferret is having its blood taken from a vein on the side of its rear leg.

This test tube is filled with fluid that was taken from a ferret that had a distended abdomen due to liver cancer. analysis of this fluid in conjunction with other diagnostic tests gives us a clue as to its cause.

A useful tool as an aid in this diagnosis is radiography. It gives us a clue as to the presence of fluid along with abnormalities of the internal organs.This ferret is laying on its right side, and has a distended abdomen due to a large liver and fluid in its abdomen. It also has a large spleen. In addition, there are 3 metallic clips visible just under the kidney from a prior surgery for adrenal gland disease. The clips were used to stop bleeding when the diseased adrenal gland was removed. The identified organs are: Liver (L), Stomach (S), Kidney (K), Spleen (SP) and Bladder (B).

a view of this same ferret while it is on its back shows the large area of the liver and the large spleen. Look carefully at the spleen because it is folded over on itself in this picture and is larger than it first appears.

Whenever we suspect cancer we take a radiograph of the chest to look for evidence that the cancer has spread. We use the chest for this radiograph because the small blood vessels that are located around the lungs act as a filter to trip cancer cells that have spread. The black background of the lungs allows us to visualize these cells that are white in color.

In this same ferret as above we are looking at a side view of its chest with the head to the left. The windpipe (W) goes from left to right, the Heart (H) is in the very center, and the air filled Lungs (Lu) are above the heart. To the right of all of these structures you can see the large white area that denotes the large liver.

Surgical Treatment

The above information gave us reason to suspect a high probably of liver cancer, so an exploratory surgery was performed. The owner was aware of the poor prognosis in this case but wanted to know for sure what was going on.

Several precautions must be taken when this surgery is performed. Ferrets can easily become hypothermic due to the anesthesia and the fact that their abdomen will be open during the procedure. They can also become hypoglycemic due to the stress of the procedure. Special precautions are taken to help mitigate these problems.

The following area contains graphic pictures of an actual surgical procedure performed at the hospital. It may not be suitable for some children (and some adults also!). 

Brandi is a high risk anesthetic patient. In addition to the usual precautions we take for hypoglycemia and hypothermia, we have to be concerned with the induction of anesthesia. a special induction chamber is used for Brandi to breathe in the anesthetic gas and slowly go to sleep. You can see her doing what ferrets do best when they fall asleep-curl up.

Once she is relaxed enough a small tube is put into her windpipe to allow us to give her 100% oxygen along with precise amounts of anesthetic. In this view you can see her breathing tube on the left. She has been clipped for surgery and her final prep is about to begin. The distended abdomen is obvious. The pink bandage on her left front leg is where her intravenous catheter (IV) is placed so that we can accurately give her fluids.

We made a rapid entrance into her abdomen due to her anesthetic risk. What we encountered was a abdomen filled with blood. In this picture there are intestines visible on the left with abdominal fat on the right. Encountering this much hemmorhage at the start of the surgery is not a good sign.

The tissue was very delicate and bled easily when touched. In this picture we are using a laser beam to cauterize bleeding blood vessels.

When the bleeding was relatively under control we slowly exteriorized the severely diseased liver, seen here under Dr. P’s fingers. The spleen is starting to become visible under the surgeon’s hands (arrow).

A closeup of this liver lobe shows how enlarged and hemmorhagic it is. For comparison purposes, a normal liver is below this picture of a diseased liver.

Notice the tremendous difference in color and size in this normal liver lobe.

The liver was so delicate (the medical term is friable) that it bled significantly when touched. We were unable to get an adequate biopsy due to this problem We are using the laser beam again to control the bleeding we caused.

After we checked the liver we exteriorized the spleen. It is enlarged and hemmorhagic also. Go back up to the x-ray and now see if you can visualize the full size of the spleen.


A very important organ to check during and exploratory surgery is the adrenal gland since adrenal gland disease is common in ferrets. Brandi had her left adrenal gland removed previously. We know this because we did it and because of the hemoclips on the x-ray we showed you above.

Prognosis

Brandi survived the surgery (we are not sure her mother has recovered yet). Unfortunately, several months after this surgery we euthanized her because her problem had progressed significantly.

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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.

Modern anesthetics allows us to safely anesthetize high risk animals like this duck with a fractured wing. You can see her surgery in our Wildlife Care page.

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 most important part of monitoring your pet while it is under anesthesia is our nurse technician that is with your pet the whole time it is under anesthesia

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.

Pre-Anesthesia

A pre-anesthetic exam is performed just prior to anesthetizing any animal. We are looking for any problems, particularly with the heart and lungs.

We perform this exam just prior to anesthetizing your pet

Even our more unusual patients get an exam prior to surgery

One of the precautions we take to minimize the risk of anesthesia is 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.

We prefer to perform an exam and blood panel about one week prior to surgery. We send this blood panel out to our lab for a thorough analysis of important organs like red blood cells, liver, and kidney.

 This report is showing a kidney problem

 

In an emergency, or when we cannot send the blood out to our lab several days prior to surgery, we can perform an analysis in our hospital by our blood analyzer

We can have this report in 30 minutes. This is how it checks the CBC (Complete Blood Count). It also gives us a biochemical report like the one above that checks the internal organs like the kidneys.

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

Older pets, or those with medical problem,s 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.

IV fluids are one of the most important treatment modalities we have for a wide variety of medical situations in addition to surgery

Pre-Anesthetic ECG

For elderly pets, those with heart murmurs or heart conditions, we perform an electrocardiogram just prior too surgery.


This one has a potential problem that needs to be addressed

Blood Transfusions

For those pets that are anemic, or in surgeries where we anticipate significant blood less, we give whole blood before, during, and after the surgery. This is important in surgeries like splenectomies.

This is what anemia looks like in a CBC from our in house blood machine

Dog do not have iso antibodies, so in an emergency, and if the dog has never received blood before, we can give blood from most any dog donor. It is not our preferred way of doing a blood transfusion.

Before we give the blood we prefer to do a cross match

We use whole blood that is specially prepared and stored

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 anesthethesia.

Injectable anesthesia is given intravenously, and rapidly induces relaxation so that we can put in a breathing tube

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.

Gas Anesthesia

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

Lisa is watching carefully as this budgie is being anesthetized for a surgery to remove a growth on its cloaca

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 these 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.

Keeping a pet under anesthesia is important in orthopedic surgery to make sure the plates, pins, or screws are properly placed and in alignment. If they are not, this can be corrected before a pet wakes up completely. 

Endotracheal Tube

Oxygen is routinely 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 they 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.

 

The endotracheal (ET) tube is placed directly into the windpipe

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

We can easily breathe for your pet and inflate your pet’s lungs by gently squeezing the bag connected to the tube, 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.

Vaporizer

An instrument called a precision vaporizer is used to deliver the Isoflurane 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.

We can precisely and easily change the level of anesthesia during the procedure as needs change

For most surgeries we administer the anesthetic at a setting of 1-3 %. This small percent of anesthetic, added to the 100% 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 decreases anesthetic time,  another way we minimize anesthetic risk.

Monitoring

Our surgeon is one of the best monitors, because he/she 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.

In addition to all the high tech monitoring equipment we have, our anesthetist is hands-on in monitoring your pet. Here Brianna is using  her stethoscope to check the heart, even though the heart monitor behind her is doing the same thing. 

After listening to the heart she keeps a close tab on oxygen flow and the anesthetic level of our precision vaporizer

We keep detailed records of fluid rate rates, anesthetic and oxygen levels, and physiologic parameters, during the surgery

We keep a close tab on the heart with the stethoscope on all of our more unusual surgical patients

Since our small patients can easily become hypothermic due to the anesthesia and surgery, we monitor temperature continuously.

Surgery-GPigWaterBlanket

Surgery-GPigWaterBlanket1

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.

Anesthetic Monitor

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

It is a sophisticated instrument that gives us an early warning sign of impending problems with your pet’s physiology

It is calibrated prior to surgery to ensure accuracy

Watch it in action, and see if you an figure out what all these numbers mean

We sometimes use other instruments to monitor you pet while it is under anesthesia, even though the Surgical monitor does this also. It pays to be redundant. The two most important additional instruments we use are:

Pulse Oximeter (Pulse Ox)

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 Guinea Pig has the pulse oximeter sensor attached to his foot in preparation for surgery

The Pulse Oximeter measures oxygen saturation of 92%  and a heart rate of 87 beats per minute (BPM). Both of these are normal on this pet, which is a pot bellied pig.

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).

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.

Blood pressure can also be checked manually at any time

Our hypertension page has a video of the doppler blood pressure monitor in action when we use it in an exam room.

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.

Capillary refill time on this pet is less than one second

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. We monitor this closely, and will give additional injections as needed. This pain injection will keep your pet calm its first night home from any surgery. We will also send you home with oral pain medication also for several days.

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 so it is in full effect when your pet wakes up.

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 (Fentanyl) 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. If we put it on the leg it is covered with a bandage. 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.

One of our nurses is applying it in this picture using gloves to ensure she does not come into contact with the active ingredient.

We will commonly staple the patch to the skin if we put it between the shoulder blades

Our surgical patients are monitored closely immediately after surgery. We will verify the pain medication is working, and that there are no ill effects from the anesthetic. 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.

This video shows you how we calibrate and set the laser for a neuter surgery

Companion Laser Surgery Post Op

For additional pain control we use our  Companion Laser on the incision line before your pet wakes up from anesthesia. This decreases post operative swelling and pain, and makes your pet much more comfortable.


You get to wear cool glasses when we use this laser

Watch it in action

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.

To learn much more about how we do surgery at the Long Beach Animal Hospital please visit our Surgery Page and our Diseases Page.

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