Category: Guinea Pig

Laser Neuter -Guinea Pig

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We neuter (castration or orchiectomy) Guinea Pigs in a manner similar to other animals. We always use the laser for its major advantages of minimal to no bleeding during surgery, and minimal to no pain, swelling, and inflammation after surgery. Those of us that have had surgery are aware of how much pain there is after surgery, and we do anything we can minimize that pain for our patients.

Our laser is warmed up and calibrated for the specific surgery we are doing before we start the procedure

The laser is so important for our patients we use it on all of our neuters. Here is a short video of how we use it on a dog. Notice the lack of bleeding.

Sometimes people get a jaded mindset when it comes to routine surgeries like neuters, that are performed by the thousands, especially at low cost spay and neuter clinics. It is a major surgery, and we treat it as such at the Long Beach Animal Hospital, which you will learn about in this page when we neuter a cutie named Felix.

Several days prior to any surgery one of our doctors will perform a physical exam to confirm your pet is ready for anesthesia. At that time we will go over any questions you have.

On the day of surgery we need your Guinea Pig in the hospital between 7:30 AM and 8 AM. Feed your Guinea Pig the morning of surgery, and we will feed it also when it is here. We don’t fast them like we do with some other animals.

Our surgeon will call you after the surgery is complete and your Guinea Pig is awake. It can go home in the late afternoon the day of surgery unless instructed otherwise. Please call our office at 4 PM for pickup time, you will be given written post operative instructions then. We are open until midnight if you need to pick up later.

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

We scrub all the way to the elbow to minimize any chance of spreading an infection during surgery

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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.

We keep a close tab on important physiologic parameters for all of our surgeries to minimize the risk of anesthesia. Minimizing the anesthetic risk also allows our patient to recover from anesthesia faster and recover from surgery faster.

Brianna is listening to the heart rate of Felix during the surgery

Monitors give us an early warning of an impending problem. Instruments like this give us a big safety margin since we can anticipate problems before they cause any trouble.

Surgery-Monitor

This machine monitors:

Temperature

Heart Rate

Heart rhythm

Oxygen saturation

Carbon dioxide level

Respiratory rate

Important anesthetic data is recorded for this surgery 

Graphic surgical photos coming up

Most Guinea Pigs have both testes in the scrotum, making them readily accessible by a scrotal incision. On rare occasion they might be undescended and in the abdomen, although this is more of problem in dogs and cats.

Brianna, our anesthetist, is keeping Felix cozy and warm as she brings him into our surgical suite

Felix is put on a warm water blanket and Dr. Wood performs an exam on him to make sure he is ready  for anesthesia. When the OK for anesthesia is given Felix gets a pain injection. 

After the pain injection he is placed in a chamber with 100% oxygen along with an anesthetic

When Felix is relaxed his oxygen and anesthesia are administered by a special mask that fits over his face

Felix is given fluids under the skin (SQ or subcutaneous) to help support important internal organs like liver and kidney

Felix’s boy parts are cleansed carefully prior to surgery

Extra attention is paid to keep Felix warm due to his small size. Starting at the bottom, you can see three things in this photo to accomplish this:

Warm water blanket on the bottom

Fluids that have been warmed up above the blanket

Warm blankets that surround Felix on top


When our patient is ready for surgery we start the scrotal incision with the laser

The lack of bleeding on this highly vascular and sensitive organ is because of the laser, as opposed to a scalpel blade. In the above photo the scrotum has been incised with the laser and what you are seeing is a strong tissue covering the teste called the tunic. 

Notice in this video how there is no bleeding as the testicle is brought out of the incision with the tunic still covering it.  The laser will now cut through the tunic to expose the testicle.

Guinea Pig testes have substantial fat around them

The fat is ligated first. This fast has minimal blood supply so one suture suffices. 

The teste has a much greater blood supply than the fat.  It  is double ligated as an extra safety margin to prevent any bleeding after surgery


After transecting the blood supply to the teste our surgeon checks for suture integrity and any bleeding from the cut edge. We use the laser to cut the edge for control of bleeding and for comfort. 


When our surgeon is sure there is no bleeding the blood supply to the teste is placed back into the tunic

The tunic is sutured to prevent any hernia

A close up of the teste after it has been removed. On the right is the epididymis, on the left is the teste. 

The scrotum is closed with surgical tissue glue, which is much more comfortable than sutures

Our surgical patients are given cold laser (we call it Companion Laser) treatment to aid in healing and minimize post operative swelling and discomfort. You get to wear cool glasses when using this type of laser!

Dr. Wood is making sure our patient is doing OK before bringing him to recovery.

Felix recovered without any problems, and was soon munching away at his favorite food. The pain inject he was given prior to surgery is in full effect when he wakes up from surgery. If he needs more he will be given another one, although that is rare when we use the laser. He was a great patient, and will be back to doing his Guinea Pig thing in no time.  

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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.

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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.

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

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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.

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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

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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.

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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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Bladder Stone Removal

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Mr. Darcy was having symptoms of not feeling well and with blood in his urine, so his mom brought him to see Dr. Meredith Kennedy for a thorough exam.

During his exam, Dr. Kennedy palpated Mr. Darcy’s bladder, and noticed he was uncomfortable. As part of his routine diagnostic tests a radiograph was taken.

Mr. Darcy has not one, but two, stones in his bladder. Do you see them in this radiograph, just to the right of center?

If you can’t see them this view might help

It is not too often that Guinea Pigs get these stones. Bladder stones have several names. These include cystic calculi and urolithiasis. There are many different types of bladder stones, all with different causes. Our Bladder Stone page goes into this in more detail.

Graphic surgery pictures to follow.

Before surgery was performed we needed to make sure he is ready for surgery with a blood panel and medical treatment. Once we were sure he is ready for anesthesia we can begin the surgery to remove the stones. This surgery is called a cystotomy.

Mr. Darcy has had his tummy shaved, is connected to the anesthetic monitor, and has been scrubbed for his surgery

While Mr. Darcy is being prepared for surgery Dr. K is getting her sterile instruments ready

Our anesthetist closely monitors anesthesia, and only when he is stable, and at the proper level of anesthesia, does the surgery begins

After draping the first thing Dr. K does is infuse a long acting local anesthetic. This allows us to use less anesthesia during the procedure, and also allows Mr. Darcy to wake up pain free from his skin incision.

The skin incision is made just long enough to exteriorize the urinary bladder. Once through the skin Dr. K cuts through the subcutaneous (SQ) tissue to get down to the muscle layer

Mr. Darcy is 10 months old, and is being neutered at the same time, so that will also be done through this incision instead of through his scrotum. The less incisions the better for healing.

After the skin incision is made a scalpel is used to enter the abdomen by going through an area of the abdominal muscle where the tendons are located. This tendinous area causes minimal bleeding, and has better holding ability when the sutures are placed here at the end of the surgery.  This will prevent a hernia.

The tendon incision at the abdominal muscles is extended to the proper length with a special surgical scissors

Once the abdomen has been entered Dr. K palpates the area to find the urinary bladder

Guinea Pigs have a large cecum (our appendix), that wants to come out through the abdominal incision. You can see the urinary bladder between Dr. K’s fingers on the right. 

Once the intestines are put back where they belong (they want to keep coming out during the surgery) a special suture called a “stay” suture is put in the urinary bladder to keep it exteriorized and away from the intestines. In this picture Dr. K is using our laser to make the initial urinary bladder incision. 

This bladder is inflamed and painful due to the stones irritation the lining. We use our carbon dioxide laser routinely on problems like this due to its tremendous ability to minimize bleeding during the surgery, and post operative pain and inflammation after the surgery. We have a page dedicated to laser surgery for more information.

As Dr. K continues to use the laser to enter the urinary bladder the stones become apparent

Once the urinary bladder is fully incised the stones are brought out with a hemostat

After the stones are removed the urinary bladder is carefully palpated to make sure there are no other stones or problems before being sutured closed. 

A special suture material is used that is strong, will not inflame the bladder, and will dissolve slowly on its own over several months. This is an important part of the procedure, and the bladder is sutured carefully. 

Dr. K neuters Mr. Darcy through the same incision. You can see the testicle in her hand as she is getting ready to remove it.

Our patients with skin incisions are given companion laser treatment before they are awakened from anesthesia. This laser allows for faster skin healing with less pain and inflammation. 

Mr. Darcy is in good hands just after his surgery

We keep a close tab on him before he is put in recovery

Once in recovery he is closely monitored for temperature, breathing, pain, and bleeding

Mr. Darcy recovered rapidly and feels much better now that those stones are not irritation his urinary bladder. The next day he is checked carefully by Dr. K.

His incision looked great with no inflammation or sign of pain or infection. He was cleared to go home.

Mr. Darcy’s mom is happy he is feeling better

She sent Dr. K flowers as a token of her appreciation

You can learn more about how we do surgery in general on a wide variety of species at the Long Beach Animal Hospital from this link.

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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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Diabetes Mellitus (Sugar Diabetes)

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

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

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

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

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

Other facts influence diabetes mellitus. An important one is dental disease. The infection in the mouth can make it difficult to regulate a diabetic cat. We have a detailed page on dental disease to learn more about this.

Chronic pancreatitis can also predispose your cat to getting diabetes mellitus. We have a page on this (which includes inflammatory bowel disease) to learn more about pancreatitis.

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

We have a summary page on DM if this page has too much information for you.

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


Normal Physiology

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

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

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

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

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

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

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

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

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

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

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

  • Genetic predisposition
  • Infection
  • Toxins
  • Inflammation

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

Pathophysiology

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

Many diabetic cats will start having a rise in their blood glucose levels before the onset of symptoms, and before the beta cells in the pancreas lose their abilitly to secrete insulin. If we can catch this early, insulin secretion might possibly be restored. This emphasizes the importance of yearly exams with a blood panel and urinalysis to screen for this.

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

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

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

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

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

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

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

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

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

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

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

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

Classification

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

  • Type I

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

  • Type II

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

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

Symptoms

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

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

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

This is what the abnormal (plantigrade) posture looks like

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

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

Symptoms in dogs typically include:

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

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

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

Diagnosis

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

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

Signalment

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

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

History

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

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

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

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

Physical Examination

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

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

Diagnostic Tests

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

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

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

This cat has diabetes mellitus, its blood glucose is 390

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

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

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

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

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

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

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

This cat does not have ketonuria or an infection.

Treatment

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

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

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

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

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

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

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

Diet

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

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

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

Oral Hypoglycemics

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

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

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

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

Insulin

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

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


Regular

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


NPH

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


Ultralente

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


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

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

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

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

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

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

An ideal blood glucose level for a diabetic cat is 65-220 mg/dl. Every cat is different, and we have diabetic cats with numbers lower than this, and numbers higher than this, that are doing fine. Your feedback on how your cat is doing and eating, and also how much it is drinking and urinating, is very important.

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

  • Glargine and Detemir- Ultra long acting

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

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

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

  • PZI (Protamine Zinc Insulin)- Long acting

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

  • Vetsulin (Lente)- Intermediate acting

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

  • NPH (Neutral Protamine Hadedorn)- Intermediate acting

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

Ketoacidotic Diabetes Mellitus

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

Regulation

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

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

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

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

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

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

 

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

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

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

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

Insulin Injections

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

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

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

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

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

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

 

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

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

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

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

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

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

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

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

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

Home Monitoring

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Long Term Care

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

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

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

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

Complications of Diabetes

  • Hypoglycemia

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

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

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

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

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

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

  • Liver Disease

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

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

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

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

  • Somogyi Effect (Insulin Induced Hyperglycemia)

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

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

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

    Insulin antagonism

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

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

  • Infections

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

  • Cataracts

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

Boarding a Pet with Diabetes

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

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

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

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

Summary

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

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

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Guinea Pig X-Rays

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This little guy is laying on his back, with the front legs towards the top. The big dark spot the arrow is pointing to is air in the intestines, and is normal. Did you notice he is missing one of his front legs? It was amputated years earlier.


 

This is the same pig from the side view. Can you tell he has only one front leg from this view?

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Guinea Pig Eye Surgery

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This cute little one had a problem with his eye. There was a congenital problem with the hair above the eye. It was overgrown and irritating the cornea.

The extra lash is easily seen on this magnified view 

The cornea is the outer clear part of the eye. This extra hair can cause severe problems to the cornea if the problem goes on long enough. There will be a corneal ulcer, which is painful. As time goes on the cornea can become thickened and vision loss will occur. In severe cases the cornea can be perforated from this ulcer and the eye will need to be removed.

The green on this inflamed cornea is fluorscein stain. This is a special stain that shows if an ulcer is present, and how severe it is. 

This cornea is scarred and the eyeball is severely inflamed. This eye needs to be removed due to pain and loss of vision.

Due to all these possible complications it is imperative that we take care of the problem as soon as it is diagnosed.

All of our surgical patients are given a thorough exam the day of surgery. Many of our patients are tiny, and we need to pay particular attention to anesthesia.

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Here he is starting his anesthesia before surgery

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Small animals can lose body temperature easily while under anesthesia, and can become hypothermic. We keep them on a warm water blanket and monitor their temperature during the surgery to prevent this.

All of our Guinea Pigs are connected to instruments that closely monitor important physiological parameters. This one is being connected to a Pulse Oximeter to keep close tabs on oxygen levels and heart rate

This video show how we use it. The number on the left is the oxygen saturation level, the number on the right is the heart rate

We also connect all of our surgical patients to an EKG (electrocardiogram) that is monitored by or Surgical Vet anesthetic monitor.

The SurgiVet Monitor keeps close track of many important parameters

Here it is in action on a different patient

We don’t rely only on hi tech anesthetic equipment, and are hands on at all times in monitoring our patients.

Our anesthetist nurse is monitoring our patient under the surgical drape. She is checking the color of the mucous membranes, along with the heart rate and respiratory rate

While our patient is being prepped for surgery our surgeon is getting the sterile instruments ready. 

Now that our surgeon is ready, and our patient is safely under the proper plane of anesthesia, we can begin the surgery

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This is meticulous surgery so Dr. Ridgeway needs magnification (he looks like an alien creature)!

Here he is gently pulling up the inside of the upper eyelid to get an idea of how the lash is attached. He will now remove it with our surgical laser. 

We use the laser for many reasons. It gently removes the hair, and it does this without any bleeding or inflammation. This is important in this very sensitive area. In the years before we had the laser we used a small scalpel blade. Even though it was a small blade it still caused bleeding and inflammation post operatively.

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The laser in action

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No more hair, and more importantly to our surgeon, no bleeding or swelling

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Lisa keeps a close tab postoperatively to make sure our small patients wake up without any problems

This is how we like to see our Guinea Pigs right after surgery!

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Mange (Guinea Pig)

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Mange in Guinea Pigs is caused by a parasite that is similar to the scabies parasite in people. It is seen more often in households that have several pigs. This disease occurs in other animals also, including dogs and cats.


Cause

Mange is caused by a parasite know as Sarcoptes. It is transmitted by direct contact, usually when a new pig that has the mite is introduced with pets already in your household. The mites that cause mange in guinea pigs does not affect humans.

Symptoms

Most Guinea Pigs that have Mange are itching and have patches of hair loss. Some even lose weight and have unhealthy looking hair coats.

This little guy has the problem on his face and his arms

 

This pig has a patch of hair missing on his backside. He also has infected skin secondary to the scratching.

Diagnosis

Any pig that has hair loss and is scratching is a suspect for Mange. The primary method of diagnosis is with a skin scraping.

Treatment

The usual treatment for Mange is a drug called Ivermectin. Usually 2-3 injections are given between 1-2 weeks apart.

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