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Frequently Asked Questions -

Chronic Problems

 

What is diabetes mellitus and how is it diagnosed?
How is diabetes mellitus treated?
What happens if my animal receives too much insulin?
What is chronic renal failure?
Could the renal failure have been diagnosed earlier?
How can renal failure be treated?
What is hypothyroidism?
How is my dog diagnosed and treated for hypothyroidism?
What is hyperthyroidism?
How is my cat diagnosed and treated for hyperthyroidism?
What is degenerative joint disease, or chronic arthritis?

How can I control my dog’s degenerative joint disease?
What is hip dysplasia?
How can hip dysplasia be treated or the risk of hip dysplasia reduced?
What causes my animal to lose weight?
What is inflammatory bowel disease?
How is inflammatory bowel disease diagnosed and treated?
What is epilepsy?
How is epilepsy diagnosed and treated?
What is anal sac disease?
How is anal sac disease treated?
What is a urinary tract infection?
How can a urinary tract infection be diagnosed and treated?
What is feline idiopathic cystitis and how is it related to feline lower urinary tract disease?

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What is diabetes mellitus and how is it diagnosed?
Diabetes mellitus is a medical condition resulting in an excessive amount of glucose or sugar in the blood. This is caused by a deficiency of insulin, which is a hormone secreted by the pancreas. Diabetes seen more frequently in middle to old-age animals and, in cats, is more common in males than females.

The most common signs of diabetes mellitus are increases in water consumption, food consumption  and urination, and weight loss.

The diagnosis of diabetes mellitus is made based on clinical signs, persistently elevated blood glucose concentration and the presence of glucose in the urine. However, a diagnosis of diabetes cannot be made on a single blood and urine sample as other conditions, in particular stress, may also cause a transient rise in glucose levels.

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How is diabetes mellitus treated?
Diabetes mellitus is a treatable condition. Although long-term treatment requires commitment and dedication, it can be rewarding to successfully manage this condition in a beloved pet. Initial steps in treating a diabetic pet may involve removal of any predisposing causes (like some drugs, pancreatitis or obesity) for the diabetes. If there are no predisposing causes, or if correction of the predisposing causes does not lead to resolution of the diabetes, specific treatment is required. Most animals will require insulin injections to control the diabetes. Dietary therapy plays a large role in the treatemetn of diabetes, especially in cats.

During the initial stages of treatment, your pet will require several hospital visits until an appropriate insulin dosage is determined. Most animals will require twice daily injections of a small dose of insulin. Consistency is vital to proper management of the diabetic animal, and monitoring your pet’s treatment is important to make sure the treatment is working properly. You should never change the dose of insulin without first discussing it with your veterinarian. If an animal receives too much insulin, it is possible for the blood sugar level to drop dangerously low. The typical signs displayed by a cat or dog with a very low blood sugar level (hypoglycemia) are weakness and lethargy, shaking, unsteadiness and even seizures and unconsciousness. If a diabetic pet shows any of these signs it is important to seek immediate veterinary advice because, untreated, hypoglycemia can become fatal. In mild cases of hypoglycemia, you may observe “wobbling” or “drunken” walk, and the pet may not arouse when you call or pet it. In cases of mild or early hypoglycemia, you should administer approximately a tablespoon of corn syrup, honey or sugar solution by mouth.

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What happens if my animal receives too much insulin?
You should never change the dose of insulin without first discussing it with your veterinarian. If an animal receives too much insulin, it is possible for the blood sugar level to drop dangerously low. In mild or early cases of hypoglycemia (low blood sugar level), you may observe “wobbling” or “drunken” walk, and the cat may not arouse when you call or pet them. For mild cases, you should administer approximately a tablespoon of corn syrup, honey or sugar solution by mouth. The typical signs displayed by a cat or dog with more sever hypoglycemia are weakness and lethargy, shaking, unsteadiness and even seizures and unconsciousness. If a diabetic cat shows any of these signs it is important to seek immediate veterinary advice because, untreated, hypoglycemia can become fatal.

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What is chronic renal failure?
Chronic renal failure is the gradual loss of kidney function. The kidneys lose their ability to concentrate urine, remove waste products from the blood stream, retain essential nutrients such potassium at the correct level and maintain hydration. They have a large amount of spare capacity to perform their various functions so at least 70% of the kidneys need to be dysfunctional before any clinical signs are seen. In many cases this means that the damage to the kidneys has been occurring over a number of months or years before failure is evident. Chronic renal failure is the end stage of a number of different disease processes rather than a specific condition in its own right.

Chronic renal failure is most commonly seen in older pets. Early signs of disease such as weight loss and poor coat quality are often dismissed as normal aging changes. After approximately 70% of the kidney tissues are destroyed, there is a rapid rise in waste products in the bloodstream and an apparent sudden onset of severe disease. The most common changes seen are weight loss, poor hair quality, halitosis (bad breath) and variable appetite which may be associated with mouth ulcers, lethargy and depression. Less commonly, pets are seen to drink and urinate more and some will have vomiting and diarrhea. Rarely, renal failure is seen as sudden onset blindness. Unfortunately, once the kidneys are damaged, they have very limited ability to recover, but with treatment, your cat may have several years of good quality, active life ahead.

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Could the renal failure have been diagnosed earlier?
Unfortunately, this is very difficult, as neither clinical signs of renal failure nor rises in BUN and creatinine in the blood are evident until significant loss of kidney function has occurred. In earlier stages of disease  weight loss and poor coat quality are often dismissed as signs of aging so sophisticated renal function tests, which can pick up early renal damage, do not seem necessary. We recommend that all senior pets have bloodwork and urinalysis performed at least annually to diagnose kidney disease at it earliest stages.  Also, regular teeth cleanings can help prevent chronic renal failure.

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How can renal failure be treated?
Since dialysis is not an option, the treatmetn relies on helping your pet's remaining kidney tissue to carry out all the necessary tasts. This includes maintaining appropriate potassium and phosphorus blood levels and treating high blood pressure if present. The majority of pets can be effectively managed with diet change including supplementation and one or two other treatments. It is important that fresh water is available at all times because cats and dogs with renal failure can dehydrate rapidly. Treatment can be very rewarding, but the disease will progress inspite of treatment, usually slowly but sometimes quite rapidly.

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What is hypothyroidism?
The thyroid gland, located in the neck, regulates the body’s metabolic rate. Hypothyroidism is when the thyroid gland is underactive in a dog, causing the metabolism to slow down. Virtually every organ in the body is affected.  Most dogs with hypothyroidism have one or more of the following symptoms:

  • Weight gain without an increase in appetite
  • lethargy and lack of desire to exercise
  • Cold intolerance (gets cold easily)
  • Dry, dull hair with excessive shedding and flaking
  • Very thin to nearly bald hair
  • Increased dark pigmentation in the skin
  • Increased susceptibility and occurrence of skin and ear infections
  • Failure to re-grow hair after clipping or shaving
  • High blood cholesterol

Some dogs also have other abnormalities such as:

  • Thickening of the facial skin so they have a "tragic facial expression"
  • Seizures
  • Abnormal blood clotting
  • Abnormal function of nerves causing non-painful lameness, dragging of feet, lack of coordination, and a head tilt
  • Loss of libido and infertility in intact males
  • Lack of heat periods, infertility, and abortion in non-spayed females
  • Fat deposits in the corneas of the eyes

    Hypothyroidism is usually caused by one of two diseases: lymphocytic thyroiditis, where the immune system decides that the thyroid is abnormal or foreign and attacks it, or idiopathic thyroid gland atrophy, where normal thyroid tissue is replaced by fat tissue. The former disease is the most common cause of hypothyroidism and is thought to be an immune-mediated disease.

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    How is my dog diagnosed and treated for hypothyroidism?
    Hypothyroidism is diagnosed with blood testing. It is not curable, but it is treatable with oral administration of thyroid replacement hormone. This drug must be given for the rest of the dog's life. If the medication is overdosed signs of hyperthyroidism can result. These include hyperactivity, lack of sleep, weight loss, and an increase in water consumption. If any of these occur, contact your veterinarian immediately.

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    What is hyperthyroidism?

    The thyroid gland, located in the neck, regulates the body’s metabolic rate. Hyperthyroidism is when the thyroid gland is overactive in a cat, causing the metabolism to speed up. This is a fairly common disease of older cats. Although the thyroid gland enlarges, it is usually a benign or non-malignant change.

    The most common clinical sign of hyperthyroidism is weight loss secondary to the increased rate of metabolism. The cat tries to compensate for this with an increased appetite, but most cats continue to lose weight. The weight loss may be very gradual or quite rapid. Affected cats often drink a lot of water and urinate more frequently. There may be periodic vomiting or diarrhea, and the fur may appear unkempt. In some cats, anorexia develops as the disease progresses.

    Many organs are affected by hyperthyroidism. Two secondary complications of this disease can be significant. These include hypertension (high blood pressure) and a heart disease called thyrotoxic cardiomyopathy. In some cats, blood pressure can become so high that retinal hemorrhage or detachment will occur and result in blindness. Heart problems develop because the heart must enlarge and thicken to meet the increased metabolic demands. Both of these problems are potentially reversible with appropriate treatment of the disease.

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    How is my cat diagnosed and treated for hyperthyroidism?
    In most instances, diagnosis of this disease is relatively straightforward with blood tests. Because less than 2% of cats with hyperthyroidism have cancerous growths of the thyroid gland, treatment is usually very successful. Treatment can follow three different paths: radioactive iodine therapy given by injection to destroy all abnormal thyroid; surgical removal of the affected thyroid lobe or lobes; and administration of an oral drug, methimazole (Tapazole®). Most cats have a very good chance of returning to a normal state of health.

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    What is degenerative joint disease, or chronic arthritis?

    Degenerative joint disease is chronic arthritis where the smooth resilient cartilage which covers the ends of bones degenerates and becomes brittle and may actually split from the bone and become detached within the joint. The damaged cells of the cartilage release substances which result in inflammation, pain and further damage to the cartilage, creating a vicious cycle. A dog with degenerative joint disease may have joint stiffness and/or pain, may be slow to rise or have pain on rising, may have a stiff gait, may be lame, or may have a reduced range of motion.

    Degenerative joint disease can follow a number of joint diseases including infection and may follow surgery. It also occurs from excessive weight and obesity.

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    How can I control my dog’s degenerative joint disease?
    Most of the damage caused by degenerative joint disease is irreversible. Fortunately, new products are available that can slow the progress of the disease and promote cartilage healing. In addition, modern medications can effectively control pain with few side effects. Because many dogs suffering from degenerative joint disease are overweight, it is imperative that your pet’s weight be monitored and reduced. There are also certain dietary supplements that seem to be helpful.

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    What is hip dysplasia?

    Hip dysplasia is a deformity of the hip joint when uniform growth does not occur. The result is looseness in the joint followed by degenerative joint disease or arthritis, which is the body’s attempt to stabilize the loose hip joint.

    Weakness and pain in the hind legs are the usual signs. The dog appears wobbly and is reluctant to rise from a sitting or lying position, mostly commonly in dogs one to two years of age. However, some pets with significant signs of hip dysplasia on x-rays may not exhibit any lameness or other signs, while others with minimal changes in the hip joint may experience severe pain and lameness.

    There are two primary causes of hip dysplasia, genetics and diet. Larger dogs are more at risk, and large breed puppies should be fed a special diet during the first year of life to reduce this risk. The goal of this diet is to slow growth rates so that bone and joint will grow at a more uniform rate.

      

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    How can hip dysplasia be treated or the risk of hip dysplasia reduced?
    Treatment depends upon the pet’s signs and amount of discomfort. There are very effective non-steroidal anti-inflammatory drugs, and the alternative to the drugs is surgery.

    To reduce the risk of hip dysplasia, large breed or at-risk puppies should be fed a special large-breed diet designed to slow their growth during their first year of life.

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    What causes my animal to lose weight?
    Weight loss results when the body does not take in as many calories as it requires. This can affect any of the body’s organ systems. Weight loss may be associated with many normal and abnormal conditions, and most chronic diseases will result in weight loss at some time during the course of the disease. Changes in diet, environment or stress levels, including the addition of new pets, may lead to weight loss that is rarely permanent or significant.

    Weight loss is considered to be clinically significant when it exceeds ten percent of the normal body weight and when it is not associated with fluid loss or dehydration. For example, a healthy Golden Retriever weighing a breed-normal seventy pounds would have to lose over seven pounds before the weight loss would be considered clinically significant. Treatment varies depending on the cause of your pet’s weight loss.

    Significant weight loss may be caused by:

  • High energy demand associated with excessive physical activity, prolonged exposure to cold, hyperthyroidism, pregnancy or lactation, fever, infection, inflammation and cancer
    • Inadequate or poor quality diet
    • Excessive loss of nutrients or fluid from vomiting, diarrhea, or excessive urination
    • Anorexia due to a behavioral condition or disease
    • Pseudoanorexia caused by loss of smell, inability to grasp or chew food, swallowing disorders, vomiting or regurgitation
    • Malabsorptive disorders that inhibit the body’s ability to absorb nutrients from the intestinal tract
    • Maldigestive disorders that interfere with the body’s ability to break down food into usable nutrients
    • Metabolic disorders such as diabetes mellitus, hypoadrenocorticism (Addison’s disease), hyperthyroidism (rare in dogs, common in cats) and cancer
    • Diseases involving the major organs (heart, liver or kidney)
    • Neuromuscular disease resulting in weakness or paralysis
    • Swallowing disorders
    • Central nervous system disease causing depression, anorexia or pseudoanorexia

       

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    What is inflammatory bowel disease?
    Inflammatory Bowel Disease is a chronic disease of the intestinal tract where an allergic-type response occurs within the intestinal tract. This inflammation interferes with the ability to digest and absorb nutrients. Occasionally, the stomach may be involved. Most dogs and cats with inflammatory bowel disease have a history of recurrent or chronic vomiting or diarrhea. During periods of vomiting or diarrhea, the anmal may lose weight but is normal otherwise. For some animals, diet plays a role in causing inflammatory bowel disease. Bacterial proteins may be involved in other cases. In some instances, an exact underlying cause cannot be identified.

     

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    How is inflammatory bowel disease diagnosed and treated?
    Inflammatory bowel disease is most accurately diagnosed by biobsy of the intestinal wall, but when this is not possible, the diagnosis is made by excluding other diseases via a range of tests, including fecal evaluations and blood tests. When a diagnosis of inflammatory bowel disease is made, the dog is usually placed on a hypoallergenic, low residue diet. If the dietary trial does not result in improvement, medication may be used to control the problem. Once the appropriate drugs or diet is determined, many dogs remain on these for life, although dosages of the drugs may eventually be decreased.

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    What is epilepsy?
    Epilepsy is a brain disorder characterized by recurrent seizures caused by abnormal electrical activity in the brain. The source of the abnormal electrical activity is unknown but appears to be at least partly genetically determined. Epilepsy is somewhat common in dogs and rare in cats. Breeds that have a higher incidence of epilepsy include beagles, shepherds, border collies, boxers, cocker spaniels, collies, dachshunds, golden retrievers, Irish setters, keeshonds, Labrador retrievers, French poodles, St. Bernards, Shetland sheepdogs, Siberian huskies, springer spaniels, Welsh corgis, and wire-haired fox terriers. Seizures are often characterized by stiffening of the neck and legs, stumbling and falling over, uncontrollable chewing, paddling of the limbs, loss of bladder control and violent shaking and trembling. Afterwards, the pet may appear confused, dazed or sleepy. Seizures can last a few seconds to a few minutes.

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    How is epilepsy diagnosed and treated?
    A diagnosis of epilepsy is made only after all other causes of seizures have been ruled out.

    After diagnosis, there are various anticonvulsant medications that may be recommended for your pet. Since anticonvulsants are very potent, treatment must be continued for the remainder of the pet’s life. Irregular dosing schedules (including starting and then stopping the medication, or forgetting to give pills) may result in more frequent or more violent seizures. After treatment begins, blood tests and liver function tests will be needed every six months to ensure that your pet's blood levels do not get dangerously high or low, and that no damage to the liver is occurring.

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    What is anal sac diease?

    The anal sacs, or the anal glands, are two small pouches located on either side of the anus, lined with sweat glands that produce a foul smelling secretion. Each sac has a small duct which opens just inside the anus, and dogs use this secretion as a territorial marker. Although cats can use their anal sacs for the same purpose, most domestic cats have no need to mark territory or repel predators. In both dogs and cats, a small amount of anal fluid is usually squeezed out by muscular contractions during defecation. Problems with the anal gland are common in all dogs but are much less common in cats.

    The fluid in the sacs becomes thick and solidified, usually due to blockage of the ducts, and the sacs will become swollen and distended. The first sign of anal sac disease is often scooting or dragging the rear along the ground. There may be excessive licking or biting, often at the root of the tail rather than the anal area. It may be painful to pass feces. The secreted material within the anal sacs is ideal for bacterial growth, allowing abscesses to form. An anal sac abscess will appear as a painful, red, hot swelling on one or both sides of the anus. If the abscess bursts, it will release a quantity of greenish yellow or bloody pus. If left untreated, the infection can spread and cause severe damage to the anus and rectum.

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    How is anal sac disease treated?
    If you are concerned that your pet may have an anal sac problem, call your veterinarian at once.  Treatment for scooting involves emptying the sac and using fiber in the diet to bulk up the stool and aid in normal emptying. Treatment for impaction involves flushing and removal of the solidified material. Since this condition is painful, many pets will require sedation for this treatment. In the case of an abscessed anal sac antibiotics are prescribed and sometimes may need to be instilled into the sacs over a period of several days. Most animals will receive pain relief medications for several days until the swelling and pain have subsided. In some cases, surgery may be necessary, especially for dogs with recurrent problems. In cats, recurrent anal sac disease is rare. However, some overweight cats will have chronic anal sac problems because the sacs of obese cats do not drain well.

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    What is a urinary tract infection?

    A urinary tract infection is a bacterial, fungal or algal infection anywhere along the urinary tract, which includes the kidneys, ureters, urinary bladder and urethra. In dogs, urinary tract infections are usually caused by intestinal or environmental bacteria that ascend to the bladder and flourish. Free access to fresh water and regular urination can help flush microorganisms out of the urinary tract and helps prevent urinary tract infections. However, in cats most urinary tract infections are caused by some previous medical condition or defect that makes a cat more easily infected by bacteria, viruses or fungi. A more common condition in cats that causes similar symptoms is feline idiopathic cystisis.

    Urinary tract infections are fairly common in dogs and affect dogs of all ages and breeds. They are less common in cats. In both species, infections are more common in females. Because so many animals do not show symptoms of disease, it is important for owners to rely on regular veterinary examinations, including blood tests and urinalyses, to identify the infection. Urinary tract infections are usually very painful, but many animals have a high pain threshold and do not act unusual. Chronic infections can damage the urinary tract and become much more difficult to treat with the passage of time. Even uncomplicated infections without symptoms, if left untreated, can lead to much more serious conditions.

    When an animal does have observable symptoms, they may include:

    • Abnormally frequent urination
    • Larger volumes of urine
    • Increased thirst/water intake
    • Difficulty urinating or excessive urgency
    • Inappropriate urination in places that are not customary (house, car, outside the litter box)
    • Incontinence
    • Cloudy urine
    • Urine with an abnormal smell
    • Blood in the urine
    • Fatigue, listlessness
    • Depression
    • Loss of appetite
    • Fever
    • Inflammation and irritation around the genitalia
    • Licking of the vulva (females)
    • Vaginal discharge (females)

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    How can a urinary tract infection be diagnosed and treated?
    Urinary tract infections are usually easy to diagnose through regular urinalyses and blood testing. If left untreated, this disease can cause severe damage. Treatment usually begins with antibiotics. If the infection persists or recurs, the precise cause of the infection will have to be identified to treat the root causes. The outcome after treatment for pets with uncomplicated bacterial urinary tract infections is excellent, but complicated urinary tract infections can be much more difficult to treat.

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    What is feline idiopathic cystitis and how is it related to feline lower urinary tract disease?

    Feline idiopathic cystitis (FIC) is lower urinary tract disease with an undiscovered cause. Lower urinary tract disease, which causes similar symptoms but is not the same as a urinary tract infection, is a set of symptoms associated with abnormal urination than can be due to a wide variety of causes including bacterial infection, bladder stones, inflammation of the bladder wall, abnormal growths or abnormal development of the bladder. However, in a majority of cases in cats, the cause is unknown. While most cases of feline idiopathic cystitis recover relatively quickly with minimal treatment, some will not, and in male cats urinary tract obstruction is a serious risk, so these cases are always taken seriously. Also, recurrence of clinical signs is common. Medical treatment may help reduce the recurrence or improve clinical signs.

    The most common clinical signs of urinary tract disease, regardless of cause, are:

  • Straining to urinate
  • Bloody or discolored urine
  • Frequent urinations
  • Urinating in unusual locations
  • Inability to urinate
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    Diagnosis is based on tests to eliminate the known causes of abnormal urination, including exams, blood tests and urinalyses. X-rays and ultrasound may also be required. Since the exact cause of FIC is unknown, treatment will be based on the cat's needs.

     

     

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