This is Marley. He has lymphoma and is receiving chemotherapy through the combined efforts of MSU Oncology, Veterinary Care Specialists and, of course, his owner.
Marley loves snow, playing and his owner and we were so happy to receive these pictures from his family this week.
Researchers in the veterinary clinical sciences department at THE Ohio State University, (I can make fun of them since I received my Masters of Science degree from OSU) , have reported a new technique for calming stressed felines. They developed a clip, similar to a large ladies hair clip, that is applied to the scruff (the loose skin) of the cats neck. This mimics the technique that mother cats use to subdue fractious kittens and move them. They found that this clip aided in relaxing the cat so that minor procedures could be performed without a struggle, creating a safer situation for cat and clinician! Even more important than the improved cooperation of the patient, they found that the cats were happier, some times purring and kneading the blanket they were on. They had lower blood pressures and in general were more content. They coined the phrase, 'clipnosis' for the technique.
About 15 years ago I was working at an area ER clinic where the techs and doctors felt it was cruel to 'scruff' or apply tension on the back of a stressed cats neck to aide in handling them. I thought that was odd since it quieted the cat and allowed us to treat it with minimal stress. I am glad to see that we now have some scientific proof that , once again, we just need to pay attention to those well designed systems that occur within nature.
I was speaking with a classmate from veterinary school recently, she reminded me, albeit gently, that we graduated from Michigan State's College of Veterinary Medicine 24 years ago. It is difficult to comprehend that it has been that long and that we are now the old timers that we looked upon with disdain when we graduated! Since that conversation, I have been thinking about how much patient care has changed since 1986. Almost every hospital and certainly every emergency clinic and referral hospital can monitor blood gasses with a hand held device, SpO2’s are checked on patients throughout surgery and recovery, MRI’s and CT’s are commonly available. These changes have aided our patients and their owners immensely and they have helped our profession grow by leaps and bounds. I am confident that even our professors would not have been able to foretell how our profession would grow. I have recently read a few articles that brought the passing of time into perspective, but these articles spoke to how our patients and their maladies have changed.
Over the years the type of cases I see and the degree with which I understand the patient’s condition has changed immensely as well. After finishing my residency training in the early 1990’s I was with a large referral practice called Veterinary Referral Associates in Gaithersburg, Maryland. We were presented with a wide variety of referral cases at VRA.I recall one of the dermatologists in the area referring a Doberman that sucked the skin on it’s flank area and self mutilated. This was quite a curiosity and the dermatologist was unable to find cause. Fortunately, the dog would stop if an Elizabethan collar was applied (an e-collar, a clear piece of plastic that prohibits the patient from getting access to certain areas on the body). We too thoroughly evaluated the patient and found him to be normal except for his overwhelming desire to suck and lick his skin. We tried sedatives, anticonvulsants and analgesics to no avail. It was unfortunate, but the dog was relegated to wearing the e-collar on and off for the rest of its life. I recall that it was rarely that we would see this type of case and they would first see a dermatologist since they had all the hallmarks of a severe, irritating skin condition that plagued the poor animal to distraction.
In 1992 , I returned to the Detroit area and with a gradually increasing frequency I would be consulted regarding Dobermans, Bull Terriers and other (usually terrier) breeds that tail chased, flank sucked, spun in circles and self mutilated to the point of doing themselves serious harm and driving their poor owners crazy as well. As time progressed we grew to learn that these were Obsessive-Compulsive Disorders. Although many feel that they are best cared for by behaviorists, I argue that these are not solely behavioral problems. I think these cases are neuro-psychiatric conditions, that have multiple factors, certainly environmental, behavioral, but also genetic, neurochemical and structural factors are at play as well. Obsessive Compulsive Disorders are best managed, similar to many human psychiatric conditions, through the management of the environment, diet, retraining (behavioral modification), medication and the treatment of other underlying neurological and metabolic disorders.
So why are these conditions more common? Are we just more observant? Are pet owners more tolerant of these problems and seeking help rather than pursuing
euthanasia?
Possibly, however, the two articles I mentioned earlier, I feel, better explain this escalating problem. First, in the journal, The American Naturalist, two biologists, Christian Klingenberg, PhD, of the University of Manchester and Abby Drake, PhD, of the College of the Holy Cross, looked at the diversity in the structure of the canine skull (the container within which the brain is housed). They found that over the past century, with the benefit of human influence and selection for specific structural traits, we have created an extremely diverse population of animals that are so different they are not similar to the other members of the family Canidae. This means that we, us humans, have exerted our influence to such an extent that we have created animals that could not survive in nature, that are not even akin to their naturally evolving relatives in structure and function. By changing the structure of the skull in some breeds we have taken away their ability to naturally reproduce (ie .the bull dog). By changing the skull shape and hence the brain structure what else have we unwittingly changed? We know that by selecting for a certain skull shape we may have created a serious neurological condition in the King Charles Cavalier Spaniel. What other problems have developed via the unnatural selection pressure of the ‘breed standard’?
The second publication addressed the genetic link for canine compulsive disorders (CCD). In the study, the researchers found an association between CCD and the neural cadherin-2 gene (CDH2) on chromosome 7 in the dogs. Dogs exhibiting multiple compulsive behaviors had a higher frequency of the risk DNA sequence than dogs that showed less severe behaviors (60 and 43 percent, respectively, compared with 22 percent in non-CCD dogs).This article was in the journal,Molecular Physiology.
I think that these two articles illustrate that our patients have changed and are changing, sometimes at a rapid and unnatural rate. As the result of the selective pressures we have applied to that canine breed we aided in creating significant health issues. Possibly, we have inadvertently selected for genes that make Veterinary Neuro-psychiatry a burgeoning field.
The tragedy in Haiti has left many of us wondering how to best help. The human tragedy is over whelming and I am sure many of us wonder where our money and efforts are best placed. I am fortunate to be part of an international organization, Rotary, and can give to the project, Shelter Box, which provides shelter and necessities to ten people with each of their efficiently packaged boxes.
As an animal advocate, I also realize that there is a huge catastrophe affecting Haiti’s wild and domestic animals. The health of the islands animal population can be closely linked with the well being of the humans as well. Haiti, already an impoverished country with many zoonotic diseases, is at risk of epidemics of these diseases ( zoonotic diseases are diseases that can be spread from animal to human and vice versa). Rabies, leptospirosis, and tuberculosis are just a few of the diseases that may spread more readily. Also the suffering of the livestock and domestic animals that may not have food or clean water is a huge concern.
There are a number of well respected aide organizations that are preparing or already have began to move forward to assist. The AVMA (American Veterinary Medical Association) reports that the International Fund for Animal Welfare already has staffers in Haiti, aiding in vaccination of live stock and some companion animal care. Also the World Society for the Protection of Animals plans to have representatives in the field as does the American Humane Association. Henry Schein, Inc has proposed to donate a million dollars in medical supplies to the relief effort. American Dog Rescue in conjunction with the Humane Society of the United States are also pledging funds for animal relief.. Be sure to remember these groups when considering funds that you wish to donate to the relief effort. Keeping the animals of Haiti healthy and safe benefits the animals and ecosystem as well as the humans of that nation.
Recently, I was speaking with a referral client who, because of her pets health issues, we had suggested stopping all vaccines. She was in a panic and was particularly concerned that her dog would go without rabies vaccination. It was only after the call, I realized that since the owner was from India she lived where rabies was more common and people were also commonly exposed to the disease. No wonder she was worried about the risk of the disease and exposure of her family. Many countries continue to have a huge endemic rabies problem. The disease is not only a risk to wild and domestic animals, but the human population as well.
Earlier this fall a case of a human infected and dying from rabies occurred in Michigan's Upper Peninsula. They had been exposed to a rabid bat their cat caught. Although we may live in a part of the world were exposure to zoonotic diseases (diseases that can be spread from animals to humans)is less common, they are still a threat.
Rabies, distemper, parvo virus and feline leukemia are all still out there, vaccines are still necessary, however I think we have gotten a lot smarter about their use. Our hospital designates certain vaccines as core vaccines, the distemper combination(distemper, hepatitis, parainfluenza, adenovirus and parvo virus) and rabies for dogs and the feline distemper (feline calici, rhinotrachietis, panleukopenia and chlamydia) and rabies vaccines for cats. We consider leptospirosis, bordatella and feline leukemia to be necessary additional vaccines based on the patients life style. We also recommend that vaccine schedules be reduced as the patient ages (distemper and rabies every 3 years) and in geriatric pets the distemper vaccines can be discontinued. Outdoor cats for example should have regular vaccines as well as the feline leukemia vaccine. Dogs that board or are regularly groomed the bordatella, kennel cough , vaccine is indicated. Dogs that live in rural environments or go to the park regularly should be vaccinated for leptospirosis. Also, vaccine titers can be performed that may help us decide if a vaccine is even necessary. Of course, like the dog I mentioned earlier there is a population of animals that have had cancer or other immune mediated diseases that should no longer be vaccinated and they should be managed in such a way to limit their exposure to the diseases they are no longer vaccinated against.
Like everything in life it is a matter of balance and finding the vaccine protocol that works best for your pets. The goal is to avoid contracting controllable diseases, while balancing the risk of vaccination and ultimately keeping your pet and your family healthy.
About a week ago I did some over night ER shifts at the hospital. The staff joked that I appear to be a magnet for all the busy late nights and unusual cases. Anyways, I saw a few wildlife cases those 3 nights. One was a screech owl that had been hit by a car. An owl with vertigo is quite and sight. Another case was a young Canadian goose that had been shot with an arrow. Fortunately, the arrow had pierced through his breast and exited out the other side, not piercing his thoracic cavity or abdomen. He had been caught by an area wildlife rehabilitator and brought to the hospital to see if we could help him. Radiographs were taken, the patient was anesthetized and the arrow removed. He recovered uneventfully and was sent off the next morning to recuperate with the rehabiltator. I was happy to help him, but more than a little disappointed in my fellow human.
I find this type of gross disregard for a living creature to be incredibly upsetting.It really doesn't matter if it is a field mouse, a turtle or a deer. Frankly it is all the same regardless of their size or perceived value. And this is not about whether hunting is appropriate or not, I can assure you the person who did this was no hunter since a capable hunter would never leave an animal to suffer and die a miserable death.
We have so much natural space around us in these little towns. We are fortunate. Hopefully, people can think twice before inflicting senseless harm on another living creature since their actions hurt all of us.
Presented by J. A. Hass DVM, MS
A client seminar presented on 13. October, 2009
Hector and Jimmy’s Restaurant
Milford. MI 48380
Diabetes is a term used to describe diseases that cause polyuria (increased urine production). Diabetes mellitus is a chronic syndrome of impaired metabolism resulting in insufficient secretion of insulin or insulin resistance. In humans there are two major type of diabetes, Type 1 and Type 2. Diabetes mellitus in veterinary patients, although similar in behavior as human diabetes, is more accurately categorized as Insulin dependent (similar to type 1 in people) and Non-insulin-dependent (similar to type 2 diabetes). Dogs more commonly are insulin dependent, or require insulin therapy to remain normoglycemic. Cats can be either, about 30-50 % of feline diabetics are non-insulin dependent. There is no test that distinguishes the insulin-dependent pet from the non-insulin-dependent, the differentiation between the two is made through careful evaluation, observation and management.
There are many factors that may predispose your pet to becoming diabetic. Genetics can play a roll in predisposing a dog or cat to diabetes, just as it does in humans. However, at this time we do not understand the relationship of genetics in the diabetic dog and cat. We do appreciate that diabetes is more common in certain breed groups and as we investigate further the genetic link and how it triggers diabetes, we will develop a better understanding of the familial and genetic influence on diabetes in the dog and cat.
The role of other illnesses and environmental factors in causing diabetes are better understood. Pets that develop pancreatitis, an inflammation of the pancreas, can develop diabetes as a result of damage to the beta cells that produce insulin. Repeated bouts of inflammation can cause permanent damage of beta cells and decrease insulin production.
Amyloid, a polypeptide, deposited within the cells of the pancreas is another mechanism of beta cell damage and decreased insulin production. This occurs more commonly in cats and humans. Amylin is secreted along with insulin and aides in decreasing glucose intake and appetite. However, in obese patients this substance is produced in excessive amounts and results in amyloid deposition within the islets of the pancreas and further damage and altered insulin production.
Obesity is another factor in creation of a diabetic pet. It causes the pet to be resistant to the effects of insulin and eventually leads to diminished insulin production. Cats that become diabetic as a result of obesity, if treated promptly, may be managed through diet, oral glycemic control medications, and weight loss.
Certain medications can also lead to weight gain and poor glucose management. Steroid use can aide in creating a diabetic pet. The use of oral, topical or injectable steroids can mimic an illness called Cushing’s Disease (hyperadrenocorticism). Cushing’s disease is an endocrinopathy, or hormonal imbalance, that leads to excessive cortisol or steroids in the body. This causes insulin resistance and hyperglycemia. Other endocrinopathies like hypothyroidism may predispose a patient to developing diabetes.
As a pet develops diabetes there are common clinical signs (symptoms) that may be noted very early in the disease process. Noting these signs in your pet and seeing your veterinarian as soon as they are noticed may prevent having to manage diabetes for the rest of your pet’s life or it may prevent more serious health issues from developing. There are four signs that are common to the diabetic patient; increased thirst, increased urination, excessive appetite and weight loss.
When a diabetic is not treated or their diabetes is inadequately controlled additional health issues can develop. Cataracts result in an irreversible clouding of the lens of the eye. Cataracts are treated through a surgical procedure that is performed by a veterinary ophthalmologist. Secondary skin and urinary tract infections also can occur when an individual has diabetes. Diabetic neuropathy causes weakness and difficulty ambulating. This disease is most often noted in the feline diabetic, but can be seen in dogs. Pancreatitis, often a contributor to the development of diabetes, and hepatic lipidosis, an abnormal deposition of fat in the liver and subsequent liver dysfunction, are common sequelea of diabetes. Ketoacidosis, a medical emergency, causes a metabolic acidosis, life threatening electrolyte shifts and ultimately, coma and death. Most of these conditions, like ketoacidosis, are treatable, but there is always the risk of complications and deterioration of the patient’s general condition as a result of multiple illnesses. It is always best and more economical, to avoid compounding an already serious health issue, like diabetes.
Diabetes mellitus is an illness that is managed via a variety of techniques. First, the diet is altered. The patient is placed on a regular feeding schedule. Carbohydrate levels in the diet are reduced and the patient is given a diet that is higher in protein and fat with reduced calories when appropriate. There are many diets that are formulated for the canine and feline diabetic. Each one must be chosen based on the needs of the individual animal. Many commercially available canned cat foods, composed mostly of meat proteins, have helped reduce insulin requirements in some of my feline patients. Careful choices regarding the patient’s diet and feeding schedule can prove pivotal in managing a diabetic successfully.
Insulin therapy is another very important key to diabetes management. Most insulin therapies are administered by injection, twice daily, after the pet has eaten their meal. Insulin administration should remain on a very regular schedule. The type of insulin that is chosen by your veterinarian is decided by whether your pet is a dog or cat, the severity with which they are affected and their pattern of hyperglycemia. Each insulin product has a different time of maximal effect and a different degree of glycemic control. NPH insulin is most often prescribed for dogs and PZI insulin is most commonly chosen for cats.
Oral medications that stimulate insulin secretion from the pancreas can be utilized with patients that still have functional beta cells. These medications are only successful in patients that can still produce insulin and therefore are not insulin dependent diabetics. Glipizide, a sulfonylurea, is one of the more commonly used oral hypoglycemic drugs.
Regular exercise and activity is important for both the feline and canine patient. Certainly it is easier to get your dog out for regular walks. But cats can be encouraged to begin new routines and you can make a point of having them with you and interacting with you on a daily schedule. This also allows you to monitor their response to therapies.
Our therapeutic goal for the diabetic patient is to reduce the visible signs of diabetes. The diabetic patient should begin to drink less, urinate less often, eat more regularly and appear more robust with good stamina. As we manage the patient more successfully, long term, we avoid cataracts, neuropathies, liver, kidney and heart disease.
Certainly, the obvious improvements in a diabetics condition are helpful indicators of success, but these occur over time and may not be as accurate techniques of monitoring from week to week or day to day. Other tests can allow us to monitor diabetic management and base our decisions on tests that quantify and qualify the treatments success.
Fructosamine levels can be tested from a single blood sample. Fructosamine is a protein synthesized after the binding of glucose to proteins. Fructosamine concentrations are a marker of blood glucose levels over the past 2-3 weeks. It will not be influenced by stress induced glucose changes and normal levels have been established for the diabetic dog and cat. If glucose levels have been too high over the past 2-3 weeks, the fructosamine will be elevated.
When an animal has high blood glucose, the glucose will leak through the kidneys and can be found in the urine. Urine glucose monitoring allows us to have an indirect indicator of the pet’s blood glucose. Urine glucose monitoring works best with dogs that urinate regularly under circumstances where we can collect samples. Urine glucose can be influenced by a variety of factors that make it a less accurate technique than blood glucose monitoring.
Blood glucose monitoring can be performed both in the hospital and at home. This is the most accurate technique to monitor the patient’s response to therapies and to gauge the quality of glucose control. Blood glucose monitoring gives us numbers that can be held in comparison from day to day. Certain blood testing machines or home glucometers are more accurate that others and careful attention to maintaining a consistent testing technique is necessary.
Blood and urine monitoring allows your veterinarian to aide you in making better decisions regarding insulin dosing as well as deciding which insulin type should be utilized. Visible signs (symptoms) and long term side effects of diabetes can be more consistently avoided through judicious and accurate monitoring.
Additional benefits of monitoring at home include removing the influence of stress of being at the veterinary hospital for glucose testing, called the white-coat phenomena. Stressed animals can have transient hyperglycemic episodes that may interfere with the accuracy of testing. Home testing also allows the pet owner to communicate accurately and in a timely manner regarding changes in the patient’s condition.
Accomplishing the technique of home monitoring, using properly calibrated equipment, accurate record keeping and prompt and complete communication to your veterinarian are the keys to successful long term management of your diabetic pet.
Abbott Laboratories has developed one of the most user friendly and accurate home glucose monitoring divices for the canine and feline diabetic. AlphaTRAK®Blood Glucose Monitoring System Features; fast results (within 15 seconds), less costly home testing that may help prevent expensive and lengthy hospital stays, small sample amounts and tests that are calibrated and validated for the dog and cat. Read more about the AlphaTRAK system and see examples of techniques in collecting samples for testing at
http://www.abbottanimalhealth.com/ad_ah_com/url/content/en_US/20.30.30:20/general_content/General_Content_0000009.htm
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