Autoimmune Hemolytic (aiha)

"Autoimmune" literally means the immunity against the self. "Hemolytic" is the destruction of red blood cells. Anemia is defined as a decrease in the number of red blood cells (RBC's) or the amount of hemoglobin, resulting in a decrease in the oxygen- carrying capacity of the blood. When the spleen and the rest of the immune system is working to rid the body of old, diseased or damaged red blood cells, it is doing its job properly.

In AIHA, markers called antibodies, stick to the red blood cells and cause the body to believe the red blood cells are a "foreign invader".This causes the immune system to attack the red blood cells and destroy them. When a large percentage of the cells are affected, and they are removed faster then they are replaced, hemolytic anemia (AIHA) results. The mechanism by which the immune system mistakes the red blood cells for a "foreign invader" varies somewhat according to the cause. It can be due to a drug, toxin, or parasite adhering itself to the surface of red blood cells. The immune system wishes to attack the offending agent, but manages to injure the red blood cells as well. In true AIHA the exact cause for the body to start attacking red blood cells is unknown.

The destruction of red blood cells often leaves recognizable cellular debris in the blood stream. In particular, a form of damaged red blood cell known as a spherocyte occurs. Finding spherocytes on a blood smear almost guarantees that some form of hemolytic anemia is occurring. Since this disorder does not stop the production of red blood cells, there are usually immature red blood cells in the bloodstream which can be detected on the blood smears as well. The symptoms or clinical signs of AIHA can appear suddenly or they may be gradual and progressive.

The signs are usually related to the lack of oxygen and manifest themselves in the form of weakness, lethargy, decreased appetite, and an increase in the heart and respiration rate. Pale mucous membranes (gums, ears, eyelids) may be observed. The dog also may appear to be jaundiced. This is due to a build up of bilirubin, one of the breakdown products of hemoglobin. Vomiting or abdominal pain may be present. Owners may note the presence of blood in the urine or stool. An increase in temperature may also be observed in some dogs.

A diagnosis of AIHA is made on the basis of these clinical signs as well as a complete blood count. A test called a Coomb's test should be performed to confirm the diagnosis. This confirms the presence of antibodies attached to the surface of red blood cells. A small percentage of dogs that have AIHA will test negative on the Coomb's test.

There is strong evidence for a genetic basis in the development of AIHA. Although all breeds can be affected, Cocker Spaniels are diagnosed more commonly with this disease than other breeds. Females are affected with AIHA 3-4 times more frequently then males. Treatment is aimed at slowing the immune process. Corticosteroids such as prednisone or dexamethasone are often used to treat this illness. Other medications such as cyclosporine, danazol, and azathioprin may also be used. Occasionally red blood cell transfusions are needed if the anemia is severe enough. Recently treatments with intravenous immunoglobulins have been shown to be promising in halting the premature destruction of red blood cells.

Overall the prognosis is guarded for dogs diagnosed with this disease. While many dogs will survive the initial illness, they may need to stay on medications for many months or years.

Cancer

As our pets are being cared for better, they are living longer and healthier lives. Because they are living longer we have begun seeing more and more develop heart disease and cancer - just like people. Dogs, cats and exotic animals all get many different types of cancer. Some kinds of cancer are curable, some are treatable, and for some we can only provide supportive care. Whether a treatment or therapy is appropriate for your pet with cancer will depend on:

• The type of cancer (based on biopsy or cytology)
• The grade or stage of the cancer (how aggressive or fast-moving it is)
• The location or locations of the disease.

In order to be able to give you and your pet the best option, a definitive diagnosis and a staging workup must be performed.

These procedures involve obtaining a biopsy or aspirate of the tumor, and examining for spread (metastatic sites) for that particular form of cancer. We can use palpation, ultrasound, radiographic studies, CT or MRI, and needle aspirates to look at the lymph nodes, lungs, spleen, liver and other metastatic sites. We will also need to know how the rest of your pet's body is working - are there problems with the urinary tract or liver, is there diabetes, heart or lung disease? These other diseases may be more serious than the cancer, or may change what forms of therapy are appropriate. Once we have a complete understanding of your pet's health and type of cancer, we can design a treatment plan that fits your pet's needs best. Cancer therapy in pets includes surgery, medications (chemotherapy), radiation therapy and other forms of therapy.

Chemotherapy is used in pets if cancer involves more than one part of the body or if the cancer is one which is likely to metastasize (spread). Some cancers are very responsive to chemotherapy (80-90%), while others may have minimal to no response. Depending on the type of cancer, different drugs or combinations of drugs are used. Pills, injections, intralesional therapy, and IV infusions are some of the many of the types of chemotherapy given to dogs and cats. Most treatments are done on an outpatient basis. In general, most pets receiving chemotherapy experience minimal side effects. Some even seem to have more energy and an improved appetite. Some drugs can cause nausea, vomiting or diarrhea in sensitive pets, but these side effects can typically be prevented or minimized. Low white blood cells counts are a more common problem, so before chemotherapy is given, complete blood counts are monitored. Hair loss is exceptionally uncommon in most pets, although some drugs can cause hair loss in dogs like Poodles or Miniature Schnauzers. Pets receiving chemotherapy should be able to perform and enjoy all of their normal activities.

Canine Cardiomyopathy

Dilated cardiomyopathy (DCM) is a disease of the heart muscle which causes the heart to enlarge and not function properly. The disease usually afflicts larger breeds of dogs such as the Doberman pinscher, Scottish deerhound, boxer, Newfoundland, golden retriever, Labrador retriever, and the Irish wolfhound. However, it can also affect both the English and American cocker spaniel and rarely, other small breeds of dogs. The occurrence of dilated cardiomyopathy increases with age and typically has an age of onset between 4 and 10 years.

The cause of DCM in dogs is still unknown; however, many factors suggest a genetic cause. Dilated cardiomyopathy usually affects both the left and right sides of the heart with either side being more severely affected. Typically, both the ventricle (lower chamber) and the atria (upper chamber) enlarge and the ventricle loses its ability to contract and pump blood out to the body or the lungs. The consequence of the heart failing in its ability to pump blood can be compared to a simple mechanical pump. If the sump pump in your basement fails, water backs up into the basement; if the left heart fails, fluid backs up into the lungs and if the right heart fails, fluid backs up in the abdomen or space surrounding the lungs.

Long term prognosis for dilated cardiomyopathy varies considerably. Unfortunately, most dogs with signs of heart failure at the time of diagnosis die as a result of the disease within 6 months to two years. Unfortunately, some dogs, especially certain breeds with a more severe form of the disease may survive only weeks to a couple of months.

Treatment of dilated cardiomyopathy is aimed at both improving the heart's function and controlling the signs of congestive heart failure. Drugs such as Lanoxin (Digoxin, Digitalis) are used to help the heart contract better and to slow the heart rate down if certain arrhythmias exist. Once your dog is started on Lanoxin, you will be asked to watch for signs digoxin toxicity that, although uncommon, include loss of appetite, vomiting, diarrhea, and lethargy. These adverse signs can hopefully be avoided by having a blood test run by your regular veterinarian 7 to 14 days after the drug is initiated. To check for appropriate levels of Lanoxin in the bloodstream, a blood test must be drawn 6 to 8 hours after your dog’s morning dose of the Lanoxin. However, if any of these signs do occur, please call our office or your regular veterinarian. If these signs are severe, you can stop the Lanoxin and then call us; however, if the signs are mild, the ideal situation would be to go to your regular veterinarian and have a Digoxin level drawn so that we can be sure that the drug is causing the problems and the signs are not related to something else.

Diuretics are also used to help both control and prevent accumulation of fluid in or around the lungs. Lasix (Furosemide) is usually the drug of choice. Potential side effects of diuretic use include increased thirst and potentially increased urination. Another essential drug that is used in the treatment of dilated cardiomyopathy is termed a balanced vasodilator. This helps the heart pump more effectively against the pressures of the arteries and veins. Examples of this drug include Vasotec, Enacard, Zestril, Prinavil, and Lotensin. These drugs are usually started gradually with a low dose and then building up to your dog's required dosage. These drugs can occasionally interact with the kidneys. For this reason, you will be asked to see your regular veterinarian in 7 to 10 days, in 4 weeks, and then every three months to have a chemistry blood panel checked to assure that kidney function is preserved.

Other drugs utilized in the treatment of dilated cardiomyopathy are aimed at controlling cardiac arrhythmias (electrical disturbances in the heart). Arrhythmias can be very problematic in some cases of DCM and can even be life threatening. Certain breeds are more predisposed to this additional problem. If possible, it is a good idea to buy an inexpensive stethoscope to monitor your dog's heart rate and rhythm. Keep a journal of these records and if you are seeing a progressive increase or decrease in your dog's heart rate or hear an irregular heartbeat, please call our office.

It is also important for you to monitor your dog's overall attitude and outward signs. If you notice any heavy/labored breathing, coughing, fainting spells, restlessness, or profound lethargy, please call us or see your regular veterinarian as soon as possible.

Finally, your observations at home and your dedication in administering the prescribed medications in conjunction with our advice is what will help your dog the most. You know your pet the best. If you feel there is something wrong or you have any questions, please don't hesitate to call our offices.

Cushings Disease

Canine Cushing's syndrome or hyperadrenocorticism is caused by the production of too much adrenal hormone, in particular corticosteroids. It can occur naturally or be caused by the administration of corticosteroids such as prednisone (iatrogenic Cushing's). The latter is easy to cure - just stop the administration of corticosteroids slowly to allow the body to return to normal function. Treatment of the former is more difficult.

Hyperadrenocorticism occurs for two reasons --- a tumor of the adrenal gland that produces too much adrenal hormones (cortisol) or stimulation of the normal adrenal glands from the hormones that control it. The primary reason for this to occur is a pituitary gland tumor that produces excessive ACTH, which stimulates the adrenal gland to produce cortisol. Adrenal gland tumors account for 15% of the cases of naturally occurring hyperadrenocorticism. Pituitary tumors account for 85%

Canine Cushing's syndrome can cause increased drinking, increased urination, increased appetite, panting, high blood pressure, hair loss - usually evenly distributed on both sides of the body, a pendulous abdomen, thinning of the skin, calcified lumps in the skin, increased susceptibility to infections, diabetes, weakening of the heart and skeletal muscles, nervous system disease and other symptoms. Most owners reach a point where the water consumption and urination become noticeable and bothersome to them. The diagnosis of Canine Cushing's syndrome is often made with the help of several blood tests. A routine biochemical profile can often give the first hint that Cushing's may be present. Urine tests may be done to determine how concentrated the urine is or to screen for infection. To confirm its presence, either a test known as a low dose dexamethasone suppression test or an ACTH stimulation test may be recommended. These tests can help determine a dog's ability to respond to suppression or stimulation of the adrenal glands.

Once the disease is diagnosed, it is possible to differentiate between adrenal tumors and pituitary gland tumors using a second test, either a high dose dexamethasone suppression test or an endogenous ACTH concentration. Either or both of these tests may be necessary to differentiate between the two problems. X-rays, ultrasonography, and CT scans can help determine if an adrenal gland tumor is present. If it can be determined that there is an adrenal gland tumor, it can be removed surgically.

Many veterinarians prefer to have a specialist attempt this since the surgical risks can be high. Pituitary gland tumors are not usually removed in veterinary medicine. This situation is treated using Lysodren (o'p'-DDD, which is a relative of DDT) or ketaconazole. Lysodren selectively kills the area of the adrenal gland that produces cortisol . By administering it in proper amounts it is possible to kill just enough of the gland off to keep the production of cortisol to normal levels. Obviously, close regulation of the use of Lysodren by monitoring blood tests are necessary since overdoing it can cause severe problems with hypoadrenocorticism (too little cortisol produced by the body) . Adverse reactions to Lysodren do occasionally occur but it is the standard treatment at this time. Over medication with Lysodren can cause inappetence, vomiting, diarrhea, lethargy and weakness. If any of these signs occur then your veterinarian should be immediately notified. Treatment of Canine Cushing's syndrome caused by pituitary tumors is symptomatic therapy -- it does not cure the pituitary tumor.

Diabetes Mellitus

Diabetes mellitus is a common disorder of both dogs and cats. While the exact sequence of events leading to development of diabetes may be somewhat different, the signs of the disease and its treatment remain very similar for both species.

Diabetes mellitus, or sugar diabetes, is a hormonal disorder which causes a persistent elevation of blood and urine sugar called glucose. Persistent glucose elevations induce the signs of the disorder, which are excess thirst and increased urination. Insulin therapy remains the most common and effective treatment for dogs and cats with diabetes mellitus. Insulin is a hormone normally produced in the pancreas and released into the bloodstream to prevent elevations of blood and urine sugar. Insulin therapy involves the pet owner injecting the hormone under the skin with a needle and syringe once or twice daily. There is no form of insulin available that can be given by mouth or added to the pets food.

Important facts regarding diabetes mellitus in pets:

• With few exceptions, diabetes mellitus is a permanent disorder which requires treatment for the rest of your pet's life.
• With proper treatment, diabetes can be effectively controlled over the normal lifespan of your pet. In addition to insulin therapy, effective treatment may include strict diet and exercise regimens, use of high fiber special diets, administration of oral drugs which can help lower blood glucose and frequent follow-ups with your veterinarian.
• Left untreated, diabetes mellitus can be fatal in pets. Additionally, diabetes can cause cataracts, severe metabolic toxicity (ketoacidosis), nerve and muscle weakness, rapid weight loss, increased susceptibility to infection, and damage to the kidneys, eyes, and brain.

A close cooperative effort with your veterinarian is critical to successful regulation of your pet's diabetes. The number of and length of visits to your veterinarian's hospital and the annual costs of your pet's health bills will increase. What your pet gains from this cooperative effort is good health with a minimally restrictive lifestyle and a normal lifespan. Treatment of a pet with diabetes is not easy and certainly not practical for every pet owner. However, the treatment is very rewarding and worthwhile if the time and effort required can be provided.

Gastric Dilatation and Volvulus (GDV)

Bloat, twisted stomach, gastric torsion

Affected AnimalsDogs of any breed. However, large breeds built with deep chests and narrow abdomens, such as the Great Dane, Mastiff, Irish setter, golden and Labrador retriever, and the Irish wolfhound, are more prone to getting bloat. Smaller breeds such as the dachshund, Lhasa Apso, and poodle may also develop the illness.

OverviewAny dog that shows signs of bloat, a serious and potentially fatal illness, should receive emergency veterinary medical care immediately. Clinically known as gastric dilation, bloat occurs when a dog’s stomach becomes so swollen with gas that it is unable to relieve the pressure. As the stomach becomes distended, it often rotates on its axis. This volvulus, or twisting, cuts off blood flow to the stomach and often the spleen as well, and is thus clinically known as gastric dilatation and volvulus, or GDV. A dog with GDV can experience a number of potentially fatal complications, including septic shock, a perforated stomach, massive blood loss, and disruption of the blood clotting mechanisms. The exact cause of bloat is unknown. Large breeds of dogs built with big chests and narrow abdomens are more commonly affected. Excitable dogs, as well, are at risk since the stomach can develop bloat by filling with air during high-energy type activities such as barking, panting, excitement, and swallowing air while exercising.

SurgeryNon-productive retching; vomiting small amounts of foam or saliva; restlessness; pacing; lying down and getting up again; weakness; lethargy; panting; abdominal distention.

SymptomsVomiting; coughing up small amounts of saliva; restlessness; pacing; weakness; lack of energy; panting; an enlarged stomach or abdomen.

Description Gastric dilatation and volvulus, or bloat, occurs when a dog’s stomach becomes so swollen with gas that it is unable to relieve the pressure. As the stomach becomes distended, it often rotates on its axis, cutting off blood flow to the stomach and often the spleen as well.

Bloat can progress into a life-threatening illness requiring immediate emergency medical intervention. If the dog’s stomach is not decompressed before the disease becomes severe, the enlarged abdomen will pose a dangerous threat to the circulatory system by preventing the blood in the stomach and the rear limbs from returning to the heart. This disruption of blood supply will stop the necessary amount of oxygen from being carried to the cells. Shock, a serious and potentially fatal condition, will result. As the dog’s body goes into shock, there is a breakdown of the protective barriers that normally keep the bacteria inside the stomach, small intestines, and colon from releasing toxins into the bloodstream.

Once these toxins are let loose, the dog’s blood pressure will start to plummet and the vital organs will not receive an adequate blood supply. Additionally, the dog’s heart rate is often increased and may begin beating with an abnormal rhythm, a condition known as arrhythmia. If not closely monitored, arrhythmias can lead to additional circulatory disturbances or sudden death. Other serious complications may continue to threaten the dog’s survival. One is called necrosis, which occurs when parts of the stomach wall begin to die because the blood supply to the stomach has been drastically reduced. Necrosis in turn can lead to perforation of the stomach and leakage of its contents into the abdominal cavity. The result is peritonitis, which has a very high mortality rate.

In addition, the spleen may become twisted as a result of its attachment to the stomach, sometimes cutting off its life- supporting blood supply. Yet another potential complication, which may occur any time the body is so severely injured, is the development of disseminated intravascular coagulation (DIC), an often-fatal condition in which the body begins forming many small blood clots within its vessels. These clots can plug up small vessels, preventing the blood from flowing properly and, as a result, damaging tissues in vital organs such as the kidney, liver, lung, and brain.

Because of the large numbers of clots that have formed, the body will have used up the clotting factors and platelets that were available to stop hemorrhaging. Once a dog has begun hemorrhaging from DIC, it is usually fatal. Even if a veterinarian is able to regulate the dog’s arrhythmia during emergency surgery, stomach perforation and DIC can occur independently - sometimes a full 24 hours after the blood pressure problem has been addressed. Often, the cause of death in dogs who die from bloat is a combination of factors.

DiagnosisThe examining veterinarian will base the diagnosis of bloat on an evaluation of the dog’s symptoms and x-rays of its stomach. Because GDV can lead to shock and the release of toxins into the bloodstream, the veterinarian also may conduct tests such as a complete blood count, or CBC, a packed cell volume, or PCV, and an assessment of the total protein present, or TP. A serum chemistry panel and a clotting profile are often needed.

Prognosis The prognosis depends on a number of factors, the most important one being whether the dog receives medical treatment as soon as possible, typically before the condition becomes so debilitating that the animal has collapsed and is unable to walk on its own. Animals that are walking under their own power and are in minimal distress generally do better than animals that are collapsed or in a severe state of shock. If parts of the stomach and the spleen need to be removed, the prognosis is less certain. An arrythmia can also be a dangerous factor. Overall, the survival rate for more stable animals may be 80 to 90 percent. In severely affected animals,it may be 50 percent or less.

Transmission or CauseThe cause of bloat is unknown. Large breeds built with deep chests and small abdomens, such as the Great Dane, Mastiff, Irish setter, golden and Labrador retriever, and the Irish wolfhound are more at risk for getting bloat because of their deep-chested body conformation. Aerophagia, or the swallowing of air, another risk factor for bloat, is often seen in very excitable dogs, or dogs with poor ability to breathe through the nose. Bloat can also be caused by another underlying disease that prevents the stomach from emptying itself at a normal rate, such as a tumor of the stomach.

TreatmentOnce a veterinarian diagnoses the condition, the initial treatment will be directed towards stabilizing the dog and addressing any complications. Intravenous fluids are given very rapidly to increase blood pressure and to treat or prevent shock. Sometimes two intravenous catheters are needed to supply the dog with enough fluids to support it. Dogs with bloat are also given antibiotics to prevent them from developing an infection.

The veterinarian will need to decompress the dog’s stomach to decrease the pressure and improve blood flow. To assess the position of the stomach, he or she may take x-rays. The usual method for decompression is to insert a tube through the mouth into the stomach.The tube allows the passage of air and ingesta out of the stomach. If the stomach has twisted, and the tube cannot be inserted, it may be necessary to pierce the stomach with a hollow needle so that the gas can escape.

If the stomach has twisted because of the bloat, surgery is generally required to reposition it. Surgery may also be needed to assess the health of the stomach wall and the spleen. If they are severely damaged, the spleen and parts of the stomach may need to be removed.

Lastly, a procedure called gastropexy, in which the stomach is securely attached to the body wall, is performed to prevent any future twisting. Without a gastropexy, the recurrence rate may be as high as 50 percent. During recovery from this surgery, the dog is treated aggressively to prevent the development of shock, DIC, and infection.

PreventionUnfortunately, the reason GDV occurs is not fully understood at this time, but there are several recommendations for prevention,including:

• Feeding multiple smaller meals, rather than one large one
• Avoiding heavy exercise after meals
• Avoiding excitement after meals
• Storing food out of reach to prevent a dog from gorging itself

Hemorrhagic gastroenteritis, or HGE

Affected AnimalsDogs of all ages and breeds can be affected by hemorrhagic gastroenteritis. Young adult dogs of toy and miniature breeds, especially schnauzers and poodles, may be affected more frequently.

OverviewThere are many causes for bloody diarrhea and vomiting in dogs. Hemorrhagic gastroenteritis, or HGE, refers to a specific syndrome usually seen in young adult dogs of the toy and miniature breeds. In HGE, fever is usually not present, and the main laboratory abnormality is a marked elevation of the hematocrit (concentration of blood cells) due to fluid shifts and intestinal fluid loss. There is no diagnostic test that confirms the presence of HGE. Its diagnosis is made mainly on clinical grounds.

Just as there is no unique diagnostic test for HGE, there is no established cause for the illness. Treatment is similar as that for other causes of vomiting and bloody diarrhea in dogs. However, relatively large amounts of fluid are usually needed to replace the fluid lost into the intestinal tract, and to reverse shock, if present. Antibiotics are also given because bacteria may play a role in causing HGE. Although the signs are sudden and severe, and some dogs do not survive, most animals with HGE recover fully with prompt treatment. Recurrences are possible in an individual dog, but they are not common. Prompt veterinary attention is vital for any dog with severe gastrointestinal signs and depression, whether due to HGE or other causes.

Clinical SignsThe clinical signs of hemorrhagic gastroenteritis include vomiting, bloody diarrhea, depression, and collapse,or shock.

SymptomsSee Clinical Signs

DescriptionCanine hemorrhagic gastroenteritis, or HGE, is a syndrome characterized by the sudden onset of vomiting, bloody diarrhea, depression, and an elevated hematocrit on bloodwork. The etiology, or cause, of HGE is not known. Changes in the mucosa, or lining tissue, of the intestine result in fluid shifts from the vascular system and changes in fluid secretion into the intestinal tract. These changes appear to cause the symptoms of HGE. Animals can become extremely ill in a very short period of time. Small and toy breed dogs from two to four years of age are affected most commonly. There is no specific diagnostic test for HGE, but the occurrence of severe bloody diarrhea in a dog with an elevated hematocrit, a normal white blood cell count, and no fever, strongly suggests its presence.

Treatment requires prompt and aggressive fluid administration, and shock-level doses are usually needed at first. Food and water are withheld until the vomiting and diarrhea resolve. Steroids are given to animals that are in shock, and dogs with severe blood loss may require blood transfusion. Antibiotics are also given as part of the supportive treatment for HGE. Most dogs recover with appropriate treatment, although some may have additional bouts of the same signs after the initial episode resolves.

DiagnosisThe diagnosis of hemorrhagic gastroenteritis usually rests on the presence of severe diarrhea in a dog with an elevated hematocrit. The elevated hematocrit results from fluid shifts out of the blood vessels, and excessive fluid loss through the intestinal tract. Additional bloodwork and x-rays are helpful for excluding other causes of bloody diarrhea, as is testing of the feces for the presence of parvovirus.

PrognosisWith prompt and aggressive treatment, most dogs with HGE recover completely. Occasionally, some dogs will have recurrent episodes.

Transmission or CauseThe cause of hemorrhagic gastroenteritis is unknown. A bacterium called Clostridium perfringens has been isolated from cultures of intestinal contents in dogs with HGE, but its exact role in the syndrome has not been identified.

TreatmentThe main aspect of treatment for HGE is intravenous fluid replacement. Large doses of fluids are usually required for initial therapy. Fluids are continued for one to two days, as long as the diarrhea persists. Antibiotics are also used because of the potential role of bacteria in the development of HGE. Steroids may be administered if the affected dog is in shock. Blood transfusions may be needed if blood loss is severe. Food and water are withheld until vomiting and diarrhea subside. These treatments are similar to those for almost any cause of acute, severe diarrhea in dogs. HGE symptoms should improve within 24 to 48 hours. If the affected dog fails to improve after 48 hours, other causes of the symptoms should be considered.

PreventionSince the cause of HGE is not completely understood, at present no known preventive measures exist.

Kidney Disease

The main function of the kidney is to filter the body’s blood supply of body poisons and waste products. All of the body’s blood flows through the kidneys to be cleansed of all chemicals not needed by the body. The kidney allows some of the water and other essential substances to pass back into the bloodstream to maintain the normal body composition while excreting waste products into the bladder.

Causes of kidney disease include birth defects, bacterial or viral infectious, injury, poisons, stones, cancer and many others. If the kidneys are damaged severely, they are not able to perform properly, so waste materials accumulate in the blood, poisoning the body.

The more common forms of kidney disease are often progressive and may become more serious, especially without proper care. However, most pets are able to recover from many forms of kidney disease with proper treatment and diet changes.

The body can continue to function fairly normally as long as there remains at least 10% functional kidney tissue.

Initial signs of kidney disease include: loss of appetite, increased water consumption, and increased urination. Later signs include: vomiting, depression, and dehydration resulting from an inadequate amount of water in the body, from the vomiting, inability to drink, or excessive urine output.

Signs of kidney disease are seen when damage reaches the point that the kidneys cannot rid the body of waste products that accumulate continuously or when the delicate fluid/electrolyte balance of the body cannot be maintained.

Excessive urine is allowed pass through the kidneys once severe damage occurs. This results in dehydration causing the pet to drink more and more leading to a continually increasing volume of urine. The cycle gets worse and worse.

Vomiting, diarrhea, and difficult breathing appear as the disease progresses with a buildup of waste products in the blood stream.

Anemia may occur in severe cases because the kidneys are involved in the production of red blood cells.

Mangement of Kidney Disease

• Allow free access to clean, fresh water
• Protect your pet from stress, such as extreme exertion, excitement, and hot or cold temperatures.
• Feed Prescription Diet k/d, g/d or u/d as directed. These diets are specially formulated to reduce the demands on the kidney. The highest quality protein available must be utilized to decrease the continuing damage occurring within the kidneys.
• Give drugs as directed depending on the type of kidney disease present.

Liver Disease

The liver is one of the most important organs in the body. It is impossible to live without a functioning liver. It aids in the digestion of food, production of blood components, detoxification of harmful substances, protein manufacture, and vitamin production.

The liver produces various digestive enzymes including "Bile" that is stored in the gall bladder, attached to the liver. Stones can develop in the gall bladder obstructing the passage of bile into the intestine. Liver damage can result from ingestion of toxic substances, viruses, bacterial infection, abnormalities of the immune system, and tumors. Many causes of liver problems are never known. Other diseases such as Feline Leukemia and Diabetes can also affect the liver. Long-term damage to the liver results in "cirrhosis--a buildup of scar tissue in the liver which replaces the normal healthy tissue. Cirrhosis of the liver can lead to central nervous system damage ("seizures") and/or bleeding disorders.

Signs of liver disease are proportional to the amount of damage present. Signs include loss of appetite, vomiting, diarrhea, abdominal pain and/or distention (enlargement), and "jaundice" (yellow discoloration of the gums and membranes).

Diagnosis of specific liver disease can be complicated. History, physical examination, abdominal radiographs (x-ray), urinalysis, and blood testing may be needed. The liver has a remarkable ability to heal itself. Basic therapy is based on assisting the body as much as possible allowing the liver time to rest and recuperate. Recovery is typically very slow--taking weeks to several months. Repeated later attacks are quite common.

Treatments Include:

• Antibiotics to prevent or eliminate bacterial infection.
• Medications to help prevent a buildup of fatty deposits in the liver.
• Steroids or other anti-inflammatory drugs to counteract the severe inflammation of the liver affecting the metabolism of carbohydrates.
• IV Fluids and Nutritional Supplementation in severe cases.
• Pain Medications.
• Anti-Nausea drugs for vomiting and cramping.
• Drugs to decrease the acid secretion into the stomach causing vomiting.

DIET: (a) Feed Prescription Diet l/d (b) Cottage Cheese & Rice with added corn syrup for energy. (c) Feed SEVERAL SMALL meals daily. (d) NO tablescraps or greasy foods for rest of life! (e) Vitamin supplementation.

Notify GVS if your pet appears to worsen in any way, or if vomiting continues more than 24 hours.

Pancreatitis

Affected Animals Dogs and cats. Middle-aged to older female dogs are more likely to be affected by pancreatitis than other dogs. Dog breeds with a higher incidence of the disease include the miniature poodle, cocker spaniel, and miniature schnauzer. Pancreatitis is more difficult to diagnose in cats than in dogs.

Overview Canine pancreatitis is a potentially life-threatening disease that more commonly affects middle-aged to older female dogs. The pancreas is a gland that functions as part of the digestive process by producing enzymes that help break down food. Unfortunately, if these enzymes become activated within the gland, the pancreas begins digesting its own glandular tissue, creating inflammation, or pancreatitis.

Typical symptoms include vomiting, loss of appetite, and abdominal pain, but sometimes signs can be more mild or vague. The severity of the disease and response to treatment will vary from case to case. Animals with severe disease may die either from complications or lack of response to treatment. Diagnosis and treatment are aimed at identifying and eliminating any underlying causes of pancreatitis. The disease is best prevented by correcting obesity, ensuring that the animal does not eat high-fat foods, and preventing other conditions associated with pancreatitis.

Clinical Signs The clinical signs of pancreatitis in dogs vary, but include vomiting, anorexia, depression, upper abdominal pain, diarrhea, severe weakness or collapse, dehydration, shock, and fever. Dogs may exhibit signs of abdominal pain by acting restless, panting, crying or wincing when picked up, shaking, standing with an arched back, or lying with the front end down and the rear end elevated.

SymptomsSee clinical signs.

Description The pancreas is a V-shaped gland found within the tissue located at the angle formed by the pylorus and the duodenum. Ducts leading from the pancreas deliver the digestive enzymes formed within the gland to the duodenum. The pancreas has a number of functions, including the release of digestive enzymes that aid in the breakdown and absorption of ingested nutrients, and the secretion of protective agents that counteract stomach acid when digesta enter the duodenum. The protection of the gland itself from autodigestion by the enzymes it produces is another important function of the pancreas. Inflammation of the pancreas, or pancreatitis, is caused by the failure of the gland to prohibit activation of the digestive enzymes while they are still within the gland. Pancreatitis may be acute, with no long-term effects, or chronic, involving a permanent abnormality of the gland. Chronic pancreatitis cases usually involve recurrent bouts of acute illness. Some common causes of pancreatitis include obesity, elevated levels of lipids in the blood, ingestion of a very fatty meal, other diseases, and steroids. Numerous cases of pancreatitis are diagnosed following holidays, during which dogs often are given meat or fat scraps. However, in some cases of pancreatitis, no cause can be determined. Symptoms associated with pancreatitis may be obscure and mild or very clear and severe. Some dogs recover completely with appropriate medical therapy and dietary modifications, whereas others die from severe illness and secondary complications. The course of pancreatitis is usually unpredictable, and may be slow. Complications of pancreatitis include shock, inflammation and fluid accumulation within the abdomen, sepsis, respiratory compromise, heart arrhythmias, liver and kidney failure, and abnormal bleeding and clotting. Chronic recurrent pancreatitis, pancreatic abscesses, diabetes mellitus, and insufficiency of pancreatic enzyme secretion also may be caused by chronic pancreatitis. The presence of one or more of these problems worsens the dog’s chance of recovery.

Diagnosis A presumptive diagnosis of pancreatitis can be made based on a history and physical examination. In particular, significant risk factors such as obesity, or the recent ingestion of a high fat meal, may warrant a suspicion of pancreatitis. The examining veterinarian will perform other tests to confirm this diagnosis and to help determine the cause of the illness. Diagnostic procedures commonly include a CBC, or complete blood count, a serum chemistry that evaluates the pancreatic enzymes amylase and lipase, and a urinalysis. Amylase and lipase values typically will be elevated in the early or acute stage of pancreatitis. These values may increase threefold in some dogs, but such an elevation should not be relied upon in interpreting the severity of the disease. Other blood tests the examining veterinarian may perform include a serum trypsin-like immunoreactivity assay, or TLI assay, and an ELISA test for trypsinogen activation peptide, or TAP. Trypsin substances are elevated in cases of pancreatitis, and are more specific to the pancreas than are amylase and lipase. X-rays usually are taken of the abdomen, and may show changes associated with pancreatitis; they may also help rule out other problems that can mimic the symptoms of pancreatitis, such as a gastric foreign body. A typical x-ray finding will show a ground-glass appearance corresponding to the location of the pancreas. Also, expansion of the angle between the duodenum, the section of the small intestine adjacent to the stomach, and the pylorus, or outlet of the stomach, may indicate the presence of the disease. Distention of the stomach and intestines with gas is non-specific, but is commonly seen with pancreatitis. If the dog is having respiratory problems, x-rays will be taken of the chest as well. An abdominal ultrasound may be used to check for the presence of pancreatitis, a pancreatic abscess, a pancreatic tumor, or free fluid within the abdominal cavity. Ultrasound- guided biopsies may be used to confirm a diagnosis. Certain dogs will require a surgical exploration of the abdomen for biopsy samples, or for treatment of abscesses or tumors.

Prognosis Pancreatitis can be a life-threatening condition. Dogs with a mild case of the disease usually have a fair prognosis and recover with appropriate treatment. For those cases involving severe disease, concurrent illness, or secondary complications, the prognosis is poor to guarded.

Transmission or Cause Known causes include obesity or hyperlipidemia, trauma, decreased blood flow to the pancreas, toxins, medications, chronic kidney disease, infectious agents, pancreatic duct obstruction, and neoplasia. Pancreatitis can occur without a known cause, but a veterinarian typically will find and treat inciting factors.

Treatment Most cases of canine pancreatitis require hospitalized treatment for a minimum of three to four days, and sometimes much longer. There are several goals to the treatment of pancreatitis in dogs. First, the overall blood volume and circulation of blood within the pancreatic gland must be maintained. The prevention of stimulation of the pancreas that causes it to secrete enzymes is also essential. Additional goals include the removal of circulating activated enzymes from the blood, the management of abdominal pain, and treatment of acute or chronic complications of the disease. Intravenous fluid administration is used in treatment as needed. The veterinarian may try to allow the pancreas to "rest" by keeping the dog off food, water, or oral medications for three days or more. The use of medications to decrease vomiting and control pain, and occasionally antibiotics, also may be indicated. A veterinarian also will treat diseases caused by the pancreatitis. Dogs that fail to respond to medical therapy may require surgical exploration of the abdomen. Dogs with pancreatitis are considered to be at a higher risk for anesthetic and surgical complications, but they may have little chance of recovery without the operation. Typical conditions that require surgical intervention include pancreatic or bile duct obstruction, severe inflammation of the pancreas and abdominal cavity, and a pancreatic abscess or mass of some other type.

Prevention Obese dogs should be placed on a weight reduction diet that excludes high fat foods and treats. Regular veterinary examinations are useful for the early detection and treatment of other predisposing illnesses and could help prevent secondary pancreatitis.

Pyometra, cystic endometrial hyperplasia-pyometra complex

Uterine infection, pus-filled uterus

AffectedAnimalsPyometra is a common disease in female dogs. Older, intact female dogs that are one to two months beyond estrus are at high risk for pyometra. Intact females of all ages that receive progesterone or estrogen hormones for estrus synchronization or mismating are also at risk. Spayed animals are rarely affected

OverviewPyometra, a serious infection of the uterus, is a well-recognized disease of female dogs. Pyometra often results from the animal’s own bacteria within the genital tract. Escherichia coli is the most common bacteria identified in pyometra. Whenever levels of the reproductive hormone progesterone rise, the uterine lining becomes susceptible to bacterial infection.

Dogs with pyometra commonly have a vaginal discharge, fever, lethargy, and a loss of appetite. Affected dogs are often dehydrated; some may drink and urinate excessively. Some dogs will appear asymptomatic until after vaginal discharge begins. Others will go into shock. Laboratory tests often show dehydration-related abnormalities of electrolyte balance and kidney function. Changes in the white blood cell count are common. Most patients are diagnosed using history, clinical signs, physical examination, and abdominal x-rays.

Pyometra requires prompt treatment. Antibiotics to fight the infection, and intravenous fluids to correct dehydration-related abnormalities, are routinely administered. Supportive therapy is given to correct other organ system dysfunction and to stabilize the patient. Generally, surgical removal of the uterus and ovaries is the preferred treatment. However, owners of valuable breeding animals may elect an intensive medical approach instead of surgery.

Clinical SignsSigns of pyometra usually appear between one to two months after the female is in heat, or after the hormone progesterone has been administered. Common symptoms include vaginal discharge, anorexia, lethargy, pyrexia, depression, polyuria, and polydipsia. Some dogs remain asymptomatic except for a thick, vaginal discharge. This discharge is usually purulent, or pus containing, but may occasionally be mixed with blood.

Physical examination reveals abdominal distention, an enlarged, palpable uterus, vaginal discharge if the cervix is open, and lethargy. A closed-cervix pyometra more likely will result in the animal showing signs of septicemia, including shock, hypothermia, dehydration, vomiting, and collapse.

SymptomsCommon symptoms include foul or bloody discharge from the vulva, loss of appetite, inactivity, fever, depression, and increased water consumption and urination. The abdomen frequently enlarges. Severely affected animals may show signs of blood poisoning, with pale mucous membranes, cold extremities, reduced body temperature, vomiting or collapse. The presence of vaginal discharge is variable.

DescriptionPyometra refers to uterine infection that occurs when contaminating bacteria overcome the normal uterine protective mechanisms. This usually occurs when blood levels of progesterone are elevated. Progesterone increases may occur naturally, as part of diestrus or ovarian phase of reproduction, or iatrogenically, secondary to the administration of reproductive hormones.

As intact female dogs age the uterus may become progressively thickened and cystic from repeated hormonal stimulation. This condition called cystic endometrial hyperplasia. Uterine secretions are greatest during diestrus, the period following estrus, when blood levels of progesterone hormone are maximal. Some inflammatory cells are always present in the secretions. Despite frequent opportunities for bacterial contamination from the lower reproductive tract, the fluid accumulation in the thickening uterus remains free of bacterial infection in most dogs. Pyometra occurs when the excessive uterine secretions become infected with bacteria.

Escherichia coli is the most common bacteria isolated from the uterus of patients with pyometra. This bacterium has the ability to bind specifically to uterine lining cells changed by progesterone. External sources of estrogen hormone potentiate the effects of progesterone, increasing the risk for pyometra. Young dogs that are unlikely to have significant cystic endometrial hyperplasia may develop uterine infections if hormones are administered. Pyometra may occur one to eight weeks after an injection of estrogen. Bacterial infection of the uterus causes increasing inflammation within the organ and leads to systemic effects. Bacteria or bacterial toxins may enter the blood stream from the diseased uterus, leading to the clinical signs described previously.

The severity of the resulting illness is greatly influenced by the degree of drainage from the uterus. If the cervix is closed, then fluids and toxins accumulate, like an abscess, with potential for toxic effects. Rupture or slow leakage from one of the uterine horns can release inflammatory products into the abdominal cavity, causing peritonitis. If the cervix is patent, or open, then drainage limits the accumulation of inflammatory products and bacterial toxins, and increases the likelihood of early recognition of the problem. Signs of increased thirst and urination have been linked to the direct influence of bacterial toxins on the kidneys’ urine concentrating mechanisms.

Bacterial infection and toxins may cause secondary damage to the liver as well. Endotoxic shock alters blood supply to all tissues and can disrupt normal blood clotting mechanisms. Microscopic blood clots or clumps of circulating bacteria can further impact upon the blood supply to vital organs such as the heart and brain, permitting seizures, cardiac rhythm disturbances and other grave consequences.

Diagnosis Diagnosis is based in part on the history, reproductive status, and clinical signs. Pyometra usually occurs one to two months after the heat cycle, or estrus. The clinical signs of vaginal discharge and a palpably enlarged, doughy-feeling uterus are helpful in establishing the diagnosis, especially if there are attendant signs of septicemia as well. Laboratory testing and imaging are frequently used to aid in the diagnosis. The dog’s complete blood count, or CBC, is influenced by the degree of drainage from the uterus.

Patients with a closed cervix and limited uterine drainage are more likely to show significant elevations of, or reductions in, the white blood cell count. The white blood cells are also more likely to appear immature or unhealthy in those patients. Red blood cell counts are often reduced; patients with chronic disease frequently have low-grade anemia. Dehydration can mask this feature by reducing the amount of water in the bloodstream; consequently, the red blood count appears higher than it really is. Blood urea nitrogen, or BUN, and creatinine reflect blood flow to the kidneys. The level of these nitrogenous waste products in the blood will frequently rise with dehydration and kidney dysfunction, which are common in patients with pyometra.

Elevated blood protein levels and disturbed electrolytes will often reflect the state of dehydration. The urine may be very dilute, reflecting toxic influences on the kidneys, or well concentrated as an appropriate response to dehydration. The urine may contain bacteria or inflammatory cells, if collected after voiding, due to contamination by the vaginal discharge. If pyometra is suspected, urine samples are rarely collected directly from the urinary bladder, via needle aspiration, because of worries about perforation of the distended, fluid-filled uterus. Urinary protein levels may be elevated if the kidneys have been damaged by the presence of chronic infection The vaginal discharge can be examined microscopically for the presence of white blood cells and bacteria.

Diagnostic x-rays of the abdominal cavity may demonstrate a fluid-dense tubular structure. A ground-glass appearance on the x-ray may suggest fluid accumulation around the diseased uterus if leakage has contributed to peritonitis. Ultrasound imaging will help to detect or verify the uterine enlargement, to define uterine size and wall thickness, and to differentiate between pyometra-related uterine enlargement and that of pregnancy. Ultrasound imaging is especially helpful in detecting stump pyometra, which occurs in spayed females; this condition consists of infected uterine remnants. Rarely, surgery is required for definitive diagnosis of a focal or stump pyometra.

PrognosisPrognosis following ovariohysterectomy, or spay, is good if there is no uterine rupture or other source of contamination. Mortality is less than 10 percent. If there is gross contamination of the abdomen, then open peritoneal drainage is indicated. These patients will certainly be hospitalized for longer periods of time, with a need for intensive care. The prognosis for such patients is guarded.

Dogs with an open cervix that are treated medically with prostaglandin generally have a good response to treatment, with complete resolution of infection in 75 to 90 percent of cases. In contrast, only 25 to 30 percent of dogs with closed cervix pyometra demonstrate complete resolution of signs. The majority of patients will require a second series of injections. Unfortunately, recurrence is common. Perhaps 80 percent of dogs treated medically will have a recurrence of pyometra. Ovariohysterectomy is then advised.

Following medical treatment of pyometra, to increase the chances of conception, the patient should be bred during the next estrus or heat. Pregnancy may also protect against recurrence of pyometra.

Transmission or CauseE. coli and other bacteria tend to overgrow in a hormone-sensitized uterus. Pyometra may be a natural complication of degenerative and inflammatory changes that attend cystic endometrial hyperplasia in the aging intact female. In younger dogs, the problem is most often linked to progesterone administration for estrus synchronization or to estrogen given to aid in pregnancy prevention after inadvertent mating.

TreatmentPyometra usually necessitates immediate therapy. Those patients with a closed cervix may be more ill at the time of diagnosis. Intravenous fluids and antibiotics are routinely administered to patients that are severely ill, irrespective of the patency of the cervix. Potent antibiotics are given by injection, in combinations to target the most common bacterial pathogens. Supportive measures are customized for individual patient needs, according to the levels of shock, dehydration, electrolyte imbalance, organ dysfunction or cardiac arrhythmia. The patient is stabilized medically, if possible, to prepare for emergency ovariohysterectomy, or spay, to remove the infected uterus and the ovaries from the abdominal cavity. Most patients are released two to three days after uncomplicated surgery. Antibiotics are continued for seven to 10 days after most procedures.

While surgery is considered the treatment of choice for companion animals with pyometra, owners of valuable breeding animals may elect to treat pyometra medically. Stable patients may be given prostaglandin f2-alpha by injection for several consecutive days to dilate the cervix, stimulate uterine contractions and to decrease the blood progesterone level. The dog remains hospitalized for observation, monitoring for side effects of the prostaglandin or for worsening condition, and for continued antibiotic administration. Clinical improvement is expected within the first 48 hours of medical treatment. Surgery should be considered for patients that deteriorate. If purulent vaginal discharge persists seven days after conclusion of treatment, or if other parameters indicate ongoing infection or uterine enlargement, then repeating the treatment may be advised, provided that the patient remains physiologically stable. Some veterinarians reserve attempted medical evacuation of the uterus for those patients with an open cervix. Cervical dilation is inconsistent with prostaglandin f2alpha, thus the drug may cause expulsion of infected materials into the abdominal cavity through the fallopian tubes, or direct uterine rupture if administered to patients with a closed cervix.

Prevention An elective ovariohysterectomy of the young dog will virtually eliminate the possibility of pyometra. Avoidance of estrogen or progesterone administration will decrease the risk of pyometra in both young and mature pets.

Feline Thromboembolic Disease

One of the most difficult and frustrating diseases for veterinarians is feline thromboembolic disease. The presentation of a caudal aortic thrombus (saddle thrombus) is familiar to many of us. These cats present with an acute onset of rear limb dysfunction. The foot pads and nail beds are blue. There is no palpable femoral pulse. While recognition of this condition is straightforward, management can be difficult.

Ninety-nine percent of the time, a feline saddle thrombus occurs secondary to severe heart disease. If the cat survives the first episode, there is great risk of future clot formation. The cat may have any form of cardiomyopathy (restrictive, hypertrophic, dilated, hyperthyroid). Feline cardiomyopathies typically cause diastolic dysfunction due to development of a stiff left ventricle. Cats develop left atrial enlargement secondary to restricted ventricular filling. When this occurs, stagnant blood flow and endothelial damage within the left atrium can activate the clotting system. Most frequently, the clot forms within the atrium. A piece of this clot can break off and float out the aorta to lodge in any artery. The most common site for embolization is the caudal aorta. Other locations include the renal arteries, the cerebral artery, the brachial artery, the thoracic aorta, the cranial abdominal aorta, the mesenteric artery, and the coronary arteries. When a clot lodges in a cerebral artery, seizures may occur. Renal infarction causes acute renal failure.

Surgical and medical therapies have been attempted to manage saddle thrombi. Cats usually do not live through surgery because of their underlying heart disease and reperfusion injury. Prior to surgery, nuclear imaging or angiography is required to locate the clot. To the author's knowledge, there is not an institution currently performing surgery on these patients. Aggressive thrombolytic agents have been utilized. Streptokinase appears to be toxic to cats. Tissue plasminogen activator (TPA) will dissolve the clots, but the cats often die from hyperkalemia and reperfusion toxicity One cardiologist claims that with conservative therapy (heparin), 50% of his patients regain use of their limbs.

The following list contains helpful hints for veterinarians using conservative medical therapy (heparin, acepromazine, etc.) when managing a cat with a saddle thrombus:

• Upon initial presentation, it is very important to obtain blood samples for BUN, creatinine and potassium. Obtaining a coagulation panel is also helpful. During my residency we performed nuclear scans on these cats. Based on the nuclear scans, it was evident that sometimes the clot lodges in die aorta near the renal arteries. When this occurs a renal artery may also be obstructed. If severely azotemic on initial laboratory work-up,there is a good chance that the cat has renal artery obstruction and should be euthanized
• It is important to remember that tachypnea is not always just due to pain. These cats are often in congestive heart failure when they present with a saddle thrombus. Therefore, chest radiographs and lasix may be included in your treatment plan. Giving lasix to these patients can be a delicate matter, however, because these cats are usually not eating or drinking very well.
• While instinct tells us to put a dehydrated patient on IV fluids, this practice can be very dangerous for cats with saddle thrombi due to their underlying heart disease. If fluids are needed, you can try to administer a maintenance volume of subcutaneous fluids (divided into 34 doses/24 hours). If you believe IV fluids are necessary, use half strength saline at a very low rate (consult with a cardiologist for specific recommendations regarding individual cases).
• Monitor the potassium daily (twice daily is optimal) for at least the first three to five days. When muscle is not perfused, the muscle membranes become fragile and potassium is released, producing hyperkalemia. If the cat does become hyperkalemic, remember that saline diuresis is not the best treatment option due to the cat's underlying heart disease and inability to handle a high fluid load.
• Monitor the BUN and creatinine daily for at least the first week. Dehydration is one concern. The other reason for monitoring renal function is the potential development of renal artery occlusion. I've treated some cats who had aortic clots lodged near the renal arteries (determined by nuclear scans). The renal arteries, however, were not obstructed on initial nuclear scans. For the first three to five days these cats were stable, then suddenly became very ill. In these cases, the creatinine increased rapidly to >6.0 mg/dl. A repeat nuclear scan in two cats demonstrated renal artery obstruction. We suspected that deposition of clot material around the original embolus had allowed the clot to grow enough to obstruct a nearby renal artery. I also examined one cat who had a saddle thrombus for one week. On physical examination, he was fairly alert and reportedly was eating small amounts of food. His renal panel, however, revealed a BUN > 400 mg/dl and a creatinine of 12.6 mg/dI. Therefore, if an owner wants to give his/her cat a chance with medical therapy, it is important for the owner to understand the importance of recheck examinations and laboratory monitoring.
• Pain medication such as butorphanol can be given to these cats to help provide analgesia.
• It can take months for these patients to regain use of their limbs. Some cats may regain use of their limbs and not have a palpable femoral pulse. In these instances, nuclear medicine has determined that collateral circulation maintained perfusion of the limbs.
• Some cats seem comfortable and will eat well despite their disease. Other cats however, remain painful and ill. You and the owner need to discuss euthanasia for the cat who remains uncomfortable and anorexic despite your best effort to stabilize the patient.
• Consider physical therapy of the limbs 3-4 times/day if the cat is not too painful.
• Cats with saddle thrombi should have an echo to determine the underlying cause for the embolic event. Recently, I evaluated one cat who had a saddle thrombus secondary to bacterial endocarditis. A piece of a valvular vegetation had broken off the valve and embolized the caudal aorta. The heart muscle was normal. In this instance, without the echo, it would have been a big mistake to assume that the cat had cardiomyopathy. As a result of the echo, we were able to plan an appropriate work-up and treatment plan for the cat.
• If the cat survives the embolic event, the owner should be informed about the great risk for future clots. Anticoagulant therapy includes baby aspirin and warfarin. Baby aspirin is not very effective. Warfarin is not 100% guaranteed to prevent clot formation. Institution of warfarin therapy requires a lot of monitoring (coagulation profiles) and trips to the veterinarian. The owner should be allowed to make an informed decision regarding anticoagulation. Warfarin is not ideal for everyone

Feline Cardiomyopathy

Hypertrophic cardiomyopathy is the most common disease of the heart muscle seen today in cats. This form has many variations and is defined by thickening of the primary pump to the body, the left ventricle. Depending on the specific variation, the problem can be primarily in the blood flowing out of or into the cat's heart. This differentiation using echocardiography and other examination findings helps determine which medications your cat requires.

With appropriate medication and early intervention, we can frequently achieve stabilization of the disease and sometimes reversal of the problems. A genetic predisposition to develop hypertrophic cardiomyopathy has been found in Maine Coon and American shorthair cats. We suspect there is a genetic predisposition in ragdolls and Persians as well.

Cats who are afflicted with this illness at a younger age (1-4 years) have a tendency towards a more aggressive form of the disease. Male cats are also over represented. A common secondary change in cats with cardiomyopathy is enlargement of the left atrium. This finding is particularly worrisome in cats because they are susceptible to blood clot formation. If your cat has an enlarged left atrium, we may prescribe aspirin therapy (children's aspirin twice weekly is safe in cats) or other medication to attempt to delay or prevent blood clot formation.

Unfortunately, the development of a blood clot is unpredictable and can occur on any medication. Blood clot formation can result in a cat being paralyzed in the rear legs, limping on a front leg, exhibiting episodes of abnormal behavior, or even sudden death. Older cats may have a thickened heart muscle due to other underlying generalized illnesses.

In middle aged and older cats high blood pressure, kidney disease, and hyperthyroidism are common problems that increase the workload of the heart muscle and cause secondary thickening. We always try to rule out a potential underlying cause before we make the diagnosis of hypertrophic cardiomyopathy. If your cat has another problem, the response to therapy for that primary problem usually improves and may resolve the secondary heart changes.

The response to any therapy depends on the stage of disease (how severe the problem) in your cat. The best responses are seen when therapy is started early in the course of the problem. Restrictive cardiomyopathy is another type of heart muscle disease. This form can be a late stage of hypertrophic disease or may be a totally separate condition.

Unfortunately, restrictive cardiomyopathy presents a much greater challenge in its treatment. These cats tend to have very large left atria and are usually at high risk for the development of a blood clot and heart failure.

Both types of cardiomyopathy can cause congestive heart failure (fluid in or around the lungs). If your cat has experienced an increased effort or rate of respiration, he or she may have experienced an episode of heart failure. Multiple medications are typically recommended to improve this situation and try to maintain your cat's normal lifestyle and appetite. If fluid is found within the lungs it is best treated with oxygen and diuretics (lasix). If fluid is found around the lungs it is best treated by removal of the fluid. If your cat has not been eating for several days, we may also recommend placement of a feeding tube to provide the calories and fluid your cat needs to recover. Unfortunately, feline patients hide signs of disease instinctively and many times present with advanced forms of cardiomyopathy because they have hidden their problems so well. As with all heart disease, early diagnosis is the key to achieving the best possible clinical response.