Georgia Veterinary Specialists is a multi-specialty referral practice
and 24-hour emergency facility committed to providing the highest quality veterinary
care for your pets.
The GVS team of board-certified specialists works in collaboration with primary
care veterinarians throughout Metro Atlanta and surrounding communities to diagnose
and treat complex, challenging, and often life-threatening pet health problems.
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
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.
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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
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.
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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
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
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
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.
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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
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.
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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.
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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
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.
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
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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
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
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.
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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 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
- 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.
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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
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
- 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.
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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
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
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.
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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
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
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
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
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
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
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.
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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
- 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
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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
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
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
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.