Dr. Ron Carsten,
DVM, PhD, CVA, CCRT was one of the first veterinarians in Colorado to use the integrative approach, has lectured widely to veterinarians, and has been a pioneer in the therapeutic use of food concentrates to manage clinical problems. In addition to his Doctor of Veterinary Medicine, he holds a PhD in cell and molecular biology and is a certified veterinary acupuncturist and certified canine rehabilitation therapist. He practices integrative veterinary medicine in Glenwood Springs.
Dr. Carsten writes a monthly column for the Glenwood Post Independent. Links for the articles by topic are listed below. The articles can also be found below the links in chronological order.
DVM, PhD, CVA, CCRT was one of the first veterinarians in Colorado to use the integrative approach, has lectured widely to veterinarians, and has been a pioneer in the therapeutic use of food concentrates to manage clinical problems. In addition to his Doctor of Veterinary Medicine, he holds a PhD in cell and molecular biology and is a certified veterinary acupuncturist and certified canine rehabilitation therapist. He practices integrative veterinary medicine in Glenwood Springs.
Dr. Carsten writes a monthly column for the Glenwood Post Independent. Links for the articles by topic are listed below. The articles can also be found below the links in chronological order.
Dogs and Cats
How to help pets cope with tick season
(Dr. Ron Carsten - Glenwood Post 5-28-17)
Tick season in Colorado is early spring to early summer. These unsettling little creatures are often found in the woods, in grassy, brushy areas on the edge of fields and along commonly used trails.
According to Colorado State University Extension, more than 30 tick species live in Colorado. The Rocky Mountain wood tick (Dermacentor andersoni) is most common in our area. These ticks have four stages in their life cycle – egg, larva, nymph and adult. Completion of the life cycle requires that ticks feed on a mammal host at each of the three mobile stages.
The ticks drop off following a blood meal and mature to the next stage. In the early stages, they generally feed on small mammals like rodents. As they mature, they feed on larger mammals, and eventually as adults, encounter humans and their pets. It is during these feeding periods when the ticks can become infected with diseases like Colorado Tick Fever or ehrlichiosis.
In addition to the unpleasant prospects of finding ticks crawling on your pet or yourself, there is concern for transmission of certain diseases if the tick has been able to burrow into the skin and start feeding. Risk of disease is unclear because of difficulty in diagnosis and vague symptoms, but it appears that the risk is generally low in this region based on current data.
The Companion Animal Parasite Council (CAPC) provides forecast information by region based on ongoing studies of prevalence. However, it is important to note that the incidence is likely to increase as awareness and reporting improve. Toward this goal, Gov. John Hickenlooper recently proclaimed May 2017 to be Lyme and Tick-Borne Disease Awareness month in Colorado.
During tick season, exposure to ticks can be minimized by avoiding areas that are likely to contain ticks, checking your pets for ticks after each outing and, in high-risk settings, using tick repellent products. When using tick repellents, make sure they are safe for your pet.
It takes approximately 12-24 hours after the tick is on your pet before feeding begins. This should give adequate time to look for ticks and remove them
from your pet before they begin feeding. If the tick becomes attached, the best way to remove them is to grasp the tick firmly with blunt tweezers as close to the skin as possible and pull slowly. Once the tick has been removed, wash and disinfect the area as you would any wound. Wash your own hands thoroughly. Note that covering ticks with petroleum jelly or touching them with a match are not considered effective removal methods.
Diseases of concern for your pet according to CAPC include Lyme (Borrelia burgdorferi), ehrlichiosis and anaplasmosis. Some controversy exists regarding diseases like Lyme in Colorado because of the tick species implicated in its transmission. However, it is still valuable to minimize tick exposure and increase knowledge of these diseases.
The good news is that more than 90 percent of dogs exposed to Lyme do not become ill. Their immune systems appear to be able to successfully clear the infection. For those dogs that become ill, signs of illness may not develop until months after the tick bite. Signs of illness include fever, lameness that shifts between legs, swollen lymph nodes and joints, lethargy and loss of appetite. Signs of ehrlichiosis are also vague, and include fever, swollen lymph nodes, weight loss and bleeding disorders that can last two-four weeks.
It is important to keep in mind that information about the incidence of these diseases in Colorado continues to evolve and the true risk of infection is unknown. Therefore the best approach is to avoid areas that are common habitat for ticks, check your pet regularly for ticks during tick season and remove the ticks as soon as they are found.
Keep your pet's immune system in optimal health by maintaining overall health especially with the digestive system. For example, a balanced intestinal microbiome has beneficial impact on the immune system (see previous article, Probiotics provide important benefits, Glenwood Post Independent 8-27-16).
If you have questions about ticks and tick-borne diseases in your pets, contact your veterinarian.
Properly selected herbs provide effective therapies
(Dr. Ron Carsten – Glenwood Post 4-28-17)
Herbs have been used for their health benefits in humans and animals for thousands of years. In the past, eclectic physicians and veterinarians in the U.S. made extensive use of herbs. However, with the increased availability of effective drugs, the use of herbs significantly declined.
Now, there is a resurgence of interest in the use of herbs for therapy. In a 2016 report from the American Botanical Council, U.S. consumer spending for herbs was estimated to be $6.92 billion in 2015. This represents a 7.5 percent increase over the previous year. Importantly, this is part of a continuous trend of increased sales over the last 12 years.
With the millennia of use, extensive folklore surrounds the therapeutic use of herbs. While this folklore use has provided guidance for herb selection, current clinical application relies on a growing body of scientific research. For an herb to be beneficial, it must be safe for use, the active compounds must be effective for the intended purpose, be sufficiently absorbed after ingestion, be distributed to the target tissue, reach therapeutic levels in that tissue and remain in that tissue for an appropriate amount of time.
An additional layer of complexity involves the fact that plants contain a wide variety of compounds. For example, Boswellia, popular for its anti-inflammatory effects, contains more than 340 different compounds. Defining the therapeutically active compound(s) in plants can be challenging. Further, it is becoming increasingly clear that combinations of plant compounds work in a synergistic way which makes them more effective therapeutically at lower doses.
Many plant compounds are formed as part of the normal processes of life for the plant. Other compounds are formed by the plant for protection. For example, grapes produce resveratrol to protect the grape from fungal infections. This means that some plants will have higher concentrations of these active compounds depending on the level of need for protection.
Certain growing conditions can create stresses for plants resulting in higher or lower levels of key compounds.
Therefore, it is important to recognize that there are variations in amounts of plant compounds based on the plant strain, part of the plant (i.e. leaf, flower, or root), seasonal growing conditions and storage after harvest. For example, a study on turmeric (Curcuma longa) showed a 10-fold difference in curcumin content between turmeric strains and variation in the same strain by year of production.
Hawthorn (Crataegus laevigata) is an example of an herb that has clinical effects documented with current research that is consistent with traditional use. Hawthorn leaves and flowers have long been used for heart problems. It is now known that the active compounds in hawthorn increase the force of the heart contraction, improves blood flow to the heart muscle and reduces the heart muscle oxygen demand. Clearly, for these effects to be documented in human and animal studies the active compounds must reach the heart after ingestion, and elimination must be slow enough to maintain therapeutic levels between doses.
Not all herbs are effectively absorbed. Herbs such as turmeric are felt to be poorly absorbed and do not maintain significant levels in the body for long periods of time. These factors have a direct effect on the dose of the herb, how frequently the herb is ingested, and even the combination or form used. For other herbs the method of elimination is important. For example, cranberry (Vaccinium macrocarpon) has been shown to be beneficial in certain urinary conditions. Efficacy of these compounds relies on their presence in urine. More than 40 different cranberry related compounds have been found in urine following ingestion and metabolism.
A wide variety of herbs are available with varying amounts of supportive research documenting their efficacy in patients. Properly selected herbal therapies can be effective alone or when integrated with other supportive methods. While successful use of herbs depends on appropriate selection, it also involves the use of high quality herbs and herb products that are true to label claims.
If you have questions about the use of herbs for your pet companions, contact a knowledgeable veterinary herbalist.
Understanding the importance of vitamin D for pets
(Dr. Ron Carsten – Glenwood Post 3-25-17)
Vitamin D has been emerging as a very interesting substance. In some respects it acts as a hormone, while in other aspects as a vitamin. Its wide range of actions in the body underscore both the importance of vitamin D for health and the complexity of its role in the body. Vitamin D in this article refers generically to vitamin D and its metabolites in the body.
Vitamin D from cod liver oil was first shown to prevent rickets in dogs in 1914. Rickets is a disease of the growing bone in young animals. Following this discovery, the role of vitamin D in absorption of calcium and phosphorous from the small intestine was determined. Additional work showed that vitamin D also played an important role in maintaining blood calcium levels by regulating mobilization of calcium from bone.
Over time it has become increasingly clear that vitamin D has an essential role in maintaining health beyond its function for healthy bones and calcium metabolism. It is estimated that vitamin D controls up to 5 percent of the human genome. One study of white blood cells showed that nearly 300 genes were influenced by vitamin D. This effect on the genes results in a wide-ranging impact on cell and organ function. For example, vitamin D has an effect on insulin production, inflammation reduction, and heart and immune function.
In humans, sunlight exposure is a primary source of vitamin D. This is not the case for dogs and cats. They are not able to produce significant vitamin D through exposure to sunlight. Vitamin D must be included in their diet. Since vitamin D is a fat-soluble (dissolves in fat instead of water) vitamin, it is stored in the fat tissue of the body.
Before commercial dog foods, dogs obtained their vitamin D from eating the fat of their prey. Commercial pet foods have added vitamin D in amounts that are sufficient to prevent rickets. However, these amounts do not appear to be sufficient to meet all the vitamin D needs. This is complicated by variation in the ability to absorb vitamin D from the diet. Once in the body, vitamin D must undergo processing in the liver and then the kidney to become the active form.
A study published in 2015 found a wide variation in the
vitamin D levels in the blood of dogs. Interestingly, although the study groups were small, there was a significant difference in vitamin D levels between breeds. For example, the German Shepherds had significantly higher levels than Golden Retrievers. The authors note implies breed differences in ability to absorb vitamin D from the intestines. Another interesting observation was a difference in vitamin D levels between male and female dogs and if they were spayed or neutered, implying some sex hormone influence on vitamin D absorption.
These findings are important because there has been an association between low vitamin D levels and cancers including lymphoma and hemangiosarcoma, and health problems including infections, inflammatory bowel disease, and heart and kidney disease in dogs. Another study from 2014 determined that the vitamin D blood level needed to prevent abnormal bone development (20-25 ng/ml) was not sufficient to prevent or reduce risk of other diseases. As a result, experts now recommend levels of 100-120 ng/ml. Based on this new recommended value, 85 percent of dogs in the 2015 study were in the insufficient range.
Our own observations are consistent with these studies. The majority (more than 95 percent) of our tested patients fall into the insufficient range. These are patients with a variety of problems ranging from osteoarthritis to cancer. One observation has been the overall improvement in joint comfort once the vitamin D blood levels reach the sufficient range. Many of these patients become more active and initiate more play behaviors.
Since vitamin D is fat soluble and stored in the body, there is concern for toxicity when over-supplemented. Therefore, it is always best to test blood levels before starting vitamin D supplements and to periodically retest because of the variability of absorption.
Contact your veterinarian if you have questions about vitamin D or would like to have vitamin D testing performed.
A common cause of lameness in dogs
(Dr. Ron Carsten – Glenwood Post 3-4-17)
The most common hind leg injuries in the dog are cranial cruciate ligament (CCL) insufficiency and iliopsoas muscle strain. CCL disease was previously discussed in this column; therefore, the focus here will be on the iliopsoas.
Interestingly, iliopsoas injuries are common in humans. While the spelling of iliopsoas looks intimidating, just ignore the “p” when pronouncing (il-e-o-so-as). The name is based on the fact that two muscles (the psoas major and iliacus) join to form the iliopsoas. These two muscles together move the leg forward at the hip and when standing, aid bending the lower back to the side.
Injuries to the iliopsoas result from excessive force on the muscle. This can occur in dogs competing in athletic activities where the muscle is contracting while it is stretched. However, iliopsoas injury can also occur when a dog slips into a splay-legged position, during rough play with other dogs, or when jumping out of a vehicle.
Dogs with iliopsoas strains can have variable amounts of lameness ranging from subtle, intermittent reduced weight bearing on the affected side to a significant lameness that worsens with activity. Affected dogs will have discomfort and spasms when the muscle is touched during examination. Pain may be accentuated by stretching the muscle while examining.
X-rays are generally not useful in the early phases but may reveal mineralization where the muscle attaches to the femur in longstanding cases. The use of CT scans, MRI, and ultrasound may be used to identify iliopsoas injury. However, the history, physical exam, and response to treatment can provide evidence to support the presumptive diagnosis of iliopsoas injury.
Treatment depends on severity and how longstanding the problem is. For acute (recently started) injuries, treatment generally includes controlled activity, cryotherapy (ice packs), and non-steroidal anti-inflammatory drugs (NSAID) such as carprofen. Herbs like boswellia, turmeric, and ginger have anti-inflammatory effects that can be helpful. In severe cases, muscle relaxants may be used to reduce pain and muscle spasms.
Rehabilitation techniques including laser therapy can be beneficial for reducing pain and improving healing. Acupuncture can also be valuable for promoting healing and pain management. Additionally, proper alignment of the sacroiliac joints, lumbar spine, and front part of the pelvis are critical. It is important to note that it can take 4-6 weeks or longer to recover from an iliopsoas injury.
For chronic (longstanding) injuries, supportive care and management are similar to the acute injuries except there is a need to reinitiate the inflammatory process to assist in remodeling and healing of the tendon fibers. Maintaining proper alignment and mechanics of movement are essential to avoid ongoing strain to the muscle. Laser therapy, acupuncture, massage, stretching and heat can benefit healing a chronic iliopsoas injury.
Iliopsoas injuries can be slow to heal and are prone to reinjury. Some performance dogs can never return to competition. Household companions may also be limited in their ability to hike as much as they did prior to the injury.
Ongoing osteopathic or chiropractic care is valuable along with regular laser therapy sessions, massage, and core strengthening programs. Core strengthening activities focused on the gluteal, hamstring and iliopsoas muscles include controlled, slow walking up and down gradual hills, use of cavaletti poles, and standing with the front paws on an elevated surface. Keep in mind that it is important to gradually increase the activity to avoid reinjury. Chronic iliopsoas problems can take longer to heal than the acute injury.
Regenerative medicine treatments with stem cell injections can be used for patients that do not response to conservative therapy and rehabilitation management. Surgery may be an option when the iliopsoas strain occurs at regular intervals.
Nutritional supplements and other products that may be of benefit during the recovery process include glucosamine, vitamins C, D, and B complex, and manganese. Each of these has some value in supporting the connective tissues and tendons.
If you suspect that your dog has an iliopsoas injury, contact your veterinarian for an evaluation and therapy plan.
Dental health essential for pets’ quality of life
(Dr. Ron Carsten – Glenwood Post 1-28-17)
February has been designated as National Pet Dental Health Month because pet dental care is fundamental for overall good health. While poor dental health can result in bad breath and pain associated with dental disease, poor oral health also has been linked to increased risk of heart, liver, and kidney problems.
More than 80 percent of dogs and 70 percent of cats older than 2 years have periodontal disease. Periodontal disease is an inflammatory condition affecting the tissues of the mouth that support the teeth. With aging, the frequency of periodontal disease increases. Almost all dogs and cats by 5 years of age are affected, making periodontal disease the most common health problem seen in dogs and cats.
Good oral health for dogs and cats, just as for humans, requires eating good quality food, daily teeth brushing, regular dental checkups, and periodic dental cleanings. Ideally, plaque is removed daily by brushing. Plaque is a sticky combination of food particles, saliva and bacteria. When not removed, plaque hardens into tartar. Tartar is more difficult to remove.
Since plaque and tartar contain large amounts of bacteria and can build up along the gum line, the gums can become inflamed with long contact. Inflamed gum tissue appears red and swollen. Over time, the bacteria multiply and the inflammation can widen. Breakdown of the gum tissue from the inflammation and infection can progress to periodontal disease that includes damage to the periodontal ligament and even bone loss around the tooth. Further progression can result in infections affecting the root of the tooth. While there is some individual variability in susceptibility, some dog breeds like the pug, Yorkshire terrier, and Chihuahua are prone to periodontal disease.
Ideally, pets should be trained as puppies and kittens to allow their teeth to be brushed, but older pets can also be trained. Start simple by getting the pet accustomed to lifting their lip then gradually touching the teeth and gums. Placing a small amount of a food item like peanut butter on the finger can act as a reward to help the process of training.
The next step is to gently introduce the toothbrush. Use a toothbrush designed for pets. Some pets respond better to finger brushes or pads. Don’t rush the process — make it fun
and give plenty of reward treats. Be cautious if your pet tends to bite. Toothpaste for dogs and cats can have appealing flavors like poultry or seafood and they are safe to swallow. Daily brushing is a lifelong health benefit and worth the effort.
If brushing just is not possible, many products are designed to remove or reduce plaque. These products can physically rub or scrape off the plaque when chewed. Some products add enzymes or other ingredients that can reduce the amount of bacteria and plaque formation.
The Veterinary Oral Health Council has developed criteria for accepting products that have been shown to reduce plaque. Look for their acceptance.
Keep in mind that not all available products have been reviewed by this group, so some basic guidelines for selecting chewable products is important. Avoid hard products like cooked bones or nylon. Chewing on these items can result in broken teeth. Depending on the personality of your pet, avoid products like rawhide chews or dried pig ears that can be partially chewed and swallowed in large pieces. The large pieces can cause chocking or even intestinal blockage. Choosing softer items that are flexible and have an irregular surface may fill the need for something to chew that can help to reduce the plaque. Crunchy foods and chew treats can also be helpful.
Nutritional support for the tissues in the mouth can help to reduce periodontal disease. Nutrients of interest include vitamin A for healthy mucous membranes and saliva flow; vitamin B12 for its ability to reduce periodontal disease progression; vitamin C for connective tissue repair and reduction in inflammation; vitamin D for calcium absorption, benefits for bones and growing teeth, and anti-inflammatory effects; and vitamin E for reducing inflammation in the mouth tissues.
It is not possible to keep the mouth completely clear of any plaque or tartar so periodic dental cleanings under anesthesia are necessary. The timing of these cleanings is based on recommendations from your veterinarian following an examination of your pet’s mouth.
Good oral care is essential for quality health. Contact your veterinarian if you have questions about your pet’s dental health and care.
Celebrating pet companionship
(Dr. Ron Carsten – Glenwood Post 12-24-16)
Recently, someone told me that they adopted a dog a number of years ago to “replace her son that left home for college.” Of course she told me she was kidding because no one could replace her son, however, she felt the dog did significantly fill the void by giving her companionship.
It is widely known and accepted that pet companionship improves people’s lives. Benefits that have been documented include improved heart health, lowered blood pressure, slower heart rates, reduced stress and anxiety, fewer doctor visits, enhanced and increased social interactions with people, and reduced levels of depression.
While current scientific research has identified and continues to define health benefits of pet companionship, appeal of animal companionship has deep historical roots. It is estimated that the domestication of the ancestor of modern dogs occurred 12,000-14,000 years ago. Cats are thought to have begun living with humans about 8,000 years ago. The common assumption has been that domestication of dogs and cats occurred because they performed useful functions such as assisting with hunting, guarding, herding and elimination of mice and other small prey that were considered pests. However, there is archaeological evidence from 12,000 years ago that implies that even in the beginning the human-animal bond was more than just a working relationship.
The nobility and ruling classes of many societies are known for their pet ownership. For example, the Egyptian pharaohs are frequently shown in murals with pet companions. Chinese emperors and Greek and Roman nobility are also known to have kept pet companions. During the classical Greek period, dog breeding flourished.
Puppy selection, naming and training were of significant importance. Dogs of young Greek aristocrats are shown wearing collars attached to leashes and accompanying their owners. In Athens, children were given small dogs as pets. Other types of pets including birds, roosters, ducks, geese, hares, goats and fawns were also kept as pets in ancient civilizations.
During the Middle Ages in Europe, pets were popular among the aristocracy. Noble ladies kept lap dogs while the noble men focused on hunting hounds and falcons. Hunting
with hounds was considered important as a symbol of power and status. This led to the development of dog breeds specifically for pursuing quarry.
Unfortunately, during the Middle Ages, there was a growing movement against pet ownership. There was fear that pet ownership was associated with pagan worship. This reached a peak during the Inquisition. The witch trials of the 16th and 17th centuries also focused on associations with animals. Ironically, the accused tended to be elderly and socially isolated women who kept animals for companionship. As fears of witchcraft declined, interest in pets regained popularity.
Pet ownership was not generally accepted until the end of the 17th century; becoming common in the middle classes at the end of the 18th century. Our current pattern of pet ownership is likely derived from the Victorian era.
While our relationship to animals as companions has evolved and shifted over time, it appears that we again recognize the enjoyable and beneficial aspects of pet companionship. An estimated 62 percent of U.S. households (71 million) own pets. Most people now consider their pets a member of the family. More than 60 percent of households with pets have a Christmas stocking for their pets and give them gifts.
Ancient Greeks kept dogs in their healing temples because they were thought to cure illness. We now know many of the healing benefits of pet companionship that the Greeks recognized. Dogs again assist with therapy by reducing levels of pain and anxiety among hospitalized children and adults. In assisted living facilities, interaction with dogs leads to more social interactions among residents and less loneliness.
Pets uplift our lives in innumerable ways. They provide us with unconditional love and nonjudgmental companionship. They raise our spirits when we are down. They ease our anxieties. They improve our health — even watching fish has health benefits. They improve our social life and benefit our human interactions. They provide therapy for the elderly and housebound.
As you reflect on the holidays, family, friends and pets, take a moment to thank your veterinary health care team. They are a hardworking, compassionate group that strives to care for the needs of your companions. Happy Holidays.
Exercise for dogs is important - especially in winter
(Dr. Ron Carsten – Glenwood Post 11-25-16)
It is widely recognized that regular exercise is valuable for maintaining good mental and physical health regardless of whether you are a human, dog, cat or any other species of animal. For dogs, exercise is especially important for maintaining heart health, mobility, muscle tone and strength, and controlling weight. Obesity is considered the No. 1 preventable disease in dogs in the U.S. It affects more than 25 percent of dogs. Interestingly, weight reduction in obese dogs is a critical component for managing osteoarthritis (OA). Osteoarthritis is a degenerative process that affects joints. It is considered to be the most common joint disease and the most common cause of chronic pain in dogs. Since obesity worsens OA and makes pain management for OA more difficult, the winter weight gain many dogs experience can be a bigger problem than many recognize. Many dogs gain weight in the winter because they are less active. Not only can increased activity in winter help with weight management, consistent exercise can have beneficial effects on reduction or elimination of behavior problems related to boredom, anxiety and destructive behaviors.
Winter in western Colorado creates a number of challenges for maintaining an effective exercise routine. The short days with darkness at the beginning and end of the workday, cold temperatures, snow and ice affecting safe footing and busy family schedules related to the holidays contribute to less opportunity for exercise. This often results in a pattern of winter weight gain that is not completely lost during the spring and summer.
Optimal amounts of exercise are dependent on the dog breed, age and health status. Daily walks provide needed physical activity while providing mental stimulus and opportunity to eliminate. Walking for 30 minutes each day can be sufficient for some dogs, but others may need much more. Some authorities recommend two hours or more of activity per day depending on the breed, age and overall
health. That can be quite a challenge when the outside
temperature is too cold and the footing too unsure because of ice.
Indoor exercise can range from simple activities that do not require purchasing equipment to the more elaborate that involves specialized equipment like treadmills designed for dogs. Simple activities include games of fetch, hide-n-seek, find the treat, scent work and practicing tricks and training commands. For all of these activities, make sure the activity is safe for the pet. Slipping and falling on slick floors or stairs can result in medical problems. More elaborate activities requiring equipment or rearranging the house involve an indoor agility course or conditioning equipment. Chairs, tables, broom handles and blankets can be used to create an agility course. Couch cushions can be used to create conditioning opportunities. Other activities to consider include play dates with other dogs, doggy day care and dog parks. All dogs should get along so that the interaction is positive while providing quality physical and mental stimulation.
Keep in mind that any activities you share with your dog should be safe, fun and stimulating for both of you. Involve the whole family whenever possible. However, it is important to consider your dog’s health status when deciding on the activity. For example, don’t expect a dog with a heart condition or one with OA and unmanaged pain to fully participate in an indoor agility course. The proper activity may simply be gentle passive range of motion exercise, three legged stands and standing on the couch cushion. It is also important to strive for optimal pain management or heart support. Be cautious of playing hard all weekend and being relatively inactive during the week. Warm up by walking before intense activity. Maintaining muscle tone with at least 20 minutes of activity three times per week may be beneficial for avoiding injuries like torn cranial cruciate ligaments (ACL).
If you have questions about what activities are appropriate for your dog, contact your veterinarian.
Feline asthma is a common, serious problem
(Dr. Ron Carsten – Glenwood Post 10-22-16)
Feline asthma, also known as allergic airway disease, is the most common respiratory disorder in cats. It is estimated that 1-5% of cats are affected. This means that over 800,000 cats are affected by acute or chronic asthma in the US. Affected cats are often chronically affected and it is thought to be a lifelong problem. The average cat is diagnosed between 4-5 years of age, although it is believed that a low grade inflammatory process starts at a much younger age. Most agree that feline asthma is caused by an allergic reaction to inhaled allergens. This allergic reaction results in inflammation (see last month’s inflammation article) in the small airways of the lungs resulting in swelling that constricts the airway. In addition, mucus accumulation can cause further complications.
The intensity of the signs associated with feline asthma can range from mild to severe. Some authorities classify feline asthma into four categories: 1) mild - intermittent signs that do not interfere with normal activity, 2) moderate - signs occur daily but do not interfere with regular activities, 3) severe - debilitating signs that occur daily, and 4) life-threatening - airway constriction so severe that oxygen deprivation occurs and emergency treatment is needed. Difficult breathing may appear as rapid breathing that may include open mouth breathing with the head extended. Wheezing, coughing or hacking may also occur. Episodes often begin suddenly. Severely affected cats focus on trying to “catch their breath” and, in addition to the signs already described, often have excessive breathing effort with the chest and abdominal muscles.
Diagnosis of feline asthma involves gathering a complete history of the problem, a physical examination, blood tests that include a complete blood count, serum chemistries, and tests for feline leukemia virus, and chest x-rays. Additional tests may include bronchoscopy, culture of airway secretions, feline heartworm tests, and stool exam for parasites. These tests are important because feline asthma is one of a group of lung diseases that can affect cats. A full evaluation is important so that therapy can be focused appropriately on
reducing the airway inflammation and constriction.
Effective management of feline asthma requires a range of approaches that are somewhat dependent on the severity. Basic care involves avoidance of the allergen triggers and substances that can affect the airways. This includes avoidance of cigarette smoke (second hand smoke is a major trigger for sensitive cats) and wood smoke especially in the winter. Gradually changing litter to an unscented, dust free or low dust cat litter is important. Use dish soap or vinegar to clean the litter box and rinse well. Avoid chemical sprays, aroma therapies, and scented products. Consider an air purifier. Minimize stress for affected cats. Feed a high quality food and be aware of potential allergic reactions to foods that can complicate the management of the feline asthma problem.
The choice of medication for treatment depends on the severity and occurrence of acute episodes. In an acute episode with severe respiratory difficulty, tranquilizers, airway dilators, and oxygen may be needed. While steroids and airway dilators are the central focus of conventional therapy for chronic management of feline asthma, there is concern for increased risk of diabetes and pancreatitis with steroids. It is important to make sure that each cat has been adequately treated for roundworms. Integrative support care also involves reducing the inflammatory reaction in the airways and improving the overall health of the lung tissue. This can help to reduce the need for ongoing or high levels of steroids. Use of vitamins A and C can be supportive of the respiratory lining. Vitamin A must be in the retinoid form found in foods like liver or cod liver oil. Vitamin D plays a role in controlling inflammation. Be cautious to avoid toxicities from too much vitamin A or D. Improved adrenal function and fish oil can aid in reducing inflammation. Probiotic support of the intestinal flora can be beneficial in supporting the immune system. Essential oils should be avoided because they may aggravate feline asthma and because cats are more sensitive to potentially toxic effects of the compounds found in some essential oils.
Contact your veterinarian if you have questions about feline asthma.
Chronic inflammation can negatively impact health
(Dr. Ron Carsten – Glenwood Post 9-24-16)
Inflammation is a process that is critical for good health, but too much inflammation can cause damage.
Our understanding of inflammation has grown significantly since the ancient physicians described it as redness, swelling, heat, pain and loss of function. We now know that these ancient observations are the result of a complex sequence of cell and chemical reactions that leads to increased blood flow to the affected area (redness and heat), increased leakage of fluid and cells from blood vessels (swelling), tissue damage from the initial insult or from the inflammatory response (pain) and reduced mobility from swelling or loss of cells to injury (loss of function).
The ancient physicians saw inflammation as a beneficial part of the healing process. In contrast, during the last century, many viewed inflammation as an undesirable process that had damaging effects. Modern understanding of inflammation now recognizes that inflammation has both good and bad aspects.
The good aspect of inflammation is that it is an essential part of the body’s normal defense and repair processes. Inflammation is triggered whenever tissues are damaged. Damage can be caused by insults like trauma or infections.
Since the majority of the defense cells and defense chemicals are found in the bloodstream, an important sequence of events is initiated when injury occurs. These events allow the blood vessels to dilate and become leaky so that defensive cells and substances begin to arrive at the site of injury quickly. The focus of this process is to limit the spread of damaging organisms, dispose of dead and damaged cells, eliminate any bacteria that are present, and facilitate tissue repair and restoration of function.
Without the inflammation, the immune system would not be able to respond properly and the body would not be able to effectively heal after injury. From this perspective, inflammation is clearly essential for health.
The beneficial events of inflammation occur rapidly following an injury, and once the problem is resolved, the process of inflammation should stop. When it becomes an ongoing or chronic process, the bad aspects of inflammation can occur.
In some conditions, the process of inflammation does not resolve and can become a long-term or even a lifelong
problem. Examples of problems where chronic inflammation can play a role include inflammatory bowel disease, osteoarthritis, heart disease, kidney disease, cranial crucial ligament injury and cancer.
In some situations the injury or infection is ongoing, preventing resolution of the inflammation. For example, a disrupted intestinal microbiome (see last month’s probiotic article), can lead to a chronic inflammatory condition in the intestinal wall leading to inflammatory bowel disease. In other situations, the processes that turn off the inflammation fail to effectively stop the inflammatory process. For example, poor adrenal gland function can contribute to low cortisol production and ineffective dampening of the inflammation. Deficiency of certain nutrients including vitamin D can also result in inadequate control of inflammation.
Clearly, addressing the source of the inflammation is critical for effective control. This could involve the use of antibiotics for a bacterial infection if an infection was the source of inflammation. Unfortunately it is not always possible to identify the source of inflammation, making it essential to support the normal processes that help to control the inflammatory process. Important areas of the body to support include the intestinal tract, intestinal microbiome, adrenal glands and liver. Each of these areas of the body has a direct or indirect influence on the inflammatory process. Nutrients of importance include vitamins A, C, and D, glutamine, and n3 fatty acids like fish oil.
Nonsteroidal anti-inflammatory drugs like carprofen (Rimadyl) are commonly used for osteoarthritis in the dog. They are anti-inflammatory and help reduce pain. Steroid drugs like prednisone are also commonly used to control inflammatory conditions. Numerous herbs and spices have anti-inflammatory properties. Some like boswellia and turmeric have gained widespread use for inflammatory joint conditions like osteoarthritis. In addition, certain herbs are showing benefits for inflammatory bowel disease and other generalized inflammatory conditions. Each herb or drug has advantages and disadvantages. Unfortunately, the doses and tissue distribution of most herbs has not been adequately determined.
If you have questions or concerns about inflammatory conditions in your pet, contact your veterinarian.
Probiotics provide important benefits
(Dr. Ron Carsten – Glenwood Post 8-27-16)
How likely would you be to give a pill to your pet that could speed up the recovery from episodes of diarrhea, help with allergic skin problems, assist the body to deal with stressful situations, support the immune system and improve the immune response to vaccinations? This sounds like a tale that is unbelievable, but, it is true.
A growing number of studies have shown that probiotics can deliver these beneficial effects in humans and animals. Probiotics are living organisms that confer health benefits in addition to their basic nutritional value.
Probiotics contribute to improvements in intestinal and immune function because they can exert positive effects on the gut microbiome. The gut microbiome is a collection of living microorganisms such as bacteria, fungi, archaea and protozoa. It is estimated that there are 10 times more microorganisms in the gut than there are cells in the entire animal body. Bacteria are a significant part of the microbiome of the gut, and it is no surprise that there is an incredible variety of bacteria types.
This vast variety of microorganisms results in a complex interaction between the microorganisms in the microbiome. Some of these interactions have been determined but many remain to be identified and understood. In addition, the microorganisms can form a defensive barrier against bad bacteria such as E. coli and salmonella, help to breakdown nutrients in the diet, provide important nutrients for intestinal cells and the body, and regulate the immune system.
The balance of the microbiome is constantly being impacted by factors like stress, altered secretions and motility of the gut, antibiotic use, consumption of certain foods or diet changes, and colonization with bad bacteria. Changes in the microbiome can result in alterations in the intestinal barrier, absorption of nutrients and vitamins, and proper metabolism of bile acids and soluble fiber. In addition, an altered microbiome can result in toxic substances passed in the bile being absorbed back into the body.
Interestingly, dogs with chronic intestinal problems have been shown to have changes in the microbiome. Some of the bacterial groups that are significantly reduced are ones that produce short-chain fatty acids which play an important role in the health of the large intestine. Other bacterial groups that secrete metabolites with anti-inflammatory properties
have also been shown to be reduced in individuals with inflammatory bowel disease.
With the increased understanding of the importance of the gut microbiome and the realization that many disease processes can result from an abnormal microbiome, the use of probiotic products to support the microbiome has dramatically expanded. Numerous probiotic products are available, making selection of the appropriate product difficult.
General guidelines for probiotic selection includes 1) ability of the microorganism to survive passage through the stomach, 2) ability of the microorganism to establish itself on the lining of the intestine, 3) number of strains of microorganisms in the product, 4) number of viable microorganisms in each product dose, and 5) does the product contain a prebiotic.
Ability of the microorganisms to survive passage through the stomach and establish colonies on the intestinal lining is critical. Not all microorganisms can survive the acid in the stomach. For example, microorganisms in yogurt, unless specifically included as a probiotic microorganism, are generally not considered likely to be able to establish in the intestines. Some probiotics products contain one or a handful of microorganism strains while others contain 10-14 strains.
The argument is that products with lots of strains are better. However, this has not been uniformly accepted as an important criterion. Successful therapy with products with a small number of strains has been shown. An additional consideration is the number of microorganisms in each dose of the probiotic. A common recommendation is 3-4 billion microorganisms per dose. Prebiotics are substances that feed the good bacteria and help them to establish. Some prebiotics like FOS (fructooligosaccharides) can also have suppressive effects on bad bacteria.
Another consideration focuses on the question of giving animals probiotics that are intended for humans. Some have argued that these products are not effective in animals, but, research and clinical experience show that these products can be effective in animals. Products intended for animal use have not always performed better.
As the understanding of the gut microbiome increases, the selection of microorganism strains for specific health problems will become possible. This will result in more effective therapeutic use of probiotic products for health maintenance.
Back problems in cats can significantly reduce their quality of life (Dr. Ron Carsten – Glenwood Post 8-2-16)
Intervertebral disc disease (IVDD) in dogs is well recognized with an estimated 2.3 percent of dogs affected. In cats, the incidence is generally considered to be low with an estimated 0.02-0.12 percent of cats. These low estimates are likely a reflection of how good cats are at hiding the disability and pain caused by IVDD. With the increasing awareness of chronic pain in cats, there is a growing recognition of the prevalence of conditions like degenerative joint disease and spinal disorders in cats leading many authorities to believe that IVDD is much more common in cats than earlier estimates. This is supported by autopsy evaluations that show disc rupture and herniation are common and generally found in middle-age to older cats. The discs in the spine of the chest (thorax) and lower back (lumbar) are most often affected. Disc degeneration generally leads to degeneration of the small joints of the spine and formation of bone spurs that can, when severe, bridge between vertebrae.
In one study, the most severely affected area for IVDD was the lumbosacral (LS) disc. The LS disc lies between the last lumbar vertebra and the sacrum. This is the area at the front of the pelvis. Disease of the LS area is complex and can involve disc protrusion, degeneration of the articular areas of the vertebra, and thickening of the associated soft tissues. Some of the associated soft tissues are inside the spinal canal, and the thickening results in narrowing of the spinal canal. Problems with the disc and instability of this area of the spine can result in pain from degeneration and nerve impingement.
By some estimates, cats with LS disease are generally 8 years of age and older. Affected cats compensate for weakness and pain in the rear limbs by reducing their activity, discontinuing jumping, and by pulling themselves up onto furniture using their front limbs. This effort to compensate often leads to overuse of muscles associated
with the front limbs, which can cause some amount of discomfort. Depending on the level of discomfort and dysfunction with the LS area, these cats may have difficulty even getting into the litter box to defecate and urinate, especially if the box has high sides. In addition, they often have difficulty posturing to eliminate. As a result, many affected cats will eliminate outside of the litter box.
Cats with these signs should have a full evaluation, because there are other problems that can affect this part of the spine and result in a pattern of dysfunction similar to LS disease. These problems include infectious disease, inflammatory problems, injuries, vascular problems and cancer. Evaluation should include a complete history of the problem, physical examination, neurological examination, blood and urine testing, and X-rays. These tests are a valuable part of the evaluation, but definitive diagnosis typically involves MRI studies.
Treatment recommendations for cats with LS disease generally involve pain management medications, control of inflammation, weight reduction as needed, and possibly surgery to remove herniated disc material and stabilize the affected vertebra. While the number of medications available for pain management is growing for the cat, options for long-term management are still limited. Integrative supportive care involves the use of osteopathic or chiropractic manipulations, acupuncture, laser therapy, rehabilitation therapies, homeopathic remedies and nutritional supplements. Supplements that may be beneficial include glucosamine, fish oil (n-3 fatty acids), vitamins C, E and A, and minerals like manganese. Since this is a degenerative problem, ongoing supportive therapy and pain management are needed with the goal of maintaining quality of life.
If you have questions or concerns about back pain and dysfunction in your cat, contact your veterinarian.
Cause of dog seizures can be hard to determine
(Ron Carsten – Glenwood Post 6-25-16)
The most common neurological condition in dogs is the seizure, which affects approximately 1 percent of dogs. A seizure is caused by abnormal electrical discharges from brain cells that result in uncontrolled muscle activity seen as involuntary jerking movements of the head and limbs. Excessive drooling can occur, along with voiding urine or stool.
Seizures generally start and stop suddenly and last a few minutes or less. Immediately after a seizure, the dog may be uncoordinated, temporarily blind, appear confused or disoriented, restless or even aggressive. This can last for minutes to hours. Affected dogs can seem completely normal between seizures.
Often the cause of seizures can be challenging to determine because numerous abnormalities in the body can trigger seizures. These include abnormal organ function, environmental toxins or abnormalities in the brain itself. Examples of organ dysfunction that can lead to seizures include liver disease, kidney disease, low blood glucose levels or heart disease. Problems with the brain itself include infections and tumors.
Brain tumors are not uncommon in older dogs. Unfortunately, growing numbers of young dogs have brain tumors. Certain breeds like the Boxer, Boston Terriers and English Bulldogs are predisposed to developing brain tumors. While the neurological signs of a brain tumor vary considerably, seizures can be one of the signs.
With the wide range of causes for seizures, a complete work-up including physical examination, neurological examination, blood tests and urinalysis should be performed. Based on the results of these tests, additional testing may be recommended. This might include evaluation of the heart, if indicated, or specialized imaging like MRI or CT scans of the brain.
Ideal management of seizures depends on a clear diagnosis; however, this is not always possible even with extensive evaluation.
Once other possible causes are eliminated, a diagnosis of idiopathic epilepsy is often made. Idiopathic epilepsy is the
most common cause of seizures, affecting 80 percent of dogs with seizures. Idiopathic means that the cause cannot be determined. Some authorities feel that there may be an inherited aspect to idiopathic epilepsy with beagles, collies, Labrador Retrievers and Golden Retrievers commonly affected, but it can occur in any breed.
When a seizure occurs, remain calm and note the time that the seizure started. Make sure the pet is on the floor and away from water, stairs, other pets and children. Pets are not at risk of swallowing their tongue, so do not reach into their mouth during a seizure. If the seizure lasts longer than 5 minutes or there are multiple seizures in a day, contact your veterinarian. A single seizure that lasts only a few minutes is generally not dangerous. There is more concern when there are multiple seizures within a short period or if the seizures continue for longer than a few minutes. Prolonged seizures can result in elevated body temperature, which can lead to other problems.
Therapy should be directed at the cause of the seizure. For example, if the primary problem is low blood glucose, this should be corrected.
Deciding when to start anticonvulsant treatment depends on the frequency, severity and diagnosis. The goal of anticonvulsant drug therapy is to reduce seizure frequency to an acceptable level because it is not always possible to completely prevent all seizures. About 30 percent of dogs with idiopathic epilepsy do not respond to anticonvulsant therapy.
There are a number of commonly used anticonvulsants and combinations of anticonvulsants. Each has advantages and disadvantages including cost and side-effects. Integrative support for the seizure patient includes supplements and herbs for organs that are impacted by the side-effects of anticonvulsants. For example, phenobarbital can cause liver problems and herbs like milk thistle may be beneficial for supporting the liver. Other supportive care for seizure patients includes evaluating alignment of the neck, nutritional supplements, acupuncture and Chinese herbs.
Contact your veterinarian if you have questions about seizures in dogs.
Kittens need nurturing during development
(Ron Carsten – Glenwood Post 5-28-16)
Kittens, like puppies, need to be nurtured in specific ways during their development to avoid behavior challenges later in life. Some authorities believe that kittens learn to become cats from their mothers and siblings before they are 8 weeks old.
Further, behavior lessons not learned during this time may never be learned. The socialization period occurs when kittens are very young. This period can have a significant impact on later life experiences.
Kittens are born completely dependent; they cannot regulate their own body temperature, they cannot see or hear, and they cannot move more than a few inches without assistance. They progress from this beginning to become incredibly athletic individuals that have sensitive hearing, ability to see in very low light conditions and have a heightened sense of smell.
The foundation for this transformation occurs in a few short weeks. Tactile sensitivity and sense of smell are present at birth and are important for locating the nipple during nursing. Purring begins on day two. Eyelids open by two weeks. Smell becomes well developed by three weeks. Teeth erupt during week four, and kittens can orientate to sounds. Walking and running skills improve during weeks four and five, and kittens can begin to stalk and pounce. Weaning is completed by weeks six to eight. Motor skills continue to improve and reach maturation at about weeks 10-11.
The period for socialization in cats is much earlier than dogs. This period starts in week two when eyes and ears open and are functioning. Some advocate handling kittens gently for a few minutes several times per day starting in the second week and gradually increasing the time as the kittens continue to age.
Make sure that the mother is accepting of this handling. Handling kittens for only 15 minutes per day from birth to 12-14 weeks of age produces kittens that are more interested
in people. Interestingly, in one study, handling kittens for 40 minutes per day resulted in kittens that would more enthusiastically approach people and stay in their laps longer than kittens handled for 15 minutes per day.
Another benefit of handling kittens regularly from birth to 45 days is that they appear to be more confident later in life. They will approach unfamiliar objects rapidly and spend more time with the objects when they are four to seven months of age. Kittens handled by numerous people from five and a half to nine and a half weeks show less fear and more interest in people later.
Ideally, kittens should be handled by men, women and children so that they form a general picture of the human race. Kittens exposed to only one gender have a tendency to be fearful of the other gender.
It is essential to recognize the importance of the mother cat in the socialization process. Studies show that kittens separated from the mother at two weeks are fearful and aggressive to other cats and humans. They also appear to learn poorly. Social play between kittens is also critical and begins during weeks three and four. A well-socialized kitten should also be exposed safely to other species. Kittens exposed safely to another species, such as a dog, at four weeks, will show no fear of the other species when the kitten reaches 12 weeks.
It is clear from the research that gentle handling of kittens early in life is important for later quality of life. In addition, with the rapid growth and developmental changes that occur with kittens, quality, balanced nutrition is essential. Foods that contain nutrients that benefit brain development and function may provide added benefits. For example, fish oil and B complex vitamins have been shown to support brain development. Preventive health care for intestinal parasites and vaccinations should be used to avoid periods of illness during these important growth and development stages.
If you have questions about your kitten, contact your veterinarian.
Puppies undergo fast physical, mental development
(Ron Carsten – Glenwood Post 4-23-16)
Nurturing a puppy into a healthy and happy adult requires basic understanding of puppy development. Raising a well-socialized and content dog avoids problems associated with a fearful or aggressive dog. During certain phases of puppy development, puppies are prone to fear reactions that can imprint for life. At other phases, they are learning and are very receptive to training. Since experiences in the early part of a puppy’s life can have significant impacts on later quality of life and health, understanding puppy development during the first months of life is critical.
Puppies are born relatively helpless, unable to see or hear, unable to control their own body temperature, and barely able to move on their own. They progress from this dependency to eating softened food, responding to taste and smell, and beginning to explore their environment during the first month of life. Their learning and awareness changes rapidly and, by some estimates, a 5 month old puppy is equivalent to a 10 year old child. It is clear that there is a tremendous rate of change in a relatively short time.
During the 3rd week of life, puppies begin to learn and remember what they have learned. Since they are becoming aware of their environment, they can startle easily with loud sounds and sudden movements. Startling events at this stage can be imprinted and affect a puppy lifelong. Social bonding begins to occur. Orientation to visual and auditory stimuli occurs and they begin to recognize familiar stimuli. Puppies begin to eliminate in a group elimination area. From week 3-7, puppies begin to learn dog behaviors like chasing, barking, biting, and body postures. They are gaining co-ordination skills, problem solving, bite inhibition, and important socialization skills. In addition, they are learning and accepting discipline from mom and learning submissive body postures. These skills are critical for later life because they set the foundation for interacting with other dogs and for accepting training from humans.
The amount and complexity of appropriate stimulus in a puppy’s environment can have an affect on their rate of development. Providing safe exposure to other people, pets, and new situations that require problem solving are important during the socialization
period that can last into week 12. Lack of appropriate socialization can lead to difficult fear and/or aggressive behaviors later in life. During this time, a puppy’s mental abilities are fully formed and they are learning fast. Behaviors can be shaped and modified. Training helps increase mental capacity by stimulating brain cells in important brain regions. However, it is vital to recognize that puppies also have a heightened susceptibility to fear during weeks 8-10. This means that emotionally and physically traumatic situations should be avoided. Learning at this age is considered permanent. Training should be short sessions that are kept positive. Necessary medical care should be turned into fun visits.
From 3-4 months, puppies are becoming more independent and trying to figure out who is in charge. This makes it important to continue to provide a safe, structured environment as your puppy works through this transition period. By 16 weeks, it is thought that a puppy’s brain is 80% developed but their emotional development is completed.
During the 4-8 month period, puppies become more independent, act out, and can be more stubborn. They seem to forget all their previous training and act like “rebellious teenagers.” Understanding that this stage will occur, helps with the transition through it. Continuing to have a calm and safe environment while gently reinforcing training will reduce frustrations during this time.
As you can see, there are significant changes that happen in puppy development over a very short period of time. Recognizing the developmental phases provides an opportunity to help puppy grow into a well-adjusted, well-socialized adult dog. Training requires a gentle persistence. Keep in mind that medical issues such as teething can be a distraction from learning.
Puppies are lots of fun and a big responsibility. During this early part of life, proper veterinary care is important. Veterinary care can be facilitated with home training that includes examining the teeth, ears, and eyes as well as handling the paws. Brushing the teeth daily is also an important part of training. Quality nutrition is essential for body growth and support of the developing puppy brain. Contact your veterinarian if you have questions about your puppy.
Essential oils can be toxic to cats
(Ron Carsten – Glenwood Post 3-26-16)
Essential oils are be coming increasingly popular for medicinal uses. They have a long history of use in humans and are now gaining widening acceptance as a therapeutic approach in animals.
There is a long list of proposed therapeutic uses ranging from treating bacterial and viral infections to reducing nausea, controlling inflammatory conditions and managing pain. There are approximately 400 aromatic plants that are processed for commercial use. The essential oils derived from these plants contain a mixture of volatile organic compounds that contribute to the flavor and fragrance of the plant. Additionally, many of these compounds have therapeutic value.
Extraction of essential oils includes steam distillation, solvent extraction and, more recently, CO2 extraction. Each of these methods has advantages and disadvantages that can affect on the quality of the essential oil, especially if it is intended for therapeutic use. Therapeutic essential oils should be free of contaminants, including solvents and pesticide residues.
Therapy can be performed through inhalation with a diffuser, through the skin with topical application and/or by mouth in animals. While many of the compounds in essential oils have been shown to have effects in cell culture, therapeutic effects in people and animals have not been completely studied. However, it is important to note that clinical experiences, in combination with mechanism of action studies, have provided valuable insights into the potential for therapeutic benefits.
With the growing interest in essential oil therapy for animals, it is important to consider the potential benefits and problems for a species like the cat. Cats are considered strict carnivores and have evolved differently than dogs and humans in regard to how efficiently they metabolize chemicals like phenols and terpenes found in certain foods and certain drugs.
The enzyme glucuronyl transferase, which is critical for efficient elimination of these chemicals, is deficient in cats. Toxicology studies have shown that it can take 48 hours for the liver to process these compounds using other enzymes. This means that cats are slow at removing drugs like aspirin, acetaminophen and certain compounds found in essential
oils. As a result, cats are more susceptible to becoming toxic from these compounds than other animals like the dog.
Since essential oils contain a wide range of chemical compounds, it is important to understand the chemistry of each essential oil to determine the potential for toxicity, the therapeutic use, and the optimal dose and method of treatment. While some essential oils appear to be relatively safe for cats, the use of essential oils in cats has become controversial.
Some advocate the use of any essential oil with the idea that it is natural and therefore safe, especially if it is highly diluted. This is an erroneous assumption. Others recommend using only very small doses of very diluted essential oils in cats in an attempt to avoid toxicity. Still others are adamantly opposed to using any essential oils in cats.
The most rational approach centers on understanding the compounds found in each oil and determining which essential oils represent small or limited risk for toxicity in cats. These essential oils can be diluted and in some cases given infrequently enough to allow appropriate elimination from the body.
This approach allows for the careful use of essential oils in cats to achieve therapeutic goals while striving for safety. Examples of essential oils that are considered relatively safe in cats include frankincense, clary sage and helichrysum. However, it is important to use caution when using even the essential oils considered safe, especially in a cat that may have an illness that further inhibits the ability to process the essential oil.
Examples of essential oils that are considered unsafe for cats include citronella, tea tree, clove, pennyroyal, oregano, pine and wintergreen. Keep in mind that this is only a short list of essential oils that are not considered safe. There are many others. General signs of a possible toxicity in cats can include lethargy, loss of appetite, vomiting and diarrhea.
Once all the factors are considered regarding the ability of cats to detoxify and the chemistry of the essential oils, caution should be used when choosing essential oil therapy for cats. Careful selection of essential oils, small doses, large dilutions and infrequent applications may reduce some of the potential risk. Before initiating the use of essential oils in cats, seek the advice of someone experienced in their use.
Pets grieve for their companions
(Ron Carsten – Glenwood Post 2-28-16)
In her book, “How Animals Grieve,” Barbara J. King describes grief behaviors in a variety of animal species ranging from cats and dogs to chimpanzees. She uses observations of animal behaviors to illuminate their capacity to grieve. From her descriptions, it is clear that there are variations in the expression of grief between species and even among individuals of the same species; however, there are some common patterns.
Grief is a firmly accepted response to loss in humans. It is the result of the emotional suffering experienced when someone or something you love is taken away. The intensity of the grief is related to the significance of the loss. Death of a loved one is often the cause of the most intense grief, however, there are many causes of grief, including loss of health, retirement, and selling a home. While grief has been divided into 5 stages, not everyone experiences all stages and there is no defined time line for grief. Grieving for humans is an individual process just as it is for animals.
While it is clear that humans grieve, the recognition that animals grieve has not always been accepted. There have been concerns about inappropriately attributing human emotions to animals. This concern, in conjunction with challenges in defining what grief looks like in animals, has slowed acceptance that animals grieve.
The American Society for the Prevention of Cruelty to Animals (ASPCA) completed a study in 1996 investigating the expression of grief in dogs and cats. This study was prompted by calls to the Companion Animal Services’ Behavior Helpline seeking guidance for pets exhibiting grieving behaviors over the loss of another household pet. The Companion Animal Mourning Project evaluated the response of surviving dogs and cats after the loss of another pet in the household. Over 65% of pets showed 4 or more behavioral changes. Identified behavior changes included reduced or loss of appetite, seeking more attention from
owners, increased or decreased vocalization, and changes in sleeping places and habits. Other authorities also discuss lack of interest in everyday activities, searching for the deceased pet, and loss of interest in play behaviors. In the ASPCA study, 63% of dogs changed vocalization patterns, over 50% of dogs and cats were more affectionate, and 36% of dogs and 46% of cats ate less food with 11% of dogs and 8% of cats completely stopped eating. Since grief is a manifestation of distress associated with loss of a loved one, the length of time that grieving occurs varied from weeks to over 6 months.
Common recommendations for helping a pet with their grieving include monitoring them closely for changes, maintaining normal daily routines, providing more attention to the grieving pet if the pet is seeking more attention, encouraging more exercise and play, rewarding calm and relaxed behaviors, and keeping your own anxiety and stress in balance. Keep in mind that these are general recommendations, and the best approach is to tailor the interactions to the needs of each pet. For example, some pets do not want more affection or attention and forcing unwelcome attention can cause unnecessary distress. Avoid getting a new pet until the grieving process is completed.
Since common medical problems can lead to behavior changes, seek veterinary care if behaviors seem extreme or continue for an unreasonable period of time. It is important to identify and initiate treatment for any underlying medical conditions. Prolonged periods of not eating in cats can be a serious problem and may require medical intervention. Other recommendations for support for the grieving process include the use of Bach Flower Remedies, pheromone containing products, nutritional supplements that support the adrenal glands, carefully selected herbs, and in some cases appropriate drug therapy may be indicated.
If you have questions or concerns about your pet, contact your veterinarian for additional information.
Intervertebral disc disease a threat to dogs
(Ron Carsten – Glenwood Post 1-22-16)
Intervertebral disc disease (IVDD) is the most common neurological problem in dogs. It can result in problems ranging from pain and mild nerve dysfunction to complete paralysis. In addition, the onset can range from very rapid or more gradual, occurring over a longer period of time.
The pain can result in a reluctance to move, loss of appetite, or vocalizing when touched or moved. Nerve damage can result in weakness, loss of urine and bowel control, and if severe enough, an inability to walk. Clearly IVDD can be a very serious problem.
Intervertebral discs are positioned between the vertebrae (bones of the spine) of the back and neck. They stabilize and act as a cushion between the vertebrae. Each disc has an outer fibrous layer and a gel-like center. As dogs age, discs undergo a process of degeneration where the central gel loses its fluid and is less able to recover or withstand normal mechanical stresses. The outer, fibrous portion also weakens and becomes stiffer.
As the degenerative changes advance in dogs with IVDD, the central gel part can bulge into or rupture through the outer layer. This more severe manifestation of degeneration and can lead to disc material pressing against the spinal cord or the adjacent nerve roots, causing pain and nerve damage. Bulging or rupture can sometimes occur slowly, often leading to milder problems. Other times the disc bulge or rupture can occur rapidly, causing more severe signs.
It is generally difficult to identify a single event such as jumping or aggressive play that results in a bulging or ruptured disc. This is because the problem is thought to be caused by a combination of normal activity and normal mechanical stresses on a weakened, degenerated disc. It is also interesting to note that the majority of dogs will experience a progressive deterioration over a few hours or days rather than sudden paralysis. Some dogs experience recurrent episodes of pain or nerve deficits over months or even years.
Some dog breeds are predisposed to IVDD. The chondrodystrophic dog breeds — those with the short legs with angular deformities like the dachshund, bulldog, basset hounds, corgis, and shih tzus are genetically programmed to undergo disc degeneration starting at an early age. Generally, these breeds are affected in middle age (4-8 years)
but it is not uncommon for 2- to 3-year-old dogs to have disc problems.
Episodes in the chondrodystrophic breeds tend to be an acute, explosive rupture of the disc leading to neck or back pain, depending on which disc is involved. Severity of the injury to the spinal cord and location of the affected disc dictates the type of nerve dysfunction seen. In dog breeds that are not chondrodystrophic, such as German shepherds, Labrador retrievers and Dobermans, the IVDD involves a gradual herniation of the disc material in older dogs (8-10 years of age). The most common area of the spine that is affected is near the last rib. Other areas that are less commonly affected include the middle of the neck and the spine near the pelvis.
A grading system for severity has been developed to help in making diagnostic and treatment decisions. Grades run from painful with no neurological deficits to complete paralysis and loss of bowel and urine control. Diagnosis is based on the history, physical examination and neurological examination, along with some combination of imaging techniques like X-rays, myelograms, CT scans or MRI. The thoroughness of evaluation for diagnosis depends on a number of factors including the severity and treatment decisions like surgery.
Treatment depends on severity and can range from conservative treatment that includes confinement, anti-inflammatory drugs and pain medications as needed, manual therapies, acupuncture and therapeutic laser to emergency surgery to remove the problem disc material. Some studies are showing that electroacupuncture alone or in combination with surgery has been more effective than surgery alone in severely affected dogs. Electroacupuncture in conjunction with corticosteroids appears to improve the speed of recovery. Therapeutic laser can improve nerve regeneration and tissue healing along with benefiting pain management. Herbs and nutritional supplements that support healing and the adrenal glands can be an important part of the recovery process. Rehabilitation therapies can also facilitate recovery.
IVDD in the dog can be a challenging and catastrophic problem to address. Early supportive care is important. If you have questions about IVDD, contact your veterinarian for additional discussion.
Owning a pet can improve your health
(Ron Carsten – Glenwood Post 12-26-15)
The holidays are a time for family and friends to share food, gifts and companionship. It is also a time to acknowledge the pets that are part of our families.
A growing body of scientific evidence supports the long-held belief that pet companions benefit human health. These health benefits include improved quality of life, better cardiovascular health, lowered risk of obesity, reduced stress and anxiety, and less depression. Nothing compares to the unconditional love that pets offer.
The number of pet dogs and cats in the U.S. has risen from an estimated 40 million in 1967 to more than 160 million in 2006. Approximately two-thirds of U.S. households own at least one pet.
Archeological evidence indicates that this relationship between humans and pets has existed for at least 12,000 years. These numbers tell a significant story about the human-animal bond. Research has shown that human-dog interactions create the same oxytocin feedback loop seen between mothers and their infants. While this oxytocin-fueled bond has contributed to the enduring relationship between humans and pets, pet companions offer many beneficial effects on humans. Recognition and understanding of these benefits continues to increase as more research is completed. It is important to note that dogs and cats are not the only pets that contribute health benefits through their companionship and interaction with humans.
Results of a recently released study by the Human Animal Bond Research Institute estimates that $11.7 billion is saved on U.S. health care annually as a result of pet companionship. The largest amount of saving comes from fewer physician visits by pet owners compared to non-pet owners. This equates to an estimated saving of $11.37 billion in health-care costs. In addition, dog owners that walk their dogs five or more times per week have a lower incidence of obesity, saving an estimated $419 million in health-care costs.
A study paid for by the National Institute of Health found that adults suffering from heart attacks, regardless of the severity, were more likely to be alive a year later if they owned a dog compared with those not owning a dog. In another study, married couples with pets were found to have
lower heart rates and blood pressure at rest and when undergoing stress tests. Interestingly, pet owners had milder reactions and recovered faster from stress when they were with their pets than when they were with their spouse or a friend.
Dog owners typically get more exercise, are less likely to be obese, and tend to walk further and faster than those who did not walk regularly. Elderly dog walkers tended to be more mobile in their homes. In addition, dog walking leads to increased conversation and social interaction with others. People with more social relationships generally live longer and have less physical and mental declines as they age.
Children also benefit from pet companionship. They generally have improved immunity, are less likely to have allergies, and have increased empathy for others. Also, children who are emotionally attached to their pets are better at building relationships with other people. From a therapeutic perspective, dogs can help calm hyperactive or overly aggressive children; of course supervision and proper training should be a component.
Animal-assisted therapy programs are becoming more widely available as the benefits of the human-animal bond are increasingly recognized. These programs have provided an important function for children in K-12 programs, college students, and for patients in hospitals and nursing homes. At-risk children, those in need of improvements in areas like self-confidence, self-esteem, motivation, empathy and behavior control have benefited. For individuals hospitalized or in nursing homes, animal-assisted therapy has improved patient moods and reduced anxiety.
As scientific investigation into the health benefits of pet companionship increases, new information will continue to emerge that further defines the essential role that these companions play in our daily lives. However, it is critical to understand that pet ownership is a long-term commitment that requires diligence, motivation and careful thought. Pets need fresh food and water daily, exercise, training, routine veterinary care and, as their lives progress, geriatric health care similar to humans.
In this season of sharing, take a moment to hug that pet that provides unconditional love. You will get back so much in return.
Holidays can be hazardous for your pets
(Ron Carsten – Glenwood Post 11-28-15)
The holidays are a time of excitement and fun as family and friends gather for season’s greetings, meals and gifts. Unfortunately, it can also be a time of stress for many family pets when their daily routines change, holiday decorations alter the home, visitors arrive and unfamiliar activities occur. Added to this is the fact that some holiday decorations, ornaments, plants and foods can be health hazards for pets. Understanding some of the common holiday risks and taking steps to avoid problems can help to ensure pet safety and happiness during this busy time.
When decorating your home, take steps that ensure pet safety by preventing access to electrical cords, ribbons, strings, tinsel and small ornaments. Chewing a plugged-in electrical cord could result in electrical burns, shock or even death; ingesting parts of an electrical cord, ribbons, tinsel or ornaments could result in stomach or intestinal problems. Once ingested, the problem may be minor, resulting in irritation and limited vomiting followed by a rapid recovery — or the problem could be major, requiring surgery to remove the ingested object. In addition to potential digestive tract injury, some ornaments contain toxic materials.
Toxicity can also occur from ingestion of certain holiday-season plants. These plants include the poinsettia, lilies, holly and mistletoe. Poinsettia is now considered to be only mildly toxic; therefore, it is much less of a concern than other common holiday season plants. One or two bites of lily, often used in holiday bouquets, can result in kidney failure in cats. Some authorities even feel that the water in the flower vase containing lilies can be toxic. Christmas and English holly have spiny leaves that can upset the digestive tract and they contain potentially toxic compounds. The Japanese Yew, used for wreaths, contains a toxic compound that can cause dizziness, abnormal heart rate, coma and even death.
While not a holiday-season plant, pet exposure to marijuana has also increased. Dogs and cats can be intoxicated through ingestion of marijuana, marijuana-containing products or by secondhand smoke. Signs of intoxication are generally seen within three hours and can include an unsteady gait, severe depression, coma, low heart rate, hyperactivity and seizures. The effects on pets are not fully understood, but they appear to be more sensitive
to the effects of tetrahydrocannabinol, marijuana’s active ingredient. Since emergency room visits for intoxicated pets have been rising, caution should be used to prevent accidental exposure or ingestion.
Keep in mind that some holiday foods can cause a simple digestive upset because the pet is not used to them. Other foods are not safe for pets. Avoid chocolate and cocoa. They contain a chemical that is considered to be highly toxic to dogs and cats. Sugarless gums and candies that contain the sweetener xylitol should be avoided. Xylitol can cause a life-threatening drop in blood sugar and liver failure.
Fatty leftovers may increase the potential for developing pancreatitis leading to abdominal pain, vomitin, and diarrhea. Undercooked foods or foods that have been allowed to sit for extended periods may provide the opportunity for bacteria like Salmonella or E. coli to grow. These organisms have the potential to cause food poisoning or bacterial contamination resulting in severe intestinal problems and illness.
According to Colorado State University Extension, when the room temperature is less than 90 degrees Fahrenheit, food should not be left out for more than two hours and cooked leftovers should be used within four days. Onions and garlic pose a danger. Cats are more sensitive than dogs, and depending on the amount ingested and the sensitivity of the individual, damage to red blood cells can occur along with nausea, vomiting and diarrhea. It is best to be cautious and keep your pets on their regular foods even though it is tempting to give them treats.
Ice-melt products can cause contact skin irritation and digestive upset when small amounts are ingested. Ingesting larger amounts may lead to salt poisoning, vomiting and seizures.
It is important to recognize that this season can be stressful to pets. Take time to maintain their normal routines. Spend as much time with them as possible. Consider using stress-relieving products like Rescue Remedy for dogs and cats or products containing appeasing pheromones like Feliway for cats or Adaptil for dogs.
Have an enjoyable holiday season. Spend quality time with your pets and make your holidays pet safe. Contact your veterinarian if you have any concerns about your pet.
Thyroid disease epidemic in cats
(Ron Carsten - Glenwood Post Independent 10-24-15)
The thyroid gland is the most commonly diseased gland in cats. It is almost always overactive (hyper-), so the condition has been referred to as hyperthyroidism. Unfortunately, hyperthyroidism in cats is so common today that it is being described as an epidemic.
Feline hyperthyroidism was first reported in 1979. Prior to that, enlarged or abnormal thyroid glands and signs of thyroid illness were rarely observed. Since then, there has been a steady and dramatic increase in the number of cats affected. Along with this increase in incidence, it has become a major cause of death in cats.
In spite of numerous theories for the cause of hyperthyroidism in cats, sadly, the cause is unknown and there is no clear recommendation for prevention. The two main areas of focus are nutritional factors including excesses or deficiencies in cat food and thyroid-disrupting compounds present in the environment, drinking water or food.
In more than 95 percent of the hyperthyroid cats, the glands have benign (not cancer) changes and are overproducing hormones. In 70 percent of affected cats, both glands are involved. Less than 5 percent of hyperthyroid cats have cancer in the thyroid glands. The average age of affected cats is 13 years, but 5 percent are younger than 10.
The thyroid is a paired hormone-producing gland that is located on each side of the trachea near the throat. Hormones produced by the thyroid, mainly T4 and T3, affect nearly all organs in the body. As a result, when elevated, they can cause other problems including an elevated heart rate and heart enlargement. Over time this can lead to compromised heart function and even heart failure. Elevated blood pressure can also occur. This hypertension can cause damage to the eyes, kidneys, brain, and heart.
Indications that a cat is affected by hyperthyroidism can be mild initially and progress to severe over time. These signs include weight loss, increased appetite, increased thirst, urination, hyperactivity, diarrhea and vomiting. Often the hair coat is matted and unkempt. The heart rate may be increased and the cat may be depressed or have aggressive
behavior. Some cats are restless, mentally confused and may yowl at night.
Diagnosis of hyperthyroidism typically involves measurement of the T4 hormone in the blood. However, since there are other diseases with the same signs, such as diabetes, chronic kidney failure and intestinal disease, it is valuable to perform a complete blood count, serum chemistry profile, and urinalysis. A thorough physical exam is important along with palpation for enlarged thyroid glands.
While most cats with hyperthyroidism have an elevated T4, 2-10 percent will have a normal T4, making the diagnosis more complicated. These normal T4 values in a hyperthyroid cat may be the result of mild hyperthyroidism or a concurrent illness that is suppressing the T4 levels so that they appear normal.
There are basically three accepted therapies for hyperthyroidism: oral treatment with methimazole, surgery to remove the thyroid glands or treatment with radioactive iodine. While radioactive iodine is currently considered the treatment of choice, each approach has advantages and disadvantages. These should be discussed with your veterinarian so that the appropriate therapy can be planned. The pet food manufacturer Hills has developed a Prescription Diet, y/d that has been beneficial for some cats with hyperthyroidism. Regardless of the therapy chosen, once the thyroid hormones are returned to a normal range, underlying kidney or heart disease may become apparent. The high blood flow caused by the hyperthyroidism, can mask these underlying problems.
From an integrative perspective, the organs that are stressed by the hyperthyroidism should be supported using appropriate nutritional supplements and herbs. These organs include the kidneys, heart and liver. If high blood pressure is present, supportive care for the eyes may also be beneficial in addition to controlling the blood pressure.
If you have questions about hyperthyroidism or suspect your cat may be hyperthyroid, contact your veterinarian for further information.
'Twisted stomach' in dogs is a serious problem
(Ron Carsten - Glenwood Post Independent 9-26-15)
Gastric-dilatation-volvulus looks like a convoluted and complex name. This name however, gives a clear description of a serious, life-threatening problem that occurs in dogs. The condition affects the stomach (gastric), involves bloating of the stomach (dilatation), and finally, twisting or rotating of the stomach (volvulus). It is often abbreviated as GDV.
While the cause of GDV is unclear, it has often been associated with older, large-breed, deep-chested dogs that are fed one large meal a day and are related to other dogs that have experienced GDV. Any dog can be affected, but the most common breeds are Great Danes, Weimaraners, St. Bernards, Irish setters, and Gordon setters. Interestingly, aggressive dogs seem to be at higher risk. There also appears to be an increased risk if a susceptible dog is fed primarily dry kibble dog food in one or two large portions each day, compared with those that are allowed to eat smaller meals throughout the day or are fed canned foods. In addition, high fat content in foods has been associated with increased risk.
Many of the initial signs associated with GDV are general and do not conclusively indicate GDV. These signs include an anxious look, looking at the abdomen, standing and stretching, panting and drooling. As the GDV progresses, signs become more focused on the bloated stomach and include distended abdomen, retching, unproductive vomiting and difficulty breathing. With continued progression, the dog can collapse from poor blood circulation and difficulty breathing.
These later signs reflect the fact that GDV is a serious problem that affects the whole body. The bloating stomach puts pressure on the blood vessels, reducing the ability of the blood to properly circulate. Pressure on the diaphragm makes breathing difficult. When the stomach rotates, the blood circulation in the body and stomach is further compromised. Toxins begin to be released. Irregular heartbeats can occur. These events can lead to shock, collapse, coma and even death if not treated. GDV is an emergency and should be treated immediately. The sooner it is aggressively treated the better the outcome.
Diagnosis of GDV relies on a characteristic gas pattern in the stomach seen on X-rays. Initial treatment is focused on stabilizing with IV fluids and oxygen, and getting the gas and fluid out of the stomach. Once the dog is sufficiently stabilized, anesthesia and surgery will be performed. The surgery is intended to untwist the stomach and tack the stomach to the inside of the abdomen wall (gastropexy) to prevent reoccurrence of GDV. In addition, the stomach will be inspected for areas that have to be removed as a result of damage from poor blood flow during the GDV. If the spleen has also twisted, it must be untwisted. The spleen may also be removed if it has become too damaged. Antibiotics will be needed because bacteria can leak into the bloodstream from the compromised intestine. There may also be disturbances in the blood pH and electrolytes like potassium that need to be addressed. Irregularities in the heart rhythm can occur. These irregularities, if unmanaged, can sometimes be life-threatening.
After surgery, monitoring of the heart is important for the first 24 hours. Exercise restrictions will also be recommended for the first one to two weeks while the surgery site is healing. Frequent small meals of bland food are often advocated along with frequent small amounts of water. Monitoring of the kidneys may be important initially depending on the severity of poor blood circulation during the GDV.
Since GDV is an emergency that is best handled by stabilizing with decompression of the stomach, intravenous fluid therapy and surgical intervention, integrative approaches are best used to support the stabilization process and surgical recovery. These therapies may include acupuncture to help manage pain and promote return of normal stomach and intestine contractions after surgery, laser therapy may facilitate healing and reducing pain in the incision, probiotics help replace beneficial bacteria in the digestive tract, and nutritional supplements and herbs may be supportive of a compromised kidney.
GDV is a life-threatening emergency. Contact your veterinarian or veterinary emergency facility if you suspect your dog is experiencing GDV.
An overview of heart disease in cats
(Ron Carsten - Glenwood Post Independent 8-22-15)
The heart is a marvel of engineering and function. In the resting cat, it is a muscle that contracts on average almost 190,000 times per day (130-140 times per minute) only resting briefly between contractions. In addition, the heart has the ability to increase its rate to meet the needs of the exercising body.
The heart is designed to force blood to move forward with each contraction for efficient movement throughout the body and lungs. This forward movement of the blood is made possible because of the valves in the heart and in the large arteries leaving the heart along with the elastic fibers in the major arteries. Valves in the veins prevent blood from moving backward while muscle contraction acts to squeeze blood forward toward the heart.
In order to efficiently circulate blood to all parts of the body, the heart is divided into two sides. Each side has its own circulation path — the right side pumps to the lungs and left side pumps to the rest of the body. Oxygenated blood from the lungs returns to the left side of the heart to be pumped to the rest of the body. Deoxygenated blood from the body moves into the lung circulation through the right side of the heart.
The general term for heart muscle problems in cats is cardiomyopathy. This means heart (cardio-) muscle (myo-) disease (pathy). These diseases can be categorized as primary or secondary. Primary cardiomyopathy is a problem specific to the heart muscle, while secondary cardiomyopathies are caused by another health issue, such as an overactive thyroid.
Primary cardiomyopathies include: 1) hypertrophic, 2) restrictive and 3) dilated.
Hypertrophic cardiomyopathy (HCM) is the most common, accounting for 85-90 percent of primary patients. HCM is a condition where the heart muscle becomes abnormally thickened. This thickening reduces the volume of blood filling the heart chamber and prevents the heart muscle from relaxing between contractions. It mainly affects the left side of the heart. There is no clear explanation for its cause, but a genetic component is likely.
In the restrictive cardiomyopathy (RCM), the heart muscle has increased amounts of fibrosis (scar type tissue), making the heart walls stiff so the chambers cannot fill with blood properly or empty completely with a contraction. RCM occurs in about 10 percent of primary cardiomyopathy
patients and mainly affects geriatric cats.
Dilated cardiomyopathy (DCM) is just as it sounds. The heart muscle is thinner than normal and cannot contract properly. DCM is relatively uncommon, accounting for about 1-2 percent of the patients. DCM was once more common until it was determined that the cause was a taurine deficiency. Pet foods generally contain appropriate levels of taurine now.
Secondary cardiomyopathies occur when the heart is affected by a problem that exists in another part of the body. These include nutritional imbalances, hyperthyroidism, cancer, infections, immune reactions and toxicities.
Indications that a cat is affected by cardiomyopathy include difficult or rapid breathing, general weakness, lethargy, poor appetite, and sudden weakness or paralysis in the back legs. Gallop sounds or abnormal rhythm may be heard when listening to the heart. Lung sounds may be muffled or harsh. Body temperature may be low due to poor blood circulation.
Evaluation for a diagnosis generally includes blood tests, chest X-rays, ultrasound of the heart and electrical recordings of the heart. Treatment recommendations depend on the diagnosis and how advanced the problem is. For example, in life-threatening congestive heart failure, a rapid response is indicated and may include the use of diuretic drugs, oxygen therapy, blood pressure medication and drugs to improve heart contractions. Treatment for blood clots may be important. Factors contributing to the heart problem, like an overactive thyroid or an infection should be addressed.
Cats that are in early stages of cardiomyopathy or not in a life-threatening situation may benefit from long-term support in addition to any medications that are necessary. Supportive care may include nutrients that are beneficial for the heart muscle like vitamins E and C, taurine, L-carnitine, and appropriate levels of minerals including magnesium and calcium. Herbal therapies like hawthorn may be helpful for improving blood flow to the heart muscle and increasing the strength of contraction.
With reduced heart function, the kidneys may be compromised. In addition, ongoing stress places more demands on the adrenal glands. Support for both the kidneys and adrenal glands should be considered as part of an overall care plan.
If you have questions about heart disease in cats, contact your veterinarian.
Teaching about old dogs
(Ron Carsten - Glenwood Post Independent 7-25-15)
It is hard to imagine that puppy with boundless energy or that young adult with the fluid grace of an athlete, becoming, in what feels like a few short years, an individual that sleeps longer, has diminished eyesight and hearing, and has discomfort associated with osteoarthritis. Dogs progress through the same aging changes as humans. In fact, the similarities have lead to development of university based aging studies in the dog as a way to better understand human aging.
The average lifespan of a dog is 12-15 years. Unfortunately, the aging process occurs much more rapidly in giant-breed dogs than in small-breed dogs. This means that small and medium size dogs (less than 50 pounds) would be considered senior at 7 years of age, large breed dogs (51-90 pounds) at 6 years, and giant breeds (over 91 pounds) at 5 years. In general, a dog is considered elderly when it is in the last 25 percent of its lifespan.
Aging changes happen gradually, making them less obvious in daily interactions. Common signs of aging include gray hair, grayish lenses and reduced vision, less acute hearing, sleeping more and more deeply, development of osteoarthritis, weakness and difficulty getting up from laying or sitting, reduced ability to exercise, alterations in intestinal function, and changes in cognitive behavior. The speed and severity of the changes, in conjunction with your pet’s normal lifestyle, dictate how impactful these age-related changes are. For example, a dog that hikes regularly can be significantly impaired by osteoarthritis while a small dog that spends the majority of time indoors generally is not.
The above changes can be observed through daily interaction. Many other changes are found with a physical examination and routine blood and urine testing. The physical examination can identify irregularities with the heart such as a murmur or changes in lung sounds. Early evaluation of lumps and bumps can make management easier. Monitoring oral health becomes increasingly important because dental disease can compromise the heart and kidneys. Aside from the effects of poor oral health, liver and kidney function are known to decline with age, making regular testing important. Thyroid function can also be impaired, complicating the aging process. This makes early identification of health problems essential for optimal care.
While the normal loss of function associated with aging cannot be stopped, there are approaches that may slow the decline. For example, keeping a dog active will help to maintain muscle strength and muscle tone longer. Unfortunately, dogs with unmanaged osteoarthritis are less active and can lose strength rapidly. One of the keys to improving activity levels, and by extension muscle strength, is to address joint pain. Depending on the intensity of the joint pain, supportive care may involve weight loss, use of glucosamine, herbs like boswellia, nutritional supplements, vitamin D supplementation, and nonsteroidal anti-inflammatory drugs.
Joint discomfort is not the only reason for decline in muscle strength. There is an age-related, progressive decline in the ability of muscle cells to produce work and there is a loss of muscle fibers. In addition, nerve function also declines. These factors can result in weakness and an unsteady gait. While these changes relate directly to the ability of muscles to perform work, other issues that affect muscle include diminished heart and lung function resulting in reduced oxygen and blood flow to muscles. Exercise is an important way to maintain muscle strength. However, activity levels must be tailored to the dog’s ability. This often means giving up strenuous hikes and instead using multiple short walks daily.
Cognitive dysfunction in older dogs can also be challenging. Some dogs experience degeneration of nerves in the brain that affects behavior and cognitive ability. These dogs may have decreased awareness, confusion, vocalization, altered sleep cycles and loss of house training. Increasing the levels of antioxidant vitamins has been advocated to reduce declining brain function. Interestingly, providing whole food, rich in antioxidants has been more successful than the use of isolated vitamins. Providing more B vitamins and fatty acids in the form of fish oil may also be beneficial.
Aging happens to everyone, including our pets. The process is complex and each individual experiences aging in different ways. Support for the aging dog should focus on quality nutrition, appropriate levels of exercise, mental stimulation, the use of targeted nutritional supplements and herbs, and regular veterinary exams to detect emerging age related diseases.
If you have questions about your aging dog, contact your veterinarian to discuss these important issues.
Pancreatitis in cats surprisingly common
(Ron Carsten – Glenwood Post Independent 6-28-15)
Studies indicate that feline pancreatitis is surprisingly common, with 67 percent of cats having microscopic changes in the pancreas that indicate inflammation. It is the most common problem affecting the enzyme-producing part of the pancreas. Interestingly, 45 percent of cats that appeared healthy had microscopic changes consistent with pancreatitis.
The pancreas, a gland found in the abdomen, is associated with the first part of the small intestine, weights about 6-8 ounces, and is vital for digestion and glucose regulation. One part of the pancreas produces hormones such as insulin, which is critical for controlling blood glucose and preventing diabetes mellitus. The other part of the pancreas is responsible for producing digestive enzymes. These digestive enzymes break down the ingested food so nutrients can be absorbed from the intestine.
To protect the pancreas from digesting itself, the digestive enzymes are in an inactive form while in the pancreas. Once secreted into the intestine, the enzymes are activated so they can begin digestion of the food. Premature enzyme activation in the pancreas is often the initiating event for an episode of pancreatitis.
Pancreatitis can be acute (sudden onset), recurrent acute (repeat acute episodes) and/or chronic. Acute episodes are often more severe than the chronic problem. Unfortunately, signs of pancreatitis in cats are not very specific. The majority of cats with pancreatitis are lethargic, not eating, and are dehydrated. Vomiting is seen in less than half of the affected cats. Pain and diarrhea are not prominent in cats. Since loss of appetite and lethargy are common with many cat diseases, these signs do not automatically point to pancreatitis.
While the causes of acute pancreatitis are not fully understood, a number of issues may contribute to development of pancreatitis. These include bile tract disease, inflammatory bowel disease, pancreatic duct blockage, certain drugs, ingestion of toxins or insecticides, infections like toxoplasmosis or feline infectious peritonitis, and trauma. These conditions can also contribute to chronic pancreatitis. Intermittent episodes of pancreatitis can occur over time gradually leading to scar tissue in the pancreas. Scar tissue reduces the ability of the pancreas to function
Since the list of diseases that can look like pancreatitisis long and we have lacked a specific test for pancreatitis, effective evaluation of the ill cat has often required extensive testing to rule out the other diseases. Typical evaluations have included a complete blood count, chemistry profile (includes testing for liver, kidneys, and glucose), X-rays and ultrasound. Biopsy of the pancreas is considered the most informative, but because surgery is required in an ill cat, biopsy is not frequently used. Fortunately, newer tests specific for cats have become available, making it easier to diagnose pancreatic problems.
Therapy for pancreatitis is based on severity. Supportive care like IV fluids, use of medications to prevent vomiting and antibiotics are often indicated for acute pancreatitis. Even though pain is not a common observation with cats with pancreatitis, there does seem to be improvement when pain management is initiated. Some cats with acute pancreatitis develop a transient diabetes mellitus that may need to be treated short term with insulin. Whenever possible, contributing problems like inflammatory bowel disease and bile duct disease should be treated. It is important to keep cats eating whenever possible to avoid a problem with fatty liver. For cats with chronic pancreatitis, management of the contributing factors is important.
Integrative support care includes the use of nutritional supplements and herbs to manage inflammatory bowel disease and bile duct inflammation, if present. Since pancreatitis can contribute to liver dysfunction, liver support can be important. Beneficial herbs for the liver and intestines include milk thistle, boswellia and slippery elm. Glutamine is important for the cells lining the small intestine. Vitamin B12 is often deficient and should be considered as a component of supportive care. Probiotic therapy can be beneficial for improved intestinal health and immune function, especially if there is ongoing antibiotic therapy. Acupuncture can be used to improve comfort and function. Avoid foods to which the cat may be sensitive or may contribute to inflammation in the intestine. Easily digestible foods may be beneficial along with the addition of digestive enzymes.
If you suspect your cat has pancreatitis or you have questions, contact your veterinarian.
Cruciate ligament injuries often cause lameness in dogs
(Ron Carsten – Glenwood Post Independent 5-22-15)
One of the most common causes of lameness and pain in the hind leg of the dog is a torn cruciate ligament. Cruciate ligaments in the dog knee have a similar but more complex function than those in the human knee. Basically, cruciate ligaments provide important knee support. The ACL (anterior cruciate ligament), or more correctly termed the CCL (cranial cruciate ligament) in the dog, prevents forward motion of the tibia (bone below the knee) with respect to the femur (bone above the knee). In addition, the CCL limits over straightening of the knee and rotation of the tibia.
In the dog, the CCL can be partially torn or completely torn resulting in partial or complete instability. CCL damage can occur from trauma like an acute injury or long-term or chronic degeneration. A partially torn CCL occurs in 25-30 percent of dogs. Frequently the partial tear progresses to a full tear. A damaged CCL leads to instability and degenerative changes within a few weeks of injury. Degeneration can progress to severe within a few months. Over 50 percent of dogs with a torn CCL will also experience a torn or damaged meniscus, the fibrocartilage pad in the knee.
Traumatic tearing of the normal CCL occurs in only about 20 percent of dogs. Interestingly, it has been estimated that in a normal CCL, it requires a force 4 times the body weight of the dog to cause a tear. In the remaining 80 percent of dogs, tears occur with much less force in a CCL that has undergone long-term chronic degeneration. Unfortunately, because degeneration plays a role in a large number of dogs, 40-60 percent of dogs will eventually experience a torn CCL in the other leg.
Factors that contribute or predispose to ligament degeneration include aging, obesity, poor physical condition, abnormal confirmation, disuse, immune mediated damage, and genetics factors. Degeneration related to aging is more significant in dogs over 30 pounds and over 5 years of age. Abnormal confirmation such as bowlegged, knock-kneed, or having straight knees and hocks predisposes to CCL rupture. Some dog breeds like the Rottweiler, Newfoundland, Staffordshire Terrier, Mastiff, Akita, Saint Bernard, Chesapeake Bay Retriever, and Labrador Retriever are more commonly affected. A genetic mode of inheritance has been
identified in the Labrador Retriever.
The signs of CCL injury include difficulty rising from sitting, reduced activity, varying severity of lameness, loss of muscle mass, thick area on the inside of the knee, pain, and stiffness. Keep in mind that these signs are not specific to CCL injury and can be caused by other problems. Therefore, it is important to have a thorough examination that may include X-rays. Complete tears are generally straightforward to diagnosis while the partial tears can be more challenging. An increased cranial draw motion (tibia slides forward abnormally) is consistent with CCL tear. In addition, there is often increased fluid in the joint.
Optimal treatment of the torn CCL depends on the dog’s activity level, size, age, knee conformation, and amount of knee instability. Surgical stabilization is generally thought to be the best approach. There are a number of surgical techniques that are commonly used and are generally selected based on the size of the dog and the surgeon’s preference. The goal for surgery is to stabilize the knee so that degeneration is eliminated or its rate of progression significantly slowed. However, surgery is not practical for all dogs due to health concerns associated with anesthesia risk or financial reasons. When surgery is not practical, some dogs can be kept comfortable using a custom made knee brace. These are designed to provide support during activity, but are not intended to be worn continuously. Partial tears may benefit from prolotherapy.
In addition to surgery or a knee brace, there are a variety of nutriceutical products, supplements, and herbs that can be used to help manage inflammation, pain, and reduce degeneration of the joint. For example, glucosamine and chondroitin products reduce the damaging effects of inflammation on the cartilage surface in the joint. Fish oil and herbs like boswellia help to reduce inflammation. Manual therapies may be indicated to help maintain appropriate alignment of the back and pelvis because there is additional stress in these areas during times of lameness. Non-steroidal anti-inflammatory drugs like Rimadyl help to reduce inflammation and pain. Acupuncture and therapeutic laser can be used to reduce pain and improve healing after surgery. A rehabilitation program can be beneficial after surgery.
If you have concerns or questions about your dog, contact your veterinarian for further information.
Obesity and your cat
(Ron Carsten - Glenwood Post Independent 4-25-15)
It has been estimated that 36 percent of American adults are obese. Ironically, more than 50 percent of cats are overweight and 25 percent are considered obese. This is a trend that has increased over the last 30 years in a similar to the increase in diabetes. Obesity in cats has increased health risks similar to those experienced by humans, including heart disease, diabetes, respiratory compromise, certain liver diseases, urinary tract disease, ligament injury and osteoarthritis. More common in older, less active cats, obesity is also often seen in cats fed free choice, and spayed or neutered cats that do not have their food intake managed. Interestingly, a neutered male cat requires 28 percent fewer calories.
The simplest explanation for obesity is that it is the result of excess energy intake and insufficient energy use. Unfortunately, the development of obesity is often complex with multiple contributors. In addition to excess energy intake, other contributors include genetic factors, food preferences developed as kittens, excess carbohydrate-containing foods and some metabolic issues. A further complication is that white adipose functions as an endocrine (hormone) gland by secreting a wide range of hormones called adipokines and obesity is associated with chronic, low-grade inflammation.
These factors mean that obesity prevention and management is not always simple. Health issues such as heart disease or osteoarthritis may prevent adequate exercise. Cats may refuse to eat the diet food selected by the owner. Managing effective volume control for feeding can be especially difficult if there are multiple cats in a household.
Since there are numerous body types and cats come in many sizes, it is important to be able to recognize when a cat is becoming obese. The first step for assessing obesity is to feel both sides of the chest with your fingers. With ideal weight you should be able to feel the ribs with a thin layer of fat under the skin. In a severely obese cat, it may not be possible to feel the ribs through the fat layer. The second step is to view the cat from the side. An obese cat may have a layer of fat hanging below the abdomen. The third step is to view the cat from above. Cats that are obese will not have a waistline because it is hidden below a layer of fat. Body
condition charts are also available for comparison. Ask your veterinarian for assistance if you have questions.
As with many diseases, prevention of obesity is easier than the treatment. Avoiding obesity includes increasing activity. It is estimated that the typical cat needs 15-30 minutes of activity each day. Access to a variety of toys can help. In addition, managing energy (calories) intake is critical. This can involve both the amount of food given and the type of food offered. The growing consensus is that cats should not be fed free choice. In addition, they should be fed a high-quality canned food. Canned foods generally have higher protein, lower carbohydrates and are high in water content. Keep in mind that carbohydrates that are not being used are being stored as fat. There should be distinct feeding times and no treats or snacks in between. Making changes gradually can be important for many cats because some cats are stressed by change and may not tolerate or accept rapid diet changes.
For cats that are already obese, increasing activity, if not limited by a health problem, is important. Check the food manufacturer’s recommendation for the amount of food daily. Carefully measure the food when feeding. If the amount fed is consistent with the manufacturer’s recommendation, some veterinarians recommend reducing the amount of food by 25 percent and then another 10 percent every two-three weeks until 1 percent of the starting body weight has been lost. This will give you an amount to feed until the desired weight is lost. Consult with your veterinarian before starting a weight-loss program. There may be health issues that contribute to obesity or require close monitoring. Also, too drastic food or weight reductions can create problems.
In addition to exercise and diet management, some cats benefit from support for organs and glands that are stressed in the obese cat. These include the adrenal glands and liver. Any existing health problems should also be supported. For example, cats with osteoarthritis should have appropriate pain management, such as acupuncture, for improved quality of life and to encourage more activity.
If you have questions about obesity in cats and need assistance for developing a weight management plan, consult your veterinarian.
Ear problems in dogs — common challenge
(Ron Carsten - Glenwood Post Independent 3-27-15)
Ear problems are reported to be the second most common reason for taking a dog to a veterinarian. These veterinary visits cover a broad range of ear problems that include issues with the earflap (pinna), ear canal, middle ear and inner ear. Of all the ear problems, inflammation of the ear canal (otits externa) is seen most frequently.
Dogs with otitis externa will generally have some combination of head shaking, ear scratching, redness, pain, discharge or odor. Since there are numerous causes of otitis and because of the complex nature of ear disease in dogs, otitis is often challenging to treat.
It is well known that dog hearing is more acute than that of humans. They can hear about four times the distance of humans and hear high-pitched sounds. Dogs have 18 muscles that allow them to move their ears in the direction of the sound. The dog pinna comes in many sizes and shapes; some ears are erect, others are folded and hang down. Unlike humans, the dog ear canal is a very long 2 inches with a vertical portion then a horizontal portion.
It is the size, shape and length of the dog ear canal, along with the type of pinna, that can predispose dogs to otitis, can make diagnosis difficult and can make management challenging. Otitis generally starts with inflammation. Inflammation left untreated can lead to bacterial or yeast infections. With chronic otitis, the lining of the ear canal can undergo changes that are often permanent. These changes can make the otitis worse, more difficult to treat and contribute to future problems.
Issues related to otitis can be divided into groups in an effort to better understand the problem. These groups are predisposing factors, primary causes, secondary causes and perpetuating factors. Predisposing factors for otitis include a narrow ear canal, hair in the canals, pendulous pinnae, excessive cerumen production and debilitated health.
Primary causes that stimulate inflammation include allergies to food ingredients, environmental allergens (inhaled and contact), parasites, foreign bodies, thyroid dysfunction and autoimmune disease. Secondary causes include bacterial and yeast infections. They contribute to ear problems only in the abnormal ears or in combination with other issues.
Finally, perpetuating factors can prevent resolution of the
otitis and are a major reason for poor response to therapy. Perpetuating factors include microscopic changes in the lining of the ear canal caused by chronic inflammation. These changes reduce the ability of the ear canal to maintain a healthy ear environment. Over time, ongoing otitis and the chronic inflammation can lead to narrowing of the ear canal and even calcification of the canal cartilage.
Treatment and management of otitis includes identification and management of the primary cause, treating secondary causes like bacterial and yeast infections and addressing perpetuating factors. How each of these factors is dealt with depends on the primary cause and severity. Once a diagnosis is made, treatment may be as simple as removing the foreign body (i.e. grass awn) or more complex if the primary cause is an issue like allergies. The ear canal should be cleaned. Use an appropriate ear cleaning solution. Never push Q-tips into the ear canal. Sometimes cleaning requires sedation or anesthesia. For bacterial infections, antibiotics placed into the ear canal may be sufficient. However, some severe situations require the use of oral antibiotics. A number of herbal and enzyme ear products are now available that may offer some therapy advantages for bacterial and yeast infections. Control of any ongoing inflammation is important.
It is noteworthy that allergies to food ingredients and/or environmental allergens like pollen are the most common predisposing factor for otitis. It is estimated that 83 percent of dogs with allergies have otitis. In some dogs the only indication of allergies is the otitis. For the dogs with allergies, avoidance of allergens is important. Food changes may be critical. Avoiding environmental triggers and/or desensitization guided by allergy testing may be necessary. Numerous nutritional supplements and herbal remedies have been advocated for managing allergy problems. While results have been variable, some products can contribute to improved management of otitis.
For dogs with poor thyroid function (hypothyroidism), thyroid therapy should be initiated. Dogs that are susceptible to otitis after swimming should avoid getting water in the ears or use a “swimmer’s solution” regularly.
Acupuncture and laser therapy provide benefits for making management of otitis easier when used in conjunction with other therapies that address the primary cause.
If you have concerns about your dog’s ears, contact your veterinarian for a consultation.
Diabetes in cats, a growing problem
(Ron Carsten - Glenwood Post Independent 2-20-15)
As with dogs and humans, diabetes mellitus in cats is a common problem. The incidence has been increasing over the last 30 years. With an estimated seven of every 1,000 cats affected with diabetes, there are approximately 800,000 diabetic cats in the U.S. While all cats can be affected, diabetes is seen most often in middle-aged and older cats. Risk factors include obesity, genetics, dental disease, certain drugs and inactivity, especially with indoor cats.
Diabetes in cats shares similarities with diabetes in dogs, but has some notable differences. These differences are important because unlike diabetes in dogs, which is almost always type 1, 80-95 percent of diabetic cats have type 2. Type 2 diabetes occurs because insulin secretion from the pancreas is impaired. At the same time cell response to insulin becomes reduced (increasing resistance or lowered sensitivity).
Insulin is critical for control of the glucose level in blood by signaling cells to take in glucose where it is used for energy. In addition, when energy levels are sufficient, insulin signals the liver to take in glucose and store it. With type 2 diabetes, the insulin levels are low, often 80-90 percent below normal, and body cells become less responsive or insensitive to the insulin. This results in cells not being able to effectively take in glucose and liver production of glucose is not switched off contributing to the increased blood glucose. The body starts using fat as an energy source. Altered metabolism of carbohydrates, fats, and proteins occurs.
The altered carbohydrate metabolism contributes to elevated blood glucose and to glucose in the urine once the blood glucose rises high enough. It is this elevated glucose that results in increased urination and drinking. Altered fat metabolism can result in increased fat in the blood and liver changes. Cats with a reduced ability to use glucose, proteins and fats can become lethargic, lose weight, are hungrier, have a poor hair coat, experience reduced immunity and can have recurrent infections when the diabetes is not treated.
Diagnosis of diabetes in cats is based on a combination of the signs of excessive drinking, excessive urination, increased appetite and weight loss combined with persistently elevated blood glucose and glucose in urine. The presence of a persistent glucose elevation is important because cats have the ability to significantly increase their
blood glucose in response to persistent glucose elevation is important because cats have the ability to significantly increase their blood glucose in response to stress. Since this rise is temporary, it does not reflect the daily ongoing blood glucose levels. For some cats, repeating the blood glucose measurement is important to document a continuing high level. Another valuable test measures blood fructosamine. This provides information about what the blood glucose levels were two-four weeks before.
Diabetes in cats is treatable. The typical approach for treating diabetic cats is to rule out and treat diseases, such as an over-active thyroid, that can complicate management of diabetes. Drugs, like methylprednisolone, that have been linked to increased risk of diabetes should be eliminated if possible.
In the early stages of diabetes where the problem is subclinical, oral hypoglycemic drugs may be beneficial along with control of obesity and use of high protein, low carbohydrate canned foods. When the diabetes is more advanced and clinically evident, the administration of insulin is essential. Your veterinarian can provide guidance on the best approach for each individual cat. Monitoring of the blood glucose is important especially early in treatment. As the diabetes becomes controlled, some cats can have reduced need for insulin injections over time and some can go into remission. This makes ongoing monitoring vital for effective management.
In addition to oral hypoglycemic drugs and insulin, supportive care for the liver, pancreas and immune system using nutritional supplements may be beneficial. There are a number of herbs advocated for use in diabetic cats to aid in reduction of blood glucose levels. These include gymnema leaf, dandelion root, and burdock root. However, it is important to note that these herbs have not been fully evaluated to demonstrate their real value for diabetes management in cats. As a result, caution should be used to avoid potential negative complications including lowering the blood glucose too much. In addition, cats are less able to metabolize many substances compared to dogs and people, making them more susceptible to potential toxic reactions.
If you have concerns about your cat and diabetes, contact your veterinarian for guidance. Diabetes can be a complex problem to manage making regular interaction with your veterinarian valuable as you assist your cat companion with this common disease.
Diabetes affects 1 percent of dogs
(Ron Carsten - Glenwood Post Independent 1-23-15)
Diabetes mellitus is a common disease in dogs. It affects an estimated 1 in 100 dogs, and the incidence has tripled over the last 30 years. While the exact causes of diabetes are not known, there is speculation that autoimmune disease, genetics, obesity and chronic pancreatitis could be important predisposing factors.
Certain dog breeds like Australian terriers, standard and miniature schnauzers, dachshunds, poodles, keeshonds and samoyeds are more commonly affected. Occurrence in female dogs is twice that in males. The peak age for onset of diabetes is 6-9 years in dogs. Fortunately, diabetic dogs that receive treatment, and have their blood glucose controlled, have the same average lifespan as dogs of the same age and gender that are not diabetic.
There are two types of diabetes. In the dog, almost all diabetic patients are type 1; type 2 rarely occurs. Type 1 diabetes requires insulin administration and occurs because the pancreas does not produce enough insulin. Lack of insulin is a significant problem because insulin plays a critical role in controlling blood glucose. Insulin signals cells to take in glucose to be used for energy, and when there is sufficient energy, insulin signals the liver to take in glucose and store it. When blood insulin is low or absent, as with diabetes, glucose is not taken up by most body cells. When this happens, the body uses fat as a source of energy. In addition, blood glucose increases because liver production is not switched off. Altered metabolism of carbohydrates, fats and proteins occurs.
Without enough insulin, the altered carbohydrate metabolism leads to elevated blood glucose and glucose in the urine once the blood glucose rises high enough. This elevated glucose results in increased urination and drinking. Cataracts can also form. Alterations in fat metabolism can lead to increased fat in the blood and liver changes. Reduced ability to use glucose, proteins and fats can lead to lethargy, weight loss, hunger, poor hair coat, reduced immunity and recurrent infections when the diabetes is not treated.
Diagnosis of diabetes is based on elevated levels of glucose in the blood. This is important because the signs associated with diabetes — increased or excessive drinking, increased urination, weight loss, increased appetite and recurrent infections — can be caused by other health problems. A thorough history, physical examination, and blood and urine
testing are all important parts of a complete evaluation.
Diabetic dogs that receive treatment, and have their blood glucose controlled, have the same average lifespan as dogs of the same age and gender that are not diabetic.
In uncomplicated diabetes, treatment involves injection of insulin along with careful regulation of feeding time and use of specific diets. Consistent amounts and frequency of exercise are also important. Therapy is lifelong and tailored for each individual dog. There are a number of different types of insulin grouped by how long they work in the body. There are also individual responses to the insulin. Your veterinarian will provide advice on the proper selection of insulin.
Some dogs are more sensitive to insulin and will need less for optimal control of the blood glucose. These factors make monitoring of the blood glucose a critical component of establishing the optimal insulin dose initially. Periodic blood glucose measurement can be valuable to ensure that the correct insulin dose is continuing to be given. For some dogs this is a relatively straightforward process, while for other dogs, it is very challenging and sometimes frustrating. Management of diabetes can be complicated when there are concurrent disorders such as those that involve the adrenal or thyroid glands, when infections are present, when poor kidney, liver, or heart function occurs, with obesity, or if there is cancer. Urinary tract infections are common in diabetic dogs. In addition, diabetic dogs are also more susceptible to developing infections in the mouth.
Integrative care involves, in addition to insulin, nutritional or herbal support of organs that have reduced function such as the liver or kidneys. Probiotics can be used to improve the intestinal flora and have a beneficial impact on the immune system. This is especially important if antibiotics are being used to treat infections. Opinions vary on the best commercial or prepared foods to use. For example, many advocate the use of high-fiber diets while others argue that many dogs do well on moderate fiber diets.
Successful management of diabetes in dogs is based on consistency. This includes consistency with monitoring, dosing of insulin, types and amounts of food, the amount of daily exercise, and control of any concurrent problems. If you have concerns that your pet may have diabetes, contact your veterinarian for a complete discussion of this important issue.
Urinary problems are common issues for cats
(Ron Carsten - Glenwood Post Independent 11-14-14)
Feline urinary problems are the most common health issue in cats. Affected cats often have bloody urine, urinate frequently, urinate in unusual places and may strain to urinate. These signs associated with the lower urinary system have been described in cats for at least 90 years, yet the causes are still not fully understood. Currently these urinary problems are grouped together and called feline lower urinary tract disease (FLUTD). Inflammation in the urinary bladder appears to play a significant role.
Unfortunately, there are numerous causes of bladder inflammation, making diagnosis and management challenging. Sources of the inflammation include bladder stones, infections, urinary tract cancer, trauma, or a combination of stones and infections. No cause for inflammation can be identified in at least two-thirds of the cats with FLUTD, even after extensive testing. These cats fall into a classification called feline idiopathic cystitis (FIC); idiopathic meaning the cause of the bladder inflammation (cystitis) is unknown.
Cats showing signs of FLUTD should be evaluated to rule out life-threatening issues like a urethral blockage and to determine a cause if possible. Evaluation generally includes a physical examination and a urinalysis. Depending on those findings, your veterinarian may order blood work and X-rays or ultrasound.
The most common causes of FLUTD are urinary stone, urethral blockage and, mostly FIC. Interestingly, FIC shares many similarities with human interstitial cystitis. FIC cats may have blood and inflammatory cells in their urine with no recognizable cause such as stones or infection.
Crystals are often found in the urine, but are no longer felt to be the cause of the cystitis but rather the result of cats producing very concentrated urine. Cats with FIC tend to have a group of abnormalities in common, including a defective urinary bladder glycosaminoglycan (GAG) layer, neurogenic inflammation, stress and abnormal responses to stress. The GAG layer protects the bladder wall cells against damaging substances found in urine. In FIC, this GAG layer is insufficient, allowing damage and irritation to occur, leading to inflammation.
Neurogenic inflammation can occur when nerves in the
bladder wall are stimulated by local irritation or sometimes stimulation by the brain as part of a stress response. This nerve stimulation can result in release of neurotransmitters that can worsen local inflammation and pain. Stress can initiate FIC episodes. Affected cats have an adrenal gland and brain response to stress that is abnormal.
Since FLUTD issues can be complex, it is important to use a variety of therapeutic and supportive approaches. These approaches include dietary management, modifications to the environment, supplements, herbs and drugs including antibiotics, anti-inflammatories and pain medications as indicated.
The main goal of dietary management is to encourage more drinking and urination by feeding canned foods. More water intake contributes to more dilute urine and more frequent urination. Special diets are indicated for cats with specific problems such as bladder stones. Offering fresh water in multiple locations, using bowls that cats often prefer (i.e. shallow), or offering running water (a pet fountain) can also have a beneficial impact on water consumption and frequency of urination. Using multiple litter boxes placed in quiet, strategic locations can help promote more frequent urination.
Identifying stresses and striving to eliminate them or reduce them can be important. Enriching the environment with cat toys, hiding place, and scratching posts can be helpful. Managing issues like osteoarthritis can be important for improving litter box use, increasing activity and reducing stress.
Antibiotics are important for bladder infections. Chinese herbs, cranberry and marshmallow, for example, have been used to manage FLUTD problems. Products like Feliway and Rescue Remedy can help reduce stress. Improvements in adrenal gland function using herbs and supplements may help with stress responses and inflammation. Nutrients like vitamin A can be beneficial for the urinary bladder lining cells (be cautious to not over supplement). Injectable and oral glucosamine products may offer benefits for the bladder GAG layer and help arthritic joints.
If your cat is showing any signs of urinary problems such as frequent urination, straining to urinate, not using the litter box properly or blood in the urine, a visit to your veterinarian is important.
Osteoarthritis, a common problem that is not just for old dogs
(Ron Carsten - Glenwood Post Independent 10-10-14)
Osteoarthritis is the most common joint disease and the most common cause of chronic pain in dogs. It is a degenerative process that involves loss of joint cartilage, local tissue damage, ongoing inflammation and formation of new bone at joint surfaces and margins.
OA is often associated with large dogs, but all sizes and all ages of dogs can be affected. The typical age of onset varies by dog breed and contributing factors like malformations, traumatic injuries or obesity.
While the initiating causes of OA are not always clearly defined, one fundamental component is damaged joint cartilage. This damage can be caused by excessive forces on normal cartilage or even with normal forces if the cartilage is abnormal or defective. Conditions that result in excessive forces on normal cartilage include defective joint development, limb deformities, cranial cruciate disease or incorrect joint alignment.
Certain breeds are predisposed to joint disease; genetic factors can play a role in defective joint development as seen with hip dysplasia. Environmental factors like the amount of exercise, body weight and diet can affect the onset, severity and rate of progression. Overfeeding growing puppies can result in rapid growth that increases bone length and body weight. In addition, excess weight predisposes the aging dog to OA.
Generally, dogs with OA appear to be suddenly lame following episodes of minor trauma or excess exercise on an already-diseased joint. Stiffness after rest is often seen before obvious lameness. The stiffness typically resolves in just a few minutes after rising from rest. Lameness, stiffness, and pain may be worsened by long periods of exercise, cold conditions and obesity.
Some dogs may experience depression, loss of appetite or become aggressive as a result of their discomfort. Affected joints may be swollen, normal joint movement may be restricted, and pain may be detected at the limits of extension and flexion. Heat and redness are usually not seen unless there has been trauma or an infection is present. Diagnosis is often based on history, examination and X-rays.
OA is a progressive problem with no cure. The goal of therapy is to manage the OA in a way that maintains quality of life and slows progression. Early intervention is important. Therapy can be divided into broad areas including lifestyle changes, nutritional supplements, herbs, acupuncture, medical treatments and rehabilitation techniques. Many obese dogs no longer have signs of OA or can be more easily managed once they reach their ideal body weight. Appropriate levels of exercise are important. Inactivity can lead to tissue and muscle weakness along with joint stiffness that makes therapy more complicated. In contrast, overexercise can make the OA condition worse by accelerating the degenerative process.
A range of nutritional supplements, nutraceuticals and herbs are available. The focus is to facilitate improved tissue health and function even in the face of the ongoing degeneration. Nutritional supplements and tissue extracts that can support the ligaments and joint capsule can contribute to improved stability. Some products like glucosamine and chondroitin have been shown to be anti-inflammatory and reduce cartilage damage. Essential fatty acids found in fish oil prevent inflammation and reduce degradation of the cartilage. Herbs like Boswellia serrata improve lameness and reduce pain. Acupuncture can be useful, especially if pain is present.
Dogs experiencing pain are often given nonsteroidal anti-inflammatory drugs. However, other pain medications can be combined with the NSAIDs for a multimodal drug therapy. The value of this multimodal approach is that the dose of individual drugs can often be reduced while improving pain management.
A key to effective management of OA in the dog is early recognition. Combining nutritional supplements with lifestyle changes (including obesity management) should be part of the initial approach. Manual therapies like massage, passive range of motion exercises and other rehabilitation approaches can help to maintain improved joint fitness and comfort. Intervention with NSAIDs and other pain medications along with acupuncture can be layered on the foundation created by the above supportive methods.
If you feel that your dog has OA or you have questions, please contact your veterinarian.
Cognitive dysfunction in aging cats is a common problem
(Ron Carsten - Glenwood Post Independent 5-16-14)
It is estimated that there are more than 82 millions cats in the United States. In the last 20 years there has been a 40 percent increase in cats older than 7 years of age and a 15 percent increase in those older than 10 years. More than 10 percent of cats are greater than 10 years of age. Clearly cats are living longer. As with humans, aging cats are increasingly impacted by age related problems like cognitive dysfunction, osteoarthritis, chronic kidney disease, systemic hypertension, reduced vision and hearing loss. At least 28 percent of cats 11-14 years of age develop at least 1 age-related behavior issue that reflects decline in mental functioning. By 15 years and older, 50 percent of cats exhibit behaviors like aimless wandering and vocalizations. These declines in mental functioning have been collectively referred to as cognitive dysfunction syndrome (CDS).
Signs of CDS include changes in behavior, inappropriate elimination, altered interaction with family, inappropriate vocalizations, and changes in sleep/wake cycles and activity. It is important to determine that these behavioral changes are not caused by other medical conditions. For example a cat with osteoarthritis may have inappropriate eliminations outside the litter box because they have difficulty stepping into a box with high sides. In addition, a cat with osteoarthritis may avoid interaction with family members because of discomfort. Dental problems can result in reduced appetite. Vision changes can be caused by systemic hypertension impacting on the retina. Uncontrolled diabetes can cause increased urine and often urination outside the litter box.
Since there are numerous medical problems that can appear like CDS, it is critical to have a complete evaluation by your veterinarian before deciding that your cat has age-related CDS. This evaluation will include a full history, complete physical examination including blood pressure measurements and mobility assessment, blood testing (including a complete blood count, chemistry profile and thyroid), and urine evaluation. These results can lead to a recommendation of further testing which may include X-rays, ultrasound, ECG, biopsies, or feline leukemia testing.
The causes of CDS in cats are not yet fully understood, but it is likely that a combination of factors leads to brain dysfunction. These factors include decreases in blood flow to the brain resulting from changes in the brain blood vessels, reduced output of blood from the heart, and altered blood
viscosity. This diminished blood flow to the brain can cause lowered oxygenation of the brain and reduced delivery of nutritive substances and removal of cell metabolism products. Excess levels of free radical compounds can lead to cell damage. In addition, age-related loss of nerves and nerve connections in the brain can occur.
Cats with CDS can appear to be disoriented or confused; they can get trapped in corners or forget where their litter box is located. Behavioral responses change; they can be more irritable, have increased anxiety, or have reduced responses to stimuli. There may be changes in sleep/awake cycles with a tendency to sleep during the day and be awake at night. They may vocalize inappropriately, especially loud crying at night. Many cats will aimlessly wander or pace. Eating patterns can change with either an increased or, more commonly, a decreased appetite. There may be a reduction in grooming. Memory loss may occur.
Cats with CDS can appear to be disoriented or confused; they can get trapped in corners or forget where their litter box is located.
Although there are no published studies documenting effective therapy in cats, studies have been published in other species and form the basis for current recommendations. Treatment and supportive care include diet changes, environmental management, and possible drug treatments. Dietary changes are focused on supplying foods (vegetables and fruits) with increased levels of antioxidants to reduce damage caused by the free radicals. Increased levels of vitamins C and E, essential fatty acids, beta-carotene, and L-carnitine may be beneficial. Environmental enrichment can lead to an increase in cognitive function especially in conjunction with dietary changes. However, once cats have significant CDS signs, changing the environment may actually lead to increased stress and negative effects because these cats may be unable to adapt to these changes. A number of drugs have been used in cats including selegiline, buspirone and fluoxetine with varying success; however, studies in cats are lacking.
If you suspect your cat has CDS, contact your veterinarian for an evaluation to make sure there are no other age-related diseases that mimic CDS signs or are contributing to declining cognitive function. Since many older cats have multiple problems, a complete evaluation is essential for diagnosis and planning. Early supportive care for CDS appears to slow progress of dysfunction and helps to maintain quality of life.
Heartworm infection in dogs
(Ron Carsten - Glenwood Post Independent 4-29-14)
Heartworm (Dirofilaria immitis) infection in dogs has been reported in all U.S. states. The highest numbers are in the Southeast and Mississippi River Valley with infection rates in some areas as high as 45 percent. In 2001, approximately 240,000 cases were diagnosed in the U.S. The mosquito is an essential part of the heartworm life cycle. This means that the incidence of heartworm varies between regions and climates relative to the mosquito populations. In Colorado, the regions of most concern are Grand Junction and Front Range areas. Dogs living in or traveling to these areas, especially during the mosquito season are at higher risk. Fortunately there is a simple blood test to detect heartworm infection and there are effective preventive drugs.
The life cycle of the heartworm is interesting and complex. In a dog infected with heartworms, adult heartworms live in the pulmonary (lung) arteries and to a lesser extent in the right ventricle of the heart. After mating, the adult heartworm releases microfilaria (baby heartworms) into the blood. Female mosquitoes ingest these microfilaria while feeding. Then the microfilaria undergo two molts over 8-17 days in the mosquito. At this stage, they can be injected back into a dog at another feeding where a third molt occurs over 1-12 days. A final molt occurs over 50-68 days to become an immature adult. Immature adults enter the bloodstream and migrate to the heart and lungs where they mature. Amazingly, male heartworms grow to about 15-18 cm and the female to 25-30 cm. Mating occurs and production of microfilaria begins. The complete life cycle takes about 184-210 days with microfilaria found in the circulating blood at 7-9 months. Adult heartworms are known to live 5-7 years and microfilaria up to 30 months. Interestingly, heartworm molting and maturation are dependent on the presence of a symbiotic bacterium.
Signs seen in dogs with heartworm infection range from no signs (majority of dogs) to weight loss, reduced ability to exercise, cough, difficulty breathing, and formation of abdominal fluid. Heart murmurs and arrhythmias may occur. The severity of signs depends on the number of worms, length of infection, and the dog’s reaction to the heartworms. Heartworm numbers have been reported to range from 1 to over 250. The worms can produce a toxic substance, induce an immune reaction, cause damage to
the lining of the blood vessels, and in severe cases create blockage of blood vessels. Dead heartworms can block arteries and form emboli.
Diagnosis is made using blood to test for adult heartworm antigens. Dogs with a positive antigen test generally have a second confirming test performed followed by a test to look for the presence of microfilaria. Additional evaluation includes other blood tests and chest X-rays. This information is important for planning treatment. Depending on the severity of infection and clinical signs, complications associated with treatment can be challenging. Melarsomine has been approved for treatment of adult heartworms but it is in critically short supply. The American Heartworm Society has developed guidelines for treatment and care when melarsomine is unavailable.
It is clear that heartworm infection can cause serious problems and be challenging to treat. However, preventive steps can be taken, including monthly administration of a preventive product such as Heartgard, Interceptor, or Revolution.
Our region does not yet have an endemic heartworm problem even though we live in a river valley. However, common recommendations for reducing the individual risk here include annual testing for heartworms even when your dog never leaves the valley, use of the monthly preventive year round or at least during mosquito season, and not traveling with your dog to a heartworm area during mosquito season. Annual testing can be important to make sure that infections are identified and treated early especially because a small number of dogs become positive even while taking the preventive.
Alternatives to the monthly preventive drugs have been proposed including the use of herbs like walnut and wormwood, and homeopathic remedies. Unfortunately, none of these proposed approaches have been adequately evaluated to determine their efficacy. In addition, there is concern about toxicity with the use of wormwood-containing products. Therefore, it is important to be fully informed before using these products.
Heartworm infection is a serious problem that is preventable. Even though we live in an area that is relatively free of heartworm problems, it is still valuable to discuss this issue with your veterinarian and establish a proactive approach for protecting your dog companion.
Osteoarthritis, an under-recognized problem in cats
(Ron Carsten - Glenwood Post Independent 3-26-14)
The U.S. cat population is aging. In the last 10 years, the percentage of cats over 6 years of age has grown from 24 percent to 47 percent, the percentage over 10 years of age has grown 15 percent, and the percentage over 15 years of age from 5 percent to 14 percent.
As the cat population ages, there is an increasing awareness that they are affected by osteoarthritis (OA) just like dogs and other species. This recognition is important because traditionally it has been assumed that cats do not suffer from OA, mainly because cats generally don’t show lameness like dogs. However, it is now clear that cats are affected by OA.
Over 90 percent of cats over 12 years of age are reportedly affected. Instead of lameness, affected cats show their chronic pain through changes in lifestyle and behavior, including loss of appetite, weight loss, poor grooming habits, urination or defecation outside the litter box, reluctance or inability to jump on or off objects, change in attitude, irritability when handled and prolonged sleeping.
OA is a progressive, degenerative condition affecting joints. The cause and contributing factors in cats are poorly understood. Over time, the normal cartilage in the joints breaks down; pain results from inflammation, bone on bone contact, formation of bone spurs, and other degenerative changes affecting the joints and surrounding tissues. The most commonly affected joints are the elbows and hips; however, shoulders and hocks are also reported. Significant numbers of cats have OA involving the spine and sternum. Since OA is a progressive problem, it should be actively managed with the goal of slowing progression, preserving remaining joint function, and maintaining quality of life.
Interestingly, OA in cats can be difficult to diagnose even for experienced veterinarians. Cats appear to be very tolerant of severe joint disease because of their small body size and normal agility. Diagnosis is complicated by the fact that most cats do not like to be examined and generally do not walk around the veterinarian’s examination room. In addition, the degenerative changes associated with OA in cats are subtle. Obvious reduced joint range of motion and crepitus (grinding or crunching) are uncommon in the cat. Thickening of the tissue around the joints is common in cats, but the extent is not always easy to completely appreciate.
X-rays can be valuable, but a large number of cats with OA associated pain do not show OA changes on X-rays. As a result of these challenges, the owner observations at home are essential for alerting the veterinarian that there is a potential OA problem.
Treatment options have been limited, due primarily to a lack of research focused on cat OA. Information from dogs and other species cannot be easily or reliable extrapolated to cats because cats metabolize drugs differently and the causative factors leading to OA are unclear. Management methods include using litter boxes with lower sides for ease of entry and exit, elevating the food and water bowls to reduce the amount of bending during feeding, providing soft bedding to increase comfort, reducing or eliminating the need to jump up on the sofa, windowsill or other favored location through the use of a ramp or series of small steps, and spending time grooming the cat.
Some authorities recommend the long term use of specific non-steroidal anti-inflammatory drugs (NSAID) based on their use outside the U.S. As with all NSAID drugs, there is the potential for side-effects that may involve the stomach and intestines, kidneys, heart, or liver, especially in cats. A complete evaluation and discussion with a veterinarian should occur before initiating any NSAID therapy. Supportive therapies that have been shown to increase activity of cats with OA include diets high in glucosamine/chondroitin, green-lipped mussel extract, and fish oil. Acupuncture can be a valuable addition to the support plan. For pain not effectively managed by these options, drugs like buprenorphine, gabapentin, tramadol, and amantadine have been advocated.
Since pain is difficult to assess in cats, determination of response to therapy is based on owner observations, such as increased mobility, increased activity levels, improvements in appetite and return to previously normal behaviors. Therefore, close communication between the veterinarian and the cat owner is essential for optimal management of OA in cats.
If you suspect your cat has OA, contact your veterinarian so that a complete discussion, evaluation, and comprehensive plan for therapy can be developed. Slowing the progression of OA and managing any associated pain can improve the quality of life for your cat companion.
Liver disease affects many dogs but is hard to diagnose
(Ron Carsten - Glenwood Post Independent 2-21-14)
Liver disease is a leading cause of death in dogs. Unfortunately, signs of liver disease in dogs are generally vague and indistinct, making it difficult to recognize early. The term liver disease describes a wide range of liver problems that includes infectious diseases, inflammatory problems, toxicities, genetic issues, and cancer.
The liver is a large organ found in the abdomen next to the diaphragm. It is predominantly composed of liver cells, bile ducts, and blood vessels. Bile ducts connect to the gall bladder. Incredibly, the liver has tremendous functional reserves: three-quarters of the liver can be removed and still maintain appropriate function while regenerating. This reserve plays an important role in maintaining liver function.
The liver is responsible for maintaining optimal health through an incredible range of metabolic activities including carbohydrate, protein and fat metabolism; detoxification; vitamin, trace mineral, and glycogen storage; and bile production. The liver is intimately associated with the digestive tract with blood from almost the entire digestive tract entering the liver for processing before moving to the rest of the body. This is important for removing toxic substances from the blood before they can harm the rest of the body. In addition, the liver is in a prime location for dealing with bacteria that have inappropriately passed through the intestinal wall. These bacteria are attacked by white blood cells that are specifically maintained in the liver for that purpose. This also means that good intestinal function is critical for a healthy liver. Like all other organs, the liver relies on a steady blood flow from the heart to deliver oxygen and important nutrients and to remove cellular waste products. Clearly good heart function and blood flow are important for proper liver activity.
With its central role in maintaining health through its vast metabolic activities, the liver can be affected by a range of problems. Some problems like bacterial infections, inflammatory conditions of the liver (hepatitis) and bile ducts, or abnormal liver cell function directly involve the liver. Other problems are caused by disease in other organs or glands such as intestinal wall dysfunction, excess production of steroid (cortisol) by the adrenal glands, inadequate blood flow to the liver, or pancreatitis.
Signs of liver disease are typically vague and can range from “just not doing right” to vomiting, diarrhea, increased thirst and urination, or even seizures. From a diagnostic perspective these signs do not clearly focus on the liver. Adding to the diagnostic complication is that some problems like ingestion of a poison can cause damage very quickly while others like a chronic hepatitis can occur slowly over time. Diagnosing liver disease involves a number of steps starting with blood tests for liver enzymes like ALT (alanine aminotransferase) and ALP (alkaline phosphatase) that are released into the blood. A healthy liver releases these enzymes at a relatively constant rate while an unhealthy liver or a liver being damaged by indirect causes will typically have an increased release of these enzymes.
Unfortunately, these enzymes do not evaluate function since they leak from liver cells (ALT) or can be induced by poor bile flow (ALP). In addition, these enzymes can be increased by drugs like phenobarbital, NSAID, and steroids; muscle damage; or congestive heart failure. Measurement of bile acids before and after a meal can provide information about liver function. Levels of albumin, coagulation proteins, and bilirubin also provide insight into liver function but generally change only late in the course of disease. X-rays, ultrasound, and liver biopsies may be required to obtain a final diagnosis.
Treatment of liver disease depends on the cause and severity. Addressing the initial insult is essential if it can be determined, however, it is not always possible to identify. In most situations, regardless of the initial cause, it is important to provide supportive therapy for the liver itself. This can be done by diet changes and using products that support liver cell function including SAMe, herbs like milk thistle and schisandra, vitamins C and E, and bile acid products. Intravenous fluids and antibiotics may be required initially in some situations. Additional support of the intestinal tract with probiotics and glutamine may be beneficial as well as herbs that help move bile like dandelion.
Liver disease is a significant problem in dogs. It has a wide range of causes. Unfortunately, signs of liver disease are ambiguous and similar to many other problems. If you have concerns about your dog, contact your veterinarian and discuss blood testing for liver problems and supportive care if needed.
Marijuana intoxication can harm your pets
(Ron Carsten - Glenwood Post Independent 1-18-14)
With the increasing availability of marijuana (Cannabis sativa) in Colorado, pet exposure to marijuana has been on the rise. Dr. Meola et.al. reported in 2012 that there was a 146-fold increase in registered medical marijuana users in Colorado, and a 4-fold increase in dogs presented for marijuana toxicosis from 2005-2010 in two large Colorado Front Range veterinary emergency centers. There were two deaths out of 125 marijuana intoxicated dogs. The deaths were likely from ingestion of highly concentrated medicinal products. Pet Poison Helpline, an animal poison control center has also experienced a 200-percent increase in pet marijuana cases over the last 5 years. Significantly more dogs than cats appear to be involved.
Pet exposure occurs through secondhand smoke and direct ingestion of marijuana or foods containing marijuana. Most exposure appears to be unintentional but there is increasing interest in the use of marijuana for pain management, appetite stimulation, and prevention of vomiting in pets with cancer. Unfortunately, there currently is little research documenting the benefits of marijuana consumption, the optimal dosages, or details of how marijuana works in pets. With concerns about potential toxicity and lack of scientific documentation, a cautious approach is recommended until more research can be completed and standardized marijuana preparations become available.
More than 400 chemicals have been identified in marijuana; over 60 of these are cannabinoids including the major psychoactive compound cannabinoid δ-9-tetrahydrocannabinol (THC). Whole marijuana has not been approved by the FDA for medical use, however, cannabinoid-based drugs like Nabilone and Dronabinol (synthetic cannabinoids) are available by prescription in the United States. An extracted cannabinoid, available in Europe, is currently undergoing clinical trials in the United States. In humans, indications include pain, loss of appetite, and control of vomiting in cancer and AIDS patients.
The amount of marijuana required to cause a toxicosis in dogs or cats is dependent on the THC concentration. THC concentration is variable between plant varieties, plant part used, and growing and storage conditions. The minimum lethal dose of THC for dogs is considered to be 3g/kg of body weight. Effects of intoxication are seen 30-90 minutes after ingestion and most resolve over a period of 3-12 hours.
However, effects can last up to 4 days while the body is detoxifying. Signs of intoxication can include severe depression, walking as if drunk, lethargy, and even coma. Some pets have low heart rates, low blood pressure, depressed respiration, diarrhea, and dilated pupils. Others can be hyperactive, vocalize, and even have seizures. Vomiting is often seen with dogs even though THC has anti-vomiting properties. Intoxicated pets may lack the coordination necessary to consume food and water and may be prone to dehydration and injuries related to falling.
Use of the human urine test for dogs to detect THC has been controversial. Recent studies show inconsistent ability to detect THC in dog urine resulting in false negative results. This creates a problem for diagnosis because even though serious long-term health issues and fatality from marijuana intoxication have been extremely rare, the newer, highly concentrated medical strains of marijuana and synthetic cannabinoids have more potential for serious problems. A further concern is that marijuana toxicosis appears similar to other serious poisonings like antifreeze and other drug intoxications. Toxicity in pets can also occur from chocolate and xylitol which may be ingredients in foods mixed with marijuana.
While most pets with marijuana toxicosis recover with no problems, caution is warranted. Vomiting can be induced by your veterinarian to reduce the potential for toxicity if you discover the marijuana ingestion within 30 minutes and your pet has no signs. Some authorities also recommend giving activated charcoal after marijuana ingestion in an attempt to reduce the absorption in the digestive tract. Supportive treatments include keeping the pet warm and minimizing sensory stimuli. Pets with severe agitation may require sedation. Intravenous fluids may become necessary if prolonged vomiting has occurred or if the pet is unable to drink for an extended period.
Significant optimism exists about the potential benefits of marijuana for pets. However, a great deal of research still needs to be completed, especially with the newer, high THC concentration products. Therefore, even though serious health problems have been rarely reported in pets, a cautious approach is important. Marijuana toxicosis can also mimic other more serious poisonings. Contact your veterinarian if you have questions about marijuana toxicosis in pets or if you suspect your pet has ingested marijuana.
Keeping the holidays safe for your pets
(Ron Carsten - Glenwood Post Independent 12-19-13)
Holidays are a time of joy and sharing with family and friends. Pets are an important part of our families, so it is essential to consider their safety needs during the holiday season.
Many common holiday items can pose dangers for our pets, especially because pets often do not understand the consequences of their own actions. Potential dangers include chewing and swallowing holiday items like ornaments, decorations, electrical cords, toxic plants, foods and toys. Results can range from mild harm to the mouth to severe life-threatening emergency situations.
When decorating your home for the holidays, keep in mind that decorations can be intriguing for pets and invite play. This play can involve chewing and sometimes ingestion. Some chewed items like glass ornaments or light bulbs can injure the mouth and, if swallowed, can injure the esophagus, stomach or intestines. Chewed electrical cords can cause electrical burns and electrocution resulting in damage to the mouth and even death. Swallowing tinsel, strings, small ornaments and hooks can cause serious injury to the stomach and intestines requiring surgery to remove or repair. In addition, holiday decorations can contain heavy metals that can be toxic when ingested.
Avoid these hazards by pet proofing your holiday home. Keep tinsel and popcorn strings out of reach of your pets. Don’t leave your Christmas lights plugged in when you are not able to monitor your pet. Food should not be placed into wrapped packages that pets have access to. Toys should be designed for pets; be aware that small eyes and squeakers can be swallowed, stuffing can be eaten, and threads can be interesting to pull on and swallow. Treats should be pet-friendly and avoid ingredients that can be harmful and food should be fresh so that food poisoning does not occur. Holiday plants should be placed so that pets cannot chew or ingest them.
Foods and food ingredients to avoid include chocolate, onions and garlic, candy and sugarless gum with xylitol, bones, leftover fatty meat scraps and foods that have been left out for long periods of time. Chocolate toxicity depends on the amount of chocolate ingested and the type. Small
amounts of chocolate may only cause a mild upset withsome vomiting and diarrhea, while larger amounts may result in agitation, elevated heart rate, abnormal heart rhythms, seizures and collapse. Cats are more sensitive than dogs to the effects of onion and garlic. Depending on the amount ingested and the sensitivity of the individual, damage to the red blood cells can occur along with nausea, vomiting and diarrhea. Xylitol can cause low blood glucose and liver problems in dogs. As with chocolate, the severity of toxicity is dose dependent – only one piece of chewing gum may be enough to cause problems in a 10 pound dog.
Bones can become lodged in the stomach or intestines and result in mild (digestive upset) to severe problems (blockage) that require surgery. Leftover fatty meat scraps can potentially lead to severe inflammation of the pancreas (pancreatitis) resulting in abdominal pain, vomiting and bloody diarrhea. Foods left sitting for long periods of time can give the opportunity for bacteria like Salmonella or E. coli to grow. These organisms have the potential to cause food poisoning or bacterial contamination. Severe intestinal problems and illness can result from this food contamination. According to Colorado State University Extension, when the room temperature is less than 90 degrees, food should not be left out for more than 2 hours and cooked leftovers should be used within 4 days.
Common holiday plants include the poinsettia, mistletoe, lilies, and holly. Poinsettias are no longer considered to be highly toxic to pets. The milky white sap of the poinsettia can cause a mild self-limiting oral irritation, salivation and vomiting. Mistletoe is also currently considered to be less toxic than thought in the past. Ingestion of the American mistletoe leaves or berries may result in some vomiting and lethargy. Lilies like the tiger, Asiatic, Easter and day lilies are dangerous for cats. Ingestion of 1-2 leaves or flower petals can result in sudden kidney failure. Holly leaves are considered to be more of an irritation to the mouth from the spiny leaves while the berries can cause stomach and intestinal upset.
The best policy is to make your holiday home pet safe and monitor your pets so that you can have a quiet and enjoyable holiday season. Contact your veterinarian if you have any concerns about your pet.
What you should know about kidney disease in cats
(Ron Carsten - Glenwood Post Independent 11-17-13)
Chances are if you have a cat or know someone with a cat, you have encountered feline kidney disease. Kidney disease is one of the most common problems in cats.
Cats older than 7 are most at risk, and nearly 30 percent of cats older than 10 are affected. This is a concern because proper kidney function is vital to life. These incredible organs do more than just filter blood to form urine and eliminate metabolic waste. They also play an important role in blood pressure regulation, vitamin D activation, blood electrolyte and acid-base regulation and fluid balance, and they produce a hormone signal that is critical for red blood cell production and prevention of anemia.
These functions are continuously performed by a pair of kidneys that are normally only 2-1/2 inches long in the cat. Despite their small size at only 0.5 percent of the total body weight, they receive 25 percent of the blood pumped by the heart. At the microscopic level, it is the nearly 200,000 nephrons that are responsible for important functions of the kidney, and it is the loss of functioning nephrons that results in kidney failure.
There are many causes of kidney failure in cats. Some damaging insults cause sudden kidney failure (also known as acute renal failure or ARF). These insults include antifreeze poisoning, urinary obstruction, plant toxins, certain drugs like the non-steroidal anti-inflammatory drugs (NSAID) or certain antibiotics, heart failure, and bacterial infections of the kidney. Generally, if these problems are appropriately treated, kidney function can be restored.
Chronic kidney disease (CKD), on the other hand, generally evolves over time. Diseases that contribute to CKD include bacterial infections of the kidneys, ongoing inflammatory conditions, cancer, immune disorders and exposure to toxins and certain drugs. Since CKD is typically a slowly progressing problem and the kidney has tremendous ability to compensate and continue to perform its vital tasks, affected cats generally don’t show illness until the disease is advanced. Underscoring this point is the recognition that the ability of the kidney to concentrate urine does not start to decline until 2/3 of kidney function has been lost, and the
creatinine blood value does not rise until approximately 3/4 of kidney function has been compromised. Diagnosis of kidney failure is made by blood tests measuring the blood urea nitrogen (BUN) and creatinine. Analysis of urine and other evaluations like abdominal X-rays and ultrasound can provide valuable information. Early indications of kidney problems can be subtle and may only be seen as increased water drinking and increased urination. As the kidney function continues to decline and the cat becomes increasingly unable to effectively detoxify, they can become depressed, lose their appetite, experience vomiting, and if the toxicity is severe enough, ulcers in the mouth may develop. Since the kidney has many more functions than just detoxification, the cat may also experience high blood pressure that can contribute to injury to the retinas of the eye, become anemic, become continuously dehydrated, and have problems regulating potassium and phosphorus.
Once kidney disease is diagnosed and contributing causes identified, treatment can be initiated. For ARF, the main goals are to restore hydration, work to flush out the toxins, address contributing factors, control any nausea and vomiting, and maintain food consumption. For CKD, treatments are based on the stage of severity. Generally for cats that are ill, efforts are focused on stabilizing the cat, slowing progression of the deterioration of the kidney, and maintaining quality of life. Unfortunately, in most cases of CKD it is not possible to return the kidney to normal function. Treatment and supportive approaches depend on severity and may include fluid injections, special diets, phosphorus binders, blood pressure medications, stomach acid blockers, and steps to combat anemia. Affected cats are monitored carefully for progression and support therapy modified accordingly. The integrative approach may include the addition of acupuncture, omega-3 fatty acids, herbs and supplements. While specific studies are not always available for every supportive approach, numerous clinical observations indicate that these supportive methods can be beneficial for the long-term care and comfort of affected cats.
Contact your veterinarian if you suspect your feline companion is showing any signs of kidney problems. It is always best to start supportive care early.
Nearly every dog and cat is affected by this disease
(Ron Carsten - Glenwood Post Independent 10-26-13)
When was the last time you looked at your dog’s or cat’s teeth and gums? You might be surprised by what you see.
Periodontal disease affects almost all dogs and cats at some point in their lives and contributes to increased risk of heart, kidney, and liver disease similar to humans. Understanding periodontal disease is the first step toward recognition and successful management. Over 80 percent of dogs and 70 percent of cats over 2 years of age are affected. The frequency of disease increases with age and affects almost all dogs by 5 years of age. This makes periodontal disease the most common health problem seen in dogs and cats.
Periodontal disease involves two distinct inflammatory conditions. The first inflammatory condition affects the gums and is called gingivitis. The second inflammatory condition is called periodontitis because the gums, tooth attachment tissues, and the associated bone are affected. Any dog or cat can be affected, but, periodontal disease is most common in small and toy breeds such as the toy poodle, Yorkshire terrier, and Maltese. There are a number of factors that contribute to periodontal disease including small mouth size with crowded teeth and a genetic predisposition. In addition to bad breath, periodontal disease can result in mouth pain, difficulty eating, and tooth loss. Also a big concern is that bacteria and bacterial toxins from the mouth can be shed into the bloodstream. This means that the larger the amount of bacteria and bacterial toxins in the mouth the greater the risk of heart, kidney, and liver disease.
Periodontal disease starts out as gingivitis. This inflammation in the gum tissue is a reaction to the soft food particles and bacteria (plaque) accumulating in the area where the gum tissue attaches to the tooth. In addition to bad breath, swollen and bright red gums, minor bleeding may occur when toys or rawhides are chewed. Gingivitis is the initial stage of periodontal disease. It is considered reversible with appropriate care involving removal of the plaque and calculus and daily teeth brushing. Regular daily brushing is recommended because, when plaque is mixed with saliva and minerals in saliva, it quickly hardens into calculus.
While teeth brushing is considered the best home care, not all dogs and cats allow their teeth to be brushed. Other care
options include dental diets, special chews, water additives, and certain toys. Some dental diets work by mechanically breaking up the plaque and binding calcium in the saliva to reduce calculi formation. Chlorohexidine-based oral products and zinc ascorbate gels have been shown to reduce plaque accumulation and can reduce the bacteria that cause periodontitis. Unfortunately, these approaches may not completely control the problem, therefore, it is important to be aware that a dental cleaning and polishing under general anesthesia may be recommended by your veterinarian. General anesthesia is important because it allows the veterinarian to carefully clean the plaque and calculi in the gum sulcus and between the teeth that may not be visible without a thorough inspection. Also, overgrown inflammatory gum tissue can be removed, and a search for periodontal pockets can be completed.
Gingivitis can progress into periodontitis where the gums and the tissues that attach the tooth to the jaw bone become inflamed and the tooth attachments can breakdown. Periodontitis can fluctuate between periods of active inflammation and no inflammation. Therefore, there are periods of time where the mouth looks stable and periods of rapid decline. The severity of the periodontitis is graded based on the depth of periodontal pockets, the amount of gum tissue destruction, and the amount of bone loss around the tooth root. In some cases, the complete extent of the periodontal disease can only be determined with an X-ray.
Diseases such as diabetes, feline leukemia virus, and anemias can play a role in progression of periodontal disease. Treatment of periodontitis requires antibiotics, general anesthesia, a complete dental cleaning, and surgical correction of periodontal pockets. In addition to daily teeth brushing, use of dental diets, and appropriate oral rinses, long term management may be improved with the addition of foods that provide increased vitamins such as vitamin A and C that are supportive for the gums and connective tissues and immune system. Oral probiotics have potential benefits. Additionally, probiotics can be supportive of a healthy immune system and have benefits following antibiotic use.
Since your pet is likely affected, contact your veterinarian to discuss periodontal disease. Prompt treatment is essential for long term health in the mouth and the entire body.