National Pet Diabetes Awareness Month

By Brianna Backlund, DVM, DACVIM

Thursday, November 21, 2013

As the holiday season approaches, thoughts of pumpkin pies, gingerbread houses and sugar plum ferries occupy a lot of our free time. I’ve heard many people joke about going into a diabetic coma after taking in too much sugar. You may not realize that, although it’s not quite as straightforward as that, our canine and feline family members too can have serious consequences from an imbalance in blood sugar levels.

Is your cat or dog drinking a lot of water and urinating more than usual? Is your dog losing weight despite a good appetite or is your cat overweight? If so, then you might take them to your primary care veterinarian for screening for diabetes mellitus. Cats and dogs can also develop diabetes, just as humans can. One in 50 to one in 500 cats have diabetes and one in 100 dogs reaching 12 years of age has diabetes.

Diabetes mellitus results from the body’s cells not being able to use glucose taken in from food or made by the body for energy. This disease can develop due to a variety of underlying causes that can make the disease more complicated, but with uncomplicated diabetes mellitus, its original diagnosis is actually quite straightforward. In order to make the diagnosis, your veterinarian will simply need to collect blood and urine samples for testing with the goal of identifying high blood glucose levels with glucose in the urine. Just like people, diabetic pets often need a diet change as well as injections of insulin to allow glucose to enter the cells and provide them with the needed energy to function. Many of the insulin types used are the same as those used for human diabetics. As you can imagine, it is difficult to manage a human with diabetes. It can be just as difficult, if not more so, to undertake this care for a diabetic dog or cat.

As a general rule, this is a chronic disease condition that can respond well to appropriate insulin injections. If these subtle signs however have gone unnoticed for an extended amount of time, the body can only cope for so long without an appropriate supply of energy to the cells and your pet can develop an emergent condition called diabetic ketoacidosis (DKA). When your pet becomes very ill with DKA, they will most likely need to be taken to the ER for hospitalization, monitoring, supportive care, and starting insulin therapy.

If you have worries about your pet and feel that they are demonstrating some concerning signs, please take them in right away to your veterinarian for evaluation and to discuss diabetes mellitus in more detail.

Case Study: Wild Mushrooms – Playing Roulette if You Eat Them for Dinner

Friday, November 8, 2013

By Beth Davidow, DVM DACVECC

It’s that time of year when all of us start seeing more mushrooms around. The combination of sun, rain, and increased organic material on the ground is perfect for fungal growth. This year in particular has been very good for mushrooms in the Pacific Northwest and those mushroom hunters who know what they are doing, have had a banner year. However, the conditions that make for amazing edible chanterelles, also lead to more of the poisonous variety as well.

Last weekend, we saw several cases of mushroom toxicity in dogs. Molly, a six-year-old female spayed Labrador, was seen to eat mushrooms in the yard. She vomited some mushrooms and began having diarrhea within the hour. However, she then became wobbly when walking and was comatose when she presented to our emergency hospital in Renton a few hours later. Molly was intubated (tube was placed in her throat to protect her airway) and we initiated breathing for her. We pumped her stomach to try to remove mushrooms and also gave her enemas, which removed even more mushrooms. She was placed on intravenous fluids as well as supportive ventilation. She needed to be ventilated overnight but by the next morning, she started to wake up and could breathe on her own. She continued to improve, was fairly normal by dinnertime and was sent home that evening, about 36 hours after arrival. She continues to do well with no organ injury.

The mushrooms were identified by a mycologist as Amanita muscaria. They are part of the family of “death cap” mushrooms, but unlike Amanita phalloides, they do not cause kidney or liver failure. Their appearance can vary making identification tricky. While the signs caused by Amanita muscaria are extremely dramatic, all the dogs we have treated with this ingestion have done well, but needed 24-48 hours of very intensive care. More information on this mushroom type can be found :

http://en.wikipedia.org/wiki/Amanita_muscaria

Amanitas are not the only poisonous mushrooms in this area. Other toxicities seen with mushrooms can include severe tremor syndromes, dangerously low heart rates, and severe gastrointestinal signs. Our veterinarians have treated pets with all of these different syndromes.

A general rule is that if your pet gets sick very quickly after eating a mushroom, they probably won’t have longterm damage but if they get sick hours later, it could be extremely serious. If you see your pet eats a mushroom, it is best to contact your veterinarian right away. If there are other similar mushrooms in the same vicinity, you can use a paper bag to pick a few for identification. Mushrooms are very tricky to identify but it is easier when they are stored in paper rather than plastic bags. The best way to keep your pet safe is to get rid of any mushrooms you see in your yard and to prevent them from eating any mushrooms they might find on a walk. 

Why Fat Cats and Dogs are a Problem

By Beth Davidow, DVM DACVECC

Wednesday, October 9, 2013

As the fall sets in, I always feel that I really want to eat more. The colder weather means we are inside, closer to the kitchen. I find I’m baking more and thinking about desserts for upcoming holidays. As we eat more, and spend more time in the kitchen, our furry companions tend to join us and they know just how to meet our eyes, do tricks and convince us, that they too need a little extra something yummy.

But just as extra pounds can be problematic for us, extra pounds can also be problematic for our pets. Because they are smaller than us, we sometimes don’t realize how much the percentage gain really is. While if we average 150 lbs and then went up to 200 lbs over the winter, we would probably be very concerned with our weight gain, we sometimes don’t bat an eye when our 15 lb cat suddenly becomes 20 lbs, a similar proportional gain.

Obesity is a huge problem for animals and has been an increasing problem. As in humans, obesity in our pets can lead to bone and joint problems, increased risk for certain cancers, increased heart and lung problems, increased urinary issues, and much increased risk for diabetes.

At our emergency hospital, one common life-threatening emergency in cats is urinary blockage. There are good studies that show that overweight cats are at a much higher risk for this condition than cats in good body condition. In small dogs, a large portion of the dogs with severe respiratory problems are also overweight. Many of these patients present on emergency needing oxygen and end up on many medications. If owners are successful in having these dogs lose weight, many end up requiring less medications over the long haul.

So why do dogs and cats become obese?  In the vast majority of cases it is because caloric intake is in excess of the calories burned during the day. In a few cases, they have an underlying problem such as hypothyroidism but this is the exception not the rule. Thus, to keep thin, pets either need less calories or more exercise. As in people, often the culprit is not the meals but the in between meal snacks. Remember that if your 10 lb dog usually gets a ¼ cup of food twice a day, two large milk bones probably increased his calories by 10%.

This fall, try not to succumb to that cute little face cocking their head at you to share your muffin. Although extra treats may show them you love them in the short term, the consequence may be higher vet bills and more trips to the emergency room. Instead, pick up their leash, brave the rain, and take them for a walk. You will both be happier and healthier in the long run. 

Parvovirus – An update

By Beth Davidow, DVM DACVECC

ACCES Medical Director

A week ago, we alerted referring veterinarians in the area to an uptick in the number of parvovirus cases we were seeing at ACCES’ two referral hospitals (Seattle and Renton). Word quickly spread to the greater community setting off an unexpected scare.

Parvovirus is a virus that causes vomiting and severe diarrhea. In addition, it can suppress the immune system and put animals at risk for secondary infections. It mainly affects puppies and can cause death if not treated appropriately. With treatment, which includes intravenous fluids, anti-nausea medication, antibiotics and plasma in severe cases, survival is 90%. Adults dogs can get the infection as well but often are less sick or may shed virus and not have clinical signs.

The virus is shed in stool and can live in the environment for weeks to months. It is extremely hardy and not killed by standard disinfectants – bleach is most effective. The virus can be passed from an animal shedding the virus, picked up on clothes, shoes, and other objects, and then carried to another animal.

Parvovirus is not a new infection. It is a virus we have known about for a long time and one of the first diseases for which we developed a vaccine for dogs. The vaccine is extremely effective when administered properly. Puppies need to receive vaccines every three to four weeks from eight weeks of age until they are over 16 weeks of age, again at one year and then every three years thereafter.

The difficulty with this disease is that puppies often get sick in the window after they have had one vaccine but not the full series. If puppies are in environments where the virus has been shed by asymptomatic carriers, they can pick up the virus. Health for the dog population relies on compliance by everyone – a concept known as “herd immunity”.

This year we have seen an uptick in the number of parvo cases. We see an average of 16 cases a year and have diagnosed 28 this year, eight in the last three weeks. The virus does ebb and flow so this may just be a high year. Cases have been from a number of locations and have been mostly young, incompletely vaccinated dogs. However, it is also possible that the move away from vaccines has led to less herd immunity and more shedding of virus. Speaking to other hospitals in the area, some are also seeing more cases but other clinics north of us are not.

Our recommendations are:

1)     VACCINATE – make sure your puppy gets the full SERIES of vaccines up to at least 16 weeks of year. Make sure the vaccine is boostered one year later and then every three years after that.

2)     Do not take incompletely vaccinated puppies to dog parks or other high traffic areas. Dog parks are great places to socialize but only after the full series of puppy shots have been given.

3)     If you have a dog with vomiting and diarrhea, have them seen promptly. Early diagnosis and proper treatment does lead to a good long term outcome.

If your dog is fully vaccinated, there is no reason to avoid the dog parks – let your dogs play if we have a sunny day. 

Parvovirus; Think Outside the Box

By Dr. Beth Guerra

Quite a few years ago, I evaluated a one year old schnauzer for an acute onset of vomiting and diarrhea. He had no known medical problems and had not eaten anything unusual that could have caused his symptoms. The owner allowed me to do a complete workup, including x-rays and bloodwork. There were very few abnormalities except for a very low white blood cell count, which can indicate overwhelming infection or inadequate bone marrow response to infection. I was wracking my brains for a cause that would also explain his symptoms, when I noted in the chart that the owner had acquired him as a very young puppy and that he was not yet neutered.  When I asked why she had not neutered him, she said he had never visited a veterinarian. That set off a bell in my head, and I questioned her about vaccine status. She reported he had never had any vaccines or boosters and that the breeder did not mention that he was given any before she acquired him. I immediately set up a parvo test, and it was a strong positive.

Veterinarians tend to think of parvovirus as a disease of very young puppies, usually under 16 weeks of age. The general public knows of parvo as “the puppy killer” because it is highly contagious and often affects young dogs that are not fully developed and therefore have an immature immune system. What I had failed to think of in this case was that even though this dog was a year old, he had never been vaccinated and therefore was still at risk for contracting the virus. We just had another case present this week with a severe parvo infection who is 4 years old, but again, had not been fully vaccinated.  In our current case, he had a single puppy shot and not the full series needed to produce immunity.

Parvovirus is ubiquitous in the environment and very difficult to kill with normal disinfectants; prolonged contact with a bleach solution is required. It is highly contagious and can remain in the environment for many months. Transmission between animals is via oral exposure to feces containing the virus, however, objects such as bedding and toys can also transmit the virus. Infection can be widespread in environments such as pet stores or breeding facilities due to close contact between animals. Incubation within the body can be up to two weeks and the virus can continue to be shed in the feces after infection has resolved.

The virus targets specialized crypts in the intestinal lining where new cells are rapidly produced. These cells die off and the intestinal lining becomes more permeable, allowing for loss of vital blood proteins and electrolytes and also letting harmful bacteria into the bloodstream from the intestinal tract. 

Symptoms include vomiting, diarrhea (often bloody), inappetance, and abdominal pain. Septic shock or disseminated intravascular coagulation (widespread hemorrhage) can occur in severe cases. The virus can also destroy developing white blood cells. The drop in crucial white cells increases the risk of secondary bacterial infections.

Diagnosis is based on presenting symptoms, vaccine history, and test results, which can include a positive parvo test (fecal test that can be done in house), decreased white blood cell count, or low blood albumin. Some puppies also have intestinal parasites that are found on fecal exam. Therapy is supportive while the virus runs its course. Intravenous fluids, anti-emetics, and broad spectrum antibiotics are utilized to minimize secondary effects of the virus. Some animals receive transfusions of whole blood or plasma. Parvovirus can be rapidly fatal if left untreated and these cases usually require several days of hospitalization on the road to recovery. Puppies that develop severe sepsis or secondary infections, such as pneumonia, may succumb to the disease. However, studies have shown that chance of survival with aggressive treatment is over 90%.

Once infection has cleared, the puppy may have lifelong immunity, however, vaccines are the best prevention. Puppies usually receive a series of “combo” vaccines, which include distemper, parvovirus, adenovirus, and parainfluenza. Vaccines begin around 8 weeks of age and boosters are administered every few weeks until they are 16 weeks of age. Whether you obtain a puppy from a breeder, pet store, or friend, it is important to question them about the vaccination status up to that point. Infection with parvovirus can occur at any time between boosters, so it is important to have your puppy evaluated by a veterinarian and comply with the  FULL vaccine schedule.