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Cassie the diabetic Retriever

[caption id="attachment_1858" align="alignleft" width="300"]Cassie Cassie[/caption] Cassie the retriever was diagnosed with diabetes mellitus last year, and has twice-daily treatment with insulin. Apart from her injections, and regular blood tests, she is able to lead a normal life and do all the things she enjoyed before she became diabetic. Cassie is just 6 years old, but with good management of her condition, she has every chance of enjoying a full life. Diabetes is an illness where the animal has a lack of the hormone insulin, or the body does not respond normally to its own insulin. Insulin is produced in the pancreas, a gland which lies close to the stomach. Usually, insulin helps keep the level of glucose in the bloodstream stable. When glucose levels start to rise, insulin is produced to halt this rise in a number of different ways: it increases the uptake of glucose into body tissues, it stimulates conversion of glucose into glycogen for storage in the liver, and it stops glucose production from metabolising fat and protein. Without insulin, glucose levels in the blood go on rising (hyperglycaemia), causing a variety of symptoms. When it reaches a certain level in the blood, the kidneys can no longer filter it out so glucose appears in the urine (glycosuria). This creates ideal conditions for bacteria to live and multiply, so urine infections can result. The symptoms of diabetes in dogs or cats include drinking more than usual, urinating more than usual, eating more than usual and weight loss despite a good appetite. If left untreated, complications like liver disease, cataracts and weakness develop, and ultimately it can be fatal. In most cases, the first thing noticed by the owner is an increase in thirst. Obesity can be a factor in causing diabetes and is a very important reason to keep your pet at a healthy weight. [caption id="attachment_1861" align="alignright" width="300"]This is the sort of equipment which might be used at home to treat and monitor a diabetic patient. Full training will be given by the vet or vet nurse at the practice, and telephone advice can be given whenever it is needed. This is the sort of equipment which might be used at home to treat and monitor a diabetic patient. Full training will be given by the vet or vet nurse at the practice, and telephone advice can be given whenever it is needed.[/caption] Diagnosis is made by a full clinical examination and by urine and blood tests. Diabetes is not the only condition which causes these symptoms, and it can occur in combination with other conditions, so it is important to get a definite diagnosis and to rule out other illnesses. Stress can cause a temporary rise in blood glucose, so it may be necessary to repeat the tests before the diagnosis is made. When a high level of glucose is found in the blood, a second test may be done to check the levels of fructosamine. This tells us whether the blood glucose has been raised over a period of several weeks, or if it has just happened. Further tests may be needed to confirm that diabetes is present and to rule out other illnesses. Treatment of diabetes is nearly always by injections of insulin, given once or, more commonly, twice daily. These need to be given for the rest of the animal’s life, except in a few cases where the diabetes goes into remission and treatment can be stopped. This happens more often in cats than in dogs. These cases will be picked up by the monitoring carried out by your vet. Giving injections to your own dog or cat can seem quite daunting but is actually much easier than most people think. The needles used are very small so that the injections do not hurt, and full training will be given by your vet or vet nurse. The insulin has to be kept under the right conditions (upright, in the fridge) and must not be shaken, but these things very quickly become second nature. Noting any changes in your pet’s thirst, appetite and urination can also be useful. At the start of treatment, your dog or cat will need to be stabilised on the right dose of insulin, which differs with each patient, by slowly increasing until the right dose is reached. Your vet may also carry out a test called a glucose curve, when your dog or cat is blood tested at frequent intervals over a 24 hour period. This helps by showing how long after an insulin injection the glucose levels dip to their lowest level, and how long after eating the blood glucose levels rise to their maximum level. The aim is to control the glucose level throughout the day as close to normal as possible. While your dog or cat is undergoing tests and being stabilised, it might be hospitalised, but usually treatment can be given at home after a short time. Regular blood tests every few weeks (or months if very stable) will be needed after that. Sometimes owners will perform some of these blood tests at home using a kit very similar to that used by people with diabetes to test their glucose levels. The use of glucose testing kits which give a very rapid result, whether used at home or at the surgery, means that it is no longer necessary to collect daily urine samples from the pet. Monitoring the glucose in the blood can be more accurate and allows better control of the insulin dosage. A diabetic dog or cat needs to have a regular amount of exercise and food, given as near as possible to the same time of day each day. A special diet may be recommended by your vet because it helps to control the condition if the diet is higher in protein, lower in fat, higher in fibre and contains carbohydrates which release their energy slowly. All of these help to keep glucose levels as stable as possible, with no sudden peaks or troughs. Keeping your pet at the correct weight is also important. Unspayed bitches which develop diabetes may suffer from changes in their insulin requirements when they come into season, because of other hormonal changes, which may destabilise them again. Your vet may want to discuss neutering with you. Complications can occur in diabetes and your vet or nurse will make you aware of what problems to look out for. The most likely would be if glucose levels fell too low (hypoglycaemia). The dog or cat would become confused and twitchy or may collapse. It is essential to have some form of sugar or honey easily available to give by mouth if this happens, and then to phone the surgery straight away for further advice. Looking after a dog or cat with diabetes requires a certain amount of commitment from the owner, but most people say that it becomes easy once they get used to it. The key is to give your pet a standard daily routine of food, exercise and insulin injections, and to use your veterinary surgery for support and advice whenever you need it. Most diabetic dogs and cats will have a very happy life without even being aware that they have a medical condition. If you are worried that your dog or cat may be displaying symptoms of diabetes please call your vet immediately. If you are not sure how urgent the situation is please use our interactive pet symptom checker Jenny Sheriff BVM&S MRCVS

When Liver Meets Lungs – Diaphragmatic Hernia in a Cat

Up a TreeOne evening whilst playing outside, a little 6 month old kitten (let’s call her Tilly) climbed up a tree. A rather inexperienced hunter, when she saw a little birdie on the end of the branch she reached out to get it and, crash! The branch was too thin to support her weight and she fell to the ground. Now what they say is often true, cats do tend to land on their feet, but not always and poor Tilly landed on her side. She got up though and ran into the house, so her owner assumed she was OK. A few hours later her owner noticed that she was quieter than normal and not interested in her dinner. She was also breathing faster than normal but otherwise seemed OK, purring and affectionate, so her owner went to bed and planned to take her to the vet if she was still not right in the morning. As you could probably guess, at 8:00 the next morning I got a phone call from Tilly’s owner, as she had not gotten any better overnight - she was still very quiet and breathing even faster than before. We told her to come straight down and we would take a look right away. A few minutes later Tilly arrived, looking quite sorry for herself, but still happy enough to give me a little purr. I did a full physical exam and found her to be in good health except for her breathing, which sounded quieter than normal through the stethoscope. Her respiratory or breathing rate was very high and she seemed to be struggling to get enough air in. She also seemed depressed, certainly not what I would expect of such a lively young kitten. Once we were certain that everything else seemed to be OK, we gave her some pain medicine and then a little bit of sedation so she would sit still while we took some x-rays of her chest. What we found was no surprise given her history, but still always comes as a bit of a shock when we see it – Tilly had a diaphragmatic hernia. What is a diaphragmatic hernia? The diaphragm is a large, thin muscle that separates the chest cavity (with the heart and lungs) from the abdomen (with the stomach, liver and intestines among other things). It is normally an air-tight barrier which allows the chest cavity to achieve negative pressure, in other words there is pressure on the lungs to expand out rather than collapse in. When the diaphragm moves down with each breath, the lungs move with it causing them to expand even further when you breathe in. And when it moves back up again, it helps the lungs to contract so the air is forced out when you exhale. Without a diaphragm or with a damaged one you can still breathe, just not very well, and this is what poor Tilly was experiencing. A hernia is the protrusion of an organ through a hole in the body cavity which normally contains it. In the case of a diaphragmatic hernia, a hole develops in the diaphragm which allows the organs of the abdomen to enter the chest cavity. As you can imagine, this is neither good for chest, as the invading organ takes up precious lung space, nor for the organ itself as sometimes its blood supply can get cut off in the process. Some diaphragmatic hernias are emergencies and need to be corrected immediately, while some can go on for weeks without anybody even noticing, it depends on the size of the hole and which organs get displaced. Some animals are even born with them. In Tilly’s case, the sudden pressure on her belly from hitting the ground caused her diaphragm to tear and some of her liver to move up through the hole. It was a serious condition but not a life-threatening emergency, and it has been shown that there is a higher success rate in some cases if surgery is done after 24-48 hours, so she was scheduled for surgery to repair the hernia the following day and kept in hospital under close observation until then. [caption id="attachment_1805" align="aligncenter" width="640" caption="This is an image of Tilly’s chest – the dotted line shows where the diaphragm usually sits and the solid line shows Tilly’s diaphragm, with the liver sitting inside the bulge. A relatively easy but dramatic diagnosis!"]This is an image of Tilly’s chest – the dotted line shows where the diaphragm usually sits and the solid line shows Tilly’s diaphragm, with the liver sitting inside the bulge.  A relatively easy but dramatic diagnosis![/caption] So what happened? We took Tilly to surgery the following day and once we could see inside, the extent of the injury became apparent. There was a 5 cm tear in the diaphragm muscle, and about half of her liver was now sitting right next to her lungs! We were able to carefully pull the liver back into the abdomen and sew up the hole, making sure that all the organs looked happy and healthy before finishing the surgery. Our nurse did a fantastic job keeping Tilly stable under the anaesthetic, and even had to breathe for her for a few minutes while we sewed up the hole. Just before we woke her up, we inserted a needle into the chest to drain out all the extra air so that her chest cavity could regain its negative pressure. Her breathing was immediately improved, and stayed that way throughout her recovery. The next day she was eating and even trying to play with the notes on her cage, so she was able to go home. It has now been nearly a week and Tilly is still doing really well. Her owner says she is even trying to climb things, despite being told that she must stay very quiet to allow her injuries some time to heal. If only you could explain to her how she got into this trouble in the first place! All the best to brave Tilly and her brave owners, I expect she will make a full recovery and be back to her usual kitten acrobatics in no time. If you are worried about any problems with your cat, talk to your vet or try our Interactive Cat Symptom Guide to help decide what to do next.
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