The previous two months have featured hyperthyroid cats, one of whom received radioactive iodine treatment and one who had surgical treatment. This month we look at Ashes, who is the first patient at our hospital to receive a new, breakthrough medical treatment, using dietary manipulation. We will let her owner tell the story in her own words.

“Ashes, is a grey domestic shorthair, about nine years old whose previous owner was no longer able to care for her. She was re-homed to me in about April of 2011. Ashes is very playful and active for being a senior cat and also talks a lot. Her meows’ great anyone who comes over, before they even reach the door.

A few months ago I decided to have a geriatric blood profile performed on her so that in her later years I would have a baseline. However upon weighing her that day I noticed she’d lost weight since arriving. The blood work revealed Ashe’s thyroid level was close to the top of the charts and she was diagnosed with hyperthyroidism by Dr. Welsman.

After having a urinalysis performed to ensure that her kidneys were functioning and that the rest of the blood work revealed no worrying parameters Ashes would have been placed on a twice daily medication called methimazole. However, timed with her diagnosis was the release of the Hills Pet Food: y/d.

In the month since Ashes has been eating y/d her thyroid levels have been cut in half, putting them back in normal range. She has gained back almost all the weight she had lost, and though she still likes to chat she doesn’t do it quite as much and seems content to sleep through the afternoons in her sunny window seat. She loves the taste of both wet and dry y/d and never leaves a morsel behind.”

Hills y/d therapeutic diet controls the clinical signs of hyperthyroidism by restricting dietary iodine. Iodine is essential for the production of thyroid hormones, and is usually present in excess of requirement. y/d restricts the amount of iodine to the amount that is essential for life. Without extra iodine the abnormal thyroid cells cannot overproduce thyroid hormone. It is important to emphasize that y/d does not cure hyperthyroidism, it is a lifelong treatment and cats eating y/d must not be fed any other food or treats. However, it is a great option for many patients including those individuals who also have kidney disease, as Hills y/d is also optimized for cats who have kidney problems.

Just over 2 years ago Scooby was found as a stray by the Hendricks family. He was very skinny, had a tremendous appetite but seemed to be otherwise healthy. Scooby couldn’t have made a better choice, and settled in with his new family.

Late this summer it seemed Scooby was losing weight. Despite being bright, active and eating more than his share, he just seemed to be shrinking away. It was time to have Scooby examined, so he was brought to Riverside Small Animal Hospital.

On examination Scooby was very lean weighing only 3kg when he should have been nearer to 5kg. Scooby had a significantly elevated heart rate, small feeling kidneys and generally poor muscle tone. Palpation of his neck suggested a possibly enlarged thyroid gland (the thyroid is not normally evident in cats). A senior blood health screen including a complete blood count, serum biochemistry, thyroxine (T-4, thyroid hormone) and urinalysis was performed. Based on these tests it was determined that Scooby had hyperthyroidism and renal insufficiency.

Hyperthyroidism is a common disorder that occurs in cats, it is caused by hyperfunctioning nodules that develop in the thryroid gland and release abnormal amounts of T-4 into circulation. It typically occurs in cats over 8 years of age. Hyperthyroidism affects multiple body systems including the heart, intestinal tract, the kidneys, the nervous system and behavior. Fortunately management of hyperthyroidism is available and generally successful in reducing severity or alleviating many of the secondary effects of elevated T-4. The goal is to reduce the amount of T-4 being released into circulation. Given Scooby’s good nature and dedicated owners, it was decided to place Scooby on oral Methimazole. Methimazole is a medication that selectively controls the abnormal production of T-4.

Soon after methimazole therapy commenced; Scooby’s owners noted that he was scratching face and ears more than he ever had before. Facial itchiness, is a know symptom of methimazole hypersensitivity (allergy). If this symptom develops there is no other oral medication which can be used to successfully manage hyperthyroidism. Once Scooby was taken off the methimazole his itchiness resolved, confirming the allergic response.

With this treatment complication there were only two other ways of addressing Scooby’s hyperthyroidism. One being radioactive Iodine treatment which meant a trip with Scooby to Vancouver for treatment.  Then following treatment a number of days where the cat is kept in isolation (because they are temporarily radioactive) until it can safely return home. The other procedure is surgical removal of the thyroid glands (thyroidectomy), a more invasive procedure and there can be local damage to associated structures such as the parathyroid glands or local nerves.

After weighing their options, Scooby’s owners chose thyroidectomy and on November 22, 2011 Scooby had both of his thyroid glands removed. When conducted by an experienced surgeon the surgical risks are very small, and follow-up examination and blood work confirmed that the parathyroid glands are functioning and there was no significant damage to local nerves. Scooby has recovered well from the procedure, doesn’t require daily medications and will be monitored for any changes including return of symptoms or weakness. Although Scooby still has to deal with his reduced renal function, close management of his diet should help him live a long and happy life!

Tiger is a 17 year old neutered male domestic short hair cat. His owner describes him as sensitive, bossy and definite creature of habit, reminding his owner of feeding time, litter box cleaning time and cuddle time. He even reminds his owner when it is pill time. In April of 2011 Tiger stopped eating. His owner had noticed that for weeks prior to this Tiger seemed ravenous; he wanted to eat anything anyone else was eating but he was losing weight. Tiger’s weight loss was what concerned his owner the most.

When Tiger was examined at the Riverside Small Animal clinic, he was thin, dehydrated and had a very high heart rate. A blood panel and urinalysis were recommended. Tiger is a wonderful cat to work with and was very co-operative and happy to oblige with the blood and urine taking. After the lab tests were done, Tiger was diagnosed with hyperthyroidism as well as a urinary tract infection (UTI).

Nothing is simple, however, because hyperthyroid cats are supposed to be hungry not anorectic. Tiger was hospitalized and hooked up to IV fluids to rehydrate him. He was also started on thyroid medication as well as antibiotics for his UTI. Unfortunately, Tiger continued to not want to eat and started vomiting. The reasons for the vomiting was not immediately apparent from his presentation or his disease so Dr Carrigan discontinued all Tiger’s oral meds and the vomiting stopped! The thyroid medication was added back to the treatment protocol and Tiger seemed to tolerate that well. When the oral antibiotics were added back poor Tiger started vomiting again. The culprit was identified and the oral antibiotics replaced by a long acting injectable antibiotic.

Despite being rehydrated and treated for his hyperthyroidism, Tiger still refused to eat. We encouraged him to eat by syringing mushy food into his mouth, which he seemed to like. The problem with continually syringe feeding cats is that they can develop a food aversion, which we really did not want to happen. Dr. Carrigan discussed a feeding tube with Tiger’s owner, but it was decided to try feeding Tiger at home. True to form, Tiger was a trooper and tolerated syringe feeding then started eating on his own!

Over the next few months we monitored Tigers thyroid hormone level and kidney function. When cats are hyperthyroid, they have really high blood pressure, which pushes lots of blood through the kidneys. When we treat them, and their blood pressure returns to normal we unmask any underlying kidney issues which were hiding. Knowing Tiger’s owner wanted to send Tiger to Northwest Nuclear Medicine (NWNM), in Vancouver, for radioactive Iodine treatment, we kept in close contact with them, constantly reviewing the blood results and how Tiger was doing. After several months of treatment, with stable kidney function Tiger came off his medication and went off to NWNM!

Tiger spent a week in Vancouver after his injection with radioactive Iodine. The iodine attacks the overactive cells in the thyroid gland and destroys them, offering a clinical cure for hyperthyroidism. The cats have to stay in hospital for around a week as they shed the radioactive Iodine in the urine, saliva and feces. They have to be barrier nursed and all their waste handled as Radioactive until the radioactivity decays away so that their owners and caregivers are not to exposed to this potentially dangerous compound. Tiger has never looked back. He is gaining weight, eating and d drinking normally and all round a happy kitty.

Tiger’s owner’s decision to take Tiger to NWNM was a difficult one. She weighed the pros and cons of the other treatment protocols and because she works shift work and could not guarantee giving Tiger his medication every 12 hours, she opted for radioactive Iodine treatment. She also worked out the cost for treatment and monitoring blood work for 3 years and found that the costs were comparable.

Tiger holds a very special place in his owner’s heart; a few years ago she had a back injury and while bed ridden, every night Tiger would lay beside her and rest his head on her shoulder and purr her to sleep. Tiger starts purring the minute he comes through the hospital door. He is always so happy to see everyone. Tiger is a true gentleman and has never been anything but wonderful to work with. We are glad that Tiger’s treatment went so well and he and his owner are back to their normal routine of him telling her what to do!

In June of this year a co-worker of Nukka’s owners found Nukka tied-up and starving while a few local kids threw rocks at her in Cape Dorset, Nunavut. Nukka is a female Husky mix sled dog; she was 12 weeks old when her rescue journey began.

As with many other northern communities of Nunavut, stray dogs are abundant, poverty is high and immunizations are rare in Cape Dorset. Most of these communities control their dog populations through dog culling days, on which unclaimed or unwanted dogs are shot. A loose network of Husky rescue volunteers attempts to relocate some of these dogs to southern homes.

Nukka’s journey to Kamloops was spent on 4 different planes. To the disappointment of her owner travelling with her, she was relegated to the cargo hold. She flew from Cape Dorset Iqaluit and then to Ottawa at which point the airline couldn’t find room for her to carry on west. After one phone call and without hesitation, a local Ottawa couple drove to the airport and picked Nukka up to look after her overnight. The next morning they took Nukka back to the airport and made sure she continued on her journey to Vancouver and then Kamloops. Finally, Nukka arrived in Kamloops bewildered and with evidence that air travel was not her bag. Almost immediately, Nukka began bonding with her new family. We first met Nukka when she came to see us for a health check and vaccinations.

Nukka’s quickly got into her new routine of regular hikes, mountain bike rides and runs with her owners… a far cry from her northern life. Unfortunately, while she was out for a run in September, a larger dog playfully pounced on her, resulting in a broken femur. Her owners brought her to Riverside and Dr Buist repaired the fracture with twin intra-medullary pins. After six weeks her fracture had completely healed and it was time to remove the pins. Since Nukka was also needing to spayed we were able to combine these two procedures in to a single anaesthetic.

Nukka’s owners elected for Nukka to have a Laparoscopic Spay. Laparoscope is a camera system which enables us to carry out complex abdominal procedures through a 10mm ‘keyhole incision’. This means reduced pain and discomfort post surgery when compared with traditional open abdominal surgery and a much quicker return to full activity post surgery. This was important for Nukka and her family after 6 weeks of convalescence after her accident. Just in time for winter, Nukka is getting back into shape in a more familiar snow covered environment, running behind skis.

Nukka is a great dog and was a perfect patient. We wish her good fortune in her new life.

September 30th, 2011 is a night that won’t soon be forgotten by Margit Bull and her 3yr old Great Dane Shelby. The evening was like many others in the Bull household, Margit was playing her guitar and her two Great Danes were at her feet enjoying the music, or so it seemed. Shelby though present, was not herself, she was fidgiting and moving about trying to get comfortable. Soon she was attempting to vomit and just not producing any material. This is when Margit decided it was time to call the emergency service who that evening was Shelby’s regular clinic Riverside Small Animal Hospital. After a brief discussion and a 40 minute late night drive to the clinic Shelby was examined and radiographs revealed a dilated and twisted stomach; a true life threatening condition that occurs most frequently in large deep chested dogs.

Gastric Dilation and Volvulus (GDV) or in general terms bloat, is a rapidly fatal condition where the stomach becomes distended with gas and abnormal motility leads to twisting. Early in the condition the dog seems unsettled, attempts to vomit unsuccessfully, visible evidence of abdominal distension will soon follow. Internally there are changes in circulation, respiration and cardiac function occurring. The condition tends to progress rapidly and can be fatal within hours. The exact cause is not known but seems to be related to body type (large, deep chested), timing and volume of meals, gastrointestinal disease and perhaps even temperment.

Shelby was fortunate that Margit was knowlegable about the condition and wasted no time getting her to the clinic. Shelby was stabilized by providing IV fluid support for her pending shock, her stomach was partially deflated with a small trocar through her body wall and then a stomach tube was passed. Shelby was then taken to surgery which involved untwisting the stomach, observing for any damage to the stomach and other oragans due to loss circulation, and permanently suturing her stomach to her body wall (tacking or pexy). In the future if her stomach distends this should act as an anchor to prevent the life threatening twisting. This procedure is at times is done in at risk dogs as a preventative, in fact Margit’s other dog Jezabelle was ‘tacked’ at her spay (Shelby is a breeding female and not spayed).

Surgery was complete and Shelby was in recovery by 2am, just under 3 hours after her owner called the clinic. By 8am Shelby was standing at her kennel door waiting for a morning walk. Through the next 24 hours Shelby continued to improve and went home for the remainder of her recovery. She has been doing very well since her surgery; the hardest part of her recovery has been trying to keep her quiet!

Daisy is a wonderful cat who has demonstrated to us all the strength and determination of our four legged family members, and also the persistence and patience of her amazing owners. Daisy presented to us for a routine spay in April but she had symptoms of an infection of her urinary tract. A simple urinalysis revealed significant infection so it was elected to treat her, spay her a week later when she would be healthy, and let her live like a princess the rest of her days. Daisy, however, had other plans.

Shortly after being discharged from the clinic Daisy came into heat and became pregnant. The owner elected to allow her to have the kittens and she proceeded with her pregnancy in a routine manner. In early June Daisy’s owners were horrified to find her hanging by her hind leg from a truck. The owners managed to cut her free but she ran off in a blur only using three of her legs. The owners searched for her in vain and were very worried about her only to have her return of her own accord 4 days later. She was rushed into Riverside Small Animal Hospital to assess the extent of her injuries and to see how her unborn kittens were doing. Her xray revealed a compound fracture of both the tibia and fibula with multiple fragments. Fortunately an ultrasound of her abdomen revealed 5 kittens with strong and vibrant beating hearts.

It was elected to send Daisy to Dr. Mark Smith in Kelowna who specializes in orthopedic surgeries. After a careful assessment he chose to place an external fixator on the limb. This technique involves placing pins horizontally through the bone on both sides of the fracture and then joining them with a stabilizing rod. Daisy also had open wounds with her injuries which needed to be managed with daily bandage changes, frequent flushing of the wound bed and the application of honey to promote healing and reduce infection. Daisy greeted us daily with warm chatter and her trusting purrs. She was always gracious and well mannered through her treatments and made us all admire her toughness and her unlimited capacity for forgiveness. It must be mentioned that Daisy’s owners the Bisgaards did an amazing job caring for Daisy and were simply wonderful throughout Daisy’s ordeal.

Beneath the surface of her sweet nature there still remained Daisy’s determined independence. One evening she escaped with her very bulky bandage and managed to hide in a culvert. No amount of convincing could get her to leave her new hiding spot so a camp was made and Mr. Bisgaard slept out all night keeping watch over his ward. In the morning Daisy was finally convinced to come out from her hiding place and while she was none the worse for wear, her bandage was soaked through and Mr. Bisgaard was in need of a good rest.

Daisy had her kittens that very night. Five vibrant healthy sweethearts that we saw grow into dynamic kittens before our eyes. Daisy was an attentive and caring mother and before we knew it the kittens had been weaned and placed in great homes. Daisy is now on the home stretch of her recovery but still has one small but important procedure to be completed. She is due to be spayed very soon!

Coco and Louis are a tribute to early, low stress handling as puppies. We routinely see the two of them for nail trims and to express their anal glands.

The anal glands in dogs can frequently become impacted, making it painful for your dog to pass feces and possibly leading to infection. As this can be extremely painful many pets will require sedation or anesthetic for the treatment. For those dogs that seem to be prone to problems with their anal glands, we routinely express them to help prevent impaction.

Not surprisingly many dogs are nervous when coming into the clinic and will struggle when restrained. It is important that our pets trust us to handle them gently and that nothing bad will happen to them.

Coco and Louis’ owners have gently handled them both so they do not fear this type of handling – all puppies should learn this – for more information www.drsophiayin.com

In honor of these stars, and all others like them we have recently implemented the “good dog nail trim” discount!

Congratulations to all owners who help their pets to understand our world.

These two patients have been on a weight loss program and have reached their goals.

Duncan

The first patient, Duncan, a six year old Labradoodle, started on a weight loss program in November. His weight in November was 27kg or 59.4lbs. Duncan came in for a nutritional consult and it was decided that he needed to lose 15lbs.

Duncan is a very active dog and loves to go hiking so exercise was not a problem he just needed the right nutrition. Duncan’s new diet was a reducing diet that is low in fat, high in fibre which helps reduce body fat while ensuring that he feels full. It also has high levels of carnitine which increases lean muscle mass. It has antioxidants that defend the cells from free radicals which promotes a healthy immune system.

In order for Duncan to lose weight, he needed full cooperation of his family. Duncan was in every 2 weeks so we could check his weight. We also had to cut back on his treats drastically which was very hard because Duncan, who is part Labrador retriever, really loves his food. When he comes in for his weight checks he assesses all of our food shelves to see what we have, he usually tries to pick out a few bags of cat food or treats from the treat section. It was important for him to still have a treat or two so we put him on a low fat dental chew that not only tastes good but reduces plaque and tartar.

It took six months for Duncan to reach his goal weight so it was a big commitment. It was important for Duncan to not lose the weight too quickly. Ideally it is 1% a week which worked out to be 1kg per month which Duncan achieved. His family reports that his energy levels have increased dramatically since his weight loss and he is now able to go running with his family.

Zeus

The second patient, Zeus, an 11 year old Golden Retreiver, started on a weight loss program in May, 2010. Zeus weighed 52kg or 114lbs at this time. During his exam it was decided that he needed to lose 22lbs.

Zeus started on the same reducing diet that Duncan was on. For Zeus it was incredibly important to lose the weight. We wanted him to be very healthy during his senior years. Dogs that are overweight are more prone to be at a high risk for a number of abnormalities such as exercise intolerance, joint problems such as arthritis and ruptured ligaments, diabetes, problems with the digestive system such as pancreatitis and constipation, and it increases the workload on their heart. The plan for Zeus was to reduce his weight by 4.5lbs a month. Zeus lost the weight perfectly each month.

His family was very diligent and in 6 months Zeus was at his ideal weight. As you can see from his photo’s Zeus looks fantastic. He is now on a maintenance diet and at his last veterinary check-up he had so much energy we had a hard time examining him.

Two of our young patients, Leela, a 2 year old border collie and Angus, a one year old Scottish deerhound, underwent stem cell therapy.

Angus was playing in deep snow and had got his hind leg stuck in a fence. When he pulled his leg out of the fence, he created a tear in the anterior cruciate ligament in his knee. The function of a ligament is to hold bone to bone. In this case it is connecting the femur to the tibia to make up the knee joint or stifle. Angus was incredibly painful and unable to bear weight on his leg. There were two choices to repair Angus’s ligament, a surgical repair which, replaces the natural ligament with one made of a strong suture material, or stem cell therapy. Angus’s family chose to try the stem cell therapy.

Leela has severe hip dysplasia. Hip dysplasia is an abnormal formation of the hip socket. Leela was incredibly painful and very reluctant to exercise. She required pain medications on a regular basis.  Leela was also on a diet specifically formulated to help with her mobility. Leela’s family decided to try stem cell therapy rather than a total hip replacement.

Stem cell therapy is a new treatment for dogs with arthritis and tendon and ligament injuries. The stem cells can increase the body’s ability to decrease inflammation, they home in on damaged tissues and recruit other cells that help with tissue growth, they support tissue remodeling over scar formation, and are able to differentiate into bone, cartilage, tendon, and ligament tissue.

To harvest the stem cells, both Leela and Angus had a general anesthetic, and then Dr. Nicol removed approximately two table spoons of fat tissues from their abdomens. The fat tissue is shipped in a special media on ice to Vet-Stem, a laboratory in California that harvests the stem cells from the fat tissue. The laboratory in California keep some of the cells in a bank at their laboratory so if Angus or Leela need a treatment in the future we can gave them shipped to us. The laboratory has an advanced technology which enables them to take the cells and grow new ones directly from the original cells. The cells are shipped back to us immediately. The time from collection to the laboratory in California and back to us is usually 48 hours. The family’s of Leela and Angus are on standby while we wait for the cells to arrive. Both of the dogs had another general anesthetic, they needed to be asleep so we could clip and surgically prep the joints so we could inject the stem cells into them. A portion of the cells is injected intravenously. The cells travel through the venous system to treat damaged cells.

Today, Angus’ ligament is one hundred percent healed. We tried to get a video of him running but we were unsuccessful because he is too fast!

Leela’s mobility has improved considerably, her family is able to take her for hikes and she is able to play with her housemate, Jake. She has not had to have pain medication for the entire year since her stem cell treatment.

Learn more about Vet-Stem at www.vet-stem.com

In May of 2010, Maggie, a 14 year old Dalmation mix, was examined at the hospital because she had been vomiting. Dr. Nicol ordered a blood panel which revealed elevated kidney enzymes and Maggie was diagnosed with advanced kidney failure.  In pets with kidney failure, the kidneys are unable to filter the waste products and they begin to build up in the blood stream. Kidney disease can occur for several reasons and in Maggie’s case it was most likely due to the aging process. Maggie also has a grade 5/6 heart murmur.

Since Maggie’s diagnosis in 2010, her treatment program consists of three heart medications, one to control the workload of the heart, one to control the fluid build -up in her lungs, and one medication that helps both the kidneys and the heart. This medication aids the heart by opening up the blood vessels as they leave the heart and so reduces the resistance to blood circulating around the body. This reduces the work that the heart has to do. At the same time, it opens up the blood vessels that return blood to the heart, reducing pressure on the heart. It aids the kidneys by dilating the blood vessels to the kidneys, which provides them with an adequate blood flow. Maggie is also on medications to improve the way her kidney’s function. The first medication is a probiotic and soluble fibre that uses three different types of bacteria that eat the nitrogenous waste products that are in Maggie’s intestines. This helps the kidneys by reducing the amount of waste products that they need to filter by creating a concentration gradient allowing nitrogen waste to move from the blood in the intestinal villa into the soluble fibre in the intestinal lumen. The second medication is one that binds phosphorous. This is important for dogs with kidney disease.

These are just the medications that Maggie takes, some of them twice a day, but there is a lot more that goes into keeping Maggie healthy. Maggie’s care requires an incredible amount of diligence. Maggie’s family cooks a healthy low protein diet and low phosphorous diet for her as Maggie refuses to eat the commercial foods. Maggie requires a low protein diet to reduce her kidney’s workload by avoiding excessive by products that the kidney needs to excrete. Maggie also has a magnetic pet bed which, it is said, increases blood circulation on the areas where pain occurs, hence forcing blood to flow through a magnetic field. The heat produced from this process would increase the flow of oxygen to the affected area to help speed up the healing process. Maggie’s family also monitors her very closely for signs that her kidneys are not functioning well. The signs include not eating, depression, lethargy drinking more water and urinating more than usual, vomiting, and strong breath odour. When Maggie’s family feels that she isn’t doing as well they bring her intravenous fluid therapy. Large quantities of intravenous fluids are given to “flush out” the kidneys. This flushing process, called diuresis, helps to stimulate the kidney cells to function again and adequately meet the body’s needs for waste removal.

Maggie is one of our most famous patients and has been coming to our hospital since 1998. We have had the privilege of getting to know Maggie and her family very well from her frequent visits to the hospital. Maggie’s family is incredibly diligent in caring for her. Maggie is incredibly spunky and tenacious and we appreciate her ability to make us laugh every time she is in the hospital.