Puppy Hypoglycemia

Posted by Aaron

Wednesday, September 30, 2009

Glucose is the blood sugar that circulates around the body and it is the principle nutrient that your body’s cells use for energy. The liver stores extra sugar in the form of a starch called glycogen. Your body can then use this glycogen to make extra blood sugar between meals to keep the levels of sugar in the blood stable.

Livers of toy breed puppies aren’t very good at making glycogen. This means that they are susceptible to having their blood sugar drop if they don’t eat. This drop in blood sugar can be severe. Their livers are usually able to make normal levels of glycogen by the time they are 12 weeks or so.

Signs of hypoglycemia include:

Lethargy, excessive tiredness, “drunken” appearance or walk, confusion, weakness, sedation, panting, coma, death

What needs to be done?

Hypoglycemia is an EMERGENCY and MUST BE SEEN right away. If it is after hours, please take your puppy to your local animal emergency hospital. Additional blood sugar must be administered and the blood sugar has to be checked frequently over the next 12 hours.

When you first notice a change in behavior at home, you can immediately offer food. If the puppy is too tired to eat, a small amount of corn syrup, maple syrup, or honey can be smeared on the gums. This is absorbed across the gums and can sometimes “wake them up” enough to eat. Either way – this puppy needs to be seen by a veterinarian!

How can I prevent hypoglycemia?

One major misconception is that feeding more sugar (like honey or syrup) to the puppy will avoid hypoglycemia. Sugars are used very quickly and do NOT help keep blood sugar stable. Additional sugar does not hurt the puppy, but is not helping.

The most important thing you can do is increase the frequency of feeding. Fats, fiber, and proteins will help keep the blood sugar stable between feedings. Toy breed puppies should ALWAYS HAVE ACCESS TO FOOD. Most toy breed puppies eat very little to begin with, so it is not the quantity, but the frequency that is so important. Some puppies do best when offered small amounts of food (a tablespoon of wet food for instance) five or six times daily. There should always be a small amount of a small, dry kibble to eat.


Cat in a Can

Posted by Aaron

Monday, September 28, 2009

Canned food - Why is this important?

Most cat foods have a fairly high percentage of their calories that come from carbohydrates. I'm talking about excellent, outstanding foods here, not mega-merchant crap. Carbohydrate sources are inexpensive, highly digestible, and shelf stable. They provide good nutrition and we have made good use of them in our foods. Carbohydrate sources include rice, corn, wheat, and oat for the most part. Each of these can be fantastic energy sources.


IF we are correct about cats requiring a lower carbohydrate diet, the best way BY FAR to do this is with canned food. Kibble is a baked product, right? It requires flour and water. So you simply can't get a kibble with low carbohydrates. It's against their nature.

Canned, on the other hand, allows more flexibility to play with it and as a result, canned foods are nearly always lower in carbohydrates than their dry counterparts.

What about my cat's teeth? I thought hard food was required for dental health?
We used to think that. As it turns out - it really doesn't matter. Canned or dry - pretty much the same dental issues.

Why people don't like canned food:
It stinks
It has to be put down fresh (I can't leave for a day and just leave a bowl full of food.)
My cat won't eat it
It produces too much packaging waste

All of these are true. Cats are texture driven, and if they have always eaten dry foods, it is very possible that they will refuse wet foods. It requires a period of time for them to adjust if you have to switch to canned foods. You must keep the food fresh and canned food tends to stink more. Oh well.

The other reason behind encouraging canned foods:
Water! Remember my post on the miracle nature of water? Most cats don't drink enough. Their genetic code is still left behind from their desert ancestors, and they just don't feel the need for water.

But water does all kinds of critical things for cats - the most important of which is that it keeps their urinary output high and that is one of the single most important aspects of treating lower urinary tract disease in cats.

So am I advocating canned food diets in cats? Probably :) The jury is still out regarding some of these points, but I think they make sense. Canned diets are probably going to be the best choice for any cat with diabetes, obesity, kidney disease or lower urinary tract disease.

Don't stress if your cat won't eat canned food, though. Some cats just won't.

And now for the disclaimer:
FEED THE CAT, NOT THE BAG OR THE BLOG! If your cat looks great, feels great, is a normal weight, and is doing well on the food they are on - there's probably no reason to change. BUT - if not, talk to your veterinarian. There are a lot of good foods out there.

Don't hesitate to feed wet food, though. Canned food will NOT do any harm if the formula is appropriate for the cat (kidney cats need therapeutic kidney diets, for instance). You would have no argument from me if you wanted to feed your cat canned food exclusively. Probably a good idea for most all cats. We'll see if the veterinary community still feels this way in five years...


Cats and Carbs

Posted by Aaron

Saturday, September 26, 2009

I recently attended a veterinary conference in Kansas City and was REALLY excited to get to hear one of the clinical professors from Texas A&M talk about feline nutrition, obesity, and diabetes. This is cool stuff. Cats are bad about storing mesenteric fat. This is the belly fat. Fat that gets packed around the intestines, kidneys, and liver. This is where most human men (including ME) tend to pack the fat in. So this is a subject close to my heart (or at least close to my pancreas).

Mesenteric fat is uber bad. Fat in the belly pushes up on your chest and stomach and causes difficulty breathing and stomach reflux simply because of its bulk. It also makes it difficult for blood to circulate around the lower half of the body and helps drive up blood pressure. As if all that wasn't bad enough, we have now found that mesenteric fat cells are also capable of producing lots of their very own hormones as well. But wait - it gets worse. Most of the hormones that these fat cells make actually encourage more fat production, cause inflammatory changes in the body, and increase appetite! How horrible is that!

Feline nutritional requirements:
It is becoming more and more apparent that cats have a much higher requirement for protein than we once thought. It is also becoming more apparent that cats have a much LOWER tolerance of carbohydrates than we thought. This probably goes back to the fact that cats are true carnivores and their prey are only made up of a relatively small amount of carbohydrate with the remainder being made up of fats and proteins. Our domestication and inbreeding of cats has muddied the nutritional waters, but the basic genetic code is still pretty close. Wild felids (cats) don't normally eat much carbohydrate.

So is too much carbohydrate bad for a cat? THAT is the big question right now. There is some good research that would suggest that increased consumption of carbohydrates actually encourage deposition of abdominal fat and upset the pancreas in cats. Remember that abdominal fat is the worst kind of fat.

So should we eliminate or severely restrict carbohydrates for our cats? NO! ABSOLUTELY NOT! Carbohydrates are essential to life. Severe restrictions in carbohydrate intake are known to be bad. The discussion here is all about balance. The best balance for a cat is different than the best balance for a dog. (And this assumes that we're talking about a 'normal' adult cat or dog. In cases of illness, very young, very old then everything changes.)

Here's MY OPINION based on what I've been presented: I think it is reasonable that we are feeding more carbohydrate than we should. It could start to explain quite a few things. I see waaaay to much obesity, diabetes, lower urinary tract disease, and renal disease in cats. I KNOW our current nutrition isn't perfect. It's damn good, but we've been missing something. I believe increased belly fat is absolutely associated with lots of bad disease. If increased carbohydrates are, in fact, the main cause of the increased belly fat, then we need to change up how we feed our kitties.

What am I recommending to my patients?
First things first - FEED THE CAT, NOT THE BAG. If your cat is an ideal weight with ideal body condition, then keep feeding whatever you're feeding.
However, in cases of obesity, pancreatitis or diabetes I am leaning towards lower carbohydrate, higher protein foods unless concurrent illness in the patient tells me not to. (Diabetic cat in kidney failure, for instance.)

Next post, I'll build on this discussion and talk about canned foods for cats and why that might actually be the best way to feed your kitty.


Herbicides and Lymphoma

Posted by Aaron

Tuesday, September 22, 2009

I guess I'll continue with my cancer theme here and briefly comment on a question I was asked the other day.

Do herbicides cause cancer?

Like all things - it's controversial. There has been some good work done to show that the herbicide 2,4-D is associated with an increased risk of lymphoma in dogs. There's also lots of work to suggest otherwise. (2,4-D is, by the way, a cousin of Agent Orange.)

As I mentioned in my post on cancer development, there is rarely ONE thing you can blame for causing a particular cancer. This is especially true for lymphoma. Genetics, chemical exposures, foods, and hormones are all associated. So the truth probably is that 2,4-D can probably cause cancer in a predisposed individual, but may not in another individual if all other things are equal.

I'm a believer that exposure to environmental chemicals like herbicides HAS to be related to our increased incidence of cancers (in general). Which ones to blame? That's the sticky part! I don't know. But since there is good research that shows 2,4-D is a likely suspect, I try to avoid it as much as physically possible.


18, 19, 20... Wow that's a lot of toes!

Posted by Aaron

Thursday, September 10, 2009

It's always dangerous to refer to something as "normal" or "abnormal." Normal is in the eye of the beholder, right? Instead, I will employ the word "typical" when discussing supernumeray feline phalanges.

In otherwords... Polydactyl cats.

When I was a new graduate I practiced in New England. I didn't appreciate it at the time, but there were a LOT of polydactyl cats in Connecticut. I did some research into this and it appears that polydactyl cats originated in England, probably in Wales. The genetics quickly found their way to Boston. The appearance of polydactylism around the New World appears to be related to when various governments began trade with Boston. Most sailors considered polydactyl cats lucky and they were therefore regular stow-aways on trade ships.

Remember - domestic cats, like horses, did not exist in the Americas until the dang europeans brought them. Horses became fairly popular, but I don't know how the native peoples felt about cats. My guess was that after we killed them all with Smallpox and stole their land, they were pretty reluctant to embrace our feline friends. Horses could be ridden and used to carry things for you. On the other hand, have you ever tried to get a cat to do anything USEFUL? Maybe if THEY WANT to do it or they think it's their idea, but they sure as hell won't do it because you ASKED them to do it. The phrase pack cat just doesn't sound as useful as pack mule.

But I digress...

The typical cat has 5 toes on each front foot and 4 on each rear. Grand total = 18. Anything more than this is polydactyl. Even if it's only one extra. Usually cats are polydactylier than just one extra toe and they are usually symmetrical. Most all of these guys are polydactyl on the front feet only.

The extra toes can sometimes be used as opposable thumbs. My nephew cat Thomas (named for Tom Thumb, not Tom Cat) uses his thumbs to play and catch with. He's practically simian with the things. I'm surprised he hasn't learned how to open the door with them.

The extra toes aren't always attached to the wrist by good bony joints. Sometimes the toes are kind of "floppy" and other times they are fully functional. The wrist is designed to have tendons and ligaments for 5 digits. Anything more than that and there usually isn't enough anatomy to go around.

I've had one person tell me that all polydactyl cats came from Hemmingway's house in Florida. Nope. He had a particular fondness for them and most of his cats were polydactyl, but that's all.

FYI - the current Guiness Record holder has 28 toes. That's impressive!


Male Calico

Posted by Aaron

Tuesday, September 8, 2009

Did you know that the gene for calico coloring in cats is sex related? Two copies are required and they both belong to the female. So only females can be calico.


You have an XXY male - also known as Klinefelter Syndrome in humans. Approximately 1 in 10,000 calico cats are male. That's the last published statistic I've found. Rumor has that they may be slightly more common, but either way - it's pretty rare.

XXY males also have the unfortunate side effect of being sterile. This means you can't breed more male calico cats. They simply happen at random.



Treats for Tricks

Posted by Aaron

Sunday, September 6, 2009

What kinds of treats are OK to give my dog?

Everything in moderation, and nothing to excess. -Aristotle

This is a pretty common question I hear every day in practice. Anyone who has seen me in person (especially in profile :P) would agree that I think treats are pretty important. We get into problems when we forget that they are TREATS and as such should not me a major part of our diet.
In my case - scoop of ice cream=good. PINT of icecream=BAD.
In your dog's case - dog biscuit=good. Handful of biscuits=BAD.

First and foremost, keep in mind that most biscuits and treats for dogs and cats are about as calorie dense as an equal amount of their kibble. I've had owners complain that their dog "only eats a cup of food a day" and are shocked that they have gained weight. After we really look at what goes into the dog over the course of the day, I find out that they get 10 mini-milkbones a day. That's nearly another cup of food!

Just walk down the treat isle at the local pet store and you will be shocked at the sheer number of different options. Notice that nearly all of them are marketed to you, not your dog! Does your dog really care that his food is in the shape of a bone? He eats poop, afterall. Would he like it any better if it were a poop shaped cookie?

There are an unfortunate number of treats that are much to hard to be safe. Nylabones (sorry Nylabone people) and dried beef bones are just plain dangerous. Same goes for ice! Your dog will bust a tooth on one of these. I believe Nylabone does make a flexible/squishy chew. That's OK.

Rawhide: One of the most popular treats. Dried cow skin. Cousins to this would be pig snouts/ears and bully sticks (dried beef penis - I kid you not). Rawhide can be a great treat IF your dog isn't an idiot and tries to swallow it whole. Rawhide does NOT digest once swallowed. Big chunks of rawhide will cause obstruction. Some dogs methodically chew and gnaw the strip down to little bits. Rawhide is great for them. These treats do absolutely nothing for the teeth unless they are enzymatically or antimicrobially treated. They simply turn to slimy wads of old skin. Pretty disgusting, but dogs love them!

Greenies (all all associated copy cats): Greenies were the chlorophyl treat that made all of the other "edible compressed starch" chewies popular. The original form of the treat was too hard and if swallowed in big pieces, would cause obstruction. The company has long since reformulated them and they are now completely digestible. Some dogs get diarrhea when eating a Greenie (or similar). This is probably the case with all treats, but Greenies seems to be accused more than others. Don't know why. Any of the compressed corn starch treats or compressed veggie treats are probably fine.

Table foods: Look below for a list of acceptable fruits and veggies. This section is specifically addressing table foods. We humans eat some very, very calorie dense foods. It doesn't take much "table food" to provide big-time calories to our pets. We MUST be careful with this one.

Fats: High fat items are dangerous for your dog. Steak trimmings, bacon, nut butters, and dairy butter are very effective triggers of pancreatitis. Pancreatitis can be exceptionally dangerous and even fatal. High fat foods must be fed in small quantities only if they are fed at all.

Bones: Raw bones are soft and can be great to chew on. You have the issue of microbial food safety, but the bones won't cause damage. COOKED bones are an entirely different story. Ribs, steak, hambones are all popular treats but should not be fed. Cooked bones have all of the fat and soft tissue cooked out of them and the result is that only the hard calcium matrix. This can not be chewed through. It's harder than a tooth and will break a tooth pretty easily. Once swallowed, cooked bones cannot be digested and can cause obstructions or perforations.

Fruits and veggies:
Pretty much any fruit or veggie is OK with a couple of major exceptions:

Grapes and raisins are expressely forbidden! Bad. Some dogs die of horrid renal failure after eating grapes or raisins. Others have absolutely no problems. So, NO GRAPES FOR YOU!

Onions and garlic (allium family veggies) are dangerous to cats. Dogs can handle small amounts, but you must be careful. Cats have acutally died from drinking onion soup broth. The reason for this toxicity is that cat red blood cells (and to a lesser extent, dogs) are very sensitive to the oxidative damage that allium species do to the surface of the cell. They get damaged, the body takes them out, and the pet ends up with dangerous anemia and expires. Onions-cats-bad.

Some favorites I've had people give: frozen green beans (or fresh - dogs seem to like the crunch), carrots (fresh - NOT frozen), celery stick, sliced apple, sliced pear, and red or green bell pepper.

Post a comment on your favorite treat for your pet. There are tons out there. I'll comment back if you'd like.


Cancer Treatment - How to kill the tumor and not the patient

Posted by Aaron

Friday, September 4, 2009

The title sounds a bit hard-core, but it's the truth.

Our last discussion was about how and why we get tumors. Some of these tumors become what we would refer to as cancer. Once a particular tumor has been identified and we know what we are dealing with, we can then begin discussing treatment.

The words radiation or chemotherapy often begin to evoke visceral reactions from owners. Most people have been exposed to the idea of chemotherapy or radiation because of a family member or friend who has battled cancer. Some chemotherapy and radiation options are pretty rough on the body. Some patients get very sick. But not everything that counts as chemo or radiation is hard on the body at all It really depends on the specific protocol.

In my opinion, it's all about QUALITY of life. Some would see it differently and say that QUANTITY is the more important half of the equation. I disagree. Quantity is nothing without quality. The sticking point becomes defining the point at which quality and quantity intersect at an acceptable point for YOU and YOUR PET.

By example, I am currently treating my own dog for stage 4-b lymphoma. That's about as bad as it gets. We decided to start chemotherapy because many of the initial drugs I was going to use in her treatment were fairly benign and it was worth a shot. Surprisingly, she's responded very well to her chemo and hasn't had any bad days because of it.

Until now.

I made the decision to go ahead and give her the doxorubicin. That is the one most likely to make her 'feel bad' for a few days. My decision to use that drug was based on the fact that a few days of nasty were worth the few weeks or months of happy. That was my take on it. Others would argue that the cost and misery of a few days is not an acceptable price to pay for a few weeks or months.

The take-home point is that the decision to treat and the decision how to treat is not something that can be made for you. Your doctor should give you options and you should consider the total picture and make an informed decision. For some, the answer is an easy. Hopefully you enjoy the support of a caring oncologist or primary care veterinarian and you will be an active part in the decision making process.

Staging the tumor:
Staging is something done when we are dealing with a malignancy (cancer). The goal of staging is to evaluate how 'badly' the tumor is behaving so that we can determine what therapy is required. It is necessary to help direct types of therapy in most cancers.

How we stage a tumor depends on tumor type. Some tumors tend to metastasize to the lungs first. Others met to a regional lymph node first. In the case of lymphoma we have to determine if the tumor is in the spleen, liver, or thymus and if it is in lymph nodes. Different locations have different prognoses because. Believe it or not - the same tumor found in two different places could behave dramatically differently.

If we are able to physically remove the tumor then we often take this as our first course of action. After all, why would we poison the entire body if we can cure the cancer by physically removing it from the body. There are many tumors where this is the ONLY treatment recommended.

Other times, our goal is to de-bulk the tumor. We know we won't get the entire tumor. We know there will be microscopic tumor left behind. But if we get all of the visible tumor, it makes the microscopic much easier to heal.

Because there is often microscopic invasion of the tumor in surrounding tissues, the amount of tissue to remove is sometimes impressively large. As an example, mast cell tumors require margins of approximately 3cm in every direction. By the time you account for the shape required to close the defect, a patient with a 1/2" mass may end up with a 6 inch incision.

Just like with real estate, it can all be about location, location, location. That same mast cell tumor on the foot simply can't be removed. There's not enough foot left to close the wound. So there are times that tumor location may dictate amputation of a particular body part (toe, ear, etc). Amputation doesn't have to be a bad word. Life without a toe isn't a bad idea if the only other option is death.

Radiation therapy means that energy in the form of radiation (gamma rays, x-rays) is poured into the tumor in hopes of causing such severe damage to the tumor cells that they die off. Unfortunately, normal tissues always get caught in the crossfire. There are some great new technologies that allow for the very precise delivery of radiation to a very tiny area and help minimize the amount of collateral radiation damage. Local reactions like burns (mild or severe) are the usual side-effects. When talking about the skin, that's not so bad. But if you are trying to irradiate a tumor in the pelvic canal, you end up burning the colon a bit, and the colon does not handle this very well. Again - Location, location, location.

Some tumors are particularly sensitive to radiation and die off quickly and easily. Some are very resistant and radiation doesn't really work. Radiation is usually applied to a very specific and focused location, but there are times where it is appropriate to irradiate an entire limb or an entire body. Whole-body radiation is something usually reserved for killing off the bone marrow in leukemia patients prior to marrow transplantation.

Chemotherapy - The 'other' Big C:
The goal of chemotherapy is to poison the body JUST ENOUGH that the tumor cells die but the patient does not. Chemotherapy is generally administered to the entire body. This is good if you have tumor around the entire body, but it also means that you are exposing all the normal cells in the body to the drug.

Nearly all chemo drugs target fast growing cells. This makes sense because the tumors are usually growing quickly. However, there are lots of cells in the body that have to grow quickly. Bone marrow, cells lining the intestines, and hair follicles are the major players. Not all drugs cause the same problems. For instance - vincristine is one of the drugs in lymphoma treatment. It is VERY well tolerated and is pretty uncommon to cause any issues. Doxorubicin, on the other hand, is quite likely to cause pretty severe gastrointestinal problems. In some dogs, it will cause balding.

The moral of the story is that you should not let the name chemotherapy scare you away all together. Some drugs are fairly simple and may provide excellent responses with nearly NO side effects. Others may be tolerated well in one patient but horribly in another. You simply have to weigh all the variables - patient, prognosis, finances, transportation, side-effects.

This posting does not even begin to cover everything. My hope was to at least cover the big picture. Like I say - I'm happy to entertain questions about specific tumors, drugs, or topics anytime. Just e-mail me!