Archive for February, 2017

Osteoarthritis in our dog and cat companions

Monday, February 27th, 2017

Geriatric pet care

Our canine and feline companions are living long active lives well into their geriatric years. Therefore assessing and treating osteoarthritis is an important part of geriatric pet care. Many pet owners make the comment that they believe arthritis is the cause of stiffness and a slow rising from rest in their pets.  Up to 60% of dogs are diagnosed with the disease based upon radiographic evidence at some time in their life.

As with most medical conditions, treatments for osteoarthritis are specifically targeted to the physiologic processes that cause the disease.  At Carlson Animal Hospital we strive to educate pet owners about the physiologic basis of the treatments we employ. In this blog we will delve into a bit more detail about the disease itself.

Osteoarthritis and the synovial joints

Osteoarthritis is a chronic, degenerative disease that affects synovial joints.  Synovial joints are articular joints between two bones that are joined by a joint capsule containing fluid and cartilage. The purpose of synovial joints are to allow smooth movement between two bones. The term arthritis, without the osteo prefix, refers to inflammation of a joint of any sort.  Whereas osteoarthritis refers to the chronic degenerative process of cartilage breakdown and associated inflammation.

cat being examined for osteoarthritis

Dr. Swindell examining a feline patient.

Osteoarthritis affects both dogs and cats.   Sometimes the disease is related to aging and sometimes it is not.  Osteoarthritis may also occur secondary to an injury or instability of a joint. A common orthopedic injury in dogs is a rupture of an anterior cruciate ligament (also known as an ACL rupture).

dog hip examination

Dr. Swindell performing a hip exam.

Hip dysplasia is an instability of the hip joint that is often diagnosed earlier in life. These pets will eventually develop osteoarthritis in that joint due to the chronic instability/inflammation.

Physiology of osteoarthritis

Moving on to the physiology of osteoarthritis. We’ve included a definition of a few key terms:

  1. Cartilage– firm, smooth, flexible connective tissue found inside the surface of a joint.
  2. Chondrocyte – a cell that creates the matrix of the cartilage that is found inside cartilage.
  3. Hyaluronate and Chondroitin sulfate – polysaccharides associated with cartilage that are the joint’s shock absorbers.
  4. Inflammatory mediators – signals sent by cells in the body as a response to damage- they cause the body’s protective response, including inflammation. (This is a very simplified discussion of a very complex process!)

The primary pathology of osteoarthritis is cartilage breakdown.  The cartilage becomes weaker, less elastic with less ability to absorb shock.  Small fissures within the cartilage develop propagating a self-perpetuating degenerative process.  Enzymes are produced that degrade the chondroitin, hyaluronate and the collagen of the cartilage further.  As the cartilage is degraded the fluid in the joint secretes inflammatory mediators which cause inflammation inside the joint.  As the osteoarthritis progresses,  osteophytes ( new bone formation) occur around the joint.  These are little outgrowths of bone that occur near where there is damaged cartilage. These osteophytes further create a decreased range of motion and pain.  Osteophytes have sometimes been described as bone spurs.

dog hip with osteoarthritis damage

Model of a normal canine hip joint on the left and a hip joint with osteophytes and chances from osteoarthritis on the right.

Diagnosis includes a physical exam and radiographs (X-rays)

We believe that it is important to diagnose osteoarthritis prior to beginning treatment, especially since the treatment and the disease are frequently chronic.  The initial portion of the diagnosis is based upon a physical examination of the pet.  Joints with osteoarthritis often have a decreased range of motion with associated pain upon careful manipulation.  Radiographs (x-rays)  of the affected joints are advised.  While radiographs will not show us damaged cartilage, they will document the osteophytes that occur in the advanced stages of osteoarthritis, as well as an increase in joint fluid if present,  which is usually associated with inflammation and discomfort. The radiographs below demonstrate a normal canine knee joint on the left.  A radiograph of a knee joint with osteophytes (the osteophytes are noted as small irregularities along the margins of the larger bones surrounding the joint) and osteoarthritis on the right.

dog's knee radiograph

A dog’s normal knee joint – no osteophytes.

dog knee arthritis radiograph

A dog’s arthritic knee joint with osteophytes.

 

 

 

 

 

 

 

 

Multi-modal treatment

At Carlson Animal Hospital we employ a multi-modal approach to the treatment of osteoarthritis.  This means that we target the disease based on the various physiologic processes you  just learned about in this blog.  We decrease inflammation with medication, we help build and support cartilage with supplements, we incorporate a moderate exercise program and weight loss program.  We can even employ a very safe and effective drug that helps decrease the enzymes that cause the breakdown of chondroitin and collagen.

By using all these tools,  we can actually modify the course of the disease, rather than just decreasing pain and stiffness.  We continually re-assess management options based upon the current research through the medical literature and medical conferences.  Fortunately, we continue to see treatment options which increase the comfort of pets affected by osteoarthritis, and decrease the speed of the process of cartilage breakdown.

Our Doctors would be pleased to speak with you about these treatment options and whether they may be helpful to your four legged family members.

It is our pleasure to serve you and your pets. Please do not hesitate to call our offices if you have any questions or concerns. Thank you for allowing us to be a part of your veterinary healthcare team.

www.carlsonanimalhospitals.com

Carlson Animal Hospital, Oak Park, IL 708.383.3606


 

 

Diabetes Mellitus In Cats and Dogs: A General Understanding

Wednesday, February 8th, 2017

Early detection of diabetes mellitus

The increase in diabetes mellitus in cats and dogs mirrors the increase in people; it can be serious and is on the rise. Because of this, we recommend an annual physical examination to address any early warning signs.  With early detection we can increase the chances of the most favorable outcome. When we test for diabetes mellitus we recommend a physical examination, a simple blood test, and urinalysis.

Pancreas and it’s role in diabetes mellitus

To understand diabetes, let’s start with a brief understanding of the pancreas and one of its main functions. The pancreas has several functions, but we will focus on the role of insulin production.

The pancreas produces insulin and regulates blood glucose levels. Glucose, as well as sucrose and fructose, are carbohydrates (we often refer to them as simple sugars).

Dog ultra-sound pancreas

Normal dog pancreas ultra-sound

Cat ultra-sound pancreas

Normal cat pancreas ultra-sound

A normal pancreas should produce insulin as a response to increasing glucose in the blood (after a meal, for example) or when the body recognizes that the cells need glucose. The insulin then regulates the flux of glucose out of the blood stream and into cells.  This is a very important cellular function. Without insulin, glucose cannot enter the cells and provide the energy they need. Without cellular glucose, the body thinks it is starving and searches for an alternate energy source. This sets off a cascade of protein (muscle) and fat breakdown within the body as an alternate energy source.  This in turn leads to harmful metabolic by-products such as ketones formation and weight loss.  This occurs while there is an abundance of glucose in the body just waiting to be used as energy, but it is unable to be utilized.

feline weight loss and diabetes

An increase in appetite coupled with weight loss might be an indicator of illness. Dr. Leslie weighing a feline patient.

Clinical signs including increased appetite may appear even though the pet is losing weight and experiencing muscle breakdown. Next the glucose is so abundant in the blood stream that the kidneys are unable to filter it entirely. Glucose spills over into the urine, bringing water with it, resulting in increased urine production and a secondary increased thirst to make up for the increased urine losses.Therefore pets will drink more water than usual and urinate more than usual.

It is our goal that pet owners recognize the abnormal signs early. Earlier detection means better outcomes!  By the time a pet has reached the life threatening advanced stage of diabetes it has become very lethargic and severely anorexic.  Once an animal reaches this stage, treatment and management are much more difficult.

Types of pet diabetes

Many of you have probably heard, or read about or even known somebody with type 1 ( juvenile onset) or type II  (adult onset) diabetes mellitus. Dogs and cats develop these types of diabetes as well. Many subtypes are being recognized, but for our discussion, we will only briefly discuss these types.

Type 1 is also known as insulin dependent diabetes. In these cases, the pancreas produces decreased insulin or no insulin at all. Type II can also be referred to as non-insulin dependent (although insulin may be needed for the management of this disease). In Type II diabetes the pancreas produces insulin,  but it is either insufficient amounts or the insulin is unable to enter the cell at the receptor level.

 Insulin dependent – typically dogs

In our four legged friends, dogs are typically considered to have insulin dependent diabetes, or Type I, and it is frequently seen in conjunction or secondary to other diseases.  The majority of cats have non-insulin dependent diabetes or Type II.

Diabetes in Dogs

canine diabetes annual examination

Dr. Carlson examining a patient with Diabetes Mellitus.

As opposed to the majority of cats, dogs are generally considered to have Type I diabetes or “latent autoimmune diabetes.” In these cases, the pancreatic beta cells are not producing insulin. In addition to the decreased insulin production by the pancreas, these patients frequently present with underlying causes of insulin resistance secondary to other disease processes.  Some of these underlying diseases include: hyperadrenocorticism (Cushing’s disease), pancreatitis, pancreatic exocrine insufficiency, obesity, any systemic inflammatory disease, severe dental disease, steroid usage, thyroid disease, acromegaly (growth hormone abnormality) and chronic diseases such as kidney disease. These patients will require insulin and addressing each of the associated abnormalities to manage their diabetes.

Diabetes in Cats

cat diabetes risks

Diabetes risk factors include: obesity, eating a high carbohydrate diet, feeding free choice dry food, orange coat color and an age of 8-12 years.

The risk factors for developing diabetes mellituss in a cat include obesity, eating a high carbohydrate diet (most commercially available dry foods), feeding free choice dry food, orange coat color, and an age of 8-12 years.The pathophysiology of diabetes mellitus in a cat is associated with obesity, deficiency of an enzyme glucokinase and genetics. We will briefly discuss each since they are important in the prevention and management of diabetes mellitus in cats.

Obesity is the major contributing factor in the development of diabetes mellitus in cats. Fat cells produce hormones that predispose a patient to diabetes mellitus.  These hormones play a complex role in the body and start a cascading process of negative changes. The hormones produced by excess fat cells decrease the utilization of glucose, decrease insulin production by the pancreas, decrease insulin response, increase insulin receptor resistance at the cellular level, increase inflammatory mediators and increase steroid receptors at the cellular level. All of these changes favor developing diabetes mellitus.  Please be cognizant that over feeding your cat predisposes them to obesity and diabetes.

Diet is a second risk factor for developing diabetes in cats. All cats are deficient in an important enzyme glucokinase that allows the removal of the ingested glucose (sugars) from the blood stream following a meal, and the conversion of these sugars to a usable storage form within the body. Therefore, the commercially available high carbohydrate dry food diets are not an ideal diet for cats. Since cats are carnivores, their insulin production is not based upon a glucose stimulus as in dogs but, rather on a protein stimulus. Talk with us about the best diet for your cat; our discussion might extend the length of your cat’s healthy life.

Genetics is the final contributing factor in the formation of diabetes mellitus. Some cats produce and deposit excessive amyloid in the cells of the pancreas where insulin is produced damaging the pancreas.  This is an inherited trait; cats that produce this extra amyloid are genetically predisposed to developing diabetes.

Certainly many of the same diseases that predispose dogs to developing diabetes mellitus may also complicate the management in cats.  These include pancreatitis, a growth hormone abnormality, dental disease, any inflammatory disease, thyroid disease and others.

Diseased cat pancreas ultra sound

Abnormal cat pancreas ultra-sound

In many instances, the management of diabetes mellitus in cats consists of a diet change and weight management. Frequently we will advise a high protein, low carbohydrate diet +/- insulin supplementation. However, in cats there is a chance that the pancreatic cells can recover and regain their normal function over time.  When this occurs, cats are considered to be in a diabetic remission.

Early identification and prevention of diabetes mellitus is paramount

It is the goal of our team to recognize associated risk factors and the “pre-diabetic” or carbohydrate intolerant patient prior to the development of diabetes.

human treats are can be harmful to pets

Avoid giving pets human treats to aid general health and wellness.

Two of the most important actions a pet owner can take to prevent diabetes are to keep your pet’s weight within a normal range and have annual physical examinations.  Although we may show our love by giving our pets treats or excessive food,  please remember that excess weight is bad for them. Please speak to one of our doctors if you have any questions or concerns about diabetes, the most ideal diet or if you are are noticing any increased urination, increased thirst, weight loss or increased appetite with your pet. We recommend every pet be evaluated at least annually so we can recognize any disease process early and give our patients the best chance at a favorable outcome and treatment.

It is our pleasure to serve you and your pets. Please do not hesitate to call our offices if you have any questions or concerns. Thank you for allowing us to be a part of your veterinary healthcare team.

carlsonanimalhospitals.com

Carlson Animal Hospital, Oak Park, IL 708.383.3606