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Kidney Disease-Get Informed

KIDNEY DISEASE-WHAT CAN YOU BEFORE IT HAPPENS?
Kidney or Renal Disease by Dr. Becky Marks
Kidney Disease

IV Fluids for Renal Care

Kidney disease is common cause of death in our older pets (cats, dogs, birds, guinea pigs). It seems to be a silent disease in pets until it becomes very severe. Veterinary medicine continues to explore new diagnostic tools and treatments.

The body has two kidneys.These organs lay under the last ribs of the body on the left and right side. The role of the kidneys is to filter waste products and to recycle useful components of the blood.Lets try the analogy of a screened window. It keeps the flies out (bad) and always fresh air (oxygen) in. If you get a tiny hole in the screen you will have some ants creep through. The large the hole allows a wasp to creep through. All the blood is screened through the kidneys. If there is a medication, infection or toxins in the system healthy kidneys can handle small amounts. Damaged kidneys a limited in this function. Even an antibiotic may become harmful to a poor kidney.

The result is a concentration of the bad products . They stay in the bloodstream because they couldn’t get filtered out. The worst of these is the end product of protein. Protein gets broken down into “ammonia”. Small amounts are normal but in large amounts are poisonous. On blood work the raised blood ammonia levels are the first indication of kidney disease. Then other numbers begin to rise, too. When we see changes on the blood work it means the kidneys are working at about 1/4 of their normal function or conversely they have lost 3/4 of normal function. As the toxins begin to build up vomiting occurs. Until that point a pet owner may not see any changes. Weight loss, increased thirst and urination and lethargy are usually present.

Now there is an earlier detection test available called the SMDA. It is a biomarker test which measures . Not available at all labs.

Staging of Kidney Disease by the standardized IRIS system is the first step to identifying the severity of the disease and treatment.

Treatment of moderate or severe kidney disease is possible. However, not all animals will respond. Usually these patients require hospitalization, fluids and medication. However, if the mild disease is identified early your pet has a much great chance of improvement and longevity. In addition the treatment may be a simple diet change. The key is having screening tests done. Don’t wait until your companion is lethargic or vomiting. Allow your veterinarian to perform these simple tests as they enter their senior years ( 7 years old and upward).

Reading Food Labels

 Labels–the  guaranteed analysis

by Dr. Becky Marks

 

Firstly, an diet that says “for all stages of life” you already have problems. All diet have modications for the various stages of life. A puppy requires lots more in fat , calories and proteint for growth . The old lab that really is overweight and winding down needs less fat, calories and protein.  It is that simple.

Reading labels for pet food

Many Clients now looks for grain free diets. The idea implies that grains cause allergies or gluten issues. This is not the case. Keep in mind that cats and dogs in the will eat grains whenever they catch a rodent or rabbit they eat the GI contents for the extra (green) nutrition.

In the process of reading the pet food bag there is a lot of information that you might skim over. In the case of the recalls you quickly read through the ingredient list and relied on the accuracy of the label. Labels that have the American Feed Control Official (AAFCO) approval means the law has defined what can be used for manufacture. These are the minimum requirements. Some companies go beyond the basics. Better companies use human grade ingredients. Others use human non-edible grades.  There are also quality standards regarding packaging, physical integrity of the food, adequacy of sterilization, freedom from toxins and microbes.  Canada and Europe have different guidelines.

Remember that more nutrients are NOT always better in pet nutrition — many nutrients are actually toxic in excessive amounts! And every dog and cat has unique nutritional needs based on age, health and activity level.

Ingredients: Ingredients are required to be listed in their proper order of predominance by weight. The weights of ingredients are determined as they are added in the formulation, with their inherent water content. Water content greatly affects the weight of the listed ingredients. If the food is listed on As-is analysis then water is present and the calculations would need to be recalculated on the Dry Matter basis. For example, one pet food may list “chicken” as its first ingredient, and “corn” as its second. The manufacturer doesn’t hesitate to point out that its competitor lists “corn” first (chicken meal is second). However, chicken is very high in moisture (approximately 75% water). On the other hand, water and fat are removed from chicken meal, so it is only 10% moisture. If we compared both products on a dry matter basis, one could see that the second product had more chicken meal than the first product had chicken.

Some categories such as meat, meat by-products, and poultry by-products are confusing.Meat is the clean flesh of slaughtered animals (chicken, cattle, lamb, turkey, etc.). The flesh can include striated skeletal muscle, tongue, diaphragm, heart, esophagus, overlying fat and the skin, sinew, nerves and blood vessels normally found with that flesh.Meat By-products: Meat by-products are clean parts of slaughtered animals, not including meat. These include lungs, spleen, kidneys, brain, liver, blood, bone, and stomach and intestines freed of their contents. It does not include hair, horns, teeth, or hooves.Poultry By-products: Poultry by-products are clean parts of slaughtered poultry such as heads, feet, and internal organs (like heart, lungs, liver, kidneys, abdomen, and intestines). It does not contain feathers.

Guaranteed analysis:

As you scan the guaranteed analysis you will see the breakdown of categories: Protein, Carbohydrates, Fats, Water, Vitamins and Minerals.  Protein is the main element of body tissues like muscles, blood, skin, organs, hair and nails. Carbohydrates provide energy for the body’s tissues. Fats absorb, store and transport vitamins, moisturize skin and coat, make healthy pet food taste great and supply energy. Water is the most critical nutrient for survival. Vitamins assist in maintaining an animal’s metabolism. Minerals are necessary to develop healthy skin and hair, proper skeletal support and development. Minerals are usually abundant in pet food ingredients.

 

Minimum and maximum levels are in the guaranteed analysis. This may have some advantages when you are concerned about the maximum fat in a diet. However, in a pet with kidney disease the level of protein will be the main item of concern. Low protein is critical for kidney patients. When the level states “minimum’ protein 21% you have know idea what the maximum value may be. Now you are learning how to read “between the label lines’. At minimum, a pet food label must state guarantees for minimum percentages of crude protein and crude fat, and maximum percentages of crude fiber and moisture. The “crude” term refers to the specific method of testing the product, not to the quality of the nutrient itself.

 

Some manufacturers include guarantees for other nutrients as well. Maximum ash is often guaranteed, especially on cat foods. Cat food commonly also bear guarantees for taurine and magnesium as well. For dog foods, minimum levels of calcium, phosphorus, sodium, and linoleic acid are found on some products. If the guarantees don’t include information on a particular nutrient that you are interested in, ask the company, or don’t buy the product.

Comparing the guaranteed analyses of dry and canned products, one will note that the levels of crude protein and most other nutrients are much lower for the canned product. This can be explained by looking at the relative moisture contents. Canned foods typically contain 75-78% moisture, whereas dry foods contain only 10-12% water. To make meaningful comparisons of nutrient levels between a canned and dry product, they should be expressed on a similar moisture basis.  To roughly approximate this, the guarantees for the canned product should be multiplied by four.

When buying a canned food, look at the moisture guarantee. The maximum moisture content for a pet food is 78%, except for products labeled as a “stew,” “in sauce,” “in gravy,” or similar terms. The extra water gives the product the qualities needed to have the appropriate texture and fluidity, but you are paying for it.

 

Nutritional Adequacy Statement  will also state for which life stage(s) the product is suitable, such as “for maintenance, or “for growth.” A product intended “for all life stages” meets the more stringent nutritional needs for growth and reproduction A maintenance ration will meet the needs of an adult, non-reproducing dog or cat of normal activity, but may not be sufficient for a growing, reproducing, or hard-working animal.  Puppy/kitten, adult maintenance, low activity and senior pets can easily have their needs met with respective diets for each stage.

Feeding Guidelines:

Feeding guidelines instruct the consumer on how much product should be offered the animal. At minimum, they should include verbage such as “feed ___ cups per ____ pounds of body weight daily.”The feeding directions should be taken as rough guidelines, a place to start. Breed, temperament, environment, and many other factors can influence food intake. The best suggestion is to offer the prescribed amount at first, but don’t be afraid to increase or cut back as your eye guides you.

 

Trusting the information on the label will be difficult for you with regard to the recent recalls. The Pet Food Institute  has just announced the formation of a National Pet Food Commission. The purpose of the Commission is to investigate the cause of the recall and to recommend steps the industry and government should take to further build on safety and quality standards already in place. The Commission is an industry/government partnership composed of government officials, veterinarians, toxicologists and food scientists who are committed to maintaining and enhancing the high standards we have set in this country that protect our pets.

Bladder stones

Bladder Stones in Cats and dogs

Plugged Cat

Bladder stones or calculi may not be a topic of interest to most pet owners unless your pet has had illness related to these mineral densities. However, you may be predisposing your pet to problems depending on the diet you currently are feeding.

Cats and dogs can have urinary calculi. Early signs of calculi include frequent urination, straining to urinate, blood in the urine and/or licking the urethra. Cats spend extra long times in the litter box. In severe cases no urine is voided. There are six different types based on the mineral crystal content in the stone. The body forms these different crystals in relation to specific diseases. Let me discuss each briefly.

One of the most common calculi we see is called Struvite. This is a combination of magnesium, ammonia and phosphorous. While dogs or cats of any breed can have these crystal formations we tend to see cats in severe emergency states more often. Perhaps since the monitoring of cats for urination is not a highly visible activity cats may be unobserved until they are howling and can no longer move. Now the pet is in a critical stage and must be examined and be hospitalized for catheterization, fluid therapy and treatment of the crystals. Males have more difficulty trying to pass these stones because of the small opening of the penis. The male becomes “plugged” meaning he can’t urinate .  In hours the effects on the bladder wall, kidneys and heart can lead to death.  Females can be in trouble if the stones are larger. Stones beyond sand size need surgical removal.

In young cats we see Struvites. While the exact cause is not known it is generally accepted that bladder infections and diet cause development of the calculi. There a several veterinary prescription diets available. A few store brand diets are available and are creating a increase in another type of crystal that we rarely saw years ago. As cats age they can develop oxalate crystals. The easy accessability of the store brand diets when fed to middle aged and older cats creates Calcium oxalate crystals. The bladder is like a chemistry lab and a few reagents (diet ingredients) and minerals added here and there will alter the kidney and bladder function. These are serious calculi causing both lower and upper urinary tract disease.

Urate crystals can form from excess Uric Acid in the bloodstream and in the urine. Many Dalmations and Bulldogs develop these crystals. In humans this causes gout because the joints collect crystals, too. We don’t see this phenomenon. Treatment of concurrent liver disease and specific low protein diets often with medication will control the disease successfully. Xanthine crystals can result if the medication is in excess.

Cystine crystals are found in animals that have an amino acid metabolism defect. Fortunately these are not common. Breeds which may be predisposed are Newfoundlands, dachsunds and Siamese.

Calcium Phosphate crystals (You guessed it this is beginning to sound like a chemistry class.) occur with excess calcium and phosphorus in the bloodstream and urine. Some times breeders feel they will push their pups to be have a larger skeletal frame if they supplement minerals. This is a rotten result.

In most instances the calculi can be controlled with specific diets and sometimes additional medication. In cats stress contributes to the urinary tract disease.Stress may include disease, crowding, changes in environment or new pets in the household. Regular tests on the urine will be helpful to keep current on the disease of the urinary tract. The best advice is to feed your pet a good quality diet. Cheaper brands tend to be high in bone meal which is a large source for minerals. The same minerals can be found in the bladder stones.

Cat Fights and Wounds

Cat Fights and Wounds

Authored by
Becky Marks, DVM

If you are reading this article then likely you own
a cat. It is equally likely that you have had experience with your cat
getting into a fight. Cats often end up with wounds that become
infected. This article discusses cat fight wounds and treatment.

Cats have several mechanisms with which to fight.
They would prefer not to engage in contact with their opponent for
several reasons. Contact involves energy, risk and consequences. If you
watch a cat fight the cats generally become vocal first. This requires
the least energy. Next is the body language which includes hair raising
( to increase body size and increase threat), stiffening of the body
(poised for action)and avoidance of eye contact.With a continued
threat  movement is next. Cats will still keep distance from the
opponent but may now involve circling and full  eye contact. This
completes the threat. The challenge is on!

Nails are the first contact tool because they are at
the end of the extremity and allows the cat to keep there opponent at a
distance. About 50% of the fight wounds are from toenails. They carry
bacteria related to the earth and common to the feces. Bite wounds
carry there own set of bacteria that normally inhabit the mouth and
obviously don’t cause problems there.Common bacteria are Staphlococcus,
Eschericia Coli, B-Hemolytic Streptococcus, Pasturella and Pseudomonas.
Additional infective agents can include abnormal inhabitants such as
viruses (Herpes, Feline Leukemia, Feline Immuno Deficiency Virus ,
Mycoplasma, Chlamydia, Calicivirus and fungii.As the point of the nail
or tooth penetrates the skin the infective organism is now introduced
percutaneously (under the skin) and infection begins.

Generally from the time of the penetration to
obvious clinical illness is 48-72 hours. The cat may become withdrawn
and typically hides for safety but also to be left to “lick his
wounds”. A fever has set in. If the infection penetrated into the blood
stream sepsis (infection in the blood) will transpire. This can be life
threatening. The cat may refuse food and water. For this reason he may
not urinate or defecate.In addition most cats do not want to be handled
because of moderate pain at the wound site. Now the owner becomes aware
his/her cat is sick.

The examination of the cat by your
veterinarian (hopefully you have scheduled an exam by this point)
reveals a lethargic cat, fever ranging from 103-106F, often cranky if
the wound site(s) is touched . The wound may appear as a large swelling
with redness and heat. This is an abcess.The wound may have advanced
into a mature tissue degradation where the center of the wound is soft
and is becoming necrotic  or “dead” and soon will rupture. When
this happens a distinct odor is noted. The contents of the abcess is
usually blood tinged, thick and white. It might be comparable to
strawberry yogurt.  It is a combination of white blood cells,
bacteria , toxins and blood.

Treatment for the patient can be simple in the
earliest of stages. If the owner observed the cat fight then  an
immediate exam, cleaning the puncture sights and dispensing of
antibiotics is appropriate. However, the advanced stages  more
aggressive therapy is required.. The cat is treated in hospital. He
may  have bloodwork, IV Fluid therapy, antibiotics, pain
medications and anesthesia to flush, debride and  manage the
wound. A rubber/latex tubing is sutured into place to allow continued
drainage.  Often the care involves a  minimum 24 hour
hospital stay. The patient is released with antibiotics, pain
medications and Elizabethan collar to prevent the patient from removing
the drain.  The drain is removed by the hospital on the recheck
exam in 3 to 5 days.  Some clinics are using a single antibiotic
injection that lasts 2 weeks. This is really a poor choice as this
particular antibiotic (Convenia) is effective against only Pasturella
in cats. This is a very narrow spectrum. Pain medications such as Metacam,
Oipoids and Onsior can be carefully administered. Never give
tylenol to  your cat.

As the wounds progressively get infected your cat start to
give you clues. Abcesses are a common result of cat fights. Treatment
should be started immediately to avoid extreme illness in the
cat.

Canine Influenza

Alert to Dog Owners                                   :
First Case of Canine Influenza in Oregon reported this week.

We have vaccine available– Call for an appointment*

The Portland Veterinary Medical Association, the Oregon Veterinary Medical Association, and the State Public Health Veterinarian, Dr. Emilio DeBess, are recommending proactively vaccinating of all at-risk dogs for CIV to protect of these patient and prevent an outbreak in our community.

Dogs at increased risk of exposure include but not limited to dogs with lifestyles that include dog parks, dog-daycare, dog shows, grooming, boarding, travel (car, air, etc), rescue animals and dogs with pre-existing heart disease or lung disease, potential senior dogs, and brachycephalic breeds.

Symptoms include sneezing, nasal discharge and frequent coughing that can last for two weeks or more. Some dogs develop more serious disease and pneumonia that requires hospital care.

Most dogs that get canine flu recover, but in the same way the flu affects older humans and those with weakened/new immune systems, young and very old dogs are at a higher risk.

*The canine influenza vaccine is a “lifestyle” vaccine, and is not recommended for every dog.

Timberland Animal Clinic 18110 SE Division St. Portland, OR 92376

503.655.1194