Browsing tag: Blood test

Do you know when your pets are poorly?

It may seem like a silly question, of course you would know when your pets are sick wouldn’t you? They share your life, your home and you know them really well, just as you do other members of your family. However, what many people don’t realise is that our animals are extremely adept at masking signs of illness and often by the time we realise there is a problem, they have been struggling for a while.

This blog was inspired by a cat I saw last week. She was owned by some lovely clients; regulars with their other pets and they definitely have their best interests at heart. I didn’t blame them for not noticing sooner this one was poorly because a) felines are notoriously good at hiding illness and b), you know, I’m a vet, so really I should be quite good at spotting when animals are sick but I don’t expect others to be.

However, I think they may have realised they had left it a little long to bring her; several times during the consultation the husband mentioned that they had waited because she didn’t seem in ‘distress’ and here in lies the nub of the matter for this cat, and for many of the pets I see.

Animals are very, very good at hiding when they aren’t feeling well or are in pain. You could say they are made of much sterner stuff than us humans, and they probably are, but in the main this characteristic comes from millennia of evolution; in the wild sick creatures are soon picked off by predators. This means that even when they feel dreadful animals will do their level best to behave as normally as possible or they may simply go off and sit quietly in a corner or curl up and sleep much more than usual. What they won’t do it moan or groan (or winge and demand tea and sympathy!), the most we might get is a reduced appetite or a limp. This is especially true of problems like arthritis, cancer or kidney failure, all of which are common in older pets.

Sadly this little cat had the latter of these and I will tell you how this tale ends now; blood tests showed her renal function was so damaged the kindest thing was to put her to sleep. Many people would think it almost impossible to not notice a pet was so sick they were near death but this is not the first time I have dealt with a case like this and it won’t be the last.

Obviously you don’t want to be dashing down to the surgery every 5 minutes when a pet isn’t quite themselves but neither do you want to leave things too long. So what is best to do? My advice would be to always be aware of how your pets are and if they have seemed ‘off’ for more than a day, ring your practice for a chat. A good clinic should take the time to speak to you and help you decide whether there is really a problem or not or use the symptom checker on this website!

Cat Henstridge BVSc MRCVS – Read more of her blogs at catthevet.com

Part 3: Surgical Colic

As we saw in the previous part of this series, Medical colics are those which can be managed medically, usually on the yard. However, about 1 in 10 cases of colic require emergency referral to an equine hospital for surgery.

This is what most horse owners are terrified of. The general indicators that a horse has a surgical colic are:

1) Heart rate over 60 that isn’t relieved by injectable painkillers.
2) Dilated loops of small intestine on rectal exam.
3) Positive stomach reflux from the stomach tube.
4) A definite rectal diagnosis of a surgical problem.
5) “Toxic rings” – dark red or purple gums, that indicate that the horse is going into toxic shock.

Of course, it varies between horses, and the vet has to make a judgment call based on all the evidence available.

We also have to talk to the (by now usually frantic) owners about costs. Colic surgery usually costs between £4000 and £5000, but can easily be a lot more. Even if the horse is insured, it is important to check how much the insurance company will cover – there are a couple of companies out there who will only cover part of the costs of emergency surgery. If in doubt, always call your insurer’s helpline.

However, colic surgery is one of the most genuine emergency operations there is – and it can be truly life-saving.

So, what causes a surgical colic? Probably the most common are:

1) Twisted bowel. If a length of bowel twists around itself, it can cut off the circulation. At this point, the gut begins to die, and unless it can be removed by surgery, and quickly, the horse will go into toxic shock and die. This commonly happens in the small intestine or occasionally the colon, but there’s also a condition where the caecum gets turned partially inside out (an intussusception).

2) Small intestinal blockages. Horses rarely eat things that get stuck in the small intestine (although it can happen). More commonly, a really heavy worm burden can simply block up the bowel; with the bowel overfull, the blood supply starts to fail, and the gut, again, can die. I once had a patient who was a little foal with a severe colic; we removed two gallons of worms from her small intestine!

3) Strangulating Lipomas. These are really common in older horses and ponies. A small, benign, fatty tumour forms somewhere in the abdomen, causing no harm at all. However, it grows on a stalk, and eventually, the stalk gets wrapped around a length of gut, cutting off the blood supply… This results in the bowel dying, as if it had twisted. Fortunately, these are usually really simple surgical procedures; unfortunately, older horses and ponies are less likely to be insured for surgery.

There are also a number of medical conditions that can mimic those requiring surgery – particularly peritonitis and anterior (or proximal) enteritis. Horses with these conditions are often referred for possible surgery because it’s very hard for the vet in the field or on the yard to be 100% certain they’re not surgical. I think that most of us would say it makes a lot more sense to have the horse at the hospital, with a surgeon on call, to make the definitive diagnosis, rather than waste time in the stable, and risk having to then decide it needs surgery when it’s still an hour or more away in travelling time from the hospital!

So, what happens when the vet decides that a colic case isn’t suitable for medical management?

Firstly, they’ll talk to you about the options. If a horse isn’t insured, or there’s no money for treatment, it is a perfectly respectable and responsible decision to decide, sadly, to put the horse to sleep rather than prolong its suffering.

Hopefully, of course, that won’t be the case. Once you and the vet have decided that referral is the way forward, your vet will get in contact with a referral hospital. If you’re very lucky, it will be one run by your vet’s practice, but in most cases, it will be a specialist referral hospital. I must say here that not every centre with surgical facilities is able to cope with emergency colic surgery – they need not only to have the facilities (knock-down box, operating theatre, recovery box etc), but also the staff (not only a surgeon, but also enough vets and nurses to take care of your horse in the vital recovery period). Your vet will have a list of suitable referral hospitals – generally, its best to send the horse to the closest one with the shortest transport time, but your vet will be able to advise you.

Making an emergency referral is simple – but only your vet can do it. A referral hospital will not accept referrals from the horse’s owner! Once you’ve made the decision to refer, your vet will call them and speak to the veterinary team on call, who will be available 24/7/365 (when I was part of one such team, we ALWAYS seemed to get our referrals at about 10pm!). They’ll let him or her know what they want done during transport – generally, they’ll describe what painkillers they want given, and what samples they want taken (don’t be surprised if your vet gives you a couple of blood tubes to take up and give to the referral team). In addition, they’ll sometimes ask the vet to put in a stomach tube and tie it in for the journey – this is to prevent the stomach from getting over-full and bursting if there’s an obstruction in the small intestine. Don’t forget your horse’s passport – legally, they do need it even when being rushed to emergency surgery.

Your vet will generally give you directions and a contact number for the hospital, and send you on your way. Remember, they can’t normally go with you, because your horse’s colic, while devastating, is probably only one of several cases they’ll have to deal with.

If there’s a problem (e.g. your horse getting distressed) in transit, call your vet or the referral number you were given – but if at all possible don’t stop unless they tell you to! Remember, you’re on your way to the best equipped help available.

On arrival at the hospital, you can expect to be met by the veterinary and nursing team. Your horse will be rushed to an assessment area, and you’ll probably be given a lot of scary-looking paperwork to sign. Generally, this comes into 2 parts – firstly, you’re signing to give consent for whatever they need to do (and remember, a lot of drugs aren’t technically licensed for use in horses, because the manufacturers haven’t paid for an official license for that drug in horses. It doesn’t mean a drug is dangerous or experimental, it’s probably used on a daily basis by the hospital. You’ll have to sign consent to use unlicensed medication – it’s absolutely routine, and nothing to worry about). Most hospitals will also ask to see your passport – if you haven’t got it, or it isn’t signed to mark the horse as “not intended for human consumption”, legally the hospital can refuse treatment (although they rarely do).

The second set of paperwork you’ll sign is a bit more pedestrian – you’ll be signing to say that you will pay for any treatment!

While you’re contemplating the paperwork, your horse will be undergoing another examination by the veterinary team. This is to establish what’s going on, and what’s changed since your vet examined him back on the yard. They may well repeat some tests – most colic conditions are dynamic (i.e. constantly changing), and sometimes the change is more useful in working out what’s going on than a one-off test. Other tests they may wheel out include ultrasound – the powerful ultrasound systems available in a hospital environment can give the vets a lot more information about what’s going on. The vets will then make a decision about what to do – don’t be disappointed or worried if they don’t rush immediately to surgery! They may decide to try a course of medical treatment first (remember, they don’t have to rush as much as your vet does – if your horse’s situation deteriorates, they can operate at a moment’s notice).

In many cases, however, they will decide to take the horse straight to theatre. If so, you normally won’t be able to follow, so I’m going to describe what happens once you’ve been gently steered in the direction of a waiting room.

To begin with, the horse will have an intravenous catheter fitted, to allow easy access for fluids and drugs. A horse with colic is systemically weakened, so will almost invariably be given intravenous fluids during surgery. He’ll then be given a premed – this is a sedative, designed to make induction into anaesthesia gentler. It will usually contain the drug acepromazine, because the use of this before surgery has been demonstrated to reduce the risks of anaesthetics.

He’ll then be led into a knock-down box: this is a special padded room, designed to make induction of anaesthesia safer. Then he’ll be anaesthetised with an injection containing (usually) a mixture of 2 anaesthetic agents, ketamine (no, it’s not a tranquilizer, it’s an anaesthetic) and diazepam or a similar drug. Shortly after the injection, he’ll go wobbly, and then quickly lie down.

Once he’s asleep, the team will swing into action: a tube will be passed down his throat to help him breathe and he’ll be moved into the operating theatre. While this was going on, the surgeon(s) will have been scrubbing up, ready to start.

Once he’s in theatre and safely ensconced on a well cushioned table (to prevent pressure sores etc), he’ll be put onto anaesthetic gas to keep him asleep.

Colic3 - SurgeryThe surgery involves a long incision down the midline of the belly. The surgeons can then have a good look through all the intestines, to find the problem. This is the exciting, sexy bit, but it’s actually pretty simple in principle: “if in doubt, cut it out”. In other words, removing devitalized (dead) bowel, emptying out anything in the bowel that shouldn’t be there (e.g. a caecal impaction), replacing anything that’s got stuck in the wrong place (e.g. an entrapment) and untwisting anything that’s tied up. There are usually at least 2 surgeons, because one person is needed to hold loops of intestines (and they don’t stay still – sometimes they wriggle around in your arms)! Meanwhile, the anaesthetist will be carefully monitoring all sorts of parameters (heart rate, blood pressure, ECG, reflexes, breathing and blood gasses can all be monitored at many hospitals) and adjusting the anaesthetic and any other drugs to give the safest and most effective anaesthetic.

Once whatever the problem was has been found and (hopefully) sorted out, your horse will be returned to the recovery room. In many ways, this is the most dangerous part of the procedure. Horses are very prone to breaking things when they wake up, so everything is done to keep it as calm and quiet as possible. Sometimes, the veterinary team will help the horse to rise, using hoists and lifts; other times, it works out better to let him get up in his own time. In either case, he will be moved into a padded room, and left in dim light, as quietly as possible, so he wakes up slowly.

Once awake, and steady on his feet, he’ll be moved to an intensive care box; he’ll almost certainly be on a drip to keep him hydrated. At regular intervals through the next 24 hours (or longer) he’ll be checked by vets and nurses. In some cases, the guts don’t start working properly on their own, and medication may be needed to encourage motility (e.g. a lidocaine drip). Although everyone gets excited about the surgery, it is this recovery period that is in many ways the most important in getting a good long-term prognosis.

As time goes on, the vets and nurses will try and tempt the horse to eat – normally, we’ll try and get him eating fresh grass as soon as possible. As soon as he is stable enough and eating on his own, he’ll be sent home – most horses do better in their own home environment, so as soon as they no longer require advanced medical intervention, they can go home. Once home, it’s important that the discharge instructions from the hospital are followed – it can be tempting to try and speed things up, but don’t rush it! Major abdominal surgery takes time to recover from.

Colic is a worrying condition to have to deal with as an owner, especially as it often seems to come out of the blue. However, if you ever have to go through it, I hope that having read these blogs, you’ll have some idea of what’s being done, and why. Remember, our aim as vets is to help your horse and, if at all possible, send him home to you fit and well.

If you are worried your horse or pony may be suffering from colic, talk to your vet, or check the symptoms using our Interactive Equine Symptom Guide to help assess how urgent the problem may be.

Colic: Part 1: Diagnosis and Workup

Horse colic examination and anatomy
When talking about colic, it’s important to have some idea of what the various parts of the equine gut are… So, here we go:
Stomach – quite small, and hidden away deep up in the ribcage.
Small intestine - this is very long, but quite narrow (perhaps 1 or 2 inches across). It is all coiled up throughout the abdomen.
Large intestine – this is divided into three parts:
The Caecum is a large sac perhaps four or five feet long, pointing forward, and can be heard on the right flank. Generally, it makes a loud gurgling noise every 20 to 30 seconds in a normal, healthy horse.
The Large Colon makes up a double U shape, lying on the bottom of the abdomen. It can be up to a foot across, but at each end is a sharp 180-degree bend; the bend near the pelvis (the pelvic flexure) is especially narrow.
The Small Colon runs from the large colon down to the rectum, along the top of the abdominal space.

It’s something all horse owners dread – colic. However, colic is a symptom, not a disease in its own right, and has a wide range of different causes. This is the first in a three-part series where I’ll be looking at colic in horses – its diagnosis and treatment, and what happens if your horse has to be referred for surgery.

Put simply, all colic is, is abdominal pain. However, before you’re tempted to dismiss it as a stomach ache, it’s worth remembering that the horse’s intestines are as complicated as a major chemical factory! Anything that causes disruption to their function is potentially life-threatening.

Occasionally, colic pain comes from a non-intestinal source, e.g. Liver disease (think ragwort poisoning, or liver fluke), or a kidney issue. In mares, it can also be caused by certain disorders of the reproductive tract. However, the vast majority are due to disease, damage or malfunction of the intestines.

If you call your vet and tell them that your horse has colic, they’ll treat it as an emergency, because it can be. They’ll generally take a bit of history from you, a quick description of what the horse is doing at the moment, and then they’ll head out to examine the horse. Most vets will also give instructions for what to do while you’re waiting; it’s important to do what they say, not what someone else on the yard suggests. This is because they may have an idea what sort of colic your horse has, and will try to tailor their instructions to the specific case. For example, some forms of colic respond well to being trotted around on the lunge; however, that can worsen other types.

When they arrive, the vet will want to establish three things:
Firstly, does the horse actually have colic? I’ve been called out to “colic” cases that proved to be laminitis; to a mare foaling down; once even to a tired (but perfectly healthy) horse sleeping in his stable!
Secondly, assuming it is a colic, is it a Medical or a Surgical Colic? (I’ll talk more about this distinction in a minute).
Third and finally, can they make a specific diagnosis of what kind of colic it is?

Every vet will have their own routine, but my workup goes something like this:

What’s the horse’s behaviour like? Is he alert, or dull and unresponsive? Is he thrashing about, or just looking at his flanks occasionally? Generally, a quieter horse is likely to have a milder colic, unless he or she is so toxic that they are depressed or spaced out. One exception is that some spasmodic colics are incredibly painful – however, the pain usually comes in waves.

Are there any droppings in the stable? Hard, dry lumps of faeces is suggestive of an impaction, or blockage; while very runny faeces or diarrhoea may suggest colic secondary to an infection, e.g. Salmonella.

Then I’ll start my examination:

Mucous membranes (gums are usually most accessible and reliable) – what colour are they, what is the refill time, are they tacky?
The normal colour is described as being “salmon pink”, and if you press with a finger for a moment, the colour should fade to white, then return within 2 seconds. They should also be nice and moist to the touch. If they are red, or purple, or the colour doesn’t fade, it is highly suggestive of toxic shock (like septicaemia). This is a marker of a really, really severe injury to the gut wall, that’s allowing bacterial toxins to enter the circulation. If the refill time is greater than 2 seconds, or the membranes are tacky or dry, it suggests dehydration and/or shock.

Heart rate - how fast, is the rhythm good? As a (very rough and ready!) general rule, a heart rate under 60 beats per minute implies a Medical colic, while over 80 suggests a Surgical case. If there’s an abnormality in the rhythm, it can mean heart disease as well, or severe toxic shock.

Gut sounds - what do the guts sound like in all 4 quadrants?
This is where you’ll see your vet putting a stethoscope to the horse’s flanks, listening to the guts. The normal, healthy gut makes a wide range of bubbling, gurgling noises (the sort that anywhere else you would associate with really cheap plumbing!). The bottom left is the left Large Colon, bottom right is the right Large Colon and perhaps some Caecum, the top right is the base of the Caecum, and the top left is mainly small intestine. This is one of the most useful tests we can do – reduced sounds mean the guts are “slowing down” – this can mean an impaction or blockage, but it can also mean a serious disease e.g. a twisted gut. Increased sounds is generally a good sign, as it usually means a Spasmodic colic.

Finally, I’d want to take the temperature (a horse with a fever is likely to have another disease, e.g. Salmonella, that is the underlying cause of the colic), and then, if at all possible, do a rectal exam. People get very excited about this, and it’s one of the standard jokes about vets, but I’d like to go on record and say that I doubt anyone actually enjoys rectalling a horse! Apart from anything else, it’s dangerous to the vet, and uncomfortable to the horse… However, it can provide more information than almost any other test. What we’re feeling for is anything unusual: is the large colon a normal size and texture? How about the Caecum? Can you feel the small intestine? Usually, the small intestine is almost impossible to feel – it just slithers out of the way. If, however, you can feel thick, swollen loops of intestines (they feel a bit like black pudding, or really thick, soft sausages, if you’re interested!), it is an indication of a complete blockage in the small intestine, which needs emergency colic surgery. On the other hand, if you feel a doughy, squishy mass in the colon, that means the horse has an impaction.

Sometimes, if there is doubt about whether food is passing from the stomach or not, the vet will pass a stomach tube and see how full the stomach is. This looks really easy in theory – you pass a tube up the horse’s nose, he swallows it, and then you syphon out the stomach. If you get lots, it’s too full, if not, it’s fine. However, not all horses are quite so easy! Some horses are really difficult to get to swallow the tube, and it can take several attempts to make sure it’s not in the windpipe (which would be a disaster). Also, the equine stomach is, as one equine surgeon I know once put it, “a fantastic organ – it can be completely dilated (full), and you’ll get nothing out of it until you move the tube half an inch, then it all comes spurting out”. However, if there’s any doubt, it can be a great tool to ensure that there isn’t a rapidly life- threatening blockage; it can also be emergency first aid to prevent the horse’s stomach rupturing in a severe surgical colic.

The vet will also sometimes take blood samples – we tend to hold onto these in case they’re needed, but the main things we’re looking for are:
1) Evidence of dehydration – the blood tests will allow us to quantify the degree of dehydration, making it easier to plan a course of treatment.
2) Evidence of infection – if the white cell count is significantly abnormal, it suggests there may be something else causing the colic that we might need to look into.
3) Liver and kidney function – sometimes liver or kidney disease can present as colic
4) MOST IMPORTANTLY – Fibrinogen levels. Fibrinogen is a substance that can be used to assess inflammation and tissue damage – a high Fib level in a colic case is very suggestive that the gut integrity is damaged, and that surgical intervention may be needed.

There’s one other sample that can be very useful, especially as a “rule out” test if the clinical findings are contradictory or unclear. This is a peritoneal tap. This test carries some risk, but sometimes it’s the best way to find out what’s going on inside the abdomen. The belly of the horse is clipped, and prepared so make it as sterile as possible – we don’t want to risk introducing infection. The area is numbed with local anaesthetic, and then either a small incision is made with a scalpel and a blunt cannula inserted or (more usually) a small sterile needle is VERY CAREFULY inserted through the abdominal wall. The fluid that comes out is collected in a sterile sample pot for examination. The risk, of course, is that damage is done to the intestines; however, we’re very careful to avoid them as far as possible, and instead to collect the fluid that surrounds the intestines, the peritoneal fluid. In the lab, the numbers of cells can be counted to assess if there’s infection in the belly (peritonitis); however, in the field we can tell three things:
1) The tap fluid is clear (you can read text through it) yellowish – this suggests that the abdomen is basically OK, and means that in the absence of any other findings, the case can be managed medically.
2) The tap is cloudy, reddish or umber in colour - this means severe damage to the gut walls and/or peritonitis (infection in the abdominal cavity). This horse needs urgent referral for investigation at a hospital.
3) The tap contains gut contents (green or brown, lumpy) – sadly, this means that the intestines have ruptured; the horse is highly unlikely to survive. Alternatively, this may mean that the needle has gone into a part of the intestines, so if I get this, I’ll usually repeat the tap a few inches away, to make sure. If the needle has damaged the intestine, it’s not a disaster, but it is something to be avoided if possible.

So, using all the information from our history and workup, the vet has to decide if the colic is Medical or Surgical.

The terms are more or less self-explanatory: a medical colic can be managed with drugs, while a surgical colic needs emergency surgery.

As a rule of thumb, 9/10 colics are medical, and can almost always be managed on the yard. In my next blog, I’ll be looking at these Medical colics, their causes and treatment.

If you are worried your horse or pony may be suffering from colic, talk to your vet, or check the symptoms using our Interactive Equine Symptom Guide to help assess how urgent the problem may be.

Sammy’s Story – Feline Diabetes Isn’t As Scary As It Sounds!

Sammy catSammy is a lovely, and much loved, 13 year old moggie who has always been the picture of health. Healthy appetite, healthy weight and body condition – and he seemed pretty happy too. But a few months ago his owner noticed him at the water bowl more than she used to. At first she didn’t think anything of it, but with the extra drinking came extra urination, and it also seemed to be associated with an increase in appetite. But still she assumed that this was normal as the weather was getting colder and he was spending more time inside. However, at his next annual check-up with me, we found out that he had actually lost almost a pound in the past year. I recommended a blood and urine test and his owner agreed, and when the results came back the answer was clear – Sammy was diabetic.

His owner was in tears. How could she possibly cope with a diabetic cat? She works full time and has two small children, and besides, she has no medical training so how on earth would she be able to give an insulin injection twice a day? She even thought about having him put to sleep because she simply wasn’t going to be able to handle his condition. But we had a nice long chat about what it means to be diabetic and what the treatment would and wouldn’t entail, and by the end of the conversation she was willing to give it a try.

What is diabetes?

This gets a bit complicated, but I’ll do my best to explain it. Sugar in the blood (also called glucose) is a very important source of energy for the body and without it the body’s organs (particularly the brain) run out of fuel and start to shut down resulting in lethargy, confusion, fits, coma and even death. Too much of it however can also be harmful and diabetes is a condition that results in the cat’s blood sugar being too high. Most of the time this is because the body doesn’t produce enough insulin, the hormone responsible for lowering and stabilising blood sugar. High blood sugar in turn results in lots of very sugary urine which leads to more frequent urination, and the increased urination causes increased thirst and drinking. A lack of insulin also means that the body’s cells can’t use the glucose, even if there’s lots of it in the blood, so the body starts to break down other tissues such as fat and protein for energy. This then causes weight loss, but also an increase in appetite as the body tries to compensate. Therefore, the four most common symptoms of diabetes are:
Amber drinking

1. Drinking more than normal
2. Urinating more than normal
3. Eating more than normal
4. Weight loss

Diabetes is not the only disease that causes these symptoms, but if all four come together, it puts diabetes at the top of the list.

How is diabetes diagnosed?

Diagnosing diabetes sounds like it should be pretty easy – if a cat has high blood sugar, it has diabetes, right? Not quite. Cats can have high blood sugar for a couple of different reasons, the most common being stress. And what cat isn’t stressed by the time it gets to the vet, let alone has its blood taken for testing? It is therefore important for your vet to make sure that it isn’t just stress causing the high blood sugar. One of the easiest ways to do this is to test the urine for sugar as well – if there is sugar in the urine, chances are the cat is truly diabetic but this still isn’t a perfect test. If your vet suspects that your cat may have diabetes, a second blood test will typically be run. This could either be, depending on your vet’s personal preference, a single test called fructosamine, or a series of glucose measurements over several hours called a glucose curve. Fructosamine measures the average amount of glucose in the blood over the past 2 weeks (thus making it a more accurate test than a single glucose measurement) whilst a glucose curve measures both the highest and the lowest blood sugar levels on a curve over the course of a day. Both tests are used commonly and both can help the vet diagnose and treat diabetes.

And now the scary bit – how is diabetes treated?

Because diabetes usually means the body doesn’t make enough insulin, the best way to treat diabetes is to give the body more insulin. This may sound easy, but unfortunately insulin can only be given by injection with a needle under the skin. And it has to be given every day, usually twice a day, at about the same time each day so a regular routine is essential. The good news is that the needles are very very small, and so is the volume that needs to be injected. Therefore most of the time the cat doesn’t even seem to notice, especially once they get used to the process. The bigger concern for the cat is having to go into the vet periodically for check-ups and blood tests to see how their body is coping with the treatment, but even that isn’t too bad and once their condition is stabilised these checks can often be done less often.

Another thing that may help is a change of diet to something that is high in protein and low in carbohydrates (the nutrient that gets broken down into glucose after digestion). It is important to monitor your cat’s diet when they are on insulin, as if they do not eat regularly, the insulin could actually hurt them. Similarly, weight loss can help the body better regulate its glucose metabolism so losing excess weight in a controlled manner could make a big difference to their treatment and in some cases may even result in the disease resolving completely.

If your cat is diagnosed with diabetes treatment is essential. It is not generally acceptable to allow the disease to go untreated as it can cause significant discomfort and severe problems for the cat. With insulin therapy, a well-managed diabetic cat can go on to live many healthy, happy years. Insulin, however, is not without risks itself, as giving too much of it can result in a condition called hypoglycaemia, or blood sugar that is too low. As mentioned above, this is a life threatening condition that can result in lethargy, confusion, fits, coma and even death. You should speak with your vet about what symptoms to look out for and how best to manage them should they arise and it’s very important that you let your vet know immediately if you think your cat may be hypoglycaemic.

I am happy to say that both Sammy and his owner are doing very well today. His owner gives him two injections a day, which she has fit into the family routine and no longer sees it as a bother, just something else that has to be done. She has even offered to speak with other owners of newly-diagnosed diabetic cats to give them the confidence they need to get through the initial diagnosis and first few weeks of treatment. So if you find yourself with a diabetic cat, don’t be discouraged, it’s not actually that scary and yes, you can do it!

If you are worried that your cat is showing the symptoms described above, please talk to your vet or try our Interactive Cat Symptom Guide to help decide what to do next.

How we prepare your pet for anaesthetic.

Once you relinquish your pet to the green fairies, you may be wondering what actually happens “out the back”.

Well, wonder no more. Firstly we make sure that we have an accurate weight for your pet as this is what we use to calculate the dose of the drugs that we give your pet. Once we have this we settle them in a kennel with nice squishy blankets while we go and get everything prepared.

If you have opted for, or we have recommended, a blood sample before anaesthesia then your pet is taken to a quiet part of the practice where we can safely take the sample. To take the sample, a patch of hair is shaved over the jugular vein which runs down the side of the neck, to one side of the windpipe and a needle is inserted to collect the blood. Most animals tolerate this quite well with the gentle yet firm restraint that we green fairies have down to a fine art. Some animals on the other hand object quite vociferously and may have to have the blood sample taken once they are anaesthetised. Not ideal but better if they are getting too stressed.

Once the results have come back and been received by the veterinary surgeon, they can decide what to pre-med with and whether the use of intravenous fluids is necessary. Intravenous fluids are usually considered if there is any elevation of the liver and kidney enzymes which show that these organs need a little help during anaesthesia as that is where most of the drugs used are metabolised. Some veterinary surgeons also advocate the use of fluid therapy during routine bitch spays as a spay is a fairly major and invasive procedure and fluids help maintain blood pressure and support the body during this procedure.

There are a few ways that we can induce anaesthesia in your pet. One way is to use the anaesthetic gas and get them to breathe the gas in via a mask or an anaesthetic chamber. This way is usually used with smaller creatures such as rabbits, guinea pigs and rats and they fit into the anaesthetic chamber and can have oxygen administered in this way before the gas is turned on.

Another way is to inject an anaesthetic agent called Propofol into the vein and then maintain anaesthesia directly into the airway using an endotracheal tube which is fitted into the windpipe. This is the most commonly used induction for surgeries as induction is quick, Propofol wears off quickly and then the anaesthetic can be controlled with the gas.

The final way is to inject a combination of sedative and tranquilliser drugs into the muscle, usually the lumbar muscle or the quadriceps. This way is usually used for short, less painful and less invasive procedures such as cat castrates where the animal only needs to be asleep for a short period and is reversible with another injection.

If your pet is having surgery, the affected area will have to be shaved and cleaned to maintain the sterility of the site. This is why we advise that dogs are fairly clean when they come in so that we don’t have to spend so much time cleaning them which means they spend less time under anaesthetic.

So, that answers the question of how we prepare your pet for anaesthetic or why he has so many bald patches!

If you are worried about your pet’s surgery please talk to your vet, or check any post op symptoms with our Interactive Symptom Guide to see how urgent the problem may be.

Roses are Red, Violets are Blue, Lilies are Downright Dangerous

Lilies - the stamens can easily be removed but ALL parts of the plant are poisonous if eaten

Lilies - the stamens can easily be removed but ALL parts of the plant are poisonous if eaten

As far as plants go, lilies are among the most beautiful. They smell lovely and seem to last forever, making them a fantastic addition to any floral arrangement. Humans adore them and most animals aren’t bothered by them, but for cats, lilies are positively deadly. And it doesn’t take much. A single bite of leaf or lick of pollen can be all it takes to send a cat into irreversible kidney failure. As cat owners, we all need to be aware of how dangerous this common household plant can be, and take the necessary steps to keep our unsuspecting pets safe.

What makes lilies so toxic to cats?

• We don’t know exactly which chemical within the lily is so dangerous, but we do know that ingesting the smallest amount of leaf, stem, flower or even pollen can be deadly.
• Most types of lilies are poisonous, including asian lilies (Lily asiatica), tiger lilies (Lilium tigrinum), stargazer lilies (Lilium orientalis) and Easter lilies (Lilium longiflorum).
• Other animals, including dogs and rabbits, can eat lilies with just a bit of mild stomach upset and do not seem to suffer from toxicity.

What are the symptoms of lily poisoning?

• At first, lily poisoning can mimic other cases of ‘dietary indiscretion’ as we like to call it (eating something that they shouldn’t have), so it can be difficult to know what has happened unless you saw them eat it. Signs include vomiting and lethargy, lack of appetite and shaking. If your cat does vomit, always take a look to see what they brought up – this may be icky but it could save your cat’s life if you can tell the vet what they got into.
• These initial symptoms can actually disappear for a few hours to a few days, after the plant has passed through the digestive tract but before the real disease becomes obvious.
• Within a few days, however, the symptoms become those of kidney failure. This includes increased thirst and urination, dehydration, and worsening lethargy, vomiting and inappetence. Eventually, this increased urination turns into a decrease in urination, and finally no urination at all, which indicates that the kidneys are no longer functioning.

What can be done about it?

• If you think your cat has eaten any amount of any part of a lily, it is critical that you take them to the vet right away, even before clinical signs appear. And of course, if you notice any of the symptoms listed above, get them to the vet immediately. If it happens outside of your vet’s normal opening hours, phone the designated emergency clinic.
• If they make it to the vet within a few hours of ingestion, the vet will likely induce vomiting and possibly give a substance called activated charcoal, which will help lessen the effects of the toxins.
• Then, or if too much time has already gone by, the vet may put your cat on a drip and give IV fluids for as long as necessary. These fluids will help support the kidneys as they try to process the poison and flush out any toxins that do make it into the blood stream.
• There is no special blood test to diagnose lily toxicity, so many cases go undiagnosed. Your vet will however likely run a general blood and urine test to check how badly the kidneys may have been damaged. These tests will probably need to be repeated several times during their stay in hospital.

What happens next?

• If you are able to get your cat to the vet within a few hours of ingestion, the chances are much greater that they will make it through the incident with the appropriate medical care. It is vitally important that your cat see the vet as soon as possible to begin treatment.
• If it has been more than 4 hours since ingestion and the lily toxins have already been absorbed, the prognosis is significantly worse and kidney damage to some degree is likely.
• If no treatment is given, or the kidneys have been damaged to the point where urination is starting to decrease, then sadly the chance of survival is very low.
• The feline kidney is a very delicate structure and unlike other organs such as the skin or the liver, it does not heal itself once damaged. Therefore, the chance of permanent kidney damage is high and even if the cat survives the initial incident, they may suffer from chronic kidney disease later in life. Long-term fluid therapy and regular blood tests may be necessary to monitor kidney function even after recovering from the initial toxicity.

How can lily poisoning be prevented?

• The best way to prevent lily poisoning in your own home is to prevent lilies from entering your home in the first place. This is easier said than done when well-meaning significant others or dinner guests bring home a lovely bouquet, however most people will understand your concerns.
• Remember, however, that it’s not just lilies in your house that can be deadly, always check your own garden for these and other toxic plants. The internet is a good resource for finding out which plants are child and pet-friendly and which should be avoided, just always make sure you trust the source of your information.
• Spread the word – by telling other people about the dangers of lilies, you are helping to increase awareness of the problem. The ISFM (International Society of Feline Medicine) has launched a campaign to help educate the public about lily toxicity. Their website has informative posters and tags to be put around floral arrangements that contain lilies at the florist. The more people know about lily toxicity, the safer all of our cats will be.

If you are concerned that your cat may have eaten any part of a lily, or any other toxic material, contact your vet immediately. If you are sure lilies are not to blame our Interactive Cat Symptom Guide can be used to check out any problems you are worried about.

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