Browsing tag: Urine test

Ask a Vet Online – ‘My vet says my poodle cross Pom, may have cushings disease what is this please?’

Question from Carol Fogerty

Hi my vet says my poodle cross Pom ,may have cushings disease whot is this please

Answer from Shanika Winters MRCVS, Online Vet

Hi Carol and thank you for asking about Cushing’s disease (HAC hyperadrenocorticism) which is a condition where the body makes too much of the steroid cortisol which can result in a variety of symptoms.  HAC is most common in middle aged to older dogs but does also affect cats, horses, hamsters and ferrets.

There are three different types of HAC:

Pituitary dependant HAC (PDHAC) is the most common type and this is when a tumour of  the pituitary gland in the brain is making too much of a hormone called adrenocotricotrophic hormone (ACTH)  this causes the adrenal glands to make too much cortisol.

Adrenal dependant HAC (ADHAC) is less common, this is when a tumour of the adrenal glands causes too much cortisol to be produced.

Iatrogenic HAC (IHAC) is when very high doses of steroid given as medication lead to symptoms of HAC.

What are the signs of HAC?

If your pet is showing some of the following signs then your vet may suspect HAC:

Increased drinking (PD polydypsia), increased urinating (PU polyuria), increased appetite (PP polyphagia), a large rounded low slung abdomen ( tummy), muscle weakness, hair loss on both sides (bilateral symmetrical alopecia), hard areas under the skin due to deposits of the mineral calcium (calcinosis cutis) and dark spots on the skin due to blocked keratin (hair protein) filled hair follicles  (comedones).

How do we test for HAC?

There are several blood tests, urine tests and diagnostic imaging tests than can be done to try and make a diagnosis of HAC:

    Routine blood tests in cases of HAC may show up increased levels of liver enzymes, increased cholesterol, increased blood glucose (blood sugar) and also changes to the white blood cell numbers.
    Routine urine tests may show an increase in glucose, white blood cells and protein.

More specific tests for HAC include:

    Urine creatinine: cortisol ratio, here a urine sample collected from your pet is sent to a laboratory for analysis, abnormal results are found in cases of HAC but can also suggest diabetes, liver disease or womb infection (pyometra).
    ACTH stimulation test, this is a set of blood tests in which a blood sample is taken from your pet, an injection of artificial ACTH is given into a vein (blood vessel) and 1-2 hours later another blood sample is collected. The laboratory results are abnormal in approximately 80% of dogs with HAC, this test is also often used to monitor dogs on treatment for HAC.
    Plasma cortisol level, this is a blood test which directly measure the level of cortisol in the blood , the blood sample has to be treated very carefully and sent to the lab quickly so as to get an accurate result.
    Ultrasound scan of the abdomen can be used to check the size of the adrenal glands (found next to the kidneys), look for a tumour and assess the other abdominal organs. IN PDHAC the adrenal glands are usually normal size or slightly enlarged with ADHAC the adrenal glands are usually different sizes, the large irregular gland being the one with the tumour.
    Low and High dose dexamethasone suppression test (LDDST & HDDST) are blood tests where the effect of artificial steroid on the adrenal glands is measured, the results can sometimes help tell apart PDHAC form ADHAC.
    Magnetic resonance imaging (MRI) scans and computed tomography (CT) scans can be performed at referral centres to help in the diagnosis of HAC and also tell which type it is.

How is HAC treated?

Trilostane is a tablet with blocks a step in the production of cortisol in your pet’s adrenal glands therefore decreasing the amount of cortisol in your pet’s body.

Mitotane is another tablet which works by destroying the parts of the adrenal glands that produce cortisol.

Surgery to remove the actual tumours can be performed usually at referral centres.

Trilostane and mitotane are the most commonly used treatments for HAC, they are effective on both PDHAC and ADHAC and your pet should have regular blood tests to monitor that the dose given is correct for your pet. Too much medication for HAC can lead to symptoms of Addison’s disease (Hypoadrenocorticism) where there is not enough cortisol which includes dehydration, depression, diarrhoea and lethargy (weakness).

I hope that my answer has given you some useful information about HAC, the exact test done on your pet will need to be discussed with your vet. The aim of treating your pet is to reduce the signs of HAC to improve your pet’s quality of life and is best achieved by working closely with your vet.

Shanika Winters MRCVS (online vet)

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.

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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