Bladder Stone - What's the big fuss?!

Hi everyone

so this post is going to be about bladder stones, this is relevant for any species from dogs, cats and even guinea pigs.  For this post we will focus on dogs and cats. We'll talk about what they are, how they develop, symptoms and how to deal with them... enjoy!!!

Lets start with what they are and how they develop;

Bladder stones are the accumulation of microscopic mineral crystals that are present in the urine, that along with a mucus like substance produced by the bladder build up and stick to each other growing and growing over time.  The correct name for bladder stones are uroliths. 

Different uroliths develop in urine of differing PH levels, some favour acidic conditions and other alkaline. 

The most common crystals found in dogs are;

- Struvite uroliths (magnesium ammonium phosphate or MAP)

- Urate uroliths 

- Cystine uroliths

- Calcium oxalate uroliths

If left untreated they will eventually reach a size that is visible to the naked eye and some to the size of say the stone in a plum!!! Some of you may remember this picture from one of our "What is it Wednesday's" of some bladder stones that were surgically removed from a dogs bladder.

So why are they so dangerous? 

There are many answers to this question but the main reasons are as follows;

1. These stones are rough and hard and they move freely around in the bladder, this scratches and traumatises the lining of the bladder which causes bleeding, inflammation and pain.

2. These can also get lodged in the urethra (the tube that carries urine from the bladder to the outside world). This not only causes pain and trauma but can actually block the urethra meaning that it is impossible for the patient to pass urine either at all or only be able to pass small amounts.

What do you think happens when the bladder is unable to empty? 

The kidneys continue to produce urine and the bladder continues to fill meaning that in extreme cases it cannot take anymore urine, to the point that the bladder bursts like a water balloon. I'm sure you can imagine that repairing a ruptured bladder is not an easy task and the risk of infection is very high.  Unfortunately if the bladder does rupture there is a high chance it will prove fatal for the patient.

If the bladder doesn't burst you still have urine backing all the way up the urinary tract, right back to the kidneys which can cause the kidneys to fail further adding to the patients complications.

What causes bladder stones... 

The pH level of a substance tells us how acidic or alkaline it is and depending on these conditions we either have a normal or abnormal environment. When the environment is normal we don't get the development of these crystals (but be aware of calcium oxalate crystals).  When it's abnormal it creates the perfect development site for them.

Some crystals only develop in acidic urine and others in alkaline,  for example calcium oxalate loves an acidic urine but they can also develop in neutral urine!!!, whereas triple phosphate AKA struvite crystals adore an alkaline urine.  There are other crystals too including; cystine, ammonium urate (Dalmations are prone to these), uric acid, calcium phosphate and calcium carbonate but the two most common we see in our practice are struvite and calcium oxalate. 

Diagnosis -

When we perform a urine analysis we also perform a 'dipstick' which indicates the presence of; glucose, bilirubin, ketones, blood, protein, pH, uroliths and leucocytes. We then check how concentrated it is using an instrument called a refractometer - this gives us an idea of how well the kidneys are functioning.  Again you may remember this picture from another What is it Wednesday...

Refractometer view

Once all this is done the vet will review the results and based on these as well as the patients clinical exam or symptoms described by the owner we will decide if a urine sediment should be examined under the microscope.

To perform a urine sediment we take a small sample of urine and spin it down in the centrifuge at a speed of 1500rpm for 5 minutes. The result is a separation between the urine at the top of the sample and the sediment at the bottom. We take a sample of the sediment, this is done my removing the upper layer of urine, adding a drop of sedistain and then re-mixing the sediment. With a pipette we then suck up the remaining fluid and put a drop on a microscope slide and then cover with a very thin, glass cover slip. It is now ready to examine under the microscope.

Below are photos taken of a patients urine sediment.  When we request a urine sample from your pet this is one of the test that we do.  We centrifuge a sample of the urine, this sends all the "hard" particles to the bottom of the sample which we pipette out and examine under the microscope.

Struvite

Calcium Oxalate

As well a urine crystals we may also see red blood cells, casts and white blood cells.

If there are crystals present we now need to diagnose if they have yet formed stones which can be done by ultrasound examination of the bladder although this isn't 100% accurate so ideally x-rays and sometimes contrast x-rays should be used... See pictures below.

Large Bladder stone almost filling the bladder

Bladder stones in a Guinea Pig

If stones are present we need to be looking at removing them surgically and if they have not yet developed we need to do everything we can to keep it that way.

Prevention -

We need to change the pH of the urine, this is achieved through a diet change and we recommend Royal Canin Urinary prescription food which will dissolve the existing microscopic crystals and any tiny stones. We will need to keep a close eye on the patients urine, so regular dipstick and sediment rechecks will be done.

When feeding this prescription food it is important that no other food is fed - including treats, as it will instantly alter the pH of the urine and undo all the good work of the prescription food.

We don't charge to test your pets urine and we recommend you bring a morning sample to their booster appointment where a routine dipstick test can be performed if you wish.

Now go and share your new found knowledge and pictures with your friends :)

Ryan's Story

Just like us, our pets can also be affected by cancer and getting a diagnosis can be both terrifying and a relief at the same time... The relief comes from having a reason why your pet has been unwell but of course it’s also a very upsetting and distressing time too.  What does it mean? What are the treatment options? How long do I have left with my pet, are all likely questions to be rushing through your mind as you try to comprehend what the vet is saying to you.

It’s our job as Vets, Nurses & Receptionists to support you and your pet through the road ahead, whatever that may entail.

A diagnosis of neoplasia (cancer) doesn’t always mean your pet has a poor outlook, there are certain types that can be held at bay for many years or sometimes even cured... each particular type is different and so requires individual understanding.

Ryan’s story starts back in October 2013 when his owners noticed that the glands in his neck were enlarged.  These were Ryan’s submandibular lymph nodes and when the vet examined him further she found that his lymph nodes near his shoulders (pre-scapular) and at the back of his knees (popliteals) were also enlarged.  You may have found yourself saying that your “glands are swollen” in your neck when you have a cold and these are our lymph nodes.  Their job is to deal with infectious material. So when they’re all enlarged like Ryan’s were, we start to worry that something may be going on throughout his entire body that is overwhelming his immune system.

It was decided by the vet and Ryan’s owners that he would have a biopsy taken from one of the lymph nodes to be sent to the lab for microscopic examination.  So, the next day, Ryan came in for his surgery under general anaesthesia.  Five days later, we had the results back, it was lymphoma (lymphosarcoma).  This is a cancer of the white blood cells, so whereas a lump may be diagnosed as cancerous and removal may be curative, with lymphoma it’s not quite the same.

Ryan would need to have chemotherapy in order to stop the cancer from progressing and hopefully to get him into remission.  How successful chemotherapy would be depends on what type of lymphoma Ryan had.  One type is of B-cell origin and the other T-cell.  We had our fingers crossed that it would be of B-cell origin as unfortunately the prognosis for lymphoma of T-cell origin is very poor.  The lab had already started the process to determine this but it would take a little more time, so it was decided that Ryan would start chemotherapy as soon as possible in the hope we got the result we wanted.

On the 25^th October 2013 Ryan had his first treatment.  With chemotherapy it’s really important to protect owners and clinical staff from the negative effect of the drugs used.  These drugs do not hunt out cancerous cells, instead they kill all fast growing cells so there’s a negative side to them that we don’t want to be exposed to.  For this reason Ryan's faeces needed to be double bagged, his urine washed away in the garden and saliva contact needed to be prevented.  For these reasons it may be that a family with small children would be advised against chemotherapy for one of their pets due to the high risk it poses to humans.  As you can see from the pictures from one of Ryan’s treatments we are very well “suited & booted” to ensure we do not come into contact with the drugs ourselves.

Two days after his first treatment we heard from the lab that they knew which type of lymphoma Ryan had… it was B-Cell… thank goodness.  Ryan’s treatment plan would now consist of the following;

•  Weekly chemotherapy for the first 8 weeks
• Then every 2 weeks until he went into remission (this would hopefully be around the 6 month mark)
• Once in remission he would need maintenance treatments every 3 weeks
• After 12 months Ryan would drop to maintenance treatments once every 4 weeks
• Ryan would also be having oral medications at home as part of his chemotherapy regime.

Unlike humans it isn’t possible to “cure” pets that have lymphoma but it is possible for patients in remission to live a normal & happy life.  Ryan initially had vomiting and diarrhoea at the start of his treatment regime but soon recovered and has since had no complications.

Treatment of this type of illness varies between each patient, it depends on the type of neoplasia a patient has and whether remission is possible.  Where this is not likely to occur, it is our job to make them comfortable and pain free for as long as possible by trying to slow down the spread of the neoplasia and treating symptoms as they occur.  We get to know these patients VERY well and when the time comes that they are taken away from us or the decision is made to let them go, we grieve with the owners as if they were our own.  Thankfully for Ryan, his owners and us this isn’t the case for him… he still has plenty of life in him yet and we love him to pieces. 

Ryan having his IV catheter placed which will be used to deliver his chemotherapy drugs

Here you can see that we have attached a giving set to his catheter... this is so that we can run IV fluids through at the same time.  The drugs used are very dangerous and can even lead to the need for amputations if given outside of the vein so the fluids ensure we can check the catheter is 100% perfect before giving the drug. 

 An extra precaution we take is to cover all entry points with a damp swab as extra cover for any drug that might escape the closed circuit or squirt back on administration (See below also)

Ryan having a cuddle with Reanne after his treatment

We hope you've enjoyed reading this post and that we've answered some of the questions you may have had about treating neoplasia in our pets.

A special thank you to Ryan's owners for letting us share his story and of course a huge thank you to Ryan himself for being an amazing patient every step of the way... we love you Ryan :)

Should we call the vet???

So this post is going to be a short but sweet one... In an emergency, things need to be precise and straight to the point and that's exactly what this blog is about. 

We understand that there are times when you know something isn't quite right with your pet but you're not sure if its urgent, or requires a visit to the vet.

Unfortunately it is impossible for a vet to diagnose over the phone, without being able to fully examine your pet but there are a few symptoms that definitely require URGENT veterinary care, so below is a short list of such symptoms. BUT please be aware that this list is not extensive... It is just a guide.

Remember that at Barnsley Vets4Pets we are open 24/7 365 days a year. 

1. Collapse

2. Seizure or any neurological abnormalities

3. Difficulty breathing - sometimes pets will extend their neck or spread their front legs

4. Increased or decreased heart rate

5. Pale gums

6. Unable to urinate or difficulty urinating 

7. Extreme pain

8. Vomiting or diarrhoea that has lasted 24 hours or more

9. Toxin ingestion (see previous post on poisons)

10. Trauma such as fractures

11. Open wounds or excessive bleeding

12. Snake bite

13. Burns

14. Difficulty during labour

15. Hyperthermia

16. Unable to walk

17. Bloated abdomen

18 Unproductive retching

19. Allergic reaction
20. Unexpected bleeding or bruising

Any of the above scenarios can range from being mild, severe to life threatening but don't wait for things to get worse before calling the vet, book your pet in for an emergency appointment straight away and let the vet fully assess, diagnose and treat your pet appropriately.

We always say... it's better to over react, than not react at all. 

Thanks for reading guys, take care. 

Diabetes Mellitus

Diabetes Mellitus - What is it? and How is it diagnosed & treated?

There are two types of Diabetes; Diabetes Mellitus and Diabetes Insipidus.  This blog is focused on Diabetes Mellitus and will be referred to simply as diabetes.

Diabetes is a complicated and often challenging disease to deal with, there are many factors involved in the diagnosis, treatment and monitoring of it, that it can often be overwhelming for owners - in this blog our aim is to break down and simplify the key factors involved with diabetes to allow you to better understand and deal with the disease.

Like us, our pets can suffer from diabetes and it is diagnosed, treated and monitored in very much the same way.

Diabetes results from the lack of production, or lack of response to a hormone called insulin, which is produced in the pancreas.  This is the key difference between the two types;

•             Insulin dependent – in humans this is referred to as Type 1 diabetes and results from the lack of insulin production and is often the type that dogs suffer from.  Life long insulin treatment will be required to treat this type of diabetes.

•             Non-insulin dependent – in humans referred to as Type 2 diabetes and results from the lack of response to insulin i.e. insulin resistance and is often the type that cats suffer from.  Often life long insulin treatment will still be required as in Type 1, but sometimes cats can go into remission – this is one of many reasons why correct monitoring is required and this will be discussed later. 

The role of insulin is to deliver glucose into the cells of the body for them to use as energy.  If the cell cannot gain access to this energy source it has no option but to find other ways such as breaking down fats and proteins - this leads to two of the common symptoms of diabetes... appetite increases as the body detects the need for sugar but weight loss occurs due to the breaking down of fats and proteins.

So how do we diagnose diabetes?

Often owners will bring their pets to the vet as they've noticed some physical or behavioural changes.  

Symptoms can include some or all of the following;

•             Increased urination and thirst (polyuria & polydypsia aka PUPD)

•             Urinary accidents in the house

•             Dehydration

•             Vomiting

•             Increased or decreased appetite

•             Lethargy

•             Weight loss - although patients can often be overweight initially.

•             One of the later symptoms you may see in cats is that they can walk really low on                 their back legs - this is called diabetic neuropathy – when this occurs the disease                   has been present for a long time.

                                                         Diabetic Neuropathy

Diagnosis

The first thing the vet will do to gain a diagnosis of diabetes is to take a fasted blood sample and run a full biochemistry & hematology to check the blood glucose level but also to rule out any other conditions and or complicating factors.  A urine sample will also be requested so that urine glucose and ketone levels can be checked, the presence of these are a good indicators of diabetes as they are rare in other conditions. However, their presence alone is not enough to give a definitive diagnosis of diabetes.

The vet will need to take into consideration other reasons that a patient’s blood glucose levels may be increased other than diabetes… for example when an animal is stressed their blood glucose levels can increase, but this doesn't mean that they have diabetes. 

For this reason a fructosamine blood test may also be required, fructosamine is a protein that binds to glucose and therefore gives a good estimation of the blood glucose levels.  Fructosamine levels don’t increase as a response to stress and other factors that affect blood glucose and so these results can help your vet to estimate your pets blood glucose levels over the past 2-3 weeks.  In general, the higher the fructosamine levels, the higher the blood glucose.

Treatment & Monitoring

Once a diagnosis of diabetes has being made we then need to look at how we are going to treat the patient.

The vet may advise that a blood glucose curve is carried out before any treatment starts, to track how your pet’s blood glucose levels alter throughout the day.  This will highlight any important low episodes and also help determine the initial insulin dose that your pet will start on. 

After having a consultation with the vet to explain and demonstrate how, owners will need to administer sub-cuticular insulin injections after a meal, often twice daily - depending on the type of insulin used and its duration.  This will mean that every day owners will be giving two injections to their pets at home.  This will be a long term commitment that will affect all sorts of things such as making arrangements for the injections to be given when owners are on holiday, ensuring that meals and injections are given at the same time every day.  However not all cases of diabetes require insulin treatment to be started straight away, for example in some cases of Type 2 diabetes it might be that initial treatment starts with diet, weight loss or other medications. 

Once the suitable treatment has been in place for a couple of weeks the blood glucose curve will be repeated to check your pet’s response to the insulin treatment.  This will involve your pet staying at the practice for the day and over a 12 hour period every 2-3 hours a blood sample is tested to check the blood glucose level, which is recorded on a chart.  These readings allow the vet to identify if your pets diabetes is being well controlled.  It may be that after this blood glucose curve your pets insulin dose is altered or will remain the same.  Owners need to be aware that gaining adequate control of their pets diabetes can take up to 3-6 months as each patient is different and can respond differently.  Once control has been gained owners often find that most and if not all, symptoms are rectified.

In order to keep blood glucose levels as consistent as possible, to avoid critical highs and lows, feeding has to be set in to meal times rather than grazing and ideally your pet would be fed a prescription diet specifically for diabetic patients.  The aim of which is to help maintain blood glucose levels within the normal range.  We recommend Royal Canin Diabetic food.

Royal Canin Diabetic food

Exercise has to be consistent each day when caring for a diabetic patient, i.e. when the weather is nice don't suddenly take your dog for a 3 hour walk in the countryside when you would normally only do 30 minutes around the block.  This will "use up" too much of the circulating blood glucose and may lead to a "hypo".

It is also advised that at least once or twice yearly a fructosamine test is done, as stated earlier this gives the vet an idea of what your pets blood glucose levels have been doing over the last couple of weeks. 

It is important that these monitoring protocols are carried out as problems can be detected early and before any serious consequences occur.  For example cats are capable of overcoming diabetes, however if the correct monitoring is not done this may be missed and insulin injections will continue - this may lead to life threatening hypogylcaemia as the insulin will lower the blood glucose to dangerous levels.  

Consequences of undiagnosed or poorly controlled diabetes

Diabetes that is poorly controlled affects almost every organ in the body, the side effects of this are vast but below are some of the more common side effects;

•  Eyes – glaucoma, cataracts and diabetic retinopathy
•  Nervous system – diabetic neuropathy, digestion problems
•  Poor healing times

Can diabetes be prevented?

There are certain medical conditions that can increase the risk of a patient developing insulin resistance such as being overweight or obese.  We recommend regular health checks with your vet and weight checks with our nurses.  All of this increases the chances of early detection of not just diabetes but most medical conditions allowing diagnosis and treatment to commence before serious symptoms occur.   

So as you can see there is lots surrounding diabetes in our pets and your vet will always be happy to discuss any questions or concerns you may have.  We know that it is not always an easy disease to deal with, however once a patient is stabilised owners often find it less daunting than they expected.

We hope that you have enjoyed and found this post useful.

Take care guys.

Poisons - What You Need To Know

Hello everyone

as promised we are going to be doing lots of blogs about all the stuff you need to know as a pet owner.

This blog is about some of the most serious poisons/toxins that our pets can come across but we have focused and the things we don't want our dogs and cats getting a hold of. We will go into a bit of detail with some of the most common poisons but the general rule of thumb is that if your pet has come in to contact with anything that you think may cause them harm, ring the vet as soon as possible for advice. 

Do Not Wait For Symptoms To Start!!!  Act Before This Happens!!!

Some of the common toxins that you may have heard of are;

• Chocolate
• Raisins / anything from the grape family
• Vermin control products e.g. rat poison, slug pellets, ant killer
• Lilies
• Poinsettas 
• Daffodils
• Adder bite
• Many human medications including, paracetamol, some anti-inflammatory drugs,  (always check with your vet)
• Blue/Green algae
• Caffeine
• Ethylene glycol (anti-freeze)
• Some nuts, including peanuts, macadamia
• Nicotine
• Salt (do not make any animal sick with salt water)
• Toad venom
• Vitamin D
• Xylitol (found in chewing gum)
• Dog flea treatments can be fatal if applied to cats 

In most cases of poison/toxin ingestion our first aim is to rid the body of said poison, which is done by given an injection of apomorphine in the scruff of the neck.  This can only really be done up to 2 hours after ingestion as the stomach will have likely emptied after this time.  We will often recommend Intra-Venous Fluid Therapy which is exactly the same as when we are put on a drip at the hospital, the aim of this is to dilute and flush the toxins from the body and to support the kidneys are they are often the target organ for poisons to affect.  In some cases we will also advise charcoal ingestion as it acts as a sponge for the toxins and absorbs them before they can cause harm to the body.  

Depending on what poison and when it was ingested and will determine what treatment we recommend, but as stated above DO NOT wait for symptoms to start!!! Act straightaway!!!

We also induce vomiting when animals have eaten things they shouldn't such as socks, underwear and all the other strange and wonderful things our pets think are a good idea to eat.  The only time we wouldn't induce vomiting is when the eaten product may cause further harm on its way back up the food pipe e.g. caustic substances like bleach or anything sharp like a needle. 

Below is some information on the top 3 poisons we see in our practice;

Chocolate - The toxic ingredient in chocolate is theobromine, which is found in cocoa. Therefore the higher the cocoa content the more toxic it is, so dark chocolate in more harmful that milk chocolate.  Theobromine increases the heart rate and affects the nervous system.  

Symptoms - vomiting, increased water intake, excitement - if left untreated tremors and seizures can develop.  Cardiac arrest is the most severe outcome but also kidney failure can develop, which in its own right can be fatal.

Raisins/Grape family - These food types are very dangerous to dogs and cats, the ingredient that causes the harm is not yet known but even small doses can prove fatal.  Grape and raisin ingestion causes acute renal disease (sudden onset kidney failure).

Symptoms - lack of urination or only urinating small amounts, Vomiting and or diarrhea, reduced or loss of appetite, dehydration (this can be identified by a skin tent of sticky gums), lethargy or weakness. 

Lilies - All parts of the lilie are poisonous -  It is quite well known that lilies are poisonous to cats but they can also be poisonous to dogs too.  The general rule of thumb is that if you have pets - don't have lilies... Lilies are actually my favorite flower but I never have them in the house because of Charlie and Dobby, my dog and cat. 

Symptoms - drooling, vomiting, anorexia (loss of appetite), dehydration and again because it's the kidneys that are affected we see lack of urination.

Probably the best advice we can give is that if your dog or cat has eaten anything that you are unsure is safe or not, give us a call.  There are times that even we don't know but we have access to the Veterinary Poisons Information Service who are always on hand to help out. 

Stay safe :))