Exciting News!

As of Wednesday, November 27, 2013, Pet Network Incline Vets will be moving the practice down the hill to Spanish Springs.  We will be reopening the practice under the name, Sage Veterinary Care, with the same veterinarians, Dr. Kelly MacLellan and Dr. Dawn Hess, and offering the same high quality level of veterinary care.  We want to take this opportunity to thank our clients for their patronage, it has been wonderful getting to know you and your pets.

Please contact us via email (petnetworkinclinevets@gmail.com) or phone (775.685.9454 or 775.685.9455) if you would like to have your records transferred.

Please stay tuned for further information on the opening date of Sage Veterinary Care.

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What is Diabetes in Dogs and Cats?

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There are actually several diseases/syndromes that begin with the word diabetes—we’re going to discuss diabetes mellitus.  Lets start with some basic underlying physiology.

The pancreas is an L shaped gland that sits near the stomach and the first part of the small intestine.  It produces digestive enzymes that empty into the small intestine and insulin that is secreted into the bloodstream to help the body bring glucose into cells.  In diabetes mellitus there is not enough insulin to perform that job and the body feels like it is starving even though there is lots of glucose (sugar) circulating.  The body begins to break down body stores of protein, carbohydrate (sugars) and fat.  There is lots of glucose circulating and the kidneys can’t filter it out.  Sugar begins to spill into the urine and as a result water follows this molecule.  This leads to excess thirst and urination usually seen in unregulated diabetic animals.  This glucose in the urine also makes a great place for bacteria to set up housekeeping so diabetics frequently have bladder infections as well.  In addition, in more advanced cases the breakdown products from fat metabolism cause ketones to build up in the blood and spill into the urine.  Ketones wreak havoc on the ph levels of the body and cause a more serious form of diabetes called diabetic ketoacidosis.  Ketones are detected in the urine along with glucose and the patient is typically much sicker at this stage of the disease.

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The symptoms we typically see with diabetes mellitus are excessive appetite/eating, excessive thirst/drinking, excessive urination, and weight loss.  In cats we can also see walking with dropped hocks that can signal early weakness from diabetes.

To make a diagnosis the signs are not enough. Other disease processes can mimic these symptoms.  We need the history, a physical exam, bloodwork and a urinalysis.  Cats can have a stress glucose elevation in the blood and often we add an additional test called a fructosamine to differentiate between stress hyperglycemia (high blood sugar) and true diabetes.

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Once we make the diagnosis, treatment varies based on how ill the patient is, are they ketoacidotic, do they have a bladder infection, etc.

An uncomplicated diabetic is one who has no ketones, no infections, and is typically early in the course of the disease.  In those cases we start them on one of several possible forms of insulin injections.  Most patients require hospitalization in the initial phase of regulation so we can check frequently for too rapid drops in blood glucose and electrolyte changes.

In those animals who are sicker with infections, ketones, and depression—those patients need more aggressive intervention which can include repeat bloodwork, intravenous fluids, repeat urinalysis, antibiotics, and more intense monitoring and hospitalization sometimes for several days to stabilize them.

To treat diabetic patients long term, once that patient is stable, they need insulin injections.  Dogs will need insulin typically twice a day for the rest of their lives.  Some cats, if we catch the disease early enough, will need insulin for a period of time and can sometimes begin to produce enough insulin on their own again and go off the injections.  A prescription diet makes managing this problem much easier in both dogs and cats.  If possible we want to feed the patient the same amount of food twice a day and the insulin following the meal.  It’s important not to give these diabetic patients food or treats in between meals.  Each time they eat, their blood sugar goes up.  The insulin follows to bring that glucose level down.  We want to keep the glucose levels within a narrow normal range if we can.  When you feed treats or other meals at additional times during the day this causes an elevation out of this range and can cause a return of symptoms and further problems.  It is also wise not to feed the semi-moist pouches of food as these foods have more sugar in them.

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Most owners are intimidated by the idea of giving their beloved pets an injection twice a day.  Insulin syringes have extremely tiny, thin needles and I have yet to see a patient who seems to react to the injection.  Its is much easier than it sounds and most people can master this task with a little instruction when we show them how to do it and how little their pet minds the process.

Long term monitoring requires blood glucose checks and typically rechecks of urine as diabetics are very prone to bladder infections and infections in general.  Exercise, diet, stress, and infections can all affect glucose levels and insulin needs.  Things can change over time even when everyone is doing everything right and sometimes patients have problems that need to be addressed.  It is a commitment in time and attention to detail to keep these patients as healthy as we can.  They do best when they get meals and insulin roughly 12 hours apart every day.  So when clients want to leave on vacation or even short trips, its vital that someone can take care of these patients and continue to medicate and feed them on a routine schedule.

Insulin needs to be handled gently and not shaken.  If shaken it destroys the delicate insulin molecules and becomes inactive.  Typically a bottle of insulin will last a patient 6-8 weeks if handled correctly.  Your veterinarian has several insulins to choose from and that needs to be addressed on an individual case basis.

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Once your diabetic pet is regulated and on a schedule these are things to watch for that could signal a problem that needs to be addressed.  If your pet begins to lose weight again, begins to drink or urinate excessively, seems to feel ill, has a ravenous appetite, becomes disoriented or depressed or groggy, have that animal checked quickly.  If your pet seems wobbly or drunken, the blood sugar level may be too low.  This would occur if too much insulin is given or the regular dose is given without the animal eating its regular meal or only part of its meal.  Try to feed the pet if they are alert enough to swallow but if that is not possible or if the patient seizures, take a little Karo syrup, orange juice, sugar water or honey and rub it on the gums in the mouth until the animal appears more alert (typically 1 tablespoon per 5 lbs).  If this does not stabilize the patient seek immediate medical attention.  If the animal does respond and seems more alert, try to feed the patient and have that animal checked preferably that day if possible.

Some pets can be difficult to regulate due to drugs used like forms of cortisone, the presence of hormones like progesterone (unspayed females), other health issues like Cushing’s disease or chronic sources of infections like severe dental disease just to name a few.  Its important to identify these causes and correct the underlying problem to make regulation more effective.

Diabetes mellitus is a time consuming ailment that takes dedication to manage and it’s a lifelong problem unless you happen to be that lucky cat that is able to go off insulin with early, successful management.  Your veterinarian can discuss the process in more detail but this overview gives you an idea of what this disease is and how we can keep our diabetic pets with us longer after diagnosis.

Dawn Hess, DVM

Pancreatitis: What is it and why should I care about it?

Pancreatitis by definition is an inflammation of the pancreas, the gland that sits near the greater curvature of the stomach, the liver and the first part of the small intestine called the duodenum.  There are many things about this condition we don’t understand but let me share with you what we do.

The pancreas is an L shaped organ that is a light tan to a light pink color.  It produces insulin to regulate our body’s glucose levels and allow that glucose to be taken into cells to nourish them.  It also produces digestive enzymes that help our small intestine process and absorb nutrients.  When the pancreas becomes inflamed it becomes bright red and angry looking and typically the first part of that function that stops or becomes damaged is the ability to process food and particularly fats.  The pancreas has a small duct that deposits those digestive enzymes into the duodenum but when the organ is inflamed, the powerful digestive enzymes begin to digest the pancreas itself.  It is usually extremely painful and if allowed to continue can be life threatening.  As it progresses, if it begins to damage the cells that produce insulin, then diabetes mellitus can occur which means insulin injections daily lifelong to replace what this damaged gland can no longer produce.

Canine Pancreas

Symptoms of pancreatitis unfortunately can’t tell us if it’s present because the symptoms   can be caused by many other things as well.  The following is a list of some of the many presentations I have seen in 25 years that have turned out to be pancreatitis in dogs— vague NDR (not doin’ right); slight decrease in appetite; weight loss; intermittent vomiting; intermittent diarrhea; pain but unable to localize it; some people have described a dog that “seizures” (not a true seizure as it turns out); a dog who doesn’t want to be around people or other dogs; daily severe vomiting; daily severe diarrhea with blood and mucus; painful abdomen; straining to defecate; straining to urinate; anorexia; dehydration; depression/lethargy; poor appetite; suddenly won’t eat treats; and some dogs have presented laterally recumbent; reluctant to move; minimally responsive and in really bad shape.  Some of these patients have died and some have gone on to need emergency surgery to try to save their lives.  All needed treatment and the level of intervention varied with the patient and severity of signs.

78455716In cats it’s even harder to diagnose and suspect.  Most cats, until the last 7 years, were diagnosed mainly on necropsy—found after they died and a necropsy was conducted.  Cats seem to be even better at hiding this problem from us and unless we suspect it we may see very vague symptoms—just a cat who is cranky (pain?), has an intermittent poor appetite, maybe has diarrhea, often intermittent vomiting (but cats also vomit for simple reasons like hairballs!).

Fortunately we now have a sensitive test called a spec cPL in dogs and a feline PLi in cats. These tests look for levels of specific pancreatic lipase found only in the pancreas.  It’s not 100%, nothing is, but it has made diagnosing this problem much more successful.  It’s a blood test but there are additional things we can use to help us be as confident as we can be that pancreatitis is really what we are dealing with.  A cbc (complete blood count), chem (chemistry panel), fecal check and urinalysis help us look for other underlying disease conditions that can look similar like liver disease, kidney disease, infections, anemia, parasites, etc.  X-rays helps us rule out cancer, enlarged organs, foreign bodies, and other conditions that may lead us in a different direction with very different treatment.  If we suspect pancreatitis and all of the above still leaves us unsure of the diagnosis then abdominal ultrasound can sometimes give us that extra piece of the puzzle that helps us be more certain the pancreas is really the problem.

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Treatment consists of treating the symptoms.  There is no drug or specific thing we can give an animal that magically heals a damaged pancreas.  All we can do is support the patient and they have to heal from the damage.  One of the cornerstones of treatment consists of giving the patient fluids that help to get good blood flow to the organ which allows it to heal faster.  Pain medication is usually indicated and often additional medications that help with the symptoms of vomiting and diarrhea.  Treatment needs to be individualized to the patient and the severity of their symptoms.  There is no one size fits all but definitely very low fat in the diet during recovery from this disease as this exacerbates the problem.

The cause?  In cats we just aren’t sure but we suspect because their pancreatic duct is small, short and wide that when they vomit the force may push things from the small intestine up into the gland and start the problem.  That may be one scenario but certainly not the only possibility.

In dogs it seems to be related to feeding people food to our dogs and the most common history I get is “I just feed Fluffy a little bit of people food here and there, it’s not enough to really be a problem and I have done it for years so that can’t be the reason!”  Unfortunately this disease process seems to be insidious and that little bit of people food here and there over time gradually inflames the pancreas until we see what we recognize as symptoms of some kind of problem and are alerted to look for the cause.  Once a dog has pancreatitis and recovers, some can never go back to even regular dog food, it’s too rich for them and they need to stay on a prescription food.  Others seem to heal well and although they can’t tolerate any added fat in their diet or treats, can resume normal dog food.  I have had a few patients who recover and then the owners go back to old habits of feeding that little bit of steak after dinner or other treats the pet shouldn’t have and when they have a flare up, have died despite our best efforts to save them.  The truly sad thing about this disease is it seems to be preventable by just not feeding human table scraps.  Sure some dogs get into the trash and get it from that and accidents do happen to all of us but its so sad to know most of the cases I see are preventable.

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So why is it important and why should you care?  It’s a common practice to feed our dogs from the table and often bits of meat and high fat foods.  You may be causing a painful disease process that is preventable in most cases by not doing that.  Stick to dog food, water and dog treats that are not full of fat and you may save your dog from a very painful, life threatening condition.  If your cat or dog has any symptoms that suggest pain or possible chronic gastro-intestinal signs, consider getting them checked for pancreatitis.

Dawn Hess DVM

Pet Network Incline Vets

Pet Obesity

The best way to make sure that your pet is happy is to make sure it’s healthy. Obesity is a serious health concern for your pet and prevention starts with a well balanced diet appropriate to your pet’s breed, age, and health status. Fat cells develop during the growth stage of your pet’s life. As such, we need to make sure that you are feeding your pet an optimal puppy or kitten food to ensure healthy development. As animals mature their diet needs to change periodically to balance with their lifestyle whether it’s speeding up or slowing down.

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There are four factors that contribute to overweight pets:

1: Poor quality or improper diet

2: Overeating

3: Lack of exercise

4: Medical diseases

A veterinarian can determine if your pet’s size, weight, and feeding schedules are appropriate by calculating body condition scoring. Body scores range from one to nine, one being extremely thin, and a nine being markedly obese. An ideal score is a four or five. (See Purina Body Condition Score Guidelines for further information).

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Just like in humans, there are many health risks associated with obesity. As your pet’s weight increases so does their risk of developing one or more of these serious problems:

  • Arthritis
  • Breathing difficulties
  • Diabetes
  • Exercise intolerance
  • Fatty liver
  • Heart disease
  • Ruptured ligaments and soft tissues
  • Vertebral disc diseases

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Overweight pets are also a greater anesthetic and surgical risk, they have less energy and often are not able to groom properly. Weight reduction can be achieved by lowering caloric intake along with correction of concurrent medical conditions. Before starting any new exercise program, your pet should be examined by a veterinarian prior to doing so. There are medical conditions that can cause your pet to be obese and can be ruled out by a blood test and physical exam. Increased exercise is critical, but can be impractical in cats and difficult in dogs due to arthritis and other painful diseases.

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For any diet and exercise program to be successful, an owner must be committed to its successful outcome. Veterinary prescription diets are also available to aid in weight reduction. The principle in all therapeutic diets is to reduce caloric density but maintain the right amount of protein, vitamins, and minerals. There are a number of different formulations that offer a low fat content combined with high levels of indigestible fiber, which rely in part on an earlier feeling of satiety (that feeling of fullness) to limit food intake. As most dogs and cats will eat to meet their daily caloric requirements, calorie restriction remains the gold standard of successful weight loss. Although most cases of obesity can be corrected with proper owner compliance, early pet owner education remains the best preventative measure.

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Overfeeding puppies and kittens may lead to being overweight later in life. In puppies, overfeeding may also accelerate the growth rate, which in certain breeds may increase any predisposition to certain skeletal and orthopedic diseases. Young pets should be fed an appropriate daily amount of a balanced food with a caloric density that will result in normal growth rates and lean body condition. For most adult pets, avoidance of free choice feeding and poor behavioral habits like allowing them to beg and be rewarded for the behavior. Regular exercise still remains the best approach to the prevention of obesity.

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Based on your pet’s age and nutritional needs, your veterinarian can recommend a weight loss program to get your pet back on the right track. With the proper diet and exercise your pet will lose weight. It can be a real challenge to stick to a weight management program but it’s worth it to have a happier, healthier pet, which will benefit you both in the years to come. The plus side of exercising regularly with your pet is that you may see a negative in your scale number as well as your four legged friends.

Dr. Kelly MacLellan, DVM

Stop! Get Out of the Street!

Hit By Car – Accidents Involving Your Pets

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If you know or suspect your pet has been hit by a car, seek veterinary treatment immediately. Many animals are disoriented and painful or bleeding, so the best plan is to wrap them in a blanket and drive them directly to the nearest veterinary hospital to seek immediate attention. Your veterinarian will be able to perform a complete physical examination and detect signs which may indicate internal injury.  Injuries are often confirmed by performing diagnostics such as the following.

 

 

The Veterinary Exam May Include

A Complete Blood Count (CBC) and Chemistry Panel to look for signs of infection and organ function and damage to things such as the liver, kidneys or spleen.

A Pulse Ox Monitor may be applied to the animal’s tongue to ensure the body is getting adequate oxygen. Supplemental oxygen may be given to improve this condition.

An ECG or Electrocardiogram; a monitoring device that looks at heart function and rate to ensure it is beating correctly and that there is no arrhythmias from the accident that may require immediate medications to prevent heart failure.

Radiographs or X-Rays may be taken of the chest or abdomen (belly) to ensure there are no internal injuries to organs or broken bones. Multiple views are often needed as small fractures can be difficult or impossible to find with one image. As well; multiple radiographs of a painful limb are often taken to asses if there is a fracture and categorize it so that it can be best stabilized and repaired.

Ultrasound Exam of the chest or abdomen is often performed to look for damage to internal organs, such as bleeding from the liver, which will not show up on radiographs. This information may help the veterinarian determine if emergency surgery is required.

Emergency Surgery; some pets may need to be taken to surgery immediately as the condition is eminently life threatening. Other conditions that require surgery may be delayed so that the patient can be stabilized first and in better condition to withstand anesthesia. This may include pain medications, antibiotics, intravenous fluids, oxygen therapy, and actively increasing the pet’s body temperature.

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Monitoring Your Pet at Home

After returning from your veterinarians; you should monitor your pet closely for any of the following signs:

  • Difficulty breathing or pain which may be in the form of rapid shallow breathing or deep, laboured breathes
  • Bleeding from anywhere on the body (nose, gums, anus)
  • Pale or bluish mucus membranes and gums
  • Disorientation, stumbling or falling over
  • Reluctance or inability to stand and move
  • Vomiting or retching
  • Not eating, drinking or a change in attitude (quiet/depressed)
  • Dark coloured stools or urine (or blood tinged)
  • A bloated abdomen or belly
  • Other signs your veterinarian may have discussed at your visit.Golden Retriever puppy

How to Prevent Hit by Car Accidents and Protect Your Pets

Young Couple Walking DogKeep your dog on a leash at all times when outside or in a dog approved and fenced park.

Ensure that your pet’s backyard is securely fenced and check it regularly.

Spay and neuter your pet to discourage their desire to wander in search of a mate.

Keep cats indoors always or especially at night when they are prone to wander.

Make sure your pet is secure when traveling on foot or by car; ensure they are wearing proper and current identification tags.

If your dog is riding in the back of a truck, ensure they are wearing a secure fitted harness. Fasten their leash to a center anchor point directly behind the cab. Also, the leash should be long enough for your dog to move around and lay down but short enough so they can not put their front or back legs over the side of the truck bed and fall partially out resulting in choking or worse.

Ensure that your pet is microchipped so they can be safely returned if they run off after being hit by a car. Pets are fearful and painful and will often run from the scene and their owners.

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Play an active role in helping report lost or found pets so they can be returned safely to their owners as soon as possible.

Kelly MacLellan DVM, DACVS

Myths Surrounding Heartworm Disease in Dogs

There are many myths surrounding Heartworm Disease in dogs.  Here are some of the most common ones.

1)  I only need to put my dog on heartworm meds during the warm months when mosquitoes are out.

2)  I can tell if my dog has heartworm disease by a stool check or symptoms.

3)  Incline Village and Nevada in general don’t have any heartworm disease problems.

4)  If I keep my dog on heartworm preventative year round I never have to test again.

Heartworm disease is a disease spread by mosquitoes.  A dog or coyote who has heartworm disease has microscopic larvae circulating in the blood stream.  When a mosquito bites an infected animal and takes a blood meal, they ingest the larvae.  The larvae then matures into stage 3 larvae inside the mosquito and that is what a mosquito deposits in the next animal it bites to pass the disease on.  Only stage 3 larvae are contagious so even a blood transfusion from a heartworm positive dog does not give the disease to the animal who receives the transfusion.

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When the larvae get into the tissues of the new host, they spend 6-9 months migrating through the dog and eventually reach the right side of the heart where they become 10-12 inches long and can number anywhere from a few worms to 300 in a single dog.  You can imagine the damage they do living inside the heart as it pumps.  The adult female heartworm produces a protein antigen which is what our typical heartworm test picks up when we test for this parasite from a small sample of blood.  We can also look at a drop of blood and often see the larvae swimming and wiggling around in the blood under a microscope.

It may take 2-3 years before symptoms occur and can be vague like just not doing right, a minor cough, a major cough, weight loss, or more severe like fluid building up in the abdomen, severe depression and lethargy, symptoms of advance heart failure or death.  Once the patient is showing signs of heart disease from heartworm infestation there is a treatment but the only thing we have to kill the adult worms is a form of arsenic and the treatment is dangerous and costly.  It is so much easier and less expensive to prevent it than to treat it.

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Northern California and particularly Auburn are notorious for heartworm positive animals and in Northern Nevada our incidence is not as high; we routinely have 1-5 heartworm positive animals per clinic per year in the clinics that even test for it.  In Texas we know that 70% of the coyote population is postive for heartworm disease.  We have no figures on the percentage of the coyote population in Nevada that is positive.

So if you only give the preventative in the warm months, you miss the other months (remember it migrates for 6-9 months) where the larvae are maturing within the dog.  The preventative will only treat a small window in time where the larvae is molting from 1 stage to another and once that window is gone, that larvae is beyond our medicine and it will become and adult when it reaches the heart.

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Nothing in medicine or surgery is 100% and if you keep your dog on preventative year round, that is the best we can do to prevent this deadly disease.  Many of us have gotten to the end of our meds and found an extra tablet and wonder when we missed the dose.  Your dog can also vomit up a pill and you never know.  That animal is unprotected and could be heartworm positive in 6-9 months from the missed dose.  Is it common?  No, but if it happens to your beloved pet it’s 100%.

So we recommend yearly heartworm tests for all dogs and year-round heartworm prevention.

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Pet Network Incline Vets

What a Great Opening Day!

Today was our first official day open and we saw 6 patients. Still have a few kinks to work out, forms to make, software to perfect, but we are open and loving it!  Dr. Hess and Dr. MacLellan hit the ground running and appointments are filling fast!  Please give us a call or come down and meet us, we’d love to see you and your pet(s)!
First Patients seen today!
Buddy and Cashmere
       Buddy and Cashmere
Snow Cat and Marcie
Snow Cat and Marcie
Snow Cat and Marcie
Dakota
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Nori
Nori
Dr. Dawn working in the office
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Dr. Kelly seeing a client
Dr. Kelly and client
Dr. Dawn’s birds, Murray and Nikki hanging out
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New wall being built between surgery and radiology by Dr. Dawn’s handy husband, Mike
new surgery wall