Disease Articles

Dogs and cats are frequently diagnosed with a variety of diseases.Learn more about the most common diseases for dogs and cats.

Demodicosis

About the Diagnosis
Demodicosis (red mange, demodectic mange) is a skin condition caused by a microscopic parasite, Demodex. This condition is more common in dogs than cats and is not contagious to humans. The mites, Demodex canis in dogs and Demodex cati and Demodex gatoi in cats, are present on the skin of healthy animals; they are transmitted under normal circumstances from the mother’s skin to the offspring shortly after birth. The animal’s immune system keeps the mite population low enough so they do not cause skin problems. However, if the immune system is weak, the mites can reproduce in high numbers and cause disease. Conditions that cause a weak immune system include inherited immune deficiencies, poor nutrition, internal disease(s) affecting the whole body (cancer, hormonal imbalances, etc.), and certain drugs (chemotherapy, glucocorticoids). The maturation of the immune system during youth (dogs and cats <1 year old) may leave animals with inadequate immunity for a short time (e.g., days to weeks), such that demodicosis develops more frequently in young animals.
Demodicosis is usually diagnosed by performing multiple skin scrapings, which involves gently scraping the surface of the skin to harvest cells and mites for examination under the microscope. Demodex mites are too small to be seen with the naked eye. Although mild bleeding may occur where the skin is scraped, the procedure is superficial and painless. If the scrapings show no mites, skin biopsies may aid diagnosis; small samples of skin are surgically removed and sent to a laboratory to be evaluated microscopically for mites and other skin diseases. Excessive grooming in cats often dislodges Demodex gatoi mites from the animal’s fur, resulting in negative skin scrapings; diagnosis may be based on response to treatment in suspected cases. Because demodicosis usually occurs secondary to an underlying condition, additional tests generally are needed to identify the predisposing factor(s) and allow treatment of the underlying cause whenever possible.
Living with the Diagnosis
Two forms of demodicosis occur in dogs and cats. Localized demodicosis affects one small patch of skin, while generalized demodicosis affects more than one area of skin at the same time, potentially including the feet (demodectic pododermatitis).
Dogs: Demodex canis mites live beneath the surface of the skin in the hair follicles (sac-like pores where hairs are rooted). Demodicosis is not contagious between dogs or to humans. Demodicosis is more common and more severein certain breeds of dogs, suggesting a hereditary (genetic) predisposition.
Localized demodicosis affects dogs under 1 year of age. Symptoms include hair loss, redness of the skin, and blackheads (comedones-hair follicles plugged with skin secretions) in the affected area. About 1 in 10 cases will progress to the generalized form.
Generalized demodicosis is more serious than the localized form. There are two classifications of generalized demodicosis. Juvenile-onset demodicosis affects animals less than 1 year of age and generally is due to a temporary state of weakened immunity that resolves on its own or with minimal treatment. The second classification, adult-onset demodicosis, affects older animals and usually develops secondary to an underlying condition or illness. The mite-infested hair follicles often become infected with bacteria (folliculitis), causing bumps and scabs on the skin.

Mild itchiness may develop due to the folliculitis. Demodectic pododermatitis may cause limping (lameness). It is common for a superimposed, secondary deep bacterial skin infection to develop. The combination of demodicosis and bacterial infection can trigger intense itchiness, whereas demodicosis alone usually does not. In some cases, the bacterial infection may become quite severe, resulting in skin ulcers and draining sores (deep pyoderma, cellulitis) and generalized illness (fever, lethargy, not eating); rarely, this condition may even become life threatening.
Cats: Symptoms are similar to dogs. Some cats develop an ear infection (otitis externa) as the only symptom. Demodex cati lives in the hair follicle and is not contagious between cats. However, Demodex gatoi lives on the skin surface and is contagious between cats; infected cats are usually very itchy and groom excessively.

Treatment
Most dogs (90%) with localized demodicosis will recover without treatment. However, because some cases will progress to the more serious generalized form, the condition must be monitored closely. Veterinarians sometimes prescribe a topical medication (e.g., skin ointment or cream) to assist healing.
Approximately half of all dogs with generalized demodicosis will also heal without treatment; however, treatment is usually recommended because the progression and outcome cannot be determined at the outset and because of the potentially serious nature of this condition. It is also important to identify and treat any underlying cause(s). Specific treatment for generalized demodicosis consists of topical applications (directly applied to the skin) of medicated dips (available through your veterinarian) over a period of weeks to months, until 3 consecutive skin scrapings are negative. Skin scrapings are usually performed every 2 to 4 weeks to monitor healing. Because hairs from infected follicles will continue to fall out during the initial treatment period, the skin condition may appear to worsen before it improves. Other therapies are used in resistant cases that do not respond to the dips. Antibiotics are administered in cases of generalized demodicosis and in cases of localized demodicosis that have a secondary bacterial infection (pyoderma).
Good nutrition and minimizing stress are important for recovery. Neutering is recommended to prevent stress associated with heat cycles (females), reproduction, and mating. Neutering is also recommended in generalized demodicosis because the animal (male or female) may have a hereditary predisposition that could be passed to its offspring.
DOs
• Have a veterinarian evaluate all cats that have had contact with an infected cat; Demodex gatoi is contagious between cats.
DON’Ts
• Do not wet animals between dips, unless advised to do so by a veterinarian.
• Do not miss follow-up appointments, even if the pet’s condition has improved; it is important that your veterinarian monitor and/or treat the condition until the pet has completely healed.
• Do not use mange medications that are not specifically prescribed for demodicosis by a veterinarian. Most over-the-counter products are ineffective in treating demodicosis and may be toxic to your pet.
When to Call Your Veterinarian
• Dogs may be very sleepy for 24 hours after being dipped. However, vomiting, diarrhea, lethargy, tremors, wobbliness, or any abnormal behavior may indicate a serious adverse reaction to the dip; an antidote is available for dogs.
Signs to Watch For
• Skin ulcerations, lethargy, and not eating (call your veterinarian).
Routine Follow-Up
• Every 1 to 2 weeks for dips and reevaluation.

Dermatophytosis

About the Diagnosis
“Ringworm” (dermatophytosis) is a skin disease that is caused by a fungus, not a worm. It can affect cats, dogs, other animals, and people. Long ago, it was thought that a parasite (worm) was responsible, but it is now known that ringworm is caused by a type of fungus called dermatophytes, which infect tissues containing keratin. Keratin is a protein produced by skin cells. The outermost layer of skin cells contains keratin. Hair and nails are also made of keratin. All of these tissues can be invaded by dermatophytes.
Ringworm skin infections tend to enlarge in a circular pattern as the organisms continuously infect more skin and hair on the edges of the area-hence the “ring” in the name ringworm. Three types of ringworm/dermatophyte infections are common in dogs and cats. One, Microsporum canis, is usually transmitted from one pet to another. The other two, Microsporum gypseum and Trichophyton mentagrophytes, are normally found in soil and on rodents, respectively, but can infect pets as well. People can become infected with any of the three types of ringworm from contact with infected pets.
Symptoms: Skin and hair ringworm infections cause hair loss in a circular pattern. The ringworm infection weakens the hairs, causing them to break off easily. Small red bumps, scales, and hyperpigmentation (darkening) of the skin may occur. Infected nails become deformed and may have a discharge at the base of the nail. Some infected cats show no symptoms at all but can be carriers, transmitting the ringworm infection to dogs or other cats. Other cats can develop miliary dermatitis, a condition where small crusts (scabs) can be felt beneath the hair coat.
Diagnosis: The signs and symptoms of ringworm infection are similar to several other skin diseases so the diagnosis of ringworm cannot be made by appearance alone. Your veterinarian may use an ultraviolet lamp called Wood’s light to screen suspicious areas for ringworm. Some dermatophytes produce substances that glow with a green color under Wood’s light. However, this is a screening tool only, since not all dermatophytes show this response and conversely, some substances on the skin that are not ringworm can cause a false positive reaction. The best test for diagnosing ringworm infection is fungal culture. For this simple test, a few hairs are plucked from the affected area and incubated in a special culture medium called dermatophyte test medium, or DTM. Cultures take some time, so results will not be known for a few days or up to two weeks. Microscopic examination of the fungus growth on the DTM can identify which of the three dermatophyte organisms is causing your pet’s infection, which is helpful in determining the source (i.e., the risk of reinfection).
Living with the Diagnosis
Microsporum canis is the most contagious type of ringworm. It is important to realize that the environment and all infected pets in the household must be treated to eliminate ringworm and prevent its spread to other pets and to people. Dermatophyte organisms on shed hairs can remain infectious (contagious) for weeks. Other pets in the household should be inspected for infection. Since asymptomatic cats may be carriers, they should be tested by sampling the hair (brushing the haircoat with a brand new toothbrush) and then submitting the entire toothbrush and its collected hairs for DTM culturing. Infected pets should be isolated from other pets and from people, especially immunocompromised people including persons receiving cancer chemotherapy, people with human immunodeficiency virus (HIV) infection, and others. See the Treatment section below for more information. If your pet has contracted ringworm due to Microsporum gypseum or Trichophyton mentagrophytes, avoiding exposure to contaminated soil and rodents or rodent burrows will help prevent reoccurrence.
Treatment
Most pets will have an immune response to the fungus that will eventually eliminate the infection. However, treatment is needed to speed the process and to prevent the spread of the ringworm organism to other pets and people. If for any reason, your pet is receiving any medications that suppress the immune system, such as corticosteroids, they should ideally be stopped; you should discuss this with your veterinarian to find suitable alternative medications if necessary. Long-haired pets should have their entire haircoats shaved off and the hair carefully collected and disposed of. Fungicidal dips (soaking the pet in diluted, purpose-made fungicidal shampoo or solution) help reduce the infectiveness of remaining hairs. Frequent, thorough vacuuming and cleaning of the area where the pet is kept are needed to remove infected hairs from the environment. All pet bedding and grooming equipment should be disinfected or destroyed. The entire house should be carefully cleaned to remove pet hairs. Consult your veterinarian for recommendations of cleaning agents that will destroy the organisms.
Pets affected with mild cases of ringworm (small, isolated skin lesions) can be treated with antifungal creams and lotions (“topical medications”), which are applied directly to the affected areas of skin. It is important to wear gloves, such as disposable latex or rubber medical gloves, to avoid contracting the infection from the pet when applying these topical treatments. Oral antifungal medication is required for pets if topical treatment is not successful or if the pet is severely affected. Several oral drugs are available. Treatment of skin infections typically takes about three months. Nail/claw infections require much longer treatment-often from 6 to 12 months. A vaccine is licensed for control of Microsporum canis infection in cats. It has not proven to be very effective, and is not recommended for use except in some cattery situations.
Dos

– Realize that hairless areas on the skin of dogs and cats, particularly if circular and reddened, may indicate ringworm infection, which is contagious to other animals and to people.
– If ringworm is confirmed take steps to decontaminate your home as well as treating your pet(s).
– Use topical treatments and oral medications exactly as directed.
– Some oral antifungal medications need to be given with food to enhance drug absorption; ask you veterinarian about this issue if oral antifungal medications are prescribed.

DON’Ts

– Many antifungal medications should not be given to pets that are pregnant or to male animals that are being used for breeding. Check with your veterinarian if this is a relevant concern for you.

When to Call Your Veterinarian

– When giving oral antifungal medication, if your pet has any of these problems: vomiting, diarrhea, lack of appetite, itching, depression, or incoordination

– Signs to Watch For

– Circular areas of hair loss that grow larger.
– Deformed nails/claws.

Routine Follow-Up

– Some oral antifungal drugs can cause bone-marrow suppression or liver damage.

– Periodic blood tests are needed to check for these side effects. Fungal cultures should be repeated before stopping oral antifungal medications to be certain the infection has been completely eliminated.
Additional Information

– If any people in the household develop areas of red, itchy skin, consult a physician.
– Individuals who are immunocompromised should seek guidance from their physicians and avoid contact with the pet or its surroundings if there is a suspicion or confirmation of ringworm in the pet.

Diabetes Mellitus

About the Diagnosis
Cause: The pancreas is an organ within the belly (abdomen). The two main functions of the pancreas are to produce enzymes that are involved with digestion and hormones that are primarily involved with the utilization (metabolism) of sugar (glucose). Insulin is one of the most important of these hormones.
Diabetes mellitus (DM), generally just called diabetes, is a disease that affects dogs and cats. Diabetes mellitus is caused by a deficiency of insulin that results in the inability of the body’s tissues and organs to properly utilize glucose. When glucose is not used properly by the body, high blood sugar levels develop. This is exactly like diabetes mellitus in human beings. There are two types of diabetes mellitus. Type I (insulin-dependent diabetes mellitus) occurs when the pancreas does not produce enough insulin. Type II (non-insulin-dependent diabetes mellitus) occurs when the body’s ability to utilize insulin that is produced is abnormal. Almost all dogs with diabetes mellitus have type I, whereas 50-70% of cats diagnosed with diabetes mellitus have type I and the remaining 30-50% have type II. In dogs, diabetes mellitus is commonly a permanent disorder, whereas in cats a short-term (transient) and reversible form of diabetes mellitus exists. In human beings, by contrast, type II diabetes is more common than type I (juvenile) diabetes.
Diabetes mellitus is one of the most common endocrine (hormonal) disorders in cats and dogs. Diabetes mellitus usually affects middle-aged to older cats and dogs. Any breed can be affected; however in dogs, the keeshond, puli, miniature pinscher, Cairn terrier, poodle, dachshund, miniature schnauzer, and beagle are breeds with higher risks.

In dogs, females are more commonly affected, whereas in cats, males are more commonly affected.
The causes of diabetes mellitus can include a genetic susceptibility, infectious diseases, immune system abnormalities that cause destruction of the hormone producing regions in the pancreas, pancreatitis (inflammation of the pancreas), drugs (corticosteroids, progestins), as well as other hormonal diseases (hyperadrenocorticism, acromegaly). Other risk factors include animals that are overweight and female dogs that have not been altered(spayed).
Diabetic animals are more prone to developing bacterial and fungal infections (opportunistic infections). Urinary tract infections are very common as sugars present in the urine of diabetic patients can allow bacteria to multiply.
Most diabetic dogs and cat have mild or moderate symptoms. At the far end of the spectrum, however, ketoacidosis is the most serious complication of diabetes mellitus and is considered a medical emergency. Uncontrolled, ketoacidosis produces diabetic coma and may be fatal. Animals with diabetic ketoacidosis are most often lethargic (sluggish), have little or no appetite, and generally seem profoundly ill; diagnostic testing by a veterinarian is necessary to identify ketoacidosis, and intensive care treatment is generally necessary for animals with diabetic ketoacidosis.
Diagnosis: Symptoms of diabetes mellitus can vary from patient to patient and are often common to several other diseases. The most common early signs of diabetes mellitus include an increase in thirst and urination, weight loss, and an increase in appetite. Later in the course of the disease, sluggishness and vomiting can be noted. Dogs can also develop poor vision and a white or cloudy discoloration of the eyes, whereas cats can develop a poor hair coat, yellow discolorations to the skin, gums, and whites of the eyes (jaundice), and hind limb weakness with an abnormal flat stance (diabetic neuropathy).
Your veterinarian will begin by asking you several questions to try to determine if diabetes mellitus, or another type of problem altogether, could be responsible for symptoms. You should provide whatever information you have when you answer these questions, which often include: the type of symptoms observed, the length of time they have been occurring, effects on vital functions such as appetite and urine elimination, current diet, and any current medications or supplements you are giving your pet.
When examining your pet, your veterinarian will look for some of the abnormalities that can occur with diabetes mellitus, which include obesity (overweight), dehydration, jaundice and a liver that can be felt by the fingertips to be enlarged (seen commonly in dogs and cats as a result of abnormal fat accumulation within the liver as the body tries to compensate for abnormal glucose utilization), cataract formation (seen commonly in dogs as a result of abnormal accumulation of sugars within certain structures of the eye), oily coat with dandruff, and diabetic neuropathy (seen occasionally in cats). If diabetes mellitus is suspected by your veterinarian, further testing will be recommended.
Routine lab tests consisting of blood and urine tests are typically recommended in order to diagnose diabetes mellitus as well as rule out other possible medical problems that produce similar symptoms. A blood sugar level and urinalysis are the tests of choice. Finding persistently high levels of glucose in the blood (hyperglycemia) and urine (glucosuria) in a fasted (no intake of food for 8 or more hours) animal is typically diagnostic for diabetes mellitus. It is important to keep in mind, however, that healthy cats can have high levels of glucose in the blood as a result of high levels of stress, not diabetes. In some of these cases, small amounts of glucose can also be seen in the urine, making a diagnosis of diabetes mellitus more difficult in some cats. Repeatedly high blood and urine glucose levels and the measurement of glycosylated hemoglobin, or fructosamine, levels can help your veterinarian diagnose true diabetes mellitus versus stress in your cat. These tests give a better indication of what the blood sugar levels have been in the animal over the previous several weeks and are less affected by short periods of stress such as travel to the veterinary clinic.
A complete blood count (CBC), biochemical profile, urine culture and sensitivity, imaging techniques (x-rays and ultrasound), and tests for other hormonal problems are also commonly performed to rule out other concurrent illnesses and underlying diseases.
Living with the Diagnosis
Diabetes mellitus can be a serious and life-threatening disease if left untreated. On the other hand, most diabetic animals that are diagnosed and treated properly and that respond well to treatment can live a normal or near-normal life span with a good quality of life. Managing a diabetic animal requires a great commitment of time, education, observation, and follow-up care.
The most important factor in a diabetic animal’s life is routine. Ideally meals and treatments are given as close to the same time as possible each day. Strenuous exercise generally should be avoided. A consistent amount of controlled exercise each day is ideal. A good routine will help prevent irregular fluctuations in blood sugar levels.
Give all prescribed medications as directed by your veterinarian. These medications are essential in regulating blood sugar levels as well as improving the quality of your pet’s life. Most of these medications will be required for the rest of your pet’s life. Some cats can go through periods of time where they no longer require medication for diabetes mellitus (diabetic honeymoon period). In a few of these cases, they will never require medication again, whereas in most of the cases, symptoms will develop again at a later time and require further treatment. Discuss with your veterinarian all of the possible side effects of any medications your animal is prescribed, as well as the appropriate actions to take if you notice any of these symptoms.
If your animal requires insulin injections, it is very important to become familiar with the proper handling, administration, and disposal of insulin. Your veterinarian will be able to give you detailed instructions. Insulin is a fragile substance and must be kept in a cool dry place (refrigerator). The insulin bottle should be mixed well prior to removing any of its contents. Ideally the bottle is rolled gently in the hands until thorough mixing is achieved and should never be shaken since this can damage and inactivate the insulin. You should be aware of the type and source of insulin and syringes your animal was prescribed, so that when you need a refill, you are able to ensure that you have received the proper medication and syringe size. Insulin needles and syringes should never be reused or disposed of in the trash. Rather, collect them in a puncture-proof container (e.g., empty bleach jug) and bring it to your veterinarian for disposal.
You should discuss an ideal diet for your pet with your veterinarian and feed only the recommended foods. Some prescription pet diets are made especially for diabetic patients and should be used if your pet enjoys the taste of them. If your pet is no longer willing to eat the special diet, contact your veterinarian prior to changing foods. Consistent nutrition is extremely important in the regulation of a diabetic patient. Always provide unlimited access to fresh clean water. It is also important to talk to your veterinarian about any changes that should be made to your pet’s medications if they are unwilling to eat or if they have digestive problems (vomiting).
The first few months after an animal is diagnosed with diabetes mellitus, several trips to the veterinarian will be required. In most situations, daily injections of a low dose of insulin are given, and the dose is gradually increased until the original symptoms are gone (i.e., the diabetes is well-controlled). Blood sugar levels are measured every hour or two for a 12- or 24-hour period 1 to 2 weeks after starting the insulin (the first recheck visit) and periodically thereafter to ensure that appropriate glucose levels are seen. This helps prevent overdosing your animal and allows for fine-tuning of the insulin dose. It is common initially for blood glucose levels to be taken every 1 to 2 weeks. Your animal generally will have to stay in the hospital for the day in order to monitor blood glucose levels every few hours. Once the diabetes is well regulated, these visits will be less frequent, but some degree of monitoring is still required (a few times per year) since insulin requirements can change with time. It is very important to carefully note any changes in your pet’s weight, drinking, urination, and eating habits between appointments. Measuring the amount of water your animal drinks in a day can be very useful. This information can help your veterinarian make appropriate adjustments in your pet’s medications, especially insulin. Keeping a daily diary of your observations and of the dosage and timing of insulin injections is very helpful and can also help you keep track of medications.
Once your animal has started any treatment for diabetes mellitus, monitoring for signs of low sugar levels (hypoglycemia) is also very important. Too much insulin can cause blood sugar levels to go too low. Low sugar levels can cause disorientation, sluggishness, seizures, coma, and even death if prolonged. If you notice that your animal seems disorientated or weak but is still responsive, offer food immediately. If your animal seems unconscious, apply a sugary solution like corn syrup to the gums. In both of these cases, contact your veterinarian or local emergency hospital immediately.
Treatment
The goal of treating a diabetic animal is to minimize blood glucose fluctuations, eliminate the symptoms associated with high blood glucose levels (excessive drinking, urination, and appetite), and improve the quality of the pet’s life.
Treatment of diabetes mellitus must be based on the individual patient, the severity of the symptoms, the underlying cause, the type of diabetes, and the secondary diseases that may be involved. In every patient however, all medications that can precipitate diabetes mellitus should be identified and discontinued (steroids, progestins), and all concurrent or underlying diseases should be diagnosed and treated. Intact females (dogs or cats that have not been altered) should be spayed. Hormonal changes that occur when animals are in heat can alter the effects of insulin and the body’s use of glucose.
Patients with severe symptoms of diabetes mellitus or ketoacidosis will likely need to be hospitalized initially while intravenous (IV) fluids are given to correct dehydration, electrolyte, and acid-base abnormalities and medications including insulin are initiated. If hospitalization is not required, your veterinarian will start your pet on medications and treatments that can be given at home. Ketoacidosis and severe symptoms (such as loss of appetite, vomiting, and collapse) is a very serious combination that carries a guarded prognosis; one third of patients do not survive even with intensive care.
Insulin treatment is required in all dogs and most cats. Insulin is a very fragile hormone that can easily be inactivated. This is why insulin is given as an injection under the skin with a small needle. There are several different types and sources of insulin. They vary in strength and length (duration) of effect. Your veterinarian will recommend the most appropriate insulin for your animal. Most animals require two insulin injections daily, ideally given approximately 12 hours apart with a meal. Most owners become very efficient at giving these injections and most pets become very tolerant of the treatments. Type I diabetes typically requires lifelong insulin injections.
A diet and weight management program is essential to proper treatment of diabetes mellitus. Diets that are high in simple carbohydrates (sugars), which can cause a spike in blood sugar levels, are avoided. Diets containing complex carbohydrates (starches) that are broken down and used by the body more slowly are preferable. Fiber is an important ingredient in diabetic diets since it slows the absorption of carbohydrates in the body and can decrease hunger sensations for those animals that are overweight. There are several different commercial prescription diets available that can meet the needs of all diabetic patients, whether weight loss, maintenance, or gain is the goal. Achieving and maintaining an ideal body weight is helpful in the treatment of type I, and type II diabetes mellitus.
Some cats with type II diabetes mellitus can be managed with diet therapy and medication given by mouth rather than insulin injections. Only a very small minority of diabetic animals will respond well to these medications. Your veterinarian will help you decide if this is a good alternative for your pet.
Cataracts (cloudy eyes with poor vision to blindness) that develop in dogs as a result of diabetes mellitus will not resolve once the diabetes mellitus is regulated. There is a surgery that can remove the cloudy portion of the eye and restore vision. This type of surgery is generally performed by a veterinary ophthalmologist.
DOs
• Realize that diabetes mellitus is a very treatable disease but that the proper management of a diabetic animal requires significant commitment of time, finances, and attention.
• Realize that serious and life-threatening complications can arise, especially if diabetes mellitus is left untreated or treated inappropriately. If you notice that your animal seems disorientated but is still alert and responsive, offer food immediately. If your animal seems unconscious, apply a sugary solution like syrup to the gums. In either of these cases, contact your veterinarian or local emergency hospital immediately.
• Keep all recommended follow-up appointments with your veterinarian since they are essential in keeping your pet’s blood sugar levels well regulated.
• Contact your veterinarian, if your pet’s symptoms change, worsen, or any new problems arise.
• Have your veterinarian or veterinary technician show you how to give all medications and demonstrate the correct method for insulin handling, administration, and disposal.
• Handle and give all medications exactly as directed by your veterinarian. If your animal is having side effects from any medications or you are finding it very difficult to medicate your animal, contact your veterinarian for advice before discontinuing the treatment.
• Ask your veterinarian questions about information you do not understand. If you do not trust or are not comfortable with your veterinarian, get a second opinion from another veterinarian or a veterinary internal medicine specialist.
DON’Ts
• Do not postpone a visit to your veterinarian if you observe any symptoms of illness or of diabetes mellitus since early diagnosis and treatment can aid in preventing serious and life-threatening complications of the disease and improving the quality of your pet’s life. The initial screening may only require a physical exam and routine blood and urine tests.
• Do not give any medications that are not prescribed by your veterinarian for the specific animal in question.
• Do not stop any medications if your animal is feeling better without consulting with your veterinarian first.
• Do not assume that all sources of information are accurate or complete (i.e., Internet sites, outdated pamphlets or books, pet store workers, friends, etc). Ask your veterinarian for recommended sources of information.
• If you are giving insulin injections at home, do not reuse or dispose of needles or syringes in the trash. Rather, collect them in a puncture-proof container (e.g., empty bleach jug) and bring it to your veterinarian for disposal.
When to Call Your Veterinarian
• If you are unable to give medications as prescribed or if you require a prescription refill. When you have any questions or concerns related to your pet’s continual treatment plan or current status.
Signs to Watch For
• Watch for general sign of illness, which can include changes in appetite, weight loss, decrease in activity, sluggishness, dull or poorly kept coat, and changes in behavior such as hiding and aggressiveness.
• Watch for signs of diabetes mellitus, which can include an increase in thirst (Are you filling up the water bowls more often? Is your animal drinking water from taps, bath tubs, fountains, etc.?) and urination (Is your animal asking to go outside more frequently or having accidents in the house? Do you notice larger urine spots in the litter box, or do you have to change the box more frequently than usual?), vomiting, weakness, changes in vision and appearance of the eyes, yellow discolorations to the skin, gums, and whites of the eyes, and hind limb weakness with an abnormal flat stance.
Routine Follow-Up
• As insulin requirements of a given animal can change over time, it is very important to keep all recommended follow-up appointments and lab tests with your veterinarian in order to monitor blood sugar levels.

Dilated Cardiomyopathy

About the Diagnosis
Cause: The heart is an organ made of muscle cells. When the heart contracts, it pumps oxygenated blood to the body and at the same time it sends “used” unoxygenated blood to the lungs to pick up oxygen. Within the heart are four chambers and four valves. These one-way valves ensure that blood always flows in the correct direction.
Dilated cardiomyopathy is a reduced ability of the heart to contract that leads to decreased pumping of blood forward throughout the body. The problem is an inherent weakness of the heart muscle tissue, which occurs as a result of genetics (usually) or nutritional deficiencies (rarely). With dilated cardiomyopathy, the circulation is disrupted in such a way that fluid weeps through the walls of the blood vessels and accumulates in the lung tissue (pulmonary edema) or leaks into body cavities such as the abdomen (ascites) and chest cavity (pleural effusion).

Dilated cardiomyopathy is often a serious, life-threatening disease, but it has many degrees of severity. Some patients diagnosed early respond well to treatment and live comfortably for months or sometimes years, whereas in other, more serious cases, dilated cardiomyopathy is the cause of death within days or weeks of diagnosis. The way to determine the severity of the case is to perform a series of cardiac tests (see below), and even then, the ability to predict life span is never exact.
This disease is rarely diagnosed in small dogs or cats; however, it is a common cause of heart disease in large and giant breed dogs that are middle- to older-aged. The cause is often unknown but is thought to be genetic in some breeds. Unfortunately, dilated cardiomyopathy may be present without symptoms (see Signs to Watch For) and may deteriorate quickly once symptoms occur. The onset of symptoms can be sudden and severe.
Diagnosis: The symptoms of dilated cardiomyopathy are often subtle at first and/or not specific (i.e., they look like symptoms of other, entirely different diseases). Therefore, your veterinarian will begin by performing a thorough physical exam and taking a complete history from you, including asking questions about the nature and duration of symptoms you observed, any current medications, previous medical problems, and so on. Chest x-rays are necessary; they show the size of the heart, may show fluid accumulation in the lungs or chest cavity if present, and can help to identify the presence or absence of other reasons for breathing problems. An electrocardiogram (EKG) depicts the pattern of electrical activity in the heart and is important in dilated cardiomyopathy because the heartbeat is sometimes severely erratic (requiring specific types of medications) as a result of this disease. Blood work, including a complete blood count (CBC) and serum chemistry profile, and a urinalysis can help to determine if other organs are affected and to pinpoint risk factors that would influence the choice of medications for treatment.

The confirmatory test for dilated cardiomyopathy is an echocardiogram, commonly called a cardiac ultrasound. This test shows the internal architecture of the heart including the function of the different heart chambers, thickness of the walls, condition of the heart valves, and direction and speed of blood flow, all of which are important points in assessing patients suspected of having (or known to have) dilated cardiomyopathy.
Living with the Diagnosis
Give all medications as directed by your veterinarian. Talk to your veterinarian about the possible side effects of the medications so that you know what is normal and abnormal. During the course of treatment, one or more of the tests mentioned above will often be repeated to ensure that the drugs are working safely and effectively.
When the pumping action of a heart with dilated cardiomyopathy is severely compromised, then congestive heart failure may occur. See Congestive Heart Failure.
Follow instructions to restrict your dog’s activity level. Too much exercise or play in a patient with dilated cardiomyopathy can exacerbate this condition.
Feed only recommended diets. Some treats have a high sodium content and should be avoided. Be sure to discuss treats that are permitted with your veterinarian.
Occasionally, dilated cardiomyopathy is caused by a deficiency of taurine, a type of amino acid normally found in food. Many breeds of dogs have taurine deficiency associated with their dilated cardiomyopathy, and it is important to identify this deficiency (with a blood test) because adding taurine to the food can help stabilize or even reverse the dilated cardiomyopathy process.
Treatment
Treatment depends on the stage of the disease and your pet’s overall health. If symptoms are severe, your dog may be hospitalized while medications and oxygen supplementation are given. Your dog may need a sedative to promote relaxation. Stress and anxiety can make breathing more difficult. In these more serious cases with severe respiratory distress (very labored breathing), the tests described above may be withheld and treatment begun only once your dog is more comfortable.
The cornerstones of treatment for dilated cardiomyopathy are specific medications. Diuretics remove fluid that has accumulated in the abdomen or lungs and can cause your dog to drink more water and urinate more. An angiotensin-converting enzyme inhibitor (ACEI) helps to relax blood vessels to allow more efficient blood flow from the heart and ease the workload on the heart. In some cases where fluid has accumulated around the lungs and is compressing or collapsing the lungs, a needle may need to be used for withdrawing the fluid from the chest cavity and allowing the lungs to re-expand. Not all of these medications may be necessary, and others are available. The treatment is tailored to the patient’s exact situation and therefore is almost never the same from one case to another.
DOs
• Go to your veterinarian or the local emergency clinic immediately if your dog develops breathing problems or losesconsciousness.
• Inform your veterinarian if your dog has ever been diagnosed with a medical condition and is taking medication.
• Give medication exactly as directed by your veterinarian and if you are concerned about possible negative effects, discuss them with your veterinarian immediately rather than simply discontinuing the treatment.
• Realize that dilated cardiomyopathy is often an irreversible disease that is of genetic origin and that medications can make patients with dilated cardiomyopathy comfortable, happy, and active, but rarely athletic.
• Realize also that many individual dogs do not understand the limitations of their heart condition and may wish to be more active than they should given their heart’s compromised state. Finding the right balance between cardiac risk (from physical activity) and enough activity to bring a dog satisfaction and happiness should be discussed with your veterinarian.
DON’Ts
• Do not postpone visiting your veterinarian if you observe any symptoms of dilated cardiomyopathy. Prompt diagnosis and treatment may improve your dog’s quality of life.
• Do not give medication that you have at home that has been prescribed for human use; some of these may interfere with treatment and cause even more severe problems.
• Do not assume that your dog with dilated cardiomyopathy knows when to withhold its physical exertion level.
When to Call Your Veterinarian
• If you cannot keep a scheduled appointment.
• If you are unable to give medication as directed.
Signs to Watch For
• Watch for general signs of illness, which include vomiting, diarrhea, changes in appetite and weight, and changes in behavior such as hiding more than usual and aggressiveness.
• Watch for signs of dilated cardiomyopathy, which include weakness, lethargy, coughing, exercise intolerance, and fainting.
Routine Follow-Up
• Because this is a progressive disease, follow-up appointments are necessary to monitor progress, to determine if treatment should be adjusted, and to pursue any abnormalities on previous blood tests.

Eclampsia

About the Diagnosis
Cause: Eclampsia is a sudden onset of potentially life-threatening symptoms resulting from low blood calcium (hypocalcemia) in the female dog (bitch) or female cat (queen) that has given birth in the preceding 3 weeks. In the bitch, eclampsia can occur at any time during lactation (nursing), but it is most likely to occur during the first 3 weeks of lactation, which begins within minutes after birth. Eclampsia occurs most commonly in small dogs with large litters, but it can occur in any bitch after whelping (giving birth). Symptoms of eclampsia include panting, pacing, restlessness, muscle stiffness and trembling, inability to rise, seizures, and coma. If eclampsia progresses to produce severe symptoms such as seizures and coma and is not treated immediately, death is possible. Eclampsia does not occur during pregnancy (before giving birth). Eclampsia occurs very rarely in cats.
The cause of eclampsia is a sudden transfer of circulating calcium from the mother’s blood into the milk; while this is beneficial to the puppies, the mother may experience such a sudden drop in blood calcium levels (hypocalcemia) that eclampsia and the symptoms described above occur. There are many additional factors that contribute to this disorder. Maternal calcium is sacrificed for growth of the fetuses during gestation (pregnancy), and additional factors such as poor diet during gestation and lactation or excessive calcium supplementation during gestation can upset calcium balance and predispose to eclampsia, Offering reasonable amounts of a regular balanced diet and avoiding calcium supplementation during pregnancy (because these encourage the body to absorb only a small fraction of ingested calcium, leaving it totally unprepared for the massive calcium absorption needed once milk production and nursing begin) are important preventive measures that can be taken to reduce the risk of eclampsia.
Diagnosis: Eclampsia is usually diagnosed based on the onset symptoms hours, days, or a few weeks after giving birth, and the positive response to treatment with calcium gluconate injections in a lactating bitch or queen. Although hypocalcemia confirms the diagnosis, the time and equipment necessary for performing this blood test are not always available in the short time frame (minutes) during which treatment with calcium gluconate is often necessary.
Living with the Diagnosis
Eclampsia is a serious, potentially life-threatening condition, but it is a temporary condition that leaves no permanent aftereffects and requires no ongoing treatment if the initial stages are detected early and if adequate treatment (usually only needed for a few weeks at most) is provided. If your dog or cat has been diagnosed and treated for eclampsia, give medication at home exactly as your veterinarian prescribes it. Follow your veterinarian’s instructions regarding hand-feeding the puppies or kittens if necessary, as a reduction in nursing may lessen the burden of milk production and decrease the amount of calcium being transferred from the mother’s body into milk. Eclampsia can recur if nursing resumes and the dam’s calcium level is not regulated.
Eclampsia can recur with subsequent litters. To prevent this disorder, it is important that the bitch or queen has a nutritionally balanced diet during pregnancy and lactation. To ensure that this diet is consumed, the puppies or kittens can be removed from the dam for a short period of time several times daily while she eats. Solid food can be gradually offered to the puppies and kittens (beginning the weaning process) beginning at approximately 3 weeks while they are still nursing. Calcium should NEVER be given to the dam during pregnancy because it can disrupt the normal balance of calcium in the body and, counterproductively, it actually makes eclampsia more likely.
Treatment
Eclampsia may progress quickly and can be fatal if it is not treated. Therefore, treatment should begin immediately. Calcium (gluconate) is administered intravenously, very slowly and with careful monitoring (because intravenous calcium excess is also potentially very dangerous) until clinical signs resolve. Low blood glucose (hypoglycemia) is treated with dextrose, which can be given by mouth or intravenously. If seizures do not respond to this treatment, an anticonvulsant medication may also be given. Depending on their age, kittens or puppies may need to be weaned and hand-fed to lessen the calcium drain of milk production.
When the bitch or queen is recovering from eclampsia and is stable, calcium should be supplemented at home. A carefully calculated and monitored dose of oral vitamin D may be needed to help the body absorb calcium. A well-balanced diet is important and may obviate the need for vitamin D supplementation. Several commercial diets are available. Your veterinarian can discuss appropriate diets and supplements with you.
DOs
• Be aware, despite the excitement of the birthing process, that after birth (for up to 3 weeks) symptoms of irritability, muscle twitching, or any others described above may indicate the beginning of eclampsia.
• Do seek veterinary attention if any of these symptoms occurs; early intervention is a critical determinant of success and an important way of avoiding life-threatening eclampsia.
• Inform your veterinarian if your pet has ever been diagnosed with a medical condition or is taking medication.
• Give medication exactly as directed by your veterinarian, and if you are concerned about possible negative effects, discuss them with your veterinarian immediately rather than simply discontinuing the treatment.
• Feed your pregnant and lactating dog or cat a well-balanced diet. Be sure that they always have access to fresh water.
DON’Ts
• Do not give calcium or vitamin D supplements to your pregnant dog or cat since these actually “set the stage” for eclampsia.
• Do not allow the puppies or kittens to resume nursing if your veterinarian has indicated that they should not.
When to Call Your Veterinarian
• If the dam’s appetite decreases or If you are unable to give medication as directed.
• If you are unable to hand-feed the puppies or kittens.
Signs to Watch For
• In the postpartum bitch or queen: panting, nervousness, awkward/stiff gait, muscle stiffness or trembling, inability to rise, seizures.
• During gestation or lactation: decreased appetite, weakness, vomiting.
Routine Follow-Up

• A follow-up visit often is necessary to measure the blood calcium level.
Additional Information
• Note that eclampsia in dogs and cats is not the same disease as in pregnant women. In women, this disease is associated with kidney problems and an inability to regulate blood pressure before birth. Both diseases have the potential for seizures in common but are otherwise extremely different.

Elbow Dysplasia

About the Diagnosis
In dogs and cats, the elbow is the joint in the front leg (forelimb) that is closest to the chest and that points towards the dog’s hind end. Elbow dysplasia is a general term which indicates a malformed elbow joint. Elbow dysplasia includes four problems that can contribute to malformation and arthritis of the elbow. All four conditions result from abnormal growth of the bones of the elbow. Elbow dysplasia is an inherited condition and may occur in one or both elbows. Elbow dysplasia is one of the most common causes of front leg limping (forelimb lameness) in large and giant breed dogs. Breeds known to have an increased occurrence are the Labrador retriever, rottweiler, golden retriever, German shepherd, Bernese mountain dog, chow chow, bearded collie, and Newfoundland. The diagnosis is most commonly made in young dogs from 8 to 18 months of age, although mild cases may not be detected until arthritis becomes apparent when the dog is older.
The four abnormalities of elbow dysplasia are listed as follows. More than one condition may be present in the same joint:
• Ununited anconeal process-a projection on the ulna, the bone at the back of the elbow, does not fuse properly to the main part of the bone.
• Osteochondritis dissecans-a defect in the cartilage of the joint due to growth abnormalities. Some of the cartilage is not attached to the underlying bone and a loose cartilage flap forms.
• Fragmented medial coronoid process-a projection of bone on the inside edge of the ulna becomes fractured due to osteochondritis.
• Incongruity-the surfaces of the elbow joint do not fit together perfectly due to bone abnormalities.
Initially, the lameness may only be detected as stiffness after rest. Later, foreleg lameness may be apparent all the time or intermittently. Exercise will usually make the lameness worse.
There is no way to tell which of these four components, if any, are present in a dog that is limping. However, it is important to determine whether elbow dysplasia is present and, if so, to what extent because the treatment approach and prognosis (outlook for return to normal) vary depending on the severity of the problem.
As a first step, a veterinary examination which includes manipulation of the elbow can localize the pain to the elbow joint. This is important because a dog limps on a leg in the exact same way whether the problem is in the shoulder, the elbow, or the paw. A series of x-rays (usually four views) of the elbow is taken to detect the exact abnormality present. Your pet usually will need to be sedated for these x-rays since careful positioning and motionlessness arerequired. In some cases, laboratory examination of a small amount of joint fluid may help confirm the diagnosis.

Arthroscopy can also be used for diagnosis. Both elbow joints should be examined since about 50% of affected dogs have the condition in both elbows, although only one leg may appear painful at first.
Living with the Diagnosis
Weight control is important in dogs that are overweight to any degree to reduce the stress and strain on the joints.
Treatment
Elbow dysplasia is often compared to having a stone in one’s shoe, where the stone is a fragment of bone or cartilage and the shoe is the elbow joint. For the best long-term outcome surgery is virtually always the best treatment, and in most cases, it is better to have it be performed early on (within days or weeks of the diagnosis of elbow dysplasia) in order to minimize the risk of permanent damage, scarring, or arthritis inside the joint. As an exception, some older pets with longstanding elbow dysplasia and advanced arthritis by the time the problem is attended to may not benefit from surgery, if the secondary arthritis is severe.
After surgery, your pet’s activity must be severely limited for a minimum of four weeks to allow healing of the cartilage in the joint. Exercise should be limited to leash walks.
Analgesic and anti-inflammatory medications can be used for relieving pain due to elbow dysplasia and the resulting arthritis. It is essential NOT to use certain over-the-counter anti-inflammatory drugs. Ibuprofen (Advil, Motrin, and others), naproxen (Naprosyn, Aleve), and many others can severely damage the lining of dogs’ stomachs and are considered TOXIC to dogs. If your dog seems uncomfortable after surgery, talk to your veterinarian immediately.
DOs
• Restrict exercise for at least 4 weeks after surgery.
• Use analgesic medication as recommended by your veterinarian for pain.
• Check your pet’s surgical incision daily for redness, swelling, or discharge.
DON’Ts
• Do not use over-the-counter human medications like anti-inflammatories without first discussing them with your veterinarian. Many of these products, which may be perfectly safe for humans, are toxic to dogs.
• Don’t bathe your pet until the stitches have been removed.
• Do not let your pet lick or chew the incision.
When to Call Your Veterinarian
• If there is swelling at or drainage from the surgical incision or if your pet is licking the incision.
• Lack of appetite or vomiting may be signs of stomach irritation, which can be a side effect of anti-inflammatory pain medications.
Signs to Watch For
Foreleg lameness that becomes progressively worse in young large breed dogs.
Routine Follow-Up
• After surgery, have stitches removed in 10 to 14 days.
Additional Information
• Do not breed affected animals since elbow dysplasia is an inherited disorder.
• In puppies, rapid growth and excess feeding of highly nutritious diets may be related to the development of the joint abnormalities and must be avoided to reduce the risk of elbow dysplasia.

Eosinophilic Granuloma Complex

About the Diagnosis
Eosinophilic granuloma complex includes three distinct skin diseases in cats. All are thought to be a result of allergies or reactions to parasite infestations and respond to similar treatment. The name of the disorder comes from the observation that in all cases microscopic study of the affected tissues reveals large numbers of eosinophils. Eosinophils are a type of white blood cell that is involved in allergic reactions. Cats with one of the eosinophilic granuloma complex diseases may have allergies to fleas or insects, to food ingredients, or to environmental substances (pollen, house dust). Studies have shown that, at least in some cases, the tendency to develop these skin diseases is inherited genetically. This observation helps understand that eosinophilic granuloma diseases may flare up despite treatment and may persist for months or years.
• Eosinophilic plaques are hairless, flat, raised areas on the skin that are often red, moist, and glistening. Plaques are most often found in the groin or armpit or on the outside of the thigh. The condition seems to be very itchy, and cats will lick the areas constantly.
• Eosinophilic granulomas are hairless, raised, yellow areas; they often have sores on the surface. The most common site is along the back of the thigh, although other areas of the body can be affected. Eosinophilic granulomas can occur inside the mouth and on the tongue. Cats with mouth involvement may drool and be unable to eat.
• Indolent ulcer, or rodent ulcer, affects the upper lip. The lip becomes swollen, and a sore develops where the skin meets the mucous membrane of the inner lip.

Living with the Diagnosis

Skin problems caused by the eosinophilic granuloma complex tend to wax and wane. In some cats, the problem is seasonal. If the underlying allergic cause can be determined and controlled, the problem can be prevented from reoccurring. If fleas are present, a rigorous flea control program should be started. Seasonal problems may be due to bites of insects, such as mosquitoes, or to environmental substances that trigger allergic skin responses, such as inhaled pollens. Trials with restricted diets can be used for finding out if food allergies are involved. Restricted diets are specially formulated from a limited number of food sources to test for allergies to the common ingredients in commercial diets. Environmental allergies are determined by intradermal skin testing. Consulting a veterinary dermatologist may help in determining and eliminating underlying causes.

Treatment
All three forms of eosinophilic granuloma complex respond to treatment with corticosteroids (cortisone-like drugs). Administration may be either by mouth or by long-lasting injection. Long-term use of corticosteroids can have serious side effects, so an effort should be made to find the underlying cause of the allergic reaction and to eliminate it. If corticosteroids are used, they should be given for as short a period of time as possible. The skin problems tend to wax and wane, so reoccurrence is unpredictable except in cases that tend to reoccur seasonally. Since corticosteroids mask the problem, rather than eliminating it, an effort should be made to identify the cause and possibly use other types of treatment if effective. Here, too, a veterinary dermatologist may be extremely helpful.
DOs

• If giving medication by mouth, follow directions exactly.
• Realize the value of seeking a second opinion with a veterinary dermatologist for confirmation of the diagnosis and the most recent forms of treatment. Veterinary dermatologists are known as Diplomates of the American College of Veterinary Dermatology; your veterinarian can suggest a referral to one of these specialists.

DON’Ts

• Do not use lotions, ointments, or other topical medications on the areas unless directed to do so by your veterinarian. Cats quickly lick off topical medications, and some may be harmful if swallowed.

When to Call Your Veterinarian

• If the areas do not heal with the prescribed treatment.
• If the condition reoccurs.
• If your cat is having difficulty eating due to eosinophilic granulomas in the mouth.

Signs to Watch For

• See the description of each form of eosinophilic granuloma complex in the About the Diagnosis section.

Routine Follow-Up

• If your cat needs long-term corticosteroid treatment to control its skin disease, periodic testing may be recommended to watch for side effects

Ethylene Glycol Toxicity

Overview

Ethylene glycol toxicosis is a type of poisoning that occurs after ingestion of antifreeze or other fluids containing the ingredient ethylene glycol. Ethylene glycol is metabolized in the animal’s body to several extremely toxic chemicals that are responsible for its potentially lethal effects. Without treatment, ethylene glycol toxicity is most often fatal.

Ethylene glycol affects the nervous system and causes severe kidney failure with almost complete cessation of urine output. Definitive treatment should be started as soon as possible after consumption of ethylene glycol (within a few hours). If treated promptly and appropriately, pets that have consumed ethylene glycol will not develop kidney failure and have a good chance of survival.

Diagnosis and Treatment Notes:

Ethylene glycol toxicity is generally diagnosed with a thorough history and physical examination, bloodwork, urinalysis and an ethylene gycol test. In some cases, a kidney biopsy may be necessary.

Treatment depends on the severity of the disease, your individual pet, and your veterinarian. Pets with ethylene glycol toxicity are generally treated with drugs that may induce vomiting if the ingestion was recent, activated charcoal, fluids, and medication aimed at reducing the toxicity of the ethylene glycol. The drugs most commonly used to reduce the effects of ethylene glycol are ethanol or 4-methylpyrazole. Dogs with acute kidney failure require more extensive therapy including dialysis. Discuss treatment details when your pet is diagnosed with this condition.

What to Watch for*:

Vomiting
Drooling
Increased thirst and increased urination
Lethargy
Stumbling and staggering (acting drunk)
Coma

Please notify us if you notice any of the above signs or if you have any questions!

Exocrine Pancreatic Insufficiency

About the Diagnosis

The pancreas is an organ in the abdomen that produces substances that are critical for digestion and for the body’s normal metabolism. Microscopically, the pancreatic tissue is composed of two parts: exocrine and endocrine. Exocrine pancreatic tissue is responsible for producing and releasing enzymes (digestive juices) that help to break down and digest food in the intestine. Appropriate digestion permits nutrients to be absorbed and used by the body, and in this way, the pancreas is essential for transforming food into energy and building blocks that the body can use. The endocrine pancreatic tissue produces hormones that circulate in the bloodstream and are necessary for vital processes such as blood sugar (glucose) control.
Cause: In dogs, pancreatic exocrine insufficiency is caused by degeneration (atrophy) of the cells that produce digestive enzymes (pancreatic acinar cells, which are part of the exocrine pancreatic tissue). The exact reason why these cells waste away is not known. Exocrine pancreatic insufficiency (also called EPI, pancreatic exocrine insufficiency, and PEI) may be genetically transmitted in German shepherds and rough-coated collies, and symptoms of the disease may be evident by 2 years of age in these breeds. However, this disease can develop in any dog breed. In cats, pancreatic exocrine insufficiency is thought to be caused most commonly by chronic inflammation of the acinar cells of the pancreas and is very rare.
Although dogs and cats with this disorder tend to have healthy to ravenous appetites, weight loss is common. The body cannot utilize the food that an animal eats because the absence of pancreatic enzymes (digestive juices) means the food is not properly digested. That is, the actual intake of food is adequate or even higher than normal, but the food is not taken up properly and is excreted in the feces largely undigested. As a result, animals with pancreatic exocrine insufficiency may ingest their own feces (coprophagia) or unusual material such as dirt (pica) in an attempt to compensate for nutritional deficiencies. A thin body condition and a poor hair coat are common results. The volume of feces (stool, excrement, bowel movements) may be normal or increased, and feces may be gray or yellow. Frequent bowel movements, diarrhea, and flatulence also commonly occur as part of pancreatic exocrine insufficiency.
Diagnosis: Your veterinarian will perform a thorough physical exam and take a complete history from you, asking you questions such as the duration and appearance of symptoms you have observed, whether you have given any medications and if so, whether any effect was apparent, and so on. To determine your pet’s general health status and to rule out other problems in the abdomen that could cause similar symptoms, routine blood tests such as a complete blood test (CBC) and blood chemistry profile, a urinalysis, and x-rays or ultrasound exam of the abdomen (belly) and chest may be performed. Microscopic analysis of a sample of your pet’s feces may be done to check for parasites (a common “impostor” that causes symptoms identical to pancreatic exocrine insufficiency) and to look for undigested fats and starch. The most reliable test for pancreatic exocrine insufficiency is a blood test that measures the circulating levels of enzymes (substances that are produced by the pancreas for digestion). This test is called the serum trypsin-like immunoreactivity (TLI) assay. Normal healthy individuals have a certain background level of these enzymes in the bloodstream at all times, whereas patients with pancreatic exocrine insufficiency are mostly or entirely deficient in the enzymes, as the blood test reveals. Rarely, some results are indeterminate, and a second sample may need to be tested at a later date.
Living with the Diagnosis
When it is identified early and treated properly, pancreatic exocrine insufficiency is not a life-threatening disorder. Most dogs and cats diagnosed with pancreatic exocrine insufficiency respond well to treatment (see Treatment), and once treatment is underway, most individuals enjoy an absolutely normal quality of life and normal life expectancy.

The pancreas often does not regenerate when it is affected by exocrine pancreatic insufficiency, and treatment is typically required for the life of the pet. Relapses may occur and can be caused by forgetting to give the enzyme supplement or the development of complications such as bacterial overgrowth in the intestine or other digestiveupsets that occur from time to time.
Treatment
Treatment given every day is essential and simple. It consists of adding replacement pancreatic enzymes directly to the food because the pancreas does not make the enzymes when affected with exocrine insufficiency. Pancreatic enzymes are best supplemented in the diet. These enzymes are available as powder, capsules, and tablets. Diet modification may be necessary as well since some foods are better tolerated than others when patients have pancreatic exocrine insufficiency (consult your veterinarian). Antibiotics may sometimes be given for the first several weeks of treatment. Cats may require additional supplements. Your veterinarian can discuss these nutritional requirements with you.
Your dog or cat’s treatment protocol may need to be changed several times before the best regimen is found. Your veterinarian will tailor treatment for your pet.
DOs
• Realize that pancreatic exocrine insufficiency is not a life-threatening condition when it is diagnosed early and treated and monitored properly. Affected pets generally live normal lives with medication.
• Inform your veterinarian if your cat or dog has ever been diagnosed with a medical condition and is taking medication.
• Give medication and enzyme supplements exactly as directed by your veterinarian, and if you are concerned about possible negative effects, discuss them with your veterinarian immediately rather than simply discontinuing the treatment.
• If you have several dogs that run together in a yard and it is not clear which dog has abnormal feces (e.g., diarrhea), you may feed each dog half a nontoxic wax crayon (different colors-keep track of who gets which one), and the colors will appear in the feces to identify whose is abnormal.
DON’Ts
• Do not postpone visiting your veterinarian if you observe any symptoms of pancreatic exocrine insufficiency in your dog or cat. Prolonged malnutrition can have severe effects.
• Do not give medication that you have at home that has been prescribed for human use; some of these may interfere with treatment and cause even more severe problems.
When to Call Your Veterinarian
• If you cannot keep a scheduled appointment.
• If you are unable to give pancreatic enzymes or medication as directed.
• If your dog or cat is not improving after treatment begins.
Signs to Watch For
• General signs of illness: lethargy, weakness, vomiting, hiding more than usual, aggressiveness, and other behavior changes.
• Signs of uncontrolled exocrine pancreatic insufficiency: weight loss despite an increased appetite; increased volumeand/or frequency of feces; eating feces, dirt, or other foreign materials; flatulence; frequently “growling” stomach (borborygmus); and poor hair coat quality.
Routine Follow-Up
• Follow-up appointments are typically scheduled to monitor progress. Treatment may be adjusted based on findings at follow-up visits. Once the condition is stable and symptoms are gone, rechecks are usually annual or semiannual.