Posts Tagged ‘vomiting’

When to Say Yes to a Diagnostic Test

April 8, 2011
As veterinarians we have access to so many incredible diagnostic tests. They help us uncover medical issues in our patients that, in the past, we could only guess about. How can you know whether or not to say, “Yes” to your vet when she or he recommends a diagnostic test, whether advanced or more basic? Here are my suggestions:  

© Susannah Kay

 

Begin by talking with your veterinarian about all the potential risks and benefits and pros and cons associated with the recommended testing. What will be involved for your dog or cat (sedation, general anesthesia, time spent in the hospital) and what will be involved for you (time, expense)? Most importantly, before making a decision about whether or not to proceed with recommended testing, be sure to ask yourself the following two questions:   

1. Will the results of the testing have the potential to change what I do next?
2. Will the results of the testing have the potential to provide me with some necessary peace of mind?   

If your answer to one or both questions is, “Yes” then it is certainly reasonable to consider proceeding with the diagnostic testing. However, if your answer to both questions is, “No” the testing is impossible to justify. Not only will it be a waste of your money, why on earth subject your dog or cat to a needless test? Remember, satisfying your veterinarian’s curiosity is definitely not a reason to proceed with any recommended testing!   

Here are a couple of real life examples excerpted from my practice life that illustrate how the answers to these two questions help in the decision-making process. Shasta is a sweet as can be twelve-year-old Golden Retriever mix, brought to see me because of vomiting and anorexia (food refusal). When I noninvasively looked inside her belly with ultrasound I found multiple masses within the liver, stomach, and spleen. As I told Shasta’s mom I was 99% certain I’d identified cancer involving multiple organs. Surgical removal would not be an option (disease too widespread) and the only option for potentially helping Shasta would be chemotherapy, that is, if the cancer were of the type that is responsive to chemotherapy. We discussed performing an ultrasound guided biopsy to “name the enemy” and know whether or not chemotherapy might be of some benefit. Shasta’s mom was clear that, depending on the tumor type, she would wish to give chemotherapy a try. She opted for the biopsy procedure (the biopsy results are pending at the time of this writing). In this case Shasta’s medical advocate opted for diagnostic testing because the results had the potential to change what would happen next.   

Here’s a second example- this time it’s Pixel, an eight-year-old mid-sized mutt who presented for coughing. X-rays of his chest revealed multiple lung masses, and I told Pixel’s family that I could be 90% certain that they were malignant growths. I left the 10% door open to the slim possibility of an unusual infectious disease. We discussed further diagnostics including a computed tomography (CT) scan of the chest cavity and aspirate or biopsy of a mass in order to “name the enemy”. With that information we could know whether or not we might be able to provide effective treatment for Pixel. His family members felt certain that if Pixel had cancer they would not wish to treat it. Additionally, 90% certainty that their boy had cancer was good enough for them. Pixel’s people had all the peace of mind they needed and the results of the testing would be highly unlikely to change what they would do in terms of treating their little boy. Pixel went home on a cough suppressant and pain medication and is doing reasonably well for the time being.   

Have you ever found yourself in a decision-making dilemma concerning diagnostic tests for your pets? If so, would answers to the two questions above have helped you make your choice?  

Best wishes for good health,         

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook         

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.

Advertisements

Avoiding Pancreatitis During the Holidays

November 22, 2010

I wrote the following for one of my favorite magazines, BARK (the inventors of “Dog is my co-pilot”).  With the holidays once again upon us, I thought I’d toss this information out into cyberspace as a timely reminder to avoid overindulging our dogs!

‘Tis the season for family gatherings, gift giving, and food galore.  Veterinarians know that this is also the season for canine pancreatitis (inflammation of the pancreas), a painful, potentially life-threatening condition most commonly caused by overindulgence in foods that are particularly rich or fatty. And what kitchen isn’t overflowing with such foods this time of year?

The pancreas is a thin, delicate-appearing, boomerang-shaped organ that resides in the abdominal cavity, tucked up against the stomach and small intestine. While the pancreas may be diminutive in appearance, its actions are mighty! It is the body’s source of insulin and enzymes necessary for food digestion. When pancreatitis is chronic or particularly severe, this little factory sometimes permanently closes down, resulting in diabetes mellitus (requires insulin shots) and/or exocrine pancreatic insufficiency (requires digestive enzyme replacement therapy). 

When a dog eats, enzymes are released from the pancreas into the small intestine, where they are activated for food digestion. Sometimes, for reasons we do not understand, these enzymes are activated within the pancreas itself, resulting in the inflammation of pancreatitis. In addition to rich or fatty foods, certain drugs, hormonal imbalances and inherited defects in fat metabolism can also cause pancreatitis. For some dogs, an underlying cause is never found. Classic pancreatitis symptoms include vomiting, abdominal pain, and decreased appetite and activity levels. 

Short of performing a pancreatic biopsy (an invasive and risky procedure), diagnosing pancreatitis can be challenging, because noninvasive tests are fraught with false-negative and false-positive results. Veterinarians must rely on a combination of the following: 

• A history of dietary indiscretion, vomiting and lethargy.

• Physical examination findings (particularly abdominal pain).

• Characteristic complete blood cell count (CBC) and blood chemistry abnormalities.

• A positive or elevated Spec cPL (canine pancreas-specific lipase) blood test.

• Characteristic abdominal ultrasound abnormalities. 

There is no cure for pancreatitis—much like a bruise, the inflammation must resolve on its own. This is best accomplished by allowing the pancreas to rest, which means giving nothing orally (not even water) to prevent digestive enzyme secretion. Treatment consists of hospitalization for the administration of intravenous fluids; injectable medication to control vomiting, pain and stomach acid secretion; and antibiotics to prevent secondary infection or abscess formation. Dogs should be monitored around the clock for the life-threatening complications that sometimes accompany pancreatitis, such as kidney failure, heart rhythm abnormalities, respiratory distress and bleeding disorders. Small amounts of water and a fat-free diet are typically offered once vomiting has stopped, abdominal pain has subsided, and there is blood test and/or ultrasound confirmation that the inflammation has calmed down. If your dog has pancreatitis, count on a minimum of two to three days of hospitalization, and be sure to ask who will be caring for your dog during the night. 

Long-term treatment for pancreatitis typically involves feeding a low-fat or fat-free diet. This may be a life-long recommendation, especially if your dog has been a “repeat offender.”  Most dogs fully recover with appropriate therapy; however, some succumb to the complications associated with this disease.

Nicky 

How can you prevent pancreatitis during this food-oriented time of year? You can avoid feeding holiday leftovers altogether (this would cause canine mutiny in my household) or you can heed the following recommendations. New foods should be fed sparingly and only if well tolerated by your dog’s gastrointestinal tract and waistline.  Keep in mind that whether offered a teaspoon or a tablespoon of something delicious, most dogs will gulp it down in the same amount of time and reap the same psychological benefit. Don’t offer tidbits from the table while you are eating. This is a set up for bad behavior. Offer the treat only after you’ve left the table. If you shouldn’t be eating the food yourself (emphasis on shouldn’t), please don’t feed it to your dog! By all means, give your precious poopsie a bit of turkey breast, but without the turkey skin or fat-laden mashed potatoes and creamy gravy. Go ahead and offer your sweet snookums a bite of brisket, but please —no potato latkes or sour cream! Bear in mind that most dogs are so darned excited about getting a treat, they don’t care what it is, only that they’re getting it!

Some people dream of sugar plum fairies, a white Christmas or a stress-free family gathering. I’m dreaming of a holiday season in which not a single dog develops pancreatitis!

Wishing you and your four-legged family members a joyful and healthy holidays season.

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, American Animal Hospital Association 2009 Animal Welfare and Humane Ethics Award
Recipient, 2009 Dog Writers Association of America Award for Best Blog
Recipient, 2009 Eukanuba Canine Health Award
Become a Fan of Speaking for Spot on Facebook 

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller. 

Free Christmas or Chanukah guft wrap with books purchased between now and December 25th (www.speakingforspot.com/purchase.html).

Avoiding Pancreatitis During the Holidays

November 30, 2009

I wrote the following last year for one of my favorite magazines, BARK (the inventors of “Dog is my co-pilot”).  With the holidays once again upon us, I thought I’d toss this information out into cyberspace as a timely reminder to avoid overindulging our dogs!

‘Tis the season for family gatherings, gift giving, and food galore.  Veterinarians know that this is also the season for canine pancreatitis (inflammation of the pancreas), a painful, potentially life-threatening condition most commonly caused by overindulgence in foods that are particularly rich or fatty. And what kitchen isn’t overflowing with such foods this time of year?

The pancreas is a thin, delicate-appearing, boomerang-shaped organ that resides in the abdominal cavity, tucked up against the stomach and small intestine. While the pancreas may be diminutive in appearance, its actions are mighty! It is the body’s source of insulin and enzymes necessary for food digestion. When pancreatitis is chronic or particularly severe, this little factory sometimes permanently closes down, resulting in diabetes mellitus (requires insulin shots) and/or exocrine pancreatic insufficiency (requires digestive enzyme replacement therapy). 

When a dog eats, enzymes are released from the pancreas into the small intestine, where they are activated for food digestion. Sometimes, for reasons we do not understand, these enzymes are activated within the pancreas itself, resulting in the inflammation of pancreatitis. In addition to rich or fatty foods, certain drugs, hormonal imbalances and inherited defects in fat metabolism can also cause pancreatitis. For some dogs, an underlying cause is never found. Classic pancreatitis symptoms include vomiting, abdominal pain, and decreased appetite and activity levels. 

Short of performing a pancreatic biopsy (an invasive and risky procedure), diagnosing pancreatitis can be challenging, because noninvasive tests are fraught with false-negative and false-positive results. Veterinarians must rely on a combination of the following: 

• A history of dietary indiscretion, vomiting and lethargy.

• Physical examination findings (particularly abdominal pain).

• Characteristic complete blood cell count (CBC) and blood chemistry abnormalities.

• A positive or elevated Spec cPL (canine pancreas-specific lipase) blood test.

• Characteristic abdominal ultrasound abnormalities. 

There is no cure for pancreatitis—much like a bruise, the inflammation must resolve on its own. This is best accomplished by allowing the pancreas to rest, which means giving nothing orally (not even water) to prevent digestive enzyme secretion. Treatment consists of hospitalization for the administration of intravenous fluids; injectable medication to control vomiting, pain and stomach acid secretion; and antibiotics to prevent secondary infection or abscess formation. Dogs should be monitored around the clock for the life-threatening complications that sometimes accompany pancreatitis, such as kidney failure, heart rhythm abnormalities, respiratory distress and bleeding disorders. Small amounts of water and a fat-free diet are typically offered once vomiting has stopped, abdominal pain has subsided, and there is blood test and/or ultrasound confirmation that the inflammation has calmed down. If your dog has pancreatitis, count on a minimum of two to three days of hospitalization, and be sure to ask who will be caring for your dog during the night. 

Long-term treatment for pancreatitis typically involves feeding a low-fat or fat-free diet. This may be a life-long recommendation, especially if your dog has been a “repeat offender.”  Most dogs fully recover with appropriate therapy; however, some succumb to the complications associated with this disease.

Nicky 

How can you prevent pancreatitis during this food-oriented time of year? You can avoid feeding holiday leftovers altogether (this would cause canine mutiny in my household) or you can heed the following recommendations. New foods should be fed sparingly and only if well tolerated by your dog’s gastrointestinal tract and waistline.  Keep in mind that whether offered a teaspoon or a tablespoon of something delicious, most dogs will gulp it down in the same amount of time and reap the same psychological benefit. Don’t offer tidbits from the table while you are eating. This is a set up for bad behavior. Offer the treat only after you’ve left the table. If you shouldn’t be eating the food yourself (emphasis on shouldn’t), please don’t feed it to your dog! By all means, give your precious poopsie a bit of turkey breast, but without the turkey skin or fat-laden mashed potatoes and creamy gravy. Go ahead and offer your sweet snookums a bite of brisket, but please —no potato latkes or sour cream! Bear in mind that most dogs are so darned excited about getting a treat, they don’t care what it is, only that they’re getting it!

Some people dream of sugar plum fairies, a white Christmas or a stress-free family gathering. I’m dreaming of a holiday season in which not a single dog develops pancreatitis!

Wishing you and your four-legged family members a joyful and healthy holidays season.

Dr. Nancy Kay
Specialist, American College of Veterinary Internal Medicine 

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, or your favorite online book seller.  

Speaking for Spot, signed by Dr. Kay, a great gift idea for holiday 2009 shoppingOrder  a copy of Speaking for Spot personally signed by Dr. Kay – http://www.speakingforspot.com/purchase.html

Join our email list – http://speakingforspot.com/joinemaillist.html

Look for us on Twitter – http://twitter.com/speakingforspot

Become a Fan of Speaking for Spot on Facebook

Listen to Dr. Kay’s interview – A Veterinarian Advises “How to Speak for Spot” on NPR’s Fresh Air with Terry Gross