Kristen Nelson grew up on a farm in Watertown, Minnesota, where she developed a deep love for animals of all kinds. She received a Doctor of Veterinary Medicine degree from the University of
Minnesota, College of Veterinary Medicine. Kris then complete a small-animal internship at the presitgious Animal Medical Center in New York City. In addtion to writing and speaking, she cares for
dogs, cats and exotic animals in Scottsdale, Arizona. Dr. Nelson is widely quoted in the media. Her credits include USA TODAY,The Los Angeles Times, DisneyFamily.com and numerous radio and television
interviews. Kris and her husband, Steve, share their home with rescued cats, birds and a dog.
Hypoadrenocorticism or Addison's Disease is a serious health problem that can cause death if left untreated. In this disease, the adrenal glands fail to produce two very important hormones, cortisol and aldosterone. Cortisol is the stress hormone important for regulating heart rate and blood pressure. Aldosterone is the hormone that regulates electrolyte levels. Without aldosterone, levels of sodium plummet while potassium surges. Without treatment, the electrolyte derangements will slow the heart until it stops beating.
Hypoadrenocorticism is more common in females than males. Dogs may display a variety of nonspecific signs. Early in the disease, I often see intermittent bouts of bloody diarrhea, vomiting, generalized weakness, lethargy, poor appetite and increased water consumption. Blood work at this stage often shows increase in BUN and creatinine that may be confused with simple dehydration, as well as, a decrease in blood sugar. As the disease progresses, the clinical signs listed above become more consistent. In addition to an increased BUN and creatinine, blood levels of sodium fall and potassium rises. To make the diagnosis, an ACTH stimulation test is performed. ACTH causes cortisol release from the adrenal glands. Blood is drawn for cortisol analysis before and after an injection of ACTH. Humans and animals with hypoadrenocorticism do not respond to the injection. Their cortisol levels do not increase as they should.
Treatment is based on replacing the missing cortisol and aldosterone. Replacing cortisol is easy. The dog is put on oral hydrocortisone or prednisone therapy. Replacing the aldosterone is another matter. Currently, there are two medications being used for this, fludrocortisone (Florinef) and DOCP (Percorten-V). Florinef is a tablet given orally. Percorten-V is an injectable medication that is given approximately every 30 days. Please note there is a condition called atypical Addison's disease that only requires cortisol replacement.
Most dogs respond well to treatment and live normal lives. Unfortunately, problems arise when owners cut back on the dose or frequency of administration of Flurinef or Percorten-V in order to save money. This can lead to disastrous results. Both medications must be given at the recommended dosages and frequency to control this disease.
Now that Walmart is offering an NPH insulin (RelinOn) for approximately $25.00 a vial, I am getting questions from some people wanting to switch their pets to save money. Unfortunately, not all insulin is the same which means switching may not save money. Let me explain:
There are many types of insulin used in human and veterinary medicine. Insulin is classified based on its duration of action into short, intermediate and long-acting. In veterinary medicine, short-acting insulin is used primarily to bring down blood sugar levels quickly in patients with diabetic ketoacidosis. Short-acting insulin is called regular and usually has an R after the trade name. It only lasts a few hours and requires careful monitoring while the animal is hospitalized. NPH (isophane) insulins have an intermediate length of action that is often used twice a day to control blood sugar levels. Intermediate-acting insulin has an N after the trade name. Glargine and PZI insulin are long-acting insulin which in some patients, may be dosed once a day.
Most diabetic dogs are controlled with twice daily injections of either NPH or Vetsulin insulin. Vetsulin made by Intervet is a combination of amorphous and crystalline zinc insulin derived from pigs. NPH is a human product that is used off label in dogs. Since dogs are genetically closer to pigs than humans, it is believed there is less chance of dogs developing antibodies with Vetsulin versus NPH. In my experience, dogs who are on NPH insulin most often are on the brand Humulin N produced by Eli Lilly. ReliOn N is also NPH insulin but produced by Novo Nordisk. For Walmart's distribution the company renamed its product Novolin N as ReliOn N.
Unfortunately, the two different brands of NPH insulin are not interchangeable. According to veterinary endocrinologist, Dr. Mark Peterson, each firm uses different manufacturing techniques and ingredients to create their product. That means the two types of insulin do not react the same when injected into the patient. Therefore, a patient who changes from one brand to another must be re-regulated to find the proper dose of the new insulin. In my experience, the cost of doing blood glucose curves, urinalysis and/or fructosamine level far outweigh any potential savings. Also, use the proper syringe to match the concentration of the insulin.
WARNING! Before changing the type, brand, dose or frequency of insulin for your pet, please check with your veterinarian. NPH of any brand is not used in cats.
Sources: -Peterson, Mark. Humulin Versus Novolin NPH Insulin: Are They Bioeqivalent?, Insight into Veterinary Medicine (Blog), April 3, 2014.
Weight loss and/or poor appetite is a common problem in elderly cats. A cat who used to be a good eater suddenly becomes selective, refusing to eat any food consistently. Concerned owners try all kinds of foods including a variety of canned and dry food, human baby food and home cooking. Unfortunately, the results are disappointing, the cat will eat it for a few days then refuse. It is one of the most frustrating syndromes veterinarians and owners face. << MORE >>
Tear stains are a common problem in toy breed dogs due to their confirmation. Once and awhile, a dog with normal confirmation will develop tear stains from a blocked tear duct. In either case, tears spill down the face usually between the inner corner of the eye and nose. I was taught in veterinary college that the stains are caused by porphyrins within the tears. The chronic moisture also contributes to bacterial growth which may cause a skin infection.
Over my career, I have seen many different treatments for tear stains. Here are some of the most common ones: 1) Lacrimal flush- Sterile saline is flushed through the lacrimal duct with an olive-tipped catheter to remove debris. 2) Topical shampoos and/or solutions- I have seen many different chemicals used on tear stains. I personally do not recommend them for fear of damaging the cornea if some of the chemical gets into the eye. 3) Probiotics- After attending a holistic veterinary course, I tried probiotics for tear stains in a few dogs. In this limited experience, it worked well for one dog but did nothing for the others. 4) Tetracycline and Tylosin- These two antibiotics are thought to decrease the amount of porphyrins in the tears. They also might decrease the viscosity of tears, allowing for better flow through the lacrimal ducts. A low dose of either of these antibiotics is given orally to the dog. Tylosin comes in a powder or in a flavored tablet marketed as Angels' Eyes. I personally am not a fan of giving chronic antibiotics, even at a low dose, for fear of creating bacterial resistance. ***Please note: Tetracycline will stain developing teeth. Only use tetracycline in dogs with all of their adult teeth present. 5) Hypoallergenic diets- I have placed a few dogs on hypoallergenic diets for food allergies and noticed that their tear stains improved. I have also noticed improvement when dogs who suffer from atopy are treated with anti-inflammatory medications. 6) Surgical correction- depending upon the confirmation of the dog, there are several different techniques that can be used. Procedures include ablation of hair that grows in the area, enlarging the opening of the lacrimal duct and relocating the entire duct.
Personally, I rarely recommend the treatments listed above (and some of them I never recommend) because this is primarily a cosmetic problem. If the dog's face is kept clean, they rarely develop any problems. I recommend keeping the hair around the inner corner of the eye trimmed short and cleaning the face with a warm washcloth to keep it clean.
Next weekend, April 12th & 13th, 2014 is the Desert Dog K9 Police Trials. Spectators are allowed to watch the protection work held at Scottsdale Civic Stadium. Starting at 9am, watch dogs from the military, police, hospital and private security firms, show off their skills. My favorite part is a drill called the 'recall' (First Image) because it gives a glimpse into the dog's personality. During this exercise, the dog is signaled to apprehend a bad guy (agitator) in a bite suite. When the dog is almost there, the trainer will call them off. Most dogs instantly return to their handler, but I have seen a few dogs have a little fun with the agitator. One dog jumped up and barked in the agitator's face while another gave the agitator a hip check from behind. Who says dogs don't have a sense of humor! More information at www.desertdogk9trials.com.
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Demodex mange is a very itchy skin condition caused by a mite named Demodex canis. Most dogs are infected as puppies while they are nursing. The mites live in the hair follicles and sebaceous glands on the skin. Many dogs will have mites without showing any clinical signs. In some dogs thought to be immuno-compromised, the mites cause an inflammatory response in the skin that makes the dog miserable. Their hair falls out revealing flaky skin. If not treated early, the hair follicles will rupture creating a condition called furunculosis (boils). Dogs with furunculosis often have secondary bacterial and/or yeast infections that can become life-threatening. << MORE >>
Feline infectious peritonitis (FIP) is a horrible disease seen most frequently in young cats and kittens. The disease is caused by a corona virus shed in the feces and then ingested. Most cats will develop diarrhea that resolves with time. In 5 to 10% of infected cats, the virus causes severe, usually fatal immune-mediated disease. The virus damages blood vessels which then causes an immune reaction called pyogranulomatous inflammation. If the damage is widespread, the cat develops the wet or effusive form of FIP. Fluid oozes out of the damaged blood vessels and often accumulates in the abdomen. The fluid is straw colored and very sticky. If the damage is confined to one or two organs, the noneffusive or dry form occurs. This form can be very difficult to diagnose and often requires a biopsy to do so. << MORE >>
One of the most frustrating conditions I treat in dogs is acral lick dermatitis (commonly called a lick granuloma). This condition most commonly occurs on the legs of large breed dogs. The condition starts as a discoloration of the fur. With more licking, the skin thickens and the hair falls out. Eventually the area becomes an ugly mass with a wound in the middle.<< MORE >>
I am pleased to announce the 2014 Animal Charity Grant. It is open to animal charities in all 50 states. The grant is my talk, "Embrace Animals To Improve Your Live, Love & Health". I will give the talk for free and cover all of my own expenses. The charity may use the talk to make money by charging for tickets and/or generate donations. This is a great presentation for donors, volunteers and boards of directors.
Please share this grant with your favorite charity and encourage them to apply. I should emphasize that all applications should be exceedingly brief. This is meant to be easy for them to apply. For further information, please visit;
As many of you know, I am alive today because of my cat. Tigre diagnosed cancer in my abdomen by scent, then hissed and tried to paw a sheet over me. Now it is my turn to help Tigs. During the last year, he stopped jumping up on counters and furniture. At night, he sat by the bed and cried until I picked him up. Eventually, I purchased cat stairs so he could come and go as he pleased.
Unfortunately, I diagnosed Tigre with osteoarthritis. When I flexed his knees, it felt like sandpaper rubbing on wood. Imagine how much pain he felt. I approached his treatment like I do for all of my patients. I start with the safest, cost effective treatments and then move up. For Tigs, that meant using supplements to reduce inflammation. If Tigs had been overweight, I would have placed him on a diet as well. I tried many different supplements, but always with the same results. Tigs would eat them for a week or two then refuse. For my next course of treatment, I started him on Adequan which is an injectable polysulfated glycosaminoglycan (PSGAG).
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