The Importance of Pre-Anesthetic Blood Work

1. The health and safety of your pet is our foremost concern. Because your pet can't describe symptoms to let us know if anything might be wrong, we recommend blood tests to give us the answers we need, especially before surgery.

2. Blood chemistry tests provide an inside look at your pet's vital organs. By testing blood chemistries we can evaluate the status of your pet's major organs. The function of the liver and kidneys is especially important because these organs process and rid the body of medications used during anesthesia.

3. Hematology tests provide an inside look at the blood itself. Blood is composed of different types of cells with different functions. It is important to know the status of each, prior to surgery. Red blood cells are responsible for carrying oxygen throughout the body. Packed cell volume (PCV) gives us information on these cells.

4. Results of these tests will determine your pet's readiness for surgery. Depending on those results, we may adjust the dose or type of anesthetic used, or advise delaying surgery

Why do Pre-Anesthetic Blood Work?
An option offered at most veterinary clinics today is a pre anesthesia blood panel. This usually includes a CBC or complete blood count, which measures both red and white blood cells, and platelets.

This checks for anemia, infection, and clotting ability. Measuring these cells also indirectly checks the function of the bone marrow, and can pick up or indicate things such as leukemia, parasites, allergic responses, clotting problems, and dehydration, to mention a few things.

The panel also includes a serum chemistry panel, which measures the functional of several organ systems. These organs can directly affect the body’s ability to handle and break down various anesthetic agents, and to handle the stress of anesthesia and surgery.

All older animals (those over 8 years) should have pre anesthesia blood work performed. Older animals have a greater chance of abnormalities that would directly affect how they handle anesthesia and surgery.

Younger animals also benefit from blood work. Occasionally problems show up in younger animals that were not apparent – such as inherited kidney or liver problems. We would rather find problems before surgery than during surgery.

Pre anesthesia blood work is one tool we use to make anesthesia and surgery on your pets as safe as possible. By combining this with other tools, we try to assure that your pet has a safe and effective anesthesia experience.

 Feline Diabetes

Diabetes occurs less frequently in cats than in dogs. However, when it does occur, it can be more difficult to regulate.

When a diabetic cat ingests glucose and can't process it properly, it leads to the build up of sugars in the blood stream. Eventually, the blood sugar gets so high that sugar begins to be spilled in the cat's urine. Both the high blood sugar and the loss of sugar through the urine can cause severe, and sometimes life threatening, consequences.

Common Profiles
Diabetes can occur in cats of any age, though most are over six-years old. Some cats can be insulin dependent and can be helped by life-long insulin therapy.

Other cats can be non-insulin dependent and only require insulin when stressed. Typically, these cats regain their balance once the stressful event is over.

History and Physical Examination
The common signs of diabetes are increased thirst and urination, along with increased appetite and weight loss. However, these signs can be masked in cats that have other illnesses.

You may see signs of illness, such as vomiting, diarrhea, loss of appetite, breathing difficulties, weakness, and straining to urinate. These symptoms can appear suddenly, over a few days, or over several months.

Diagnosis
In many cases, cats that have diabetes can be difficult to diagnose because they also have a concurrent illness or disease that can mimic diabetes. Some of these diseases are hyperthyroidism, kidney disease or failure, adrenal gland disease, gastrointestinal disease, cancer, liver disease or failure, and some types of drug treatment.

To diagnose feline diabetes, veterinarians use the following tests:

Fasting blood-sugar level. Test results that show a blood-sugar level over 200 indicate the possibility of diabetes. However, stress alone can result higher blood-sugar levels (up to 300 to 400) in cats without diabetes, attributed to a surge of released adrenaline.

Urine glucose. Diabetic cats have sugar in their urine. They can also have ketones in their urine, which results from a defective fatty acid metabolism. Cats without diabetes that are under stress may also have some glucose in the urine, but it is temporary.

Blood chemistries. Lipemia, which is increased fat in the blood can be evidence of liver dysfunctions.

Urinalysis. In addition to sugar and possible ketones, there may be signs of bladder infections.

Treatment
Insulin injections are still the most accepted means of treating insulin-dependent diabetic cats. Initially, a diabetic cat is hospitalized and regulated for three to four days. During that time, multiple blood sugar tests are given to establish a proper schedule for the cat.

The goal of treatment is to maintain a blood-sugar level between 100 and 200 during each 24-hour period and to improve or eliminate any symptoms. Often, numerous hospitalizations for serial blood sugars are required for monitoring and making adjustments in insulin dosages.

The nature of cats can make diabetes management difficult. Because they have a very strong stress response, it can be hard to interpret blood-sugar tests. Some other difficulties in management difficulties are caused by the following conditions:

Variability in insulin activity and dosage requirements

Feline eating habits. Ideally, diabetic cats should be fed two to four times per day. Since most cats are fed by free choice, it can be hard to change them to interval feeding. Also, some cats will only eat one type of food, making it hard to change to a new diet.

Transient diabetes. Some diabetic cats may spontaneously lose the need for insulin after years of treatment.

Failure to perform serial glucose tests. Basing treatment on one random glucose test is considered a hit-or-miss approach, and is usually more time consuming and expensive than doing serial tests. It can also cause wide fluctuations in blood sugar levels.

• Failure to properly educate the diabetic cat owner
• Failure to give the proper dose of insulin
• Improper storage and handling of insulin
• Improper cat diet
• Improper blood-sugar monitoring
• Prolonged or frequent boarding of the cat
• Hormonal influences. Blood sugar can be controlled more easily in a spayed or neutered cat.
• Concurrent diseases
• Concurrent drug therapy

KCS (Dry Eye) and Breeds Pre-disposed to the Condition

Description of KCS
Keratoconjunctivitis sicca (KCS) or "dry eye" describes the changes in the eye which result from lack of tear production. To understand "dry eye" it is helpful to know how tears help keep the cornea healthy. The cornea is the optically clear portion of the eye that allows entry of light into the eye. Like all living tissue, the cornea requires a supply of oxygen and energy to remain healthy. Oxygen and nutrients are supplied to most tissues by the blood that moves through the area in blood vessels. The healthy cornea has no blood vessels, if it did it wouldn't be clear, so the oxygen and nutrients are supplied through the three-layered 'tear film.'

The outer most layer of the tear film is an oily layer supplied by glands in the eyelids. This layer helps prevent evaporation of the next aqueous layer. The middle layer is the liquid aqueous layer produced by the main tear gland and a gland in the third eyelid. This is the layer that is decreased in dry eye. The innermost layer in direct contact with the cornea is a mucous layer produced by glands located in the folds of the eyelid. The mucus layer helps the aqueous layer adhere to the surface of the cornea.

A breakdown in the tear film and a loss of the aqueous layer causes dry eye. This loss results in dryness to areas of the corneal surface or in more advanced cases, drying to the entire corneal surface. When the cornea is deprived of oxygen and nutrients through the tear film, it rapidly undergoes destructive changes. These changes result in brown pigmentation, scar tissue growth, ulcer development, and blood vessel growth across the cornea leading to partial vision loss.

The eyes of a patient with KCS sting constantly just as ours do on a very windy day. The stinging we feel is due to the wind drying our eyes quicker than tears can be provided. Therefore, the patient with dry eye is uncomfortable almost all the time. When a patient has "dry eye" where there is a lack of the watery layer of the tears, the oil and mucus layers are increased. This leads to a thick, mucoid, greenish discharge that sticks to the hairs around the eye. Often this is the main reason that a patient is presented to the veterinarian. The discharge will clear up whenever any medication is used but will return when the medication is stopped. When this occurs, the patient is often referred to a veterinary ophthalmologist for further examination and treatment.

Diagnosis of KCS
Diagnosis is made by collecting a history about the condition, an examination, and a number of testing procedures. These tests include the Schirmer tear test which measures the production of watery layer. Fluorescein stain is used to define possible breaks in the corneal surface and the rate of the tear breakup. In addition, Rose Bengal stain may be used to evaluate the health of the outer layer of the cornea called the epithelium.

Causes of KCS
A number of causes have been reported for dry eye. These include hypothyroidism, infections of the tear glands such as canine distemper virus and immune-mediated diseases that attack the tear glands. Another frequent cause of dry eye is a toxic effect produced by certain sulfa-containing drugs and certain anti-inflammatory drugs. Some of these drugs may be necessary for the treatment of other diseases. In some cases, changing or stopping the medication may result in improvement of the dry eye, while in others the toxic damage is done and the KCS is not reversible, and must be managed medically. In many cases the cause of dry eye remains unknown yet treatment can still be instituted. Loss of nerve impulses to the gland due to long-standing ear infections and other nerve disorders will cause a unilateral (one sided) dry eye often combined with a dry nose in some cases.

Treatment of KCS
There are several objectives in treating dry eye. These include:

• Tear Replacement
• Lubrication
• Reduce bacterial overgrowth
• Reduce inflammation
• Stimulate natural tear production.

Since the aqueous tear fraction is absent or reduced, tear replacement is very important. Natural tear production is continuous, so it is very difficult to replicate this with drops. Most owners with a bit of co-ordination with family members can manage to apply artificial tears 4 to 6 times daily. Commerical tear replacement products such as Tears Naturale II, Hypotears, and Isopto-Tears are suitable.

Artificial tears alone do not lubricate as well as natural tears, so we recommend the addition of a lubricant in addition to the use of artificial tear solutions. Lacrilube, Tear Gel or Hylashield Nite are suitable.

The dry eye patient frequently has a buildup of mucus in the folds of the eyelids that is no longer being washed with liquid tears. This mucus is food for bacterial growth. These bacteria may not be disease-causing bacteria but need to be controlled. In most cases an antibiotic and acetylcysteine (an ingredient which will help break down the mucus) are added to the artificial tear solution to help keep the mucus discharge and the bacterial overgrowth under control.

Topical anti-inflammatory drugs are indicated when the flourescein dye test shows no ulceration. This medication reduces inflammation and long-term scarring effects. Corticosteroids (cortisone drugs) cannot be used when ulcers are present because they decrease healing speed and enhance the ulcer process.

Occasionally patients with a nerve loss are treated with pilocarpine given by mouth. This drug stimulates the lacrimal gland to produce tear but may have undesirable side effects.

The newest drug used for the treatment of dry eye is an immune-suppressing medicine called cyclosporine. This medication has provided relief of symptoms in some patients while other patients have had a marked increase in tear production. A 0.2% cyclosporine ointment called "Optimmune" is a licenced product for dogs and has proven effective in many dry eye cases, while some dogs require a stronger (but unlicenced) 1% or 2% formulation of cyclosporine.

Outcome
Most patients with dry eye will do well if medications are administered on a timely basis. In cases where medicines cannot be given regularly or do not work, surgical techniques must be considered. A parotid duct transposition (surgical movement of a duct from a saliva producing gland) is available. In general, with good owner treatment, no patient need lose eyesight due to the dry eye condition.

The most common cause of KCS is "idiopathic" or unknown origin. In these cases, there is felt to be an immune mediated association with inflammation of the lacrimal gland. There is also a breed predilection with the Shih Tzu, Llasa apso, Pug, English bulldog, Cocker Spaniel, West Highland White Terrier, Miniature Schnauzer, Miniature Poodle, and Pekingese being the most commonly affected. However, KCS has been documented in almost every breed of dog.

Why You Should Suspect Your Cat Has Your Email Password

• Mean emails from some guy named "Fluffy."
• Traces of kitty litter in your keyboard.
• Your web browser has a new home page http://www.feline.com.
• Your mouse has teeth marks in it... and a strange aroma of tuna.
• Your new ergonomic keyboard has a strange territorial scent to it.
• Little kitty carpal-tunnel braces near the scratching post.