What are signs of hypoglycemia?
Common signs of low blood sugar include weakness, vomiting, collapse, or seizures.

How is hypoglycemia diagnosed?
Low blood sugar is diagnosed based on history (young puppy) with consistent symptoms. A blood test that evaluates glucose levels is confirmatory. Additional testing may be necessary to rule out other potential causes for a low blood sugar.

What is the treatment for hypoglycemia?
Hypoglycemia can be life threatening in a very short time period. If your puppy is showing signs of hypoglycemia, first offer them food. If they are unwilling to eat, rub Karo syrup, maple syrup, or honey on their gums. Life-saving sugar can be absorbed directly through mucous membranes. Take your puppy immediately to a veterinarian even if this means an emergency visit in the middle of the night. Many conditions can make a puppy more prone to hypoglycemia and the issue may recur if not addressed. Make sure to keep your puppy warm (wrapped in blanket) while on the way as low blood sugar can predispose to low body temperature.

A puppy with signs of hypoglycemia requires immediate potentially life-saving treatment. Notify hospital staff as to the severity of the situation and allow them to take your pet directly to a veterinarian even if this means being separated for a period of time. Intravenous injections of glucose are typically administered. Hospitalization until the puppy is able to maintain a safe blood sugar level is common.

What can be done to prevent hypoglycemia?
Preventing hypoglycemia involves providing a source of energy (sugar) on a regular and frequent basis. For predisposed, small, or young puppies offering and ensuring eating of some amount of food every four to six hours minimum is recommended. Nutrical, a commercial high caloric vitamin paste, is an often used product by breeders and veterinarians to further ensure safe levels are maintained. If a puppy is experiencing vomiting or diarrhea or has lost their appetite for even eight to twelve hours this can be an urgent medical concern and should be addressed by a veterinarian. Fortunately most puppies grow out of juvenile hypoglycemia by six months of age.

HGE, Canine

Hemorrhagic Gastroenteritis (HGE)

By Dr. Karen Burgess

Diagnosing HGE….
To diagnose HGE other causes of bloody diarrhea and vomiting must first be ruled out. Bloodwork is one of the first tests to be run. It tells us how dehydrated your pet has become, whether infection is in the bloodstream, and whether other problems may be present (for example, pancreatitis, liver disease, or bleeding disorders). Examination of feces under the microscope also helps us look for parasitic infections.

Treating HGE….
After being admitted to the hospital your pet will have an intravenous (IV) catheter placed in one of their veins. This allows us to give fluids and medication directly into the bloodstream. Initially a large dose (bolus) of fluids is given until your dog’s hydration has improved. Maintenance fluids are then given until vomiting and/or diarrhea resolve. At the same time antibiotics are given and any other necessary medications. A physical examination is performed each day your pet is hospitalized along with nursing care and necessary treatments or diagnostics. We will be keeping in touch with you daily as to how your dog is doing, changes in treatment, and expense.

After HGE….
Your pet will likely go home with a specific food and oral medications. It is important to monitor your pet closely after discharge for any vomiting, stool consistency, appetite/water consumption, and attitude. It is not uncommon for pets to be tired after being sick and hospitalized, but if you are at all concerned, please call. Fortunately, HGE tends to only occur once in a dog’s life, but always watch your pet closely for any signs of recurrence.

Diarrhea, Canine & Feline

Diarrhea in Dogs and Cats

By Dr. Karen Burgess

One of the most common causes of diarrhea is intestinal upset from a sudden change in diet, giving an unfamiliar treat, or feeding table scraps. Diarrhea caused by food changes can often be resolved at home as long as it is not severe and the pet continues to act and feel normally. Withholding food for 24 hours (while continuing to encourage water consumption) allows the digestive system to heal. After 24 hours small amounts of a bland diet such as white rice and chicken can be offered (see recipe/schedule below). After two days of normal stool appearance, regular food can be gradually reintroduced over several days. If diarrhea does not improve or gets worse, veterinary treatment is recommended.

In order to avoid intestinal upset due to a new food, all changes should take place over several days to allow for the digestive system to acclimate. For the first three days of a food switch, feed ¼ of the new diet and ¾ of the old food. If no issues develop, then feed half new food and half old food for another three days, then ¼ old food and ¾ new food for another three days. This slow transition will help to minimize intestinal upsets and decrease the chances of diarrhea.

Although many pets regularly receive table scraps, care must be taken to ensure that these human foods are not too rich for their system. Fatty foods in particular can cause diarrhea, vomiting, and may lead to pancreatitis (a potentially life threatening inflammation of the pancreas). It is also important to remember that pets should NEVER be given turkey, chicken, or rib bones as these can splinter into small pieces and puncture the stomach and intestines.

While the goal of diarrhea treatment is aimed at solving a specific underlying problem many times this is difficult to accomplish. Supportive or symptomatic care is often what ends up resolving the problem. If loose stools are present for less than 24 hours and there are no other signs of illness (normal energy level, eating and drinking normally), a conservative approach of “wait and see” may be appropriate. However, if there are any additional signs of distress, such as increasing amounts of diarrhea for any length of time or bloody stools, a visit to the veterinarian is required.

Upon visiting the veterinarian a full history will be obtained. When the diarrhea started, its frequency, volume, and consistency will be discussed. It is helpful to bring a fresh stool sample to the visit. After a comprehensive physical exam, the following tests may be performed:

• Fecal examination – Testing for parasite infections or bacterial overgrowth
• Blood work – Evaluation of a variety of body systems (ex. kidneys, liver, hydration, red and white blood cells) to give a reading of basic health
• X-rays – Radiographs may be recommended to diagnose potential intestinal obstructions or ingested foreign bodies

Treatment of diarrhea may involve a bland diet, probiotics, deworming, or antibiotics. Severe cases may require hospitalization and intravenous therapy

Chronic diarrhea (lasting for three or more weeks), while less common, is also reason for a visit to your veterinarian. Often the stool may begin to firm up only to become soft and unformed again. It is also not uncommon to see mucous or even small amounts of blood. Chronic diarrhea can lead to poor digestion and absorption of nutrients, low energy levels, and poor quality hair coat.

Food allergies and intolerances are a common cause of mild chronic diarrhea. Similar to lactose intolerance in people, pets may have or develop allergies or sensitivities to a variety of ingredients in pet food leading to chronic inflammation in the intestinal tract. Pancreatic diseases, inflammatory bowel disease, and cancer are also causes of chronic diarrhea.

Whether chronic or acute, diarrhea is almost always a sign of an underlying medical condition that needs to be addressed. Because diarrhea in itself has the potential to be life threatening, any pet suffering from more than a short-term bout or showing signs of other medical problems should be seen by a veterinarian. In addition, because young animals are so susceptible to several potentially fatal viruses, the presence of diarrhea in any puppy or kitten should be treated as a medical emergency until proven otherwise.

Bland diet recipes
8 ounces cooked white rice (baby rice cereal for cats), 4 ounces single protein source (ex. boiled beef, boiled chicken, low fat cottage cheese). Can boil together, use lean meat, 1# food mixture daily for a 30# dog.

What are potential causes of constipation?

• Dietery related (insufficient fiber intake, ingestion of abnormal substances such as hair, bones, foreign material, lack of water consumption)
• Environmental related (changes in daily routine, hospital stay, moving, change in litterbox, dirty litterbox, lack of exercise)
• Medical related (aging or debilitation, masses or lesions involving the rectum or anus, spinal disease, numerous other metabolic, hormonal, or systemic diseases)
• Idiopathic constipation is diagnosed when all other causes are ruled out.

What is involved with treatment for constipation?
If your pet’s constipation is severe, a hospital stay, fluid therapy, enemas, or manual removal of the stool all may be required. Injectable pain medication and/or sedation are often required as the condition can be quite painful. In cases of chronic recurrent constipation surgical removal of the large intestine may be indicated.

How are pets with constipation treated at home?

Potential at home constipation treatments (consult with veterinarian prior)

• High fiber diets (i.e. Hills W/D, Purina OM)-these increase water retention in the intestine which then softens the stool.
• Brushing long-haired animals frequently to remove excess hair.
• Maintaining a clean litterbox for cats and exercising dogs 30-60 minutes after eating.
• Always having fresh water available.
• Fiber supplementation-All-Bran cereal (Kellog’s, etc) 1-5 TBSP daily with food, canned pumpkin pie filling 1-5 TBSP daily with food, Metamucil, Fiberall 1-5 TBSP daily with food, Laxatone, Kat-A-Lax 1-5 ml by mouth daily
• Do not administer enemas at home to your pet unless specifically directed by your veterinarian. Some products can be toxic to cats and the wall of the rectum/colon can be unintentionally torn or damaged during improper administration.

Colitis, Canine

Large Bowel Diarrhea (Colitis)

By Dr. Karen Burgess

Diet
There are three different approaches to controlling colitis; low residue, novel antigen/hydrolyzed protein and high fiber diets. Typically we will start with one of these three products and evaluate for response. If improvement is not noted after a period of time, another approach may be recommended. A commercially made prescription version of these diets is recommended as these are made under controlled conditions which ensure reliability. While feeding any of these diets, it is very important that no other food or treat be given unless specifically approved by your veterinarian.

• Low-Residue diets are made of highly digestible ingredients therefore leaving less material for the colon to deal with.
• Novel antigen diets are made with a new protein and carbohydrate source that a pet has not been exposed to previously. Hydrolyzed protein diets contain nutrients that have been reduced to a size that is not recognized by the immune system. Both of these diets are used to help rule out symptoms that may be related to a specific component of the diet (food sensitivity or food allergy). These diets usually need to be fed for a minimum of 8 weeks to evaluate for response. It is extremely important that now other food items pass your pet’s lips during this trial period.
• High fiber diets bulk up the stool thus enhancing gut mobility and improve cellular health. Metamucil and canned pumpkin are other options to help bulk up a diet.

Intestinal deworming
An intestinal parasite exam is performed on a fecal sample to help identify parasite issues. In some cases, eggs may be transiently passed or not detected on a single sample. For this reason a prophylactic broad spectrum deworming is often administered to ensure that parasites are not a contributing factor in cases of colitis.

Medications
There are several different medications that may be used in conjunction with diet.

Antibiotics

• The bacteria in the colon can become imbalanced and contribute to signs of colitis. Metronidazole and Tylan are common antibiotics used in the management of colitis in the short and sometimes even long run. In addition to assisting with bacterial loads, these medications also have anti-inflammatory and immune-modulating effects that can also help the gut.

Steroids

• Steroids suppress inflammation and at high doses are immunosuppressant. While very beneficial when indicated, steroids have numerous known side effects and should ideally only be used in diagnosed cases of steroid responsive diseases (ex. Inflammatory Bowel Disease). Once steroids have been started they can alter future diagnostic test results or hinder response to other treatments (in the case of cancer).

Anti-inflammatory drugs

• Anti-inflammatory drugs that target the gut are typically well tolerated and have somewhat lower risk of negative side effects.

Probiotics

• While not 100% proven to help with gastrointestinal disease, there have been promising results with the use of probiotics that provide pet’s with a dose of “good” bacteria in an effort to normalize their intestinal flora. With no real side effects, this nutraceutical should be purchased only from your veterinarian to ensure quality of the product.