Thursday, October 3, 2013

The Land of Confusion

   Who Let The Mites OUT? Allergies.... Again

 


How some GMOs might make them worse

 

 



Man....I wish I didn't suck at immunology.  The last time I studied the subject, the Gipper was President.
A one-hit-wonder  was topping the charts having us walk like an Egyptian. The juiciest affair of the era wasn't between a President and an aide wearing a blue dress,  or a Twitter flurry of penis images- it was the Iran-Contra affair involving an exchange of weaponry.  Genesis described the era best-  it really was a land of confusion.




 Needless to say, those long forgotten lessons did not make me an immunologist, and I  hate playing one on the net.   But a  recent Twitter conversation with Nathanael Johnson, a food reporter writing a long series on GMOs on Grist,  prompted me to dig around  for whatever remnants of immunology I've not yet forgotten- to explain the scientific reasons I am seeing allergic reactions to GMO ingredients in my patients, clinically- in real life. 

So, lets review some basics. 

In people atopy causes hay fever, asthma and eczema, while food allergies are an undeclared emerging epidemic.

The job of the immune system is to detect and destroy "bugs" out to kill us while leaving our own tissues alone, known as tolerance.  Allergies are seen when the immune system gets "confused" and overreacts to harmless stuff like pollen or dust mites (allergen/ antigen)  reacting to them as if they were lethal invaders. When the immune system declares nuclear war on the body, the result is a life-threatening anaphylactic reaction. 

An allergic reaction typically occurs when an antibody known as IgE binds the antigen, activating mast cells to release inflammatory chemicals, the most famous of which is histamine.
Common anti-histamines like Benadryl work by preventing their release.  Thus, when testing for allergies is done, what immunologists are usually testing is the antibody IgE.

 Did you know that an allergy to birch tree pollen can cause allergies to apples and other fruits?  It is true. This is due to an antigen is known as bet v 1. And allergy to cockroaches or dust mites could make you more prone to allergies to shrimp due to a shared tropomyosin.   And if you were to develop an allergy to latex you might become allergic to kiwis and chestnuts.

  • Cross-reactivity explains the reasons for the overlap of symptoms between inhalant/contact allergies known as atopy and food allergies 

 Cross- reactivity refers to the ability of the IgE antibody to react with more than one allergen/antigen from different sources due to shared antigenic components, such as those between birch pollen and fruit, or grasses and grains, or dust mites and shrimp. Good list of cross-reacting allergens.

Cross reactions arise because the binding site on the allergen-- known as an epitope-- the business end of the allergen made up of a chain of folded amino acids--fits the IgE antibody,  like a lock and key in three dimensions.


Phew...... not too bad, right?

Now that we have some basic immunology figured out,  what does any of this have to do with GMOs?
 

We will get to it in just a minute.
First, I'd like to introduce you to some microscopic critters billions of whom share our homes, our beds, couches and live on your pet's kibble. They are known as dust mites. Nasty looking critters, aren't they? Another type of mite called storage mites,  just as ugly as these, also live on cereals and your pets' dry food.

Dermatophagoides pteronyssinus Wikipedia

Because house dust mites are microscopic the general feeling about them among clients could be "How much harm can they cause my pet or me?"
 In fact, the most common allergen in dogs and cats (and in people, too) is dust mites. Anyone who is allergic to dust mites can attest to the miserable symptoms this condition can cause. It seems our domestication of dogs and cats (i.e., bringing them into our households and beds) also succeeded in sensitizing them to this common allergen.....so; they suffer from them just like we do.




  • So, what if.. these mites are not only living on the food but are actually in the food


And this is where genetically modified foods (GMOs) come in. No, I am not saying that eating a genetically modified organism (GMO) means you are eating microscopic mite body parts.


  • But...  there is a distinct possibility that a segment of a dust mite allergen might have been spliced into Round Up Ready GMO foods



And this is why.

The most common commercialized GMOs are Round Up resistant: corn, soy, canola, sugar beets and alfalfa. They were engineered to be herbicide resistant by insertion of a  transgene known as Cp4 EPSPS which produces a protein EPSPS  (Enoyl Pyruvyl Shikimate Phosphate Synthase), isolated from a bacteria found growing in an herbicide waste tank,  which rendered it resistant to the herbicide- Round Up -Agrobacterium CP4.

Insertion of exogenous, new and foreign DNA into plants raises concerns about unintended effects such as the creation of novel allergens.  The World Health Organization (WHO) gathered together global experts in allergies and published guidelines on screening GMOs for known allergens in 2001.

The  very first step in the decision  tree WHO experts established screening GMOs for novel allergens is this fundamental rule.  " if a  new gene product  spliced in shares 6 amino acids ( protein building blocks) with known allergens, such a  match  triggers further allergy testing  on  serum from  25  people with an allergy to that substance."

It turns out that Cp4 EPSPS shares a window of similarity of  7 amino acids with common house dust mites, an allergen known as der. p.7.  ( abbreviation of  Dermatophagoides pteronyssinus).  
It isn't the only one.
If you look at Table 4 and Table 5 in the link below, you will notice other potential allergenic matches between new genes being spliced in and known allergens, which I haven't checked.   The decision tree is also graphically illustrated in the article linked below.


Screening of transgenic proteins expressed in transgenic food crops for the presence of short amino acid sequences identical to potential, IgE – binding linear epitopes of allergens



























 This brings me back to the conversation with Nathanael and  a link  he provided to studies on genetically modified foods conducted thus far which  help answer the following question:

"did the companies commercializing these crops conduct proper studies to make sure that the transgene was not allergenic based on the guidelines established by the WHO"?  Did they even perform the most basic preliminary steps to screen out allergens? 

And the answer is: no, not really.





While GMO advocates quote these authoritative bodies to support their safety, as you will soon find out--the basic safety guidelines established by these bodies are not followed! 

Ruling out cross-reactivity between the dust mite allergen and the new protein coded by the transgene, an ELISA inhibition assay is required on 25 serum samples from patients with high titers to dust mites-- according to a global panel of allergy experts assembled by the World Health Organization.  Since allergies to dust mites are so incredibly common, it should be exceedingly easy to locate serum samples.

 Unfortunately, a targeted screen utilizing   inhibition ELISA was performed on a pooled sample of 4  in one of the studies cited by Nathanael. Interestingly, it did show minimal cross-reactivity.  But pooling a sample reduces its accuracy while  a sample of four has a very low probability of detecting cross-reactivity.

Additionally, the studies cited were performed on patients in Korea, Portugal and Japan---countries where GMOs are neither as prevalent as in the US nor sold unlabeled. There is not a single study done on a statistically significant number of samples (>10) from Americans with the longest and highest level of exposure to GMOs. 

Thus,  if you, your child or your pet is sensitized to mites, dust mites or storage mites,   the allergies might be exacerbated by foods containing some or all Round Up Ready crops:  soy, corn, canola, sugar beets ( beet pulp). Remember, with allergies it isn't the quantity or the amount--it is exposure to an allergen.

  • Unfortunately, it takes only a tiny amount of mite allergen to elicit an allergic reaction in our pets and people. 
  • Allergic cross-reactivity is often encountered as a reaction without prior exposure.  A very common public misunderstanding is that people and pets express allergies on the first time they are exposed to an allergen. This is very rare, as normally sensitization over a long period is required to have allergy symptoms. 
If you or your pet are sensitized to dust mites of which we have an unbelievable amount in Long Beach California,  or storage mites, does it mean that they or you will automatically be allergic to these foods?   No, it does not.  Even if there is cross- reactivity between the new gene in these foods and mites, cross-reactivity alone does not mean a clinical allergy. It isn't as simple as that. But being aware will allow you to watch yourself or your allergic pet for exacerbation of allergy symptoms with exposure to these ingredients or improvement when they are eliminated, and acting accordingly.


Oh, and please--  if any real immunologists are reading this I'd   appreciate your help! I hope you've enjoyed this little journey through the land of confusion. 






------------------------------------------------------------------------------------------------------------

Footnotes: 

[1] Email I sent to Nathanael- I never received a response. 


Hello, Nathanael.
I believe that GMOs are allergenic based on seeing patients for many years who improve when they are removed from their diets or deteriorate when added to their diets.Allergies are veterinarians' bread & butter out here in dusty Southern California and after 24years of practicing I think I've gotten pretty good at them.
 As I shared with my friend Kevin Folta, I see a case or two a week, whose allergic flare ups, I suspect, are triggered by GMOs. The last one was 2wks ago--the owner switched food, and the dog broke out on his face and feet within 48hrs. The only difference was that the new food had beet pulp, most likely RR. Someone who isn't aware of GMOs would never notice the connection and most vets are clueless about them.  Plus they are much easier to treat with immunosuppressive drugs, then dig around for the cause.  I suspect, but don't know, that the same level of ignorance is also true of the human medical profession--which is even worse because specialization so compartmentalizes it.
Of course, my observations are anecdotal, but if I am right, there is a whole lot of suffering and pain these foods could be contributing to. The immune system is incredibly complicated, there is more we don't know than we do, and there isn't a fine line between an allergy, seen as a nuisance, and devastating inflammatory/ autoimmune diseases in the genetically-vulnerable.
The studies in your link are a mess. They are not standardized; they are poorly done and hard to follow, and none of them do a serum test on 25 patients with allergies to Dermatophagoides pteronyssinus (der. p.). Some do skin prick tests rather than serum tests; others are made up of small sample sizes (10).  There is no standardization of methodology.
 The safety tests of GMOs are a mess, in general. It is like that example you gave off different people feeling different parts of an elephant. So while you are reading a study that examines the elephant's trunk or his tusk, it says absolutely nothing about the whole darn beast.  
The best that can be said about them is that they are pilot studies and that studies on a much higher number of people need to be done.
The Goodman affair I linked on Genetic literacy was to show clearly that Dr. Goodman, who is the director of the biotech allergy database, as well as the new editor of the journal most of the GMO literature is published in, I believe, could not provide a study which fulfills the WHO-established allergy testing standards. Neither could Rod Herman of Dow, who rewrote the GMO- allergy rules, likewise, in the comments in your series.  Either because they do not exist. Or they do exist, since it is a relatively simple test, and it showed that EPSPS and dust mites do cross react, and these companies know it.

I don't know how journalism works, but you do have two biotech people saying on the internet print "record" that the WHO guidelines for allergy testing are not being followed. Ask yourself if that is good enough considering that CP4 EPSPS is in most of our human and animal food and just about everyone and their aunts, uncles & cousin are allergic to dust mites.


I am not sure whether Grist is really allowing you to do genuine investigative journalism, because I noticed ads for Dows cotton in your series. Don't know, but expect, that media outlets have to pay their expenses with advertisers dollars and the biotech companies are in the midst of a media blitzkrieg.


Having said all that, I hope you are a "good guy", might have some room to maneuver and can do some public good.

If you want to know why I am spending this much time on the subject it is really very simple. I have unique training. As a veterinarian I took an oath which obligates me to prevent pain and suffering and watch out for public health. I don't take oaths lightly, and I feel an allegiance to the taxpayers of the state of California who spent a quarter million to educate me. Besides, if  someone, somewhere, doesn't do something,  Monsanto et. al. will destroy the field of biotechnology--they have already turned it into a dirty word.   
Thanks for listening.
Please do your best to do some good. With all the smoke & mirrors, combined with how very complicated this subject really is, some intelligent dogged reporting is sorely needed.
Thanks very much,
Ena
  




Sadly, for the American public,  there are very few trustworthy  journalists on the GMO beat abiding by the   Journalism Code of Ethics.

Society of Professional Journalists explainer on  journalism Ethics:
Members of the Society of Professional Journalists believe that public enlightenment is the forerunner of justice and the foundation of democracy. The duty of the journalist is to further those ends by seeking truth and providing a fair and comprehensive account of events and issues. Conscientious journalists from all media and specialties strive to serve the public with thoroughness and honesty. Professional integrity is the cornerstone of a journalist's credibility.


[2] Le Monde article on Dr. Goodman in charge of the allergen database. 







Tuesday, September 17, 2013

Nemo got Chemo


Recently, an animal much  more likely to end up on your breakfast plate than to receive cutting edge veterinary treatment is in the news.  Nemo, the rescued pig,  is getting chemotherapy  for his lymphoma. It is being administered through a surgically implanted catheter at Cornell University.  

 The word chemotherapy conjures up images of icky deadly poison flowing through veins leading to nausea, sickness and hair loss. And while it is true that chemotherapy can cause serious side effects,  and I would prefer not to ever need it, I find treatment of  lymphatic cancer in our pets very worthwhile.  Veterinarians' goals are very different than they are in people, in whom aggressive protocols are often used to produce a cure. Veterinarians do not aim to  cure the disease,  but rather our goal is more humble-  improving the animal's quality of life.  So, the doses and protocols chosen are scaled down to minimize nasty side effects.



730 pound pig with cancer being treated at Cornell University

Posted: 07.30.2013 at 1:34 PM
Updated: 07.30.2013 at 6:30 PM


Nemo, a 730 pound pig with cancer gets treatment at Cornell University   / Photo: Alex Dunbar
Photo
ITHACA -- He's 730 pounds but surprisingly quick and his doctors have to move fast to keep up with him. 4-year-old Nemo's owner brought him up to Cornell's Animal Hospital from his home in the Catskills when he started acting strangely.
Nemo was soon diagnosed with B-cell lymphoma - a blood cancer. Cornell vets then had to come up with a new treatment plan for their massive, mud loving patient.
"We have treated other large animals, we treated a horse with lymphoma years ago but most of the time we mainly treat dogs and cats for cancer," said oncologist Cheryl Balkman.
Balkman and a team of doctors had to determine how much chemotherapy Nemo could handle safely and what dosages of medication would work. Nemo is believed to be the first ever documented case of lymphoma treatment in a pig. His chemotherapy drugs are delivered though a catheter behind his ear. Cornell doctors say the innovative method could help treat other large animals.
"That was a huge breakthrough because I think that was one of our biggest concerns - how do we administer the chemotherapy without harming us as well as most importantly him," said Balkman.
The doctors say Nemo's treatments are showing progress. His appetite is back and his energetic play gets some interested looks from the rest of the patients. After a big meal he takes his medicine and a few Tums before settling in for a nap. Nemo weighs more than three average NFL offensive linemen but his doctors say he's been a model patient and a gentle giant.
"We're fortunate to be able to take care of him and hope to publish our results so people can follow in our footsteps down the road if they can," said Dr. Emily Barrell.
His doctors say they are hopeful Nemo will be healthy enough to return home after just a few more chemo treatments.

http://www.cnycentral.com/news/story.aspx?id=927770#.UjjtBFTn-M8






Tuesday, April 2, 2013

Pretty & Deadly things

I was shopping at Ralphs on 4th Street & Orizaba and  noticed a very large display of Easter Lilies. Evidently the grocery stores don't realize that Easter Lilies ( and other species of lilies) are terribly toxic to cats.  Ingestion of any plant parts, including pollen are toxic. A cat might brush up against a flower, get some pollen on their coat, later ingesting it while grooming--and go on to develop kidney failure.

Please spread the word wherever you see Easter lilies in grocery stores. Keep your kitties safe from kidney disease. Kidneys are an unforgiving organ which can't repair itself from damage.


Lilies Lethal to Cats

Tuesday, March 19, 2013
[March 19, 2013; Philadelphia, PA] – With Easter rapidly approaching, the veterinarians at the University of Pennsylvania School of Veterinary Medicine would like to remind pet owners that Easter lilies are highly toxic to cats, with the potential for causing kidney failure. All parts of the plant are considered poisonous, so lilies should be kept away from cats at all times.Easter lilies
Lilies dangerous to cats include:
• Easter lily
• Tiger lily
• Rubrum lily
• Japanese show lily
• Day lily
A cat may vomit, lose its appetite or become lethargic within a few hours of eating a dangerous plant. If this happens, see your veterinarian immediately.
In addition, pets should not ingest onions, macadamia nuts or alcohol, as they are toxic to both dogs and cats. Pets also should never be fed chocolate, as it contains the heart stimulant theobromine, which can cause severe heart arrhythmias or seizures if ingested in large doses.

Friday, January 25, 2013

If they could only talk

yourpurebredpuppy.com



Some days physicians' jobs seem like cake walk. Notwithstanding the fact that M.D.s only work on one single species (human), while vets are licensed to medicate and surgicate on everything else- starting with a tarantula and extending east of a rhino; and  the fact that M.D.s often specialize in just one organ--gallbladders, for instance--while the majority of us are generalists doing everything from manicures to chemotherapy;  the fact that our patients can't speak to us and describe their symptoms actually makes  the most profound difference. For a vet the skill of  history gathering is a science and an art, sometimes taking circuitous routes into strange lands.

I can tell the precise time  and day when my history taking skills hit their zenith.  At 6:57pm  on a Friday night, as Natalie was  tucking in the patients in the back of the hospital and as I picked up the car keys, my nose and  palate already tasting the  bouquet and rich flavor of a 7 year old Pinot Noir I had at home, the hospital phone rang.
"Bellflower Veterinary Hospital"
Distressed, sobbing female caller on the other side of the line. " Hi. My name is Shelly Smith. I think my dog Herb has a brain tumor.  He has been having seizures for half an hour.  We are on the 91 Freeway--can you please see us?"
"A brain tumor? How old is your dog, Shelly?"
" He is two." A little too young for a tumor, I thought to myself.
" I am so sorry. If your dog is having seizures, you are probably better off taking him to the ER because he will need overnight care and  we close in  three minutes"
The woman  sounding more agitated: "I don't know this area at all....we are from Washington state ....drove down to show Peaches and Herb at the Eukanuba International dog show in Long Beach tomorrow. I don't know where the ER  is  II am  really very worried about Herb.  Please! Is it Ok if we bring Herb in- we are on the off ramp to your clinic?"
" Well, OK. We'll see you in a minute"

Natalie came up to the lobby looking puzzled at the sight of  the intravenous catheter and fluids set up.
"Natalie. I am  very sorry,  we need to see a seizing patient. Can you please get the valium out of the drug safe?".
"Sure, not a problem. Didn't have grand plans for tonight anyways"
Four  minutes later Natalie and I greeted  a worried woman, tears welling up in her eyes, clutching the cutest  Cairn terrier we've ever seen. Herb would put Toto to shame.


I quickly examined Herb in Natalie's arms, while Shelly filled out our admission forms.
His mucous membranes were pink and he was well hydrated. The chest sounded normal on auscultation, though his heart was racing. His pupils were dilated and responsive to light and he was visual. Except for his eyes rapidly exploring the lobby around him as if  surrounded by swarms of invisible fairies, there were no signs of  abnormalities on a brief exam. Herb was not seizing but there was something a little different and odd about him. Cairn terriers are normally very busy little dogs, but this one looked busier than normal.

"Most dogs with brain tumors are geriatric Ms. Smith  Lets not panic, OK?

"Is it possible that Herb got into something", asked Natalie,"a toxin of some sort.... could he have gotten into the garbage, eaten some moldy food, insecticides, pesticides, human drugs?"
"No, it isn't possible. We have Peaches and Herb crated when they aren't being directly observed."
"Nat...  could you please put Herb down on the floor so we can evaluate his gait?"

She set the adorable little terrier on the ceramic tile. The scruffy little thing proceeded to  ricochet from the counter to the chairs to the walls chasing invisible hockey pucks in our lobby."
 Has Herb been eating well, Ms. Smith?
"Yes"
"Vomiting, diarrhea, coughing, sneezing, drinking excessively?"
"No"
"Is he normally this active and busy, Ms. Smith?"
" Well..... yes and no. He seems to have  more energy than normal"
" Have you noticed him circling to one side, head tilt, any signs of gait abnormalities....acting blind before this incident?"
"No. He was completely normal until about  an hour ago".
"So what happened an hour ago, Shelly... where was  Herb?"
"We unpacked our stuff and let him out of his carrier in our hotel room. He went under the bed for a few minutes"
"Where was Peaches while Herb was sniffing around under the bed?
"She was in her crate in the hotel room"
"How is she?"
"Peaches is  fine. She happens to be the number one Cairn terrier in the country... won Westminster last year. The Eukanuba show was going to be Herb's first show... we had high hopes for him until he got the brain tumor"
"So Herb was OK until he went exploring under the bed. Peaches was crated and she is perfectly fine.
How much did you pay for your hotel room, Shelly?"
"Excuse me?"
"Was it over a hundred dollars.... under a hundred dollars, less than fifty dollars?'
" I don't understand why that would make any difference to you,  Doctor. What does the cost of my hotel room have to do with Herb's brain tumor?"
Natalie and I inflated the Doppler cuff and checked his blood pressure... 140mmHg.
"Ms Smith -Herb's blood pressure is OK. We will  perform an EKG  to be sure he isn't having any heart issues and run some blood-work on him. Is that OK?"
"Sure, do whatever you need to do"
After getting a blood sample and recording a lead II EKG strip we put Herb in a cage to do happy little figure eights  racing with the lollipop guild.   Fifteen minutes  later, our blood tests were completed.

"Shelly.... Fortunately  Herb's lab-work, chemistry, electrolytes and  heart are fine. His red  blood cell count was a bit high, and the EKG showed a sinus tachycardia which is understandable. He has a bit of a respiratory alkalosis probably due to hyperventilation.  Things  look better than we have a right to expect.  I  totally understand that this makes no sense to you, but did you pay less than $60 for your hotel room?"
"Well, yes... we don't know this area, but we found a  little motel a few miles from here for $49 a night"
"I don't know much about Washington, Shelly, but do you know who tends to use $49 motel rooms in Southern California?"



"No...who?"
"Hookers and drug users"
Shelly stared at me as if a  unicorn horn just sprouted from my skull. " Have you heard of meth- the most common of all street drugs? It would take a few particles licked  off the carpet under the bed  for a little creature to do just what you are seeing. I am afraid Herb is tweaking"
"He is doing what?"  It felt like the horn on my head just grew a few inches.
"Tweaking. Tweaking is slang for being  high on methamphetamines.  Your doggie, Herb,  has gone way over the rainbow".

"Is he going to be OK?"




"I think he needs to be monitored for hypertension and for arrhythmias until the drug wears off.  We are going to give him some IV fluids for supportive care.
 I sure hope he will be OK--he is a cutie and I really want him to do well tomorrow".

We heard from Shelly a few days after the show- Peaches earned first place.
Herb was better than OK--he earned second place in a national dog competition on his first time out--we will never know if illicit drugs had anything to do with it.

If you believe your pet got into toxins or drugs, please do let your veterinarian know. Our job is to help your pet.  You could help us greatly in this effort by being observant.  Although often there are no specific antidotes available  to ingestion of illicit drugs and toxins, please be honest with us even if it makes you a bit uncomfortable. We are not the police and we will not report you-- being informed enables us to optimize patient care increasing chances of a good outcome for you and your pet.

"If your dog ate your pot, it is really important that you tell the doctor that your dog ate your pot. THC is toxic to dogs. If your dog ate any prescription medication (legally obtained or otherwise), tell your vet. If your dog ate a condom that SOMEHOW has peanut butter inside it, tell your vet. Vets are also bound by doctor-patient confidentiality, so they’re not going to narc on you. They will report abuse however, such as people drugging their pets to “see what would happen.” Don’t do that." 
http://www.xojane.com/relationships/how-not-to-be-a-dick-at-the-vet-hospital


http://www.huffingtonpost.com/2012/03/23/poison-prevention-week-pet-poisons_n_1375075.html#s807071&title=Also_On_The

http://veterinaryteam.dvm360.com/firstline/article/articleDetail.jsp?id=807099&pageID=1

http://petdoctormom.wordpress.com/2011/01/21/moldy-walnuts/

http://www.2ndchance.info/antifreeze-ASPCAsop.pdf















Thursday, January 17, 2013

Pancreatitis... medical challenge & enigma.




Pancreatitis.   Much more common  in cats then we realize. 









The pancreas performs two important and different jobs

  1. The exocrine pancreas produces digestive enzymes to break down and aid digestion of  fat, protein, and carbohydrates. These chemicals are very caustic to normal tissues and cause tremendous damage if they leak out into the belly in the course of pancreatitis,  literally causing digestion of organs.  They are secreted inside the small intestine ( duodenum) through a tube known as the pancreatic duct, which in cats joins the common bile duct from the liver. 
  2. The endocrine part of the pancreas makes hormones such as insulin ( the absence of which causes diabetes ),  as well as glucagon and somatostatin. 

Pancreatitis means inflammation or infection of the pancreas.

Cats unlike people and dogs can have very subtle and vague signs

 In dogs and people the disease produces extreme abdominal pain and nausea but these signs are absent in cats. Often cats with pancreatitis are presented with symptoms we like to call ADR ( ain't doing right).


Dogs

 

Causes


  • toxins and drugs: potassium bromide, L-aspraginase, sulfa drugs, azathioprine
  • obesity
  • hyperlipidemia -familial in miniature Schnauzer
  • high fat or spicy meals--- getting in the garbage
  • high calcium levels
  • hypothyroidism
  • Cushing's disease
  • blunt force trauma


Symptoms:

  • abdominal pain
  • loss of appetite
  • nausea, diarrhea
  • weakness
  • dehydration
  • shock

 

Cats:

 

Causes


  • blunt force trauma- rare
  • high calcium-rare
  • viral infections : FIP, calici, herpes
  • parasitic: Toxoplasma, flukes
  • high fat meals not implicated

concurrent diseases:
  • inflammatory bowel disease
  • hepatic lipidosis-  can be seen since pancreatitis can lead to loss of appetite and mobilization of fat
  • cholangitis/ cholangiohepatitis
  • diabetes

Symptoms
  • lethargy
  • depressed appetite
  • weight loss
Less commonly seen,  unlike dogs are: abdominal pain in less than a quarter of cats and vomiting in  less than half of cases. 

  •  diarrhea, jaundice, abdominal mass felt on examination, fever

Diagnosis:

Blood Count changes are non specific.
anemia ( low red blood cell counts), elevation and decrease of white blood  cells in less than 1/4 of cases
depressed platelet counts especially in the more severe cases leaning to D.I.C. ( disseminated intra-vascular coagulation)

Biochemistry
  • elevated bilirubin
  • elevated liver enzymes
  • electrolyte abnormalities
  • azotemia: elevated BUN due to dehydration
  • low calcium due to saponification of fat in severe cases
  • glucose can be elevated due to stress/ concurrent diabetes- or- depressed
  • amylase is of no utility in cats
  • Lipase of 2-3 times normal range is specific for pancreatitis in dogs, but not in cats
  • Pancreas Specific Lipases:
spec cPL is a  sensitive test (93%) of pancreatitis in dogs , while spec fPL is slightly less sensitive  test of pancreatitis for cats. While when elevated these tests help diagnose pancreatitis, absence  of elevation  doesn't rule it out completely.


Radiographs (X-rays) are helpful in diagnosing pancreatitis about 25% of the time, but they are often performed to rule out  other causes of vomiting such as obstructions and foreign bodies. 

Abdominal ultrasound is a very useful tool in diagnosing pancreatitis if performed by a skilled, experienced ultrasonographer using newer and more sensitive equipment.


As the symptoms  of pancreatitis can be  vague and nonspecific in cats: lethargy, loss of appetite and dehydration- the disorder is easy to miss and is believed to be under-diagnosed in cats.


Treatment


There is no specific treatment for pancreatitis, and the patients are typically hospitalized for supportive symptomatic care, and it consists of: 
  1. Intravenous fluids to correct dehydration, improve blood flow to the pancreas and correct acid-base and  electrolyte abnormalities
  2. Anti-emetics to control nausea
  3. Analgesics  to control pain, which can be extremely severe requiring opioid pain relievers.
  4. Plasma transfusions in some cases to provide anti-proteases, clotting factors and macroglobulins and/ or synthetic colloids to improve pancreatic perfusion ( blood supply).
  5. Antacids if there is evidence of gastrointestinal bleeding
  6. Dogs are fed small amounts of  bland fat-restricted diets, while in cats fat- restriction is not needed and is not effective. Cats sometimes required feeding tubes to prevent or treat coexisting hepatic lipidosis ( fatty liver disease).
  7. B12 vitamin deficiency is common in cats with intestinal disease, so it is often supplemented
  8. Corticosteroids which used to be thought of as a cause of pancreatitis are now being used to treat chronic pancreatitis in cats due to high frequency of coexisting inflammatory bowel disease and inflammatory liver diseases.  
  9. Insulin is administered if  pancreatitis has progressed to diabetes mellitus. 
References:
Treatment Recommendations for Feline Pancreatitis

Take-away: 

In most dogs and cats where dietary indiscretion, such as ingestion of garbage or a fatty/spicy meal has been ruled out, the cause is unknown.

recent study found evidence of pancreatitis  in 67% of the cats  admitted to a teaching hospital for various unrelated causes on autopsy, though remarkably in the 90's the disorder was diagnosed in  less than 1% of cats.   So either we are much better at diagnosing this illness,  or there has been a profound environmental change since the 1990s predisposing cats to pancreatitis.


I tend to believe it is the latter, and so feel  it is important to evaluate the  changes occurring  in the cats' diets in the last several decades. This brings us back  to genetic modification of soy, which is commonly included in pet foods and was demonstrated to induce alteration in  pancreatic zymogen granules in rodents. http://www.ncbi.nlm.nih.gov/pubmed/12448776.  Therefore, until thorough studies are performed, the precautionary principle dictates not feeding cats soy.













Wednesday, December 19, 2012

Happy Holidays



Wishing Everyone a Merry Christmas 

Ryden, the dude who packs hundreds of tons of charm and courage into  his tiny 5lbs.

Hercules who nearly weights a ton, and isn't done growing yet
Bandit and Becky-the spoiled rotten travelers

"Boyd"
Big Bear, California

&
 &
Much Joy and Happiness in the New Year
It has been our pleasure helping you take care of your pets!

Nigel McMillan
Ilana and Lindsey McAllister -two ladies with hearts of gold

Jed, Richard, Mika & Zombie-our dear friends for a decade

Zenith, George and Casper (the only 19 yr.  I know who lived to have her pacemaker battery replaced) adjusting  to  new  kittens rescued this year

Thank you all for your support!


Friday, December 14, 2012

Train your dog to love nail trims


rensepets.com



Unlike many of my girlfriends, most  dogs don't think  manicures and pedicures are any fun at all. They don't get excited about new  dazzling sparkly nail polish colors, foot baths and massages.  I think it might have something to do with  a bad experience they've had,  where the nail is trimmed past the "quick" causing pain and bleeding,  lack of socialization as puppies and fun.

 Hoping this post can change that.

It is a good idea to socialize puppies to have all parts of their body handled-- feet, ears, and  gums for routine dental cleanings.  When a puppy grows up having experienced the human touch in a stress-free, pain-free  fashion they grow up unafraid of manicures, pedicures, ear and teeth  cleaning, so long as socialization starts early and repeated frequently.

If like so many pet parents, you are having a difficult time teaching your dog to accept nail trims, Dr. Sophia Yin has great  tips on desensitization and counter-conditioning to teach your dog to love them. The trick is to pair the event with something positive.  Generous food treats and patience are essential ingredients for success.

Please click on the link to  read the entire article and view the videos to learn how to enjoy giving a manicure to Fido.


http://www.pethealthnetwork.com/lifestyle/train-your-pet-love-grooming-and-nail-trims








Note the pink triangle in which the nerve and the artery reside and learn to trim below it at a 45 degree angle. 
adventuresofadogsmom
Consider using a Dremel tool  to grind down the nails instead of cutting them, if  the nail trimmers scare you or your dog.  Some dogs accept  the nail grinding better than trimming, but the method of teaching the dog is the same: use food treats, introduce the dog to the tool, its noise and vibrations a little bit at a time...go slow.   
Stop if Fido shows signs of fear or anxiety, give him a break and start over later.

A concise demonstration of a nail trim  by Dr. Sara Liddell & Fritz:
http://www.youtube.com/watch?v=FJXJe8oNKSQ


 Dazzling nail polish is optional
but with so many fabulous nail polish colors....
and even  horses enjoying manicures ...why not?

Enjoy