Burlington Emergency & Veterinary Specialists » Internal Medicine http://bevsvt.com Wed, 05 Jul 2017 18:29:30 +0000 en-US hourly 1 http://wordpress.org/?v=4.1.18 Radio Interview with Bruce and Hobbes 92.1 WVTKhttp://bevsvt.com/2017/radio-interview-with-bruce-and-hobbes-92-1-wvtk/ http://bevsvt.com/2017/radio-interview-with-bruce-and-hobbes-92-1-wvtk/#comments Fri, 21 Apr 2017 22:53:39 +0000 http://bevsvt.com/?p=2165 Our Hospital Administrator, Whitney was fortunate enough to be interviewed by Bruce and Hobbes on WVTK. Listen to the interview about BEVS, you’ll get some great info on the hospital and how to find us in a pinch! The interview aired on Thursday, April 20th, 2017.

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Meow’s Radioactive Iodine Experiencehttp://bevsvt.com/2014/meow/ http://bevsvt.com/2014/meow/#comments Mon, 23 Jun 2014 14:30:26 +0000 http://bevsvt.com/?p=1575 “Meow”, a stunning 16 year-old feline, was not feeling her best—she had been progressively losing weight despite an increased appetite, urinating and drinking more than normal, and having intermittent vomiting. Once blood work was completed at her veterinarian office, it was determined “Meow” had hyperthyroidism–a condition in which the thyroid gland makes too much thyroid hormone. After review of her options, “Meow” and her mom traveled across Lake Champlain to come see Dr. Bryan Harnett for Radioiodine Treatment, (I-131). Radioactive Iodine Treatment is the only permanent, nonsurgical cure for feline hyperthyroidism with a 98+% success rate. Before treatment, “Meow’s” thyroxine hormone (T4) level was 16.9. The normal range is 0.8-4.0.

One month after I-131 treatment, “Meow’s” T4 level is 1.1 and her mom says she is back to her playful self and has gained back some healthy weight. We are so pleased with the outcome and appreciate being part of “Meow’s” health care treatment!

For more information on Radioiodine Treatment, please visit our Radioiodine Page, http://bevsvt.com/specialty-services/radioactive-iodine/.

Houle, Meow3 Houle, Meow

Written by Aimee Gilfillan

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Cleo’s Casehttp://bevsvt.com/2013/cleos-case/ http://bevsvt.com/2013/cleos-case/#comments Wed, 18 Sep 2013 20:54:12 +0000 http://bevsvt.com/?p=1010  

A 16-year-old female spayed domestic short-haired cat weighing 6.3kg was evaluated for decreased appetite, hind limb weakness and vomiting. She had been seen by her family veterinarian 3 days prior to presentation to BEVS for “landing hard” after jumping down from the counter.

 Significant findings on physical examination consisted of severe ventral neck flexion (cervical ventroflexion) (fig. 1) and profound weakness in her hind limbs. 

 

 

 

 

 

Figure 1

Clinicopathologic abnormalities included hypokalemia (2.5mmol/L, reference range 3.5-5.8 mmol/L), hyperglycemia (180mg/dL, reference range 71-159mg/dL) and elevated creatine kinase (15319U/L, reference range 64-440U/L).  Mild hypertension was noted (blood pressure 160mmHg, systolic). Abdominal ultrasound revealed a homogeneous, 14mm diameter right adrenal mass (fig. 2). 

 

 

 

 

 

 

 

Figure 2

The adrenal mass and markedly elevated serum aldosterone levels (>1376pg/ml, 11.3-294.3pg/ml) are consistent with a diagnosis of primary hyperaldosteronism. At this time an adrenalectomy was recommended.  However, the owner elected medical therapy alone. 

Treatment while hospitalized consisted of intravenous fluids (IV) (Normosol-R with potassium chloride [KCl] 60mEq/L and Thiamine 100mg at 20ml/hr), spironolactone (12.5mg per os [PO] q 12 hours), and potassium gluconate gel (2mEq PO q 6 hours). Electrolytes and blood pressure were followed q 12 hours and the cat was released to the owner with improved, but still moderate hypokalemia (3.1mmol/L, reference range 3.5-5.8mmol/L).

Treatment at home consisted of spironolactone (12.5mg PO q 12 hours), potassium gluconate gel (4mEq KCl q 12 hours) and cyproheptadine (2mg PO q 24 hours). 10 days after presentation, recheck examination revealed improved overall strength and resolution of the ventral neck flexion.  Continued hypokalemia and hyperglycemia were noted on follow-up serum chemistries (2.8mmol/L, reference range 3.5-5.8mmol/L; 265mg/dL, 71-159mg/dl, respectively).  Blood pressure was improved (130mmHg systolic). Spironolactone (25mg PO q 12 hours), and potassium gluconate (6mEq KCl am, 4mEq pm) dosages were increased. 

 

By day 30, recheck examination with the family veterinarian revealed persistent moderate hypokalemia (2.8mmol/L, reference range 3.5-5.8mmol/L). On day 60, BEVS received a thank you note from the owner. She indicated Cleo was “back to normal” and enclosed a picture (fig.3) 

 

 

 

 

 

 

 

Figure 3

Common differentials for cervical ventroflexion in cats include hypokalemia, thiamine deficiency, hyperthyroidism, CRD, DM and neuromuscular disease (i.e. Myasthenia Gravis). Clinical signs of weakness, cervical ventroflexion, hypertension, mydriasis, and retinal detachment have been reported in cats with hyperaldosteronism. 

Hyperaldosteronism is generally thought to be primary when clinical and laboratory signs are consistent together with the presence of unilateral or bilateral adrenal neoplasia or hyperplasia.  Secondary hyperaldosteronism occurs in the presence of chronic renal failure, hepatic failure or congestive heart failure with up-regulation of the renin-angiotensin aldosterone system.  Ideally, serum renin concentrations would have been measured to differentiate primary from secondary hyperaldosteronism. However, with normal cardiac, renal and hepatic values, financial concerns and a documented adrenal mass, secondary hyperaldosteronism was thought unlikely in this case. 

Ideally, these cases would be managed surgically with an adrenalectomy. But when surgery is not an option, long term control is possible with medical management (anti-hypertensives, aldosterone antagonism and potassium supplementation). 

 

Written by Dr. Bryan Harnett, DACVIM

 

To Dr. Harnett & staff,  

This is a long overdue update and thank you for the care you gave to my kitty Cleo.  

Back in late January I brought my very sick kitty to BEVS with no idea what was wrong with her. Dr. Harnett quickly diagnosed her with having low potassium levels. The next morning he found the cause was a growth on her adrenal gland. 

 After I decided surgery, because of her age, was out of the question she was put on a daily regimen of potassium supplements and spironolactone to control the problem. I give her the powered form of the potassium, mix it in her food and she doesn’t even know its there. Much better than having to give her the caplets 2 – 3 times a day!  I am happy to say that after almost three months she is doing quite well.  Even though we don’t know what tomorrow will bring or how much longer she will be with us, today, as most days, she is happy & content (and right now snoring up a storm as she sleeps on the back of the sofa).

 Again, thank you Dr. Harnett and to everyone who cared for and about my Cleo. 

 Lori 

 

 

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Joey’s Storyhttp://bevsvt.com/2012/joeys-story/ http://bevsvt.com/2012/joeys-story/#comments Tue, 18 Dec 2012 18:36:54 +0000 http://bevsvt.com/?p=796 Joey’s owners were worried.  After having been sprayed by a skunk directly in the face a few days before, this 4 year old Chihuahua mix had never returned to his happy old self.  His skin looked yellow, his gums were very pale, and he was passing dark orange urine.  They brought him to the Burlington Emergency and Veterinary Specialists Hospital where it was quickly discovered that, for some unknown reason, his body was destroying his red blood cells and he would need to be admitted to the hospital for emergency supportive care.  Joey had a disease called autoimmune hemolytic anemia and he was in need of blood transfusions and medications to stop the immune system’s attack.

Normally, red blood cells are produced in the bone marrow and then released into the circulation. As the red blood cells age or become damaged, they will be removed from the circulation and will be recycled to form new red blood cells. The number of red blood cells may become reduced if there is a decrease in the bone marrow’s production of or increased loss of them from the circulation. 

Anemia is a medical term referring to a reduced number of circulating red blood cells and is not a specific disease but rather is a symptom of an underlying disease process or condition. Red blood cells deliver oxygen to the body’s tissues, therefore a patient who is anemic will suffer from symptoms related to a lack of oxygen such as weakness or rapid, shallow breathing. 

Autoimmune hemolytic anemia (AIHA) is an immune system disease in which the body attacks and destroys its own red blood cells. In dogs with AIHA, red blood cells are still being manufactured in the bone marrow, but once released into the circulation, they have a shorter-than-normal life span.  AIHA may be primary or idiopathic (an unknown underlying cause), or it may be secondary to another disease process. 

With primary AIHA, the dog’s immune system is not working properly and it makes antibodies that target its own red blood cells. With secondary AIHA, the surface of the red blood cells becomes altered by an underlying disease process or a toxin. The dog’s immune system then recognizes these red blood cells as ‘foreign’ invaders that must be destroyed. Secondary AIHA may be triggered by cancer, infections (especially tick borne diseases), blood parasites, drug reactions, snake bites, chemicals, toxins, bee stings, and, perhaps as in Joey’s case, skunk spray. 

Most dogs with AIHA have severe anemia, and their gums will be very pale rather than the normal pink to red color. Dogs with anemia will be listless and will tire more easily because there are not enough red blood cells to carry oxygen to the tissues. To compensate for this lack of oxygen to the tissues, the heart rate will increase and the patient will breathe more rapidly. 

As the disease progresses, excessive levels of bilirubin, a breakdown product of ruptured red blood cells, build up within the body. Some of this excess bilirubin spills over into the urine, causing it to appear dark. This excessive level of bilirubin can also cause the skin, gums and other mucous membranes to appear yellow, or icteric.

 Anemia is diagnosed by performing a blood test called a Complete Blood Count (CBC). The CBC measures a number of different values in a sample of whole blood. To test for anemia, the number of red blood cells are counted and the individual cells are examined under a microscope to determine their size and shape. With AIHA, the number of red blood cells will be low and the size and their shape abnormal. In many cases of AIHA, there will also be evidence of ‘autoagglutination’ or abnormal clumping of red blood cells.

 Because Joey’s anemia was so severe he needed a blood transfusion.  When anemia becomes life-threatening, a blood transfusion is administered to stabilize the dog while the underlying cause of the anemia is determined and other treatments can begin to take effect.  Before giving a transfusion, blood samples will be taken for diagnostic testing. 

If the AIHA is secondary, the treatment will be directed at the underlying cause, such as the infection or toxin. If no underlying cause can be detected, as is most often the case, or if the disease is determined to be primary or idiopathic, immunosuppressive therapy will be used. Immunosuppressive medications are drugs that inhibit or prevent the activity of the immune system.  In some cases of idiopathic AIHA, the dog will respond rapidly to treatment with immunosuppressive doses of corticosteroids. In other cases, the patient may require a combination of immunosuppressive medications to get the condition under control. 

Joey responded very well to his life-saving blood transfusion and medications.  He was discharged from the hospital a few days later and is recovering well at home today.  He comes in for monthly recheck blood work as his medications are slowly tapered down and the owners happily report that he is the old Joey once again.  

 

-Tanya Donovan, DVM, Diplomate ACVIM

 

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