Prevent Chronic Kidney Disease

Each February and September the IVMA (Iowa Veterinary Medical Association) invites veterinarians to attend their conferences. These conferences are held either at Iowa State University at the Scheman building or at Prairie Meadows Conference Center in Altoona. On Valentine’s Day, I attended the 2nd day of speakers and visited the booths of many of the companies that sell animal products from surgical to medical to dietary items. It is also a time we can share ideas and renew friendships with other veterinarians that attend the conference. New techniques and ideas are shared by speakers that come from all over the USA. Dialogue is encouraged during the sessions to enhance the learning opportunity for everyone.

I did not expect to attend a session that resonated with me so soundly. However, the sessions I attended were on the topic of Chronic Kidney disease (CKD) and how it is affected by other diseases. I have my own personal experience with CKD that I will detail to come. We learned about how important it is to screen for these different diseases early in our pets to allow a longer and better life. The take away is that kidney disease is something that cannot be detected on physical exam. Laboratory work is necessary to screen for this devastating disease. Dr Greg Grauer indicated that these tests are best performed annually so comparisons can be made from one year to the next. If elevations are noted this may be a cause for concerns even if we are still in the normal range.

The second session I attended by Dr. Grauer began by sharing some statistics of human kidney disease. I question if he was prompting veterinarians to “Go to the Doctor.” We should be more aware than the general population that these diseases cannot be found on physical exam. We should be keeping our diet and exercise in check to prevent obesity which is one of the leading causes of diabetes and high blood pressure. Diabetes and high blood pressure are common causes of CKD.

This topic of human CKD is very familiar to me. My younger brother was diagnosed suddenly with CKD in the spring of 2017. He was totally unaware of any issues before his diagnosis. The process he went through at Mayo in Rochester determined he was transplant eligible. They never gave him a definitive cause for his CKD. They recognized he did have high blood pressure. He had taken numerous allowable doses of Advil when in pain. He had a kidney stone a few years prior that may have caused a stricture in his ureter. He was born prematurely in 1965 and maybe had some damage early on. Whatever the cause he now was faced with changing his lifestyle while waiting for a possible donor. He was given strict dietary measures to reduce damage to the remaining kidney function. He was told to lose weight. He was placed on medications to lower his blood pressure. He made frequent trips to Mayo to monitor his blood levels while waiting to see if a donor could be found. They prefer to keep transplant recipients off dialysis, if possible, before transplant. This is a fragile time line.

Myself and my 2 sisters were willing to be tested to see if we could possibly be donors. The first step is an online questionnaire. Both of my sisters were not allowed to continue the questions related to health concerns of their own. I completed the survey and submitted it and later found out that I had passed the first step. They sent me a laboratory test kit to have blood drawn at a local facility to see if our blood types were compatible. Siblings can have very different blood types. It turned out that my brother and I were considered a “perfect match.” This indicates that we have the same blood type which is crucial. Yet to be a perfect match the other 6 subcategories need to match up as well. We were 6 for 6. They will do transplants with 3 or 4 subcategories of the 6 matching up. When these subcategories match up it may allow for less rejection medications and better opportunity for the kidney to live a long and natural life within my brother. The doctors at Mayo indicated that 52 years ago they had another sibling donor-recipient transplant that was a perfect match and both are still doing great.

In January of 2018, I spent 3 days in Rochester going through evaluations of my physical and mental health. I had my own transplant team that supported me through the process. If at any time I determined that this was something that I did not want to do, all I had to say was I have decided I do not want to do this and it would be over. They told me that even the day of surgery I could back out. They reminded me numerous times that I did not need to do this. They asked me numerous times, “Why are you doing this?” They gave me all the statistics from the successes to the potential failures. They presented the “What if’s?” What if my kidney is rejected? What if my brother does not take care of the kidney that I have given him? What if my family does not want me to do this? What if something unforeseen happens to you or your brother? It was almost as if they were trying to talk me out of doing this procedure. I guess in a way they were preparing me for anything and everything. It was only a few weeks and I received a call that I had passed and was able to be a donor for my brother. I waited to tell him so I could contact all my children and share the news with them first. I then made a trip north to let him know that I would love to be his donor.

November 21, 2018 was the date set to do the transplant. They would first operate on me and then soon after place the kidney into my brother. Both of my kidneys were healthy and so the left kidney would be removed. I would have two incisions for instruments on the left side about 1 inch in length and one lower horizontal incision about 3-4 inches to remove the kidney. There were 15 family members present in the waiting room supporting both my brother and I. We had prayers from more people than I can name during that entire procedure and recovery period. My kidney was placed within my brother and started working very quickly. The family would get updated text messages from the OR as things were happening. I am happy to report that my brother and myself are doing extremely well. I received a “Donor Diploma” from Mayo that I am proud to own. I am hoping that by sharing this experience it may encourage others to consider being a living donor. I did this for my “baby brother” because I could not bear to see him restricted from living the life he was meant to live. Mayo hospitals perform these procedures multiple times in a year and have high success rates for both donors and recipients post-operatively.

CDK issues occur in our fur babies as well. Transplants and dialysis are currently not an option. Obesity in pets is at an all-time high. We feel that if we love our pets, we should shower them with treats, chews, pet food, people food, etc. This is not the way to show love. Love needs to be shown through time spent with your pets by playing games and offering lots of tender loving care. Our pets will most definitely eat whatever is offered to them but I would encourage you to instead get out their leash or ball or both and go outside. The exercise will not only be great for them but also yourself. During our long cold winters, it is hard to spend time outdoors with our pets. I would challenge you to sign up for a class at the local dog training facility. Take a trip to a pet store to walk around and meet other pets and people. It is amazing how exhausted our fur babies can become when their mind is stimulated with new activities. Some hardware and home builder businesses allow dogs on leash to shop with their owners. Take them to doggy daycare for a day and see how tired they are when they come home. If the sun is shining and the wind is not blowing take a walk outdoors and be sure to wash off their feet when you come back inside. Some ice melt products can cause an irritation to the pads of our dogs. Strive to keep your pets body condition score at a 4 or 5. This will help them live a much longer and happier life.

If you know of anyone in need of a kidney and you have wondered if you could be a donor, do not hesitate to find out. I was told the oldest living donor Mayo has had was in his early 70‘s. My brothers insurance covered all medical costs associated with the transplant. There are grants and tax deductions available for out of pocket expenses not covered by insurance for living donors and recipients. My only restriction after surgery was no lifting of 10# or more for 4-6 weeks. I returned to work the day after Christmas and have been doing great. I expect to live a long and healthy life with my one kidney. I pray that my brother will be able to do the same. Either way I have no regrets. If being a living donor is not for you then at least consider being an organ donor after your death. The number of lives that you can impact after your death by organ donation is amazing as well. It is easy to have “organ donor” added to your driver’s license. Anyone can be a donor now or later.

If you are wondering if your pet should be screened for CKD or other health risks speak with your veterinarian. Most cats over 10 years of age and dogs over 8 years of age are considered senior pets. Starting laboratory testing at this time will offer a baseline for your pet’s future. Early intervention in the face of these diseases can offer added years with your fur baby.

February is Dental Health Month

February is the month that we focus on education about dental disease and the need for pets to have professional cleanings to remove tarter and decay that has built up on their teeth over the years.  Many pet owners do not know that this is an important part of care!  Most pets have some form of dental decay as early as 3 years of age since most owners chose not to brush their pets’ teeth daily. Brushing a pets teeth is the best way to keep them healthy. There are chews and special treats and diets that are helpful when attempting to freshen your pets’ breath or reduce tarter. Yet, nothing seems to work as good as regular brushing.  It is important to prevent your pets from chewing on items that are harder than the surface of their teeth. These items, such as bones, antlers, rocks, and hooves, will often cause fractures or flattening of the tooth surface. It is best to avoid these and keep your pets’ teeth healthier through the years.

Many studies have shown that poor oral health can have significant effects on other organs within the body. The biggest concern is with the heart, liver, and kidneys as bacteria becomes systemic and deposits within these organs. When pets have bad teeth, they often will not chew their food and that leads to more tooth decay. In recent years veterinary dentist have surfaced to help fix fractured teeth to prevent pain associated with the exposed pulp cavity. They have improved the bite of young dogs that were born with congenital defects of the jaw. Veterinary Dentists have repaired cavities to preserve the tooth that has been damaged. Advanced veterinary care has continued to improve the quality of our pets’ lives. These procedures are not for every pet but it is important that pet owners know their options. If you are interested in learning more about Veterinary Dentistry, we can refer you to the specialists.

If you have noticed odor from your pets’ mouth, I would encourage you to flip up their lips on each side and look at the teeth and gums. If you see more brown than white on the surface of the tooth or notice extremely red gums above the tooth surface, your pet is in need of a professional cleaning.  I wish we could clean a pets’ teeth without anesthesia, but pets could not remain still during the cleaning/polishing procedure. The biannual exams and cleanings humans receive are difficult for some of us so image how a cat or dog would react. I know anesthesia is a concern but ignoring a pets’ oral health is a huge risk as well. Once a professional cleaning has been done it would be wonderful if you began home care to reduce the build-up in the future. Brushing your pet’s teeth is the most effective way to prevent tarter build up. Other options include special prescription diets that will reduce tarter when the pets chew the kibble. A new product called “Oravet” can protect a dog’s teeth and offer fresher breath if offered once a day. Finding a healthy chew or toy that your pet will chew on at least 15 minutes a day can promote healthier teeth and gums. Avoiding soft foods and treats that stick to the teeth is helpful. There are any number of items that can help reduce tarter build up but nothing is more effective than brushing your pet’s teeth.

Teaching a pet to allow brushing of their teeth is much easier to do when they are a young puppy or kitten. At an early age we see more success in getting acceptance of handling their mouth and introducing the toothpaste/toothbrush. Starting this routine early, many pets will find it a fun daily event and look forward to it. The following video was created by a client of ours that has been brushing her pet’s teeth for a number of years. The teeth look amazing and she has yet to do a dental procedure on any of her pets. It really does make a difference if you are willing to take the time to brush daily. It is possible to teach an old pet to allow you to brush their teeth. It requires more patience and persistence but the rewards are worth the time and effort.

Click to view video of brushing pet’s teeth:

With the cold winter days, it makes getting outdoors with your pets next to impossible. Why not start working with them to allow you to brush their teeth? Why not schedule a professional dental scaling to improve your pets’ oral health and reduce risk to other internal organs? Your pet will thank you and those kisses will be more enjoyable.

Bring in a Stool Sample?

If your veterinarian staff request a stool sample…please do not bring them one of these! I got a good laugh when one of my clients presented me with this “stool” sample a few years ago. I keep it around as a reminder to be more specific when talking with clients about their pets. It is a great conversation piece as well. Why are stool samples, or more appropriately called fecal samples, important?

I have mentioned parasites such as fleas, ticks, and heartworms, but have yet to share important information about the “other parasites” that can be just as deadly if not treated. To start the new year off right for your furry friends I hope to enlighten my readers with some common knowledge about the “other parasites.”

Kittens and puppies are commonly infected with intestinal worms at the time of birth. The mother can infect her babies while still in the uterus and the parasites can be spread through nursing. The most common intestinal parasite is the roundworms that can be found in all pets but especially in kittens and puppies. These parasites can appear like a piece of spaghetti and can be seen in vomit or stools. When seen in stools or vomit you know that this pet is loaded with roundworms. The belly is usually more rounded and bloated. The scary part is that these roundworms can be present and no symptoms noted except microscopic eggs being found in a stool specimen. We encourage every owner of a puppy or kitten to have a stool sample check. These parasites are a stress to the immune system and need to be treated. Humans can contact this parasite and it will lead to infection within the liver, eyes, and or Central Nervous System. There must be direct stool to mouth contact with the parasite eggs. The most common place for this to occur is with sand boxes and children.  Cats love to use sand boxes as litter boxes and many children have been known to put sand into their mouths. We encourage people to cover sandboxes if possible and watch children when playing in them.

Hookworms are another intestinal parasite that can infect our pets. This parasite can cause anemia in any pet but especially the young. We also have seen skin lesions in heavily parasitized pets. Diarrhea is commonly associated with this parasite and can be difficult to find in a runny stool. The hookworm can be transmitted to people. It will cause a rash that can be itchy. Humans can be exposed through contact with the skin when walking barefoot or sitting in areas where hookworm larvae are present.

Whipworms are another parasite that can infect dogs more than cats. When present they shed microscopic eggs in small numbers making it difficult to find them in a stool specimen. They cause dogs to lose weight, have diarrhea, and sometimes cause anal itching. Anal gland impaction and allergies can cause anal itching also. Therefore it is important to consider all causes for anal itching. This parasite is less common than the roundworms or hookworms, but just as important to prevent.

Tapeworms are common in both dogs and cats. This parasite is the most common worm that owners are aware of.  When asking people if they have dewormed their furry friend, I often hear, “I do not see any worms in the stool.”  This is the only worm that 100% of the time will eventually be seen in the stool or even attached to the hair around the tail. This worm can be up to 6 inches in length and will break off in tiny white segments and eventually work its way out of the rectum and onto the stool or the area around the rectum. When it dries up on the hair or stool it almost appears to be like a sesame seed. If a pet licks or swallows one of these segments the infection will begin again. Fleas can transmit tapeworms and therefore infect pets when they swallow a flea. Rabbits and mice are common carriers of tapeworms. Guess who likes to eat mice? Our hunting cats are commonly infected by these parasites and therefore we recommend routine deworming. This parasite is more difficult to find in our fecal floatation, but owners usually do not miss this parasite when present.

What options are available to treat these “other parasites”? In the last many years our heartworm preventions have added intestinal parasite preventatives to their formula. At Winterset Veterinary Center we encourage owners to use Interceptor Plus monthly as a heartworm prevention and an intestinal parasite preventative for roundworms, hookworms, whipworms, and tapeworms. As of today this is the only heartworm prevention that prevents all 4 of the most common intestinal parasites for dogs. Over the counter intestinal dewormers may treat certain parasites but often not all of them.

For our cats we recommend Profender which is a topical intestinal dewormer that can be placed on the skin and done 3-4 times a year. It will treat roundworms, hookworms, and tapeworms. With both of these products the parasites are removed within a few days after the product is given. If the pet is exposed again soon after the treatment, they can get the infection right back. There is no product on the market that will continue to prevent or treat our furry friends after administration.

If your pet has been diagnosed with intestinal parasites, every stool that pet has deposited in your yard or litter box has those parasite eggs in it.  The stool disappears as it is being decomposed.  When the stool is gone the microscopic egg will remain in the environment. This is an opportunity for your pet to pick the infection back up. If your pet stays strictly indoors and is not a hunter and does not have fleas, then it would be unlikely they would become exposed. The one common cause that many people do not think about is bringing home that new puppy or kitten. Every new pet brought into the home is a potential source of infection for your current pets. Do yourself a favor and keep new pets away from your furry family members until they have been checked by your veterinarian. Definitely bring in the “stool” sample to make certain your pet is intestinal parasite free!

As we close out 2018, I want to take this opportunity to thank you for following my blog. If you have found a topic interesting or have a topic that you would like to suggest, please visit with me about it.  Winterset Veterinary Center hopes everyone has a happy and healthy 2019. See you next year!

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