Our Pet of the Month is the delightful Rascal, seen here recovering from removal of his anal sacs. Rascal had the misfortune to suffer months of anal sac issues ranging from impaction to infection with associated pain and discomfort, making anal sac removal the only viable way forward.

What are the anal sacs?
The anal sacs are two small pouches located on either side of the anus at approximately the four o’clock and eight o’clock positions. The walls of the sac are lined with a large number of sebaceous (sweat) glands that produce a foul smelling fluid. The fluid is stored in the anal sacs and is released through a small duct or canal that opens just inside the anus. The anal sacs are commonly called ‘anal glands’. The sacs are present in both male and female dogs.

What is their function?
The anal sac secretion contains chemicals that act as territorial markers or ‘dog calling cards’. The secretions are similar to those produced by a skunk, which are used to repel enemies and alert other animals to their presence. Anal sac fluid is usually squeezed out by muscular contractions whenever the dog passes a bowel movement, providing a distinctive odor (or individual ‘scent signature’) to the feces. This is why dogs are so interested in smelling one another’s feces.

Why are the anal sacs causing a problem in my dog?
Anal sac disease is very common in dogs. The sacs frequently become impacted (plugged) usually due to inflammation of the ducts. The secretion within the impacted sacs will thicken and the sacs will become swollen and distended. It is then painful for your dog to pass feces. The secreted material within the anal sacs is an ideal medium for bacterial growth, allowing abscesses to form. Bacteria that are normally present in the feces can readily travel up the ducts and enter the sacs. In normal situations, the bacteria are flushed out when the secretions are expelled during a bowel movement. However, if the sacs are impacted, the fluid does not empty normally and they become infected. The fluid then becomes bloody and eventually the sacs become filled with pus, forming an anal sac abscess.

The abscess will appear as a painful, red, hot swelling on one or both sides of the anus. If the abscess bursts, it will release a quantity of greenish yellow or bloody pus. If left untreated, the infection can quickly spread and cause severe damage to the anus and rectum.

Another cause of recurrent anal sac disease is change in stool consistency. This can occur in dogs with gastrointestinal diseases such as food allergies and inflammatory bowel disease.

How will I know if my dog has anal sac problems?
The first sign is often scooting or dragging the rear along the ground. There may be excessive licking or biting, often at the base of the tail rather than the anal area. Anal sac disease is very painful. Even normally gentle dogs may snap or growl if you touch the tail or anus when they have anal sac disease. If the anal sac ruptures, you may see blood or pus draining from the rectum.

How is anal sac disease treated?
Treatment for impaction involves expressing or emptying the sacs. If the impaction is severe or if there is an infection, it may be necessary to flush out the affected sac to remove the solidified material. Since these conditions are painful, some pets require a sedative or an anesthetic for this treatment. Antibiotics are often prescribed and sometimes may need to be instilled into the sacs. Most dogs will require pain relief medications for several days until the swelling and inflammation have subsided. In advanced or severe cases, surgery may be necessary.

Problems with the anal sacs are common in all dogs, regardless of size or breed. If you are concerned that your pet may have an anal sac problem, call your veterinarian.

Is the condition likely to recur?
Some dogs will have recurrent anal sac impactions or abscesses. Overweight dogs tend to have chronic anal sac problems because their anal sacs do not empty well. Each impaction may cause further scarring and narrowing of the ducts, leading to recurrences that are even more frequent. If this condition recurs frequently, surgical removal of the sacs is indicated. If the cause of anal sac disease is change in stool consistency, prevention involves treating the underlying cause and may require changing the dog to a higher fibre diet.

Are anal sacs necessary for my dog? Will removal have any adverse effects?
Anal sacs produce the pungent smelling secretion that allows the dog to mark his or her territory. For our domesticated dogs, this is an unnecessary behavior and removal will not adversely affect your pet.

Are there any risks associated with surgical removal of the anal sacs?
Removal of the anal sacs is a delicate and specialized surgery. Some dogs will experience loose stools or lack of bowel control for one to three weeks following surgery. This occurs because the nerves controlling the anal sphincters (muscles that close the rectum) run through the soft tissues near the anal sacs. If the infection is deep and extensive it can be impossible to avoid damaging the nerves during the surgery. This damage resolves without further treatment in the majority of pets. In rare cases, the nerve damage is permanent and can result in fecal incontinence or the inability to control bowel movements, with constant leakage of feces from your dog’s anus.

As with any surgery, general anesthesia is required which always carries some degree of risk. Advances in anesthesia drugs and monitoring continue to decrease these risks. For dogs suffering from chronic or recurrent anal sac infection or impaction, surgical removal is the best option to relieve the pet’s pain.

What other problems can develop with the anal sacs?
Older dogs can develop cancer of the glands within the anal sacs called adenocarinoma. Therefore, it is very important to have your dog examined by a veterinary as soon as any of the above clinical signs are seen.

IBD is not a single disease but a group of chronic gastrointestinal disorders caused by an infiltration of inflammatory cells into the walls of a cat’s gastrointestinal tract. The infiltration of cells thickens the wall of the gastrointestinal tract and disrupts the intestine’s ability to function properly.
IBD occurs most often in middle-aged and older cats.

How is IBD diagnosed?

Symptoms of feline IBD are not specific.  They may include vomiting, weight loss, diarrhea, lethargy and variable appetite.
The symptoms of IBD can vary depending on the area of the digestive tract affected.
A definitive diagnosis of feline IBD can only be made based on microscopical evaluation of tissue collected by means of an intestinal (or gastric) biopsy.

How is IBD treated?

The treatment of IBD usually involves a combination of change in diet and the use of various medications.  There is no single best treatment for IBD in cats. Your veterinarian may need to try several different combinations to determine the best therapy for your cat.
Hypoallergenic diets are usually tried first. Corticosteroids like prednisolone may be used to reduce inflammation of the gut, and antiobiotics such as metronidazole are commonly used.

What does the future hold for a cat with IBD?

IBD is a chronic disease.  Few cats are actually cured. Symptoms of IBD may wax and wane over time. IBD can often be controlled such that affected cats are healthy and comfortable. Vigilant monitoring by the veterinarian and owner is critical.

We are very pleased to report that Bob has responded well to dietary management and is currently not requiring additional medication. Luckily he is not adept at hunting and so we have no fear that he might upset the illness through illicit snacks!

What is Diabetes Mellitus (Sugar Diabetes)?
Most of the food that animals eat is turned into sugars to provide energy for the body. The sugar in the blood then needs to get into the cells of the body to help them work. A hormone called insulin, which is produced by the pancreas (an organ in the tummy near the stomach), helps the sugar to get into the cells. Diabetes develops when the body does not produce sufficient insulin. Insulin regulates blood sugar levels, and when the insulin levels are too low, blood sugar (glucose) levels increase, resulting in diabetes. Diabetes is a potentially life threatening illness, but fortunately it is one which we are able to treat successfully in the majority of cases.

Diabetes occurs most commonly in older dogs, and in middle-aged overweight cats. Some dogs and cats develop diabetes when they are younger, because they have a genetic predisposition for the condition.

What are the signs of Diabetes?

• Increased thirst
• Increased frequency and/or volume of urination
• Possible increased appetite
• Possible weight loss
• Possible smelly urine – because of the presence of ketones (see below) or infection
• Possible lethargy/tiredness

How is Diabetes treated?

Diabetes is best treated with insulin. In most cases, insulin is administered as an injection under the skin twice a day.

Ketoacidosis is a potential complication of Diabetes. In cases of uncontrolled diabetes, toxic (poisonous) metabolites (natural break-down chemicals) are produced which can lead to illness, lethargy, coma and death.

In Molly’s case we believe that her diabetes became unstable when she came into season, due to her altered hormonal levels, and we hope to spay her at an appropriate time in the near future.

Following intensive care Molly has substantially improved and her diabetes is being more effectively controlled with the use of a Flash monitoring system (Freestyle Libre).

A flash glucose monitoring system measures sugar (glucose) levels continuously throughout the day. It can help your diabetes team see:

• if sugar levels are going up or down
• how sugar levels change over time
• the past 8 hours so you can see what happens overnight

Flash does not actually measure blood sugar levels. It measures the amount of sugar in the fluid under your skin, called interstitial fluid. Interstitial fluid sugar readings are a few minutes behind your blood sugar levels.

The measurements can help your vet team make decisions about treatment and any adjustments you need to make.

A flash system is made up of:

• a sensor which is stuck to the body (about the size of a £2 coin)
• a reader – a small device you use to scan the sensor to see your pet’s sugar levels

You can also use a smartphone app to scan the sensor.

Sensors usually last for 14 days.

Pet of the month for January is Brooke, a 9 year old Jack Russell Terrier cross, who has suffered from Diabetes Mellitus since last August. We are delighted to report that she is doing very well and has just been into the clinic for one of her regular monitoring appointments called a ‘blood glucose curve’ (see below).

What is Diabetes Mellitus (Sugar Diabetes)?
Most of the food that animals eat is turned into sugars to provide energy for the body. The sugar in the blood then needs to get into the cells of the body to help them work. A hormone called insulin, which is produced by the pancreas (an organ in the tummy near the stomach), helps the sugar to get into the cells. Diabetes develops when the body does not produce sufficient insulin. Insulin regulates blood sugar levels, and when the insulin levels are too low, blood sugar (glucose) levels increase, resulting in diabetes. Diabetes is a potentially life threatening illness, but fortunately it is one which we are able to treat successfully in the majority of cases.

Diabetes occurs most commonly in older dogs, and in middle-aged overweight cats. Some dogs and cats develop diabetes when they are younger, because they have a genetic predisposition for the condition.

What are the signs of Diabetes?

• Increased thirst
• Increased frequency and/or volume of urination
• Possible increased appetite
• Possible weight loss
• Possible smelly urine – because of the presence of ketones (see below) or infection
• Possible lethargy/tiredness

How is Diabetes diagnosed?
Diabetes is diagnosed by careful assessment of the patient’s history and a physical examination, followed by blood and urine tests. Excessive levels of sugar in the urine and blood are highly suggestive of diabetes, although occasionally a sick or anxious patient may have increased sugar levels as a result of stress (such as visiting the vets!). If there is some doubt about the significance of a single high blood and urine sugar result, we may perform a special blood test (fructosamine) which gives us an indication of the blood sugar levels over several previous weeks.

When a patient is diagnosed with diabetes, we often look for underlying causes of diabetes such as obesity, Cushing’s syndrome (a steroid hormone imbalance), pancreatitis (inflammation of the pancreas – the organ that produces insulin) or previous administration of some medications. If we find any of these underlying problems, they also need to be managed alongside the diabetes.

What effects does diabetes have?
Diabetes leads to a build up of sugar in the bloodstream and in the urine, and not enough sugar can actually get from the blood into the tissues that need sugars to work properly. This leads to widespread effects on the body, including urinary tract infections, kidney disease, liver disease and eye disease.

If diabetes is left untreated or poorly controlled, the body is starved of glucose-based energy supplies, and the body reacts by using up protein and fat stores for energy instead. Protein stores can be converted to glucose, but using up stored fat leads to the production of substances called ketones. A build up of ketones can lead to a very serious condition called Diabetic Ketoacidosis (see later) – this is a medical emergency requiring intensive care.

How is Diabetes treated?
Diabetes is best treated with insulin. In most cases, insulin is administered as an injection under the skin twice a day. There are also tablets that can be used to help regulate blood glucose levels, but these are not the best way of treating the condition.

Although owners are often concerned about giving injections to their pet, most dogs and cats are very amenable to being given injections. If your pet is diagnosed with diabetes, we will spend as much time as is necessary to teach you how to give insulin injections and how to look after the insulin and syringes.

There are several types of insulin, and the dose of insulin is very individual. It is very important that you do not change the dose of insulin without instructions from your veterinary surgeon. Most dogs and cats need a little modification of the doses of insulin with time, and these changes will be made based on monitoring and blood tests. You may be instructed on how to monitor blood or urine glucose/ketone levels at home. Urine should be checked regularly for the presence of ketones, as the presence of these for two or more days can indicate a complication of uncontrolled diabetes – Diabetic Ketoacidosis (see later).

Care and use of insulin:
It is important that affected dogs continue to exercise regularly as this will help to keep their weight down. Also exercise has also been shown to make insulin work better, resulting in better stability of the blood sugar levels.

• Diet - In addition to insulin, it may be important to modify your pet’s diet, particularly if your dog or cat is overweight, or has inflammation of the pancreas (pancreatitis) in addition to diabetes. These dietary changes will be directed by your veterinary surgeon. Once stabilised, dogs and cats are fed just before the insulin is administered, to make sure that they have eaten before the insulin is given. We have a full-time veterinary nutritionist who can be consulted regarding the specific dietary needs for your pet.
• Exercise - It is important that affected dogs still exercise regularly. This helps them to maintain a healthy weight, and it helps to keep the blood sugar more stable.

How quickly does the treatment work?

• Don’t expect a quick fix. It can be very difficult to regulate the blood sugar in some diabetics. Even in the best situation, it will take several weeks, including check-ups and blood tests, before your pet’s diabetes can be stabilised. It is important to discuss any concerns you have about giving insulin with your vet at any check-up. We may ask you to show us how you are storing insulin and administering it, should control be proving difficult.

Some medications (such as steroids e.g. prednisolone), hormones (such as progesterone) and diseases (e.g. infections such as tooth and gum infections) will interfere with insulin’s action in the body. Any additional medications that your pet is having should be discussed with your veterinary surgeon prior to use. Because hormones affect the action of insulin, it is important that entire female bitches are neutered (spayed) to help to control their diabetes.

What is a ‘hypo’ episode (hypoglycaemia)?
Hypoglycaemia is a low blood sugar level. This occurs when too much insulin for the amount of food eaten results in too little sugar circulating in the blood. This most often occurs when a pet does not eat and still has insulin given, or is accidentally given a higher than normal dose of insulin (most often because the insulin is given twice, by mistake). Low blood sugar levels will make the affected animal very weak, and this can result in collapse or twitchiness and seizures (fits). If you are ever concerned that you have given your pet too much insulin, or that you have given insulin and your pet has not eaten, or has vomited up his or her food, please contact us.

How to monitor your pet’s diabetes at home
There are many features you can measure or observe at home to help to monitor your diabetic pet:

• Amount of water being drunk
• Frequency and volume of urination
• Appetite – how much is eaten?
• Body weight
• Behaviour
• Presence of ketones/glucose in your pet’s urine (using a special dipstick that you put into the urine)

It is very helpful to make a diary with this information in it, and provide it to your vet at every check-up.

Follow-up consultations are performed frequently (the frequency depends on the individual patient). These follow-up visits may include a single blood test (fructosamine), or they may be followed by admission of your pet into hospital for the day for a ‘blood glucose curve’. A blood glucose curve involves us performing several small blood tests throughout the day, and plotting the results on a graph (making a ‘curve’ on the graph). This allows us to see how your pet’s blood glucose changes throughout the day which can be useful for adjusting your pet’s food intake and insulin dosing regime.

What are the possible complications of diabetes?

• Cataracts – cataracts are changes in the lens inside the eye which can lead to blindness. Many dogs develop cataracts within 6 to 12 months of developing diabetes. Specialist treatment is available, and the majority of diabetic patients do very well after cataract surgery. Diabetic cataracts do not tend to develop in cats unless the diabetes occurs when they are very young • Retinal disease – degeneration of the sensitive area at the back of the eyes
• Neuropathy – disease of the nerves causing weakness
• Nephropathy – kidney disease
• Infections – it is common for diabetic patients to develop infections, especially of the urinary tract (bladder and kidneys)
• Ketoacidosis – in cases of uncontrolled diabetes, toxic (poisonous) metabolites (natural break-down chemicals) are produced which can lead to illness, lethargy, coma and death

The better the stabilisation of the patient, the better these complications are likely to be controlled or prevented.

What is the long term outlook?
Diabetes can be a very rewarding condition to manage. Most pets are very amenable to treatment, and diabetic animals can have a very good quality of life. Diabetes in cats can be temporary, and affected cats may only require insulin administration for a limited time (often 3 to 6 months) provided that the underlying cause, such as obesity or pancreatitis, is removed. Many dogs with diabetes eventually develop cataracts and these can cause quite rapid onset blindness. Fortunately most diabetic dogs with cataracts are good candidates for surgery, and Specialist eye vets are very experienced in treating cataracts.

Patients should be reassessed at regular intervals set by your veterinary surgeon. Pets that are having insulin treatment should also be reassessed if they:

• become unwell
• are losing weight
• have a change in appetite
• have excessive thirst or urination
• become weak, wobbly or disorientated (this can be an emergency due to hypoglycaemia or severe diabetic ketoacidosis – see above)
• have ketones in their urine for more than 2 consecutive days

If you have any concerns about your diabetic pet please do not hesitate to contact us.