Many parents mistakenly think a child-friendly dog means the dog should tolerate anything a child does. Although kids and dogs can, and often do, have great relationships, it may not be as easy as it seems. Children are unpredictable because they make loud noises and move suddenly, causing even the most mild-mannered dog to become frightened and overwhelmed. Any dog, even one who loves kids, can bite if they feel threatened, especially if they can’t escape the situation. Research shows that kids are most often bitten by a dog they know. In these situations, adults may not be watching or believe their dog would bite.

Prevention

Adults should actively engage with the children and dogs. When direct supervision is not possible, separate the dogs and children using barriers. Provide your dog with their own space. This should be a closed room or secure crate with everything your dog needs. Baby gates can be used to set up this safe haven. Teach your dog to love their special place and teach the children to never approach when the dog is resting there.

Learn Your Dog’s Language

Children are more at risk of dog bites because they haven’t been taught how to read a dog’s body language and can’t assess the danger. Dogs will often display subtle signs of discomfort, such as yawning and avoiding eye contact, before escalating to more obvious signs such as growling. By watching for these signs, you can step in to safely manage the situation by guiding your dog away from the child. If ignored or punished, then your dog is more likely to bite “out of the blue”.

Teach your children to recognize your dog’s body language by using children’s books, videos, and coloring pages. Adults still need to manage all child/dog interactions.

Structured Interactions

Show children appropriate ways to interact with dogs so they can be safe. Structured, predictable interactions between dogs and children can build positive relationships. With adult supervision, the following activities are appropriate for children with dogs who have never shown aggression:

Fetch –
Using two or more toys, older children can play fetch without needing to take toys away from the dog. The child tosses the first toy and when the dog returns, they toss the next toy.

Flirt pole –
For dogs who love to chase, attach a plush toy to a rope and stick that your child can hold. Using the flirt pole the same way you would a cat wand, let the dog chase the toy. Always finish the game with a treat.

Training –
Involving kids with the dog’s training can help create a strong, positive bond between them. Start training sessions with cues the dog already knows, like “sit”.

Tossing treats or kibble –
Another simple but effective game is to have kids toss either treats or kibble across the room for the dog.

Teach your child to freeze in place if your dog starts chasing or jumping at them. More movement or noise from children will encourage the dog to continue. If you have taught recall or “touch”, call your dog to you. If your dog does not come when called, they should be leashed.

Visitors

Avoid Punishment

When creating happy, peaceful relationships between children and dogs, punishment is never appropriate. In scary situations, punishing a frightened dog can ruin relationships and doesn’t change the underlying issue.

Safety is the priority when managing relationships between dogs and children. If you are having a hard time creating positive interactions or your dog has shown aggression, contact a behavior professional for assistance.

Kidney transplants are something everyone has heard of for people, but may not have considered possible for pets. In fact, while transplants are confined to specialized facilities with experienced surgeons, successful kidney transplants in cats have been going on since the mid-1980s. Canine programs have been less successful but are also available in limited facilities.

To the uninitiated, the impression may be that once someone receives a new kidney, life is renewed and all the kidney problems are solved. In fact, this is hardly the case. There are immune-suppressive medications needed to prevent the new organ from being rejected, not to mention potential for infection, on-going screening tests, and other issues.  A kidney transplant is a very big deal regardless of the species, and not every patient is even a candidate, so let’s walk through the main considerations.

These cats are classified as “specific pathogen-free,” which means they are free from infectious diseases. They are matched by blood typing and potentially by tissue typing, depending on the transplant program. A research cat is selected, and a kidney is removed for the recipient. After the procedure, the owner of the recipient cat must adopt the donor.

Some transplantation programs allow the owner of the recipient cat to provide the donor. Donors must be young adults, generally at least 10 pounds in size, be free of infectious diseases such as feline immunodeficiency virus, feline leukemia virus, and toxoplasmosis, and must have excellent kidney function. Basic blood testing and urine cultures must be normal.

You enter the program with one cat and leave with two cats.

Is Your Cat a Candidate?

Kidney transplantation is not a procedure that is left until all medical therapies have been exhausted. The best candidate is free from other medical problems besides kidney disease.

Typical screening includes:

1. Basic blood panel (including thyroid level) and urinalysis
   
2. Urine culture (elimination of latent infection is crucial, and often a trial of immune-suppressive drugs is used after an infection has been cleared to ensure that the infection does not come back)
   
3. Feline leukemia virus and feline immunodeficiency virus screening
   
4. Ultrasound examination of the heart (heart diseases that involve high blood pressure development can damage the new kidney)
   
5. Screening for toxoplasmosis (the immune suppressive drugs needed to maintain the new kidney could reactivate a latent infection with this parasite). A positive test for Toxoplasma does not preclude the transplant but a positive donor must be selected. Recipient cats testing positive for Toxoplasma are generally kept on clindamycin for life. Recipient cats testing negative will be periodically screened for Toxoplasma for the rest of their lives.
   
6. Blood typing
   
7. Blood pressure monitoring
   
8. Urine protein to creatinine ratio to evaluate glomerular disease/renal protein loss.
   
9. Teeth cleaning (performed under anesthesia)

Different programs may have additional required screening tests such as kidney biopsy, intestinal biopsy to rule out inflammatory bowel disease, test doses of immune-suppressive medications, etc. Obviously the details would be provided by the specific program being considered.

If the cause of the kidney failure is felt to be something that would lead the new kidney to fail as well, this may disqualify the patient from the program. Such conditions would include renal lymphoma or other cancer, amyloidosis (a malignant protein deposition), and pyelonephritis (a deep kidney infection, although if the infection is truly felt to have been eliminated, the patient might still qualify). Again, each program will indicate what conditions might serve to automatically disqualify a recipient.

An additional problem for dogs worth mentioning is intestinal intussusception. Imagine a telescope. Unfolded, it is basically a cylinder, but folded, and one segment collapses inside an outer segment. Now, imagine this happening to a piece of the intestine. A life-threatening obstruction results. A procedure called enteroplication is given in conjunction with the transplant. In this procedure, the intestines are tacked down with sutures into a formation that precludes any telescoping motions. This procedure, along with proper pain medication post-surgically, seems to prevent intussusception.

Cats with relatively early kidney failure are not yet candidates for transplantation. Cats with advanced kidney failure are not good candidates either, although dialysis (available at advanced critical care facilities such as those that perform kidney transplants) may improve the values.

The best candidates are those with an acute cause of kidney failure (such as a poisoning), cats who do not respond well to the usual medical management, or cats with a creatinine greater than 4.0 mg/dl. The cat should have a decent appetite and be as strong as possible prior to this major surgery.  Again, each transplant center will have its own criteria.

Prior to surgery, the recipient cat should be made as stable as possible. Usually, a blood transfusion is needed to correct the renal failure-associated anemia. Sometimes dialysis is also needed.

Is your Dog a Candidate?

Recipient screening is similar to that for the feline patient though heartworm testing is needed. Blood clotting tests are also needed for dogs. Similar conditions will also rule a patient out as a candidate (no cancer, heart disease, amyloidosis, or inflammatory bowel disease.) The adrenal hormone excess known as Cushing’s disease also precludes getting a kidney transplant. Kidney transplants for dogs are generally not as successful as for cats, so be sure you understand what you are getting into and the likelihood of obtaining the outcome you are hoping for.

What Kind of Home Care Will the Recipient Require?

The recipient is going to require suppression of his immune system for the rest of his life. This not only requires a substantial financial commitment for the medication but also the ability to give the cat oral medication at least twice a day for the rest of his life. The heart of this therapy is a medication called cyclosporine, a medication that has revolutionized organ transplantation for humans. Prednisolone, a commonly used cortisone derivative, is typically used as well, at least to start.

Cyclosporine is typically given twice a day with the lowest blood level of the day being approximately 500 ng/ml around the time of surgery and lowering to 250 ng/ml after a month or so of recovery after surgery. (Rejection of the new kidney occurs when levels dip below 200 ng/ml.)

Cyclosporine has some disadvantages that include:

• Expense
  Cyclosporine is expensive. Concurrent administration of ketoconazole, a medication normally used to treat fungal infection, has the added benefit of “potentiating” cyclosporine. This means that less cyclosporine is needed to achieve the desired effect. As long as ketoconazole is well tolerated, it may become possible to dose the patient only once a day rather than twice. Approximately 30% of transplant patients will not be able to utilize this protocol due to the development of excessive cyclosporine levels or liver enzyme elevations from the ketoconazole.
    
• Expenses for Monitoring
  Periodic blood level monitoring is needed to check that the right dosage is being used. For most drugs, “what you swallow is what your body gets.” For other drugs, there are individual variations in how the medication is absorbed, and cyclosporine is one. When two patients take the same amount of cyclosporine, they may not achieve the same serum levels; some individual fine-tuning is needed.
     
• Long-term use of cyclosporine increases the risk for the development of cancer, specifically lymphoma. At the University of Wisconsin Renal Transplant Center, a 14% incidence of malignant tumor development is reported for cats with post-transplant time (and thus cyclosporine use time) of greater than one year.

In dogs, the chemotherapy agent azathioprine is also regularly used for its immuno-suppressive properties. It’s usually given every other day long term. Medication costs for dogs can vary from $150 per month to $2000 per month depending on the dog’s size.

What are Potential Complications for the Recipient?

• Infection from immune-suppressive therapy is the second most common cause of transplant-associated death (rejection being the first). In cats, Toxoplasma infection is of particular concern, and while preoperative testing may have already been negative, some cats turn positive after the immune suppression begins. Also, in cats, old viral upper respiratory infections can be expected to recur, and they can be severe. In dogs, life-threatening infections can emerge in any organ system.   
• Stricture (narrow scarring) of the ureter, which is the tiny tube that carries urine from the new kidney to the urinary bladder. If this occurs, another surgery is needed to trim the scarred area and re-attach the ureter to the urinary bladder. The original kidneys are generally not removed unless there is a reason to do so. The new kidney is simply an extra one. There is an approximately 21% incidence of this complication in the first 62 days post-operatively in cats. Mostly, males are affected.
• The risk for developing diabetes mellitus increases by approximately five times after a kidney transplant.

What Kind of Survival Time Can You Expect?

In a recent study of feline kidney transplants, 59% of renal transplant patients were still alive 6 months after surgery and 41% were still alive 3 years afterwards. Apparently the first 6 months is a somewhat crucial time in determining long-term survival.

The University of Wisconsin Renal Transplant Center reports 70% survival at 6 months for cats and 50% survival at 3 years. Of the cats that survived to be discharged from the hospital (i.e. they did not succumb to problems directly related to the surgery), 96% survived to 6 months.

The picture is not nearly as bright in dogs. The University of California at Davis program had a success rate of about 40%. 

Kidney transplantation is an expensive undertaking. The University of California at Davis program, for example, required a deposit of $11,000 for cats and $13,000 for dogs. Transplantation involves the adoption of a donor and long-term medication and blood testing for the recipient. If this is something you are seriously considering, be sure to discuss the procedure with the transplant center closest to you as well as with your regular veterinarian.

An uncomplicated kennel cough runs a week or two and entails frequent fits of coughing in a patient who otherwise feels active and normal. Uncomplicated cases do not involve fever or listlessness, just lots of coughing.

Numerous organisms (some of which may be prevented by vaccination) may be involved in a case of kennel cough; it would be unusual for only one agent to be involved.

Infections with the following organisms frequently occur concurrently to create a case of kennel cough:

1. Bordetella bronchiseptica (bacteria)
2. Parainfluenza virus
3. Adenovirus type 2
4. Canine distemper virus
5. Canine influenza virus
6. Canine herpesvirus (very young puppies)
7. Mycoplasma canis (a single-cell organism that is neither virus nor bacterium)
8. Canine reovirus
9. Canine respiratory coronavirus.

The classical combination for uncomplicated kennel cough is infection with parainfluenza or adenovirus type 2 in combination with Bordetella bronchiseptica. 

Infections involving the distemper virus, Mycoplasma species, or canine influenza are more likely to progress to pneumonia, and pneumonia can readily result in any dog or puppy that is sufficiently young, stressed, or debilitated.

Not sure what a Coughing Dog sounds like?

Dogs can make assorted respiratory sounds. Usually, a cough is recognizable but it is important to be aware of another sound called a reverse sneeze. The reverse sneeze is often mistaken for a cough, a choking fit, sneezing, retching, or even for some sort of respiratory distress. The reverse sneeze is a post-nasal drip or tickle in the throat. It is considered normal, especially for small dogs, and only requires attention if it is felt to be “excessive”. The point here is to know a cough when you hear one. A cough can be dry or productive, meaning it is followed by a gag, swallowing motion, and the production of foamy mucus (not to be confused with vomiting). Here are some videos that might help.

Coughing Dog (with Productive Cough): Dixon has kennel cough

Note: We have received a great deal of emails from people who have viewed this video, compared it to what their own dog is doing, and concluded their dog has kennel cough. This video is meant to demonstrate coughing in general. It is important to note that there are many causes of coughing and the nature of the cough does not generally reflect on its cause.

Reverse Sneezing Dog: Maggie reverse sneezes

How Infection Occurs

An infected dog sheds infectious bacteria and/or viruses in respiratory secretions. These secretions become aerosolized and float in the air where they can be inhaled by a healthy dog. Obviously, crowded housing and suboptimal ventilation play important roles in the likelihood of transmission but organisms may also be transmitted on toys, food bowls, or other objects.

The cilia beat in a coordinated fashion through the lower and more watery mucus layer called the sol. A thicker mucus layer called the gel floats on top of the sol. Debris, including infectious agents, gets trapped in the sticky gel and the cilia move them upward toward the throat where the collection of debris and mucus may be coughed up and/or swallowed.

The mucociliary escalator is damaged by the following:

1. shipping stress
2. crowding stress
3. heavy dust exposure
4. cigarette smoke exposure
5. infectious agents (as listed previously)
6. cold temperature
7. poor ventilation.

Without this, a fully functional mucociliary escalator or invading bacteria, especially Bordetella bronchiseptica, the chief agent of kennel cough, may simply march down the airways unimpeded.

Bordetella bronchiseptica organisms have some tricks of their own as well:

• They can bind directly to cilia, rendering them unable to function within 3 hours of first contact.
• They secrete substances that disable the immune cells normally responsible for consuming and destroying bacteria.

Because it is common for Bordetella to be accompanied by at least one other infectious agent (such as one of the viruses listed below), kennel cough is a complex of infections rather than infection by one agent.

Classically, dogs get infected when they are kept in a crowded situation with poor air circulation and lots of warm air (i.e., a boarding kennel, vaccination clinic, obedience class, local park, animal shelter, animal hospital waiting room, or grooming parlor). In reality, most causes of coughing that begin acutely in dogs are due to infectious causes and usually represent some form of kennel cough.

The incubation period is 2 to 14 days. Dogs are typically sick for 1 to 2 weeks. Infected dogs shed Bordetella organisms for 1 to 3 months following infection.

How is a Diagnosis Made?

A coughing dog that has a poor appetite, fever, and/or listlessness should be evaluated for pneumonia.

Usually, the history of exposure to a crowd of dogs within the proper time frame, plus typical examination findings (coughing dog that otherwise feels well) is adequate to make the diagnosis. Radiographs show bronchitis and are particularly helpful in determining if there is a complicated pneumonia.

Recently, PCR (polymerase chain reaction) panels have become available in many reference laboratories. Using technology to amplify the presence of DNA in a swab, the lab is able to test for most of the kennel cough infectious agents listed. This knowledge is helpful in guiding therapy and understanding expectations.

How is Kennel Cough Treated?

An uncomplicated case of kennel cough will go away by itself. Cough suppressants can improve patient comfort while the infection is resolving. The dog should be clearly improved, if not recovered, after about a week. That said, several infectious agents in the kennel cough complex are more intense and can cause minor bronchitis to progress to pneumonia, which is a potentially life-threatening disease. Given this possibility, antibiotics are frequently prescribed to kennel cough patients to prevent or curtail pneumonia before it warrants hospitalization.

It is important to distinguish an uncomplicated case of kennel cough from one complicated by pneumonia for obvious reasons. The uncomplicated cases will not have a fever or appetite loss, nor will they be listless. As mentioned, they will seem normal except for coughing. Dogs with pneumonia appear sick.

Prevention through Vaccination

For Bordetella bronchiseptica, vaccination can either be given as a separate injection or as a nasal immunization. There is some controversy regarding which method provides a better immunization or if a combination of both formats is best.

Nasal Vaccine

Intranasal vaccination may be given as early as 3 weeks of age and immunity generally lasts 12 to 13 months. The advantage is that local immunity is stimulated right at the site where the natural infection would try to take hold.

It takes four days to generate a solid immune response after intranasal vaccination, so it is best if vaccination is given at least four days prior to the exposure. Some dogs will have some sneezing or nasal discharge in the week following intranasal vaccination; this should clear up on its own. As a general rule, nasal vaccination provides faster immunity than injectable vaccination.

Nasal vaccines for Bordetella generally also include a vaccine against parainfluenza virus and some also include a vaccine against adenovirus type 2.

Oral Vaccine

An oral vaccine is available for Bordetella bronchiseptica (but not adenovirus or parainfluenza). The idea is that it is easier to give the vaccine with a syringe in the mouth – just inside the cheek – and there is no concern about sneezing out some of the vaccine. The oral vaccine can be given to puppies as young as 8 weeks of age. The vaccine is given annually.

Injectable Vaccine

Injectable vaccination is a good choice for aggressive dogs who may bite if their muzzle is approached. For puppies, injectable vaccination provides good systemic immunity as long as two doses are given (approximately one month apart) after age 4 months. Boosters are generally given annually. Some dogs experience a small lump under the skin at the injection site. This should resolve without treatment.

Vaccination is not useful in a dog already incubating kennel cough.

Bordetella bronchiseptica vaccination may not prevent infection. In some cases, vaccination minimizes symptoms of illness but does not entirely prevent infection. This is true whether nasal, oral or injectable vaccine is used.

Dogs that have recovered from Bordetella bronchiseptica are typically immune to reinfection for 6 to 12 months.

What if Kennel Cough doesn’t Improve?

As previously noted, this infection is generally self-limiting. It should be at least improved partially after one week of treatment. If no improvement is seen after that week, a re-check exam (possibly including chest radiographs) would be a good idea. Failure of kennel cough to resolve suggests an underlying condition. Kennel cough can activate a previously asymptomatic collapsing trachea or the condition may have progressed to pneumonia. Alternatively, there may be another disease afoot entirely such as non-infectious bronchitis, congestive heart failure, or some other condition that causes coughing.

If you have questions about a coughing dog, do not hesitate to bring them to your veterinarian.

How many dogs have been relegated to back-yard living because they jump all over family and guests whenever anyone walks through the door?

Then when someone goes out to visit the lonesome dog, the jumping is worse because the dog is even more excited to see someone. Only now the dog is dirty, too. Not good! Let’s talk about how to solve this problem once and for all.

We humans encourage dogs to jump on us by petting them, starting in puppyhood, when they stand on their hind legs to get closer to our loving face and hands. This normal unruly behavior is most likely attention-seeking in nature when it’s not accompanied by aggression. They don’t mean anything bad by jumping up, but very few people like being jumped on by a dog. As the dog gets older and stronger, he may scratch people and knock people down. It’s not only children and elderly people, but bigger, stronger dogs can potentially knock adults down as well. The behavior becomes a way to get your attention, even you start pushing them off and telling them ‘No.’ The person may see this as a punishment, but your dog may not see it as aversive at all.

When a dog is still a very young puppy, the best way to handle jumping up is never to allow the puppy to even start doing it. Don’t let anyone pet your cute little tootsie of a puppy unless all four feet are on the ground. If you teach your puppy that all petting happens when four feet are on the ground, your big dog will not be jumping on people. Instead, the dog will develop sweet ways of greeting people such as laying a head lovingly against your knee.

This training is harder than it sounds because dogs are usually rewarded by someone for this behavior, and chances are you have an adolescent or adult dog who is jumping on people. What do you do now? It’s the same principle as with the puppy, only it will take longer.

Attack this problem on more than one front. Here are the ingredients for training your dog to greet with four on the floor:

1. Teach your dog to sit, even when excited. When the dog is IN the sit position, give petting, praise, and treats. Do not praise AFTER the dog has gotten up, because that is not the desired behavior. Praise and reward DURING the desired behavior, the sit. This is the crucial training step that most people miss. Teaching the dog not to jump isn’t enough. We have to teach the dog that the petting will come when the dog is doing the right behavior. Put your focus on this moment. You’ll start this training in unexciting situations (i.e. in your house without visitors) and gradually build to more and more exciting situations (i.e. your backyard, then a quiet park) until the dog is totally steady. It takes time and practice. Then start to incorporate strangers. Teaching a dog to sit in more distracting situations sounds easy, but she not only has to be able to sit, she has to be able to do it when she is highly excited, and that is not an easy feat! So don’t expect it to be all fixed in a week. Signing up for a positive reinforcement training class may be a good way to start increasing distractions and the participants will be more likely to follow your instructions of asking your dog to sit when she approaches them and ignoring jumping behavior.
   
2. Teach your dog that when she comes to you or anyone else her default behavior is to sit and not jump. People should ask her to sit every time she approaches them. Alternatively, teach her a come cuddle command (see below).
   
3. When you come into the house, come in quietly. Excited greetings when you come in encourage a dog to jump on you.
   
4. When you have guests arrive, keep your dog under leash or other control (i.e. confining her to a separate room) for about 15 minutes until everyone is settled. This is the time of wildest excitement for the dog, and it will be much easier for the dog to muster self-control after this initial period. Eventually you will want to train this behavior without a leash, too.
   
5. Never let anyone pet or otherwise give your dog attention when she is standing on her hind legs. The best remedy for jumping up is to withhold attention. This is different for every dog. For some dogs you can keep your hands to yourself and turn a hip toward the dog or turn your back on the dog, but for some dogs you may have to actually leave the room (separating yourself from the dog), until your training has progressed to the point of being able to get the dog to’sit’ on cue. When the dog has been jumping and stops jumping, ask her for a couple of commands before petting to separate the jumping behavior from the reward of petting.
   This request is recommended because some dogs are so smart they will jump and then sit just to be petted.
   
6. If you are going to do anything to interrupt your dog’s jumping, keep in mind that your goal is a dog that is safe with people. Don’t fall into the trap of trying quick-fix methods for jumping up, such as stepping on the dog’s toes or whacking her in the chest with your knee. These methods cause pain, which could make her fearful of people, or worse, injure her. Any training method that punishes your dog when, in her mind, she is being friendly to your guests, could damage your dog’s good attitude toward guests, so be careful about that too. You want to give her a chance to earn praise for good behavior, not be getting in trouble when all she is trying to do is say hello.
   
7. Finally, a head collar may help as it gives you more control as you increase distractions.

People can be inconsistent about ignoring undesirable behavior and rewarding good behavior, so you may have to choose who your dog interacts with. If even one person encourages jumping, she will continue to perform the behavior.

Come Cuddle

One good way to teach your dog to greet without jumping is a simple cue to go to the person’s knees. Start by putting your open hands, palms facing outward, on the front of your knees. You’ll be bending forward to get your hands here. Tell your dog ‘come cuddle’, and your dog will likely be drawn to your inviting hands. Pet your dog. Do the ‘come cuddle’ practice over a few sessions until the dog responds quickly. Then find someone else to help you, have them take the position, point to them, and tell your dog to ‘go cuddle’. Have them encourage the dog verbally to come to them, and give petting when the dog arrives. Then you call the dog to ‘come cuddle’ to your hands at your knees.

Do a few repetitions back and forth, stopping before the dog gets bored. Repeat this, and soon you’ll find when you say ‘go cuddle’, your dog will aim for a person’s knees even if their hands are not there. Prompt the person to lean down and pet the dog at knee level – be firm with people that they must not ruin your training by inviting your dog to jump up on them!

A Note about Little Dogs

You may not mind your small dog jumping up on you, but give this some thought. You’re not going to want the dog to spoil someone’s clothing by clawing at their legs. Also, a little dog jumping and expecting to be caught can be injured if the person misses.

Safety

Many of us see no reason to teach our dogs not to jump up. We don’t mind, and if a friend or relative needs the dog not to jump, we simply put the dog on leash.

We get older, though, and our dogs age even faster than we do. Besides age, many physical problems can arise that make jumping up downright dangerous. At some point in your dog’s life, jumping will become a hazard to her. Your dog will live with less risk of pain if taught early on not to jump.

The non-jumping dog’s life will include more petting and love, because it’s so much easier and more enjoyable to pet a dog who has four feet on the ground.

Jumping on People 101 covered the long-term plan for working with a unruly attention-seeking jumper, but what if you encounter a friendly dog jumping on you right now?

If your situation is a big dog jumping up on people, you need first aid! Here are some ways to cope today until training can take full effect.

Please note that none of these techniques are enough to teach the dog not to jump on people in general, and none of them will apply to all dogs. Because dogs, people, and situations vary so much, these are options, but you’ll have to decide which ones you can use in a particular situation.

1. If you see the dog about to spring, but she is still on the ground in front of you, either ask her to sit or take both hands, palms down, and cross the hands, using them to block the path of the dog’s face from coming up. Many dogs will stop the jump if you do this.
   
2. If someone else has the dog on leash, or for some other reason she can’t come forward, step back out of jumping reach. Be careful about doing this if she is not on the ground (such as on a bed, sofa, or table). It will keep her from jumping on you, but could put her at risk of injury from crashing to the floor. Timing is important in these situations, as is the ability to read and predict the dog’s movements.
   
3. Swivel your hip to face her as she leaps on you. This shouldn’t harm her, but it will deflect the force of the jump off of the more vulnerable parts of your body.
   
4. If the dog has a collar on and you are side-to-side with (not facing) her, hold the collar without letting your wrist bend. Your grip is stronger this way. Be careful, though, because some dogs become aggressive when you take them by the collar! This response is for the friendly goober dog who just wants to lick your face.
   
5. Get closer to the dog initially, even taking a step forward, rather than moving away or even jumping away as many people instinctively do. Don’t lean your head away from her. Tilting the upper part of your body or your head backward actually induces some dogs to jump on you. You may be able to prevent the jump by simply starting your encounter with your hands at the dog’s level and petting.
   
6. Give the dog a ball or other toy to hold. Many dogs will learn to go get the toy themselves as an aid to self-control.

Remember, don’t encourage someone else’s dog to jump on you!

It’s usually unwise, though, to attempt to train someone else’s dog to stop jumping on people. Teaching this properly is a fairly long process that needs to be integrated into the dog’s life as a whole. Remember that when you attempt quick fix punishment-based training with someone else’s dog who is trying to be friendly to you (which is, after all, what jumping up on people means), you risk causing problems for that dog and owner in how the dog will relate to people in the future.

The chicken jerky treats made in China have been associated with kidney disease for a few years. Ever since the association between these products and illness was made in 2007, the U.S. Food and Drug Administration (FDA) has cautioned consumers to not give these treats to their pets.

While the treats are typically referred to as jerky, they may also be labeled tenders or strips.

Signs may occur within hours or days after a dog eats the treat. Signs include decreased appetite; lethargy; vomiting; diarrhea (sometimes bloody); and increased thirst and urination. Contact your veterinarian if the signs last for more than 24 hours, or if they seem severe.

If your dog is vomiting, lethargic, or does not want to eat, and has recently eaten these jerky treats, it does not automatically mean your dog has kidney disease from them.

Test results on affected dogs have shown kidney problems. The kidney problems are often similar to Fanconi disease. (Fanconi disease is an inherited disease in which electrolytes and nutrients are lost in urine.)  Although many affected dogs can be treated and get well, some jerky treat-related deaths have been reported.

In 2007, affected dogs were seen in Australia and the United States. That original outbreak ended in 2009 after all the affected treats had been pulled from the market. However, similar cases have been seen since then in the United States and Canada. Unfortunately, the definitive cause of the problem is still unknown.

The FDA has prepared a “Caution” statement.

In June 2011, the Canadian government sent out notices about the about jerky treats causing Fanconi-like signs in Canadian dogs; in March 2012, the American Veterinary Medical Association sent out a new alert about Canadian cases. In May 2012, the FDA updated their public information on their concerns about chicken jerky.

The FDA continues to investigate complaints and test products eaten by affected dogs. No specific brands have been recalled as of this time because there are only complaints, not evidence. However, there are a number of dogs with some level of kidney illness who have eaten the China-produced chicken jerky treats, so pet owners should be cautious about giving those.

Anecdotal reports from veterinarians indicate similar concerns about sweet potato pet treats made in China. Although no evidence is available that these sweet potato treats cause kidney issues similar to those related to chicken jerky treats, pet owners should be aware of the possibility.

If your pet has the signs listed above, and has eaten chicken jerky or sweet potato treats made in China, contact your veterinarian. Save the treats and packaging so that they can be tested by the FDA if they are suspected to cause the illness.

When a dog starts having housetraining accidents, it’s easy to believe the dog is acting out of anger or some other defiant motive. That is rarely the case. Let’s look at reasons for housetraining accidents and methods for improving your dog’s batting average.

Medical Causes

Medical causes should always be ruled out first. Any medical condition that causes increased frequency, urgency, or volume in urine or stool can lead to house soiling. Having the dog evaluated by your veterinarian is a good idea. Your veterinarian may recommend specific testing such as fecal, urine, and blood tests based on your dog’s specific problems and the results of the physical exam.

1. Dietary problems can cause housetraining issues. Feeding a high-fiber diet can result in the dog not being able to hold feces until the next relief opportunity, as can feeding on a schedule that just doesn’t work for your particular dog. Many dogs need to defecate within an hour after eating. Any change in food (including treats) can result in diarrhea and loss of control, too. Feed your dog carefully and consistently for the best housetraining results.
   
2. Intestinal parasites or other illness affecting the intestines such as inflammatory bowel disease or even a food allergy can cause the dog to lose control of his bowels.
   
3. A dog with a urinary tract infection, kidney failure, or urinary incontinence from other causes needs veterinary care. In most cases, housetraining problems from these causes can
   be solved or vastly improved by treating the medical condition appropriately.
   
4. Orthopedic problems can make it painful for your dog to squat for relief. The dog may wait and wait, afraid of the pain, and then lose control in the house. Sometimes the family thinks the dog’s arthritis or other orthopedic pain is under control because the dog doesn’t complain. This is especially true for older dogs, but even young dogs can have orthopedic problems such as hip dysplasia, knee, or spinal problems that result in pain. Your veterinarian can likely help your dog be more comfortable and at the same time improve the housetraining problem.
   
5. Another senior pet problem that can lead to house soiling is senility. Your elderly dog may have simply forgotten where he is supposed to go. Have him examined by your veterinarian as apparent senility can actually be caused by a myriad of medical causes. If your vet determines that the problem is senility, going back to the basics of housetraining (direct supervision or confinement when you can’t supervise and rewarding urination/defecation outside) is in order. Your veterinarian may also prescribe supplements for brain health and recommend appropriate mental stimulation to delay further signs.  

Behavioral Causes

Once medical causes have been eliminated, consider these behavior causes. Getting to the root of the problem will ensure proper treatment and the best chance for successful resolution of the problem.

• Sometimes we think a dog is housetrained when that is not actually the case. Housetraining does not automatically transfer to a new location, either. Dogs need consistent human help to keep the housetraining habits we humans want from them. Be sure not to give your dog too much responsibility for housetraining before he is ready. The general rule is that your dog should have one month without accidents before adding freedom a little at a time.
  
• Dog instincts can be overwhelmed by the scent of past accidents, whether it’s this dog’s scent or scent left by another pet. It’s imperative to remove this scent, and people often use the wrong products. The most reliable results are from bacterial enzymatic odor eliminating products.  These products actually degrade the urine rather than just cover up the smell. 
• When dogs are punished for housetraining errors, a common side effect is that they become afraid to relieve themselves in front of people. This makes it extremely difficult to teach the dog your desired relief location.
  The solution to this problem is to stop all punishment (even a harsh tone of voice) and start giving the dog rewards such as food treats for relieving himself. At first you can reward the dog for simply being in the relief area. Another step can be to move feces from an indoor accident out to the relief area and reward the dog there. Look for any opportunity to reward the dog for behavior that’s moving in the right direction. Dogs are incredibly forgiving.
  
• Sometimes dogs become afraid to go to the relief area. This can happen for various reasons, including weather conditions that scare the dog, leaving the dog outside alone too long, the dog being shocked by an electronic fence collar, a dog with a nervous temperament, other animals outdoors, humans teasing or abusing the dog outside, and frightening sounds such as fireworks or gunfire.
  
  A veterinary behavior specialist can help deal with the underlying anxiety creating the aversion to the relief area, which needs to be addressed to make your dog more comfortable in order to solve this problem.
  
• If your dog doesn’t have access to the relief area when his body needs relief, that’s a recipe for housetraining problems. Take the dog out more often. A journal of accidents can help you spot the pattern of when your dog needs to go out. These management issues can be caused by adding a new family member to the home, a family member moving out, or changing the family’s schedule, among many other causes.
  
• Causes of anxiety, such as separation anxiety, can lead to house soiling. If the dog is anxious or panicking, the stressed body needs to relieve more often. A veterinary behavior specialist can help address underlying anxiety.
  
• Fear of the crate (think claustrophobia) can cause the same symptoms as separation anxiety. Some dogs can be rehabilitated when they’ve developed a fear of being crated, while for most dogs it’s better to permanently use an alternative method. A veterinary behavior specialist can diagnose and treat this problem.
  
• Male dogs tend to mark their territory. Female dogs do too, but their drive is usually much lower. Urine marking is typically just a small amount, often on a vertical surface such as a chair leg, bed skirt, or the grocery bag you just set down. This is different than toileting, which is a large amount usually on a horizontal surface.
  
  Neutering helps solve this problem, but may not eliminate it if the dog is marking for other reasons such as anxiety or as part of a territorial display. Some causes of urine marking not related to hormones include a baby in diapers, a  baby starting to crawl, a new family member, a family member moving out, and territorial aggression to visitors or dogs, and people passing by outside the house. The specific causes need to be determined and treated for resolution of urine marking. A belly band—soft fabric around the tummy to catch urine—can be helpful in managing urine-marking as a short-term solution, but can foster infection if overused.
  
• Female dogs in heat tend to urinate frequently. Spayed female dogs don’t go into heat, so spaying is one solution for this possible housetraining issue, as well as eliminating the potential for staining furniture from the discharge.
  
• Some dogs have been raised in conditions that forced them to live in their own waste. This scenario damages their instincts to keep the den area clean. Since housetraining a dog requires that instinct, you will need to help this dog regain it. During the housetraining process, don’t use a crate or small area that forces the dog into contact with the waste. Use a larger confinement area for a while, so the dog can get used to being clean. Keep the dog’s area very clean. Eventually you may be able to use a crate with the dog.
  
• Sometimes, due to past management, a dog has a long-established habit of relieving on a surface, such as carpet or in a specific location, such as the spare bedroom, that you do not want the dog to use. It helps to keep the dog off carpeting and out of the undesired locations except when you can pay full attention to redirect any elimination behavior to the proper place.
  
• Alternatively, the dog may have an aversion to the material you prefer that he relieves himself on, such as if your backyard is made up of rocks. In that case allow your dog to eliminate on his preferred material and gradually add in the material you prefer.

Be a Detective—and a Friend

You can see from this long list that a lot of things can throw off a dog’s housetraining habit. You need to determine what could be causing your dog’s problem. There could be multiple reasons. With your veterinarian’s help and possibly the help of a behavior specialist, you can make it better.

Housetraining is a habit. The dog doesn’t understand why we want this, and yet dogs are so adaptable that most of them can be helped to develop the housetraining habit and to restore it when something has interfered. Even people have bathroom problems from time to time, so we shouldn’t be at all surprised that it happens with dogs.

One way dogs help humans to live longer, healthier lives is by needing our care. This is a day-to-day reason to get out of bed and to think beyond our own problems. You could even say that housetraining is good for us!

• Constricted pupil
• Elevated third eyelid
• Retraction of the eyeball into the head
• Slight drooping of the eyelid
• Increased pink color and warmth of the ear and nose on the affected side (very hard to detect in small animals)

These signs appear on the side of the face (and eye) with damaged sympathetic nerves.

What is the Sympathetic Nervous System?

Sympathetic vs Parasympathetic

The autonomic nervous system is divided into the sympathetic nervous system and the parasympathetic nervous system. The parasympathetic system maintains a status quo, a normal business-as-usual state; the sympathetic system prepares the body for a fight-or-flight situation.

For example, the sympathetic nervous system kicks in with anxiety or fear leading to increased sweating, pupil dilation, increased heart and respiration rates, and increased blood flow to the muscles. The body is preparing to defend its life either by running or fighting. When danger passes, the parasympathetic nervous system kicks in to return everything to normal.  Both systems coexist to provide balance in a healthy body.

In the eye, the sympathetic nerve fibers dilate the pupil, widen the eyelids, drop the third eyelid, and keep the eye in a forward position in the socket. The parasympathetic nerves constrict the pupil, raise the third eyelid, and retract the eye for protection. Both systems are working at the same time, one system slightly dominating the other depending on what is happening.

When the sympathetic nerves controlling one of the eyes are damaged, only the parasympathetic nerves work and Horner’s syndrome is created.

How can the Sympathetic Damage Occur?

The nerve carrying the tiny nerve fibers that provide sympathetic control to the eye has a long path, and damage may occur anywhere along it. Also, some types of injuries are more likely to occur in certain areas along the path. 

This path begins in the brain’s hypothalamus. A group of nerves exit the hypothalamus and travel down the brainstem, continuing down the spinal cord, down the length of the neck, and just into the chest. This segment is called the central segment and is shown in blue in the illustration to the right. This pathway extends from the brain and brain stem down to the level of the second thoracic vertebra, all within the spinal cord.

From here, the nerves form right and left bundles and exit the spinal cord to make a U-Turn and travel back towards the eyes. The bundles are called the right and left sympathetic trunks (or the “pre-ganglionic segments”) and they extend from the top of the chest back to the area of the middle ear. They are shown in red in the illustration.

From there, the nerves connect to the last segment of nerves (the postganglionic segments – one on the right and one on the left), as shown in yellow. This segment starts just below the ear and travels to the eye.

The damage can occur in the neck or spinal cord area, the ear area, or the eye area. Damage can occur in the form of trauma, tumor involvement, infarction (abnormal blood clot), middle ear infection, or diseases of the eye itself. Each segment of the nerve pathway is vulnerable to different types of damage, so knowing which segment is involved gives us a good idea of what caused the damage.

Locating the Damage

First Order Lesions (involving the blue segment)

Diseases that hit nerve fibers in the brain, brainstem, or spinal cord include tumors of the brain, vascular accidents (such as stroke) in the nerve tissue, fibrocartilaginous embolism in the spinal cord where disk material sprays into the spinal cord, or even a herniated intervertebral disk in the area of the neck. Horner’s syndrome stemming from any injury such as one of these might prompt a search for other neurologic issues. Advanced imaging such as an MRI might be a good idea.

Second Order Lesions (involving the preganglionic red segment)

Diseases that strike the sympathetic trunk include foreleg injuries especially if the foreleg is pulled and the nerves that exit the spinal cord in the armpit area become over-stretched. Sometimes a mass in the chest, such as a tumor or fungal granuloma, will damage the sympathetic trunk. Neck trauma such as pulling very hard on a leash could be severe enough to cause a second order lesion. If there is no obvious history to suggest injury, it might be a good idea to radiograph the chest to see if there are masses in the lung that might be involved in a second order lesion.

Third Order Lesions (involving the postganglionic yellow segment) 

These are the most common causes of Horner’s syndrome because ear infections are so common for small animals. Inflammation in the middle ear can easily lead to Horner’s syndrome. Third order lesions are associated with vestibular disease, the imbalance and dizziness of the middle ear infection, in many cases. When Horner’s syndrome localizes as third order, the ears should be thoroughly investigated as the source.

Treatment

It is not necessary to treat Horner’s syndrome. The syndrome is not painful and does not interfere with vision. The significance of the syndrome is that it indicates nerve damage that must be recognized. If you wish to treat the syndrome for cosmetic reasons, phenylephrine eye drops can be prescribed to relieve clinical signs. The most important thing is to determine what caused the Horner’s syndrome. Horner’s syndrome itself probably does not need treatment, but its underlying cause very well might.

It has been said that the treatment of heartworm infection is something of an art. There are several strategies that can be used depending on the dog’s medical condition, including the option of not treating at all. The important concept to realize is that, while there are off label alternative heartworm-killing protocols, the FDA-approved method of killing adult heartworms involves very harsh arsenic-based drugs and killing large adult heartworms is neither simple nor safe. Let’s review some of the dangers and options in clearing the body of this parasite.

Patient Evaluation

Prior to therapy, the heartworm patient is assessed and rated for risk into one of four categories. Important factors include: how many worms are thought to be present based upon the tests performed, the size of the dog, the age of the dog, concurrent health factors, severity of the heart disease, and the degree to which exercise can be restricted in the recovery period. Some hospitals use computerized formulas to categorize heartworm infected patients. The categories into which patients are grouped are as follows:

Class I: Lowest Risk. These dogs are typically without symptoms and their infection is a surprise discovery during a routine annual health examination when a positive test comes up. Other blood tests are normal and radiographs show mild changes if any change at all.

Class III: Severely Affected. Dog is suffering from weight loss, cough, difficulty breathing, and blatant damage to the vasculature is apparent on radiographs; lab work reveals a more severe anemia and marked urinary protein loss. The damage to the lung blood vessels from the worms creates extra resistance for the heart to pump against, and often, episodes of collapse occur with exercise. 

• Class IV: Caval Syndrome. Dog is collapsing in shock with dark brown urine evident. Heartworms are visible by ultrasound in the AV valve of the right side of the heart, with very abnormal bloodwork. These dogs are dying and can only be saved by the physical removal of adult heartworms via an incision through the jugular vein. If such a dog can be saved from this crisis, further treatment cannot be contemplated until the dog is stable enough to fit into one of the other categories above. In this video (we warn you this is not for the faint of heart), view the physical removal of adult heartworms from the jugular vein of a dog with caval syndrome.

After knowing what class the patient fits in, treatment can be determined. The dog has three groups of heartworms in their body: microfilariae (basically newborn worms whose parents are living inside the dog in question), newly arrived immature worms (relatively fresh from the mosquito bite and living in the skin tissues), and adult worms themselves.  

• Microfilariae are the first stage larvae (basically the youngest stage). These are the children of the adult worms living in the heart and blood vessels. The mother worm gives live birth (no eggs involved) and the babies swim freely in the host’s bloodstream. They must be killed so that they cannot be picked up by mosquitos and transmitted to new dogs..

The newly arrived heartworm larvae, freshly delivered from mosquito bites in the last 3 months. These are third and fourth stage larvae living in the skin. For practical purposes, we will include the L5 larvae in this group. The L5’s are old enough to leave the skin tissues and enter the circulation but they are not really mature enough to be called adults. This group of young worms (L3’s and L4’s in the skin and L5’s in the circulation) represent the first 5-7 months of infection. We need to kill them before they reach maturity and begin to wreak havoc on the cardiovascular system of the host.

Stabilization First

Killing the Microfilaria and Migrating Worms 

The next step in treatment is clearing the migrating immature worms. Heartworm treatment is a project that lasts at least a couple of months. We do not want immature worms to mature in that time frame. Since our goal is to have fewer adult worms when the time comes to kill the adult worms, it behooves us to kill the younger worms right off the bat.

The tissue-based L3 and L4 larvae are killed by monthly macrocyclic lactone-based heartworm preventive products (avermectins and milbemycin). Killing the L3 and L4 larvae prevents heartworm infection. Some of these products can also kill circulating microfilariae (which need to pass through a mosquito before becoming infective to other animals).  The only FDA-approved product for killing microfilariae after adulticide therapy is Advantage Multi®, which contains moxidectin. Other products can be used for this purpose also, but it should be noted that an anaphylactoid reaction can occur if a large number of microfilariae are killed rapidly with products such as high-dose ivermectin (off-label) or high-dose milbemycin (e.g., Interceptor). This problem has not been noted with Advantage Multi. While low-dose ivermectin products (e.g., Heartgard) will gradually eliminate microfilariae in most dogs, the package insert discourages it for this use.

Killing Wolbachia

Wolbachia is a genus of rickettsial organisms (sort of like bacteria, but not exactly) that live inside heartworms of all developmental stages, but their numbers begin to expand once the young worms reach their infectious stage. Wolbachia organisms seem to be protective or beneficial to the heartworms that harbor them, aiding in metabolism and general worm health. Without Wolbachia colonization, many female worms are not able to reproduce, and third-stage larvae are not able to infect new hosts. 

Wolbachia organisms possess inflammatory surface proteins that are released when adult worms die or are killed in treatment, and these proteins greatly increase the chances of severe circulatory reactions in the canine host.

It has been found that killing Wolbachia with an antibiotic such as doxycycline is helpful in treating the heartworm infection as the Wolbachia can be removed from their heartworm hosts, thereby weakening the worm and minimizing the release of inflammatory proteins when the worm finally dies. To minimize reactions, the American Heartworm Society recommends using doxycycline along with heartworm preventives for a good month as soon as the diagnosis is made and prior to the use of the arsenic compounds needed to kill the adults.

Killing the Adult Worms

he only product currently available for treating adult heartworms is melarsomine dihydrochloride (Immiticide^® or Diroban^®. If you go by the manufacturer’s recommendations, treatment can be done in two or three doses, depending on the class of heartworm infection. Most universities, however, opt to treat all patients with the three-dose protocol as it creates a more gradual kill of the adult worms (which is safer in terms of embolism and shock).

The patient receives an intramuscular injection deep in the lower back muscles. This is a painful injection with a painful substance, and it is common for the patient to be quite sore at home afterward. Pain medication may be needed. Be careful around the injection site, as the pet may bite. The site may form an abscess that requires warm compresses. Approximately 30% of dogs experience some injection site reaction. These generally resolve in 1-4 weeks. 

In the two-dose protocol, the dog returns for a second injection the next day on the opposite side of the lower back. In the three-dose protocol, the dog comes back one month later for two doses 24 hours apart (the first dose is an introductory treatment to kill some of the more sensitive worms.) Keep in mind that too many worms dying at once creates circulatory shock. The benefit of the three-dose protocol (sometimes called the split dose protocol) is that the first injection serves to kill off any older or weaker worms without killing off the stronger, younger ones. When the two consecutive doses occur one month later, there will be fewer worms dying at once.

After treatment, the patient must be strictly confined for one month following the final treatment. No walks, no running around. The dog must live an indoor life. The reason for this is that embolism, to some degree, is inevitable, and it is important to minimize embolism-related problems. Exercise increases heart rate and oxygen demand, and we need the heart to rest during this recovery period.

Watch for:

• Coughing
• Fever
• Nose bleeds

If any of these occur, report them to the vet as soon as possible. The most critical time period is seven to 10 days following a melarsomine treatment, but these signs can occur anytime in the following month.

The “Slow Kill Method” with Ivermectin Only

Melarsomine treatment is expensive and often out of reach for rescue groups, shelters, and many individuals. If the dog is stable (Class I), one option is to simply leave the dog on an ivermectin-based preventive. This option has led to a great deal of misconception about the ability of ivermectin to kill adult heartworms.

Let us lay the rumors to rest now:

1. Ivermectin does not kill adult heartworms.
2. Ivermectin does shorten the lifespan of adult heartworms.
3. Ivermectin does sterilize adult heartworms.
4. Ivermectin does kill microfilaria (keeping the dog from being a source of contagion)
5. Ivermectin does kill L3 and L4 larvae (preventing new infections).

This means that if you opt to treat a heartworm-positive dog with only an ivermectin heartworm preventive, you can expect the dog to remain heartworm-positive for as long as two years and the heartworm disease will be progressing during that time. This is not good for the dog but certainly beats getting no treatment of any kind.

The “Slow Kill Method” with Mox-Dox 

Adding doxycycline to ivermectin has changed the way slow kill works. As the “slow kill” protocol evolved, topical moxidectin has been substituted for ivermectin, and a month of twice daily doxycycline is used to kill the Wolbachia bacteria that are so protective of the living heartworms. The result seems to be a much faster slow kill with microfilaria clearing three weeks or so (addressing the resistance in microfilaria issue of slow kill). The adult worms die over 3-4 months, which is similar to the 3-dose protocol (1-3 months on preventive, one dose of melarsemine with two doses following a month after that).

Exercise restriction is still needed, and relatively high doses of moxidectin are also needed. (The topical product is essential; long-acting injectables wane too quickly). Heartworm antigen testing is performed nine months after starting the protocol and continued monthly until negative. If the dog is still heartworm antigen positive after 15 months, new decisions should be made (do mox-dox again, use melarsomine, etc.) The American Heartworm Society views this protocol as a salvage procedure, meaning that it could be considered for a dog for whom melarsomine is not an option. Research and controversy continue with regard to this method.

The goal in long-term management of diabetes mellitus is the alleviation of unpleasant clinical signs (constant thirst, weight loss, etc.) and the prevention of dangerous secondary conditions (infections, ketoacidosis, etc.). To accomplish this, blood sugar levels should be regulated between 250 mg/dl (13.88 mmol/L) and 80 mg/dl (4.44 mmol/L). This is not as good as the body’s natural regulation, but it is a fair and achievable goal in most cases.

Some patients just seem completely unaffected by even high doses of insulin, and it is important to have a step-by-step plan to rule out causes of insulin resistance so that regulation can be achieved.

Insulin resistance is defined as:

Persistent high blood sugar levels throughout the day when three units of insulin per four pounds of patient body weight are used.

or

A unit or more of insulin per pound of patient body weight (or more) is needed to achieve regulation.

This may seem basic, but it is important not to skip the basics. Confirm that the amount of insulin being drawn into the insulin syringe is correct, that the injection technique is correct, and that the patient is actually receiving the injection. Rule out any snacking or changes in the patient’s feeding schedule. Be sure the bottle of insulin is not expired and that it has been properly stored. Ideally, the veterinary staff will observe insulin administration and will check the bottle while the pet is being checked in the hospital.

Review insulin storage and handling.

Step Two: Determine for sure that the Patient is Insulin Resistant

A glucose curve is needed to distinguish the following three phenomena.

Somogyi Overswing

In the case of Somogyi overswing, the insulin dose is too high and drives the blood sugar low for part of the day. When the blood sugar is low, other hormones such as cortisone or adrenalin are released to raise blood sugar. These hormones can have a prolonged effect (many hours), thus creating hyperglycemia (high blood sugar). If the patient’s high blood sugar has been caused by a Somogyi overswing, a lower dose should be used and a new curve performed in a week or two. One might think a flat glucose curve (i.e. one not showing hypoglycemia followed by hyperglycemia) would rule out Somogyi overswing but, in fact, a Somogyi hyperglycemia can persist for days and create a flat curve. Often a good approach is to cut the insulin dose back and see what the curve looks like.

Rapid Insulin Metabolism

In this case, the insulin simply is not lasting long enough to create sustained normal blood sugar levels. If the curve shows that the insulin effect is wearing off too soon, twice a day administration of the insulin may solve this problem or a longer-acting insulin may be needed. Longer acting insulins tend to have poorer absorption into the body from an injection site. This may also necessitate change to a different insulin type. Often it is necessary to change to a human insulin from a canine insulin.

True Insulin Resistance

Here no significant drop in blood sugar level (levels stay greater than 300 mg/dl[16.65 mmol/L]) is seen in response to the insulin dose used. Usually there is a history of prior increases in insulin dose, all met with minimal response.

Step Three: Spay

Hormone fluctuations will easily account for insulin resistance as progesterone is one of many hormones that raise blood sugar levels (by stimulating growth hormone secretion). Canine unspayed female diabetics need to be spayed if regulation is to be achieved. (Feline patients do not have a similar relationship with naturally occurring progesterones and do not require spaying; however, progesterone-type medications can produce diabetes in cats. Diabetic patients of either species should not take progesterone-related medications.)

Step Four: Rule out Infection

Diabetic animals are at risk for developing bladder infections because they have so much sugar in their urine. Stress of any kind will contribute to high blood sugar and infection would lead to stress. A urine culture should be done to rule out bladder infection, plus the teeth and skin should be inspected for infection in these areas. If infection per se is not found, the patient should be screened for other chronic illnesses that might constitute a stress. A basic blood panel would be a logical starting point.

If infection or other stress is allowed to go unchecked, ketoacidosis, an especially life-threatening complication of diabetes mellitus, can develop.

To avoid infection issues, it is a good idea to plan for diabetic patients to have their teeth cleaned annually and to have the urine periodically cultured whether there are symptoms of a problem or not.

Step Five: Control Obesity

Insulin response is typically blunted in obese patients. If obesity is an issue, it should be addressed. A formal weight loss program using measured amounts of a prescription diet and regular weigh-ins is necessary for success. See general information about weight loss for pets. If these steps do not reveal a relatively simple explanation for the poor insulin response, then it is time to seek more complicated causes. This generally means an additional hormone imbalance.

Hyperadrenocorticism (Cushing’s Disease)

This condition is relatively common in dogs but less so in cats. This condition involves an excess in cortisone-type hormones, either from over-production within the body or over-treatment with medication. Cortisone – more accurately referred to as cortisol – is secreted naturally in response to a fight or flight situation and prepares the body for exercise by mobilizing sugar stores. If sugar is mobilized into the blood stream in the absence of a fight or flight situation, diabetes mellitus can result. If the excess cortisone situation is resolved, it is possible that the diabetes will also resolve.

About 10% of dogs with Cushing’s disease are also diabetic. About 80% of cats with Cushing’s disease are also diabetic. Testing for Cushing’s disease cannot proceed until some degree of diabetic control has been achieved and the patient is not ketoacidotic.

Excess Circulating Lipids

High levels of circulating triglycerides (fats) interfere with binding insulin to the cells it needs to act upon. While most dogs with excess circulating lipids are not diabetic, when a diabetic patient is insulin resistant it may be helpful to attempt to reduce the circulating fats. Excess lipids in the blood usually occur because of some other hormone imbalance (Cushing’s disease, hypothyroidism in dogs etc.) but they can simply happen spontaneously in the miniature schnauzer.

Circulating fats are reduced by treating the hormone imbalance that caused them if there is one. If there is no underlying disease, circulating lipids can be reduced with diet and omega 3 fatty acid supplementation.

Acromegaly

Acromegaly results from an over-secretion of the pituitary hormone known as growth hormone. This hormone normally is responsible for one’s growth from infancy to adulthood. When adulthood is achieved, its secretion dramatically slows, bone growth plates close, and growth essentially stops. If for some reason, this hormone begins secreting again, growth resumes but not generally in normal proportions as the limb bones have closed their growth areas.

One of the effects of growth hormone is causing the body tissues to become resistant to insulin by interfering with tissue insulin receptors. Animals with acromegaly are frequently diabetic.

The prognosis and treatment for acromegaly is different between dogs and cats. Dogs generally develop acromegaly due to excess progesterone secretion, as would occur from an ovarian cyst. Canine patients are thus usually older, unspayed females and spaying may be curative depending on the remaining ability of the pancreas to secrete insulin.

Antibodies against Insulin

When a patient is treated with insulin from another species, the immune system recognizes the introduction of the foreign protein and generates antibodies. It was because of this phenomenon that most commercial insulin available is genetically engineered human insulin so that the world’s human diabetics no longer need to worry about making insulin antibodies.

But where does this leave dogs and cats? It leaves them making antibodies against human insulin, that’s where. There is no feline insulin product available; the closest thing is beef insulin. Dogs are luckier as their insulin is identical to pig insulin and porcine insulin is available as Vetsulin® (Caninsulin® in Canada). If a human insulin is used, some degree of antibody production is a forgone conclusion.

You would think this would pose a big problem but in fact insulin antibodies are not always bad. Most of the time the antibodies simply interfere with removal of the insulin, leading to a longer-acting insulin than would be achieved with the same type of insulin made from the native species. For example, Humulin N® (human insulin) will last longer in the dog than Canine Insulin N (if there were such a product). This may be desirable depending on the patient; changing the species of origin of the insulin is one way to get the insulin to last a bit longer.

To become insulin resistant from antibodies, a body must lose 70% or more of the insulin injection to antibody binding. This is very unusual but possible and should not be forgotten as a possible cause of insulin resistance. Blood tests to measure insulin antibodies are available in some areas. Insulin can be switched to a species of origin more closely related to the species desired.

If a Cause Cannot be Found

If a cause cannot be found or if treatment for that cause is not practical or possible, the good news is that multiple high doses of insulin can generally overcome the resistance. Sometimes combinations of short and long-acting insulins are used together to achieve reasonable regulation.