Kidney disease is one of the prevalent syndromes we deal with in veterinary medicine. With our improved diagnostic skills, better nutrition, and a willingness of our clients to invest in good preventive care, our beloved pets are living longer, healthier lives. As our pets age, thier list of maladies increase. It is safe to say that if a pet lives long enough, it will have to face the prospect of kidney disease. I am constantly telling my clients that age is not a disease, but as we age, we face a myriad of ills as our bodies wear out.
Most clients become aware of kidney disease in their pet when they become clinically ill. The most common clinical signs are an increased thirst, increased urination, weight loss, and in the latter stages diminished appetite. The two main functions of the kidneys are to excrete urinary biproducts and to concentrate urine. As the kidneys fail, they are unable to concentrate urine and the pet dehydrates. They try to compensate by drinking more. Unfortunately, they cannot drink enough to replenish what they have lost, and they dehydrate more, worsening the kidneys’ function. The other main function of the kidneys is to rid the body of urinary waste products, ie urea and creatinine. These are products of protein metabolism and are toxic. A normal functioning kidney removes these toxins in the urine. When the kidney begins to fail, these toxins build up in the bloodstream, causing inappetance, nausea, and ulcers. The kidneys have to be 80% compromised before the first elevations in kidney enzymes are noted in the bloodwork. This is why early preventive blood screening is so important.
Treatment is aimed at restoring hydration and flushing the bloodstream of these urinary toxins. In the early stages of kidney disease, we treat with a low protein diet and check blood pressure. Hypertension can cause kidney disease and vice versa. If hypertension is present, we treat with anti-hypertension drugs which can help preserve kidney function as well. We always check a urine sample. The urine is an excellent barometer of kidney function. Dilute urine and protein in the urine are indicators that the kidneys’ function is becoming compromised. As the disease progresses, we prescribe medications that can help combat the urinary toxins. In the latter stages of kidney disease, we often begin intravenous or subcutaneous (under the skin) fluid administration. This helps flush out the impurities and rehydrates the patient. Clients can be taught administer subcutaneous fluids at home. This is very easy to do, well tolerated, and cost effective. We have had clients manage their pets’ kidney disease for years with these treatment protocols. The take home message is, routine wellness screenings will enable us to detect kidney and other diseases at their earliest, most treatable, and least expensive stages.
Aural hematomas are hematomas (blood blisters) that occur in the ear of dogs and less commonly cats. They develop when the dog shakes its head violently as a result of an irritant such as an insect bite or more commonly from an ear infection. The shaking of the head causes blood vessels between the ear cartilage and skin to break, resulting in a blood filled blister on the inside of the ear. This can emerge literally overnight and manifests as a soft, fluctuant swelling that can be small or very large resulting in occlusion of the external ear canal.
Aural hematomas are common and easily managed. It is very important to treat the underlying cause, ie ear infection concurrently. There are several treatment options:
Aspiration- this is accomplished by inserting a needle and syringe into the hematoma and draining the blood out. This is simple to do and requires no anaesthesia, but is usually a temporary measure because it leaves a small hole which seals up quickly and the empty pocket tends to fill back up with blood.
Lancing- this is also a simple procedure not requiring anaesthesia. We normally perform this procedure outside because it can get quite bloody. We take a sharp blade and make a sizable incision over the hematoma and drain the blood. We do not numb the area, as the numbing hurts more than the quick nick of the scalpel blade. This leaves a larger hole which the owners can “milk” more easily. Milking is massaging the blood out that wants to refill the defect,. The object is to keep doing this, preventing the hole from closing so the blood can drain out. This is done only if there are 2 people with the dog going home, one to drive and one to hold a gauze over the dog’s ear. We do not do this procedure when the dog is brought in by one person because the dog will shake its head and create a bloody mess in the car, mimicking a crime scene. This could result in having the authorities pull you over and search the vehicle for the “body”.
Canula insertion- Cow teat canulas are small plastic tubes that are used to treat cows with mastitis. They work wonderfully as a semi-permanent drain for a hematoma. The dog is given light sedation, a nick is placed in the ear with a sharp scalpel blade and the canula is inserted into the hematoma. It is the sutured in place and left for 30 days. We instruct the owners to milk the ear twice a day, massaging the blood out of the ear through the canula. This procedure works nicely, is minimally invasive, does not require general anaesthesia, and is not expensive to do. It also is the one procedure that leaves the most cosmetically pleasing result.
Do nothing- this is the least desirable option. Eventually the blood in the hematoma will clot and consolidate. The ear will shrivel and create a cauliflower ear. An ear hematoma is uncomfortable as the ear becomes heavy with blood, and the constant head shaking could cause a hematoma in the other ear to form. This is why few clients choose this option.
The best results are achieved when a hematoma is first observed by the owner, before clotting has taken place. Clots are more difficult to remove and can cause permanent
The vertebrae or backbone are a series of bones that support and protect the spinal cord. In between these vertebrae are disks that cushion the bones and act as spacers between the vertebrae. These disks can herniate or protrude into the spinal column causing pain and neurologic deficits. This tends to occur in middle aged to older, small, long back breeds. The most overly represented breed is the dachshund, but this syndrome can occur in all breeds including the larger breeds. We see an average of 3 cases a week in our practice.
The clinical signs can range from mild back pain to complete paralysis. Typically a dog will present with the complaint that it is not jumping up on the couch as usual, and cries when picked up. Often the owner will say their appetite is less and they may be reluctant to “go to the bathroom.” This occurs because the back and neck are painful and the dog is reluctant to bend to eat, or assume the position to defecate or urinate. On the physical examination there may be conscious proprioceptive deficits, weakness especially in the rear legs, and pain when the neck is manipulated or the back palpated. CP deficits are documented when the toes are turned with the topside down. The dog should immediately right the foot to the proper position. A delay signifies and interruption in the signal from the foot to the brain. More serious clinical signs include dragging the rear legs, crossing of the rear legs when walking, and a frog legged stance.
Diagnosis is made on clinical signs, and occasionally with radiography. The more serious cases are referred to a veterinary neurologist who will perform myelograms, or an MRI to identify the exact location of the herniated disk.
Treatment depends on the severity of signs. Early cases are treated with cage rest and steroids or non-steroidal anti-inflammatories, muscle relaxants, pain medication, and intravenous polyethylene glycol. We have a therapeutic laser machine that is a wonderful treatment modality. The light laser is anti-inflammatory, and relieves pain. This is also used post surgery to speed up recovery. A study at the University of Florida College of Veterinary Medicine showed that paralyzed dogs that received post operative laser therapy walked an average of 5 days post op versus dogs that didn’t that walked an average of 17 days later. There are no side effects and we use it extensively in the treatment of iv disk disease. Surgery is recommended by a board certified neurologist if there is significant paresis or weakness in the legs, or if the dog is very painful and does not respond to medical treatment. Prognosis depends on the severity of the herniation, how soon after the occurrence of the disk herniation the dog is seen by a veterinarian, and how aggressively the dog is treated. Surgery involves removal of the disk, and occasionally making a window in the vertebrae to make room for the disk material.
Prevention entails keeping the dog physically fit, as overweight dogs have a much higher incidence of intervertebral disk disease. I try to discourage clients with predisposed breeds to allow them to get on couches and beds as puppies. It is much easier to train them not to do this than to try and keep them off a bed after the condition develops.
Pet insurance is a good investment in your pet’s health. There are many insurance companies and plans, so it is important do do your homework. The best source of information is your veterinarian. We promote health insurance at our veterinary practice, because pets that are insured tend to be better taken care of. Pet owners are more likely to keep up with wellness programs, routine physical exams, bloodwork, and treatment plans.
Pet insurance is similar to human dental health insurance in the fact that it is a reimbursement plan. An insured patient pays for services, then submits a claim to the insurance company who then reimburses them a percentage of the bill. There are many pet insurance companies and it is up to the pet owner to research them and select the one that best fits their needs.
There are many factors to consider when choosing a health plan for a pet. Ideally, insurance is taken out on a young pet with no pre-existing conditions. I cannot tell you how many clients ask if they can get insurance when their pet is seriously ill. There is usually a waiting period for illnesses on most policies. An insurance company, for example, will not pay for an anterior cruciate ligament tear a week after a policy has been taken out. Deductibles vary depending on the plan. There are plans that cover wellness exams, vaccinations, heartworm prevention, spays and neuters. These tend to be more expensive and it may make more economic sense to pay out of pocket for wellness issues and take out a policy that covers accidents or catastrophic illnesses like cancer. This prevents financial euthanasia. There have been many cases of pets having treatable but expensive to treat illnesses that end up being euthanized because the owners can’t afford to treat.
For more information, you can contact us at our hospital at (772) 336-8111
I often tell my clients that housetraining a puppy is not much different than potty training an infant. As a father of 4 and a pet owner of over 60 pets, I am very qualified to speak on both subjects. I am a very ardent proponent of positive reinforcement and reward motivation. My dear wife Carolynn, got our kids out of diapers with MM’s as a positive reinforcement tool. If the kids went potty in the little potty, they received 2 MM’s, if they went potty in the big potty, they received 4 MM’s because Mommy and Daddy didn’t have to clean up the little potty. This technique worked like a charm. I can remember with a touch of nostalgia, having to excuse myself from a client in a room to field a phone call from an excited child telling me of their accomplishment. We all like to receive “Atta boys or girls” even as adults, puppies are no different.
The first step in potty training a puppy, is to establish a set feeding pattern. Puppies poop after naps, meals and bedtime, so a puppy that is allowed to free feed throughout the day, will have to potty all day long. It will be next to impossible to train. I recommend that puppies be fed twice a day, and be allowed to free feed for a half hour. Do not limit the amount being fed, but do limit the time they have to consume it. If the puppy eats it all in 5 minutes and wants more, give it more. If they look at the food and make a face and walk away, the clock is ticking. The food will be picked up after a half hour. They will quickly learn that the food will be there for a limited amount of time and potty schedules can be established. My father raised us kids with the saying “This is not a restaurant. You will what’s put in front of you, when it’s put in front of you.” The same can be applied to our dogs.
When a puppy has an accident, DO NOT stick their noses in it or spank them. No one would argue the fact that you do not haul off and smack an infant for soiling their diaper, same principle with puppies. Take them to the spot and say No in a firm voice. Pick up the feces or urine soaked paper towel, take the puppy and the mess outside and place it on the ground and act as if the puppy had just relieved itself on the grass. Make a big deal and give them a favorite treat (not MM’s, LOL) I am a big proponent of food rewards as most animals are food motivated, like yours truly.
I do not recommend crate training until a puppy has reached at least 12 weeks of age, because their sphincter muscles are not strong enough to hold urine or feces for more than 2 hours. The point of crate training is most dogs will not soil an area that they have to sleep in. If they cannot hold it and soil their cage, it will ruin that concept and make potty training that much more difficult.
The most important tenet of housetraining a puppy , is patience. Remember to take a deep breath and follow the above suggestions when confronted with a puppy “accident”. Good luck!
We all know our beloved 4 legged children age at a rate of 7 years to our 1. Typically pets are seen yearly for their physical exams, vaccinations, heartworm checks, and fecal exams. We encourage our clients to bring in their pets biannually, especially when they reach middle age at the age of 6.
We all can relate to our own annual exams with our own doctors. A typical annual physical for us includes, weight, temperature, blood pressure, comprehensive bloodwork, urinalysis, EKG, and possible chest x-rays. Our pets deserve no less. We can articulate to our doctors our concerns and pains, animals cannot. There are many disease processes that, if caught early, can be treated. It is heartbreaking to have pets brought in advanced stages of kidney, thyroid, or cardiac disease which could have been managed if they had only been diagnosed earlier.
Hypertension is something one does not think about in our pets, but occurs with some frequency. High blood pressure can lead to kidney disease and vice versa. In cats the most common presenting complaint is acute blindness. This is called hypertensive retinopathy. When the blood pressure gets high in some cats, it causes the pressure in the eyes to go up and can lead to retinal detachments and acute blindness. This can be prevented and controlled by routine blood pressure checks and medication.
This economy has forced many of us to make difficult decisions regarding to what we can spend on our pets. Pet insurance purchased when the pet is young without any pre existing conditions is an investment that can literally save our pets’ lives. People who purchase pet insurance are much more likely to invest in early diagnostic testing that can diagnose conditions in the early, treatable stages.
Most veterinary practices, including our own, offer senior wellness packages. These packages offer substantial savings than if the individual components were purchased separately in the event a pet is brought in with an illness. November would be a good month to start an annual routine of preventive wellness exams for our beloved furry family members.
Rabies is a neurotropic rhabdovirus that can affect any warm blooded animal. This means that the virus has an affinity for nervous tissue, this includes nerves, spinal cord, and brain. There are 3 main carriers of rabies in the United States, bats, raccoons, and foxes. Mongoose is the main carrier of rabies in Puerto Rico. The predominant wildlife host on the east coast, including Florida, is the raccoon.
Rabies is transmitted from the saliva of an infected animal to an exposed host. This usually takes place as a bite, but the virus can be transmitted from a scratch, if there is saliva on the nails of the infected animal. Rabies can be transmitted from aerosol exposure. This is especially important with spelunkers (cave explorers) who enter caves where there is a large population of bats. The virus can be inhaled through the mucuous membranes by a susceptible host.
Early clinical signs of rabies include fever, muscle aches, anxiety, and progress to hallucinations, deliria, seizures, muscle twitching, change in behavior, aggression (madness), and hydrophobia (fear of water). The incubation period is dependent on where the entry point of the vrus. The virus travels up the nerves, to the spinal cord, then enters the brain. The closer to the head the person or pet is exposed, the shorter the incubation period. Death without treatment is almost a certainty within 2-10 days after exposure.
Transmission of the rabies occurs via the saliva. The animal is capable of transmitting rabies when the virus migrates from the brain to the salivary glands. When a domestic animal with an unknown vaccination history bites a person, they are quarantined for 10 days. The animal can only transmit the virus when it is in the salivary gland and studies have shown that if they were infective at the time of the bite, they will be dead within 10 days. The bitten person then is subjected to rabies post exposure treatment. This treatment involves 5 painful injections and is very expensive, but without treatment, death is almost a certainty. There have been only a few cases of people surviving rabies without post exposure treatment.
All pets should be vaccinated for rabies and kept inside. Cats are more likely to contract rabies and more likely to transmit the disease because they are more predatory by nature and become much more aggressive when they develop rabies. The vaccination is inexpensive, safe and very effective.
Hypertension in our pets is not something most pet owners give a second thought to, but it is much more prevalent than you think. We associate hypertension in humans with stress, smoking, diabetes, obesity, too much salt consumption, or familial history. Hypertension in humans is often considered own primary, meaning an underlying cause cannot be determined. In animals, hypertension is usually secondary. The most commonly associated diseases with hypertension are hyperthyroidism (in cats), Cushings disease ( overactive adrenal disease in dogs), diabetes mellitus, and kidney disease.
The most common sign associated with hypertension is vision loss. The retinas are very sensitive to high blood pressure and are usually the first organs to be affected. Unfortunately, a pet cannot communicate a loss in visual acuity, and often a pet owner does not realize this until the pet becomes acutely blind. This is most common in cats. The presenting sign is a cat that was normal one day, and the next has huge dilated, unresponsive pupils, and is bumping into things. Oftentimes once this happens, the retina has detached and the blindness is permanent.Early diagnosis is key to good control just like in humans. We take it for granted that our blood pressure is measured every time we visit our own physicians, don’t our pets deserve the same? We encourage blood pressure checks in any pet 6 years of age and older at least twice a year, and in any pet that has a disease that is associated with hypertension. We include blood pressure checks in any pet with kidney disease, dilute urine, protein in the urine, Cushings disease, diabetes, and hyperthyroidism. We usually do blood pressure checks after we have the results of the bloodwork. If a cat is diagnosed with hyperthyroidism, we treat that condition first, and oftentimes the blood pressure normalizes.
Blood pressure is measured in pets similarly to humans. A special inflatable cuff is applied to the foreleg of the pet and a series of measurements are taken. We usually take 3-5 blood pressure readings and the average is interpreted. This allows the pet to calm down and minimize the “white coat syndrome”, which can artificially elevate the blood pressure.The most important reading is the systolic blood pressure. We want the systolic blood pressure to be below 160.
Treatment is similar to humans. The underlying disease needs to be controlled. The most common blood pressure medications we use in veterinary medicine are benazepril, enalapril, and amlodipine. These are the same medications we use in human medicine to control hypertension.
Hypertension is common and treatable if diagnosed early. Blood pressure checks should become as routine in veterinary medicine as it is in human medicine.
Around the holiday season, we veterinarians prepare for an increase in the cases of pancreatitis.
The pancreas is an organ attached to the small intestine.
It serves two basic functions:
The endocrine side produces insulin which enables the body to process glucose. Glucose is the body’s main energy source.
The exocrine side produces enzymes to digest food. Food must be digested in order for the intestines to absorb the nutrients contained in the food consumed.
When a pet consumes food that is high in fat, the pancreas gets overworked, swells and actually leaks enzymes into the abdominal cavity. This causes autodigestion and is very painful and can even cause death. The most common cause of pancreatitis we see in veterinary practice is when pets are fed people food. We see the most cases of pancreatitis the days after Thanksgiving, Christmas, and Easter. The clinical signs of pancreatitis include vomiting, diarrhea, fever, painful abdomen, and inappetance. Untreated cases can cause death.
Treatment is usually supportive with iv fluids, hospitalization, antibiotics, anti-emetics, and antidiarrheals. We often withhold food in dogs for several days to give the pancreas a chance to settle down. Feeding a dog with pancreatitis literally fuels the fire, stimulating the pancreas to produce more enzymes. A new treatment for severe cases of pancreatitis is hyperbaric chamber treatment. Some patients require surgery and drains. Management of dogs and cats with pancreatitis is done with a high fiber, low fat diet. Prevention is the key. We cannot say this loudly enough or more emphatically, DO NOT GIVE PETS PEOPLE FOOD!
Discussing pancreatitis with clients is a daily occurrence. Pancreatitis does not happen to every pet fed people food, but the risk is certainly much higher. The human analogy is not all smokers die of lung cancer, but your odds certainly go up if you do.
Pet owners often equate food with love. I am all for spoiling our pets, but this can be accomplished without endangering their health and lives.
It only takes one like Hurricane Andrew to cause devastation. Pet owners should prepare before a hurricane is on their doorstep.
There are many things people can do to protect their beloved pets in the event of a storm.
Make sure their pets are up to date on all their vaccines and that proof of vaccinations are in a readily accessible place. If you have to evacuate and board your pets at a boarding facility or veterinary hospital, you will have to show proof of updated vaccinations.
Make sure any medications your pet may need are refilled. It may be days to weeks after a hurricane makes landfall, before veterinary hospitals or pharmacies might be able to reopen.
Consider microchipping your pet. Pets can become lost if dwellings are damaged during a storm. Microchips enhance the odds that your pet will be returned to you safely. Make sure the microchips are registered with updated information.
Make sure you have enough food and water for your pet for at least a week. Provide the boarding facility with both for your pet. Power and water may be lost for days to weeks after a storm hits.
Make provisions for your large animals like horses. We bought wax markers and wrote our cell phone numbers on both sides of our horses. In the event of a hurricane where the barn is damaged, horses may wander off. We also microchipped our horses. We installed hurricane garage doors and hurricane panels on our barn and had it reinforced to withstand 140 mph winds. The barn has withstood 3 hurricanes and the horses were very safe and comfortable.
People who are forced to evacuate should go online and find hotels and motels that are pet friendly. ( http://www.petswelcome.com/ , http://www.pet-friendly-hotels.net/ ). Do not wait until the last minute to get reservations.
Contact your veterinarian long before a hurricane becomes an imminent threat and see if they have hurricane boarding facilities. Most animal hospitals are not equipped to handle that many animals in a situation where electricity and water may not be available.
Hurricane season can be extremely stressful. By following these simple steps, it will make a difficult situation easier to endure and ensure your beloved pets remain safe.
Parvo is a highly contagious viral disease that affects dogs. Transmission is mainly from exposure to the virus through feces from infected dogs. Parvovirus causes the lining of the intestines to necrose (slough). Clinical signs include diarrhea, often bloody, vomiting, lethargy, and dehydration. The less common cardiac form can cause sudden death. Most infected dogs are puppies and dogs that are not current on their parvovirus vaccination.
Parvovirus is a relatively new disease, appearing in the late 1970’s. There were widespread outbreaks and the mortality rate was quite high before the development of a vaccine. Puppies are vaccinated monthly in a series of 3 injections starting at 8 weeks of age until they are 4 months old. Boosters are given yearly after that. Parvovirus is highly contagious and the mortality rate in untreated dogs can reach 91% in as little as 24-72 hours. Concurrent illness with bacteria, parasites, and malnutrition worsens the clinical signs. Certain breeds are predisposed: Rottweilers, Dobermans, and Pit Bull Terriers. Treatment is mainly supportive and can be quite expensive. Dogs are hospitalized for several days on intravenous fluids, antibiotics, antidiarrheals, and anti-emetics. Infected dogs that recover can shed virus in their feces for up to 3-6 weeks and should be kept away from any other dogs until this period is over. The virus can persist in the environment for up to a year and is cold and heat tolerant. The only disinfectant that effectively kills the virus is bleach. We recommend that infected dogs be taken to a small area in the yard to defecate, and the fecal material be picked up to avoid exposing other dogs by contaminating the environment.
There have been several parvovirus outbreaks locally. In these difficult economic times, dog owners are cutting corners with their pets’ health. The parvovirus vaccine is usually included the distemper vaccine that is given yearly to dogs. Prevention of this deadly disease is the key. It is an inexpensive, and safe way to ensure the health of our beloved canine family members.
Leptospirosis is a zoonotic disease transmitted by the spirochete bacterium Leptospira spp. The bacteria is shed in the urine of an infected host which can include mice, raccoons, skunks, deer, sheep, dogs and even humans. The bacteria remains viable in the environment as long as it is moist, so it is most prevalent in Florida during the wet summer months.
Dogs most commonly come in contact with the bacteria by licking urine off the grass, or drinking from puddles in the yard that have been contaminated with infected urine. Clinical signs are jaundice (yellowing of the skin, eyes), bloody urine, fever, lethargy, vomiting, inappetance, and kidney failure, and death. The incubation period in dogs is 2-20 days. In humans the signs include lethargy, fever, severe headache, chills, muscle aches, vomiting, diarrhea, and jaundice, and death. The incubation period in humans is 4-14 days. People who are exposed to contaminated water such as surfers, and professionals who are exposed to contaminated urine such as veterinarians, and slaughterhouse workers are most at risk.
Diagnosis is made from blood samples and fresh urine in early infections.
Treatment if caught early, is with antibiotics such as penicillin, and doxycycline. Penicillin is given initially to control shedding of the bacteria in the urine, then doxycycline is used to get rid of the carrier state. The key is prevention. There are no vaccines available for humans, but there are effective vaccines for dogs. The canine leptospirosis vaccine contains the 4 most common serovars, and is included in most distemper/parvo vaccine combination protocols. There are many veterinary practices that do not include leptospirosis vaccine in their annual vaccination protocol and 3 years ago we had 4 cases of leptospirosis. Two of the dogs were not current on any vaccines, and the other two came from veterinary hospitals that did not include leptospirosis in their vaccine protocol. We were able to save two of the dogs. This also posed a significant risk to the owners’ health. We advised them to avoid contact with their dogs’ urine and confine the area where their dogs urinate to limit the area that could become contaminated. This past month we had 2 young dogs with unexplained kidney disease that were had not been vaccinated against leptospirosis by their previous vets. Their owners spent some anxious moments while we waited for the leptospirosis titers to come in.
We strongly recommend that all dogs be vaccinated against leptospirosis annually to prevent this potentially fatal disease.
The hot summer months and humidity bring with it mosquitoes which can transmit many diseases to pets and humans. Heartworm disease is prevalent in dogs and to a lesser extent cats and ferrets. Mosquitoes feed on the blood of warm blooded animals. Mammals infected with heartworms have circulating larvae in the bloodstream. When a mosquito ingests blood from a heartworm infected animal, the larvae mature and develop in the host. The larvae eventually migrate into the heart and pulmonary vessels where they mature and cause clinical signs of heartworm disease.
The clinical signs of heartworm disease in dogs often to do not become evident until late in the course of the disease. These signs include coughing, exercise intolerance, lethargy, collapse, and even sudden death.
Heartworm disease diagnosis in cats can be challenging. The disease in cats tends to cause signs that mimic asthma. Coughing is the predominant sign, but vomiting and acute sudden unexplained death has been reported. There is no treatment for heartworm disease in cats because cats go into anaphylactic shock when the worms die. The object of heartworm treatment is to kill the heartworms which could induce anaphylaxis. The drugs that are used to treat heartworm disease are also toxic in cats.
Heartworm disease is preventable in all the affected species. The heartworm prevention comes in many forms including : chewable monthly tablets, monthly topical applications that have flea prevention included, and now a 6 month shot for dogs.
Heartworm treatment is expensive. Heartworm prevention is inexpensive and safe. Heartworm disease can cause permanent damage to the pet’s heart. Pets that are not on heartworm prevention, especially in Florida where the mosquito is the state bird, are likely to result in the pet becoming infected with heartworms. I tell clients it’s the proverbial, “ You can pay me now or you can pay me later!”
There is no reason for an animal to develop heartworm disease. Yearly heartworm blood tests and monthly heartworm prevention will ensure our pets will not contract this potentially deadly disease.
With summer, we are reminded what the southern heat can do to our beloved pets. We were involved in a case last year where 2 large dogs were left in a car while the owner attended classes at a local university. He had the windows cracked and left water in the car for them to drink. The outside temperature was 94 degrees F and the heat index was over 100 degrees F. Good Samaritan bystanders discovered the distressed dogs and called Animal Control. When they arrived the female dog was dead and the male was unconscious. The officer wet the dog down with cool water and transported him to our veterinary hospital. His rectal temperature was 105 degrees F and he was non responsive. The normal rectal temperature of a dog is 100-102 degrees F. We applied wet towels on his body and turned on a hose with cool water to wet him down. We applied ice packs to his head and groin and armpit areas. An intravenous catheter was inserted and vigorous amount of fluids were administered. An oxygen mask was placed on his nose and his heart rate and temperature were monitored. Once we felt he was stable enough for transport to the Animal Emergency and Referral Center, he was taken there by Animal Control. He unfortunately did not respond and had to be euthanized later that evening. The owner is facing 2 felony counts of animal cruelty.
Two days later I read of a K-9 police officer in Woodstock, Georgia with 12 years experience, was arrested after leaving his canine police officer in his cruiser. The dog died, and he faces a felony count of animal cruelty, and he has lost his job. This is particularly disturbing because this happened to a person with experience dealing with dogs.
Hyperthermia can occur very quickly in this brutal Florida heat. The temperature in a car can reach 140-150 degrees F in a very short period of time. Dogs do not perspire. They can only dissipate heat from panting and from slight sweating of the pads of their feet. If the ambient temperature is higher than the dog’s core temperature, panting cannot dissipate the heat, and the dog’s internal temperature can rise very rapidly. Signs of hyperthermia are obvious; panting, restlessness, crying, lethargy, red and tacky gums, unconsciousness, and death.
When the body’s core temperature rises above 105 degrees F, serious damage can occur in a very short period of time to the brain, kidneys, intestines, and blood. Once clinical signs begin, they progress rapidly and can result in irreversible organ damage and death.
Prevention is the key. Dogs and other animals should never be left in a car, especially in the summer. In the heat of the day, pets should be allowed to go outside for short periods of time and they should avoid strenuous physical exertion. If they have to be outside, there should be plenty of shade and adequate amounts of water should always be available. We had an English Bulldog present to our hospital 2 years ago on a Saturday morning with heat stroke. The owner had taken the dog out for a walk on a hot morning. The dog began to pant, and collapsed. The owner carried the dog a half a mile to her house before bringing it to our hospital. The dog presented unconscious with a rectal temperature of over 110 degrees F. The owner was riddled with guilt. She innocently took the dog out for a walk, and 2 hours later, the dog was dead. Overweight and brachycephalic dogs are more predisposed to heat stroke. Brachycephalic dogs have the “pushed in noses” and they cannot dissipate heat as well by panting.
Dogs are not the only animals that can experience heat stroke. We own 8 horses and during the summer, we are constantly vigilant of the outdoor temperatures and heat indices. Once the heat index reaches 100 degrees F, we bring the horses in their stalls. We have overhead fans and they have automatic waterers in their stalls.
The people that were responsible for their dogs dying of heat stroke are not bad people. They were people who took chances with their pets’ lives and lost. I am not a gambler because I am not willing to lose. Let’s be safe and enjoy our summer with our pets!
Addison’s disease, also known as hypoadrenocorticism, is a condition where the adrenal gland does not produce adequate levels of hormones needed to balance metabolic functions. The adrenal gland produces two types of hormones:
Corticosteroids are hormones that allow us to handle stress, the “flight or flight syndrome”. They control protein and glucose metabolism which are the main sources of energy that allow us to cope with stress factors.
Mineralocorticoids are hormones that control electrolyte balance. This in turn affects kidney function.
The cause of Addison’s disease is rarely found, but it typically affects younger patients, typically 4-5 years of age and it affects females twice as often as males. This disease affects dogs, and very rarely, cats. Clinical signs can range from no signs, to an acute crisis where the patient is presented comatose. The first signs an owner might notice is a dog that is consuming more water and urinating more. As the disease progresses, lethargy, inappetance, vomiting and cardiac signs develop as the potassium levels rise.
Diagnosis is made based on clinical signs, urinalysis, and bloodwork. The classic Addisonian has an elevated potassium and a decreased sodium. The ratio of sodium to potassium typically drops below 25. Kidney values will begin to elevate as the disease progresses. Not all Addisonian patients fit this classic presentation and the clinician must be open to the possibility of Addisosn’s disease in a young dog that presents with unexplained signs of kidney disease even with normal electrolyte levels. Confirmation of the disease is made with a blood test called an ACTH Stimulation test. ACTH (adreno corticotropic hormone) is a hormone produced in the pituitary gland in the brain that stimulates the adrenal gland to secrete corticosteroids and mineralocorticoid hormones. Addisonian patients have low corticosteroid levels and do not stimulate post acth administration.
Treatment is usually very successful. A patient in crisis is given intravenous fluids with sodium chloride, and corticosteroids. Mineralocoricoid supplementation is begun and can be accomplished with an oral medication called Florinef, or an every 28 day injection called Percortin. Dogs tend to do better with the injection. Care must be taken with future stresses such as surgery, and low dose oral steroid supplementation may be needed for life.
Dogs can live normal happy, productive lives with Addison’s disease as long as they are managed appropriately. The most famous human that had Addison’s disease was President John F. Kennedy.
One of the most frequent reasons pet owners visit their veterinarians for, is to treat and consult over allergic skin disease. The most common clinical signs are: scratching, licking and chewing at their skin and feet, shaking their heads, scales and flakiness of their skin, discoloration of the hair and skin, and hair loss (alopecia).
There are many causes to allergic skin disease:
Inhalent allergies occur when a patient has an allergic reaction to things that are in the air. The most common of these is pollen. Pets that have inhalant skin disease tend to have clinical signs that are seasonal, or are worse at certain times during the year. This is by far the most common cause, and pets tend to chew at their feet, have ear infections, and scratch to the point where secondary bacterial infections develop which aggravates the itchiness. Most pets develop skin infections as a result of scratching and licking. The itchiness comes first. This is why it is important to identify the cause of the discomfort and not just treat the infections.
Food allergies are an important component in the skin puzzle. Oftentimes they are not the sole cause of the problem, but they contribute to the symptoms. Pets that have food allergies tend to develop these at early ages and have hairloss in the backside , under the tail. Food elimination trials can be implemented to address this potential cause skin discomfort.
Ectoparasites, ie. fleas and ticks are a smaller proportion of the allergic puzzle with the advent of effective products to control them. Thankfully, we see very few cases of flea bite dermatitis anymore. It is important to exercise good preventive measures to control fleas and ticks, especially in allergic pets.
Contact dermatitis occurs when a susceptible pet is exposed to something they are allergic to by direct contact. The most common areas of the body affected are the feet. A pet that is chewing at their feet and nowhere else, is likely allergic to the grass they are exposed to. Another common sign is redness in the groin area because it is the most hairless part of the body and the part most likely to contact the grass, when a pet lays down. Other possible causes of contact dermatitis are rugs, or towels and even the laundry detergent used to clean the pet’s bedding.
Treatment is aimed at controlling the itch. This is achieved with topical sprays and shampoos, antihistamines, and sometimes steroids. Steroids should be used with caution, and only on a short term basis because of potential long term side effects. Antibiotics are used to control secondary infections and must be continued until the infection is cleared. This could take 2-6 weeks.
Underlying conditions such as hypothyroidism need to be addressed and treated as well.
Diagnosis is made by trial and error, and allergy testing. This can be done with blood testing (RAST) and intradermal skin testing, usually done by a dermatologist. Food trials can be done without expensive testing by trying novel diets. The definition of a hypoallergenic diet is one protein and one grain. If a food trial is instituted, the pet must get nothing other than the food for 30-45 days for an objective assessment to be made.
Anterior cruciate injuries are the most common cause of acute lameness in dogs. Cats can develop ACL injuries but do so much less frequently. Large breed, and overweight dogs tend to be more predisposed. The anterior cruciate ligament is one of two ligaments that help stabilize the stifle or knee joint. Injury can occur in a young active dog, or an overweight dog that has abnormal stresses on the dynamics of the stifle. An injury typically occurs when a dog twists his leg, either running around a corner, or mis-stepping in a hole in the back yard. This is a common injury in professional athletes like football players and skiers.
The typical presentation is a dog that is presented three legged lame, and toe touching. There is usually no pain elicited and the knee may or not be swollen.
Diagnosis is made on clinical history and the presence of an anterior drawer sign. An anterior drawer is when the is abnormal forward movement of the tibia in relation to the femur. This sign can be difficult to elicit in a nervous dog because the tensing of the muscles could artificially stabilize the stifle. Sedation sometimes is required. ACL pull or tear is suspected in any dog that presents with acute, non painful, toe touching lameness. I normally recommend a series of therapeutic laser treatments in our office and send the dog home with glucosamine chondroitin sulfate/ MSM supplements, non steroidal pain medication, and orders for strict rest, leash walks only, and no running or jumping for at least two weeks. The rule of thumb is if the dog is still lame after two weeks, surgery is usually required to stabilize the joint. If this is not done degenerative joint disease or arthritis sets in very quickly.
There are several surgical options to stabilize the knee joint after an ACL tear:
Extracapsular repair– The stifle is opened and inspected and any remnants of the torn ligaments are removed. If the meniscus is damaged, it is removed, and any bone fragments are cleaned away. A large suture is placed around the back of the joint and inserted in the front of the stifle. This stabilizes the knee. This procedure is best used in smaller dogs that don’t have to support as much weight.
TPLO (Tibial Plateau Leveling Osteotomy)– This is considered by many, the best way to stabilize the stifle after acl rupture. It is a complex surgery requiring specialized equipment, and many radiographs. This is done by a surgical specialist.
TTA(Tibial Tuberosity Advancement)– This procedure is also complicated, but considered by many to be the preferred method of repair. It is less invasive than the TPLO, but also requires specialized equipment and expertise.
Rehabilitation is important to the ultimate success of any procedure. Rest, and leash walks are a must for 4-6 weeks post surgery. Icing the joint can reduce swelling. Passive range of motion exercises can be begun in 2-3 weeks. Light exercise can be introduced slowly. Full return to normal function can be expected in 2-3 months.
We are blessed to live in the semitropical climate of Florida. It is a paradise for humans, but it is also an ideal environment for fleas. Fleas are a year round problem in South Florida. It is important to understand the flea life cycle in order for us to adequately protect ourselves and our pets against these biting pests.
There are 4 stages in the life cycle of the flea:
Egg: A female flea can lay up to 40 eggs per day. Eggs incubate in warm temperatures of about 65-85 degrees and high humidity. Female fleas lay their eggs on the pet where they fall off into the environment
Larva: eggs hatch into larvae which feed on the “flea dirt” or flea feces left behind by the adults in the environment. This stage is the stage that picks up the tapeworm eggs that later become infective to the host.
Pupa: This is the cocoon stage of the flea. They can remain dormant in the carpet for months, waiting for the ideal environmental conditions, and a nearby viable host to feed on, before they emerge as adult fleas.
Adult: Fleas can survive for months without a bloodmeal. Once a suitable host is found, they aggressively attach and feed. A female flea will begin to lay eggs about 24-48 hours after feeding, and continue until she dies. The average life span of a flea is 4-6 weeks and the average time from egg to adult is 21 days.
Fleas can spread several diseases to pets. The most common is tapeworms. A dog or cat will ingest a flea in the process of grooming. If that flea was carrying tapeworm eggs, it will develop into adult tapeworms in the intestine of the host. The eggs are shed in the pet’s stool in egg packets or segments that the pet owner can readily see. The flea larvae then ingest the eggs and the cycle continues.
Flea control must occur on the pet as well as in the environment. Environmental sprays do not kill the egg, larva l, or pupal stages, so if there is a severe infestation, the environment should be resprayed in 3 weeks, when the eggs hatch into adults.
There are many effective products for flea control on the pet. Topical flea applications and oral flea prevention are common and effective. It is important to coordinate flea control on the pet and the environment to effectively keep these pesky parasites out of our lives.
Cardiac or heart disease can take many forms, and have many causes (etiologies).
Congenital is when a problem is present at birth, usually as a result of an anatomical anomaly. Examples are patent ductus arteriosus which occurs when there is a shunt around the major arteries that supply the heart that does not close at birth. This is usually detected by a veterinarian at the pet’s first visit and is manifested by a very loud and pronounced murmur. Treatment is the surgical ligation of the shunt, reestablishing proper blood flow dynamics to the heart.
The other congenital anomalies are septal defects of the heart. The septum is the wall that separates the 4 chambers of the heart. If a hole is present between the chambers, blood leaks through and causes the other chambers of the heart to enlarge due to an increased blood volume. Eventually heart failure occurs. The murmurs present in these cases are not as pronounced as the patent ductus arteriosus. Surgical correction is much more difficult because it involves in open heart surgery versus ligating vessels outside the heart.
Valvular defects can be congenital or acquired. Acquired cases usually occur in older patients, usually smaller breeds. Predisposing factors include chronic dental disease that seeds the valves with bacteria setting up placque deposits, not allowing the valves to close properly, causing an audible murmur, and eventually causing other chambers of the heart to enlarge.
Cardiomyopathies are syndromes where the the heart muscle is affected and the heart gets larger. Certain breeds are predisposed, ie Doberman Pinschers, Boxers, and Great Danes. Heartworm disease can cause permanent damage to the heart. The severity of the infection and length of time with the disease before treatment, will contribute to the severity of damage to the heart.
Diagnosis is usually made during a routine physical exam. Ideally the pet is not showing any clinical signs and a murmur is detected. As heart disease progresses, the pet owner may notice coughing, especially at night and early morning. Exercise intolerance, weight loss, lethargy, and bloating may be seen as the disease progresses into heart failure. We are very aggressive in promoting diagnostic tests when a cardiac abnormality is detected. We can do chest radiographs, electro cardiograms, blood pressures, and ideally, we refer to a cardiologist for an echocardiogram.
Cardiac disease, as in most disease processes, responds best when diagnosed early. There are many drugs available that help manage and slow down the progression of the disease. We do not ascribe to the commonly held suggestion that “ just watch him/her. If he/she starts coughing, or has exercise intolerance, we will pursue it further.” What you are then telling a client is we will wait until their pet is in congestive heart failure before we treat. If we had received the same suggestion from one of our physicians, I am sure most of us would seek a second opinion. Pets can lead long and productive lives with heart disease if they are diagnosed early and monitored routinely.
Canine influenza is a highly contagious respiratory virus. 80% of dogs that are exposed to the virus contract the disease. The virus is similar to the human influenza virus. It is the H3N8 strain that only affects dogs. There have been many outbreaks around the country. Texas is currently having an epidemic. Locally there have been cases reported in Palm Beach and Highlands counties.
Clinical signs of canine influenza include persistent, occasional ly moist productive cough, low grade fever, nasal discharge, lethargy, inappetance, and in severe cases, pneumonia, and even death. The cough can persist up to a month and can be confused with the less virulent kennel cough. Kennel cough is caused by the bacteria Bordetella bronchiseptica and is treated with antibiotics. Canine influenza should be suspected in a dog that does not respond quickly to antibiotics.
Dogs that are at highest risk are ones that are kenneled in boarding facilities, go to grooming salons, doggie parks, and areas where they are exposed to other dogs. Canine influenza is generally spread through aerosol contact through coughing, direct contact like kissing, licking, and nuzzling . Transmission can also occur through contact with contaminated surfaces and clothing. A person can transmit the virus when they get the virus on their hands and touch things like doorknobs exposing other people to the virus.
There is no specific treatment for canine influenza. Treatment is supportive with antibiotics, hospitalization, iv fluids, and good nutritional support. Infected patients sometimes need to be hospitalized for many days on oxygen support.
Prevention and minimizing exposure is the key to controlling the disease. A well cared for dog, that is up to date on its vaccines, on a good plane of nutrition, and is current on heartworm prevention will be much more likely to have a good immune system, and more capable of fighting the disease. There is an effective, safe vaccine to prevent the canine influenza virus. It is given twice the first year, 2 weeks apart, and then yearly after that. Dogs that are boarded or groomed regularly should be vaccinated and pet owners should select those establishments that require dogs to be vaccinated against canine influenza over those that do not. Dog owners should avoid areas where dogs congregate like stores, doggie parks, kennels, and grooming shops when news that the virus is present in a particular area.
Ringworm is a skin disease caused by a group of fungi called dermatophytes. In humans it causes a red ring-like lesion that is itchy and was therefore misnamed a worm. The more proper terminology is not ringworm, but dermatophytosis. Ringworm fungi are soil borne organisms that affect many species of animals including humans. They are highly contagious, and spores from infected individuals can fall off the host and contaminate the environment. Some individuals can be carriers without showing any clinical signs.
Cats tend to be affected more readily than dogs, and kittens are the most easily infected because of their immature immune systems.
Clinical signs in pets tend to be non-specific and can look like most any other form of skin disease. Scabs appear on the skin that may or may not have the red ring around them. Most cases are diagnosed when a pet has not responded to an appropriate course of antibiotics to treat the much more common staph infection.
Diagnosis is made definitively with fungal cultures. Screening tests include fluorescence under a Wood’s lamp and looking at hair samples microscopically. Most ringworm cases will fluoresce under a Wood’s lamp, but not everything that fluoresces is ringworm. Microscopic identification can be difficult, so most veterinarians do ringworm culture tests when ringworm is suspected.
Treatment is aimed at minimizing shedding of the spores into the environment while treating the patient. Some cases require shaving to facilitate topical treatment with antifungal shampoos. Oral antifungal medication: itraconazole and griseofulvin are the mainstays of successful treatment but it can be expensive and typically must be given for at least 6 weeks. Infected animals should be segregated from other pets and human family members to reduce the risk of infection and to prevent shedding of infective spores throughout the environment. Lime sulfur dips can be effective, but are very foul smelling (rotten eggs), and can stain clothes and carpets. Some pets fight off the infection without treatment, but those cases are rare. The environment can be disinfected by using dilute bleach to disinfect animal bedding and carpets.
Ear infections are a common reason people bring their dogs in to a veterinarian. The typical presenting signs are a dog that shakes his/her head, paws at the ear, has a head tilt, and has a foul odor coming from the ear. If the dog shakes his head too violently, blood vessels can rupture between the ear cartilage and the skin causing a bubble to develop. This is called an aural hematoma, and is basically a large blood blister.
Ear infections usually are caused by allergic disease. The ear is an extension of the skin and oftentimes, the dog will have concurrent scabs on the skin and be quite itchy everywhere. The ear becomes inflamed because of the irritation. Wax develops which traps moisture. The ear is a dark place especially in floppy eared dogs like spaniels which promotes bacterial and yeast growth. This causes more inflammation and pus to accumulate in the ear which is the source of the foul odor that develops. Another common cause of ear infection is “swimmer’s ear”. Dogs that enjoy swimming like Retrivers tend to be predisposed to ear infections.
Diagnosis is made with clinical signs, physical exam, cytology of the ear, and sometimes bacterial culture and sensitivity of the ear. The physical exam is important to rule out parasitic causes like ear mites (rare in the dog), foreign bodies, and tumors (ceruminous gland tumors). Ceruminous glands produce the wax in the ear and tumors (benign and malignant), can cause an increase of the production of wax which can predispose a dog to an ear infection. It is also important to ensure that the tympanic membrane (ear drum) is intact.
Treatment is aimed at identifying the underlying cause and treating the infection. Allergic skin disease is a systemic problem so identifying the allergen and treating the resulting irritation is important in the overall success of the treatment. The drugs we use to treat ear infections generally contain an antibiotic to treat the bacteria, antifungals to treat the yeast component, and steroids to reduce the inflammation. If tumors are identified, they must be removed, and sent to a pathologist. Treatment must be continued until complete resolution of signs and this time period can vary from patient to patient. Discontinuing treatment before resolution can lead to resistant bacteria. We are beginning to see more and more of this including MRSA. If an ear hematoma develops, it must be drained and a canula inserted.
We advise clients to check their dog’s ear and clean them once a week, especially if they are prone to infections. The first sign of a problem is an increase in the production of wax. If they are checking it weekly, they can address it before it becomes infected.
Oral care is second nature for us humans. We religiously brush and floss our teeth at least twice a day and have our teeth professionally cleaned twice a year.
A recent survey showed that only about 5% of pet owners routinely brush their pets’ teeth. Most clients are open to the idea, but when it comes to implementing oral care into their busy daily schedules, reality sets in, we tend to not follow through. The best time to start oral care for our pets is when they are young. This then becomes part of the daily routine for both pet and owner. There are many good products to help us maintain good oral health in our pets from chicken flavored toothpaste, soft toothbrushes, finger cots, oral rinses, water additives and dentachew treats and oral care diets.
Good dental hygiene is important in our overall health as well as our pets. The bacteria that grow in our mouths create gingivitis causing erosion of the gums and tooth loosening. The bacteria that generate in the mouth can become systemic affecting the heart, kidneys, and liver. Prevention is the key to sound dental health. A favorite expression of mine is “ Better to catch something early than to wait and have the treatable become untreatable!”
We do comprehensive dental cleaning, scaling and fluoride treatment on our patients, just like we receive at our own dentists. Because dogs and cats have not mastered the rinse and spit technique, they must be sedated for the dental prophy. We take great care and require pre-anaesthetic bloodwork to make sure there are no unknown issues that could affect anaesthesia. All animals are intubated and the anaesthesia we use is the same ones that are used in human practice. All animals have heart and oxygen saturation monitors. The procedure normally takes about 15-20 minutes and most patients are awake with 10 minutes,. We call all our pet owners as soon as their babies are awake, and they can usually go home by early afternoon.
Age is not a limiting criteria for doing dental care. We have had numerous patients that came from other veterinary practices that were told that their pets were too old and it was not worth it. I absolutely do not ascribe to that philosophy. I would rather do a dental cleaning on a healthy pet that is eating well, regardless of age, than to wait until they stop eating because of loose teeth, or a tooth abscess and then do the dental cleaning. The pet is now more compromised and a greater anaesthetic risk. I keep telling my clients that age is not a disease and as I get older and grayer, I hope my own doctors have that same consideration for me.
Take advantage of pet dental month and get your pets’ mouths evaluated. We are discounting the cost of dentals this month and your pet will be healthier for it.
A simple step pet owners can take to increase the chances their pets are returned to them safely is microchipping. Microchips are tiny implants, the size of a rice grain, that are injected under the skin of dogs, cats, horses, parrots, etc. This procedure is relatively painless, takes seconds to perform, and can be done during a routine veterinary visit. Microchips can be detected with special scanning devices that most animal shelters, animal control officers, and veterinary facilities now routinely have.
Microchips were developed by the military and have been widely used for the last 15 years. Most animal shelters and humane societies have replaced the tattoo method of identification for animals adopted from their facilities. Once a microchip has been implanted, the pet owner is given the id number of the microchip and a registration form. Most microchip companies have minimal registration fees to enter the pet’s and pet owner’s contact information in a national database. It is important that pet owners keep this information current. When a pet is lost, many of these companies have alert capabilities, notifying animal hospitals, local animal control and animal shelters of the pets disappearance. Microchips have also proven useful in ownership disputes and theft. A microchipped pet can easily be identified, and returned to its rightful owner. Many countries require animals to have microchips as a permanent identifier prior to entering their borders.
Many pet owners in Florida include microchipping in their hurricane preparation plans. Pets often become separated during violent storms. Collars can be lost. A microchipped pet is much more likely to be successfully reunited with their owners.
Microchips are inexpensive, safe and permanent identification devices that all pet owners should consider. No one plans to lose their pets. Microchips just stack the odds in our favor of recovering our beloved furry family members should they get separated from us.
Lymphoma is a cancer of the lymph system, which is part of the immune system. It is the most common type of cancer in humans and pets. Lymphoma can affect almost any part of the body. Dogs typically are presented with enlarged lymph nodes or glands. The ones that are usually the first to enlarge are the sub mandibular lymph nodes which are just below the jawline. Dogs that are brought in for “enlarged glands” are usually totally normal, eating, and active, but have generalized lymph node enlargement. Cats rarely present with enlarged lymph nodes. Their disease is usually manifested with gastro intestinal signs, kidney signs, or respiratory signs. Cats usually present thin, with chronic diarrhea, lethargic, and a lack of appetite. Palpable lymph nodes are more likely to be internal, with the lymph nodes that drain the intestines being enlarged. Diarrhea, and weight loss that is not responsive to treatment should alert the clinician and pet owner that lymphoma is a possibility.
Diagnosis is made with fine needle aspirates, or biopsies. Sometimes special stains have to be used to confirm the diagnosis. Lymphoma usually is very responsive to chemotherapeutic drugs. Lymphoma has been studied extensively in humans and effective chemotherapy protocols are readily available. Remission can usually be achieved in 93% of dogs using a combination drug protocol. Length of remission varies, but the usual first remission length is 12-13 months. Smaller dogs tend to stay in remission longer than their larger counterparts. Once dogs come out of remission, they have a reduced chance of going into a second remission, and the length of remission is usually half of the first remission.
The usual protocol is weekly chemo treatments for 4 treatments, then every other week for 20 weeks with a week off between cycles. Weekly CBC’s (complete blood counts) have to be done before chemotherapy treatments. The white count should be above 5000. If the levels are lower, the treatment is postponed. These drugs tend to suppress the bone marrow/immune system and make the patient susceptible to infection. Treatment is usually tolerated very well and the quality of life is excellent. I can attest to this. My dog Candi had lymphoma for 22 months before succumbing to the disease . My cat Charlie had nasal lymphoma and lived just 3 months after detection of the tumor.
Radiation therapy has shown promise in lymphoma patients especially those affecting the head and sinuses and is now available in several institutions in the state.
Vaccination clinics have become pervasive recently as people look for ways to save money when it comes to their pets’ care. These mobile clinics do not have a history with the clients or their pets. They do not perform physical exams on their patients which is the single most important part of an annual visit. The price of vaccines and heartworm checks that mobile vaccination clinics charge is comparable to the prices full service animal hospitals charge. We veterinarians need to do a better job in educating our clients and emphasizing the importance of a thorough physical exam in the annual and preferably bi annual visits. Animals age much faster than we do. Typically the dog or cat ages at about the rate of 7 years to our one. When they come in for their annual visit, it is like us going in to our family doctor every 7 years for physical exams.
I had a case of a dog that came in with the complaint of coughing. I had not seen the dog in over 6 years. When I inquired about vaccination and heartworm history, the owner informed me that she was current. The dog had been vaccinated 2 months before at one of the mobile vaccination clinics. The dog was in serious distress, open mouth breathing and panting heavily. I performed a physical exam and detected a severe heart murmur and an irregular heartbeat. During the course of the exam, the dog collapsed and died. We were initially able to revive her, but she succumbed after much effort on our part to save her. This dog might not have met an untimely end if she had had a physical exam when she was vaccinated. The murmur and irregular heartbeat would surely have been detected and medications would have been dispensed. This was a tragic and needless death of a beloved family pet.
I would encourage clients to speak to their veterinarians about their pets’ annual visits. Arrangements can be made to space vaccinations apart to make it more affordable for the owners without sacrificing the critical physical exam that should be a part of every pets’ annual visit.
Diabetes mellitus or “sugar diabetes” is a common endocrine disorder that affects dogs and cats of all ages. Diabetes mellitus is a deficiency in the hormone insulin. Insulin is produced in the pancreas and its function is to bind glucose from the blood and take it to the tissues where it is the main source of energy. The overwhelming predisposing factor in diabetes of pets is a history of obesity. This is one of the main arguments for maintaining a healthy weight, and to refrain from giving our pets people food which tends to be high in fat and can cause pancreatitis.
The main clinical signs are increased thirst and urination. There are many disorders that can do this, but in my experience, when a client, without any prompting from me, offers that their pet is drinking and urinating excessively, it is usually diabetes mellitus. The kidney can handle glucose and prevent spillage in the urine. A diabetic pet has so much glucose in the urine, that it exceeds the renal threshold. The sugar draws more water into the urine, which causes an increase in urine produced. This can lead to kidney disease, and urinary tract infections. High concentrations of glucose in the urine provides a fertile environment for bacterial growth. Diabetic pets usually have a history of obesity, but as the diabetes progresses, weight loss ensues. Diabetic dogs are also predisposed to cataract formation.
The diagnosis of diabetes mellitus is very straightforward. An elevated blood glucose along with glucose in the urine, confirms the diagnosis of diabetes mellitus.
Management of the disease is with a strict diabetic diet and insulin injections. Oral management is used frequently in humans, but it is ineffective in the management of diabetes mellitus in pets. Insulin injections are given once to twice daily. Cats almost always require twice a day injections. In our practice, we send home charts with our diabetic pet owners that outline how to monitor their pet’s diabetic requirements. We ask our canine pet owners to test their dog’s urine every morning, and adjust the dose of insulin given accordingly. A log of the amount of daily insulin given is kept by the owner, and used as a guide in determining the correct dose to give based on the urine test strip results. Cats do not urinate on command, so they must be managed by having their blood glucose levels checked at our practice until they are managed adequately. This is usually done weekly until the insulin and glucose levels are stable.
Dogs are diabetics for life, once the diagnosis is made, but some cats can be transient diabetics, and with proper management can revert back to a non insulin dependent state.
Diabetic patients can lead long, and happy lives with proper management, but it is a major commitment on the part of their human owners.
Splenic tumors ( tumors of the spleen) are becoming increasingly more common in veterinary practice. The spleen is a large tongue shaped organ that lives in the left side of the abdomen below the stomach and liver. It serves as a reservoir of red blood cells and is an important component in the immune system. In my clinical experience, splenic masses tend to occur in middle aged to older, large breed dogs. When a tumor develops in the spleen, it tends to grow in size and because it is so vascular, it eventually starts to bleed into the abdomen. The clinical signs can be very subtle, but splenic tumors are always on the list of differential diagnoses in a dog that “just isn’t doing right”, has a tense, distended abdomen, pale mucous membranes, and is lethargic. The lethargy comes and goes , and coincides with bleeding. The body’s platelets cause clotting and the abdominal fat (omentum) tends to migrate and stick to the source of the bleeding and and acts as a patch. When this occurs, the bleeding stops, the red blood cells regenerate, and the dog improves.
Diagnosis can be straight forward or difficult. Large splenic masses can be palpated on routine physical exam. I have diagnosed splenic masses in dogs that showed no clinical signs, and were there for routine annual exams. The diagnosis can be more difficult to attain, if the tumor is small, the dog is overweight, or if there is a lot of blood in the abdomen. We often will radiograph the abdomen and chest of a dog we suspect of having a splenic tumor. We radiograph the chest because malignant tumors of the spleen have a high metastatic potential to the lungs and the right side of the heart. If the abdomen is distended we will perform an abdominocentesis, where we insert a needle into the right side of the abdominal wall. The presence of blood is a very bad sign.
Treatment is usually palliative. Malignant splenic tumors or hemangiosarcomas tend to be very aggressive and spread to the heart, lungs, liver and other abdominal organs. 25 % of splenic hemangiosarcomas will spread to the right side of the heart. Surgery alone to remove the spleen buys the owner limited time, 1-2 months at best. The addition of chemotherapy can extend survival a median of 205 days.
In the literature, it states that many splenic tumors are benign. In my experience, this is not the case, and a vast majority, tend to be malignant hemangiosarcomas and carry a grave prognosis.
Spaying and neutering dogs and cats is the most common elective surgery we veterinarians perform every day. Most pet owners choose this procedure because they do not want unwanted litters of puppies and kittens. This is a very real and responsible benefit, but we usually address neutering and spaying as a significant health benefit.
Studies have shown for over 25 years that female dogs and cats that are spayed before their first heat have a 0.05% risk of developing breast cancer later in their lives. If the surgery is done after their first heat, the risk jumps to 8%, and if it is done after the second heat the risk jumps to 26%. Spaying performed after 2 ½ years or 4 heat cycles has no sparing effect on the incidence of breast cancer, but if the pet is presented with mammary tumors and is unspayed, we recommend it to stop the estrogen source to the tumors.
Another risk to unspayed pets are pyometras, or uterine infections. These normally occur 30-60 days post heat. Uterine infections can be life threatening especially if they are with a closed cervix, because the purulent material cannot drain and the pet becomes septic, or the uterus could rupture.
Dogs that are unneutered increase the risk of prostate issues, including cancer. The prostate has receptors for the male hormone, testosterone and grows with age. As a prostate cancer survivor myself, it is a subject that is very near and dear to my heart.
The behavioral benefits of sterilization are well documented. Males do not roam as much, or mark their territory. Males that are neutered, tend to be less aggressive. This does not mean that they will not defend their owners or their families. Females do not bleed and attract males when they come into heat. A common misconception is that pets become overweight when they are sterilized. Sterilization does slow down the metabolism somewhat, so if a pet starts gaining weight, the solution is simple, feed less, exercise more.
One of my favorite sayings is “ My crystal ball is in the shop, and I would never say your pet WILL develop these conditions if they are not sterilized, but their chances definitely go up. Spaying or neutering is just one good proactive thing to do for your pet, to minimize the risks of future health issues!”
Anine demodectic mange disease is caused by the mite demodex canis. These mites are found normally on the skin of most dogs. The demodex mange mite is transmitted from mother to pup during the first few days of life. Normally these mites do not present a problem, but those puppies with compromised immune systems are not able to fight the mange off and the disease takes over. Puppies’ immune systems mature as they get older and become stronger and this is why demodectic mange disease is normally seen in puppies under a year of age. When seen in older dogs, it is usually secondary to some other systemic illness such as kidney, liver, or thyroid disease or cancer. Cats rarely are affected by demodex mange mites.
The disease typically manifests as a localized area of hair loss. This is called localized demodicosis. Left untreated, the disease progresses into a generalized state. This is more difficult to treat and takes longer to get under control. Demodectic mange is not usually itchy unless a secondary staph infection has occurred.
Demodectic mange is caused by a weakness in the body’s immune system that does not allow normal healthy defenses to fight off the mite. It is for this reason that dogs that have demodectic mange as puppies, not be used for breeding purposes. Demodectic mange is not contagious, therefore affected dogs need not be quarantined.
Diagnosis is usually very simple. A veterinarian will take a scalpel blade and scrape the skin and swab a microslip slide which has a drop of mineral oil on it. The slide is placed under a microscope and scanned. Demodectic mange mites are quite easily seen under the microscope with this simple test. They appear as cigar shaped organisms with 8 legs.
There are several treatment protocols. Amitraz dips were once the standard treatment, but their toxicity to both pet and client, has caused this treatment to fall out of favor. Oral ivermectin solutions are very effective, but should not be used in collies, shetland sheepdogs, Australian shepherds and their mixes because of sensitivity issues. There are several topical flea and tick applications which are effective, the best being Promeris but is now not available. It is important to treat the disease past resolution of clinical signs and confirmed by a negative skin scraping. Stopping before a cure is achieved only invites resistance and a more difficult time treating it once it has recurred.
We strongly recommend that all dogs and cats be spayed to prevent a whole host of issues, but we do not advise doing so in demodex affected dogs until the disease has been controlled successfully. Stress can make the clinical signs worse and surgery is a major stress. Demodectic mange rarely comes back once successfully treated, unless a dog that has had demodex as a puppy, is given steroids which compromises the immune system and invites the mite to return.
Bufo toad (Bufo marinus) are toads that were introduced to Florida from Central and South America. They are commonly referred to as cane toads. They can become quite large and are notable for their large parotid glands (salivary glands) that secrete a cardio/neurotoxin when attacked.
Dogs are the most common victims and smaller dogs fare worse because of their small size. When a bufo toad is bitten, it secretes a slimy substance from their parotid gland that is very caustic. It instantly causes irritation to the mucous membranes of the mouth and profuse salivation. These signs can progress to crying and pawing at the mouth and face, incoordination and stumbling, vomiting, seizures and death. Pet owners need to be aware of the signs and act decisively and promptly. The most important treatment is to lavage your pet’s mouth vigorously with water. This will reduce the amount of contact with the mucous membranes in the mouth and prevent further ingestion of the poison. There is no antidote for bufo toad poisoning. Treatment is symptomatic to address the gastrointestinal, neurological, and cardiac signs.
When a person discovers their pet has had exposure to a bufo toad and is showing the signs of profuse salivation, and pawing at the mouth, they should first copiously rinse out the mouth, then seek immediate veterinary care. This most likely will be at a veterinary emergency center because most poisonings occur at dusk when most veterinary hospitals are closed.
Pet owners should be vigilant when letting their pets outside after dark. They should be supervised and any water and food should not be left outside because it will attract the toads.
Bufo toads are non native species that were introduced to Florida. They have thrived and are now found everywhere in south Florida. Pet owners must be aware of this emergent problem and be prepared to act decisively in the event of a bufo toad poisoning.
Easter is almost upon us and one of most popular holiday plants is the Easter lily. Easter lilies are extremely toxic when ingested, and cats are most commonly affected because of their habits of nibbling on plants.
Two years ago my wife Carolynn received a belated birthday bouquet of lilies from her brother. It arrived late on a Saturday morning. I came home at 1 pm from work and noticed this large bouquet of lilies on the counter. I asked my wife what are those, and she replied,” aren’t they beautiful? George sent them to me as a belated birthday gift!” I told her that we needed to get the lilies out of the house, they are extremely toxic if ingested, and we have 9 indoor cats. Carolynn was shocked and said that she already had to shoo several of the cats away from the flowers.
Thursday morning, she called me at work and said she noticed Midnight, our 1 ½ year old cat had not eaten now for the second day, and was hovering over the water bowl. I told her to bring him right in. His body temperature was 92 degrees Fahrenheit, 10 degrees below normal and bloodwork revealed he was in profound kidney failure. We immediately began intra venous fluids, and placed him on a heating pad and transferred him to the Animal Emergency and Referral Center for critical care. We approved all measures to save, him including dialysis. He was there for 2 days and unfortunately did not respond. His kidneys completely shut down and I had to make the heartbreaking decision to euthanize my beautiful cat.
Lilies are extremely toxic, and all parts of the lilies are poisonous. A small piece ingested can cause irreversible kidney failure unless treatment is begun within 18 hours. We did not know Midnight had consumed the lily and by the time he showed clinical signs, it was too late. I urge all my clients not to have any lilies around the house. This is especially important during the Easter season as lilies are ubiquitous. Clinical signs are vomiting, dehydration, lethargy, inappetance, and increased thirst and urination as the kidneys fail. If a cat is known to have ingested lilies, it is critical they be taken to a veterinarian immediately. Vomiting is induced and intravenous fluids are begun. Mortality rates approach 100% in cats that are treated 18 hours or more after a lily is consumed.
I called the local news agencies, television stations and asked that my story be told to prevent another cat owner from going through the grief, we suffered. No one took us up on the offer, they didn’t feel it was newsworthy enough. I called FTD and asked that they consider placing warning labels on their Easter lilies so clients with cats can take preventive measures. It also fell on deaf ears. I hope this article informs cat owners, so no one has to go through the pain we suffered with our dear Midnight.
Hyperadrenocorticism, better known as Cushings disease, is a relatively common disorder of middle aged to older dogs. The disorder is caused by an increase in the production of corticosteroids from the adrenal gland. The adrenal gland normally produces corticosteroids when the blood levels drop or when the body needs an increase in the level of steroids like in a fight or flight syndrome. The pituitary gland produces hormones that stimulate the adrenal gland to produce corticosteroids. If there is a tumor in the pituitary gland, it will produce steroids even when blood levels are adequate. If there is a tumor of the adrenal gland, it will produce steroids even if there are adequate levels in the blood, and no stimulation from the pituitary gland. The resulting clinical signs are increased thirst and urination, increased appetite, and panting. Dogs that have Cushings disease tend to be overweight and have pendulous abdomens, have thin skin, and are predisposed to infections because steroids cause suppression of the immune system. Cushings disease also causes pulmonary hypertension which can lead to cardiac disease. High levels of systemic steroids also can lead to pancreatitis which can result in diabetes mellitus. Clients that have diabetic pets that also have Cushings disease, have a difficult time controlling their pets’ insulin needs because Cushings can cause insulin resistance. The most common cause of Cushings disease in veterinary practice is iatrogenic. This means that we veterinarians and clients actually can cause the disease by over prescribing steroids for the treatment of skin allergies. Clients tend to want their dog to stop scratching yesterday, and steroids are quick and inexpensive. I try to discuss the causes of the allergies, ie food, fleas, inhalants, and treat the cause rather than treating the symptoms. We try antihistamines, and omega 3 fatty acids first, and discuss flea control, and food trials before we resort to steroids.
We veterinarians become suspicious of Cushings disease when we run blood panels and the alkaline phosphatase ( a specific liver enzyme) is elevated when all the other liver enzymes are normal or slightly elevated. The enzyme alkaline phosphatase is highly sensitive to steroids and is the first biochemical clue to early Cushings disease. This is one more reason we encourage routine annual blood panel screens for all pets. This way we can diagnose disease in the earliest and most treatable stage.
There are several tests to diagnose Cushings disease. There is a stimulation test and a suppression test. We do the stimulation test and send it to a lab in Tennessee that also measures hormone levels that are the precursors of corticosteroids. We have found this lab to be the most reliable one in diagnosing the disease.
There are several treatments for Cushings disease. Surgical treatment is impractical, very risky, and expensive. Medical treatment is aimed at management of the disease.
Christmas is almost upon us and children have by now finished their Christmas wish lists. I thought it would be appropriate to give parents some guidelines as to how to choose the perfect Christmas reindeer.
Selecting the right family reindeer can be a daunting task. There are so many sources of poor quality reindeer, that one must do their homework to prevent ending up with a “dud” reindeer. Most sources of reindeer do not allow exchanges or returns after Christmas. Children become attached quickly and it will become harder to exchange a misfit reindeer even if the reindeer source will allow it. Find a reputable breeder. The absolute best source would be from Kris Kringle himself. He has been doing this for generations, and his breeding stock is unmatched in quality and temperament. Mr. Kringle’s reindeer command a higher price, but his reindeer are of the highest quality and temperament, and can fly. The ability to fly is also something that is only seen in the reindeer raised by Mr. Kringle. Most reindeer cannot fly, but this does not detract from their pet qualities. I would definitely stay away from Craigslist or eBay reindeer. These tend to be older reindeer, with pre-existing problems. Humane Societies and animal shelters tend to suspend reindeer adoptions during the holiday season so people don’t adopt them for the wrong reasons. Demand a current health certificate from a veterinarian experienced in reindeer medicine. A good source of names is the AVMA (American Veterinary Medical Association ) directory.
Descendants of one of his most popular reindeer, Rudolph, are the most expensive. The fluorescent, glowing nose is a recessive trait that is only seen every couple of generations. It is also a sex linked trait so only the males have the shiny, red nose. The ability to speak is pure fantasy folks, so don’t be disappointed if your reindeer cannot speak.
I do not recommend reindeer as house pets as they can be very difficult to house train. The tropical Florida climate is not ideal for reindeer, but one can look for the subspecies Reindeerensis floridensis, which have adapted well to our warm climate.
Reindeer do well with pelleted deer feed and good forage. It may be difficult to find deer feed, but most local feed stores can special order them for you. Do not give candy or table scraps as this can lead to diabetes. There is nothing worse than giving twice a day insulin shots to a reindeer. Been there, done that, not fun.
I hope this helps and you enjoy your Christmas reindeer. Merry Christmas to all and a Happy New Year!