Adverse Food Reactions
When we see dermatitis (skin irritation), particularly in very young dogs or cats, we must consider the possibility that there is an inappropriate immune system reaction to something in our pet's diet.
Frustratingly, this is only one of several causes of dermatitis, but read on and we will take you through how we find out whether food is part of the problem or not and what can be done with diet.
What is a Food Allergy?
When an animal eats food, the proteins are broken down in the stomach and intestine leaving only very small protein sections after digestion has taken place. Normal immune systems don't react to these very small protein fragments, but if the intestine absorbs bigger sections of protein, then the immune system can develop an allergic reaction. Once this sensitization process has occurred, then even small proteins can sometimes be a problem.
Unlucky animals can even develop allergy to a food they have been eating for years - it is not always a new diet that will cause problems.
What are the Signs of Food Allergy?
We often see some mild gastro-intestinal signs like soft stools, frequent defaecation, flatulence etc, as well as the skin/ear signs we would associate directly with dermatitis.
The skin signs are often greater on the face, ears and feet, though skin lesions in other areas, or the absence of gastro-intestinal signs, certainly does not rule out food allergy as a contributing cause.
How do we Diagnose Food Allergy?
When we need to rule out or rule in food allergy in animals, we go through a 'food trial' process.
We either choose a protein source and carbohydrate source the animal has never had before, or sometimes we use a special prescription diet, and we feed only this new food, for an 8 week period.
We must be careful not to feed anything else like treats and flavoured wormers. We must be careful what animals pick up around the house and yard or when out on walks.
Ideally we control everything that goes into the mouth, for the 8 week period.
After 8 weeks, we re-introduce all the foods the animal was eating in the past. If the skin (and sometimes the stomach) show worse signs than previously, this shows strong evidence for food allergy.
Why are we looking at a food trial in my pet then?
Usually we need to work out if food allergy is part of the overall skin problem. If it is, then we can use diet as part of our control package. This also may save us from further treatment like allergy testing and desensitization and further diagnostic testing, as well as making your pet's life more comfortable.
Food allergy can be present with other skin problems though and this can be a source of great frustration for owners. For this reason we must see a food trial through and watch fairly closely in first week when we revert back to what we were feeding before the food trial.
If we observe our pets daily for signs of skin itch and stomach upset, then results from food trial are quite accurate.
What do we do if we see a positive result?
A positive result is when an animal improves on the diet trial, then worsens again on re-challenge with the previous diet.
If this happens, we need to avoid the previous diet and find a good long-term option, by repeating our food trial, with the pet.
Most often we try to get animals onto a hypoallergenic diet, though there are sometimes other options available. We must try to find a complete and balanced diet (one that satisfies all nutritional requirements) that is also not going to cause allergy signs.
Thankfully, we can do this one way or the other, usually with a minimum of fuss.
What do we do if we see a negative result?
A negative result is where an animal does not improve on the food trial or does not worsen when re-challenged with their previous diet.
If this happens, we have ruled out food allergy as being part of your pet's skin problems, and will work elsewhere to get on top of the skin disease.
You have now ruled out a potentially major differential in your pet's skin problems.
Canine Congestive Heart Failure (CHF)
Normal Heart Function
The heart, composed primarily of muscle, acts as a highly effective pump. It receives un-oxygenated (or 'used') blood from the body and then pumps it through the lungs where it is re-oxygenated. This blood is then returned to the heart before being pumped through the body.
The heart is composed of four chambers separated by one-way valves; these valves are designed to prevent back flow of blood as the heart beats. Blood can be easily pumped through the valve, but once the more forward chamber is filled, the valve snaps closed to prevent blood from flowing backwards into the atrium. These valves are extremely important to allow the heart to work effectively. See figure 1.
Figure 1 - Anatomy of the heart
What causes heart failure?
The 2 most common forms of heart failure in dogs are dilated cardiomyopathy (DCM) and mitral valve insufficiency (MVI).
Dilated cardiomyopathy (DCM) mainly affects large breed dogs such as Dobermans and Labradors. With DCM, there is dilation of the ventricular chambers, caused by an inherent weakness in the muscle structure of the heart. The heart itself becomes enlarged, bloated, and unable to contract adequately, severely hampering the circulation.
Mitral valve insufficiency (MVI) generally occurs in small to medium size dogs, and some breeds (especially Cavalier King Charles Spaniels), are more susceptible than others.
The mitral valve is located on the left side of the heart and it is this valve that most commonly causes heart disease. MVI occurs when the normally smooth valve edges (which create a perfect seal when closed) become thickened, lumpy and distorted. This results in failure of the valve to completely close with each heartbeat allowing backflow of blood. This causes a traffic jam of blood within the lungs as the heart fails to pump blood effectively in a forward direction, and fluid leaks into the lungs causing coughing. Coughing typically occurs after exercise, excitement, or when the animal has first gotten up after sleeping.
In time the heart starts to fail because of its increased work to try hard to effectively pump blood around the body. At first the muscles of the heart wall strengthen, thereby increasing how thick they are. Over time, however, even these 'athletic' muscles start to fail, at this stage a patient will be weaker and tire more easily, maybe even faint. Due to this muscle remodelling the heart becomes larger and this also can result in coughing due to the pressure the 'big heart' puts on the overlying windpipe (trachea).
Heart failure simply means that the muscles 'give out' due to the heart being required to do more than it is physically able to. Unlike a heart attack in humans, heart failure in the dog is usually a slow process that occurs over months or years. For a time your dog's body may make adjustments to allow it to cope. In fact some dogs manage with a murmur for many years. However, at some point, the disease overrides the adjustments that have been made and the dog can deteriorate and show signs of heart failure.
How is congestive heart failure diagnosed?
The vet may pick up clues to any heart-related problems by examining your dog in addition to important symptoms that you may have noticed at home. By listening to your dog's heart with a stethoscope, the vet can assess the heart rate and rhythm, and detect if there is a murmur present. A murmur can be heard as a result of backward and turbulent blood flow through the 'leaky' valve.
Your vet might also recommend x-rays for your dog to detect fluid on the lungs, or an increase in heart size.
Finally, your vet may recommend an ultrasound of the heart. This provides a clear 3-D picture of your dog’s heart in action, giving information on the appearance of the heart’s walls, chambers, valves and blood vessels. Whilst ultrasound is one of the most accurate methods of diagnosing heart failure, it may not be necessary in some of the more straight forward cases.
What does a diagnosis of mitral valve insufficiency (MVI) mean for my dog?
Although your dog may have been diagnosed with MVI there are many things you can do to help your dog live a full and happy life. It is important to remember that unfortunately, to date, there is no cure for heart failure in dogs but there are many things that can be done to manage the condition. Treatments are aimed at improving quality of life and extending your dog's life span.
Medical treatment may consist of some or all of the following:
- Diuretics (fluid tablets) that remove excess fluid from the lungs
- Medicines that help the heart to work more efficiently
- By opening up blood vessels taking blood away from the heart the work the heart has to do to pump blood around your dog's body is reduced
- By opening up the blood vessels returning blood to the heart results in reduced pressure on the heart
- Medicines that improve the strength and effectiveness of your dog's heart beat
Your vet may prescribe more than one medication to help treat different aspects of heart failure, and may also need to make regular adjustments to the treatments (because heart failure can progress over time).
As well as providing medication, lifestyle, general health care and monitoring are extremely important:
- Body weight - keeping your dog’s weight healthy can lessen the severity of symptoms.
- Dental disease - valves of the heart can be injured by infection, this infection often arises from dental disease as bacteria from the mouth enters the bloodstream. Good oral health is extremely important in heart disease.
- Exercise - regular gentle exercise is thought to be beneficial for dogs that have only mild symptoms but if your dog seems tired, stop exercising.
- Diet – during heart failure, the body will retain more salt and water than is required, so it's a good idea to cut down on your dog's salt intake. Your vet can help you choose the right brand of pet food for your dog that is nutritionally balanced and low in salt. Treats and "people food" like chips, cheese and processed meat are all high in salt and are not suitable for a dog with heart failure.
- Counting breathing rates can help you to monitor your dog's lung function. When your dog is resting or sleeping, count the number of breaths he or she takes in 15 seconds. Multiply that number by 4 to get the number of breaths per minute. In well controlled patients the number of breaths per minute should not be more than 30-40. If the respiratory rate is above 40 or increases by more than 20% suddenly, let your vet know.
Unfortunately there is no cure for MVI. Medications however help to both slow down the progression of the disease and improve quality of life for your pet.
What does a diagnosis of Dilated Cardiomyopathy (DCM) mean for my dog?
Unfortunately the prognosis for dogs with DCM is worse than for that for dogs with MVI.
DCM is always fatal. Death usually occurs 6-24 months following diagnosis but can occur sooner if the disease is very advanced at the time of diagnosis.
Dogs that have irregular heartbeats are more likely to have shorter survival times or to suffer sudden death.
Medical treatment may consist of some or all of the following:
- Medication that help the heart to work more efficiently
- By opening up blood vessels taking blood away from the heart the work the heart has to do to pump blood around your dog's body is reduced
- By opening up the blood vessels returning blood to the heart results in reduced pressure on the heart
- Medication to help with an irregular heartbeat.
- Diuretics (fluid tablets) that remove excess fluid from the lungs.
What is reverse sneezing?
Reverse sneezing refers to the sound a dog makes similar to inhaling a sneeze, similar to a honk or snort. Whilst hearing your dog make reverse sneezing noises can be quite distressful and noisy, it in fact is a simple condition that usually does not need any treatment.
What causes reverse sneezing?
The most common cause of reverse sneezing is an irritation of the soft palate and throat that results in a spasm. During the spasm, the dog's neck will extend and the chest will expand as the dog tries harder to inhale. The problem is that the trachea (windpipe) has narrowed making it difficult to get the normal amount of air into the lungs.
Irritation of the throat and soft palate can be caused by anything, including allergens like pollen or other irritants like perfumes. Excessive pressure on the throat, excitement, rapid food and water ingestion ('inhaling food') are also common causes. Obesity is also a major and common factor.
One of the most common causes is elongation of the soft palate, common in brachycephalic dogs such as Pugs and British Bulldogs. This is when the soft palate is sucked into the throat during inhalation, resulting in reverse sneezing.
It is important to note that a large majority of cases of reverse sneezing do not require treatment. Treatment does depend mainly on the inciting cause of the reverse sneezing. For example if allergies are the root of the problem, your veterinarian may prescribe antihistamines or steroids. Elongation of the soft palate can be surgically corrected if necessary.
However if reverse sneezing becomes a chronic problem rather than an occasional occurrence, and provides a hindrance to your dog's daily activities, your veterinarian may need to look up the nasal passages with a flexible camera (rhinoscopy), and may even need to take a biopsy to determine the cause of the problem. Sometimes, however, no cause can be identified.
Some dogs have these episodes their entire lives; some dogs develop the condition only as they age. In most dogs however the spasm is a temporary problem that goes away on its own, leaving the dog with no after effects.
Brachycephalic means short-headed (short-nosed), and many breed of dogs have been bred for this type of appearance. Boston terriers, Pekingese, Pugs, Bulldogs, and Shih Tzus are all examples of breeds with a "pushed-in," or brachycephalic, face. The bones and associated structures of the head are shaped in such a way as to give these dogs the typical appearance of their breed. However, this shape also causes mild to severe breathing problems because the upper airway is too small-especially the nasal passages, glottis (throat), and trachea (windpipe).
The term brachycephalic upper airway syndrome describes the anatomic abnormalities and the problems associated with having an excessively short nose and face. This applies to short-nosed dogs more often than short-nosed cats like Persians.
Stenotic nares: Narrow, small nostrils make it difficult for the dogs to draw in air through the nose.
Elongated soft palate: These dogs have excess tissue of the soft palate that can obstruct the flow of air through the pharynx and larynx (upper throat).
Everted laryngeal saccules: These small sacs in the throat are normally inverted and cannot be seen. With excessive negative pressure (which occurs when these dogs inhale), they can be sucked inside out and further obstruct the airway
Hypoplastic trachea: The tracheal rings may be smaller than normal, resulting in a trachea that is narrower in diameter than it should be.
• Increasingly noisy breathing (stridor).
• Respiratory distress (more than just panting-fighting to breathe).
• Difficulty swallowing.
• Excessive snoring or restless sleeping habits (dog cannot sleep deeply).
• Exercise intolerance.
• Cyanosis (gums and tongue turning blue) or syncope (fainting).
The symptoms of this syndrome vary based on how severe the anatomic irregularities are. The abnormal structures are present from birth, but clinical problems often do not arise until the dog is over 2 years of age because the tissues attain their adult size around this time. Some dogs only develop mild symptoms and do not require intervention. The typical "snorting" of a bulldog or Boston terrier is a mild example, and many dogs are not otherwise affected. However, at the other extreme, other dogs develop such a degree of airway obstruction that they have trouble breathing, especially on inhaling.
The condition is progressive over time. Elevated resistance of airflow over a long period of time can cause increased obstruction and weakening of the larynx, leading to possible laryngeal collapse. Such severely affected dogs may become cyanotic (bluish tongue and gums caused by oxygen deprivation) and experience exercise intolerance and syncope (fainting). These very serious symptoms are exacerbated by obesity, hot weather, and excitement, and dogs with brachycephalic upper airway syndrome should avoid these conditions, especially if respiratory difficulty is noted to worsen. If an episode of dyspnoea (difficulty breathing) is severe enough, the dog could die from brachycephalic upper airway syndrome.
Confirming that brachycephalic upper airway syndrome exists in a certain dog is based on your description of the symptoms you have observed and physical examination to assess respiratory system and confirm the presence of stenotic nares. Under sedation, an inspection of the larynx using a laryngoscope (speculum with a light) can detect an elongated palate and everted laryngeal saccules. Radiographs (x-rays) of the chest may be taken to rule out other airway of lung diseases and to visualize the trachea.
Brachycephalic upper airway syndrome does not necessarily affect life expectancy. However, an episode of respiratory distress can quickly worsen into an emergency situation. You must monitor your pet closely to avoid these situations and to intervene early if complications (such as replacement of the pink color of the gums and tongue by a blue color-cyanosis) occur. A dog having difficulty breathing can easily panic and increase his or her respiratory efforts, which in turn can create swelling in the structures of the upper airway and cause a self-perpetuating decline in respiratory function. In such cases, it is important to keep the animal cool and calm while heading directly to a veterinary facility.
If your dog has this condition and it worsens to the point of requiring hospitalization in an emergency situation, treatment may include the following: tranquilization to calm the dog down, anti-inflammatories given by injection to decrease swelling in the nose and throat, and supplemental oxygen. The veterinarian may need to perform a temporary tracheostomy (surgical opening into the throat) if the condition has reached a life-threatening state. As for humans, such a procedure involves a plastic tube that is surgically placed into the trachea for a few hours or a day or two to bypass a swollen or collapsed larynx so that the dog can breathe.
If your dog has brachycephalic upper airway syndrome, your veterinarian will be able to help you decide if surgery is appropriate to increase the size of the airway and reduce the risk of future breathing difficulty. Surgery most often involves resection (trimming) of stenotic nares to widen the nostrils, resection of the soft palate, and/or resection of everted laryngeal saccules. An important consideration is that surgery may be most effective if performed on young dogs before there is a problem. Once the soft tissues structures of the larynx are chronically inflamed, surgery may be more risky and invasive. It is for this reason that we will often recommend that your pet is assessed for the anatomical abnormalities when young and surgical correction undertaken at desexing at 6-12months of age.
Soft Palate Resection:
Removal of Everted Laryngeal Saccules:
At Home Management:
Home management consists mostly of avoiding situations that can lead to respiratory problems.
Obesity increases the work of breathing, so it is important to make sure that dogs with brachycephalic upper airway syndrome are not overweight.
Overheating and prolonged panting can be dangerous to these dogs. Keep your dog cool on hot humid days and never leave him or her in a car, outside on a hot day, or in an enclosed kennel.
Stress also poses a major risk. In dogs with brachycephalic upper airway syndrome, it is important to discourage excited behavior such as persistent barking at visitors
Use a harness instead of a collar to avoid pressure and swelling to the neck.
Monitor your dog closely for worsening of symptoms, in terms of intensity of symptoms, frequency of symptoms, or both.
The normal eye and tear function
In a healthy dog, the eyes look bright, clear and moist. Normally, tears are produced by several glands around the eye and spread by the process of blinking to form a protective layer over the surface. It is this tear film that keeps the surface of the eye and the lining of the eyelids in a healthy condition.
Tears perform a vital function. They not only lubricate the movement of the eyelids and wash out any foreign material, but also provide nutrition and oxygen to the cornea - the clear, outermost surface of the eye. In addition they contain substances which help to prevent bacterial infection. So with insufficient tears the health of the eye is jeopardised.
What is KCS?
There are many causes of KCS but in most cases the dog's own immune system - which usually works to protect the animal against disease - is responsible for the condition. It appears that the dog's immune system identifies its own tear glands as 'foreign' and attempts to destroy them. As a result, tear production is progressively reduced.
Left untreated, the glands continue to be progressively damaged and may lose the ability to produce tears altogether. And without tears, the eye may become permanently scarred, leading to blindness.
What are the signs of KCS?
Most cases of KCS are chronic, meaning they develop and worsen over time. In the early stages of disease KCS may not show many signs. However a number of signs develop over time. These include:
- Discharge - usually thick mucoid or pus like discharge that can be caked to the eyelid margins
- Corneal ulceration (figure 1)
- Squinting and rubbing at the eye/s
- Red eyes and other signs of conjunctivitis (figure 2)
- Keratitis - colour change (cloudiness and discolouration) and blood vessel growth on the normally clear eye surface
Figure 1 - Corneal ulceration following application of fluorescein dye
Figure 2 - Conjunctivitis and scleral injection
Figure 3 - Demonstration of the Schirmer tear test
How is KCS diagnosed?
Your vet may be suspicious of KCS if your dog is showing classical clinical signs of KCS or is an at risk breed.
To confirm the diagnosis of KCS a Schirmer Tear Test (STT) (Figure 3) needs to be performed. A special paper test strip is placed in each eye and the tears produced in one minute are measured.
A normal dog produces more than 15mm/minute of tears. KCS is diagnosed when less than 15mm/minute of tears are produced. Not only does the STT diagnose KCS but is also used to monitor response to treatment over time.
In a very small percentage of individuals there is a problem with tear quality rather than quantity. This can be assessed by a specialist ophthalmologist.
How is KCS treated?
KCS is much easier to treat while there is still some functional gland tissue present. Patients that have an initial STT result of more than 5mm/minute and who have had the disease for less than six months have a better prognosis and are more likely to respond to treatment.
Cyclosporin ointment (Optimmune) is an immune-modulator which acts to reverse the immune process that lies at the root of the problem of KCS. It works in three distinct ways:
- Reverses the immune response that causes damage to the tear glands, restoring your dog's normal tear secretion.
- Actively stimulates the production of genuine tears, containing all the substances so vital to the health of the eyes
- An anti-inflammatory action which helps control the pain and discomfort, and reduce the amount of discharge.
Are other treatments required?
In the early stages of treatment, whilst the tear glands are recovering their function artificial tears and protective ointments will need to be used.
- Artificial Tears - There are many brands of artificial tears on the market. These can be purchased from the chemist. Some examples include Liquifim, Cellufresh, Celluvisc, Tears Naturale, Tears Plus and Hylashield.
Some dogs may be irritated by the preservatives in these tears in which case preservative free tears should be used. These come in individual vials such as Refresh.
These need to be used every one to two hours when possible (as they only last this long on the cornea).
These can last on the surface of the cornea for six to eight hours. They do not however replace the need for artificial tears.
These should be used when you are not able to put artificial tears in the eyes every one to two hours. For example before you go to bed or before work or going out.
Viscotears is the best protective ointment to use in KCS cases.
After KCS has stabilised these preparations do not need to be continued however are very important in the early stages of treatment as Optimmune does not instantly fix or control the condition.
Your vet may also dispense other ointments to control infection or to help reduce or reverse signs of keratitis. This will vary from case to case.
How to use Optimmune
- Store Optimmune at room temperature (<25 C)
- Optimmune can be placed in the fridge for 15-20 minutes prior to use (but do not leave it in the fridge), this makes the ointment a little firmer so that a smaller amount of ointment can more easily be applied
- Only a small amount of ointment needs to be used, approximately the size of a grain of rice (more can be used but the tube will last much longer if you use only a small amount)
- Gently pull down (roll out) the lower lid and squeeze a strip of ointment into the inside of the eyelid. As your dog blinks the ointment will spread over the eye.
- Wash your hands before and after treating your dog.
How will I know if my dog is getting better?
The speed of recovery very much depends on how far the disease has progressed before treatment has started. In most cases your dog will appear more comfortable, the eye will be more moist and the discharge will start to clear within the first couple of weeks. It can however take six to 12 weeks for the condition to stabilize. Regular re-checks with your vet will be required while the condition is stabilising, the Schirmer tear test will be repeated and they will advise you when your pet needs the next check up. Once the condition has stabilised check-ups once every 6 months will be all your pet needs.
DO NOT STOP TREATMENT even if the eyes look better, the condition is lifelong and Optimmune will be required every day for the rest of your dog's life. If the ointment is stopped the condition will return and the longer the condition is not treated, or inadequately treated, the more difficult it is to control.
In some cases that do not respond well to Optimmune alternative treatments or increased frequency of Optimmune may be required. In extremely severe cases that fail to respond to topical medication referral to an ophthalmologist may be required and for some patients a surgery, known as a parotid duct transposition, may be recommended.
Hyperadrenocorticism aka Cushing's Disease
What is Cushing's disease?
Cushing's disease, or hyperadrenocorticism, occurs in dogs who are producing excessive amounts of cortisol, an important hormone that helps to regulate the body's metabolism.
Cortisol plays a vital role in protein, carbohydrate and fat metabolism and is released into the bloodstream at times of stress to prepare the body for a flight or fight response.
Cortisol is produced by the adrenal glands - two small glands located in the abdomen, next to each kidney. A hormone called ACTH controls the production and release of cortisol from the adrenal glands. ACTH itself is produced by the pituitary gland, a pea-sized gland located at the base of the brain.
The concentration of cortisol in the blood of healthy animals varies greatly as the body's demand for cortisol fluctuates. For example, during a period of stress or illness, it is normal for the adrenal glands to increase their production of cortisol. Once this period of stress has passed, the cortisol concentration in the blood returns back to normal.
What causes Cushing's Disease?
Most dogs with Cushing's disease (approximately 85% of cases) have a benign tumour of the pituitary gland. The tumour cells produce large amounts of the hormone ACTH, which in turn stimulates the adrenal glands to overproduce cortisol.
The other cause of Cushing's (approximately 15% of cases) is a tumour of one (or very rarely both) of the adrenal glands, which produces excessive amounts of cortisol.
Irrespective of the cause of Cushing's syndrome in your dog, the result is always the same - more cortisol is produced than is actually needed by the body. This results in the slow development of a combination of clinical signs that are classically associated with Cushing's.
What are the signs of Cushing's disease?
Cushing's is more often seen in older dogs and in smaller breeds of dog. The most common clinical signs include:
- Hair loss or hair thinning
- Muscle wastage
- Skin diseases and/ or thin skin
- Changes in behaviour
- Increased drinking/ water intake
- Frequent urination and possible incontinence
- Increased or ravenous appetite
- Excessive panting
Not all dogs will react to the disease in the same way and your dog may not necessarily display all of these signs.
How is Cushing's disease diagnosed?
Because the most common signs of the disease are very similar to those associated with the normal ageing process the disease can at times be difficult to diagnose and later monitor. Additionally, in most cases, the changes in your dog's appearance and behaviour caused by Cushing's occur very gradually, making them easy to overlook.
Initial signs and behaviours at home might alert your vet to Cushing's disease or sometimes the results of a routine blood test may lead your vet to suspect this condition. It is important however to know that diagnosis is not always straightforward.
Once your veterinary surgeon suspects Cushing's, he/she will need to perform more specific blood tests to confirm the diagnosis.
The two tests that are used to confirm a diagnosis of Cushing's are called the ACTH stimulation test and the low-dose dexamethasone suppression test. It may be necessary to perform both tests or just one.
The ACTH stimulation test is the most common test performed. It involves taking blood to measure cortisol before and after your dog is given a synthetic version of the hormone, ACTH. This test assesses how well your dog's adrenal glands control the production of cortisol. You will need to leave your dog at the hospital for a few hours or for the day.
In addition to blood tests it may be recommended that an abdominal ultrasound is performed to look for an adrenal tumour.
How is Cushing's disease treated?
Cushing's syndrome cannot be cured but it can be successfully managed and controlled through a medication, maintaining a good quality of life for your dog for years to come. The medication used is called trilostane and contains a chemical substance that reduces the production of cortisol by the adrenal glands.
Trilostane needs to be given once daily. We recommend that you give your dog trilostane with a meal in the morning, as this will make it easier for your vet to perform monitoring tests 4-6 hours after dosing.
The following points should be followed when using trilostane:
- Wash hands after handling
- DO NOT split capsules
- DO NOT handle if pregnant or trying to conceive
- DO NOT double dose if a tablet has been missed
- DO NOT change your dog's dose without advice from your vet
- Ensure you continue giving your dog the prescribed dose of trilostane every day. Even if you notice dramatic physical improvements to your dog's health - for example your dog's appetite is back to normal or your dog is no longer incontinent - this does not mean that you should stop treatment. Trilostane will curb the excesses associated with the overproduction of cortisol but it will not cure the disease.
Many clients like to take a photo before starting treatment so that improvements that are less noticeable on a daily basis (hair regrowth or loss of pot belly) can be monitored. Note your dog's weight, water consumption, appetite and frequency of urination before treatment so you can monitor its improvement once treatment starts.
The clinical signs of Cushing's such as lethargy, increased drinking, eating and urination improve quickly - often within the first two weeks of treatment. Skin changes and hair loss however usually take up to 3 to 6 months to improve.
What ongoing monitoring is required?
Your dog will need to be carefully monitored and return for follow-up appointments on a regular basis. Once your vet is happy that your dog is stable, you will normally need to visit every three to six months to make sure nothing is affecting your dog's condition.
The results of routine blood tests and an ACTH stimulation test are used to assess the effectiveness of trilostane treatment. These tests are usually performed at 10 days, four weeks, 12 weeks and every three to six months after starting treatment.
At some stage during therapy it might become necessary to adjust the dose of trilostane prescribed as it is common that requirements change over time.
What possible side effects can occur?
Trilostane is very well-tolerated by most dogs. If your dog becomes unwell at any time whilst on consult your vet as soon as possible.
Monitor you dog carefully for any lethargy, vomiting, diarrhoea and anorexia, if any of these occur please stop treatment immediately and contact your vet.
Monitoring is important and regular checks performed by your vet will ensure your dog continues to get the best possible care.
What is hypothyroidism?
Hypothyroidism is a disease where a dog's immune system slowly destroys their thyroid gland tissue.
Thyroid glands produce thyroid hormone, which is vital in maintaining metabolic rate.
This affects all the cells and organs in the body, though some areas are more affected than others: the stomach and intestines, the skin and the immune system for instance are more affected by hypothyroidism.
It affects larger breed and older dogs, more-so than smaller breeds and younger dogs. It has a largely genetic basis.
Signs of hypothyroidism?
Often not all of these signs are present, but these are some of the signs we do look for:
- Weight gain, sometimes despite not feeding much food;
- Hair loss and increased skin pigmentation;
- A history of problems in stomach/intestine, airways and urinary tracts (usually through a weak immune system allowing infection in);
- Dogs may seek warmth/heat, even on warm days
- They may be mentally dull
Other problems can arise from undiagnosed hypothyroidism. We can see oesophageal enlargement and dysfunction, problems around the vocal folds which affect breathing and sore dysfunctional muscles
Diagnosis of hypothyroidism
Diagnosis needs to be done with some care, though all in all cases, blood testing is the way to achieve a diagnosis.
There are a few ways of testing the thyroid, the most useful and effective combination of tests is checking a dog's free T4 and also their thyroid stimulating hormone (TSH).
Figure 1 - Thyroid physiology
Figure 2 - Laryngeal Paralysis (PetMD.com)
Other tests are sometimes done and we do see markers of hypothyroidism on other tests, for example, other blood tests, skin biopsies or by diagnosing vocal fold (laryngeal) or oesophageal problems (see figure 2). We can then check the thyroid more directly if dog owners feel inclined to pursue the problem.
Treatment and Monitoring
Treatment is quite simple and safe and usually inexpensive: we provide the thyroid hormone, in a tablet form, that the body would otherwise produce for itself.
In order to ensure the right level of support is given, as too little or too much will eventually cause problems, we need to check the levels by doing a simple blood test. This is most easily done just before the evening tablet is due, but can be done in other ways if necessary.
We do need to keep hypothyroid dogs on medication (thyroid hormone tablets) for life, as once the thyroid tissue is gone, it does not grow back.
Sometimes we need to monitor the problem more frequently (if there are more ups and downs in results or if dogs are just not doing as well as we would like).
Other times dogs are checked only once or twice a year, if they have been on medication for a long time. There is a balance to be struck in each case, our vets will allow you to see what the options are and to make a decision which suits your situation best.
If you think your dog may have some of the signs of hypothyroidism, or if you want to know for sure (sometimes for breeding purposes etc), then please phone our hospitals or mention it next time you are talking to one of our vets or nurses.
What is diabetes?
Diabetes is a common disorder in people as well as dogs, any breed, age or gender of dog can be affected. Diabetes occurs when the body is unable to regulate blood glucose (blood sugar) levels. Blood glucose levels are normally well controlled by insulin, a hormone produced by the pancreas. In a diabetic dog the insulin producing cells of the pancreas do not produce adequate insulin to regulate blood glucose. This usually occurs because the cells have been damaged by disease or self destruction (known as immune mediated destruction). The type of diabetes that affects dogs is type 1, or insulin dependent diabetes.
- enables glucose to pass from the blood stream and into body cells where it is needed to be used as fuel (or energy). In a diabetic dog glucose within the blood stream (from food that is eaten) is not available for the body to use. The body responds to this by breaking down stored protein and fat to be utilised as an alternative energy source. As a result your dog may want to eat more food than usual in an effort to supply this additional energy but despite this increased appetite and intake your dog may lose weight. See Figure 1 for a diagramatic representation.
In addition to weight loss despite increased appetite, increased thirst and urination is also seen. This occurs because of high urine glucose as excess blood glucose is filtered by the kidneys and excreted in the urine. This high urine glucose acts to pull excess water into the urine hence increased urination occurs. As a direct response of excess water loss through urine a diabetic dog needs to drink more water in order to replace it
What are the symptoms of diabetes?
The following symptoms are most commonly seen in diabetic dogs:
- Increased appetite
- Weight loss
- Excessive thirst and urination
Signs of more advanced Diabetes include:
- Loss of appetite
- Ketoacidosis - a life threatening complication of untreated or inadequately treated diabetes
- Blindness due to cataracts
Diabetes is diagnosed by a combination of clinical signs, blood and urine tests (see figure 2).
How is diabetes treated?
The treatment of a diabetic pet requires a very dedicated owner. Treating a diabetic pet requires considerable commitment, both personally and financially. Treatment involves management or treatment of any concurrent diseases, medication to lower blood glucose concentration (insulin), and dietary management.
Figure 1 - Pathophysiology of diabetes (WebMD)
Figure 2- Urine dipstik test
Most owners are capable of administering insulin injections after proper instruction and demonstration.
Diabetic patients require twice daily insulin injections; each dose must be given at the same time and time interval each day. All insulin should be stored in the refrigerator.
Injections should be given in the same general area of the pet each time (see figure 3). Most clients find the back or the neck/ shoulder area easiest. The skin does not need to be prepared before injection but it should be clean and dry. The same syringe can be used for 2 consecutive days (4 doses) so long as the needle stays sharp and is capped between uses. All needles need to be discarded into a sharps container after use.
We recommend giving insulin after your dog eats or during a meal. If for some reason your dog will not eat a half dose only should be given and an appointment should be made if inappetence continues.
If at any stage you are unsure if your dog has received the correct amount of insulin (if another family member may have given it or if part of the injection does not go under the skin) we advise not to give more insulin until the next dose is due.
Figure 3- Administering insulin injections
The correct amount of kilocalories (food) must be given each day.
The total energy requirement for the patient needs to be calculated, feeding a commercial feed is the best way this calculation can be adhered to. The amount needs to be fed in 2 equal meals at the same times each day. The ideal food will release carbohydrates slowly, avoiding rapid changes in blood glucose levels.
The appropriate food for your pet will be determined based on body weight and discussion with your vet.
Unfortunately, we recommend no between meals snacks. Fresh water must always be available.
Daily exercise should be provided but it must be constant in the amount and the intensity.
After initial diagnosis your pet will need regular blood glucose curves. Usually they will be every 2 weeks to start with, until things have stabilised and then less frequently. They will normally have a repeat blood glucose curve 2 weeks after any change to insulin dosage as well.
Longer term a full physical examination and blood glucose curve will need to be conducted at the hospital every 6 months once your dog is stabilised. Ongoing blood glucose curves are important as over time a diabetic’s insulin requirements change.
Blood glucose curves involve your dog staying in hospital for the day after normal breakfast and morning insulin is given at home. Throughout the day multiple blood glucose samples are taken to create a curve. Blood glucose curves allow alterations in dosage to be made before either insulin overdose occurs or complications arise from inadequate treatment.
The body weight of a diabetic must be closely monitored. As weight changes, the body's requirement for insulin is altered. For this reason regular weight checks are extremely important. We recommend fortnightly to monthly weigh-ins during the stabilisation period followed by every three months once stable (more frequently if any obvious changes are noticed).
Water consumption needs to be measured at home once a month. This should be done more frequently if any changes in are noticed.
We also recommend regular urine tests (every three to six months) to check for urinary tract infections.
What to do if an overdose of insulin is given or your pet shows signs of hypoglycaemia (low blood glucose)?
Hypoglycaemia can occur when an accidental overdose occurs or when you dog's insulin requirements slowly or quickly change. It may also occur if your pet is unwell and doesn’t eat or vomits up food they have eaten. Sudden, strenuous activity can also potentially cause hypoglycaemia.
Hypoglycaemia can be life threatening it is extremely important to be aware of the signs and know what to do if this occurs.
Signs can include altered behaviour, nervousness, weakness or wobbliness, collapse, twitching muscles, disorientation, seizures, and abnormal lethargy.
If any of these signs are seen your pet should be seen by a vet immediately.
At home we recommend owners apply glucose syrup or honey to their dog's gums and try and get them to eat.
Figure 4 - A glucometer is used to check blood sugar levels
Complications of diabetes
- Recurrent infections, especially oral (dental) and urinary tract infections. Unfortunately infections can result in insulin resistance and can therefore complicate diabetes control or 'destabilise' well controlled patients.
- Poor wound healing.
- Cataracts - cataracts result from deposition of sugars into the lens of the eyes. Subsequent to this water is pulled into the lens causing swelling and damage to the lens fibers and causes cataracts.
- Pancreatitis and Cushing's disease - dogs with diabetes have an increased risk of these diseases and can complicate control.
Although a serious disease requiring a large amount of commitment in order to treat, a well stabilised and regularly monitored diabetic pet can enjoy a long and happy life.
Figure 5 - Poor dental health can cause complications with diabetes
What is Osteoarthritis?
Osteoarthritis is a painful, degenerative condition of the joints affecting 20% of adult dogs. Most commonly this condition affects the shoulders, elbows, hips and knees.
The condition occurs when the normal smooth cartilage lining of the joint is reduced resulting in mobility loss, pain and discomfort.
Dogs of any age or breed can be affected by osteoarthritis however older, large breed or overweight dogs are more prone to the condition.
Although symptoms are variable owners often notice the following signs in their dogs:
- Activity reduction: reluctance to walk, play, jump or climb stairs, lagging behind on walks.
- Lameness, difficulty rising from lying down especially in the morning or in cold weather.
- Aggressive, irritable or painful behaviour especially when touched
- Muscle wasting
Although a progressive condition with no cure there are multiple strategies available to help preserve healthy cartilage, increase joint mobility and ease pain.
What can be done to help?
- At Home
- Bedding: always ensure your dog has a warm and comfortable place to sleep, with plenty of padding and out of cold, wet or drafty conditions.
- Exercise: avoid vigorous or unaccustomed exercise, such as ball games or long weekend outings, which may aggravate diseased joints and cause considerable discomfort to your pet. Instead chose regular low intensity exercise to maintain muscular strength such as walking or swimming.
- Weight control: excess weight places a large strain on your pet’s joints. Obesity causes increased aggravation, pain and damage to joints. It is extremely important to strive to maintain your pet at his or her ideal weight in the management of osteoarthritis.
- Prescription diets: HILL’S J/D is a diet clinically proven to help arthritic patients. In addition to being a complete and balanced food J/D provides omega-3 fatty acids to reduce inflammation around and within joints. This may in turn reduce your pet’s reliance on medications such as anti-inflammatory drugs.
- Additives: SASHA’S BLEND, PERNAEASE POWDER and JOINT GUARD are natural concentrates that can be added to your dog’s food. These products contain ingredients such as chondroitin, glucosamine sulphate, green-lipped mussel, abalone powder, shark cartilage. These are aimed to promote normal joint function and mobility.
- Veterinary assistance
- Disease modifying drugs: CARTROPHEN VET is an injection that can be given by your vet to slow the progression of arthritis, it works by inhibiting the destruction of cartilage within affected joints and increasing the production of joint lubricating fluid. The injection is usually given weekly for four weeks then as a three or six monthly booster.
- Anti-inflammatory medications:
These drugs are used to reduce the pain and inflammation associated with arthritic joints. They work by reducing the body’s production of substances that give rise to both pain and inflammation associated with arthritis. This can be beneficial in increasing mobility as well as quality of life for your pet. Like many drugs these medications can have effects on internal organs such as the liver and kidneys. For this reason our hospital recommends a blood test be performed to check organ function prior to starting medications and during treatment.
As some animals wont tolerate anti-inflammatory medications for different reasons Gabapentin provides an alternative long term pain control for arthritis. It has minimal side effects but does need to be given daily ongoing in order to be effective.
The normal knee joint
Within the knee joint there are two cruciate ligaments, the cranial cruciate ligament (often called the anterior cruciate ligament in people) and the caudal cruciate ligament.
These ligaments cross over each other as they pass between the two main bones of the leg, the femur and tibia (or the thigh and shin bone). These ligaments act to stabilize the knee (see figure 1)
What is cruciate ligament injury and how does it happen?
Most commonly it is the cranial cruciate ligament that is involved in cruciate ligament injury and this can be either the partial or full rupture of the ligament. There are two main ways cruciate ligament injury can occur, acute or degenerative. These categories however are often interrelated as ligaments weakened by degeneration are more susceptible to trauma.
1) Acute - sudden overextension or over rotation of the knee caused by certain activities such as ball chasing, quick stop-start or turning movements or jumping down from a height.
2) Degenerative - slow wearing out of the ligament due a variety of factors such as age, arthritis, obesity or conformational abnormalities (straight back legs for example).
Figure 1 - Normal stifle anatomy
How is cruciate ligament injury diagnosed?
Dogs with torn cruciate ligaments often present to the hospital with a sudden minimally or non-weight bearing lameness. They are usually holding their leg off the ground or just touching their toes or foot to the ground but are reluctant to put much pressure on the foot. This may occur after normal activity (in degenerative cases) or after athletic activity or trauma (in cases of acute rupture). In some cases however lameness may be only mild or intermittent in nature if the ligament is only partially torn. Partially torn ligaments often progress into full ruptures in time.
In patients with older ligament injuries sometimes the thigh muscles of the affected leg become wasted from disuse and the knee joint may also be thickened from inflammation and arthritic changes.
The instability of the knee joint that occurs following a cruciate ligament tear can sometimes be determined by the vet during a consult. In many dogs however this instability or movement can only be detected in the sedated or anaesthetised animal. This is because most animals are very tense and in pain and therefore do not fully relax their knee joint in consultation.
In addition to confirming cruciate ligament injury while anaesthetized and relaxed xrays are also taken. Xrays do not show up the ligament directly but help provide information about joint health, provide post operative prognostic information and help determine the best surgical method of repair depending on the anatomy of the individual (see figure 2).
How is cruciate ligament injury treated?
Surgery is the only recommended treatment for cruciate ligament injury. Various factors determine the best surgical approach for an individual and these factors include weight, leg and knee joint anatomy, prior arthritic changes, breed, age and temperament of the dog.
Figure 2 - X ray of arthritic knee joint with cruciate rupture
What happens without treatment?
In cases where the knee joint is not stabilised by surgery, arthritic changes develop within weeks and progress to severe changes within months. This results in muscle wastage, pain and continued lameness.
Although surgery is advised in all dogs to ensure optimum function, in dogs that weigh less than 10kg, non-surgical management of cruciate ligament injury can be tolerated in some cases. However it is important to be aware that although lameness may appear to be improving within three to six weeks the instability persists and arthritic changes ensue causing ongoing pain.
Surgical methods for repair
The De Angelis Repair Method
This method of repair is suitable for all dogs that weigh less than 20kg and some dogs who weigh over 20kg. The procedure involves placing a prosthetic (artificial) ligament outside of the knee joint (see figure 3)
This method of repair is used as it is not practical to repair the original ligament because of its position deep within the joint and the fact that it is only a very short ligament (less than one centimetre long).
In this technique a prosthetic ligament is anchored above and behind the knee, it is then pulled across the outside aspect of the joint to attach in front and below the joint.
The result of this placement is the prosthetic ligament mimicking the original and providing stability to the joint.
Once the prosthesis has been placed the overlying tissues are sutured closed and your dog will be left with a line of stiches or staples on the outside of the leg extending above and below the knee joint.
Figure 3 - De Angelis Suture
The TTO (Triple Tibial Osteotomy) repair method
This repair method is the recommended for dogs who weight more than 20kg. It is not suitable for smaller dogs because their bones are too small for the plates used.
Because the De Angelis repair method has a higher failure rate in large, athletic and young dogs we recommend the TTO method in these patients. The TTO also has the advantage of allowing joint movement in multiple planes (or directions) and a reduced chance of damage to structures within the joint due to the increased pressure the De Angelis repair can create in some knee joints.
The procedure does not repair the ruptured ligament or mimic this but instead alters the angles and forces within the joint. By changing these angels the tibia (shin bone) no longer slips forward when pressure is applied from above by the femur (thigh bone) during weight bearing. Effectively this stabilises the knee joint.
The method involves making three cuts in the tibia (shin bone) and the removal of a small wedge of bone (shown in the diagram on the far left).
These cuts are then stabilised with a metal plate and screws.
Once the plate and screws have been placed the overlying tissues are sutured closed and your dog will be left with a line of stiches or staples on the inside of the leg extending above and below the knee joint.
Post-operative x-rays are generally taken six weeks after the operation to monitor bone healing and hence guide rehabilitation.
As opposed to the De Angelis method the TTO uses more equipment (special plates, screws and bone cutting and measuring equipment) and is a longer surgical procedure. For these reasons the increased cost of the TTO is reflective of this.
Post operative expectations and rehabilitation
Recovery may take several months including two to four months of rehabilitation. Progressive degenerative joint disease (arthritis) is common even with surgery but is minimized if treated quickly. Return to complete athletic function is uncommon.
It is vitally important that after surgery a confined environment and only controlled exercise is allowed according to instructions.
Although your pet will not need 24 hour supervision they must be provided with a safe environment that encourages quiet behaviour. Some boisterous patients will require a small dose of daily sedation to keep them quiet.
In the first two weeks after surgery your pet should be strictly confined and walked to the toilet on a lead. Activities such as jumping up and down off lounges, walking up and down stairs or playing with other pets are not allowed.
Rehabilitation primarily focuses on safe weight bearing of the limb, this involves a combination of massage, heat therapy, passive range of motion, swimming and lead walking. A rehabilitation schedule will be individually designed for your pet.
What is medial patella luxation?
The medial luxating patella is an extremely common problem in toy breed dogs. In a normal dog, the kneecap (patella) sits in place in a smooth groove (the trochlear groove) where in normally moves up and down
(see figure 1).
Clinical signs occur when the dog's patella slips out of the trochlear groove in a medial direction, which is in a direction towards the body (as opposed to laterally which is away from the dog). With the patella luxated medially, the knee is unable to extend properly and thus, stays bent. In mild cases the dog is able to slip the kneecap back where it belongs and walk normally again; however in some cases this is not possible.
Owners usually notice that when their dog is running, they have a little skip in their step. The dog may even run on three legs, and hold one hind leg up, and then miraculously be back on four legs as if nothing has happened
Approximately 50% of affected dogs have both knees affected while the other 50% has only one knee involved.
If a dog's MPL is assessed to be of low grade (discussed later) then these dogs can be managed medically, in a similar way to the management of dogs with arthritis. This involves the prevention of excessive exercise and sudden bouts of activity, the use of cartrophen injections, and
anti-inflammatories such as carprieve or previcox. Please refer to the article on Arthritis management in Dogs for more information.
It is important to note though that the grade of MPL can increase with time in some dogs which may then necessitate the need for surgical intervention.
Which dogs need surgical correction? There is a grading system to categorise MPLs in order of severity in order to determine which dogs require correction.
Grade 1: The kneecap can be moved out of place manually but will spontaneously fall back into its natural position once released.
Grade 2: Same thing except that the kneecap does not spontaneously move back to its normal position when released. These dogs are likely to progress to arthritis development and should be considered for surgery to prevent conformational damage.
Grade 3: The patella is out of place all the time but can be manipulated back into its normal position manually (though it will not stay there).
Grade 4: The patella is not only out of place all the time but cannot even be manipulated back into place by hand. Such a dog has extreme difficulty extending his knees and walks with his knees bent virtually all the time.
Dogs with Grade 1 luxations do not require surgical repair.
Grade 2 dogs may benefit from surgery and most often the owner is called upon to judge how big a problem the lameness is.
Dogs with Grade 3 or 4 luxations definitely should have surgery.
Wedge resection trocheoplasty and lateral fascial imbrication
In toy breed dogs the groove in which the kneecap sits in is very shallow, allowing the patella to slip. A wedge resection trocheoplasty involves deepening of the groove by means of removal of a wedge from the trochear groove, thus allowing the patella to stay where it belongs. Further imbrication, which involves tightening the joint capsule to prevent slipping of the kneecap from the groove, is performed to ensure a snug fit (see figure 2).
Tibial Crest Transposition
In some severe cases, especially in larger breed dogs, the tibias (or leg bones) will have rotated. In particular, the crest on the tibia where the thigh muscle (the quadriceps femoris) attaches may have migrated inward. If this is the case, the crest will have to be removed and pinned back where it belongs to straighten out the leg. Severe rotation of the tibias may involve actually cutting through the entire bone and de-rotating it back into place.
6 to 8 weeks of confinement with easy walking (no running or jumping) is necessary following surgery. The dog should be using the leg by two weeks post-operatively though some dogs must be retrained to use the leg after surgery. Physical therapy is in order if the dog is not using the leg after one month.
Most dogs make a full recovery following surgery and are able to walk and run normally and comfortably.
Please do not hesitate to contact us at any of the hospitals if you would like any more information.
What is a viral papilloma?
|Viral warts, or papillomas in dogs, are lumps with characteristic round yet rough and almost jagged surfaces, reminiscent of a sea anemone or a cauliflower. These are caused by the papillomavirus and usually occur on the lips and muzzle of a young dog (usually less than 2 years of age). Less commonly, papillomas can occur on the eyelids and even the surface of the eye or between the toes. Usually they occur in groups rather than as solitary growths.
How is this Virus Transmitted?
The infection is transmitted via direct contact with the papillomas on an infected dog, or contact with the virus in the pet's environment. The virus requires injured skin to establish infection; healthy skin will not be infected. The incubation period is 1 to 2 months. This virus can only be spread among dogs - it is not contagious to other pets (eg cats) or to humans.
To become infected, the dog generally needs an immature immune system, thus this infection is primarily one of young dogs and puppies. Dogs taking cyclosporine pills to treat immune-mediated disease may also have an outbreak of papilloma lesions.
In most cases, treatment is unnecessary; the papillomas go away on their own, as the dog's immune system matures and generates a response against the papillomavirus.
It takes between 1 to 5 months for papillomas to regress, with oral growths tending to regress sooner than those around the eyes. Occasionally, some papillomas will stay permanently.
Occasionally an unfortunate dog will have a huge number of tumors, so many that consuming food becomes a problem. Tumors can be surgically removed or frozen off cryogenically. Sometimes crushing several growths seems to stimulate the host's immune system to assist in the tumor regression process. In humans, anti-viral doses of interferon have been used to treat severe cases of warts and this treatment is also available for severely infected dogs though it is costly and yields inconsistent results.
Generally the prognosis for viral papillomatosis is excellent.
While many of us as pet owners enjoy feeding our pets various forms of 'human food' in order to show our love, or as rewards for good behaviours, it is important that we realise that some foods are a definite 'no-no' when it comes to our canine friends.
The following are foods that should be avoided being fed to our pets.
AVOCADOS Avocados can cause tummy pains & upsets including vomiting & diarrhoea. Avocados contain a substance called Persin, which is highly toxic in most animals.
CHOCOLATE Dogs should NEVER eat chocolate! It contains a stimulant called theobromine, which affects the central nervous system & cardiovascular system of dogs. If you believe that your dog has eaten chocolate, you must seek veterinary advice immediately, as ingestion can cause death. Cooking chocolate contains the highest concentration of theobromine, followed by dark, milk & white chocolate. Symptoms of poisoning include vomiting, diarrhoea, restlessness, hyperactivity, muscle tremors, increased urination & an increased heart rate (tachycardia).
COFFEE/TEA Caffeine affects the central nervous system & the heart. Symptoms of poisoning include vomiting, a racing heart rate & in severe cases, even death.
SWEET BISCUITS They are high in fat & sugar. They offer no nutritional value to our pets. Feeding them a sweet biscuit may seem innocent but they are individually the equivalent of giving them a hamburger.
SUGAR FREE's Sugar free lollies/chewing gums contain a sweetener called Xylitol which causes excessive insulin release. Ingestion can cause vomiting, weakness, un-coordination, seizures & low blood sugar (hypoglycaemia).
ALCOHOL Alcohol is toxic to dogs. It can cause vomiting, diarrhoea, breathing difficulties, tremors & depression of the central nervous system.
HUMAN DRUGS Many medications that we use can be extremely toxic to dogs. These include paracetamol (Panadol), ibuprofen (Advil, Voltaren, Nurofen), contraceptive pills, codeine (Codral) etc. If you think that you dog has ingested ANY of these, seek veterinary advice IMMEDIATELY!
FAT TRIMMINGS Never give your dog fat trimming from meat, especially those from marrow bones and ham, as high-fat consumption could lead to pancreatitis. Pancreatitis can range in severity from mild to life threatening (including necrotising pancreatitis) & is an extremely painful condition
GRAPE FAMILY Grapes and the dried variety of grapes, including raisins and sultanas can cause kidney damage. Deaths have been reported with ingestion of large quantities. Repeated vomiting and hyperactivity are early signs of poisoning.
ONIONS (And to a lesser extent, Garlic) can cause damage to the membranes of red blood cells, that result in anaemia (Heinze body anaemia). Signs generally develop days after ingestion & signs include breathlessness, weakness and blood-tinged urine
What are Anal Sacs?
The anal sacs (also called anal glands) are two small pockets located just inside the anus, on the left and right sides of the anal canal in dogs and cats. Normally they produce a smelly, clear to light yellow liquid secretion, which is expressed from two small pores when the animal defecates. They can also discharge this odorous secretion spontaneously, or when the dog or cat is startled, injured, or excited.
Disease of the Anal Sacs:
Several different types of problems can arise from the anal sacs. These include inflammation, infection, and even tumor formation. Dogs, especially small breeds, are more commonly affected than cats. The most common anal sac problems are:
Failure of the anal sacs to discharge, resulting in inspissation (drying out and hardening) of the contents, which then accumulate, causing discomfort.
Infection & Abscessation
Bacterial infection of the sacs, usually following an impaction. Inflammation and pain in the area will be present. The abscess can often burst through the sac, draining pus and blood onto the skin and hair coat around the anus.
Inflammation of the anal sacs is called anal sacculitis and can include impaction or infection/abscessation.
Luckily, anal sac impaction or abscessation generally is not a serious illness. It can, however, be a chronic problem and can recur frequently, causing discomfort. Anal sac disease is commonly associated with allergic skin disease and/or inflammatory bowel disease but many dogs are affected for no apparent reason. There are no preventative measures to guarantee that the problem never returns. The most important thing is to monitor your pet's behavior and defecation habits and seek veterinary attention if constipation or pain becomes apparent.
The diagnosis of anal sac disease is made based on history (what you have observed as your pet's symptoms) and the physical exam performed by the veterinarian. In terms of symptoms, dogs with anal sac impaction or abscessation are often reported to "scoot" (drag their rear end across a floor or carpet). They also may attempt to lick the area frequently or seem "bothered" by discomfort. You might notice a change in their stool habits. This can be either a variation in the shape of the faeces (thin, like a ribbon) or pain when attempting to defecate.
On physical examination, your veterinarian will perform a rectal palpation to check the anal sacs. He or she will attempt to express (empty) the anal sacs manually by applying gentle but firm pressure. If this is too difficult or too painful for the dog, sedation may be necessary in order to expel the contents and be sure impaction is not present. Various degrees of inflammation (redness, heat, swelling, pain) may be noted with anal sac diseases, and the material in the sacs may be dark and flocculent (with chunks) or firm like clay. There may be pus and/or blood present in the sacs, or draining through the skin beside the anus from an abscess that has already burst.
In the case of impaction, your veterinarian can often help by expressing the anal sac material. During a rectal palpation, pressure is applied the sac to empty it. If this is painful or the material is too hard, sedation of the dog or cat is recommended so the emptying can be done without discomfort. Occasionally, a small tube (catheter) is placed into the sac through the pore, and the sac is irrigated with saline to flush it. This can help soften very hard material if present. Depending on the degree of inflammation, your veterinarian may prescribe antibiotics or anti-inflammatories. These medications should be given as directed.
Often, the first sign of an abscessation is noting pus and/or blood draining from the anal area beneath the tail after the abscess has burst through the skin. Owners report seeing blood staining around their dog's anus. If the abscess has not yet burst, your veterinarian will often lance the infected anal sac under sedation and flush the area with saline. It is important that the lanced abscess remain open for as long as possible to fully drain the infected material. Warm compresses can help and may be recommended by your veterinarian. Antibiotics and anti-inflammatories will likely be prescribed.
If the problem recurs, the anal sacs may have to be expressed repeatedly. Some dogs require this procedure every 1 to 2 weeks after having an episode of impaction, gradually decreasing the frequency to whenever necessary. Your veterinarian may be willing to show you how to do this at home.
It has been reported that a change in the diet, such as increasing the fiber content, can be beneficial. By altering the stool, the anal sacs may express without intervention. Your veterinarian may recommend a different dog food or additives such as bran or Metamucil to your pet's regular food.
In refractory (nonresponsive) cases where symptoms persist despite treatment, it may be advised to have the anal sacs removed (anal sacculectomy). This is a surgical procedure in which one or both sacs are removed under general anesthesia. It is not a difficult operation, but there is always a small risk of complications such as infection or compromise of the anal sphincter, resulting in fecal incontinence. It is a delicate but short procedure, and the patient usually goes home the next day with some home care such as warm compresses and pain medication (anti-inflammatories) and antibiotics.
Signs to Watch For
Scooting, licking at the hind end, pain on defecation, swelling or drainage around the anus.
Your veterinarian will offer recheck appointments based on the severity of the case. As mentioned, many dogs require routine expression of their anal sacs. The frequency will depend on the patient.
What is IMHA?
Immune-mediated hemolytic anemia is a condition where the patient's immune system begins attacking his or her own red blood cells.
In a patient with a normal, healthy immune system, old red blood cells circulate through the spleen, liver, and bone marrow, and are removed from circulation and destroyed, a process called extravascular hemolysis.
Problems arise when the immune system attacks the patient's own red blood cells causing anaemia with possibly yellow-tinged (jaundiced) gums and tissues.
Clinical signs of IMHA
Animals with IMHA are usually depressed, weak and have lost interest in food. The gums, sclera (whites of the eyes) and sometimes the skin are yellow-tinged. Most animals are also feverish.
Diagnosis of IMHA
If the vet suspects IMHA, a blood test (involving a Complete blood count or CBC, and biochemistry panel) is usually run as part of a normal diagnostic panel.
A haematocrit, which is part of a CBC, measures the percentage of red blood cells making up the blood volume. A patient is anaemic if the red blood cell count is low. This can be caused by mainly blood loss (haemorrhage) internally or externally, chronic disease, kidney disease, bone marrow suppression, or haemolysis, among others.
The serum of patients with haemolytic anaemia is usually yellow to orange in colour. This is because the spleen is overwhelmed with red blood cells, resulting in large degree of cell destruction, and thus increasing the amount of bilirubin (a yellow pigment) in the blood.
The white blood cell count of patients with immune-mediated haemolytic anaemia is usually elevated and this will be reflected as part of the CBC.
Other tests that support the diagnosis of IMHA would be analysis of a blood film to assess for the presence of spherocytes. These are specific red blood cells produced when a red blood cell is not completely removed by the spleen. The spleen cell "bites off” only a portion of the red cell, leaving the rest to escape back to the circulation.
Another test involves noticing the presence of autoagglutination. This involves placing a drop of blood on a microscope slide. In severe cases of IMHA, red cells clump together (because their antibody coatings stick together).
The Coombs' test is a test designed to identify antibodies coating red blood cell surfaces. This test is the current state of the art for the diagnosis of IMHA.
Keep in mind though, that not all causes of haemolytic anaemia are immune-mediated. For example, some blood parasites, as well as Onion and Zinc toxicity, can cause haemolytic anaemia as well.
Causes of IMHA
Unfortunately, if the patient is a dog, there is a good chance that there will be no answer to this question.
Depending on which of several studies are examined, 60-75% of IMHA cases do not have apparent causes.
In some cases, though, there is an underlying problem: something that triggered the reaction. In older animals, some tumours can result in onset of IMHA (such as haemangiosarcomas), as can the use of some drugs such as penicillin and trimethoprim sulphur drugs. In cats, viruses such as Feline Leukaemia, as well as blood parasites like Mycoplasma hemofelis, can result in IMHA.
Treatment of IMHA
Patients with IMHA may be unstable especially if the hematocrit has dropped to a dangerously low level, which would require a blood transfusion.
General supportive care is needed to maintain the patient's fluid balance and nutritional needs. Most importantly, the hemolysis must be stopped by suppressing the immune system's red blood cell destruction.
High doses of corticosteroid tablets are the cornerstone of therapy for IMHA. Prednisolone is the most common corticosteroid used for treatment of IMHA. These hormones help to suppress the body's production of antibodies. If the patient's red blood cells are not coated with antibodies, they will not have been targeted for removal, so stopping antibody production is an important part of therapy.
Corticosteroids may well be the only immune suppressive medications the patient needs. The problem is that if they are withdrawn too soon, the hemolysis will begin all over again. The patient is likely to be on high doses of corticosteroids for weeks or months before the dose is tapered down and there will be regular monitoring blood tests. Expect your pet to require steroid therapy for some 4 months; many must always be on a low dose to prevent recurrence.
Corticosteroids in high doses produce excessive thirst, re-distribution of body fat, thin skin, panting, predisposition for urinary tract infection and other signs that constitute Cushing's disease. This is an unfortunate consequence of long-term steroid use, but in the case of IMHA, there is no way around it. It is important to remember that the undesirable steroid effects will diminish as the dosage diminishes.
More Immune Suppression
If no response at all is seen with corticosteroids, supplementation with stronger immune suppressive agents is necessary. The two most common medications used in this case are azathioprine and cyclophosphamide.
IMHA is a serious disease associated with a high mortality rate. Sadly, many dogs have succumbed. Many dogs do require life long immunosuppressive treatment unless an underlying treatable cause is identified.
What is an aural haematoma?
An aural haematoma is the collection of blood and blood clots in the pinna of the ear (the cartilaginous ear flap). Pooling of the blood causes the pinna to thicken and swell.
Aural haematomas are usually caused by self-trauma to the ear, most commonly through ear infections (otitis externa). Excessive scratching results in damage to the many small blood vessels in the ear, thus causing bleeding and the pooling of blood.
Clinical signs of aural haematomas
Aural haematomas are very easily recognisable. Sometimes, owners can pre-empt the signs that lead to aural haematomas, such as excessive head shaking or scratching of the ears and pinna.
Treatment of Aural haematomas
If the degree of swelling of the pinna is minimal and is not causing discomfort to the dog, a medical approach is generally recommended. It is important to identify the primary cause of the self trauma as described above.
Medically managed haematomas resolve over a period of between 2 to 6 weeks provided that there is no further self trauma to the ear (sometimes with the aid of an elizabethan collar).
Surgery is recommended in patients with moderate to severe haematoma formation. This involves drainage of the haematoma under general anaesthesia.
It is important to note that scarring of the pinna (a cauliflower ear) is not uncommon with untreated aural haematomas.
Generally, if aural haematomas are identified at an early stage, before significant swelling can occur, and the primary cause for the irritation can be identified, the prognosis for good cosmetic recovery is excellent.
Please contact us at one of our clinics if you require additional information.
What is Canine Cognitive Dysfunction (CCD)?
Canine Cognitive Dysfunction (CCD) is a group of behaviour changes associated with age-related alterations in brain chemistry and function. It is a medical condition that can be very difficult to diagnose as many of the changes are subtle and are often attributed to other disease processes.
There are 4 main categories of presenting signs for CCD:
2. Changes in social & environmental interaction
3. Changes in sleep/wake cytcle
4. Breakdowns in housetraining
Dogs suffering from cognitive dysfunction will show a delay in the recognition of people, places and objects and in some cases there may be no recognition at all. These dogs will often bark at these objects as if they have never seen them before and some may show real fear. Failure to recognise the home driveway on the return from a walk or a tendency to sit at internal doors when asking to go out into the garden can also be symptoms of disorientation and unexplained staring is also a potential indicator of cognitive dysfunction.
Changes in Social & Environmental Interaction
One of the most obvious signs of a lack of connection between context and behaviour is seen in the interactions that senile dogs have with the people and other dogs. One of the most distressing examples of this is an alteration in the social interaction between the dog and its owners and a decrease in the enthusiasm of greeting behaviour. Together with a decrease in the time spent engaging in play and in affectionate interaction this can signal the onset of cognitive dysfunction changes. There is often a change in the consistency and speed with which these dogs respond to commands and owners often mistake this change for stubborn behaviour.
When considering interactions with other dogs it is not uncommon to see an increase in confrontational reactions in other dogs who appear to be threatened by the bizarre behaviour of the senile individual. Dogs suffering from cognitive dysfunction may also become more irritable themselves and owners may be aware of an increase in aggression from their dog, together with a general decrease in the desire to interact and play with other dogs on walks.
Loss of Previously Conditioned Behaviours
The most common example of this aspect of cognitive dysfunction is a loss of previously reliable house training. However, there are numerous other examples of conditioned behaviours which can be lost as a result of this condition. Learned verbal commands such as sit or stay may no longer register with the patient and this may be misinterpreted as an increase in stubborn behaviour or a decrease in obedience.