Health Topics

Topics:

Pancreatitis     
     The pancreas is an organ with a very specific function. It manufactures enzymes used in the digestion of food as well as insulin to control blood sugar. Pancreatitis is inflammation of the pancreas. Pancreatitis is commonly diagnosed in dogs and tends to occur in middle aged and older dogs. Obesity can be a predisposing factor. Often, in taking the history, there has been some dietary indiscretion or the dog ingested a meal high in fat and protein before the onset of symptoms. In dogs, pancreatitis generally presents as an acute condition, the symptoms having a rapid onset. Your dog may exhibit any number of the following symptoms: vomiting, loss of appetite (anorexia), diarrhea, abdominal pain, dehydration, and/or fever.
     In cats, pancreatitis is hard to diagnose. The symptoms tend to be non-specific and the cause of pancreatitis idiopathic (obscure or unknown). Cats are generally presented showing lethargy, anorexia, and dehydration. In cats, pancreatitis appears to be more of the chronic nature; one text referring to it as being “smoldering” pancreatitis.(2) Some studies suggest that pancreatitis is almost as common in cats as in dogs but because of the non-specific symptoms it is often under diagnosed. (1) 
     Diagnosis of pancreatitis is determined by the patient history, physical exam, clinical signs, and diagnostic blood work. Often in cases of pancreatitis, blood work will show an increase in liver enzymes and the pancreatic specific enzyme amylase. In more severe cases, an ultrasound or x-ray may be required. Since pancreatitis is inflammation of the pancreas, the goal of treatment is to protect the pancreas from further assault and at the same time provide supportive care. The treatment regime commonly consists of:
  • Fluid therapy  for treatment of dehydration;
  • Controlling vomiting by administration of an anti-emetic;
  • Administration of an anti-inflammatory drug to reduce inflammation and give pain relief;
  • Administration of an antibiotic to prevent  secondary bacterial complications;
  • Nutritional therapy with small frequent meals of a therapeutic diet low in fat and protein which is  easily digested to decrease stress on the pancreas.  
     Most patients recover after medical treatment. However, prognosis is very poor if there are other complications present such as a pancreatic abscess, neoplasia, biliary obstruction, or septic peritonitis. 

References:
(1) Noseworthy GD, Crystal Ma, Grace SF, Tilley, LP, The Feline Patient, Essentials of Diagnosis and Treatment, Lippincott Williams & WilkinsBaltimore, 2003, p. 391.  
(2) Birchard, Sherding, Saunders Manual of Small Animal Practice, W. B.Saunders Company, Pennsylvania, 1994, p. 820.


Pyometra     
    Pyometra is an infection within the uterus. It is more often diagnosed in canine bitches but does occur in feline queens as well. Canine bitches tend to be older at time of diagnosis, e.g. over five years of age. Pyometra in feline queens can occur at any age.  

     Initially, the animal usually experiences undefined symptoms: lethargy, depression, fever, polyuria (excess urination), and polydipsia (excess drinking). As the infection worsens, additional signs of dehydration, anorexia (not eating), vomiting, and diarrhea appear. A full examination, blood work, and a review of the animal’s reproductive history directs the veterinarian to the cause of these symptoms. There may be vaginal discharge if the cervix has remained open, but no discharge will be evident if the cervix is closed. In bitches, the symptoms appear approximately thirty days after they have had their last heat. Blood work will show increased levels of leukocytes (white blood cells) indicating that an infection is present somewhere in the body. Confirmation of pyometra is determined by palpation, x-ray, and/or ultrasound if available. The x-ray and ultrasound will show an enlarged fluid filled uterus.

    Treatment will involve electrolyte therapy (intravenous fluids) to counteract the dehydration, antibiotic therapy to fight the infection, and surgery. Surgical treatment is highly recommended. “Although less successful than ovariohysterecomy (spay), medical therapy may be attempted in breeding bitches as an alternative to surgery.”(1) The longer the infected uterus remains within the body, the more toxic it becomes and the condition becomes life threatening. Your veterinarian will perform an ovariohysterecomy as soon as possible. 

    Prevention is highly recommended. Spaying your pet at a young age will prevent this condition developing in the future. Other benefits of spaying your animal when it is young include: 

  • you do not have to contend with heat cycles; 
  • less expense for treatment and surgery; 
  • less risk in the development of mammary tumours.                                       
 
References:
(1) Ford, Richard B. Mazzafero, Eliza M., Kirk and Bistner’s Handbook of Veterinary Procedures and Emergency Treatment, 8th Edition, Elsevier Inc., 2006, page 137
McCurnin, D., Bassert, M., Clinical Textbook for Veterinary Technicians, 5th Edition, Elsevier, Philadelphia, Pennsylvania, 2002

 Hyperthyroidism in Cats 
     The thyroid gland is one of the most important glands in the body. The thyroid gland produces, stores, and releases hormones used in the normal metabolic processes of the body cell. It regulates the chemical processes within the body that allow the organs to perform their vital functions. The function of the thyroid gland is very complicated. When there is not enough thyroid hormone released into the system the result is a condition known as hypothyroidism. If there is too much thyroid hormone released, the condition is known as hyperthyroidism. Oddly enough, hyperthyroidism is very common in cats and rarely seen in dogs. On the other hand, hypothyroidism is seen in dogs and extremely rare in cats. 
    Hyperthyroidism is most common in cats over eight years old. The symptoms are excessive weight loss in spite of a healthy appetite, restlessness, hyperactivity, intolerance to stress, diarrhea, vomiting, increased heart rate, unkempt hair coat, and excessive shedding.
    Diagnosis of hyperthyroidism is determined by clinical signs, examination, and a blood test. During a regular office visit, a complete history and the owner's concerns will be noted. A full exam may reveal additional clinical signs. The swollen thyroid gland can often be palpated during a routine exam. To confirm the diagnosis, your veterinarian then will run a T4 test that measures thyroid function.
    Once the diagnosis is made, treatment will follow. There are three methods of treatment for hyperthyroidism:
    1. Radioactive iodine - This treatment involves the injection of radioactive iodine into the affected gland. The radioactive iodine destroys all the abnormal thyroid tissue without damaging normal tissue. It is a highly effective treatment for this condition, however it can be expensive. Treatment involves a 1 to 2 week period of hospitalization in a hospital licenced for the administration of radioactive iodine.
    2. Surgery - Removal of the affected lobe by surgical means is a very effective treatment. Once the abnormal tissues are removed or destroyed, the symptoms disappear and the animal should return to normal health.
    3. Oral Medication - This treatment requires the daily administration of oral medication. The medication does not cure the condition but helps to shrink the thyroid gland and prevent the production of excess thyroid hormone. Oral medication is used in some cats until the animal has become stabilized enough to permit surgery or the radioactive iodine treatment. Older cats who are not candidates for the other forms of treatment can control their symptoms by taking medication daily for the rest of their lives.
 References:
Ward E. E. Jr., DVM, Feline Hyperthyroidism, Lifelearn Inc., 2002
Schell Julie, DVM, The Silent Disease, Pets Magazine Nov/Dec 2007
Madsen Laura, DVM, Understanding Common Endocrine Tests, Veterinary Technician, June 2007
 
     If you are a sports enthusiast, you've probably heard the term "ACL" when commentators talk about athletes' injuries. It stands for Anterior Cruciate Ligament (also known as Cranial Cruciate Ligament or CCL). Rupture of this ligament is a very common injury among athletes. It is also the most common orthopedic surgery performed on dogs. The knee on the back leg of a dog is very similar in structure to that of the human knee.  
    The bone above the knee (femur) and the bones below the knee (tibia and smaller fibula) are connected by ligaments. The cruciate ligaments run from the back to front and front to back of the knee joint. They are called the cruciate ligaments because they "cross-over" in the joint forming an X. These ligaments permit hinge action of the joint but at the same time give it stability. 
    Injury to this joint can be caused by twisting the joint or over-extending the joint.  We have had dogs acquire this injury by being tackled by another dog from the side, by dogs leaping from a slippery surface and over extending the joint, and by dogs turning sharply while chasing a squirrel or other animal, twisting the knee and tearing the cruciate ligaments.
    When this injury occurs, the dog usually will give a sharp yelp and suddenly become lame on that leg. They can have a complete rupture to both ligaments, tear only one ligament, or have only a partial tear. Often the cartilage within the joint is damaged at the same time as the ligaments are ruptured. In any case, the joint is no longer stable and there is extreme pain. 
    A tentative diagnosis is based on the history (client reporting the incident), palpation, and observation. Often a dog with a torn ligament will put their toe down every third or fourth step. The veterinarian will palpate the joint in order to determine if there is instability. If the dog is very strong and/or in a lot of pain it will hold against the veterinarian and diagnosis will be inconclusive. Definitive diagnosis is determined by sedation and radiology. Sedation will relax the muscles and allow the veterinarian to properly palpate the joint.  Radiology will show whether there are other issues creating the instability and pain.
    Unfortunately, surgery is the preferred method of correction for this injury. Having the joint repaired as soon as possible after the injury occurs, will lessen the degree of arthritis that will develop in the joint.
    There are several options of correcting the instability of the joint, but most fall into two methods - one being extra-capsular whereby the implant of a false ligament replaces the ruptured ligament. The other is to modify the anatomy of the joint to acquire stability.  
    "No surgical technique has been proven to be superior".(1) The method chosen to repair your pet's joint will be determined in consultation with your veterinarian. The method used to modify the anatomy of the joint generally costs twice as much as the method to implant a false ligament.  When the surgeon goes in to repair the stability of the joint, an assessment will be made of the joint capsule and cartilage. If roughness or clicking is palpated in the capsule, it will be opened and the damaged cartilage removed. Then the joint will be stabilized. Success of recovery and length of time to return to normal activity will depend on several factors:
  • the skill of the surgeon;
  • method of repair used;
  • how soon after the injury, diagnosis is made and surgery performed;
  • post-operative care.
    The dog will be allowed only limited activity after the surgery. Recuperation will require a strict and gradual return to normal activity laid out by your pet's veterinarian for a minimum of four months post-surgery. Good function should return to the joint in approximately three months.
     A caution: When the knee is unstable, a lot of stress is put on the good knee. One survey found that 37% of large breed dogs and 45% of small breed dogs went on to rupture the other knee.
    Unfortunately with all injuries, arthritis will be a factor later in life for your pet. The degree of arthritis that develops can be lessened by quick surgical intervention after the injury, control of body weight, and nutritional supplements for joint care. Obesity is a risk factor in cruciate rupture. Excess weight puts more strain on the ligaments and weakens them. Keeping your dog at a healthy weight can decrease the risk of cruciate rupture.
 

References:
1
Grognet, Jeff, DVM, Cranial Cruciate Ligament Rupture, Dogs in Canada, September 2002.
Ward E. E. Jr., DVM, Cruciate Ligament Rupture, Lifelearn Inc., 2002
Grognet, Jeff, DVM, Cruciate Injury, Dogs in Canada, December 2008.
Norsworthy and Fooshe, Ask the Vet: Questions and Answers for Dog Owners, Lifelearn, Guelph, 1997
Piermattei, Flo, DeCamp, Small Animal Orthopedics and Fracture Repair, 4th Edition, Saunders, Missouri, 2006
 


Diabetes Mellitus
    Diabetes mellitus is a metabolic disorder where the body is unable to regulate blood sugar levels. Either the pancreas is unable to produce sufficient insulin (Type 1 diabetes) or there is resistance to insulin in the body's cells (Type 2 diabetes). Insulin is a hormone that controls the metabolism of glucose in food, for energy. Without sufficient insulin the body is not able to access the energy from the bloodstream. The body then turns to the body's fat stores. When the fat stores are depleted the body then starts to breakdown muscle. Eventually the animal will waste away. High glucose levels also makes the animal more susceptible to infections, especially urinary tract infections. 
    Dogs and cats can both develop diabetes. Dogs tend to develop Type 1, while the majority of cats develop Type 2. Diabetes can occur in any breed, at any time. However, older and obese animals in both the canine and feline species are at a higher risk for developing the disease. 
    Diabetes has a gradual onset. It may take several weeks before symptoms appear. Sudden weight loss, excessive appetite, excessive drinking, lethargy, and an increase in the volume and frequency of urination are classic symptoms. Diagnosis is determined by a physical examination, clinical history, hyperglycemia (high blood sugar), glucosuria (glucose in urine), and the presence of characteristic clinical signs. 
    Your pet will remain in the clinic for a day or two. Staff will take blood to determine glucose concentration. The plotting of glucose concentration over a 12 to 24 hour period (a glucose curve) will determine how much insulin your pet will require each day. 
    When your pet is ready for discharge the staff will spend some time explaining to you about the disease and its management. Understanding the process will inform you as to how important it is to regulate the blood glucose levels in your pet. You will be trained in the technique of giving insulin and testing for urine glucose levels. Keeping this information recorded in a small notebook will help the staff to assist you in regulating your pet's glucose.
    The amount of insulin required will depend on the activity of the animal, its stress level, and the amount of food it ingests. If these parameters change, your pet may get into trouble. The staff will educate you on the signs of insulin overdose so that you can seek immediate attention should they occur.
    Once the diagnosis of diabetes mellitus is made, it is not the end of the world for the owner or the pet. The veterinary staff can assist and educate you about the disease and its management. It will take some time and patience but this disease can be managed quite well and the animal can live happily for some time to come.

References:
Diabetes Mellitus in the Dog and Cat, Intervet Caninsulin Booklet, Intervet, Whitby, Ontario
Little, Susan, Diabetes Mellitus in Cats, Pet Magazine, Nov/Dec 2004.
Crocker, Tanya, RVT, Client Education of Diabetes Mellitus, TechNews, Vol 31,Issue 1

    "Age has been described as a progressive reduction in the ability to maintain normal bodily function in relation to the demands of the environment."  (Dr. J. Hall, Dr. D. Houston, Working With Seniors, OAVT Conference Proceedings, London, 2005 pg 46.)
   
    The aging process is one that no living thing can escape. We must remember that aging is a process and not a disease in itself. As the aging process runs its course, physical, metabolic, and behavioural changes occur. As the aging process advances, the vulnerability to disease increases. Therefore, as our pets age, we must recognize their special needs. These needs will vary by breed, age, diet, and lifestyle. For this reason, the staff at Dr. Wright Veterinary Services have developed the following categories to describe the aging pet. Along with these categories, appropriate protocols are being recommended to ensure that disease processes are detected early so that your pet may have the best quality of life for as long as is possible:
Mature - Are all animals that have turned the age of seven (giant breeds 5 years) that have not had any major health problems to date but are slowing down their pace. As the normal body ages these animals are more vulnerable to disease. It is recommended that a blood sample and urine sample be collected at the time of the annual exam. The samples will test for various body functions and the information will be a base line for comparison later in the aging process.
Middle Age - Are all animals aged 9-11 years (giant breeds 7 years) and those that have been diagnosed with a major health problem regardless of age. The "retirees", their pace has slowed down but they are still very active and enjoying life. However, they are at greater risk for developing disease. It is recommended that the pet visit the veterinarian twice yearly for a thorough exam. In addition, it is recommended that a blood sample and urine sample be collected a minimum of once yearly. This way the staff and the client can monitor for any changes that may be occurring.
Senior - Are any animals exhibiting signs of a major health problem regardless of age, and all animals 12-15 years of age (giant breeds 9 years). These animals have definitely slowed their pace and are highly vulnerable to age-related diseases. It is recommended that these animals visit the veterinarian every six months for a thorough exam, blood test, and full urinalysis. Other diagnostics may be required as determined by the symptoms presented.
Geriatric - Are any animals over 15 years of age, and any animal that is exhibiting signs of more than one major health concern regardless of age. The frequency of visits to the veterinarian and diagnostics will be determined by the severity of symptoms presented.
  
    One of the most frightening episodes for any pet owner and the basis of many a frantic call to the veterinarian is a seizure. Seizures can present themselves in many ways and can be very mild or extreme. In the most severe of seizures, an owner may see their pet's eyes roll back, the animal may stumble or fall over as it loses consciousness, the limbs may go rigid, or the pet may paddle at the air, foam at the mouth, and lose bowel and/or bladder control. It is no wonder owners are frightened and at a loss as to what to do. It may be the longest two minutes an owner experiences. 
    Epilepsy is described as a condition that causes recurring seizures or convulsions. There are two types, primary and secondary. In Primary Epilepsy, also known as Idiopathic Epilepsy, the cause of the seizures is unknown nor is it related to any disease process(es). Secondary Epilepsy on the other hand is the result of some disease process such as trauma, poisoning, liver, kidney or heart disease, cancer, or electrolyte imbalance. 
    Seizures or epilepsy is one of the most common neurological diseases in dogs and can be either primary epilepsy or secondary.
Seizures do not occur very often in cats, and are generally secondary in nature. 
    There are three phases to a seizure episode:
  1. The first stage is known as the pre-ictal stage. In this stage the pet may appear restless, tremble, or whine. It can last for only a few seconds or continue for a couple of hours before the actual seizure. To the inexperienced owner, this stage can pass completely unnoticed.
  2. The second stage is the ictal stage. This is the actual seizure itself. It can be very mild, only involving a glassy stare or spaced look to a full blown seizure comprising convulsions, frothing, and loss of body functions. Frightening as the are, most seizures only last for a few seconds to a few minutes.
  3. The third stage is the post-ictal stage. It follows immediately after the seizure. Your pet may show disorientation or confusion and fatigue. This stage can last for only a few minutes to hours, to even days.
    When your pet has a seizure they feel no pain, only bewilderment. It is important to stay calm and to make sure they do not hurt themselves during the seizure. Make sure they are away from sharp furniture corners, open fireplaces, stairs, etc. where they may do themselves harm. They will not swallow their tongue so do not put your hands near their mouth. You could be badly bitten. 
    Once the seizure is over allow your pet to rest in a quiet place and continue to observe him. Call your veterinarian and have him make an assessment as soon as it is possible. A seizure, in itself, is not generally cause for alarm, however there are times when it can be an emergency. The first is when the pet continues to seizure after five minutes. This condition is known as "status epilepticus" or in the state of continuous seizure. The second is when your pet has numerous seizures one after another. This is known as cluster seizures. Both these conditions can be life threatening and you should seek treatment for your pet immediately. 
    When your pet has had a seizure it is important that your veterinarian does an assessment of your pet. A number of diagnostic tests will be needed to discover what caused the seizure. These will involve blood tests to check liver and kidney function, x-ray, and EKG to examine the heart and internal organs. Should these tests determine an ongoing disease process, then this would be secondary epilepsy. Steps will be taken to treat that disease process. If no disease process is found then the seizures are determined to be primary or idiopathic epilepsy. 
    Some dogs may have only one seizure in their life time while others may have them regularly and frequently. If the seizures are infrequent, occurring less than once a month, usually no treatment is prescribed. If the frequency is greater than once a month or the pet has demonstrated status epilepticus or cluster seizures then treatment is needed. Treatment is in the form of drug therapy. Drug therapy may not eliminate all seizures but it will decrease the frequency and severity. Your veterinarian will determine the drug most appropriate for your pet. Phenobarbital is the most prevalent drug prescribed and can be administered in pill form or liquid. Potassium bromide is also used to treat seizures, on its own or in conjunction with Phenobarbital. The pet will have to remain on the drug regime for its entire life. 
    Should you recognize that your pet is having a seizure:
  • Stay calm, don't panic. 
  • Make sure that your pet is safe so that it will not harm itself.
  • Let the seizure run its course.
  • If it appears that your pet is suffering from cluster seizures, or status epilepticus, call your veterinarian immediately.
  • Otherwise, make an appointment with your veterinarian as soon as possible for an assessment of your pet.
  •  
References:
A Primer on Epilepsy, Dogs in Canada, April 2001, Spiegle, Mark, DVM
Lalonde, Janet, DVM, Diagnosis and Treatment of Epilepsy, Dogs in Canada, April 1997
Dowling, Patricia, Update on Therapy of Canine Epilepsy, Canadian Veterinary Journal, Volume 40, August 1999
Dog Seizures Guide, http://www.dogseizures.net/ Accessed August 28, 2009
Ward E. E. Jr., DVM, Seizures in Dogs, Lifelearn Inc, 2002
 
Arthritis in Our Pets
    Osteoarthritis, commonly called arthritis, is one of the most common joint diseases in people and animals. Osteoarthritis is described as a slowly debilitating condition due to the loss of cartilage and changes in the bone structure of the joint. These changes are caused by trauma to the joint through poor conformation (ie.hip displasia, luxating patella), injury (ie. torn ligament), or obesity and inactivity. Inactivity weakens muscles. Muscles support the joints and if they are weak, they leave the subject prone to injury. Excess weight puts extra stress on the muscles and joints and again makes the subject more prone to wear and tear and injury. Joint degeneration results in pain. 
    Dogs suffer more from osteoarthritis than cats. Osteoarthritis can affect animals at any age, but it is seen more commonly as our pets age. There is a broad spectrum of drugs and treatments for animals and humans in the treatment of arthritis. The first aim of any treatment is to decrease the joint degeneration. Surgery can correct cruciate ligament tears or a luxating patella. A change in diet and a slow increase in exercise can reduce weight, thereby reducing the stress on the joints. Chiropractic or physiotherapy techniques can improve alignment of a joint. The second aim of treatment is to relieve pain. There are numerous products on the market to treat arthritis pain, be it mild or chronic and intense. Your veterinarian is the best person to advise you on appropriate medications for your pet with arthritis. 
    How does one recognize when their pet is in pain? The first step in the treatment of your pet’s arthritis is to recognize that they have pain. In some cases the indication of pain can be very subtle. Animals try and hide their pain as much as possible. This is a survivor instinct because to show pain is to show vulnerability. Some of the signs of pain are as follows:
  • Reluctance to walk or play
  • Difficulty in getting up or climbing stairs
  • Sensitive to touch on the back or hind legs
  • Limping or lameness
  • Swollen joints
  • Lethargy or decrease in overall activity
  • Frequent yelping or whimpering
  • Soiling in house - reluctance to move
  • Changes in behaviour
  • Reduced appetite.

     These signs could be symptoms of any number of disease processes, so if you recognize any one of them you should take your pet to his/her veterinarian for a complete exam.

References:
Boehringer Ingelheim Newsletter, Pain Solutions: Spotting Pain, Volume 1, Issue 1

Leptospirosis
    
Leptospirosis (or lepto) is a zoonotic (can affect humans) disease caused by the Leptospira bacterium. There are many serovars (subtypes) of this bacterium that affect many mammals including dogs and humans. Dogs contract leptospirosis from consuming water or food contaminated with infected urine. The source of this infected urine is usually from wildlife, mainly rats, raccoons, skunks, and opossums. An animal can harbor the bacterium in their kidneys for many months after an infection. The bacterium is shed into the environment through urination.
    The clinical signs associated with this disease are varied. They may include fever, inappetence, (not eating), vomiting, abdominal pain, diarrhea, polyuria/polydipsea (increased urination/increased drinking), myalgia (muscle pain), jaundice (yellow mucous membranes), epistaxis (nose bleed), and hematuria (blood in urine). The most frequent clinical signs are vomiting and diarrhea. The bacterium damages many tissues including the kidney, liver, and spleen, and is suspected of being the major cause of renal failure in dogs in the U.S.
    Diagnosis of leptospirosis is based on clinical signs and a positive leptospirosis antibody test. Most cases of leptospirosis are diagnosed between September and December.
    Treatment initiated during the early stages of infection is usually effective. However, damage to organs can be permanent. Treatment involves intravenous fluids and multiple antibiotic therapies to control the bacterium. Mortality rate is approximately 25%. Another 25% of dogs affected will have permanent kidney damage where the remaining 50% may recover with no long-lasting ill effects. 
    Since leptospirosis is a zoonotic disease, care should always be taken whenever cleaning up any urine, soiled bedding, or feces of your pet to avoid transmission of this and any other zoonotic diseases. 
    Prevention involves vaccination and due diligence. The occurrence of mild reactions to the vaccine are higher than with other vaccines so veterinarians tend to vaccinate only dogs at high risk for lepto. Outdoor dogs, exposed to wildlife areas, are considered to be the most at risk. However statistics show any dog can contract leptospirosis. Your veterinarian can help you assess the risk level of your pet. When walking in wildlife areas, you should not allow your pet to drink from rivers, streams or standing pools of water or swim in contaminated waters.

References:
Leptosirosis, Dogs in Canada, Health Supplement 2004
Ward E. E. Jr. DVM, Canine Leptospirosis, Lifelearn Inc., 2002
Leptosirosis, Posing New Threat for Canine Hepatic, Renal Disease, DVM Newsmagazine In Focus supplement 2002


Otitis Externa

     One of the most common issues we see on consultation is otitis externa, or inflammation of the external ear canal and pinna of the ear. The client usually reports that the patient has been scratching or rubbing its ear, shaking its head, or that there is discharge or smell from the ears. In severe cases the ear is very sore and reddened.

     Incidents of otitis externa can be acute, chronic or reoccurring. The predisposing factors of the inflammation can be many and include:
* Incidents Conformation: the animal may have long ear canals, or pendulous pinnae that prohibit air flow in and around the ear canal.
* Parasites: Mites are more prevalent in cats. Bacteria and yeast infections are more prevalent in dogs.
* Moisture: Moisture may have gotten trapped in the ear during swimming or bathing creating an environment that will encourage growth of bacteria and yeast.
* Occlusion: Excessive hair, polyps or hyperplasia may occlude the ear canal preventing air flow, creating an environment that will encourage growth of bacteria and yeast.
* Other Medical Conditions: The animal may have an immunological deficiency, allergies or an endocrine imbalance. Bilateral infections are indicative of a predisposing medical condition.
* Trauma: Excessive cleaning or plucking of the hairs resulting in trauma to the skin surface.
     One or more of these factors can interfere with the “delicate balance of the normal secretions and microflora and result in opportunistic infections”(1). The veterinarian will first needs a history of the patient. He/she will want to know when the discomfort began, is this the first occurrence or have there been other occurrences. This information will help in determining if this incident is acute, chronic or reoccurring.
     Then a physical examination will be conducted. During the examination a sample will be taken from the affected ear(s). It is necessary to clean the ear(s) of excessive debris and exudate that will prevent any medication from reaching the ear surface and render any treatment ineffective. As some ear infections are very painful it may be necessary to sedate an animal before the examination, sampling, and cleaning can be conducted. Using a cotton applicator, a sample is taken from the ear. The sample is then smeared onto a microscope slide and examined under a microscope. This sampling can reveal the presence of parasites, bacteria, yeast and inflammatory cells, allowing the practitioner to make a rapid and relatively inexpensive diagnosis.
     If bacteria are present on the slide, a sterile sample will be taken from the ear. This sample will be cultured to determine the offending bacteria and appropriate antibiotics to use in treating the infection. If another medical condition is suspected further tests may have to be considered (eg. thyroid, cortisol, allergy testing).
     The treatment goals for otitis externa are to: decrease the inflammation and discomfort of the animal; address the underlying causes of the otitis externa; and, prevent further occurrences if possible. Treatment and duration of treatment will vary depending upon the diagnosis. Treatment includes an antibacterial/antifungal topical ointment. If the ears are painful, this ointment may also contain a steroid to decrease the inflammation. If a skin infection is also present oral antibiotics may be prescribed as well. Determining the underlying causes of otitis externa is the key to its management and control. Chronic otitis externa may take weeks to resolve.
     The best treatment is prevention. Routine use of an ear astringent two to three times weekly and after swimming or bathing is recommended. The astringent will help to keep the ear dry and if used after an occurrence of otitis externa with help bring the normal secretions and microflora of the ear back in balance.

References:
Birchard, Sherding, Saunders Manual of Small Animal Practice, W. B.Saunders Company, Pennsylvania, 1994.
(1) Kahn, C.M., Line, S. (Editors), The Merck Veterinary Manual, 10th Edition,Merck & Co. Inc., New Jersey, 2010, pg 482.

     A corneal ulcer is an area of trauma to the outermost layer of cells on the eye (epithelium) and can be caused from scratches or a foreign object trapped against the eye, causing irritation.

    In cases of an ulcer, an animal is usually presented at the clinic showing some discomfort to the eye. “This pain is manifested as excessive tearing, sensitivity to bright light, and squinting....” (1). There may be a discharge. The tissues of the eye are very fragile and any issue with the eyes should be seen by a veterinarian as soon as possible.  A diagnosis is made by first examining the eye with an ophthalmoscope, a hand-held instrument that shines a light and has a magnifying glass behind the light, aiding the veterinarian holding it to look in the eyes.

    To aid in the diagnosis, a sterile sample is taken from the eye for culture. This is done by using a sterile cotton-tipped applicator. The sample is applied to a petri dish with a blood based medium and placed in an incubator. The sample is cultured for 24 hours. An infection in the eye complicates the treatment of the ulcer.

    Next, a drop of fluorescein dye is placed in the corner of the eye. The fluorescein dye fluoresces when a black light is shone in a dark room and aids the veterinarian in evaluating the width and depth of the ulcer. The epithelium of the eye resists the dye naturally, so a negative test shows no fluorescence on the globe (eye ball) itself. When that first layer of cells is missing, however, the next layer does take up the stain, and thus the ulcer can be visualized. The next layer down is again resistant to the stain, so a deep ulcer can show a bulls-eye appearance.

    If the fluorescein test reveals an ulcer and while the results of the culture are pending, the owner is given antibiotic eye drops and pain medication. If the culture comes back negative for bacterial infection, then the ulcer should heal normally.

    However, this is not always the case. Should a recheck five days later, show that no healing had occurred, the ulcer is now classified as indolent (non-growing, non-healing). The next move is a surgical procedure known as a striated keratectomy. The pet is placed under general anaesthesia. The skin around the eye is cleaned with povodone iodine to maintain the site aseptically. The eye itself is cleaned with sterile saline. A sterile cotton-tipped applicator is then placed it into the corner of the eye closest to the nose (medial) and moved under the bottom eyelid to the corner closest to the ear (lateral). The applicator is then moved back medially so that it passes behind the third eyelid (a structure in many mammals that functions like an eyelid and hides in the medial corner of the eye), and then rotated up and behind the top eyelid. A different sterile cotton-tipped applicator is gently swabbed around the ulcer, to remove any weakly healing cells and improve healing after the procedure. A small needle (22 gauge) is used to etch a 4x4 grid onto the ulcer, with each striation beginning at healthy epithelium on one side of the ulcer, and ending on the healthy epithelium of the opposite side. The goal of the striations is to agitate the cells in and around the ulcer so that the body will respond with blood vessels and factors to the site that encourage healing of the ulcer.

    It is important to protect the site throughout healing, using either specialized contact lenses or a third eyelid flap. Since the lenses can be difficult to keep in place in active animals, we recommend the third eyelid flap procedure. The third eyelid is actually quite large, though we normally never see more than the outer edge. The third eyelid is extended so that it reaches under the upper eyelid, and 2 sutures are placed through it and the upper eyelid. The sutures are tied over buttons, which help reduce tension on the upper eyelid. The third eyelid acts as a bandage protecting the eye.

    In addition, the patient is sent home to heal with autogenous serum to apply to the eye. This is a solution made from the patient’s own blood (‘auto’ meaning ‘self’) where a blood sample is spun in a centrifuge to remove the cells. The liquid remaining is called serum, and it contains rich healing factors and proteins. Drops of this serum are applied to the affected eye by pulling down on the lower eyelid (as the upper one is sutured to the third eyelid). 10 days after the procedure, the sutures are removed and the ulcer re-examined. A fluorescein test is repeated, to ensure the ulcer has healed completely.

Written by Amanda D’Souza, OVC Year 2014 (2013 Summer Student at Dr. Wright Veterinary Services). Reprinted from “The Pawsitive Express”, Vol 2, Fall 2013.


     How will we know when it is time? This is a question asked time and time again when a client is informed that their pet’s condition is not, or no longer, treatable and the pet is facing the end of its life. It is a question raw with emotion and not an easy one to answer. Every pet and every situation is unique. It is impossible to tell how much time your pet has. It may be days, weeks, or even several months. It is impossible to know how difficult that time will be for your pet. 
     A common reply to clients is to estimate when the pet’s bad days outnumber the good days. How do you determine how good or bad a day is? In order to assist in assessing your pet’s condition, Dr. Alice Villalobos has developed a “Quality of Life Scale”. She encourages pet owners to examine different aspects of their pet’s life and rate them on a monthly, weekly, or daily basis. Using a score from 1 (very poor) to 10 (ideal), the following parameters are rated: 
  • Hurt – How well is pain under control? 
  • Hunger – How well is the pet eating?
  • Hydration – How well is the pet drinking? 
  • Hygiene – Is the pet grooming itself? 
  • Happiness – Is the pet responding to his/her surroundings and owners?
  • Mobility – How mobile is the pet, does it want to walk, does it need assistance? 
  • Quality of Life – has the pet more good days than bad? 
     According to this Quality of Life Scale, a score above 35 out of a total score 70 is deemed acceptable. If the score falls below 35, then the quality of life is compromised and the human-animal bond may not be enjoyable for pet or owner. Ideally we would like all of our pets to die quietly and peacefully. However that is not always the case. If your pet is suffering, difficult as it may be, the best recourse is to make the decision to humanely end your pet’s life. It is our responsibility to ensure our pet/companion doesn’t suffer inhumanely. Having a "Quality of Life Scale" such as the one developed by Dr. Vallalobos can assist in determining the state of their pet’s quality of life and when it is time to make that final decision.

References:
http://www.pawspice.com/ 

     Anesthesia is scary whether it is for a puppy’s spay or neuter, a dental cleaning, or another surgical procedure. There are horror stories from neighbours or friends ‘who know a guy that knows a guy’. But where did all these stories come from and what is the truth, if any? We are here to answer what anesthesia is all about, what risks exist, who is at the greatest risk, and how the risks are minimized. 
What is Anesthesia?
     Anesthesia, from its Greek roots, means “without sensation”.4 It can be accomplished by using a variety or combination of drugs that act by depressing the functions of nerves (local anesthesia) or by making the patient unconscious (general anesthesia).4 The anesthetic technique used depends on the patient and the procedure being performed. For example, if you need a cavity filled at your dentist, a local anesthetic is commonly injected into your gums to numb the area to relieve the pain. If a more invasive procedure is required, like taking out your wisdom teeth, the dentist may use a general anesthetic instead. Since our pets aren’t trained to sit still and say “Ahh”, they often need a combination of local and general anesthesia for their dental cleaning. The combination of anesthesia helps prevent movement and limit any pain that might be experienced. 
What are the Risks of Anesthesia and Who is at Risk? 
    
The risks of anesthesia vary and often depend on what is used to obtain anesthesia, why anesthesia is being used, and the individual patient’s reaction. For example, the risks are slightly higher in sick pets, in emergency procedures, and in very involved, complicated, or lengthy surgeries.6 The risks range from mild reactions like swelling at the injection site or a short-term decrease in the heart’s function, to severe reactions like anaphylactic shock or death.4 Fortunately, the use of anesthesia in our pets has become safer over the years with better protocols, safer drugs, improved personnel training, and sophisticated monitoring equipment.3,6 Although the risks can never be eliminated entirely, they are quite low. For example, anesthetic death in dogs and cats is 1 in 2,000 which means that 99.95% of patients do just fine.1 Stated in another way, the risk of anesthetic death is lower than the risk of driving to and from the clinic for the procedure!4 Also, we would never use anesthesia in your pet if the risks outweigh the benefits!
How are the Risks Reduced?
     Although it is not possible to completely eliminate the small but unavoidable risk whenever a pet undergoes anesthesia and surgery, our pre-anesthetic work-up and perioperative monitoring helps to reduce those risks.5 The pre-anesthetic work-up may include talking about your pet’s history, performing a thorough physical examination, or doing preoperative diagnostics (which may include blood tests, urine tests, or x-rays). The pre-anesthetic work-up aids in reducing the potential for unexpected complications, and ensuring your pet has a safe procedure (including a smooth and uneventful recovery) by detecting both clinical and sub-clinical problems.4,5 The extent of the pre-anesthetic work-up that is recommended will depend on your pet (e.g. their age, any health concerns, etc) and the procedure being performed.5 For example, prior to every surgery, fasting (withholding food) is routinely recommended in every animal to prevent a potentially life-threatening condition known as aspiration pneumonia.1,4 Aspiration pneumonia occurs more commonly in anesthetized pets because they lose their normal swallow reflex. If they vomit while under anesthesia, food or water in the stomach can accidently enter the lungs (be aspirated).1,4 A thorough history is taken. A discussion regarding the use of any medications or supplements, any health concerns or pre-existing medical conditions, and any changes in behavior will be held. A thorough physical examination will also be done prior to admission of every animal.1,4 The information gathered during the pre-anesthetic discussion and physical examination can help identify at-risk patients and allow your veterinarian to modify their anesthetic plan appropriately.1 Other aspects of the pre-anesthetic work-up like blood tests, urine tests, or x-rays, may only be recommended to certain patients or in preparation for certain procedures.1 For example, blood tests may be recommended for older animals, pets with known or suspected medical conditions, or as an extra precaution. Blood tests increase the chance of finding a hidden problem or other abnormality.1,4,5
     In most cases, your pet will be given a combination of drugs to provide anesthesia that are suited to their individual needs (a technique called balanced anesthesia).4 The drugs may reduce the stress of being in hospital or provide pain relief, making your pet more relaxed and comfortable.2,4 An intravenous (IV) catheter is placed into your pet’s arm for the delivery of injectable anesthetics and as a lifeline for emergency drugs or fluids should the need arise.2 Lubricating gel is put into your pet’s eyes to prevent drying of the cornea.2 A breathing tube (called an endotracheal tube) is inserted into the trachea to ensure accurate delivery of oxygen and anesthetic gas throughout the procedure.4 The endotracheal tube also seals off the airway and helps prevent any material from getting into the lungs (further reducing the risk of aspiration pneumonia as previously discussed).4
     In addition to the precautions taken before anesthesia is performed, your pet is carefully monitored before, during, and after they are anesthetized (referred to as perioperative monitoring) to ensure they are stable and the side effects from the anesthetic drugs are minimized.2 The surgical assistant continuously monitors your pet visually and assesses various parameters like their heart rate (number of beats per minute), blood pressure, temperature, and breathing patterns and rate. 2,4 Any unwanted increases or decreases in the various parameters will be detected early and adjustments can be made quickly to ensure the process is smooth and uneventful.4 Your pet is also monitored closely after the procedure is complete to ensure they are recovering well. They are given a place to recover that is warm, dry, quiet, and comfortable.2 They are monitored for normal behaviours, such as eating, drinking, elimination habits (including appropriate use of the litterbox in cats), grooming, and attention to the environment.2
     Although there are risks with anesthesia, precautions are taken to minimize them at every step of your pet’s visit. Your veterinarian will weigh the risks and benefits for your pet and only recommend anesthesia if the benefits outweigh the risks! If you have any questions about anesthesia, please talk to us and we can provide you with answers. 

References:
1 Seymour, Chris and Duke-Novakovski, Tanya. BSAVA Manual of Canine and Feline Anesthesia and Analgesia, Second Edition. British Small Animal Veterinary Association. 2007.
2 Fossum et al. Small Animal Surgery, Fourth Edition. Elsevier Mosby. 2013.
3 Jones, R.S. Comparative Mortality in anesthesia. Editorial II, British Journal of Anesthesia. 2001.
4 Ward, Ernest. Anesthesia for Dogs and Anesthesia for Cats. Client Education Handout, Lifelearn Inc. 2009.
5 Ruotsalo, Kristiina. Presurgical Preparation and Testing. Client Education Handout, Lifelearn Inc. 2009.
6 Zeltzman, Phil. How Safe is Anesthesia for Your Pet? Pet Health Network
.


     Do you give your pet any vitamins, neutriceuticals, or supplements? If you do, you should always inform the veterinary staff what products your pet is receiving. "Although many consumers believe that herbal medicines are safe because they are 'natural', herbal medicines and synthetic drugs may interact, causing toxicity to the patient".1 The presence of a neutriceutical or natural supplement may interfere with the medication's effectiveness leading to under or over dosing. For example, herbal remedies such as St. John's Wort and Ginkgo Biloba have anticoagulation properties causing excessive bleeding during a surgery or dental extraction. These and other unexpected side effects may be the result when a natural product is used. Therefore, your veterinarian should be made aware of their use before he makes his/her recommendation of a pharmaceutical product or surgical procedure. A product may claim that it is natural, but that does not always mean that it is completely harmless.

(1) http:/en.wikipedia.org/wiki/Herbalism accessed Feb. 26, 2014

     As the weather gets warmer, our pets and ourselves will be out in the yard. As you are cleaning up the twigs, branches, and other debris from the winter, make sure you pay attention to debris that may pose a danger to your pet. Bird seed, scraps of food, faeces, and anything else that has been lying frozen in the snow, are now thawing and decaying with the warmer weather. Although our pets view these item as special treats, they can make them very ill.
     At this time of year, we see an increase in the number of cases of gastroenteritis (animals presented with vomiting and diarrhea). Gastroenteritis is also referred to as "garbage gut". If your animal ingests any of this debris and becomes sick, offer them ice instead of water to drink, take them off food, and contact the office for an appointment as soon as possible.
     Dehydration can occur with prolonged vomiting and diarrhea and then the situation becomes life threatening. Besides, who wants to deal with the mess! Make an appointment to bring your pet to the clinic and we can treat them with medications that will get their digestive systems back on track quickly.
     Can you just pick up medication? No, the animal has to be seen by the veterinarian. Although there is a good chance it is gastroenteritis from eating something foul, there are other more serious conditions that also cause vomiting and diarrhea. It is important that the veterinarian rule out the more serious conditions before the animal is treated for gastroenteritis.
     When a veterinarian prescribes a medication for your pet, the client should be aware that there are certain concepts that are followed when prescribing any medication. The doctor chooses the treatment that will best suit your pet and its current condition. The dose of the medication is calculated taking into account:
  • the strength of the medication;
  • the recommended dosage per kilogram based upon the lean weight of your pet;
  • the length of time the medication will be prescribed.
These all depend upon the type of illness for which your pet is being treated.
 
     Follow the instructions given, carefully. The purpose of the prescribed medication is to obtain a certain level of the drug in the blood stream and maintain that level for the duration of the prescription. Therefore, try and administer the medication as regularly as possible. For example, the medication has been prescribed to be given twice a day. If you leave for work at 7:00 a.m., give the morning dose before you leave, then the second dose just before 7:00 p.m. each day. If the prescription calls for three times a day, try to administer the medication at 7:00 a.m., 3:00 p.m., and 11:00 p.m., or as close to those times as possible. If you administer the medication at irregular intervals or miss doses, the level of the medication will not be maintained at an even level in the blood stream and the treatment will not be as effective.
      Administer all the medication as prescribed. Once your pet appears to have returned to a normal activity level, it is very easy to forget to administer the remaining medication. However, it is imperative that you continue to administer all the medication as prescribed. Although your pet is feeling better, the infection may not yet be completely eradicated. Stopping the medication too early can result in a relapse of the infection and the bacteria developing resistance to the antibiotic.
      Administer all the medication. Sometimes it is recommended that a medication be given with food. Your pet may be too ill and not want to eat but it is imperative to administer the medication to get them feeling better. In this case you will have to administer the medication even if your pet will not eat. It is better that they receive the medication and have a bit of an upset stomach, than not getting the medication.

     Observe your animal carefully for signs of improvement or adverse affects. Your animal should show signs of improvement within a couple of days. If your animal does not show any improvement within this time frame, call your veterinarian. Though adverse reactions to medication are rare, if you observe any adverse reactions such as swelling of the face, hives or lethargy, etc. call your veterinarian immediately.

     Do not adjust the dosage of medication unless you have consulted with your veterinarian first or have been instructed to do so by your veterinarian. The dosage is calculated for your particular animal’s condition and body weight. If you decrease the dose, the treatment will not be effective and will encourage antibiotic resistance. If you increase the dose you may risk over-dosing and the resultant side effects.

     Do not give your animal medication that has been prescribed for other animals or for people. Your neighbour or aunt may think the condition of your pet is the same as that which their pet experienced. This may or may not be true. They are not a veterinarian and the medication they offer may not be appropriate for your pet. You should never give your pet medication that has been prescribed for another animal or person, as there may be unforeseen consequences.

     For instance a parasite medication with the active ingredient ivermectin, for most dogs this would be an appropriate choice. However, collies and dogs that are collie crosses lack a particular gene to process this medication. In the case of these dogs the result of the use of ivermectin can be fatal. Another example is acetaminophen. People tolerate this drug very well where as our pets do not. Never administer acetaminophen to your pet(s). The result could be fatal.

     Do not stop the administration of the medication without consulting your veterinarian first. If you have any concern with regard to the medication that is being prescribed, do ask your veterinarian. You may have concerns after reading on the internet the various side effects of a medication. Be aware that these side affects are often based on high dosage and long term use or a person’s opinion. Any concerns you have over the medication should be discussed with your veterinarian.


On-Line Pharmacies: A Caution

     Veterinarians can offer to write a prescription for medications to be dispensed by a local or on-line pharmacy directly to the client. However, there are some cautions to consider when having prescriptions filled off site.
     Some medications are prepared for animals only. Your local pharmacy may be unable to obtain certain medications developed for only animals. Your veterinarian is the best source for these drugs.
     With the development of the internet it is now possible for clients to access medications through On-line Pharmacies. However the buyer should be aware of the dangers of shopping on line. It is difficult to know the business that you deal with on-line. Do they follow proper shipping and storage protocols for the drugs they sell? What is the quality of the product that they are selling? One must also be aware that there are fake pharmacy sites on the internet that will sell you inferior or counterfeit drugs. You should be aware that products obtained outside of Canada are not subject to the same regulated approval process that drugs approved by Health Canada/Veterinary Drugs Directorate. You should research the Internet supplier before making your purchase to decide whether or not you wish to assume that risk.” (1)
     The U.S. FDA (Food and Drug Administration) has an excellent resource with respect to purchasing medications on line called Protect Yourself and Your Pet: Be A.W.A.R.E. You can find this resource at http://www.awarerx.org/get-informed/safe-acquisition/recommended-vet-vipps-online-pharmacies.
     There is a process that must be followed.  On-line Pharmacies must have verbal authorization from the prescribing veterinarian to verify the faxed script because they do not receive the original copy of the prescription.
     When the On-Line Pharmacy requests verification of the prescription, regulations dictate that the veterinarian must respond to the inquiry him/herself, check the patient’s record, verify the prescription and record the call in the patient’s record.
     The College of Veterinarians of Ontario has confirmed that veterinary clinics can charge for the time involved in providing this service. The clinic can charge a “Prescription Writing Fee”, and a “Consult with Other Professional/Specialist Fee”. With these additional fees, using an On-Line Pharmacy may not necessarily reduce your costs, plus it may take longer to get the medication that your pet needs. Be aware of the risks and research the On-line Pharmacy thoroughly before considering purchasing medication for your pet(s) on line.

References:

(1) http://www.cvo.org/For-the-Public/Frequently-Asked-Questions.aspx  accessed March 5, 2015.
 http://www.awarerx.org/get-informed/safe-acquisition/recommended-vet-vipps-online-pharmacies, accessed March 5,  2015


Urolithiasis (Bladder Stones)

    Four dogs and one cat were treated for urolithiasis (bladder and/or kidney stones) in the last few months. Stones or uroliths are most commonly found in the bladder and kidneys. For uroliths to develop, a nidus must be present to which the minerals are drawn. This could be bacteria or protein molecule. Also the urine must be supersaturated with minerals in order for the minerals to precipitate and for a urolith(s) to form. Different minerals create different stones.

    “The pathogenic mechanisms of urolith formation in animals with calcium oxalate, sterile struvite and silica urolithiasis are poorly understood.” (1)

Although the process is not fully understood, it is known that some risk factors include breed, gender, age and diet. Dalmatians are predisposed to urate

based uroiths while Miniature Schnauzers, Shih Tzu, and Lhasa apsos are more likely to develop struvite uroliths.

    An animal presented with a recurrent urinary infection is always suspect for urolithiasis. Other clinical signs are blood in the urine, discomfort in the abdomen, frequent urination and occasionally fever. Some animals do not show any clinical signs and the uroliths are incidental findings on radiographs or ultrasound requested for other purposes. A thorough patient history, physical exam, blood work, complete urinalysis including culture and sensitivity test, radiographs and/or ultrasound will be required to determine the diagnosis.

    Treatment will involve antibiotics if bacteria are present. A change in diet can be used to dissolve struvite uroliths. Some uroliths with require surgical removal. Often the doctor will recommend dietary therapy for one month to six weeks. At the end of this period a repeat of the radiographs will show if any progress in dissolving the urolith(s) has occurred. If there has been no improvement, surgical removal is recommended. Once a urolith or uroliths are removed they will be sent to a laboratory for analysis. Reoccurrence depends upon the type of mineral involved. Knowing the mineral content of the urolith(s) will aid the doctor in developing a treatment protocol to prevent future urolith development.

    Follow up therapy will aim to eliminate risk factors and prevent reoccurrence of uroliths. Monitoring protocols will require regular screening including; urinalysis, radiographs or ultrasound. Dietary intervention will involve the recommendation of a therapeutic diet to change the acidity of the urine. A change from a dry diet to a moist diet to dilute the urine may also be recommended. Antibiotics to eliminate any bacterial infection would be prescribed. Any future urinary infections would require prompt treatment with appropriate antibiotics.

     A caution must be made whenever an animal has urolithiasis. The stones may be small enough to enter the urethra and cause a blockage. This can happen at any time before, after diagnosis and during treatment. Any blockage is a grave situation and requires immediate attention.


References:

(1) Birchard, Sherding, Saunders Manual of Small Animal Practice, W. B.Saunders Company, Pennsylvania, 1994, page 881.

McCurnin, Bassert Clinical Textbook for Veterinary Technicians, 5th Ed., Saunders, Philadelphia, 2002


 

Back Pain

    Did you know that dogs and cats suffer from back pain too? The most common types of back pain that we see in pets are Osteoarthritis and Degenerative Disc Disease. Dogs are commonly presented with back pain issues. Cats can also suffer back pain issues but it is less frequently seen and they hide pain well.

Spondylitis: Osteoarthritis develops slowly from general wear and tear on the joints. When it involves the spine it is called Spondylitis. Wear and tear on the joints creates inflammation which in turn stimulates the development of bone growth. In Spondylitis this growth develops spurs of bone on and between the spinal vertebrae. Eventually these bone spurs decrease the animal’s flexibility and mobility and cause chronic pain.

Signs of Osteoarthritis can be morning stiffness, loss of muscle mass (muscle atrophy), reduced activity, hunched back, decreased mobility, irritability, lameness, and pain. Cats may also exhibit inappropriate elimination and grooming activity may decrease. Elimination outside the litter box may reflect the inability to step into it. Severe chronic pain may lead to aggression when touched or manipulated. 

    To diagnose Spondylitis a full history of the pet’s health and activity levels will be reviewed. The pet will undergo a thorough physical exam and radiographs of the spine will be taken. Once Spondylitis has been diagnosed, a treatment plan will be developed. The goal of the treatment plan will be to reduce the pain and inflammation and increase the pet’s flexibility and mobility. Treatment usually involves non-steroidal anti-inflammatory medication to relieve pain and inflammation, gentle exercise to maintain mobility, and condro-protective therapy like glucosamine to protect the joints. If the patient is overweight, a weight loss program to decrease the stress and pressure on the joints would be mandatory.

Degenerative Disc Disease: The main cause of Degenerative Disc Disease, once again is wear and tear on the spinal joints. It can occur in all breeds of the dog or cat but is more prevalent in those breeds with long backs (eg. Dachshunds, Bassett Hounds).

    The discs in the spine are small pads of fibrocartilage between the vertebrae. They act as the shock absorbers protecting the spine during movement. Wear and tear on the spine leads to the degeneration and calcification of these discs. When weakened these discs rupture or herniate putting pressure on the spine.

    The degeneration of the vertebrae is a process that occurs slowly over time and may go un-noticed. However, the rupture of a disc occurs abruptly and requires immediate attention. A ruptured disc in a pet may be presented with signs of pain, hunched back, and/or proprioceptive deficits (inability to feel where feet are, knuckling over of toes with no correction). In severe cases, the patient may be presented with paralysis and loss of feeling to limbs and tail.

    The veterinarian will review the patient’s history, conduct a full physical exam and take radiographs. Treatment will be tailored to the individual depending upon the severity of the clinical signs. Prognosis or outcome of the treatment depends upon duration of clinical signs. The longer the symptoms persist the poorer the prognosis.

The condition cannot be reversed. Management of the condition usually consists of strict rest, the administration of corticosteroids to reduce the inflammation and pain management, along with supportive care (eg. using a sling to assist walking). Physiotherapy, thermal therapy (application of heat and cold) and massage may also be beneficial.

    Once the acute situation has responded to treatment the patient’s condition can be managed and quality of life restored. However, precautions must be taken to avoid a reoccurrence. If the patient is overweight, a weight loss program to decrease the pressure on the joints would be mandatory. Avoidance of stairs is recommended and where not possible the installation of a ramp(s) is advised. In severe cases, surgical treatment may be required to remove the injured disc and fuse the vertebrae.

    Where complete paralysis is present and the patient has not responded to treatment, the patient may be fitted for a wheel cart to assist with mobility. Dogs have been found to respond extremely well to these mobility carts and can continue to live active healthy lives.


References:

Birchard, Sherding, Saunders Manual of Small Animal Practice, W. B.Saunders Company, Pennsylvania, 1994.

McCurnin, Bassert Clinical Textbook for Veterinary Technicians, 5th Ed., Saunders, Philadelphia, 2002.

Little, Susan E., The Cat: Clinical Medicine and Management, Elsevier Saunders, Missouri, 2012.


 

Feline Herpesvirus (FHV-1) and Feline Calicivirus (FCV)

    Frequently feline patients are presented at the clinic suffering from weepy eyes and/or nasal discharge and sneezing. After a history has been taken, clinical signs observed and a physical exam conducted it is often determined that the diagnosis is infectious upper respiratory disease.

Feline infectious respiratory disease is caused by a variety of viruses and bacteria, especially feline herpesvirus and calicivirus. The clinical signs that result from these infectious agents overlap and are often indistinguishable; thus these infections are collectively referred to as feline infectious respiratory disease or upper respiratory infection (URI).” (1)

    Feline Herpesvirus (FHV-1) and Feline Calicivirus (FCV) are both highly contagious. They are spread by direct contact with infected individuals, contaminated surfaces or from airborne droplets. Many cats are infected as kittens from their mothers.

    In mild cases the symptoms are nasal and/or ocular discharge, sneezing and/or cough. In more severe cases FHV-1 can cause Keratitis (inflammation of the cornea) and ulcers of the cornea. With FCV, ulcers of the mouth and throat are more commonly seen. Kittens infected with upper respiratory disease are highly susceptible to secondary infections causing dehydration, depression, anorexia, fever, and death.

    Most cats recover from infections from FHV-1 and FCV as these viruses tend to be self-limiting. However, once a cat has recovered from an infection, the virus lies latent within the cells of the body. “At least 80% of cats become latently infected for life.”(2) Cats that have been infected by FCV may become carriers and shed the virus for weeks, months and even years after recovery.

    With FHV-1, the virus can be re-activated at times when the cat’s immune system is stressed. The clinical symptoms reappear and the animal is once again contagious. The virus itself is self-limiting; however the weakened immune system is subject to attack by secondary infectious agents. It is usually the severity of the secondary infection that brings the patient to the clinic for treatment.

    Treatment is symptomatic. It may involve the administration of oral antibiotics, or ophthalmic ointment to treat the eyes. The owner should supply supportive care, making sure the pet is hydrated and nourished and an attempt should be made to limit any stressors affecting the pet.

    It is important to try and prevent outbreaks of infectious upper respiratory disease. This can be accomplished by:

  • Vaccinating your pet. Many strains of FHV-1 and FVC exist in the environment. Today’s vaccines carry components that are effective against some of the strains. Vaccination helps to control to the spread of these viruses and lessons the severity an outbreak in vaccinated felines. However vaccination with present day vaccines will not totally eradicate the viruses.
  • Recognizing and treating infected felines especially queens to be used for breeding early as possible.
  • Avoiding contact with other felines.
  • Cleaning areas occupied by an infected cat with bleach.
  • Practicing proper hygiene and hand washing to limit transfer of the virus.
  • Isolating any new cat by preventing them from coming into the household for a minimum of three weeks.
  • Reducing stressors that may re-activate the virus.
  • Preventing overcrowding – particularly where high feline populations occur like Humane Societies and rescue agencies.

    There are many sources of stress among our feline pets. Trauma or illness weakens the immune system setting the stage for FHV-1 or FCV re-activation. A change in your pet’s routine or environment, or the addition of a new pet or human member to the household can create stress for your pet. Some cats get stressed when the cold weather limits their access to the outdoors. Too many cats in a household or viewing a new cat in the yard through the window can also stress some cats.

Vaccination and preventing reoccurring bouts of upper infectious respiratory disease is the key to minimalizing the effect of these viruses.


References:

(1) Birchard, Sherding, Saunders Manual of Small Animal Practice, W. B.Saunders Company, Pennsylvania, 1994, p144.

(2) Cote, E., Clinical Veterinary Advisor Dogs and Cats, 3rd Ed., Elsevier Mosby, Missouri, 2015, p 482.

 Little, Susan E., The Cat: Clinical Medicine and Management, Elsevier Saunders, Missouri, 2012.



 

Compliance

    Clients bring their ill pets to the veterinary clinic because they want the veterinarian to heal their pet. After a diagnosis is made, the veterinarian will recommend a course of treatment. The treatment regime may involve medication, diet, exercise and/or life style changes. Not all conditions can be cured or reversed but the goal of the treatment plan would be to achieve the best outcome for the patient, be it a cure or the best management of the patient’s condition.

    Medications are dispensed based on the suitability to the condition, the patient’s condition and the patient’s body weight. The client will be given instructions as to the timing, dosage, frequency and duration of administration of the medication. Diets and exercise programs and changes to life-style will be discussed where appropriate and solutions suggested.

    However, compliance can always be an issue. Compliance is the response of the client to the health recommendations made by the health care provider. There are multiple factors that may influence how successful a client will comply with the recommendations given.

    A client may not be compliant if they did not fully understand the instructions given. Sometimes the treatment regime does not fit well with the client’s life style – eg. timing of medication if a client works extra-long hours or works shifts. Not all animal patients take pills or liquid medication willingly. Clients may become discouraged and cease treatment if the treatment regime is very complicated or of long duration. For example, weight loss can be a very challenging task for any owner. The cost of a medication or diet can be the prohibitive factor. If the client cannot see an immediate benefit in the treatment plan they may also become discouraged.

    However, it is important to your pet’s health that you fully comply with the recommendations by the veterinarian. If a pet is prescribed antibiotics, you may see an immediate response in a couple of days. The duration of the prescription may indicate treatment for ten days. It is imperative that you follow the instructions fully. Although your pet is showing signs of feeling better; the issue will not be fully resolved until the full course of antibiotics is completed. If you cease treatment before the full course is administered, you risk a reoccurrence of the infection and additional medical costs. Ceasing administration of the medication early may also contribute to the resistance of that particular infectious agent to the medication prescribed. In cases where medication is prescribed to manage a medical condition like seizures or low thyroid, the condition will revert back to the situation before medical intervention.

    The treatment regime is designed solely with your pet’s health in mind. If you have any issue(s) with the treatment plan we may but not always, be able to prescribe an alternative medication that is given less frequently, or substitute a medication or diet that is less costly. We may be able substitute a liquid medication for one that is in pill form. It is imperative that you follow the recommendations given as thoroughly as possible. Should there be any difficulty in doing so please do not hesitate to contact the clinic and discuss it with our medical team.


References:

http://www.cdc.gov/primarycare/materials/medication/docs/medication-adherence-01ccd.pdf - accessed August 07, 2015

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2503662/  - accessed August 07, 2015

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