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? 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.
Anesthesia, from its Greek roots, means “without sensation”. 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). 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.
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. 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. 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. Stated in another way, the risk of anesthetic death is lower than the risk of driving to and from the clinic for the procedure! Also, we would never use anesthesia in your pet if the risks outweigh the benefits!
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. 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. 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. 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 accidentally enter the lungs (be aspirated). A thorough history is taken. A discussion will be held regarding the use of any medications or supplements, any health concerns or pre-existing medical conditions, and any changes in behavior. A thorough physical examination will also be done prior to admission of every animal. 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. 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. 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.
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). The drugs may reduce the stress of being in hospital or provide pain relief, making your pet more relaxed and comfortable. An intravenous (IV) catheter is placed into your pet’s arm for the delivery of injectible anesthetics and as a lifeline for emergency drugs or fluids should the need arise. Lubricating gel is put into your pet’s eyes to prevent drying of the cornea. A breathing tube (called an endotracheal tube) is inserted into the trachea to ensure accurate delivery of oxygen and anesthetic gas throughout the procedure. 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).
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. 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. 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. 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. 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.
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.
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:
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.
An aural hematoma is an injury to the pinna (the flap of the ear) caused by trauma. The injury can be caused by excessive scratching of the ear or shaking of the head. In all cases there is an underlying cause for the scratching or shaking such as inflammation of the ear flap or infection of the ear canal, foreign body, a bite wound, injury to the pinna and parasites (ticks, black flies or ear mites). The ensuing trauma from shaking or scratching results in a blood vessel rupturing and forming a hematoma. The blood from the ruptured vessel oozes into the space between the ear cartilage and the skin. The consequence is a very swollen pinna. The ear flap is heavy and looks like a small pillow. Aural hematomas are more frequently seen in dogs
but can occur in cats.
Treatment of an aural hematoma is two-fold. Firstly, the underlying cause must be determined. If there is an ear infection, it must be treated. If insect induced hematoma, precautions need to be put in place to ease the discomfort and discourage further trauma. If a foreign body is the culprit it needs to be removed.
Once the underlying cause has been addressed, then the hematoma can be treated. The process involves draining the hematoma and applying compression on the layers of the ear so the hematoma does not recur. This procedure will be conducted under general anesthesia. If the aural hematoma is not attended to, the pet will develop a condition known as cauliflower ear.
The surgery requires surgically shaving of the underside of the ear and disinfecting the surface. Then a small incision is made to drain the fluid. Once the ear is drained, the ear flap is sandwiched between two aural hematoma pads. These pads are of a sponge like material shaped to fit the ear. The surgeon will suture through the sandwich to compress the tissues and hold the pads in place. The ear is then bandaged to assist with compression and to absorb any discharge. A second bandage may be placed around the head and an Elizabethan collar dispensed to protect the ear from further trauma. The sutures remain in place for 10 to 14 days before removal. It is advised that the pet continue to wear the Elizabethan collar for several days after the stitches are removed to prevent further trauma to the ear.
Unfortunately, aural hematomas can reoccur. To prevent an aural hematoma, be vigilant. If you see your pet scratching their ears excessively, rubbing their head along the carpet, or you notice reddening of the ear pinna or foul odour,have it investigated and treated at once. Further trauma may result in an ear hematoma.
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 unnoticed. 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 reoccurance. 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.
Bladder Stones (Urolithiasis)
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.” 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.
Cancer is a word that no one wants to hear. A cancer diagnosis causes extreme stress and is emotionally painful for any owner to hear. The result of increased health care and nutrition for our pets means that they are living longer. As a consequence there has been an increased incidence of cancer among companion animals. However, over the past three decades science has made significant advancement in the treatment of neoplasia. Science has provided clinicians with more tools and methods to enable them to diagnose, evaluate, and manage the treatment of many types of neoplasia.
There is a tendency to use the terms; mass, tumour, and cancer interchangeably. These terms are used to describe uncontrolled growth of cells or tissue. The proper term for this uncontrolled growth is neoplasia. The actual growth is called a neoplasm or a tumour. A neoplasm can be either benign or malignant. The term cancer truly refers only to those neoplasms that are malignant.
Neoplasia is not a simple disease. Neoplasia presents itself in many forms and can vary in appearance, rate of growth and aggressiveness. There are many kinds of neoplasia and each type will require different treatments. Science has determined that several factors may contribute to the development of neoplasia. One factor may be genetics. Some breeds of dogs and cats are more predisposed to certain neoplasia than other breeds. There are also environmental factors such as:
Chemical – cigarette smoke, pesticides, etc. and some medications, cyclophosphamide
Physical – sunlight, trauma/inflammation, radiation, asbestos
Hormonal – estrogen and progesterone – e.g. mammary cancer
Viruses – even some viruses cause neoplasia e.g. papillomaviruses, retroviruses
Initially, patients present to the clinician with general signs of illness; lethargy, anorexia and weight loss. Other presenting signs could be abdominal swelling, bleeding from the mouth or nose, difficulty breathing, lumps, bumps or discoloured skin, persistent diarrhea or vomiting etc., but these are all general signs that could be attributed to many other diseases. A thorough physical exam and a general work-up will be necessary to determine the cause of the malaise. Diagnostic blood-work and urinalysis may reveal the cause of the malaise. It must be noted that there are no standard chemical blood tests at present that detect tumors. Some tumors may not invade surrounding tissue. It is only when they are large enough to compromise the function of an organ do we see any irregularity in the blood work. Radiographs are the next step in diagnosis. If a neoplasia is present on the radiograph(s), a follow-up ultrasound exam is generally advised. The ultrasound exam aids in determining the extent of the tumour and informs the clinician whether the tumour is confined within itself, to one particular organ, or whether has it begun to metastasize. The physical and diagnostic exams may also reveal other concurrent diseases or conditions present in the patient. These conditions may affect treatment of the existing tumour(s) and will be taken into consideration when a treatment plan is determined.
Once the diagnosis has been made and the extent of disease determined, the veterinarian will consult with the client. The client will be presented with the extent of the neoplasia. The clinician will explain available treatments choices, their costs and prognosis. The client will be made aware of the risks, benefits, and toxicity of the treatments. In consultation with the client and if the prognosis is good, a treatment plan will be undertaken. Cancer treatment is very specialized and not all veterinary hospitals have the expertise, special medications and handling equipment to perform cancer treatment. If treatment is beyond the capability of the facility, a referral consultation with an oncology specialist can be arranged. If the prognosis is poor and funds limited the client may opt for palliative treatment or euthanasia.
Treatment will be multi-faceted. Treatment may involve several therapies: surgery, chemotherapy and/or radiation. In addition treatment for other concurrent diseases will be addressed along with nutritional therapy and pain relief. Tumours produce anorexigenic substances that suppress appetite. Anorexia (loss of appetite) is common in neoplasia patients and many are under nourished. As malnutrition hinders healing, it is important to ensure the patient gets adequate nutrition while under treatment. Pain management is also an important aspect of treatment in the cancer patient to relieve suffering and improve quality of life. The origin and severity of the pain are determined and an appropriate treatment protocol developed. Continual re-assessment is necessary. Throughout treatment period, the patient will be regularly assessed, adjustments to treatment and pain therapy made, all in an effort to maintain quality of life for as long as possible.
Cruciate Ligament Rupture
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 leaping from a slippery surface and over extending the joint, and by 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". 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; and 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.
Degenerative Joint Disease (Osteoarthritis)
Osteoarthritis is a chronic, progressive disease resulting in the degeneration of joint tissue “in which function is diminished or structure is impaired.” Osteoarthritis can affect dogs and cats of any age, size or breeding. It is caused by:
joint instability caused by congenital defect, e.g. patella luxation, hip dysplasia
joint instability caused by trauma, e.g. cruciate rupture
developmental orthopaedic disease such as osteochrondrosis
aging, the general wear and tear on the joints
Osteoarthritis is chronic and insidious. It develops slowly over time, initially showing no outward signs of development. Eventually, there are sufficient changes in the joint tissue that the pet starts to exhibit signs. A pet with osteoarthritis may show signs of lameness, pain, stiffness, and a decreased tolerance to exercise. A cat may stop jumping onto the bed or into high sided litter boxes. A dog may be reluctant to climb the stairs.
Upon presentation at the clinic the veterinarian may find: joint enlargement or thickening: crepitus – grating sensation upon movement; muscular atrophy (lessening of muscle mass); decrease range of motion in the joint(s); production of marginal osteocytes (new bone growth) in response to irritation and/or inflammation.
A radiograph of the spine of a dog showing a normal vertebrate on the left and an arthritic vertebrate on the right. This bridging of bone tissue of the spine is known as spondylitis.
Osteoarthritis can affect any joint but is seen most often in the limb joints, stifle (knee), carpus (wrist), and hip as well as in the spine. Diagnosis of osteoarthritis is determined by a thorough history, physical examination and radiography. Once a diagnosis is made, treatment will be designed to minimize discomfort of the patient, improve function, increase muscle mass to provide shock absorption and prevent further degeneration of the joint(s). Some treatment may involve surgery to stabilize the joint such as in a patella luxation or a cruciate rupture. Other treatment would involve:
pain relief using non-steroidal anti-inflammatory drugs to reduce pain and inflammation
weight reduction to decrease stress on the joint
passive range of motion exercises, massage, or therapeutic ultrasound to increase range of motion
use of a diet designed for joint issues high in Omega 3 fatty acids
use of dietary supplements such as glucosamine
high impact exercise like running and jumping should be discouraged.
Treatment includes prompt recognition and intervention of osteoarthritic conditions may delay the progression of the disease. Once the disease is present it is not reversible. It will continue to slowly progress. However, with medical and/or surgical intervention along with modifications in life style, the disease can be managed. The prognosis is favourable and the aim is to help your pet continue to enjoy good quality of life.
Dental Health of Dogs and Cats
Like humans, oral health is important to our pet friends. Dental disease is caused by the accumulation of plaque and tartar (calculus) on the teeth. Dental disease is a progressive disease. The first sign of disease is gingivitis. This is the accumulation of plaque on the teeth causing inflammation along and just under the gum line. Other signs are halitosis (bad breath) and accumulation of calculus (tartar). If treated immediately with dental prophylaxis (cleaning) the condition is reversible. However, if left untreated, the condition develops into periodontitis, inflammation of the connective tissue of the teeth and their boney sockets. Signs of periodontitis are severe inflammation, recession of the gums, loose teeth due to the destruction of the periodontal ligament, and/or abscessed teeth. Periodontitis is irreversible resulting in permanent loss of teeth and re-absorption of the jaw bone. In addition, dental disease harbours bacteria in the mouth. These bacteria can migrate to the internal organs and cause, heart, liver and/or kidney disease if treatment is not sought.
When your pet is in the hospital for a routine exam, its mouth is examined. The veterinarian assesses the condition of the mouth and assigns a number. These numbers correspond to the following stages of dental disease as established by Dr. Wright.
Stages of Dental Disease:
0 New Teeth/young teeth – no sign of tartar or gingivitis
1 Marginal gingivitis, where the only sign is inflammation of the edge of the gingiva: the red line sign
Action: Routine cleaning by owner
2 Moderate gingivitis. The gingiva is oedematous (swollen) and inflamed
Action: Prophlaxis with in next 3 to six months
3 Severe gingivitis. The entire gingiva is oedematous, bleeds easily, and periodontal pockets are starting to form
Action: Prophlaxis with in next 3 months
4 Moderate periodontitis. The inflammation is severe, pockets and pus are present, and there is some bone loss and slight
Action: Prophilaxis within 4 weeks
5 Severe periodontitis. There is advanced bone loss, definite tooth mobility and tooth loss
Action: Health is impaired. Prophlaxis as soon as possible.
If a pet’s mouth scores 3 or higher on this scale, a dental prophylaxis will be recommended. Depending on the severity of the disease extractions may be necessary.
To maintain oral health of your pet;
Daily teeth brushing will help maintain oral health in pets. Ideally, pets should be trained for teeth brushing when very young, however taking small steps, proceeding slowly, remaining calm and patient, older pets can learn to tolerate teeth brushing as well.
Use only pet toothpaste. Human tooth paste is not meant to be swallowed and could be harmful to your pet.
Check your pet’s teeth regularly by gently lifting the gum on the side of the mouth to view the molars. The molars are often the first teeth to be affected by gingivitis and accumulated plaque.
Give the pet appropriate chew toys and treats.
Feed a dental diet. Dental diets are designed to retard build-up of plaque and the accumulation of calculus.
Maintain regular veterinary check-ups.
Book a dental prophylaxis (cleaning) when deemed necessary by your veterinarian.
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.
For a proper diagnosis, 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.
Ear Inflammation (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 need 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.
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.
Eye Lids - Common Conditions
There are some conditions that we commonly see that affect the eyelids of our pet. This article will discuss issues that affect the Meibomian Glands, the gland of the 3rd eyelid and the lacrimal ducts. Lubrication of the eye is paramount to its function. Tears are produced by the Lacrimal System which is a series of glands that protect the eye from infection, lubricate the movements of the eye and eyelid, and also ensure the presence of a tear film over the eye and in the eye cavity.
Meibomian Glands are modified sebaceous glands that produce a lipid component to lubricate the eye. This lipid component is released through numerous small openings along the edge of the eye lid. Infection of the meibomian gland presents with swollen eyelid margins and the presence of crusty exudate. The small ducts may become blocked and thick opaque sebaceous material builds up at the eyelid edge. To the pet owner, this blockage appears as a small dark growth along the eyelid. Treatment with an antibiotic may clear up the infection. The veterinarian may express the gland to release the blockage but if blockage persists, expression may have to be repeated in future visits. Sometimes tumours develop along the line of the meibomian openings. Most of the tumours are benign; cancerous tumours are rare. These tumours can become enlarged and irritate the cornea causing pain and possible corneal ulcers. Treatment is to have these tumours surgically excised.
Gland of the 3rd Eyelid is located proximity to the nasal passage below the eye. This gland produces 50% of the aqueous component of the tear film. The nictitating ligament holding this gland can fail allowing the gland to prolapse upward above the eyelid. Exposed to the air, the gland becomes inflamed and swollen. It appears as an angry red mass in the corner of the eye. Due to its appearance the condition has been come known as “Cherry Eye”. Cherry Eye can occur in any breed of dog and occasionally in cats. Some canine breeds are more prone to this condition (eg. Spaniels, English bulldog, Lhaso apso, Bull Mastiff and Beagle). Treatment is to surgically correct the prolapse. Under general anaesthetic, the gland is repositioned to its normal position and anchored within the conjunctiva with sutures to hold it in place. Post-operative ophthalmic antibiotics would be prescribed. Prognosis is favourable but there is a risk of a secondary prolapse in the future. In the breeds that are predisposed to this condition both eyes may be affected by 3rd eyelid prolapse.
Lacrimal Duct: Small tubes, originating in the nasal corner of the eyelids, one to the upper lid and the second to the lower lid, converge to create the lacrimal duct. Excess tears flow through the tubes (puncti openings) to the lacrimal duct and empty into the nasum. Lacrimal duct obstruction is commonly seen in dogs, not so much in cats. Some facial features of certain breeds predispose them to lacrimal duct obstruction (eg. Bulldog, Boxer, Boston terrier). A congenital defect in the development of the lacrimal duct before birth occurs. The consequence being, there is no opening where there should be one in the conjunctiva. Infection and/or inflammation of the eye can also result in the lacrimal duct becoming blocked.
In either case, the dog will exhibit excess tearing of the eye. The fur below the eyes may have marked staining from the excess tearing. In severe cases, the moisture in the fur below the eye attracts bacteria. A skin infection may develop causing redness, itching, swelling and possible hair loss.
Any excess tearing is a cause for concern as it is an indicator of possible disease or injury to the eye(s). It is important to have a veterinarian assess the eye(s) as soon as possible to determine the cause of the excess tearing.
If no disease process or ulcer(s) is present, the veterinarian will run a fluorescein test to determine if a blocked lacrimal duct is the cause of the symptoms. Fluorescein drops are placed in each eye to test the patency of the ducts. After being applied the stain should flow through the lacrimal ducts and appear in the nose and the mouth. The yellow fluorescein stain is very visible under black light. If the stain is not seen in the nose or mouth after 3 - 5 minutes it is determined that the lacrimal ducts are blocked.
Treatment of a blocked lacrimal duct(s) requires irrigation of the ducts to alleviate the blockage. This procedure is done under general anaesthetic. A very fine cannula (tube) is inserted into the opening of the duct and saline is flushed in the tube. This method can clear the blockage in cases where the obstruction is minor. However, in cases where there has been chronic inflammation or congenital deformity, clearing the obstruction may not be possible. In all cases of infection and inflammation treatment with antibiotics and anti-inflammatory medication would be appropriate.
Any excessive tearing, discharge or swelling in and around the eye(s) are symptoms of injury or a disease process and is a cause for concern. You should make an appointment to have the issue investigated by your veterinarian as soon as possible.
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.. 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 provodone 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). Ten 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.
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).”
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.” 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 minimizing the effect of these viruses.
Feline Lower Urinary Tract Disease (FLUTD)
Feline Lower Urinary Tract Disease is a term used to describe a group of clinical signs related to problems voiding urine. FLUTD usually presents itself as inappropriate urination however the symptoms of FLUTD are many: pollakiuria (voiding small amounts of urine frequently), hematuria (blood in urine), dysuria (exhibiting pain upon urination or straining to urinate), vocalization, hiding, and periuria (urinating outside the litter box). Medical reasons for inappropriate urination include: bladder infections, crystals in the urine, bladder stones, feline idiopathic cystitis (blood in urine with no bacterial infection), diabetes mellitus (sugar diabetes), kidney disease, hormonal imbalances, bladder cancer, or nerve damage. Behaviour issues resulting from stress or a change in environment can also cause an animal to urinate inappropriately.
Finding urine puddles on the kitchen floor, or next to a litter box, should alert you to the fact that something is wrong. Do not assume that it is a behaviour issue. Seek advice from your veterinarian immediately. Urinary issues although common, are not always simple or easy to resolve. Unfortunately, they are often the reason cats are relinquished to shelters or euthanized. Therefore, it is imperative to determine the underlying cause of your pet's inappropriate urination in order to recommend the appropriate treatment or management regime to resolve the issue.
Diagnosis begins with a detailed history and physical examination. The veterinarian will require a fresh, sterile urine sample. A urinalysis and bacterial culture and sensitivity tests will be performed on this sample. Results from the urinalysis indicate whether there is blood, bacteria, or crystals present in the urine. The culture and sensitivity test will determine which bacteria if any are present and determine the best antibiotic to use against the bacteria. Other disease processes may be identified. Infections can be successfully treated with antibiotics. Crystals in the urine can be resolved by a diet change to lower the pH to make the urine more acidic. However, other processes are more difficult to resolve.
Feline idiopathic cystitis, or FIC, is the most common urinary issue in young and middle aged cats. Idiopathic means of unknown cause and cystitis means inflammation of the bladder. Results from the urinalysis and culture and sensitivity tests are all negative for bacteria in this syndrome. Although the cause for the bladder inflammation is unknown there is a suspicion that stress may be one of the causal agents. Cats like to be independent and can be stressed easily. In a multi-cat household stress can result from competition for the food dish, litter-box and/or a quiet space. Cats can be stressed by changes to their environment. These changes may be as simple as boredom, a change in the weather, a stray cat or dog in the yard, change in your routine, or a change in litter type to more drastic changes like moving to a new home or the addition of a new baby or new pet in the household.
With FIC, the primary actions are: 1. reduce stress; 2. environment enrichment is essential, eg. the use of scratching posts, climbing platforms, interactive toys that mimic the hunt; 3. diet change to encourage water consumption e.g. feed canned food; 4. feeding a diet designed to lower urine pH, eg. Royal Canine Urinary SO or Hill’s u/d diet; 5. drug therapy – when environmental enrichment and diet change is not effective. The good news is that a significant number of FIC cases resolve if recognized early and treated appropriately.
Urethral obstruction occurs when a cat develops a blockage of their urethra. Crystals or mucous can be the offending agent in their urine. Male cats are more prone to ral obstruction than females due to their long narrow urethras. Should your cat be showing signs of a urethral blockage, it is an emergency situation. They cannot void the urine from the bladder. Toxins build up in the blood and they become very sick. In the most severe cases the bladder enlarges to the point where it ruptures. If you notice your cat straining, having difficulty voiding, or unable to void, call your veterinarian immediately. This condition is life threatening. The photo to the right shows a struvite crystal in urine under a microscope.
Blood tests, ultrasound, and x-rays are additional tools that assist the veterinarian in diagnosing the specific problem. Blood work can be taken to determine if there is an underlying disease process like diabetes or kidney disease. These conditions require medications and a diet change. Ultrasound and x-rays can detect bladder stone(s) and tumours.
If no medical reason is determined, the veterinarian will explore the issue of behaviour. A thorough examination of the patient’s history and environment will be explored. The veterinarian will determine the possible causes for the inappropriate elimination and give advice on how to correct the behavior.
The primary actions for behaviour issues are: 1. reduce stress; 2. retraining is essential; 3. environment enrichment, eg. the use of scratching posts, climbing platforms, interactive toys that mimic the hunt; 4. drug therapy – not recommended unless retraining and environmental enrichment is not successful.
Owners sometimes assume the issue is behavioural and do not seek veterinary advice immediately. The pet continues urinating inappropriately, developing a habit of this behaviour. When presented to the veterinarian, a medical cause is found but there is the acquired behaviour issue to overcome as well.
Treatment and prognosis of FLUTD depends upon the underlying cause and the speed in which the condition is dealt with. The important point to remember is that there are many causes of inappropriate elimination and your veterinarian has the knowledge and tools to help resolve the issue with your pet. Early diagnosis makes for a more successful resolution.
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, feces, 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.
Hyperthyroidism is the most common endocrine system disorder in cats. Thyroid hormones are produced in the bi-lobed thyroid gland located beside the trachea. Thyroid hormones are essential in cell development and metabolism. These hormones regulate the metabolism of fats, proteins and carbohydrates in the various cells of the body. They also play a role in regulating body heat and oxygen consumption.
Hyperthyroidism occurs when the thyroid gland produces an overabundance of thyroid hormone. The most common cause of hyperthyroidism is a benign adnemona (non-malignant tumour) of the thyroid gland. An excess of thyroid hormone can affect the function of the entire body.
Hyperthyroidism appears in cats of any age. However, the majority of cats present with symptoms between eight and ten years of age. If left untreated the condition can lead to cardiac disease and hypertension. A cat with hyperthyroidism may present with any number of the following signs: weight loss, increased or ravenous appetite, increased fluid intake, increased urination, restlessness, hyperactivity, matted or unkempt coat, alopecia from over grooming, vomiting and diarrhea.
The diagnosis of hyperthyroidism is determined by the presentation signs, palpation and blood-work. Some enlarged thyroid glands can be palpated but not all. Also not all enlarged thyroid glands indicate hyperthyroidism. The definitive diagnosis is made through blood-work.
Once hyperthyroidism is diagnosed, the aim is to get the thyroid levels under control. This is achieved through drug therapy and diet. The cat may initially be treated with Methimazole which inhibits the synthesis of thyroid hormone and will be fed exclusively, an iodine-restricted diet (Hill’s Y/d diet). It will take about three months before the thyroid levels are brought back to normal. Regular monitoring of Thyroxine or T4 (a thyroid hormone), along with, CBC (complete blood count) and blood chemistry levels will be required every three to four weeks during this time. Existing medical conditions need to be treated concurrently with the hyperthyroid treatment.
Once the thyroid levels are under control the client and veterinarian will decide on the next course of action. The thyroid levels can be continued to be managed with the drug and/or diet regime with regular monitoring as mentioned above. However the use of this Methimazole and Y/d diet do not halt the progression of the thyroid ademoma(s). The client in consultation with their veterinarian may choose a more permanent solution to reverse the hyperthyroidism: radioactive iodine (I131) therapy, or surgical excision.
Radioactive Iodine (I131) involves the administration of the radioactive concentrate orally or by subcutaneous (under the skin) injection. The radioactive material concentrates in and destroys the hyperactive tissue within the thyroid gland leaving normal tissue unharmed. A single treatment is required to reverse hyperthyroidism in most cats. Although the therapy is simple it can only be performed in approved licensed facilities under extensive compliance with Health Canada’s Radiation Laws. Radioactive Iodine (I131) has a half-life of 8 days therefore, after treatment the patient must remain in special isolation for 8 to 10 days. This therapy requires travel, separation from the pet and is moderately expensive.
Surgical excision involves removal of the effected thyroid gland(s), or excision of the hyperactive tissue in the thyroid gland. This is another option available to the client that is considered permanent treatment for hyperthyroidism. However, in 5% where both thyroid lobes are removed and 20% where only one thyroid gland is removed, hyperthyroidism has reoccurred. This method is relatively effective, moderately difficult, and moderately expensive.
Methimazole has been used as a long term treatment in cases where the cat tolerates the drug’s side effects and the permanent options are beyond the client’s willingness or means to pursue a more permanent treatment. In the last decade Hill’s y/d diet has been an added tool to the successful treatment of hyperthyroidism. The prognosis of the hyperthyroid patient having good quality of life is excellent provided that there are no other underlying medical conditions
Canine influenza (also known as dog flu) is a contagious respiratory disease in dogs caused by a specific Type A influenza virus. Canine influenza is a new virus to Canada and our pets have no inherited immunity or previous exposure immunity to it. This lack of immunity and the highly contagious nature of Canine influenza makes the disease a public concern. All dogs are susceptible to canine influenza, but those most susceptible to severe illness are the young, the aged, and brachycephalic breeds (pugs, boxers, bulldogs, etc). The illness tends to spread most where dogs are congregated: kennels, shelters, dog parks, and canine events. Symptoms manifested in dogs can be cough, runny nose, fever, lethargy, eye discharge, and reduced appetite. The symptoms associated with canine flu range from no visible signs to severe illness. Most dogs recover within 2 to 3 weeks; however, some may develop secondary bacterial infections which may lead to more severe illness, pneumonia, and death.
Canine flu can spread to other dogs through the air from the coughing and sneezing of infected dogs or contact with contaminated objects and surfaces. Therefore, owners whose dogs are coughing or showing other signs of respiratory disease should limit the exposure of their dog to other dogs. Contaminated objects and surfaces should be disinfected after exposure. Should your pet be showing signs of canine influenza, notify the staff of these symptoms when booking your appointment at the hospital so that necessary infection control measures can be put in place for your visit.
Treatment largely consists of supportive care which may include medication to make your dog more comfortable and fluids to ensure that hydration is maintained. Broad spectrum antibiotics may be prescribed if a secondary bacterial infection is suspected. Canine influenza cannot be diagnosed solely by clinical signs (coughing, sneezing and nasal discharge). These clinical signs are also common to other canine respiratory illnesses. If your pet is suspected of suffering from canine influenza, a test will be run for confirmation.
Ontario veterinarians and veterinary laboratories are required to immediately report known or suspected infections with “novel influenza viruses” to their local medical officer of health.
Vaccination can reduce the risk of a dog contracting canine influenza and/or reduce the severity and duration of clinical illness. Consult with your veterinarian to determine your dog’s risk of exposure to the canine influenza virus and if vaccination is appropriate for your dog.
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.
Medication Do's and Don'ts
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 to 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.
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, 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.
Neutriceuticals, Natural Supplements, and Herbal Products
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. 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.
Online Pharmacies: A Caution
Veterinarians can offer to write a prescription for medications to be dispensed by a local or online 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 online 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 online. 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.
The U.S. FDA (Food and Drug Administration) has an excellent resource with respect to purchasing medications online 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. Online 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 online 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 (CVO) 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 online 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 online pharmacy thoroughly before considering purchasing medication for your pet(s) online.
The pancreas is responsible for two main functions:
1) The production of insulin for glucose regulation/stabilization.
2) The secretion of various enzymatic chemicals for the digestion of food. This is exocrine activity. This article will focus on the exocrine functions of the pancreas.
Abnormalities associated with exocrine activity are hard to diagnose and difficult to differentiate from small intestinal disease.
Pancreatic disease is a multifaceted syndrome rather that a single disease. Clinicians use names and terminology to try and describe the complex disease but there is considerable overlap in presenting signs. A variety of names and name changes will occur as we better understand this condition. The exocrine activities of the pancreas include;
· secretion of enzymes for digestion of carbohydrates, protein and fats
· secretion of bicarbonate to neutralize gastric acid
· absorption of cobalamin (vitamin B12)
· secretion of antibacterial proteins to regulate intestinal micro-flora.
The interruption or obstruction of any or all of these pancreatic activities results in pancreatic disease. The inability of the pancreas to secrete adequate digestive enzymes results in the failure of the small intestines to maintain proper nutrient absorption to sustain cell life.
Two serious but not common diseases of the pancreas are: Pancreatic Acinar Atrophy and Exocrine Pancreatic Insufficiency.
The most common pancreatic disease in young dogs is Pancreatic Acinar Atrophy (PAA). It is a disease where the pancreas slowly degenerates. Previously, it was thought that there was a genetic disposition to Pancreatic Acinar Atrophy. However, recent research suggests that Pancreatic Acinar Atrophy is an autoimmune disease. It is generally diagnosed in dogs between the ages of 18 months to 4 years and most often seen in German Shepherds and Rough-coated collies.
Exocrine Pancreatic Insufficient (EPI) is another syndrome where there is insufficient secretion of pancreatic digestive enzymes from the pancreas. It affects both dogs and cats but is more commonly found in dogs. Approximately 50% of dogs diagnosed with Exocrine Pancreatic Insufficiency (EPI) also have Pancreatic Acinar Atrophy (PAA).
The most common cause of Exocrine Pancreatic Insufficiency affecting dogs and cats of any age is chronic pancreatitis (inflammation of the pancreas). Pancreatitis may be presented with concurrent small intestinal dysbiosis (abnormal bacterial flora of the GI tract) and /or inflammatory bowel disease. Exocrine Pancreatic Insufficiency occurs when 85 to 90 % capacity of the pancreas secretion is lost. This results in the mal-digestion of nutrients from the intestines and the patient fails to thrive. In addition, acid injury to the duodenal mucosa, deficiency of Vitamin B12 and fat soluble vitamins, and overgrowth of intestinal bacterial floral often develop. Chronic pancreatitis can also result in the development of diabetes mellitus (sugar diabetes).
Signs of Pancreatic Acinar Atrophy (PAA) and Exocrine Pancreatic Insufficiency (EPI) include weight loss, the production of large volumes of soft, semi-formed, pale, odorous feces and/or diarrhea, ravenous appetite, poor body condition and/or poor hair coat. Chronic dysbiosis is another clinical sign. It must be noted that some of these symptoms are also found with small intestinal disease.
Consequently the diagnosis of pancreatic disease is complex. The veterinarian will begin with a review of the patient’s medical history, and clinical signs presented. Blood work consisting of a complete blood count (CBC) and clinical chemistry, along with a urinalysis will be required. In addition, radiographs and/or ultrasound may be performed to rule out other diseases that may present with similar symptoms. If no other cause is found for the patient not thriving; the veterinarian will request additional blood tests, including vitamin B12 serum level and the Trypsin-like Immunoreativity Assay or TLI panel. The TLI test is highly sensitive and the most accurate test for the diagnosis of pancreatic disease. Normal serum level of TLI for dogs is 5.7 to 45.2 mcg/L, and for cats 12 to 82 mcg/L. If the TLI serum level for dogs is less than 2.5 mcg/L or less than 8.0 mcg/L for cats, the test is diagnostic for Exocrine Pancreatic Insufficiency (EPI) or Pancreatic Acinar Atrophy (PAA). If the serum level is greater than 2.5 mcg/L for dogs and greater than 8.0 mcg/L for cats but lower than the normal parameters, these patients may have subclinical pancreatic disease or chronic small-intestinal disease. Progression of subclinical pancreatic disease may ultimately lead to exocrine pancreatic insufficiency.
If testing is suggestive of Exocrine Pancreatic Insufficiency (EPI) or Pancreatic Acinar Atrophy (PAA) treatment will be multi-faceted. It is crucial to supplement the loss of the pancreatic enzymes. Treatment will be life-long. The patient will be prescribed a pancreatic enzyme extract to be administered with each meal. 80 % of dogs and virtually all cats with Exocrine Pancreatic Insufficiency have low vitamin B12 levels. Therefore the patient will receive weekly or bi-weekly vitamin B12 injections until such time as their vitamin B12 serum level returns to normal. This therapy may take a number of months before the normal serum level is reached. In addition, the veterinarian may prescribe an antibiotic and/or probiotics to treat intestinal dysbiosis and prescribe antacids to combat the excess acids in the stomach. The pet owner will be advised to monitor food intake, and stool quantity and character on a regular basis. The veterinarian will want to monitor the patient’s vitamin B12 blood serum levels, body weight and general well-being, regularly. Most animals diagnosed with Exocrine Pancreatic Insufficiency (EPI) or Pancreatic Acinar Atrophy (PAA) can be fed an ordinary maintenance diet. If you have found this confusing you are not alone. These pancreatic syndromes are very complicated. None the less most patients diagnosed with PAA or EPI respond well to the treatment regime and live normal lives.
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. 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:
"Age has been described as a progressive reduction in the ability to maintain normal bodily function in relation to the demands of the environment."
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 Wright Veterinary Hospital 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:
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.
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.
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.
Treatment Compliance - Finish That Prescription!
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.
Uroliths (Urinary or Renal Stones)
Like humans, dogs and cats can develop kidney and bladder stones. What predisposes one pet to develop uroliths and not another is still undetermined. However, risk factors such as age, gender, breed, and diet have been identified. It is also suggested that stress and obesity could be contributing factors. For uroliths to develop, a nidus must be present to which the minerals are drawn. This could be bacteria or a protein molecule. Also the urine must be supersaturated with minerals in order for the minerals to precipitate and enable a urolith(s) to form. Different minerals create different stones.
An animal presented with a recurrent urinary infection is always suspect for urolithiasis (bladder stones). 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 radiography or ultrasound. A thorough patient history, physical exam, blood work, complete urinalysis including culture and sensitivity test, radiographs and/or ultrasound are used to determine the diagnosis.
The composition of the minerals precipitated determines the type of stone present. The most common types found in pets are struvite and calcium oxalate. In the mid-1980’s about 78% of uroliths submitted for analysis were struvite. Struvite stones dissolve with prescription diets. These diets also discourage the development of new struvite stones and therefore the afflicted pet should be fed the specialized diet for the remainder of their life.
In recent months four cats admitted to Wright Veterinary Hospital, have been diagnosed with calcium oxalate stones in their bladders. The Canadian Urolith Centre has reported a decrease in struvite stones and an increase in calcium oxalate stones being submitted for analysis. The recent statistics from that Centre indicate 49% of submissions received were calcium oxalate while only 42% were struvite stones.
This is a disturbing trend since oxalate stones are not dissolved by changes in the diet. One hypothesis suggests that the diets formulated to increase urine acidity may also predispose our pets to hypercalciuria (calcium in the urine) and the development of calcium oxalate stones. We have anecdotally noted a number of pets fed RAW diets have been presented with calcium oxalate stones. Calcium oxalate uroliths (stones) are removed surgically. At Wright Veterinary Hospital we remove the stones surgically and then flush the bladder before closing the surgical incision. Once a urolith(s) is removed it will be sent to a laboratory for analysis. Reoccurrence depends upon the type of mineral involved and compliance with dietary recommendations. Follow up therapy will aim to eliminate risk factors and prevent reoccurrence of calcium oxalate uroliths. Bladder infections found are usually secondary to the development of the uroliths. Calcium oxalate stones are not smooth like struvite stones but more like shards of glass with irregular rough surfaces which traumatize the bladder wall causing bleeding and predisposing to bladder infections. Culturing the urine at surgery will determine the need for antibiotic treatment.
Dietary intervention will involve the use of a therapeutic diet with restricted protein, and high in moisture content aimed at decreasing the acidity of the urine. The pet will require a regular screening protocol including; urinalysis, radiographs or ultrasound to ensure no new uroloith(s) develop.
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 an emergency and requires immediate attention.