LYME DISEASE

The infection known as Lyme Disease, named for the Connecticut town of Lyme, has been around for at least a century. The bacterium which causes Lyme Disease, Borrelia burgdorferi, is a special shape called a “spirochete” because it looks a bit like a long corkscrew. The bacteria are transmitted by ticks, the most common culprit being the deer tick Ixodes scapularis. Once in the bloodstream, the bacteria are carried to many parts of the body, often localizing in the joints. The disease causes different symptoms in dogs and humans, and cannot be transmitted between the two, only by the bite of an infected tick.

In humans, a “Bulls-eye” shaped rash and flu-like symptoms are most common. Most people don’t even recall being bitten by the tick. A few weeks afterwards, joint pain develops, and some people will develop neurologic problems or heart rhythm disturbances. Months after the disease begins, some people will continue to experience intermittent attacks of arthritis and long-term illness.

Lyme Disease is quite different in dogs. To begin with, dogs don’t get the characteristic rash, and most dogs don’t start having any signs of illness until months after the tick bite. Affected dogs often come to the vet because they appear to have difficulty moving and look as though they are “walking on eggshells.” The painful lameness can sometimes shift from one leg to another. They may also have lost their appetite or have a high fever. But the most important long-term complication of Lyme Disease is the development of “glomerular disease.” This is a type of kidney damage that occurs due to the chronic nature of the disease. The immune system makes antibodies to fight the infection. But the constant production of antibodies can result in “clumps” of the antibodies, which become deposited in the kidneys and “clog” up the filtering process. When the kidneys can’t filter the blood properly renal failure results.

Dogs with lameness, swollen joints, and fever are suspected of having Lyme Disease. One test we can use is an antibody test, but it just tells us if the dog has been exposed to the spirochete at some point in time. Dogs can be exposed to the organism without getting sick, so dogs may test positive without actually requiring treatment. This test can be falsely negative if the dog has not yet formed antibodies, or if it has had the disease for a very long time and is not making enough antibodies for the test to detect. The second test is a PCR test which is much more specific and sensitive because it tests for presence of the spirochete, and is most effective when joint fluid is tested (rather than blood).

Because Lyme Disease is caused by a bacterium, it can be controlled with antibiotics. However, it often takes a long course of treatment in order to completely rid the spirochete from the body.

The key to prevention is keeping your dog from being exposed to ticks. The feeding tick is attaches to the host, and regurgitates enzymes which prevent clotting so it can continue to take a blood meal. The spirochete that causes Lyme disease is transmitted in this regurgitation process. However, it takes a minimum of 48 hours for the transfer to occur, so if the tick is removed before this time, the spirochete cannot be transmitted. Tick control products such as Frontline, Advantix, and the PrevenTic collar work by either killing the tick, or causing it to drop off before the 48 hour deadline.

A vaccine is also available for dogs, but there is quite a bit of controversy regarding its use. The vaccine prevents infection in dogs vaccinated before any exposure to Lyme disease has occurred. Therefore, young puppies and dogs from non-endemic areas traveling to endemic areas are most likely candidates. Annual boosters are needed to continue the immunity. The argument against vaccination is that over 90% of dogs exposed to the disease never get sick, and the 5-10% that do have problems can be treated with a safe and inexpensive course of antibiotics. However, due to the potential for life-threatening kidney disease after long-term exposure means that for a few animals, the vaccine may be very important. It is best to discuss with your veterinarian the concerns you have regarding Lyme Disease, your pet’s risk, and how you can most effectively protect your dog from ticks.

IN MEMORY OF BEAR

Bear was a very sweet 4 year old German Shepherd dog. His owners had never seen a tick on him before. When he became lethargic and had not been eating well, they brought him in for an exam. Bear’s vet decided to use the 3DX test to screen Bear for Heartworms, Lyme Disease, and Erlichiosis. He came up positive for Heartworms and Lyme Disease. Bear also had several types of intestinal parasites. Even more concerning, though, was the elevation of his kidney enzymes that showed up on his blood chemistry. Bear was showing signs of kidney damage from chronic Lyme disease infection.

Bear was hospitalized for a week and received IV fluids to flush out his kidneys and antibiotics for the infection. Then his owner learned how to give him fluids under his skin so he could continue to be treated at home. Unfortunately, when Bear returned in a few weeks for his recheck, his kidney enzymes were no better. Bear’s kidneys had received too much damage and there was no hope of recovery. Bear’s owner decided to relieve his suffering with humane euthanasia. He will always be remembered as a sweet and loving dog.

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MEET TINKER BELL

Tinker Bell was rescued from a puppy mill a few years ago. She was estimated to be middle-aged at that time, but she had been so poorly cared for that it was difficult to tell. She had severe dental disease and most of her teeth were removed because her mouth was so infected (that’s why her tongue sticks out).

Tinker Bell’s foster family noticed she had a dry, hacking cough that seemed to get worse when she was excited. As a Pomeranian, it was suspected that she had a collapsing trachea. Cough suppressants worked for a while to help calm her down and ease the hacking when she would have an episode. X-rays at the time showed only a little narrowing of her trachea.

< The dark line is the trachea

As time has gone by, Tinker Bell has had several more episodes of tracheal collapse. A few times she has needed emergency treatment because her cough becomes so severe that she can’t breathe. When this occurs, her doctor gives her oxygen, sedatives and cough suppressants. She often has to receive sedation and steroids for a few days afterwards because her airway becomes so inflamed when she coughs. Now her x-rays show the collapsing trachea quite clearly. Because Tinker Bell is an older girl now, surgery is not a great option. So her mom is very careful to make sure she doesn’t get too excited, and to give her medicine at the first signs of coughing.

Notice how much thinner the trachea is >

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What you need to know about Mast Cell Tumors

A normal mast cell is part of the immune system’s defense against invading organisms. These cells help participate in the war against parasites. They are found within tissues that contact the external world, such as skin, respiratory and intestinal tracts. Mast cells contain granules of especially inflammatory biochemicals used to fight invading parasites. These granules act like little “bombs” that can be released. The mast cell has binding sites on its surface for a special type of antibody called IgE, which is produced in response to the antigens of most parasites.

< normal mast cell with granules

When an IgE antibody finds a mast cell, it perches on it. IgE antibodies are Y-shaped - their foot is planted in the mast cell while their arms lift up hoping to capture antigen – a signal that parasites are present. When the antigen comes by and is grasped by the IgE antibodies the mast cell releases is granules, like a toxic biochemical weapon. These chemicals are harmful to the parasite and also signal other immune cells to come in and help the battle.

However, the IgE/Mast cell system is not perfect. It can become stimulated with other antigens that are similar to parasite antigens in size or structure, usually a pollen. So mast cells are frequently implicated in the signs of allergies, since the biochemicals they release produce redness, itch, and swelling.

Any type of cell in the body can develop a tumor, and the mast cell is no exception. When this happens, the cells of the tumor are unstable, and they can release their toxic granules with simple contact, or even at random. Mast cell tumors are also notorious for growing deep into tissues and being difficult to treat.

Dogs
Mast cell tumors are especially common in dogs, accounting for approximately one in every 5 skin tumors. Certain breeds of dogs are at especially high risk including the Boxer, English Bulldog, Boston Terrier, Sharpei, Labrador Retriever, Golden Retriever, Schnauzer, and Cocker Spaniel. However, any breed of dog can develop a mast cell tumor. Mast cell tumors don’t have a characteristic appearance, but because they can cause swelling by releasing granules, some owners will notice that the mass grows quite suddenly, or that the mass seems to itch the dog.

Because the mast cell has very characteristic granules, it is often easily diagnosed by a fine needle aspirate. The vet will take a small needle and puncture the mass, then spread the collected cells on a slide. The slide is stained and examined under the microscope. An actual tissue biopsy is needed to grade to tumor. It is crucial to have this type of tumor graded in order to determine prognosis and treatment plans.

< Mast cell tumor - Notice the “exploding” granules

A pathologist will grade the biopsy of the tumor and check the margins for complete excision. The grade reflects the malignant characteristics of the cells - which generally correlates to the behavior of the tumor.

Grade I: The best type to have, it may be more locally invasive but tends not to spread. Surgery is usually curative. If the margins show the mass was not completely excised the tumor may grow back, and the doctor may want to re-excise the surgical site to clean up any remaining cells. Almost half of grade I tumors can be cured with surgery alone.

Grade II: These tumors are the most unpredictable in behavior. Radiation therapy administered at the site of the tumor after surgery can cure greater than 80% of patients as long as the tumor has not already shown signs of spreading. The most common place of spread is the closest lymph node, so the vet may want to aspirate or biopsy the lymph node.

Grade III: The worst grade to have, they account for about 25% of all mast cell tumors. These are very invasive and aggressive. If only surgical excision is attempted without follow-up chemotherapy, the mean survival time is only 4 to 5 months.

Patients with mast cell tumors are also staged to help devise a therapeutic plan. The tumor is staged as such:

• Stage 0: one skin tumor, but incompletely excised
• Stage I: one skin tumor, no lymph node involvement
• Stage II: one skin tumor, with nearby lymph nodes involved
• Stage III: many tumors, or deeply infiltrating tumors, with or without lymph node involvement.
• Stage IV: any tumor with distant spread evident, further defined as:

  • Substage a: no clinical signs of illness
  • Substage b: with clinical signs of illness

Other testing that may be done to evaluate a patient with mast cell tumor includes basic blood work to evaluate the kidneys and liver and their ability to handle chemotherapy. It can also screen for circulating mast cells (a very bad sign), and anemia. Lymph node aspiration can help to determine if the tumor cells have started to spread. Because so many lymph nodes are present in the chest, the doctor may do radiographs of the chest to look for enlarged lymph nodes. The spleen is an organ of the lymph system, and ultrasound-guided needle aspiration can help to determine if a mast cell tumor has spread through the lymphatic system.

Once a patient has been diagnosed and staged, the doctor will determine what therapy is best. Surgery, radiation, and chemotherapy, or a combination of these can be used to treat mast cell cancer. Surgery can be curative for some patients, although it can be difficult to completely remove a mast cell tumor. Deep and extensive margins are needed to assure clean borders – 3 cm is the recommendation. If a grade I or II tumor cannot be completely removed, radiation therapy may be able to treat the remaining cells. Radiation can only be used for localized disease that is one that has not spread. Chemotherapy is also used in addition to surgery, and can be used for more systemic disease.

Cats
Mast cell tumors are a bit different in cats. They generally affect older cats, generally around ten years of age. Pathologists don’t categorize feline mast cell tumors as strictly as they do for dogs. In cats, mast cells tumors are grouped into one of two categories: Well Differentiated and Poorly Differentiated. The well differentiated tumor is generally more benign.

There are also two basic forms in cats: Cutaneous (in the skin) and Visceral (located internally), and some cats can have both. The skin form usually arises around the head and neck. They can even occur in clusters. Surgical excision is the best option for these tumors, and radiation can be used treat any remaining cancerous cells.

The Visceral form is more serious than cutaneous. The most common organs to be affected are the spleen, liver, and intestines. Vomiting, weight loss, and appetite loss are common signs of illness. Surgery is again the treatment of choice. Testing can be done to try to stage the disease, but the most important piece of information comes from the cat – a cat that is still eating well at the time of diagnosis has a much longer average survival time.

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Broken Bones

HOW DO WE FIX THEM? It can certainly be stressful and even frightening when your beloved pet has been injured. Most cases of trauma to pets are emergency situations, and quick decisions are often necessary in order to provide your pet with the best outcome possible. Once an animal has been stabilized, long-term care must be decided. Fractures are a common complication for many trauma patients, whether from an automobile accident, a fight with another animal, or even a household injury. And fractures occur in all animals, both young and old. Veterinary medicine has adopted many techniques for correcting fractures from human medicine, and we have many different ways of helping bones, and pets, to heal after an injury. Doctors use many different factors to decide which form of fixation is best for each individual pet, including which bone is broken and where the fracture is located, how many pieces, whether there are open wounds, and the age and healing capability of the pet.

CASTS or splints are great for stabilizing fractures of the lower legs if the fracture is very simple and the bones are still well-aligned. They are often used in younger animals because puppies and kittens heal much more quickly than older pets. Casts and splints do require some maintenance, however, as they cannot become wet, and sores can develop under the padding which results in serious infections.

INTRAMEDULLARY PINS (IM pins) are frequently used for fractures of the long bones. These long metal shafts are placed down the center of the bone into the bone marrow and help keep the bones straight while they heal. But IM pins usually have to be used with wires or external fixators if there are multiple pieces of bone in the fracture. Once the bones are fully healed the pin is removed.

ORTHOPEDIC WIRE or cerclage wire can be used for very small fractures that don’t have to bear the animal’s weight (such as in the jaw), or very frequently is used in addition to other fixation techniques. For example, many thigh bone fractures can be fixed with an IM pin to hold the big pieces together, and then several wires are placed around the bone to keep the pieces aligned and prevent them from moving away from the pin.

BONE PLATES AND SCREWS can be used to stabilize a variety of broken bones and are great for complicated fractures. Plates can be bent to conform to the shape of the bone and provide strength to the healing bones. Screws hold the plates in place and also can be placed so that they bring the fracture pieces closer together to make healing faster. Screws can also be used without a plate for specific fractures involving only small pieces of bone that are displaced, such as when the end or corner of a bone has been broken off.

EXTERNAL FIXATORS are composed of several pins that are drilled into the bone and attach to a bar that runs along the outside of the leg. These contraptions are very versatile because they are customized to the fracture, and they can be changed to meet the pet’s needs as the bones are healing.

MEET KENDALL

Kendall is a very active 4 year-old pitbull today. Kendall lives out in the country and she loves to run, despite that her owners try to keep her at home. One January morning she was out on another romp, and was hit by a car. A concerned neighbor called Kendall’s mom at home, and friends came to help get her to the hospital. Kendall had received bruising in her lungs, numerous skin scrapes and cuts, and 2 fractured legs: both her front and rear right legs were broken. Nobody, even the doctor, was sure she would be able to recover. But she was otherwise young and healthy so her family decided to give her a chance.

Kendall’s rear leg was a fairly simple fracture – straight across and only two pieces – so an IM pin was placed to stabilize the bones. Her front leg was a bit more complex. There were numerous small pieces broken off within the fracture. The doctor decided an external fixator would be the best way to hold the bones in place to allow healing. Four pins were placed through the bone segments and then attached to plastic supports along either side of her leg.

Kendall received lots of pain medications and lots of rest while her bones healed. Today she is just as active as before, and you would never know that she had suffered such severe injuries as a puppy – she doesn’t even limp!

Kendall’s broken front leg

With an external fixator

Kendall’s broken back leg

With an IM pin

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WHAT IS PARVOVIRUS?

A virus is a very small organism which is made up of an outer protein coating, or “capsid,” which holds the genetic information as either DNA or RNA. A virus uses the host’s cells to make copies of itself. Parvoviruses are actually a class of viruses, but each type of parvovirus infects usually only one species of animal. Parvoviruses are extremely effective at infecting rapidly dividing host cells such as intestine, bone marrow, and lymph nodes.

The first canine parvovirus was discovered in 1967, but a new variant called CPV-2 has emerged and it causes much more severe disease. The virus has now become “ubiquitous” meaning it is present in every environment unless regular disinfection is applied.

Parvovirus infects mostly young dogs that are unvaccinated, so clearly puppies are at the greatest risk. The virus enters the body from the environment and makes its way to the GI tract where it attacks the cells which line the intestines. These cells make a lining over the microvilli and are responsible for absorbing nutrients and water from the gut, so when they are killed by the virus the puppy can no longer absorb anything. The killing off of these cells results in severe vomiting and bloody diarrhea, which causes serious dehydration. It also makes an easy path for the normal bacteria in the gut to get to the blood stream, so these dogs can very easily get systemic bacterial infections.

All puppies that are having lethargy, inappetance, vomiting, or diarrhea should be tested for parvovirus. The most common diagnostic test is performed in the clinic and works very much like a home pregnancy test. Another common test is to check the White Blood Cell count, since parvovirus commonly causes a severe drop in the puppy’s WBC number.

Parvovirus is one of the viruses that are included in most puppy vaccines. Puppy shots must be boostered every 3-4 weeks to make sure the immune system creates a strong enough reaction to be able to recognize and fight the parvovirus if the puppy is exposed. Puppies should avoid being out in public areas until they are fully vaccinated.

Parvovirus in the Environment

Parvovirus does not have a viral envelope which makes it much more hardy in the environment. This is part of the reason it is so difficult to control infection once it is in an area. Parvovirus is easily carried on shoes to clothing to new areas. It is able to withstand freezing temperatures in the ground outdoors, and many household disinfectants cannot kill it. Here is what we know about a contaminated environment:

• Infected dogs shed virus in their stool in extremely large amounts during the first 2 weeks after exposure. This means the environment is HEAVILY contaminated.
• Because parvovirus is so hardy, no environment can be considered “free” unless it is regularly disinfected. A parvovirus infection can be picked up ANYWHERE though it is more likely to come from an environment which has been contaminated by an infected dog simply due to the large amount of virus excreted there. An “infectious dose” which will cause infection is about 1000 viral particles, while an infected dog may shed 35 million viral particles per ounce of stool.
• Whether or not a dog becomes infected depends on the number of viral particles he is exposed to, how strong his immune system is against the virus (Has he been vaccinated? Exposed previously? Been infected previously?), and how healthy the dog is at the time of exposure (stress, diet, parasites, etc.).

INDOOR DECONTAMINATION

• Indoors, the virus loses its infectivity within one month. It should be safe to introduce a new puppy indoors one month after the active infection has ended.
• To disinfect indoors, bleach is the best and most effective product. Mix 1 part bleach with 30 parts water and clean all bowls, floors, surfaces, toys, bedding, and anything that else that won’t be ruined by bleaching.

OUTDOOR DECONTAMINATION

• Because freezing is protective to the parvovirus, over-wintering cannot be expected to disinfect a yard. Shaded areas can be considered contaminated for 7 months. Areas with good sunlight should be safe after 5 months.

Treatment of Parvovirus

There is no specific treatment to kill the parvovirus infection inside the dog. Treatment is aimed more at providing supportive care while the virus runs its course. Because the virus kills the cells that line the intestinal tract, infected puppies have severe vomiting and bloody diarrhea, as well as nausea and abdominal pain.

One of the most deadly side effects of the virus is the dehydration caused by uncontrollable vomiting and diarrhea. Puppies become dehydrated very quickly and cannot replace lost fluids by drinking since the death of intestinal cells means they cannot absorb it. Intravenous fluids (given by an IV catheter) are given at very high doses to correct fluid losses caused by the vomiting and diarrhea. Fluids are often supplemented with electrolytes, vitamins and sugar since the puppy won’t be able to eat for several days or more.

Another very bad side effect of parvovirus infection is the likelihood of secondary bacterial infections. This occurs because the when the intestinal cells die there is no barrier to prevent intestinal bacteria from getting into the blood stream. Puppies with parvovirus often have systemic bacterial infections which make them even sicker. Part of treatment includes antibiotics to try to prevent these bacteria from causing such widespread infection. If a puppy is showing signs of an infection, we will often use more than one antibiotic to make sure we can take care of the infection as best as possible. These are strong antibiotics and must be given by injection since the puppy is vomiting.

Constant vomiting is not only uncomfortable, but adds to dehydration and can cause damage to the esophagus. So puppies also receive anti-nausea medicine by injection to control the vomiting. We also may add medicine to control the stomach acid secretions to make their sick tummies feel better.

Other treatments that may be needed include plasma transfusions to keep their blood pressure up and provide some white blood cells to help fight infection, and anti-endotoxin medications to help fight the toxins produced by the bacteria in the blood stream. Sometimes the “usual” anti-nausea medicines just are not strong enough, so we have to use very expensive human medications.

Meet Zane

Zane is a young Mastiff-mix puppy. At 22 pounds, he still has a lot of growing to do. His brothers and sisters are at least 7 pounds bigger than he is. That’s because Zane had a rough start – he had to fight parvovirus.

Zane was about 7 weeks old when his owner noticed he was a bit lethargic. She was already concerned because a puppy he had been playing with recently came down with parvovirus, and Zane had not been vaccinated yet. So she brought him in for an exam with the doctor. Zane hadn’t shown any signs of vomiting or diarrhea, but he did throw up in the car on the way to the vet clinic. Because he hadn’t been vaccinated, the doctor ran a parvo test. The results were back in just a few minutes: Zane had parvovirus.

The doctor immediately put in an IV catheter so he could receive fluids and all of his medications. Even at this early in the disease, dehydration can become a problem and we wanted to be ahead of the game. We started Zane on antibiotics, anti-nausea medicine, and stomach protectant medications. We also gave him a small plasma transfusion to help boost his immune system.

Zane was holding his own the first few days, but he seemed to get more and more ill as the days went by. He was still having vomiting and diarrhea even on the medicine, and he looked terribly depressed. Stronger antibiotics and nausea medicines were added, he had vitamins and sugar added to his fluids, but he just kept getting weaker each day. Finally, about a week after being admitted to the hospital, Zane seemed to perk up a bit. He was able to eat some food and water, and he kept it down. Zane eventually went home with a strict diet of bland food, antibiotics, and oral nausea medicine.

A few weeks later, Zane returned for his first vaccine, and he had already gained 3 pounds. He’s growing quickly now, but he may never catch up to his brothers and sisters because of the illness he had as a puppy.

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SPECIAL ALERT:

We have seen several cases of heatstroke in dogs already this summer. Just as in humans, heatstroke is an emergency and can result in death. During these extremely hot days with high humidity, even healthy animals can quickly be overcome by the heat. When the body temperature increases above 106°F, numerous problems can arise including kidney failure, loss of clotting ability, seizures, and coma. The best prevention is to keep your pet indoors with air conditioning.

If your dog MUST be outside:

• Be sure there is plenty of shade and water available.
• Consider a baby pool of water so they can cool off by wading.
• Check on your dog often during hot weather to be sure he’s comfortable.

Older dogs may not be able to handle the heat and humidity as well as they used to, so give your aging friend special consideration as the temperature rises. Arthritic dogs may have trouble getting up and moving to a shaded area. Older dogs also sleep harder and may not wake up to move themselves as they overheat.

Brachycephalic dogs (short-nosed breeds) such as Pugs, Bulldogs, and Boston terriers may also have more difficulty in the heat. These dogs have narrow windpipes and nasal passages so when they pant they don’t release the heat as well. This applies also to dogs diagnosed with a “collapsing trachea.”

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LUXATING PATELLA: The Trick Knee

The patella, or knee cap, is a small piece of bone that makes up part of the knee joint. It normally rides in the center of the knee within a groove at the lower end of the thigh bone. A luxating patella is a knee cap that does not stay in place. Owners of dogs with luxating patellas may notice the dog has a little “skip” in his step occasionally, or sometimes the dogs will hold up its leg for a few steps and then go back to running normally. In half of affected dogs both knees are involved, while the rest have only one affected knee.
The patellar ligament attaches the bottom of the thigh muscles to the shin bone (tibia), and it runs over the top of the knee cap to help hold it in place. The trochlear groove at the bottom of the thigh bone (femur) also keeps the patella in place. In some dogs, the patellar ligament does not attach directly in the center of the tibia, and this usually is towards the inside of the leg. As the thigh muscles contract, the force is pulled towards the inner side of the groove. If the groove is very shallow, as occurs in some small breed dogs, the patella can be pulled over the edge of the trochlear ridge, resulting in a dislocation of the knee cap. Over time, this popping in and out can further wear down the trochlear ridge, making the dislocation more frequent.

< Normal patella riding in the trochlear groove.

The severity of the problem is based on a grading system:

• Grade 1: The knee cap can be moved out of place but will replace itself when the manipulator lets go.
• Grade 2: When the knee cap is moved out of place, it stays out of place until it is moved back manually.
• Grade 3: The patella is out of place all the time, but it can be manipulated back into place by hand (though it won’t stay).
• Grade 4: The patella is out of place all the time and cannot be moved back into the normal position. These dogs may walk with their knees bent all the time because they cannot fully extend them.

The luxation itself is not painful, and some dogs can tolerate the problem for years. However, the chronic wear and tear on the trochlear ridges can result in arthritis. The changes in the weight-bearing stress of the hind leg is unbalanced and can cause changes in the hips and long bones as well, causing pain and arthritis in other joints. And the misalignment of the knee predisposes dogs to other knee injuries such as cruciate ligament tears.

Surgery is available to correct the predisposing factors which cause patellar luxations. Depending on the severity of the luxation, several corrections may be made. First, the point of attachment of the patellar ligament can be moved back to the center of the tibia. Secondly, the trochlear groove can be made deeper to help the knee cap stay in place. Also, the capsule around the joint can be tightened to prevent the patella from luxating again. If surgery is performed before arthritis occurs, the prognosis is very good for full recovery. If arthritis has already formed, there may be intermittent pain in that joint and arthritis medications may be needed.

Cici is a middle-aged little Pomeranian girl. She has had several health issues to deal with, but it wasn’t until last Christmas that she started having trouble with a luxating patella on her right knee. She had been diagnosed a few years before with a luxating patella on both knees, but hadn’t really had pain until now. When she got to surgery, the doctor found she had completely worn down the trochlear ridge. So she had a tibial crest transposition to fix the patellar ligament alignment, a trochlear wedge resection to make the groove deeper, and joint imbrication to make the joint capsule tighter.

Cici did well after surgery, until only 3 months later when her other knee started to bother her. She would not even put it down it was hurting so badly. She had a grade 4 luxation on the left side, so the same surgery was performed. Today she is recovered from both surgeries and is doing very well.

CiCi’s x-rays before surgery >
Notice the patellas both riding to the inside of the trochlear groove.

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What is Acupuncture?

Acupuncture has been practiced on humans in China for more than 4,500 years. Traditional Chinese medicine views disease as an imbalance between two polarities of Qi: yin and yang. Acupuncture is a method to assess and rebalance the flow of “qi”, or energy, which travels along 12 main linear pathways, or meridians, in the body. Sickness comes from blocks or imbalance in the body’s qi. To correct these imbalances, small needles are inserted in any number of 365 basic acupuncture points which redirects the flow of energy and restores the body to health.

The Chinese regularly practiced acupuncture on horses, then gradually tried it on other farm animals and finally dogs, cats, and birds. They discovered that animals have similar meridians and reflex-points to humans. These meridians lie along the skin and are the fields in which QI energy flows. Meridians connect with internal organs, muscular and joint structures, and the nervous system. Acupuncture points lie along these meridians. The acupuncturist manipulates the animal’s Qi by stimulating specific acupuncture points, which alleviates the blockage or imbalance.

Western medicine explains acupuncture by pointing out that most of the body’s 365 main acupuncture points are located at clusters of nerves and blood vessels. Stimulating these areas triggers a host of local and general physiological effects, stimulating the body’s own healing power. We have recently learned there is a close relationship between brain chemistry and the immune system. Studies have shown that acupuncture can increase blood flow, lower heart rate and improve immune function. Acupuncture also stimulates the release of certain neurotransmitters such as endorphins, the body’s natural pain killers, and smaller amounts of cortisol, an anti-inflammatory steroid.

Acupuncture for Pain
One of the most common uses for acupuncture is for relief of pain. Pain serves to protect us from damage by warning us of harmful situations, but in chronic conditions it is as debilitating as the disease process itself. Abnormal chronic pain states are thought to result from damage within the pain pathway itself, which includes the nerves, brain and spinal cord.
The body has its own pain-suppression mechanisms which cause release of endorphins that act much the same as opiate medications. Acupuncture stimulates these endorphins to be released. Acupuncture can also cause blood vessels to dilate, which may be part of the reason it is so effective for musculoskeletal disorders. Dilated blood vessels are better able to remove pain-producing and inflammatory substances that are released in a diseased area.

What Else Can Be Treated?
Reproductive:
Many reproductive conditions of both males and females are known to respond to acupuncture treatment.

Hormonal:
Many hormonal systems can be affected, including all of the pituitary functions, thyroid and parathyroid functions, and adrenal functions.

Neurological:
Anxiety, epilepsy, and behavioral disorders have all responded well to acupuncture treatments.

Dermatological:
The skin can tell us if our pet is getting proper nutrition and how well they are disposing of waste through the respiratory, digestive and urinary systems. The acupuncturist can keep these organs in good condition, which is reflected in the skin.

Performance:
Acupuncture is being used to influence the performance of dogs and horses. Two to five days after a treatment there is an increase in the vigor and vitality of the patient.

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Feline Hyperthyroidism

The thyroid glands are located in the neck and play a vital role in regulating the metabolic rate. Hyperthyroidism is a condition of older cats where the thyroid glands become enlarged. Although the change is generally benign (only 2% are malignant), it does cause the glands to produce too much thyroid hormone.

The clinical signs of hyperthyroidism are directly related to the increase in thyroid hormone production. The increased metabolic rate causes most cats to become very thin. These cats have a huge appetite, but even increased food can’t support the high metabolism and they continue to lose weight. Some cats may drink a lot of water and have to urinate more frequently. Some cats may have periods of vomiting or diarrhea, and their fur may appear unkempt. Some cats will eventually develop anorexia.

There are two important complications of this disease as well. The increase in thyroid hormone stimulates the heart to pump more quickly and with more pressure. This can result in an increase in blood pressure, or hypertension. High blood pressure can damage many organs, including the retinas of the eyes. The vessels of the retina are very thin and if they are damaged the retina can become detached, resulting in blindness. Because the heart has to pump extra hard with every beat, the muscles of the heart can become thickened, which can eventually make it harder for the heart to keep up with the body’s demand. This type of heart disease is called thyrotoxic cardiomyopathy. Both of these complications are potentially reversible with treatment.

The diagnosis of feline hyperthyroidism is fairly straightforward. Cats that have clinical signs are tested for an increase in one or more of the thyroid hormones. The most common test is the total thyroxine, or TT4. If the TT4 is very high, there is no question to the diagnosis. Some cats that are suspected of having hyperthyroidism can have a TT4 that is still within the range of “normal.” These cats may undergo further thyroid hormone evaluations with a Free T4 or a T3 suppression test. A thyroid scan can also be performed at a referral center.

There are several options to treat a cat with hyperthyroidism, and many factors are taken into account when determining which is best for each patient. First, the overall health of the cat must be determined by performing screening tests such as blood chemistries, urinalysis, x-rays, EKG, Blood pressure, and in some cases a cardiac ultrasound.

Radioactive iodine: This treatment must be performed in a specialty hospital that is licensed to perform radiation therapy. After a nuclear scan to confirm the location of the thyroid glands, an injection of radioactive iodine (I131) is given which will destroy all abnormal thyroid tissue without endangering other organs. Treatment requires one to two weeks depending on how long the cat remains radioactive after the injection. For most cats, this is the safest and most effective treatment. Although expensive, it is a one-time treatment.

< Nuclear scan of normal cat thyroid glands

Nuclear scan of hyperthyroid cat with enlarged gland >

Surgical removal of the thyroid: Thyroidectomy is an effective treatment, but there can be some risk in these cats because many of them are geriatric pets. Often, the cat is treated with anti-thyroid medication prior to surgery to help them gain weight and relieve the hypertension and high heart rate. Without a nuclear medicine scan, it can be difficult to determine during surgery whether one or both of the glands are affected. A potential complication of surgery is the inadvertent removal of the parathyroid glands which regulate calcium levels in the body. Thyroid tissue can also be present in an abnormal location, and if not removed the condition will recur within 2 years.

Oral medication: Methimazole, trade name Tapazole, is an oral medication which blocks the production of excess thyroid hormone rather than destroying the abnormal thyroid tissue. Therefore, this drug must be given for the rest of the cat’s life. Some cats can become difficult to medicate over time, so this medication can be compounded into a flavored liquid or a transdermal gel. It is an inexpensive treatment compared to radiotherapy or surgery, but several years of treatment and monitoring can make it comparable. Potential side effects include lethargy, loss of appetite, and vomiting. More serious side effects include facial twitching, bone marrow changes, and liver failure. Blood tests are performed to make sure the dose is regulated well and the cat is not having any side effects.

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The Latest Medications To Keep Your Pet HEALTHY

DO YOU COME HOME TO FIND:
BARKING & WHINING?
CHEWING & DIGGING?
DROOLING & PANTING?
POOP & PEE?

Your dog may be suffering from CANINE SEPARATION ANXIETY You are not alone! And now Southwoods Animal Hospital is pleased to offer you a solution for this frustrating problem.
RECONCILE ™ (fluoxetine) is now approved for dogs, and comes in a convenient flavored tablet. Given once a day, it is a safe and effective medication to help control your dog’s anxiety. Your purchase of a 2-month supply comes with a training CD and manual to teach you how to help your dog overcome separation anxiety.
Reconcile™ is used to relax your dog so your training can be the most effective. When your dog is responding well to the program, the medication may be stopped.

DOES YOUR OLDER DOG OR CAT SUFFER FROM ARTHRITIS? ARE ANTI-INFLAMMATORIES NOT ENOUGH? HELP IS HERE! Southwoods Animal Hospital can now provide additional pain control for dogs and cats with advanced arthritis with GABAPENTIN. Gabapentin provides pain control through a mechanism completely different from traditional analgesics. It can be used with other medications you’re currently using for arthritis such as: NSAIDS like Deramaxx and Carprofen, and natural anti-inflammatories and anti-oxidants like SynoviG3, Fish oil supplements, and vitamins. Gabapentin is also very effective for pain in cancer patients. Additionally, Gabapentin has anti-seizure activity when used with other medications for seizure patients.

Does your dog turn GREEN just thinking about a car ride? CERENIA™ to the rescue! If you’ve ever wanted to take your dog on vacation, but didn’t want to put him through all the drooling and gagging, then this is for you!
Cerenia™ was developed because about 1 in every 6 dogs has trouble with motion sickness. Dogs get motion sickness either because they are anxious while traveling, or because their balance is affected by movement. Cerenia™ blocks vomiting signals in the brain, which prevents dogs from getting sick. One dose lasts for 24 hours, and it’s non-sedating so both you and your dog can enjoy your next trip!

Introducing a Breakthrough For Dogs with Heart Failure: VETMEDIN™ Vetmedin™ is the only FDA-approved veterinary inodilator for heart failure. This means it dilates the blood vessels and increases the contractility of the heart muscle. The result is improved circulation, and a more efficient heart with every beat.
Vetmedin™ is designed for dogs in early stages of heart disease that are experiencing clinical signs of heart failure such as fatigue, shortness of breath, and coughing when exercised. It is also for dogs already taking medication for heart failure that are still experiencing symptoms. It comes in a flavored chew, so it’s easy to give. And most owners report improved clinical signs in just 8 days. Vetmedin™ is labeled for dogs suffering from AV Valve Insufficiency (AVVI) or Dilated Cardiomyopathy (DCM). Could your dog be at risk? These breeds are most commonly affected:

AV Valve Insufficiency
Boston Terrier, Miniature and Toy Poodle, Cavalier King Charles Spaniel, Miniature Schnauzer, Chihuahua, Pekingese, Fox Terrier, Pomeranian, Miniature Pinscher and Whippet.

Dilated Cardiomyopathy:
Cocker Spaniel, Boxer, Dalmatian, Doberman Pinscher, English Bulldog Great Dane, Newfoundland, Saint Bernard and Irish Wolfhound.

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BLOAT: THE MOTHER OF ALL EMERGENCIES

There are many injuries and physical disorders that represent life-threatening emergencies. There is only one condition so drastic that it over-shadows all others in terms of the need for immediate emergency treatment and potential for drastic consequences. This is the Gastric Dilation and Volvulus (GDV), or “Bloat”.
The stomach sits high in the abdomen and contains a small amount of gas. It normally undergoes rhythmic contractions as it grinds food and dispenses it out to the small intestine. In the bloated stomach, gas and/or food stretches the stomach to many times its normal size, causing severe abdominal pain. Sometimes the process stops here. But for reasons we do not fully understand, in some dogs the bloated stomach will rotate, thus twisting off its blood supply and trapping the gas inside. The spleen is closely associated with the stomach and may be pulled across the abdomen as the stomach rotates, trapping blood inside and causing distention. Once the stomach dilation (bloat) and volvulus (turning) occurs, the dog will die in a matter of hours unless drastic steps are taken.
There are multiple risk factors for bloat, although it can occur in any dog. Most frequently the condition occurs in “deep chested” dogs such as Great Danes, Greyhounds, and setter breeds. Dogs weighing more than 99 pounds have an approximate 20% risk of bloat. Also, dogs that have recently eaten a large meal and then exercised heavily are at high risk.

Other Factors Increasing the Risk of Bloating:

So, how can you tell if your dog has bloated?

The dog may have an obviously distended stomach, especially near the ribs, but this is not always evident. The biggest clue: the dog keeps trying to vomit but nothing comes up. Some dogs will also drool profusely. If you think your dog has bloated, rush him to the vet immediately!

There are several steps to saving a bloated dog’s life, and all must be done immediately. A dog with GDV is in a severe state of shock, and every minute counts.

The stomach must be decompressed because it is pressing on all the major blood vessels, which prevents blood from returning to the heart. The stomach tissue is dying because it is stretched so tight. The doctor will attempt to pass a stomach tube to relieve the gas, but it may not advance due to the twist in the stomach. A very large needle can be passed through the body wall into the stomach to allow the gas to escape, but this provides only temporary relief.

Intravenous fluids are vital to replace the blood that cannot get past the bloated stomach. Most patients require two large catheters to help the fluids get in as fast as possible. The catheters also allow medications for shock, pain, sepsis, and electrolyte imbalances caused by the bloat.

A very dangerous heart rhythm can be caused by the GDV – premature ventricular contractions, or PVC’s. It is believed that this rhythm disturbance is caused by toxins released from the dying tissues of the stomach and the engorged spleen. The rhythm may not be evident until after the surgery, even into the next day, so frequent EKG readings are common. Intravenous medication is needed to help stabilize the heart. Dogs with PVC’s at the time of diagnosis have a 38% mortality rate.

All bloated dogs, once stable, should have surgery. Correcting a GDV is a major abdominal surgery, since extensive damage may have occurred to the stomach and spleen. These patients can also continue to bloat, even within the next few hours. First, the stomach and spleen are returned back to the normal position. Then the surgeon must evaluate the stomach for damage, and if dying tissue is found it must be removed. If the spleen twisted along with the stomach, it may also need to be removed. Once all the damage is repaired, the surgeon will “tack” the stomach into place to prevent it from flipping again should the dog ever bloat in the future. This procedure, called a gastropexy, can reduce the recurrence rate down to 6%.

Gastropexy can also be performed in young, healthy dogs to prevent GDV. It is recommended for dogs that are considered high-risk breeds or that have a family history of bloat. This surgery, called “prophylactic gastropexy,” is often performed at the same time as a spay or neuter, since the animal is already under anesthesia. The surgery won’t prevent bloating, but it will prevent the stomach from twisting.

Careful attention to diet, feeding, and exercise regimens can also help prevent gastric dilation and volvulus.

Irish Setter       German Shepherd          Boxer

WHO’S MOST AT RISK?

#1 GREAT DANE         #2 ST BERNARD         #3 WEIMARANER

In a 1993 German study of 134 dogs presented with GDV to the vet school:

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DIABETES IN DOGS

There are two forms of Diabetes in dogs: diabetes insipidus and diabetes mellitus. Diabetes mellitus is also known as “sugar diabetes” and is more common than diabetes insipidus. Diabetes mellitus is a disease of the pancreas. The pancreas is a small organ that serves two very different purposes. One function of the pancreas is to produce enzymes that are vital for digestion. The other function is to make the hormone insulin. Insulin is required to get sugar (glucose) into the cells of the body to be used for energy. When the amount of insulin produced is too low, the cells of the body can’t use glucose and the sugar stays in the blood stream, resulting in high blood sugar, or “hyperglycemia.” The build up of glucose in the blood stream can result in damage to many organs of the body.

Glucose is a vital substance which provides much of the energy needed for life. But the glucose is used INSIDE the cells for energy. If there is no insulin to help the glucose get in the cells, the cells have to use another source for energy. This results in a dog that eats more but loses weight. The body tries to eliminate the excess glucose by excreting it into the urine. But glucose attracts water, so large amounts of urine are produced. To avoid dehydration, the dog drinks more and more water. Therefore the four “classical” signs of Diabetes are:

1. Weight loss
2. Increased appetite
3. Increased water consumption
4. Increased urination

DIAGNOSIS OF DIABETES

The diagnosis of diabetes mellitus is based on three criteria: the four classical clinical signs, the presence of persistently high levels of glucose in the blood stream, and the presence of glucose in the urine. Certain side effects of persistently high blood sugar can also help support the diagnosis.

The normal glucose level in the blood is 80-120 mg/dl, although it can rise up to 300 mg/dl for a short time after a meal. Diabetes is the only common disease that will cause the blood glucose level to rise above 400, and some dogs can have levels as high as 800 mg/dl. Most untreated diabetic dogs will have a blood glucose that ranges from 400-600 mg/dl during the day.

Normal kidneys do not allow glucose to be filtered out of the blood stream until an excessive level is reached. So, normal dogs will not have any glucose in the urine. Diabetic dogs have very high levels of glucose in the blood, so it is filtered out by the kidneys and is found in the urine. Glucose in the urine frequently leads to urinary tract infections, so many newly diagnosed diabetics must also be treated with antibiotics to control the infection.

Another side effect of diabetes is cataracts in the eyes. This occurs in dogs, not cats. The high level of sugar in the blood stream can cause changes in the lens of the eye that results in cataracts. This can result in blindness if the diabetes is left uncontrolled. Fortunately, for dogs with mature cataracts and well-controlled diabetes, surgical removal of the cataracts with replacement of the lens is available to restore their vision.

TREATMENT OF DIABETES IN DOGS

Initially after diagnosis, some dogs may need to be hospitalized in order to deal with the immediate crisis and to begin the regulation process. The “immediate crisis” is only great if your dog is so sick that it has quit eating and drinking for several days. Dogs in this state, called ketoacidosis may require a week or more of hospitalization. Otherwise the initial hospitalization may be for only a day or two.

At home, the most important key is consistency in management of the diabetes. Dogs do best when they are on a regular routine of feeding, medication administration, and a stress-free lifestyle. Most dogs do best on a high-fiber diet because these foods are generally lower in sugar and slower to be digested. This means that the dog does not have to process a large amount of sugar at one time. The fiber also helps these dogs feel more satisfied when they eat. It is also important that dogs are fed on a schedule, usually twice daily to correspond with the insulin injections.

While human diabetes is divided into two forms (Types I and II), canine diabetes does not really follow the same models. All diabetic dogs are treated with insulin. Insulin and the required syringes are easily obtained from any pharmacy or your veterinarian. It comes in many brands and types, with very slight differences in the actual hormone. Many dogs are now on Vetsulin, a brand of insulin made specifically for dogs and available only from the veterinarian.

Many owners are concerned about giving injections to their dogs. However, insulin does not cause discomfort when it is injected, and the needles are so small that many dogs do not even feel them.

Once a diabetic dog has been regulated on insulin, monitoring can come in different forms. Some owners feel comfortable monitoring glucose levels at home, while most prefer to have periodic monitoring performed at the hospital in the form of simple blood tests. Glucose detection strips can be used to monitor for high levels of sugar in the urine. If the insulin dose has changed, or if a diabetic dog is having side effects, the veterinarian will perform a “glucose curve” to monitor the pattern and range of blood sugar throughout the day.

MEET DOTTIE

Dottie is a sweet girl who’s about 10 years old. She has a history of elevated liver enzymes, so when she started to become lethargic her owner thought she was probably having liver failure. When Dottie started to drink a lot of water and have accidents in the house, her family knew it was time to figure out what was wrong.

When Dottie came in the vet, we checked her blood chemistries. Her liver enzymes were still mildly elevated, but her glucose was 461. Given her healthy appetite and urinary issues, it was clear that Dottie had Diabetes. When checking her urine, it was also found that Dottie had a urinary tract infection.

Dottie has started her insulin therapy with Vetsulin, an insulin made specifically for dogs. Her urinary tract infection was treated with antibiotics and she is doing much better. She has also started a high fiber diet to help make her sugar levels more even through the day. It may take some time before her Diabetes is completely controlled, but her family is so excited that she has a treatable disease.

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