One of the most common conditions affecting dogs is allergy.  In the allergic state, the dog's immune system "overreacts" to foreign substances (allergens or antigens) to which it is exposed.  These overreactions are manifested in three ways.  The most common is itching of the skin, either localized (one area, such as ears or paws) or generalized (all over the dog).  Another manifestation involves the respiratory system and may result in coughing, sneezing, and/or wheezing.  Sometimes, there may be an associated nasal or ocular (eye) discharge.  The third manifestation involves the digestive system, resulting in vomiting or diarrhea.

Types of Allergies

There are five known types of allergies in the dog: contact, flea, food, bacterial, and inhalant.  Each of these has some common expressions in dogs, and each has some unique features.

Contact Allergy

Contact allergy is the least common of the five types of allergy.  They result in a local reaction of the skin.  Examples of contact allergy include reactions to flea collars or to types of bedding, such as wool.  If the dog is allergic to such substances, there will be skin irritation and itching at the points of contact.  Removal of the contact irritant solves the problem.  However, identifying the allergen can require some detective work, including possible allergy testing.

Flea Allergy

Flea allergy is common in dogs.  A normal dog experiences only minor irritation in response to flea bites, often without any itching.  On the other hand, the flea allergic dog has a severe, itch-producing reaction when the flea's saliva is deposited in the skin.  Just one bite causes such intense itching that the dog may severely scratch or chew itself, leading to the removal of large amounts of hair.  There will often be open sores or scabs on the skin, allowing a secondary bacterial infection to begin.  The area most commonly involved is over the rump (just in front of the tail). 

The most important treatment for flea allergy is to get the dog away from all fleas.  Therefore, strict flea control is the backbone of successful treatment.  We recommend monthly preventive treatment from April through November. In the case of a flea-bite allergy, corticosteroids (or "cortisone" or "steroids") can be used to block the allergic reaction and give relief.  This is often a necessary part of dealing with flea allergies.  Fortunately, dogs are more resistant to the side effects of steroids than humans, so much of what you know about the side effects in people do not apply to dogs.  If a secondary bacterial infection occurs, appropriate antibiotics must be used.

Bacterial Allergy

Staphylococcus (Staph) is a bacterium found on normal dog skin.  If the skin is normal and the dog's immune system is normal, Staph causes no problems to its host.  However, some dogs develop an allergy to this bacterium.  When this happens, the dog develops areas of hair loss that look much like ringworm.  They are often round and 1/2 to 2 inches in diameter.  These same lesions develop in true Staph infection; they are easily treated with certain antibiotics, but the Staph-allergic dog has recurrent "Staph infections."  The lesions will usually clear with appropriate antibiotics but return as soon as antibiotics are discontinued.  After a while, some dogs become resistant to antibiotic treatment.

Treatment of Staph allergy involves antibiotics to control the immediate problem and desensitization with Staph antigen for long-term relief.

Inhalant Allergy

The most common type of allergy is the inhalant type, or atopy.  Dogs may be allergic to all of the same inhaled allergens that affect humans.  These include tree pollens (cedar, ash, oak, etc.), grass pollens (especially Bermuda), weed pollens (ragweed, etc.), molds, mildew, and the house dust mite.  Many of these allergies occur seasonally, such as ragweed, cedar, and grass pollens.  However, others are with us all the time, such as molds, mildew, and house dust mites.  When humans inhale these allergens, we express the allergy as a respiratory problem; it is sometimes called "hay fever."  The dog's reaction, however, usually produces severe, generalized itching.  In fact, the most common cause of itching in the dog is inhalant allergy.

Most dogs that have inhalant allergy react to several allergens.  If the number is small and they are the seasonal type, itching may last for just a few weeks at a time during one or two periods of the year.  If the number of allergens is large or they are they are present year-round, the dog may itch constantly. 

Treatment depends largely on the length of the dog's allergy season.  It involves three approaches: 

1. Anti-inflammatory / Immunosuppressants (Cyclosporine).  Steroid or immunosuppressant therapy will dramatically block the allergic reaction in most cases.  These medications may be given orally or by injection, depending on the circumstances.  If steroids or immunosuppressants are appropriate for your dog, you will be instructed in their proper use.  Antihistamines can be of value in treating the allergic dog when they are combined with steroids.  In some dogs, antihistamines can significantly decrease the amount of steroid needed to provide relief.  Fatty acid supplementation can also be implemented with the above medications.  When the three of them are combined, most allergic dogs are significantly improved.  This is a non-specific approach, which does not treat the allergy, only the complications of the allergic state (itching).

2. Shampoo therapy.  Many dogs are helped considerably by frequent bathing with a hypoallergenic shampoo.  It has been demonstrated that some allergens may be absorbed through the skin.  Frequent bathing is thought to reduce the amount of antigen exposure through this route.  In addition to removing surface antigen, bathing alone will provide some temporary relief from itching and may allow the use of a lower dose of steroids. 

3. Hyposensitization.  The third major form of allergy treatment is hyposensitization with specific antigen injections (or "allergy shots").  Once the specific sources of allergy are identified, very small amounts of the antigen are injected weekly.  The purpose of this therapy is to reprogram the body's immune system.  It is hoped that as time passes, the immune system will become less reactive to the problem-causing allergens.  If hyposensitization appears to help the dog, injections will continue for several years.  For most dogs, a realistic goal is for the itching to be significantly reduced in severity; in some dogs, itching may completely resolve.  Generally, steroids are only used on a brief and intermittent basis.  This therapeutic approach is recommended for the middle-aged or older dog that has year round itching caused by inhalant allergy.  This approach is not successful with food allergy.

Although hyposensitization is the ideal way to treat inhalant allergy, it does have some drawbacks and may not be the best choice in certain circumstances and for these reasons: 

1.  Cost: This is the most expensive form of treatment. 

2.  Age of Patient: Because many dogs develop additional allergies as they get older, young dogs may need to be retested 1-3 years later.

3.  Success Rate: About 50% of dogs will have an excellent response.  About 25% get partial to good response.  About 25% get little or no response.  The same statistics are true for people undergoing desensitization.

4.  Food Allergies: Although tests for food allergy are available, the reliability of the test is so low that it is not recommended at this time.  A food trial remains the best diagnostic test for food allergy.

5. Time of Response: The time until apparent response may be 2-5 months, or longer. 

6.  Interference of steroids: Dogs must not receive oral steroids for 2 weeks or injectable steroids for 6 weeks prior to testing; these drugs will interfere with the test results.

Food Allergy

Dogs are not likely to be born with food allergies.  More commonly, they develop allergies to food products they have eaten for a long time.  The allergy most frequently develops in response to the protein component of the food; for example, beef, pork, chicken, or turkey.  Food allergy may produce any of the clinical signs previously discussed, including itching, digestive disorders, and respiratory distress.  We recommend testing for food allergy when the clinical signs have been present for several months, when the dog has a poor response to steroids, or when a very young dog itches without other apparent causes of allergy.  Testing is done with a special hypoallergenic diet.  Because it takes at least 8 weeks for all other food products to get out of the system, the dog must eat the special diet exclusively for 8-12 weeks (or more).  If positive response occurs, you will be instructed on how to proceed.  If the diet is not fed exclusively, it will not be a meaningful test.  We cannot overemphasize this.  If any types of table food, treats or vitamins are given, these must be discontinued during the testing period.  There may be problems with certain types of chewable heartworm preventative or flavored toothpaste, as well.  Your veterinarian will discuss this with you.

Because dogs that are being tested for inhalant allergy generally itch year round, a food allergy dietary test can be performed while the inhalant test and antigen preparation is occurring.

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Anal Sac Disease in the Dog

The anal sacs are located on either side of the anus at the 9:00 and 3:00 positions; they are positioned just under the skin.  They connect to the anus by means of small canals, or ducts.  Anal sacs produce and store a dark, foul-smelling fluid.  These are the same types of organs that a skunk has to scare away its enemies.  Although dogs can use these for the same purpose, most dogs live in an environment that has no enemies.  Because the sacs are rarely emptied, the fluid builds up, solidifies, and becomes an ideal environment in which bacteria can grow.

Prevalence

The prevalence is higher in smaller breeds of dogs.

Causes

There are 3 diseases that occur in the anal sacs. 

1)  When the fluid becomes thick and solidified, the condition is called impaction. 

2)  When bacteria grow in this material producing a yellow or bloody pus, the condition is called infection. 

3)  When the infection builds to create a hot, tender swelling in the gland, the condition is called an abscess.  When the abscessed material overflows the sac, the skin over the sac breaks open, and the pus drains onto the skin.

Clinical Signs

Symptoms of anal sac disease are:

Scooting or dragging the anal area
Excessive licking under the tail
Pain, sometimes severe, near the tail or anus
A swollen area on either side of the anus
Bloody or sticky drainage on either side of the anus

Diagnosis

Physical examination, including a rectal examination, will usually confirm the diagnosis.

Treatment

The treatment for impaction is to express the sacs and clean out the solidified material.  For infection, the sacs must be expressed and antibiotics administered to kill the bacteria.  If the sacs abscess, the abscess must be surgically drained and antibiotics administered.

Some dogs are born with anal canals that do not close well.  These dogs are constantly draining anal sac fluid and leaving a foul-smelling drop wherever they have been.  This is another indication for anal sac removal.  There does not appear to be any other way to stop this, and these dogs usually do not outgrow this problem.

Prognosis

Many dogs have recurrent anal sac disease.  Some breeds of dogs, such as Poodles, commonly have problems.  The anal sacs of obese dogs do not drain well and, thus, these dogs are predisposed to recurrent problems.  If a dog has several episodes of anal sac disease, the anal sacs can be removed surgically.  Because these sacs are virtually unused, there is no loss to the dog.  It is the only way to permanently cure the problem.

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Anemia in the Dog

Anemia is defined as a reduced number of red blood cells or hemoglobin, or both.  It is a clinical sign, not a specific disease.  It is a significant finding because red blood cells, or erythrocytes, are needed to transport oxygen to the tissues.  When the total numbers of red blood cells are reduced, there can be insufficient oxygen delivery to vital organs. 

Red blood cells are produced in the bone marrow, or hollow core of the bones, by specialized cells.  Before being released into circulation, the precursor cells must undergo a specific sequence of steps to reach full maturity.  Once released by the bone marrow, the red blood cell lives about 120 days in dogs.  Interestingly, the red blood cell lives much shorter in cats, about 60-70 days.

Prevalence

Anemia is probably the most frequent laboratory abnormality involving the blood cells.  It is a relatively common finding in dogs of all ages and breeds.

Clinical Signs

The most easily observed sign of anemia is a loss of the normal pink color of the gingiva (gums).  Anemic dogs also have little endurance so they seem very weak or tired.  Pale gingiva and lethargy make us want to perform some tests on blood to document anemia.  Sometimes, anemia can cause the heart rate to elevate and a heart murmur to develop.  If the anemia is caused by red blood cell destruction, the skin may have a yellow tint (jaundice or icterus).  When certain cancers are the underlying cause of anemia, the lymph nodes, spleen, intestines, or liver might be enlarged.

Diagnosis and Evaluation

Initial Tests

The initial tests performed on blood are needed to determine the severity of the anemia and the ability of the bone marrow to respond to the anemia.  The most common test for anemia is the packed cell volume (PCV); it is also called the hematocrit.  A blood sample is placed in a centrifuge to separate the red blood cells from the plasma (the liquid part of the blood).   This takes only a few drops of blood and can be performed in about five minutes.  The normal PCV of the dog is 35%-50%; anemia is defined as a PCV below 35%.

A more complete assessment of the red blood cells can be calculated by very sophisticated instrumentation; a number of specific measurements can be provided.  These include hemoglobin, as well as the diameter and volume of individual red blood cells.  

Responsiveness of the bone marrow to the anemia is evaluated by the reticulocyte count.  The reticulocyte is a young adult red blood cell.  It has not quite completed all of the steps to maturation.  A rough index of the reticulocyte numbers can be gleaned by examining a blood smear.  The precise count is easy to determine by mixing a small amount of blood with a special stain and then re-examining the blood smear.  It is generally preferable to have a reticulocyte count that reflects the ability of the bone marrow to respond to the anemia; this is called a “regenerative anemia.”  When the marrow appears unresponsive based on reticulocyte numbers, this is called a “non-regenerative anemia.”               

Additional Tests

Several other tests are usually indicated for complete evaluation of the dog with anemia.  These are described below.

A careful study of the blood smear is important to look for parasites that might be causing red blood cell destruction and abnormal cells that could indicate leukemia.  A test to look for immune-system destruction of red blood cells, called a “Coombs Test,” may also be done at this time.

A bone marrow biopsy or aspirate is a procedure that recovers a small sample of cells from the bone marrow for evaluation by the veterinary pathologist.  Studying these cells can give valuable information about the cause of some anemias and the condition of the bone marrow.  Sometimes it is prudent to give the bone marrow a few days to respond to the anemia if there is a suspicion of recent blood loss.  When this is the case, a bone marrow aspirate may be temporarily postponed.  In some situations, it is clear that the anemia is long-standing and a bone marrow evaluation should be done as soon as possible.

A biochemical profile and urinalysis are other important tests for anemic dogs.  These tests evaluate organ functions and electrolyte levels.  They will often provide important information about the total health of the dog.  A fecal exam is also important for identification of parasites in the intestinal tract that might be causing blood loss.

Causes/Transmission

Several tests are important for an anemic dog because there are many diseases that cause anemia.  These are grouped into 1) diseases that cause blood loss, 2) diseases that cause hemolysis (red blood cell breakdown), and 3) diseases that decrease the production of red blood cells.

The main causes of blood loss in dogs include:

Trauma or injury that severs blood vessels or internal organs
Parasites such as fleas, ticks, and hookworms
Tumors of the intestinal tract, kidneys, and urinary bladder
Diseases that prevent proper clotting of blood

The main causes of hemolysis in dogs include:

Autoimmune disease
Blood parasites
Chemicals or toxins
Neoplasia (cancer)

The main causes of bone marrow suppression in dogs include:

Any severe, chronic disease
Very poor nutrition or nutritional imbalances
Autoimmune disease
Chemicals or toxins
Neoplasia (cancer)

It is noteworthy that while iron deficiency anemia is a common finding in people, especially women, it is uncommon in dogs and only occurs secondary to some form of chronic blood loss.

Treatment

If your dog's anemia is so severe that it is life threatening, a blood transfusion is needed.  This may be performed immediately after a blood sample is taken for testing.  The main purpose of a blood transfusion is to stabilize the dog long enough that a determination of the cause of the anemia can be made. 

Further treatment will be determined once the underlying disease has been diagnosed.

Prognosis

The prognosis is dependent upon identification of the underlying cause and a positive response to appropriate therapy.  Sometimes, the prognosis cannot be given for a few days because all of the diagnostic tests may not be completed.

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Hematoma of the Ear in Dogs
(Aural Hematoma)

An aural (ear) hematoma is a collection of blood, serum, or a clotted blood within the pinna (earflap).  When present, the pinna will be very thick.  The swelling may involve the entire pinna or it may involve only one area.

The earflap is composed of a two layers of skin surrounding a layer of cartilage.  The cartilage gives the earflap its shape.  Blood vessels go from side-to-side by passing through the cartilage.  Violent shaking can cause the vessels to break as the skin slides across the cartilage; however, in some cases, the cause remains undetermined.  (See Causes.)

Causes/Transmission

The cause of aural hematomas is unknown.  Vigorous shaking of the head and ears has been thought to be responsible, yet a large percentage of affected dogs develop hematomas without shaking their head.  Disease of the ear canal is also considered to play a role, but not all dogs with aural hematomas have ear disease (otitis). 

Clinical Signs

Most dogs with an aural hematoma have a history of head shaking.  Debris or odor may occur in the ear canal if an infection is present.  However, the most consistent clinical sign is a thickened earflap.

Diagnosis

A physical examination of the earflap is usually all that is needed to make the diagnosis.

Treatment

There are two approaches to treatment: a medical approach and a surgical approach

                Medical Treatment

This is the simplest and least invasive procedure; however, it is not always successful.  Many dogs are treated in this manner first.  If it is not successful, the surgical treatment is used.

The blood in the earflap is aspirated with a syringe and needle.  One of several medications, often a cortisone-type drug, is injected into the space from which the blood was taken.  The earflap is taped over the head as described below.  The dog is checked in 3-7 days to assess the outcome of treatment.  If an ear infection is present, it is also treated.

                Surgical Treatment

The blood is removed from the pinna.  This is accomplished by making a small incision in each end of the hematoma.  A rubber drain tube is passed through the hematoma and sutured to the ear.  This assures drainage of any more blood or serum that accumulates in the area. 

The space where the blood accumulated is obliterated.  Since the skin over the hematoma has been pushed away from the cartilage, it must be reattached to it to prevent another hematoma from occurring.  This is accomplished by a series of sutures that are passed through the earflap. 

The pinna is stabilized to prevent further damage.  The presence of the drain tube will cause the dog to shake its head even more.  Shaking at this time may cause further damage to the pinna.  Therefore, the pinna is laid on top of the dog's head and bandaged in place.  Although the bandage may be somewhat cumbersome, it will prevent further damage to the pinna and allow proper healing to progress.

The cause of the problem is diagnosed and treated.  Another important aspect of treatment is dealing with the cause of any potential head shaking.  If an infection is present, medication is dispensed to treat it.  However, some dogs have no infection but have foreign material (a tick, piece of grass, etc.) lodged in the ear canal.  If so, the foreign material is removed.  It is also possible that a foreign body initiated the shaking but was later dislodged.  If that occurs, and no infection is present, further treatment of the ear canal is not needed.

The drain tube and bandage are generally removed in about 3-5 days.  At that time, the hematoma is usually healed.  There will be two holes in the skin where the drain tube entered.  They will close within a few days.  If discharge occurs from the holes before they close, it should be cleaned off with hydrogen peroxide.

If an infection was present, it will be necessary to recheck the ear canal to be sure that the infection is gone.  Otherwise, another hematoma may occur.

Prognosis

Usually the prognosis is good for recovery, but it is not uncommon for the hematoma to recur at least once.

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Bladder Stones in Dogs

Bladder stones, or uroliths, are rock-like collections of minerals that form in the urinary bladder.  Uroliths may occur as a large, single stone or as dozens of smaller stones.  Individual stones can vary in size from tiny stones, which can be voided in the urine stream to larger stones the size of a golf ball.

Kidney stones (nephroliths) do not have to be present for bladder stones to form.  In fact, kidney stones are relatively uncommon in the dog.  Both stones are unrelated to development of gallstones (stones in the gall bladder).

Bladder stones are classified by their mineral content; this is determined by laboratory analysis of a stone.  The types of stones reported to occur in dogs include struvite, calcium oxalate, urate, cystine and silicate stones.

Contributing Factors

Predisposing factors for development of stones are unique for each type of stone but can include the following: 

1.     Presence of a urinary tract infection
2.     Excessive loss of urate or calcium into the urine
3.     Inability of the kidney to re-absorb certain amino acids

The factor that can be eliminated with appropriate treatment is a urinary tract infection.  For the others, a metabolic disturbance is responsible for stone formation and may not be preventable (see Prevention).

Prevalence

Bladder stones are a relatively common problem in the dog and occur in about 1-2% of all dogs.  Bladder stones are more common in middle-aged dogs.  Struvite, the most common stone, is seen with higher frequency in female dogs; the other types of stones are more common to male dogs.

Breeds commonly affected with bladder stones include the following:  Dalmatian, Pekingese, miniature Schnauzer, Yorkshire Terrier, Scottish Terrier, Dachshund, Bulldog, miniature Poodle, Pug, Basset Hound, Shih Tzu, and Cocker Spaniel.  Certain types of stones are more commonly found in certain breeds. 

Causes/Transmission

There are several theories of bladder stone formation.  Each is feasible in some circumstances, but there is probably an interaction of more than one of them in each dog.  The most commonly accepted theory is called the Precipitation-Crystallization Theory.  This theory states that one or more stone-forming crystalline compounds are present in elevated levels in the urine.  This may be due to abnormalities in diet or due to some previous disease in the bladder, especially infection with bacteria.  When the amount of this compound reaches a threshold level, the urine is said to be supersaturated.  This means that the level of the compound is so great that it cannot all be dissolved in the urine, so it precipitates and forms tiny crystals.  These crystals stick together, usually due to mucus-like material within the bladder, and stones gradually form.  As time passes, the stones enlarge and may increase in number.

Growth will depend on the quantity of crystalline material present and the degree of infection present.  Although it may take months for a large stone to grow, some sizable stones have been documented to form in only a few weeks.

Clinical Signs

The two most common signs of bladder stones are blood in the urine (hematuria) and straining to urinate (dysuria).  Hematuria occurs because the stones mechanically irritate the bladder lining, causing bleeding from its surface.  Dysuria occurs when stones obstruct the passage of urine out of the bladder.  Large stones may cause a partial obstruction at the point where the urine leaves the bladder and enters the urethra; small stones may flow with urine into the urethra. 

Bladder stones may also pass into the urethra but be too large to get completely out of the body, resulting in complete obstruction of the urethra.  When this occurs, urine cannot pass out of the body and the dog becomes very painful in the abdomen.  It may cry in pain, especially if pressure is applied to the abdominal wall.

Hematuria, dysuria, and inability to urinate are the most common signs seen, but abdominal pain usually occurs also.  We know this because when bladder stones are removed surgically, many owners tell us that the dog feels noticeably better and is more active soon after surgery.

Diagnosis

Most dogs that have bladder infections do not have bladder stones.  These dogs will often have blood in the urine and will strain to urinate, the same symptoms as a dog with bladder stones.  Therefore, we do not suspect bladder stones just based on these clinical signs.

Some bladder stones can be palpated (felt with the fingers) through the abdominal wall or with a rectal exam.  However, failure to palpate them does not rule them out.

Most bladder stones are visible on radiographs (x-rays) or an ultrasound examination.  These procedures are performed if stones are suspected.  This includes dogs that show unusual pain when the bladder is palpated, dogs that have recurrent hematuria and dysuria, or dogs that have recurrent bacterial infections in the bladder.

Some bladder stones are not visible on radiographs.  They are said to be radiolucent.  This means that their mineral composition is such that they do not block the x-ray beam.  These stones may be found with an ultrasound examination (if available) or with special radiographs that are made after placing a dye (contrast material) into the bladder.

Treatment

There are two options for treatment.  Quick results can be achieved with surgical removal of the stones.  This requires major surgery in which the abdomen and bladder are opened.  Following two to four days of recovery, the dog is relieved of pain and dysuria.  The hematuria will often persist for a few more days, and then it stops.  Surgery is not the best option for all patients; however, those with urethral obstruction and those with bacterial infections associated with the stones should be operated unless there are other health conditions that prohibit surgery.

The second option is to dissolve the stone with a special diet.  This avoids surgery and can be a very good choice for some dogs.  However, it has three disadvantages. 

1. It is not successful for all types of stones.  Unless some sand-sized stones can be collected from the urine and analyzed, it is not possible to know if the stone is of the composition that is likely to be dissolved. 
2. It is slow.  It may take several weeks or a few months to dissolve a large stone so the dog may continue to have hematuria and dysuria during that time.  Continued trauma to the bladder wall may thicken it and leave it scarred.
3. Not all dogs will eat the special diet.  The diet is not as tasty as the foods that many dogs are fed.  If it is not consumed exclusively, it will not work.

Prognosis

Prognosis depends upon whether the underlying cause can be eliminated (urinary tract infection) or it is rooted in a metabolic disturbance.  Obviously, metabolic tendencies are cannot be manipulated with great success.  Therefore, the prognosis is dependent upon each individual dog’s particular situation.

Prevention

In some cases, stones can be prevented from recurring a second time.  There are at least four types of bladder stones, based on their chemical composition.  If stones are removed surgically or if some small ones pass in the urine, they should be analyzed for their chemical composition.  This will permit us to determine if a special diet will be helpful in preventing recurrence.  If a bacterial infection causes stone formation, it is recommended that periodic urinalyses and urine cultures be performed to determine when antibiotics should be given.

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Bloat in Dogs

This is a term that is synonymous with the more scientific term "Gastric Dilatation/Volvulus."  It is often called GDV.  It means that a dog's stomach distends with gas to the point that the dog goes into shock and may die.

Dilatation means that the stomach is distended with air, but it is located in the abdomen in its correct place.  Volvulus means that the distention is associated with a twisting of the stomach on its longitudinal axis.  Normal outflow from the stomach is obstructed and it distends with air even more severely.

Prevalence

This condition almost always occurs in adult, deep chested dogs of large and giant breeds.  Some of the more commonly affected breeds include Great Danes, Irish Setters, German Shepherds, and Afghan Hounds.

Causes/Transmission

Even after extensive study, we still do not know the cause of GDV.  In all likelihood, there are multiple causes.  Original theories suggested that it occurred when a dog ate a large meal of dry food and then consumed an excessive amount of water.  The water caused the dry food to swell.  Vigorous exercise, including running and jumping, after eating contributed to the twisting (torsion) as the stomach moved about in the abdominal cavity.  There is still no clear scientific evidence to support this theory. 

Other theories have included consideration of excessive stomach acid production, swallowing air, stress, and fermentation of bacteria in the stomach.

In most dogs experiencing GDV, the stomach is not excessively full of dry food and the dog has not recently engaged in strenuous exercise.  The most current theory is that the stomach's contractions lose their regular rhythm and trap air in the stomach; this can cause the twisting event.  However, the sequence of events for most cases defies a good explanation.

Clinical Signs

An enlarged stomach will cause the abdominal wall to protrude prominently, especially on the dog's left side.  The swelling will be very firm and obvious enough to see across the room.  Occasionally, this distention is not very apparent.  This occurs in dogs that have a large portion of the stomach up under the rib cage.  In most cases, however, the owner is able to detect the distention.  The dog will be very restless, painful, or very depressed.  It may lie in what is commonly called a "praying position" with the front legs drawn fully forward.  Vomiting will eventually progress to nonproductive retching (dry heaves).  This sequence of events occurs relatively quickly, over two or three hours in most cases.

Diagnosis

The first step in diagnosis is to determine if the correct breed is involved.

The next step is to establish that the stomach is distended with air.

The presence of a rapidly developing distended abdomen in a large breed dog usually provides adequate evidence to render a tentative diagnosis of GDV.  A radiograph (x-ray) is used to confirm that the diagnosis of dilatation.  It can also identify the presence of volvulus, in most cases.

Treatment

The first major life-threatening event that occurs is shock.  This occurs because the distended stomach puts pressure on the large veins in the abdomen that carry blood back to the heart.  Without proper return of blood, the output of blood from the heart (cardiac output) is diminished and the tissues are deprived of blood and oxygen. 

Reduced blood output from the heart and high pressure within the cavity of the stomach cause the stomach wall to be deprived of adequate circulation.  If the blood supply is not restored quickly, the wall of the stomach begins to die; the wall may rupture.  If volvulus occurs, the spleen's blood supply will also be impaired.  This organ is attached to the stomach wall and shares some large blood vessels.  When the stomach twists, the spleen is also rotated to an abnormal position and its vessels are compressed.

When the stomach is distended, digestion stops.  This results in the accumulation of toxins that are normally removed from the intestinal tract.  These toxins activate several chemicals that cause inflammation, and the toxins are absorbed into circulation (endotoxemia).  This causes problems with the blood clotting factors so that inappropriate clotting occurs within blood vessels.  This is called disseminated intravascular coagulation (DIC) and is usually fatal. 

Several important steps must be taken quickly. 

1. Shock must be treated with administration of large quantities of intravenous fluids.  They must be given quickly; some dogs require more than one intravenous catheter.

2. Pressure must be removed from within the stomach (gastric decompression).  This may be done with a tube that is passed from the mouth to the stomach.  Another method is to insert a large bore needle through the skin into the stomach.  A third method is to make an incision through the skin into the stomach and to temporarily suture the opened stomach to the skin.  The last method is usually done when the dog's condition is so grave that anesthesia and abdominal surgery is not possible.

3. The stomach must be returned to its proper position.  This requires abdominal surgery that can be risky because of the dog's condition.  During surgery, the stomach wall will be inspected for areas that may have lost its blood supply.  Although this is a very bad prognostic sign, the devitalized area(s) of the stomach should be removed.

4. The stomach will be attached to the abdominal wall (gastropexy) to minimize the possibility of recurrence of GDV.  Although this is not always successful, this procedure greatly reduces the likelihood of recurrence.

5. Abnormalities in the rhythm of the heart (arrhythmias) must be diagnosed and treated.  Severe arrhythmias can become life threatening at the time of surgery and for several days post-operatively.  An EKG will be recorded every few hours to detect this problem.

Prognosis

The prognosis is guarded.  Early intervention improves the likelihood of a good outcome.  Other factors related to survival include the severity and duration of the distention, the degree of shock, how quickly treatment is begun, presence of endotoxemia, and the presence of other diseases, especially those involving the heart.  Dogs who survive the surgery and immediate post-operative period have a good prognosis.

Prevention

The most effective means of prevention is gastropexy, or the surgical attachment of the stomach to the body wall.  This will not prevent dilatation (bloat), but it will prevent volvulus in most cases.

Various dietary and exercise restrictions have been used, but none of these have proven value.

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Lameness in Growing Pups
(Juvenile Bone Diseases)

There are several causes of lameness in young dogs.  Most of these are relatively minor and will resolve with time and rest.  However, there are other more serious causes that are not self-limiting and, if not treated promptly, may result in irreversible lameness and/or arthritis. 

Large and giant breeds of dogs (ie., those whose adult weight is over 60 pounds) are most susceptible to disorders of orthopedic development.  These juvenile bone diseases occur during the period of rapid growth which, in large breeds, can extend until 2 years of age. 

To minimize the possibility of permanent lameness, it is important to achieve an accurate diagnosis of any lameness that lasts more than 2 weeks.  The history, physical examination, and radiographs (x-rays) are all helpful and provide complementary pieces of information.  

Radiographs of the affected leg usually provide a starting point for evaluation.  In some cases, the opposite (normal) leg may be radiographed for comparative purposes.  Depending on the age and breed of the dog, other bones and joints may later need to radiographed.  Several radiographs taken from different angles are usually necessary in order to provide the most complete assessment.  This will often require a short-acting anesthetic in order to get the positioning that is necessary.

Lameness Involving the Rear Legs Only
               
Rear-limb lameness in large breed dogs is usually caused by hip dysplasia or an abnormally formed hip joint.  The hip is a ball and socket joint.  When a dog has hip dysplasia, the ball (head of the femur bone) is not round and the socket is not deep, therefore the two bones do not fit together well.  This malformation results in a characteristic laxity, or looseness, of the joint. 

Hip dysplasia is multifactorial (has several contributing causes), but the primary cause is genetic.  Some dogs may show signs of lameness by six months of age, whereas others do not show any signs until older.  The lameness may be sudden in onset or can develop slowly and appear only intermittently.  A dog of the high-risk breeds for hip dysplasia should not be bred before radiographs of the hips are taken.  There are several choices of treatment available depending upon the age of the dog, level of discomfort, degree of arthritic changes, and owner finances.  Both surgical and medical options are available for management of hip dysplasia.

Lameness Involving the Front Legs Only

                Elbow dysplasia, or un-united anconeal process (UAP), is a failure of the top of the ulna to fuse with the rear point of the elbow.  It is a condition most common to German shepherd dogs, although other breeds may be affected.  It occurs about twice as often in male dogs as female dogs and both elbows may be involved.  Lameness often occurs within a few months of birth and is usually intermittent in nature.  Affected dogs may stand, sit, or walk with the elbow in an unusual position.  Most dogs demonstrate pain when the elbow is fully flexed (bent) and extended.  Surgical intervention is the treatment of choice since medical therapy alone is less successful and more likely to lead to progressive arthritis.

                Fractured (fragmented) coronoid process is the other common developmental disorder of the elbow.  This condition is often seen in retrievers, German shepherd dogs, and Rottweilers.  It is more common in male dogs and both elbows are usually involved.  Lameness may not appear as early as with UAP.  The cause of this disorder is unknown, but involves fracture of the bone or cartilage of the medial coronoid process of the ulna. Eventually, a bone or cartilage fragment may break free and become loose in the joint.  This disorder can appear similar to UAP and may be harder to confirm with radiographs.  Sometimes, the diagnosis is not made until surgery.  Unless surgery is done promptly after the fracture occurs, return to normal use of the leg is unlikely.

Lameness Involving the Front or Rear Legs

                Panosteitis is an inflammatory bone disease with an unknown cause.  It involves the shaft of the long bones.  It is most common in German shepherd dogs, but is also seen with frequency in Great Danes, Golden and Labrador retrievers, Doberman pinschers, and basset hounds.  Male dogs are more commonly affected than female dogs.  Lameness is usually sudden in onset and may vary in intensity.  The pain may shift between limbs, or more than one bone may be involved at a time.  Placing pressure on the shaft of the involved bone will usually elicit a pain response.  Diagnosis is usually achieved with physical examination and radiographs.  The disease is self-limiting but some pain medications may be helpful in controlling signs and relieving discomfort.

                Osteochondritis dissecans (OCD) is a defect in the smooth cartilage surface within one or more of several joints.  Male dogs are most commonly affected.  It may affect the shoulder (most commonly), the elbow, the hip, the knee, or the stifle.  Some of these defects may heal with confinement of the dog for several weeks.  However, most do not and a few may result in a piece of cartilage breaking off and floating freely in the joint.  This disease causes pain, which varies in its severity.  It is best treated with surgery to remove the defective cartilage.

                Hypertrophic osteodystrophy (HOD) is an inflammatory disorder of the growth plates (end) of the long bones.  It causes swelling and pain at the end of the bone.  Fever, pain, and loss of appetite will occur in more severely affected dogs.  It is usually self-limiting, although some dogs may suffer permanent damage to the growth plates and later develop deformed legs. Medication can be given to relieve pain and suppress inflammation.

Nutritional Supplementation of Puppies

It is always recommended that growing puppies be fed the best quality food which can be provided.  When this is done, supplementation with vitamins and minerals should be avoided.  Each dog has the genetic potential to reach one size and one size only.  Nutritional supplementation does not alter this genetic potential.  However, supplements can make the dog reach this size more quickly.  When cartilage grows too rapidly, the developing blood supply may not be able to grow at the same rate.  This can lead to the cartilage defects associated with OCD. 

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Kennel Cough in Dogs

Canine infectious tracheobronchitis, or “kennel cough,” is an important respiratory disorder because it is highly contagious between dogs.  A number of different infectious agents may be involved with this disease.  It is characterized by bouts of nonproductive (dry) coughing lasting from days to even weeks.

Contributing Factors

Kennel cough spreads rapidly between dogs housed in close proximity, such as a boarding kennel.  Affected dogs usually have a history of recent boarding or some similar stressor, such as a trip to the groomer or a dog show.

Some researchers report that there is an increased incidence of kennel cough in the fall.

Causes/Transmission

As noted above, a number of different agents may be involved with kennel cough.  The canine adeno-2 virus (CAV2), the parainfluenza virus (PIV), and the bacterium Bordetella bronchiseptica are the common primary pathogens (responsible for setting up the initial respiratory disease).  Secondary invaders, such as Mycoplasma, become involved once an inflammatory process is present in the airway.

Clinical Signs

A dry, hacking cough is the hallmark of this disease.  Many times, owners mistakenly believe that the dog is choking on a foreign body.  Other than the cough, most dogs are still bright and alert with a good appetite.  Fever and enlarged tonsils are occasionally found.

Diagnosis

In most cases, the history and physical exam are adequate to provide a presumptive diagnosis of kennel cough.  Rarely are specific diagnostic tests indicated, although they may be helpful in cases that are not resolving as expected.  These additional tests might include a blood count and blood chemistries, chest x-rays, and a sample of fluid from the trachea (windpipe) or bronchi.

Treatment

Although antibiotic therapy can be helpful for the bacterial component of kennel cough, there is no specific therapy for the viruses.  For dogs that cough continually, a mild cough suppressant can be prescribed.  However, it is for short-term use only.

Dogs who are recovering from kennel cough should not be stressed with exercise or excitement for at least a week.  Rest is recommended to avoid precipitation of the cough caused by increased activity.

Prognosis

The prognosis is usually good and, in most cases, has the potential to resolve without complication.  Infrequently, long-term respiratory problems can result from kennel cough.

Transmission to Humans

Canine infectious tracheobronchitis does not pose any health risk for humans.

Prevention

Vaccines are available to protect against the main infectious agents responsible for kennel cough.  Bordetella vaccines are given intranasal (drops in the nose) because this route produces rapid immunity.  Sometimes the intranasal vaccine can lead to a mild cough.

Immunity against the two main viral diseases is covered with standard vaccine protocols (injection).

Because the immunity offered is neither 100% protective nor permanent, boosters are needed on a periodic basis.  These are especially important before a dog is placed into a kennel situation; many kennels require these boosters before allowing a dog to enter the facility.

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Breeding Dogs and Raising Puppies

Breeding dogs and raising puppies can be an extremely rewarding experience or it may produce frustration and failure.  The following information is provided in order to increase your chances of success.

Frequency of Heat Cycles

The female dog comes into heat (estrus) about every 6 months, although very large breeds of dogs may cycle every 8-10 months.  The heat period lasts about 3 weeks. 

Signs of Heat

The most notable sign of heat is vaginal bleeding.  This begins about the end of the first week of estrus and lasts for about 10-14 days.  Another consistent sign is swelling of the vulva.  During estrus male dogs will be attracted to her. 

Insuring Successful Breeding

Male dogs are more successful breeders when the environment is familiar.  Therefore, it is preferable to take the female to the male's home for breeding.  The timing for breeding is critical.  The most fertile time is considered the 10th through the 14th days of estrus; however, some dogs will be fertile as early as the 3rd day and as late as the 18th day. 

Tests for Determining Breeding Time

There are two tests that are used for this purpose.  The first is a microscopic examination of vaginal cells to detect changes cell appearance and numbers.  This has been used for many years and is reasonably reliable.

A newer test determines changes in the progesterone level in the blood.  This test is more accurate, and more expensive, than monitoring vaginal cells.  It is used for dogs that have a history of unsuccessful breeding or that are very valuable breeders.

Pregnancy

Pregnancy, also called the gestation period, ranges from 60 to 67 days, averaging 63 days.  Most dogs deliver (whelp) between days 63 and 65.  The only way to accurately determine the stage of pregnancy is to count days from the time of breeding.  If possible, the breeding date(s) should be recorded.  The mother should be examined 3 weeks after breeding to confirm her pregnancy.

A pregnant dog should be fed a puppy formulation of a premium brand of dog food for the duration of the pregnancy and through the nursing period.  These diets are generally available through veterinary hospitals or pet stores.  Puppy diets provide all the extra nutrition needed for the mother and her litter.  If the mother is eating one of these diets, no calcium, vitamin, or mineral supplements are needed.  The puppy formulation is necessary to provide the extra nutrients for pregnancy and nursing. 

During pregnancy, the mother's food consumption will often reach 1.5 times her level before pregnancy.  By the end of the nursing period, it may exceed 2 times the pre-pregnancy amount.  Do not withhold food; increasing the number of feedings per day is helpful in allowing her to eat enough for her needs and those of the puppies.

Preparing for Whelping

From the time of breeding, many dogs show behavioral changes.  Most develop an unusually sweet and loving disposition and demand more affection and attention.  However, some may become uncharacteristically irritable.   Some experience a few days of vomition ("morning sickness"), followed by the development of a ravenous appetite that persists throughout the pregnancy.

During the latter stages of pregnancy, the expectant mother begins to look for a secure place for delivery.  Many become uncomfortable being alone and will cling closely to the owner.  At the onset of labor, many nervously seek a place to make the "nest" or birthing place.  If the dog is attached to her owner, she will not want to be left alone at the time of delivery.  If left alone, she may delay delivery until the owner returns.  

Prior to the time of delivery, a whelping box should be selected and placed in a secluded place, such as a closet or a dark corner.  The box should be large enough for the dog to move around freely, but have low enough sides so that she can see out and so you can reach inside to give assistance, if needed.  The bottom of the box should be lined with several layers of newspapers.  These provide a private hiding place for the expectant and delivering mother and will absorb the birthing fluids.  The upper, soiled layers may be removed with minimal interruption to the mother and her newborn puppies.

Labor and Delivery

Most dogs experience delivery without complications; however, first-time mothers should be attended by their owners until at least one or two puppies are born.  If these are born quickly and without assistance, further attendance may not be necessary, although it is desirable.  If the owner elects to leave, care should be taken so that the dog does not try to follow and leave the whelping box.

The signs of impending labor generally include nervousness and panting.  The dog will often quit eating during the last 24 hours before labor.  She will also usually have a drop in rectal temperature below 100 F.  The temperature drop may occur intermittently for several days prior to delivery, but it will usually be constant for the last 24 hours.    

Delivery times will vary.  Dogs having slim heads, such as Shelties, Collies, and Dobermans, may complete delivery in one to two hours.  Dogs having large, round heads generally require longer delivery times.  English Bulldogs, Boston Terriers, and Pekinese puppies tend to have sizable heads that make delivery more difficult.  It is not unusual for these breeds to rest an hour or more between each puppy.  Rarely, a dog may deliver one or two puppies, then have labor stop for as long as twenty-four hours before the remainder of the litter is born.  However, if labor does not resume within a few hours after the delivery of the first puppies, examination by a veterinarian is advised.  If labor is interrupted for twenty-four hours or more, veterinary assistance should definitely be obtained.

Puppies are usually born head first; however, breech presentations, in which the puppy is delivered tail end first, occurs about 40% of the time and is also considered normal.  Each puppy is enclosed in a sac that is part of the placenta ("afterbirth").  The placentas usually pass after the puppies are born.  However, any that do not pass will disintegrate and pass within 24-48 hours after delivery.  It is normal for the mother to eat the placentas.

If the delivery proceeds normally, a few contractions will discharge the puppy; it should exit the birth canal within ten minutes of being visible.  Following delivery, the mother should lick the newborn's face.  She will then proceed to wash it and toss it about.  Her tongue is used to tear the sac and expose the mouth and nose.  This vigorous washing stimulates circulation, causing the puppy to cry and begin breathing; it also dries the newborn's haircoat.  The mother will sever the umbilical cord by chewing it about 3/4 to 1 inch from the body.  Next, she will eat the placenta.

If the puppy or a fluid-filled bubble is partially visible from the vagina, the owner should assist delivery.  A dampened gauze or thin wash cloth can be used to break the bubble and grasp the head or feet.  When a contraction occurs, firm traction should be applied in a downward (i.e., toward her rear feet) direction.  If reasonable traction is applied without being able to remove the puppy, or if the mother cries intensely during this process, the puppy is probably lodged.  A veterinarian's assistance should be sought without delay.

It is normal for the mother to remove the placental sac and clean the puppies; however, first-time mothers may be bewildered by the experience and hesitate to do so.  If the sac is not removed within a few minutes after delivery, the puppy will suffocate, so you should be prepared to intervene.  The puppy's face should be wiped with a damp wash cloth or gauze to remove the sac and allow breathing.  Vigorous rubbing with a soft, warm towel will stimulate circulation and dry the hair.  The umbilical cord should be tied with cord (i.e., sewing thread, dental floss) and cut with clean scissors.  The cord should be tied snugly and cut about 1/2 inch from the body so it is unlikely to be pulled off as the puppy moves around the whelping box.

Newborn puppies may aspirate fluid into the lungs, as evidenced by a raspy noise during respiration.  This fluid can be removed by the following procedure.  First, the puppy should be held in the palm of your hand. The puppy's face should be cradled between the first two fingers.  The head should be held firmly with this hand, and the body should be held firmly with the other.  Next, a downward swing motion with the hands should make the puppy gasp.  Gravity will help the fluid and mucus to flow out of the lungs.  This process may be tried several times until the lungs sound clear.  The tongue is a reliable indicator of successful respiration.  If the puppy is getting adequate oxygen, it will appear pink to red.  A bluish colored tongue indicates insufficient oxygen to the lungs, signaling that the swinging procedure should be repeated.

It may be helpful to have a smaller, clean, dry box lined with a warm towel for the newborn puppies.  (A towel can be warmed in a microwave oven.)  After the puppy is stable and the cord has been tied, it should be placed in the incubator box while the mother is completing delivery.  Warmth is essential so a heating pad or hot water bottle may be placed in the box, or a heat lamp may be placed nearby.  If a heating pad is used, it should be placed on the low setting and covered with a towel to prevent overheating.  A hot water bottle should be covered with a towel.  Remember that the newborn puppies may be unable to move away from the heat source.  Likewise, caution should also be exercised when using a heat lamp.

Once delivery is completed, the soiled newspapers should be removed from the whelping box.  The box should be lined with soft bedding prior to the puppies' return.  The mother should accept the puppies readily and recline for nursing.

A veterinarian should examine the mother and her litter within 24 hours after the delivery is completed.  This visit is to check the mother for complete delivery, to check the newborn puppies.  The mother may receive an injection to contract the uterus and stimulate milk production.

The mother will have a bloody vaginal discharge for 3-7 days following delivery.  If it continues for longer than one week, a veterinarian should examine her for possible problems.

Difficulty During Delivery

Although most dogs deliver without need for assistance, problems do arise which require the attention of a veterinarian.  Professional assistance should be sought if any of the following occur:

1) Twenty minutes of intense labor occurs without a puppy being delivered.

2) Ten minutes of intense labor occurs when a puppy or a fluid-filled bubble is visible in the birth canal.

3) The mother experiences sudden depression or marked lethargy.

4) The mother's body temperature exceeds 103o F (via a rectal thermometer).

5) Fresh blood discharges from the vagina for more than 10 minutes.

Difficulty delivering (dystocia) may be managed with or without surgery.  The condition of the mother, size of the litter, and size of the puppies are factors used in making that decision.

Premature Delivery

Occasionally, a mother will deliver a litter several days premature.  The puppies may be small, thin, and have little or no hair.  It is possible for them to survive, but they require an enormous amount of care, since they are subject to chilling and are frequently very weak and unable to swallow.  Some may be able to nurse but are so weak that they must be held next to the mother.  Puppies that do not nurse can be fed with a small syringe, bottle, or stomach tube.  The equipment and instructions for these procedures are available from a veterinarian.  Premature puppies must be kept warm.  The mother can provide sufficient radiant heat from her body if she will stay close to them.  If she refuses, heat can be provided with a heat lamp, heating pad, or hot water bottle.  Excessive heat can be just as harmful as chilling, so any form of artificial heat must be controlled.  The temperature in the box should be maintained at 85 to 90 F, but the box should be large enough so the puppies can move away from the heat if it becomes uncomfortable.

Stillborn Puppies

It is not uncommon for one or two puppies in a litter to be stillborn.  Sometimes, a stillborn puppy will disrupt labor, resulting in dystocia.  At other times, the dead puppy will be born normally.  Although there is always a cause for this occurrence, it is often not easily determined without an autopsy that includes cultures and the submission of tissues to a pathologist.  This is only recommended in special circumstances.   

Caring for Newborn Puppies

The mother will spend most of her time with the puppies during the next few days.  The puppies need to be kept warm and to nurse frequently; they should be checked every few hours to make certain that they are warm and well fed.  The mother should be checked to make certain that she is producing adequate milk.

If the mother does not stay in the box, the puppies' temperatures must be monitored.  If the puppies are cold, supplemental heating should be provided.  During the first four days of life, the newborns' box should be maintained at 85 to 90.  The temperature may gradually be decreased to 80 F by the seventh to tenth day and to 72 F by the end of the fourth week.  If the litter is large, the temperature need not be as high.  As puppies huddle together, their body heat provides additional warmth.

If the mother feels the puppies are in danger or if there is too much light, she may become anxious.  Placing a sheet or cloth over most of the top of the box to obscure much of the light may resolve the problem.  An enclosed box is also a solution.  Some dogs, especially first-time mothers, are more anxious than others.  Such dogs may attempt to hide their young, even from her owner.  Moving from place to place may continue and will endanger the puppies if they are placed in a cold or drafty location.  Dogs with this behavior should be caged in a secluded area.  This type of mother has also been known to kill her puppies as a means of "protecting" them from danger.

Puppy Difficulties

Puppies should eat or sleep 90% of the time during the first 2 weeks.  If they are crying during or after eating, they are usually becoming ill or are not getting adequate milk.  A newborn puppy is very susceptible to infections and can die within 24 hours.  If excessive crying occurs, a veterinarian should examine the mother and entire litter promptly.

When the milk supply is inadequate, supplemental feeding one to three times per day is recommended and should be performed on any litter with 5+ puppies.  There are several commercial formulae available that are made to supply the needs of puppies. They require no preparation other than warming.  They should be warmed to 95 to 100 F before feeding.  Its temperature can be tested on one's forearm; it should be about the same as one's skin.  An alternative is canned goats' milk that is available in most grocery stores.  The commercial products have directions concerning feeding amounts.  If the puppies are still nursing from their mother, the amounts recommended will be excessive.  Generally, 1/3 to 1/2 of the listed amount should be the daily goal.  Supplemental feeding may be continued until the puppies are old enough to eat puppy food.

If the mother does not produce milk or her milk becomes infected, the puppies will also cry.  If this occurs, the entire litter could die within 24 to 48 hours.  Total replacement feeding, using the mentioned products, or adopting the puppies to another nursing mother is usually necessary.  If replacement feeding is chosen, the amounts of milk listed on the product should be fed.  Puppies less than 2 weeks of age should be fed every 3-4 hours.  Puppies 2-4 weeks of age do well with feedings every 6-8 hours.  Weaning, as described below, should begin at 3-4 weeks of age.

The First Few Weeks of Life

For the first month of life, puppies require very little care from the owner because their mother will feed and care for them.  They are born with their eyes closed, but they will open in 7 to 14 days.  If swelling or bulging is noted under the eyelids, they should be opened gently.  A cotton ball dampened with warm water may be used to assist opening the lids.  If the swelling is due to infection, pus will exit the open eyelids and should be treated as prescribed by a veterinarian.  If the eyes have not opened within 14 days of age, they should be opened by a veterinarian.

Puppies should be observed for their rate of growth.  They should double their birth weight in about one week. 

At two weeks of age, puppies should be alert and trying to stand.  At three weeks, they generally try to climb out of their box.  At four weeks, all of the puppies should be able to walk, run, and play.

Puppies should begin eating solid food about 3 to 4 weeks of age.  Initially, one of the milk replacers or puppy food that has been soaked in water to make a gruel should be placed in a flat saucer.  The puppies' noses should be dipped into it 2 or 3 times per day until they begin to lap; this usually takes 1-3 days.  Next, canned or dry puppy food should be placed in the milk replacer or in water until it is soggy.  As the puppies lap, they will also ingest the food.  The amount of moisture should be decreased daily until they are eating the canned or dry food with little or no moisture added; this should occur by 4 to 6 weeks of age.

Milk Fever

Eclampsia, or milk fever, is a depletion of calcium from the mother due to heavy milk production.  It generally occurs when the puppies are 3-5 weeks old (just before weaning) and most often to mothers with large litters.  The mother has muscle spasms resulting in rigid legs, spastic movements, and heavy panting.  This can be fatal in 30-60 minutes, so a veterinarian should be consulted immediately.

Feeding Puppies

Diet is extremely important for a growing puppy.  There are many commercial foods specially formulated for puppies.  These foods meet their unique nutritional requirements and should be fed until 12-18 months of age.  Puppy foods are available in dry and canned formulations.  Dry foods are less expensive and can be left in the bowl for the puppy to eat at will.  Canned foods offer a change and are just as nutritious.

We recommend that you buy FOOD FORMULATED FOR PUPPIES.  Adult formulations are not recommended since they do not provide the nutrition required for a puppy.  Advertisements tend to promote taste rather than nutrition, so one should be careful that their influence on purchasing habits is not detrimental to one's dog.  Generic foods should be avoided.  Table food is not recommended; although often more appealing than dog food, balanced, complete nutrition is usually compromised. 

We recommend that you buy NAME BRAND FOOD.  It is generally a good idea to avoid generic brands of food.  We recommend that you only buy food that has the AAFCO (American Association of Feed Control Officials) certification.  Usually, you can find this information very easily on the food label.  AAFCO is an organization that oversees the entire pet food industry.  It does not endorse any particular food, but it will tell you if the food has met the minimum requirements for nutrition, which are set by the industry.  Most of commercial pet foods will have the AAFCO label.

First Vaccinations

Puppies are provided some immunity to canine diseases before and shortly after birth.  The mother's antibodies cross the placenta and enter the puppies' circulation.  Some antibodies are also provided in the mother's milk.  These "maternal antibodies" protect the puppies against the diseases to which the mother is immune.  This explains why is it desirable to booster the mother's vaccinations within a few months prior to breeding. 

Although very protective, maternal antibodies last for only a few weeks; after this time, the puppy becomes susceptible to disease.  The vaccination program should be started at about 6 to 8 weeks of age.  Puppies should be vaccinated against distemper, hepatitis, leptospirosis, parainfluenza virus, parvovirus, corona virus, and rabies.  Other vaccines are also available for certain situations, and will be discussed at the time of the first visit for vaccinations.

Maternal antibodies are passed in the mother's milk only during the first 1-3 days after delivery.  If, for any reason, the puppies do not nurse during this important period of time, their vaccinations should begin about 2 to 4 weeks of age, depending on likely disease exposure.  A veterinarian can make specific recommendations for each particular situation.

Treating Puppies for Worms

Intestinal parasites ("worms") are common in puppies.  Symptoms include general poor condition, chronic soft or bloody stools, loss of appetite, a pot-bellied appearance, loss of luster of the haircoat, and weight loss.  Some parasites are transmitted from the mother to her offspring, and fleas carry others.  Some are transmitted through the stool of an infected dog.  Very few of these parasites are visible in the stool, so their eggs must be detected by the veterinarian with a microscope.

A microscopic examination of the feces will reveal the eggs of most of these parasites.  Generally this test should be performed at the time of the first vaccinations.  However, it may be performed as early as 3 weeks of age if a parasite problem is suspected.  Treatment is based on the type of parasites found although some veterinarians elect to treat all puppies because they know that fecal tests can be falsely negative.  Your veterinarian should be consulted for specific recommendations for your puppies.

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Coccidia Infections in Dogs

Intestinal coccidiosis is an infection with a one-celled organism; these organisms are classified as protozoa and are called coccidia.  Coccidia are not worms; they are microscopic parasites that live within cells of the intestinal lining.  Because they live in the intestinal tract and commonly cause diarrhea, they are often confused with worms.

Contributing Factors

Conditions of crowding, poor sanitation, and stress contribute to infections with coccidia. 

Prevalence

Coccidiosis is a relatively common finding in young kittens and puppies especially if they are strays or have come from a crowded environment with poor hygiene (pet store, puppy “mill,” etc.). 

Causes/Transmission

Oocysts (immature coccidia; "eggs") are passed in the stool of the dog.  They lie in the environment and eventually sporulate (mature; hatch) into a more developed oocyst that can infect the dog again.  Other dogs, dogs, or mice may also become infected.  This process can occur in as little as 6 hours, but it usually takes 7-10 days.  If the sporulated oocysts are swallowed, they mature in the dog's intestine to complete the life cycle.  If the oocysts are swallowed by a mouse, the dog may also become infected by eating the mouse.

Clinical Signs

Most dogs with coccidia have subclinical infections, meaning that they do not have diarrhea or any other clinical signs.  When the eggs (oocysts) are found in the stool of a dog without diarrhea, they are generally considered a transient, insignificant finding.  However, in puppies and debilitated adult dogs, they may cause severe, watery diarrhea, dehydration, abdominal distress, and vomiting.  In severe cases, death may occur.

Diagnosis

Coccidiosis is diagnosed by performing a microscopic examination of a stool sample.  Since the oocysts are much smaller than the eggs of the intestinal worms, a very careful study must be made.  Infection with some of the less common coccidial parasites is confirmed with additional tests that require specialized laboratory facilities.

Treatment

The most common drug used to eliminate coccidia is a sulfa-type antibiotic.  It is given for 10-14 days.  The medication is sweet tasting and objection to the taste is usually not a problem.  If the sulfa-type drug is not effective, others are available.  Additional medication may be needed if diarrhea and dehydration occur.

Prognosis

In most cases, a good response to treatment is expected and most dogs recover.  The presence of concurrent diseases or immune suppression can make the prognosis less certain. 

Transmission to Humans

The most common coccidia found in dogs do not have any affect on humans.  However, less common types of coccidia are potentially infectious to humans.  One parasite, called Cryptosporidium, may be carried by dogs or dogs and may possibly be transmitted to people.  This parasite has also been found in public water supplies in some major cites.  Another coccidial organism, Toxoplasma, is carried by cats and is of particular concern to pregnant women because of the potential to cause birth defects in newborns.  This organism is only able to complete its life cycle in the cat. 

These two coccidial parasites pose a health risk for immunosuppressed humans (i.e., AIDS patients, those taking immune suppressant drugs, cancer patients, and the elderly).  Good hygiene and proper disposal of dog and cat feces are important in minimizing risk of transmission of all parasites to humans.  Although there is risk of pets transmitting parasites to humans, it does not warrant removing the dog from the household except in very rare instances. 

Prevention

Reinfection of dogs is common so environmental disinfection is important.  The use of chlorine bleach, one cup in a gallon of water, is effective if the surfaces and premises can be safely treated with it.  Because coccidiosis tends to be a problem in areas of poor sanitation, the need for environmental decontamination cannot be emphasized enough. 

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Collapsed Trachea in Dogs

The trachea, also known as the windpipe, is an important structure that connects the throat to the lungs.  It serves the purpose of directing air into the respiratory tract. 

The normal trachea is tubular.  It maintains its shape because of a series of rings made of cartilage.  These rings do not completely encircle the trachea.  Instead, they go from the 2 o'clock to 10 o'clock positions.  The remainder of the trachea composed of a flexible membrane that joins the ends of the cartilage rings.

When the cartilage rings are flattened from the top to the bottom, the trachea is said to be collapsed.  Rapid inhalation of air can cause the trachea to flatten and make it difficult for air to enter the lungs.

Cause

We do not completely understand how this condition develops.  However, we know that these dogs have an abnormality in the chemical makeup of their tracheal rings.  The rings loose their stiffness so they are not able to retain their circular shape.  We also know that it occurs in certain breeds of dogs, notably Chihuahuas, Pomeranians, Shih Tzus, Lhasa Apsos, Toy Poodles, and Yorkshire Terriers.  Because of that, we suspect that there is a genetic factor involved.

Clinical Signs

The most common clinical sign is a chronic cough.  It is often described as dry and harsh and can become quite pronounced.  The term "goose honk" is often used to describe it.  Coughing is often worse in the daytime and much less at night.  The cough may also begin due to excitement, pressure on the trachea (from a leash), or from drinking water or eating. 

Diagnosis

A dog of the breeds listed above with a chronic cough, especially a “goose honk,” should be suspected as having collapsed trachea.  Many times, very light pressure placed on the trachea during the physical examination can raise a suspicion of collapsed trachea in a small dog with a persistent dry cough.  While the information gained from the physical examination is helpful, other tests are needed to confirm this condition.

Radiographs (x-rays) of the chest can identify the trachea and its shape.  However, a collapsed trachea changes its diameter during the respiratory cycle.  It is usually collapsed during inhalation and normal during exhalation.  Therefore, we attempt to make radiographs during both phases of respiration.  This is easy in some dogs and rather difficult in others since dogs are not likely to understand the command, “Take a deep breath and hold it.”

Endoscopy is another way to visualize the trachea.  An endoscope is a tube that is small enough to insert into the trachea; the operator can see through it and visualize the inside of the trachea.  By watching the trachea during inspiration and expiration, abnormal collapsing can be seen.  Unfortunately, tracheal endoscopes are expensive and not available at every veterinary hospital.

Coughing and Heart Failure

Coughing is a common sign of heart failure, and many dogs with collapsed trachea will also have heart disease.  Testing that occurs when diagnosing this disease should include chest radiographs (x-rays) so the heart can be evaluated.  Treatment for heart disease is not indicated unless it can be demonstrated with some form of testing.

Treatment

Collapsed trachea can be treated medically or surgically.  Some dogs respond well to brochodilators and various types of anti-inflammatory drugs.  The trachea of these dogs is easily infected, so antibiotics are usually part of the treatment.  If obesity is present, weight loss is often beneficial.  Excitement and vigorous exercise are likely to cause a relapse, so they should be avoided as much as possible. 

Some dogs respond well to the medical approach, and others do not.  Because medical therapy only treats the symptoms and does not correct the problem, these dogs are always subject to recurrences of coughing and breathing difficulty.

If medical therapy is not successful, the dog should be evaluated for possible surgery.  Radiographs and endoscopy are used to determine how much of the trachea is collapsed.  If the only abnormal part is that segment between the throat and the point where the trachea enters the chest (the thoracic inlet), surgery may be curative.  However, if the segment of the trachea that is within the chest cavity is abnormal, surgery is not likely to be helpful because that part is not accessible to the surgeon.

There are several surgical approaches that have been used.  Each approach implants an artificial support device that is secured around or within the trachea.  The purpose of the support device is to hold the tracheal rings in their normal, open position.  Although some dogs have excellent results and are truly cured of the disease, the outcome is not uniformly successful. 

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Corneal Ulcers in Dogs

The cornea is the clear, shiny membrane that makes up the surface of the eyeball.  It is much like a clear window.  To understand a corneal ulcer, you must first understand how the cornea is constructed. 

The cornea is comprised of three layers.  The most superficial layer is the epithelium.  Actually, this layer is comprised of many, very thin layers of cells.  Below the epithelium is the stroma, and the deepest layer is Descemet's membrane.  Because all of these layers are clear, it is not possible to see them without special stains and a microscope. 

An erosion thorough a few layers of the epithelium is called a corneal erosion or a corneal abrasion.  A corneal ulcer is an erosion through the entire epithelium and into the stroma.  If the erosion goes through the epithelium and stroma to the level of Descemet's membrane, a descemetocele exists.  If Descemet's membrane ruptures, the liquid inside the eyeball leaks out and the eye collapses.

Causes

There are several causes for corneal ulcers in dogs.  The most common is trauma.  An ulcer may result from blunt trauma, such as a dog rubbing its eye on carpet, or due to a laceration, such as a cat scratch.  The second most common cause is chemical burn of the cornea.  This may happen when irritating shampoo or dip gets in the eye. 

Less common causes of corneal ulcers include bacterial infections, viral infections, and other diseases.   These may originate in the eye or develop secondary to disease elsewhere in the body.  Examples of other diseases include Epithelial Dystrophy (a softening of the cornea which is inherited in breeds such as the Boxer), Keratoconjunctivitis Sicca (drying of the cornea due to abnormal tear formation), and diseases of the endocrine system (diabetes mellitus, hyperadrenocorticism, and hypothyroidism).

Clinical Signs

A corneal ulcer is very painful.    In response to pain, most dogs rub the affected eye with a foot or on the carpet.  To protect the eye, they keep the lids tightly closed.  Occasionally, there will be a discharge that collects in the corner of the eye or runs down the face.

Diagnosis

Superficial corneal abrasions are usually not visible.  They can be visualized with the use of fluorescein stain.  A drop of this stain is placed on the cornea.  The dye will adhere to an area of ulceration and is easily visualized with a special black light called a Wood's light.  This is the most basic test performed and may be the only test needed if the ulcer is acute and very superficial.  If the ulcerated area is chronic or very deep, samples are taken for culture and cell study prior to applying the stain or any other medication.

Treatment

Treatment depends on whether there is a corneal abrasion, corneal ulcer, or descemetocele present. 

Corneal abrasions generally heal within 3-5 days.  Medication is used to prevent bacterial infections (antibiotic ophthalmic drops or ointment) and to relieve pain (atropine ophthalmic drops or ointment).  Antibiotic drops are only effective for a few minutes so they must be applied frequently; ointments last a bit longer but still require application every few hours.  It is suggested that an antibiotic preparation be instilled in the eye 4 to 6 times per day.  On the other hand, the effects of atropine last many hours so this drug is only used twice daily. 

If a corneal ulcer or descemetocele is present, measures must be taken to protect the eye and to promote healing.  Since dogs do not wear eye patches well, surgical techniques are often used to close the eyelids and cover the ulcer or descemetocele.  These measures protect the eye for several days, then are reversed so the dog can use the eye again.

Ulcers that do not heal well often have a buildup of dead cells at the ulcer edge.  These dead cells prevent normal cells from the corneal surface from sliding over the ulcer edge and filling in the defect.   If this appears to be part of the healing problem, the dead cells are removed from the edges of the ulcer before the eyelids are surgically closed.  In some cases, removing the dead cells may be all that is needed to start the healing process, so surgical closing of the eyelids may not be necessary.

Mistake in Treatment

It is possible to mistake a corneal abrasion from a corneal ulcer when the latter is very superficial.  Therefore, after 2-3 days of treatment, your dog should be reexamined to be sure that healing is progressing properly.  If that does not happen, a decision may be made to perform surgery.

Side-effects of Eye Medications

Rarely, a dog will be allergic to an antibiotic that is instilled in the eye.  If your dog seems more painful after the medication is used, discontinue it and contact the veterinarian.

A dog with a corneal ulcer has quite a bit of pain in the eye, so it keeps it tightly shut.  Atropine is used to relieve that pain.  However, atropine also dilates the pupil widely.  This means that the dog is very sensitive to light in that eye.  Because of the light sensitivity, the eye will be held closed in bright light.

Atropine's effects may last for several days after the drug is discontinued.  Do not be alarmed if the pupil stays dilated for several days.  Should you accidentally get atropine in your eye, the same prolonged pupillary dilation will occur.

Drooling After Treatment

The tear ducts carry tears from the eyes to the back of the nose.  The eye medications may go through the tear ducts and eventually get to the throat where they are tasted.  Atropine has a very bitter taste that may cause drooling and pawing at the mouth.  You are seeing your dog’s response to a bad taste, not a drug reaction.

Use of Topical Anesthetics to Control Pain

A topical anesthetic is often used to numb the cornea so the diagnostic tests may be performed.  However, these drugs are toxic to the corneal epithelium; they prevent proper healing.  They are safe for one time use, but they should not be used as part of treatment.

Conclusion of Treatment

The best way to tell that the cornea has healed is to repeat the fluorescein stain test.  This should be done after about 5-7 days of treatment.

Red Streaks Near the Ulcer

The normal cornea has no blood vessels going through it.  However, when a corneal ulcer or descemetocele occurs, the body senses a need to increase its healing capabilities.  New blood vessels are created by a process called neovascularization.  The new vessels begin at the sclera (the white part of the eye) and course their way to the ulcer. 

Neovascularization is a good response because it hastens healing.  However, after the ulcer is healed, these vessels remain in the cornea.  They are not painful, but they do obstruct vision.  Therefore, it is desirable to remove them.  This is done with steroid (cortisone) ophthalmic drops or ointment.  Cortisone is used for a few days to several weeks, depending on how many vessels exist. 

It is important that steroids not be used in the eye too soon because they will stop healing of a corneal ulcer and may worsen it.  Therefore, the fluorescein dye test should be performed before beginning this type of medication.  If steroids are used and the eye becomes painful again, discontinue the steroids and have the eye rechecked.

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Coronavirus Infection in Dogs

Canine coronavirus is one of the infectious causes of enteritis, or intestinal inflammation, in puppies and dogs.  The first reported outbreaks of this disease came in the 1970’s.  It is highly contagious between susceptible dogs but, fortunately, most dogs recover without complication.  Because of this, it not generally considered a serious pathogen (infectious agent) of dogs.

Contributing Factors

Crowding of dogs, especially in unsanitary conditions, promotes spread of the virus between dogs. 

Prevalence

It is considered a widespread disease.  One study found that 70% of dogs in a selected population showed antibodies to coronavirus.

Causes/Transmission

Canine coronavirus is shed in the feces of susceptible dogs for two or more weeks.  Ingestion of feces represents the main source of infection for susceptible dogs. 

There are no breed predispositions for canine coronavirus.  All ages may become infected; infection is most serious for newborn puppies.

Clinical Signs

The sudden onset of diarrhea is the main sign of intestinal coronavirus infection.  Vomiting may be present but is inconsistent.

Diagnosis

A definitive diagnosis is not usually achieved because this requires electron microscopy of a stool sample.  Signs are usually not severe enough to warrant the cost for this procedure.  A presumptive diagnosis is adequate for dogs that respond to supportive care and improve in the expected time.

Treatment

Good supportive care consisting of intravenous fluids and electrolytes may be the only therapy needed.  Young puppies or very debilitated animals may need additional treatments.

Prognosis

The prognosis is usually very favorable for a full recovery, although the diarrhea may persist for several weeks.  Dogs who have a dual infection with coronavirus and parvovirus have a more guarded prognosis.

Transmission to Humans

The virus poses no health risk to humans.

Prevention

A vaccine is available and is included in many of the canine vaccines used by veterinarians.  Dogs that should definitely receive this vaccine would include those that are frequently kenneled or groomed and those that participate in dog shows.

The vaccine is not considered 100% protective.  There are a number of different strains of the coronavirus, and it is not possible to produce a vaccine that protects against every strain.

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Cystitis in Dogs

The term "cystitis" literally means inflammation of the urinary bladder.  This term is rather general and applies to any disease that inflames the urinary bladder.

Causes

The most common cause of cystitis in dogs is an infection due to bacteria.  However, other common causes include bladder stones, tumors or polyps in the bladder, and diverticula.

Clinical Signs

The most common sign seen by most owners is hematuria (blood in the urine).  In addition, many dogs have discomfort when urinating; they will spend several minutes passing only a small amount of urine, and they may urinate more frequently than normal.

The signs will be determined by the specific cause of cystitis.  Bacterial infections usually cause hematuria and dysuria (straining to urinate.)  Bladder stones are often very rough; they cause irritation to the bladder as they rub against the bladder wall also creating hematuria and dysuria.  Tumors or polyps are usually not highly irritating to the dog’ bladder, but they can cause bleeding and mild straining to urinate.  A diverticulum is a small pouch in the wall of the bladder that usually causes hematuria and dysuria secondary to the chronic bacterial infection that occurs.  Bacteria often reside deep in the diverticulum and are nearly impossible to remove without surgery.

Diagnosis

A history of hematuria, dysuria, and increased frequency of urination is strong evidence of some form of cystitis.  When these are seen, several tests are appropriate.

The first group of tests includes urinalysis, urine culture, and bladder palpation (feeling with the fingers).  A urinalysis consists of several tests to detect abnormalities in the urine, including abnormalities in the urine sediment.  These are generally adequate to confirm cystitis, but they are usually not adequate to determine the exact cause.  A urine culture determines if bacteria are present and what antibiotics are likely to be effective in killing them.  This is appropriate because most cases of cystitis are caused by bacteria that may be eliminated easily with antibiotics.  Bladder palpation is the first “test” for bladder stones, since many are large enough to be felt by experienced fingers.

The Negative Culture

About 20% of the time the culture will be negative for bacteria and stones cannot be felt.  When it happens, it is important that more tests be performed so that a diagnosis can be achieved.

Plain radiographs (x-rays) are taken to further evaluate the bladder because many stones can be seen with this technique.  However, the mineral composition of other stones requires that special radiographs, using contrast materials, be utilized.  Plain radiographs are usually not able to visualize bladder tumors, polyps, or diverticula.  A plain radiograph can be made without sedation or anesthesia in a cooperative dog.

An ultrasound examination is also useful in evaluating the bladder.  This technique uses sound waves to visualize stones and some tumors and polyps.  It may also identify other abnormalities of the bladder wall, including wall thickening.  It, too, can be performed without sedation or anesthesia in a cooperative dog.

Contrast radiographs are taken when plain radiographs and an ultrasound examination do not render the diagnosis.  The bladder is filled with a negative contrast material (usually air), a positive contrast material (a special radiographic dye), and then a little positive contrast material with a negative contrast material (double contrast study).  A radiograph is taken each time.  These three procedures permit visualization of otherwise unseen bladder stones, tumors and polyps, diverticula, and wall thickening.  It is necessary to pass a catheter into the bladder and to distend it with the contrast materials; therefore, general anesthesia is required.

Dogs showing other signs of illness, such as fever, poor appetite, or lethargy, should also be evaluated for systemic diseases and bleeding disorders that may be causing hematuria.  For these dogs, a chemistry profile and complete blood count (CBC) should be performed.  If a clotting problem is suspected, a bleeding profile is appropriate.

Treatment

Treatment depends on the cause.  Bacterial infections are generally treated rather easily with antibiotics.  Some bladder stones can be dissolved with special diets; others require surgical removal.  Benign bladder polyps can usually be surgically removed, but malignant bladder tumors are difficult to treat successfully.  A bladder diverticulum should be removed surgically.

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Dilated Cardiomyopathy and Heart Failure in Dogs

The heart has four chambers.  The upper chambers are called atria (singular: atrium), and the lower chambers are called ventricles.  In addition to the upper and lower chambers, the heart is also considered to have a right and a left side.

Blood flows from the body into the right atrium.  It is stored there for a few seconds, then pumped into the right ventricle.  The right ventricle pumps blood into the lungs, where it receives oxygen.  It flows from the lungs into the left atrium; it is held here for a few seconds before going into the left ventricle.  The left ventricle contains the largest muscle of the heart so the blood can be pumped out to all parts of the body. 

Dilated cardiomyopathy (DCM) means that the heart muscle, called the myocardium, becomes much thinner than normal.  In particular, the thick muscle wall of the left ventricle is affected.  The pressure of the blood inside the heart allows this thinned wall to begin to stretch, resulting in a much larger left ventricular chamber.  Therefore, the two characteristics of dilated cardiomyopathy are a heart wall that is much thinner than normal and a chamber that is much larger than normal.

Prevalence

Primary dilated cardiomyopathy is the most common cause of heart failure in large breeds of dogs.  Small breeds are only occasionally affected.  The most commonly affected breeds are Boxers, Doberman Pinschers, and Great Danes.  Occasionally, medium sized breeds, notably Cocker Spaniels and English Springer Spaniels, develop this condition.

Causes/Transmission

In some cases, DCM develops secondary to a chemical toxicity, nutritional deficiency, or inflammatory condition in the heart.  Doxorubicin, a drug commonly used in chemotherapy, can induce DCM after repeated administration.  Nutritional deficiencies of carnitine and taurine have been lined with DCM, although this cause is uncommon.  Some non-cardiac conditions, such as pancreatitis and electrical shock, have occasionally been found as a cause of DCM. 

Unfortunately, for most dogs, the cause is unknown.  This is called primary or idiopathic (cause unknown) DCM.

Clinical Signs

When the heart begins to fail, it is unable to deliver adequate oxygen to all the tissues of the body.  This sets into motion a series of compensatory events.  In other words, the body's cells become desperate and trigger a series of responses.  Various hormones are released by several organs in an attempt to correct the problem.  These hormones conserve fluid in an effort to increase blood volume and the output of blood and oxygen by the heart. 

For several months, these compensatory responses help the situation.  However, the increased fluid retention eventually becomes harmful.  Perhaps the most detrimental event occurs when this excessive fluid leaks out of the pulmonary capillaries and into the air spaces (alveoli) of the lung; this is called pulmonary edema.  This fluid collection in the lungs produces very obvious signs and may be one of the first things an owner might notice.  Noticeable signs include weakness, coughing or gagging, fainting or collapse, and obvious exercise intolerance.

Fluid may also collect in the abdominal cavity and body tissues.  Fluid within the abdominal cavity is called ascites.  Fluid in the tissues of the legs is called peripheral edema.  Congestive heart failure is a common cause of these signs.

Dilated cardiomyopathy may have a very sudden onset.  Some dogs go into severe heart failure in what appears to be a matter of hours.  Rapid, heavy breathing, a blue tongue, excessive drooling, or collapse may be the first signs.

Diagnosis

There are several tests that are used to look at different aspects of the heart’s structure and function.

1. Auscultation (listening with a stethoscope).  This valuable tool allows us to identify murmurs, their location, and their intensity and an abnormal heart rhythm (arrhythmia).  It also allows us to hear lung sounds; this aids in our understanding of what is happening within the lungs.

2. Blood and urine tests.  These do not give direct information about heart function, but they allow us to understand other disorders in the body that may impact on heart function and treatment of heart disease.

3. Chest radiographs (x-rays).  These give us the best look at the lungs and a view of the size and shape of the heart.  In most cases, dilated cardiomyopathy causes tremendous enlargement of the heart.  These changes are usually very apparent on the x-rays.

4. Electrocardiogram (ECG or EKG).  This is an assessment of the electrical activity of the heart.  It allows us to accurately determine heart rate and to more accurately identify any arrhythmias that might be present.

5. Ultrasound examination (sonogram, echocardiogram).  This examination uses sound waves that bounce off the structures of the heart and are read on a TV-like monitor.  It gives the most accurate determination of the size of each heart chamber, and permits measurement of the thickness of the heart walls.  This is seen on the monitor in actual time so the contractions of the heart can be evaluated.  Certain measurements can be taken which allow the actual strength of the heart's contraction to be measured as a number and compared to the normal animal.  Ultrasound may not be available in all private veterinary practices because of the additional training needed to learn how to perform the examination and because of the cost of the equipment.

The combination of all of these tests give us our best evaluation of the dog and its heart function.  However, if cost considerations prohibit us performing all of them, two or three will provide much valuable information.

Therapy

If the dog has a sudden onset of heart failure, rapid administration of appropriate medication is essential to survival.  The following drugs may be used at various stages of treatment.  Initial stabilization usually depends on the first two.

1. Diuretics.  These drugs stimulate the kidneys to remove excess fluid from the body.  Furosemide is most commonly used, although others will be selected in certain circumstances.

2. Nitroglycerin.  This drug is called a venodilator; it dilates the veins throughout the body, especially the ones going to the heart muscle.  It decreases the amount of blood returning to the heart by allowing some of it to "pool" in the veins.  This temporarily reduces the workload of the heart.  This class of drugs can be very useful for treating pulmonary edema.

3. Digitalis.  This drug improves heart function in several ways.  It helps in control of certain arrhythmias,
slows the heart rate, and strengthens each contraction of the heart.

4. Enzyme blockers.  This is a relatively new class of drugs that can help module the imbalance of hormones related to heart failure.  ACE-inhibitors, such as enalapril, are the most commonly used drugs.

5. Vasodilators.  These drugs dilate the arteries (+/- the veins) of the body so that the heart doesn't have to generate as much pressure to eject blood into the arteries.  They may be used long-term because they continue to be effective, as opposed to the short-term effects of nitroglycerin.

Prognosis

There are many factors that must be considered before that question can be answered.  The results of the tests are important, and the response that occurs within the first few days is another indicator.

If response does not occur within a few hours to days, the prognosis is guarded to poor.  However, most dogs that stabilize quickly will live for a period of a few months to many months, but the long-term prognosis remains unfavorable.

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Demodectic Mange in Dogs

Mange is a parasitic skin disease caused by microscopic mites. Two different types of mange mites are significant in dogs.  One type lives just under the surface of the skin, while the other type resides in the hair follicles.  Although both types of mites share some similar characteristics, there are also important differences.  It is important not to confuse the two types of mange because they have different causes, treatments, and prognoses.

Demodectic mange, sometimes just called "demodex," is the most common form of mange in dogs.  It is caused by the demodectic mange mite, a parasite which lives in the hair follicles of affected dogs.  Under the microscope, this mite appears shaped like an alligator with 8 legs.  All dogs (and many humans) have a few of these mites on their skin.  As long as the body's immune system is functioning, these mites cause no harm. 

Contributing Factors

A dog with demodectic mange usually comes from a litter containing other affected puppies.  This is because development of the immune system is under genetic control.  Owners of littermates should be put on the alert to watch for it.  Because the disease is due to a genetic defect, affected dogs should not be bred.  Also, parents of the affected dog should not be bred again.

Prevalence

Demodectic mange is a common parasitic skin disease of dogs.  It is primarily seen in dogs less than one year of age.

Causes/Transmission

Demodectic mange most often occurs when a dog has an immature immune system, allowing the mites to grow rapidly.  Consequently, this disease occurs primarily in dogs less than 12-18 months of age.  In most cases, the immune system matures as a dog grows.  When we see the disease in adult dogs, we can usually make the assumption that the dog has a defective immune systems.

Since the mite is found on virtually all dogs, exposure of a normal dog to one with demodectic mange is not dangerous.  The other type of mange, called sarcoptic mange, is highly contagious between dogs.

Clinical Signs

Surprisingly, a dog with demodectic mange does not itch severely, even though it loses hair in patches.  Areas of bare skin will be seen.  Hair loss usually begins on the face, especially around the eyes. 

When there are only a few patches of hair loss, it is termed localized demodectic mange.  If the disease spreads to many areas of the skin, it becomes generalized demodectic mange. 

Diagnosis

Diagnosis is made by a deep skin scraping that is examined under the microscope.  Usually, large numbers of mites are found.

Treatment

The localized form is usually treated with topical medication.  The generalized form requires shampoo therapy and a special dip or oral medication.  Shampooing with special cleansing shampoos helps to flush out the hair follicles prior to dipping.  Dipping is described below.

For dogs with generalized demodectic mange, secondary skin infections may represent a complicating factor requiring antibiotic therapy.  Dogs with skin infections have very red, inflamed skin.  This is the source of the term "red mange." 

Because the immune system does not mature until 12-18 months of age, a dog with demodectic mange may have relapses until that age.  It is important for retreatment to begin promptly to minimize the possibility of developing uncontrollable problems.  Demodectic mange may also occur in very old dogs because function of the immune system often declines with age.  Dogs who have immune suppression due to illness or medication are also candidates for demodectic mange.

Prognosis

Treatment of the localized form is generally successful.  Treatment of the generalized form is also usually successful.  However, if the immune system is defective, neither the mites nor the infection may respond to treatment.

Transmission to Humans

Canine demodectic mange is not contagious to humans.

Prevention

The dip commonly used for demodectic mange contains the insecticide amitraz.  Its use requires some caution because it is a strong insecticide that can have some side effects to your dog and to you if it is not used properly.  Your dog may experience vomiting and sedation for 24-36 hours following each application.  If so, those problems will usually be self-limiting.  If this occurs, the dip should be diluted with 25% more water the next time it is used.  Since each dipping results in the development of tolerance to the dip, your dog is less likely to have side effects with each subsequent treatment.  Your dog should be dipped 3 times at 7 day intervals, then examined for the presence of live mites or mite eggs.  Further treatment will be determined by the results.  If you do the dipping yourself, be sure to wear rubber gloves to prevent getting it on your hands.

Instructions for treatment of your dog are noted:

1) ____ Apply  the dispensed ointment to the areas of hair loss.  Do not get it in your dog's eyes.  Apply it once daily for 10-14 days.  At that time, the dog should be reexamined to decide if further treatment is needed.

2) ____ Give ____ ml of the oral insecticide once daily.  This needs to be continued for 2-4 weeks past apparent recovery. 

3) ____ Bathe your dog with the recommended medicated shampoo, then rinse the shampoo.  Next, slowly pour amitraz dip over the entire body.  This should be done 3 times at 7 day intervals.

                Mix one bottle of amitraz with two gallons of water.  Once the bottle is opened, amitraz deteriorates rapidly, even if not diluted.  Therefore, unused dip cannot be used later.  Wear rubber gloves while handling the dip; wash your hands and arms with soap and water after treatment of your dog.  Do not rinse the dip off your dog; allow it to air dry.  A hair dryer may be used if the temperature is cool.

                If vomiting or sedation occurs within 24-36 hours after dipping, dilute the dip with 25% more water (2.5 gallons instead of 2 the next time).  These side effects should resolve without treatment.

4) ____ After the third dipping, we should examine your dog for the presence of live mites or mite eggs.  The need for further treatment will be discussed.  Some dogs require up to 12-15 dippings before no live mites or eggs are present.  We should examine your dog after every third dip.

5) ____ Administer the dispensed antibiotics according to the label.  When the prescription is completed, your dog should be examined to determine if further antibiotic treatment is needed.

6) ____ For lesions on the feet, mix l cc of amitraz dip (straight from the bottle) with 1 oz of propylene glycol.  Apply this mixture to the feet 2-3 times per week.  It must be mixed fresh each week.  If the feet are affected, they will often be the last part of the body to heal. Let us know if you cannot find the propylene glycol at your pharmacy.  Remember to wear gloves when applying dip to the dog's feet.

7) ____ At the first sign of recurrence of this disease, we should see your dog again to determine what treatment is needed.  This may happen until it is 12-18 months old.

8) ____ We will apply the amitraz dip to your dog.  Return the dog in ____ days for the next treatment.

9)  ____ Return your dog in ____ days to have it examined for the presence of mites.

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Dental Disease in Dogs

Dental disease is a common and often overlooked problem in dogs.  While cavities represent the most common dental disease of humans, dogs are more frequently bothered by tartar buildup on the teeth.  Tartar accumulation leads to irritation of the gums around the base of the teeth, ultimately leading to exposure of the roots.   Potential outcomes of this tooth root exposure include gum infections and tooth loss.

Contributing Factors

One of the main factors determining the amount of tartar buildup is the individual chemistry in the mouth.  Some dogs need yearly cleanings; other dogs need a cleaning only once every few years.

Diet plays more of a minor role in development of tartar accumulation than most people think.  Because dry food is not as sticky as canned food, it does not adhere to the teeth as much and thus, does not cause tartar buildup as rapidly.  However, eating dry food does not remove tartar from the teeth.  Once tartar forms, a professional cleaning is necessary. 

Causes/Transmission

Many different disorders can lead to dental disease in the dog.  In general, the veterinarian will try to determine whether the problem is limited to the oral cavity (primary dental disease) or has developed as a consequence of another disease (secondary dental disease).

Clinical Signs

In some cases, owners are unaware that their dog has dental disease.  The problem may be identified with a routine physical examination or during investigation of another problem.

In other situations, the probability of dental disease is apparent to the owner.  The dog may have very bad breath (halitosis), difficulty eating, drooling, or changes in temperament. 

Diagnosis

Diagnosis of dental disease is usually very straightforward.  A visual examination of the oral cavity reveals tartar and gingivitis.  However, in most cases, the true extent of the disease cannot be determined unless the dog is under anesthesia.  This facilitates a more complete examination of the oral cavity.

Treatment

Proper cleaning of the teeth requires complete cooperation of the patient so that plaque and tartar can be removed properly.  Anesthesia is required to thoroughly clean the teeth.  Many owners have a high degree of anxiety related to general anesthesia for their dogs.  While there is always a degree of risk with any anesthetic, be aware that delaying proper dental care may ultimately compromise the dog's health. 

To minimize risk, our hospital uses modern anesthetics that are deemed safe even for older dog.  Also, depending on your dog’s age and general health status, blood may be drawn prior to anesthesia to evaluate blood cell counts and blood chemistry.

There are four steps in the cleaning process that will be used on your dog:

1. Scaling removes the tartar above and below the gum line.  This is done with hand instruments and ultrasonic cleaning equipment.  The tartar that is under the gums must be removed for a dental cleaning to be complete.

2. Polishing smooths the surface of the teeth, making them resistant to additional plaque formation. 

3. Flushing removes dislodged tartar from the teeth and helps to remove the bacteria that accompany tartar. 

4. Fluoride Coating decreases teeth sensitivity, strengthens enamel, and decreases the rate of future plaque formation.

Prognosis

In the early stages of dental disease, the problems may be reversible.  At some point, however, even cleaning cannot restore the mouth to normal.  This is not a reason to avoid cleaning!

The prognosis is worsened if tartar is left on the teeth indefinitely.  Some of the consequences of delayed dental care are:

1. The tartar will mechanically push the gums away from the roots of the teeth.  This allows the teeth to loosen in their sockets and infection to enter the root socket.  The teeth will loosen and fall out or have to be extracted. 

2. Infection will accumulate in the mouth, resulting in gingivitis (gums), tonsillitis, and pharyngitis (sore throat).  Although antibiotics may temporarily suppress the infection, if the tartar is not removed from the teeth, infection will return quickly. 

3. Infection within the mouth will be picked up by the blood stream and carried to other parts of the body.  Kidney and heart infections frequently begin in the mouth.

Prevention

Several preventive measures can be recommended to aid in oral hygiene for the dog.

1. Seek regular veterinary care and have the teeth cleaned when advised.

2. Try to maintain home dental care with brushing the teeth.  Special toothbrushes and flavored toothpastes are available.  We will be happy to show you how to do this and to recommend a schedule.

3. A tartar control diet is available through our clinic.  It can be used as a maintenance diet or as a treat.  It will not clean the teeth but will prolong the interval between professional cleanings (under anesthesia).

If we are planning to clean your dog’s teeth, please follow these recommendations:

In order for us to clean your dog's teeth, we ask that you schedule the procedure a few days in advance.  It will be necessary to withhold food after _________ PM the night before; please do not remove the water.  Your dog should be admitted to the hospital early by _________ AM and will generally be ready for discharge in the late afternoon.  It will need to stay indoors that evening to insure that no accidents (falls, etc.) occur until complete recovery from anesthesia.  If that is not possible, you may elect to have the dog spend the night in the hospital.  It should be fed and watered lightly that evening and returned to normal feeding the next morning, at which time it should be completely recovered from the anesthetic.

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Diabetes Mellitus in Dogs

There are two forms of diabetes in dogs: diabetes insipidus and diabetes mellitus.  Diabetes insipidus is a very rare disorder that results in failure to regulate body water content.  Your dog has the more common type of diabetes: diabetes mellitus.  This is a fairly common disorder and is most often seen is dogs 5 years of age or older.  There is a congenital form that occurs in puppies, but this is not common. 

Diabetes mellitus is a disease of the pancreas.  This is a small but vital organ that is located near the stomach.  It has two significant populations of cells.  One group of cells produces the enzymes necessary for proper digestion.  The other group, called beta-cells, produces the hormone called insulin.  Simply put, diabetes mellitus is a failure of the pancreas to regulate blood sugar.

The Types of Diabetes

In humans, two types of diabetes mellitus have been discovered.  Both types are similar in that there is a failure to regulate blood sugar, but the basic mechanisms of disease differ somewhat between the two groups. 

1.  Type I, or Insulin Dependent Diabetes Mellitus, results from total or near-complete destruction of the beta-cells. This is the only type of diabetes known in dogs.  As the name implies, dogs with this type of diabetes require insulin injections to stabilize blood sugar. 

2.  Type II, or Non-Insulin Dependent Diabetes Mellitus, is different because some insulin-producing cells remain.  However, the amount produced is insufficient, there is a delayed response in secreting it, and the tissues of the dogs body are relatively resistant to it.  People with this form may be treated with an oral drug that stimulates the remaining functional cells to produce or release insulin in an adequate amount to normalize blood sugar.  Because Type II diabetes does not occur in dogs, oral medications are not appropriate for treating diabetic dogs.

The Purpose of Insulin

The role of insulin is much like that of a gatekeeper:  it stands at the surface of body cells and opens the door, allowing glucose to leave the blood stream pass inside the cells.  Glucose is a vital substance that provides much of the energy needed for life, and it must work inside the cells.  Without an adequate amount of insulin, glucose is unable to get into the cells.  It accumulates in the blood, setting in motion a series of events that can ultimately prove fatal.

When insulin is deficient, the cells become starved for a source of energy.  In response to this, the body starts breaking down stores of fat and protein to use as alternative energy sources.  As a consequence, the dog eats more; thus, we have weight loss in a dog with a ravenous appetite.  The body tries to eliminate the excess glucose by excreting it in the urine.  However, glucose (blood sugar) attracts water; thus, urine glucose takes with it large quantities of the body's fluids, resulting in the production of a large amount of urine.  To avoid dehydration, the dog drinks more and more water.  Thus, we have the four classical signs of diabetes:  

                CLASSICAL SIGNS OF DIABETES MELLITUS:

Weight loss
Ravenous appetite
Increased water consumption
Increased urination

Diagnosis

The diagnosis of diabetes mellitus is based on three criteria: the four classical clinical signs, the presence of a persistently high level of glucose in the blood stream, and the presence of glucose in the urine. 

The normal level of glucose in the blood is 80-120 mg/dl.  It may rise to 250-300 mg/dl following a meal.  However, diabetes is the only common disease that will cause the blood glucose level to rise above 400 mg/dl.  Some diabetic dogs will have a glucose level as high as 800 mg/dl, although most will be in the range of 400-600 mg/dl.

To keep the body from losing its needed glucose, the kidneys do not allow glucose to be filtered out of the blood stream until an excessive level is reached.  This means that dogs with a normal blood glucose level will not have glucose in the urine.  Diabetic dogs, however, have excessive amounts of glucose in the blood, so it will be present in the urine.

What Diabetes Means to You and Your Dog

For the diabetic dog, one reality exists: blood glucose cannot be normalized without treatment.  Although the dog can go a day or so without treatment and not get into a crisis, treatment should be looked upon as part of the dog's daily routine.  Treatment almost always requires some dietary changes and administration of insulin. 

As for the owner, there are two implications: financial commitment and personal commitment. 

When your dog is well regulated, the maintenance costs are minimal.  The special diet, insulin, and syringes are not expensive.  However, the financial commitment is significant during the initial regulation process and if complications arise. 

Initially, your dog may be hospitalized for a few days 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 with quite a bit of laboratory testing.  Otherwise, the initial hospitalization may be only for a day or two to get some testing done and to begin treatment.  At that point, your dog goes home for you to administer medication.  At first, return visits are required every 5-7 days to monitor progress.  It may take a month or more to achieve good regulation. 

The financial commitment may again be significant if complications arise.  We will work with you to try and achieve consistent regulation, but a few dogs are difficult to keep regulated.  It is important that you pay close attention to our instructions related to administration of medication, to diet, and to home monitoring.  Another complication that can arise is hypoglycemia, or low blood sugar; if severe, it may be fatal.  This may occur due to inconsistencies in treatment.  This will be explained in subsequent paragraphs.

Your personal commitment to treating this dog is very important in maintaining regulation and preventing crises.  Most diabetic dogs require insulin injections once or twice daily.  They must be fed the same food in the same amount on the same schedule every day.  If you are out of town, your dog must receive proper treatment while you are gone.  These factors should be considered carefully before deciding to treat a diabetic dog.

Treatment

Consistency is vital to proper management of the diabetic dog.  Your dog needs consistent administration of medication, consistent feeding, and a stable, stress-free lifestyle.  To best achieve this, it is preferred that your dog live indoors.  Although that is not essential, indoor living removes many uncontrollable variables that can disrupt regulation.

The first step in treatment is to alter your dog's diet.  Diets that are high in fiber are preferred because they 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 preferred diets are Prescription Diet Canine w/d, CNM-OM, and CNM-DCO.  If your dog is overweight, Prescription Diet Canine r/d is fed until the proper weight is achieved, and then your dog is switched to one of the others.

Your dog's feeding routine is also important.  Some dogs prefer to eat several times per day.  This means that food is left in the bowl at all times for free choice feeding.  Another way is to feed twice daily, just before each insulin injection.  If a two-meals-per-day feeding routine does not work for you dog, it is still very important that you accurately measure the amount of food that is consumed.

The foundation for regulating blood glucose is the administration of insulin by injection.  Many people are initially fearful of giving insulin injections.  If this is your initial reaction, consider these points. 

1)  Insulin does not cause pain when it is injected. 
2)  The injections are made with very tiny needles that your dog hardly feels. 
3)  The injections are given just under the skin in areas in which it is almost impossible to cause damage to any vital organ. 

Please do not decide whether to treat your dog with insulin until we have demonstrated the injection technique.  You will be pleasantly surprised at how easy it is.

The injection technique is as follows:

About Insulin.  Insulin comes in an airtight bottle that is labeled with the insulin type and the concentration.  Before using, mix the contents.  It says on the label to roll it gently, not shake it.  The reason for this is to prevent foam formation, which will make accurate measuring difficult.  Some of the types of insulin used in dogs have a strong tendency to settle out of suspension.  If it is not shaken properly, it will not mix well, and dosing will not be accurate.  Therefore, the trick is to shake it vigorously enough to mix it without creating foam.  Since bubbles can be removed (as described later), it is more important to mix it well than to worry about foam formation. 

Insulin is a hormone that will lose its effectiveness if exposed to direct sunlight or high temperatures.  It should be kept in the refrigerator, but it should not be frozen.  It is not ruined if left out of the refrigerator for a day or two and not exposed to direct sunlight, although this is not advisable.  Insulin is safe as long as it is used as directed, but it should be kept out of reach of children.

Drawing up the Insulin.  Have the syringe and needle, insulin bottle, and dog ready.  Then, follow these steps:

1)  Remove the guard from the needle, and draw back the plunger to the appropriate dose level.
2)  Carefully insert the needle into the insulin bottle. 
3)  Inject air into the bottle; this prevents a vacuum from forming within the bottle. 
4)  Withdraw the correct amount of insulin into the syringe.

Before injecting your dog with the insulin, check that there are no air bubbles in the syringe.  If you get an air bubble, draw twice as much insulin into the syringe as you need.  Then withdraw the needle from the insulin bottle and tap the barrel of the syringe with your finger to make the air bubble rise to the nozzle of the syringe.  Gently and slowly expel the air bubble by moving the plunger upward.

When this has been done, check that you have the correct amount of insulin in the syringe.  The correct dose of insulin can be assured if you measure from the needle end, or "0" on the syringe barrel, to the end of the plunger nearest the needle.

Injecting the Insulin.  The steps to follow for injecting insulin are:

1)  Hold the syringe in your right hand (switch hands if you are left-handed).
2)  Have someone hold your dog while you pick up a fold of skin from somewhere along your dog's back with your free hand (pick up a different spot each day).
3)  Quickly push the very sharp, very thin needle through your dog's skin.  This should be easy and painless.  However, take care to push the needle through only one layer of skin and not into your finger or through two layers of skin.  The latter will result in injecting the insulin onto your dog's haircoat or onto the floor.  The needle should be directed parallel to the backbone or angled slightly downward.
4)  To inject the insulin, place your thumb on the plunger and push it all the way into the syringe barrel.
5)  Withdraw the needle from your dog's skin.  Immediately place the needle guard over the needle and discard the needle and syringe.
6)  Stroke your dog to reward it for sitting quietly.
7)  Be aware that some communities have strict rules about disposal of medical waste material so don't throw the needle/syringe into the trash until you know if this is permissible.  If it is not, we can dispose of them for you.

It is neither necessary nor desirable to swab the skin with alcohol to "sterilize" it.  There are four reasons:

1)  Due to the nature of the thick hair coat and the type of bacteria that live near the skin of dogs, brief swabbing with alcohol or any other antiseptic is not effective. 
2)  Because a small amount of alcohol can be carried through the skin by the needle, it may actually carry bacteria with it into the skin. 
3)  The sting caused by the alcohol can make your dog dislike the injections. 
4)  If you have accidentally injected the insulin on the surface of the skin, you will not know it.  If you do not use alcohol and the skin or hair is wet following an injection, the injection was not done properly.

Although the above procedures may at first seem complicated and somewhat overwhelming, they will very quickly become second nature.  Your dog will soon learn that once or twice each day it has to sit still for a few minutes.  In most cases, a reward of stroking results in a fully cooperative dog that eventually may not even need to be held.

Monitoring

It is necessary that your dog's progress be checked on a regular basis.  Monitoring is a joint project on which owners and veterinarians must work together.

                Home Monitoring

Your part consists of two forms of monitoring.  First, you need to be constantly aware of your dog's appetite, weight, water consumption, and urine output.  You should be feeding a constant amount of food each day that will allow you to be aware of days that your dog does not eat all of it or is unusually hungry after the feeding.  You should weigh your dog at least once monthly.  It is best to use the same scales each time.   

You should develop a way to measure water consumption.  The average dog should drink no more than 7 1/2 oz. (225 ml) of water per 10 pounds (4.5 kg) of body weight per 24 hours.  Since this is highly variable from one dog to another, keeping a record of your dog's water consumption for a few weeks will allow you to establish what is normal for your dog.  Another way to measure water consumption is based on the number of times it drinks each day.  When properly regulated, it should drink no more than six times per day.  If this is exceeded, you should take steps to make an actual measurement.

Any significant change in your dog's food intake, weight, water intake, or urine output is an indicator that the diabetes is not well controlled.  We should see your dog at that time for blood testing.

The second method of home monitoring is to determine the presence of glucose in the urine.  If your dog is properly regulated, there should be no glucose present in the urine. 

There are several ways to detect glucose in urine.  You may purchase urine glucose test strips in any pharmacy.  They are designed for use in humans with diabetes, but they will also work in the dog.  A fresh urine sample should be collected and tested with the test strip.  If glucose is detected, the test should be repeated the next two days.  If it is present each time, we should see your dog for a blood test. 

You should keep a small container to catch urine as the dog voids.  A large amount of urine is not needed to test for urine glucose; it is not necessary to catch the entire amount of urine.  Because the female dog usually squats to urinate, a shallow pan or dish may be placed under the hindquarters when she begins to urinate.  For male dogs, urine can be collected as soon as the dog lifts his leg to void.  Male dogs often urinate small amounts in several different places and most often urinate on vertical objects, such as bushes and trees.

                Monitoring of Blood Glucose

Determining the level of glucose in the blood is the most accurate means of monitoring.  This should be done about every 3-4 months if your dog seems to be well regulated.  It should also be done at any time the clinical signs of diabetes are present or if glucose is detected in the urine for two consecutive days.

Timing is important when the blood glucose is determined.  Since eating will elevate the blood sugar for several hours, it is best to test the blood at least 6 hours after eating.

When testing the blood we want to know the highest and lowest glucose readings for the day.  The highest reading should occur just before an injection of insulin is given.  The lowest should occur at the time of peak insulin effect.  This is usually 5-8 hours after an insulin injection, but it should have been determined during the initial regulation process.  Therefore, the proper procedure is as follows:

1)  Feed your dog its normal morning meal then bring it to hospital immediately.  If you cannot a get it to the hospital within 30 minutes, do not feed it.  In that situation, bring its food with you.
2)  Bring your dog to the hospital early in the morning without giving it insulin.
3)  A blood sample will be taken immediately, then we will give insulin and feed your dog if it did not eat at home.
4)  A second blood sample will be taken at the time of peak insulin effect.

If your dog gets excited or very nervous when riding in the car or being in the hospital, the glucose readings may be falsely elevated.  If this occurs, it is best to admit your dog to the hospital the morning (or afternoon) before testing so it can settle down for testing the next day.  Otherwise, the tests give us limited information.

Hypoglycemia

Hypoglycemia means low blood sugar.  If it is below 40 mg/dl, it can be life threatening.  Hypoglycemia occurs under two conditions:

1) If the insulin dose is too high.  Although most dogs will require the same dose of insulin for long periods of time, it is possible for the dog's insulin requirements to change.  However, the most common causes for change are a reduction in food intake and an increase in exercise or activity.  The reason for feeding before the insulin injection is so you can know when the appetite changes.  If your dog does not eat, skip that dose of insulin.  If only half of the food is eaten just give a half dose of insulin.  Always remember that it is better for the blood sugar to be too high than too low.

2) If too much insulin is given.  This can occur because the insulin was not properly measured in the syringe or because two doses were given.  You may forget that you gave it and repeat it, or two people in the family may each give a dose.  A chart to record insulin administration will help to prevent the dog being treated twice.

The most likely time that a dog will become hypoglycemic is the time of peak insulin effect (5-8 hours after an insulin injection).  When the blood glucose is only mildly low, the dog will be very tired and unresponsive.  You may call it and get no response.  Within a few hours, the blood glucose will rise, and your dog will return to normal.  Since many dogs sleep a lot during the day, this important sign is easily missed.  Watch for it; it is the first sign of impending problems.  If you see it, please bring in your dog for blood testing.

If your dog is slow to recover from this period of lethargy, you should give it corn syrup (1 tablespoon per 10 pounds of body weight by mouth).  If there is no response in 15 minutes, repeat the corn syrup.  If there is still no response, contact us immediately for further instructions.  

If severe hypoglycemia occurs, a dog will have seizures or lose consciousness.  This is an emergency that can only be reversed with intravenous administration of glucose.  If it occurs during office hours, come in immediately.  If it occurs at night or on the weekend, call our emergency phone number for instructions.

SUMMARY OF INSTRUCTIONS

1)  Read and reread this material so that you understand the specifics of proper regulation and how to recognize and treat hypoglycemia.

2)  Get the supplies for treatment.  Your prescription will specify the type of insulin and syringes.  If you will be using urine glucose tests strips, they should be purchased at a pharmacy.  

3)  Give the first injection of insulin of _____units at about_________AM/PM.

4)  Return for a glucose curve, no later than 8:00 a.m., on ____________.  Feed your dog that morning and immediately bring it to the hospital.  Do not give insulin, but bring it with you.  (If it will take more than 30 minutes to drive to the hospital, call for instructions on feeding.)

5)  Following regulation in the hospital, measure the urine glucose 2 consecutive days, then twice weekly for the next 2 weeks.  If glucose is not detected, measure the glucose 2 consecutive days every other week.

6)  If you are unable to test the urine for glucose, return to our hospital in 2-4 days for a blood glucose test.  This should be done about 5-8 hours after an injection of insulin.  If two injections are given each day, be sure the test is done before the evening injection.

7)  Return to our hospital for a blood glucose test in 1 month.  This should be done about 5-8 hours after an injection of insulin.  If two injections are given each day, be sure the test is done before the evening injection.

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Diarrhea in Dogs

Diarrhea is not a disease; rather, it is a symptom of many different diseases.  Many mild cases of diarrhea can be resolved quickly with simple treatments.  Others are the result of fatal illnesses, such as cancer.  Even diarrhea caused by mild illnesses may become fatal if treatment is not begun early enough to prevent severe fluid and nutrient losses.

Serious vs. Non-Serious

We attempt to determine how sick the dog has become as a consequence of the diarrhea.  When the dog is systemically ill (i.e., more than one body system is involved), some of the following may be noted:

1. Vomiting
2. Dehydration
3. Loss of appetite
4. Abdominal pain
5. High fever
6. Lethargy
7. Bloody and/or watery diarrhea

Diagnostic Tests

If diarrhea is associated with several of the above signs, we perform a series of tests in the hope that a diagnosis can be made.  This permits more specific treatment.  Diagnostic tests may include radiography (x-rays) with or without barium, blood tests, stool cultures, biopsies of the intestinal tract, and exploratory abdominal surgery.  Once the diagnosis is known, treatment may include special medications and/or diets, or surgery.

If your dog does not appear systemically ill from diarrhea, the cause may be less serious.  Some of the minor causes of diarrhea include stomach or intestinal viruses, intestinal parasites, and dietary indiscretions (such as eating garbage or other offensive or irritating materials).  A minimum number of tests are performed to rule out certain parasites and infections.  These cases may be treated with drugs to control the motility of the intestinal tract, drugs that relieve inflammation in the intestinal tract, and, often, a special diet for a few days.  This approach allows the body's healing mechanisms to correct the problem.  We expect improvement within 2-4 days; if this does not occur, a change in medication or further tests are done to better understand the problem.  Please keep us informed of lack of expected improvement so that we may manage the situation properly.

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Degenerative Disk Disease in Dogs

The spinal cord is one of the most important and most sensitive organs in the body.  If it is traumatized, its cells will not regenerate; injuries usually result in permanent damage.  Therefore, the spinal cord is protected in a very special fashion.  It goes through a bony canal within the spine where it is surrounded by protective bone everywhere except over the disks.  This extreme protection reflects its importance and its fragility. 

Disks are rubber-like cushions between the vertebrae.  They allow the back to move up and down and sideways without allowing contact between the bones of the spinal column.

Contributing Factors

Most owners report that a disk rupture occurred following a traumatic event, such as a relatively small jump or fall.  Although this act is frequently blamed for the disk rupture, if the disk had not already been degenerating, the rupture would not have occurred.

Prevalence

Most dogs with degenerative disk disease are 3-7 years old.  It is most often considered to be a spontaneous event that is most likely controlled by genetic factors.  Certain breeds, notably the Dachshund, Poodle, Pekingese, Lhaso Apso, and Cocker Spaniel, have a high incidence of disk disease.  Large breeds, such as the German Shepherd, Labrador Retriever, and Doberman Pinscher, also have disk disease.

Causes/Transmission

The disk is composed of two parts.  The outer covering is much like a thick shell.  It is comprised of tough fibers that protect and contain the central part.  It is thinnest at the top; this thin area is located just below the spinal cord.  The central part of the disk has the consistency of thick toothpaste and is much softer than the outer part.

When the outer shell degenerates, it allows the central part of the disk to escape.  This is called a disk rupture or a ruptured disk.  Since the shell is thinnest near the spinal cord, disk material that escapes almost always goes upward, putting pressure on the cord.  Because the spinal cord is encased within its bony canal, it cannot move away from the pressure and it becomes pinched or compressed.

Clinical Signs

The spinal cord is much like a telephone cable that is carrying thousands of tiny wires.  When it is crushed, transmission of information through the wires is stopped.  When the disk degenerates and ruptures, a similar event occurs.  The central part is forced upward, putting pressure on the spinal cord and/or the nerves that leave the spinal cord over the disks (i.e., spinal nerves).  Pressure on the spinal nerves results in pain; pressure on the spinal cord results in pain and/or loss of information transmission.  This results in paralysis or partial paralysis.

Most disk ruptures occur in the middle to lower part of the back.  However, they may also occur in the neck.  The former often causes paralysis without severe pain; the latter often causes severe pain without paralysis.  If paralysis affects all four legs, the disk rupture must be in the neck.  Because of the way the nerve tracts are arranged in the spinal cord, disk ruptures in the neck may affect the rear legs first or even exclusively.

Disk degeneration usually occurs relatively slowly, i.e., over several days or weeks.  The dog usually experiences pain and becomes reluctant to move.  It may lie around for a few days allowing the body to resolve the problem, often without the owner being aware that a problem existed.  However, disks may also rupture very acutely.  Some dogs will go from normal walking to total paralysis in less than one hour.

Diagnosis

A presumptive diagnosis of disk disease is made based on the dog's history of neck or back pain, incoordination when walking, or paralysis when there is no history of trauma.  The physical examination will indicate that the problem originates from the spinal cord, giving further evidence to disk disease.  Another important factor is the breed.  If the dog is one of the high incidence breeds, the diagnosis is even more likely.

In some cases, plain radiographs (x-rays) may assist the diagnosis, but they may also be normal since neither the disk nor the spinal cord are visible.  If the diagnosis is in doubt or if surgery is to be performed, a myelogram may be done.  This procedure involves injecting a special dye around the spinal cord.  When radiographs are taken, the dye will be seen outlining the spinal cord.  A break or disruption in the continuity of the dye column means that there is pressure on the spinal cord.  A myelogram is performed with the dog under general anesthesia.

It is possible that the pressure is due to a blood clot or a tumor.  Both are possible but not very common, especially when compared to the frequency of disk ruptures.  If the breed of dog is correct for disk disease, there has been a sudden onset, and there has been no trauma, there is about a 95% chance that a disk rupture is causing the pressure.  However, the diagnosis is not definite until the time of surgery.

Treatment

Treatment is based on the stage of the disease.  Stage I disk disease produces mild pain and is usually self-correcting in a few days.  Stage II disk disease causes moderate to severe pain in the neck or lumbar (lower back) area.  Stage III disk disease causes partial paralysis (paresis) and results in the dog walking in staggering or uncoordinated movements.  Stage IV disk disease causes paralysis but the ability to feel is present.  Stage V disk disease causes paralysis and loss of feeling.  These stages tend to overlap in some dogs, and dogs may move from one stage to another over a period of hours to days.

Dogs with Stage II and III disease are usually treated with anti-inflammatory drugs, pain relievers, and restriction from exercise.  Surgery may be considered if the pain or incoordination persists after 4-7 days of treatment or if the neurological status declines from one day to the next.  It is important that the dog not receive pain medication unless total confinement to a crate or cage is enforced.  If the pain sensation is taken away, the dog is more likely to progress to total rupture of the disk.  The sensation of pain is important for limiting motion.  The length of confinement will vary among different dogs.

Dogs with Stage IV disease should have surgery, although a small percentage will recover without it.  Dogs with Stage V disease should have surgery, and the sooner that surgery is performed the better the prognosis.  If at all possible, these dogs should be operated within the first 24 hours of the onset of paralysis.

The goal of surgery is to remove pressure from the spinal cord.  If the disk rupture occurs in the lower back, a window is made in the side of the vertebral bone to expose the spinal cord.  This window allows removal of disk material and relieves pressure from the cord.  If the disk rupture occurs in the neck, a window is made in the bone exposing the spinal cord.  This may be done either from the top or the bottom, depending on the situation and the training of the surgeon.

Following surgery, your dog will be hospitalized for 3-7 days.  Bladder and bowel control are often lost when the dog is paralyzed, so it is best for control of these functions to return before going home.  However, it is generally best not to extend hospitalization beyond 7 days because regaining the ability to walk partly depends on exercise and motivation.  Since motivation is such an important part of the recovery process, visitation is encouraged beginning the day after surgery.  Please ask about scheduling your visits.

Hospital Discharge

If paralysis was present before surgery, your dog may not be able to walk when it is discharged from the hospital.  You will be given detailed instructions on the procedures that should be performed.  Recovery is dependent on four factors: whether or not permanent damage was done before surgery, if the surgery was performed promptly, physical therapy performed at home, and the motivation of your dog.  You will be instructed on ways to achieve the last two.

Prognosis

When surgery is completed, we hope to achieve two things.  First, the dog should be recovering from the anesthetic.  Secondly, the disk rupture should be located and the pressure relieved from the spinal cord.  However, the return of walking ability and relief from pain may not occur for several days, or even weeks, so success can not be determined immediately.

Recurrence and Prevention

More than 95% of degenerated disks will heal without surgery.   The chance of your dog needing surgery a second time is less than 5%.

Other Diagnostic Considerations

The purpose of the myelogram is to identify pressure on the spinal cord.  If the myelogram is normal, there is no pressure on the spinal cord.  This has several important implications.  First, it means that surgery will generally not be appropriate because the purpose of surgery is to relieve the pressure from the cord.  Second, it means that one of the following conditions is likely to exist.

1. Spinal Shock.  This is a temporary loss of spinal function that is generally associated with trauma.  It occurs suddenly and is somewhat like a concussion of the brain.  It may leave permanent damage, or full recovery may occur.  Recovery from spinal shock generally occurs within a few hours to a few days.

2. Fibrocartilaginous Infarct or Embolism.  In this condition, a small amount of disk material ruptures and gets into one of the blood vessels leading to the spinal cord.  As the vessel narrows, the disk material obstructs it, depriving a certain segment of the spinal cord of its blood supply.  Without proper blood supply, that segment of the spinal cord quits working, resulting in paralysis.  Surgery will not help these dogs because there is no pressure on the spinal cord.  Often, paralysis involves only one rear leg, or one rear leg is more severely affected than the other.  Complete recovery may occur in a few days to weeks, or there may be permanent damage to a portion of the spinal cord.

Diagnosis of fibrocartilaginous infarct/embolism is based on the correct clinical signs and a normal myelogram.  Confirmation requires a biopsy of the spinal cord so the diagnosis is confirmed only with an autopsy.

3. Degenerative Myelopathy.  This condition means that the spinal cord is slowly dying.  It results in progressive paralysis that begins with the dog dragging its rear feet as it walks.  This is called “knuckling over” and results in the toenails of the rear feet being worn because they drag the ground with each step.  It progresses to weakness of the rear legs, then paralysis.  It generally takes several weeks before paralysis occurs, and it generally occurs in large breeds of dogs, especially German Shepherds.  Because there is no successful treatment and paralysis includes loss of urine and bowel control, euthanasia is generally recommended.

Diagnosis of degenerative myelopathy is based on the correct clinical signs, especially in a large breed of dog, and a normal myelogram.  Confirmation requires a biopsy of the spinal cord so the diagnosis is confirmed only with an autopsy.

A normal myelogram in a dog with slowly progressive paralysis is very frustrating because the two most likely diseases (numbers 2 and 3) cannot be confirmed without an autopsy. 

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Distemper in Dogs

Canine distemper is a contagious viral disease of dogs.  It was a fairly common disease in the United States until the introduction of effective vaccines in the 1960’s.  In some parts of the world, it remains an important and devastating disease.

Prevalence

Canine distemper virus (CDV) is present on a worldwide basis.  In addition to dogs, other species can become infected.  These other species include coyotes, foxes, raccoon, ferrets, mink and skunks.

Young dogs are more susceptible to the distemper virus than are more mature dogs.  For dogs that become infected with CDV but survive, longstanding immunity usually results, but this immunity may decline with time.

Research statistics have shown that many more dogs are infected with CDV than actually show signs of the disease.

Causes/Transmission

Dogs infected with the virus shed it in their feces, saliva, urine, ocular (eye), and respiratory secretions.  New infection is established in a dog by inhalation of aerosolized respiratory secretions.  Once the virus invades the dog’s respiratory tract, it begins to reproduce.   If the dog does not initiate a strong immune response by the second or third week of the infection, cells infected with the virus begin to spread to other parts of the body.  At this point, recovery from the disease becomes less likely.

Clinical Signs

There is great variation in the duration and severity of signs with distemper.  In some dogs, distemper presents as a relatively mild disease with either no clinical signs or nonspecific signs, such as fever, depression, enlarged tonsils, or weight loss.   

More specific signs include ocular and nasal discharges, respiratory distress, coughing, diarrhea, vomiting.  The ocular and nasal discharge usually starts out as clear and then changes to a more cloudy fluid.  Some dogs develop skin infections or very thickened footpads.  For this reason, distemper has been called “hard pad” disease.  Puppies that have become infected while their permanent teeth are developing will often have defects in the tooth enamel.

In some dogs, CDV invades the central nervous system.  Once this occurs, recovery from distemper is almost impossible.  A variety of neurologic signs can be seen and include seizures (“chewing gum fits”), complete or partial paralysis, incoordination, visual problems, a head tilt or head bobbing, muscle tremors, and neck pain.  In old dogs, progressive encephalitis called “old dog encephalitis” occurs rarely.  It is thought to be caused by CDV.  In these dogs, compulsive circling and head pressing are observed most commonly.

Diagnosis

In many cases, a presumptive clinical diagnosis can be made by the particular clinical signs, evaluation of the vaccination history of the dog, and changes in bloodwork.  To aid in the diagnosis, blood can be analyzed at special laboratories to determine rising levels of globulins (antibodies) in the blood over a period of a few weeks.  When it is possible to obtain spinal fluid, this can also aid in the diagnosis. 

Definitive diagnosis can be made by demonstration of the unique “inclusion” bodies seen microscopically in some cells.  These inclusions can be seen in blood cells, bone marrow, and tissue samples.

Treatment

No specific therapy is available.  At best, good supportive care and control of any secondary bacterial infections is all that can be offered.  Supportive care should be directed toward minimizing stress and meeting the need for fluids and nutrition.

Prognosis

The prognosis is uncertain because there is no effective antiviral medication for canine distemper once a dog has become infected.  In most cases, once a dog shows clinical signs, the prognosis is guarded; many die of the disease.

Transmission to Humans

There is no health risk to humans caused by CDV.

Prevention

Young puppies usually have protective immunity transferred from the mother through her milk.  This immunity declines by six to eight weeks of age, however, and leaves the puppy susceptible to CDV.  At this time (6-8 weeks), puppies should begin CDV vaccination with boosters given every 2-3 weeks until 14-16 weeks of age.  These periodic boosters are recommended because some puppies may not begin to respond to the vaccine until after they are 6-8 weeks of age.  Thereafter, yearly boosters are given.

No vaccine is considered 100% protective, but most dogs will respond to distemper vaccine and have adequate protection against CDV.

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Ear Infections in Dogs

Infection of the external ear canal (outer ear) by bacteria or yeast, is one of the most common types of infections seen in dogs.  We call this otitis externa.  Some breeds, such as Cocker Spaniels and Miniature Poodles, seem more prone to ear infections, but they may occur in any breed.

Symptoms

A dog with an ear infection is uncomfortable; its ear canals are sensitive.  It shakes its head trying to get the debris and fluid out, and it scratches its ears.  The ears often become red and inflamed and develop an offensive odor.  A black or yellowish discharge commonly occurs.

Ear Mites

Ear mites can cause several of these symptoms, including a black discharge, scratching, and head shaking.  However, ear mite infections generally occur most commonly in puppies.  Ear mites in adult dogs occur most frequently after a puppy carrying mites is introduced into the household.  Sometimes, ear mites will create an environment within the ear canal that leads to a secondary infection with bacteria and yeast (fungus).  By the time the dog is presented to the veterinarian, the mites may be gone, but a significant ear infection remains.  

Types of Infections

There are several kinds of bacteria and at least one type of fungus that might cause an ear infection.  Without knowing the kind of infection present, we do not know which drug to use.  In some cases, the ear infection may be caused by a foreign body or tumor in the ear canal.  Treatment with medication alone will not resolve these problems.  Also, the dog must be examined to be sure that the eardrum is intact.  Administration of certain medications can result in loss of hearing if the eardrum is ruptured.  This determination is made by the veterinarian and must be done in the office.

Treatment

First, the ear canal is examined with an otoscope, an instrument that provides magnification and light.  This permits a good view of the ear canal.  This examination allows us to determine whether the eardrum is intact and if there is any foreign material in the canal.  When a dog is extremely painful and refuses to allow the examination, it must sometimes be completed under sedation or anesthesia. 

The next step is to examine a sample of the material from the ear canal to determine which organism is causing the infection.  This is called cytology.  Examination of that material under the microscope is very important in helping the veterinarian choose the right medication to treat the inflamed ear canal.

The results of the otoscopic examination and cytology tell us what to do.  If there is a foreign body or tick lodged in the ear canal, the dog is sedated so that it can be removed.  As stated previously, some dogs have such a heavy buildup of debris that sedation is needed to cleanse the canal and examine it completely.  Cytologic study of debris from the ear canal dictates which drug to use.  Sometimes, it reveals the presence of more than one type of infection (i.e., a bacterium and a fungus, or two kinds of bacteria); this situation usually requires the use of multiple medications or a broad-spectrum medication.

An important part of the evaluation of the patient is the identification of underlying disease.  Many dogs with chronic or recurrent ear infections have allergy problems or low thyroid function (hypothyroidism).  If underlying disease is found, it must be diagnosed and treated, if at all possible.  If this cannot be done, the dog is less likely to have a favorable response to treatment.  Also, the dog might respond temporarily, but the infection will relapse at a later time (usually when ear medication is discontinued). 

Prognosis

Nearly all ear infections that are properly diagnosed and treated can be cured.  However, if an underlying cause remains unidentified and untreated, the outcome will be less favorable.  A progress check may be needed before the process is completed, but we expect ultimate success. 

Complications

Dogs with ear infections are miserable.  Their ears are a source of constant pain resulting in head shaking and scratching.  However, that is not the only problem.  Head shaking and scratching can also cause broken blood vessels in the earflap, requiring surgery, and chronic ear infections can penetrate the eardrum and result in an internal ear infection. 

Closing of the ear canal is another result of a chronic ear infection.  There are medications that can shrink the swollen tissues and open the canal in some dogs.  However, some cases will eventually require surgery.

Ear Surgery

The surgery for a closed ear canal is called a lateral ear resection.  Its purposes are to remove the vertical part of the ear canal and to remove swollen tissue from the horizontal canal.  Removing the vertical canal should be successful, but removal of large amounts of tissue from the horizontal canal is more difficult.  In some cases, the ear canal is surgically obliterated.  This solves the canal problem, but it leaves the dog deaf on that side.

Medicating the Ears

It is important to get the medication into the horizontal part of the ear canal.  Be aware that the dog’s external ear canal is “L” shaped.  The vertical canal connects with the outside of the ear; the horizontal canal lies deeper in the canal and terminates at the eardrum.  The ear canal may be medicated by following these steps:

1. Gently pull the earflap straight up and hold it with one hand.
2. Apply a small amount of medication into the vertical part of the ear canal while continuing to keep the earflap elevated.  Hold this position long enough for the medication to run down to the turn between the vertical and horizontal canal.
3. Put one finger in front of and at the base of the earflap, and put your thumb behind and at the base.
4. Massage the ear canal between your finger and thumb.  A squishing sound tells you that the medication has gone into the horizontal canal.
5. Release the ear and let your dog shake its head.  If the medication contains a wax solvent, debris will be dissolved so it can be shaken out. 
6. If another medication is to be used, apply it in the same manner.
7. When all medications have been applied, clean the outer part of the ear canal and the inside of the earflap with a cotton ball soaked with a small amount of rubbing (isopropyl) alcohol.  Do not use cotton tipped applicators to do this, as they tend to push debris back into the vertical ear canal.

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Flea Control for Dogs

Successful flea control has two aspects.  Fleas must be controlled on your dog, and fleas must be controlled in your dog's environment.  Since cats and dogs share the same fleas, the presence of a cat in your dog's environment can make flea control much more difficult.

Diagnosis of Flea Infestation

When a dog is heavily infested with fleas, it is easy to find them.  If the numbers are small, it is best to quickly turn your dog over and look on its belly.  If you do not find them there, look on the back just in front of the tail.  Be sure to part the hair and look at the level of the skin.  When the numbers are very small, look for "flea dirt."  Flea dirt is digested blood left behind by the fleas.  Flea dirt is actually fecal matter from the flea.  Finding flea dirt is a sure indication that fleas are present or have been present recently. 

Flea dirt looks like pepper.  It varies from tiny black dots to tubular structures about 1/32" (1/2 mm) long.  If you are not sure it is flea dirt, put the suspected material on a light colored tabletop or counter top.  Add one or two drops of water, and wait about 30 seconds.  If it is flea dirt, the water will turn reddish brown as the blood residue goes into solution.  Another trick is to put some of the material on a white paper towel and then wet the paper towel with water.  A red stain will become apparent if you gently wipe the material across the surface of the paper towel.

Many people find tiny drops of blood in a dog's bedding or where the dog sleeps.  This is usually flea dirt that was moistened, then dried.  It leaves a reddish stain on the bedding material and is another sign that fleas are present.

Life Cycle of the Flea

To appreciate the complex issue of flea control, you must understand something about the flea's life cycle.

Although you are only able to see the adult flea, there are actually 4 stages of the life cycle.  The adult flea constitutes only about 5% of the entire flea population if you take into account all four stages of the life cycle.  Flea eggs are pearly white and about 1/32" (1/2 mm) in length.  They are too small to see without magnification.  Fleas lay their eggs on the dog, but the eggs do not stick to the dog's hair.  Instead, they fall off into the dog's environment.  The eggs make up 50% of the flea population.  They hatch into larvae in 1 to 10 days, depending on temperature and humidity.  High humidity and temperature favor rapid hatching.

Flea larvae are slender and about 1/8-1/4" (2 to 5 mm) in length.  They feed on organic debris found in their environment and on adult flea feces, which is essential for successful development.  They avoid direct sunlight and actively move deep into carpet fibers or under organic debris (grass, branches, leaves, or soil.)  They live for 5 to 11 days before becoming pupae.

Moisture is essential for their survival; flea larvae are killed by drying.  Therefore, it is unlikely that they survive outdoors in shade-free areas.  Outdoor larval development occurs only where the ground is shaded and moist and where flea-infested pets spend a significant amount of time.  This allows flea feces to be deposited in the environment.  In an indoor environment, larvae survive best in the protected environment of carpet or in cracks between hardwood floors.  They also thrive in humid climates.

Following complete development, the mature larvae produce a silk-like cocoon in which the next step of development, the pupa, resides.  The cocoon is sticky, so it quickly becomes coated with debris from the environment.  This serves to camouflage it.  In warm, humid conditions, pupae become adult fleas in 5-10 days.  However, the adults do not emerge from the cocoon unless stimulated by physical pressure, carbon dioxide, or heat. 

Pre-emerged adult fleas can survive up to 140 days within the cocoon.  During this time, they are resistant to insecticides applied to their environment.  Because of this, adult fleas may continue to emerge into the environment for up to 3 weeks following insecticide application.

When the adult flea emerges from its cocoon, it immediately seeks a host because it must have a blood meal within a few days to survive.  It is attracted to people and pets by body heat, movement, and exhaled carbon dioxide.  It seeks light, which means that it migrates to the surface of the carpet so that it can encounter a passing host.  Following the first blood meal, female fleas begin egg production within 36 to 48 hours.  Egg production can continue for as long as 100 days, which means that a single flea can produce thousands of eggs.

This entire life cycle (adult flea >>> egg >>> larvae >>> pupa >>> adult) can be completed in 14-21 days with the proper temperature and humidity conditions.  This adds to the problem of flea control.

If untreated, the female flea will continue to take blood for several weeks.  During that time, she will consume about 15 times her body weight in blood.  Although the male fleas do not take as much blood, they, too, contribute to significant blood loss.  This can lead to the dog having an insufficient number of red blood cells, which is known as anemia.  In young or debilitated dogs, the anemia may be severe enough to cause death.

Contrary to popular belief, most dogs have rather limited itching due to fleabites.  However, many dogs become allergic to the saliva in the flea's mouth.  When these dogs are bitten, intense itching occurs, causing the dog to scratch and chew on its skin.

Flea Control

Successful flea control must rid the dog of fleas and it must rid the dog's environment of fleas.  In fact, environmental control is as important as treatment of the dog.  If your dog remains primarily indoors and you do not have other pets that come in from the outside, environmental control is relatively easy, especially with the advent of the new topical products (see below).  However, the dog that goes outdoors frequently or stays outdoors presents a somewhat greater challenge and a few fleas may occasionally be seen indoors.

Many of the older insecticides (which have been the mainstay of flea control for years) have limited effectiveness against fleas because they are only effective for a few hours after application on the dog.  Also, these are primarily geared to kill adult fleas.  Flea powders, sprays, and shampoos will kill the fleas present on your dog at the time of application.  However, most of these products have little or no residual effects, so the fleas that return to your dog from his environment are not affected.  Thus, your dog may be covered with fleas within a day after having a flea bath or being sprayed or powdered. 

However, there are some newer, more effective sprays that can be a valuable part of the overall treatment plan.  They kill adult fleas rapidly and are safe enough to use daily, if necessary.  Flea sprays containing insect growth regulators are helpful in managing the overall problem because they help to break the flea life cycle.  Some of the newer sprays with growth regulators are not recommended for daily use; once weekly application is recommended.  Always read the label when first using any new product on a dog.  In general, flea sprays, collars, powders and dips have become less popular since the introduction of the newer products.

Newer Products

Four relatively new products have come onto the market in the last couple of years.  The “flea pill” is an oral medication that is given to the dog once a month.  This product, Program, does not kill adult fleas but is helpful in breaking the life cycle of the flea.  When the female flea produces eggs, they are essentially “sterile” eggs and do not hatch.  In effect, this product acts like a birth control product for the flea.  Three new topical treatments are applied to the nape of the neck.  They are Advantage, Frontline Top Spot, and Revolution.  All are safe and very effective.

Environmental Control

The newer topical products do not require the aggressive environmental control that is necessary if only dips, sprays, or collars are used.  This is one reason that they have become so popular with pet owners.  Many people try the newest products for 1-2 weeks to see if they are adequate.  Please consult with us about the requirements for your specific situation. 

When environmental flea control is indicated, it must be directed at your house and your yard. 

House.  Even though fleas may be in your house, most people never see them.  Fleas greatly prefer cats and dogs to people; they only infest humans when there has not been a cat or dog in the house for several days.   (There are exceptions to this.)  A professional exterminator may be called to treat your house or you may use a house fogger or a long-lasting spray.  These foggers and sprays are very effective for adult fleas, but they will not kill adults that are still in their cocoon.  You should purchase a fogger or a spray that kills the adult fleas and inhibits development of the eggs and larvae.  In climates with extended warm temperatures and high humidity, it may be necessary to treat two or three times with a 30-day residual product before all stages of the fleas are removed from the house.  The second treatment is most effective if it is done 2 weeks after the first.

There is at least one company that will treat your carpet with a flea-killing powder.  The powder is non-toxic to people.  It is worked deeply into the carpet to prevent it from being removed by vacuuming.  This treatment has proven very successful, even in the face of heavy flea infestations.  However, the treatment does not address fleas in your yard.  The same chemical, a form of boric acid, is also available for application by the homeowner.  However, the self-application kits do not offer the year guarantee.

Yard.  Yard control may also be done by professional exterminator or with various insecticides you may use yourself.  Be sure that any insecticide that you use has a 30-day residual.  This keeps you from having to spray every week.  In climates with extended warm temperatures and high humidity, it will often be necessary to treat monthly during the warm months of the year.  You should use a 30-day residual product each time. Your veterinarian is able to help you choose the most effective product for your situation.

Re-emergence of Fleas

If you recall, pre-emerged adult fleas can survive up to 140 days within the cocoon.  This is significant when your pets are gone from home for extended periods of time.  During the time that the house is quiet and empty, pre-emerged adults remain in their cocoon.  Even if the house was treated with an insecticide, their cocoon protects them.  When people and pets return to the house, adults emerge from their cocoons and immediately begin to seek a blood meal.  They jump on cats, dogs, and even people.  Although it may appear that a dog just returned from boarding brought fleas to your home, it is also very possible that a sudden emergence of adult fleas may account for the fleas present.  If large numbers of fleas are seen, they are almost certainly newly hatched fleas and have not been brought home with the pet.

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Food Allergy in Dogs

One of the most common conditions affecting dogs is allergy.  In the allergic state, the dog's immune system "overreacts" to foreign substances (allergens or antigens) to which it is exposed.  These overreactions are manifested in three ways.  The most common is itching of the skin, either localized (one area) or generalized (all over the dog).  Another manifestation involves the respiratory system and may result in coughing, sneezing, and/or wheezing.  Sometimes, there may be an associated nasal or ocular (eye) discharge.  The third manifestation involves the digestive system, resulting in vomiting or diarrhea.

Types of Allergy

There are five known types of allergies in the dog: contact, flea, food, bacterial, and inhalant.  Each of these has some common expressions in dogs, and each has some unique features.

Food Allergy

A food allergy is a condition in which the body’s immune system reacts adversely to a food or an ingredient in a food.

Any food or food ingredient can cause an allergy.  However, protein, usually from the meat source of the food, is the most likely offender.  Proteins commonly found in dog foods are derived from beef, chicken, lamb, and horsemeat.

Lamb and Rice Diets

Although many people think lamb and rice diets are hypoallergenic, they are not.  They are not inherently less likely to cause allergy than other diets.  However, they have this reputation.  Here is why.

Several years ago there were no dog foods on the commercial market that contained lamb.  A manufacturer of prescription dog foods formulated a food from lamb that was suitable for allergy testing, which will be explained below.  Because of that situation, lamb-based dog food was considered “hypoallergenic.” 

Food Allergy Testing

Dogs are not likely to be born with food allergies.  More commonly, they develop allergies to food products they have eaten for a long time.  The allergy most frequently develops in response to the protein component of the food; for example, beef, pork, chicken, or turkey.  Food allergy may produce any of the clinical signs previously discussed, including itching, digestive disorders, and respiratory distress.  We recommend testing for food allergy when the clinical signs have been present for several months, when the dog has a poor response to steroids, or when a very young dog itches without other apparent causes of allergy.  Testing is done with a special hypoallergenic diet.  Because it takes at least 4 weeks for all other food products to get out of the system, the dog must eat the special diet exclusively for 4-8 weeks (or more).  If positive response occurs, you will be instructed on how to proceed.  If the diet is not fed exclusively, it will not be a meaningful test.  We cannot overemphasize this.  If any type of table food, treats or vitamins are given, they must be discontinued during the testing period.  There may be problems with certain types of chewable heartworm preventative, as well.  Your veterinarian will discuss this with you.

Because dogs that are being tested for inhalant allergy generally itch year round, a food allergy dietary test can be performed while the inhalant test and antigen preparation are occurring. 

INSTRUCTIONS:  Those instructions that are specific for your dog have been checked:

___ 1)  Your dog is to exclusively eat a hypoallergenic diet.  If it will not do so readily, mix it 25:75 with the current diet for several days, then gradually increase the special diet to 100%.  If this does not work, contact us for an alternative plan.  Discontinue any chewable treats or vitamins, including heartworm preventatives.  Table food is not allowed.  Offer only distilled water to drink, if that is possible.

___ 2)  An injection of steroids was given.  Relief should be apparent within 12-24 hours.  If not, please call.  The dog should feel better and itch less for about one month.  If an increase in water consumption or urination occurs, please report this to us for future reference.  These side effects are common with steroid administration and will go away in a few days without treatment.  Return for further evaluation when the first signs of itching recur.

___ 3)  Begin oral steroids when the first signs of itching return.  Give ____ tablets every other morning.  Adjust the dosage upward or downward to the lowest effective dose, with a maximum dose of __________ permitted.  Stop giving the medication every 4-6 months to see if there are times of the year when therapy is not needed.  Report any increase in water consumption to us at once.

___ 4)  We have dispensed oral steroid tablets.  Prednisone is most commonly used.  The specific drug being dispensed for your dog is labeled on the bottle.  Give ____ of the ____ mg tablets every other day for 3 doses (6 days), then ____ tablets every other day for 3 more doses (6 more days).  Continue this downward progression (________________________________) until the first signs of itching recur.  At that time, go back to the next higher level and report that level to us (so we can be sure it is a safe level).  Stop giving the tablets every 4-6 months to see if there are periods of the year when they are not necessary.  When itching returns, begin immediately at the maintenance dose.  If that does not stop the itching, increase the dosage slightly (to a maximum of ___ tablets) for a few doses, then return to the lower dose.  Report any increase in water consumption to us at once.  (This may occur at the initial dose but should stop on the maintenance dose.)

___ 5)  Your dog has a flea allergy or has enough fleas to make the other allergy problem worse.  Flea control is very important and should include treating the dog and its environment.  Bear in mind that flea allergies often accompany other types of allergies, especially inhalant allergy.

___ 6)  Your dog has a bacterial skin infection secondary to allergy.  The following are recommended:

a) Antibiotics are to be used for the next _____ days.  If the infection is not gone by the time the medication is completed, call for a refill or for a change in medication.

b) The medicated shampoo,_____________________, is to be used every _____ days.  Allow the shampoo to stay in the haircoat for a few minutes before thoroughly rinsing the dog.

c) The topical medication, _____________________, is to be used ______ times daily for __________ days.

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Giardia Infection in Dogs

Giardia are sometimes confused with worms because they invade the gastrointestinal tract and can cause diarrhea.  They are not worms; instead, they are one-celled parasites classified as protozoa.

Most dogs that are infected with Giardia do not have diarrhea or any other signs of illness.  When the eggs (cysts) are found in the stool of a dog without diarrhea, they are generally considered a transient, insignificant finding.  However, in puppies and debilitated adult dogs, they may cause severe, watery diarrhea that may be fatal.

Infection

A dog becomes infected with Giardia when it swallows the cyst stage of the parasite.  Once inside the dog's intestine, the cyst goes through several stages of maturation.  Eventually, the dog is able to pass infective cysts in the stool.  These cysts lie in the environment and can infect other dogs.  They may also be transmitted through drinking infected water. 

Diagnosis

Giardiasis is sometimes diagnosed by performing a microscopic examination of a stool sample.  The cysts are quite small and usually require a special floatation medium for detection, so they are not normally found on routine fecal examinations.  Occasionally, the parasites may be seen on a direct smear of the feces.  A blood test is also available for detection of antigens (cell proteins) of Giardia in the blood.  This test is probably more accurate than the stool exam, but it requires several days to get a result from the laboratory performing the test.

None of the tests for giardiasis are completely accurate.  Therefore, some veterinarians choose to treat the dog with one of the safe and very effective medications.  If successful, this approach will eliminate the parasite even though a confirmed diagnosis is not made.

Treatment

The most common drug used to kill Giardia is metronidazole, an antibiotic-type drug.  It is given for 5-7 days.  Other drugs are also used if diarrhea and dehydration occur.  If metronidazole is not effective, others are available.

Transmission to Humans

Giardia can also cause diarrhea in humans.  Therefore, environmental disinfection is important.  The use of chlorine bleach, one cup in a gallon (500 ml in 4 liters) of water, is effective if the surfaces and premises can be safely treated with it.

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Heartworm Disease in Dogs

Heartworm disease (dirofilariasis) is a serious and potentially fatal disease in dogs.  It is caused by a worm called Dirofilaria immitis.

Heartworms are found in the heart and large adjacent vessels of infected dogs.  The female worm is 6 to 14 inches (15 to 36 cm) long and 1/8 inch (5 mm) wide; the male is about half the size of the female.  One dog may have as many as 300 worms. 

How Heartworms get into the Heart

Adult heartworms live in the heart and pulmonary arteries of infected dogs.  They have been found in other areas of the body, but this is unusual.  They survive up to 5 years and, during this time, the female produces millions of young (microfilaria).  These microfilaria live in the bloodstream, mainly in the small blood vessels.  The immature heartworms cannot complete the entire life cycle in the dog; the mosquito is required for some stages of the heartworm life cycle.  The microfilaria are therefore not infective (cannot grow to adulthood) in the dog--although they do cause problems.

As many as 30 species of mosquitoes can transmit heartworms.  The female mosquito bites the infected dog and ingests the microfilariae during a blood meal.  The microfilariae develop further for 10 to 30 days in the mosquito and then enter the mouthparts of the mosquito.  The microfilariae are now called infective larvae because at this stage of development, they will grow to adulthood when they enter a dog.  The mosquito bites the dog where the haircoat is thinnest.  However, having long hair does not prevent a dog from getting heartworms.

When fully developed, the infective larvae enter the bloodstream and move to the heart and adjacent vessels, where they grow to maturity in 2 to 3 months and start reproducing, thereby completing the full life cycle. 

Geography

Canine heartworm disease occurs all over the world.  In the United States, it was once limited to the south and southeast regions.  However, the disease is spreading and is now found in most regions of the United States and Canada, particularly where mosquitoes are prevalent.

Contagion

The disease is not spread directly from dog to dog.  An intermediate host, the mosquito, is required for transmission.  Spread of the disease therefore coincides with the mosquito season.  The number of dogs infected and the length of the mosquito season are directly correlated with the incidence of heartworm disease in any given area.

It takes a number of years before dogs show outward signs of infection.  Consequently, the disease is diagnosed mostly in 4 to 8 year old dogs.  The disease is seldom diagnosed in a dog under 1 year of age because the young worms (larvae) take up to 7 months to mature following establishment of infection in a dog.

Effects on the Dog

Adult worms:  Adult worms cause disease by clogging the heart and major blood vessels leading from the heart.  They interfere with the valve action in the heart.  By clogging the main blood vessels, the blood supply to other organs of the body is reduced, particularly the lungs, liver and kidneys, leading to malfunction of these organs.

Most dogs infected with heartworms do not show any signs of disease for as long as 2 years.  Unfortunately, by the time signs are seen, the disease is well advanced.  The signs of heartworm disease depend on the number of adult worms present, the location of the worms, the length of time the worms have been present, and the degree of damage to the heart, lungs, liver, and kidneys from the adult worms and the microfilariae.

The most obvious signs are: a soft, dry, chronic cough, shortness of breath, weakness, nervousness, listlessness, and loss of stamina.  All of these signs are most noticeable following exercise, when some dogs may even faint.

Listening to the chest with a stethoscope will often reveal abnormal lung and heart sounds.  In advanced cases, congestive heart failure may be apparent and the abdomen and legs will swell from fluid accumulation.  There may also be evidence of weight loss, poor condition, and anemia.

Severely infected dogs may die suddenly during exercise or excitement.

Microfilariae (Young worms):  Microfilariae circulate throughout the body but remain primarily in the small blood vessels.  Because they are as wide as the small vessels, they may block blood flow in these vessels.  The body cells being supplied by these vessels are deprived of the nutrients and oxygen normally supplied by the blood.  The lungs and liver are primarily affected.

Destruction of lung tissue leads to coughing.  Cirrhosis of the liver causes jaundice, anemia, and general weakness because this organ is essential in maintaining a healthy animal.  The kidneys may also be affected and allow poisons to accumulate in the body.

Diagnosis

In most cases, diagnosis of heartworm disease can be made by a blood test that can be run in the veterinary hospital.  Further diagnostic procedures are essential, in advanced cases particularly, to determine if the dog can tolerate heartworm treatment.  Depending on the case, we will recommend some or all of the following procedures before treatment is started.

Serological test for antigens to adult heartworms:  This is a test performed on a blood sample.  It is the most widely used test because it detects antigens (proteins) produced by adult heartworms.  It will be positive even if the dog does not have any microfilaria in the blood; this occurs about 20% of the time.  Dogs with less than five adult heartworms will not have enough antigen to turn the test positive, so there may be some false negative results in early infections.  Because the antigen detected is produced only by the female worm, a pure population of male heartworms will give a false negative, also.  Therefore, there must be at least 5 female worms present for the most common test to be positive.

Blood test for microfilariae:  A blood sample is examined under the microscope for the presence of microfilariae.  If microfilariae are seen, the test is positive.  The number of microfilariae seen gives us a general indication of the severity of the infection.  However, the microfilariae are seen in greater numbers in the summer months and in the evening, so these variations must be considered.  Approximately 20% of dogs do not test positive even though they have heartworms because of an acquired immunity to this stage of the heartworm.  Because of this, the antigen test is the preferred test. Also, there is another microfilarial parasite which is fairly common in dogs; on the blood smear, these can be hard to distinguish from heartworm microfilariae.

Blood chemistries:  Complete blood counts and blood tests for kidney and liver function may give an indirect indication of the presence of heartworm disease.  These tests are also performed on dogs diagnosed as heartworm-infected to determine the function of the dog's organs prior to treatment.

Radiographs (X-rays):  A radiograph of a dog with heartworms will usually show heart enlargement and swelling of the large artery leading to the lungs from the heart.  These signs are considered presumptive evidence of heartworm disease.  Radiographs may also reveal the condition of the heart, lungs, and vessels.  This information allows us to predict an increased possibility of complications related to treatment. 

Electrocardiogram:  An electrocardiogram (EKG) is a tracing of the electric currents generated by the heart.  It is most useful to determine the presence of abnormal heart rhythms.

Echocardiography (Sonogram):  An echocardiogram allows us to see into the heart chambers and even visualize the heartworms themselves.  Although somewhat expensive, this procedure can diagnose heartworms when other tests fail.

Treatment

There is some risk involved in treating dogs with heartworms, although fatalities are rare.  In the past, the drug used to treat heartworms contained arsenic so toxic effects and reactions occurred somewhat frequently.  Now a newer drug is available that does not have the toxic side effects of the old one.  We are able to successfully treat more than 95% of dogs with heartworms. 

We see some dogs with advanced heartworm disease.  This means that the heartworms have been present long enough to cause substantial damage to the heart, lungs, blood vessels, kidneys, and liver.  A few of these cases will be so far advanced that it will be safer to just treat the organ damage rather than risk treatment to kill the worms.  Dogs in this condition are not likely to live more than a few weeks or months.

Treatment to kill adult worms:  An injectable drug to kill adult heartworms is drug is given for two days.  It kills the adult heartworms in the heart and adjacent vessels. 

Complete rest essential after treatment:  The adult worms die in a few days and start to decompose.  As they break up, they are carried to the lungs, where they lodge in the small blood vessels and are eventually reabsorbed by the body.  This is a dangerous period, and it is absolutely essential that the dog be kept quiet and not be allowed to exercise for 1 month following treatment.  The first week after the injections is very critical because the worms are dying.  A cough is noticeable for 7 to 8 weeks after treatment in many heavily infected dogs.

Prompt treatment is essential if the dog has a significant reaction in the weeks following the initial treatment, although such reactions are not common.  If a dog shows loss of appetite, shortness of breath, severe coughing, coughing up blood, fever, and/or depression, you should notify us.  Response to antibiotics, cage rest, and supportive care, such as intravenous fluids, is usually good in these cases.

Treatment to kill microfilaria:  Approximately 1 month following treatment to kill the adults, the dog is returned to the hospital for administration of a drug to kill microfilariae.  Your dog needs to stay in the hospital for the day.  Seven to ten days later a test is performed to determine if microfilariae are present.  If they have been all killed, the treatment is complete.  If there are still some present in the blood, treatment for microfilariae is repeated.

In some cases, the heartworm infection is "occult," meaning that no microfilariae were present.  In this case, a follow-up treatment at one month is not needed. 

Other treatments:  In dogs with severe heartworm disease, it may be necessary to treat them with antibiotics, special diets, diuretics to remove fluid accumulations, and drugs to improve heart function prior to treatment for the heartworms.

Dogs with severe heart disease may need lifetime treatment for the failing heart, even after the heartworms have been killed.  This includes the use of diuretics, heart drugs, aspirin, and special low salt, low protein diets.

Response to treatment:  Dog owners are usually pleasantly surprised at the change in their dog following treatment for heartworms, especially if the dog had been showing signs of heartworm disease.  The dog has a renewed vigor and vitality, improved appetite, and weight gain. 

Prevention

When a dog has been successfully treated for heartworms, you cannot sit back and relax because dogs can be reinfected.  Therefore, it is essential to begin a heartworm prevention program.  There are four drugs that can be used to prevent heartworm infection.  Filaribits Plus is a daily, chewable tablet; two others, HeartGard and Interceptor, are chewable tablets that are given only once monthly.  Revolution is a topical product that is applied once monthly.  All four products are very safe and very effective.  Their costs are similar.  One of these should be started immediately after the treatment is completed.

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Infectious Canine Hepatitis

The word “hepatitis” is a nonspecific medical term describing any inflammatory process of the liver.  A number of different diseases can cause hepatitis.  One infectious cause is Infectious Canine Hepatitis, or (ICH).  This viral disease was first recognized as a unique disease of dogs in 1947.

Prevalence

ICH is found on a worldwide basis.  It most commonly infects young dogs, but any dog without immunity is considered at risk for contracting the virus.

Causes/Transmission

The ICH virus infects the dog by contact with the oral or nasal surfaces.  Following viral reproduction in the tonsils and lymph nodes of the head and neck, it spreads to all parts of the body.  It preferentially infects cells of the liver, eye, and kidney.

During this early stage of infection, the virus is shed in the urine, feces, blood, and oral and nasal secretions.  Eventually, the virus localizes in the kidneys; it may be shed into the urine for up to a year.

Clinical Signs

Once the dog is infected with ICH virus, the incubation period lasts 4-7 days.  In many cases, especially for adult dogs, the signs of ICH may be completely inapparent.  Dogs with mild illness may be slightly depressed and run a low-grade fever, with complete recovery after a few days.  Dogs who continue to run a fever and do not resolve the infection within this time period will go on to show other signs: enlarged lymph nodes and tonsils, abdominal tenderness, diarrhea, and coughing.  Widespread hemorrhage and jaundiced skin develop in some of the more serious cases.  Death from ICH is a possibility.

In some dogs, the virus invades the eye and stimulates the immune system.  The inflammatory response that results leads to edema in the cornea, or the clear surface of the eyeball.  This gives the cornea a bluish cast.  For this reason, ICH is sometimes called “Blue Eye.”

Diagnosis

A presumptive diagnosis can be made based on vaccination history, clinical signs, and laboratory findings.   Conclusive diagnosis can be made when two separate blood samples (taken on different days) show a rise in antibody level to ICH virus.

Treatment

Most dogs infected with ICH will recover with good supportive care.  This includes attention to nutrition, fluid intake, nursing care, and control of any secondary infections.

Prognosis

The more body systems that have become involved, the worse the prognosis. 

Transmission to Humans

There is some serologic (blood test) evidence that ICH can infect humans.  This still remains to be studied further.  Even if this is proven true, there are no reported clinical signs of disease in humans related to ICH.

Prevention

Although no vaccine assures 100% protection, the hepatitis vaccine is generally considered safe, effective, and very beneficial in preventing ICH.  Following completion of puppy immunizations, mature dogs receive a booster once yearly during their annual vaccinations.

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Hemorrhagic Gastroenteritis in Dogs

Hemorrhagic gastroenteritis (HGE) is a fairly common disorder of dogs that is characterized by the sudden development of vomiting and/or diarrhea.  The vomitus and the diarrhea may contain variable amounts of bright, red blood or dark, digested blood.

Contributing Factors

There are no known contributing factors.  Most dogs appear healthy prior to the onset of clinical signs.

Prevalence

Any breed may be affected but certain breeds are more often involved.  Usually, the dog is a young to middle-aged small breed, such as the miniature Poodle, miniature Schnauzer, Dachshund, and Yorkshire terrier. 

Causes/Transmission

The exact cause of HGE remains unknown.

Clinical Signs

There is some variability in the both the severity and course of this disease but, generally, signs are very sudden in onset.  Vomiting is followed by the onset of bloody diarrhea.  The rapid onset of profound dehydration is one of the hallmarks of HGE.  The continuing loss of bodily fluids can progress so rapidly that hypotension (low blood pressure) and shock develop.  Fever is not a characteristic finding.

Diagnosis

The diagnosis of HGE is one of exclusion, meaning other possible causes of bloody vomitus and/or bloody diarrhea must first be considered.   Some of these possible causes include ulcers, trauma, gastrointestinal tumors or obstruction, foreign bodies, infectious diseases, and coagulation disorders.  Evaluation of these other causes might require such tests as a complete blood count, biochemical analysis of the blood, urinalysis, x-rays, coagulation tests, fecal evaluation, ultrasound or endoscopic (fiberoptic) evaluation of the gastrointestinal tract.  Because the cost of all these tests could be significant, it is sometimes prudent to treat the dog for a short while with supportive care to see if the signs resolve.  More details on this are given below.

The blood count of affected dogs is characterized by an extremely high hematocrit (red blood cell count).  Most normal dogs have a hematocrit of 35-55%, while dogs with HGE may have hematocrits well above 60%.  The elevated hematocrit provides the veterinarian with an important diagnostic clue that the dog may have HGE.

Treatment

Dogs with HGE will appear profoundly ill and, if left untreated, may die.  In most cases, the disorder appears to run its course in a few days if the animal is given appropriate supportive care.  Intravenous therapy given at the veterinary hospital provides the cornerstone of therapy for HGE.  Fluids given under the skin (subcutaneous fluids) are generally not considered adequate to meet the significant fluid requirements of most dogs with HGE.

If intravenous fluid therapy is not given, the dog's red blood count will continue to elevate.  Eventually, the blood may become so thick that it flows very slowly through the blood vessels.  In this situation, the dog is at risk for a potentially fatal clotting disorder called DIC.  Once DIC has begun, it is often irreversible and often leads to death of the animal. 

Additional therapy may include antibiotics and anti-ulcer medication.

Prognosis

The prognosis is usually good for complete recovery.  A small number of dogs will have a later recurrence of the disorder. 

Transmission to Humans

Canine HGE poses no known health risk to humans.

Prevention

Because the cause is unknown, there is no recommended preventive therapy.

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Hip Dysplasia in Dogs

Hip dysplasia (HD) is defined as a deformity of the coxofemoral (hip) joint that occurs during the growth period.  Hip dysplasia is a hereditary condition that creates a poorly fitting hip joint.  As the dog walks on this joint, arthritis will eventually develop, causing pain in the joint.  The degree of lameness that occurs is usually dependent upon the extent of arthritic changes in the hip joint.

Contributing Factors

Dogs suffering from HD have a genetic background, but the releasing factors are many. Two of the most important are overnutrition and excessive exercise, especially in the young puppy.

Prevalence

Most breeds of dogs can be affected with hip dysplasia although it is predominantly seen in the larger breeds of dogs, such as the German Shepherd, St. Bernard, Labrador Retriever, Pointers, and Setters.  There is equal distribution of the disease between male and female dogs.

Causes/Transmission

The causes of hip dysplasia are complex and multiple.  Environmental and genetic factors are both involved.  It is difficult, if not impossible, to pinpoint a single cause.

Clinical Signs

The typical clinical signs of hip dysplasia are rear leg pain, incoordination, and a reluctance to rise from a lying position.  Wasting of the large muscles in the rear limbs may eventually develop.  Most owners report that the dog has had difficulty in rising for a period of weeks or months; lameness and pain subsequently develop.  Again, the severity of signs and progression of the disease usually correlate with the extent of arthritis in the joint.  Clinical signs can occur as early as 4-6 weeks of age, but most dogs manifest the disease as a lameness around one to two years of age.  Dogs with mild hip dysplasia and minimal arthritis may not become painful and lame until 6-10 years of age.

Diagnosis

Tentative diagnosis of hip dysplasia is made on the basis of history, breed, and clinical signs.  A large breed dog that has been slow to rise for several months and now is lame is highly suspect for hip dysplasia; a dog that refuses to rise should also be considered a candidate.  Because the clinical signs may mimic other diseases, final diagnosis of hip dysplasia can only be made on the basis of specific radiographic (x-ray) findings.  To obtain the proper radiographs, dogs must be carefully positioned on the radiographic table.  This procedure requires the use of a short-acting anesthetic.  The radiographs are evaluated for abnormal shape of the hip joint and for degenerative changes (arthritis).

Treatment

The degree of clinical signs and arthritic changes in the joints determine the specific approach to therapy. Treatment of hip dysplasia may involve the use of drugs or surgery, or both.  The options are as follows:

l.  Anti-inflammatory drugs.  Several drugs will give relief from pain.  Aspirin or acetaminophen may work well in some dogs.  Other steroidal (cortisone) and non-steroidal drugs may also be used.  Most have some side effects and most require administration once or twice daily.  Many dogs have severe stomach irritation to ibuprofen so this drug is not recommended.  Unfortunately, it is not possible to predict which dog will respond to which drug.  Therefore, a series of trials may be needed to find the most effective one for your dog. 

Extreme caution is advised when these drugs are given to dogs with a history of kidney disease or with marginal kidney function.  Many of these drugs have an adverse effect on blood flow to the kidneys and can lead to kidney failure.  This does not appear to be a concern if kidney function is normal.  As alluded to above, dogs with a history of ulcers are also at risk for complications.  Your veterinarian can determine the risk for your dog.

Anti-inflammatory drug therapy is most often used in older dogs, in dogs that did not get good relief from surgery, or in dogs for which surgery is not feasible.

2.  Surgery:  There are four main procedures that are used to treat hip dysplasia. 

Pectineal myotomy is a relatively minor procedure that involves cutting a small muscle on the inside of the leg that puts pressure on the hip joint.  It results in no loss of leg function and gives good to excellent relief in 80-90% of dogs.  If both hips are abnormal, both hips may be operated at the same time.  The dog recovers from surgery in one to two days.  However, this procedure does not stabilize the hip joint or prevent progression of arthritic changes.  Within a few months to several years, pain and lameness will usually return.

Femoral head ostectomy (FHO) is another choice.  The hip joint is a ball and socket joint.  FHO is the removal of the ball part of the joint.  This gives excellent results in small dogs because a functional "false joint" forms.  However, some large dogs may not form this "false joint" very well.  This procedure is usually used in large dogs if arthritis is very severe, if the hip dislocates, or if the expense of the other procedures is prohibitive.

Triple osteotomy is a procedure in which the pelvis is cut in three places around the hip joint.  The bone is rotated to create better alignment with the femoral head (the ball).  It is reattached so that the joint functions in a more normal fashion without looseness and pain.  This should only be performed in a dog with no arthritic changes in the joint, with a fairly deep acetabulum (hip socket), and less than 1 year of age.  It is an expensive procedure.

Hip joint replacement is possible, as is done in humans.  A stainless steel ball and socket are attached to the pelvis and femur in place of the abnormal ones.  It is another expensive procedure, but it may give many years of pain-free use of the hips.  Although the intent is for the transplant to be permanent, the new joint may loosen after a period of time.

Prognosis

The prognosis is variable depending upon the age of the dog, severity of the dysplasia, and response to medical and/or surgical intervention.

Prevention

Research has shown that the cause of hip dysplasia is related to a combination of genetic and environmental factors.  The disease is known to be an inherited condition and the genetics of hip dysplasia are extremely complicated.  In addition, environmental factors such as overfeeding and excessive exercise can predispose a dog (especially growing puppies) to developing hip dysplasia.  Because the inheritance of the disease is so complicated, many questions remain regarding eradication of the disease. 

Here are some practical suggestions: 

1. Have your dog radiographed before breeding to be sure the hips are normal.  If they are not, this dog should not be bred.

2. Consider a feeding program to slow growth.  There is a growing body of evidence indicating that dogs that grow very rapidly are more likely to have hip dysplasia.  Many authorities recommend feeding a dog food specially made for large-breed puppies or an adult-type food to puppies of high risk breeds so their growth is slower. They will still reach their full genetic body size, but just not as rapidly.

3. Avoid excessive exercise in a growing puppy.  Any abnormality in the structure of the hip joint is magnified if excessive running and jumping occur.  It is not necessary to treat your puppy as it were handicapped, but long sessions of running or chasing thrown objects can be detrimental to joints.

Hip Certification

The Orthopedic Foundation for Animals (O.F.A.) is an organization established for the purpose of standardizing the evaluation process of canine hip radiographs.  The O.F.A. consists of a board of certified veterinary radiologists who are skilled in detecting hip dysplasia.  If the radiographs submitted to the O.F.A. are declared normal, the dog is issued an O.F.A. certificate number indicating that it has normal hip confirmation.  The O.F.A. requires that dogs must be a minimum of two years of age to be certified.  Many breeders require that a dog must have an O.F.A. certificate before breeding is allowed.

Another hip evaluation program is called the PennHip method.  Radiographs are made of the anesthetized dog in such a manner as to place outward force on the hip joints.  This can reveal looseness in the joints that may elude detection by the more standard radiographic methods.  It is also useful in identifying hip dysplasia in puppies as young as 4 months of age.  Although any veterinarian can make the appropriate radiographs and submit them for O.F.A. certification, the PennHip method must be performed by a veterinarian specifically trained and certified in this procedure.

The radiographs must be imprinted with identification information about your dog at the time they are made and developed.  This procedure creates a permanent mark on the radiograph.   In addition, OFA now requires that certified dogs be permanently marked with either a tattoo or a microchip implant.  The implant process is simple and very effective.   A tiny microchip is implanted under your dog’s skin through a special injection needle.  A special scanner can detect these chips through the skin.  They can identify the dog and its owner through its code number and a registry system.  This is also an excellent means of getting lost dogs back home because the registry system is national in scope.

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Hookworm Infection in Dogs

Dogs have many parasites, both internal and external.  Internal parasites are those which live in the various organs inside the dog's body.   Some of the internal parasites migrate through a number of different organs.  Intestinal parasites are internal parasites that live in the small or large intestine (colon).   External parasites, such as fleas, ticks, and mites, live on the outside of the body. 

Hookworms represent a common intestinal parasite of the dog.

Prevalence

Various species of hookworms are found on a worldwide basis.  The most common hookworm of dogs in warm (tropical or subtropical) climates is called Ancylostoma.  The canine hookworm found in cooler climates is called Uncinaria.

Causes/Transmission

Dogs may become infected with hookworms by four routes: orally, through the skin, through the mother's placenta, and through the mother's milk. The oral and transcolostral (through the mother’s milk) routes are the most common.  The latter is of particular importance for puppies.

It is important to note that if a pregnant dog has hookworms, the pregnancy may reactivate larvae.  These larvae will enter the female's circulation and pass to the puppy through the placental blood flow.

Clinical Signs

Hookworms received their name because of the characteristic hook-like mouthparts that they use to attach to the lining of the intestinal wall.  Because they are very small (about 1/8” in diameter), you have to be looking very carefully to see the adult worm.  Despite this, they are one of the most pathogenic worms found in dogs because they suck blood from the tiny vessels in the intestinal wall.  A large number of hookworms can cause anemia; this occurs especially in puppies, but it may even occur in some adult dogs.

A blood transfusion may be needed in some dogs because of the rather severe anemia that can be produced by hookworms.  The presence of pale gums, weakness, and diarrhea (possibly with blood) might suggest the need to specifically determine the dog’s red blood cell count.  Iron deficiency anemia secondary to hookworm infection can be a life-threatening problem for puppies.

Skin irritation and itching can be one of the common signs of a heavily infested environment.  The larvae burrow into the skin and cause the dog a great deal of discomfort.  The most common hookworm of dogs does not appear to have this type of burrowing behavior. 

Diagnosis

Finding hookworm eggs during microscopic examination of a stool sample is diagnostic for the parasite.  Because eggs are produced on a daily basis, they are usually plentiful in number.  The adult female hookworm is reported to produce as many as 20,000 eggs a day!

In puppies, adequate numbers of worms may not be present for production of ova.  For this reason, fecal examination may be less reliable in puppies than in adult dogs. 

Treatment

There are a number of effective drugs that will kill hookworms.  These are given by injection or orally and have few, if any, side effects.  However, these drugs only kill the adult hookworms.  Therefore, it is necessary to treat again in about 3-4 weeks to kill any newly formed adult worms that were larvae at the time of the first treatment.

Since the dog's environment can be laden with hookworm eggs and larvae, it may be necessary to treat it with a chemical to kill them.  There are several available products that are safe to use on grass.

Prognosis

Hookworms can be life threatening for young puppies and for adult dogs lacking immunity to the parasite.  Puppies who suffer severe hookworm infection may be stunted and never reach their full growth potential. In general, the prognosis is good for adult dogs.

Transmission to Humans

Adult hookworms do not infect humans internally.  However, the larvae can burrow into human skin.  This causes itching, commonly called "ground itch," but the worms do not mature into adults.  Direct contact of human skin to moist, hookworm infested soil is required.  Fortunately, this does not occur very often if normal hygiene practices are observed.

In rare instances, the canine hookworm will penetrate into deeper tissues and partially mature in the human intestine.  A few reports of hookworm enterocolitis (small and large intestinal inflammation) have surfaced in the recent past. 

Prevention

1.  All new pups should be treated by 2-3 weeks of age.  To effectively break the life cycle of the most common intestinal parasites, the pups should be dewormed on the schedule recommended by your veterinarian.
2.  Prompt deworming should be given when parasites are detected; periodic deworming may be appropriate for pets at high risk for reinfection.
3.  Prompt disposal of all pet feces, especially in yards, playgrounds, and public parks.
4.  Strict hygiene is especially important for children.  Do not allow children to play in potentially contaminated environments.  Be mindful of the risk posed by public parks and non-covered sandboxes.  Sandboxes that have fitted covers are popular and are recommended to prevent infection of children with intestinal parasites.
5.  Nursing females should be treated concurrently with their pups; nursing may reactivate infection in the female.
6.  Use of a heartworm preventive that contains medication for prevention/control of hookworms is advisable.

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Hypothyroidism in Dogs

The thyroid gland is one of the most important glands in the body.  It is located in the neck near the trachea and is composed of two lobes, one on each side of the trachea (windpipe).  This gland is controlled by the body’s master gland, the pituitary gland, located at the base of the brain.

The thyroid gland regulates the rate of metabolism.  If it is hyperfunctional, metabolism speeds up.  If it is less functional than normal, metabolism slows down.  The latter is the basis for the clinical signs of hypothyroidism.

Causes

Hypothyroidism is almost always caused by one of two diseases: lymphocytic thyroiditis or idiopathic thyroid gland atrophy.  The former disease is the most common cause of hypothyroidism and is thought to be an immune-mediated disease.  This means that the immune system decides that the thyroid is abnormal or foreign and attacks it.  It is not known why the immune system does this.  Idiopathic thyroid gland atrophy is also poorly understood.  Normal thyroid tissue is replaced by fat tissue in what is considered a degenerative disease.

These two causes of hypothyroidism account for more than 95% of the cases.  The other five percent are due to uncommon diseases, including cancer of the thyroid gland.

Clinical Signs

When the rate of metabolism slows down, virtually every organ in the body is affected in some manner.  Most affected dogs have one or more of several “typical” physical and/or chemical abnormalities.  These include:

Weight gain without an increase in appetite
Lethargy and lack of desire to exercise
Cold intolerance (gets cold easily)
Dry haircoat with excessive shedding
Very thin haircoat to near baldness
Increased pigmentation in the skin
Increased susceptibility to skin and ear infections
Failure to regrow hair after clipping or shaving
High blood cholesterol

Some dogs also have other abnormalities that are not the typical findings.  These include:

                Thickening of the facial skin so they have a “tragic facial expression”
Abnormal function of nerves causing non-painful lameness, dragging of feet, incoordination, and a                                 head tilt
Loss of libido and infertility in intact males
Lack of heat periods, infertility, and abortion in females
Fat deposits in the corneas of the eyes
Keratoconjunctivitis sicca (“dry eye” due to very thick tears)

Diagnosis

The most common test is for the T4 level.  This is a measurement of the main thyroid hormone in a blood sample.  If is below normal and the correct clinical signs are present, the test is meaningful.  However, testing for the T4 level can be misleading because some dogs that are not hypothyroid may have subnormal levels.  This happens when another disease is present or when certain drugs are given.

If hypothyroidism is suspected but the T4 is normal, other tests can be performed.  These are more expensive so they are not used as first line tests.

Treatment

Hypothyroidism is treatable but not curable.  It is treated with oral administration of a thyroid replacement hormone.  This drug must be given for the rest of the dog’s life.

There is a standard dose that is used initially; it is based on the dog’s weight.  However, after about one month of treatment, further testing is done to verify that the thyroid hormone levels are normal.  In some dogs, the dose will need to be further adjusted every 6-12 months.

Overdosing of Thyroid Medication

Signs of hyperthyroidism can be caused.  These include hyperactivity, lack of sleep, weight loss, and an increase in water consumption.  If any of these occur, notify us so that a proper adjustment can be made.

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Inflammatory Bowel Disease in Dogs

Inflammatory bowel disease (IBD) is an important and relatively common medical problem of dogs.  It is not a specific disease; rather, the term IBD represents several processes that are manifested as inflammation of the bowel.  It may involve only the small intestine, large intestine, or stomach; in some cases, all parts of the gastrointestinal tract are affected.

Prevalence

IBD most often occurs in middle-aged dogs, although it may occur in any age dog.  Males and females are equally affected.  It may be more common in Rottweilers and German Shepherd Dogs as compared to other breeds.

Causes/Transmission

In most dogs, the cause (or causes) of IBD are not found.  When a cause is not identified, it is called “idiopathic IBD.”  Some of the identified causes include infection with certain types of bacteria or other parasites, toxins, dietary intolerance, or immune reactions.  Regardless of the cause, the lining of the intestine (mucosa) becomes damaged by the inflammatory process and allows transport of proteins across the normally intact barrier.  These proteins are intended to remain confined to the inside of the intestine and are not recognized by the immune system.  The immune system tries to process these foreign proteins and it leads to further damage of the intestinal lining.

Clinical Signs

Three general presentations have been identified for IBD: (1) dogs with primarily vomiting, (2), dogs with primarily diarrhea, and (3) dogs with both vomiting and diarrhea.  It often begins as an intermittent event but, over months to years, progresses to the point that medical care is sought. 

Diagnosis

Chronic inflammation stimulates immune cells, primarily lymphocytes and plasma cells, to invade the stomach and/or intestinal wall.  Occasionally, eosinophils and neutrophils will be found.  Thus, the disease is diagnosed when these cells are identified in abnormal numbers in the tissue.  A pathologist is responsible for this part of the diagnosis; his or her report usually calls the disease lymphoplasmacytic gastritis (stomach), lymphoplasmacytic enteritis (intestine), or lymphoplasmacytic colitis (colon). 

In order to obtain these cells, a biopsy is required.  In most cases, an endoscope is passed into the dog’s stomach, small intestine or colon (with the dog under anesthesia).  A tiny biopsy instrument is passed through the endoscope and used to take small samples of the lining (mucosa) of the affected organ.  These biopsies, while fairly superficial, are extremely helpful in determining the type of cells present.

While the presence of an inflammatory process is determined with a biopsy, isolating the cause of the inflammation will usually require other tests.  Tests or treatments should be performed to rule out stomach and intestinal parasites, cancer, and infections.  In addition, diseases of the kidney, liver, and pancreas should also be ruled out.  In many cases, the cause cannot be determined.

Treatment

When possible, an underlying cause is identified and treated.  Sometimes the above mentioned tests will do that, and sometimes a cause cannot be found.   Unfortunately, many cases of IBD are considered idiopathic.

Some dogs with IBD respond to a change in diet.  This is done in two ways.  First, a food is chosen that contains a protein source that the dog has not eaten in the past.  If changing protein sources is not helpful, a high-fiber diet is tried.  Unfortunately, a true food trial requires that the test diet be fed exclusively for 4-6 weeks.

If dietary therapy is not successful or feasible, drugs are used to suppress the inflammatory reaction.  Corticosteroids (“cortisone”) are the most effective so they are used first.  Prednisolone is the most effective of the corticosteroids and has the least side effects.  However, it is not effective in all dogs.  Sometimes a stronger drug is used initially to gain control of the disease.  Then, prednisolone is tried again as a maintenance drug.  Other drugs can be tried if corticosteroids are not successful.

Corticosteroids are renowned for causing a variety of side effects in humans.  This is not a much a problem in dogs as humans; however, to minimize any possible adverse effects, our goal is to use the lowest possible dose that is effective and to administer it on an “every other day” schedule.  By giving prednisolone every other day, the last dose is out of the body for about 12 hours before the next dose is given.  During this 12 hour period, the adrenal glands are stimulated to function and the body does not forget how to manufacture its own corticosteroids.

It will be necessary to begin therapy with a rather high dose, but once response occurs, the dose is gradually tapered to the point that the signs are controlled.  Long-term therapy is required for many dogs.  Generally, a dog is treated for a few months then prednisolone is tapered to a lower dose to see if it is still needed.  If the signs of vomiting or diarrhea recur, it is resumed.

Prognosis

In most cases, it is reasonable to hope for control of the disease.  However, unless a specific cause can be identified, a cure is not expected.  Also, the intestinal biopsies taken with the endoscope can be helpful in determining the severity of the IBD, which helps in considering prognosis.  In some cases of severe lymphoplasmacytic IBD, the dog will progress to a malignant process, called intestinal lymphoma.  This has a grave prognosis.

Transmission to Humans

IBD is not transmitted to humans.  Potentially, some of the parasitic causes of IBD could be infectious to humans but, in most cases, a cause is not identified.

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Icterus in Dogs

 Icterus is also known as jaundice or yellow jaundice.  It means that a yellow pigment is found in the blood and in the tissues.  It is most easily seen in the gums, the sclerae (white part of the eyes), and the pinnae (ear flaps).  However, if these tissues normally have a dark color, icterus will probably not be seen.

Causes/Transmission

The causes of icterus fall into three major categories:

Destruction of red blood cells.  This can occur within blood vessels (intravascular) or in the spleen and liver (extravascular).  The process of red cell destruction is known as hemolysis.

Liver disease.  Any disease that causes destruction of liver cells or causes bile to become trapped in the liver can cause icterus.

Obstruction of the bile duct.  The bile duct carries an important fluid for digestion (bile) from the gall bladder to the small intestine.  Obstruction can occur within the gall bladder or anywhere along the bile duct.

Clinical Signs

Regardless of the underlying cause, dogs with icterus are often weak and depressed.  If the dog is very anemic, these signs may be even more pronounced.  In addition to the yellow color of the skin, the urine often is dark yellow.  In a rare instance, the bile duct is completely obstructed and the dog’s feces will appear pale gray or whitish in color.

Diagnosis

Within each category listed above are several possible causes.  Determining the cause of icterus requires a series of tests.  Some of these tests determine which category is involved.  Once that is known, other tests are done to look for a specific disease that is leading to the icteric state.

1. Hemolysis   Hemolysis can be caused by toxic plants, chemicals, or drugs, parasites on the red blood cells, heartworms, autoimmune diseases, and cancer.  Several tests are needed to determine which of these is the cause. 

Since hemolysis results in red blood cell destruction, determination of red blood cell numbers is one of the first tests performed on the icteric patient.  There are three tests that may be used for this.  The red blood cell count is an actual machine count of red blood cells.  The packed cell volume (PCV) is a centrifuge-performed test that separates the red blood cells from the serum or plasma (the liquid parts of the blood).  The hematocrit is another way to determine if there is a reduced number of red blood cells.  All three of these tests are part of a complete blood count (CBC).

2. Liver Disease   The most common causes of liver disease include bacterial infections, viral infections, toxic plants, chemicals, or drugs, cancer, autoimmune diseases, and certain breed-specific liver diseases.

A chemistry profile is performed on dogs with icterus.  This is a group of 20-30 tests that are performed on a blood sample.  The chemistry profile contains several tests that are specific for liver disease.  The main ones are the ALT, AST, alkaline phosphatase (ALP), and total bilirubin.   If these tests are normal, and there is reason to suspect liver disease, a bile acid analysis is performed. 

Although these all look at the liver from a slightly different perspective, ultimately they only determine that liver disease is occurring.  None of them are able to determine the exact cause of the disease.  To make that determination, a biopsy of the liver is necessary.  This can be done in three ways.

A.  Fine-needle aspirate or biopsy.  To perform this procedure, a small gauge needle is inserted through the skin into the liver.  A syringe is used to aspirate some cells from the liver.  The cells are placed on a glass slide, stained, and studied under a microscope.  This is the least invasive and quickest test, but it has certain limitations.  Because only a few cells are obtained, it is possible that a representative sample from the liver will not be obtained.  It is also not possible to view the cells in their normal relationship to each other (i.e., tissue architecture).  Some diseases can be diagnosed with this technique, and others cannot.

B.  Needle biopsy.  This procedure is similar to the fine-needle aspirate except a much larger needle is used.  This needle is able to recover a core of tissue, not just a few cells.  The sample is fixed in formaldehyde and submitted to a pathologist for analysis.  General anesthesia is required, but the dog is anesthetized for only a very short period of time.  If it is done properly and with a little luck, this procedure will recover a very meaningful sample.  However, the veterinarian cannot choose the exact site of the liver to biopsy because the liver is not visible.  Therefore, it is still possible to miss the abnormal tissue.

C.  Surgical wedge biopsy.  The dog is placed under general anesthesia, and the abdomen is opened surgically.  This permits direct visualization of the liver so the exact site for biopsy can be chosen.  A piece of the liver is surgically removed using a scalpel.  This approach gives the most reliable biopsy sample, but the stress of surgery and the expense are the greatest of all of the biopsy methods.  Bleeding from the biopsy site is a potential complication from this procedure so coagulation tests are often performed prior to needle biopsy or surgical biopsy.

3. Obstruction of the bile duct.  Obstruction of the bile duct may occur as a consequence of pancreatitis (inflammation of the pancreas), cancer, trauma to the abdomen, thickened bile that is sludged in the bile duct, or a stricture of the bile duct. 

Important tests for diagnosis of these disorders include a CBC, chemistry profile, abdominal x-rays, abdominal ultrasound, and specific tests for pancreatitis.

Treatment

General supportive care for liver disease often includes intravenous fluid therapy and antibiotics.  Additional treatment is dictated by the underlying cause of the icterus.

Prognosis

Prognosis is dependent upon identification and successful treatment of the underlying cause. 

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Inhalant Allergy in Dogs

One of the most common conditions affecting dogs is allergy.  In the allergic state, the dog's immune system "overreacts" to foreign substances (allergens or antigens) to which it is exposed.  These overreactions are manifested in three ways.  The most common is itching of the skin, either localized (one area) or generalized (all over the dog).  Another manifestation involves the respiratory system and may result in coughing, sneezing, and/or wheezing.  Sometimes, there may be an associated nasal or ocular (eye) discharge.  The third manifestation involves the digestive system, resulting in vomiting or diarrhea.

Types of Allergy

There are five known types of allergies in the dog: contact, flea, food, bacterial, and inhalant.  Each of these has some common expressions in dogs, and each has some unique features.

Inhalant Allergy

The most common type of allergy is the inhalant type, also known as atopy.  Dogs may be allergic to all of the same inhaled allergens that affect humans.  These include tree pollens (cedar, ash, oak, etc.), grass pollens (especially Bermuda), weed pollens (ragweed, etc.), molds, mildew, and the house dust mite.  Many of these allergies occur seasonally, such as ragweed, cedar, and grass pollens.  However, others are with us all the time, such as molds, mildew, and house dust mites.

When humans inhale allergens, we express the allergy as respiratory problems.  These include coughing, sneezing, a runny nose, and watery eyes.  The dog's reaction, however, usually produces severe, generalized itching.  It will chew, lick, or scratch almost any area of the body, including the feet.  Chewing and scratching produce hair loss and inflamed areas of the skin.  Saliva will stain light colored hair, so dogs that lick excessively will have orange or reddish brown hair.  This is often seen on the feet.  Although most people think that itching is related to fleas, the most common cause of itching in the dog is inhalant allergy.

Determining the Cause

Determining the offending allergin is not something that we can do easily.  The itching produced by ragweed allergy is the same as that produced by oak pollen allergy.  In other words, an individual animal or person can be allergic to many different things with the end result (itching) being the same.  In some cases, allergy testing can make specific determinations, and sometimes an educated guess can be accurate if the itching corresponds with the blooming season of certain plants.  However, it is not always necessary to know the specific allergen for treatment to be successful. 

Seasonal vs. Year Round Allergy

As the names imply, some dogs only have allergic reactions during specific periods of the year.  Others will itch year round.  A year round allergy occurs for two reasons.  First, the allergen is present year round.  This is the case for indoor dogs that are allergic to house dust mites, also known as “house dust.”  Second, the dog is allergic to so many things that at least one of those allergens is present at all times.

Even though many dogs begin with allergies on a seasonal basis, they often have problems year round after a couple of years.  With the passage of time, it usually becomes allergic to more and more things.  After several years of acquiring new allergies, it reaches the point that it is constantly exposed to something to which it is allergic.

Grass Allergy

Dogs that are allergic to “grass” are really allergic to grass pollen, not to the grass itself.  The blades of grass will cause no harm to your dog so walking in it is not a problem.  Bermuda grass is the most allergenic grass because it releases so much pollen into the air.  Keeping it mowed so it does not pollinate seems logical, but your neighbors must do the same because the pollen is airborne.  The same principle applies to trees.  Dogs are not allergic to the wood of a certain tree, only to its pollen.

Treatment Options

Our recommendation for treatment depends largely on the length of your dog's allergy season and involves four approaches: 

1. Anti-inflammatory drugs.  Anti-inflammatory therapy will dramatically block the allergic reaction in most cases.  Steroids (“cortisone”) may be given orally or by injection, depending on the circumstances.  If steroids are appropriate for your dog, you will be instructed in their proper use.  Antihistamines can be of value in treating the allergic dog when they are combined with steroids.  In some dogs, antihistamines can significantly decrease the amount of steroid needed to provide relief.  Fatty acid supplementation can also be implemented with steroids and antihistamine.  When the three of them are combined, most allergic dogs are significantly improved.  This is a non-specific approach which does not treat the allergy, only the result of the allergic state (itching).

2. Shampoo therapy.  Many dogs are helped considerably by frequent bathing with a hypoallergenic shampoo.  It has been demonstrated that some allergens may be absorbed through the skin.  Frequent bathing is thought to reduce the amount of antigen exposure through this route.  In addition to removing surface antigen, bathing alone will provide some temporary relief from itching and may allow the use of a lower dose of steroids.  Some of the hypoallergenic shampoos incorporate fatty acids; these may be absorbed through the skin and offer a localized anti-inflammatory action.  The role of the fatty acids in allergy treatment is an area of active research interest in veterinary medicine.

3. Antibiotics.  Dogs that damage their skin by licking, chewing, and scratching are quite susceptible to bacterial infections in the skin.  If this occurs, antibiotic should be given until the infection is controlled.  The skin infection itself can be quite irritating and cause a dog to itch even more.

4. Hyposensitization.  The third major form of allergy treatment is hyposensitization with specific antigen injections (or "allergy shots").  Once testing identifies the specific allergens, very small amounts of the antigen are injected weekly.  The purpose of this therapy is to reprogram the body's immune system.  It is hoped that as time passes, the immune system will become less reactive to the problem-causing allergens.  If hyposensitization appears to help the dog, injections will continue for several years.  For most dogs, a realistic goal is for the itching to be significantly reduced in severity; in some dogs, itching may completely resolve.  Generally, steroids are only used on a brief and intermittent basis.  This therapeutic approach is recommended for the middle-aged or older dog that has year round itching caused by inhalant allergy.

Although hyposensitization is the ideal way to treat inhalant allergy, it does have some drawbacks and may not be the best choice in certain circumstances and for these reasons: 

1. Cost: This is the most expensive form of treatment. 
2. Age of Patient: Because many dogs develop additional allergies as they get older, young dogs may need to be retested 1-3 years later.
3. Success Rate: About 50% of dogs will have an excellent response, about 25% get partial to good response, and the remaining 25% get little or no response.  The same statistics are true for people undergoing hyposensitization.
4. Food Allergies: Although tests for food allergy are available, the reliability of these tests is so low that it is not recommended at this time.  A food trial remains the best diagnostic test for food allergy.
5. Time of Response: The time until apparent response may be 2-5 months, or longer. 
6. Interference of steroids: Dogs must not receive oral steroids for 2 weeks or injectable steroids for 6 weeks prior to testing; these drugs will interfere with the test results.

How Fleas Relate

A dog with inhalant allergy will itch even if fleas are not present.  However, if fleas are crawling around on your dog, the itching will increase.  Although getting rid of all of your dog’s fleas will not stop the itching, it will make it much easier to control the itching successfully.

Terrible Skin Odor

There are two possible causes of odor associated with inhalant allergy.  These dogs are very prone to ear infections because the ear canal is an extension of the skin.  When it becomes inflamed, it is easily infected.  These dogs are also likely to have seborrhea.

Sebum is the oily material normally produced in the skin.  When a dog scratches, sebum production increases dramatically.  This produces a musty odor.  A bath will remove the odor, but it is gone for only a few hours.  The key to controlling seborrhea is to stop the itching and scratching.

Hypothyroidism

Hypothyroidism is a disease in which the thyroid gland does not produce enough thyroid hormone.  This has many effects on the body because it controls the rate of metabolism.  Hypothyroid dogs frequently have abnormalities of the skin and haircoat.  Skin infections (which themselves may increase itching) are common with this hormonal disorder and may aggravate allergic conditions.

A simple blood test will make the diagnosis in most dogs.  However, for some dogs, the thyroid value falls into a "gray zone," and further testing of the thyroid gland is necessary to confirm a diagnosis.  Sometimes, illness will cause a dog to have low thyroid values when hypothyroidism is not really present. 

Hypothyroidism can be treated with thyroid replacement hormone tablets.  Without treatment for this disease, treatment for inhalant allergy is more difficult.

Treatment Failure

There are two scenarios in which there will be disappointing results to treatment.  The first scenario is when tablets are given and the response is poor.  A few dogs will respond better to injectable steroids than to the oral form.  Fortunately, this only occurs about 5% of the time.  However, successful management of itching in those dogs will require periodic injections of steroids, if the itching cannot be controlled with other drugs or other forms of treatment.

The other scenario is either a total failure to respond to injectable or oral steroids or a response to an injection is short-lived, lasting only a few days instead of a few weeks.  This could occur because the dose was too low; however, it may also mean that the dog has food allergy.  Food allergy causes itching and scratching identical to inhalant allergy, but it responds very poorly to steroids.  Food allergy is diagnosed with a food trial using a hypoallergenic diet.

INSTRUCTIONS:  Those instructions that are specific for your dog have been checked:

___ 1)  An injection of steroids was given.  Relief should be apparent within 12-24 hours.  If not, please call.  The dog should feel better and itch less for about one month.  If an increase in water consumption or urination occurs, please report this to us for future reference.  These side effects are common with steroid administration and will go away in a few days without treatment.  Return for further evaluation when the first signs of itching recur.

___ 2)  Begin oral steroids when the first signs of itching return.  Give ____ tablets every other morning.  Adjust the dosage upward or downward to the lowest effective dose, with a maximum dose of __________ permitted.  Stop giving the medication every 4-6 months to see if there are times of the year when therapy is not needed.  Report any increase in water consumption to us at once.

___ 3)  We have dispensed oral steroid tablets.  Prednisone is most commonly used.  The specific drug being dispensed for your dog is labeled on the bottle.  Give ____ of the ____ mg tablets every other day for 3 doses (6 days), then ____ tablets every other day for 3 more doses (6 more days).  Continue this downward progression (___________________________________) until the first signs of itching recur.  At that time, go back to the next higher level and report that level to us (so we can be sure it is a safe level).  Stop giving the tablets every 4-6 months to see if there are periods of the year when they are not necessary.  When itching returns, begin immediately at the maintenance dose.  If that does not stop the itching, increase the dosage slightly (to a maximum of ___ tablets) for a few doses, then return to the lower dose.  Report any increase in water consumption to us at once.  (This may occur at the initial dose but should stop on the maintenance dose.)

___ 4)  Your dog has a bacterial skin infection secondary to allergy.  The following are recommended:

___a) Antibiotics are to be used for the next _____ days.  If the infection is not gone by the time the medication is completed, call for a refill or for a change in medication.

___b) The medicated shampoo,_____________________, is to be used every _____ days.  Allow the shampoo to stay in the haircoat for 5-10 minutes before thoroughly rinsing the dog.

___c) The topical medication,_____________________, is to be used ______ times daily for __________  days.

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Chronic Kidney Disease in the Dog

Chronic kidney disease is a relatively common disorder in dogs, especially geriatric dogs, although it can occur in young dogs.  It occurs when the kidneys are no longer able to perform their normal function of removing waste products from the blood.  This is not the same as the inability to make urine.  In fact, most dogs with renal disease are producing large volumes of urine.  This disparity between the large volume of urine produced and declining kidney function are often a source of confusion for owners. 

Typically, chronic kidney disease comes about as the kidneys undergo aging changes and begin to “wear out.”  It is a process that develops over months to years.  Initially, there may be no apparent signs and the dog’s bloodwork is normal.  However, there are irreversible microscopic changes underway in the aging kidney.   Eventually, the kidneys will begin to shrink because of scar tissue and will become small and hard.  By this time, there are usually signs of progressive kidney disease and the labwork will indicate associated changes. 

The kidneys are nothing more than filters which selectively keep certain compounds in the blood, while allowing unnecessary waste products to escape into the urine.  When aging causes the filtration process to become progressively less effective, blood flow to the kidneys increases in an attempt to improve filtration.  This is the reason that the dog with kidney disease is producing a large volume of urine.  Because of the loss of excessive fluid through the urine, the dog is obligated to drink more water to avoid becoming dehydrated.  This is called a compensatory change.

Thus, the early clinical signs of kidney disease are increased water consumption (polydipsia) and increased urine production (polyuria).

Contributing Factors

Infection in the urinary tract, toxic substances, and kidney stones can be a primary cause of kidney disease or can lead to deterioration of function in previously diseased kidneys.  However, in many cases of advanced chronic kidney disease, the underlying disease cannot be determined.

Prevalence

Various clinical studies have evaluated the prevalence of renal disease in dogs.  For most dogs, onset of clinical signs begins anywhere from 7-12 years of age.  However, the prevalence of overt kidney disease is highest in dogs older than twelve years of age.  One study found that approximately 30% of dogs over 12 years of age had chronic renal disease.

The frequency of renal disease in male dogs is essentially the same as for female dogs.

Renal disease in young dogs is most likely due to a congenital defect in the structure of the kidneys.  A number of breeds are at risk for juvenile kidney disease; these include the Shih Tzu, Samoyed, Doberman pinscher, Shar Pei, Lhasa Apso,  and Basenji. 

Causes/Transmission

In most cases, a specific cause cannot be identified.  A number of infectious, inflammatory, or neoplastic (cancerous) conditions can lead to kidney disease in the dog.

Clinical Signs

As described above, the classic signs of kidney disease are increased urine output and a compensatory increase in water intake (thirst).  The clinical signs of more advanced kidney disease include loss of appetite, weight loss, depression, vomiting, diarrhea, and very bad breath.  Occasionally, ulcers will be found in the mouth.  When kidney disease is accompanied by these clinical signs, it is called "uremia."  In effect, this means "urine in the blood."  High blood pressure (hypertension) occurs in a large number of dogs with chronic renal disease.  This can only be diagnosed with measurement of the dog’s blood pressure.

For most small dogs, the early signs occur at about 10-14 years of age.  However, large dogs have a shorter age span and may develop kidney disease as early as 7 years of age.  For dogs with congenital kidney disease, signs usually occur by 2 years of age.

Diagnosis

The diagnosis of kidney disease is made by determining the level of two waste products in the blood:  blood urea nitrogen (BUN) and creatinine.  A urinalysis is also needed to complete the study of kidney function.

Although BUN and creatinine levels reflect kidney disease, they do not predict it.  A dog with marginal kidney function may have normal blood tests.  If that dog is stressed with major illness or surgery, the kidneys may fail, sending the blood test values up quickly.

Treatment

Treatment occurs in two phases. 

Phase 1 - Diuresis. 

In the first phase of treatment, large volumes of intravenous fluids are given in an attempt to flush toxins from the body.  This flushing process, called diuresis, is designed to maximize the function of all remaining kidney tissue.  If enough functional kidney cells remain, they may be able to adequately meet the body’s needs for waste removal, with the help of this additional fluid.  Also, the fluid therapy helps to replace various electrolytes, especially potassium.  Other important aspects of initial treatment include proper nutrition and drugs to control vomiting and diarrhea.

Unfortunately, there are no reliable tests that will predict the outcome of this first phase of treatment.  We hope that intensive fluid therapy will substantially decrease the blood levels of BUN and creatinine.  If there is no improvement after 3+ days of fluid therapy, the prognosis is more guarded than for dogs who show significantly decreased values.

Phase 2 - Ongoing medical therapy.

The second phase of treatment is designed to maximize the remaining function of the diseased kidneys.  This is accomplished with one or more of the following, depending on the situation:

1. A low protein, low phosphorous, low sodium diet.  This helps to keep the blood tests as close to normal as possible.  This improvement in the bloodwork often correlates with improvement in the way the dog feels.  We can recommend a commercially prepared food that has the quantity and quality of protein needed by your dog.  The new diet should be introduced gradually over a few weeks because of the lowered sodium content. 

2. A phosphate binder.   As the filtering ability of the kidneys declines, phosphorous begins to accumulate in the blood.  High serum phosphorous contributes to depression and anorexia.  Certain drugs will bind excess dietary phosphorous in the intestine so that less is available for absorption.  Blood levels of phosphorous can be monitored to help tailor the drug dosage.

3. Fluids given at home.  After your dog has completed a course of intravenous fluid therapy in the hospital, fluid can be given at home.  The fluid is dripped  under the skin, or subcutaneously.  This serves to continually “restart” the kidneys as their function continues to decline.  This is done once daily to once weekly, depending on the severity of kidney disease.  This technique is easily mastered by most owners so don’t be afraid to consider this very helpful option.

4. A drug to regulate the parathyroid gland and calcium levels.  Calcium and phosphorus must remain at about a 2:1 ratio in the blood.  The increase in blood phosphorus level, as mentioned above, stimulates the parathyroid gland to increase the blood calcium level by removing it from bones.  This can be helpful for the sake of the normalizing calcium:phosphorus ratio, but it can make the bones brittle and easily broken.  Calcitriol can be used to reduce the function of the parathyroid gland and to increase calcium absorption from the intestinal tract.

5. A drug to stimulate the bone marrow to produce new red blood cells.  The kidneys produce erythropoietin, a hormone that stimulates the bone marrow to make red blood cells.  Therefore, many dogs with kidney disease have a low red blood cell count, anemia.  Epogen, a synthetic form of erythropoietin, will correct the anemia in most dogs.  Unfortunately for some dogs, the drug cannot be used long term because the immune system recognizes the drug as "foreign" and will make antibodies (immune proteins) against it.  Another class of drugs, called “anabolic steroids,” may also be used, although their effectiveness is less predictable.

6.  For dogs with confirmed high blood pressure (hypertension), medication may need to be administered.

7.  Stressful situations, such as boarding, should be avoided as these can precipitate a crisis with declining kidney function.

Prognosis

The prognosis is quite variable depending on response to the initial stage of treatment and your ability to perform the follow-up care.   However, we encourage treatment in most situations because many dogs will respond and have good quality life for up to 4 years.

Prevention

For the most part, kidney disease is not a preventable disease.  It occurs as a consequence of aging. 

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Leptospirosis in Dogs

Leptospirosis is an important and relatively complex infectious disease of dogs.  It can affect almost all species of warm-blooded animals, including humans. 

Recognition of the disease is sometimes difficult because clinical signs will vary depending upon the particular serovar, or strain, of the Leptospira organism that has infected the dog.  At least ten different serovars are known to infect dogs.  Most commercial vaccines contain antigens (proteins) which stimulate immunity against the icterohemorrhagiae and canicola serovars.  The incidence of disease caused by these two serovars has decreased because of vaccines; however, other serovars are becoming more common in the animal population.

Prevalence

Leptospirosis occurs on a worldwide basis, especially in subtropical climates.  Although the organism cannot reproduce outside of the host animal, it can survive for prolonged periods of time in water or wet soil.  It is found in both urban and rural environments.  Most cases in dogs are reported in the summer and early fall of the year. 

Leptospirosis can develop in any age, breed or gender of dogs. 

Causes/Transmission

The leptospire organism is a unique type of bacterium called a “spirochete.”  The name is derived from its slender, coiled (spiral) appearance under the microscope. 

The organism is shed in the urine of the infected animal.  It enters the new host animal by penetrating mucous membranes or entering through abraded (open) skin.  Infrequent routes of transmission to new hosts include venereal contact, through bite wounds, by ingestion of the organism, and through the placenta.

Clinical Signs

Once the organism has infected the dog, it can replicate (reproduce) in many different tissues.  In dogs, the greatest numbers of organisms are usually found in the liver and kidneys.  The signs can be dependent upon which strain of the organism is involved.  For example, one particular strain of Leptospira impacts primarily on the liver, whereas another involves the kidneys.

In many dogs, the disease is subclinical, meaning that there are no specific signs.  Dogs who have a rapid onset of signs following infection (peracute infection) will have fever, depression, weakness, vomiting, and muscle pain.  The skin may have a jaundiced (yellow) tint and the mucous membranes (gums) will be pale.  The pulse and respiration rates may be increased and shock will develop.  If clotting problems occur because of damage to the lining of blood vessels, hemorrhage from the nose or bowel develops; obvious bruises will appear under the skin.  If the disease progresses to this point, death can rapidly follow from liver or kidney failure.

Dogs who do not develop more acute infections or survive such infections may go on to develop chronic liver or kidney problems.  In fact, the majority of dogs do not have the peracute infection described above, but are chronically infected.  The infection may be subclinical, meaning that there are no apparent signs.

Diagnosis

In many cases, a presumptive diagnosis can be made based on the dog’s clinical signs, vaccination history, and potential exposure to the organism. 

Diagnosis is complicated because it is difficult to find the organism in tissue samples or urine.  The most common laboratory test involves detection of increasing levels of antibody (protein) in the blood over a period of two to four weeks.  The antibody is produced as an immune response against the organism.  Some newer tests are on the horizon, such as the polymerase chain reaction test (PCR).  This is a test to detect DNA of the organism.  This particular assay is only available in a few laboratories at this time.

Treatment

Treatment of infected dogs involves appropriate antibiotic therapy and good supportive care. 

Antibiotic therapy involves two phases.  The first phase is designed to inhibit reproduction of the organism, decrease shedding of it into the urine, and to protect the liver and kidneys from fatal complications.  Most commonly, penicillin injections are given for about two weeks and are followed with another antibiotic. The second phase is aimed at eliminating residual organisms from the kidney.   Appropriate antibiotics can include drugs in the streptomycin or tetracycline families.

Supportive care of animals who show clinical signs will primarily involve intravenous fluid therapy.  Fluids support the animal’s hydration status and blood pressure.  Fluids also help preserve blood flow through the kidneys; this is important if kidney function is to be salvaged. 

Because of the number of organ systems that can be affected by leptospirosis, blood work (cell counts and blood chemistries) need to be performed frequently during early stages of treatment.

Prognosis

The prognosis is dependent upon several factors, including the strain of the organism, the dog’s vaccination status, damage done to individual organ systems, and the dog’s response to treatment.  In general, dogs that have a peracute infection are more likely to die than those more chronically infected.

Transmission to Humans

There is risk of the infected dog transmitting leptospiral organisms to humans.  As such, special precautions must be taken when handling these patients; in particular, contact with the dog’s urine must be avoided.  Even for dogs that appear recovered, the organism can be shed into the urine in large numbers for many months after treatment is completed.

The Centers for Disease Control receives reports of about 50-100 human infections per year. 

Prevention

Most commercially available vaccines protect dogs against the icterohemorrhagiae and canicola serovars, but they do not provide immunity against other important serovars.  Vaccines that protect against up to five serovars are under development. 

In areas where leptospirosis is prevalent, vaccinations should be boostered frequently. 

Some types of leptospirosis vaccines are associated with adverse reactions.  For dogs that have had a reaction to the leptospirosis vaccines, recommendations are made by the veterinarian on an individual basis.

Vaccines reduce the severity of the disease but do not prevent some dogs from becoming chronic carriers of leptospirosis.

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Lick Granulomas in Dogs

A lick granuloma is an open sore on the skin caused by and perpetuated by constant licking.  It is generally located on one of the legs, especially near the carpus (wrist) joint.  Typically, the hair will be licked off and the area will be either raw and weeping or thickened and scar-like.

Lick granulomas usually begin with an itching or tingling sensation on the leg.  The dogs respond to that by licking; this may serve to further increase the itching or tingling.  Very shortly, a viscous cycle develops, creating a habit much like a child sucking its thumb.  Even if the problem that initiated the itching or tingling sensation is gone, the habit of licking continues.

Breed Susceptibility

Certain breeds are more likely to get lick granulomas.  The occur most commonly in German Shepherds, Doberman Pinschers, Great Danes, Labrador Retrievers, and Irish Setters, but it is possible in any breed.  In addition, male dogs are twice as likely to do this when compared to female dogs.

Cause

There is not agreement on the reason that some dogs develop this compulsion to lick.  There are three basic views on the subject.  Some see it as a primary skin disorder.  Some see it as a behavioral problem, and some see it as a neurologic disease involving the nerves in the area.  It is likely that most lick granulomas have more than one cause or a single cause with one or more contributing problems.

Diagnosis

In most cases, the diagnosis is made based on the appearance and location of the lesion and the fact that the dog has a compulsion to lick the area.  However, certain skin tumors, parasites, embedded foreign bodies, and allergies can create lesions that look very similar.  In addition, trauma that causes bone fractures or nerve injury can also lead to constant licking, creating a similar lesion.  Therefore, if the diagnosis is in doubt or if the dog does not respond well to initial treatment, fungal cultures, radiographs (x-rays), and biopsies may be recommended.

Treatment

Many approaches have been taken to this problem, and none have been successful in all cases.  Often, success is only achieved after several “trial-and-error” attempts have been made.

The approach to treatment generally begins by trying to eliminate potential psychological factors.  Boredom and stress are important issues that should be addressed.  It has been suggested that another dog be acquired to keep the affected dog distracted from the licking cycle.  Since this approach may not be successful, it should be limited to situations in which acquisition of another dog has already been a consideration.

If no initiating cause can be found and eliminated, various medications are used.  These fall into two categories: drugs to deaden feeling or relieve inflammation in the area and mood-altering drugs.  In many cases, a drug in each category will be used simultaneously as a means of attacking the problem from both angles.

Some dogs respond best with combination drug therapy and the use of restraint collars.  These collars are wide enough to obstruct the dog’s access to the lick granuloma.  They may be needed for 6-8 weeks. 

Many dogs develop secondary bacterial infections within the lick granuloma.  Long-term antibiotic therapy of 6-8 weeks duration can be helpful in some situations.

Some rather aggressive and unusual treatments have been used with variable degrees of success; improvement is seen in 20-40% of cases.  These alternative treatments include radiation therapy, surgical excision of the lesion, cryosurgery (freezing), and the injection of cobra antivenin.

Prognosis

This is one of the most difficult medical problems that happen to the dog.  Because the initiating factor is usually not identified and because there is such a strong habit that forms, treatment can be very frustrating.  Regardless of the initial treatment chosen, it is always possible that it will not be successful.  If that happens, important that you communicate that to us so another avenue can be pursued.

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Luxating Patella
(Dislocated Kneecap)

The patella, or kneecap, should be located in the center of the knee joint.  The term "luxating" means out of place or dislocated.  Therefore, a luxating patella is a kneecap that moves out of its normal location.

Contributing Factors

The muscles of the thigh attach, directly or indirectly, to the top of the kneecap.  There is a ligament, the patellar ligament, running from the bottom of the kneecap to a point on the tibia just below the knee joint.  When the thigh muscles contract, the force is transmitted through the patella and through the patellar ligament to the point on the top of the tibia. This results in extension (straightening) of the knee.  The patella stays in the center of the leg because the point of attachment of the patellar ligament is on the midline and because the patella slides in a groove on the lower end of the femur (the long bone which fits between the knee and the hip).

Prevalence

Patellar luxation is most common in small toy breeds of dogs.

Causes/Transmission

The patella luxates when the point of attachment of the patellar ligament is not on the midline of the tibia.  It is almost always located too far medial (toward the midline of the body).  As the thigh muscles contract, the force is pulled medial.  After several months or years of this abnormal movement, the inner side of the groove in the femur wears down.  Once the side of the groove wears down, the patella is then free to dislocate.  When this occurs, the dog has difficulty bearing weight on the leg.  It may learn to kick the leg and snap the patella back into its normal location.  However, because the side of the groove is gone, it dislocates again easily.

Clinical Signs

Some dogs can tolerate this problem for many years, some for all of their lives.  However, this weakness in the knee predisposes the knee to other injuries, especially torn cruciate ligaments.  Also, arthritic changes may take place in the joint and make it painful.

Diagnosis

Luxating patellae can be detected with a routine orthopedic examination of the knee joint.

Therapy

A luxating patella can be repaired surgically by relocating the point of attachment of the patellar ligament and by deepening the groove in the femur.  This should be done if your dog has a persistent lameness or if other knee injuries occur secondary to the luxating patella.

Prognosis

Surgical repair is generally very successful.  The prognosis is more favorable when the luxation is not severe or if repair occurs before arthritis develops. 

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Lyme Disease in Dogs

Lyme Disease (not Lyme's Disease) is caused by a spirochete called Borrelia.  A spirochete is a type of bacterium.  It is transmitted to dogs through the bite of a tick.  Once in the blood stream, it is carried to many parts of the body.  It is especially likely to localize in joints.

It was first thought that only a few types of ticks could transmit this disease, but now it appears that several common species may be involved. 

Lyme Disease is named after the city in which it was first discovered, Old Lyme, Connecticut.  Thus, it is called “Lyme Disease” and not “Lyme’s” Disease.

Also a Disease of Humans

Humans also get Lyme disease; however they do not get it directly from dogs.  They get it from being bitten by the same ticks that transmit it to dogs.  Therefore, preventing exposure to ticks is important for you and your dog.

Clinical Signs

Many people having the disease develop a characteristic rash at the site of the bite within 3 to 30 days.  For these people, the disease can be easily diagnosed at an early stage.  However, symptoms of Lyme Disease are more difficult to detect in animals than in people. 

This characteristic rash does not develop in dogs or cats.  Because the other symptoms of the disease may be delayed or not recognized, and because the symptoms are similar to those of many other diseases, Lyme Disease in animals is often not considered until other diseases have been eliminated. 

Many dogs affected with Lyme Disease are taken to a veterinarian because they seem to be experiencing generalized pain and have stopped eating.  Affected dogs have been described as if they were "walking on eggshells."  Often these animals have high fevers.

Dogs may also become lame because of the disease.  This painful lameness often appears suddenly and may shift from one leg to another.  If untreated, it may eventually disappear, only to recur weeks or months later.

Some pets are affected with the Lyme Disease organism for over a year before they finally show symptoms.  By this time, the disease may be quite widespread in the body. 

Diagnosis

Dogs with lameness, swollen joints, and fever are suspected of having Lyme Disease.  However, other diseases may also cause these symptoms.  There are two blood tests than may be used for confirmation.  The first is an antibody test.  This test does not detect the actual spirochete in the blood but detect the presence of antibodies created exposure to the organism.  A test can be falsely negative if the dog is infected but has not yet formed antibodies, or if it never forms enough antibodies to cause a positive reaction.  This may occur in animals with suppressed immune systems.  Some dogs that have been infected for long periods of time may no longer have enough antibodies present to be detected by the test.  Therefore, a positive test is meaningful, but a negative is not.

The second test is the polymerase chain reaction (PCR) test, or DNA testing.  This is also known as DNA testing.  It is very specific and sensitive.  However, not all dogs have the spirochete in their blood cells.  If a blood sample is tested, a false negative may occur.  The best sample for testing is the fluid from an affected joint.

Treatment

Because the Lyme spirochete is a bacterium, it can be controlled by antibiotics.  However, a lengthy course of treatment is necessary to completely eradicate the organism.

The initial antibiotic selected to treat an infected pet may not be effective against the disease, especially if the infection is long-standing.  In this situation, a switch to another antibiotic is often effective.  Occasionally, the initial infection will recur, or the pet will become reinfected after being bitten by another infected tick.

Prevention

The key to prevention is keeping your dog from being exposed to ticks.  Ticks are found in grassy, wooded, and sandy areas.  They find their way onto an animal by climbing to the top of a leaf, blade of grass, or short tree (especially Cedar trees).  Here they wait until their sensors detect a close-by animal on which to crawl or drop.

Keeping animals from thick underbrush reduces their exposure to ticks.  Dogs should be kept on trails when walked near wooded or tall grass areas.

Removing a Tick from Your Dog

Check your pet immediately after it has been in a tick-infected area.  If you find a tick moving on your pet, the tick has not fed.  Remove the tick promptly and place it in rubbing alcohol or crush it between two solid surfaces.

If you find a tick attached to your pet, grasp the tick with fine tweezers or your finger nails near the dog's skin and firmly pull it straight out.  You may need another person to help restrain your dog.  Removing the tick quickly is important since the disease is not transmitted until the tick has fed for approximately 12 hours.  If you crush the tick, do not get the tick's contents, including blood, on your skin.  The spirochete that causes Lyme Disease can pass through a wound or cut in your skin.

Vaccination

A vaccine is now available for protecting dogs against Lyme Disease.  This vaccine is initially given twice, at two or three week intervals.  Annual revaccination is also necessary to maintain immunity.  The vaccine has been shown to be safe and very effective.  We recommend it for any dog that has exposure to ticks.

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Mitral Valve Disease and
Heart Failure in Dogs

The heart has four chambers.  The upper chambers are called atria (singular: atrium), and the lower chambers are called ventricles.  The heart is also divided into right and left sides.

Blood flows from the body into the right atrium.  It is stored there for a few seconds, then pumped into the right ventricle.  The right ventricle pumps blood into the lungs where it receives oxygen.  It flows from the lungs into the left atrium where it is held a few seconds before going into the left ventricle.  The left ventricle is surrounded by the largest and strongest of the heart muscles.  This large muscle is necessary to pump blood to all parts of the body.

Each side of the heart has a valve to keep blood from going backward from the ventricles to the atria.  The valve between the left atrium and left ventricle is called the mitral valve.  Because of the very large pressures created when the left ventricle contracts and the eventual process of  “wearing out,” the mitral valve becomes leaky in many dogs.

Because this is a progressive disease, we assign each dog to one of four stages based on clinical signs, historical findings, and x-ray findings.  Stage 1 is the earliest stage of mitral valvular disease.  Stage 4, the final stage, is the presence of life-threatening heart failure.

Prevalence

This is the most common cause of heart failure in small dogs.  Large breeds have relatively low incidence.  Interestingly, this heart disease is extremely rare in cats.  Many small dogs develop a mitral murmur as early as 6 years of age; most of them will have a murmur by 10 years of age.

The breeds most commonly affected include Cocker Spaniels, Boston Terriers, Fox Terriers, Poodles, Miniature Schnauzers, and Chihuahuas.  The Cavalier King Charles Spaniel has a high incidence of mitral valve disease, and it tends to occur at a relatively younger age than in other breeds.

Causes/Transmission

The exact cause of the degenerative changes in the mitral valve remains unknown.  It is suspected that these changes may be related to alterations in the connective tissue component of the valve.  The edges of the valve should be smooth and flat; instead, they become thickened and knobby.  When this occurs, the valve is unable to provide an effective seal between the upper and lower chambers of the heart.  This results in an audible heart murmur when a stethoscope is placed over the valve.

Clinical Signs

The earliest sign of a leaking mitral valve is a heart murmur.  The murmur is created by turbulent blood regurgitating backward from the left ventricle into the left atrium.  The murmur is audible through a stethoscope and may progress in intensity as the disease progresses.  Another early sign of mitral valve disease is a chronic dry, hacking cough.  This occurs because the enlarging left atrium puts pressure on the bronchus (a branch of the airway); this compression leads to a cough. 

                Heart failure.  The presence of a murmur does not mean that heart failure is imminent.  But, as time goes on, the leak becomes more severe and more and more blood goes backwards.  This results in reduced pumping efficiency and, eventually, congestive heart failure.  From the time a murmur develops, it may be a few months to several years until heart failure occurs.

When the heart begins to fail, it is unable to deliver adequate oxygen to all the tissues of the body.  This sets into motion a series of compensatory events.  In other words, the body's cells become desperate and trigger a series of responses.  Various hormones are released by several organs in an attempt to correct the problem.  These hormones conserve fluid in an effort to increase blood volume and the output of blood and oxygen by the heart. 

For several months, these compensatory responses help the situation.  However, the increased fluid retention eventually becomes harmful.  Perhaps the most detrimental event occurs when this excessive fluid leaks out of the pulmonary capillaries and into the air spaces (alveoli) of the lung; this is called pulmonary edema.  This fluid collection in the lungs produces very obvious signs and may be one of the first things an owner might notice.  Noticeable signs include weakness, coughing or gagging, fainting or collapse, and obvious exercise intolerance.

Diagnosis

There are several tests that are used to look at different aspects of the heart’s structure and function.

1. Listening with a stethoscope (auscultation).  This valuable tool permits identification of murmurs, their location, and their intensity.  It also allows us to hear lung sounds so that we can better understand what is happening within the lungs.

2. Blood and urine tests.  These do not give direct information about heart function, but they allow detection of other disorders in the body that may have significance to heart function.

3. Chest radiographs (x-rays).  The chest x-ray is useful for examining the lungs and for viewing the size and shape of the heart.  It is also helpful in determining that the left atrium is enlarging because of backward blood flow.

4. Electrocardiogram (ECG or EKG).  This is an assessment of the electrical activity of the heart.  It allows accurate determination of heart rate and rhythm.  Abnormal rhythms (arrhythmias) can be detected and evaluated.

5.  Ultrasound examination (sonogram, echocardiogram).  This examination uses sound waves that bounce off the structures of the heart and are read on a TV-like monitor.  It gives the most accurate determination of the size of each heart chamber, and permits measurement of the thickness of the heart walls.  This is seen on the monitor in actual time so the contractions of the heart can be evaluated.  Certain measurements can be taken which allow the actual strength of the heart's contraction to be measured as a number and compared to the normal animal.  Ultrasound may not be available in all private veterinary practices because of the additional training needed to learn how to perform the examination and because of the cost of the equipment.

The combination of all of these tests give the best evaluation of the dog and its heart function.  However, if cost considerations prohibit performing all of them, two or three will provide much valuable information.

Therapy

A leaky heart valve can be replaced surgically in people.  However, this is rarely feasible in dogs.  There are several drugs that will improve heart function, even in the presence of a leaky valve.  In addition to the drugs described below, a low-salt diet is usually indicated and can be obtained from your veterinarian. 

1. Diuretics.  These drugs stimulate the kidneys to remove excess fluid from the body.  Furosemide is most commonly used, although others will be selected in certain circumstances.

2. Nitroglycerin. This drug is called a venodilator; it dilates the veins throughout the body, especially the ones going to the heart muscle.  It decreases the amount of blood returning to the heart by allowing some of it to "pool" in the veins.  This temporarily reduces the workload of the heart.  This class of drugs can be very useful for treating pulmonary edema.

3. Digitalis. This drug improves heart function in several ways.  It helps in control of certain arrhythmias, slows the heart rate, and strengthens each contraction of the heart.  It is only indicated in the end-stages of mitral valvular disease.

4. Enzyme blockers. This is a relatively new class of drugs that can help module the imbalance of hormones related to heart failure.  ACE-inhibitors, such as enalapril, are the most commonly used drugs.

5. Vasodilators.  These drugs dilate the arteries and veins of the body to permit better blood flow.  They may be used long-term because they continue to be effective, as opposed to the short-term effects of nitroglycerin.

Not all of these drugs are used in each dog in heart failure.  The results of the various tests will determine which ones are appropriate.

Prognosis

There are many factors that must be considered before the outcome of treatment can be determined.  The results of the tests are important.  Dogs in the early stages of mitral insufficiency (Stage 1) can live months to years before failure begins.  Dogs in Stage 4 may survive only hours to weeks, but the prognosis is very individualized for each dog. 

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Raising Orphaned Puppies 

Raising an orphaned puppy is a noble and rewarding experience.  Bonding that will occur in the first few days will likely last for many years.  However, orphaned puppies are very fragile; raising them requires jumping numerous hurdles.  Do not be disappointed if you are not successful.

The Problems You Must Face

Several critical problems must be addressed in caring for orphaned puppies.  Among these are chilling, dehydration, and hypoglycemia.  These problems are interrelated and may often exist at the same time.  Close observation and prompt attention if any of these problems develop are essential to survival.  Of course, proper feeding of the orphaned puppy is extremely important. 

                Chilling

Chilling in newborn puppies can lead to significant mortality.  A puppy will dissipate far more body heat per pound of body weight than an adult dog.  The normal newborn puppy depends upon radiant heat from its mother to help maintain its body temperature.  In the absence of the mother, various methods of providing heat, such as incubators, heat lamps, or hot water bottles can be used.

Rectal temperatures in a normal newborn puppy range from 95 to 99 F for the first week, 97 to 100 F for the second and third weeks, and reach the normal temperature of an adult (100 to 102 F) by the fourth week.

When the rectal temperature drops below 94 F, the accompanying metabolic alterations are life threatening.  Therefore, immediate action is necessary to provide the warmth the puppy needs to survive.  A healthy newborn can usually survive chilling if warmed slowly.

During the first four days of its life, the orphaned puppy should be maintained in an environmental temperature of 85 to 90 F.  The temperature may gradually be decreased to 80 F by the seventh to tenth day and to 72 F by the end of the fourth week.  If the litter is large, the temperature need not be as high.  As puppies huddle together, their body heat provides additional warmth.

Caution:  Too rapid warming of a chilled puppy may result in its death.

                Dehydration

The lack of regular liquid intake or the exposure of the puppy to a low humidity environment can easily result in dehydration.  The inefficiency of the digestion and metabolism of a chilled puppy may also lead to dehydration and other changes such as those discussed in this paper.

Experienced breeders can detect dehydration by the sense of touch.  Two signs of dehydration are the loss of elasticity in the skin and dry and sticky mucous membranes (gums) in the mouth. 

An environmental relative humidity of 55 to 65 percent is adequate to prevent drying of the skin in a normal newborn puppy.  However, a relative humidity of 85 to 90 percent is more effective in maintaining puppies if they are small and weak.

Caution:  The environmental temperature should not exceed 90 F when high humidity is provided.  A temperature of 95 F coupled with relative humidity of 95 percent can lead to respiratory distress.

                Hypoglycemia

Signs of hypoglycemia (abnormal decrease of sugar in the blood) are severe depression, muscle twitching and sometimes convulsions.  If a puppy shows signs of hypoglycemia, a solution containing glucose will have to be administered.  A few drops of corn syrup on the tongue can be life saving.

Food Options

Total nutrition for the newborn orphans must be supplied by a milk replacer until the puppies are about three weeks of age.  At this age, the puppies are ready to start nibbling moistened solid food.

Preferred diets:

1. A commercial puppy milk replacer
2. For short-term emergencies:
l cup of milk
l tablespoon corn oil
l pinch of salt
3 egg yolks (no whites)
Blend mixture uniformly

Since the newborn may have trouble generating enough heat to maintain its body temperature, the milk replacer should be warmed to 95 to 100F for the best results.  Testing the milk replacer's temperature on one's forearm (as for babies) is generally accurate enough.  The milk replacer should be about the same temperature as one's skin or slightly warmer.  As the puppies grow older, the milk replacer can be fed at room temperature.

Feeding Options

Spoon-feeding is slow and requires great patience.  Each spoonful must be slowly "poured" into the puppy's mouth to prevent liquids from entering the lungs.  The puppy's head must not be elevated, or the lungs may fill with fluids.  Newborn puppies usually do not have a well-developed gag reflex to signal this.

Dropper feeding accomplishes the same result as spoon-feeding but is somewhat cleaner and generally speedier.

Baby bottles made for puppies can be used quite successfully in most situations.  The size of the hole in the nipple is critical for success.  If the bottle is turned upside down and milk replacer drips from the nipple, the hole is too large.  Use of this nipple may cause drowning of the puppy.  If the bottle is turned upside down and milk replacer comes out only after considerable squeezing of the bottle, the hole is too small.  Use of this nipple will result in the puppy becoming discouraged and refusing to nurse.  The hole is the proper size if the bottle is turned upside down and milk replacer drips from the nipple with minimal squeezing of the bottle.  If you are having trouble enlarging the hole, heat a needle with a match and push it through the nipple several times.

Tube feeding is the easiest, cleanest and most efficient method of hand feeding.  However, it requires proper equipment and technique to prevent putting milk replacer into the puppy's lungs.  If bottle-feeding is not successful, we will supply the equipment and demonstrate the proper technique.  This is not a difficult procedure, so do not hesitate to ask about it if it is needed.                    

Feeding Amount and Frequency

Commercial milk replacers have directions on their labels for proper amounts to feed.  It is necessary for the puppy's weight to be obtained properly in ounces or grams.  The amounts on the labels are based on the puppy getting only the milk replacer.  The amounts given are also for a 24-hour period.  That quantity should be divided by the number of feedings per 24 hours.  Four  meals, equally spaced during a 24-hour period, are ample for feeding a puppy when adequate nutrients are provided.  Six or more feedings may be necessary if the puppy is small or weak.  Hand feeding can generally be ended by the third week and certainly by the fourth.  By this time the puppy can consume food, free-choice, from a dish (see below).

Causing Urination and Defecation

The puppy's genital area must be stimulated after feeding to cause urination and defecation.  The genital area should be massaged with a moist cloth or cotton ball to stimulate action.  This cleaning should continue during the first two weeks.  If this procedure is not followed, the puppy may become constipated.

Beginning Bowl Feeding

By three weeks, the puppy can start to eat food from the dish along with the milk replacer.  A gruel can be made by thoroughly mixing a puppy food (canned or dry) with the milk replacer to reach the consistency of a thick milk shake.  The mixture should not be too thick at first or the puppy will not consume very much.  As the consumption of food increases, the amount of milk replacer can be gradually decreased.

By four to four and one-half weeks, the orphaned puppy can consume enough moistened solid food to meet its needs.

It is better to avoid starting a puppy on a baby food regimen.  This creates extra work and can also create a finicky eater.  Many such foods will not meet the nutritional needs of a growing puppy.

Deworming

We routinely treat puppies for worms at 3 and 6 weeks of age.  Depending on the parasite load of the puppy and potential re-exposure to parasites, additional dewormings may be recommended.  We need to see the puppy at the appropriate ages so that it can be accurately weighed.

First Vaccination

The first vaccination is normally given to puppies at 6-8 weeks of age.  However, if your puppy did not nurse from its mother during the first 2-3 days after birth, there will be no protective immunity passed to it.  If that is the case, the first vaccination should be given at about 2-3 weeks of age.

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Pancreatitis in Dogs 

The pancreas is a vital organ that lies on the right side of the abdomen.  It has two functions:  1) to produce enzymes which help in digestion of food and, 2) to produce hormones, such as insulin.  When the pancreas becomes inflamed, the disorder is called pancreatitis.  It is a disease process that is seen commonly in the dog.  There is no age, sex, or breed predisposition. 

There are two main forms of acute (sudden onset) pancreatitis:  1) the mild, edematous form and, 2) the more severe, hemorrhagic form.  A few dogs that recover from an acute episode of pancreatitis may continue to have recurrent bouts of the acute disease, known as chronic, relapsing pancreatitis.  The associated inflammation allows digestive enzymes to spill into the abdominal cavity; this may result in secondary damage to surrounding organs, such as the liver, bile ducts, gall bladder, and intestines. 

Causes

The cause of pancreatitis is not known; however, there may be several contributory factors.  It is often associated with a rich, fatty meal.  In some cases, it may be associated with the administration of cortisone; however, some dogs with pancreatitis do not have exposure to either.

Under normal conditions, digestive enzymes produced by the pancreas are activated when they reach the small intestines.  In pancreatitis, these enzymes are activated prematurely in the pancreas instead of in the small intestines.  This results in digestion of the pancreas itself.  The clinical signs of pancreatitis are often variable, and the intensity of the disease will depend on the quantity of enzymes that are prematurely activated. 

Clinical Signs

The diagnosis of pancreatitis is based on three criteria: clinical signs, laboratory tests, and radiographs (x-rays) and/or ultrasound examination.  The disease is typically manifested by nausea, vomiting, fever, abdominal pain, and diarrhea.  If the attack is severe, acute shock, depression, and death may occur.  Laboratory tests usually reveal an elevated white blood cell count; however, an elevated white blood cell count may also be caused by many other things besides pancreatitis.  The elevation of pancreatic enzymes in the blood is probably the most helpful criteria in detecting pancreatic disease, but some dogs with pancreatitis will have normal levels.  Radiographs and ultrasound studies may show an area of inflammation in the location of the pancreas.  Unfortunately, many dogs with pancreatitis will elude detection with any of these tests.  Consequently, the diagnosis of pancreatitis may be tentative in some cases. 

Treatment

The successful management of pancreatitis will depend on early diagnosis and prompt medical therapy.  The mild form of the disease is best treated by resting the pancreas from its role in digestion.  The only way to "turn off" the pancreas is to withhold all oral fluids and food.  This approach is accompanied by intravenous fluids to maintain normal fluid and electrolyte balance.  In addition, anti-inflammatory drugs are sometimes administered.  The presence of shock necessitates the immediate and intense use of intravenous fluids.  Antibiotics are also indicated in many cases. 

Prognosis

The prognosis depends on the extent of the disease when presented and a favorable response to initial therapy.  Dogs that present with shock and depression have a very guarded prognosis.  Most of the mild forms of pancreatitis have a good prognosis.

Long-term Problems

There are three possible long-term complications that may follow severe or repeated pancreatitis.  If a significant number of cells that produce digestive enzymes are destroyed, a lack of proper food digestion may follow.  This is known as pancreatic insufficiency and can be treated with daily administration of enzyme tablets or powder in the food.  If a significant number of cells that produce insulin are destroyed, diabetes mellitus can result and insulin therapy may be needed.  In rare cases, adhesions between the abdominal organs may occur as a consequence of pancreatitis.  However, most dogs recover with no long-term effects.

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Parvovirus Infection in Dogs

Canine parvovirus (CPV) infection (sometimes called “parvo”) is a relatively new disease that struck the canine population in 1978.  The classic signs are vomiting and bloody diarrhea.  Because of the severity of the disease and its rapid spread through the canine population, CPV has aroused a great deal of public interest.  The virus that causes it is very similar to feline distemper, and the two diseases are almost identical.  Therefore, it has been speculated that the canine virus is a mutation of the feline virus.  However, that has never been proven.

The virus has a selective effect on the most rapidly dividing cells of the body.  For this reason, the lining of the small intestine and the cells of the bone marrow are most severely affected. 

Contributing Factors

Several factors contribute to the clinical course of parvovirus infection in dogs.  These include stress, vaccination history, age of the dog, concurrent infection with other diseases or parasites, and breed of the dog.   Various studies have reported the breeds thought to be at increased risk for parvovirus; these breeds include the Rottweiler, Doberman pinscher, black Labrador Retriever, American Pit Bull Terrier, and the German Shepherd dog.

Parvoviral enteritis (intestinal inflammation) may affect dogs of all ages, but is most common in dogs less than one year of age.  Young puppies less than five months of age are often the most severely affected and the most difficult to treat.

CPV has been regarded as reaching peak incidence in the spring and summer months, when puppies are losing the natural immunity conferred from the mother.  A 1996 study of 283 dogs with CPV found the highest incidence in July, August, and September.  Intact (non-neutered) male dogs were more likely to contract CPV than female dogs.

Prevalence

Canine parvovirus has been reported to exist in approximately 50 different countries.

Causes/Transmission

The causative agent of CPV disease is a very hearty virus.  Unlike most other viruses, CPV is stable in the environment and is resistant to the effects of heat, detergents, and alcohol. CPV has been recovered from dog feces even after three months at room temperature.  Since the virus is so resistant to decay, it can survive for long periods and be transmitted to any dog by simple contact with a contaminated object (called a “fomite”).  Examples of fomites include shoes, clothing, play toys, insects, and feet of the infected dog.  

Feces of the infected dog contain millions of viral particles.  Susceptible dogs become infected by ingesting (swallowing) the virus.  There does not have to be direct contact between the two dogs.   Dogs that become infected with the virus and show clinical signs will usually become ill within 7-10 days of the initial infection.

Clinical Signs

In a large percentage of dogs, there may be no signs at all; this is called an inapparent infection.  These dogs are capable of shedding the virus in the feces.  

When signs are present, they may be variable, but generally take the form of severe vomiting and bloody diarrhea.  Vomiting is usually the first sign to develop after infection.  Diarrhea usually begins about 24 hours later and may or may not contain blood.   Some dogs exhibit anorexia, depression, and fever.

Diagnosis

The clinical signs of CPV infection can mimic other diseases causing vomiting and diarrhea; consequently, the diagnosis of CPV is sometimes a challenge for the veterinarian.  The positive confirmation of CPV infection requires the demonstration of the virus in the stool or the detection of anti-CPV antibodies in the blood serum.  The detection of virus in the stool is easily done and takes just a few minutes.  This test can be performed in the veterinarian’s office.  Occasionally, a dog will have parvovirus but test negative for virus in the stool; fortunately, this is not a common occurrence.

A presumptive diagnosis may be based on the presence of a reduced white blood cell count (leukopenia).  If further confirmation is needed, stool or blood can be submitted to a veterinary laboratory for the other tests.  The absence of a leukopenia does not mean that the dog cannot have CPV infection.  Some dogs that become clinically ill may not necessarily be leukopenic.

Treatment

Unfortunately, there is no specific antiviral therapy that will kill the virus once it infects a dog.  The most appropriate therapy focuses on treating the damage done by the virus.  Since the lining of the intestine is compromised, diarrhea results.  This can lead to severe dehydration, loss of sodium and potassium, and may provide intestinal bacteria with access to the blood stream (septicemia).  Therefore, treatment involves intravenous fluid replacement, attention to electrolytes, and prevention of septicemia.

Additional therapies can include administration of immune serum (serum from a dog who has recently recovered from parvovirus), anti-endotoxin serum (to bind to bacterial toxins), and a drug to increase the white blood cell count.

Prognosis

Most dogs with CPV infection recover if aggressive treatment is used and if therapy is begun before severe septicemia and dehydration occur.  Prognosis is more guarded in the breeds listed above as “at risk.”

Transmission to Humans

There is no documented evidence to suggest that humans may become infected with CPV.

Prevention

Proper vaccination offers the best protection against CPV.  Puppies receive a parvo vaccination as part of their multiple-agent vaccine given at 8, 12, and 16 weeks of age.  In some situations, veterinarians will give an additional booster at 18 to 20 weeks of age.  After the puppy series of vaccinations, all dogs should be boostered at least once a year.  Dogs in high exposure situations (i.e., kennels, dog shows, field trials, etc.) may be better protected with a booster every six months.  Pregnant bitches should be boostered within two weeks of whelping in order to transfer protective antibodies to the puppies.  The final decision about a proper vaccination schedule should be made by your veterinarian.

The stability of the CPV in the environment makes it important to properly disinfect contaminated areas.  This is best accomplished by cleaning food bowls, water bowls, and other contaminated items with a solution of one cup of chlorine bleach in a gallon of water (500 ml in 4 liters of water).  It is important that chlorine bleach be used because most "virucidal" disinfectants will not kill the canine parvovirus.

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Use of Phenobarbital in Dogs

Phenobarbital is a very safe and effective drug that has been used for many years in dogs.  It is principally used for seizures.

Phenobarbital is a depressant of the central nervous system (brain and spinal cord).  If it is overdosed or if your dog is especially sensitive to it, drowsiness, excessive sleep, and even staggering when walking will occur.  On the other hand, if it is not dosed high enough the desired effect will not be achieved.  Therefore, our goal is to find the dose that controls the problem without causing drowsiness and staggering.

Some dogs are more sensitive to this drug than others; therefore, the initial dose is always subject to change.  If no response occurs, the dose should be doubled.  If excessive drowsiness or staggering occurs, the dose should be cut in half.  However, please note that this drug should be given twice daily for best results.  Since some of the tablets are so small it is tempting to lower the initial dose to once daily.  However, to get best results the lower dose should be given twice daily.

Phenobarbital is metabolized (broken down) by the liver so it can be eliminated from the body.  However, dogs do not have a very efficient system for doing this at first.  But when the dog has been taking it for about 7-10 days the liver creates new enzymes that make this elimination process more efficient.  This means that the dog will effectively lower its own dose after 7-10 days because the drug will be broken down and eliminated more rapidly.  This has some important implications in treatment:

1. If your dog is initially slightly drowsy, sleeps slightly more than normal, but does not stagger when walking, continue that dose.  After the 7-10 days initial period, these signs of overdosing will go away as the liver works more efficiently.

2. If your dog has a very good response but is not drowsy during the first week of treatment, it is possible that the response will diminish when the liver becomes more efficient at metabolism.  This means that you may need to increase the dose (usually double it) after 7-10 days.  If that change causes drowsiness, try a dose midway between the low one and the high one.

If you are uncomfortable concerning your dog's response to phenobarbital, do not hesitate to call for assistance.

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Post-operative Instructions

Your dog is recovering from major surgery that requires continued nursing care at home in order to ensure a successful outcome.  Your job in the recovery period at home is just as important as the procedure we just completed.

This care at home mainly entails restriction of activity because your dog does not understand the significance of the recovery period.  It will become very active in a short period of time, and confinement indoors by you is of the utmost importance!  This entails:

- No jumping or running
- No stair climbing
- No playing with other pets
- No “rough-housing”

When your dog goes outside to eliminate, it must be on a short leash and returned indoors immediately.  If your dog is to be left alone, it must be confined to a cage or other small area.  This strict confinement must be continued during the entire convalescent period.  Excessive activity often leads to re-injury or serious complications that result in failure of surgical implant(s) or necessitate re-operation.  This means additional expense to you and added discomfort to your dog.

Observe the incision daily for signs of redness, swelling, discharge or excessive licking.  The incision should look better daily.  Please do not hesitate to call if any of the above occur.  We have available various sizes of protective collars to keep your dog from licking the incision.  Licking usually leads to chewing out sutures, which can occur in a matter of minutes.  Call us as soon as possible if this occurs because this can result in an infection that is difficult to treat and may require hospitalization.

In general, your dog should improve gradually each day.  If it suddenly worsens please call us as soon as possible.  Our goal is to help your dog return to a normal and pain free life.  Please call if you have any concerns.

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Diseases of the Prostate of Dogs

The prostate (commonly mispronounced as "prostrate") is a gland located near the neck of the urinary bladder of male dogs.  The urethra passes through it shortly after leaving the bladder.  The purpose of the prostate is to produce some of the fluids found in normal canine semen.

Prevalence

Prostatic disease is very common in older, non-neutered male dogs.  In one study of 177 dogs, 87 were found to have a specific prostatic disorder.

Causes/Transmission

There are at least seven diseases affecting the prostate.

1. Benign prostatic hyperplasia (BPH).  This is a non-cancerous enlargement of the gland that is frequently found in older intact (non-neutered) male dogs.  It is associated with the hormone testosterone and is the most common disease of the prostate.  The prostate gland is non-painful with BPH. 

2. Squamous metaplasia.  This is a non-cancerous enlargement of the gland caused by abnormal amounts of estrogen.  An estrogen-producing tumor called a Sertoli cell tumor is usually responsible.  As with BPH, the prostate is non-painful.

3. Cystic hyperplasia.  This condition is usually secondary to benign prostatic hyperplasia or squamous metaplasia.  It is caused by obstruction of the ducts that carry prostatic secretions to the urethra.  Multiple, fluid-filled cavities develop within the gland.

4. Paraprostatic cysts.  These are fluid-filled cysts that develop adjacent to the prostate when abnormal tissue remains from embryonic development before the puppy was born.  The cysts begin to develop shortly after birth but may not cause problems or be detected until the dog is several years old.

5. Bacterial infection.  Bacteria may enter and infect the prostate by going up the urethra or by coming down the urethra from an infection in the urinary bladder.  This inflammatory condition is usually associated with a pre-existing abnormality of the prostate, such as benign prostatic hyperplasia.  The prostate may be painful with bacterial infection.

6. Prostatic abscess.  This is a progressive form of a bacterial infection.  If the ducts that drain the prostate become obstructed, the bacteria are trapped in the prostate and form a walled-off site of infection known as an abscess.  The prostate is usually found to be very painful during rectal examination.

7. Prostatic cancer.  This form is much less common than all of the others.  It may be associated with hormones from the testicles, adrenal glands, or pituitary glands or it may occur independent of hormonal influences. 

Clinical Signs

Enlargement of the gland is common with most prostatic diseases.  Since the urethra passes through it, enlargement of the prostate compresses the urethra and urination becomes more difficult.  Complete urethral obstruction only rarely occurs, but an affected dog will spend quite a bit of time urinating and often produces a stream of urine with a small diameter.  The colon, located just above the prostate, is sometimes compressed by an enlarged prostate.  This makes defecation difficult.

In addition, some dogs with prostatic disease will have blood in the urine.  Bacterial infection of the prostate is sometimes, but not always, involved with production of the bloody urine.

Dogs with prostatic abscesses may be extremely ill.  Fever, dehydration, and toxic shock can develop, eventually leading to death of the dog.

Diagnosis

The first step in diagnosis is to determine if the prostate is enlarged and whether it is painful.  This is done by feeling its size either through the abdominal wall or through the rectal wall.  It may be confirmed by radiographs (x-rays) or an ultrasound examination.  During the physical exam, the testicles are palpated to look for potential tumor masses.

Because there are so many diseases of the prostate, it is necessary to perform several tests to tell them apart.  These tests include cultures of the dog's urine, a microscopic examination of the cells in the urine, and a microscopic examination of the cells in prostatic fluid or in the prostate itself.  Samples of prostatic fluid are recovered by passing a urethral catheter to the level of the prostate and massaging the prostate to "milk" fluid out of it.  Samples of prostatic cells are obtained by aspiration or biopsy via a needle that is either passed through the body wall or passed through the rectal wall.  If the prostate is greatly enlarged, it can be aspirated or biopsied through the body wall; otherwise, an approach through the rectal wall is necessary.  An aspiration sample is taken through a very small bore needle and only recovers a few cells.  Sometimes this is adequate for analysis; other times it is not.  A needle biopsy sample is obtained through a large bore needle that is passed into the prostate by some form of electronic guidance.  This may be with a type of x-rays or with ultrasound.  A biopsy sample recovers a piece of tissue that permits a pathologist to make a more accurate diagnosis.

Treatment

1. Diseases involving primary or secondary bacterial infections are treated with aggressive antibiotic therapy.  Because it is difficult to get many antibiotics into the prostate, treatment for several weeks will probably be necessary.  Since most of the infections are secondary to another disease, treating the infection is only part of the overall treatment.

2. Diseases associated with excessive hormone levels include benign prostatic hyperplasia, cystic metaplasia, and cystic hyperplasia.  Since testosterone and estrogen are both formed in the testicles, castration is generally very effective for all of these.  The prostate will generally be normal or smaller than normal in size within one month after castration. 

3. Paraprostatic cysts and prostatic abscesses require major abdominal surgery to drain and remove the fluid and/or pus.

4. Prostatic cancer does not respond well to any currently used form of treatment.  If it is associated with an excess of a hormone, castration may be beneficial; however, most are not and metastasize rather easily to other parts of the body.  The prognosis for these is usually poor.

Prognosis

Prognosis is dependent upon identification and successful treatment of the underlying cause. A more favorable prognosis is given for non-cancerous disorders.

Prevention

Many disorders of the prostate can be avoided with neutering of the male dog.  Unfortunately, some owners wait until the dog is older and develops prostatic disease before they will consider neutering.  Later in life, the dog is more likely to have additional medical problems, which can impact upon anesthetic risks.

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Recommendations for Owners
of New Puppies

We would like to congratulate you on the acquisition on your new puppy.  Owning a dog can be an extremely rewarding experience, but it also carries with it quite a bit of responsibility.  We hope this document will give you the information needed to make some good decisions regarding your puppy.

First, let us say that we are grateful that you have chosen us to help you with your puppy's health care.  If you have questions concerning any subject related to your puppy's health, please feel free to call our hospital.  Our entire professional staff is willing and happy to help you.

Puppy Playing

Stimulating play is important during the first week.  Stalking and pouncing are important play behaviors in puppies and are necessary for proper muscular development.  If given a sufficient outlet for these behaviors with toys, your puppy will be less likely to use family members for these activities.  The best toys are lightweight and movable.  These include wads of paper and rubber balls.  Any toy that is small enough to be swallowed should be avoided. 

Discipline

Disciplining a young puppy may be necessary if its behavior threatens people or property, but harsh punishment should be avoided.  Hand clapping and using shaker cans or horns can be intimidating enough to inhibit undesirable behavior.  However, remote punishment is preferred.  Remote punishment consists of using something that appears unconnected to the punisher to stop the problem behavior.  Examples include using spray bottles, throwing objects in the direction of the puppy to startle (but not hit) it, and making loud noises.  Remote punishment is preferred because the puppy associates punishment with the undesirable act and not with you.

Vaccinations

There are many diseases that are fatal to dogs.  Fortunately, we have the ability to prevent many of these by the use of very effective vaccines.  In order to be effective, these vaccines must be given as a series of injections.  Ideally, they are given at about 6-8, 12, and 16 weeks of age, but this schedule may vary somewhat depending on several factors. 

The routine vaccination schedule will protect your puppy from five diseases: distemper, hepatitis, parainfluenza virus, parvovirus, and rabies.  The first four are included in one injection that is given at 6-8, 12, and 16 weeks old.  Rabies vaccine is given at 16 weeks of age.  There are two other optional vaccinations that are appropriate in certain situations.  Your puppy should receive kennel cough vaccine (Intra Trac II) if a trip to a boarding kennel is likely or if it will be placed in a puppy training class.  Lyme vaccine is given to dogs that are exposed to ticks because Lyme Disease is transmitted by ticks.  Please advise us of these needs on your next visit.

Why the Series of Vaccinations

When the puppy nurses its mother, it receives a temporary form of immunity through its mother's milk.  This immunity is in the form of proteins called antibodies.  For about 24-48 hours after birth, the puppy's intestine allows absorption of these antibodies directly into the blood stream.  This immunity is of benefit during the first few weeks of the puppy's life, but, at some point, this immunity fails and the puppy must be able to make its own long-lasting immunity.  Vaccinations are used for this purpose.  As long as the mother's antibodies are present, vaccinations do not have a chance to stimulate the puppy’s immune system.  The mother's antibodies interfere by neutralizing the vaccine.

Many factors determine when the puppy will be able to respond to the vaccinations.  These include the level of immunity in the mother dog, how much antibody has been absorbed, and the number of vaccines given to the puppy.  Since we do not know when an individual puppy will lose the short-term immunity, we give a series of vaccinations.  We hope that at least two of these will fall in the window of time when the puppy has lost immunity from its mother but has not yet been exposed to disease.  A single vaccination, even if effective, is not likely to stimulate the long-term immunity that is so important. 

Rabies vaccine is an exception to this, since one injection given at the proper time is enough to produce long-term immunity.

Intestinal Worms

Intestinal parasites are common in puppies.  Puppies can become infected with parasites before they are born or later through their mother's milk.  The microscopic examination of a stool sample will usually help us to determine the presence of intestinal parasites.  We recommend this exam for all puppies.  If we can not get a stool sample, please bring one at your earliest convenience.  Even if we do not get a stool sample, we recommend the use of Drontal, a deworming product that is safe and effective against several of the common worms of the dog.  It is given now and repeated in about 3 weeks.  Food should not be withheld before or after administering the tablet.  It is important that it be repeated in about 3 weeks because the deworming medication only kills the adult worms.  Within 3-4 weeks, the larval stages will have become adults and will need to be treated.  Dogs remain susceptible to reinfection with hookworms and roundworms.  Periodic deworming throughout the dog's life may be recommended for dogs that go outdoors.

Tapeworms are the most common intestinal parasite of dogs.  Puppies become infected with them when they swallow fleas; the eggs of the tapeworm live inside the flea.  When the dog chews or licks its skin as a flea bites, the flea may be swallowed.  The flea is digested within the dog's intestine; the tapeworm hatches and then anchors itself to the intestinal lining.  Therefore, exposure to fleas may result in a new infection; this can occur in as little as two weeks. 

Dogs infected with tapeworms will pass small segments of the worms in their stool.  The segments are white in color and look like grains of rice.  They are about 1/8 inch (3 mm) long and may be seen crawling on the surface of the stool.  They may also stick to the hair under the tail.  If that occurs, they will dry out, shrink to about half their size, and become golden in color. 

Tapeworm segments do not pass every day or in every stool sample; therefore, inspection of several consecutive bowel movements may be needed to find them.  We may examine a stool sample in our office and not find them, then you may find them the next day.  If you find them at any time, please notify us so we may provide the appropriate drug for treatment.

Heartworms

Heartworms are important parasites, especially in certain climates.  They can live in your dog's heart and cause major damage to the heart and lungs.  Heartworms are transmitted by mosquitoes so your dog does not have to be in contact with another dog to be exposed.  Fortunately, we have drugs that will protect your dog from heartworms.  These drugs are very safe and very effective if given regularly.  One product, Filarabits Plus, is a chewable tablet that your dog should eat like a treat; it is given daily.  Three others, Heartgard, Interceptor, and Revolution are tablets that are given only once monthly.  We recommend the product that is most likely to be given on a regular basis, either daily or monthly.  Be aware that having a long haircoat or staying primarily indoors does not protect a dog against heartworm infection.

Heartworm preventatives are dosed according to your dog's weight.  As the weight increases, the dosage should also increase.  Please note the dosing instructions on the package.  These products are very safe.  You could overdose your dog by two or three times the recommended dose without causing harm.  Therefore, it is always better to overdose rather than underdose.

Food for Puppies

Diet is extremely important in the growing months of a dog's life, and there are two important criteria that should be met in selecting food for your puppy.  We recommend a NAME-BRAND FOOD made by a national dog food company (not a generic or local brand), and a form of food MADE FOR PUPPIES.  This should be fed until your puppy is about 12-18 months of age, depending on its size.  We recommend that you only buy food that has the AAFCO certification.  Usually, you can find this information very easily on the label.  AAFCO is an organization that oversees the entire pet food industry.  It does not endorse any particular food, but it will certify that the food has met the minimum requirements for nutrition.  Most of the commercial pet foods will have the AAFCO label.  Generic brands often do not have it.

Feeding a dry, canned, or semi-moist form of dog food is acceptable.  Each has advantages and disadvantages.  Dry food is definitely the most inexpensive.  It can be left in the dog's bowl without drying.  The good brands of dry food are just as nutritious as the other forms.  As a rule, most veterinarians will recommend dry food for your puppy.

Semi-moist and canned foods are also acceptable.  However, both are considerably more expensive than dry food.  They often are more appealing to the dog's taste; however, they are not more nutritious.  If you feed a very tasty food, you are running the risk of creating a dog with a finicky appetite.  In addition, the semi-moist foods are high in sugar.

Table foods are not recommended.  Because they are generally very tasty, dogs will often begin to hold out for these and not eat their well-balanced dog food.  If you choose to give your puppy table food, be sure that at least 90% of its diet is good quality commercial puppy food.

We enjoy a variety of things to eat in our diet.  However, most dogs actually prefer not to change from one food to another unless they are trained to do so by the way you feed them.  Do not feel guilty if your dog is happy to just eat one food day after day, week after week.

Commercials for dog food can be very misleading.  If you watch carefully you will notice that many commercials promote dog food on one basis, TASTE.  Nutrition is rarely mentioned.  Most of the "gourmet" foods are marketed to appeal to owners who wants the best for their dogs; however, they do not offer the dog any nutritional advantage over a good quality dry food, and they are far more expensive.  If your dog eats a gourmet food very long, it will probably not be happy with other foods.  If it needs a special diet due to a health problem later in life, it is very unlikely to accept it.  Therefore, we do not encourage feeding gourmet dog foods.

In addition to table foods, it is also important that you not give certain other things to dogs.  Bones of birds (chicken, turkey, etc.) are hollow and splinter easily producing very sharp pointed pieces of bones.  These can easily pierce the esophagus, stomach, and intestines resulting in peritonitis and death.

Feeding Schedules

There are several “right” ways to feed puppies.  The most popular method is commonly called “meal feeding.”  This means that the puppy is fed at specific times of the day.  A measured amount of food should be offered four times per day for 5-12 week old puppies.  What is not eaten within 30 minutes is taken up.  If the food is eaten within 3-4 minutes, the quantity is probably not sufficient.  Puppies fed in this manner generally begin to cut themselves out of one of those meals by 3-4 months of age and perhaps another one later.  If a meal is ignored for several days, it should be discontinued.

“Free choice feeding” means that food is available at all times.  This works well with dry foods and for some dogs.  However, other dogs tend to overeat and become obese.  If there are signs of weight gain after the optimal weight is reached, this method of feeding should be discontinued.

Housebreaking

Housebreaking should begin as soon as your puppy enters his new home.  How long the training must continue depends on both the puppy and you.  Some pups learn sooner than others.  Your dog wants to please you.  But a puppy's memory is short, so your patience is important.  A home with a badly trained puppy is not a happy home for you or the puppy.

-The puppy's bed may be a box, open at one end and slightly larger than the puppy.  If the bed is too large, the puppy may defecate or urinate in a corner rather than go outside.  If the bed is smaller, the puppy will do its "business" outside rather than soil its bed.
-Enclose the bed in a small area, such as a laundry room.  Cover this area with newspapers to be used at night, or when your pup is left unsupervised.
-The secret to housebreaking is a scent post.  A scent post is created when your puppy has an "accident."  The problem becomes one of locating the scent post in the place you want it.
-To create a scent post, leave a smear of stool from the last "accident" or wet paper on the clean paper in the place you want it, and coax or scoot the puppy to that area.  The same is true of an outside scent post, but without the paper, in an out-of-the-way place in the yard.  This will solve the "mine-field" problem.
-The first thing in the morning, the puppy should be scooted to the scent post.  This is so he can learn his way to the door and the scent post.  Let him sniff about.  The moment he has relieved himself, pat him on the head and immediately bring him into the house.  Do not let him play about.  The toilet period and play period should be definitely separate in the puppy's routine.
-The puppy should then be fed.  In a short while the puppy will become uneasy and walk in circles sniffing at the floor.  The puppy should then be scooted and coaxed to the scent post as quickly as possible.
-This routine should be repeated every hour or two throughout the day, especially after meals and naps.
-When the puppy is taken out to play, it is wise to leave the house by another door and avoid taking him near his scent post.  Never play with your pup until after he has been taken out and has eliminated.
-There will of course be some "accidents" in the house.  Never let one of these slip by unnoticed; punishment five minutes after the offense is too late.  Scold (not whip) the puppy and rush him to the scent post.  Then scrub the area of mishap thoroughly until all odor is gone.  Sprinkle the area with red pepper or vinegar.
-Positive reinforcement of proper urine and bowel habits is just as important as properly applied discipline.  When your puppy urinates or defecates in the correct place, spend several minutes stroking and praising him.

Socialization of Puppies

The Socialization Period for dogs is between 4 and 12 weeks of age.  During that time, the puppy is very impressionable to social influences.  If it has good experiences with men, women, children, cats, other dogs, etc., it is likely to accept them throughout life.  If the experiences are absent or unpleasant, it may become apprehensive or adverse to any of them.  Therefore, during the period of socialization, we encourage you to expose your dog to as many types of social events and influences as possible.

Three Curious Things about Puppies

Puppies may be observed to make unusual sounds or movements during their sleep.  This is called “activated sleep.”  It probably occurs because your puppy is dreaming and trying to participate in the dream.  This behavior lasts a few months but rarely continues into adulthood.

Puppies also have “puppy breath.”  There is a characteristic smell about a puppy’s breath.  It is not particularly offensive or desirable.  It is much like the smell of a new car.  It is present a few weeks then disappears.

Puppies also frequently have episodes of hiccups.  They may occur for 10-20 minutes at a time then spontaneously disappear.  They are probably related to swallowing of air when eating and do not produce any significant distress to your dog.  They will stop as your puppy gets a little older.

Flea Control

Fleas do not stay on your puppy all of their time; occasionally, they will jump off and seek another host.  Therefore, it is important to kill fleas on your new puppy before they can become established in your house.  Many of the flea control products that are safe on adult dogs are not safe for puppies less than 4 months of age.  Be sure that any flea product you use is labeled safe for puppies.

If you use a flea spray, your puppy should be sprayed lightly.  Flea and tick dip is not recommended for puppies unless they are at least 4 months of age.  Remember, not all insecticides that can be used on adult dogs are safe for puppies. 

There is a trick to spraying a puppy that will make the outcome safer and more successful.  When a puppy is sprayed, the fleas tend to run away from the insecticide.  If you spray the body first, many fleas will run to the head where they are very difficult to kill.  The best method is to spray a cotton ball then use that to wipe the flea spray onto the puppy’s face, from the nose to the level of the ears.  That will keep you from getting it in the eyes and will cause the fleas to run toward the body.  Wait about 2 minutes, then spray the back of the head and the body.  Leave the spray on for about 3 minutes, then wipe off the excess.  This will permit you to kill the most fleas while putting the least amount of insecticide on the puppy.

There are four products that are given only once per month; some can be used in puppies as young as 6 weeks.  Program is a tablet that causes the adult fleas to lay sterile eggs.  It is very effective, but it does not kill adult fleas that usually live 2-3 months.  Advantage, Frontline Top Spot, and Revolution are the monthly products that kill adult fleas.  They are liquids that are applied to the skin at the base of the neck.  They are very effective and easy to use.

Chewing

One of the characteristics of puppies is chewing.  Puppies are trying their new teeth so chewing is a normal behavior.  The puppy’s baby teeth are present by about 4 weeks of age.  They begin to fall out at 4 months of age and are replaced by the adult (permanent) teeth by about 6 months of age.  Therefore, chewing is a puppy characteristic that you can expect until about 6-7 months of age.  It is important that you do what you can to direct your puppy’s chewing toward acceptable objects.  You should provide items such as rawhide chew bones, nylon chew bones, and other chew toys so other objects are spared. 

Trimming Toenails

Puppies have very sharp toenails.  They can be trimmed with your regular finger nail clippers or with nail trimmers made for dogs and cats.  If you take too much off the nail, you will get into the quick; bleeding and pain will occur.  If this happens, neither you nor your dog will want to do this again.  Therefore, a few points are helpful:

1. If your dog has clear or white nails, you can see the pink of the quick through the nail.  Avoid the pink area, and you should be out of the quick.

2. If your dog has black nails, you will not be able to see the quick so only cut 1/32" (1 mm) of the nail at a time until the dog begins to get sensitive.  The sensitivity will usually occur before you are into the blood vessel.  With black nails, it is likely that you will get too close on at least one nail.

3. If your dog has some clear and some black nails, use the average clear nail as a guide for cutting the black ones.

4. When cutting nails, use sharp trimmers.  Dull trimmers tend to crush the nail and cause pain even if you are not in the quick. 

5. You should always have styptic powder available.  This is sold in pet stores under several trade names, but it will be labeled for use in trimming nails.

Ear Mites

Ear mites are tiny parasites that live in the ear canal of dogs (and cats).  The most common sign of ear mite infection is scratching of the ears.  Sometimes the ears will appear dirty because of a black material in the ear canal; this material is sometimes shaken out.  The instrument we use for examining the ear canals, an otoscope, has the necessary magnification to allow us to see the mites.  Sometimes, we can find the mites by taking a small amount of the black material from the ear canal and examining it with a microscope.  Although they may leave the ear canals for short periods of time, they spend the vast majority of their lives within the protection of the ear canal.  Transmission generally requires direct ear-to-ear contact.  Ear mites are common in litters of puppies if their mother has ear mites.

Ear infections may also cause the production of a dark discharge in the ear canals.  It is important that we examine you puppy to be sure the black material is due to ear mites and not infection.  Please do not ask us to just dispense medication without having the opportunity to make an accurate diagnosis.

Spaying Females

Spaying offers several advantages.  The female's heat periods result in about 2-3 weeks of vaginal bleeding.  This can be quite annoying if your dog is kept indoors.  Male dogs are attracted from blocks away and, in fact, seem to come out of the woodwork.  They seem to go over, around, and through many doors or fences.  Your dog will have a heat period about every 6 months.

Spaying is the removal of the uterus and the ovaries.  Therefore, heat periods no longer occur.  In many cases, despite of your best effort, the female will become pregnant; spaying prevents unplanned litters of puppies.  It has been proven that as the female dog gets older, there is a significant incidence of breast cancer and uterine infections if she has not been spayed.  Spaying before she has any heat periods will virtually eliminate the chance of either.  If you do not plan to breed your dog, we strongly recommend that she be spayed before her first heat period.  This can be done anytime after she is 6 months old. 

Neutering Males

Neutering offers several advantages.  Male dogs are attracted to a female dog in heat and will climb over or go through fences to find her.  Male dogs are more aggressive and more likely to fight, especially with other male dogs.  As dogs age, the prostate gland frequently enlarges and causes difficulty urinating and defecating.  Neutering will solve, or greatly help, all of these problems that come with owning a male dog.  The surgery can be performed any time after the dog is 6 months old.

Breeding

If you plan to breed your dog, she should have at least one or two heat periods first.  This will allow her to physically mature allowing her to be a better mother without such a physical drain on her.  We do not recommend breeding after 5 years of age unless she has been bred prior to that.  Having her first litter after 5 years of age increases the risk of problems during the pregnancy and/or delivery.  Once your dog has had her last litter, she should be spayed to prevent the reproductive problems older dogs have.

Pet Identification

The latest in pet retrieval is microchipping.  This tiny device is implanted with a needle so the process is much like getting an injection.  Our scanner can detect these chips; humane societies and animal shelters across the country also have scanners.  A national registry permits the return of microchipped pets throughout the United States and Canada.  We recommend it.

Emergency Tips

There are several emergency situations that are common.  The following recommendations could be valuable for you to know.

Hit by car.  Let your dog stand up by itself.  If it cannot, transfer it to a hard board for transporting.  Apply pressure to wounds with soft gauze.  Keep your dog warm to prevent shock.  An injured dog may bite, even people that it knows very well.  Use caution for the safety of both you and your dog.  Seek medical attention quickly.
Overheating.  If you suspect you dog has collapsed from heat stress, start to cool it down with a cool water bath, fans, cold compresses, or ice packs.  Seek medical attention immediately.
Minor Burns.  Treat with cool water and seek medical attention.

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Pyometra in Dogs

Pyometra is defined as a bacterial infection of the uterus.  Unfortunately, most cases of pyometra are much more difficult to manage than a routine infection.

Contributing Factors

Pyometra is most often diagnosed within 1-12 weeks after the end of estrus (“heat”). 

Prevalence

Pyometra is most often seen in middle-aged bitches that have undergone numerous estrous cycles during their lifetime.  There is no known breed predisposition for canine pyometra.

Clinical Signs

Clinical signs depend on whether or not the cervix is open.  If it is open, pus will drain from the uterus through the vagina to the outside.  It may be noted on the skin or hair under the tail or on bedding and furniture where the dog has been.  Fever, lethargy, anorexia, and depression may or may not be present.

If the cervix is closed, pus that forms is not able to drain to the outside.  It collects in the uterus causing distention of the abdomen.  The bacteria release toxins that are absorbed into circulation.  These dogs often become severely ill very rapidly.  They are anorectic, very listless, and very depressed.  Vomiting or diarrhea may be present.

Toxins released by the uterine bacteria affect the kidney's ability to retain fluid.  Increased urine production occurs, and the dog drinks an increased amount of water.  This occurs in both open- and closed-cervix pyometra.

Causes/Transmission

Infection in the lining of the uterus is established as a result of hormonal changes.  Following estrus ("heat"), progesterone levels remain elevated for 8-10 weeks and thicken the lining of the uterus in preparation for pregnancy.  If pregnancy does not occur for several estrous cycles, the lining continues to increase in thickness until cysts form within it.  The thickened, cystic lining secretes fluids that create an ideal environment in which bacteria can grow.  Additionally, high progesterone levels inhibit the ability of the muscles in the wall of the uterus to contract.

Other Causes of Pyometra

The use of progesterone-based drugs can cause pyometra.  In addition, estrogen will increase the effects of progesterone on the uterus.  Drugs containing both hormones are used to treat certain conditions of the reproductive system.

Entry of Bacteria into the Reproductive Tract.

The cervix is the gateway to the uterus.  It remains tightly closed except during estrus.  When it is open, bacteria that are normally found in the vagina can enter the uterus rather easily.  If the uterus is normal, the environment is not well suited to bacterial survival; however, when the uterine wall is thickened and cystic, perfect conditions exist for bacterial growth.  In addition, when these abnormal conditions exist, the muscles of the uterus cannot contract properly.  This means that bacteria that enter the uterus cannot be expelled.  The most common bacterium isolated is E. coli.

Diagnosis

Dogs that are seen early in the disease may have a slight vaginal discharge and show no other signs of illness.  However, most dogs with pyometra are not seen until later in the illness.  Any very ill female dog that is drinking an increased amount of water and has not been spayed is always suspected of having pyometra.  This is especially true if there is a vaginal discharge or an enlarged abdomen. 

Dogs with advanced pyometra have a marked elevation of the white blood cell count and often have an elevation of globulins (a type of protein produced by the immune system) in the blood.  The urine may be very dilute due to the toxic effects of the bacteria on the kidneys.  However, all of these abnormalities may be present in any dog with a major bacterial infection.

If the cervix is closed, radiographs (x-rays) of the abdomen will often identify the enlarged uterus.  If the cervix is open, there will often be such minimal uterine enlargement that the radiograph will not be conclusive.  An ultrasound examination can also be helpful in identifying an enlarged uterus and differentiating that from a normal pregnancy.

Treatment

The preferred treatment is to surgically remove the uterus and ovaries.  This is called an ovariohysterectomy ("spay").  Dogs diagnosed in the early stage of the disease are very good surgical candidates.  The surgery is only slightly more complicated than a routine spay.  However, most dogs are diagnosed when they are quite ill so the surgery is not as routine as the same surgery in a healthy dog.  Intravenous fluids are often needed before and after surgery.  Antibiotics are given for 1-2 weeks. 

Alternative Therapy

There is a medical approach to treating pyometra.  Prostaglandins are a group of hormones that reduce the blood level of progesterone, relax and open the cervix, and contract the uterus to expel bacteria and pus.  They can be used successfully to treat this disease, but they are not always successful, and they have some important limitations.

1. They cause side effects of restlessness, panting, vomiting, defecation, salivation, and abdominal pain.  The side effects occur within about 15 minutes of an injection and last for a few hours.  They become progressively milder with each successive treatment.

2. There is no clinical improvement for about 48 hours so dogs that are severely ill are poor candidates.

3. Because they contract the uterus, it is possible for the uterus to rupture and spill infection into the abdominal cavity.  This is most likely to happen when the cervix is closed.

There are some important statistics that you should know about this form of treatment:

1.  The success rate for treating open-cervix pyometra is 75-90%.
2.  The success rate for treating closed-cervix pyometra is 25-40%.
3.  The rate of recurrence of the disease is 50-75%.
4.  The chances of subsequent successful breeding is 50-75%.

Prognosis

The possibility of successfully resolving pyometra without surgery or prostaglandin treatment is extremely low.  If a treatment is not selected and performed quickly, the toxic effects from the bacteria will be fatal.  If the cervix is closed, it is also possible for the uterus to rupture, spilling the infection into the abdominal cavity.  This will also be fatal.

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Rabies in Dogs

Rabies is a viral disease that may infect any warm-blooded animal.  Regardless of the initial site of virus introduction into the animal, the virus eventually invades the central nervous system.  With rare exception, it is a fatal disease.

Contributing Factors

For domestic pets, such as cats and dogs, the greatest risk factor for contracting rabies comes from failing to receive proper rabies immunization and then coming in contact with a rabid animal.

Prevalence

Rabies is found on a worldwide basis.  Even though all warm-blooded animals can become infected, some species are more susceptible than others.  Skunks, raccoons, and bats are considered most susceptible, with cats, dogs, horses, and humans intermediate in susceptibility.  Opossums and birds are relatively more resistant to the virus compared to other species.  It is important to note that while wildlife represents the major reservoir of rabies in nature, cats and dogs are the principal source for rabies transmission to humans. 

Causes/Transmission

The usual source of rabies infection is the bite of an animal infected with the virus.  The virus is found in high concentrations within saliva.  Once inoculated into the victim, the virus travels up nerve endings to the central nervous system.  There have been a few rare cases of humans contracting rabies by inhaling aerosolized virus in bat caves. 

Clinical Signs

Rabies is classically divided into three distinct stages: prodromal, furious, and paralytic.  The prodromal stage lasts 2-3 days and is characterized by major behavior changes.  Normally friendly domestic animals, such as dogs and cats, become aggressive.  In contrast, wildlife will lose fear the normal fear of humans. Also, wild animals that are normally seen only at night (nocturnal species) may be seen during the day.  During the furious stage, dogs will typically become very vicious and make lunge at any moving object.  They may have muscle tremors and incoordination.  During the final stage, the paralytic stage, paralysis sets in and death follows.  Most dogs die from rabies within 2-7 days after they begin to show signs of the disease.

Diagnosis

Rabies can be suspected based on clinical signs, but it can only be confirmed by microscopic examination of brain tissue.  For this reason, animals suspected of having rabies are usually autopsied with a sample of brain tissue submitted to a pathologist.  Although this can be upsetting for owners, remember that there is no room for error with rabies.  If a human has been exposed and does not receive treatment, death is inevitable.

Whenever an animal without proper rabies vaccination bites a human, the animal is usually required to be confined and observed by a veterinarian for at least a 10-day period. 

Therapy

Treatment is not recommended for animals with rabies because of the potential risk for human exposure to the virus.

Prognosis

Rabies is always fatal in warm-blooded animals that develop the disease.

Transmission to Humans

Rabies can be transmitted to a human through the bite of an infected animal or inoculation of rabies-infected saliva into an open wound.   Whenever a human is bitten by an animal, a physician should always be promptly contacted.  In some areas, physicians are required to contact local animal control officials so that the vaccination status of the animal can be verified and an appropriate quarantine initiated.

Prevention

Because rabies-immunized pets represent an important buffer between humans and the rabies reservoir found in wildlife, the importance of regular rabies boosters for pets cannot be overemphasized. 

The first rabies vaccine is usually given at 12-16 weeks of age, followed by regular boosters.  Depending upon state regulations, the boosters are given every year or every three years thereafter.  These vaccines are considered safe and effective. 

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Recommendations
for Dog Owners

Pet ownership carries with it the responsibility of being proactive in health care.  There are certain steps that you should take to prevent health problems.  We recommend the following:

        1. Keep vaccinations current
2. Brush frequently to keep hair coat from matting. 
3. Clip toenails as needed to prevent overgrowth. 
4. Keep plenty of fresh water available and monitor its consumption.
5. Keep other pets from preventing this one from free access to food and water.
6. Weigh your dog on the same scale and record results at least every 60 days.
7. Give heartworm prevention year-round.

Early Signs of Disease

There are many early signs of disease that can easily be interpreted as insignificant or even normal.  We recommend that you present your dog for an examination for any of the following:

1. Sustained, significant increase in water consumption.  (Abnormal is intake greater than 50 ml/#/day or approximately 1.5 cups (8 oz cups)/day or 12 oz total 10 pounds of body weight.)
2. Sustained, significant increase in urination.
3. Weight loss.
4. Significant decrease in appetite or failure to eat for more than two consecutive days.
5. Significant increase in appetite.
6. Repeated vomiting.
7. Diarrhea that lasts over 3 days.
8. Difficulty in passing stool or urine.
9. A break in housetraining habits.
10. Lameness that lasts more than 5 days, or lameness in more than one leg.
11. Noticeable decrease in vision, especially if sudden in onset or pupils that do not constrict in bright light.
12. Masses, ulcerations (open sores), or multiple scabs on the skin that persist more than 1 week.
13. Foul mouth odor or drooling that lasts over 2 days.
14. Increasing size of the abdomen.
15. Increasing inactivity or amount of time spent sleeping.
16. Hair loss, especially if accompanied by scratching or if in specific areas (as opposed to generalized).
17. Breathing heavily or rapid at rest.
18. Inability to chew or eat dry food.

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Ringworm in Dogs

Ringworm is a skin disease caused by a fungus (plural: fungi).  Because the lesions are often circular, it was once thought to be caused by a worm curling up in the tissue.  However, there is no truth to that; it has nothing to do with a worm.

There are four fungal species affecting dogs which can cause the disease that we call ringworm.  These may also affect humans.  The fungi live in hair follicles and cause the hair shafts to break off at the skin line.  This usually results in round patches of hair loss.  As the fungus multiplies, the lesions may become irregularly shaped and spread over the dog's body.

Incubation Period

The incubation period is 10-12 days.  This means that following exposure to the fungus, about 10-12 days will pass before any lesions occur. 

Diagnosis

Diagnosis is made in one of 3 ways:

1. Identification of the typical "ringworm" lesions on the skin
2. Fluorescence of infected hairs under a special light (however, only 2 or the 4 species of fungi fluoresce)
3. Culture of the hair for the fungus.  The last method is the most accurate, but it may take up to 2-3 weeks for the culture to become positive.

Transmission

Transmission occurs by direct contact between infected and non-infected individuals.  It may be passed from dogs to cats and visa versa.  It may also be passed from dogs or cats to people and visa versa.  If your child has ringworm, he or she may have gotten it from your pet or from another child at school.  Adult humans usually are resistant to infection unless there is a break in the skin (a scratch, etc.), but children are quite susceptible.  If you or your family members have suspicious skin lesions, check with your family physician.

Transmission may also occur from the infected environment.  The fungal spores may live in bedding or carpet for several months.  They may be killed with a dilution of chlorine bleach and water (1 cup of chlorine bleach in a gallon of water) where it is feasible to use it.

Treatment

There are several means of treatment.  The specific method(s) chosen for your dog will depend on the severity of the infection, how many pets are involved, if there are children in the household, and how difficult it will be to disinfect your pets' environment.  The one’s that are appropriate for your situation are marked.

___1. Griseofulvin.  This is a tablet that is concentrated deep in the hair follicles where it can reach the site of active fungal growth.  Griseofulvin should be given daily.  Dogs with active lesions should receive the tablets for a minimum of 30 days.  At that time, your dog should be rechecked to be sure that the infection is adequately treated. 

These tablets are not absorbed from the stomach unless there is fat in the stomach at the time they are given.  This can be accomplished by feeding a high fat diet, such as a rich canned dog food or a small amount of fat trimmings from meats (often available at the meat departments of local grocery stores upon request of the butcher).  An another option is to allow your dog to drink some rich cream. This is the most important part of the treatment.  If you are not successful in giving the tablets, please call us for help. 

If you are aware of fat consumption having caused a problem for your dog in the past or if your dog has had an episode of pancreatitis, bring this to our attention immediately.

___2. Topical antifungal medication.  Apply one of these products to the affected areas once daily for 10 days.  Do not risk getting it in your dog's eyes by treating lesions very near the eye.

___3. Baths using an antifungal shampoo.  A bath should be given 3 times on an every other day schedule.  Bathe exposed but unaffected pets once.  These baths are important in getting the spores off the hairs so they do not drop into the environment and result in re-exposure.  Lather should be formed and left on for 5 minutes before rinsing. 

___4. Lime Sulfur Dip.  This should be done twice weekly for the first two weeks then once weekly for 4-6 weeks.  Lime sulfur dip should also be applied to other pets (dogs or cats) in the household to prevent them from being affected.  If they develop ringworm lesions, they should begin on griseofulvin. You should wear gloves when applying the dip.  This is an effective form of treatment, but the dip has an objectionable odor and can tarnish jewelry.

___5. Shaving of the dog's hair.  This will remove the infected hair.  We recommend this only when the infection is extensive.

Initial Results of Treatment

Treatment will not produce immediate results.  The areas of hair loss will get larger before they begin to get smaller.  Within 1-2 weeks, the hair loss should stop, there should be no new areas of hair loss, and the crusty appearance of the skin should subside and the skin look more normal.  If any of these do not occur within two weeks, your dog should be checked again.

Duration of Contagion

Infected pets remain contagious for about 3 weeks if aggressive treatment is used.  Contagion will last longer if only minimal measures are taken of if you are not faithful with the prescribed approach.  Minimizing exposure to other dogs or cats and to your family members is recommended during this period.

Treating Exposed Dogs and Cats

Ringworm is contagious from dogs to other dogs and to cats.  If the exposed pets do not have any skin abnormalities, including hair loss, they should be treated for 10 days.  If skin lesions develop during those 10 days, treatment is extended until the fungus is gone.

A Possible Carrier State

When treatment is completed, ringworm should be cured.  Although a carrier state can exist, this usually occurs because treatment is not long enough or aggressive enough or because there is some underlying disease compromising the immune system.

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Sarcoptic Mange of Dogs

Dogs have many parasites, both internal and external.  Internal parasites are those which live in the various organs inside the dog's body.  External parasites, such as fleas, ticks, and mites, live on the outside of the body. 

Mange is a parasitic skin disease caused by microscopic mites. Two different types of mange mites are significant in dogs.  One type lives just under the surface of the skin, while the other type resides in the hair follicles.  Although both types of mites share some similar characteristics, there are also important differences.  It is important not to confuse the two types of mange because they have different causes, treatments, and prognoses.

Contributing Factors

The sarcoptic mange mite is highly contagious between dogs.  Exposure to a dog infested with this mite will likely lead to spread of the parasite.

Prevalence

Sarcoptic mange is a common parasitic skin disease of dogs.

Causes/Transmission

Sarcoptic mange is caused by a mite that burrows just beneath the surface of the skin.  It may also crawl around on the skin surface.  This mite feeds on material in and on the skin.

Clinical Signs

The presence of the sarcoptic mite causes severe itching.  The dog will chew and scratch its skin constantly.  This leads to the loss of large amounts of hair, especially on the legs and belly.  Eventually, the skin will become thickened and will darken due to pigmentation.  Frequent scratching and rubbing often leads to secondary skin infections.

Diagnosis

Diagnosis is made by a skin scraping that is examined under the microscope.  However, only a small number of mites may be present.  Because of this, a dog may be strongly suspected of having sarcoptic mange but multiple skin scrapings are negative.  A presumptive diagnosis can be made because the signs are quite typical.  Age is not a significant factor in sarcoptic mange.  Although most common in puppies, dogs of all ages are at risk.

Treatment

There are several insecticides that are effective against this mite.  Various dips have been used successfully.  Dipping should occur weekly for at least 4 weeks, at which time your dog should be re-examined to determine if further treatment is needed.  An oral product, ivermectin, is also effective.  This drug is approved for use in preventing heartworms; it is not officially approved for use in treating sarcoptic mange.  However, its ease of administration compared to dipping makes it the drug of choice in certain situations, and it may actually be more effective than dipping in some dogs

Prognosis

With appropriate therapy, the prognosis for recovery is excellent.  Re-infestation from a contaminated environment or other dogs is possible.

Transmission to Humans

Sarcoptic mange is highly contagious to other dogs; it is also contagious to humans.  The dog's bedding should be washed in hot water with bleach or, preferably, discarded.  The mites are not able to complete their life cycle on humans; therefore, they will die in a few days without treatment.  However, they will cause quite a bit of itching before they finally die.

Instructions

____ 1) Bathe your dog in any good pet shampoo then slowly pour the diluted dip over your dog(s).  This should be done on a weekly basis for 4 weeks.  Carefully read the dilution instructions on the bottle.  Do not rinse off the dip; air drying is preferred.  A towel or hair dryer may be used, especially if the temperature is cool.

____ 2) Give your dog ivermectin orally _______________________________________.

____  3) Your dog's bedding should be washed in hot water with bleach or discarded.

____ 4) If relief from itching does not begin within 5 days after treatment begins, please call us.

____ 5) Allow us to re-examine your dog in ____ days.

____ 6) Contact your physician if any family members develop an itching skin rash.  Tell your physician that you have been exposed to sarcoptic mange (also known as scabies).  In people, the mite cannot complete its life cycle so it will die in a few days.  However, it may cause itching during that time.  Reinfestation from the dog or premises can result in continued itching.

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Subcutaneous Fluid
Administration to Dogs

Administration of supplemental fluids can benefit dogs with a number of different medical conditions.  Most commonly, fluid supplementation is recommended for dogs with kidney disease.  Although the idea of giving fluids may initially be intimidating, we encourage you to consider learning this technique.  It is very normal to feel some anxiety about this but we believe that you will find that it is not nearly as difficult as it would seem. The potential benefit to your dog will make it well worth your time to learn this simple technique.

Supplies

The equipment consists of a bag of IV fluids, an IV drip set, and a needle.  The IV drip set is a simply a tube which connects the fluid bag to the needle.  Although it initially seems complicated, you will soon become very comfortable with the procedure described below.

Connecting the Fluid Line to the IV Bag

1.  Remove the outer, protective bag from the inner IV bag.
2.  Remove the IV set from its packaging.
3.  The top end of the IV set has a large, pointed end with a protective cap.  Remove this cap, but do not permit it to become contaminated.  IT SHOULD NOT TOUCH ANYTHING.
4.  Pull the protective covering from the exit port on the bottom end of the IV bag.  This will expose a hole that will accept the pointed end of the IV set.
5.  Push the pointed end of the IV set into the open hole of the IV bag.  It must be seated firmly to prevent leaks.
6.  Remove the protective cap from the lower end of the IV set, but do not discard it.  Do not permit it to become contaminated.  IT SHOULD NOT TOUCH ANYTHING.
7.  Close the lock in the middle of the IV tubing by moving the roller.  (The lock on a new IV set is often already in the open position.)
8.  Gently squeeze and release the bulb at the top of the drip set until the bulb chamber is about half full with fluid. 
9.  Open the lock (roller) on the tubing and then hold or suspend the IV bag; fluid should flow freely.
10.  Be sure that all air bubbles run out of the tubing. 
11.  Close the lock on the IV line by rolling the roller downward.
12.  Remove the protective cap on the lower end of the IV set.
13.  Break the protective covering around the needle so that the open end (not the sharp end) is exposed.  Do not permit it to become contaminated by allowing it to touch ANYTHING.
14.  Remove the protective cap from the lower end of the IV set, and place the open end of the needle on it.  Seat it firmly.

Insertion of the Needle

Insert the needle just under the skin in one of several locations that has unusually loose skin.  These are:

- At the level of the shoulder blades, just to the right and to the left of midline
- At the level of the back legs, just to the right and to the left of midline

Fluid Administration

- Choose a location where you will treat your dog.  This may be on a table, counter top, in the floor or in your lap.  The size of the dog will determine a suitable location.
- Hang the IV bag about 3 feet (1 meter) above the level of your dog's head. 
- Place your dog in the treatment location.  Be sure both of you are in a position that will be comfortable for about 5 minutes.  The end of the IV set should easily reach your dog.
- Pick up a roll of loose skin in one of the above locations.
- Lay the point of the needle at the base of the roll of skin with the needle horizontal and pointing to the dog's head.  This assumes that the dog is in an upright or standing position.
- Advance the needle slightly forward while pulling the roll of skin backward.  That should place the point of the needle under the skin.
- Release the roll of skin.  The point of the needle should remain under the skin.
- Grasp the IV set lock in one hand.  Begin the flow of fluids by rolling the roller upward.

Amount of Fluid to Give

The instructions at the end of this handout will tell you how much to give for your specific situation.  If you are using two spots, you should give half of that amount in each location.

When you have given the recommended amount, complete the following steps:

- Stop the flow of fluids by rolling the roller in the IV set lock downward firmly.  If you do not close it well and the bag is left hanging, fluid will drip.
-Remove the needle from the skin and replace its protective cap.
-PLACE A NEW, STERILE NEEDLE ON THE DRIP SET AS SOON AS YOU ARE THROUGH.  This keeps bacteria which were picked up on the old needle from migrating into the fluids.   If you wish, you may return it to our hospital for proper disposal.
- Store the equipment in a safe place until the next fluid administration.

General Considerations

It is not necessary to "sterilize" the skin with alcohol before inserting the needle.  In reality, wiping a little alcohol on the skin does not really sterile it, and the odor and feel of alcohol may aggravate your dog.  Many animals will taste the alcohol and begin to drool.

Most dogs tolerate this procedure quite well.  However, if the fluids are unusually cold or hot, they may be uncomfortable.  Ideally, they should be stored at about body temperature.  However, as long as they are at room temperature most dogs are fine.  Do not refrigerate them.

As the fluids are running, a lump will form under the skin.  Do not be alarmed; this is a pocket of fluid that will be absorbed over several hours.   If absorption is slow, gravity may cause the fluids to migrate downward.  They could move under the skin of the front or rear legs.  However, if this happens, they will still be absorbed.

There is no problem is a few bubbles of air are injected under the skin.  If quite a bit of air gets under the skin, you may feel a crackling sound when you push on the skin, and your dog may experience mild discomfort for a couple of hours, but no real harm will occur.  The body will eventually absorb the air.

Troubleshooting

What to do if the Fluids Stop Running

This often happens when the end of the needle moves against the skin or the underlying tissue.  Do not remove the needle; rather, gently reposition it until the fluids begin to flow again.  Experiment with the position of the needle until the fluids flow freely.

What to do if the Fluid Runs Slowly on Subsequent Treatments

When you are finished giving fluids, you should close the lock firmly.  However, closing the lock firmly may crush the tubing so that fluid will not flow well on subsequent use.  If this happens, move the lock to another place on the IV tubing, and open the crushed area of the tube by pinching it with your fingers.

What to do if the Fluids become Cloudy in Appearance

If any cloudiness or discoloration occurs, do not use the bag.  It usually means that the fluids have become contaminated with bacteria.  If you administer these fluids to your dog, a serious infection may occur under the skin.

Instructions for your dog:

1. Give ___________ ml of fluids at each treatment.
2. Treat your dog every ________ days or _________ times per week.
3. Return _______________________ for further tests to monitor treatment progress.

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Seizures in Dogs

Seizures are one of the most frequently seen neurological problems in dogs.  A seizure is also known as a convulsion or fit.  A seizure represents a period of abnormal brain wave activity that leads to a variety of clinical signs. 

Prevalence

Seizures represent a common neurologic disturbance in the dog.  Seizures are seen on a fairly regular basis by veterinarians in private practice.

Clinical Signs

A number of signs may be observed when a dog is having a seizure.  Signs usually start suddenly and end abruptly.  They may involve the whole body or just parts of the body, such as one limb or particular muscles of the face.  Some of the more common signs include:

1.  Loss of consciousness or a change in level of consciousness
2.  Contractions of all the muscles in the body, paddling of the legs, chewing
3.  Changes in mental awareness from non-responsiveness to hallucinations
4.  Behavioral changes, including non-recognition of owner, viciousness, pacing, and running in circles

Components of a Seizure

A seizure occurs in three phases:

1) The pre-ictal phase, or aura, is a period of altered behavior in which the dog may hide, appear nervous, or seek extra attention from people it knows.  It may be restless, nervous, shaking, or salivating.  This may last a few seconds to a few hours.

2) The ictal phase describes the seizure itself and lasts from a few seconds to about five minutes.  During this period, all of the muscles of the body contract strongly.  The dog usually falls on its side and seems paralyzed while shaking.  The head will be drawn backward.  Urination, defecation, and salivation often occur.   If it is not over within five minutes, the dog is said to be in status epilepticus, or a prolonged seizure.

3) During the post-ictal phase, there is confusion, disorientation, salivation, pacing, restlessness, and/or temporary blindness.  There is no direct correlation between the severity of the seizure and the duration of the post-ictal phase. 

Dogs that do not receive medical attention with status epilepticus are at risk for serious complications because of the physiological changes that occur.   Most significant is the rise in body temperature that occurs from continuous strong muscle activity.  This can lead to hyperthermia and death.

Causes/Transmission

There are many, many causes of seizures.   For this reason, when we first begin an evaluation of the dog with seizures, we think less in terms of the specific disease and focus more on categories of diseases.  For example, if this is a young dog, could there be a structural abnormality, such as hydrocephalus?  In an older animal, could it be a degenerative disease or a brain tumor?  For outdoor dogs, what is the potential for exposure to toxins such as antifreeze? 

Epilepsy is the most common and of least consequence to the dog.  The other extreme includes severe diseases such as brain tumors.  Fortunately, most are due to epilepsy.

Evaluation of the Dog with Seizures

When a seizure occurs, it is important that you give us a thorough account of recent events, especially recent exposure to any toxins, poisons, medications, hallucinogenic substances or history of head trauma.  A physical examination, a basic battery of blood tests, and an electrocardiogram (EKG) are also commonly performed.  These tests rule out disorders of the liver, kidneys, heart, electrolytes, and blood sugar level.

If these tests are normal and there is no exposure to poison or any history of trauma, further diagnostics may be performed depending on the severity and frequency of the seizures.  Occasional seizures are of less concern than if seizures are increasing in severity and frequency.  In this instance, a spinal fluid tap and fluid analysis may be performed.  Depending on availability, specialized imaging of the head with a CAT scan or MRI might be performed.  Fortunately, these additional tests are usually not needed.

Treatment

Your dog may be discharged with no medications or with a 1-2 week course of anticonvulsant therapy.  If there are no more seizures during that time, the anticonvulsants may be discontinued.  The next treatment is based on when, or if, another seizure occurs.  That may be days, months, or years.  At some point, many dogs have seizures frequently enough to justify continuous anticonvulsant therapy.  Since that means medication must be given every 12 to 24 hours for the rest of the dog's life, we do not recommend that until seizures occur about every 30 days or unless they last more than five minutes.

It is important to avoid sudden discontinuation of any anticonvulsant medication.  Even normal dogs may be induced to seizure if placed on anticonvulsant medication and then abruptly withdrawn from it.  We can outline a schedule for discontinuing the medication.

Additional Treatments 

Some dogs with seizures are known to have granulomatous meningoencephalitis.  This is a disease that causes inflammation in the brain and the tissue coverings around the brain.  It is not caused by infection. The only way to make a confirmed diagnosis is with an autopsy.  However, it usually responds well to corticosteroids ("cortisone " or "steroids").  Therefore, corticosteroids may be tried when phenobarbital is not effective. 

Prognosis

The prognosis is dependent upon the cause.  In some cases, the cause cannot be identified so the prognosis in uncertain.  In this situation, the frequency and severity of the seizures are monitored to assess progression of the underlying disease process.

Transmission to Humans

There are some infectious causes of seizures in dogs that pose a health risk to humans; most notable is rabies.  Fortunately, this is very uncommon. 

Many owners are bitten by the seizing animal because of a well-intentioned effort to help.  Despite the dramatic signs of a seizure, your dog feels no pain, only bewilderment.  Dogs do not swallow their tongues.  If you put your fingers into its mouth, you will not help the dog and will run a high risk of being severely bitten.  The important thing is to keep the dog from falling and hurting itself.  As long as it is on the floor or ground, there is little chance of harm occurring. 

INSTRUCTIONS

1) Call  _______________________________________________ for results of the tests.

2) Administer your dog's prescription as directed for the next __________ days.  If drowsiness occurs, reduce the dosage by 50%.  If a seizure occurs, double the dosage level and call the hospital for further instructions.

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Staph Dermatitis and
Hypersensitivity

Staph is a commonly used abbreviation for Staphylococcus, a group of bacteria commonly found on the skin.  Dermatitis is a term that means that the skin is inflamed.

Staph is a normal resident of the skin of animals and humans; however, it is considered an opportunist.  As long as the skin is healthy, Staph is dormant.  But once the skin is irritated, Staph can invade the area and multiply rapidly.

Causes of Skin Irritation

Scratching is the most common cause.  Any disorder that causes itching can create the situation that allows Staph to become a problem.  Common causes of itching include fleas, inhalant allergy, and food allergy.  Irritating chemicals, such as flea and tick dips, also can cause itching.

Diagnosis of Staph Lesions

There are two typical Staph lesions.  One type begins as a red area on the skin with a pimple-like pustule in the center.   The other type is a circular, reddish area with a crusty edge and hair loss in the center.  The latter can easily be confused with ringworm.  Finding either of these skin patterns in a dog that is scratching is highly suggestive of Staph.

Confirmation can be made with cultures or skin biopsy.  However, the lesions are so typical that this is usually not necessary.

Treatment of Staph Dermatitis

This bacterium is usually sensitive to several antibiotics.  These include erythromycin, enrofloxacin, amoxicillin with clavulanic acid, lincomycin, dicloxacillin, and oxacillin.  Since these medications can be given orally, treatment can occur at home.  However, some infections may require 3-6 weeks of treatment before the infection is under control.  Antibacterial shampoos and ointments can also be helpful in bring about rapid control of the infection.

The other essential part of treatment is stopping itching and scratching.  Other tests may be needed to determine the cause or causes.  Frequently, more than one condition contributes to itching.

Contagion

Your dog is not contagious to you or to other pets.  All dogs, cats, and people have Staph living on the skin as a normal resident.

Rapid Recurrence following Treatment

If the Staph lesions return within a week or two following treatment, another situation may exist.  This situation may be caused by an allergy to the Staph bacteria.  This is called Staph hypersensitivity or Staph allergy. 

The skin lesions that are caused by this disease are identical to those of a Staph dermatitis.  The difference is recurrence.  If Staph dermatitis is treated properly, the underlying cause is eliminated and itching is stopped, the bacterial skin disease should be eliminated.  This situation may return if itching returns.  However, when the dog with Staph hypersensitivity is treated, the skin lesions will return within a few days or weeks.

Since differentiation of Staph dermatitis and Staph hypersensitivity is based largely on recurrence, it is very important that treatment be continued long enough.  This often means a month or more of antibiotics.  If not, there will still be a question of which disease is present.

Treatment of Staph Hypersensitivity

Treatment begins the same as for Staph dermatitis: oral antibiotics, medicated shampooing, and whatever is necessary to stop the itching.  However, long-term control is best achieved with Staph bacterin.  Staph bacterin is a solution of killed Staph bacteria that is injected into the dog in very tiny amounts.  This is an attempt to reprogram the dog's immune system so it does not over-react to its own bacteria.  The use of Staph bacterin begins as a series of daily injections into the layers of the skin.  After the initial series is completed, the injections are given subcutaneously (just below the skin) on an interval of every 3-4 days to every 2 weeks.  Since this is an ongoing treatment, it is done by you at home.

Fear of Injections

Giving injections to dogs is much easier than you think.  We can teach most people to give the injections in just a few minutes.  Don't decide that you cannot do this until we show you the technique.  However, if after seeing the technique you are still not comfortable doing it, we can arrange for one of our staff members to do these for you on a regular basis.

Success Rate

Allergy shots are never successful 100% of the time, whether in dogs or in people.  We expect up to 75% of the dogs to respond well. 

Other Options Besides Injections

If you do not give the injections, you cannot arrange for one of our staff members to do so, or your dog does not respond, it will have to be treated periodically with oral antibiotics and medicated baths.  This is not the most desirable approach because Staph will often develop resistance to the antibiotics.  If this occurs, a change in the specific antibiotic used will be necessary.

INSTRUCTIONS

____1. Give the antibiotics orally according to the instructions on the label.  Do not discontinue them even though your dog's skin looks normal.  There should be noticeable improvement within 1 week.  If not, please contact us.  If the skin lesions are improved but not completely healed when the antibiotics are all given, contact us for either a refill or for another drug.

____2. Bathe your dog in the medicated shampoo every _________ days for a total of _______ baths.  Work up a lather and allow it to remain on your dog's skin for at least 5 minutes before rinsing thoroughly.

____3. An injection was given to stop itching.  If this does not occur within 24 hours, please contact us for further instructions.  If the injection causes your dog to drink and urinate excessively, pleases contact us.  If this occurs, it will stop in a few days.  It is dose related; if another injection is needed at a later date, the dose will be lowered to avoid this problem.

____4. A prescription is dispensed to control itching.  Give the first dose ___________________.  If the tablets cause your dog to drink or urinate excessively, please contact us.  If this occurs, it will stop in a few days.  It is dose related; if this medication is resumed, the dose will be lowered to avoid this problem.

____5. Staph bacterin is to be given according to the following schedule:

Dose 1: ____________________    
Dose 2: ____________________
Dose 3: ______________________                                             
Dose 4: _____________________
Dose 5: _____________________                                      
Dose 6: _____________________
Dose 7: _____________________          
Dose 8: _____________________

          Please make an appointment on each of these days.

          Following this series you will be instructed on how to give the injections at home.

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Tapeworm Infection in Dogs

The most common tapeworm of dogs (and cats) is called Dipylidium caninum.  This parasite attaches to the small intestinal wall by hook-like mouthparts.  Adult tapeworms may reach 8 inches (20 cm) in length.  The adult worm is actually made up of many small segments about 1/8 inch (3 mm) long.  As the tail end of the worm matures, the terminal segments break off and pass into the stool.  Occasionally, the mobile segments can be seen crawling near the anus or on the surface of a fresh bowel movement.  These segments look like grains of rice and contain tapeworm eggs; the eggs are released into the environment when the segment dries.  The dried segments are small (about 1/16", or 2 mm), hard and golden in color.  These dried segments can sometimes be seen stuck to the hair around the dog's anus. 

Means of Infection

First, tapeworm eggs must be swallowed by flea larvae (an immature stage of the flea).  Contact between flea larvae and tapeworm eggs is thought to occur most frequently in contaminated bedding or carpet.  The life cycle of the tapeworm cannot be completed unless the flea swallows tapeworm larvae.

Next, the dog chews or licks its skin as a flea bites; the flea is then swallowed.  As the flea is digested within the dog’s intestine, the tapeworm hatches and anchors itself to the intestinal lining.

Clinical Signs

Tapeworms are not highly pathogenic (harmful) to your dog.  They may cause debilitation and weight loss when they occur in large numbers.  Sometimes, the dog will scoot or drag its anus across the ground or carpet because the segments are irritating to the skin in this area.  The adult worm is generally not seen, but the white segments that break away from the tapeworm and pass outside the body rarely fail to get an owner's attention! 

Occasionally, a tapeworm will release its attachment in the intestines and move into the stomach.  This irritates the stomach, causing the dog to vomit the worm.  When this happens, a worm several inches in length will be seen.

Diagnosis

Tapeworm infection is usually diagnosed when the white, mobile segments are seen crawling on your dog or in the stool.  Tapeworms are not usually detected by the routine fecal examination performed by the veterinarian.  Because of this, veterinarians depend on the owner to notify them of possible tapeworm infection in the dog.

Treatment

Treatment is simple and, fortunately, very effective.  A drug that kills tapeworms is given, either orally or by injection.  It causes the tapeworm to dissolve within the intestines.  Since the worm is usually digested before it passes, it is not visible in your dog's stool.  These drugs should not cause vomiting, diarrhea, or any other adverse side effects.

Control of fleas is very important in the management and prevention of tapeworm infection.  Flea control involves treatment of your dog, the indoor environment and the outdoor environment where the dog resides.  If the dog lives in a flea-infested environment, reinfection with tapeworms may occur in as little as two weeks.  Because the medication that treats tapeworm infection is so effective, return of the tapeworms is almost always due to reinfection from the environment.

Pinworms

Tapeworms and pinworms look very similar.  However, contrary to popular belief, pinworms do not infect dogs or cats.  Any worm segments seen associated with dogs are due to tapeworms.  Children who get pinworms do not get them from dogs or cats.

Contagion to Humans

It s possible for humans to become infected with tapeworms, although infection is not common or likely because humans are not the natural host of the dog’s tapeworms.  A flea must be ingested for humans to become infected with the most common tapeworm of dogs.  Most reported cases have involved children, individuals whose immune system is not fully functioning.  The most effective way to prevent human infection is through aggressive, thorough flea control.  The risk for infection with this tapeworm in humans is quite small but does exist.

One less common group of tapeworms, called Echinococcus, is of particular concern as a threat to human health.  These tapeworms cause very serious disease when humans become infected.  This parasite is harder to diagnose than the tapeworm caused by fleas because the segments are small and not readily seen.  Hunters and trappers in the north central United States and south central Canada may be at risk for infection by this worm if strict hygiene is not observed.  Foxes and coyotes (and the wild rodents upon which they prey) are important in the life cycle of this parasite.  Dogs and cats may also become infected if they eat rodents carrying the parasite.  When eggs of Echinococcus are passed in the feces of the dog and cat, humans are at risk for infection.  Free-roaming cats and dogs may need to be periodically treated with tapeworm medication.  Rodent control and good hygiene are important in preventing the spread of this disease to humans.  As with the more common tapeworm, infection with Echinococcus is infrequent but possible.

What can be done to control tapeworm infection in dogs and to prevent human infection?

1. Effective flea control is important.

2. Prompt deworming should be given when parasites are detected; periodic deworming may be appropriate for pets at high risk for reinfection.

3. All pet feces should be disposed of promptly, especially in yards, playgrounds, and public parks.

4. Strict hygiene is important, especially for children.  Do not allow children to play in potentially contaminated environments.

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Tartar Prevention for Dogs

Plaque is a gummy substance that forms on the teeth within a few hours after a meal.  Within 24 hours, plaque hardens into tartar. 

Tartar is harmful in two ways.  First, it serves as a place where bacteria can reside and multiply in the mouth.  There is substantial scientific evidence that bacteria from tartar enter the blood stream and are deposited in various organs.  Heart and kidney disease can result.  Second, tartar builds up at the gum line.  As the tartar deposit gets larger, it pushes the gums away from the roots of the teeth.  Eventually, the teeth will loosen and fall out.

Prevention

After your dog's teeth have been cleaned, we would like to recommend a few steps that will help to reduce the process of plaque and tartar buildup.

1. Feed your dog Prescription Diet t/d.  This is a food that has been shown to greatly reduce tartar buildup.  It is formulated as a dry food and is composed of large pieces.  Because the pieces are too large to be swallowed whole, your dog must chew them.  The food contains fibers that literally scrape the plaque off of the teeth without damaging the enamel.  By removing plaque as it forms, tartar formation is greatly diminished.

2. Brushing of the teeth is another effective means of removing plaque before it turns into tartar.  We recommend the use of toothpaste made especially for dogs.  This needs to be done at least twice weekly (preferably daily), but we know that not all dogs will tolerate it.  Special brushes are made that make this task easier.

3. Use a "mouthwash" that is added to your dog's drinking water.  This type of product reduces the bacterial count in the mouth, resulting in improved breath.

4. Cleaning the teeth in 6-12 months or at the first sign of tartar buildup can be very beneficial to most dogs.  This will prevent damage to the gums and roots.

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Chronic Vomiting in Dogs

Chronic vomiting is a common problem in dogs.  It may be related to relatively minor causes, such as chronic swallowing of hair, or it may be due to much more serious diseases. 

Urgency

Because there are so many causes, there are many tests that may be needed to make an accurate diagnosis.  One of the factors that determine how quickly these tests must be performed is the condition of your dog.  If the appetite is very poor or non-existent or if weight loss is occurring rapidly, it is important that a diagnosis be obtained rapidly.  If pain or a mass is present in the abdomen, tests need to be performed quickly.  However, if neither appetite nor weight is affected, the urgency is much less.

Source of Vomiting

Vomiting may be due to disease in the stomach or intestines, or it may be due to disease in many other parts of the body.  As a rule, most of the latter diseases are detected with blood tests.  However, few diseases in the stomach are intestines show up in those tests.

Testing Procedure

The sequence of tests will vary from dog to dog.  The urgency issues already discussed are one of the most important factors that we must consider.  However, as a rule, we recommend blood tests to eliminate the diseases that are not directly involving the stomach or intestines.  If those do not detect the problem, the other tests, listed below, will be utilized.

Tests for Diseases of the Stomach or Intestines

The following tests are performed to evaluate the stomach and intestines.  Their pros and cons are listed.

Radiographs (x-rays):  Radiographs are made with and without barium.  Those without barium find foreign materials if they are made of bone or metal or other very hard substances.  Radiographs made with barium are taken as a series.  Barium is placed in the stomach and radiographs are made every 15-30 minute until the barium reaches the end of the intestines.  These radiographs permit us to evaluate:

1. How quickly the stomach empties
2. If the barium moves completely through the intestines and how quickly that occurs
3. If the intestines are dilated
4. If there are areas in the intestines that are very irritated
5. If there is a rupture of the stomach or intestines

These radiographs do not require sedation or anesthesia unless the dog is very uncooperative.

Endoscopy and Biopsy

An endoscope is a flexible scope that is inserted through the mouth, down the esophagus, and into the stomach and first few inches of the small intestines.  (It may also be inserted through the anus and into the colon, but this is generally reserved for dogs with chronic diarrhea.)  This permits us to look at the insides of the esophagus, stomach, and upper small intestines.  It also permits biopsies to be taken, which is often the most important part of the procedure.

Endoscopy requires anesthesia so there is always a small degree of risk involved.  However, it does not require a surgical incision.  One of its limitations is that some tumors of the stomach do not go completely to the inner surface of the stomach.  Since the biopsies are only made from the stomach lining, it is possible to miss them.

Ultrasound

An ultrasound study is performed with a machine that sends sound waves into the body.  Their reflections are analyzed by a computer and formed into an image on a computer-type screen.  There is no radiation involved.  These images allow a trained operator to visualize the structure of the stomach and intestinal walls.  It also permits evaluation of the liver, kidneys, and other abdominal organs.  Biopsy of abnormal areas of most organs is also possible and can provide the needed tissue samples for a diagnosis to be made. 

An ultrasound examination usually does not require sedation or anesthesia; however, the dog must lie on its back for 15-30 minutes.  Some dogs will not do that without sedation.  If biopsies are taken, sedation is usually required to prevent pain and to prevent damage to internal organs.

Surgery

Surgical exploration of the abdominal cavity is generally reserved for those dogs that cannot be diagnosed with the above tests.  It is the most invasive procedure, but it permits us to see all parts of the stomach and intestines as well as the other abdominal organs.  It also permits us to biopsy specific areas of any abdominal organ.

In some cases, surgery is performed as one of the first procedures if an intestinal obstruction is diagnosed or strongly suspected.

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Vomiting in Dogs

Vomiting is not a specific disease; it usually is a sign of a number of different diseases.  In general, the veterinarian must to decide whether the cause of vomiting is more likely to fall into a particular category of causes.  These are:

1. Vomiting caused by a disorder outside the gastrointestinal tract (systemic disease). Examples of systemic diseases include liver failure, kidney failure, and diabetes mellitus. 

2. Vomiting caused by a disorder within the gastrointestinal tract or abdomen.  Examples of these disorders include intestinal parasites, dietary indiscretion, pancreatitis, inflammatory diseases of the stomach and/or intestinal tract, and cancer.

Clinical Signs

Initially, it must be determined how ill the dog has become as a consequence of the vomiting.  When the vomiting has led to more serious problems, any of the following might be noted:

1. Diarrhea
2. Dehydration
3. Loss of appetite
4. Abdominal pain
5. High fever
6. Depression
7. Bloody vomiting

Causes

As noted above, the veterinarian must determine the source of the vomiting (systemic cause vs. gastrointestinal tract). 

Many cases of vomiting are self-limiting after a few days, and the cause may never be determined.  Less commonly, vomiting may result from a serious illness.  Even when vomiting is caused by mild illnesses, it may lead to death of the animal if treatment is not begun early enough to prevent severe fluid and electrolyte losses.

Diagnosis

If vomiting is associated with several of the above signs, a series of tests may be performed in the hope that a diagnosis will be made. 

Diagnostic tests may include radiography (x-rays) with or without barium, blood tests, biopsies of the stomach and intestinal tract, ultrasound studies, and exploratory abdominal surgery.  Once the diagnosis is known, treatment may include special medications, diets, and/or surgery.

Treatment

In some cases, such as a sudden onset of vomiting, the cause is self-limiting and only supportive care is needed.  In this instance, treatment might involve fluid and electrolyte supplementation, medications for nausea, and limiting oral intake of food and water.

In more serious or protracted cases of vomiting, the animal may need to be admitted to the hospital for intravenous administration of fluids, antibiotics, medications for nausea, and observation.  It is important to prevent dehydration from developing while additional diagnostics or treatments are underway.

Prognosis

The prognosis is dependent upon identification and treatment of the underlying cause for the vomiting.  In some instances, the problem will be self-limiting or caused by a treatable disease.  In other cases, vomiting is a sign of a more serious underlying disorder.

For the less serious cases, we expect improvement within 2-4 days.  If improvement is not seen or the dog continues to deteriorate, please contact us immediately for additional information. 

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Whipworms in Dogs

Whipworms are intestinal parasites of the dog.  They parasitize the lower intestine (cecum and colon) and cause signs related to intestinal irritation.  Infection with whipworms can be significant because they are one of the more pathogenic intestinal parasites found in the dog. 

They are small, about 1/4" (45 to 75 mm) long, and have a characteristic “whip” or “lash” at one end.  After the worm burrows into the intestine, it is this “whip” that causes damage to the lining of the bowel.  The tip of the “lash” is able to slash and shred tissue.  The worm then feeds on the blood and damaged lining of the intestine.

Contributing Factors

A dog is more likely to become infected whipworms if it resides in an environment contaminated with whipworm eggs.  The eggs are very resistant to destruction and can remain viable (infective) in the soil for months or even years.

Prevalence

The canine whipworm is found throughout North America, although it is most common in the eastern and southern United States.  In other countries, different species of whipworms can exist. 

Causes/Transmission

Whipworms pass microscopic eggs in the stool, which must be swallowed to infect the dog.  Once the eggs mature into adult worms, eggs are passed in the dog’s stool and can infect another dog. 

Clinical Signs

The most significant clinical sign of whipworm infection is bloody and/or mucoid (mucous) stool.  Overt diarrhea may or may not be present.  The dog may exhibit pain during defecation and attempt frequent bowel movements.  In dogs with chronic whipworm infection, debilitation may develop and the dog will lose weight and possibly become anemic.

Diagnosis

Whipworm infection is diagnosed by finding the characteristic eggs during a microscopic examination of the stool.  Several samples may be required because these parasites pass small numbers of eggs on an irregular basis.  Any dog with chronic diarrhea can be reasonably suspected to have whipworms, regardless of several negative stool examinations.  It is advisable to treat for whipworms based on assumption of infection when chronic or refractory diarrhea is present.  Response to treatment is an indication that whipworms were present but could not be detected on fecal examination.

Treatment and Prevention

Several available drugs are very effective against whipworms.  Two treatments are needed at a 3-4 week interval.  Since reinfection is such a problem, it is advisable to treat again every 3-4 months or to put the dog on a heartworm preventive product that also prevents hookworms.  Whipworms are not nearly as common now because of widespread use of the heartworm preventives that help to control whipworms.

Prognosis

The prognosis for full recovery is good if the entire course of treatment is completed.  In contaminated environments, reinfection may occur.

Transmission to Humans

There is a very small risk of human infection by canine whipworms.  Eggs of this parasite have occasionally been observed in stool samples of humans.  These should be noted as rare events, however.  The overall health risk to humans is considered very small.