Canine Cushings Disease

Hyperadrenocorticism better known as Cushings Disease is a relatively common disorder of middle aged to older dogs. The disorder is caused by an increase in the production of corticosteroids from the adrenal gland. The adrenal gland normally produces corticosteroids when the blood levels drop or when the body needs an increase in the level of steroids like in a fight or flight syndrome.  The pituitary gland produces hormones that stimulate the adrenal gland to produce corticosteroids. If there is a tumor in the pituitary gland, it will produce steroids even when blood levels are adequate. If there is a tumor of the adrenal gland, it will produce steroids even if there are adequate levels in the blood, and no stimulation from the pituitary gland. The resulting clinical signs are increased thirst and urination, increased appetite, and panting. Dogs that have Cushings disease tend to be overweight and have pendulous abdomens, have thin skin, and are predisposed to infections because steroids cause suppression of the immune system. Cushings disease also causes pulmonary hypertension which can lead to cardiac disease. High levels of systemic steroids also can lead to pancreatitis which can result in diabetes mellitus. Clients that have diabetic pets that also have Cushings disease, have a difficult time controlling their pets’ insulin needs because Cushings can cause insulin resistance. The most common cause of Cushings disease in veterinary practice is iatrogenic. This means that we veterinarians and clients actually can cause the disease by over prescribing steroids for the treatment of skin allergies. Clients tend to want their dog to stop scratching yesterday, and steroids are quick and inexpensive. I try to discuss the causes of the allergies, ie food, fleas, inhalents, and treat the cause rather than treating the symptoms. We try antihistamines, and  omega 3 fatty acids first, and discuss flea control, and food trials before we resort to steroids.

We veterinarians become suspicious of Cushings disease when we run blood panels and the alkaline phosphatase ( a specific liver enzyme) is elevated when all the other liver enzymes are normal or slightly elevated. The enzyme alkaline phosphatase is highly sensitive to steroids and is the first biochemical clue to early Cushings disease.  This is one more reason we encourage routine annual blood panel screens for all pets. This way we can diagnose disease in the earliest and most treatable stage.

There are several tests to diagnose Cushings disease. There is a stimulation test and a suppression test. We do the stimulation test and send it to a lab in Tennessee that also measures hormone levels that are the precursors of corticosteroids. We have found this lab to be the most reliable one in diagnosing the disease.

There are several treatments for Cushings disease. Surgical  treatment is impractical, very risky, and expensive. Medical treatment is aimed at management of the disease.

Housetraining Puppies

I often tell my clients that housetraining a puppy is not much different than potty training an infant. As a father of 4 and a pet owner of over 60 pets, I am very qualified to speak on both subjects. I am a very ardent proponent of positive reinforcement and reward motivation. My dear wife Carolynn, got our kids out of diapers with MM’s as a positive reinforcement tool. If the kids went potty in the little potty, they received 2 MM’s, if they went potty in the big potty, they received 4 MM’s because Mommy and Daddy didn’t have to clean up the little potty. This technique worked like a charm. I can remember with a touch of nostalgia, having to excuse myself from a client in a room to field a phone call from an excited child telling me of their accomplishment. We all like to receive “Atta boys or girls” even as adults, puppies are no different.

The first step in potty training a puppy, is to establish a set feeding pattern. Puppies poop after naps, meals and bedtime, so a puppy that is allowed to free feed throughout the day, will have to potty all day long. It will be next to impossible to train. I recommend that puppies be fed twice a day, and be allowed to free feed for a half hour. Do not limit the amount being fed, but do limit the time they have to consume it. If the puppy eats it all in 5 minutes and wants more, give it more. If they look at the food and make a face and walk away, the clock is ticking. The food will be picked up after a half hour. They will quickly learn that the food will be there for a limited amount of time and potty schedules can be established.  My father raised us kids with the saying “This is not a restaurant. You will what’s put in front of you, when it’s put in front of you.” The same can be applied to our dogs.

When a puppy has an accident, DO NOT stick their noses in it or spank them. No one would argue the fact that you do not haul off and smack an infant for soiling their diaper, same principle with puppies. Take them to the spot and say No in a firm voice. Pick up the feces or urine soaked paper towel, take the puppy and the mess outside and place it on the ground and act as if the puppy had just relieved itself on the grass. Make a big deal and give them a favorite treat (not MM’s, LOL) I am a big proponent of food rewards as most animals are food motivated, like yours truly.

I do not recommend crate training until a puppy has reached at least 12 weeks of age, because their sphincter muscles are not strong enough to hold urine or feces for more than 2 hours. The point of crate training is most dogs will not soil an area that they have to sleep in. If they cannot hold it and soil their cage, it will ruin that concept and make potty training that much more difficult.
The most important tenet of housetraining a puppy , is patience. Remember to take a deep breath and follow the above suggestions when confronted with a puppy “accident”. Good luck!

Caring for your Christmas Puppies

Christmas has come and gone and many of you have received puppies as Christmas gifts. I have a series of tips I give to all my new puppy owners to ensure their new family members get off to good and healthy starts.

The most important step is to get your new puppy checked out by a veterinarian as soon as possible. The veterinarian should perform a thorough examination to ensure you have a healthy free of any diseases or congenital abnormalities. I always tell my clients that the most important visit they will ever have is that first visit so we can get that puppy on a good healthy start to life.

Feeding
Puppies should be fed puppy food. This is a no brainer, but you would be surprised what some people feed their dogs. There are many good quality puppy foods available on the market. I have no preference of dry vs. canned, but there are some advantages of feeding dry food. Dry food is cheaper, better for their teeth and doesn’t smell if not consumed immediately. I generally recommend to feed as much as a puppy will eat in 30 minutes, then pull the food up and do this two to three times a day. The toy breeds may need to eat three times a day to avoid hypoglycemia. Following this schedule will accomplish two things:
Housetraining- puppies poop after naps, meals and playtime, so what is going to happen if the puppy is allowed to free feed all day long?
Obesity prevention- puppies that free feed as puppies will free feed as adults and when they stop growing vertically, they will grow horizontally and have obesity issues.
Do not feed table scraps, people food. This can cause pancreatitis and metabolic bone disease in growing puppies.

Vaccinations
We normally vaccinate puppies with the core distemper, parvo vaccinations at 8, 12, and 16 weeks of age. At 16 weeks, they are given a rabies vaccination. This is the time we normally spay or neuter, and microchip. Spaying a female puppy before her first heat cycle virtually eliminates any chance of developing breast cancer at a later date.

Heartworm Prevention
We start puppies on some form of heartworm prevention on the very first visit. Mosquitoes transmit heartworms and they will not respect the fact that these are puppies,  and not bite and transmit heartworm disease. The longer one waits to start heartworm prevention, the greater the chance that they will contract the disease. There is a six month incubation for heartworms, from the time they get bitten, until it shows up in the blood, so puppies younger than 6 months of age are not tested prior to administering heartworm prevention.

Parasite Control
We ask that all new pet owners bring in a fresh fecal sample, even if the puppy has been dewormed. It would be a mistake to assume that just because a puppy has been appropriately dewormed, it is parasite free. We outline flea and tick control both on the puppy and in the environment before a problem arises. It is always easier to prevent a problem, than it is to treat one.

Housetraining
Puppies that are on a feeding schedule are much easier to housetrain. Do not spank or put the puppies nose in it’s mess. They do not know better and need to be educated. That is our job. Puppies are not that much different than children. I don’t think anyone would argue that infants are not spanked if they soil their diapers. My wife got our kids out of diapers with an M & M reward program. If they pottied in the little potty, they got 2 M & M’s. If they went in the big potty, they got 4 M & M’s because Mommy and Daddy did not have to clean the little potty. When a puppy has an accident in the house, take them to it and say no in a firm voice. Pick the mess up and take puppy and mess outside, place it on the ground and make a big deal and reward the puppy as if he/she had done it. Carry treats to reward the puppy when they go outside correctly. Positive reinforcement is the best way to housetrain a new puppy. We do not recommend crate training until a puppy is at least 12 weeks of age, because their sphincter muscles cannot hold in their urine or feces for longer than 2 hours.

Following these simple steps will help ensure that your Christmas puppy gets off to a good, healthy start.

Senior Wellness

November is national Pet Senior Wellness month. We all know our beloved 4 legged children age at a rate of 7 years to our 1. Typically pets are seen yearly for their physical exams, vaccinations, heartworm checks, and fecal exams. We encourage our clients to bring in their pets biannually, especially when they reach middle age at the age of 6.

We all can relate to our own annual exams with our own doctors. A typical annual physical for us includes, weight, temperature, blood pressure, comprehensive bloodwork, urinalysis, EKG, and possible chest  x-rays. Our pets deserve no less. We can articulate to our doctors our concerns and pains, animals cannot. There are many disease processes that, if caught early, can be treated. It is heartbreaking to have pets brought in advanced stages of kidney, thyroid, or cardiac disease which could have been managed if they had only been diagnosed earlier.

Hypertension is something one does not think about in our pets, but occurs with some frequency. High blood pressure can lead to kidney disease and vice versa. In cats the most common presenting complaint is acute blindness. This is called hypertensive retinopathy. When the blood pressure gets high in some cats, it causes the pressure in the eyes to go up and can lead to retinal detachments and acute blindness. This can be prevented and controlled by routine blood pressure checks and medication.

This economy has forced many of us to make difficult decisions regarding to what we can spend on our pets. Pet insurance purchased when the pet is young without any pre existing conditions is an investment that can literally save our pets’ lives. People who purchase pet insurance are much more likely to invest in early diagnostic testing that can diagnose conditions in the early, treatable stages.
Most veterinary practices, including our own, offer senior wellness packages. These packages offer substantial savings than if the individual components were purchased separately in the event a pet is brought in with an illness. November would be a good month to start an annual routine of preventive wellness exams for our beloved furry family members.

Rabies

Rabies is a neurotropic  rhabdovirus that can affect any warm blooded animal. This means that the virus has an affinity for nervous tissue, this includes nerves, spinal cord, and brain. There are 3 main carriers of rabies in the United States, bats, raccoons, and foxes. Mongoose is the main carrier of rabies in Puerto Rico. The predominant wildlife host on the east coast, including Florida, is the raccoon.

Rabies is transmitted from the saliva of an infected animal to an exposed host. This usually takes place as a bite, but the virus can be transmitted from a scratch, if there is saliva on the nails of the infected animal. Rabies can be transmitted from aerosol exposure. This is especially important with spelunkers (cave explorers) who enter caves where there is a large population of bats. The virus can be inhaled through the mucuous membranes by a susceptible host.

Early clinical signs of rabies include fever, muscle aches, anxiety, and progress to hallucinations, deliria, seizures, muscle twitching, change in behavior, aggression (madness), and hydrophobia (fear of water). The incubation period is dependent on where the entry point of the vrus. The virus travels up the nerves, to the spinal cord, then enters the brain. The closer to the head the person or pet is exposed, the shorter the incubation period. Death without treatment is almost a certainty within 2-10 days after exposure.

Transmission of the rabies occurs via the saliva. The animal is capable of transmitting rabies when the virus migrates from the brain to the salivary glands. When a domestic animal with an unknown vaccination history bites a person, they are quarantined for 10 days. The animal can only transmit the virus when it is in the salivary gland and studies have shown that if they were infective at the time of the bite, they will be dead within 10 days. The bitten person then is subjected to rabies post exposure treatment. This treatment involves 5 painful injections and is very expensive, but without treatment, death is almost a certainty. There have been only a few cases of people surviving rabies without post exposure treatment.

All pets should be vaccinated for rabies and kept inside. Cats are more likely to contract rabies and more likely to transmit the disease because they are more predatory by nature and become much more aggressive when they develop rabies. The vaccination is inexpensive, safe and very effective.

Pancreatitis

As we approach the holiday season, we veterinarians prepare for an increase in the cases of pancreatitis.

 The pancreas is an organ attached to the small intestine.
It serves two basic functions:

The endocrine side produces insulin which enables the body to process glucose. Glucose is the body’s main energy source.

The exocrine side produces enzymes to digest food. Food must be digested in order for the intestines to absorb the nutrients contained in the food consumed.

When a pet consumes food that is high in fat, the pancreas gets overworked, swells and actually leaks enzymes into the abdominal cavity. This causes autodigestion and is very painful and can even cause death. The most common cause of pancreatitis we see in veterinary practice is when pets are fed people food. We see the most cases of pancreatitis the days after Thanksgiving, Christmas, and Easter. The clinical signs of pancreatitis include vomiting, diarrhea, fever, painful abdomen, and inappetance.  Untreated cases can cause death.

Treatment is usually supportive with iv fluids, hospitalization, antibiotics, anti-emetics, and antidiarrheals. We often withhold food in dogs for several days to give the pancreas a chance to settle down. Feeding a dog with pancreatitis literally fuels the fire, stimulating the pancreas to produce more enzymes. A new treatment for severe cases of pancreatitis is hyperbaric chamber treatment. Some patients require surgery and drains. Management of dogs and cats with pancreatitis is done with a high fiber, low fat diet. Prevention is the key. We cannot say this loudly enough or more emphatically, DO NOT GIVE PETS PEOPLE FOOD!

Discussing pancreatitis with clients is a daily occurrence. Pancreatitis does not happen to every pet fed people food, but the risk is certainly much higher. The human analogy is not all smokers die of lung cancer, but your odds certainly go up if you do.

Pet owners often equate food with love. I am all for spoiling our pets, but this can be accomplished without endangering their health and lives. Have a safe holiday season!

Hypertension

Hypertension in our pets is not something most pet owners give a second thought to, but it is much more prevalent than you think. We associate hypertension in humans with stress, smoking, diabetes, obesity, too much salt consumption, or familial history. Hypertension in humans is often considered own primary, meaning an underlying cause cannot be determined. In animals, hypertension is usually secondary.  The most commonly associated diseases with hypertension are hyperthyroidism (in cats), Cushings disease ( overactive adrenal disease in dogs),  diabetes mellitus, and kidney disease.

The most common sign associated with hypertension is vision loss.  The retinas are very sensitive to high blood pressure and are usually the first organs to be affected. Unfortunately, a pet cannot communicate a loss in visual acuity, and often a pet owner does not realize this until the pet becomes acutely blind. This is most common in cats. The presenting sign is a cat that was normal one day, and the next has huge dilated, unresponsive pupils, and is bumping into things. Oftentimes once this happens, the retina has detached and the blindness is permanent.

Early diagnosis is key to good control just like in humans. We take it for granted that our blood pressure is measured every time we visit our own physicians, don’t our pets deserve the same? We encourage blood pressure checks in any pet 6 years of age and older at least twice a year, and in any pet that has a disease that is associated with hypertension. We include blood pressure checks in any pet with kidney disease, dilute urine, protein in the urine, Cushings disease, diabetes, and hyperthyroidism. We usually do blood pressure checks after we have the results of the bloodwork. If a cat is diagnosed with hyperthyroidism, we treat that condition first, and oftentimes the blood pressure normalizes.

Blood pressure is measured in pets similarly to humans. A special inflatable cuff is applied to the foreleg of the pet and a series of measurements are taken. We usually take 3-5 blood pressure readings and the average is interpreted. This allows the pet to calm down and minimize the “white coat syndrome”, which can artificially elevate the blood pressure.The most important reading is the systolic blood pressure. We  want the systolic blood pressure to be below 160.

Treatment is similar to humans. The underlying disease needs to be controlled. The most common blood pressure medications we use in veterinary medicine are benazepril, enalapril, and amlodipine. These are the same medications we use in human medicine to control hypertension.
Hypertension is common and treatable if diagnosed early. Blood pressure checks should become as routine in veterinary medicine as it is in human medicine.