Leptospirosis

Leptospirosis is a zoonotic disease transmitted by the spirochete bacterium Leptospira spp.  The bacteria is shed in the urine of an infected host which can include mice, raccoons, skunks, deer, sheep, dogs and even humans. The bacteria remains viable in the environment as long as it is moist, so it is most prevalent in Florida during the wet summer months.

Dogs most commonly come in contact with the bacteria by licking urine off the grass, or drinking from puddles in the yard that have been contaminated with infected urine. Clinical signs are jaundice (yellowing of the skin, eyes), bloody urine, fever, lethargy, vomiting, inappetance, and kidney failure, and death. The incubation period in dogs is 2-20 days. In humans the signs include lethargy, fever, severe headache, chills, muscle aches, vomiting, diarrhea, and jaundice, and death. The incubation period in humans is 4-14 days. People who are exposed to contaminated water such as surfers, and professionals who are exposed to contaminated urine such as veterinarians, and slaughterhouse workers are most at risk.

Diagnosis is made from blood samples and fresh urine in early infections.

Treatment if caught early, is with antibiotics such as penicillin, and doxycycline. Penicillin is given initially to control shedding of the bacteria in the urine, then doxycycline is used to get rid of the carrier state. The key is prevention. There are no vaccines available for humans, but there are effective vaccines for dogs. The canine leptospirosis vaccine contains the 4 most common serovars, and is included in most distemper/parvo vaccine combination protocols. There are many veterinary practices that do not include leptospirosis vaccine in their annual vaccination protocol and 3 years ago we had 4 cases of leptospirosis. Two of the dogs were not current on any vaccines, and the other two came from veterinary hospitals that did not include leptospirosis in their vaccine protocol. We were able to save two of the dogs. This also posed a significant risk to the owners’ health. We advised them to avoid contact with their dogs’ urine and confine the area where their dogs urinate to limit the area that could become contaminated. This past month we had 2 young dogs with unexplained kidney disease that were had not been vaccinated against leptospirosis by their previous vets and their owners spent some anxious moments while we waited for the leptospirosis titers to come in.

We strongly recommend that all dogs be vaccinated against leptospirosis annually to prevent this potentially fatal disease.

Choosing Your Christmas Reindeer

Christmas is almost upon us and children have by now finished their Christmas wish lists. I thought it would be appropriate to give parents some guidelines as to how to choose the perfect Christmas reindeer.

Selecting the right family reindeer can be a daunting task. There are so many sources of poor quality reindeer, that one must do their homework to prevent ending up with a “dud” reindeer. Most sources of reindeer do not allow exchanges or returns after Christmas. Children become attached quickly and it will become harder to exchange a misfit reindeer even if the reindeer source will allow it. Find a reputable breeder. The absolute best source would be from Kris Kringle himself. He has been doing this for generations, and his breeding stock is unmatched in quality and temperament. Mr. Kringle’s reindeer command a higher price, but his reindeer are of the highest quality and temperament, and can fly. The ability to fly is also something that is only seen in the reindeer raised by Mr. Kringle. Most reindeer cannot fly,  but this does not detract from their pet qualities. I would definitely stay away from Craigslist or ebay reindeer. These tend to be older reindeer, with pre-existing problems. Humane Societies and animal shelters tend to suspend reindeer adoptions during the holiday season so people don’t adopt them for the wrong reasons. Demand a current health certificate from a veterinarian experienced in reindeer medicine. A good source of names is the AVMA (American Veterinary Medical Association ) directory.

Descendents of one of his most popular reindeer, Rudolph, are the most expensive. The fluorescent, glowing nose is a recessive trait that is only seen every couple of generations. It is also a sex linked trait so only the males have the shiny, red nose. The ability to speak is pure fantasy folks, so don’t be disappointed if your reindeer cannot speak.

I do not recommend reindeer as house pets as they can be very difficult to house train. The tropical Florida climate is not ideal for reindeer, but one can look for the subspecies Reindeerensis floridensis, which have adapted well to our warm climate.

Reindeer do well with pelleted deer feed and good forage. It may be difficult to find deer feed, but most local feed stores can special order them for you. Do not give candy or table scraps as this can lead to diabetes. There is nothing worse than giving twice a day insulin shots to a reindeer. Been there, done that, not fun.

I hope this helps and you enjoy your Christmas reindeer. Merry Christmas to all and a Happy New Year!

Intervertebral Disk Disease

The vertebrae or backbone are a series of bones that support and protect the spinal cord. In between these vertebrae are disks that cushion the bones and act as spacers between the vertebrae. These disks can herniate or protrude into the spinal column causing pain and neurologic deficits. This tends to occur in middle aged to older, small, long back breeds. The most overly represented breed is the dachshund, but this syndrome can occur in all breeds including the larger breeds.  We see an average of 3 cases a week in our practice.

The clinical signs can range from mild back pain to complete paralysis. Typically a dog will present with the complaint that it is not jumping up on the couch as usual, and cries when picked up. Often the owner will say their appetite is less and they may be reluctant to “go to the bathroom.” This occurs because the back and neck are painful and the dog is reluctant to bend to eat, or assume the position to defecate or urinate. On the physical examination there may be conscious proprioceptive deficits, weakness especially in the rear legs, and pain when the neck is manipulated or the back palpated.  CP deficits are documented when the toes are turned with the topside down. The dog should immediately right the foot to the proper position. A delay signifies and interruption in the signal from the foot to the brain. More serious clinical signs include dragging the rear legs, crossing of the rear legs when walking,  and a frog legged stance.

Diagnosis is made on clinical signs, and occasionally with radiography. The more serious cases are referred to a veterinary neurologist who will perform myelograms, or an MRI to identify the exact location of the herniated disk.

Treatment depends on the severity of signs. Early cases are treated with cage rest and steroids or non-steroidal anti-inflammatories, muscle relaxants, pain medication, and intravenous polyethylene glycol. We have a therapeutic laser machine that is a wonderful treatment modality. The light laser is anti-inflammatory, and relieves pain. This is also used post surgery to speed up recovery. A study at the University of Florida College of Veterinary Medicine showed that paralyzed dogs that received post operative laser therapy walked an average of 5 days post op versus dogs that didn’t that walked an average of 17 days later. There are no side effects and we use it extensively in the treatment of iv disk disease. Surgery is recommended by a board certified neurologist if there is significant paresis or weakness in the legs, or if the dog is very painful and does not respond to medical treatment. Prognosis depends on the severity of the herniation,  how soon after the occurrence of the disk herniation the dog is seen by a veterinarian, and how aggressively the dog is treated. Surgery involves removal of the disk, and occasionally making a window in the vertebrae to make room for the disk material.

Prevention entails keeping the dog physically fit, as overweight dogs have a much higher incidence of intervertebral disk disease. I try to discourage clients with predisposed breeds to allow them to get on couches and beds as puppies. It is much easier to train them not to do this than to try and keep them off a bed after the condition develops.

Kidney (Renal) Disease

Kidney disease is one of the prevalent syndromes we deal with in veterinary medicine. With our improved diagnostic skills, better nutrition, and a willingness of our clients to invest in good preventive care, our beloved pets are living longer, healthier lives. As our pets age, thier list of maladies increase. It is safe to say that if a pet lives long enough, it will have to face the prospect of kidney disease. I am constantly telling my clients that age is not a disease, but as we age, we face a myriad of ills as our bodies wear out.

Most clients become aware of kidney disease in their pet when they become clinically ill. The most common clinical signs are an increased thirst, increased urination, weight loss, and in the latter stages diminished appetite. The two main functions of the kidneys are to excrete urinary biproducts and to concentrate urine. As the kidneys fail, they are unable to concentrate urine and the pet dehydrates. They try to compensate by drinking more. Unfortunately, they cannot drink enough to replenish what they have lost, and they dehydrate more, worsening the kidneys’ function. The other main function of the kidneys is to rid the body of urinary waste products, ie urea and creatinine. These are products of protein metabolism and are toxic. A normal functioning kidney removes these toxins in the urine. When the kidney begins to fail, these toxins build up in the bloodstream, causing inappetance,
nausea, and ulcers. The kidneys have to be 80% compromised before the first  elevations in kidney enzymes are noted in the bloodwork. This is why early preventive blood screening is so important.

Treatment is aimed at restoring hydration and flushing the bloodstream of these urinary toxins. In the early stages of kidney disease, we treat with a low protein diet and check blood pressure. Hypertension can cause kidney disease and vice versa. If hypertension is present, we treat with anti-hypertension drugs which can help preserve kidney function as well.  We always check a urine sample. The urine is an excellent barometer of kidney function. Dilute urine and protein in the urine are indicators that the kidneys’ function is becoming compromised. As the disease progresses, we prescribe medications that can help combat the urinary toxins. In the latter stages of kidney disease, we often begin intravenous or subcutaneous (under the skin) fluid administration. This helps flush out the impurities and rehydrates the patient.  Clients can be taught administer subcutaneous  fluids  at home. This is very easy to do, well tolerated, and cost effective. We have had clients manage their pets’ kidney disease for years with these treatment protocols. The take home message is, routine wellness screenings will enable us to detect kidney and other diseases at their earliest, most treatable, and least expensive stages.

Aural (Ear) Hematoma

Aural hematomas are hematomas (blood blisters) that occur in the ear of dogs and less commonly cats. They develop when the dog shakes its head violently as a result of an irritant such as an insect bite or more commonly from an ear infection. The shaking of the head causes blood vessels between the ear cartilage and skin to break, resulting in a blood filled blister on the inside of the ear. This can emerge literally overnight and manifests as a soft, fluctuant swelling that can be small or very large resulting in occlusion of the external  ear canal.

Aural hematomas are common and easily managed. It is very important to treat the underlying cause, ie ear infection concurrently. There are several treatment options:
Aspiration- this is accomplished by inserting a needle and syringe into the hematoma and draining the blood out. This is simple to do and requires no anaesthesia, but is usually a temporary measure because it leaves a small hole which seals up quickly and the empty pocket tends to fill back up with blood.

Lancing- this is also a simple procedure not requiring anaesthesia. We normally perform this procedure outside because it can get quite bloody.  We take a sharp blade and make a sizable incision over the hematoma and drain the blood. We do not numb the area, as the numbing hurts more than the quick nick of the scalpel blade. This leaves a larger hole which the owners can “milk” more easily. Milking is massaging the blood out that wants to refill the defect,. The object is to keep doing this, preventing the hole from closing so the blood can drain out. This is done only if there are 2 people with the dog going home, one to drive and one to hold a gauze over the dog’s ear. We do not do this procedure when the dog is brought in by one person because the dog will shake its head and create a bloody mess in the car, mimicking a crime scene. This could result in having the authorities pull you over and search the vehicle for the “body”.

Canula insertion- Cow teat canulas are small plastic tubes that are used to treat cows with mastitis. They work wonderfully as a semi-permanent drain for a hematoma. The dog is given light sedation, a nick is placed in the ear with a sharp scalpel blade and the canula is inserted into the hematoma. It is the sutured in place and left for 30 days. We instruct the owners to milk the ear twice a day, massaging the blood out of the ear through the canula. This procedure works nicely, is minimally invasive, does not require general anaesthesia, and is not expensive to do. It also is the one procedure that leaves the most cosmetically pleasing result.

Do nothing- this is the least desirable option. Eventually the blood in the hematoma will clot and consolidate. The ear will shrivel and create a cauliflower ear. An ear hematoma is uncomfortable as the ear becomes heavy with blood, and the constant head shaking could cause a hematoma in the other ear to form. This is why few clients choose this option.

The best results are achieved when a hematoma is first observed by the owner, before clotting has taken place. Clots are more difficult to remove and can cause permanent scarring.

Bufo Toad Poisoning

Bufo toad (Bufo marinus) are toads that were introduced to Florida from Central and South America. They are commonly referred to as cane toads. They can become quite large and are notable for their large parotid glands (salivary glands) that secrete a cardio/neurotoxin when attacked.

Dogs are the most common victims and smaller dogs fare worse because of their small size. When a bufo toad is bitten, it secretes a slimy substance from their parotid gland that is very caustic. It instantly causes irritation to the mucous membranes of the mouth and profuse salivation. These signs can progress to crying and pawing at the mouth and face, incoordination and stumbling, vomiting, seizures and death. Pet owners need to be aware of the signs and act decisively and promptly. The most important treatment is to lavage your pet’s mouth vigorously with water. This will reduce the amount of contact with the mucous membranes in the mouth and prevent further ingestion of the poison. There is no antidote for bufo toad poisoning. Treatment is symptomatic  to address the gastrointestinal, neurological, and cardiac signs.

When a person discovers their pet has had exposure to a bufo toad and is showing the signs of profuse salivation, and pawing at the mouth, they should first copiously rinse out the mouth, then seek immediate veterinary care. This most likely will be at a veterinary emergency center because most poisonings occur at dusk when most veterinary hospitals are closed.

Pet owners should be vigilant when letting their pets outside after dark. They should be supervised and any water and food should not be left outside because it will attract the toads.
Bufo toads are non native species that were introduced to Florida. They have thrived and are now found everywhere in south Florida. Pet owners must be aware of this emergent problem and be prepared to act decisively in the event of a bufo toad poisoning.

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.