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.

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.

Hurricane Preparedness

We are at the peak of hurricane season and we are monitoring several systems in the Atlantic.  It only takes one like Hurricane Andrew to cause devastation. Pet owners should prepare before a hurricane is on their doorstep.

There are many things people can do to protect their beloved pets in the event of a storm.
Make sure their pets are up to date on all their vaccines and that proof of vaccinations are in a readily accessible place. If you have to evacuate and board your pets at a boarding facility or veterinary hospital, you will have to show proof of updated vaccinations.

Make sure any medications your pet may need are refilled. It may be days to weeks  after a hurricane makes landfall, before veterinary hospitals or pharmacies might be able to reopen.
Consider microchipping your pet. Pets can become lost if dwellings are damaged during a storm. Microchips enhance the odds that your pet will be returned to you safely.  Make sure the microchips are registered with updated information.

Make sure you have enough food and water for your pet for at least a week. Provide the boarding facility with both for your pet. Power and water may be lost for days to weeks after a storm hits.
Make provisions for your large animals like horses. We bought wax markers and wrote our cell phone numbers on both sides of our horses. In the event of a hurricane where the barn is damaged, horses may wander off. We also microchipped our horses. We installed hurricane garage doors and hurricane panels on our barn and had it reinforced to withstand 140 mph winds. The barn has withstood 3 hurricanes and the horses were very safe and comfortable.

People who are forced to evacuate should go online and find hotels and motels that are pet friendly. ( http://www.petswelcome.com/ ,  http://www.pet-friendly-hotels.net/ ). Do not wait until the last minute to get reservations.

Contact your veterinarian long before a hurricane becomes an imminent threat and see if they have hurricane boarding facilities. Most animal hospitals are not equipped to handle that many animals in a situation where electricity and water may not be available.

Hurricane season can be extremely stressful. By following these simple steps, it will make a difficult situation easier to endure and ensure your beloved pets remain safe.

Parvovirus

Parvo is a highly contagious viral disease that affects dogs. Transmission is mainly from exposure to the virus through feces from infected dogs. Parvovirus causes the lining of the intestines to necrose (slough). Clinical signs include diarrhea, often bloody, vomiting, lethargy, and dehydration. The less common cardiac form can cause sudden death. Most infected dogs are puppies and dogs that are not current on their parvovirus vaccination.

Parvovirus is a relatively new disease, appearing in the late 1970’s. There were widespread outbreaks and the mortality rate was quite high before the development of a vaccine. Puppies are vaccinated monthly in a series of 3 injections starting at 8 weeks of age until they are 4 months old. Boosters are given yearly after that. Parvovirus is highly contagious and the mortality rate in untreated dogs can reach 91% in as little as 24-72 hours. Concurrent illness with bacteria, parasites, and malnutrition worsens the clinical signs. Certain breeds are predisposed: Rottweilers, Dobermans, and Pit Bull Terriers. Treatment is mainly supportive and can be quite expensive. Dogs are hospitalized for several days on intravenous fluids, antibiotics, antidiarrheals, and anti-emetics.  Infected dogs that recover can shed virus in their feces for up to 3-6 weeks and should be kept away from any other dogs until this period is over. The virus can persist in the environment for up to a year and is cold and heat tolerant. The only disinfectant that effectively kills the virus is bleach. We recommend that infected dogs be taken to a small area in the yard to defecate, and the fecal material be picked up to avoid exposing other dogs by contaminating the environment.

There have been several parvovirus outbreaks locally. In these difficult economic times, dog owners are cutting corners with their pets’ health. The parvovirus vaccine is usually included the distemper vaccine that is given yearly to dogs. Prevention of this deadly disease is the key. It is an inexpensive, and safe way to ensure the health of our beloved canine family members.

Pet Insurance

Pet insurance is a good investment in your pet’s health. There are many insurance companies and plans, so it is important do do your homework. The best source of information is your veterinarian. We promote health insurance at our veterinary practice, because pets that are insured tend to be better taken care of. Pet owners are more likely to keep up with wellness programs, routine physical exams, bloodwork, and treatment plans.

Pet insurance is similar to human dental health insurance in the fact that it is a reimbursement plan. An insured patient pays for services, then submits a claim to the insurance company who then reimburses them a percentage of the bill. There are many pet insurance companies and it is up to the pet owner to research them and select the one that best fits their needs.

There are many factors to consider when choosing a health plan for a pet. Ideally, insurance is taken out on a young pet with no pre-existing conditions. I cannot tell you how many clients ask if they can get insurance when their pet is seriously ill. There is usually a waiting period for illnesses on most policies. An insurance company, for example,  will not pay for an anterior cruciate ligament tear a week after a policy has been taken out. Deductibles vary depending on the plan. There are plans that cover wellness exams, vaccinations, heartworm prevention,  spays and neuters. These tend to be more expensive and it may make more economic sense to pay out of pocket for wellness issues and take out a policy that covers accidents or catastrophic illnesses like cancer. This prevents financial euthanasia. There have been many cases of pets having treatable but expensive to treat illnesses that end up being euthanized because the owners can’t afford to treat.

For more information, you can contact us at our hospital at (772) 336-8111, or visit our website http://kellysanimalhospital.com/ and click links.

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. 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.

Heartworm Disease

The hot summer months and humidity bring with it mosquitoes which can transmit many diseases to pets and humans. Heartworm disease is prevalent in dogs and to a lesser extent cats and ferrets. Mosquitoes feed on the blood of warm blooded animals. Mammals infected with heartworms have circulating larvae in the bloodstream. When a mosquito ingests blood from a heartworm infected animal, the larvae mature and develop in the host. The larvae eventually migrate into the heart and pulmonary vessels where they mature and cause clinical signs of heartworm disease.

The clinical signs of heartworm disease in dogs often to do not become evident until  late in the course of the disease. These  signs include coughing, exercise intolerance, lethargy, collapse, and even sudden death.

Heartworm disease diagnosis in cats can be challenging. The disease in cats tends to cause signs that mimic asthma. Coughing is the predominant sign, but vomiting and acute sudden unexplained death has been reported. There is no treatment for heartworm disease in cats because cats go into anaphylactic shock when the worms die. The object of heartworm treatment is to kill the heartworms which could induce anaphylaxis. The drugs that are used to treat heartworm disease are also toxic in cats.

Heartworm disease is preventable in all the affected species. The heartworm prevention comes in many forms including : chewable monthly tablets, monthly topical applications that have flea prevention included, and now a 6 month shot for dogs.

Heartworm treatment is expensive. Heartworm prevention is inexpensive and safe. Heartworm disease can cause permanent damage to the pet’s heart. Pets that are not on heartworm prevention, especially in Florida where the mosquito is the state bird, are likely to result in the pet becoming infected with heartworms. I tell clients it’s the proverbial, “ You  can pay me now or you can pay me later!”

There is no reason for an animal to develop heartworm disease. Yearly heartworm blood tests and monthly heartworm prevention will ensure our pets will not contract this potentially deadly disease.

Heat Stroke - Hyperthermia

With summer almost upon us, we have recently been reminded what the southern heat can do to our beloved pets. We were involved in a case last year where 2 large dogs were left in a  car while the owner attended classes at a local university. He had the windows cracked and left water in the car for them to drink. The outside temperature was 94 degrees F and the heat index was over 100 degrees F.  Good Samaritan bystanders discovered the distressed dogs and called Animal Control. When they arrived the female dog was dead and the male was unconscious. The officer wet the dog down with cool water and transported him to our veterinary hospital. His rectal temperature was 105 degrees F and he was non responsive. The normal rectal temperature of a dog is 100-102 degrees F. We applied wet towels on his body and turned on a hose with cool water to wet him down. We applied ice packs to his head and groin and armpit areas. An intravenous catheter was inserted and vigorous amount of fluids were administered. An oxygen mask was placed on his nose and his heart rate and temperature were monitored. Once we felt he was stable enough for transport to the Animal Emergency and Referral Center, he was taken there by Animal Control. He unfortunately did not respond and had to be euthanized later that evening. The owner is facing 2 felony counts of animal cruelty.

 Two days later I read of a K-9 police officer in Woodstock, Georgia with 12 years experience, was arrested after leaving his canine police officer in his cruiser. The dog died, and he faces a felony count of animal cruelty, and he has lost his job. This is particularly disturbing because this happened to a person with experience dealing with dogs.

Hyperthermia can occur very quickly in this brutal Florida heat. The temperature in a car can reach 140-150 degrees F in a very short period of time. Dogs do not perspire. They can only dissipate heat from panting and from slight sweating of the pads of their feet. If the ambient temperature is higher than the dog’s core temperature, panting cannot dissipate the heat, and the dog’s internal temperature can rise very rapidly. Signs of hyperthermia are obvious; panting, restlessness, crying, lethargy, red and tacky gums, unconsciousness, and death.

When the body’s core temperature rises above 105 degrees F, serious damage can occur in a very short period of time to the brain, kidneys, intestines, and blood. Once clinical signs begin, they progress rapidly and can result in irreversible organ damage and death.

Prevention is the key. Dogs and other animals should never be left in a car, especially in the summer. In the heat of the day, pets should be allowed to go outside for short periods of time and they should avoid strenuous physical exertion. If they have to be outside, there should be plenty of shade and adequate amounts of water should always be available. We had an English Bulldog present to our hospital 2 years ago on a Saturday morning with heat stroke. The owner had taken the dog out for a walk on a hot morning. The dog began to pant, and collapsed. The owner carried the dog a half a mile to her house before bringing it to our hospital. The dog  presented  unconscious with a rectal temperature of over 110 degrees F. The owner was riddled with guilt. She innocently took the dog out for a walk, and 2 hours later, the dog was dead. Overweight and brachycephalic dogs are more predisposed to heat stroke. Brachycephalic dogs have the “pushed in noses” and they cannot dissipate heat as well by panting.

Dogs are not the only animals that can experience heat stroke. We own 8 horses and during the summer, we are constantly vigilant of the outdoor temperatures and heat indices. Once the heat index reaches 100 degrees F, we bring the horses in their stalls. We have overhead fans and they have automatic waterers in their stalls.

The people that were responsible for their dogs dying of heat stroke are not bad people. They were people who took chances with their pets’ lives and lost. I am not a gambler because I am not willing to lose. Let’s be safe and enjoy our summer with our pets!

Addison's Disease

Addison’s disease, also known as hypoadrenocorticism, is a condition where the adrenal gland does not produce adequate levels of hormones needed to balance metabolic functions. The adrenal gland produces two types of hormones:

Corticosteroids are hormones that allow us to handle stress, the “flight or flight syndrome”. They control protein and glucose metabolism which are the main sources of energy that allow us to cope with stress factors.
Mineralocorticoids are hormones that control electrolyte balance. This in turn affects kidney function.

The cause of Addison’s disease is rarely found, but it typically affects younger patients, typically 4-5 years of age and it affects females twice as often as males. This disease affects dogs, and very rarely, cats.  Clinical signs can range from no signs, to an acute crisis where the patient is presented comatose.  The first signs an owner might notice is a dog that is consuming more water  and urinating more. As the disease progresses, lethargy, inappetance, vomiting and cardiac signs develop as the potassium levels rise.

Diagnosis is made based on clinical signs, urinalysis, and bloodwork. The classic Addisonian has an elevated potassium and a decreased sodium. The ratio of sodium to potassium typically drops below 25. Kidney values will begin to elevate as the disease progresses. Not all Addisonian patients fit this classic presentation and the clinician must be open to the possibility of Addisosn’s disease in a young dog that presents with unexplained signs of kidney disease even with normal electrolyte levels. Confirmation of the disease is made with a blood test called an ACTH Stimulation test. ACTH (adreno corticotropic hormone) is a hormone produced in the pituitary gland in the brain that stimulates the adrenal gland to secrete corticosteroids and mineralocorticoid hormones. Addisonian patients have low corticosteroid levels and do not stimulate post acth administration.

Treatment is usually very successful. A patient in crisis is given intravenous fluids with sodium chloride, and corticosteroids. Mineralocoricoid supplementation is begun and can be accomplished with an oral medication called Florinef,  or an every 28 day injection called Percortin. Dogs tend to do better with the injection. Care must be taken with future stresses such as surgery, and low dose oral steroid supplementation may be needed for life.

Dogs can live normal happy, productive lives with Addison’s disease as long as they are managed appropriately. The most famous human that had Addison’s  disease was President John F. Kennedy.