Not long ago, I was using the “quiet hour” after we close to make some calls to clients when our third telephone line rang. It was our answering service.
“Mrs. J called, her dog Annie was attacked by something and she is bleeding.”
“Do you have her on the line?” I asked.
“No, she said her husband is bringing her down to the clinic now,” the operator replied.
Well, so much for the quiet hour. About the same time I was hanging up the phone, I heard Mr. J knocking at the front door. I opened the door and he walked in carrying Annie, and 80-pound Labrador.
“She’s ripped up pretty bad,” stammered Mr. J. A quick exam proved him right; the skin on the front of Annie’s left front leg had been ripped open above the elbow and pulled down 5 inches. The inside of her right rear leg had a gash that was a foot long and 4 inches wide that looked like it had been made with a scalpel.
Despite the severe wounds, there was very little bleeding. Annie was able to stand and was not in shock. Mr. J explained that Annie had been in their woodsy – but fenced – backyard. The next thing he knew she came running around the house with her skin ripped open. A closer look at Annie’s front leg showed two superficial wounds about two inches apart just above the beginning of the torn section.
“Annie is very lucky,” I told Mr. J. “It looks like she survived a close encounter with a cougar. You can see the claw marks on her front leg, and there are major arteries that lay just millimeters beneath both of her wounds. She may have surprised a young make or a female cat who got in a couple of swipes before taking off.”
Because her wounds were very clean, I decided to bandage the legs, treat with antibiotics, and the next morning Annie had surgery to repair her wounds.
Traumatic injury is just one type of emergency that a pet owner might face. With any emergency, having an emergency plan in place saves precious time and could mean the difference between the life and death of your pet.
Ask your regular veterinarian where you should seek care for your pet in case of emergencies. Don’t make the mistake of assuming that your veterinarian will be available after hours. Increasingly, fewer veterinarians make the commitments to be available to their clients and patience after hours, opting instead to refer all these problems to emergency clinics.
Those practices that still answer their after-hours calls limit this service to established clients and will not see new patience on an emergency basis.
In the case of traumatic injuries such as motor vehicle trauma, animal attacks, falls, or gunshot wounds, the pet owner should be prepared to administer basic first aid if needed.
First, check for breathing, and administer rescue breathing (mouth to nose) if needed. Second, control bleeding – in most cases direct pressure on the wound is the best way to control bleeding. Third, stabilize the animal for transport.
If the animal is down, do not try to make it get up – this could aggravate spinal injuries. If possible, get a rigid platform, like a board, and gently slide the animal onto it, then secure the animal to the board with straps, ropes or tape placed over the shoulders, midsection and hips.
Next, cover the animal with a blanket and transport immediately. A call should be made to let the veterinarian know what the injuries are and when you will arrive.
Annie survived her emergency, although Mr. J reports that she is a bit pensive about exploring her big back yard these days. Hopefully her encounter sent that cougar packing for a less complicated environment and she – or any other pet in her neighborhood – won’t have to deal with this type of emergency again.
Dirk Digger was not pleased. His morning routine was usually enough of a challenge – helping his wife get their two kids to school before racing off to work. But even before he opened his eyes, he could tell this morning was going to be different, and not in a good way.
The smell hit him about the same time his feet hit the bedroom floor. It smelled like a diaper service truck had been blown up with an improvised explosive device. Dirk immediately figured it must be Jimjim, his 4-year-old German Shorthair Pointer, since it had been eight years since his kids wore diapers.
Jimjim slept in the basement and when Dirk opened the basement door he was nearly knocked over, first by Jimjim as he ran past, headed for the backyard, and then by the full force of the horrific stench coming up the stairway from the basement below.
Dirk held his nose and staggered down the steps. For the first time in his life he understood what the term “explosive diarrhea” referred to. The carpet, walls and stairs were spattered with nasty brown blotches.
Dirk raced back up the stairs and shut the door tight behind him. Jimjim stayed outside while Dirk and his wife, Debbie, listened to their kids complain about the smell and ask a hundred questions about Jimjim and the mess in the basement. The kids were ready for school and in the car waiting for Debbie in record time.
After they left, Dirk threw out the carpet, mopped up the rest of the mess and brought Jimjim into the hospital. A quick physical exam showed Jimjim to be in good condition, if a little subdued. Dirk claimed that Jimjim didn’t get into anything bad that he knew of, that he ate the same dog food that he always gets, and that there had been no changes in his routine.
“Does he get anything else besides the dog food?” I asked.
“Well, I do give him beef bones once in a while. You know, the ones they sell at the grocery store,” he replied.
“You boil those before you give them to him, right?”
“No, he gets them right out of the package, I figured it was good the natural way,” Dirk said.
“A lot of people think that it is OK to feed dogs and cats raw meat and bones, but as you’ve discovered, it is not a good idea,” I explained. “Raw meat, bones, and eggs are contaminated with several bacteria that can cause serious intestinal disease, including Salmonella, Campylobacter and E. coli. Many mild cases of food borne illness in pets go unnoticed or clear up without treatment but pets can become very ill if they eat enough of the wrong bug. And to make things worse, even if they don’t develop diarrhea when they eat raw meat, bones, or eggs, they can pass the pathogenic bacteria into the environment in their stool, putting their owners at risk for good borne illness.”
“But what about those B.A.R.F. (Bones And Raw Food) diets I hear so much about – are they safe?” Dirk asked.
“A recent study found that 21 commercially available raw meat diets tested positive for E. coli, so those diets are not pathogen free,” I replied.
I told Dirk that as long as Jimjim doesn’t get dehydrated or depressed, that he should get over the diarrhea in 48 to 72 hours, and that cleaning up the mess properly was important because his family could get sick too. As Dirk got up to leave the exam room he turned to me and said, “You know, they should change the name of those raw food diets from B.A.R.F. to C.R.A.P., for Creates Really Awful Poop.”
It was nice to see that even though Jimjim had lost control of his bowels, Dirk hadn’t lost his sense of humor.
Over the past 5 years, the number of dog and cat food companies competing for market share in the United States has exploded. Many smaller pet food companies have entered the marketplace, often relying on novel approaches to pet nutrition to set them apart from the larger, well-established companies. These boutique pet food companies often tout high quality ingredients, exotic protein sources, grain-free formulations, and raw or unprocessed ingredients as reason their foods are superior to other brands. Because they are small companies, many do not have their own manufacturing plants and their diets are produced at large processing plants that may manufacture diets for several companies. Taken together, these boutique companies account for about 20% of pet food sales per year.
These factories, among others, contributed to a bumper crop of diet-related pet health concerns over the past several years. Pet food recalls have become a common news item in the media. Melamine contaminated ingredients sourced from China, excessive Vitamin D from “outsourced suppliers”, contamination problems with Salmonella, E coli, Listeria and other pathogenic bacteria have resulted in recalls of numerous diets. So far in 2019, three pet food companies that produce traditional diets have had recalls, and six “raw food” diet brands have been recalled.
The latest pet food health alert involves clusters of cases of an uncommon heart condition, known as dilated cardiomyopathy or DCM, that have occurred in dogs that were being fed “grain free” legume (peas or lentils) or potato containing diets. Veterinary cardiologists noticed an unexpected increase in the number of dilated cardiomyopathy cases in 2018 and soon found a link to these diets in the patients’ histories. Since then there have been 560 dog and 14 cat cases of DCM, with a connection to these diets, reported to the FDA Center for Veterinary Medicine, which is investigating the issue. In DCM, the heart muscle is weakened so that it cannot contract properly, which eventually results in the dilation of the heart and eventually heart failure. Decades ago veterinarians were seeing DCM cases erupt across many different breeds and in crossbred dogs as well. After a large research effort across several different veterinary medical disciplines, it was found that the majority of the cases of DCM were due to deficient levels of the amino acid taurine in the dog food diets. The results of the investigation let to changes in the nutritional requirements for adequate taurine levels in dog food diets to prevent further cases. After those changes were instated, the number of DCM cases dropped.
Veterinarians are again looking at a taurine connection in this current outbreak of DCM cases. They have found that 93% of the diets of affected dogs contained peas or lentils. In many cases, a low taurine blood level is documented and in many cases, taurine supplementation and/or a diet change away from lentil-based “grain free” diets results in improvement, and in some cases resolution, of the disease. The science of nutrition is complicated. A pet food company might be adding the required amount of taurine to their diets, but use a source that is not readily absorbed through the intestine or has low bio-availability. It may be sometime before the exact nutritional mechanism behind DCM is known, but veterinarians love a challenge.
Pet owners need to realize that DCM develops silently, until the signs of heart failure – exercise intolerance, a cough, fainting – become apparent. It can take years to develop. The diagnosis is made with an ultrasound exam of the heart, and is treatable. There have been DCM cases in cats reported to the FDA as well, but far fewer than dog cases. So far, none of the diets associated with these cases have been recalled, they are still in the marketplace.
Just a couple of weeks ago, I remember musing about the perfect spring we’ve had this year. “Every spring should be just like this!” I gushed. “Wet and cool; everything is so lush and green, and the lakes and rivers are full – it’s all good.” Now, I generally try to stay away from superlatives and emphatic statements, but I believe I was suffering from a brief dementia known as spring fever at that time. As great as our spring was, it was not “all good.” There has been a downside for our furry companions – the bumper crop of foxtails this year.
Anyone who has taken a shortcut through an unmowed field in the middle of summer has had a close encounter with the various types of seed heads known as foxtails; the dry, stiff, pointed and barbed devils that you can never get completely out of your socks. The product of eons of evolution, many plants have perfected this simple dispersal mechanism: grab on to anything that moves and don’t let go. Foxtails, also known as grass awns, come in many shapes and sizes; from the large, bushy seed heads to the tiny, hair-like single-seed variety, but they all have the ability to grab onto your pet’s coat and then work their way into, and through, their skin.
Once through the skin, they continue to migrate, depositing bacteria in their wake and causing infection. The body cannot break down the cellulose that makes up the awns; the most it can do is wall off the intruder with scar tissue. But the foxtail shelters the bacteria from white blood cells, so in many cases the body cannot eliminate the infection. Foxtails commonly ender the body between the tows, but they can get in through anywhere there is enough hair to hold them. They can also cause problems in the ears, nose, mouth and eyes.
The classic sign of a penetrating foxtail is a nonhealing, oozing wound. These wounds may be small and obscured by hair – so many owners may only notice their dog is licking its feet. A sudden onset of head shaking may signal a foxtail in the ear. A foxtail in the nose causes repetitive sneezing fits or a one-sided nasal discharge. A dog or cat that greets its owner with one swollen, red eye this time of year has a foxtail in that eye until proven otherwise. When presented with a penetrating foxtail, a veterinarian will try to remove it. In places like the nose, ear or eye, the awn can be visualized and extraction is straightforward. When the foxtail has completely penetrated the skin, most vets will probe up the tract with a long tweezers, blindly attempting to grab and extract it. As some of these awns may be only an eighth of an inch long and as thin as a hair, some may go unrecovered despite the careful and thorough efforts of a doctor. A course of antibiotics is required and tracts that have been cleared of foxtails will heal quickly. If a tract does not heal, or reopens after the antibiotics are finished, then the owner must decide on another blind probe or a more invasive surgical procedure where the tract is dissected open to allow visualization of the foxtail.
These procedures, along with the anesthesia or sedation and antibiotics that may be required, can be costly – so in the case of foxtails, and ounce of prevention is definitely worth a pound of cure.
Here are a few suggestions that will lower your pet’s risk for foxtails. First, whenever possible, cut them down – try to cut the tall grasses in your pet’s environment once a month April through June. If possible, pick up the clippings, because dried awns on the ground can still penetrate. Second, check your pet’s body daily, particularly the feet, and remove any awns that you see. For pets with exuberant coats and furry paws, consider clipping the hair coat short and clipping the hair on the feet down to the skin. Known as a “field cut”, this decreases the ability of the awn to get a foothold (no pun intended) and makes it easier for the owner to spot and remove it. Owners may have to get used to seeing their dogs in “poodle feet”, but I have a feeling that any dog would choose poodle feet over the scourge of the foxtail every time.
Wendy River was a self-proclaimed fishing hobo. Her 2-year-old dog Pepper had been keeping her company on many trips to rivers and lakes since she adopted him over a year ago.
But Wendy became worried when Pepper, who “had never been sick a day in his life,” suddenly took ill with vomiting, diarrhea and depression. “I think he’s got parvo,” she said.
Pepper looked shriveled; his eyes were sunken, and his skin draped loosely across his thin frame. His head sagged low below his shoulders. “Has Pepper ever been vaccinated?” I asked.
“I made sure he got two distemper-parvo vaccines when I got him, but he has not had any since then,” she replied. “I don’t know what to do, I just can’t afford to put him in the hospital.”
“I have to admit, it looks like parvo,” I told her, “but parvo is a disease we mainly see in dogs under a year of age, that have not been vaccinated. This could also be a case of salmon poisoning.”
“Oh, I haven’t been down to the river in over three months – so Pepper hasn’t been anywhere near salmon,” insisted Wendy.
“Have you done any fishing in the last week?” I asked. “I just got back from a week of trout fishing at a lake up north.”
“Could Pepper have got into any of the trout you caught?” I persisted.
“Well, as a matter of fact, my partner fed Pepper a couple of trout heads,” she confessed.
“Were they cooked?”
“No, they were raw,” Wendy slowly replied.
“Well, salmon poisoning is not caused by only salmon and steelhead. Often the same hatcheries that raise salmon and steelhead also raise trout, and the trout can be infected with the organism that causes the disease. These trout are later stocked in area lakes, so dogs can become infected from eating raw trout as well as salmon and steelhead. Why don’t we take a look at a fecal specimen and try to rule out salmon poisoning before testing for parvo?”
Pepper’s fecal specimen tested positive for salmon poisoning. We gave Pepper a bolus of fluid under his skin, an intravenous injection of antibiotics, and sent Wendy home with a 10-day course of oral antibiotics. Wendy called a couple days later and reported that Pepper was feeling much better.
Salmon have been having a hard time lately. They’ve had to put up with dams, drought, deforestation, run-off and more. The powers that be in Washington have even removed the distinction long granted to wild salmon, lumping them in with their pen-raised, corn-fed cousins when determining the success of the salmon runs in the nation’s rivers.
They don’t deserve to be labeled as dog killers – in fact, they too are victims in the complicated life cycle that gives rise to the disease. The bacteria that infects the intestine in dogs that eat raw fish is carried within a fluke that develops in a freshwater snail.
When a young fish eats the snail, the fluke finds its way into the muscle of the fish where it encysts. When a dog consumes the raw flesh of an infected fish, the flukes are released, and they start to reproduce in the intestine, releasing the bacteria.
The bacteria infect and destroy the lining of the intestine and cause fever, vomiting, diarrhea, depression and swollen lymph nodes. Salmon poisoning can kill dogs if not diagnosed and treated within a few days of the onset of signs.
The diagnosis is confirmed by finding fluke eggs in a fecal sample from a sick dog. Treatment consists of antibiotics and supportive care. Dogs that survive develop immunity that can last several years. Dog owners need to know that area lakes can be sources of infection.
Every year in January, the Cole River fish hatchery takes steelhead from the hatchery and transplants them into Emmigrant Lake these fish start to wash up on shore a few days later and present an almost irresistible temptation to dogs who visit the lake.
Owners should try to keep their dogs away from fish carcasses, and if their dogs develop diarrhea and depression, they should seek veterinary care within 48 hours. And maybe someday we will come up with a better name for the disease, and give those poor salmon a break.
Frank and Lee O’Reely had reached the end of their rope. They had known for several years that their 8-year-old Yorkshire Terrier, Sweetie, had severe periodontal disease that was progressively getting worse.
“At first the smell from her mouth was tolerable, but now I can’t even let her give me a kiss without wanting to vomit,” Lee said.
“We even have to lock her in the back of the house when we have company over,” Frank added.
“Well, I can see in Sweetie’s chart that we have discussed having her teeth cleaned several times in the past, and you have always declined, can you tell me why?” I asked.
Lee’s eyes started to tear up and she said, “We love her so much, and we are just terrified that she will die under anesthesia.”
“Let’s take a look at her mouth and then we can talk about the anesthesia issue,” I suggested.
Frank and Lee were right about the odor, which was overpowering to put it mildly. For a 4-pound dog, she had teeth the size of a Labrador and they were caked with plaque; her gums were bright red and looked raw. The gums were so eroded that many teeth were barely held in their sockets.
“There is no doubt that Sweetie needs to have her teeth cleaned and several teeth will have to be extracted,” I said. “It is also true that the condition of her oral cavity is putting her at risk for other diseases. Bacteria can get into her bloodstream from her infected mouth and cause problems in her internal organs, including her kidneys, bladder, liver and heart. Beyond all that, poor Sweetie can’t even be part of your life anymore because of that horrible smell.
“Now, I can’t tell you that anesthesia is risk-free, but modern techniques are much safer than they were even 10 years ago, we monitor our patience carefully during anesthesia and recovery, and we can reduce the risks even further by doing preoperative blood work and supporting Sweetie’s blood pressure with intravenous fluids during and after the procedure.”
Frank and Lee reluctantly agreed, and after a thorough preoperative workup Sweetie got her dental. We extracted seven teeth, and Sweetie recovered quickly from anesthesia.
When the O’Reelys picked up their dog, they couldn’t believe that the odor was gone. They were delighted to accept the multiple kisses that Sweetie offered. We sent Sweetie home with a course of antibiotics, instructions for the O’Reelys to feed wet food for 10 days, and a few days’ worth of pain medication.
When I called to see how Sweetie was doing a few days later, Lee was ecstatic.
“She’s almost like a puppy again, full of energy, eating better than ever and no bad breath,” she said. “I just wish we would have had the procedure done earlier.”
The month of February has been designated the National Pet Dental Health Month. In recent years, veterinarians have learned that keeping the oral cavity healthy is very important to a pet’s overall health, particularly as they get older.
Veterinarians use ultrasonic scaling, polish and fluoride to clean debris from above and below the gum line, and can x-ray teeth to look for disease in at the level of the tooth roots. Extractions are commonly done when indicated, and specialists can do root canals, caps and other endodontic procedures.
Anesthesia is required for these procedures (animals simply won’t hold their mouths open no matter how nicely you ask them), but in most cases, dental procedures can be done safely even in very old pets.
The signs of dental disease can range from obvious, as in Sweeties case, to more subtle signs like reduced appetite, reluctance to chew, chewing on one side of the mouth, drooling, lethargy, or pain in or around the mouth.
Your veterinarian should make a point of examining the oral cavity during the annual exam and make recommendations based on their findings. Finally, there are many new products out on the market that make it easier to take care of your pet’s teeth between cleanings.
The Associated Press reported recently that there was an outbreak of parvovirus in Medford area dogs. The story reported that there were five cases as the county animal shelter in the last 30 days.
A local veterinarian who works closely with the shelter said that of the 10 dogs with parvovirus he has treated three in the last three months, six were known to be linked to the shelter, and was unclear if the other 4 cases had any link to the facility.
Parvo has been a major cause of disease in dogs since it emerged in a severe epidemic during the late 1970s. The virus attacked the cells that form the absorptive lining of the intestine and causes severe diarrhea and vomiting, dehydration and depression.
During the first years of the epidemic, dogs had no immunity to the new virus, so most of the dogs exposed to the virus became ill and more than half the dogs treated by veterinarians died.
Special characteristics of the virus led to the large number of cases during the early years of the epidemic. Parvovirus is shed by dogs before they show signs of the disease, and for weeks after they recover from the illness.
The virus is incredibly hardy, retaining its ability to infect for months after being shed into the environment.
After a vaccine was developed, the number of parvo cases dropped significantly, and parvo became a disease of the very young or non-vaccinated dogs. You, unvaccinated dogs that are stressed by parasites or other diseases are most at risk for parvovirus, so it is no surprise that animal shelters are prime locations for outbreaks.
Although steps can be taken to isolate affected shelter animals, the virus can be inadvertently spread around the facility before the outbreak is identified, and decontamination of the grounds around the facility can be difficult.
Owners of new puppies need to follow some basic guidelines to minimize their pet’s risk of contracting parvo. Puppies should be vaccinated every 3 to 4 weeks starting between 6 and 8 weeks of age and continuing to 16 weeks of age. Owners need to avoid taking their puppies to places where dogs congregate until puppies are over 16 weeks of age and have completed the vaccine regimen.
If a puppy develops diarrhea and/or vomiting accompanied by depression, a veterinarian should be consulted as soon as possible. The diagnosis can be made rapidly using an in-house test, and with current therapeutic protocols, most dogs can survive the infection.
Finally, as the shelter considers strategies to deal with the outbreak, they may consider reducing exposure to high-risk animals by moving their vaccine clinics to an off-site location.
Canine flu is a respiratory disease caused by an influenza virus closely related to a virus that causes respiratory disease in horses. Influenza viruses can mutate and case disease in different species (this is the reason for all the concern about bird flu). The first outbreak of canine flu occurred in Florida in 2004 at a racing greyhound kennel. Since then, there have been a growing number of cases reported by veterinarians in the United States.
Canine Flu is spread through the air, and it is very contagious. Because this is a “new” virus, dogs do not have any immunity to prevent infection and at least 80 out of 100 dogs that are exposed will be infected and become ill. Of the 80 dogs that become ill, three to six could die.
The incubation period is usually from two to five days, and signs of the canine flu can vary in severity. The most dangerous cases have a rapid and severe onset, with coughing, high fever, nasal discharge and depression.
Thankfully these cases are rare, but they can prove fatal in a matter of days if not treated promptly.
Most often, the canine flu presents itself like kennel cough, with a cough and mild depression, but it also causes a fever that is not responsive to antibiotics and may continue for three or more weeks despite treatment. Some of these cases can progress suddenly to the severe, life-threatening form. Very young and very old dogs have the greatest risk of severe infections.
The cause of death in fatal cases is most often hemorrhagic bacterial pneumonia, which occurs when the protective mechanisms in the airways fail, and bacteria that are always present in low numbers multiply rapidly and infect the lungs.
Treatment for canine flu includes the traditional use of antibiotics and supportive care, and some veterinarians experienced in treating these cases are also recommending the use of antiviral medications in the early stages to prevent the development of pneumonia.
It is very important to initiate treatment quickly once symptoms appear. Most dogs are treated as outpatients, but the severe cases require hospitalization. Diagnosis requires paired serum samples taken one to two weeks apart – so treatment is initiated after a presumptive diagnosis is made.
There is no vaccine for canine flu. Exposure to the virus is most likely in places where dogs congregate, such as kennels, groomers, dog parks and even veterinary offices. Operators of these businesses and dog owners need to be vigilant and conscientious to lower the severity of an outbreak.
Coughing dogs should not be taken to the groomer, boarding kennels, or dog parks. If a dog becomes ill, the owner should notify the owners of any other dogs that may have had recent contact with the sick dog.
Veterinarians need to have isolation protocols ready so they can safely deal with these highly infectious patients.
The question is not will the canine flu come to Ashland; the question is when canine flu will come to Ashland, and will we be ready for it when it arrives?
Rosie Lenz looked up from her novel as I entered the exam room. I was relieved to see she had something to keep her occupied as I was running behind after spending more time than I had anticipated retrieving some nasty foxtails from deep within a dog’s foot.
Rosie’s big orange tabby T.T. (short for Tony the Tiger) was sitting just inside his carrier on the exam table.
“Hello, Mrs. Lenz,” I began, “it looks like T.T. is here for a couple of vaccines today, how has he been doing?”
“Oh, he is just fine, no problems at all,” Rosie cheerfully replied.
As I examined Tony, I went through my list of clinical signs of illness with Rosie.
“So has T.T. had any vomiting or diarrhea lately?” I asked.
“Oh no,” Rosie said.
“Coughing, sneezing, runny nose?” I continued.
“Not at all,” she replied.
I had just asked Rosie if T.T.’s water consumption was increased or excessive as I placed my stethoscope on the left side of Tony’s chest, but I never heard her reply. Instead my full attention was drawn to the echo of his heartbeat drumming in my ears. Something was not right. Although most cats have an increased heartrate in the exam room, they normally have a very stable and regular rhythm. T.T.’s heartbeat was decidedly irregular, with extra beats thumping in between the normal beats in a random pattern. I repositioned the stethoscope, cocked my head and listened for another 30 seconds before addressing Rosie.
“I’m afraid T.T. has an irregular heartbeat.”
“Really?” Rosie began, “he’s been acting fine.”
I could tell from her tone that problems with Tony were not a part of her plan for the visit. I told Rosie that the irregular beat could indicate underlying heart disease, and I recommended we sent an electrocardiogram to a cardiologist who would describe the nature and implications of the abnormality. Rosie was resistant, saying she had an appointment at a gallery in 30 minutes. She grudgingly agreed after I explained that we could send the ECG over the phone in ten minutes and we would have the cardiologist’s report the next day.
When I returned Tony to Rosie, I explained that I would prefer to wait on the vaccines until we understand what is going on with his heart. The next day the report from the cardiologist defined the arrhythmia as atrial premature contractions, and recommended a cardiac ultrasound to look for signs of heart enlargement. I called Rosie to discuss the report, but I got her machine so I left a message with the cardiologist’s recommendations and suggested she make an appointment at our office for the ultrasound. But I never heard back from Rosie.
Five months later, I got a fax from the local emergency clinic that Rosie had brought Tony in with difficulty breathing the previous night. The emergency veterinarian found that Tony’s chest was full of fluid that was collapsing his lungs and he had a markedly irregular heartbeat. The fax concluded by stating that due to the severity of the clinical signs, Rosie elected to put Tony down.
More often than not, heart disease in cats is insidious, often causing none of the more familiar signs such as coughing, exercise intolerance or shortness of breath associated with heart disease in dogs and people. Cats are unique in being able to somehow compensate for deteriorating heart function until they reach a critical tipping point, at which time severe and life threatening signs can rapidly progress. Often the first indication of heart disease might be an arrhythmia or heart murmur picked up during a routine physical exam.
The good news is that veterinarians are able to medically treat heart disease in cats using many of the drugs used to treat people, once the diagnosis is established with ECG, ultrasound, and other diagnostic tests. But early diagnosis of heart disease in cats requires owners who are willing to look beyond the outward appearance of health and consider what might be lurking underneath.
Warning: This article not intended for readers with delicate sensibilities. Those who find creepy-crawly encounters disgusting or nauseating should consider reading another section. Even battle-hardened veterinary technicians get the heebie jeebies when confronted with the antagonist in the following story.
Anna Lid came into the exam room with Gary, her Labrador cross reluctantly following behind her.
“It’s Gary’s eyes,” she began, “they get red every now and then, and each time we treat with the eye drops we got from you they get better, but this time they’re not getting better – they’re getting worse.”
“I’m glad you brought Gary in today,” I told her. “There may be something new going on in his eyes. Let’s have a look.”
The inside lining of Gary’s eyelids were bright red and swollen, and he had a colored discharge in the inside corner of each eye. As I manipulated Gary’s eyelids to better view the outer part of the eyeball, I saw a faint outline of what appeared to be a thin strand of mucus down in the corner of his left eye. It seemed to flick in and out of view, like some sort of apparition.
I rubbed my eyes and looked again, as it appeared and vanished once more.
I think I may have found the problem,” I said as I applied a few drops of a topical anesthetic in Gary’s eyes.
I took a small pair of tweezers out of the drawer directed them down into the corner where I’d seen the mucus. I could hear Mrs. Lid gasp as I pulled out an inch long, white worm from Gary’s eye.
“OK, what is that thing?” she said as she averted her eyes from the trophy I held up for her inspection. “This is Thelazia californiensis, also known as the eye worm. This nematode, along with several of his brothers, is causing the redness and irritation in Gary’s eyes.”
“How did he get it, and more importantly, can I get it too?” she asked.
“Adult worms live in the tissue around the eye and deposit larva which are ingested by flies that feed on the secretions from the eyes. The larvae molt twice within the fly and then are deposited in the eye of a new host while the fly feeds. The larvae feed on the eye secretions and mature into adults. Thankfully, the eye worm does not infect humans. We have to remove the eye worms manually, and we will need to sedate Gary so that he is quiet during the extraction.”
We removed about a dozen worms from each of Gary’s eyes and prescribed some anti-inflammatory eye drops. As a courtesy, we saved the still living worms in a sealed, glass tube containing saline, so Mrs. Lid could gross out her friends.
In the past three months, I’ve diagnosed four separate cases of eye worms in dogs and cats. That is four more cases than I’ve seen in the last 5 years. This mini-epidemic could be related to increased rainfall over the last year, or other environmental factors.
Although they are not a common cause of a red eye, eye worms still need to be considered as a possibility, particularly when there is little or no response to topical medications.
I have heard increasingly frequent reports of predator sightings in the Ashland area. Coyotes, bears, and bobcats have all been seen, and there are undoubtedly cougars around as well. Every year, cats and dogs fall victim to these animals; some might escape with varying degrees of injury, but most just don’t come home and are never seen again.
The presence of predators may come with living in the beautiful rural areas that surround Ashland, but there are steps that people can take to help keep their pets from becoming prey.
Most predators are active at night, and will only approach homes under the cover of darkness. Keeping pets inside from dusk till dawn greatly reduces the change that they will encounter a predator.
Some pet owners get up in the very early morning, hours before sunup, and their pets get up with them and need to go out. A well-lit fenced area next to the house can provide a safety zone for dogs that are up before dawn. Owners should not allow their dogs to roam on their property in the dark.
Felines can be even more of a challenge for their owners. We have three young neutered male cats that are allowed to be outside during the day, but must be in by dark. The two oldest cats seem to understand the routine, and usually come in when they are called at the end of the day, but the youngest just doesn’t get it.
He scampers the other way when we call for him, oblivious to the dangers that lurk in the falling night. One night last well he pulled this stunt and after 15 minutes of fruitlessly searching for him, it had become so dark that I couldn’t see 30 feet in front of me. I headed back to the house. Just as I reached it, I heard a cat scream as if it was getting the life squeezed out of it about 20 yards away on the other side of the driveway.
I yelled and sprinted in the direction of the sound and caught a glimpse of a ghostly animal running off as I crossed the drive. I couldn’t tell what it was, but it looked wild and it definitely was not my cat.
I looked around frantically and found no trace of our wayward cat. My wife and I finally located him up a tree near the area of the commotion. Thankfully he was not injured, and since then he seems more willing to answer the “come in” call.
The other problem with keeping our cats safe occurs around 4 a.m., when they wake up and want to go out. One of the older cats will jump up on the dresser and knock various items to the floor in an attempt to wake us, in hopes that we will let him out.
Although I am mightily tempted to grant his request and toss him out, I resist because it is at least an hour before sunrise, and predators may still be around. So I have become accustomed to jumping out of bed, grabbing him off the dresser, and locking him in the family room at the other end of the house while remaining mostly asleep.
It can take a lot of effort to keep pets on this type of schedule, and while there is no guarantee that a coyote, cougar or bobcat won’t strike during daylight hours, keeping our pets in between dusk and dawn will reduce their risk of being taken by predators.
Not long ago, on a busy Saturday afternoon, I stopped by Shoppin Kart on my way home from the clinic to pick up something for dinner. I jumped out of my car, and checked my pockets for the list I had scrawled during an earlier phone call with my better half.
It took only a few seconds to realize I had once again gone to the trouble of making a list only to leave it behind.
As I turned toward the store, I ran the list quickly over in my mind, and I figured I was reasonably sure of remember five of the six items that I was supposed to pick up.
But when I looked up towards the entrance of the store, I saw something that instantly pushed that list right out of my mind. Sitting in the parking spot closest to the entrance was a jacked-up long-bed Dodge pickup.
The bed of this truck was crammed full of pieces of board of various shapes and sizes, jammed in willy-nilly, with pieces of board jutting out at odd angles. This tangle of wood rose one to two feet over the sides of the truck bed, and it looked like there may have been some nails protruding from some of those boards.
Perched precariously on top of this nasty jumble was an Australian Shepard. The poor dog couldn’t even find a stable spot to stand in the stationary vehicle, and as I stared at the sight with my mouth agape, I could not imagine how that dog would manage with that truck barreling down the road.
I thought about leaving a note on the windshield of the truck about the dangers of transporting a dog in that manner, but I was worried the owner might not see it, so I decided to wait until the driver came out. I was not waiting long when a young man came out of the store and headed for the truck.
From the look of his clothes he had spent the morning hard at work doing some demolition project, and he had taken his best friend along with him to keep him company. He greeted his dog with a warm “hey buddy” and the dog responded by scrambling over the wood, trying to get closer to his owner.
As I walked up to the driver, I wasn’t sure what I was going to say, but what came out was, “How’s it going? You know your dog is not safe in the back of your truck, he’d be better off in the cab with you.”
The driver looked at me, then up at his dog, then looked back at me and said, “Oh yeah, thanks.”
Then, without another word, he lifted his dog out of the truck bed and put him in the cab beside him and drove off.
Most of us would not consider allowing our human family member to ride in our cars and trucks without wearing safety belts, and not just because it is illegal.
We are all well aware of what can happen to unrestrained occupants in even low speed collisions. Crash test safety, sophisticated restraint and airbag systems are key selling points in most new cars sold today.
Too often, however, these safety considerations don’t apply to the four-legged companions that often accompany us in our vehicles. On any given day while driving around town, I might see three or more cars or trucks carrying dogs.
Some might believe that their dogs are less likely to be injured in an accident, but this is not true. It is common to see broken bones, pulmonary contusions and other internal injuries in dogs that were inside vehicles involved in collisions.
Unrestrained dogs can also become projectiles during a collision and injure other occupants in the vehicle. One of the most devastating and unfortunately common injuries to dogs that are carried unrestrained in the back of pickup trucks is the brachial plexus avulsion.
It is ridiculously easy for a dog to get bounced out of the back of a moving pickup. When this happens, the dog will often try to land on its front feet. Because the dog is moving at the speed of the truck when it plants its feet on the ground, the legs are often violently pulled away from their bodies.
All of the nerves that run from the spinal cord down the leg enter in a large group known as the brachial plexus under the armpit. When the leg is directed away from the body during the fall, the brachial plexus is stretched and torn, resulting in permanent paralysis in the leg and requiring amputation.
These tragedies can be avoided. Dog restraints for cars and trucks are available for $20 to $80, and they are easy to use. Owners need to remember that they never know when they might be involved in an accident, and just like with their human passengers, they need to secure their canine passengers every time they get into the vehicle.
“I’ve never seen anything like this before, and I was worried so I brought her right down. I’d be the first to admit she’s the excitable type, but this is just plain wrong.”
Mr. Mount pointed at Sally, his yellow lab, as she bustled about the exam room, panting frantically. We both could see the spastic flicking of the muscles in her legs, trunk and neck. Sally was clearly growing more anxious with each successive tremor.
“Sally’s got the shakes,” he said, almost under his breath.
“She sure does – how long has she been like this?” I asked.
She was fine this morning when I left the house but when I got back this afternoon, I found her like this.”
“Was she in the house that entire time?”
“No, she can get out to the yard through the back door.”
“Sally must have got into a toxin that is causing those tremors,” I told Mr. Mount. “Could she have gotten into any medication at home?”
“No we keep all that up,” he said.
“Does anybody smoke – could she have eaten any cigarettes?”
“I don’t smoke,” he replied.
“Does Sally have access to any type of chocolate, coffee, or moldy cream cheese?”
“No, no, and no.”
“What about pesticides, bug spray and the like?”
“No, nothing like that,” he said.
That covered the list of toxins found inside the house that could cause tremors, so I asked Mr. Mount about toxins found outside the house that could be involved. I asked him if he used snail bait, rodenticides, herbicides, or pesticides in his yard. No was his answer to each query.
“Any walnut trees on your property?”
“Why yes, there is an old walnut tree back there.”
I explained to Mr. Mount that a particular fungus can grow on rotting walnuts when they are wet, and that fungus produces a toxin that can cause tremors when it is ingested.
We treated Sally with intravenous valium and muscle relaxers and made her drink two bottles of activated charcoal to absorb any toxin that was still in her intestine. By the next morning Sally was back to her old self, and Mr. Mount informed me that he had picked up “every last one of those damn walnuts.”
Toxins, whether man-made or naturally occurring, can be found almost anywhere in our pets’ environment. Exposure to toxins often results in abrupt onset of symptoms related to the specific organ systems affected by the toxins. Neurologic signs such as tremors or seizures, gastrointestinal signs like vomiting or diarrhea, cardiovascular signs like weakness or coughing, and signs associated with kidney failure like increased water consumption and depression are some of the common problems seen in pets exposed to toxins.
If an owner suspects their pet has come into contact with a toxin, they should call their veterinarian immediately. The veterinarian will need to know the type and severity of the clinical signs, how long the signs have been present, and any information about the possible toxins involved.
If the name of the toxic material is known, the National Animal Poison Control Center, (800) 548-2423, can provide information on the toxicity and treatment protocols for a small fee.
Owners can do much to lower the risk of toxin exposure in their pet’s environment. Always read labels and follow their directions regarding to safe use and storage of toxic products. Keep medications and other potential toxins out of the reach of pets. Have a bottle of hydrogen peroxide at home to induce vomiting if your veterinarian recommends it.
Prompt intervention is key to achieving a good outcome in poisoning cases – so owners should have an emergency plan in place to avoid costly delays in obtaining treatments.
Bonnie Schaffer called me the other day with an unusual request.
“I was wondering if you could write me a letter describing the heat stroke in dogs, how it happens and the consequences of heat stroke.”
“Sure, I can do that, but why do you need it?” I asked.
“Well, the other day it was really hot out – around 100 degrees – and I was walking down the street by my house and noticed a dog in a parked van. The windows were rolled down just enough for the dog to stick its face out, but it was panting really hard and drooling. I was really concerned that the dog was going to have heat stroke if it didn’t get out of the car. I called the police to let the dog out, but 15 minutes later they still had not shown up. So I walked over to the car, opened the door and took the dog home. I called the owner’s phone number on the tag and was cooling the dog down when the police finally arrived. About a minutes later the owner walked up the street.”
“You did the right thing,” I told her. “Heat stroke occurs when an animal builds up too much heat for its cooling mechanisms to dissipate. The body temperature of a dog goes from 102 degrees to over 105 degrees – sometimes as high as 109 degrees. The excessive heat causes cell death and can lead to organ failure. The temperature inside a parked car can reach 160 degrees, even with the windows rolled down partially. The excessive panting and drooling you observed are early signs. As the heat stroke progresses, weakness and shock set in, followed by respiratory distress, hemorrhagic vomiting and diarrhea, kidney failure, seizures, coma and death. You might have saved that dog’s life – but why do you need a letter from me?”
“The dog’s owner was very upset with me,” Bonnie replied. “He claimed that he had only left the dog in the car for 20 minutes and that she was overheated because they had just come from the park. He made the police arrest me for unlawful entry into his van.”
“Wow, so instead of thanking you have saving his dog, he had you arrested? I’m surprised that the police didn’t cite him for putting his dog at risk by leaving her in a parked car on a hot day after exercising her at the park.”
I told Bonnie I would write the letter for her, and even testify on her behalf if the power that be decide to waste time and money and take this before a judge.
Pet owners need to be aware that heat stroke does not just happen to pets locked in cars. Many owners enjoy regular outdoor exercise with their dogs during the summer. Owners should avoid exercising their pets in the heat of the day for extended periods.
Shade and water need to be provided to any dogs or cats that are housed outside during the day. Old or overweight animals are particularly susceptible to heat stroke.
Owners should not assume that their dogs will just stop and rest if they get too hot; many times heat stroke has already developed by the time clinical signs are observed.
If owners do see their pets showing signed of heat stroke, they should attempt to cool the animal down by dousing the hair coat with cool water and then get the pet to the veterinarian right away. The degree and duration of overheating affect the prognosis, and despite treatment, some animals will die from heat stroke.
And if I happen across a dog trapped in a hot car, I would do just what Bonnie did; notify animal control or the police department, and if necessary, get the dog out of the car and cooled down. It is a regrettable sign of our times that being a good Samaritan can result in legal hassles, but for the dog trapped in the car, the consequences of inaction could be far worse.
“You might want to check on Sassy in Room One,” said Libby; “she seems to be breathing hard.” Our technician, Libby, had just come from Room One, where she had administered fluids to Sassy Lewis, a 10-year-old cat we diagnosed with chronic renal failure only a few days earlier.
A report of “trouble breathing” gets me moving faster than a triple-shot latte with double sugar, so I dropped what I was doing and in a few seconds I was standing in front of Sassy and Mrs. Lewis.
Libby was right; Sassy sat on the table, her back up and head slightly extended, and it was easy to see the exaggerated movement of her chest and flanks that occurred with every breath.
“How long has Sassy been breathing life this?” I asked.
“She was fine two days ago, when she got her last fluid treatment,” Mrs. Lewis replied, “but yesterday she didn’t move around much and this morning she was breathing funny.”
I listened to Sassy with my stethoscope, and found that her breath sounds grew faint as I moved from high to low on the side of her chest. “We need to take an X-ray,” I told Mrs. Lewis, “it sounds like she has fluid in her chest cavity.”
We gave Sassy some oxygen for several minutes, and then took the X-rays. The films showed Sassy’s lungs floating in a sea of fluid that completely obscured the view of her heart. The fluid was compressing her lungs so she could not take a full breath no matter how hard she tried.
We placed Sassy in an oxygen cage and I went back to Room One to explain the situation to Mrs. Lewis.
“Sassy has another problem besides chronic renal failure,” I began. “Cats with chronic renal failure need increased fluid intake because they cannot concentrate their urine. But the additional fluids we have been giving Sassy under her skin have caused fluid to build up in her chest. The most likely explanation for this is Sassy must have heart disease as well.”
Mrs. Lewis looked as if she had heard enough bad news for one day.
“We need to pull some of that fluid out of her chest so she can breathe easier. We will start her on diuretics to help remove additional fluid. She will stay in the oxygen cage tonight, and tomorrow we will ultrasound her heart to get a better understanding of the nature of her heart disease.”
Mrs. Lewis hugged Sassy and said a sad goodbye. We were able to remove a large amount of fluid from Sassy’s chest, and she was visibly breathing easier when we placed her into the oxygen cage for the night.
By the nest day, Sassy had made additional improvement and was able to breathe normally outside of the oxygen cage. As soon as I began the cardiac ultrasound, I could see the heart was clearly abnormal. The right chambers of the heart were enlarged, and within those chambers were distinctive, bright parallel lines that flashed into view and then disappeared with each contraction of the heart. The cause of Sassy’s heart disease had been discovered – Sassy had heartworm disease.
“I knew my dog could get heartworms, but I didn’t realize that cats can get them too,” Mrs. Lewis said when I told her the news.
“Cats can get heartworms, but they are not as susceptible as dogs, so that in any given area, it is estimated that there is only one cat with heartworm for every five to 20 dogs with heartworm,” I replied. “Cats may show signs of coughing, trouble breathing or vomiting when they are infected with heartworms. Sudden death may occur in a small number of cases.”
“Can cats be treated to remove the worms like dogs?” she asked.
“Unfortunately, treating cats to get rid of the worms is very risky, and 20 to 30 percent of cats treated this way die from complications. But there is some good news: Cats generally only have a few worms, and with supportive treatment and a little luck, many can outlast the worms, which only live one to two years. Like dogs, cats can be given medication once a month to prevent heartworms, but the use of heartworm preventatives in cats is not as common as it is in dogs because far fewer cases are seen in cats.”
Sassy responded well to the supportive treatment, and she was put on monthly medication to prevent infection with new worms. It seems likely that, as with heartworm disease in dogs, the number of cases seen in cats will increase with time, making the use of preventative medication in cats more common as well.
Bosephus Johnson lumbered slowing into the exam room after his owner James. James was concerned that Bo just wasn’t doing right; his appetite had been down for about a week, he was drinking more water than usual, and he had vomited a few times since yesterday.
It was easy to tell Bo felt sick; normally the 100-pound golden retriever was all tail-wags and kisses, but today he looked wilted with his head down and his tail low and limp. Except for some mild dehydration, Bo’s physical exam was normal.
As Bo was an active dog who followed his owner around their little ranch all day, I asked James if Bo could have gotten into something that might have poisoned him, but he couldn’t think of anything. “We need to do a blood test and a urine test to figure out what’s going on with Bo,” I told him. “We should have results in about an hour; I will give you a call and let you know what we find.”
The results of the tests showed that Bo’s kidneys were failing. This was leading to a buildup of toxins in his blood and the loss of appetite, depression, increased drinking and vomiting. This type of acute kidney failure could be caused by poisoning, infection or autoimmune disease, but there was no evidence of infection or autoimmune disease. The kidneys’ job is to eliminate toxins that are produced by the metabolic processes taking place within the body, while conserving water. Although there are two kidneys in the body, only one is needed for adequate function.
Signs of kidney failure do not occur until more than 50 percent of the total kidney function is lost. Unfortunately, the kidney is now capable of repairing itself when it has been damaged, and failure of the kidneys often leads to failure of the animal.
Despite hospitalization and aggressive therapy, Bo’s kidney failure progressed and James made the difficult decision to put him down. I told James that Bo must have gotten into something somewhere that caused his kidney failure. “You know, I’ve been thinking about that and I remembered the day before he started acting sick, he had been into a box of grapes we picked from our vines. But he has eaten grapes before.” James said. “Could that have anything to do with it?”
“It may have everything to do with it,” I replied.
Cases of kidney failure in dogs and cats that have eaten grapes and raisins have been on the rise in the last several years, although Bo was the first case I treated where grape consumption was confirmed. The toxin agent has not been identified, although it does not appear to be a fungal toxin or pesticide, and it does not appear to be related to grape seeds.
Even 10 or 15 grapes or raisins can be a toxic dose, and signs usually appear within 72 hours. There is no explanation as to why only some of the dogs and cats that eat raisins or grapes get it, or why a dog like Bo can eat grapes for years without getting sick, and then become gravely ill after eating them. Because of the mysterious nature of grape toxicity, veterinarians now recommend that no grapes or raisins be fed to dogs or cats, and that you should talk to a vet if you know your dog or cat has eaten them.
While on the subject of unusual pet poisons, I’ll mention that pet owners should be aware that, when dogs eat sugarless gum or other products which contain the artificial sweetener knowns as xylitol or birch bark, they can experience a severe drop in blood sugar resulting in collapse, seizures and liver damage. As little as 1 – 3 pieces of gum consumed by a 20-pound dog can cause problems. Also, don’t forget that chocolate ingestion can cause tremors or seizures and ingestion of Easter Lilly is another cause of kidney failure in our pets.
Memorial Day marks the beginning of the summer season for many Oregonians. Most people associate events like cookouts, boating and camping with the holiday weekend. But for Sandy Patrick, Memorial Day will forever be associated with snakebites.
It all started on Memorial Day weekend several years ago when my pager went off – as happens occasionally on holidays. The answering service informed me that a rattlesnake had bitten Tuck, one of Sandy Patrick’s Jack Russel Terriers.
I got Sandy on the phone.
“Tuck was in the backyard and got bit on his leg about 15 minutes ago. It’s swollen up and bleeding and he won’t let me touch it,” she cried.
“Bring him down to the clinic; I’ll meet you there,” I told her.
I was hoping Tuck had received a dry bite (one of the 25 – 50 percent of rattlesnake bites that deliver little or no venom), but from Sandy’s description I knew different.
I was glad we always had a bottle of rattlesnake antivenin at the hospital.
When Sandy arrived, I explained to her how the venom could affect Tuck. “The toxin damages the tissues around the bite, causes low blood pressure, can damage the heart and can cause bleeding problems. We will draw blood so we can assess Tuck’s current status, and we will start treatment with the antivenin immediately.”
“What is the antivenin?” she asked.
“It is concentrated antibodies to the toxins,” I replied. “These antibodies will find the toxin in Tuck’s body and neutralize it. It will greatly shorten the time Tuck is in the hospital and significantly reduce the risk of serious complications.”
We administered the antivenin and Tuck went home the next day with normal blood tests and a course of antibiotics. A week later, Tuck’s wound had healed and there were no signs of lingering effects.
“Did you ever get that snake?” I asked.
“No,” Sandy replied. “It was gone by the time that I got outside and we haven’t seen it since. I figure it’s long gone by now.”
I had all but forgotten about Sandy and Tuck’s case, until I was abruptly reminded one year later when my pager went off again – on Memorial Day weekend. “Sandy Patrick’s dog got bit by a snake,” the operator said.
“Is this déjà vu or what?” I wondered. Everything was the same as it had been a year ago, except this time it was Sandy’s other Jack Russell, Roll, that had been bit.
“You know, I think it was the same snake, and he got away again,” Sandy groaned. We gave another bottle of antivenin, and witnessed another full recovery.
Since then, other Memorial Day weekends have come and gone without a repeat performance by the Memorial Day viper. But for dogs like Tuck and Roll, there is a newly available rattlesnake vaccine on the market.
The vaccine works by educating the dog’s immune system so that it makes its own anti-venom antibodies; they are ready to neutralize the toxins in case of a snakebite.
The dogs that would benefit most from this vaccine are those that live in isolated areas that have rattlesnake populations or dogs that accompany their owners on backpacking trips. For these dogs, the vaccine could make the difference between life and death.
Even with vaccination, a rattlesnake bites should be considered an emergency and the owner should seek care as soon as possible.
However, vaccinated dogs are far less likely to require antivenin – which costs around $500 a bottle – and far less likely to experience the more serious complications of rattlesnake bites. And that may be reason enough for many dog owners in Southern Oregon to consider the rattlesnake vaccine.
Jasper, the 2-year-old West Highland White, was looking more than a little off-color. In fact, he was in the pink, literally.
Beneath his snow-white hair, his skin was bright pink from his ears to his tail. The only other color represented on his body was a reddish-brown staining on the hair cover all four of his feet.
Jasper’s owner claimed that Jasper spent most of his waking hours scratching at his ears and licking his feet, and that he had developed an unpleasant “musty” odor. It was fairly obvious that Jasper was suffering from allergies, one of the most common medical conditions we see in dogs and cats.
Allergies in dogs and cats can be divided into three major groups:
Flea allergy, or flea bite hypersensitivity, is the most common allergic skin disease in dogs and cats. Animals with flea allergy develop a reaction to molecules in the flea’s saliva. Just one or two actively feeding fleas can cause signs of itchiness, hair loss, pustules and crusts in sensitive animals; often these lesions are concentrated on the back half of the body.
In temperate climates, there is usually a seasonal variation in severity, with signs increasing during the warmer months of the year (although fleas can survive indoors all year long and can continue to cause problems even in winter). Flea allergy is the easiest allergy to treat, as there are many effective flea control products on the market and the clinical signs can be controlled with low doses of steroids or antihistamines.
The second most common allergy in dogs is atopy, in which the animal reacts to inhaled material, such as pollen, molds and dust mites. Common signs include itchiness, red skin, recurrent ear infections, feet licking and occasional red eyes and sneezing. Like flea allergy, atopy usually is seasonal in temperate climates, although indoor airborne allergens can be more of a problem in winter when pets spend most of their time inside.
Treatment for atopy can be challenging because it is difficult to limit pet’s exposure to allergens in the air. Traditionally, steroids and antihistamines are helpful in mild to moderate cases, and repetitive injections with extremely diluted antigens (identified as positive reactors in the patient by skin or blood testing) can be helpful in moderate to severe cases.
The third major type of allergy is food allergy. Animals with food allergies most often react to proteins or carbohydrates in their food. The signs are much the same as those associated with atopy (with occasional vomiting or diarrhea). However, there is little or no seasonal variation in severity. Food allergies also do not respond to steroids or antihistamines as well as flea allergy or atopy.
Complicating the diagnosis of allergic pets is the fact that many pets suffer from simultaneously from two or even all three of these allergies. Veterinarians try to focus on the differences between the three.
Signs that are severe from spring through fall and then disappear in mid-winter suggest flea allergy or atopy, whereas itchiness that shows no decrease through the winter months is likely related to food. Response to a course of steroids can be another clue in figuring the type of allergy involved. With flea allergy and atopy, a course of steroids is like pouring water on a fire – the signs respond quickly and may completely resolve. The same treatment in a food allergic animal may result in little or no improvement.
The traditional “gold standard” diagnostic for flea allergy and atopy is skin testing, in which small amounts of pure antigens, such as flea saliva, specific pollen or molds, are injected under the skin, then swelling around the injection site is measured and recorded.
A more recent method of testing blood or antibodies that react to specific allergens has become increasingly common, although the reliability of the results is controversial, particularly regarding food allergens.
Most common treatment plans try to address as many factors as possible. All allergic animals should have an effective flea product applied religiously – this alone may reduce or eliminate clinical signs. Low-dose steroids or antihistamines are useful in treating flare-ups or as maintenance therapy in atopic or flea allergic animals. Allergy injections can be helpful in atopy cases that don’t respond completely to the other medications.
The only effective treatment for food allergy is a diet that consists of a single protein source and a single carbohydrate source, also known as an elimination diet. The protein source should be one that the patient has never been exposed to in their previous diets, such as salmon, venison, rabbit or duck. The carbohydrate is often potato.
The diet can be prepared at home or there are several prescription diets available. The patient is put on an eight-week diet trial in which they receive only the diet and no other treats or food (not even flavored medication, such as heartworm preventative). If there is improvement after eight weeks, new elements can be introduced to the diet, one at a time, for a 10-day period. If there is any reaction during that period, the new element is considered a reactor and eliminated from the diet. The best time of year to conduct a diet trial is in the dead of winter, where there will be less interference from atopy or flea allergy.
Jasper received treatment for atopy and was put on a diet trial with a salmon and potato prescription diet last winter. After eight weeks, he had improved significantly. On Jasper’s annual exam this spring, his owner reported that Jasper hardly licked or scratched anymore, and I could plainly see that Jasper had returned to a lighter shade of pale that would do any West Highland White proud.
“She was fine this morning, Doc; now, well just look at her,” Mr. Anderson said, shaking his head. His companion Maggie was her usual energetic self when they went to work together at the orchard. Maggie had gone off for a walk while Mr. Anderson took care of some business. An hour or so later when they got back together, he noticed Maggie was limping slightly – her right leg was bothering her.
He wondered if Maggie, his 6-year-old Border Collie, had been hit by one of the trucks in the orchard that morning, but he could find now cuts or bruises. He kept Maggie close while he finished his business, and was shocked to see Maggie start to limp on all four legs. She asked as if she was walking across broken glass. By the afternoon, Maggie did not want to move at all and Mr. Anderson brought her in to the clinic.
Maggie stood on the table with her head down, ears down and back arched. She shifted her weight from front to back and right to left, searching in vain for a comfortable position. There were no signs of trauma on her body, her heart rate was normal. She was uncomfortable when her joints were flexed, but they were not swollen.
I discussed the possible causes of Maggie’s sudden onset of shifting-leg lameness with Mr. Anderson. She was not hit by a truck, there were no signs of trauma; there were not toxins at use in the orchard that could cause these signs. I explained to him that Maggie could have an infection in her joints, or her body’s own defenses could be attacking her joints by mistake.
“You know,” I told him, “This is actually a classis presentation for Lyme disease in dogs, and we certainly have ticks which carry Lyme in the area, but I had only heard of one clinical case of Lyme disease reported in the Rogue Valley in the last 5 years.”
Maggie was also wearing a tick collar and she had been vaccinated for Lyme disease for each of the last four years. “It might be a stretch, but I have a bench top test for Lyme disease that will only take 5 minutes, why don’t we rule out Lyme so we can consider the other possibilities?”
Mr. Anderson agreed, so we drew a blood sample and ran the test. Within three minutes a blue dot appeared on the test, indicating that Maggie in fact did have Lyme disease.
“The good news is that this infection should respond quickly to the proper antibiotics,” I said.
“How could she get Lyme after all those vaccines, plus she wears a tick collar?” asked Mr. Anderson.
“Well, in areas back east that have large numbers of Lyme cases, unvaccinated dogs have twice the rate of Lyme disease seen in vaccinated dogs. But the vaccines are not 100 percent effective; vaccinated animals can and do develop Lyme disease, and tick collars can lose effectiveness under certain conditions.”
“Does it always affect them this was?”
“Some dogs become infected and don’t show any signs, many act like Maggie – sore and lame, and rarely, Lyme causes kidney damage, with depression, increased thirst and vomiting as the main signs.”
“What about my kids, Doc – can they get Lyme from Maggie?”
“No, Maggie cannot infect you or your kids, it’s likely that the infected tick bit Maggie many weeks ago, and the ticks tend to not transfer from one host to another.”
Maggie went home with a three-week prescription of antibiotics, and Mr. Anderson was to monitor her clinical signs. Lyme disease responds rapidly to antibiotic therapy; if the diagnosis is correct, the lameness should show improvement within three days. By the next afternoon Maggie had improved significantly. Fortunately, Maggie’s urine did not have high protein levels, the sign of kidney involvement.
I let Mr. Anderson know he should continue to use a tick collar or topical tick preventative, but I also suggested he check Maggie at the end of each day for ticks. After a tick with Lyme gets on a dog, it takes between 24 and 48 hours of feeding to transmit the organism – daily grooming could significantly lower any dog’s risk. Finally, one could argue that since Lyme disease can be diagnosed quickly and responds well to treatment, a vaccine that is not completely effective may not be necessary.
Mr. Anderson would probably agree.
