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Shea Cox

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Veterinarian Shea Cox has enjoyed an indirect path through her professional life, initially obtaining degrees in fine arts and nursing. She later obtained her veterinary medical degree from Michigan State University in 2001 and has been practicing emergency and critical care medicine solely since that time. In 2006, she joined the ER staff at PETS Referral Center in Berkeley and cannot imagine a more rewarding and fulfilling place to spend her working hours. In her spare time, she loves to paint, wield her green thumb, cook up a storm and sail. Her days are shared with the three loves of her life: her husband Scott and their two Doberman children that curiously occupy opposite ends of the personality spectrum. 

Arthritis in Senior Dogs
What can be done?

As our pets age, you may begin to notice subtle changes in their movement, such as having a little difficulty going up or down the stairs, or seemingly slow to rise from a comfortable laying position.  These can be early signs of arthritis, and early intervention is critical to slowing progression of the disease.  I am currently experiencing this “slow down” with my 11 year old Dobie, and I thought it would be good to share some suggestions that you, too, can consider if you have a pet that is living with some degree of arthritis.

Like any lifestyle change, one of the most important things to do first is to ensure that there are no other causes for the changes you are seeing in your pet. An intermittent and subtle slow down can be caused by many things, such as a low thyroid level or even a slowly bleeding tumor on the spleen. X-rays, a urine sample and blood work are important to ensure the overall health of your pet before starting any treatment plan.   

Today, there are a number of effective pain medications that are available to our pets, and a multi-modal approach to pain management is the best way to go.  By using pain medications that address various pain pathways, you get more complete and synergistic pain management while actually using lower doses of medications.  A cornerstone of arthritis management is a non-steroidal anti inflammatory, or NSAID. This provides excellent pain management in the early stages of arthritis, and then as the disease progresses, additional “layers” of pain management can be “added on.” These medications include such options as gabapentin, tramadol, and amantadine, with each one working to enhance the other.

Adequan is another medication that has been used in pets with degenerative joint disease or traumatic events such as a torn cruciate ligament. It works to help slow down the rate of decay of cartilage as well as stimulate new collagen and hyaluronic acid, a lubricant in joints. This is an injectable product that can be taught to be given at home underneath the skin and is initially given twice weekly for three to four weeks and then, once monthly. By the fifth or sixth injection, most pet parents usually see a more comfortable and agile pet.

Supplements such as glucosamine, chondroitin and omega-3 fish oils are good additions to managing arthritis changes. These supplements provide your pet's joints with building materials to help rebuild their cartilage and decrease the inflammation in the joints. Supplements are not an overnight fix, and they generally take at least six weeks before improvements can be seen. Products can be purchased over-the-counter and do not need to be labeled specifically for pets.  However, not all nutrapharmaceutical products are FDA regulated, and there is quite a bit of discussion with regards to bioavailability between various brands; this is a case where cheaper is not always better and I would recommend purchasing only high quality and trusted brands.  Your veterinarian can make recommendations for you. The standard dose for glucosamine/chondroitin is approximately 10 mg per pound of body weight once a day, for which you can round up or down to make tablet division or multiplying easiest.  For example, a 20-pound dog could take half of a 500 mg tablet daily (250 mg), even though its “recommended” dose is 200 mg. Also, when you are considering fish oil, you want to be sure to base it on the omega-3 concentration of EPA. The dose is 20 mg EPA for every pound of body weight once daily, and for example, our 20-pound dog would need 400 mg EPA daily.

Another area of extreme importance is your pet’s body weight.  I have to admit, I am a little guilty of letting this area slip and my boy and I recently went through a five-pound weight reduction program (I couldn’t let him “suffer” alone). How can you tell if your pet is a little too chubby? You should be able to easily feel your pet's ribs and backbone beneath the skin; if you cannot, then your pet may be overweight. Excessive weight is an added burden for already compromised joints, and you may be amazed how much better your dog will feel simply by shedding a few pounds. I can already see a difference in the way Bauer prances around.

Continued activity is also important—the old adage, “if you don’t use it, you lose it,” holds true for our pets, too. Working to keep up your pet’s muscle mass through activity can help provide stability and flexibility to joints.  Low-impact exercise is best, such as long walks and swimming, and both are highly encouraged.  

There are also newer concepts of arthritis management. One such treatment is known as Stem Cell Therapy. This is a procedure in which adult stem cells are injected into the arthritic joints, or into damaged ligaments and tendons, to aid in healing and repair. While continued studies are still needed, there are many reports of pets responding well and this therapy holds promise.  Joint replacement is a surgical therapy and has been proven to be very successful. As an example, 95% of canine patients with hip replacement can return to normal function. There has also been the development of dedicated rehabilitation centers for pets, which are becoming more widely available as the demand for options grows. Trained professionals can offer additional treatments such as hydrotherapy, acupuncture, chiropractic, massage, physical therapy, cold laser therapy, and pulsed signal therapy. Complementary treatments can offer your pet a complete approach to management of its arthritis, and many of these singular modalities, such as acupuncture, are often offered by veterinarians in general practice. These newer approaches to arthritis management are areas that I can discuss in greater detail in another blog, if there is any interest.  Let me know!

 

 

 

 

 

 

 

Legislative Alert
DEA action might hinder in-home vet practices

Legislative Alert: We need your help! Please Support S. 950, the Veterinary Medicine Mobility Act, to Allow Veterinarians to Continue to Transport Vital Medications for the Treatment of Animals!

The American Veterinary Medical Association (AVMA) is seeking urgent modification to the current Controlled Substances Act (CSA) that was put forth by the Drug Enforcement Administration (DEA) in 1970. The CSA was designed to protect public health by preventing diversion and improper use of controlled substances, and was actually implemented with the human medical field in mind. Well, the DEA is now suddenly interpreting the wording in this 43-year old legislation and has recently deemed it illegal for veterinarians to transport controlled substances outside of the veterinarian's single registered location, typically their hospital or clinic.

What does this mean? It means that it is now illegal for veterinarians to carry and use vital medications for pain management, anesthesia and euthanasia in house calls, in veterinary mobile clinics, on farms, or in ambulatory response situations such as injured wildlife. It now prohibits mobile veterinarians, rural or farm veterinarians, and in-home euthanasia veterinarians from doing their job because of this sudden and literal interpretation of the law.  As a provider of hospice care for pets, this hits especially close to home for me: I am no longer legally able to provide adequate pain relief for my terminal patients, nor am I legally allowed to provide the the gift of a peaceful passing in the comfort of a pet's home.  The DEA has already notified veterinarians in some states (California being highly targeted) that they are in violation of this law and are being threatened with fines as well as provoking licensing.  

The DEA has officially informed organized veterinary medicine that transporting these controlled substances is illegal per the CSA and thus would require a statutory change in the law to allow “us” to legally provide complete veterinary care to our patients.    

We have met this need by introducing the Veterinary Medicine Mobility Act (S. 950), which was introduced by U.S. Senators Jerry Morgan and Angus King just this week (thank you!). This legislation would amend the current CSA and will allow us to continue to treat and meet the needs of our patients—your pets.

Can you help?  It is imperative that veterinarians be able to legally transport controlled substances to the location of our patients, and we need your support.  By clicking this link you can tell your U.S Senators that veterinarians must be able to properly care for their patients.  It takes just seconds- look for the green-colored “TAKE ACTION NOW” at the bottom and with just 1 click, you can make a world of difference for our pet family members.  
 

 

Bromethalin: not all blue-green rodenticides are the same

In 2008, the Environmental Protection Agency announced that it planned to restrict sales of certain rodenticides containing second-generation anticoagulants (such as brodifacoum and bromadiolone) to pest control professionals and agricultural supply stores only. Rodenticide manufacturers came up to speed with compliance in 2011, and  in doing so, began using bromethalin more and more instead of anticoagulants in their products. 

While the change was designed to make rodenticides safer for our children, pets and wildlife, there has also been some devastating consequences. Unlike anticoagulant rodenticides, bromethalin does not have an antidote, and there are still many people and veterinarians that are not aware of its toxicity. There has been an uptick in the number of cases treated since these regulations have been put in to place, and this toxicity is once again being highlighted in veterinary publications in hopes of raising awareness.  

If a dog had ingested a rodenticide in the recent past, it was very likely a D-Con-like product. Anticoagulant toxicities are relatively easy and cheap to treat if caught early as  there is a 2-5 day lag time before bleeding actually happens. This type of exposure can also be diagnosed with a simple blood test, known as a PT test, which checks the clotting time of the blood and confirms exposure if it was not witnessed.

This is not, however, the case with bromethalin.  Bromethalin is a neurotoxin which affects the cells in the brain by causing a rapid influx of sodium particles into its cells.  When this happens, body water follows the sodium particles and leads to swelling in the central nervous system. The symptoms come on much faster and neurological signs can be seen within as little as 2 hours of ingestion. These signs can include depression, a “drunken” gait, rigid limbs, seizures and coma. Because there is no antidote, treatment is aimed at decontamination, intensive, and expensive hospitalization for support of the body and treatment of clinical signs if they develop.

I am sure many people are thinking, “Who would keep this stuff around when you have pets?!” I often have the same thought, but you would be surprised by the number of dogs we treat for this toxicity.

Here is the take home message: 

  • Severity of signs are dose-dependent, and if the poisoning is discovered within 30 minutes to an hour of ingestion, you should attempt to induce vomiting at home* if you are not close to a veterinarian; this will lessen the amount in the body, and therefore lessen the severity of signs
  • Despite how little was ingested, always assume worst case scenario: your pet should be hospitalized on IV fluids for at least 24 hours, during which time multiple doses of charcoal will be given as well as treating for any brain swelling that develops
  • Always bring in any packaging to your veterinarian to help facilitate rapid treatment
  • The lowest average lethal dose of bromethalin for dogs is 2.38 mg/kg, meaning a 10 pound dog could die from ingesting 5 small cubes of bait- not an uncommon feat
  • If at all possible, avoid the use of any rodenticide if you have pets or children

 

* If you need to induce vomiting at home, you can administer 1 ml of hydrogen peroxide per 1 pound of body weight with a maximum of 45 ml being given. For example, a 10 pound dog would need 10 ml of hydrogen peroxide and 80 pound dog should get no more than 45 ml. Trying this at home is not without risk and there are words of caution to consider: ONLY attempt to induce vomiting if your pet is very alert and if you are further than 1 hour away from your veterinarian.  Also, do not "force" the peroxide in—your pet needs to swallow the peroxide, and because it tastes bad, there is a risk of your pet aspirating the peroxide into the lungs if they are resisting and it is being forced.  Another concern is the potential for aspiration during the vomiting process. Aspiration of peroxide during administration or through the process of vomiting leads to additional problems such as pneumonia. Another note: don't waste time waiting to see if your dog will vomit... gently give the peroxide, grab a blanket to cover your car seat, and begin driving immediately to your vet. 

 

 

 

 

 

Hops Can Be Lethal to Dogs

Home-brewing is a trend that is becoming more and more popular, and unfortunately, so is the occurrence of hops toxicity in dogs. Hops is the plant used in the process of brewing beer, and both the 'raw' or spent hops are toxic. True flowers or dried hops plugs tend to be more toxic than hops pellets (pellets have less residue), while wild hops have been found to be non-toxic. The diagnosis is generally made based on history of having home-brewing supplies as well as seeing hops in vomit.

The mechanism of toxicity is unknown, but may be related to essential oils, resins, phenolic compounds, or nitrogenous constituents within the plant. Many of the substances in hops are degraded or aerosolized during the brewing process, so the exact relationship between substance and toxicity remains unknown.

Clinical signs of toxicity can include agitation, panting, excitement, flatulence, rapid heart rate followed by life-threatening elevations in body temperature. Death has been reported in as little as 6 hours without appropriate treatment. I have seen rectal temperatures greater than 108 F, and these temperatures can be very difficult to control. The high end of normal of a dog’s temperature is 102.5 F, and any temperature above 106 F can lead to an “unwinding” of the body’s proteins as well as permanent brain injury, depending upon the length of time that the elevation in body temperature persists.   

Treatment consists of aggressive decontamination measures including induction of vomiting, gastric lavage (“washing out” the stomach under anesthesia), administration of charcoal, and enemas. Active cooling by any means available is extremely important. There are also specific medications that can be given in the hospital to help control the clinical signs.

Prognosis for survival is generally guarded to poor, and unfortunately, many deaths have been reported. We have had 2 cases of hops toxicity this past year in the ER, and thankfully, both survived with aggressive treatment.

Any breed of dog may be affected, but breeds that are predisposed to malignant hyperthermia (extreme elevation of body temperature for an unknown reason) tend to be more susceptible.  These breeds include Greyhounds, Labrador Retrievers, Saint Bernards, Pointers, Dobermans, Border Collies, English Springer Spaniels, and northern breeds.   

If you suspect your dog has been exposed to hops, seek veterinary care immediately! This is not something that can be managed at home. Quickly take a rectal temperature, and if it is found to be greater than 105 F, begin active cooling measures—such as dousing your pets body with cool water and wrapping icepacks in towels and placing them over its body—in addition to running the air conditioning in car while on your way to your veterinarian or local emergency clinic. This measure could help save your pets life and give him or her the best chance for survival.

 

Moist Dermatitis in Dogs—Hot Spots
Home Treatments

A recent request by a Bark reader was, “how can I treat a hot spot at home without seeing a vet?” Hopefully I can begin to answer this, but first, one must be able to “spot” a hot spot.

A hot spot is a superficial skin infection that happens when normal skin bacteria overrun the skin’s defenses as a result of damage to its surface. This damage is most often started by the dog chewing, scratching, licking and gnawing at itself. In the first stages of the formation, the skin becomes moist, red, itchy, and infected. Pus begins to ooze from the traumatized skin as infection sets in. Then, the dried pus and damaged skin surface will work to form a tightly-adhered crust, and you will likely notice hair loss over the infection site. This can be a very painful process, and frequently, dogs will show pain when the area is touched.

Dogs are their own worst enemy when it comes to hot spots, and they are generally created by their own over-zealous self-licking and chewing. They can arise surprisingly quickly: a few minutes of “work” can create an impressive area of self-inflicted trauma. The good news is that they almost always look worse than they actually are, and infection is usually superficial—often resolving with topical treatment alone.

So, what causes our dogs to begin self-chewing and licking in the first place? Good question, with a common denominator being anything that creates irritation to the skin, causing the dog to chew or scratch at the site, can cause a hot spot. Think insect bites (fleas, flies), skin allergies, excess skin-surface moisture, dogs with heavy or dense hair coats, matted hair, saliva accumulation under the fur (think of the pet that is always licking its feet), skin scrapes, or excessive humidity in the environment can all be sources for a hot spot to develop. Another interesting cause: good old-fashioned boredom.

The location of the hot spots may help your veterinarian determine the underlying cause of the problem. For example, a hot spot over the hip area could indicate flea infestation, hip arthritis, or an anal gland infection. Similarly, a hot spot near an ear could indicate an ear problem, an allergy, or a dental/nerve irritation. 

What you can do at home:

If the hot spot is small, non-painful, recognized early, and is uncomplicated, it may be possible to begin treatment at home with over-the-counter products made for this use. There are an array of topical sprays, medicated shampoos, and herbal therapies available—too expansive a list to discuss here. The important thing is to ensure that it is a pet-approved/pet-safe product and it is always a good idea to call your veterinarian and ask if your choice seems reasonable. You need to be very careful not to use human topical products as these may be toxic to pets when licked and ingested.  For example, zinc oxide can be toxic when ingested and it is a common carrier in many human skin ointments.

The basics of home hot spot treatment are:

  • If the area is small and non painful, carefully and gently clip the fur that is covering the area—this allows air and medication to reach to wound (word of caution: use approved grooming clippers, not scissors! I see many “accidental lacerations” in the ER because of this.)
  • Keep your pet from licking the area—you guessed it, get out that cone of shame.
  • Apply a warm, moist compress to the area 3 times daily for 5-10 minutes to keep the area clean, to calm the tissues, and to encourage good circulation; allow the area to fully dry before applying anything topically.
  • Use only pet safe, veterinary approved, over-the-counter treatments; as always, it is best to consult with your veterinarian prior to starting any home treatment.
  • Do not place any bandages or wraps to cover the area—you want the area to “breathe.”
  • Alleviate the itching or irritation that started the whole thing in the first place—get to the bottom of the source, otherwise you will be faced with a loosing battle.

Tips on prevention:

  • One of the things that can’t be stressed enough is appropriate flea control! Good flea control is important for any itchy pet and is the foundation of “itch prevention.”
  • In hot, humid weather, always thoroughly dry your heavy-coated dog after bathing or swimming.
  • Make sure your dog is groomed on a regular basis.
  • Keep boredom and stress at bay—provoide adequate exercise and opportunities for mental stimulation and play.
  • Introduce essential fatty acids into your pets diet to help keep a healthy coat.

When you can’t do it alone:

The bad news is that about 30% of the pets who develop hot spots actually have some other kind of skin disease such as a deeper skin infection, a bite wound or other trauma, or even immune-mediated disease. If you have any concerns whatsoever, it is best to have your veterinarian assess them.

Another time that veterinary intervention is needed is when the hot spot becomes so big and painful that it requires sedation to properly clip and clean it (can you imagine what it would feel like to have running clipper blades go over raw flesh? Ouch!). 

An additional potential concern is if a hot spot is accompanied by deeper skin infection, which would require more extensive therapy such as oral pain medications, oral anti-inflammatory medications and oral antibiotics in addition to topical treatments. The treatment your veterinarian chooses will depend on how bad the problem is, how much pain your dog is in, how long the problem has been going on, and if the problem is a recurring one. Some dogs may get one or two hot spots and then never get another one again (luck dogs!), while some may have frequent recurrences. 

Hopefully this helps take off some of the heat of hot spots, and thank you for the suggestion, Mona J!

Paraphimosis:
Treatments to try at home

Paraphimosis is the inability to retract an extruded penis back into the preputial sheath, which is the skin that covers it. This can quickly turn into an emergency situation, as constriction of blood flow will lead to greater engorgement, necrosis (dying off of the tissue), and potential damage to the urethra. 

More common causes of this condition can include chronic licking, sexual excitement, or foreign bodies getting up under the skin. However, there are more serious causes including neurological disease (such as a herniation of a disc in the spinal cord), penis fractures, or muscular issues. Paraphimosis also needs to be differentiated from priapism, which is a state of continuous erection, usually due to a neurological problem.

A diagnosis of paraphimosis is generally based on simple observation of the penis extruded from the prepuce without any physiological reason. Paraphimosis accounts for approximately 7% of penile problems in the dog, and while not common, it can cause distress to pets (and their owners) and can have more serious consequences if left untreated or if it becomes a recurring issue. 

Treatment is generally conservative in nature, and many of these interventions can first be tried at home. Here is what you can do if this condition if noted in your pet:

  1. First, thoroughly clean the exposed penis and inspect it for any foreign material such as foxtails or long fur that is “strangulating” the tissues of the penis.
  2. Mix up a “sugar paste” using ordinary white sugar and enough water to make it into a  thick slurry.  Apply this mixture liberally to the extruded penis. The sugar works as a hyperosmotic agent, “pulling out” fluid from the tissues to help to reduce the swelling and shrink the penis. 
  3.  Wrap up a bag of frozen peas in a light towel and place over the area for 5 minutes at a time, which also helps to reduce swelling of the tissues. Packaged peas work well because they are very moldable around the dog’s anatomy. 
  4.  Lubricants, such as K-Y jelly, should then be applied. Lubrication helps aid in returning the penis back into the sheath.
  5.  If the swelling does not resolve within 30 minutes, and if the penis does not stay retracted into the prepuce despite the interventions above, then immediate veterinary assistance is needed. I have unfortunately seen several cases where the tissue of the penis had died off due to lack of blood supply, and these poor pups required a partial penis amputation—this is a true emergency in our pets.

 

 

 

Cracked, Broken or Torn Nails

A broken toe nail can be a painful and potentially expensive injury for our furry friends, and it is something that I often see in the ER. A common scenario is a pet suddenly begins to limp while out playing, and upon closer inspection, an injured nail is seen.  Some nails have just a minor crack with some bleeding, while other injuries put a toenail at a 90-degree angle (ouch!). Because they can be painful or have bleeding, a cracked or broken nail may be best treated by a veterinarian. With that being said, it may not necessarily require an urgent trip to the emergency room. A broken nail may be something you can care for at home, or, depending on the degree of injury, it may be reasonable to wait to see your regular veterinarian in the morning.   

So, what to do if your pet is suddenly favoring a paw and/or you see bleeding?  First, get a good look at the paw—including in between the toes and webbing—to see if it is a cut, foxtail or other foreign object, insect stinger, or (you guessed it) possibly a broken nail. When doing so, be sure to look closely at the nail bed, as I have seen cracks and injuries in the nail that were actually hidden underneath the fur line, where the base of the nail goes into the toe. There are 3 general “types” of nail injuries: one where the nail has been completely broken off and is bleeding, one where the nail is cracked or broken but is loosely attached, and one where the nail is cracked or broken but remains firmly attached. 

Usually, the best case scenario is when the nail is fully broken off and some bleeding is noted. In these cases, bleeding is usually mild but can be worrisome if it continues.  These are the easiest types of injuries to treat at home as you generally only need to apply pressure with a gauze or clean cloth to the nail to stop the bleeding. The key is to hold pressure for at least 5 to 10 minutes with no “peeking to see” if the bleeding has stopped before this time is up. It is important to keep your pet calm during this time, as excitement increases blood pressure and works against a good clot forming. If bleeding continues despite applied pressure, you can apply styptic powder (such as Kwik Stop) and resume applying pressure for another 5 minutes or so. If you do not have styptic powder at home, sometimes a little baking soda can do the trick. If the bleeding continues despite these measures, then I would go to the ER rather than wait.

If you do happen to find a nail that is very loose and dangling, then you can attempt to remove it at home.  It is important to have someone help restrain your pet safely while you gently try to remove the nearly broken off nail with a quick pull motion. Caution: only attempt removal if the nail is very loose!  Think “loose wiggly tooth” like when you were a kid. Also, be careful during your inspection or attempt to remove a loose nail as this can cause a sudden and unpleasant pain sensation in which some dogs may nip or bite in surprise.  If bleeding is noted following the removal, you can then use some gauze and light pressure, and/or Kwik Stop, as previously discussed.   

Lastly, there is the type of broken nail that would ideally be treated by a veterinarian.  These are nails that are cracked, continually painful, may be bleeding, and are still firmly attached. Treatment for these stubborn injured nails is typically some form of sedation with pain medication followed by cutting off the damaged nail just above the level of the crack. Sedation is needed because you are cutting through the very thick part of the nail with a live blood vessel and nerve, which is very painful. This is usually followed by styptic powder application and a bandage that is left in place for about 24 hours. The bandage promotes a day of rest so that a solid clot forms and the minor wound does not continue to bleed if it gets bumped on something. Although these types of injuries require professional care, it is something that can wait to be seen the following day if you are unable to get an immediate appointment with your veterinarian (unless your dog seems excessively painful, then I would not wait).

Whatever the type of nail injury, dogs are very good at keeping the area clean all on their own with licking, and antibiotics are not needed. A little licking is OK, and it is what a dog would do “in the wild” to keep it clean. With that being said, some of our babies get a little obsessed, and their good intentions can actually make the area more irritated by their constant worrying at it. Because of this, you should continue to monitor the area for any signs of redness, increased swelling, cloudy discharge, or increasing discomfort.  The development of these complications is rare in my experience, but if noted, then an e-collar, pain medications and possibly some antibiotics may be indicated. No matter what kind of damage has occurred to the nail, it will generally regrow normally in all but a few situations. Sometimes the nail will regrow with a slight curve or different pigment, but usually returns to its normal appearance over several months - kind of like when us humans lose a nail. 

As always, it is best to seek veterinary care if you are uncertain about the severity of any injury, but hopefully this may save you an unnecessary trip to the ER if this happens to your dog during a weekend while you are out having fun!

Hyperadrenocorticism or Cushing's Disease in Dogs:
Excessive levels of steroids in the body leading to disease

Hyperadrenocorticism, known as Cushing's disease, is a hormone imbalance that results from excessive cortisol in the bloodstream over a long period of time. Cortisol is produced and stored in the adrenal glands, which are two little glands that “sit” on top of the kidneys and is what is released in times of stress, preparing for a “flight or fight” response. However, if this system goes awry, and a dog's body is exposed to this hormone for a majority of the time instead of just in times of stress, it can become chronically debilitating. 

There are 3 main ways that a dog can get Cushing's Disease. The first way is from a tumor forming on the pituitary gland, and is known as Pituitary-dependent hyperadrenocorticism (PDH).  These tumors are generally small and non-cancerous, although rarely a cancerous tumor can occur.  The pituitary gland is located in the brain and is the “master gland” of the body.  One of its jobs is to detect when cortisol levels are declining, and in response, secrete a stimulating substance, called ACTH, that kicks the adrenal gland into gear causing it to secrete more cortisol. When the body reaches normal levels of cortisol, the pituitary gland stops this message from being sent, and production is halted. In the case of PDH, a tumor causes the pituitary gland to go into overdrive, telling the adrenals to produce excessive amounts of cortisol, despite there already being too much in the body. This is the most common form of Cushing's and accounts for about 85% of dogs with disease.  

Adrenal gland tumors are the next common cause, account for approximately 15% of dogs affected. This is a situation where a tumor is on the adrenal gland instead of the pituitary, and puts the gland into overdrive. The adrenals begin making excessive steroids all on their own, no longer “listening” to the pituitary when it tells the adrenals to shut off. These tumors are generally larger in size (usually detectable on ultrasound) and both cancerous and non-cancerous tumors are possible. Another problem that can happen with this type of tumor is that the pituitary “sees” that there is enough cortisol in the body, and subsequently stops producing ACTH.  As a result, the other adrenal gland (the one without the tumor) becomes shrunken due to nonuse.  

The last major cause is what is known as Iatrogenic Cushing's and is the result of the long-term use of steroids, or medications containing steroids. This is not from any inherent disease in the pet's system, but from the effects of the hormones given over the long term. Over time, the pituitary gland perceives that the body is getting enough steroids (thinking it is being produced from the adrenal glands-not knowing it is coming from medications) and quits sending its signal to produce more. In turn, the adrenal glands stop doing their job and also begin to shrink, temporarily loosing their ability to release cortisone on their own should their body require it to do so.  This inability to produce steroids naturally in the body can last for several months following the stopping of medication. This is why your veterinarian will instruct tapering doses of steroids instead of an abrupt stop: this gives these important glands time to recover and begin working on their own again.

There are a multitude of clinical signs that can be seen, and as always, can mimic many other disease processes. Signs are generally gradual, and because of this, they are often attributed to “normal aging” and disregarded. The most common signs that are easily observed in pets by their owners are increased drinking and urination, increased appetite (a good reminder that eating well is not always a sign of normal health), a “pot-bellied” appearance, thin skin and sparse hair coat, blackheads and/or darkening of the skin, and loss of muscle mass or muscle weakness.  Aside from these symptoms described, advanced or untreated Cushing's disease can also put a dog at risk for the development of bladder stones, diabetes and blood clots to the lungs.

If you notice any of these signs in your pet, a veterinary exam is in order. Your veterinarian can begin the process of testing for the disease, ensuring your pet is appropriately treated. If your veterinarian has reason to suspect Cushing's (based on history, physical exam and initial blood work), it will then be necessary to perform confirming blood tests and ideally, an ultrasound. This is not an easy diagnosis to make, and it requires several specific tests to positively identify not only the presence of Cushing's, but whether the problem is in the pet's pituitary or adrenal glands, as there is a different treatment for each form of disease.

The expected course of disease depends on which type of Cushing's is present, as well as response to treatment. PDH generally carries a good prognosis, and survival time for a dog treated with appropriate therapy is 2 years, with at least 10% of dogs surviving 4 years (this is better than it sounds, as dogs are generally diagnosed at an older age, usually 10-12 years old).  Dogs with non-cancerous adrenal gland tumors usually have a good to excellent prognosis; those with cancerous tumors that have not spread can have a fair to good prognosis, making early detection important.

Other tips and sidenotes:
I am often asked just how much water should a pet be drinking, to determine if the amount is excessive. As a loose rule of thumb, your pup should consume daily about 1 cup of water for each 10 pounds of its body weight. This is a loose approximation, as consumption will be variable depending on temperature of the environment, activity level, etc. The biggest thing to keep your eye on is if the amount seems to be steadily or suddenly increasing with no change in your pets daily lifestyle.
Here are two listserves available for owners of pets with Cushing's disease, and may be helpful resources for anyone living with a pet who has this disease.

www.k9cushings.com
pets.groups.yahoo.com/group/caninecushings-autoimmunecare/

 

ASPCA Poison Control Center
Emergency help only a phone call away

ASPCA Poison Control Center, 888-426-4435: 10 digits every dog owner should know!

A number of calls we receive in the ER are inquires about whether or not a substance is toxic to their pets. These inquires can include questions about specific pet or people medications, vitamins and supplements, both common and unusual household items, as well as various food stuffs.

With literally thousands of medications and oddities that our pets can get into, it becomes nearly impossible to know what is toxic, at what dose toxicity becomes a concern, and the treatment for each of these substances. Because of this, when we receive a call, we frequently refer pet parents to the Animal Poison Control Center for further information regarding the “dietary indiscretion.” This amazing service provided by the ASPCA is truly invaluable when there are questions or concerns about the potential for toxicity of any given substance. The center is staffed 24/7 by veterinary toxicologists who have at their disposal an expansive data base that includes every imaginable substance ever to have been known to meet a dogs mouth.

There is a nominal fee of $65 for this service, but a call might actually save you a trip to the ER or to your veterinarian, as well as give priceless peace of mind. When you call from home, you will actually be able to find out whether or not your pet needs medical attention, if you can induce vomiting at home (this becomes especially important for those people who live far away from veterinary care), or if you can potentially give some other home treatment. At the completion of the call, owners are given a case number that can be referenced again later should your pets condition change or clinical signs develop. If your pet does happen to need medical attention, once you arrive at the hospital for treatment, your veterinarian can call the center, also referencing this number, and can continue your pets care based on the toxicologist's recommendations.

This is truly priceless information, especially considering all the misinformation you can come across during a consult with Dr. Google. In fact, I have had to treat pets whose condition actually worsened because of an inappropriate treatment given at home. A situation that comes to mind was a good-intentioned owner who induced vomiting at home, based on what she read, after her dog ate Tide laundry detergent. Detergents can be very caustic (making vomiting a big no-no) and her dog subsequently suffered from erosive ulcers along the entire length of its esophagus as a result. Her pup required the placement of a feeding tube to bypass the esophagus, allowing it to heal. 

I would also like to add that part of our responsibility as veterinarians is to call back the toxicologist and report the response to treatment. This follow-up information continues to help others in the future as each toxic exposure, treatment and response to treatment gets added and stored in the ever-growing data base.

I cannot say enough good things about this invaluable pet resource. Every pet owner should have the ASPCA Poison Control number (888-426-4435) on their speed dial or refrigerator—this number may save your pets life as well as help other pets in the process.

 

Leptospirosis
A bacterial disease that's spreading

Leptospirosis is a bacterial disease of great importance as it can affect both humans and animals, and can readily be spread from one species to another (i.e., from our dogs to us). For many years the occurrence in pets was rare, however, in the past few years, the disease has become diagnosed more frequently-I myself have treated four dogs suspected of having Leptospirosis just this past year. The disease is caused by a bacteria that is spread through the urine of infected animals into the soil and water where it can survive for up to 180 days, given the right conditions. Then, as other animals come in contact with this contaminated area, the bacteria can then be taken up through their skin and mucus membranes (gums, nose, eyes) or through drinking the contaminated water (another reason to stay clear of puddles!).  

There are several environmental factors conducive to letting this bacteria flourish and increase risk of exposure. Warm, moist environments favor this bacteria, and they especially love stagnant water. With that being said, Leptospira do need water or damp soils to survive, and they will rapidly die on dry surfaces. The density of animal population, such as kennels and urban settings, also increases urine contamination and thus exposure. Also, areas that are heavy populated with rodents or wildlife also increases risk; they serve as “innocent hosts” meaning they are not affected by disease, but they continue to spread it to the environment through urination.    

The clinical signs of disease can be vague and mimic many other disease processes.  Signs can include fever, lethargy, loss of appetite, muscle stiffness or soreness, or vomiting and diarrhea to name a few. If the liver is involved, a yellowish discoloration of the gums or whites of the eyes can also be observed. Because Leptospirosis can look like any other disease, confirming the infection is generally not an “ah ha!” diagnosis when your pet walks into the exam room. This is something I tend to diagnosis by a “second round of tests” when the initial blood work and urinalysis look suspicious for disease. What can raise a suspicion of a Leptospira infection is an elevation in both kidney and liver values and sometimes the white blood cell count. If this is observed, your veterinarian will then recommend a special blood and urine test be sent to an outside laboratory. These results can take several days, and so antibiotic treatment is often started prophylactically pending the confirming results.

Most infections are subclinical, which means no signs of disease will ever develop and your pet will never experience illness. However, if your pet does develop sudden signs of disease, and those signs appear severe, we generally give a guarded prognosis (50/50 chance of survival). If your pet becomes ill, the extent of care needed depends on the severity of disease, but in my personal experience, the treatment generally requires a hospital stay with extensive supportive therapy. Without treatment, Leptospirosis can lead to kidney failure, liver failure, and even death. Blood or plasma transfusions are sometimes needed if the body losses its ability to clot due to liver compromise. Yes: this can be one bad bug.  

So, how can you keep you and your pets safe? In addition to good sanitation practices and limiting your pets access to areas with standing water, there is a vaccine available. Vaccines contain what are known as “serovars,” which are “components” of the bacteria used to stimulate protection from disease. However, there is a catch. There are at least nine serovars, or strains, that can cause disease, yet the vaccine contains only a fraction of these, offering incomplete protection. Often people think their dog is safe from disease because it has been vaccinated, but sadly, this is not the case.  Additionally, immunity may only last 6-8 months, and some veterinarians recommended that you should vaccinate high-risk dogs (such as dogs who hunt, show dogs, dogs with access to lakes and ponds, and endemic areas) every 4-6 months. Vaccines do not come without risk, and the use of this vaccine with regards to risk vs. benefit is definitely a conversation to have with your veterinarian. Your veterinarian can assess your dog's risk of exposure, discuss the most common “local” serovars found in your specific area and can recommend a vaccine protocol that makes sense for your pet.