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.
Wellness: Health Care
“Sunny and 70” can mean “sunny and deadly”
May 25 2016
We have been experiencing idyllic temperatures in Berkeley, Calif., these past couple of weeks—mostly sunny days and mid-70s bliss. Perfect weather for a fun-filled outing with our pets, right? For the most part, the answer is “yes” but these are the kind of days where we have to be extra cautious with our pets. At the veterinary hospital where I practice, I have had three dogs die from heat stoke in the past three weeks. These were not dogs left in unattended cars or as the result of negligent owners. They were really the result of not realizing that “sunny and 70” can mean “sunny and deadly.”
Two of the deaths were Bulldogs, one who played ball for a short 20 minutes outside and the other who went on his “normal daily walk.” The other loss was a Golden Retriever; the owner let him play at the park for an hour with the neighborhood kids, who always loved to spend time with him, such heartbreaking loss for everyone involved.
Many people are unaware of how dogs process heat and how easily they can succumb to heat stroke. Dogs cannot tolerate high temperatures as well as humans because they depend upon rapid breathing (panting) to exchange their warm body air for cooler environmental air. Therefore, when the air temperature is close to body temperature, cooling by rapid breathing is no longer an efficient process, and dogs can succumb to heat stroke in a relatively short time period.
Heatstroke can occur in many conditions that include:
Clinical signs of developing heat stroke:
Heat stroke is an emergency that requires immediate recognition and prompt treatment. A dog’s normal body temperature is 101.5 degrees plus or minus 1 degree Fahrenheit, and any time the body temperature is higher than 105 degrees, a truly life-threatening emergency exists. Initially the pet appears distressed, and will pant excessively and become restless. As the hyperthermia progresses, the pet may drool large amounts of saliva from the nose and/or mouth. The pet may become unsteady on his feet. You may notice the gums turning blue/purple or bright red, which is due to inadequate oxygen.
Severe hyperthermia is a disease that affects nearly every system in the body. Simply lowering the body temperature fails to address the potentially catastrophic events that often accompany this disorder. A pet suffering from hyperthermia should be seen by a veterinarian as soon as possible for appropriate care. There are many life-threatening after affects that happen to a pet’s body following an episode of heat stroke, and early treatment will give your pet the best chance for survival.
What to do:
What NOT to do:
What if I see a pet in distress?
California law now prohibits leaving pets unattended in a vehicle, but I still see this (“grrrrrr”) all of the time. If you do happen see a pet in distress, you can call the local animal control agency, police or 911 for assistance. Any peace officer, humane officer or animal control officer is authorized to take all steps necessary for the removal of an animal from a motor vehicle. I have also made a downloadable flyer for you to print and leave on car windshields if you notice a pet inside of a vehicle. I wanted to create way to educate others instead of just getting worried, upset and frustrated. I know it is just a small gesture, but if it can save one pet’s life, then I’ve done my job with it.
I hope this blog has offered both awareness and education and please feel free to leave questions or comments!
Wellness: Health Care
Abnormalities in stool color and consistency may indicate an underlying problem.
January 21 2016
I’ll be the first to admit that I stand outside watching each and every performance of my dogs’ “poop show.” This isn’t just a weird sort of voyeurism—rather, it’s a good way to know what’s going on with a dog’s health. If you, too, like to see what’s coming off the production line, keep in mind that the number-one rule of thumb when considering canine elimination is reproducibility. Stools should generally have the same color, size and consistency each and every time.
Many things can cause variations in a dog’s stool. Some of the more common are dietary indiscretions (“garbage gut”) or a change in diet, stress (known as stress colitis), infectious disease, inflammatory conditions, or obstructive processes. Or it may be idiopathic (meaning, we just don’t know what causes it).
A couple of episodes of diarrhea generally don’t constitute an emergency. However, there are situations that do warrant an urgent evaluation. When your dog refuses food or water, vomits, or acts ill or “off,” a trip to the vet is indicated.
Your vet may ask you to bring in a stool sample for analysis. A tablespoon is generally plenty. Also, freshness counts; fecal samples less than an hour old give the best results. If you’re not able to collect one this quickly, get a morning sample, double (or triple!) bag it and keep it refrigerated until your dog’s appointment.
Testing usually starts with a screen for giardia and “O & P,” specifically looking for giardia protozoa as well as ova (eggs) and parasites. During this evaluation, the laboratory technician will also check for overgrowth of normal gastrointestinal (GI) bacteria, which we refer to as clostridial overgrowth. If your dog is acting ill, in addition to having diarrhea, other diagnostics such as blood work and radiographs may be indicated.
1. Streaks of bright red blood and/or mucus on the surface of a mostly normal, formed stool. This is generally caused by inflammation in the large intestine, where mucus is secreted to help protect the intestinal lining. While this does not necessarily indicate an emergency, it’s a good idea to keep a close eye out for further changes in your dog’s behavior and stool.
2. Soft-formed to liquid brown diarrhea, with or without streaks of blood. “Cow patty” and “soft-serve ice cream” are two frequent descriptors. As with the previous type, it is generally not life-threatening as long as there are no other signs of concern and it begins to improve within 24 to 48 hours. If your dog is acting normally otherwise— eating well, not vomiting, good attitude —a wait-and-see home approach may be tried (more on this to follow). Here again, red blood indicates inflammation and bleeding in the colon but does not necessarily mean that your pet is bleeding internally, as is often thought. This is a step up in concern from the previous condition, in the sense that the stool is now softer.
3. A large volume of bloody, watery, diarrhea. This one does require immediate evaluation by your veterinarian, especially with smaller dogs, as it can be an indicator of a common condition called hemorrhagic gastroenteritis, or HGE. (Read more about it here: thebark.com/hge) Tissue sloughing from the intestines gives it a distinctive appearance, and it’s often described as “raspberry jam” diarrhea.
4. Black, tarry stools. This generally indicates bleeding somewhere higher up in the GI tract, such as the stomach or small intestine, and also requires an urgent trip to the vet. A bleeding ulcer (oftentimes caused by steroid or NSAID use) or more generalized bleeding, such as from rat poison, heat stroke or an immune-mediated disease, can display as black, tarry stools. The appearance of the stool is due to the presence of digested blood, and can indicate that a large amount of blood is being lost. In these cases, I usually recommend blood work and an ultrasound to better assess the lining of the intestinal tract.
5. Yellow-orange or pasty, light stools. This may indicate the development of liver or biliary disease, or a too-rapid transit through the small intestine to the colon. A more thorough examination, including diagnostic tests, is in order.
6. Grey, greasy stools. A possible indicator of inadequate digestion and malabsorption of nutrients from the small intestine, this type of stool is typical of exocrine pancreatic insufficiency (EPI), also called maldigestion, a disease in which the pancreas no longer functions as it should. The pancreas is responsible for producing digestive enzymes, and without them, nutrients cannot be properly absorbed. Both German Shepherds and Rough-Coated Collies are commonly afflicted with EPI
7. Green stools. In the ER, I have seen dogs with green stool, and upon examination of the fecal contents, have discovered the cause to be undigested rat bait mixed in with normal stool. This condition also calls for an immediate trip to your veterinarian. Although relatively uncommon, rat poison can also cause both bright blood and dark, tarry stool, so—whether or not you think your dog could have had access to them—please let your veterinarian know if there is any possibility of exposure to rodenticides.
8. Worms. Most of the time, you will not actually see worms in the stool. We typically diagnose worms by looking for their eggs under the microscope; we can tell what type of parasite is present by the shape of the eggs. Occasionally, however, you may see white spaghetti-like shapes (typically, roundworms) in the stool, particularly with puppies. You may also see small flat worms on the outside of the stool or rectum, or “dried rice” in your dog’s sleeping areas. This typically indicates tapeworms, which can take over when fleas are allowed to flourish. Although seeing worms in the stool is not an emergency, an appointment with your vet is in order so you can get medication appropriate for the type of parasite present.
Wellness: Health Care
What can be done?
May 29 2013
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!
Wellness: Health Care
DEA action might hinder in-home vet practices
May 22 2013
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.
Wellness: Health Care
May 14 2013
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:
* 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.
Wellness: Health Care
April 22 2013
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.
Wellness: Health Care
April 1 2013
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:
Tips on prevention:
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!
Wellness: Health Care
Treatments to try at home
March 18 2013
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:
Wellness: Health Care
February 22 2013
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!
Wellness: Health Care
Excessive levels of steroids in the body leading to disease
February 13 2013
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.
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