Wellness: Health Care
Company explores pain-relief potential for pets
Last year, a company called Medical Marijuana Delivery Systems, LLC (MMDS) acquired the rights to a patent for a transcutaneous (through the skin) delivery of medical marijuana to humans and animals. Since our pets suffer from many of the same debilitating illnesses that we do, and with many states legalizing the use of medical marijuana, it doesn’t seem like such a stretch to apply this concept of care to our pets. This “pot patch for pups” has been given the trade name Tetracan, and the goal is for public availability by the end of 2012.
At first blush, the thought of canine cannabis sounded a bit over the top to me. However, current research shows this new marijuana patch is a very reliable delivery system. The maker of this product ensures that only the pain relieving effects are transmitted to the patient and that it will not make your pet “high.” (See my earlier blog post about dogs brought into the ER after eating marijuana.)
This transcutaneous patch is being developed to help patients manage pain, nausea and anxiety but without the psychotropic effect of marijuana. Seattle-based MMDS is also working on topical applications for animals in place of the patch; it would be similar to applying the monthly flea and tick treatment with which many pet parents are familiar.
Of course, to buy the patches or ointment, you’d need to be a medical marijuana patient yourself since dogs can’t get authorization from a veterinarian. That is, at least, not yet. The company is pressing for changes in state laws to permit veterinarians to prescribe medical cannabis for pets.
What does the American Veterinary Medical Association think of Tetracan? At this time, the association has not released a position statement on the use of medical marijuana on animals, but it has done extensive studies on the use of fentanyl patches for pain relief. Dispensing fentanyl, a highly controlled substance and potent synthetic narcotic, is well within normal veterinary practice standards.
Fentanyl is 100 times more potent than morphine and needs to be used cautiously in geriatric, very ill or debilitated pets, especially those with underlying respiratory issues. This leads the medical devil’s advocate to ask, “Why not try to integrate a more natural, plant-based approach?” Harnessing the pain relieving effects of marijuana may prove to be a safer alternative for these pets.
While the patch does conjure up visions of pups frolicking in fields of poppies and wanting extra helpings of kibble, I have to say that I can see several potential benefits if it is carefully researched and brought to market. It will be interesting to see how the medical and legal aspects of its use develop. It may prove to be a potential alternative to chronic pain in our pets, especially when some chemical pharmaceutical painkillers can be harmful, sometimes even fatal, in weakened pets.
► What do you think about medical marijuana for pets? If it were deemed safe for dogs, and was recommended by your veterinarian, would you consider using a marijuana patch on your dog?
Dog's Life: Lifestyle
Experimental drug could help dogs and humans with spiral cord injuries
I love when medical research benefits both canines and humans. This latest study aims to help dogs and people retain their ability to walk with a new medication.
The U.S. Department of Defense is funding research to explore an experimental drug that will help dogs and humans with spinal cord injuries. The collaboration between the University of California, San Francisco (UCSF) and Texas A&M has already proved that the drug mitigates spinal cord damage in mice. The next step will be to see how the medication works in dogs. The study will specifically be looking at short-legged, long-torso breeds like Dachshunds, Beagles and Corgis. It's not uncommon for these breeds to spontaneously rupture a disc, damaging the spinal cord.
Most spinal cord injuries lead to chemical reactions that damage nearby cells and pathways, contributing to decreased hind limb function. The experimental drug may help stop this process and help dogs preserve the use of their legs.
Canine spinal cord injuries are similar to human spinal cord injuries, so scientists are hopeful that the research can help both dogs and people. A win-win for everyone!
Wellness: Health Care
Update on toxic treats from China
[Update, 3/9/12: The FDA has released new product safety information about chicken jerky treats from China. Update, 3/14: The FDA has just released the TOP 3 brands cited in chicken jerky poisoning cases: Waggin’ Train (Nestle Purina); Canyon Creek Ranch (Nestle Purina); Milo’s Kitchen Home-style Dog Treats (Del Monte)]
China has been in the news repeatedly for problems related to the production of chicken jerky treats thought to be responsible for illness and death in our canine companions.
The connection between China and toxic pet food and treats first surfaced in 2006, when melamine-contaminated food additives imported from China triggered a nationwide recall of dog food items from a variety of manufacturers. The illness and deaths of thousands of dogs and cats were linked to the melamine.
In 2010, problems returned with 50 reports of a Fanconi-like syndrome (more on that in a second), thought to be linked to the ingestion of chicken jerky treats from China, with this number increasing to more than 70 reports in 2011.
In November 2011, the Food and Drug Administration (FDA) finally issued an official warning to pet owners that chicken jerky food products imported from China may cause a Fanconi-like syndrome in dogs who routinely consume them or in cases where treats make up a large part of a dog’s diet.
Just last week, the FDA announced it is now analyzing products upon import for both melamine and diethylene glycol (another suspected toxin) because of an increase in pet owner complaints. Ready for the numbers? There have been 467 reports concerning toxicity placed with the FDA since it issued the official public warning in November 2011!
Just what is “Fanconi-like” syndrome?
This uncommon condition affects kidneys, causing them to leak glucose (sugar) and other electrolytes into the urine. Dogs who have this condition will usually be very thirsty and urinate excessive amounts. The most common finding in laboratory tests is that the dog has glucose in the urine, but has a normal blood glucose level. Symptoms of this illness include drinking a lot of water, urinating a lot or more frequently, decreased energy, diminished appetite, diarrhea and vomiting.
The spectrum of illness and recovery is broad. Some dogs go into renal failure and die while others will have only an increase in thirst and urination and go on to recover fully within a few weeks of stopping the chicken jerky treats.
Until more is known, these are the specific recommendations made by the FDA:
My recommendations are a little more straightforward:
What should I do if I suspect my pet has been affected?
Have your veterinarian examine your dog and perform blood and urine tests. These tests will help determine if the Fanconi-like syndrome is present, or if your pet has other possible medical issues such as Cushing’s disease, diabetes or kidney disease.
You should report cases of illness associated with pet foods to the FDA Consumer Complaint Coordinator in your state, or you can go to the following website for further instruction on how to report a pet food complaint: http://www.fda.gov/petfoodcomplaints.
Frustratingly, there has yet to be a specific causal link or contaminant identified. To date, scientists have not been able to determine a definitive cause for the reported illnesses (hence, no recall yet), but they do continue to perform extensive chemical and microbial testing on products.
Politician and pug parent U.S. Senator Sherrod Brown of Ohio has become the latest unofficial champion for pooches all across America. The sympathetic senator took to the Senate floor the first week in February and urged swift action on the part of the FDA to step up their investigation.
Lets hope others follow in his footsteps, and in the meantime, let’s keep spreading the word about keeping imported treats out our pet pantries.
Wellness: Health Care
Common cents caution for pets
Humans aren’t the only species with money troubles. Did you know that pennies can be hazardous to your dog’s health? One-cent coins used to be made from 100 percent copper, which is nontoxic. In 1982, the government began minting pennies that were made mainly from zinc (much cheaper) and coated them with a thin layer of copper, keeping the look of a penny. When swallowed, the copper coating of the newer penny dissolves in the stomach acids, leaving a wafer of toxic zinc.
A few years back I saw a dog who had been vomiting for two days and his blood work revealed both anemia (low red blood-cell count) and elevated kidney values. There are many causes for this type of presentation, including infectious disease, immune-mediated disease, inflammatory disease and toxins, just to name a few.
His owner had no idea if he’d eaten anything out of the ordinary. X-rays revealed a round metallic object in the stomach. You guessed it, a penny. The penny was removed non-surgically with an endoscope, and the dog recovered during the course of the week with intensive supportive care—a very expensive penny.
The clinical signs and potential problems caused by zinc toxicity include:
If an object possibly made of zinc is seen on a radiograph, it should be removed promptly. Supportive care then becomes crucial and includes fluid therapy to keep circulation to the kidneys adequate, helping to prevent failure. A blood transfusion may be necessary to combat anemia. Anti-nausea medications are indicated, as well as stomach protectants (antacids and “coating” medications), due to the corrosive nature of zinc. Researchers are still actively looking at methods for binding excess zinc in the circulation, similar to the way lead poisoning is treated, but this is not yet available.
Other sources of zinc include hardware, such as nuts and bolts, dietary supplements, and (surprisingly) zinc oxide–based skin creams, such as diaper rash ointment and sunscreen.
Prevention of zinc toxicity:
Many people are unaware of this syndrome and do not realize that pennies are far more dangerous than a “simple” foreign body. This is a recently described disease process and many questions are still unanswered. As always, prevention is best: ”Penny wise, pound foolish” has a whole new meaning.
Wellness: Health Care
Understanding hemorrhagic gastroenteritis
One of the more common problems I see on an emergency basis is a disease process called hemorrhagic gastroenteritis, also known as HGE. I recently treated Sam, the little Beagle in the photo, for a severe case of this disease.
The history I hear from owners is always the same: “My dog started having diarrhea and then, all of a sudden, it became very watery and bloody.” This can be horrifying to first-time observers and usually prompts a trip to the ER.
Hemorrhagic gastroenteritis is a potentially life-threatening intestinal condition, which manifests as a sudden onset of bloody, watery diarrhea, with vomiting often being part of the syndrome. Sloughing of the lining of the intestines occurs from severe inflammation leading to “chunks” of tissue in the otherwise watery stool. We describe this as “raspberry jam” diarrhea. This process is extremely dehydrating—much more than you would think from the amount of diarrhea observed—and dogs can go from “near normal” to “near death“ in a frighteningly short time. If HGE is not promptly treated, the massive loss of fluid can cause life-threatening shock.
Smaller dogs seem to have a predisposition towards HGE, and it should be noted that the smaller the dog, the more dangerous the condition. Small dogs just don’t have the same bodily reserve as a larger dog; it simply doesn’t take much for them to become severely dehydrated.
Thankfully, there are no long-lasting bodily effects of HGE, however, some dogs that have sensitive GI tracts to begin with can have the syndrome recur in the future.
What causes HGE?
Stress, sudden dietary changes and hyperactivity seem to be predisposing factors, but the actual cause remains unknown. A bacterium called Clostridium is also thought to play a role. In short, the condition is truly another medical mystery, and I can relate to an owner’s confusion and frustration when they ask, “Yeah, but what actually caused it?” I cannot point to an exact cause in more than 80 percent of HGE cases I treat.
How is this condition diagnosed?
There are no specific tests for HGE but a test called a packed cell volume (PCV) is helpful in narrowing down the diagnosis. Using a few drops of blood, the test measures the percentage of blood volume made up by the red blood cells. A normal packed cell volume for a healthy dog is between 37 and 55 percent, meaning that 37 to 55 percent of the blood volume should be red blood cells (the rest of the volume is fluid and white blood cells).
When the patient becomes very dehydrated, there is less fluid in the bloodstream and the percentage of blood fluid drops, and consequently the percentage of red blood cells increases. A dog with HGE will generally have a PCV greater than 60 percent.
The measurement of the PCV also includes a measurement of total protein (sometimes called total solids). In HGE, the total protein measurement from the blood sample is low or normal.
A very high PCV, low total protein and acute onset bloody, watery diarrhea can point to a diagnosis of HGE.
From a medical standpoint, one of the things that makes diarrhea difficult is that no matter what the underlying cause, the clinical picture looks exactly the same. Because of this, we may still recommend that additional tests, such as radiographs, a fecal exam (that includes a parvovirus test) and blood work, be performed to make sure there is not a more serious problem causing the clinical signs.
HGE really becomes a diagnosis of exclusion: When blood work, radiographs and fecal exams are normal, we highly suspect HGE as the cause.
What is the treatment for HGE?
The heart of therapy is very aggressive fluid replacement with intravenous fluids. The goal is to get the packed cell volume back to the normal range and keep (or get) the patient out of shock. Food is withheld for at least 12 to 24 hours and then gradually introduced after the vomiting has resolved. Symptomatic treatment for nausea and belly discomfort is typically included, as is antibiotic therapy. One to three days of hospitalization is commonly required for treatment.
With early and aggressive treatment, life-threatening complications are generally avoided and dogs return happily home. In the case of Sam, he unfortunately required four days of intensive care, including nutritional support through a feeding tube as pictured, but I am happy to report that he made a full recovery and went back home to Mom and Dad!
Wellness: Health Care
Causes and responses to a choking pet
Having “something stuck in the throat” is a common problem for our pets due to their curious natures and indiscriminate eating habits. Recently, I saw an adorable Bernese Mountain Dog named Clover after she had gotten a little over-exuberant with her tennis ball. She’d actually swallowed it. She presented for difficulties with both swallowing and breathing, and X-rays revealed that her distress was toy-induced.
True choking is actual interference with breathing caused by foreign material in, or compression on, the trachea (windpipe). Choking can occur due to an obstruction of the airway from a foreign object in the throat, severe swelling of the throat or constriction of the neck.
In order for a foreign object to cause choking, it must obstruct the opening to the airway—either directly (i.e., actually in the airway) or indirectly (i.e., compressing on the airway), as in the case of Clover. Clover managed to swallow the tennis ball, but the ball was large enough to cause compression on her trachea, making breathing difficult.
Severe throat swelling can also cause choking and is usually associated with an allergic reaction or response to trauma. The tissues within the throat can swell and block the opening to the airway.
Constricting neck injuries are usually associated with collars and ropes. Dogs whose collars become tangled can choke due to the constriction of the neck from the tightness of the collar. In severe cases, dogs and cats can hang from collars, leashes and ropes.
When I lived in Colorado, my immediate neighbor came home one day to find that her two dogs became “hooked” together by collar and jaw; the larger dog’s mouth slipped under the loose collar of the puppy while playing and they couldn’t get free; the struggle resulted in strangulation of the puppy. This was a devastating experience for everyone. Please take this moment to check your pets’ collars and ensure that they are the proper size.
Common signs of choking:
If you observe any of the above signs, seek veterinary care immediately.
If you live far from veterinary care or do not have immediate transportation, the following measures may buy you some time while you are arranging for medical attention:
If you notice that your pet is choking, remove any item that may be constricting the neck, such as a tight collar. If you can do it safely, examine the inside of the mouth and remove any foreign object you see, but do not attempt to remove an object unless you can see and identify it.
If you cannot easily remove the object, lift and suspend a small animal with the head pointed down. For larger animals, lift the rear legs so the head is tilted down (like a wheelbarrow). This can help dislodge an item stuck in the throat. Another method is to administer a sharp hit with the palm of your hand between the shoulder blades, which can sometimes dislodge an object.
If this does not work, a modified Heimlich maneuver can be attempted. Grasp the animal around the waist so that the rear is nearest to you, similar to a bear hug. Place a fist just behind the ribs. Compress the belly three to five times with quick pushes. Check the mouth to see if the foreign object has been dislodged.
If your pet is unconscious, perform a finger sweep. Open your pet’s mouth and do a finger sweep by placing your finger along the inside of the mouth, sliding it down toward the center of the throat over the base of the tongue, and gently “sweeping” toward the center to remove any foreign material. Warning: There is a structure deep in the throat (the Adam’s apple) that feels like a smooth bone. Do not attempt to pull it out!
Melanie Monteiro, author of The Safe Dog Handbook, demonstrates these techniques.
What else could it be?
More times than not, what people believe to be choking, is actually an attempt to vomit or cough. Many pet owners will seek veterinary care because they believe their pet has something stuck in its throat, however, it is far more likely that your pet has something mild and infectious, such as tracheobronchitis (also known as kennel cough), and he or she is coughing rather than choking.
Choking versus coughing: With choking, the pet has difficulty inhaling; with coughing, the pet can inhale almost normally.
A few tips to help prevent a trip to the ER:
Clover and her experience prompted me to write this blog. I hope it will help prevent, or save, another pet in the future. Clover made a full recovery following the endoscopic removal of the tennis ball that she swallowed and she continues to do well!
Wellness: Health Care
Sometimes I realize I may be getting too old for this job, particularly when I get a phone call from my resident in the wee hours of the morning.
“I’ve got a dog with a broken back,” he says. “Any chance you can give me a hand?”
I could groan, but it would take too much energy. I could say, “Can’t it wait a couple of hours?” but he’s already said the magic words. A broken back is a true surgical emergency, and there’s not a minute to lose if you want your patient to have the best possible opportunity to walk again.
“Sure,” I say, “be right with you.” I hope my robotic monotone and total lack of enthusiasm don’t register with him.
I make the 40-minute commute in silence, and though the fog in my head is beginning to burn off, I feel a low-level exasperation about having to head back to work in the middle of the night. But I perk up when I see my resident and the dog in question.
“Hunter is a Lab/Beagle mix. Eighteen months old. Adopted just two weeks ago. Owner went out for dinner at six, came home at 10 to find Hunter lying in the backyard unable to move¾he jumped through a screen in a second-story window.”
The resident shows me the X-rays: the orderly structure of Hunter’s bony spinal column is crunched and buckled in the middle. This image represents a finite moment in time. Who knows how much distortion and irreversible damage occurred before reaching this point?
“He can’t move his legs,” says the resident, “but he does have deep pain.” Deep pain is the last measurable sensation an animal retains before total paralysis.
“Good,” I say, “then we’re still in with a chance.”
Perhaps it’s the word “we” that gets the resident’s attention. “I was hoping I could do the surgery. That you could walk me through it.” Spinal fractures, which can be tricky, are respected and revered by surgeons in training, and he was up for the challenge.
There are lots of ways to fix these fractures, but the plan we devise for Hunter involves using a combination of pins and sterile cement to bridge and stabilize the break. Aim a pin in the wrong direction, push it in too far, and you risk puncturing the spinal cord (never a good thing) or, worse still, puncturing your patient’s aorta (invariably fatal).
I look at him. Unlike me, the resident was totally awake, excited and hungry for the opportunity. He was me, 20 years ago.
“Sure,” I say. “We’ll do it together.”
And we did, or rather, he did. He repositioned the broken bones and then placed his pins. I guided his hands; I approved pin positions and angulations and told him precisely when to start and stop. But the repair was his, and when we reviewed the postoperative X-rays, Hunter’s spine was once more perfectly aligned.
“Nice job,” I said, and meant it.
In the following weeks, I followed up on Hunter’s recovery, chatting with his owner, Tim.
“Hunter’s doing great, especially when he does his water therapy. He still can’t walk on his own, not yet, but he’s definitely getting there.”
In Tim’s voice I could hear the emotion common to every dog owner who’s had to deal with canine spinal trauma: eternal optimism. When faced with a forecast of slow progress, intense nursing care and an uncertain outcome, a “glass-half-full” attitude is essential.
“He’s always in a good mood. If Hunter never got any better than he is today, if I had to fit him for a cart, I know he’d still enjoy a great life.”
On the night of Hunter’s surgery, my sleepy indifference had vanished the moment I saw a dog in such dramatic need. The responsibility of trying to restore something as fundamental as the ability to walk across a room was a real eye-opener. Better than a double espresso any day.
“Don’t forget,” I had said to the resident after we finished, savoring his excitement and appreciation, “we’ve only created the possibility for recovery. The rest is out of our hands.”
I didn’t want to kill the buzz; I simply wanted to remind him that surgeons can’t play God. Nothing we do with our hands and tools can get a spinal cord to heal if too much damage has been done.
The resident nodded his understanding. I smiled, invested in and thrilled with what had been achieved for Hunter.
“Thanks for your help,” said the resident. “Next time. I won’t have to call.” And that’s when it hit me: I wouldn’t want to miss this feeling for the world.
“Call me anyway,” I said as I got ready to leave. “Remember, no two spinal fractures are ever quite the same.”
Wellness: Health Care
Canine vertigo is treatable but scary to witness
I jolt awake in the middle of the night to the sound of one of my three dogs throwing up. My first thought is, glad the floors are concrete and easy to clean. The moon provides enough light for me to make my way to the kitchen, where I see Meadow, my 10-year-old Alaskan Malamute, standing with her head slightly lowered, a small pool of yellow vomit on the floor in front of her. Her front legs are splayed wide.
“Oh, Meadow girl, I’m sorry you’re sick …” I murmur as I approach. Before I can reach her, she stumbles and falls hard to the floor, then struggles to stand up. Stumbling like a drunk, she slams to the floor again. What the hell’s going on?
Meadow, who weighs more than 90 pounds, continues trying to stand. I hold onto her collar, using my other hand to steady her. When she falls, she crashes into my legs with all her weight, almost taking me with her. Not wanting to hear that heart-wrenching thud again, I use my body to prevent her from standing. She moves awkwardly, head swaying, fighting my downward pressure.
She finally stops struggling, but is clearly distressed. Her front legs are spread out in front of her, her chest is barely on the floor and all her weight is on her elbows. One of her hind legs is pinned under her hips, the other one extended out to the side. She pants fast and heavily. She can’t possibly be comfortable, but hasn’t let out any cries of pain and resists my attempts to rearrange her legs.
I turn on an overhead light, then lift her face toward mine. I’m confronted with one of the most frightening sights I’ve ever encountered: Meadow’s eyes are darting rapidly from side to side, as though every neuron in her brain is on fire. Almost crying in fear and frustration, I’m completely stymied.
I’m also alone in a house without cell phone reception. Just me and my dogs. The nearest ER vet clinic is three hours away, but I can’t get Meadow into the car without help. “Meadow, look at me.” I sense that she’s trying to focus, that she hears me, but she can’t make her eyes stop moving. “Meadow, you cannot leave me, not now, not here,” I say to her, trying to quell my own fear that she’s dying and there’s nothing I can do prevent it. I have to do something.
Telling Meadow to stay, I quickly dress and drive the quarter-mile to my closest neighbor’s house. Amazingly, despite the hour, they get their vet on the phone. After hearing the pertinent details, the vet makes an instant diagnosis: “She’s having a seizure. It might be the only one she ever has, or she might have more. She may have brain damage, or she may not.” Brain damage? Not good, although at least I can stop worrying that she’ll die tonight. But the eye thing, her inability to stand; it was going on a good 15 minutes before I left to come here, I argue mentally, thinking a seizure should be a quick thing, like the one I’d witnessed in a friend’s dog with epilepsy. “Seizures can last anywhere from a minute to a couple of hours,” the vet informs me, as if reading my mind. “Should I bring her to you tonight?” I ask. “No,” he replies, “there’s nothing to be done. Just watch her so she doesn’t fall down and hurt herself.”
When I get home, Meadow hasn’t moved, and is still exhibiting the same symptoms. I make a bed next to her on the floor and watch, and wait. As the night wears on, Meadow’s eyes finally quit darting, and eventually—around 5 am—she puts her head on the floor and sleeps on her side. I lay with her, stroking her fur, still trying to figure out what’s happening. It just doesn’t fit my idea of a seizure. Then suddenly, I remember: three years earlier, I’d had a sudden case of extreme dizziness, and my own eyes had danced uncontrollably, just like Meadow’s. I had awoken one morning to a world spinning out of control, unable to stand without falling or slamming into walls. Even rolling over in bed made the world heave and lurch. An ER doctor diagnosed vertigo, likely the result of a severe head cold that had affected my inner ear. A drug resolved my symptoms within 20 minutes, although I had to keep taking it for a week.
Can dogs get vertigo? I wonder as I lay there, stroking Meadow’s body. As it turns out, the answer is yes. In dogs, it’s called vestibular disease. Just about any creature with ears and a brain stem can suffer from vestibular disorders.
Vertigo (from the Latin vert(ere) = whirling or turning around) is a type of dizziness, a sense of motion when one is stationary, due to a dysfunction of the vestibular system in the inner ear. It is often associated with nausea and difficulty standing or walking.
“Vertigo is a human description of a feeling; dogs can’t tell us what they’re feeling, so vestibular disease is the term used,” says Beverly Sturges, DVM, associate professor of clinical neurology/neurosurgery at the UC Davis School of Veterinary Medicine.
According to Dr. Sturges, the most frequent cases are referred to as idiopathic or “old dog” vestibular disease because it’s most often seen in older dogs and there’s no obvious cause. “It’s benign; we still have no real understanding why it occurs,” she says. “It’s self-limiting, [requiring] no treatment except supportive care and comforting the dog,” she adds. The second most common cause is infection—especially Rocky Mountain spotted fever—or inflammation.
Dr. Sturges describes two broad categories of vestibular disease: outside the brain, and inside. “When outside the brain, it involves the middle or inner ear and is referred to as peripheral vestibular disease. This type is more treatable, with a better prognosis,” she says, and includes the old-dog syndrome. “Inside the brain means it involves the brain stem and is referred to as central vestibular disease. In small breeds—Maltese, Yorkies, Pugs, Poms—it’s usually caused by a non-infectious inflammation of the brain stem, often referred to as inflammatory brain disease. It occurs mostly in younger dogs [less than] two years of age. In larger breeds, central vestibular disease is usually caused by brain tumors [putting] pressure on the brain stem. Or, sometimes, trauma to the head.” Symptoms of central vestibular disease may be more subtle, with gradual onset.
That frightening eye-darting I saw in Meadow? It’s called nystagmus, a rapid, involuntary eye movement, side to side or, less frequently, up and down. “Nystagmus is not seen in all cases, but [it] is common,” says Dr. Sturges. “It lessens as the dog gets used to the sensation. Nystagmus can be profound in old-dog vestibular disease; a few days, or perhaps one to two weeks later, it’s almost always gone. It’s a reliable symptom: if there’s nystagmus, it’s vestibular disease and not usually a seizure. But you can see a drunken gait—ataxia—and other symptoms without nystagmus and it could still be vestibular disease.”
Diagnosis is based on a description of symptoms, or better yet, actual observation of symptoms. When appropriate, a vet will do a CT scan or an MRI to see if there are tumors or brain swelling. The type of nystagmus observed (horizontal versus vertical) and the direction of the dog’s head tilt (another common symptom) can help a neurologist differentiate between peripheral and central vestibular disease. Other issues involving the inner ear, or ear infection, will be ruled out if symptoms persist.
Treating central vestibular disease in dogs depends on the type and cause. “We’re pretty good now at removing tumors from the brain stem,” says Dr. Sturges. “If there’s inflammation and fluid, that can be drained surgically if necessary. We can prescribe antibiotics or an antifungal. When a vascular cause is suspected—a temporary or permanent lack of blood supply—vestibular issues usually get better on their own,” she says. “Toxins are another possibility. Metronidazole [Flagyl] and a few other medicines can cause toxicity, including vestibular disease; taking the dog off the drug and substituting another can resolve it.”
A sudden onset of acute symptoms and an absence of other physical findings usually mean peripheral vestibular disease. You and your vet may elect to wait a few days to see if improvement occurs before doing extensive diagnostics. After some online research, this was the choice I made for Meadow. Some vets will prescribe corticosteroids to reduce swelling and antibiotics just in case the cause is inside the brain. Ultimately, the final diagnosis of old-dog vestibular disease is made by the self-limiting nature of the symptoms. According to Dr. Sturges, 5 to 10 percent of dogs who experience this problem may have additional episodes.
Unfortunately, like Meadow, many dogs with vestibular disease are initially misdiagnosed as having seizures. In some instances, unable to afford expensive diagnostics or consult a neurologist, the distressed owners put the dog down, fearing he or she has suffered brain damage and won’t recover, or will suffer repeated seizures in the future. “That’s sad,” says Dr. Sturges. “There’s no reason to put them down. We don’t often see brain damage in dogs. A seriously long seizure could cause damage, but don’t jump to euthanize, even in cases of seizure,” she emphasizes.
Granted, sudden onset of vestibular disease can look like a seizure; the two are often hard to distinguish. “A neurologist could maybe tell the difference,” says Dr. Sturges. “An EEG to measure brain electricity and some other tests could help differentiate. But actually seeing the episode is the best way to diagnose. A video—everyone has cameras and video-cams these days—would be very helpful.”
For those who have never experienced vertigo, let me assure you: it’s sudden, overwhelming and incredibly frightening. You don’t know what’s happening, or why, and your brain seems disconnected from your body. Dogs must experience similar fear. And it can be dangerous, depending on when and where it occurs. Both Meadow and I were lucky; we were safely at home and our falls didn’t cause injury. Growing up in a family of aviators, I remember hearing whispered talk among pilots about vertigo, how deadly it can be during flight; it was the one thing they seemed to fear. Then, I couldn’t understand how simply being dizzy could cause a pilot to lose control of an airplane. Now I do. In fact, vertigo is thought to be the most likely reason the private airplane piloted by John F. Kennedy, Jr., and carrying his wife and sister-in-law crashed into the ocean off Martha’s Vineyard in 1999, killing all three. With vertigo, you literally don’t know up from down. Remember white-knuckle rides on that spinning playground equipment? When you tried to get off, you’d stumble and fall to the ground, head still whirling. That’s vertigo light. The real thing is more intense, longer lasting and much scarier.
Meadow and I eventually fall asleep. Around 7 am, I’m awakened by movement. I open my eyes to see Meadow sitting up. “Meadow! Good girl!” I say excitedly. This is progress; this is huge. “Do you want to go outside?” Before I finish the sentence, Meadow is leaning forward to get her hind legs underneath her. Helping her up, I usher her unsteadily toward the door. Out in the yard, she immediately pees and poops. I’ve never before been so excited about normal bodily functions. We head back into the house, where she goes straight to her normal sleeping spot beside my bed. Her gait is wobbly, but she’s moving under her own power. As she settles down, we both heave a huge sigh of relief.
Within a few days, Meadow’s gait is back to normal. She doesn’t have the lingering head tilt common with vestibular disease, but displayed every other symptom. Follow-up blood work discloses that she’s hypothyroid, a possible cause of vestibular disease.
After the dust settled, I shared my experience with friends. Many had similar stories involving taking their dog to a veterinary emergency clinic. One - a vet - has seen several cases in her clinic. Sharing our stories can help prepare us in the event our dogs – especially our old dogs – suffer a sudden episode, making it less scary. Seek medical treatment when appropriate, but if a diagnosis doesn’t ring true, trust your own observations and get another opinion. You know your dog better than anyone.
An online search of “vestibular disease in dogs” and “nystagmus” brings up YouTube videos of dogs showing classic symptoms such as head tilt, drunken gait (ataxia) and nystagmus. The videos are hard to watch, but being aware of the symptoms of vestibular disease could save you a night of fear and stress, or help you notice warning signs of central vestibular disease, allowing early intervention and an increased likelihood of a good outcome for your dog.
Wellness: Health Care
Chasing their tails, eating grass and rolling in garbage—should you worry?
From humping to “targeted” sniffing, our pups have a plethora of odd habits—at least to those of us who walk on two legs instead of four. While no one knows for certain the exact “why” behind these behaviors, we do have some theories. And until dogs learn to speak human, divulging their best-kept secrets, we’ll just have to continue to make educated guesses about this weird-but-true realm of doggy deeds. The key is recognizing if a behavior signals poor health.
When puppies chase their tails, it’s like babies grabbing their toes—and this is a normal way for them to explore their bodies. But like anything in life, moderation is key, and problems can arise if this behavior becomes compulsive. So, how do you determine if your pooch has a case of Canine Compulsive Disorder? It comes down to whether you can distract them from this behavior. If your dog would rather chase her tail than go for a walk, she may have a compulsive disorder and veterinary assessment may be needed.
It can be common for dogs to drag their bottoms across the ground after doing their business, particularly if their stool is loose. But if this behavior is noted frequently throughout the day, this may be a sign of impacted anal glands, a condition that can have serious complications if left untreated.
Watching your dog get personal with his stuffed toy can make you want to look away, but it’s not abnormal. Many dogs discover that humping feels good, it can relieve stress or serve as an outlet for excessive feelings of exuberance and excitement. Both males and females are known to partake in this behavior, though males do it more often.
People often think that dogs eat grass when their stomachs are upset or they are ill. However, a good ol’ lawn actually serves as a gourmet snack to many dogs. As omnivores, they like to eat their meat and veggies, too. Eating grass in moderation is a normal part of a dog diet, and a walk in the park for my dogs always includes a stop at the grass buffet. That said, if all of a sudden you see your dog frantically binging on grass, this could be the sign of distress, and a call to your veterinarian is in order.
It is general custom for Spot to greet Rover with a sniff of the behind, but why share this custom with us? Bad manners? Well, not according to the canine code of conduct, as this is a perfectly acceptable way of collecting personal information about one another, including humans. So the next time you are surprised by a nosey nudge, just know that you are being greeted and assessed (and don’t worry, dogs generally won’t be offended if you just give them a pat on the head in turn).
[Recently, Bark columnist Julie Hecht, MS, took a light-hearted look at the phenomenon.]
Gross, right!? I’m asked about this all of the time and all I can do is give an empathetic cringe of the nose and a shrug of the shoulders. (I know the score: My dog Mickey used to raid the cat’s litter box, proudly returning with “kitty cigars.”) As stomach-turning as this is, eating excrement is a surprisingly normal behavior for dogs. In the early stages of domestication, dogs performed a hygienic function of cleaning up their own feces. Additionally, their digestive system is very efficient and they can actually get some quality nutrients out of it—although I can think of much better sources.
Rolling in garbage
When we see a decaying animal or a pile of garbage, our first inclination is to step around it … waaaaay around it. But, keeping true to our dog’s oddities, it is their greatest desire to jump right in, getting a good coating of ick with a strategic roll. The more foul the smell, the stronger the lure, and the more joy that is experienced by our now perfumed pups. One theory is that dogs like to cover their own scent with horrible odors to make it easier to surprise prey. You probably can’t curb your dog of this desire, so your best hope is to spot smelly things first and steer your pal in a different direction.
I hope this has shed some light on a few odd dog behaviors. Funny, as I sit here, I find myself looking over to my own dog, Bauer, wondering if he is looking back at me thinking, “Wow, there she goes again, sitting in front of that computer when she could be outside playing with her ball. Now, that’s just weird.”
Wellness: Health Care
What to do while you’re deciding what to do
These poignant signs of aging may pull at your heartstrings, but may not mean much about your older dog’s overall health. As time goes by, though, signs of aging may become more dramatic: nighttime wandering, disorientation, difficulty with stairs, accidents in the house.
At this point, your dog is entering a twilight time. You can see the horizon—a last illness or that last visit to the vet—but you’re not ready to give up. With a little effort, you can provide your dog with the comfort he needs during the last bit of time you share. (Providing him with love is a given.)
This past summer, we nursed our smallish, mixed-breed dog, Shucks, through his last illness, near the end of his almost-16-year span. Given his age, we were making more frequent visits to our veterinarian, Dr. Arthur Wohlfeiler. Indeed, we made it through this challenging time thanks in part to the moral support and help of our vet, and we accumulated some great tips and helpful products along the way. Dr. Nicholas Dodman’s Good Old Dog: Expert Advice for Keeping Your Aging Dog Happy, Healthy, and Comfortable also provided lots of good advice. Here are some of the things we learned.
Food and Water
If your old guy loses track of his water dish, or is physically unable to get to it, it’s up to you to keep him hydrated. Bring the water to him. You may have to hold the dish in front of him for a minute and wet his mouth so that he gets the idea. And make the water more interesting. Dr. Dodman suggests dissolving sodium-free chicken bouillon in his dish. Both the aroma and the flavor will encourage him to drink. Adding a half-cup or so of water to his food (both dry and canned) will help hydrate him as well; he won’t mind the soupiness.
As with people, dogs’ dietary needs and preferences usually change as they age. Try adjusting his feeding schedule; reluctant eaters can often be tempted by small portions throughout the day. Continue to feed him his regular food as long as he likes it. Switching from dry food to canned, however, may help a dog whose teeth are worn or damaged, and its stronger smell may be more enticing to him.
While your dog’s sight and hearing may decline, his sense of smell doesn’t. If he can smell his dinner, he’s more likely to gobble it. Warm the food slightly in the microwave, and add bouillon or some other flavorful treat to pique his interest. Don’t automatically switch to a “senior dog” diet. This use of this term is unregulated, and, depending on an individual dog’s specific health issues, some of these formulations can compromise his health. (Be sure to talk to your vet about any dietary changes you’re considering.)
You have options when it comes to encouraging your old dog to eat if his enthusiasm has waned. For example, feed him from one of your own dinner plates. For whatever reason, food from a “human” plate is sometimes more appealing than food in his humdrum bowl. Keep the dog’s plate on the table next to yours when you’re eating and as soon as you’re finished, give your dog his dinner.
Some dogs find it difficult to lower their head to their bowl; raising the bowl in an elevated feeder or even on a low little bench helps.
Provide your dog with a buffet. In a casserole-type dish, arrange an assortment of foods in small piles and let him “graze.” After he’s eaten the things that most strike his fancy, combine the leftovers in a small ball or two and handfeed it to him, if necessary.
Take care that you’re not forcing the issue; a lack of interest in food and water is, of course, a sign that your dog is near the end. Respect the message he’s sending.
Improve traction by tacking a piece of outdoor carpet to slippery stairs and using nonslip rugs inside. If you have a neglected yoga mat rolled up in your closet, it can also be used both inside and out as a traction aid; it’s easy to cut to size if you don’t need the entire length or width.
Rearrange your furniture, as much as you’re able, to facilitate your dog’s movement around your home. Keep debris off the floor, as even a stray magazine or slipper can trip up an arthritic dog. Block areas where he might get stuck.
Doggie steps and ramps are available online and in pet stores. Be aware, however, that many older dogs are reluctant to change their habits, and high steps and ramps might scare them. Never force their use.
Towels are great tools. You can use them to wrap your smaller dog up when you carry him outside, or, if your dog is a big guy with mobility issues, you can use a large towel as a sling. (You can also purchase slings at pet stores and online.)
Keep It Clean
During our dog’s last summer, we kept a plastic storage bin filled with water in our yard. The sun warmed the water, and it was always there to rinse him off if he soiled himself. That having been said, keep in mind that your old dog is susceptible to changes in temperature. If you’ve had to get him wet, dry him and warm him as quickly as you can.
Keep rags, rags and more rags handy at all times and check out your local pet store for special drying towels. Your elderly dog can’t shake off the water like he used to and these thirsty towels are a great help.
Believe it or not, there are such things as doggie diapers, and you might want to try them. Other products intended for housebreaking puppies can also help with your elderly dog. Housebreaking pads provide a comfortable bed if he’s having accidents in his sleep; washable waterproof pads are also good for this use. (Get several so you always have one or two clean; medical supply stores and children’s bedding outlets often carry them.) Odor removers will help keep your house livable.
Your dog’s last weeks, trying though they may be for you emotionally, can be a gift. They are an opportunity for you to reach a consensus on hard final decisions and to share your feelings about the approaching loss. Even more important, they give you one last chance to show the best dog in the world how much he or she means to you.
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