Disease Articles

Dogs and cats are frequently diagnosed with a variety of diseases.Learn more about the most common diseases for dogs and cats.

Acute Moist Dermatitis

About the Diagnosis

Hot spots, or acute moist dermatitis, are rapidly developing sores under the hair coat. They are common in thick-coated or long-haired dogs, less so in cats. They most often develop in areas where the hair coat is heavy, such as the back, tail base, and side of the thigh, neck, or face. Hot spots tend to occur more frequently in hot, humid weather. The dog often will scratch or chew at the area, although it can be quite painful (the condition is also called pyotraumatic dermatitis for this reason). When the hair is parted, the skin is seen to be moist and reddened. A pus-like discharge coats the skin and the base of the hairs.

Hot spots begin with a superficial skin injury that causes some moisture to be caught under the hair coat. Bacteria grow in the fluid, causing more skin inflammation, and the affected area rapidly expands as more fluid oozes from the skin, promoting more bacterial growth.

Living with the Diagnosis

Several skin conditions may be underlying causes of acute moist dermatitis. Anything that causes skin injury or encourages the dog to scratch or chew its skin may start the disease process. Skin parasites such as fleas, ticks, or mange mites; allergies; hair mats; or foreign material caught in the coat are common inciting factors. Preventing reoccurrence of hot spots involves controlling these conditions.

Treatment

The most important step in treatment is to clip away the hair in the area and then clean the skin of all discharge with a mild antiseptic. The hair should be clipped for at least 1 inch beyond the edge of the sore. This is best done with electric animal hair clippers, since scissors often damage or cut the skin of dogs with acute moist dermatitis-avoid doing this hair clipping at home. Your veterinarian may need to sedate your pet for this step if the area is painful. After the area is clean, an astringent (drying agent) may be used on the inflamed skin. Preparations containing an antibiotic or antiseptic are applied directly to the area to stop bacterial growth; the medications also often contain an analgesic or corticosteroid to alleviate pain. Spray-on products are preferred over ointments. Most hot spots heal rapidly since the infection is only on the surface of the skin.

Some hot spots are associated with a deeper skin infection. In these cases, red, raised bumps are found scattered in the healthy skin surrounding the hot spot. Golden retrievers seem more prone to this form than other breeds. Antibiotics given by mouth for 2 weeks or more are needed to cure this type of hot spot, in addition to the treatment mentioned above.

DOs

  • Keep your pet free of skin parasites.
  • Groom long- or thick-coated pets regularly; remove foreign bodies from the coat.
  • Treat underlying skin diseases, such as allergies, if present.
  • If a hot spot develops, have it treated immediately and use medications as directed.

DON’Ts

  • Do not apply medication to the sore without first clipping and cleaning the area.
  • Do not cut the hair over a new hot spot using scissors, as this is a common cause of severe skin injury (the scissors cut the skin) in dogs.

When to Call Your Veterinarian

  • After treatment, if the area still looks red after 48 hours, or if the problem is spreading to new areas of skin.

Signs to Watch For

  • Intense scratching or chewing at an area, sometimes accompanied with whimpering.

Acral Lick Dermatitis

About the Diagnosis

Acral lick dermatitis, also known as lick granuloma, is a self-induced skin lesion. The term acral refers to the legs and feet. The dog continually licks at one area of the leg, producing hair loss, sores, and thickening of the skin. Typical appearance is a raised, red, hairless, oval patch of skin or skin lump found over the front surface of one leg. Occasionally, more than one leg may be affected. The most common locations are over or near the carpus (“wrist”) of the front foot or just below or above the hock on the rear leg. Breeds most likely to develop acral lick dermatitis include the Doberman pinscher, Great Dane, Labrador retriever, Irish setter, golden retriever, and German shepherd, but any breed of dog can be affected. Males are affected twice as often as females. The condition may appear at any age; however, most dogs are over 5 years of age when presented for treatment. Although several conditions that cause discomfort of the skin can cause persistent licking (see Diagnosis below), in many dogs with acral lick dermatitis no underlying problem can be found. In these cases, acral lick dermatitis is considered a psychogenic disease; that is, it is caused by a behavioral disorder. For example, sometimes excessive licking or chewing can result from boredom or can be used as attention-seeking behavior; sometimes anxiety is the stimulus for stereotypic behaviors like repetitive licking. Stereotypic behaviors are excessive, repetitive behaviors engaged in to relieve psychological distress such as boredom or anxiety.

Diagnosis: Several other skin conditions may appear similar to acral lick dermatitis. These include skin tumors, granulomas (masses due to chronic inflammation), and deep bacterial or fungal infections. In addition, several conditions that cause pain or itching can be involved in the development of lick granulomas, since dogs will lick areas where they feel discomfort. Depending upon the appearance of the skin lesion and your pet’s history, your veterinarian may need to run several tests to eliminate similar conditions and underlying disorders, including skin scrapings, bacterial or fungal cultures, and skin biopsies. In some cases, x-rays may be warranted to look for joint or bone disease, such as arthritis, or bone infections that can cause pain and therefore cause a dog to lick over the painful area incessantly. A history of trauma or surgery in the area might indicate possible nerve damage as a source of discomfort. A variety of conditions that cause itching can contribute to the development of acral lick dermatitis; these include allergies, skin infections, and skin parasites (fleas, mange, etc.). If no underlying disease can be found, then by exclusion, psychogenic factors are assumed to be the cause of the dog’s constant licking.

Therefore, the first step in evaluating a dog thought to have acral lick dermatitis is to rule out other contributory medical and skin conditions (above). Once acral lick dermatitis is confirmed to be the problem, a very valuable form of evaluation is consultation with a veterinary behaviorist. These are veterinarians who specialize in assessment and treatment of behavioral disorders such as acral lick dermatitis. These specialists are known as Diplomates of the American College of Veterinary Behaviorists. Your veterinarian should be able to refer you to one of these Diplomates in your area, or by telephone, to better identify and correct the psychological/behavioral trigger that is leading to the incessant licking.

Living with the Diagnosis

Acral lick dermatitis can be challenging to treat. Medications may help. Often the visible skin lesion is only the surface of the problem, and the root cause is psychological or behavioral. Therefore, the frustration of dealing with a dog that is compulsively licking needs to be met with an understanding that some sort of underlying trigger may exist and that dealing with that trigger is critical to solving the problem. Response to treatment depends upon correction of the underlying cause. Many cases require long-term management and adjustment of treatments when the lesion reappears. It is worth remembering that stressful changes in your pet’s life may precipitate reoccurrence of the problem.

Treatment

There are many approaches to treating acral lick dermatitis, and some trial and error is usually needed to find the best treatment for an individual dog. Since deep bacterial infections of the skin usually are present as well (secondary problem due to the damage of licking), antibiotic pills are usually given for several weeks. The affected skin area can be treated directly with a variety of medications, including topical treatments and injections. Bitter-tasting topical solutions are sometimes applied to discourage licking. Most treatments applied to the lesion are aimed at altering the sensation in the skin. Agents used include corticosteroids, DMSO, capsaicin, anti-inflammatory drugs, and antihistamines. Additional treatments aimed at reducing itching or painful sensations include acupuncture, laser surgery, or cryosurgery. Removal of the lesion with conventional surgery, laser surgery, or cryosurgery is also advocated by some veterinarians. Some degree of relief can also sometimes be brought about by frequently bandaging the leg and/or placing an Elizabethan collar on the dog to break the cycle of licking-itching.

Behavioral components of the condition also need to be addressed. Boredom can be alleviated by increasing playtime, introducing another animal as a playmate, reducing confinement time, or keeping the pet occupied with toys such as those with openings for treats (e.g., Kong-type toys). Several behavioral modification training techniques can be used. Stressful conditions should be eliminated, when possible. Antidepressant and antianxiety drugs may also be helpful in some dogs.

DOs

  • Be diligent and persistent with treatment. Hair regrowth and reduced compulsion to lick happen very slowly.

DON’Ts

  • Avoid blaming or acting exasperated with a dog with acral lick dermatitis. Unfortunately, compulsive licking can truly be exasperating, but yelling at or punishing dogs for doing this simply does not register with them and often can make them more compulsive. In other words, harsh words and punishment for licking behaviors tend to be totally counterproductive.
  • Don’t assume that the problem is entirely in the skin, or entirely in the dog’s mind. Oftentimes, a combination of behavioral factors and skin factors is to blame for acral lick dermatitis.

Signs to Watch For

  • Persistent licking or chewing at one area on the foot or leg.
  • Hair loss, irritated skin, and eventually a raised, shiny, reddened area on the skin.

Routine Follow-Up

  • Because determining the best treatment of acral lick dermatitis often requires trial and error, several visits may be necessary to determine the optimal combination of treatments for your dog.
  • Once the right treatment is found, the visits become much less frequent-generally just routine checkups.

Aggression

About the Diagnosis

Aggression is a natural behavior of dogs and cats. Pets that are in pain, stressed, and under duress will often show signs of aggression. However, aggression in the home and uncontrolled aggression should not be tolerated in pets. These pets are potentially dangerous to themselves and others. Furthermore, owners of aggressive pets are ethically and legally liable for their pets’ aggression.

It is important to note that aggression is generally felt to be a learned behavior in dogs and cats. These pets have been trained (usually unintentionally) to be aggressive. Because of this source of the problem, medical/drug therapy by itself is rarely if ever beneficial.

Dogs: There are several recognized classes of aggression found in dogs:

Status or dominance aggression can be a problem within the household or when interacting with new individuals. It can be interdog aggression, aggression toward new people, aggression toward strangers, and so forth. Similarly, protection of property (the house, the toy, the owner, etc.) can lead to aggression.

Fear aggression can sometimes be difficult to predict. Dogs reacting out of fear often do not provide warning behaviors. No bark occurs before the bite. Dogs can sometimes have fear aggression when woken from sleep, but be perfectly loving dogs at any other time.

Prey or food aggression is a natural instinct that may be only slightly displaced. This can cause dogs to bite cherished members of their pack (e.g., people and other dogs) over food. The prey instinct can cause dogs to injure themselves (e.g., by chasing cars) and/or cause them to attack smaller animals and children.

Cats: In cats, aggressive behaviors typically involve intercat aggression. Introduction of new or strange cats into the household, yard, or territory can elicit aggression. Protection of toys, food bowls, owner affections, and other similar desired things and experiences may elicit these types of aggressive behaviors. Biting of owners is most common as misdirected aggression. Owners can be unintentionally bitten when they try to intervene or prevent intercat aggression.

Some cats become aggressive with excessive petting. This is not well understood, and avoiding excessive petting is the only treatment.

Play aggression can be common in young cats and kittens that have been separated from other cats at a relatively young age. Cats that are playing with their owners should be taught not to bite and scratch during this play. If they are not taught how to play appropriately, they can easily develop play aggression.

Living with the Diagnosis

  • There are two critical points to living with an aggressive pet: behavior modification and safety.
  • Behavior modification can take several forms. Avoiding or eliminating situations where aggressive behavior is displayed, training alternative behaviors, and providing adequate mental stimulus and physical exercise are all forms of behavior modification.
  • Avoiding “problem” situations reduces risk to pets and owners alike.
  • Training provides structure and positive interactions. It tells pets what you want from them.
  • Good mental and physical health can help reduce aggressive behavior. Provide your pet with positive interactions (when it is not being aggressive), mental stimulus, and physical exercise.
  • If your pet is aggressive, it is your liability. If you chose to live with an aggressive pet, you are responsible if it bites you, if it bites others, and if it attacks other pets.

Treatment

The primary treatment for aggression is training. Many veterinarians do not feel comfortable doing this, but some do. There are many good behaviorists and professional trainers. While animal behaviorists are sometimes derided, there are specialty-trained veterinarians whose focus of practice is entirely animal behavior, and their input and recommendations can be lifesaving. If you have an aggressive dog or cat, you should research these services in your area. Speak to friends and find somebody you like and trust. Additionally, the American Association of Veterinary Behaviorists is a nonprofit veterinary medical association. It regroups the specialty-trained veterinarians around the world who are experts in behavioral problems of dogs and cats (see “Diplomates” at www.veterinarybehaviorists.org or www.dacvb.org).

It is important to realize that, despite your good intentions, you may have taught your pet to be aggressive. It is therefore critical to seek outside help so that you can receive an objective perspective. Don’t be defensive, since these professionals do not want to judge but rather are available to help you and your dog or cat reduce the risk of a potentially devastating injury. Due to the nature of their work, these experts are usually kind and very understanding in addition to being highly knowledgeable.

Head harnesses, gentle leaders, and so forth often provide assistance in training.

Behavior-altering medications are rarely of any benefit and should be a last ditch attempt as an alternative to euthanasia.

Cats starting to display play aggression should be ignored (stop play immediately and move away from them) with the first aggressive behavior. Give them a break, a time-out. Do not restart play behavior until later. They will learn that it is inappropriate to bite and scratch.

DOs

  • Training, with the benefit of an outside expert. This is the only real treatment that has any potential for successfully changing the unwanted behavior(s) of an aggressive pet.
  • Head harness (dogs).
  • Provide alternate exercise and activities; meet the pet’s social and psychological needs.

DON’Ts

  • Never try to “establish dominance” or treat aggression with aggression. Choke chains and adverse stimuli are no different than hitting a dog. It is still aggression and will only cause escalation of aggressive behavior.
  • Punishment of any sort is essentially always counterproductive. Instead, appropriate actions on the part of humans must be prevention and/or diversion.
  • Don’t expect others to change because of you and your pet; if you chose to live with an aggressive pet, YOU ARE RESPONSIBLE FOR THAT PET’S ACTIONS.

When to Call Your Veterinarian

  • If your veterinarian treats behavioral problems, he or she should be kept in contact to direct you with warning signs, goals to achieve, and so forth.
  • If and when your pet gets itself into trouble (bites, wounds, etc.).
  • If training is not working and medication is necessary.

Signs to Watch For

  • Recurrence of problem behaviors/aggression: Often training becomes more relaxed once you feel the pet is doing better. This is a common problem with behavioral issues. Consistency and strict training are much more beneficial than partial training. Partial and incomplete training often teaches alternative aggressive behaviors (e.g., your dog doesn’t bite any more, but now it lunges)

Routine Follow-Up

  • As dictated by your trainer or veterinarian.
  • If medications are instituted, your veterinarian will give you guidelines for follow-up based on the drugs chosen.

Auto-Immune Hemolytic Anemia

About the Diagnosis

Cause: Anemia is a condition where the blood is too “thin,” as a result of a lower than normal number of red blood cells in the bloodstream. Red blood cells are important because they supply oxygen to all parts of the body, and when severe anemia is present, all of the body’s tissues are oxygen-starved, leading to symptoms such as sluggishness, loss of appetite, and even collapse and unconsciousness.

Immune-mediated hemolytic anemia (IMHA) is a particular type of anemia in which the number of red blood cells is low because they are destroyed (hemolyzed) by the body’s own immune system. In the healthy body, the immune system attacks foreign invaders such as bacteria and viruses. However, in immune-mediated hemolytic anemia, the body misidentifies normal healthy red blood cells as foreign and destroys them faster than the body can replace them. In some pets, the onset of this disease appears to be somehow connected to or triggered by severe generalized infections, medications, cancer, and other immune-mediated problems. However, if and how these events cause immune-mediated hemolytic anemia remains unknown, and in the majority of cases of immune-mediated hemolytic anemia, an actual trigger for the whole process is never found.

This disease is diagnosed far more commonly in dogs than in cats. In dogs, it occurs more often in females. Cocker spaniels, poodles, springer spaniels, Old English sheepdogs, and Irish setters are affected more often than other breeds. Symptoms range from mild, vague symptoms to severe, life-threatening problems such as respiratory difficulty (see Signs to Watch For). Mild symptoms can quickly progress to severe, advanced disease, and a patient with these symptoms needs to be screened for anemia with a blood test performed by a veterinarian.

Diagnosis: Anemia (whether immune-mediated or not) can be suspected by a veterinarian when the oral mucous membranes (gums) are paler than normal. A definitive diagnosis of anemia comes from a standard blood test, which shows a lower than normal red blood cell count (also called hematocrit or packed cell volume). There are many causes of anemia in general, and the results of several tests as well as a complete history and thorough physical exam help to arrive at the diagnosis of immune-mediated hemolytic anemia. Be sure to share all information with your veterinarian regarding your dog’s or cat’s medical history, including the kinds of symptoms you have seen and how long they have been present, whether you have given your pet any medications in the preceding days, and so on. An autoagglutination test is performed to determine if red blood cells clump together, which is a positive indicator of this disease. The Coombs’ test reveals if certain molecules are present on the red blood cells’ surface. Other tests may be appropriate for your dog or cat. Your veterinarian will discuss medical tests with you because this type of anemia requires them for confirmation.

During treatment, one or more of these exams may be repeated to help assess the effectiveness of treatment and to determine if adjustments are necessary. Subsequent test results may also make the long-term course of the disease clearer (help to arrive at a prognosis).

Living with the Diagnosis

Immune-mediated hemolytic anemia is a disease that often begins with a critical, potentially life-threatening crisis. The anemia may be difficult to control, and hospitalization, possibly with intensive care, is necessary for several days in the most serious cases. After this period or else right away in milder cases, oral medications are started and given daily for several weeks to months. Immune-mediated hemolytic anemia is a disease that can respond very well to treatment (all symptoms are abolished) or that may produce recurrent problems despite treatment-this varies from one dog to another. There is a wide range in how well patients respond to the medication (in some cases, not well at all and the disease becomes critical; in other cases, very well and the symptoms disappear). With immune-mediated hemolytic anemia, there is always a risk of recurrence, such that patients need to be followed closely with veterinary rechecks.

  • Give medication exactly as directed by your veterinarian. Corticosteroids and other immunosuppressive drugs must be given in gradually decreasing doses when the decision is made to discontinue them. Suddenly stopping them can have severe, life-threatening consequences.
  • Follow your veterinarian’s instructions to limit your pet’s activity level if necessary.
  • This disease may recur weeks to months after your dog or cat is apparently healthy. Continue to observe closely for symptoms.

Treatment

If your dog or cat is taking medication that might be triggering this disease, it must be discontinued. This needs to be discussed with your veterinarian first. If an infection is suspected, an appropriate medication is given to lessen or eradicate the infection. Intravenous fluids are often given to control dehydration. Corticosteroids (cortisone-like drugs, such as prednisone or dexamethasone) are commonly administered to subdue the excessively active immune system that is destroying the red blood cells. Other immunosuppressive drugs may be given in addition to corticosteroids, if necessary. Whole blood or red blood cell transfusions are sometimes necessary in moderate and severe cases to replace red blood cells that have been destroyed. Oxygen may be given. Because a serious complication of this disease is the formation of blood clots, heparin may be given as a blood thinner (anticoagulant).

Other treatment options are available, depending on how advanced the immune-mediated hemolytic anemia is. Not all of these treatments may be necessary for your dog or cat. Your veterinarian will tailor the treatment regimen for your pet.

DOs

  • If your dog or cat has pale gums and is weak or if you suspect a relapse, take your pet to your veterinarian or to the local veterinary emergency clinic immediately.
  • Inform your veterinarian if your dog or cat has ever been diagnosed with a medical condition and is taking medication.
  • Give medication exactly as directed by your veterinarian, and if you are concerned about possible negative effects, discuss them with your veterinarian immediately rather than simply discontinuing the treatment.
  • Realize that immune-mediated hemolytic anemia can be very serious and even life-threatening in some cases, but dogs that respond to the first several days’ worth of treatment can do well in the long term (months to years).

DON’Ts

  • Do not postpone visiting your veterinarian if you observe any symptoms of immune-mediated hemolytic anemia (see Signs to Watch For below). Prompt diagnosis and treatment may prevent more severe complications.
  • Do not give medication that you have at home that has been prescribed for human use; some of these may interfere with treatment and cause even more severe problems.

When to Call Your Veterinarian

  • If you cannot keep a scheduled appointment.
  • If you are unable to give medication as directed.
  • If you notice any of the Signs to Watch For listed below.

Signs to Watch For

  • General signs of illness, which could indicate a beginning (or relapse) of immune-mediated hemolytic anemia. These include vomiting, diarrhea, decreased appetite, changes in behavior such as hiding more than usual, weakness, lethargy, pale gums, exercise intolerance, labored breathing, yellow-tinted gums and/or skin (jaundice) and dark red/brown urine.
  • Reduction in symptoms, especially return of appetite to normal and a normal energy level, as significant indicators of improvement.

Routine Follow-Up

  • Follow-up appointments are always necessary to monitor progress, to determine if treatment should be adjusted or discontinued, and to pursue any abnormalities on previous blood tests. The exact interval varies from dog to dog, but the first recheck typically takes place 1 to 2 weeks after immune-mediated hemolytic anemia is first identified, and then the rechecks are spread out according to how well the problem is regressing.

Anal Sac Disease

Overview

The anal sacs are glands located near the anus (rectum) that produce secretions which are normally expressed during defecation. The secretions from these glands are normally foul-smelling and straw-colored with brown flecks. The normal function of these glands is to mark territory with a unique scent. Anal sac contents may also be expressed in times of fright producing a terrible odor in the area.

Dogs are more commonly affected with anal sac disease than cats, and small breed dogs are more commonly affected with anal sac impaction than large breed dogs. Older female dogs are more commonly affected with anal sac tumors.

Diagnosis and Treatment Notes:

Anal sac disease is generally diagnosed by a thorough history and rectal examination. Bloodwork, abdominal x-rays and abdominal ultrasound may be recommended if an anal gland tumor is suspected.

Treatment depends on the severity of the disease, your individual pet, and your veterinarian. Pets with anal sac disease may be treated with anal gland expression, antibiotics, or in chronic cases or tumors, surgical removal of the glands. Discuss treatment details when your pet is diagnosed with this condition.

What to Watch for*:

Scooting
Frequent licking of anal area or tail base
Reluctance to sit or sitting asymmetrically to avoid pressure on the painful anal sac
Straining to defecate, difficulty defecating, production of ribbon-like stools
Painful swelling at the 4 o’clock or 8 o’clock locations around the anus

*Please notify us if you notice any of the above signs or if you have any questions!

Aortic Stenosis

About the Diagnosis

Cause: The heart is an organ made of muscle cells. When the heart contracts, it pumps oxygenated blood to the body and at the same time it sends “used” unoxygenated blood to the lungs to pick up oxygen. Within the heart are four chambers and four valves to accomplish this task. The four one-way valves ensure that blood always flows in the correct direction.

Subaortic stenosis is a narrowing (stenosis) of the area underneath one of these valves, the aortic valve, that causes some degree of obstruction or blockage of the blood flow through the heart. The narrowing can be mild, moderate, or severe; if moderate or severe, it can force the heart to work harder and potentially be harmful to the heart’s health.

Subaortic stenosis is a problem that affects dogs but not cats. It most commonly occurs in large-breed dogs. Subaortic stenosis appears to be genetic in origin; the first signs of it may be present at birth (moderate or severe cases) or may appear in the first year of life (usually milder cases). The most common clue that subaortic stenosis exists is a heart murmur heard by a veterinarian with a stethoscope; there are many other possible causes of heart murmurs, however, such that tests are necessary to pinpoint the cause of the murmur (see below). In moderate (sometimes) and severe (almost always) cases, symptoms such as weakness, breathing difficulty (dyspnea), fainting (syncope), and, in extreme cases, sudden death are all possible as a result of subaortic stenosis.

Diagnosis: Your veterinarian will perform a thorough physical examination (including listening carefully with a stethoscope for a heart murmur or irregular heartbeat) and take a complete history, including asking you about whether you have seen any of the symptoms described above, whether your dog’s siblings or parents have been diagnosed with a heart murmur or with subaortic stenosis, whether your dog is receiving medication, and so on.

Chest x-rays are useful if symptoms such as labored breathing are present because dogs can develop labored breathing for many reasons, not just subaortic stenosis. Chest x-rays can show the telltale signs, such as fluid accumulation in the lung tissue in severe cases, and help to rule out other problems with similar symptoms.

An electrocardiogram (ECG) depicts the pattern of electrical activity in the heart and any irregularities in the heart’s rhythm (arrhythmias).

An echocardiogram, commonly called cardiac ultrasound, is the test of choice for subaortic stenosis. To perform this exam, a small area of the dog’s chest is shaved and an ultrasound probe is gently moved along the skin. An image of the inside of the heart is displayed on a monitor in real time. This test allows the veterinarian to assess the valves (including any narrowing), blood flow patterns and velocity, degree of stenosis (i.e., extent of blockage), and other aspects of cardiac structure and function. Probably the most important functions of the echocardiogram are to confirm or deny that subaortic stenosis is present and, if it is there, to assess its degree of severity. The degree of severity is assessed using several components of the ultrasound exam, especially Doppler ultrasound, which measures the direction and flow of blood as it courses through the heart.

Living with the Diagnosis

Mild subaortic stenosis is of no consequence to an individual dog, and generally the only intervention is to recommend not breeding. Moderate or severe subaortic stenosis may cause symptoms and may increase the risk of sudden death. Depending on the exact degree of severity, treatment may be required, and other measures (such as limiting activity) may be recommended to minimize the amount of work done by the heart.

There is no cure for subaortic stenosis. Since it is thought to be of genetic origin in some breeds such as golden retrievers, boxers, rottweilers, and some others, it is often recommended that dogs with subaortic stenosis not be bred to avoid passing the disease along to future generations.  If treatment is necessary, give medication to your dog exactly as directed. Medication may control some symptoms and improve quality of life. As the disease progresses, medication may need to be increased or changed. Understand the possible side effects of all medication being given so that you know what is normal and abnormal.

Subaortic stenosis disrupts blood flow in such a way that infection of the heart valves (endocarditis) is more likely to occur than in dogs who do not have subaortic stenosis. Therefore, to decrease the possibility of causing or worsening endocarditis, antibiotics usually are prescribed before any surgical procedures, including prophylactic teeth cleanings, and whenever the risk of blood-borne infection exists (e.g., any wounds).  Follow your veterinarian’s instructions to limit activity and stressful situations. These can make symptoms worse or even be life-threatening in dogs, especially those with very severe subaortic stenosis.

Treatment

If the disease is mild, treatment is not required. However, subaortic stenosis can get worse as a growing dog reaches its adult age and body size. Therefore, dogs with moderate or severe subaortic stenosis, whether they have that degree of subaortic stenosis when first detected or whether they “grow into” a more severe form of subaortic stenosis, may require medication. The most common form of treatment is a type of medication given orally (pills) called β-blockers, which reduce the intensity of the heart’s work, help to prevent the heart from beating too fast and can control arrhythmias.

Several surgical procedures and minimally invasive (balloon catheterization) procedures have been performed to reduce the obstruction of subaortic stenosis. None reliably enhances long-term survival, however, so treatment, when it is necessary, remains focused on medications.

DOs

  • If your dog has difficulty breathing or collapses, go to your veterinarian or the local veterinary emergency clinic immediately, even if the collapse is brief and your dog is back on his or her feet shortly.
  • Inform your veterinarian if your dog has ever been diagnosed with a medical condition and is taking medication.
  • Give medication exactly as directed by your veterinarian, and if you are concerned about possible negative effects, discuss them with your veterinarian immediately rather than simply discontinuing the treatment.
  • Understand that subaortic stenosis is a spectrum that ranges from mild (most common- requires no treatment, does not affect quality of life, and does not shorten life span) to severe (potentially life-threatening).
  • Realize that dogs with subaortic stenosis, even severe subaortic stenosis, may look perfectly healthy and active. These dogs generally do not realize that their hearts are compromised in any way-the heart is sick, but the mind is not. If your dog has been found to have moderate or severe subaortic stenosis, it is important to reduce the workload on the heart (and therefore to decrease the risk of sudden, serious symptoms like collapse, fainting, or even sudden death) by controlling or avoiding bursts of sudden activity or any intense exertion.
  • Discuss with your veterinarian what an acceptable balance is between activity restriction (to minimize cardiac risk) and activity for enjoyment (quality of life).

DON’Ts

  • Do not postpone visiting your veterinarian if you observe any symptoms of subaortic stenosis. Prompt diagnosis and treatment can improve your dog’s quality of life.
  • Do not breed a dog that has subaortic stenosis.
  • Do not give medication that you have at home that has been prescribed for human use; some of these may interfere with treatment and cause even more severe problems.

When to Call Your Veterinarian

  • If you cannot keep a scheduled appointment or if you are unable to give medication as directed.

Signs to Watch For

  • Symptoms of subaortic stenosis include weakness, exercise intolerance, difficulty breathing, and fainting.

Routine Follow-Up

  • Subaortic stenosis can be a serious disease that may significantly shorten your dog’s life. Follow-up appointments are important to monitor progress, to determine if treatment should be adjusted, and to keep your pet as comfortable as possible.

Asthma, Feline

About the Diagnosis

Feline asthma (also known as feline allergic bronchitis) is a respiratory disease that can affect cats of any age. Cats with this disease have episodes of labored breathing (dyspnea) that can include coughing and wheezing. Some cats exhibit open-mouth breathing (pant like a dog), which is abnormal in all cats except under situations of anxiety such as traveling. Cats with asthma have trouble breathing because the tiny airways (bronchioles) in the lungs become obstructed or narrowed. This constriction decreases the amount of air that is allowed to enter and leave the lungs. Over time, these airways can suffer permanent damage and remain constricted. This can be a serious, life-threatening disease for some cats.

Feline asthma can be aggravated by environmental pollutants (allergens) such as cigarette or cigar smoke, dust from cat litter, carpet or other types of household cleaners, and seasonal airborne allergies. Stressful events can also trigger these episodes in some cats.

The veterinarian may perform tests to look for other causes of these severe respiratory problems. For example, cats can get heartworms, especially in warmer climates. The outward symptoms (clinical signs) of feline heartworm disease can mimic asthma. To test for feline heartworms, a small blood sample is taken. Other possible impostors for asthma are parasites that can live in the lungs. These can be diagnosed by performing one or more fecal (stool) examinations.

Parasites and other organisms such as bacteria and viruses can sometimes be found in the lungs by performing a tracheal wash. For this procedure, the cat is sedated and a small tube is gently inserted into the windpipe (trachea). A small amount of sterile fluid is injected and removed. The fluid is then tested for various organisms.

Living with the Diagnosis

As with asthma in many humans, the cause (trigger) for asthma in cats may or may not ever be determined. Fortunately, medication is available that can help to reduce the frequency and severity of coughing and wheezing. However, once the cat begins to take medication, the symptoms may improve greatly, but it can then be difficult to determine the cause of asthma because the medication masks the symptoms. There are many things that cat owners can do at home to try to help their cat with asthma:

  • Avoid exposing the cat to cigarette and/or cigar smoke.
  • Change furnace filters regularly.
  • Control molds, mildew, and dust.
  • Do not use perfumes, hair sprays, or air fresheners.
  • Consider using an air filtration system.
  • Use hypoallergenic household cleaning agents.
  • Use shredded paper or even sand instead of cat litter.

Treatment

Emergency Treatment: Any cat that has a severe breathing problem should be taken to a veterinarian or to the local emergency clinic immediately. Despite severe symptoms, the cat is likely sensitive to surrounding stress, and an effort should be made to have the trip be as calm as possible under the circumstances. Avoid lifting and moving the cat as much as possible. This is stressful for the cat and can aggravate the breathing problem. The veterinary staff will place the cat in a calm, quiet environment. Oxygen may be given to help the cat to breathe more comfortably. Injectable medication may be given to reduce inflammation and dilate the network of airways (bronchioles) in the lungs. If this is the first time that the cat has had this type of problem and feline asthma has never been diagnosed, the veterinarian may take x-rays of the cat’s chest and perform other tests when the cat is calm. This is because labored breathing in cats may be caused by many different diseases, including those mentioned above, as well as heart diseases, certain types of tumors, and many other types of serious and less serious disorders.

Long-Term Management: Ideally, treatment involves determining the cause (allergen) of the coughing and wheezing and removing it from the cat’s environment (see Living with the Diagnosis). If the cause cannot be determined this way, medication may be necessary to help improve the cat’s quality of life if asthmatic crises are frequent and/or severe.

For cats with frequent, severe respiratory distress, meticulously trying to identify and eliminate the triggering allergen becomes a less important immediate concern because it can take too long. While the exact cause is being investigated, the cat may still be experiencing episodes of respiratory distress. For these cats, therefore, drugs are required to prevent (ideally) or control the episodes and to keep the cat as comfortable as possible. Corticosteroids, which are cortisone-like drugs, can help by decreasing inflammation in the airways but should be given on as limited a basis as possible because of their secondary effects (weight gain/obesity, opportunistic infections, etc.). Medication can also be given to further open the small airways in the lungs (bronchodilators). Some cats may need to take both types of medicine. Some cats tolerate these drugs when they are given through an inhaler once or twice daily, the same way humans inhale medication through asthma pumps. A small tube or mask containing medicine is gently held against the cat’s nose. As the cat inhales, the drug is inhaled. If certain infectious organisms are suspected (mycoplasma, bacteria), antibiotics may need to be given, although this occurs very uncommonly. For cats with seasonal allergies, drugs may only need to be given during a certain period of the year.

Your veterinarian will discuss various treatments with you after test results are known. It may be necessary to adjust the medicine (types of medicine and frequency of administration) several times to find the right schedule for your cat.

DOs

  • Give medicine exactly as directed.
  • Attempt to determine the cause of the asthma in the cat’s environment.
  • Take your cat to your veterinarian or to the emergency clinic if breathing problems develop.

DON’Ts

  • Do not force any cat to take drugs if it is too stressful.
  • Do not stop giving a drug if you suspect that you know the cause of your cat’s asthma until you have talked with your veterinarian. It can be dangerous to suddenly stop giving some drugs (withdrawal effect).

When to Call Your Veterinarian

  • If you cannot give a drug as scheduled.
  • If you cannot keep a scheduled appointment.
  • If your cat may be having an adverse reaction to a drug; signs include hives (bumps under the skin), weakness, drooling, vomiting, diarrhea, anxiety, seizures, etc.

Signs to Watch For

  • Open-mouth breathing, coughing, wheezing, and fainting.

Atopy

Overview

Atopy is an itchy skin disease of animals that is caused by an allergy to substances in the environment that are contacted through the air, either by absorption through the respiratory tract or contact through the skin. Atopy is thought to be an inherited disease and is the second most common allergic skin condition in dogs; only flea allergy dermatitis is more common.

Symptoms of atopy usually begin relatively early in life, often by one year of age. Symptoms usually are seasonal at first, with most dogs showing clinical signs in the summer months when airborne allergens (such as plant pollens) are present in higher concentrations. As atopic dogs age, their symptoms tend to become less seasonal as they become allergic to more substances. Eventually, their itchiness can occur year-round.

Diagnosis and Treatment Notes:

Atopy is generally diagnosed by a thorough history, physical examination, skin scrapings and possibly allergy testing (blood tests or intradermal testing).

Treatment depends on the severity of the disease, your individual pet, and your veterinarian. Discuss treatment details when your pet is diagnosed with this condition.

What to Watch for*:

Licking or chewing at skin, especially paws
Scratching or rubbing muzzle and/or ears
Frequent head shaking
Red, inflamed skin

*Please notify us if you notice any of the above signs or if you have any questions!

Bite Wounds

Overview

Bite wounds are often the result when two animals engage in a fight or aggressive play. Dog bites can result in significant trauma, like crushing, tearing, puncturing and lacerations of the skin and underlying tissues. Cat bites are typically puncture wounds with possible tearing or laceration. This is due to the small, sharp teeth of cats as compared to dogs.

Bite wounds, which may only appear as a small puncture wound in the skin, can actually be quite extensive. Once the tooth penetrates the skin, severe damage can occur to the underlying tissues without major skin damage.

Since the mouth is an environment filled with bacteria, all bite wounds are considered contaminated and the possibility of infection is high.

Diagnosis and Treatment Notes:

Bite wounds are typically diagnosed through physical exam and a history of a fight or rough play. Wounds are most commonly found on the neck, face and legs.

Treatment depends on the part of the body injured, severity of the wounds, your individual pet, and your veterinarian. Bite wounds are usually painful and pain medication is often given. The risk of infection is high so antibiotics will be administered after the wounds are thoroughly cleaned and the surrounding hair and debris removed. Some wounds will require surgery and possibly placement of a drain. Discuss treatment details when your pet is diagnosed with this condition.

What to Watch for*:

Bleeding
Swelling
Drainage
Limping
Breathing difficulty
Weakness
Collapse
Lack of appetite

*Please notify us if you notice any of the above signs or if you have any questions!

Brachycephalic Airway Syndrome

About the Diagnosis

Brachycephalic means short-headed (short-nosed), and many breed of dogs have been bred for this type of appearance. Boston terriers, Pekingese, pugs, bulldogs, and shih tzus are all examples of breeds with a “pushed-in,” or brachycephalic, face. The bones and associated structures of the head are shaped in such a way as to give these dogs the typical appearance of their breed. However, this shape also causes mild to severe breathing problems because the upper airway is too small-especially the nasal passages, glottis (throat), and trachea (windpipe).

The term brachycephalic upper airway syndrome describes the anatomic abnormalities and the problems associated with having an excessively short nose and face. This applies to short-nosed dogs more often than short-nosed cats like Persians. There are four different ways in which the upper airway of brachycephalic dogs can be misshapen and cause problems. Any or all of them may be present in a particular dog.

  • Stenotic nares: Narrow, small nostrils make it difficult for the dogs to draw in air through the nose.
  • Elongated soft palate: These dogs have excess tissue of the soft palate that can obstruct the flow of air through the pharynx and larynx (upper throat).
  • Everted laryngeal saccules: These small sacs in the throat are normally inverted and cannot be seen. With excessive negative pressure (which occurs when these dogs inhale), they can be sucked inside out and further obstruct the airway
  • Hypoplastic trachea: The tracheal rings may be smaller than normal, resulting in a trachea that is narrower in diameter than it should be.

The symptoms of this syndrome vary based on how severe the anatomic irregularities are. The abnormal structures are present from birth, but clinical problems often do not arise until the dog is over 2 years of age because the tissues attain their adult size around this time. Some dogs only develop mild symptoms and do not require intervention. The typical “snorting” of a bulldog or Boston terrier is a mild example, and many dogs are not otherwise affected. However, at the other extreme, other dogs develop such a degree of airway obstruction that they have trouble breathing, especially on inhaling.

The condition is progressive over time. Elevated resistance of airflow over a long period of time can cause increased obstruction and weakening of the larynx, leading to possible laryngeal collapse. Such severely affected dogs may become cyanotic (bluish tongue and gums caused by oxygen deprivation) and experience exercise intolerance and syncope (fainting). These very serious symptoms are exacerbated by obesity, hot weather, and excitement, and dogs with brachycephalic upper airway syndrome should avoid these conditions, especially if respiratory difficulty is noted to worsen. If an episode of dyspnea (difficulty breathing) is severe enough, the dog could die from brachycephalic upper airway syndrome.

Confirming that brachycephalic upper airway syndrome exists in a certain dog is based on your description of the symptoms you have observed, any medications or treatments and whether they made any difference, and so on. Your veterinarian will be interested in details such as when the breathing difficulties occur, how severe they are, and if they are worsening (more severe, more frequent, or both) over time. There are many respiratory disorders that produce symptoms similar to brachycephalic upper airway syndrome but that are completely different disorders. Therefore, your veterinarian will want to identify whether any of the four components of the syndrome is present in order to choose the best treatment. The physical examination can confirm stenotic nostrils, but the other three components of the syndrome require testing. Under sedation, an inspection of the larynx using a laryngoscope (speculum with a light) can detect an elongated palate and everted laryngeal saccules. Radiographs (x-rays) of the chest may be taken to rule out other airway of lung diseases and to visualize the trachea.

Living with the Diagnosis

It is important to realize that this condition is chronic and progressive. If you are living with a brachycephalic dog, you should discuss possible problems with your veterinarian and follow instructions. Many mild cases can be managed at home by avoiding stress, avoiding overheating, and preventing obesity (see below). In more advanced cases, surgery may be recommended to trim excess soft tissue from the nostrils, palate, or larynx. Overall, prevention and precaution are the keys to taking care of dogs with mild or moderate brachycephalic upper airway syndrome.

Brachycephalic upper airway syndrome does not necessarily affect life expectancy. However, an episode of respiratory distress can quickly worsen into an emergency situation. You must monitor your pet closely to avoid these situations and to intervene early if complications (such as replacement of the pink color of the gums and tongue by a blue color-cyanosis) occur. A dog having difficulty breathing can easily panic and increase his or her respiratory efforts, which in turn can create swelling in the structures of the upper airway and cause a self-perpetuating decline in respiratory function. In such cases, it is important to keep the animal cool and calm while heading directly to a veterinary facility.

Treatment

Home management consists mostly of avoiding situations that can lead to respiratory problems. Obesity increases the work of breathing, so it is important to make sure that dogs with brachycephalic upper airway syndrome are not overweight. Overheating and prolonged panting can be dangerous to these dogs. Keep your dog cool on hot humid days and never leave him or her in a car, outside on a hot day, or in an enclosed kennel.

Stress also poses a major risk. In dogs with brachycephalic upper airway syndrome, it is important to discourage excited behavior such as persistent barking at visitors or pulling on a leash. Use a harness instead of a collar to avoid pressure and swelling to the neck.

If your dog has this condition and it worsens to the point of requiring hospitalization in an emergency situation, treatment may include the following: tranquilization to calm the dog down, anti-inflammatories given by injection to decrease swelling in the nose and throat, and supplemental oxygen. The veterinarian may need to perform a temporary tracheostomy (surgical opening into the throat) if the condition has reached a life-threatening state. As for humans, such a procedure involves a plastic tube that is surgically placed into the trachea for a few hours or a day or two to bypass a swollen or collapsed larynx so that the dog can breathe.

If your dog has brachycephalic upper airway syndrome, your veterinarian will be able to help you decide if surgery is appropriate to increase the size of the airway and reduce the risk of future breathing difficulty. Referral to a special surgery facility may be necessary since the surgery is often delicate, and complications if the surgery is improperly done can be difficult to manage. Surgery most often involves resection (trimming) of stenotic nares to widen the nostrils, resection of the soft palate, and/or resection of everted laryngeal saccules. An important consideration is that surgery may be most effective if performed on young dogs before there is a problem. Once the soft tissues structures of the larynx are chronically inflamed, surgery may be less helpful.

DOs

  • Follow your veterinarian’s instructions regarding weight loss and stress/excitement avoidance.
  • Train your dog to exhibit calm behavior in stressful situations, such as when the doorbell rings or meeting other dogs.
  • Monitor your dog closely for worsening of symptoms, in terms of intensity of symptoms, frequency of symptoms, or both.

DON’Ts

  • Avoid neck collars and do not allow your dog to pull while on a leash. Use a harness or Gentle Leader-type face collar instead.
  • Do not allow your dog to become overheated.
  • Avoid strenuous exercise.

When to Call Your Veterinarian

  • If your dog seems very anxious for no apparent reason, or is having trouble breathing, or if he/she collapses or faints, call your veterinarian immediately. In dogs with brachycephalic upper airway syndrome, any of these symptoms is often an emergency and may be life-threatening.

Signs to Watch For

  • Increasingly noisy breathing (stridor).
  • Respiratory distress (more than just panting-fighting to breathe).
  • Difficulty swallowing.
  • Excessive snoring or restless sleeping habits (dog cannot sleep deeply).
  • Exercise intolerance.
  • Cyanosis (gums and tongue turning blue) or syncope (fainting).

Routine Follow-Up

  • Follow instructions regarding postoperative care if your pet has surgery.

Additional Information

  • Other conditions can appear with similar symptoms:
    • Heart failure, lung disease, or bronchial problems can all cause signs of breathing difficulties.
    • Masses in the upper airway (nose, larynx, or trachea) can obstruct respiration.
    • Laryngeal paralysis and tracheal collapse are other disorders that cause difficulty breathing.
  • For this reason, routine tests including chest radiographs (x-rays) are often essential to help narrow the possible causes of the breathing problems.
  • Laryngeal collapse is an end-stage condition that can follow years of living with brachycephalic upper airway syndrome. The cartilages of the larynx become weak and are no longer able to hold the airway open, causing severe obstruction of the airway. This advanced stage may benefit from surgery in some cases.

Bronchitis

About the Diagnosis

In dogs, as in people, the lungs are the organ that allows oxygen to enter the body and that expel the waste gas, carbon dioxide, from the body through the breath. In terms of structure, the lungs are made up of tissue (parenchyma) arranged into clusters of tiny, gas-exchanging chambers called alveoli. These alveoli-each one smaller than a pinhead-have a single channel for air inflow and outflow. These channels merge together to form the airways, or bronchi, and in turn, the bronchi merge together to form the trachea or windpipe. The result is that when air is inhaled the airflow enters into a single tube in the back of the mouth and nose (the trachea) and travels down the tube, splits to go into the bronchi, and then branches again many times so that the air travels through increasing numbers of smaller and smaller tubes until reaching the several million alveoli that make up the lungs. This is the normal process of each breath.

Bronchitis is the name given to irritation or inflammation of the branching tubes and airways-the bronchi. Irritation and inflammation cause swelling, and swelling of the bronchi narrows their width, restricting the amount and ease of airflow. It is a similar problem as asthma, except that in asthma, the bronchi become narrowed as a result of an allergic reaction, whereas in bronchitis, the bronchi become narrowed because either an infection or irritant particles like dust or smoke have landed on the bronchial surface and triggered both irritation and mucus (phlegm) production. Chronic sterile bronchitis and chronic obstructive pulmonary disease are the two names given to the same, common, age-related respiratory disease of older dogs in which the bronchi are irritated by noninfectious causes (in other words, by pollens, dusts, air pollution, and so on), triggering a nagging and recurrent cough.

Initially with bronchitis, symptoms are subtle or nonexistent because of the ability of the lungs to compensate for slightly decreased airflow. As the bronchitis worsens, coughing, wheezing, and increased respiratory effort develop, with the exact nature of symptoms depending on the severity and progression of the irritant process in the airways. If the bronchitis becomes severe enough, serious deficiencies in oxygen delivery can occur that can lead to weakness, respiratory distress, and collapse.

In severe cases, bacterial pneumonia is a secondary problem that can occur with bronchitis.

Chronic bronchitis can produce symptoms that mimic other respiratory diseases. Therefore, to pinpoint whether chronic sterile bronchitis is the cause of symptoms, your veterinarian will ask you questions about the symptoms you have observed, such as coughing, and how long they have been occurring, whether the severity has stayed the same, worsened, or waxed-and-waned, and so on. Your veterinarian will also examine your dog closely, including listening to the chest with a stethoscope, to try to identify clues that would make chronic bronchitis more likely or less likely. All dogs suspected of having chronic sterile bronchitis need chest x-rays and often other tests as well, such as a routine blood screen. Finally, if there is a suspicion that an infection may be present in the airways, your veterinarian will likely recommend a transtracheal wash or a bronchoalveolar lavage, which are procedures that retrieve a sample of respiratory secretions for analysis while your dog is sedated or under general anesthesia.

Living with the Diagnosis

Chronic sterile bronchitis, as the same indicates, is a longstanding (chronic) disorder not caused by infections. Therefore, the main symptom, cough, can be a nuisance to the affected dog and to family members, but the condition is rarely life-threatening. Therefore, the cornerstones of dealing with chronic bronchitis are:

  • Identifying it accurately, since many respiratory diseases can cause coughing and not all are treated with the same medications.
  • Identifying other complicating or concurrent factors. Since chronic bronchitis occurs mainly in older adult dogs, another chronic respiratory ailment of old dogs may be present at the same time. These include collapsing trachea, bronchial compression from atrial enlargement due to heart valve problems, interstitial fibrosing lung disease, and congestive heart failure. The tests described above also help to identify these other conditions and influence the overall treatment plan.
  • Pinpointing any triggers or contributing factors and eliminating them as much as possible. Triggers include airborne dusts, pollens, smoke, and volatile perfumes and fragrances (including carpet fresheners and other inhalants concentrated in low-lying areas).
  • Administering the prescribed medications and understanding that the goal is for improvement and comfort, not cure.

The longstanding nature of chronic bronchitis and the worsening that occurs with age mean that complete elimination of cough is rarely possible. By the time chronic sterile bronchitis causes symptoms (coughing), often there is some degree of permanent tissue damage to the airways. The lungs have a great ability to compensate for damage, destruction, and temporary dysfunction. Therefore, treatment is based around maximizing the function of the remaining tissue and trying to prevent further degeneration of the airways.

Treatment

Short-term care revolves around supportive care (hospitalization, oxygen supplementation if necessary, bronchodilators, anti-inflammatories, etc.). Such intensive measures are RARELY necessary, since chronic bronchitis usually produces a nagging, longstanding cough and not respiratory difficulty or distress.

Long-term care and management involves the steps mentioned above. Specific medications that are used for treating chronic bronchitis include: bronchodilators, to decrease the coughing reflex and reduce the speed of airflow during coughing; cough suppressants, to break the cycle of coughing and airway irritation and bring comfort to a chronically coughing dog; possibly antihistamines, if an allergic component is thought to be part of the trigger for coughing; and weight loss, if there is any sign of obesity because excess weight worsens lung function and reduces airway diameter. As a last-ditch effort, it may be necessary to give pills or syrups that contain corticosteroids (cortisone-like drugs). These are excellent anti-inflammatories but they also cause significant weight gain and can decrease immune function, potentially creating problems in the long term.

Inhalation therapy (“puffers”) that administers bronchodilators or corticosteroids has been an important part of management of bronchitis and asthma in human medicine. In the recent past there have been good inventions (specialized inhaler masks) to help appropriately supply these medications to dogs and cats, and this form of treatment is revolutionizing treatment for chronic respiratory disease in dogs and cats. Most animals are surprisingly tolerant to this form of treatment, and it is easy to perform. If your dog is diagnosed as having chronic sterile bronchitis and requires treatment, you should ask your veterinarian about inhalation therapy, or he/she may refer you to a respiratory specialist (a Diplomate of the American College of Veterinary Internal Medicine, specialty of Small Animal Internal Medicine).

DOs

  • Expect extended needs. Healing can be slow, and symptoms, especially coughing, often wax and wane over the rest of a dog’s lifetime.
  • Keep an eye open for unusually labored breathing at rest. This is NOT part of chronic bronchitis, so if you find that your dog is short of breath while at rest (not just panting, but having difficulty breathing), you should contact your veterinarian without delay.
  • Be sure that your dog feels well enough to continue to eat and drink. If not, a compounding problem, such as secondary infection, or different disease altogether may be present.
  • Continue to give medications even if your pet looks much better. Often, the improvement is dependent on the medication, and symptoms can return very quickly if medications are stopped.
  • Buy and use a harness instead of a collar. This will place less pressure on the neck and trachea, meaning less of a trigger for coughing.
  • Some dogs feel better when they inhale cold steam, which moistens the inside of the lungs and bronchi. You can provide this up to once or twice per day by running a warm shower and having your dog walk around the bathroom during that time.

DON’Ts

  • Avoid overexertion, which can set off a fit of coughing.
  • Avoid obesity, which is damaging in multiple ways (smaller lung capacity, narrower airways, greater demand for airflow, etc). You should candidly ask your veterinarian if he/she thinks your dog needs to lose weight. In overweight patients with chronic bronchitis, weight loss helps reduce coughing without the possible negative effects of any medications, while bringing health benefits to the joints and many other parts of the body.

When to Call Your Veterinarian

  • If symptoms are worsening. “On-and-off” coughing is to be expected, but worsening is not and may require more aggressive treatment.
  • If you notice unexplained shortness of breath or labored breathing, especially if the tongue, gums, or skin take on a bluish tinge that they did not have before. This could be a sign of insufficient oxygenation, which is an emergency.
  • Your veterinarian should also give you some specific warning signs based on medications prescribed, underlying disease, and other specifics to your pet. If not, you should ask about these points.

Signs to Watch For

  • Difficulty breathing, shortness of breath, and/or gasping for breath are considered true emergencies. If an animal with chronic sterile bronchitis is ever breathing or gasping with great distress, like “a fish out of water,” he/she needs to be seen by a veterinarian immediately.
  • Weakness, tiredness, poor appetite, and even withdrawal from normal activities are signs that could indicate a complication (like pneumonia), an unrelated but significant problem, or an adverse reaction to medication. In any case, any of these symptoms warrants a call to your veterinarian.

Routine Follow-Up

  • This is dependant on severity of signs and severity, according to test results. Typically, patients are rechecked after a few weeks, unless their initial state was so severe that they needed to stay overnight in the hospital. In these more severe cases, the first recheck will usually be in the first 7 to 10 days after discharge.
  • Routine follow-up afterward is usually every few months to monitor progress, to ensure that complications are not beginning, and to be sure medications are working properly without causing negative effects.

Cardiomyopathy, Boxer

About the Diagnosis

Boxer cardiomyopathy is a heart disease that affects the heart muscle tissue of some dogs of the boxer breed. Although boxers can begin to show outward symptoms (clinical signs) of this disease at any age, it is usually diagnosed in adult dogs.

The heart tissue is made up mainly of muscle cells. In the normal, healthy heart, the heartbeat is triggered by a normal, organized wave of electricity that travels through these muscle cells to cause the heart to contract. When the heart contracts, the blood within it is pumped to the rest of the body, providing oxygen and various nutrients. In the heart affected by boxer cardiomyopathy, the electrical pathway is occasionally abnormal, and therefore, the heartbeat is irregular (abnormal rhythm or arrhythmia). Boxers with this disease may have episodes of weakness that may or may not be triggered by excitement or exercise. Some boxers faint (syncope) when the heart begins to beat irregularly because it may beat so irregularly and so fast that the pumping action of the heart is compromised and not enough circulation reaches the brain to maintain consciousness. Between these episodes, the dog may appear healthy and comfortable. Much less commonly and as a more serious form of boxer cardiomyopathy, the heart muscle tissue may hamper the circulation such that fluid accumulates in the dog’s lungs and causes breathing problems, or in the abdomen/belly.

The problem is recognized in the breed internationally, but not all boxers have cardiomyopathy. Some boxers have an abnormal heart rhythm but no symptoms; these may be carriers of the disease who go on to develop symptoms later in life. The diagnosis is serious, because any boxer with this disease has an increased risk of sudden cardiac death.

Diagnosis: Boxer cardiomyopathy may be suspected by your veterinarian based on the dog’s history and symptoms, if any. A cardiac arrhythmia may or may not be present at the time of examination, and it is an electrocardiogram (ECG, EKG) that is the definitive test. For this test, small metal clips are gently attached to the dog’s skin in several places as the dog rests quietly. These clips are attached to a machine that can convert the heart’s electrical impulses to a graphic representation on paper; this is the same type of ECG/EKG as in human medicine. The abnormal heart rhythm that is characteristic of boxer cardiomyopathy is sporadic, however. Therefore an electrocardiogram performed in the clinic may or may not reveal the abnormality. If there is uncertainty, portable heart monitors (Holter monitor, cardiac event monitor) may be used for assessing the heartbeat over 24 hours or intermittently over several days, respectively. Finally, since many, many other disorders unrelated to boxer cardiomyopathy can cause irregularities in the heart rhythm, an accurate diagnosis usually requires further assessment (e.g., x-rays of the chest and abdomen, ultrasound of the abdomen and heart, blood tests), which can be tailored based on the veterinarian’s initial findings.

Cause: The cause of boxer cardiomyopathy is unknown. The disease has been diagnosed more commonly in particular blood lines; therefore it may be genetically acquired by some dogs.

Living with the Diagnosis

A diagnosis of boxer cardiomyopathy carries a guarded prognosis because a sudden deterioration or even a fatal event is possible. Depending on the results of the diagnostic tests (see above), different drugs can be given. However, because the exact cause of this disease is not known, these drugs only treat symptoms and are not a cure. Despite taking drugs, the disease may continue to develop in some dogs, and the goal of treatment is to reduce the symptomatic episodes and to try to reduce the risk of life-threatening heartbeat irregularities. It may be necessary to give several drugs until one is found that helps your dog.

Boxers diagnosed with this disease should not be bred in order to avoid perpetuating the problem in offspring. If your boxer is involved in a breeding program, your veterinarian may recommend regular (perhaps annual) testing with a Holter monitor.

If possible, dogs diagnosed with boxer cardiomyopathy should avoid stressful situations or events that cause excitement. This can be a difficult task for owners, but common-sense attention to minimizing environmental triggers of excitement (without severely compromising quality of life) may reduce the risk of severe or even life-threatening complications.

Treatment

Drugs are available to help control an abnormal cardiac rhythm. Your veterinarian will prescribe drugs based on the results of the x-rays, ultrasound exam, and/or electrocardiogram. These drugs help some dogs but not others, and unfortunately some dogs continue to develop problems related to this diagnosis even after taking drugs. In such cases, other types of antiarrhythmic drugs may be used, or further testing may be recommended to ensure that another disease process is not to blame.

A few boxers with this disease have benefited from a nutritional supplement, L-carnitine, when it is given several times per day, but only with the dilated form of boxer cardiomyopathy (rare; requires cardiac ultrasound for diagnosis).

Each dog diagnosed with this disease requires a tailored treatment regimen that may need to be changed periodically, depending on the dog’s response. Your veterinarian will determine the best plan for your pet.

DOs

• If your boxer has periods of weakness and/or fainting take him or her to your veterinarian or the animal emergency clinic immediately. Keep the dog as calm and comfortable as possible during the car ride.

• Give drugs exactly as directed.

• Talk to your veterinarian about having your boxer tested regularly for this disease, especially if involved in a breeding program.
DON’Ts

• Do not breed a boxer that is diagnosed with this disease.

• Do not assume that your boxer does not have this disease if no symptoms are evident.

• Do not stop giving a drug without talking to your veterinarian. Some drugs must be gradually decreased or serious side effects can result.

When to Call Your Veterinarian

• If your dog shows negative reactions to the drugs including weakness, anxiety or nervousness, vomiting, diarrhea, hives (bumps under the skin), constipation, seizures, etc.

• If you cannot return for a scheduled visit.

Cardiomyopathy, Feline

About the Diagnosis

“Cardiomyopathy” is a term used for describing disease of the heart muscle tissue. There are many types of cardiomyopathy, and “restrictive,” “unclassified,” and “intermediate” cardiomyopathy all refer to the same type: a disorder in which the heart muscle tissue has become stiffened so that the walls of the heart are less elastic than normal. The cause of this stiffening process is unknown. Cats are affected almost exclusively; dogs are not known to have this heart disease. The effect of this type of cardiomyopathy can be serious: The circulation can be hampered so severely that fluid seeps into the lungs, making breathing difficult, or else it may lead to distortions in the shape of the heart that allow blood clots to form and potentially cause strokes. These very serious developments only occur in some animals affected with this type of cardiomyopathy, and many have no symptoms at all.
Inactivity, poor appetite and weight loss, hiding or other fearful behavior, limping or sudden inability to use the hind limbs, and rapid, difficult breathing are symptoms that may be seen with restrictive cardiomyopathy. Rarely, an affected cat will have fainting spells due to irregular heartbeats.

When these symptoms are present, a complete physical exam by the veterinarian will include listening to the chest with a stethoscope, which may reveal an irregular heartbeat or, rarely, a heart murmur. These findings can help a veterinarian to suspect restrictive cardiomyopathy, but many other types of heart problems also produce these same symptoms. Therefore, restrictive cardiomyopathy requires testing (mainly cardiac ultrasound or echocardiography) for confirmation.

X-rays of the chest are important for determining the overall size and proportion of the heart and the appearance of the surrounding organs, especially the lungs. Together with cardiac ultrasound (echocardiography), it is possible to confirm or exclude restrictive cardiomyopathy. Echocardiography identifies the characteristic features of restrictive cardiomyopathy, which are enlargement of both atria, while both ventricles remain of normal size.

Echocardiography can also identify complicating factors, such as blood clots within the heart chambers, and provide an evaluation of the extent of the disease.

Living with the Diagnosis

Restrictive cardiomyopathy is a serious diagnosis because there is no treatment known to reverse it. However, medications can help to alleviate or eliminate symptoms in many cats, which brings about a good quality of life. Short-term outlook depends upon the cat’s response to therapy. The long-term outlook is a guarded one; many cats, even if they respond to the initial in-hospital treatment, develop symptoms again weeks or months later despite receiving medication. Overall, the lifespan of cats with restrictive cardiomyopathy is usually compromised by the disease, and many cats die or are euthanized within the first year or two of diagnosis; rarely, a cat may live longer than 2 to 3 years with this disease.

Treatment

A major concern, as mentioned above, is that cats with restrictive cardiomyopathy tend to accumulate fluid in the chest, both within the lungs (pulmonary edema) and within the chest cavity surrounding and partially collapsing the lungs (pleural effusion). Therefore, treatment with a diuretic (a medication that causes extra fluid to be eliminated through the urine) is vital for controlling this fluid buildup. This type of medication is in pill or oral syrup form and must be given daily or twice a day, depending on the specific medication and the extent of the heart problem. Cats that have large amounts of pleural fluid occasionally may need to have it drawn off with a needle (thoracocentesis, “chest tap”) to allow them to breathe more easily. An angiotensin-converting enzyme inhibitor (ACE inhibitor) is a type of medication also prescribed to help dilate the blood vessels and to reduce the workload of the heart. Finally, cats with a likelihood of developing blood clots, or especially those that have already developed a blood clot to the legs (“saddle thrombus”), will need some form of anticoagulant or blood thinner. Many types are available, from aspirin to very powerful anticoagulants, so you should discuss the advantages and drawbacks of each with your veterinarian before settling on one.

It is important to remember that severely affected cats may need to be hospitalized for several days until their condition is stabilized. Overall, after hospitalization is over and the cat is home, treatment generally consists of medications that bring back comfortable breathing, limit any complications, and must be given, usually on a daily basis, for the rest of the cat’s life. There is no surgery to help this type of heart problem.

DOs

• Give all medications as directed. If you have difficulty giving your cat pills contact your veterinarian. Pharmacies can formulate liquid versions of most medications that are easier to give.

• Avoid situations that increase your cat’s heart rate unnecessarily, which can be damaging to the heart. Enticing them to play until they are exhausted and allowing them to interact very vigorously with other cats are examples of situations that you can control and reduce.

DON’Ts

• If your cat has restrictive cardiomyopathy, don’t ignore mild limping or stiffness that has just recently appeared-these may be the first symptoms of a blood clot in the leg(s), and you should contact your veterinarian if you see these symptoms.

• Likewise, if your cat has restrictive cardiomyopathy, do not assume that respiratory congestion, “belly breathing,” or any other change in respirations is due to a “cold” or other harmless condition. If your cat has restrictive cardiomyopathy, these are often the first symptoms of respiratory compromise due to fluid accumulation in or around the lungs, and an exam by your veterinarian and possibly a chest x-ray are warranted.

When to Call Your Veterinarian

• If your cat is having difficulty breathing or is not eating.

• If your cat cannot get up on its hind legs or seems to be in pain.

Signs to Watch For

• Lack of appetite.
• Rapid or difficult breathing.
• Fainting spells.
• Weakness or paralysis of the rear legs (may be a sign of a thromboembolism-see Additional Information below).

Routine Follow-Up

• Periodic examinations will be needed to evaluate your cat’s response to treatment. The frequency of these examinations will depend upon the severity of your cat’s condition and his/her response to treatment.

Additional Information

• A common complication of heart disease in cats is the formation of emboli (blood clots) in the arteries. If a large clot forms in the main artery leading to the rear of the body, the blood supply to the rear legs can be cut off. Signs are severe weakness or paralysis of the rear legs.

Cataracts

About the Diagnosis

Cataracts are an abnormal opacification (clouding) of the lens inside the eye. The lens is a clear structure located behind the iris (the colored part of the eye), and its function is to focus light entering through the pupil into an image that is perceived by the retina in the back of the eye. With different extents of cataract formation, the entire lens may be opaque (cloudy) or just a part of it may be opaque. If more than 30% of the lens is opaque, vision is generally impaired in the affected eye as a result. This does not threaten vision overall if only one eye is affected, but often cataracts develop in both eyes simultaneously, which can compromise sight and even lead to blindness.
Cataracts are common in dogs but rare in cats. Some dog breeds are prone to hereditary cataracts. Breeds that commonly have inherited cataracts that progress to blindness include the miniature poodle, American cocker spaniel, and miniature schnauzer. Golden retrievers, Boston terriers, and Siberian huskies are also likely to have inherited cataracts. The most common cause of cataracts is heredity, where the likelihood of developing cataracts at some point in life is transmitted genetically. Other causes include diseases such as high blood sugar due to diabetes or low blood calcium levels. Cataracts can occur spontaneously (for no known reason) in older animals or can be a result of inflammation of the inside of the eye, called uveitis. Several infectious diseases can cause uveitis. Other causes include toxic substances, radiation, and nutritional deficiencies. Inherited cataracts may be present at birth, appear in a young pet, or not occur until the pet is older.
With cataracts, the normally black pupil looks cloudy or white in bright light. A similar, but less serious condition that resembles cataracts is called nuclear sclerosis. This is a normal, older-age-related haziness of the lens that is often referred to as “cataracts” in everyday terms. Nuclear sclerosis rarely compromises vision, is very common as dogs age, and progresses (worsens) much more slowly than true cataracts. Telling the difference between nuclear sclerosis and true cataracts is important because there is almost never a need to treat nuclear sclerosis, whereas cataracts require a search for a cause (the cataracts may be the first sign of a generalized disease that requires treatment) and may cause blindness. The difference between nuclear sclerosis and true cataracts is determined by a veterinarian during a routine examination of the eyes.
Cataracts can be diagnosed by physical examination; special instruments may be used to determine the exact location of the cataract within the lens, which can help determine the cause of the cataract (and therefore help to make the best treatment and long-term outlook known). If uveitis is also present, further tests will be run to determine if a deep-seated eye infection is causing the uveitis. Routine blood and urine tests may be recommended to evaluate the possibility of diseases that can cause high blood sugar or low blood calcium. If cataract surgery is an option, ultrasound evaluation of the eye, which is a painless procedure that is done awake, may be recommended to look for detached retinas or other eye defects that might be involved with, or masked by, cataracts. Before cataract surgery, a test called electroretinography will be used to evaluate the retina to be sure it is functional; otherwise, correction of the cataract would be of no benefit if some other part of the eye was nonfunctional and vision was not restored despite surgery. Cataract surgery can only restore vision if the other structures in the eye are normal.
Living with the Diagnosis
If surgery is an option for your pet, early treatment is recommended. Surgery is easier and has a higher success rate in the earlier stages. Cataracts that are not removed may eventually cause severe and painful, chronic eye conditions such as uveitis, glaucoma, or retinal detachment. Since the damage caused by these problems often cannot be reversed, cataract surgery should be considered early rather than late. The most important first step is to have confirmation that the cloudiness of the lens of the eye is indeed a cataract and not an “impostor” such as nuclear sclerosis. Veterinary ophthalmologists, whose work is entirely limited to treating animals with eye problems, may be a valuable resource prior to deciding about cataract surgery. They are known as Diplomates of the American College of Veterinary Ophthalmology and can be located in most large city centers in North America. Once cataracts are confirmed, it is important to schedule surgery before complications develop, since these may be irreversible.

Cataracts tend to grow larger more quickly in younger dogs than in older dogs.
Treatment
The process that leads to cataract formation is irreversible. Therefore, no medication exists that can clear cataracts, and the treatment of choice is removal of the cataract from within the eye with surgery. The outlook for good vision is excellent after surgical removal of inherited or diabetic cataracts. Treatment and outlook for others types of cataracts depend upon the cause. Surgery can involve removal of the cataract intact or the use of phacoemulsification, a process whereby ultrasonic waves are delivered within the eye to dissolve the cataract-containing lens, and the dissolved fragments are removed. Intraocular lenses, which are synthetic lenses that replace the lens removed with the cataract, can be implanted at the time of cataract removal for better near vision.
DOs
• Use all medications exactly as directed.
• Realize that cataracts may occur for genetic reasons or may be the first sign of a generalized disease (“tip of the iceberg” phenomenon). If you see a cloudiness to the eye that you suspect is a cataract, then a routine veterinary visit is recommended to confirm whether or not a cataract is actually present.
• Pay attention to your pet’s ability to see; blindness in dogs and cats may be difficult to detect but usually involves stumbling or bumping into objects when they are in unfamiliar territory.
DON’Ts
• Don’t overestimate or underestimate the possibility of cataracts when you notice that the normally black pupil has become grey or milky white. Since there are many different causes for cloudiness in the eye, a veterinary evaluation is necessary to know whether it is a cataract and if the condition is serious enough to warrant specific attention.
• If your pet has cataracts, don’t allow him or her to be near high places such as the tops of stairs (use a baby gate if necessary), edges of walls or cliffs, etc. Even a small amount of lost vision may be enough to cause serious injury from a fall that would not have occurred before the cataract existed.

When to Call Your Veterinarian
• If vision seems to be deteriorating, as evidenced by bumping into objects or walls or falling or stumbling in unfamiliar territory.
Signs to Watch For
• Cloudiness or white areas visible in the pupil of the eye.
• Loss of vision.
Routine Follow-Up
• As determined by the type and extent of cataract and whether or not surgery is performed.
Additional Information

• Pets with cataracts that are known or suspected to be inherited should not be bred.

Caudal Cervical Spondylomyelopathy

About the Diagnosis

Cause: In dogs and cats, the vertebral column is a series of back bones (vertebrae) that extends from the base of the skull to the tip of the tail. Dogs have seven vertebrae in the neck. These are called cervical vertebrae. Between the vertebrae are disks that act as cushions to prevent friction between the vertebrae. The vertebrae protect the spinal cord that runs through them.

Caudal cervical spondylomyelopathy (cervical vertebral instability, “wobbler syndrome”) is a disorder of the cervical vertebrae or disks. The vertebrae are unstable and move abnormally in relation to each other, or in some instances the disks are weakened and damaged. Either way, a hard structure (vertebral bone or disk) places pressure on the spinal cord. Since the spinal cord sends nerves to the legs, the spinal cord pressure caused by wobbler syndrome produces varying degrees of an uncoordinated gait: stumbling, dragging the knuckles on the ground, or tripping/leg-crossing during a walk are common symptoms. Some severely affected dogs are unable to rise to a standing position. The hind limbs are usually affected more than the front limbs. The dog may be reluctant to raise the head because it causes neck pain.

This disorder is progressive (worsens over time) and most commonly occurs in Great Danes and Doberman pinschers, but other large and giant breeds can be affected. The cause is unknown. It can be present at birth (congenital) or may affect middle-aged to older dogs. It is not known to occur in cats.

Diagnosis: Your veterinarian will take a complete history from you, including asking you about the nature of symptoms, their duration, and any medications you have given (and any observed effects). Your veterinarian will also perform physical and neurologic exams, which are simply examinations involving palpating (feeling with the fingers) different muscles and organs. The neurologic exam can help to pinpoint the location of the problem and includes watching your dog walk and assessing several reflexes (e.g., tapping below the kneecap to observe the strength of the kick).

X-rays and myelography are also important. Myelography is a technique that involves injecting a dye into the fluid canal around the spinal cord, which allows x-rays to identify compressed areas of the spinal cord that are otherwise invisible on regular x-rays. This information is required to help determine if surgery needs to be performed and if so, the exact location and extent of surgery. Dogs need to be under general anesthesia to have a myelogram. Your veterinarian will refer you to a veterinary specialist if a myelogram and surgery are to be performed. Nowadays, some institutions use computed tomographic scanning (CT or CAT scan) or magnetic resonance imaging (MRI) instead of myelography, but for dogs, general anesthesia is still required for these scans.

Living with the Diagnosis

There are several conservative measures that you can take that may make your dog more comfortable once the diagnosis is made. The goal of these measures, which are appropriate in mild cases, is to help reduce pain and help improve function of the limbs without resorting to surgery. These measures include strict cage rest (i.e., avoiding all outdoor activity except three 3-minute walks each day for urinating and defecating), wearing a neck brace, and allowing only short walks on a harness (not a collar) for several weeks. Anti-inflammatory medications are often given at this time as well. You may notice progress at the end of this period if the conservative measures have been effective; however, it is important not to allow a dog with caudal cervical spondylomyelopathy to resume full activity, or a relapse to the same state as before (or worse) can occur. Rather, some degree of restricted exercise, to be discussed with your veterinarian and tailored to your dog’s individual activity level and character, usually is necessary long term (months, sometimes lifelong) (see Treatment below).

If no improvement is apparent after this conservative type of treatment, surgery is usually recommended.

Treatment

Surgery is usually the treatment of choice because it offers the best chance of long-term success. The goal of surgery is to remove the hard tissue that is compressing the spinal cord, since this is the best way of relieving pain long-term and of minimizing neurologic deficits. The exact type of surgery is tailored for your dog’s particular needs.

After surgery, the healing period usually takes several days to a few weeks. It is common that for the first few days after surgery, the dog’s ability to stand and walk is even worse than before the surgery; this is to be expected as a result of the surgical manipulations round the spinal cord and progress should be apparent a few days (sometimes a week or so) after the surgery. Some dogs may need to wear a body cast to prevent movement in the neck while it heals. Therapy that can be performed at home to help with the recovery process includes physical rehabilitation exercises, short walks several times per day, or the use of a cart or sling for dogs unable to walk. Progress is intentionally slow. The long-term outlook (prognosis) depends on many factors including the stage of the disease in your dog before surgery and appropriate postsurgical care. Surgery does not carry a guarantee that a dog with caudal cervical spondylomyelopathy will fully recover from this disorder but in dogs with a confirmed diagnosis of caudal cervical spondylomyelopathy (based on the myelogram, CT scan, or MRI) and symptoms of pain or walking abnormalities, surgery generally offers the best chance at long-term improvement. As with any surgery or procedure, complications are possible, and you should discuss the possibility of these with your veterinarian prior to the surgery if possible. One potential future complication is the development of problems in vertebrae adjacent to those treated surgically, causing a return of symptoms and sometimes the need for another surgical procedure.

Nonsurgical or conservative treatment with strict cage rest for several weeks and anti-inflammatory medication is an option in a small number of dogs; however, it is important to understand that this disease is progressive and therefore that symptoms, once they have occurred, are likely to recur. Therefore, extremes of exertion and any other activity that increases movements of the neck and body should be minimized or avoided.

DOs

• If your dog experiences weakness or an awkward gait, contact your veterinarian. Minimize your dog’s activity until then.

• Use a harness instead of a collar on your dog if a veterinarian has found signs of neck pain and caudal cervical spondylomyelopathy/wobbler syndrome.

• Inform your veterinarian if your dog has ever been diagnosed with a medical condition and is taking medication, to reduce the risk of drug interactions or masking of other symptoms.

• Give medication exactly as directed by your veterinarian, and if you are concerned about possible negative effects, discuss them with your veterinarian immediately rather than simply discontinuing the treatment.

DON’Ts

• Do not force your dog to lift his or her head if reluctant. This movement can be very painful in individuals with caudal cervical spondylomyelopathy/wobbler syndrome and may even damage the spinal cord.

• Do not postpone visiting your veterinarian if you observe any clinical signs of wobbler syndrome. This disease is progressive (generally worsens over time) and prompt diagnosis and treatment may improve the long-term outlook.

• Do not give medication that you have at home that has been prescribed for human use; some of these may interfere with treatment and cause even more severe problems.

When to Call Your Veterinarian

• If you cannot keep a scheduled appointment.
• If you are unable to give medication as directed.
• If clinical signs return or begin to worsen.

Signs to Watch For

• General signs of illness, which include vomiting, diarrhea, decreased appetite, weight changes, and changes in behavior.

• Signs of persistent or worsening caudal cervical spondylomyelopathy, which include uncoordinated gait, dragging the paws, reluctance to extend the neck and raise the head, or difficulty/inability to stand up.

Routine Follow-Up

• After your dog goes home from surgery, routine appointments are required to assess progress. X-rays may be taken and neurologic exams are performed at regular intervals, with exact time frames depending on the extent of spinal cord damage and symptoms your dog is showing.

Cholangitis Cholangiohepatitis

About the Diagnosis

In cats, as in people, cholangiohepatitis is an inflammation of the liver and the bile ducts within the liver. Unlike in people, however, cats do not often have gallstones, nor do they get liver disease from hepatitis virus. Rather, cats develop cholangiohepatitis either as a result of bacteria traveling to the liver from the intestine or if the cat’s immune system mistakenly identifies the liver as foreign and begins to attack it.

Cholangiohepatitis is the second most common liver disorder in cats in the United States, after hepatic lipidosis. Two major forms of cholangiohepatitis are recognized: suppurative and lymphocytic. A liver biopsy and microscopic examination of the biopsied liver tissue are required in all cases to distinguish between the two forms. The distinction is an important one because treatments (medications) and prognosis (outlook) are different for each one.

Microscopically, suppurative cholangitis/cholangiohepatitis is characterized by the presence of neutrophils, a type of white blood cell. Bacteria can usually be cultured from the bile of affected cats, and the bacterial infection is believed to originate from the intestinal tract by migrating up the bile duct. Inflammatory bowel disease and pancreatitis are often coexisting diseases. Suppurative cholangitis/cholangiohepatitis occurs most frequently in middle-aged and older cats.

In lymphocytic cholangiohepatitis, a different type of white blood cell, called a lymphocyte, is most prominent on the microscopic analysis of the biopsied liver tissue. This suggests an immune-mediated mechanism, meaning that the body tries to destroy parts of the liver using the immune system. This may occur because the immune system mistakenly identifies the liver as foreign. Inflammation and fibrosis (scarring) also are found in the bile ducts, but bacterial infection is not present. Lymphocytic cholangiohepatitis is most often diagnosed in young cats, and Persian cats are at higher risk of contracting the disease.

Symptoms: A predominant sign in both forms of cholangiohepatitis is icterus (jaundice). With icterus, the gums, whites of the eyes, and even the visible skin in front of the ears take on a bright yellow color. Cats with the suppurative form in particular tend to feel quite ill, often having a fever and refusing to eat. Cats with lymphocytic cholangiohepatitis frequently do not seem ill, but have icterus and may have an enlarged belly due to increased liver size and accumulation of fluid in the abdomen. They often continue to eat, although some will show unintended weight loss over time.

Diagnosis: Symptoms and laboratory blood tests will establish a diagnosis of liver disease. X-rays and ultrasound examination of the abdomen are then used for assessing the size of the liver, the texture of the liver tissue, the appearance of the bile ducts, and so on. Determination of the exact nature of the liver disorder, which is essential for the reasons mentioned above, requires a liver biopsy. Since liver disease can cause problems with blood clotting, coagulation tests are necessary before the biopsy is taken, and treatment with medications or blood plasma to normalize blood clotting ability may be required. A liver biopsy is done with the cat under general anesthesia, either with a biopsy needle inserted through the skin under ultrasound guidance (minimally invasive) or surgically through an operation into the abdomen. Although the surgical option is a more invasive procedure, there are several advantages since the lesser invasive approach may be inadequate in some cases. Deciding which method to use will depend upon the condition of the individual pet and your veterinarian’s experience.

Living with the Diagnosis

The outlook for cats with suppurative cholangiohepatitis is reasonably good. The disease reoccurs in some cats, and an extended period of treatment with antibiotics may reduce the chances of reoccurrence. Success often depends on the ability to identify and control any underlying factors. If inflammatory bowel disease and pancreatitis are also present, for example, diagnosis and treatment of these conditions must be done simultaneously. Most cats with lymphocytic cholangiohepatitis respond well to treatment, but the condition can be life-long. Therefore, treatment may need to continue indefinitely, and depending on how well the treatment controls symptoms, periodic rechecks are usually necessary.

Treatment

Suppurative cholangiohepatitis is treated with antibiotics, which can be given by mouth if tolerated (and if there is no vomiting) or by injection in the hospital initially if necessary. Bacterial cultures should be submitted when the liver biopsy is taken to determine the best antibiotics to use. Treatment must continue for at least 4 to 6 weeks to minimize the risk of reoccurrence.

Since lymphocytic cholangiohepatitis is thought to be an immune-mediated disease, treatment involves the administration of immunosuppressive doses of cortisone-like drugs (corticosteroids), usually prednisolone. Other immunosuppressive drugs are sometimes used. Treatment should continue for 6 to 12 weeks with gradual tapering of the dose. Most cats respond well to treatment, but a few will need repeated treatments or long-term low dose treatment with prednisolone to prevent relapses. If a large amount of fluid is present in the abdomen, diuretics may be used initially to reduce the fluid accumulation. Colchicines may also be prescribed to limit fibrosis in the liver.

In both suppurative and lymphocytic forms of the disease, additional medications such as ursodiol may be given to promote bile flow. If clotting problems are present, vitamin K may be supplemented. The nutraceutical, SAMe, may be beneficial in the treatment of liver disease. Ultimately, there are often several medications to be given in cases of cholangiohepatitis, and the exact combination will need to be tailored depending on the particulars of your cat’s case.

In the most severe cases, cholangiohepatitis of either type may be severe enough to compromise a cat’s life span. Some indication of severity can be had from the biopsy result because the presence of excessive scar tissue (fibrosis) is a negative sign, for example. Likewise, the manner in which the disease responds to medications is always variable from one cat to the next. A positive response with reduction in symptoms and improvement in all liver values on blood work is an important indicator of success.

DOs

  • Give all medications exactly as directed.
  • Watch for improvement, or return, of icterus (yellow coloration) as a sensor of the severity of liver compromise.
  • Realize that cholangiohepatitis can be a severe problem. With proper treatment and persistence, most cats improve, and many return to a normal quality of life.

DON’Ts

  • Do not discontinue medications before your veterinarian advises you to do so. If you have difficulty giving medication to your cat, consult your veterinarian for other dosing options. Usually formulations can be prepared that will be tolerated by even the most finicky cat.

When to Call Your Veterinarian

  • If your cat is lethargic or not eating.
  • If you have difficulty administering medications.

Routine Follow-Up

  • Your veterinarian will periodically examine your cat and submit blood for analysis of liver values to monitor the progress of treatment.

Chronic Renal Failure

About the Diagnosis

Cause: A dog or a cat, like a person, has two kidneys, which are located in the belly (abdomen). The kidneys produce urine, which is carried away from the kidneys in thin tubes, the ureters, to the bladder and then voided out the urethra. The main function of the kidneys is to eliminate waste substances from the bloodstream that are produced as part of the body’s normal functions every day. Normally, a kidney is oval and is roughly the size of a chicken’s egg in a medium-size dog. The kidneys are essential to life. It is possible to live with just one healthy kidney, but if both kidneys stop working altogether (a situation referred to as acute renal failure), an individual will not survive unless the kidneys are made to start functioning again.

The normal, healthy kidney tissue is made of a variety of cells types that form the microscopic functional unit of the kidney, the nephron. The nephron is composed of the glomerulus, where the blood is filtered; various segments of renal (kidney) tubules, where metabolic waste is excreted or removed and materials needed by the body are absorbed; and the collecting ducts, where final alterations are made in the formation of urine. In addition to filtering the blood, the kidneys are also responsible for maintaining water, electrolyte, and acid-base balance, as well as producing and releasing hormones, which play an important role in controlling systemic blood pressure, red blood cell production, and parathyroid hormone levels.

Chronic renal failure (CRF) is the name given to the medical condition where the kidneys are not functioning adequately; “renal” simply means “related to the kidneys.” Kidney tissue damage may be temporary or permanent. However, like certain other organs (such as the brain and the heart), kidney tissue that is permanently damaged cannot be replaced by the body. Therefore, the goal of treatment of chronic renal failure is to prevent permanent damage and to allow temporarily damaged kidney tissue to recover.

CRF occurs when approximately 75% of the nephrons of both kidneys cease to function. Unfortunately, kidney disease can therefore be going on for a long period of time before this threshold is reached and symptoms of failure are noticed. CRF can occur for a variety of reasons (see below), but the final result is the same: the kidneys fail to perform their main function of filtering the body’s waste products out into urine. Abnormal filtration results in a buildup of waste products and toxins in the blood. Failure to produce kidney hormones can result in high blood pressure, a decrease in red blood cell production resulting in anemia, and secondary hyperparathyroidism (increased levels of parathyroid hormone).

CRF is a potentially serious and life-threatening disease, but it has many degrees of severity. It is characterized by kidney dysfunction that deteriorates progressively. Some animals diagnosed early respond very well to treatment and can live very comfortably for their normal life span. In other cases, the onset of symptoms can be so sudden and severe that CRF can progress to acute renal failure and be the cause of death within days to months of diagnosis.

CRF is a common problem in all breeds of cats and dogs. Animals of any age and sex can be affected; however occurrence of CRF increases with age. Breeds thought to be more susceptible include Abyssinian and Persian cats, Basenji, beagle, bull terrier, Cairn terrier, chow chow, Doberman pincher, English cocker spaniel, German shepherd, golden retriever, Lhasa apso, miniature schnauzer, Norwegian elkhound, rottweiler, Samoyed, Chinese shar-pei, shih tzu, soft-coated wheaten terrier, and standard poodle dogs. Although the cause (etiology) of CRF is often unknown, there are several different potential diseases in cats and dogs which can lead to kidney failure: hereditary and congenital disorders, immune system abnormalities, toxins, poor blood flow and lack of oxygen (ischemia), inflammatory or infectious diseases, cancer (neoplasia), and urinary tract obstructions.

Diagnosis: Symptoms of CRF can vary from patient to patient and are often common to several other diseases.

Your veterinarian will begin by asking you several questions to try to determine if chronic renal failure, or another type of problem altogether, could be responsible for symptoms. You should provide whatever information you have when you answer these questions, which often include: the type of symptoms observed, the length of time they have been occurring, effects on vital functions such as appetite and urine elimination, the possibility of exposure to potentially poisonous substances (such as car antifreeze) in the past, and any current medications or supplements you are giving your pet.

When examining your pet, your veterinarian will look for some of the changes that can occur with chronic renal failure, which include poor body condition, dehydration, bad breath, oral ulcers, loose teeth, pale gums, and kidneys that can be felt with the fingertips to be small and irregular. If CRF is suspected by your veterinarian, further testing will be recommended since none of these symptoms are exclusive to CRF.

Lab work consisting of blood and urine tests is typically recommended in order to diagnose CRF as well as rule out other possible medical problems that produce similar symptoms. A complete blood count (CBC), biochemical profile, and urinalysis are the tests of choice. Your veterinarian should be able to acquire samples for these tests in a short period of time. For the urine test, a needle is often used to remove urine directly from the bladder in order to get the most sterile or clean sample. The urine sampling procedure (cystocentesis) is quick, does not cause significant discomfort, and involves very little risk.

Imaging techniques including x-rays and/or ultrasound are also commonly performed. These tests can help to rule out many other disease processes, which could drastically affect the treatment plan and long-term outlook (prognosis).

Other tests that may be performed depending on the case can include: urine culture and sensitivity, blood pressure, blood gas analysis, urine protein/creatinine levels, serologic tests, specialized x-rays (contrast imaging), and kidney fine-needle aspirate or biopsy. These tests may aid in determining an underlying cause and or the severity of disease. In most cases, however, identification of an underlying cause is often masked by the advanced stages of renal failure.

All of these diagnostic procedures can help your veterinarian help differentiate CRF from acute (sudden) renal failure or other disorders, which may be reversible.

Living with the Diagnosis

An increase in thirst and urination are common early signs of CRF. This is a common misconception since many people assume that if a pet is producing a large amount of urine that the kidneys must be working well. In fact, the opposite is true: when the kidneys start to fail, they are unable to retain the correct amount of the body’s fluids, and large volumes of urine (polyuria) are the result. If kidney function deteriorates over time, weakness, decrease in activity, vomiting, diarrhea, a decrease in appetite, weight loss, lack of coordination when walking, dehydration, oral ulceration, and bad breath are often seen. In the terminal stages of renal failure, severe dehydration, vomiting, convulsions, and coma can lead to death.

CRF is a potentially serious and life-threatening illness. During the course of the disease, it is very important to keep all recommended follow-up appointments and lab tests with your veterinarian in order to monitor the progression of disease and make any needed medication adjustments. At home, by monitoring your pet’s weight (if possible) as well as changes in drinking, urination, and appetite, you will learn helpful information to bring to your next appointment.

Give all prescribed medications as directed by your veterinarian. These medications are essential in slowing the progression of disease as well as improving the quality of your pet’s life. Most of these medications will be required for the rest of the pet’s life.

Always provide unlimited access to fresh clean water. Ask your veterinarian for some ideas on how to encourage your pet to intake more water.

You should discuss an ideal diet for your pet with your veterinarian and feed only the recommended foods. If your pet is no longer willing to eat the special diet, contact your veterinarian prior to changing foods. An adequate level of nutrition is extremely important in the treatment of renal failure.

Treatment

The goal of treatment is to reduce the renal workload and the symptoms associated with the decreased renal function, prevent or slow any deterioration of kidney function, and improve the quality of the pet’s life.

Treatment of CRF must be based on the individual patient, the severity of the symptoms, the underlying cause, and the secondary diseases that may be involved. In every patient, however, all medications that potentially could have harmful side effects to the kidneys should be identified and discontinued, and all underlying diseases should be diagnosed and treated.

Patients with severe symptoms of CRF will likely need to be hospitalized initially while intravenous (IV) fluids are given to correct dehydration, electrolyte, and acid-base abnormalities and medications are initiated. If hospitalization is not required, your veterinarian will start your pet on medications and treatments that can be given at home.

Diets and treats that have a reduced quantity and higher quality of protein content, as well as reduced phosphorus and sodium, are ideal. These diets are formulated to decrease the kidney’s workload and also help reduce high blood pressure (hypertension), which is a common problem in animals with CRF. Several specially formulated commercial veterinary diets as well as homemade recipes are available. Appetite stimulants may also be beneficial in cats who are not eating well.

Fresh, clean water should always be available to your pet. In some instances, your veterinarian may suggest periodic injections of fluids by subcutaneous (under the skin) injection. This can be performed at the veterinary clinic, or if your pet needs the injections every day or several times weekly to help prevent dehydration, the veterinary staff may offer to show you how to give this type of treatment to your pet yourself at home.

Vomiting, stomach upset, and poor appetite can be treated with antinausea medications as well as antacids. If excessive phosphorus levels are still evident once the proper diet has been established, phosphate-binding gels containing aluminum hydroxide can be administered by mouth. Abnormal blood potassium levels should be managed with appropriate medications.

If secondary problems such as high blood pressure, anemia, or hyperparathyroidism are diagnosed, your veterinarian will choose the most appropriate treatments based on the severity of symptoms and your pet’s specific needs.

Hemodialysis and renal transplants are also being successfully performed in cats and dogs at selected referral hospitals. Your veterinarian will be able to tell you if your animal is a good candidate.

Not all of the medications or treatments described above are necessary for every animal with CRF, and some treatments may be changed if the kidneys improve or deteriorate in function.

DOs

  • Realize that chronic renal failure does not mean the kidneys have stopped working entirely. Rather, chronic renal failure is a condition in which the kidneys are not functioning enough, which can lead to symptoms related to waste product accumulation in the bloodstream, such as loss of appetite, sluggishness, and vomiting.
  • Contact your veterinarian, if your pet’s symptoms change, worsen, or any new problems arise.
  • Have your veterinarian or veterinary technician show you how to give all medications and demonstrate the correct method for subcutaneous fluid administration. Never reuse needles.
  • Give all medications exactly as directed by your veterinarian. If your animal is having side effects from any medications or you are finding it very difficult to medicate your animal, contact your veterinarian for advice before discontinuing the treatment.
  • Ask your veterinarian questions about information you do not understand.
  • If you do not trust or are not comfortable with your veterinarian, get a second opinion from another veterinarian or a veterinary internal medicine specialist.
  • Consider humane euthanasia if your pet is not responding to all possible treatments and you feel he or she is suffering or has a poor quality of life.

DON’Ts

  • Do not postpone a visit to your veterinarian if you observe any symptoms of illness or of CRF since early diagnosis and treatment can aid in preventing the progression of disease and improving the quality of your pet’s life. The initial screening only requires a physical exam and routine blood and urine tests.
  • Do not assume that drinking and urinating normal or higher-than-normal amounts indicates good kidney function. In fact, one of the earliest symptoms of chronic renal failure is an increase, not a decrease, in water consumption and urination.
  • Do not give any medications that are not prescribed by your veterinarian for the specific animal in question.
  • Do not stop any medications if your animal is feeling better without consulting with your veterinarian first.
  • Do not assume that all sources of information are accurate or complete (e.g., Internet sites, outdated pamphlets or books, pet store workers, friends). Ask your veterinarian for recommended sources of information.
  • If you are giving treatments at home, do not dispose of needles or syringes in the trash. Rather, collect them in a puncture-proof container (e.g., empty bleach jug) and bring it to your veterinarian for disposal.

When to Call Your Veterinarian

  • If you are unable to give medications as prescribed or if you require a prescription refill.
  • When you have any questions or concerns related to your pet’s continual treatment plan or current status.

Signs to Watch For

  • Watch for general sign of illness, which can include changes in appetite, weight loss, decrease in activity, depression, dull or poorly kept coat, and changes in behavior such as hiding and aggressiveness.
  • Watch for signs of CRF, which can include an increase in thirst (Are you filling up the water bowls more often? Is your animal drinking water from taps, bath tubs, fountains, etc.?) and urination (Is your animal asking to go outside more frequently or having accidents in the house? Do you notice larger urine spots in the litter box, or do you have to change the box more frequently than usual?), vomiting, diarrhea, dehydration, weakness, lack of coordination when walking, oral ulceration, bad breath, pale gums, convulsions, and coma.

Routine Follow-Up

  • As CRF is a progressive disease that can deteriorate over time, it is very important to keep all recommended follow-up appointments and lab tests with your veterinarian in order to monitor the progression of disease, document and treat any new problems that may arise, and make any needed medication adjustments.

Chylothorax

About the Diagnosis

Chylothorax is the accumulation of a fluid called chyle in the chest cavity. The lymphatic system, which is a network of lymph ducts and lymph nodes, collects waste fluid from the within tissues and returns it to the bloodstream. Chyle refers to lymph fluid collected from the intestines and carried by the thoracic (chest) lymph duct. Since the intestines absorb fat from the diet, chyle is a liquid that is high in fat content and has a milky appearance. A few cases of chylothorax are caused by trauma-the thoracic lymph duct is torn when the animal suffers a blow of some sort. Many other cases occur because of increased pressure in the thoracic duct. For example, heart disease or masses within the chest can interfere with lymph flow and result in increased pressure in the thoracic lymph duct. Chyle then leaks from the thoracic lymph duct into the chest cavity. In most cases, however, the cause of chylothorax is not known; it is suspected that an inherent weakness in the wall of the thoracic duct allows it to rupture and seep chyle into the chest cavity, even in the absence of an inciting cause like trauma. In chylothorax, chyle occupies some of the space in the chest normally filled by the lungs. This partially collapses the lungs, and the resulting loss of lung capacity causes the pet to have trouble getting enough air. Chylothorax occurs in both cats and dogs.

Symptoms: Labored, rapid breathing is the most noticeable sign. Gums that are normally pink in color may take on a grayish-blue color if there is severe oxygen deficiency. The pet often will be inactive or unwilling to move as much as usual. If the condition develops slowly, lack of appetite and weight loss may occur as the main symptoms.

Diagnosis: Your veterinarian may suspect the presence of fluid in the lungs after listening to the chest sounds with a stethoscope. A small needle and syringe can be used to draw off some of the fluid for analysis, to confirm chylothorax. If there is uncertainty about whether fluid is there, ultrasound examinations and x-rays are used for confirming the presence of fluid buildup in the chest. Underlying causes such as tumors or masses within the chest or heart disease may also be detected with these procedures.

Living with the Diagnosis

Occasionally, some pets with chylothorax will spontaneously recover after weeks or months. Fluid will need to be drawn off the chest in the meantime, whenever the pet’s breathing becomes difficult. This is done by a process known as thoracocentesis, which simply involves using a fine needle and syringe to withdraw a significant amount of the fluid. When thoracocentesis is not sufficient to keep the fluid away, surgery can help some cases, and in others underlying problems can be corrected. Sometimes scar tissue forms in the chest and permanently coats (“shrink-wraps”) the lungs. This process, known as fibrosing pleuritis, is one of the worst complications of chylothorax; it is not known why some individuals do not develop fibrosing pleuritis while others do, and there is no effective treatment if this happens. Therefore it is important to identify chylothorax in its earliest possible stages and to follow the condition closely with recheck appointments. Frequent rechecks help reduce the risk of chronic accumulation of chyle, which would be a risk factor for fibrosing pleuritis.

Treatment

The first step is to draw off enough fluid through a needle to allow the pet to breathe comfortably (thoracocentesis) and to confirm chylothorax via laboratory analysis of the fluid. If an underlying cause has been found, it should be treated, to address the chylothorax at its root cause. In most pets no cause can be identified. Surgical procedures to ligate (tie off) the thoracic duct can help some pets. Another treatment approach, if no cause can be found, is to draw off the fluid periodically as needed in the hope that the condition will correct itself.

DOs

  • Watch your pet for breathing difficulty. Counting the number of breaths per minute is one way to monitor breathing. In dogs, however, normal panting makes counting breaths frustrating. Therefore, it is also worth noting when a pet with chylothorax seems uncomfortable, short of breath, or otherwise breathing with excess effort for no apparent reason. In cats, this can manifest as “belly-breathing,” an excessive movement of the abdomen that accompanies discomfort and rapid, uncomfortable breathing in cats with respiratory distress.
  • A low-fat diet may slow the buildup of fluid; if your veterinarian prescribes a low-fat diet, be sure not to feed treats containing fat

DON’Ts

  • Don’t excite your pet or encourage him/her to exercise excessively. Pets will normally restrict their activity to match the loss of breathing capacity.

When to Call Your Veterinarian

  • If breathing becomes rapid and difficult.
  • If your pet becomes inactive or stops eating.

Signs to Watch For

  • Difficult, rapid breathing.
  • Gums that turn blue or gray in color (an indication of lack of oxygen) together with increased respirations.
  • Inability to exercise.
  • Lack of appetite or weight loss.

Routine Follow-Up

  • Frequent visits to draw off fluid will be needed if underlying problems cannot be corrected and surgery is not done. After successful treatment of chylothorax, your pet should be reexamined periodically by your veterinarian to check for reoccurrence.

Cognitive Dysfunction (Dementia)

Overview

Dementia, also known as senility or cognitive dysfunction, is a change in behavior seen in older dogs. Some feel it may be a normal aging change, however there appears to be a substantially accelerated form of dementia seen in some dogs.

The two most common complaints of owners with senile dogs are loss of housetraining and wandering during normal sleep time.

Cognitive dysfunction is seen in male and female dogs of all breeds that are at least 10 years old or older. The problem is progressive and the cause is unknown.

Dogs with cognitive dysfunction can disrupt their family’s routine with the house soiling, vocalization, wandering, and diminished family interaction.

Diagnosis and Treatment Notes:

Dementia is generally diagnosed by history and physical examination findings. There are behaviors that are typical for dogs with dementia. To rule out underlying disorders, bloodwork and x-rays may be recommended. In some cases, CT or MRI may be beneficial.

Treatment depends on the severity of the disease, your individual pet, and your veterinarian. Some dogs benefit from behavior modification exercises and some can improve on medications such as deprenyl (Anipryl). Discuss treatment details when your pet is diagnosed with this condition.

What to Watch for*:

Lameness
Decreased interaction with the family
Increased irritability
Slowness in obeying commands
Alterations in sleep-wake cycle
Decreased responsiveness to sensory input problems performing previously learned behaviors

*Please notify us if you notice any of the above signs or if you have any questions!

Collapsing Trachea

About the Diagnosis

The trachea is commonly known as the windpipe. This is the “tube” that extends from the back of an animal or person’s mouth to the chest, where it divides into two smaller tubes (bronchi) that lead to the lungs. Air travels into and out of the lungs through the trachea. The trachea consists of a long column of rings stacked on top of each other. These rings are made of a firm material called cartilage. For unknown reasons, some of these rings can lose their rigidity prematurely with age and partially collapse in some dogs. The rigid tube then becomes floppy and can flutter with breathing, which triggers fits of coughing. This can happen anywhere along the length of the trachea. The problem of a collapsing trachea most commonly occurs in middle-age to older dogs that are toy or miniature breeds (Lhasa apso, Yorkshire terrier, Chihuahua, Pomeranian, toy poodle, shih tzu, and others); however, a collapsing trachea occasionally occurs in younger dogs and other breeds. Very rarely, a dog may be born with this problem (congenital disorder).

The most common sign associated with a collapsing trachea is a nonproductive (dry) cough. The cough is often described as a “goose honk” because of it characteristic sound and can be induced by excitement, anxiety, exercise, eating and/or drinking, becoming overheated, and mild pulling on the collar (as opposed to pulling hard on a collar or leash, which can trigger a cough in virtually any dog). Some owners report that picking their dogs up under the chest area can bring on coughing caused by a collapsing trachea. The cough may be severe enough to cause the dog to faint. In the earliest stages, some dogs with a collapsing trachea do not cough at all and the problem goes unnoticed.

Collapsing trachea is usually diagnosed based on a combination of symptoms (coughing episodes brought on by the events listed above) and visualizing the narrow trachea on x-rays of the neck and/or chest. Occasionally, the veterinarian will recommend that other procedures be performed to help determine if the dog has a collapsing trachea or to determine the severity of the collapse. One of these tests is called fluoroscopy, which is a method of watching “moving x-rays” of the dog as it lies on a table. This confirms that collapsing trachea is present and shows the extent of the collapsing segments (i.e., severity). Bronchoscopy is a less commonly performed test to assess the severity of a collapsing trachea. Bronchoscopy involves gently inserting a long tube with a very small camera on its end into the trachea. As the tube is advanced into the airway, images of the walls of the airway are seen. The dog is sedated for both fluoroscopy and bronchoscopy procedures.

If the veterinarian suspects that the dog has another respiratory problem that may be exacerbating the collapsing trachea, several other tests may be performed while the dog is sedated or anesthetized. For example, the airway may be flushed with a sterile fluid to collect organisms and cells lining the inside of the trachea (bronchoalveolar lavage or BAL). Another test involves inserting a small brush into the trachea and gently rubbing it against the walls in several locations to collect organisms and cells (brush cytology). Yet another test involves inserting a small instrument into the trachea and cutting out tiny tissue samples of the walls of the airway in areas that look abnormal (biopsy). These tests may help to find organisms such as bacteria, viruses, fungi, or others that do not belong in the dog’s airways.
Living with the Diagnosis

Owners of dogs that are diagnosed with a collapsing trachea can do many things to help make their dogs more comfortable. Instead of collars, harnesses need to be used when taking the dog for a walk. Harnesses fit around the dog’s chest, avoiding pressure on the neck caused by collars. Do not walk the dog in hot, humid weather and avoid leaving it in a car in hot weather. Leaving the dog in a car can not only lead to overheating, but also can be stressful even in cooler weather. Even after changing from a collar to a harness, avoid overexercising your dog. For overweight dogs, switching them to a weight-reducing diet can help tremendously. If stressful situations are anticipated (for example, if the house will be full of children for a birthday party), talk to your veterinarian about giving medication to the dog before the event.

Treatment

For most dogs diagnosed with collapsing trachea, drugs can be very helpful. Your veterinarian can prescribe a specific type of drug for your dog. There are several types of drugs that work in different ways. Sedatives can help the dog to relax, which breaks the cycle of: anxiety-induced coughing, coughing-induced tracheal irritation, tracheal irritation-induced anxiety and coughing. Some types of cough suppressants can be helpful and may even contain a sedative. Another type of medicine (bronchodilator) works by dilating the tiny airways that lead to the lungs and making the work of breathing a little bit easier. Your veterinarian can discuss the schedule for these medicines with you. Some dogs may only need to be given the drugs at certain times. Other dogs may need to receive them more often. Just as in people, a dog may respond better to some medications than others. For this reason, if one medication does not appear to help, talk to your veterinarian about trying another type or any need for tests to assess why it might not be working (e.g., if complications are present).

If you take your dog to the veterinary clinic and the dog is in a state of respiratory distress due to severe collapsing trachea, the staff may give oxygen by placing the dog in an “incubator-type” box or cage filled with oxygen. Once the dog is calm, oxygen can temporarily be given through a narrow tube inserted into the nose and airway.

If the dog has other respiratory or heart problems, these may need to be treated as well. The treatment will depend on the specific problem.

In some dogs, a drug may lose its effectiveness, especially if the collapsing trachea worsens over time. If a dog no longer responds well to any of the available drugs, surgery may be an option. Synthetic rings that mimic the function of the dog’s real tracheal rings can be implanted by a veterinary surgical specialist. This procedure has had limited success and some complications. There are many factors to consider before this surgery can be performed, and not all dogs are candidates for this procedure. Your veterinarian can refer you to a specialist if surgery might be an option.

DOs

– Give medicine exactly as prescribed.
– Use a harness or Gentle Leader-type face collar instead of a regular collar.
– Avoid placing the dog in situations that you suspect may be stressful or anxiety-provoking or that have triggered fits of coughing in the past.

DON’Ts

– Do not leave any dog in a car with the windows rolled up, especially in warm, humid weather.
– Do not force the dog to continue exercising if coughing begins.

When to Call Your Veterinarian

– If the dog shows signs of an adverse drug reaction (weakness, drowsiness, anorexia or decreased appetite, hives [bumps under the skin], vomiting, diarrhea, constipation or straining to have a bowel movement, seizures, etc.).
– If your dog faints and you cannot wake it up.
– If your dog produces a greenish or whitish phlegm when coughing (or a similar nasal discharge).
– If a drug no longer appears to be effective. Some dogs become “resistant” to some drugs after taking them for a while but will respond well to other drugs.

Corneal Ulceration

About the Diagnosis
Cause: In dogs and cats, like in humans, the cornea is the transparent, front part of the eye through which one sees the pupil (black center) and iris (colored [brown, blue, green] part of the eyes). A corneal ulcer (also sometimes called a “scratch on the cornea”) is an injury to the surface of the cornea that may be superficial or deep. There are many potential causes of corneal ulcers in dogs and cats. The most obvious is direct trauma, such as when a stick or toy strikes the eye during play or a piece of gravel strikes the eye while a pet has its head out the window of a moving car. Other causes include entropion and distichia, conditions in which one or more eyelashes rub against the cornea.

Some diseases indirectly predispose to corneal ulcers, such as disorders that affect the nerves to the eyelids and result in poor or absent blink reflexes, which can also lead to dry, ulcerated corneas. Diseases that cause inadequate tear production (keratoconjunctivitis sicca, or “dry eye”) also invariably cause corneal ulceration because the cornea becomes dry and unhealthy. Various ocular infections (bacterial, viral, fungal) can cause corneal ulcers. For example, in cats, infection with feline herpesvirus may cause corneal ulcers.
Corneal ulcers are generally uncomfortable or painful and squinting (blepharospasm), redness of the eye, and excessive tear production (lacrimation) are common symptoms. Depending on the depth of the corneal ulcer (superficial versus deep), the length of time before treatment, and whether the ulcer is infected, vision may or may not be affected and corneal scarring can result. Any eye injury should be treated as an emergency and veterinary careshould be sought immediately.
Diagnosis: Corneal ulcers are diagnosed with fluorescein stain. This is a special green stain that is gently placed on the surface of the eye. A corneal ulcer retains the stain and glows bright green, whereas healthy cornea does not. To determine the cause of the corneal ulcer, your veterinarian will ask you for a complete history (including duration and types of symptoms you have observed, possibility of trauma, and previous medications, eye drops, etc.) and will conduct a thorough examination of the eye (ophthalmic examination). Specifically, the eyelids, eyelashes, and the blink response are examined as well as the general conformation of the eye. The ability to produce tears is measured.

The inside of the eye is observed using different types of lenses or an ophthalmoscope. If the corneal ulcer is very deep or even full-thickness, causing rupture of the eye, your veterinarian may refer you to a veterinary ophthalmologist (a veterinarian who has specialized in the diagnosis and treatment of diseases of the eye).
Living with the Diagnosis
Home care involves giving medication exactly as directed by your veterinarian. Usually an Elizabethan (“cone,” “lampshade”) collar is placed on the animal to avoid self-trauma through rubbing the face on the ground, and it should remain on until you are instructed to remove it by your veterinarian. Although superficial, uninfected corneal ulcers typically heal uneventfully over several days time if treated properly, deeper ulcers, persistent or “indolent” ulcers, and ruptured eyes can require multiple visits to the veterinarian and a longer course of treatment. Some corneal ulcers leave scars on the cornea and may affect vision, and the very deep or full-thickness corneal ulcers may require surgical correction.
Treatment
In both dogs and cats, the cause of the corneal ulcer must be identified, if possible, and eliminated, if possible. Topical ophthalmic antibiotics (drops or ointment made especially for use in the eyes) are placed on the eye surface multiple times per day to treat bacterial infections. Depending on the cause, topical atropine is given to control pain caused by inflammation and to dilate the pupil, which helps to prevent adhesions (bridging scars, which hamper normal eye function) within the eye. An anti-inflammatory drug may be given orally to control ocular inflammation and pain. In cats, corneal ulcers caused by herpesvirus infection, which is a common occurrence, are treated with a topical antiviral medication and oral supplementation with the amino acid lysine.
In addition to the treatment methods presented above, dogs and cats with deep or rapidly progressing ulcers or ruptured eyes may also require treatment with oral antibiotics and ocular surgery. A commonly used surgical procedure involves creating a conjunctival flap, which is a small section of the most superficial layer of the white part of the eye, which is transferred from its normal position to a position overlying the ulcer. The blood vessels in the flap can help the ulcer to heal. The eyelids may be partly sutured closed to act as a natural protective barrier during this period of healing, usually a few weeks, after which the sutures are removed and the eye retakes its normal shape.
Persistent, “refractory,” or “indolent” ulcers are superficial corneal ulcers that do not respond to conventional treatment. They can occur in any breed of dog; however, boxers are especially predisposed. These corneal ulcers are difficult to treat because the newly-growing corneal tissue fails to stay anchored to the corneal surface and after growing for days or weeks, simply peels away and restarts the corneal ulcer process. These indolent corneal ulcers usually require removal of the loose, nonadherent new corneal tissue from the surface of the cornea (debridement) and making many small abrasions on the surface of the ulcer and surrounding healthy cornea (keratotomy). This method facilitates attachment of the new tissue that grows to cover the ulcer. Several types of contact lenses or shields are available that can be placed temporarily over the corneal ulcer as a type of transparent bandage for protection and to promote healing.
DOs
• If your dog or cat suffers an eye injury, seek veterinary attention immediately.
• If you bathe your dog or cat at home, ask your veterinarian to recommend a protective ointment that you can place in the pet’s eyes beforehand to avoid chemical irritation of the cornea from the soap or shampoo (otherwise a common problem).
• Inform your veterinarian if your pet has ever been diagnosed with a medical condition and is taking medication.
• Give medication exactly as directed by your veterinarian, and if you are concerned about possible negative effects, discuss them with your veterinarian immediately rather than simply discontinuing the treatment.
• Seek a second opinion if the condition is not improving or resolving altogether. Eye specialists in veterinary medicine are known as Diplomates of the American College of Veterinary Ophthalmology.
DON’Ts
• Do not remove the Elizabethan collar until instructed to do so by your veterinarian. The collar prevents your dog or cat from further traumatizing the cornea by scratching it.
• Do not attempt to remove foreign bodies from your dog’s or cat’s eyes since doing so may cause further damage.
• Do not place any medications not intended for use in the eyes of animals in your pet’s eyes; human eye medications or veterinary medications not specifically made for the eyes may contain drugs or inactive ingredients that actually prevent healing and may cause more damage.
When to Call Your Veterinarian
• If you cannot keep a scheduled appointment.
• If you are unable to give medication as directed.
Signs to Watch For
• General signs of illness: lethargy, weakness, decreased appetite, hiding more than usual, aggressiveness, and other behavior changes.
• Signs of problems with the eye(s): increased tear production, squinting, red eyes, swollen eyelids, itching/pawing the eyes, drainage of white or greenish material from the eye, and acting in pain or defensive when the area around the eye is touched.
Routine Follow-Up
• Follow-up visits will be scheduled to assess progress and to determine if medication should be changed or the dosage adjusted.

Cranial Cruciate Ligament Injury

About the Diagnosis
Cause: In dogs and cats, as in humans, ligaments are tough connective tissue structures that normally stabilize joints and are indispensable to the proper function of joints. Whereas tendons connect muscles to bones, ligaments connect bone to bone. The cranial cruciate ligament is one of the ligaments that provide essential support to the knee, which in animals is referred to as the stifle joint. The cranial cruciate ligament is located in the hind leg, between the upper or thigh bone (femur) and the parallel middle hind leg bones, the tibia (shin bone) and fibula. It is the same ligament as the anterior cruciate ligament (ACL) in humans.
The cranial cruciate ligament can rupture suddenly as the result of certain traumatic movements or gradually as the result of degeneration. Causes of degeneration include aging, immune-mediated disease, and, most commonly, certain leg conformations in which the shape of the stifle joint in certain individuals puts lifelong, undue stress on the cranial cruciate ligament. The ligament can degenerate slowly over time, becoming weaker and culminating in a sudden, complete rupture. When this ligament ruptures, either partially or completely, dynamics of the knee joint are altered, and the joint becomes painful and unstable. The most common result is immediate limping (also called lameness or “favoring the leg”) which, if uncorrected, leads prematurely to arthritis, degeneration of cartilage in the joint, and stiffness.
Although any dog can suffer a ruptured cranial cruciate ligament, it is diagnosed most commonly in larger dogs (over 20 pounds), but rarely in cats.
Symptoms: Cranial cruciate ligament rupture (partial or complete) is the most common cause of hind limb lameness (limping) in medium- and large-breed dogs. A sudden or intermittent lameness in the hind limb is the chief symptom.

Intermittent lameness may typically appear worse after extended walks or running. Some dogs hold the affected leg up and off the ground when standing, but this symptom is commonly observed in many orthopedic conditions, not just in cruciate ligament injury.
Diagnosis: A ruptured cranial cruciate ligament may produce symptoms similar to a muscle/tendon sprain, injuries to other ligaments, arthritis, and bone disorders such as panosteitis, hypertrophic osteodystrophy, or even certain bone tumors. Since the symptoms alone do not differentiate between these disorders, several tests can be performed to pinpoint the cause of the limping and confirm or eliminate the possibility of cranial cruciate ligament rupture. Your veterinarian will take a complete history and ask you about the duration and appearance of symptoms, any medications you have given, and so on. He/she will observe your dog’s or cat’s gait (pattern of walking). Then by moving the joint through various motions and with careful palpation (feeling with the fingers), your veterinarian can help narrow the list of possible causes of limping and determine whether cranial cruciate ligament injury is likely.

The cranial drawer test is an important and simple manipulation that can be very helpful in diagnosing a cranial cruciate rupture. For this test, your dog or cat may be sedated or anesthetized to totally relax the muscles around the stifle joint. The test is positive if the bones can be moved a certain way, indicating ligament discontinuity. The range of motion is determined and compared with the opposite knee. While deep sedation or anesthesia is underway, x-rays often are taken of the stifle joints in each hind leg, since this helps assess the possibility of other disorders that might mimic cranial cruciate rupture, and if indeed cranial cruciate rupture is present, the x-rays are useful for identifying any secondary damage such as arthritis.
Living with the Diagnosis
Dogs and cats with cranial cruciate rupture may have waxing and waning lameness (“good days and bad days” of limping) until the ligament is surgically repaired. Failure to repair the ligament surgically is detrimental in the long term because the unstable joint becomes chronically inflamed, prompting scarring within the joint, and ultimately, potentially severe arthritis is the result.
If medication is part of your pet’s treatment, it must be given exactly as directed. It is also important to stop giving medication when directed. When taking anti-inflammatories, the dog or cat may feel very little or no pain, and therefore, it is important to prevent vigorous exertion as much as possible because it might injure the knee even more severely.
Surgery provides the best long-term function of the affected knee. Degenerative joint disease (arthritis) can eventually develop or continue to progress in the joint even with surgery, but the rate and severity of this irreversible complication is much lower once surgery is performed.
In 40-60% of dogs or cats with cranial cruciate ligament rupture, the ligament in the opposite knee will eventually rupture, and therefore, vigilance for the onset of lameness in the opposite hind limb is important.
Treatment
Surgery is the only definitive treatment for any dog or cat with a ruptured cranial cruciate ligament. Patients that undergo surgery to stabilize the joint have optimum long-term function.
Dogs weighing under approximately 20 pounds and cats are sometimes treated in a more conservative fashion (e.g.,strict rest for up to 6 weeks and anti-inflammatory medication for a short period and no surgery) and may have resolution of lameness and become symptom-free with this simpler approach. The joint is not as stable as it would be if surgery had been performed, and degenerative joint disease (arthritis) usually develops. To compensate, more stress is placed on the other hind limb, which may lead to a ruptured ligament in that knee, but the risk may be worthconsidering in smaller patients.
There are several surgical techniques that can be used to stabilize the knee. Your veterinarian may prefer one or may refer you to a veterinary surgical specialist.
Appropriate postsurgical care and physical therapy are extremely important. Your dog or cat must not be allowed to jump on and off furniture or go up and down steps after surgery until your veterinarian gives permission. This typically implies 2 to 3 months of exercise restriction and motion restriction of this kind. A soft bandage with or without a splint is placed on the leg at the end of surgery and may remain on the leg for up to 2 weeks, depending on the surgical technique. This bandage must be kept clean and dry. A plastic bag can be wrapped around the leg each time your pet goes outside to keep the bandage clean and dry and can then removed indoors. Initially, short leash walks on flat surfaces are encouraged to allow tissue healing and convalescence. The length of walking time is gradually increased (usually weekly), and different, more challenging terrains are encouraged until the dog or cat is able to climb stairs. In most cases, normal activities are resumed postoperatively by 12 weeks.
Therapy may also include range of motion exercises, whirlpool treatments, and swimming. Your veterinarian can discuss these options with you and establish a therapy program.
DOs
– Inform your veterinarian if your cat or dog has ever been diagnosed with a medical condition and is taking medication.
– Give medication exactly as directed by your veterinarian, and if you are concerned about possible negative effects, discuss them with your veterinarian immediately rather than simply discontinuing the treatment.
– Keep bandages and incisions (stitches and surgery line) clean and dry, even if this means using an Elizabethan (cone) collar to prevent licking.
– Prevent all jumping, climbing, and running for the full 3-month period after cruciate ligament surgery, and then reintroduce activity gradually. This is critically important, even when, as most dogs do, your dog gives you the impression of being fully recovered before the 3-month period is up. Active and cheerful dogs often have no idea that their tissues are still healing and can do severe, even irreversible damage to the knee if not prevented from being active during the 3-month convalescence period.
DON’Ts
– Do not delay visiting your veterinarian if you notice lameness (limping) involving any of your dog’s or cat’s limbs, even if the lameness is only intermittent. Early diagnosis and treatment can limit any permanent damage and therefore improve the outcome (prognosis).
When to Call Your Veterinarian
– If you cannot keep a scheduled appointment.
– If you are unable to give medication as directed.
– If you are unable to follow the physical therapy regimen after surgery.
– If your dog or cat is not improving after surgery and pain and lameness increase.
– If you notice liquid discharge, worsening redness or swelling, or a foul odor coming from a surgical incision site or bandage or if stitches are chewed out.
Signs to Watch For
– General signs of illness: lethargy, weakness, decreased appetite, other behavior changes.
– Signs of a ruptured cranial cruciate ligament: sudden or intermittent lameness of a rear limb, onset of lameness after exercise.
Routine Follow-Up
Follow-up visits are required after surgery to remove bandages and sutures/staples and to monitor progress. The schedule depends on the type of surgery performed and the physical therapy program.