Disease #2
Dogs and cats have a pair of anal gland sacs that reside under the skin at the 4 o'clock and 8 o'clock position of the anal opening. Obstruction of the ducts leading from the gland to the rectum causes the clinical signs and subsequent infection of the glandular tissue.
Under normal circumstances a dog secretes some of the anal gland material into each bowel movement. In domestic dogs and cats they have little function. In the wild, that scent is part of maintaining an animal's territorial domain. The anal gland ducts eventually become clogged with a viscous material that gets infected. Tapeworm segments may also clog this passageway. This enlarges the gland and causes clinical signs. If the signs are not relieved, it becomes an anal gland fistula.
The most common sign of anal gland sacculitis is scooting on the animals hind quarters. If not caught soon enough, owners will detect a foul odor emanating from "somewhere". For some unknown reason, dogs will also chew at their front paws when the glands are full.
Most animals do not require any lab work. Some of the anal gland residue may be cultured to find out the bacteria that are growing. This helps to select the most appropriate antibiotic to treat the animal with.
Diagnosis is made by the history of a dog or cat scooting on its hindquarters and or chewing at its front paws. Most anal gland issues are seen in smaller dogs so that is another thing to keep in mind when a dog is presented with the condition.
Treating anal gland issues is pretty straight forward. The glands are expressed to empty their contents through the anus. The pressure is relieved at this point. Animals are put on a broad spectrum antibiotic for two weeks and sent home. Some animals are in intense pain and may be put on Rimadyl® or a low dose of a corticosteroid.
The prognosis for anal gland sacculitis is usually good. The key is to notice when an animal is rubbing its back end on the floor. This is the time to take the pet to the veterinarian. Many animals are constipated and this can also lead to the problem. Adding a teaspoon or so of Metamucil® to the food several times per week will cut down on the incidence of the condition. Some veterinarians will also excise the glands under a general anesthetic.
What do you do if you get that foul smelling stuff on your clothes or carpet? DO NOT use soap and water to clean it up with. All you are doing is pushing the stuff around and not getting rid of the material or odor. DO USE isopropyl (rubbing) alcohol; which can be found in any supermarket or drugstore. That will work.
When anal gland material is not able to flow from the gland to the rectum, the gland enlarges and like a balloon will pop! This usually creates a small opening about 4 mm in width at the base of the gland. The body does this trying to rid the glandular contents to the outside since there is an obstruction the other way.
Clinical signs are similar to that of anal gland sacculitis. Scooting on their back ends plus chewing at their front paws is characteristic. The only difference is the presence of the opening or fistula opening up to the exterior skin surface. The animal is in greater discomfort than a straight blocked anal sac.
Anal gland fistulas can be difficult to heal or resolve. It is always a good idea to culture the glandular contents so that a specific antibiotic can be selected to cure the condition.
Diagnosis is usually made in a small or toy breed of dog that is scooting on its hindquarters. Looking at the perineal area will show the fistula.
Treatment of the anal gland fistula is very similar to the basic gland impaction. The anal gland materials are emptied from both sacs and the area is disinfected. Dogs are put on an appropriate antibiotic for at least 2 weeks. If the infection and gland are not healed, most veterinarians will put the dog on cyclosporine (immunosuppressant) that will aid in the sealing and healing of the anal gland fistula. Glandular excision is also possible.
The prognosis for anal gland fistulas is excellent. They may be difficult to heal but cyclosporine usually works in most cases. In those where it doesn't, the gland can be excised.
Anal gland discomfort is analogous to hemorrhoids in humans. Both cause an intense inflammation and itch. Dogs do not get hemorrhoids and humans do not have anal glands.
Anemia is defined by a decrease in the amount or numbers of circulating red blood cells. Without red cells, there could not be any life! Anemias can be broken down into regenerative and non-regenerative anemias. The former usually bounces back to normal levels and the latter does not. A lot of cancers cause a non-regenerative anemia. Causes of regenerative anemia are many. Parasites such as babesiosis cause an anemia. Poor diet and autoimmune disorders can cause an anemia. Hemorrhaging of any type also does the same. Anemia is a hallmark of many disease processes.
Inside of the red cell is a hemoglobin molecule which has iron at its center. Around it, like spokes on a bicycle, are oxygen molecules. Red cells carry this oxygen to all tissues in the body. A decrease in their numbers cause the associated clinical signs.
The most visible sign of anemia is the general poor pallor noticed. The gums will be pale as well as the conjunctiva. The skin and foot pads may appear pale if the skin pigmentation is light. A decrease in circulating red cells causes the heart and lungs to work harder hence their rates will be elevated. An animal will be tired and no longer has the energy to do much hence lethargy is common. Anorexia occurs since the dog or cat is too weak to go to the food bowl. Other clinical signs occur dependent upon the disease in question. For example, a dog with hemolytic anemia will usually have jaundice; a clinical sign of bilirubin buildup in the blood. Bilirubin is a breakdown product of hemoglobin metabolism.
The most important lab test to perform is a CBC. This informs the veterinarian of not only the numbers of circulating red cells but their size, shape and concentration of such (hematocrit). Red cell morphology may change. An example are the spherocytes (abnormal red cells) seen in auto-immune red cell diseases. A chemistry profile and urinalysis also are important. These two let the veterinarian know if any internal organs are affected. Further diagnostic tests dependent upon the suspected disease are done, such as radiographs.
Diagnosis made by noting the light pallor of tissues during a physical exam plus any lab work performed such as a CBC and other diagnostic tests.
Treatment of anemia is often based on the actual disease causing the anemia. Regardless, treatment of the underlying anemia is the same. If the red cell count is low, a dog or cat may be transfused with whole blood or blood byproducts. If blood is not readily available; high molecular weight fluids such as dextran and hetastarch may be given IV. Animals are also given iron, B12 injections to speed up red cell production if the bone marrow is cranking out red cell precursors.
The prognosis for general regenerative anemia is good. Dogs and cats that suffer from autoimmune hemolytic anemias have a more guarded prognosis until their red cell counts start to climb. Animals with a non-regenerative anemia such as cancer patients have a much more unfavorable prognosis.
Anorexia simply means a lack of desire or appetite for food. It is a hallmark of many diseases. An animal may not have an appetite due to an underlying disease condition or unable to eat even though the dog or cat has a desire to eat. Usually this entails a mechanical or physical ailment of the cervical and or head area. Conditions that cause true anorexia are: fevers of whatever origin, poisonings, liver and kidney disease, immune-mediated diseases, any process that causes vomiting and many types of neoplasms or cancers. Types of anorexia due to mechanical or anatomical issues are: a sore infected tooth or periodontal disease, enlarged salivary glands, stomatitis, lesions on the tongue or oral cavity. Any type of pain or discomfort in the body or jaw can cause this type of anorexia.
All mammals have to eat & drink to obtain calories for all of the body's metabolic processes to occur. This maintenance is called the homeostatic response. If food or water are not consumed, the body must find the calories elsewhere. This leads to initial metabolism of fats than carbohydrates and muscle tissue. This leads to chronic wasting and metabolic disorders. Lack of water leads to dehyrdration at the cellular level and electrolyte issues. Lack of fluids will lead to circulatory collapse and renal failure. Bottom line is, that all mammals have to eat and drink to survive!
Clinical signs of anorexia are highly dependent on the actual cause of the anorexia. In general, the majority of anorexic dogs and cats have lost weight. Making matters worse, anorexic cats lose weight extremely fast. They will literally lose weight overnight. If a cat does not eat within 3 days, they will start to develop liver disease. No ifs or buts about it. In addition to the weight loss, many animals will be weak and lethargic. Anorexia is not disastrous if it occurs for a day or so but long term it can be problematic.
A CBC and Chemistry profile are important to note any electrolyte imbalances secondary to the anorexia plus to point the way trying to figure out the original cause. That primary cause of anorexia will determine any further lab work needed.
Figuring out the cause of anorexia is the most important part of the diagnosis. Initially, a good history and physical exam and weight loss history will shine light on the diagnosis.
Diagnosis and Treatment of the primary cause of anorexia is crucial in reversing the overall medical problem but treatment of the anorexic condition is the same. If the animal is vomiting, it is imperative that it be stopped. If a dog or cat is vomiting, food and water can not stay down. Drugs of choice include injections of Cerenia® or ondansetron. Once the GI tract is quiet, providing appetite stimulants is appropriate. Oral and or injectable B-complex vitamins, mirtazapine and or cyproheptadine are all used for this purpose. Nutrical® is a high quality energy and vitamin packed gel that is given all the time to provide calories initially to the dog or cat. Mixing that with some Hill's® Prescription A/D works wonders. That can be fed via a syringe or the animal can eat it if able to. That diet is for both dogs and cats. If an animal will not eat, an esophageal or stomach tube may be inserted. One year ago, I had a severely anorexic dog recovering from Autoimmune Hemolytic Anemia and I brought from home chunks of rotisserie chicken from the night before. The dog literally attacked my hands getting to the meat! When, a dog or cat starts to eat on their own, you know they are on their way.
Prognosis of anorexia is dependent upon the original cause of it. If it caused by a basic respiratory virus, than the prognosis is excellent. If it is caused by an internal medical condition, than the overall prognosis depends upon the treatment of the primary cause.
Antifreeze is chemically known as ethylene glycol. This product is used in the automotive industry as a radiator coolant as well in brake fluid, windshield washing liquids and other products. It is extremely sweet and has an attractive odor to not only cats and dogs but also children. Although cats can get poisoned by this substance, it is not common. Before a cat eats or drinks anything, it has to smell it, even play with it. If the food is spoiled or an owner foolhardily tries to adulterate the food with the cat's amoxicillin drops, it will not eat it! Dogs are a different story and are attracted to it. Manufacturers have added bitter ingredients to it but it is still attractive to animals.
It only takes a few licks of antifreeze to cause problems. When the pet swallows the chemical, it is rapidly absorbed through the portal system into the circulatory system. In a few short days it will cause renal failure and eventual death if treatment is not immediately provided.
Clinical signs occur rapidly after ingestion. Signs of disorientation, lethargy, drunkenness and wobbling around are the most common. Later the animal vomits and than shows signs of depression and renal failure in the form of bad breath (halitosis). If treatment does not start the animal will not survive.
When a pet is presented ill with antifreeze poisoning, the majority of times the owner usually does not know what happened. If the owner sees the dog lapping at it, we can immediately start treatment. That is hindsight. A CBC, Chemistry profile and urinalysis are performed. It will show a marked elevation in the BUN and creatinine. Urinalysis will show an increased amount of oxalate crystals in the urine. There is an Ethylene Glycol Test Kit that will determine if the animal has ingested antifreeze. It must be run within 6-10 hours of antifreeze ingestion.
If the owner is present when the poison is swallowed, a diagnosis is right at hand. Otherwise, the physical exam and lab findings will usually lead a veterinarian to suspect antifreeze and start asking the owner about the whereabouts of antifreeze on the owners property and any chance a household member may have recently changed his radiator fluid. Up north, a lot of people do this in the fall prior to winter weather so the time of year gives veterinarians a clue.
For the animal to have any chance at survival, treatment must be started within hours after ingestion. The sooner the better. If renal failure is present treatment is usually unsuccessful. Initial treatment is providing activated charcoal and anti-emetics to stop any persistent vomiting. Intravenous fluids are mandatory to support renal function. Either fomepizole or ethanol are antidotes. Years ago, I had a case and took a bottle of vodka to the clinic where I infused it intravenously. Pharmacies offer an aziotrope of ethanol that is close to 100% ethanol for said purposes. Other supportive care measures are provided while the animal is hospitalized.
Prognosis depends upon how much antifreeze the animal ingested and the time difference between ingestion and treatment of the animal. Animals may take weeks to stabilize. Those animals in severe renal failure have a poor prognosis. The key is prevention. Cleaning up old antifreeze and keeping new product away from young children and pets is the key.