Diseases #31
Seborrhea sicca is a member of the Seborrhea Complex. It is differentiated from Seborrhea oleosa by the lack of excessive sebum production on the skin. Dry, flaky skin is the hallmark of this medical condition. Seborrhea sicca is commonly caused by:
1. Endocrine Diseases: Hypothyroidism and Cushing's Syndrome are common causes.
2. Bacterial: Bacterial pyodermas can lead to this condition.
3. Parasitic Mites: Demodectic and Sarcoptic mange can cause this problem.
4. Cancer: Many cutaneous neoplasias such as cutaneous lymphosarcoma can produce a secondary seborrhea oleosa.
5. Fungal/Yeast Infections: The big guy on the block here is Malassezia yeast. They frequently cause seborhhea sicca.
Seborrhea sicca is often seen together with Seborrhea oleosa, an oily type of seborrhea.
In Seborrhea sicca, excessive sebum is also produced since both types of seborrhea can be seen at the same time. This excessive sebum accumulates and clogs hair follicles. The dog or cat has a literal coat of sebum over its body. Sebum production is greatest along the flanks, ears and lumbar back area. This buildup causes the animal to scratch at itself. This produces dander, inflamed papules and other lesions. This irritation often sets up a bacterial pyoderma or yeast infection. In the case of seborrhea sicca, dry flaky skin is usually more extreme than sebum production.
Pets will often have a foul odor about them. There may be excess sebum present since seborrhea oleosa and sicca will be often present in the same animal. Yeast infections can cause a sweet, foul odor to the skin. Bacteria can metabolize oils and produce oil metabolites. One of the chief complaints people made to me was that "horrible stinky odor that my dog has plus all the furniture stinks". I understood clients on that one. I often could diagnose the condition before I even walked into the exam room!
Many times there will be skin folds present; which are full of sebum with bacteria and or yeast. This is a huge problem in English Bulldogs and others with natural folds of skin over the body. There will also be present: raised papules, dander and general skin inflammation.
A CBC and Chemistry profile are always performed. Both of these tests will often lead the doctor to order further tests based on those results. Skin scrapings are always done to eliminate mites. Fungal cultures are done to rule out a dermatomycosis (including ringworm). ACTH Stimulation Tests are done if suspecting Cushing's Syndrome. T4 and FT4 are performed if suspecting hypothyroidism. Surgical biopsies may be done.
Diagnosis is made by a history obtained from the owner plus the presentation of clinical signs. The primary cause is figured out by concurrent lab work test results. A surgical biopsy may lead to a diagnosis or confirm one that was tentative.
Treatment is initially geared to treating the primary cause of the Seborrhea lesions. Yeast infections are treated with Ketoconazole. Bacterial pyodermas are treated with antibiotics such as Clavamox® or Baytril® for long periods of time. Endocrine disorders such as Cushing's Syndrome are treated with Lysodren® or Trilostane®. Hypothroidism is treated by oral T4 administration.
Pruritus is usually controlled by Atarax® (hydroxyzine). This is a prescription antihistamine that alleviates some of the clinical signs associated with itch. One has to be careful about using corticosteroids. They will provide relief but can suppress the animal's immune system making it much harder to treat a bacterial, fungal or yeast infection. Giving corticosteroids to a suspect Cushing's Syndrome patient can make the condition worse! If the patient is a diabetic, steroids will really throw off the blood glucose and play havoc with an insulin dose.
Topical shampoos are crucial in providing some relief from clinical signs plus return the skin to a more normal condition. Shampoos containing chlorhexidine and or combinations of chlorhexidine and ketoconazole are very effective, if used properly. Some of the best products for this purpose are made by Virbac®. The best shampoo interval is twice the first two weeks, than once weekly for months on end. Do not use warm water. Use cool tap water or water from an outdoor hose. Warm water will make the animal scratch even more! Repeating the shampooing will keep sebum production under control; as long as the primary disease condition is being treated.
If a cause of seborrhea can not be determined, the condition is treated with antibiotics, ketoconazole and shampoos. Oral cyclosporine (Atopica®) may help some of those patients.
The prognosis for seborrhea sicca depends upon the primary cause of the medical condition. The prognosis for idiopathic seborrhea sicca is more guarded since a cause can not be found. Supportive medical care will at least keep those conditions under control in most situations.
Seizures can be caused by many things. Low calcium and blood sugar, poisons, antifreeze, bacterial (tetanus caused by Clostridium tetani), tumors and heat stroke are just a few of the medical conditions that can cause animals to seizure. One of the most common causes of cat seizures is FIP; a severe corona virus of cats. Status Epilepticus or Epilepsy is one of the most common causes of seizures in dogs. The cause of epilepsy is unknown and hence known as idiopathic epilepsy.
There may be a genetic cause to epilepsy but that has not been proven. Brain activity is altered. An analogy would be like lights flickering on and off. Just like a short circuit about ready to happen in a homes electrical system, the same thing happens in an animals brain. Prior to a seizure, animals may appear clinically normal. Certain stimuli can set off a seizure. Going outdoors to urinate. Going on a walk. Going up and down stairs. Dogs may become hyperesthetic (extremely and exceedingly sensitive) to any noise. Clapping of the hands, dogs barking, trucks backfiring can all cause an animal to seizure in certain conditions.
Clinical signs of epilepsy in dogs and cats can be insidious. No one knows why they start at a certain age. Some patients are young while others are senior citizens! The most important thing to mention is that all seizures (unless they are grand mal) do not cause any pain or discomfort to the animal. It causes more pain and consternation in their owners; which is totally natural! Animals can hurt themselves if they seizure going up or down stairs or fall off of an object.
Some animals may have a fascicular tic; a slight twitch that disappears and goes away. The most common seizure occurs suddenly with the pet becoming recumbent. They have no idea where they are. They often salivate, vomit, or defecate. Their front limbs are in a "bicycling position"; just like they are riding a bike! Their eyes look straight ahead. The majority of these seizures last anywhere from about 1-5 minutes in duration. The animal gets up exhausted but than acts normal.
The worst type of seizure is the grand mal seizure. These are seizures that do not stop! This is a true medical emergency! The same clinical signs as above but more severe. The entire musculature of the body is in one huge muscle spasm. These muscle spasms generate a tremendous amount of heat. Left untreated, they will go into heat stroke and develop renal failure, brain swelling and DIC (Disseminated Intravascular Coagulopathy).
Dogs and cats should seek immediate medical care if a seizure has occured; even if they appear normal. A CBC and Chemistry profile will be formed to check if there is any physical reason for the pet to seizure. Profiles can rule out low glucose or calcium problems as well as liver issues. A EKG can rule out heart problems along with radiographs or cardiac ultrasounds. A CT scan may be performed at a veterinary medical teaching institution.
History is perhaps the most important part of initially trying to formulate a diagnosis. The veterinarian will ask if there has been any exposure to any type of poison. Was the animal hit by a car recently? Is the pet on medications like insulin? Did the patient (if female and small) give birth to a large litter? This suggests eclampsia; a condition due to low serum calcium levels. A tentative diagnosis of idiopathic epilepsy can be given if no historical findings are found and no physical lab abnormalities are discovered. The latter is what usually happens.
If a patient has a short bout with epilepsy I usually gave the animal a complete physical and performed blood work. If the history was negative for toxins and the like, I usually did not treat the condition if it was the FIRST seizure of short duration. I did tell the owners that a seizure could happen at any time; even after just leaving the medical office! Owners should keep a diary of any seizure activity. The time of day, possible trigger for the seizure, how long it lasted and how long it took for the animal to stand again are important bits of data that doctors need to know about. After each seizure, contact your veterinarian's office for suggestions and that they update the pets medical file. The point of this exercise is to determine if there is a PATTERN of seizure activity. If a pet has a seizure once or twice a year, I usually didn't treat them with drugs. If seizures occur more often over time, the pet is evaluated again and anti-convulsant drugs are prescribed. During this period of limbo, where it is unknown whether or not the pet may require drugs in the future, it is important important to protect the animal from danger while in a seizure. Dogs should be put in a quiet, dark room to minimize loud noises and bright lights. A cellar is perfect for this. If there is no cellar, a small, comfortable dark room is appropriate. Lay the animal on a thick set of blankets and keep it on the floor. As I used to tell clients all the time (in regards to preventing injuries), you can't hurt yourself by falling off of a floor.....
In medical offices, grand mal seizuring dogs and cats are treated with intravenous doses of Valium® and or pentobarbital to control seizures. A similar approach is done orally once anti-convulsant drugs are prescribed. Phenobarbital and Potassium bromide are two of the most common drugs prescribed. Therapy is life long! It is important that dogs that are on a maintenance dose of phenobarbital have their serum levels of phenobarbital documented at least 3 times a year. I liked to have them around 20-22. Keeping the drug dose at its lowest therapeutic level will protect liver function.
The prognosis for status epilepticus is good if the animal is diagnosed early and managed correctly. The majority of dogs and cats live normal lives. They come in for vaccinations, another illness or just to say hello! (I should have said Woof or Meow!).
Be careful when going on vacation without the pet. I highly recommend that your veterinarian take care of the animal. Most hospitals are happy to do the job for you! Bring your medication along with you. This can be life saving! You can be sure that your pet is being given its appropriate dose plus if there is a medical problem, your veterinarian is right there to treat it!
Sertoli Cell Tumors are commonly seen in male dogs that have not been neutered. In this tumor, the sertoli cells of the testicle are involved. The cause of this type of tumor is unknown but genetics are always a possibility.
Although the cause is not known, many dogs with Sertoli Cell Tumors have a retained testicle. This is known as cryptorchidism. It can be unilateral or bilateral. Cryptorchidism is a genetic condition diagnosed in young male animals. That is why all doctors neuter them at 6 months of age. The testicle in the scrotal sac is removed but more importantly, the retained testicle is removed from the inguinal canal or abdomen. This prevents Sertoli Cell Tumors in the future.
Sertoli Cell Tumors in dogs are associated with a feminization syndrome. This can include gynecomastia; a breast enlargement in the dog that even produces milk! Dogs may squat to urinate like a female and the males penis often atrophies over time. The skin usually takes on a thinner, hyper-pigmented look.
If the dog is not cryptorchid, one of the two testicles in the scrotal sac is usually much smaller than the other. Normally, both are about the same size.
A CBC and Chemistry profile and radiographs are taken to rule out any systemic involvement or metastasis of the tumor.
Diagnosis of Sertoli Cell Tumors is based on physical findings and clinical signs. The diagnosis is confirmed by receiving a histopathological diagnosis from the pathologist confirming the tentative diagnosis.
The only treatment for Sertoli Cell Tumors is castration. If the dog is cryptorchid, both the normal testicle and the one lodged in the inguinal canal or abdomen are removed. The cryptorchid testicle is always sent to the pathology lab for a histopathological diagnosis.
The prognosis for Sertoli Cell Tumors depends upon the pathology report. The majority of these tumors are benign but some can be malignant and metastasize to other parts of the body. A pathology report will say that and explain the chances of metastasis based on the individual cell type. No cancer can every be cured, at the moment. The best that can be done here is castration; hence eliminating the main source of the problem.
A Sialocele, also known as a Salivary Mucocele, is a cyst surrounding a salivary gland that contains mucoid saliva dispersed in nearby tissues. The cause may due to trauma or infection of the associated salivary gland.
Saliva is normally produced in the salivary glands on each side of the neck area. The saliva passes into the oral cavity through ducts. Prior to ingesting food, saliva starts to accumulate in the mouth and serves as a tool to partially digest the food making it easier to swallow. The Mandibular salivary gland and the Sublingual salivary glands are commonly associated with Sialoceles. The cyst is full of mucoid saliva and over time enlarges. This leads to the clinical signs seen. Sialoceles are commonly seen in dogs but rarely in cats.
The most common clinical sign is a soft, fluctuant swelling on either side of the neck. It is not usually painful but over time it can be as the inflammatory response gets greater. Some dogs can have problems swallowing or breathing due to the compression of the mass on the trachea and esophagus.
A CBC and Chemistry profile are performed to evaluate organ function. Radiographs or ultrasounds of the cervical area can help delinate the size and shape of the cyst. A needle aspirate can be performed to withdraw the characteristic sticky, mucoid saliva.
Diagnosis is made by historical and physical findings. Laboratory data including the needle aspirate will differentiate between a salivary sialocele and a lymph node issue. The latter on aspiration would contain lymphocytes and be devoid of any mucoid saliva.
The treatment of choice is surgical removal of the salivary gland. Drains are usually inserted after surgery to prevent the formation of seroma pockets. The drains are usually removed after 3 days.
The prognosis for sialoceles is excellent. Prevention of seromas is crucial to healing. Dogs do not suffer from dry mouth by the excision of one or both salivary glands. Animals live normal lives after surgery.
Venomous snake bites are very common in the United States. Many parts of the country have venomous snakes that cross paths with humans and our companion animals. The most common venomous snakes seen are:
1. Copperheads
2. Timber Rattlesnake
3. Eastern Coral Snake
4. Water Mocassins
Venom is produced in the snakes head and penetrates into the victims body through hollow fangs.
Snake venom can cause different types of trauma or pathology in dogs or cats. Cardio-pulmonary, blood alterations and neurological signs can be produced by a distinctive venom type.
The severity of the medical emergency depends upon the number of snake bites found on the animal, the location of the bite wound on the animal plus the amount of venom that is originally in the snake. Excessive movement of the patient after a bite will spread the venom much more quickly through the body.
Two bite marks close together will be seen on patients. The majority of bite wounds on dogs and cats will be around the face, neck and forelimbs. They are extremely painful. Localized tissue inflammation and necrosis (dead cells) may be noticed at the bite area. Animals will become ataxic, seizure, collapse and have difficulty breathing. As the injury progresses, the animal becomes hypovolemic and shows signs of shock.
There is no initial time to evaluate the animal's bodily function. Any lab work done will be performed after getting the appropriate anti-venom into the animal. Venom contains many enzymes that cause the pathology; including renal disease over time. A CBC and Chemistry profile will be drawn as soon as possible to monitor for these problems.
A diagnosis can be made by an owner visualizing the pet being bit by the snake or the presence of fang marks or multiple fang bites over the head, neck and forelimb. The location where the person lives and the presence of venoumous snakes in the area will give a clue.
Time is of the essence when dealing with snake bites.. The owner should immediately restrict the animals movement as increased movement leads to faster spread of the toxin. Locate the fang marks on the dog or cat. If a veterinarian suggests it, apply a light tourniquet above the bite wound. This will slow the passage of venom through the body. Do nothing more and immediately seek emergency care. It is also important not to go after the snake yourself!! You do not want to get bit also!
In the hospital, the affected limb is immobilized, shaved and cleaned. Intravenous fluids with antihistamines are administered to combat the allergic reaction and reverse the hypovolemic state of shock. The use of drugs such as Rimadyl® are not recommended as that class of drug may slow down clotting time in snake bites. Corticosteroids also are controversial as some say the drugs make the condition worse. Blood is drawn periodically to check for clotting issues. Some animals may require whole blood transfusions. Anti-Venom, if available, may be administered. The problem is that for the anti-venom to be effective, it has to be administered no later than 4-5 hours after a bite. Antibiotics are also administered and dispensed to take care of any developing secondary bacterial infection. Animals are hospitalized for at least 3 days. Clotting issues and renal failure have to be prevented.
Once animals are treated with intravenous fluids, antihistamines, anti-venom and antibiotics, the prognosis for the animal is good. Animals not treated have a much higher mortality rate dependent upon the type of snake and amount of venom injected into the animal.
While practicing in West Palm Beach, FL I often used a Western Diamondback Rattlesnake vaccine in those dogs at a high risk of rattlesnake encounters. I have no idea if any of the animals were challenged but it is thought to be quite effective. If animals are bit, there are less severe signs of snake bite demonstrated. The vaccine produces antibodies against the snake venom protein. An initial vaccination that is than followed by a booster in a month is recommended. It should be than boostered annually after that time.