Common Diseases & Conditions in Pets O-P
Otitis interna is not that common in dogs or cats. Also known as an internal ear infection, it is an inflammation of the semicircular canals of the inner ear. This inflammation can be caused by bacteria, yeast or fungal infections.
When inflammation occurs at the semicircular canal area, problems of balance will occur. This balance is what causes the majority of clinical signs associated with an internal ear infection.
Clinical signs noted will vary with the severity of the infection. Some animals may just shake their heads or paw at the ear. In severely affected animals, the dog or cat may lose hearing in the ear plus have signs of vestibular disease; which include circling to the side of the infection, nytagmus (darting of the eyes) with the fast phase to the affected ear and ataxia. Some animals may vomit due to balance issues.
Damage to the ear is difficult to visualize outside of CT or MRI imaging. Cultures will be performed as deep as possible to note any bacterial or yeast growth. A CBC and Chemistry profile will be performed to rule other causes of vestibular disease; particularly in the cat!
If advanced imaging is available, a diagnosis can be arrived at. In most cases, a tentative diagnosis can be reached by ruling out other causes of vestibular disease. A fine needle aspirate of middle ear secretions can lead to potential cause of the infection.
Treatment is long term antibiotic therapy. The ear canal may need to be surgically drained. Many animals that are showing signs of vestibular disease are hospitalized to observe and prevent self inflicted trauma. Some vestibular issues can be controlled by the use of oral Meclizine®.
The prognosis for otitis interna varies with the severity of the condition. A key prognosis is the response to medical therapy. Some animals will spontaneously resolve while others will show permanent vestibular signs. Animals have a fantastic built in survivor instinct. Dogs or cats with permanent vestibular disease secondary to otitis interna will often circle and fall down. Over time, the majority will compensate and walk with their head tilted at a certain angle to walk straight! It is great to see and animals can lead a happy life!
Otitis media is also known as a middle ear infection and is commonly caused by a variety of bacterial, yeast or fungal infections. An untreated external ear infection may creep down to form a middle ear infection. In older animals cysts and other growths can impede middle ear circulation hence setting up an external or middle ear infection.
Regardless of the cause of a middle ear infection, inflammation of the anatomical area is what causes the majority of clinical signs.
Clinical signs often involve a hybrid between external and internal ear infections. Some animals may shake their heads and find it painful to open their mouths or cry out when stroked over the ears. A foul smelling ear may be present. Others may actually show signs of ataxia or in coordination due to mild vestibular signs. Hearing loss may be present since the middle ear contains the ossicles; three small bones that physically vibrate and carry sound from the tympanic membrane to the inner ear.
The most common lab test is a fine needle aspirate of the middle ear that collects secretions from the ear for culture of fungal, bacterial and yeast organisms. A culture of the external ear canal may be done since many external ear infections will drop into the middle ear.
Diagnosis of a middle ear infection may be difficult to differentiate from a pure external or internal ear infection. A collection of clinical signs may suggest one or the other. If there are vestibular signs, that would lead one to think a middle or internal ear infection. In a middle ear infection, signs of nystagmus and extreme circling or ataxia may be absent. Culturing the organism from the middle ear is also diagnostic.
Treatment of the condition is associated with treating the primary cause of the infection. Long term antibiotic therapy is used for bacterial infections. Ketoconazole is used for fungal and yeast infections. Other supportive care such as ataxia or balance issues may be taken care of by prescribing Meclizine®. The external ear canal must be kept dry and acidic with prescription ear cleaners.
The prognosis for otitis media depends upon the severity and clinical signs present. Those associated with an external ear canal have a good prognosis if treated promptly while those animals that have vestibular disease may be more difficult to treat and have a guarded prognosis.
The fact is that the majority of cats and dogs do not wear shoes! Shoes protect human feet from cuts, abrasions and the like. If a cat or dog steps on something sharp, a laceration or damage to one of its foot pads is very likely. Pad injuries can be caused by car accidents, being dragged on asphalt while an owner is driving a pickup (Yup, I have treated those!), cats jumping up on to a stove element that is on, burns, exposure to corrosive chemicals and getting caught in a chain link fence. There are probably more but these will give you a good idea.
A dog or cats foot pad sort of acts like a miniature shoe. It is composed of thick, leathery like skin that covers and protects a sweat gland under each pad. It does work in protecting the limb but can easily get injured. If torn, the lower paw area can get infected and even an abscess may form due to the presence of bacteria.
The most common clinical sign is licking at a lower limb. They are trying to remove something from their paw or respond to physical discomfort. This is what most owners see. In the medical office the pad injury is noticed. There may be just a small laceration or the entire pad may have been sheared off. Depending upon how long the animal waited for medical care, the lower limb or digits may be swollen due to an infection or abscess.
If an infection or abscess is present, a CBC is performed to check for the presence of a left shift neutrophilic leukocytosis.
Diagnosis is made by the visual appearance of an injured foot pad.
Treatment varies with the injury to the pad in question. In mild cases, the paw is cleaned, wrapped in a comfort bandage and the animal is placed on antibiotics for 14 days. To alleviate pain anti-inflammatory drugs may be prescribed. Rimadyl® for dogs and Torbutrol® drops for cats.
If the pad has been lacerated, the pad can be sutured back together or surgical glue applied to bring the wound edges together. This often has to be done with a light sedative since the animal is in pain.
Animals may have the entire pad sheared off or burned such as with car accidents or cats jumping up on hot stoves. All you can do is debribe (clean out) dead tissue and try to create a healthy wound so that granulation can take hold. The animal’s limb is bandaged plus antibiotics are prescribed for several weeks.
Wounds that are produced by irritating chemicals are treated to preserve as much pad tissue as possible. If the pad is completely destroyed or sheared off, it will not regrow since the cell type is totally different from surrounding skin.
The prognosis for pad injuries is usually excellent. During the attacks of 9/11 many of the search and rescue dogs going up into the mangled Twin Towers in NYC had many pad injuries secondary to irritants and sharp objects.
The best approach is prevention. The animal should not be allowed to run free. There is a greater risk of pad problems if the animal is not confined. Check the exterior of your home to insure that sharp objects such as nails, metal and the like do not pose a threat to your pet. Cats are natural jumpers. When cooking, do not leave the stove area unattended if cats are present.
Pancreatic insulomas are malignant tumors of the beta cells of the pancreas. The cause of the insuloma is unknown but it is most commonly seen in upper middle aged dogs and up.
The pancreas is composed of two parts: one exocrine and the other endocrine. The exocrine part produce enzymes that are needed for initial digestion of fats and sugars in the small intestine. The endocrine component consists of two types of cells; the alpha cells and beta cells. Alpha cells are responsible for the production of a hormone known as glucagon. It is responsible for raising blood sugar. The beta cells are responsible for producing the hormone known as insulin. It is responsible for lowering blood sugar. A tumor in the beta cells is called an insuloma and is characterized by the excess production of insulin. This causes a persistent hypoglycemia (low blood sugar) in the dog and associated clinical signs. Pancreatic insulomas may metastasize to the lung tissue as the disease progresses.
The most common signs are ataxia, depression, disorientation, collapse and coma.
A CBC and Chemistry profile are performed. A low blood glucose level is detected. Animals must demonstrate a persistent low blood sugar. There are tests that will measure the insulin to blood glucose ratio. Animals are fasted and the lowest blood sugar is obtained. Over time, the animal eats which forces the production of even more insulin. This is a vicious cycle that leads to persistently low blood sugars and clinical signs.
An ultrasound or CT scan may delinate the margins of the pancreatic tumor.
A diagnosis is made by the historical findings and dogs that show a persistent low blood sugar along with associated clinical signs in an upper middle aged dog and up. A CT scan can confirm the presence of a pancreatic tumor.
There is no medical cure for pancreatic insuloma. The most immediate treatment at home for dogs that show clinical signs of hypoglycemia is to smear KaroSyrup® over the oral cavity of the animal. This will rapidly raise the blood sugar and reduce clinical signs. Next stop, is a medical facility. Surgery can excise the part of the pancreas containing the tumor but cellular metastasis has usually occurred to other parts of the gland. Medical care is geared towards alleviating signs of hypogylemia and to moderate the levels of circulating insulin.
Diazoxide may be used which inhibits insulin production but it is quite expensive.
The oral administration of prednisolone or prednisone will raise a dogs blood sugar. One of the side effects of glucocorticosteroids is a hyperglycemic state. This side effect comes in handy when trying to treat persistent hypoglycemia. Breaking up a dogs meal into multiple meals also causes insulin levels to stabilize. Dietary management may sometimes be successful. Successful enough to possibly cut back on the amount of oral prednisone.
The prognosis of pancreatic insuloma depends upon the successful management of the medical condition. A poorer prognosis is the development of metastatic lesions in the lungs or other tissues.
Pancreatitis is defined as inflammation of the pancreas. Common causes of pancreatitis are excessive levels of fat in the body. In dogs and cats a leading cause of pancreatitis is obesity. Others may have concurrent diseases such as Diabetes mellitus, cholangiohepatitis or Immune Mediated Hemolytic Anemia (IMHA). A common cause in many dogs is the ingestion of spicy foods and or garbage. Once pancreatitis starts in those cases, many will turn into true insulin dependent Diabetes Mellitus. This is always seen in Miniature Schnauzers.
The pancreas is situated in the initial angle formed by the duodenum, the first part of the small intestine. When pancreatic tissue is damaged digestive enzymes can not pass into the small intestine. Instead, they leach out into the abdominal cavity digesting the pancreas itself (autolysis) and other nearby organs such as the liver. This sets up clinical signs seen commonly in the disease.
In the dog, the most frequently seen signs are vomiting and diarrhea. The presentation is different in cats. The most commonly seen feline signs are anorexia and lethargy. That is why it is sometimes hard to diagnose in cats because the initial clinical signs are so vague. Further signs in the dog are more general. Anorexia, fever, depression and abdominal pain are typical. Those general signs are seen in cats. Because of initial digestive problems, animals will lose weight. In cats this occurs lightning fast!
All internal medical cases should have a CBC and Chemistry profile performed. Chemical levels of high lipases or amylases are not diagnostic of pancreatitis even though they are elevated. A CT scan or ultrasound will visualize the pancreatic tissue. The gold standard for diagnosis of pancreatitis in the dog and cat is the Idexx® fpl (Feline) Snap Test and the Idexx® cPL (Canine) Snap Test. The feline version has a 79% sensitivity when it comes to diagnosing feline pancreatitis. Exploratories can also be performed.
Diagnosis is is made by historical findings and clinical signs. A diagnosis can be confirmed by the appropriate Idexx® Snap Test.
All cases of canine and feline pancreatitis are hospitalized with intravenous fluids. Most of the treatment revolves around supportive care. This means drugs such as Cerenia® and famotidine to control vomiting. Animals may also be placed on a broad spectrum antibiotic to prevent secondary bacterial infections and bacterial gut translocation (E. coli and Enterococcus sp.). Pancreatitis is painful and drugs are administered to control it. Butorphanol is commonly given IV to control visceral pain. Vitamins and electrolyte deficiencies are administered through the catheter. It is important to rest the pancreas. Food should not be withheld for more than 1-2 days.
Dietary management is important but differs in the management of the disease in dogs and cats. Dogs should be put on a low fat diet such as Hill’s® Prescription i/d canned or dry. In the cat, the amount of fat in the diet has nothing to do with the development of pancreatitis. Any high quality food may be administered to the animal. There is a big difference in the cat when it comes to food. Most patients are anorexic and often do not want to eat. If a cat does not eat in 3 days it will start to develop hepatic lipidosis (fatty liver). To insure that the cat eats, hospitalized patients will be syringe fed Hill’s Prescription a/d food plus gobs of Nutrical® gel. Appetite stimulants such as mirtazapine and cyproheptadine are often used. Once animals are hydrated they are discharged on supportive care plus continued treatment of the primary cause.
The prognosis for pancreatitis depends upon the primary cause and management of the primary disease causing the pancreatitis. Bouts of pancreatitis can recur if the primary condition is not managed as well as maintaining a low fat diet in dogs.
Pannus is also known as chronic superficial keratitis. It is a chronic inflammation of the cornea; which is the front clear part of the eye. The cause is an immune-mediated reaction and is seen classically in German Shepherd dogs.
In pannus, an immune-mediated reaction is thought to occur. This inflammatory response leads to chronic corneal inflammation that can lead to blindness if left untreated.
The most common sign associated with pannus is a red, fleshy piece of tissue seen over the left or right eye. Many times, both eyes are involved. These lesions are usually seen on the outer corners of the eye farthest from the nose (lateral canthus). Over time, the lesions start to advance over the cornea and become pigmented. This impairs sight and dogs can have impaired vision if not corrected.
An eye exam will be performed and a fluorescein strip will be employed to assess the integrity of the cornea and rule out corneal ulcers. All animals should be screened for glaucoma with a tonometer.
Diagnosis is made by physical exam and the presence of the typical corneal lesions present; particularly if the animal presented is a German Shepherd.
Pannus can not be cured but it can be controlled if treated before it becomes chronic. Most dogs are place on a topical corticosteroid for life. Topical antibiotics may be prescribed if there is a secondary bacterial infection. Dogs respond well with treatment. Signs may actually regress but the treatment must continue for the remainder of the animal’s life.
The prognosis for pannus is good. As long as medications are put in the eye, as directed, signs of pannus can be arrested for a prolonged period of time.
Parainfluenza is one of the common viral causes of tracheobronchitis in the dog. It is also known as one of the causative agents of kennel cough.
Parainfluenza is commonly seen in young animals that are kept in close quarters such as boarding facilities or shelters. Most young, unvaccinated animals have an immature immune system and frequently get the virus from respiratory droplets or secretions that transmit it from one animal to the next.
Clinical signs in dogs are respiratory in nature. Animals may have a fever, be off their appetite, a hacky cough plus eye and nose secretions. Some animals may have conjunctivitis. Some animals may be exposed to the virus and not demonstrate any clinical signs! They develop antibodies that neutralize the virus.
A CBC is always run to keep an eye on the white cell count. Young animals are always susceptible to secondary bacterial infections. Radiographs may be taken if the bronchi are suspected of being involved.
Diagnosis of parainfluenza is made by historical findings and a physical exam. Often by just touching the larnyngeal or tracheal areas, dogs will produce a severe, hacky cough. Chest films will also demonstrate characteristic tracheal and brochial lesions.
The goal of treatment is supportive in nature. Most animals are young and require fluid therapy and antibiotics to prevent secondary bacterial infections. In basic cases, animals are discharged on antibiotics and cough suppressants. In severe cases, associated with bronchitis, animals are always hospitalized with intravenous fluids and nebulization that is performed at least 4-5 times per day initially. They should be kept separate from other canine patients due to the contagious nature of the disease. Animals get exhausted from constant coughing. Butorphanol is routinely used to suppress cough and allow an animal to rest. Dogs that recover are discharged on antibiotics and Hycodan® syrup for cough. It is important that those animals be rechecked with followup X-Rays.
The prognosis for parainfluenza is excellent. In many dogs, the disease is self limiting and often does not produce any serious clinical signs. Animals that are aggressively treated usually do well.
The key is preventing parainfluenza in the first place. Parainfluenza is part of the core vaccine program that is administered to all dogs beginning at 6-8 weeks. This program includes subsequent boosters. The vaccine protocol should be followed exactly as prescribed by the veterinarian.
Paralysis is the inability to move a limb, several limbs or even all limbs of an animal’s body. Certain internal organs can become paralyzed such as the larynx. Paralysis can be caused by many things. One of the most common is car accidents (trauma). Others include: tick bites in Coonhound dogs, tumors, disk prolapses, firearm wounds, discospondylitis, congenital, distemper virus, any disease of the spinal cord and myastenia gravis amongst others.
Many times we take for granted our ability to get out of bed and walk to the kitchen. That basic motion requires a complex mechanism to be continuously repeated. The Central Nervous System is composed of the brain, brain stem and spinal cord. Spinal nerves leave the cord and innervate (connect to) many different types of tissues including muscle. If there is an impediment to the flow of those nerve impulses from the brain to the spinal cord to the tissue; paralysis can be the result. Paralysis is the inability to move a limb. Paresis is a weakening or decrease in the ability to move a limb. Certain parts of the body become paralyzed depending upon the location of the spinal lesion. Lesions in the lumbar vertebrae may lead to paralysis of the hind limbs. This must be differentiated from circulatory issues such as a saddle thrombus in cats.
Every paralyzed animal is different. In general terms, a paralyzed animal is not able to move the affected limb. There may be some sensation but the animal can not move that part of the body. In spastic paralysis of the hind limbs, the quadricep muscles are in a constant state of contraction and the animal holds its hind quarters underneath itself. Other animals have a flaccid paralysis in which the muscles are limp and weak and remain where they are. The problem is not just the clinical signs of paralysis but the inability of the animal to get to a food or water bowl. The inability to go out to the bathroom means an animal may soil itself unintentionally. It is the lack of mobility that leads many animals to be put down. That is the last resort, as I will discuss under treatment.
Radiographs do not show spinal cord damage except a complete severing of the spinal cord secondary to extreme trauma as a result of being hit by a car. They may also show a decrease in the intervertebral disk space. Myelograms and CT scanning may show lesions. A CBC and Chemistry profile plus other tests may be done to rule out individual causes of paralysis.
A diagnosis of paralysis may be made during physical exam but figuring out its cause can be difficult. This will take a lot of time. The client has to tell the veterinarian of any trauma to the animal. Did it get hit by a car? Did it fall down a flight of stairs? Did the animal travel where ticks were numerous? It is just those types of questions that need to be answered to try to find the actual cause of paralysis. Many times a history can not provide that, so many tests will have to be performed to rule out the many causes. The veterinarian will also test the reflexes in the affected limb. Reflexes will be checked on top of the lower limb as well on the bottom of the lower limb. The presence of some withdraw of the limb on any testing is good news.
Treatment of paralyzed animals can be difficult. One of the most common questions veterinarians get asked in these situations is if the animal will ever have normal use of the limb(s) again. My usual answer is that “I do not know”. That is an honest answer but does not stop me from trying to make that happen!
To treat paralysis is to understand the underlying cause of the issue. If it is a disk causing spinal pressure, a laminectomy or corticosteroids may be needed to take pressure off of the spinal roots. If the paralysis is caused by ticks, extreme measures are taken to rid the animal and environment of ticks and provide supportive care. Animals with paralysis that are unable to urinate or defecate on their own are difficult cases. In my experience, if an animal is going to regain reflexes and an ability to ambulate, an animal needs a period of 2 weeks to show improvement. Other therapies are acupuncture that may provide benefit to the animal.
If the animal remains paralyzed it will require a lot of dedication from the owner. The animal needs to be kept on a thick, soil proof mat that comforts the animal and prevents “bed sores” from developing. Animals can not turn over and sores may be produced by the pressure of the body on a hard surface such as a wood floor. Food and water bowls need to be kept close and anchored to the floor. They may be easily tipped over by animals attempting to get to them.
Do not give up on animals that are paralyzed in the hind quarters; even if they are fecal and or urinary incontinent! Think about purchasing or leasing a cart from K9 Carts. I once applied a cart to a dachshund that was built by my brother. It was amazing to see the dog not only immediately steer itself on the clinic sidewalk but to run over the curb so it could get to its owner! The motion of the dog and the pressure applied by the supportive belts is often enough to stimulate defecation or urination. Most veterinarians will show you how to manually empty a bladder on a dog or cat.
The prognosis for paralysis varies with the cause of the problem. Animals that have suffered a complete separation or luxation of the spinal cord have a poor prognosis. Even if the paralysis can not be treated or corrected, animals can lead a happy life; as long as the owner is committed to taking tender care of the pet as it ages.
Parvovirus is a debilitating virus that is highly contagious and is spread rapidly amongst the unvaccinated canine population.
Over the years, there have been several serotypes of Parvovirus but the one thought causing the majority of canine disease is CPV-2b. Regardless of the serotype, it is a debilitating virus that affects all unvaccinated dogs. Dogs under the age of 6 months are the most commonly infected. Doberman Pinscher and Rottweiler dogs, or their crosses, get this disease more than any other breed of dog. A lot of this is based upon the immune status of the animal. This is under genetic control.
Parvovirus is spread from one animal to another via the oral-fecal route. Feces contaminated with the virus are ingested by the unvaccinated dog. What makes Parvo extremely dangerous is that the virus can be carried on the soles of shoes and other inanimate objects such as food and water bowls. This can transfer the virus readily from an infected household to another. Making matters worse, is that Parvovirus does not act like most viruses. The majority of viruses can not survive if there isn’t a new host for it to replicate in. They die off in a few days. Not Parvo. It can sit in a snow drift for months. When the snow melts, the virus is still active!! That is why I treated a bunch of cases in late winter in my OH practice.
The Parvo problem really started in full force in 1979. I started practice in 1981 and half of a days case load was treating Parvo dogs. Every dog was coming down with it. It still exists today, particularly in shelters, but nothing like it was 30 years ago. You can give thanks to vaccines that were introduced around 1983. What we did figure out, before Parvovirus vaccine was available, that dogs could be immunized against Parvovirus by injecting them with the Cat Distemper vaccine!! It worked and prevented the disease in many a dog as a result of that heads up thinking!
The clinical signs associated with Parvovirus are usually associated with a hemorrhagic gastroenteritis. The virus replicates in the cells lining the small intestine. These cells die leading to clinical signs. Vomiting and a foul smelling bloody diarrhea are the usual initial signs. Parvo hits a dog overnight. The period of incubation is usually 5-7 days. Once a dog shows signs it goes downhill rapidly. The presence of parasites or other concurrent infections will drag a Parvo dog down even quicker. Bacteria will produce toxins that can damage kidney function and make the dog extremely ill, even septic. As the disease progresses, dehydration and further sepsis ensue. Death is rapid; usually within 24-72 hours of the first typical clinical signs. In a very few puppies there will be an immediate death due to a severe myocarditis; a severe infection of the cardiac muscle. I have only seen a few of these in my career.
Once a Parvovirus dog is presented blood work is immediated done to show the extent of the viral infection. A CBC and Chemistry profile are always performed. A low white cell count is characteristic of all Parvo dogs. There may be a neutrophilic left shift indicating a concurrent bacterial infection. These infections can be life threatening because all Parvo dogs have an absolute obliterated immune system. Not all dogs present with hemorrhagic enteritis have Parvovirus. There is an ELISA (CITE) test that is performed in most animal hospitals to confirm the diagnosis. Radiographs may also be taken to check the gastrointestinal integrity.
Parvovirus is suspected in ANY dog, but particularly those under 6 months of age, that has not been vaccinated and shows signs of hemorrhagic enteritis. Some just present sick but almost always are limp as a rag and have pale gums indicating impending circulatory collapse. If it is a Doberman Pinscher or Rottweiler, it probably IS Parvo. I have treated countless LITTERS of Dobermans or Rottweilers for Parvovirus over the years. The diagnosis can be confirmed by an in house Parvovirus ELISA test.
Treatment of Parvovirus is supportive. There is no specific drug that will cure the viral infection. All animals receive intravenous fluids that build up the circulatory system and helps to maintain kidney function. Animals are treated for vomiting and diarrhea. Parvovirus is extremely painful and all dogs are administered pain killers such as butorphanol. This is a great drug that alleviates a lot of that “visceral pain”. Antibiotics are usually given to treat and or prevent bacterial infections that almost always show up in any immunosuppressed animal; particularly puppies that have an immature immune system to begin with.
Most dogs respond to treatment within 48 hours. Easily digested diets and small amounts of oral fluids are administered to eventually wean the animal off of intravenous fluids. Dogs are sent home on medical prescription diets or they can make their own chicken and rice meals for the dog. Sports drinks are also recommended to help replenish lost electrolytes. Freezing a sports drink and tossing a few ice cubes into the animal’s water bowl will prevent over consumption of fluids. Antibiotics and other supportive products are always prescribed for home use.
The prognosis for most dogs with Parvovirus is good. My track record over the years is about 85% saved. The key is getting a dog with early clinical signs to an animal hospital. Do not wait over night because the animal may be far too gone in the morning. It is a medical emergency.
Half the battle is treating the dog, the other half is getting rid of the virus and starting a vaccine program for the sick animal plus any dogs that the sick animal may have been in contact with.
- Getting rid of the virus in the home and yard area is crucial. A solution of one part bleach to 3 parts water will kill the virus. All floors should be disinfected along with animal toys, water and food bowls or anything else the animal may have been exposed to.
- Pick up all feces in the yard to prevent other animals in the neighborhood from picking up the disease.
- All healthy pets that were in contact with the sick dog should immediately be taken to a veterinary office for exam and vaccination against the disease.
- If a pet dies, DO NOT introduce a new pet into the home for at least 4-6 weeks. Do not let any dog from anywhere enter the home for that period.
- Dogs that recover from Parvovirus may very well have a lifetime immunity to the virus but it is not worth a challenge to prove it! Wait a minimum of one month before the puppy is vaccinated for the disease. The animal’s immune system has just basically been wiped out by the disease so time is needed to build it up again.
- There is an issue of maternal antibody (passive) interfering with initial immunization but all dogs should receive their first Parvovirus immunization between 6-8 weeks of age. It than is boostered every 3-4 weeks UNTIL the dog is at a MINIMUM of 16-18 weeks of age. It is than boostered annually. It is crucial that dog owners comply with and finish a complete vaccination protocol. It is very well known that dogs that have not received boosters after 14 weeks have a 25% chance of picking up the disease. I have seen this numerous times.
- People can not get Canine Parvo Virus. I mentioned that dogs used to be vaccinated against Parvo by using the Cat Distemper vaccine before the current vaccine became available in the early 1980’s. Dogs can not get Feline Distemper and cats can not get Canine Parvovirus.
The patella or kneecap protects the knee from injury and is also embedded in the tendons that connect the quadricep muscles of the thigh to the tibial crest of the tibia. A patellar luxation is one that is caused by the patella slipping out of its normal location on the distal femur. The cause of this is almost always congenital. It is seen most frequently in: Toy Poodles, Chihuahuas, Maltese, Yorkshire Terriers and other toy breeds or their crosses.
In an animal with congenital patellar luxation, the patella that normally resides in a groove on the lower femur is extremely shallow allowing the patella to slide over to one side or the other. Some cases are permanent on one side or the other. Some may flip over to one side and than reseat itself back in the femoral groove. This is known as a patellar subluxation and almost always is medial in presentation. That means the patella slips to the inner side of the dogs hind leg.
Animals with patellar luxation usually present with a history of intermittent or constant lameness in the affected hind limb. Some animals will hold their leg out to the side. In severe cases, animals will look like they have just gotten off of a horse. They actually look bowlegged.
Orthopedic specialists may perform a CT scan as well as assess general radiographs for signs of bone dysplasia elsewhere.
Diagnosis of a patellar luxation is diagnosed by manual palpation of an unstable or unseated patella out of its normal femoral groove. Other imaging procedures will aid in the diagnosis.
Treatment of patellar luxations varies with the severity of the condition. This disease is staged in 4 different ways with grade 1 being the least problematic to stage 4 where the patella can not and will not return to its femoral groove. Many toy breeds may often require mild anti-inflammatory drugs if an animal hurt itself by running or climbing stairs. This is often the case in toy breeds. It and observation are the usual ways to go. In stage 2 through 4, specialists may perform surgical procedures that deepen the groove where the patella sits or move the tibial crest where the quadricep muscles attach. This latter procedure (transposition of the tibial crest) realigns the anatomy.
The prognosis for patellar luxations is generally good. Even if surgery is not performed, animals live a normal happy life. One great thing about dogs and cats that I have mentioned to clients over the years is that animals are lucky to be able to run around on 4 limbs! If one is affected, it usually does not slow an animal down!! Humans? You bet it will slow you down!
As the dog ages, the remaining cartilage that should hold the patella in place erodes over time. This can set up an arthritic process as the animal ages. These signs can be controlled with anti-inflammatory drugs such as Rimadyl®.
The ductus arteriosis is the vessel that carries blood from the aorta to the pulmonary artery in the unborn animal. Normally, this vessels closes when the animal is born. In patent ductus arteriosis it does not. This is a congenital defect and animals are born with it.
The ductus arteriosis plays an important functional role in the unborn animal. A dogs lungs are not functional while in the amniotic sac inside the mother. Hence, deoxygenated blood can not pass through them. Blood flows from the aorta to the puppies pulmonary artery than to the mother’s circulation to get oxygenated again than back to the puppy. When the animal is born and the lungs expand, the ductus arteriosis is supposed to close and start the normal flow of deoxygenated blood from the pulmonary artery to the lungs for oxygenation. When this does not completely seal, a fair amount of blood is diverted from the aorta thru the ductus to the pulmonary artery. This puts extra strain on the left side of the heart leading to eventual congestive heart failure. This is a very common genetic disorder seen in females the majority of the time.
Most animals that are born or very young rarely show signs of patent ductus arteriosis since they are so small. Even though there is a defect, the animal is okay since there is enough oxygen to go around. As the animal starts to gain weight, it tires more frequently, does not have the typical energy of a puppy, it may cough and have difficulty breathing. A characteristic machinery murmur is produced over the mitral valve (left heart valve).
The most common lab procedures are producing several radiographs to observe typical heart changes. The best approach is a cardiac ultrasound where blood flow can be observed.
Hearing an intense, loud machinery murmur over the left side of the heart is almost diagnostic. It can be confirmed with a cardiac ultrasound where blood flow can easily be observed.
The only treatment is surgical. Before surgery, supportive care like oxygen should be administered so that the animal is at the best anesthetic risk as possible. This is thoracic surgery and requires Positive Pressure Ventilation (PPV). Without that, the lungs would collapse during surgery. The patent ductus arteriosis is ligated (tied off) and dogs can resume normal activity in about 2 weeks.
The prognosis for animals born with PDA is very good; as long as it is diagnosed before the onset of signs of congestive heart failure. The animal should be stabilized and surgery undergone as soon as possible. Animals than can lead a normal life.
Pemphigus follicaceous is one of several autoimmune diseases that effect the skin of an animal. The cause of the condition is unknown at the time.
In normal situations a foreign antigen (virus for example) enters the body and eventually an antibody is made that protects the animal against future attacks from the same virus. This is good! In autoimmune disease, antibodies are made against cells of the animal’s body. This can include any cell type such as red cells. In Pemphigus folliaceous, antibodies are made against the skin.
This form of Pemphigus is the most common of the complex and is associated with the production of scabs, sores and ulcers around the nasal planum (bridge of the nose), distal surfaces of the limb such as foot pads, ears and eyes.
The most common diagnostic lab test is via biopsy of suspected tissue using a biopsy punch. This is sent to a pathology lab for a histopathological diagnosis.
Diagnosis is made by the presentation of clinical signs and a biopsy returned with a histopathological diagnosis of Pemphigus Folliaceous.
This is an autoimmune disease and the immune system has to be quieted. This is accomplished by treating with corticosteroids such as prednisone or prednisolone. Treatment is life long and with long term steroid use, the animal may turn Cushingoid. To minimize this, other imunosuppressive drugs like azathioprine (Imuran®) may be used. Treatment is life long and the goal is to control the immune system to minimize the clinical signs of the disease.
The prognosis for Pemphigus folliaceous depends upon the severity of the disease. Anything that causes damage to the skin should be avoided. For dogs, this would mean minimum exposure of affected areas to the ultraviolet effects of sun exposure.
Pemphigus vulgaris is one of several autoimmune diseases that effect the skin of an animal. The cause of the condition is unknown at the time.
In normal situations a foreign antigen (virus for example) enters the body and eventually an antibody is made that protects the animal against future attacks from the same virus. This is good! In autoimmune disease, antibodies are made against cells of the animal’s body. This can include any cell type such as red cells. In Pemphigus vulgaris, antibodies are made against the skin; particularly around mucous membranes.
Clinical signs associated with this disease are found around the mucous membranes of the body. Blisters or sores are found around the female vulva, anus, nostril, eyelids plus around and inside the mouth of the animal.
The most common diagnostic lab test is via biopsy of suspected tissue using a biopsy punch. This is sent to a pathology lab for a histopathological diagnosis.
Diagnosis is made by the presentation of clinical signs and a biopsy returned with a histopathological diagnosis of Pemphigus Vulgaris.
This is an autoimmune disease and the immune system has to be quieted. This is accomplished by treating with corticosteroids such as prednisone or prednisolone. Treatment is life long and with long term steroid use, the animal may turn Cushingoid. To minimize this, other imunosuppressive drugs like azathioprine (Imuran®) may be used. Treatment is life long and the goal is to control the immune system to minimize the clinical signs of the disease.
The prognosis for Pemphigus vulgaris depends upon the severity of the disease. Anything that causes damage to the skin should be avoided. For dogs, this would mean minimum exposure of affected areas to the ultraviolet effects of sun exposure.
The pericardium is the protective glove that surrounds the heart. Inflammation of this layer is known as pericarditis. The most common causes are: blunt trauma to the heart, bacterial (Pasteurella multocida) and fungal (Coccidiomycosis). In cats, causes of pericarditis can be caused by Feline Infectious Peritonitis (FIP), Toxoplasmosis and Cryptococcosis.
The pericardium consists of a thick fibrous layer and a thinner membrane layer that surrounds the heart and protects it. It produces a liquid serum that lubricates the heart so its beating is not impeded by friction. It also protects the heart against potential infectious threats. When this tissue becomes inflamed, it produces excess serum that puts excessive pressure on the heart. This becomes a vicious circle as more liquid leads to more inflammation and so on.
Clinical signs in dogs and cats are related to right sided heart failure. Lethargy and anorexia are general signs of distress but the most crucial finding in right sided failure is ascites; which is the presence of fluid in the abdomen. This puts pressure on the diaphragm making breathing much more difficult. Animals eventually become completely recumbent.
Lab work is geared towards finding a possible cause to the pericarditis. A CBC and Chemistry profile are taken to get an overview of what is happening to organs in the body. Radiographs are taken. The heart silhouette is almost impossible to see due to the inflammation and fluid buildup in the pericardial sac. Cardiac ultrasounds can also be performed. Fluid can be aspirated, with ultrasound guidance, and collected for aerobic (bacteria that need air to live) and anerobic (bacteria that do not need air to live) culture and sensitivity.
Diagnosing of pericarditis is made by historical data and a complete physical exam. Due to the fluid buildup in the pericardial sac, the intensity of the heart sounds are much lower and quite inaudible! Radiographs and cardiac ultrasounds can confirm the diagnosis. The cause may be figured out in the history or culture and sensitivity of the pericardial fluid.
The initial therapy is geared towards stabilizing the patient. This is accomplished by draining fluid out of the pericardial space. This is called pericardiocentesis. This is a serious medical condition and all animals are hospitalized. An intravenous fluid line is inserted and the causative agent is treated. Antibiotics are used for bacterial causes. Antifungals such as ketoconazole are used for fungal diseases. In case of neoplasia, such as hemangiosarcomas, chemotherapy can be instituted. It is CRUCIAL TO REMEMBER, that although signs of right sided heart failure are produced, do not use diuretics such as Lasix® in these patients as it worsens the cardiac tamponade (pressure on the heart). There are some cases where partial surgical excision of the pericardial sac is performed.
The prognosis for pericarditis is guarded. It can reoccur at any given time requiring the same prior treatment. Pericarditis that is secondary to hemangiosarcomas have a poor prognosis. The prognosis improves if the causing agent of the condition is eliminated by medical therapy.
The Pharynx is the back of the throat in man and his companion animals. Inflammation of this area is known as pharyngitis and may also cause inflammation of the tonsils. Common causes in the dog are distemper virus, kennel cough, adenovirus amongst others. In cats any respiratory virus such as rhinotracheitis and calicivirus can cause pharyngitis. Bacterial infection of the pharynx and tonsillar areas also cause the problem.
Dogs have a habit of chewing on countless types of inanimate objects. Getting sticks lodged in the pharynx or any other foreign body can cause oral lesions that can lead to pharyngitis. This can occur in cats but it is much less common than in dogs.
The pharynx is extremely vascular and normally protected by surface IgA secretory antibodies that coat it. This forms a protective barrier against invading organisms. Once that surface barrier is disrupted by foreign bodies or via ulceration of the tissue by viruses and the like, inflammation starts to kick in producing classical clinical signs. The tonsils, lymph tissues, may also get infected.
The most common clinical signs are: difficulty in swallowing food or water, extension of the neck, a hacky cough, gagging and anorexia.
Respiratory signs produced by pharyngitis need to be differentiated from other causes of cough so a CBC and Chemistry profile are performed as well as radiographs to check pulmonary functions. Culture and Sensitivity of throat secretions may show a bacterial cause.
Animals with pharyngitis are in a lot of pain and usually will not let you look in their mouths! Many times, an animal must be sedated to visually inspect the pharynx for the presence of foreign bodies or other objects. The tonsils may be inspected at the same time. Normally, they are hidden in their “crypts” but when infected will pop out of them. Diagnosis can be by visual exam or presentation of clinical signs in the dog or cat.
In the absence of a foreign body or growth, many times the cause of the pharyngitis can not be determined. Most animals are placed on a broad spectrum antibiotic for 2 weeks to treat and or prevent a secondary bacterial infection that could possibly lead to tracheitis or tracheobronchitis. Supportive measures such as nebulization therapy, warm soft foods and cough suppressants will aid in the recovery of the patient. If pharyngitis recurs over and over again, removing the tonsils usually helps. Streptococcus A that causes “strep throat” in humans can be passed to animals but the disease is self limiting in dogs and cats. However, if a human is diagnosed with strept throat, it makes sense to treat all animals in the household for it.
The prognosis for the treatment of pharyngitis in dogs and cat is excellent once treatment has been instituted.
Pneumonia is a serious respiratory disease in dogs and cats. It is so serious, that all animals are hospitalized. It is the inflammation of the lungs but is often associated with bronchopneumonia; which also involves bronchial inflammation. The most common causes of pneumonia in animals are bacterial diseases such as those caused by: Streptococcus sp, Pasteurella multocida, and Pseudomonas sp. Many bacterial pneumonia’s in dogs are secondary to viruses such as adenovirus or parainfluenza virus. One of the most commonly seen pneumonia’s in young dogs is produced by Bordetella bronchiseptica, the causing agent of “kennel cough” in the dog. Other types of pneumonia are called aspiration pneumonia’s. These are produced by the inhalation of food into the lungs via many disease processes such as anesthetic patients waking up and inhaling vomitus after the endotracheal tube has been removed.
Pneumonia causes a severe inflammation in the lung tissues and bronchi. This causes a tremendous amount of viscous mucous that is produced in response to the inflammation. This material clogs the airways all the way up top from the main bronchi, all the way down to the alveoli where oxygenated blood is exchanged at the red cell level. This clogging of the alveoli can lead to local atelectasis; a collapse of the alveolus. As the inflammation continues the lungs become “hepatic like”. Instead of the normal elastic tissue seen in the lungs, the lungs take on the texture of the liver. This makes respiration even more labored than before. The animal can not move due to oxygen depletion. Clinical signs arise from this pathophysiology.
The most common signs seen in pneumonia are: fever, anorexia, productive cough & dyspnea (difficult breathing). Some animals will produce a rattling sound in the chest. This is caused by the sound of air passing over mucous in the bronchi. Dogs and cats do not have any exercise tolerance and will often just sit there with open mouth breathing; particularly in cats. Because it is so difficult to breathe, animals can not get comfortable to sleep and will continually shift their body weight or abduct (extend out) their forelimbs making it easier for them to breathe. Some may also have nasal secretions and bilateral conjunctivitis.
Pneumonia patients require lots of lab work. A CBC and Chemistry profile will pick up any white cell elevations secondary to a bacterial infection. The Chemistry profile will profile the internal organs allowing the veterinarian to assess their function. Chest films are always taken to assess the degree of pneumonia. Radiographic signs may be all over (diffuse) or just in a few areas (focal). Bronchiolar infiltration is very easily seen. A “tracheal wash” may be taken to aspirate fluids and secretions in the trachea for culture. This will help to isolate the causing agent of the pneumonia in some cases.
Diagnosis of pneumonia is made by the history and clinical exam. Listening to the chest will produce abnormal sounds such as rales plus other wheezing sounds. The volume of the heart sounds in severe pneumonia will be muffled due to lung consolidation. Because it is so hard to breathe, the animal may present with abdominal respiration. Normally, breathing is “mixed”. The chest and abdomen move in tandem at about the same magnitude. In abdominal breathing, chest movement is minimal but abdominal breathing is exaggerated. This is an indirect attempt to move the diaphragm to get more air into the sick lungs. Diagnosis can be confirmed by radiographic findings and the cause (if bacterial) may be found via culture and sensitivity of the tracheal secretions. Aspiration pneumonia needs to be differentiated from straight pneumonia as the clinical signs are very similar. Laryngeal paralysis, cleft palates, history of surgery with intubation are just some of the factors that have to be investigated.
Treatment for pneumonia is done while the animal is hospitalized. The first treatment is cage rest and oxygen therapy, if required. The animal can not and should not move around. Young puppies have to be treated aggressively since their respiratory tract and immune systems are immature and prone to a fomenting bacterial infection that can kill them. An intravenous catheter is placed with fluids. An appropriate antibiotic is administered. Intravenous doses of Baytril® and or oral Clavamox® are usually given together. Some patients may have cephalosporins also administered. One of the most important therapies is nebulization. Animals that breathe in steam vapor, with the drug cocktail that is mixed in, will breathe so much better. This will help the dog to loosen and cough up mucous and phlegm from the bronchi and lungs. This should be done initially at least 4-5 times per day. You do not want to administer cough suppressants with a productive cough. These drugs will suppress the cough reflex allowing mucous and other debris to sit in the lung. This material is a sitting duck for bacterial infections, worsening the pneumonia. When the animal starts to feel better short walks are recommended. This will stimulate the expulsion of mucous and phlegm from the chest.
Calorie intake is also important. Animals are given Nutrical® gel plus Hill’s Prescription a/d; which is a high caloric food that aids in the convalescence of many diseases or surgical procedures.
Radiographs are periodically taken to gauge response to therapy. When radiographic signs of pneumonia are clearing and the animal is acting better and eating on its own, it may go home on antibiotics and other supportive care. It is important that the animal be kept as quiet as possible with very little initial exercise. If the animal gets stressed or is too active, the animal may relapse.
The prognosis for straight bacterial pneumonia is very good. Young puppies with pneumonia secondary to Bordetella bronchiseptica receive a guarded prognosis until the lung fields start to clear and the animal begins eating and drinking on its own. Aspiration pneumonia may resolve but is dependent upon the control of the primary cause such as laryngeal paralysis.