Pemphigus foliaceus

Pemphigus foliaceus (PF) is one of the most common autoimmune skin diseases in domestic animals. In this disease, the connections between skin cells are targeted by autoantibodies, resulting in the separation of the cells from each other. When the cells separate, they may form pustules/pimples that eventually form into crusts/scabs.

Pemphigus can start almost anywhere on the body; however, face, ears, tip of the nose, and pawpads are most commonly affected. Other diseases can mimic pemphigus foliaceus, so it is important your veterinarian rules out the chance for bacterial or fungal (i.e. ringworm) skin infections first. A skin biopsy, involving taking a segment of skin tissue, is required for definitive diagnosis of the disease.

There are many therapeutic options for pemphigus foliaceus; however, treatment may vary based upon areas of the skin where the pet is affected, if there’s any other infections on the pet, and suspected cause of the disease.

Corticosteroids (i.e. prednisone or similar) are the mainstay of therapy for PF and necessary in order to get the disease into remission. Once in remission, the medication is tapered to a maintenance dose over many months. Many dogs require additional immunosuppressive or anti-inflammatory therapies in order to be able to decrease the dose of steroids. The pet may need monitoring bloodwork throughout the therapies to ensure no untoward side effects.

While no therapy is without the chance of side effects, pemphigus foliaceus can be life threatening if not treated. It is the goal of the vet to be able to balance the side effects of any potential therapy with the severity of the disease. Seeking a referral for a board certified veterinary dermatologist may be of benefit, as they manage many pets with pemphigus foliaceus and various other autoimmune skin diseases. Few pets may not respond to therapy; however, the vast majority of pets will do well, even on life long, low, doses of steroids.

Blog Post Author: 
Katherine Doerr, DVM, Dip. ACVD
Dermatology for Animals

Auto-immune diseases

Our immune system is a remarkable network of communicating cells that helps our body fight the daily influx of bacteria, viruses and fungal organisms.  We are able to live in a non-sterile world with billions of cohabitating bacteria in our gut and not succumb to infection. Researchers continue to consider ways to use the immune system to fight cancer while HIV demonstrates the effects of a broken one.  Sometimes the immune system makes mistakes- it takes what should be recognized as “self” and turns it into the enemy. 

Auto-immune disease is a catchall term for when the immune system misfires and focuses an attack on the “good guys” (our own cells) in our bodies.  Antibodies are small proteins that normally label foreign material and bacteria for destruction. If a patient receives a transplant organ, then special medication needs to be given to help prevent that patient’s body from rejecting the new tissue by developing antibodies to the unique transplant  protein.  Veterinary patients also develop these self-destructive diseases where vital systems may be attacked. Red blood cells that carry oxygen, platelets that allow blood to clot and blood vessel lining cells are just some of the body parts that can be affected by auto immune disease.  Antibodies can develop against receptors between the nerves and the muscles rendering a patient unable to walk and swallow in a disease called myasthenia gravis. 

We often don’t know why these diseases develop. Some think there is a correlation between receiving vaccines (a stimulus to the immune system) or certain medications that might trigger the misfire that creates an autoimmune disease.  Animals that have immune mediated hemolytic anemia can lyse their red cells over days or in severe cases hours- creating a medical emergency as the oxygen carrying cells are destroyed and inadequate delivery of oxygen creates a life threatening illness. In the case of platelets being the target, those patients may bleed into their lungs- creating the inability to breathe, their intestines may undergo massive blood loss, or the brain may experience severe neurologic damage. In each case prompt care to suppress the immune system is needed to prevent irreversible damage. You can read more about the many autoimmune diseases at this link.

 http://www.provet.co.uk/petfacts/healthtips/autoimmunedisease.htm

Therapy is focused on decreasing the production of antibodies-usually by reducing the number of antibody producing cells such as lymphocytes. The aim is also to decrease the ability of the faulty antibodies to attach to the targeted proteins particularly because in these cases the proteins are part of “self” not “other”. This helps slow the process of destruction of the cells and the damage to certain parts of the body. Prednisone is one of the first line medications with cyclosporine, mycophenylate, leflunomide and in some cases intravenous gamma globulin (Privigen) to block the receptors for erroneous antibodies. If massive blood loss or rapid hemolysis of red cells are present survival rates are often less than 50%. A lengthy hospital stay or treatment period may be needed with prognosis remaining unclear for a week to 10 days in many cases. 

Prevention of auto immune disease involves monitoring your pet and creating a carefully thought out vaccination protocol with the guidance of your family veterinarian. Be sure pets are protected from common infectious diseases, based on their lifestyle, and that they have additional vaccines to protect from illness, but not more than necessary.  Many people are choosing to run vaccine titers on their pets. A blood test can confirm the presence of adequate antibodies to certain viruses- distemper, parvo virus and Rabies in order to avoid unnecessary administration of additional vaccines. The best prevention for any illness is close careful observation and regular interaction to know the attitude, energy and personality of your pet, so changes are apparent when they occur.

Blog Post Author:
Merrianne Burtch, DVM, DACVIM

Mushrooms - A Silent Killer

Our coastal environment is a haven for mushrooms, relatively mild moist times like fall and winter allow them to thrive here. Keep your pets away from mushrooms and try your best to remove them from your yard and property to minimize exposure for your pets. For dogs- they are a big concern. Puppies in particular may find the mushroom interesting and certain types are incredibly toxic resulting in acute liver failure and are fatal if not caught very early.

Amanita mushrooms are the most concerning for their toxicity but with prompt identification and very aggressive therapy we can save some of the dogs that ingest them. However, cost and severity of the clinical illness often prohibit the ability for some owners to treat their dogs.

If you see your pet consume a mushroom, taking a picture of it is recommended and if you can take a sample to the veterinarian. Get your pet to the veterinarian immediately. Local fungus experts (mycologists) can often help identify the toxicity of mushrooms which allows us to give some idea of prognosis.

If we are not able to make the dog vomit the mushroom (needs to be within an hour or two of ingestion) and the toxin has been absorbed, then prompt medical therapy is indicated. Supportive care to maintain blood sugar, hydration and adequate protein levels is essential to survival. Intravenous medications to help minimize the damage to the liver and in some cases draining the bile from the gall bladder is done since studies in humans indicate survival is increased with that procedure.

Here are a few links to learn more about mushroom toxicity and if in doubt call poison control or your veterinarian or veterinary emergency clinic to prevent this potentially fatal toxin.

Amanita Mushroom Toxicity

ASPCA: Mushroom Poisoning in Dogs

Toxicology Brief: Mushroom Poisoning in Dogs

Mushroom Poisonings in Dogs and Cats

Pet MD: Mushroom Poisoning in Dog

Blog Post Author:
Merrianne Burtch, DVM, DACVIM

Fat Cats

Cats, like people, have different body types, eating habits, and life styles.  It is true that a larger framed cat will carry more weight just like “big boned” people. Healthy Maine Coons and Norwegian Forest Cats, for example, easily weigh in at 18#.  However, many cats, particularly those that are indoor only and limited in their exercise, are overweight. This can sometimes create health problems such as arthritis, diabetes mellitus and hepatic lipidosis.

Arthritis is an aging change in the joints that can occur in cats, but will be exacerbated by one carrying too much weight. If your pet is sedentary and loves to eat then develops either knee or hip arthritis, the lack of muscle tone combined with too much weight can compromise that pet’s mobility when they become older. If your cat is overweight, talk to your veterinarian about a weight loss program. Just like people, decreased calorie intake and increased exercise is the best remedy. Some people feel feeding only canned food helps since it is lower in carbohydrates and higher in protein. Lower carbohydrate diet can help with weight loss.

Diabetes Mellitus in some cats is thought to be similar to type II diabetes in people. Too much carbohydrate “exhausts” the pancreatic cells that make insulin and those cells take a vacation and stop making insulin, so cats will have high blood sugar. As a result those cats drink more water, urinate more and are very hungry while they lose weight.  Some medications, such as steroids and synthetic hormones, can increase the chances of developing Diabetes Mellitus, particularly in overweight cats. In some cases diabetes can be reversed with a high protein diet, perhaps with short term use of insulin. More often reversal is successful if insulin therapy is used.

Hepatic lipidosis is a life-threatening disease that occurs when the body moves fat to the liver after a period of fasting. Big changes in the environment - moving to a new house or a new pet - or medical conditions that cause cats not to eat, can trigger this disease which can occur after about 4 days of not taking in calories. Overweight cats are more prone to this because they have more fat to mobilize. See your veterinarian if your cat has such a hunger strike for ANY reason, more so if you cat is overweight.

Keeping your cat on the thinner side can be a challenge particularly for those of us that work long hours and struggle to exercise them.  Using a laser light, food dispensing toys and restricted calories as well as frequent weigh-ins will all help in keeping your cat healthy.

          
Blog Post Author: 
Merrianne Burtch, DVM, DACVIM

Skinny Cats

Many cats will lose muscle mass and in some cases weight as they get older. In some cases it is a natural progression for the body type, but in other cases a medical reason can cause weight loss. It is important to make sure that your older cat is not suffering from an underlying disease if s/he is getting thinner with age. Common diseases in older cats include hyperthyroidism, kidney disease and gastrointestinal disease.

Hyperthyroidism is a disease that usually occurs in cats over 10 years of age. A benign growth on the thyroid gland excessively secretes the thyroid hormone significantly elevating the metabolic rate. These cats eat more, drink more and lose weight. They can become hyperactive and also urinate more in some cases. A simple blood test as well as palpation of the thyroid area can help determine if your cat is hyperthyroid. Treatment options include radioactive iodine which has a high success rate or medication given orally or topically that controls the thyroid level by blocking production of the hormone.  Surgery was historically a treatment, but many cats are not adequately treated with surgery.

Chronic kidney disease (CKD) occurs in many older cats. The capability of the kidneys to remove toxins from the body decreases over time and the cats will drink more and urinate more and in some cases lose weight. The word chronic is used because many cats will do well with a modified diet, monitoring of their weight and in some cases supplemental fluids. Cats can live a relatively good life for some time with a diagnosis of CKD.  Developing a close relationship with your family veterinarian, setting expectations and regular rechecks can help maximize that time and quality of life.

Gastrointestinal disease is a little more of an enigma in older cats. Older cats with weight loss may not seem to be sick at all until a significant amount of weight is lost. In many cases family veterinarians are looking for a metabolic reason for the weight loss in a blood test, but cats that have relatively normal blood tests will still lose weight. First task is to measure that cat’s calorie intake. If a cat is consuming enough calories and still losing weight, then something may be wrong with absorption or digestion of their food. These cats may need careful monitoring and discussion with your veterinarian on how to address the weight loss. In some cases these cats may need ultrasound or endoscopy and biopsies of the intestines to determine the reason for weight loss.

So, if your cat seems to be getting skinnier as it gets older there may be a medical reason and you should check with your family veterinarian to determine the cause.

Blog Post Author: 
Merrianne Burtch, DVM, DACVIM

Summer Time Blues

Summer is the season for outdoor fun. Our pets enjoy sharing that time with us at the beach, in the yard, camping, hiking and swimming. Many potential dangers present themselves during this season. Pet owners should know about these risks and do what they can to avoid injury.

Foxtails, a California specialty, are spike-like clusters of a grass that resemble the tail of a fox. Due to the unique shape, the foxtail only travels in one direction. It can be inhaled into the nose or lungs, caught in the fur or enter the ear canal and cause damage. In twenty years of practice I have taken foxtails from about every orifice you might imagine including lungs and unfortunately even the brain in one case. Keeping your yard free from foxtails and encouraging your pet to avoid running through any fields with foxtails is a start. Dogs with longer fur on their feet who frequent areas with foxtails should have their feet shaved to avoid getting these caught in the fur because they can migrate up between the toes through the skin. Check your dog’s ears, feet and coat for evidence of foxtails upon returning from an outing where foxtails are present.

Cocoa mulch is a popular additive to gardens and on sale at many garden stores. Because the mulch is made from shavings of cocoa beans, it often contains a percentage of theobromine—a caffeine-like substance used in chocolate that can have negative effects on your dog. Smaller amounts will just cause intestinal upset, but as the amount increases—say 4 to 8 ounces of mulch for a 50-pound dog—then the risk increases as well. Symptoms include increased heart rate, seizures and in extreme cases, death. If you use cocoa mulch in your yard check the brand since some companies remove the chemicals harmful to dogs. Any form of chocolate or caffeine can be toxic to dogs.

Snakebites and bee stings are another concern in the summer. Rattlesnake bites can be very dangerous for dogs particularly because they stick their curious noses into the sound of the rattle and often get bit on the face or the neck. Swelling, pain and anti-clotting affects of the venom create serious swelling for dogs. Anti-venin can be used to decrease the reaction but is very expensive. A vaccine is in place for rattlesnake bites but is controversial as to its effectiveness. Many people who hike in dry hot areas with their dogs in summer will get the vaccine in hopes it will decrease the reaction of their dog. Dogs also get stung around the face by bees, since they are often chasing the bees with their mouths. Cats more often get stung or bit on the feet since they engage these animals with their paws. Your pet may have an allergic reaction when stung by a bee.  Monitor your pet for swelling where bit, hives in the skin or change in breathing pattern. If you see any of these, a visit to the veterinarian is indicated to prevent severe allergic reactions.  Some people will use anti-histamines to help decrease the swelling but that might be inadequate therapy for a pet with a serious reaction.

Summer is one of the best times to be a pet owner enjoying the outdoors. Camping and hiking with your pet can bring such a sense of peace and appreciation for nature. Enjoy it well and be aware of the risks for your pet and do what you can to keep them safe.

Blog Post Author: 

Merrianne Burtch, DVM, DACVIM

What is the best way to prevent ear infections in dogs?

Dogs can get frequent yeast and bacterial infections in their ears. Dogs with heavier ear flaps (pinna) and more hair on and around the ears—cocker spaniels are classic for this problem—generally have more problems and infections. If your dog swims often it is best to try and make sure the outer part of the ear is dried afterward. Talk to your veterinarian about preventative wash with drying agents and how frequently you should use them to help keep infections from recurring.

What are some signs to watch for regarding dementia in aging animals?

What precautions might pet owners take if/when it develops? My dog has started barking, when she seldom did before. She also seems to be about 95% deaf. Is her new found barking because of deafness or might it be related to onset of dementia?

Many older dogs will display aging changes mentally as well as physically. It is possible that both the hearing loss and aging changes are contributing to your dogs new found barking. Similar to senility in people, dogs can get Cognitive Dysfunction Syndrome (CDS) which can manifest as behavior changes or loss of ability to perform routine activities. A dog’s loss of sensory input (deafness) and decreased vision at times causes them to use other means of “communication” to feel comfortable in their environment. Since talking with our dogs is how we communicate and deafness takes away this option, other methods become necessary. Some people feel a high pitched whistle still works in dogs that have lost hearing. You might try to work with a whistle and reward her when she comes to create a new form of communication. You may want to put a flashing light on her collar during the summer trips so she will be easier to locate.

There are options for trying to increase her cognitive skills. Talk to your veterinarian about your options and to see what you can safely try on your girl, i.e., diet, supplements and medications. Make sure she is not on any medications that might interact anything you give her. You can read about canine cognitive dysfunction syndrome at http://pets.webmd.com/dogs/cognitive-dysfunction-syndrome-dogs. Good luck!

What age can you safely take puppies to the park or the beach?

As long as your dog is on a leash to protect it from traffic and you are diligent in making sure no aggressive dogs are present, a safe trip to the beach and park can be made after 4 months (16 weeks) of age for most puppies. Puppies have a variable maturation of their immune systems. They get antibodies to common viruses—distemper, parvovirus and hepatitis—from their mother, but the timing for when the mother-granted antibodies stop working and the self-made antibodies start working is different for each individual puppy. That is why puppies need a series of shots. This is the reason that Rabies is not given until 16 weeks when the immune system is able to recognize proteins and make antibodies to them. Always check with your personal veterinarian regarding your particular puppy’s antibodies and immune system readiness.

Diabetes Mellitus

Diabetes Mellitus is a disease manifesting as excessive production of urine and inability to move sugar from the blood stream into body cells.  A hormone called insulin transports sugar from an animal's blood stream into cells for use in the production of energy.  Normally the sugar and fats from meals are transported to the liver cells where it is used for cell energy or stored for future use. The absence of insulin means the sugar stays in the blood stream and is filtered through the kidneys pulling excess water with it and causing excessive urination and thirst. 
 People can experience type I and type II diabetes. Type I diabetes occurs when the cells that make insulin are damaged or destroyed- this more often occurs in younger people.  Type II diabetes is an “exhaustion” of the insulin producing cells and often is secondary to inadequate exercise and excessive carbohydrate consumption.  Type II diabetes can often be reversed by lifestyle changes and helping decrease the carb burden. Normal human blood sugar runs from about 80 to 100 mg/dL and diabetics may have blood sugars up into the 250 to 400-mg/dL range and higher. 

Veterinary medicine sees both type I and type II diabetes with the majority of dogs experiencing the former and cats the latter.  Often cats have either a breed predisposition toward reduced glucose tolerance or a history of obesity and relatively high carbohydrate diets.  Luckily with cats we can often reverse the diabetes using a high protein diet, insulin therapy and evaluating medication history.  This should be done carefully with the guidance of a veterinarian.  Insulin therapy allows the exhausted pancreatic cells to have a rest and bring the toxic levels of sugar down. However a concern that injected insulin may bring the blood sugar too low exists, so blood sugar should be closely monitored.  Many cats who will eat high protein diets and bring their sugars consistently under 180 mg/dl can reverse the syndrome.  In people newer medications called GLP-1 (glucagon like peptide 1) agonists are helping type II diabetics live without insulin and maintain healthier weights.  Early studies in cats are promising but not yet clinically available. 

Dogs generally get type I diabetes with destruction of their insulin secreting (islet) cells in their pancreas and they are insulin dependent.  Human insulin types such as NPH, glargine or levemir are used in dogs currently. The insulin in these is a human recombinant protein hormone.  Historically diabetes was treated with insulin harvested from pigs or cows.  There are veterinary insulin types such as PZI or Vetsulin, which can work for dogs but become expensive for larger dogs.  Some dogs may develop diabetes after an insult to their pancreatic cells such as cancer or inflammation (pancreatitis). Because of a particular enzyme present in the ocular lenses of dogs, they may develop cataracts secondary to diabetes mellitus.  Originally we thought control of the diabetes would help slow or prevent cataracts, but it has become evident that some dogs develop them rapidly and others may not develop them for years.  Dogs who have a quality of life compromise resulting from cataracts can go through surgery to remove them.   I usually recommend consultation with a veterinary ophthalmologist after the diagnosis to help guide owners on the expected progress of the cataracts.  Some feel the administration of grape seed extract, as an anti-oxidant will slow the progression of cataracts so this is often prescribed.
If owners are willing to administer injections and carefully monitor diet, urination and energy level, most pets with diabetes mellitus can maintain a good quality of life. In cats that have a reversible version of the disease, monitoring diet by maximizing protein content, lowering carbs and increasing fats helps maintain their sugar balance.  Because high protein diet is a little more challenging for the kidneys (particularly in aging animals) these cats should have kidney values monitored closely.  Dogs do well as long as their overall pancreatic function is not compromised and their diet requirements are monitored. Higher protein and fiber with lower fat are the recommendations for canine diabetic patients. 

If you have a diabetic pet – there are many Internet chat sites where people share ideas and experiences about their pets, as well as means to track blood sugar levels for those owners who wish to learn how to measure blood sugars at home.  I find being able to measure blood sugar at home provides peace of mind and helpful information for both pet owners and veterinarians. It is very important though to always consult with your veterinarian before changing insulin dosage. Insulin is a powerful drug that may cause a dangerous drop in blood sugar, possibly leading to seizures or coma.

Our Doors are Always Open

A woman recently told me that she just moved to Santa Cruz from Santa Clara, where she routinely donated to a “no-kill” shelter in that area. She asked if I could confirm if we were also “no-kill,” as that was the only kind of shelter she would support. This is a question I am continually asked.

We’re “open-door,” not no-kill. Our doors are always open for our community’s animals – healthy, sick, old, young—we accept all animals at our shelter. We are a safe haven for the 6,000 animals we rescue, house, care for and do everything we can to get adopted. From the highly adoptable kitten to the most aggressive and potentially dangerous dog, we take them in—no questions asked. In addition to dogs, cats, rabbits and the like, we are also routinely rescue non-wildlife animals such as livestock, reptiles, fish and birds.

Our agency is the safety net and second chance for all local animals in need, whatever the reason. Whether a pet owner is hospitalized or deceased, or decides they no longer want their animal, those animals will find loving compassionate staff to welcome them at our shelter. When someone is arrested and their animal is left unattended, we step in and care for that animal.  If a house burns down and animals are at risk, we shelter them.  Our animal control officers bravely save stray and lost animals, rescue injured animals, and investigate animal abuse and mistreatment cases every day. We don’t turn an animal away regardless of space available, or the animal’s age, breed, health, temperament or physical condition. We take them all.

But why aren’t we “no-kill?” Typically, a “no-kill” shelter accepts a limited number and type of animal while they have available room. Once they are filled to capacity, they must turn new animals away, leaving them to be rescued by “open-door” shelters such as our own. A “no-kill” shelter works well when there is an “open-door” shelter operating nearby.

Because we love animals and because we see the tragic results of pet overpopulation and irresponsible pet ownership on a daily basis, the Santa Cruz County Animal Shelter has designed progressive programs to ensure that the very need for animal shelters decreases. 

Our Planned Pethood program offers low-cost spay/neuter surgeries including $5 spay/neuter/microchip for cats in South County and $50 surgeries for Pit bulls and Chihuahuas County-wide. Our Door-to-Door community outreach program helps pets stay in their homes, by providing free dog houses, food, toys, animal care counseling and support to interested owners. Our targeted humane education program in South County schools is changing the way the community values its animals, instilling more compassion and kindness into our community. Our dedicated staff and volunteers make sure that the animals at the shelter have a great quality of life with play groups, socialization, on-site veterinary care and lots of love.

We work tirelessly to care for this community’s homeless and unwanted animals and to provide resources for local families needing help to care for their animal companions. Our goal is that no animal be euthanized except those for whom euthanasia is necessary to relieve their suffering or for the safety of people and other animals. 

But for us to accomplish our goal, we need your help. We cannot do it alone. Help us help them: adopt locally rather than buy; spay/neuter and microchip your pet; be a responsible pet owner and properly socialize and care for your pet for the pet’s lifetime; volunteer to help local animals; and support our services and innovative programs that improve the lives of animals and people in Santa Cruz County.

For more information visit www.scanimalshelter.org

Hospice for Animals

When I first got the phone call from Tarah about her cat Ruby, I was not sure what I was going to be able to do to help.  On paper, Ruby was really only a candidate for one thing: euthanasia.  She was 18 years old and had not one, but two types of cancer, including one which affected her tongue.  She was also hyperthyroid and her kidneys were no longer functioning at full capacity.  At the time Tarah contacted me, Ruby was becoming lethargic and was no longer eating or drinking very much. 

You might think Tarah contacted me because she wanted to schedule euthanasia for Ruby.  Tarah’s partner, Jessica, was more than ready for this.  As a human healthcare provider, she had seen enough pain and suffering.  However, Tarah was not yet prepared to say goodbye.  Ruby was a cat Tarah had shared with her previous partner who had passed away, making it even more difficult to face the idea of life without her.  In addition, Tarah’s last experience with euthanasia had been many years ago when she felt her vet at the time had put pressure on her to make the decision.  Tarah wanted to make sure that she was not making such an irrevocable decision too soon.  At the same time, she did not want to see her beloved Ruby in distress.   So no, Tarah was not seeking euthanasia for Ruby, she was seeking hospice.

“Hospice for animals? What exactly is that?” you might ask.  Animal hospice is a relatively new but rapidly growing field in veterinary medicine.  It is closely modeled after human hospice and aims to meet the needs of a pet faced with terminal illness or a permanently debilitating condition until natural death occurs or euthanasia is chosen.  While palliative care is an integral part of hospice, hospice is not just palliative care.  It is family centered, rather than disease centered.  It is care provided to comfort, rather than to cure.  It is holistic in the sense that it includes treatment of the whole pet and the entire family, considering physical, mental and social factors, rather than just symptoms of disease.  The goal is to provide pain control and physical comfort to the pet as well as educational and emotional support for the family. 

So how could I apply the hospice concept to help Ruby and her family?  Well, when I finally met Ruby in her home, I found a spunky little cat still very much interested in life.  She approached me to ask for (actually demand) some love, purred when petted, then wandered over to curl up in a favorite spot nearby.  In reviewing her history, I learned her internist had sent a nurse to their home the previous day to administer fluids and a dose of pain medication.  Tarah and Jessica felt she seemed more comfortable and even ate a bit of food after this treatment.  I thought if we could keep Ruby hydrated and get her some consistent pain control, she might feel much better all around.   We instituted a regimen of fluids under the skin (subcutaneous), as well as pain medication they could administer easily on her gums.  In response to this Ruby began to perk up, feel more relaxed and eat more consistently.  To help Tarah and Jessica, I provided a Quality of Life Scale to empower them to assess Ruby at home.  We also discussed how Ruby’s disease might progress.  Tarah and I kept in regular communication by phone, email and text between visits, so I could help support them through the decision making process and adjust treatment as needed.

I visited Ruby several more times in the few weeks that followed.  She remained comfortable and active and continued to visit her food bowl regularly.  Tarah eventually did make the decision to say goodbye to Ruby.  She never let her get to the point of being in distress.  While it was still difficult, she had had some extra time to spend with Ruby, and was able to make the decision with peace and a clear heart.

Animal hospice is not for all families.  It can sometimes require round-the-clock care by family members and friends.  Providing that care can be emotionally and physically draining.  However, for those families not wanting aggressive therapies and yet not ready for euthanasia, it can be a very special way to honor the human-animal bond, create a period of closure and help give everyone involved the support to say goodbye.   To learn more about animal hospice visit any of the following links:

The Quality of Life Scale: http://vetsocialwork.utk.edu/docs/Quality%20of%20Life.pdf
The International Association for Animal Hospice and Palliative Care: https://www.iaahpc.org
The International Association for Pet Loss and Bereavement: http://www.aplb.org

Always feel free to contact Dr. Ravina directly with any questions at info@peacefulpawsvet.netor (831) 708-9588.

Dr. Ravina's hospice practice website is http://www.peacefulpawsvet.net.

Blog Post Author: 

Gabrielle Ravina, DVM

Emergencies

Since our beloved pets can’t tell us when something is wrong, we sometimes wonder and worry about what constitutes an emergency for our pets. Some emergencies are quite obvious and should be addressed immediately. Examples include: dog fights, being hit by car or bleeding lacerations. Less obvious signs of a potential emergency situation can stem from intestinal trouble, such as vomiting and diarrhea, ingestion of toxins, and difficulty breathing. When in doubt, the safest choice is to check in with your regular veterinarian, poison control or an emergency clinic.

We may become passive about occassional vomit or loose stool in our pets, when they have intermittent vomiting episodes, such as hairballs in cats. However, pets with vomiting and diarrhea should be very carefully monitored for the need to visit a veterinarian. It is true that animals tend to eat unusual things and often have occasional vomiting without significant illness. But pets can often feel well in spite of heading for serious dehydration. The overall demeanor of pets with gastrointestinal signs is very important to note. Puppies can be more susceptible to intestinal disease due to their limited energy stores when they cannot eat. Pets with decreased energy, reluctance to eat or inability to keep water down are significant emergencies and should be evaluated by a professional.

Dogs ingest toxins more often than cats, but in either case pets may have accessed unusual material without the owners’ knowledge. Signs of toxin ingestion can manifest in numerous ways such as hyperactivity, acute onset of severe vomiting, diarrhea, lethargy, inability to keep down water, or drooling. These are signs of a true emergency. If your pet is expressing unusual behavior, then a call or a visit to the veterinarian is indicated. ASPCA poison control reports ingestion of human prescription medications as the top reason for calls to poison control. You can talk to an advisor or veterinarian at poison control about a substance or medication your pet ingested at (888) 426-4435 (a fee may be applied) or check the web site at http://www.aspca.org/pet-care/animal-poison-control.

Emergencies that include breathing abnormalities should be treated promptly. Increased effort and bodily strain to breathe dictate an immediate trip to the vet or emergency clinic. Cats are prone to allergic bronchitis which can manifest as a cough or in acute panting and difficulty breathing. A dog who struggles to oxygenate well will want to stay upright and may widen the stance of their front legs attempting to increase the capacity of their chest to move air. Any time a pet is using the entire body or more of the abdominal muscles to breathe that might indicate fluid around the lungs and they should be seen by a veterinarian.

If you are in doubt about your pet, call your regular veterinarian or a local emergency clinic. Make sure you describe all the signs you see and carefully explain your concern. Part of being a pet owner is making sure we are good advocates for our pets. If your concern about your pet is greater than the concern expressed by staff at the veterinary hospital when you call, make sure they understand your concern and address your questions about whether your pet should be seen. If finances are a concern for you – be sure to express that to your veterinarian or the emergency staff, so they can prioritize the tests needed and you are able to work together for the best interest of your pet and a positive outcome. Communication and awareness are important parts of any veterinary visit. Remember, veterinarians also want the best for your pet and a positive healthy outcome whenever possible.

Blog Post Author: 

Merrianne Burtch, DVM, DACVIM

FIP - Feline Infectious Peritonitis

A friend left me a message this week telling me that her 7-month old kitten was ill and the family veterinarian suspected feline infectious peritonitis (FIP). With trepidation I called her back, as this is one of those unfortunate diseases that can affect young kittens, create a sense of helplessness for veterinarians, and great sorrow and loss for cat owners whose expectation for a lifetime of companionship is cut painfully short.

Identified in the 1980s by Dr. Neils Pederson at UC Davis, coronavirus is the root cause of FIP.  It is a common intestinal virus, which may manifest as mild diarrhea or even have no clinical signs when a cat is exposed. Most cats will clear the virus within weeks to months, but a small number of cats exposed to the virus can become carriers.  In a multi-cat household or breeding facility, a carrier of the virus can potentially infect the other cats through fecal and salivary contact. In the infected population, about 10% of cats develop the lethal form of FIP. While many cats exposed to the coronavirus do not become ill, those who mutate to FIP will show signs of illness such as weight loss, lethargy, fever and depression. Some kittens may have breathing changes if they develop fluid in their chest, while others will have abdominal distension from fluid in their abdomen.       

Prevention is challenging, as one cannot predict which cat in a group will mutate the coronavirus into FIP.  Maintaining good husbandry, decreasing population density and not breeding cats that have a high titer (concentration) of the coronavirus are some techniques recommended.  In a household where a cat has been diagnosed with coronavirus, some recommend not getting a new cat for a number of weeks to months and thorough cleaning of or destruction of the litter box and bedding of the affected pet. The virus can live for some time outside the body (up to six months), but is not resistant to good cleaning with detergents, bleach or disinfectants.

Diagnosis of feline infectious peritonitis is made based on age, history and an increase of the proteins called globulins that show up in blood tests. Changes in the liver values can often occur and many cats have either breathing changes or intestinal signs such as vomiting, diarrhea or weight loss. Definite diagnosis of FIP can be difficult and may include an expensive or invasive biopsy. Due to the poor prognosis and potential to affect other cats in the household, some will take the steps to reach a definite diagnosis in their pets.  Most diagnoses are made in cats 3 to 12 months of age, which is part of the heartbreak of this disease.

Treatment at this time is limited to supportive care and use of steroids to minimize the inflammation caused by the mutated virus. A newer therapy for FIP called omega interferon was introduced with early clinical trials in the past few years, but the response has not been as positive as initially hoped.  For now, the hopes are we see fewer and fewer cases of this devastating disease by prevention and decreasing situations where the virus has opportunities to spread and mutate.

Much information is available on the internet about FIP and the research and discovery as well as potential treatments for this disease continues forward. Here are a few links with information about the disease: http://www.winnfelinefoundation.org/education/cat-health-news-blog/details/cat-health-news-from-the-winn-feline-foundation/2009/07/22/understanding-fip; http://www.vetmed.ucdavis.edu/ccah/health_information/fip1.cfm;  http://www.veterinarypartner.com/Content.plx?P=SRC&S=2&SourceID=19.

Blog Post Author: 

Merrianne Burtch, DVM, DACVIM

 

ENVIRONMENTAL ALLERGY MANAGEMENT FOR DOGS & CATS

Allergic dermatitis is one of the main reasons a dog or cat visits the veterinarian. Most allergies can be categorized into one or more of the following types: parasite allergy, food allergy, or environmental allergies (also known as atopic dermatitis). Allergies can be further complicated by secondary bacterial or yeast infections on the skin or ear, resulting in crusts, greasiness, or ear problems.

A diagnosis of atopic dermatitis is based upon exclusion of the other allergies (parasite and food) and supportive history.  The gold standard of treatment for atopic dermatitis is allergen specific immunotherapy (i.e. allergy “shots” or oral allergy “drops”). The immunotherapy is based upon results of allergy testing, via either a blood test or an intradermal (skin) allergy test. This is the only therapy that specifically targets what the pet is allergic to with no long term side effects. As immunotherapy can take up to one year to effect, other treatments to manage symptoms may be used in the interim. Antihistamines and corticosteroids have been utilized for decades in order to manage allergies; however, antihistamines are only occasionally beneficial and corticosteroids are not ideal for long term use unless necessary. However, with the availability of Atopica®, Apoquel®, and now CADI (Canine Atopic Dermatitis Immunotherapeutic), veterinarians and veterinary dermatologists have other successful treatment options to manage allergy symptoms, with less chance of side effects than corticosteroids. CADI is the most novel therapy available that utilizes a specific dog antibody to target the itch mediator. The therapy is administered via a subcutaneous injection every four to six weeks by a veterinary dermatologist or approved veterinarian. However, it is still prudent to note that all symptomatic therapies have their limits and to discuss the pros and cons of each option with your veterinarian.

Environmental allergy management needs to be individualized for each patient’s specific needs. As not all dogs and cats are alike and respond the same to every therapy, one should discuss the various management options with their veterinarian to find the one that best suits the patient and the family.

Dr. Katherine Doerr is a practicing Veterinary Dermatologist at Dermatology for Animals in Aptos CA and other locations.

Blog Post Author: 

Katherine A. Doerr, DVM, Dip. ACVD

SCRATCHIN' THAT ITCH—OR NOT!

ITCH is one of the top ten reasons why clients bring their dogs to the vet. There are multiple causes for itch, stemming from multiple types of parasites, to allergies and also secondary infections. Here are some recommendations and potential steps in managing the itch in most dogs. Although cats can have skin sensitivity and allergies, most often we seen conditions described here in dogs.

Parasite hypersensitivity is the most common reasons dogs itch. Types of parasites include lice, chiggers, ticks, and most commonly, the flea. It is very important that all pets in the household are on consistent flea control, and many flea products contain agents to protect against other potential parasites. Fleas like to live in the carpeting, underneath couch cushions, under decks, and wood piles; anywhere that is dark and moist. Be sure to discuss with your veterinarian about a flea control product prior to applying to your pet, so that safety is ensured and you select the right product for your pet.

Environmental allergy is the next most common in pets. This allergy is manageable, but rarely curable and consists of allergies to pollens, molds and house dust mites. Occasionally, these allergies can respond to over-the-counter antihistamines; however, you must check with your veterinarian for the appropriate dose and formulation prior to administration, as some formulations are not good for dogs. Oral cold water marine fish oils can also be beneficial overall for the skin in therapeutic amounts. However, the only targeted therapy for environmental allergies is allergen-specific immunotherapy. This involves performing an intradermal skin test of the pet to determine what he/she may be allergic to. This is followed by formulating an injection or oral solution consisting of the pollen/mold extracts of what the pet is allergic to in the environment, and desensitizing the pet with those extracts. Side effects are minimal short term and absent long term.  Medications, other than antihistamines, may also be used for allergies but would be prescribed by a veterinarian.

Food allergy affects about 10% of the canine population. The only scientifically proven way to diagnose a food allergy is with a novel protein diet trial. This can be a homecooked diet, consisting of a single protein and carbohydrate that the pet has not be exposed to, or a prescription diet. The diet is fed for a minimum of 8 weeks, followed by a diet challenge. If the patient becomes itchy within 2 weeks of challenging the diet with the old food, then he/she is food allergic.

It is always important that secondary bacterial and/or yeast infections are evaluated for in any allergic or itchy pet. These infections come secondary to the change in the skin environment with the allergy "flare" and can be further exacerbated by the patient scratching his/her skin.

Allergies can be frustrating and confusing as many pets have a combination of allergies that all need to be managed. Appropriate diagnostics and therapy, as well as a strong veterinary-client-patient relationship is paramount to successful management of allergies in pets.

For additional information contact Katherine Doerr, DVM, DACVD; Dermatology for Animals. Aptos: 831-531-0090/Campbell: 408-871-3800

Blog Post Author: 

Guest Blog Post by Katherine Doerr, DVM; Dermatology for Animals

Thirsty again?

Pets drink different amounts of water based on the weather, exercise and specific habits. A change in diet (going from canned to dry food or visa versa) can also influence the amount a pet may drink. Sometimes your pet may drink more water as a sign of illness.  A significant change in water consumption warrants closer monitoring of your pet or a visit to the veterinarian. Medical issues such as endocrine disease, intestinal disease and blood loss can all cause an increase in water consumption.

Cats can have a significant increase in water consumption from endocrine disease such as diabetes mellitus, hyperthyroidism, and high calcium. Dogs also get diabetes mellitus but can have an increased water consumption from other endocrine changes including elevated calcium, hyperadrenocorticism (a syndrome also known as Cushing’s disease) or Addison’s disease which is an inadequate supply of certain types of adrenal hormones. These diseases more often affect middle age to older pets, but can occur in younger pets as well.  A thorough history, physical examination and testing can help identify these disease processes. Most can be identified with blood tests and evaluation of urine and usually treament can be successful.

Intestinal disease can be another reason for excess water consumption. Animals that have diarrhea have more water loss, so have to compensate for that loss. Also if absorption of nutrients or change in protein levels exist these pets may drink more to compensate for those physiological changes. Animals that are losing weight and drinking more or that have chronic diarrhea, should be evaluated for intestinal disease that might respond to therapy.

Animals that are losing blood will drink more because the body has a sense of not having enough blood available and the body tries to replace that lost volume.  Physiologically the body feels dehydrated and is trying to have enough blood to provide oxygen and nutrients to the tissues. Blood loss can be from an acute injury, trauma or a low grade chronic loss through the intestines or bleeding disorders. In these cases pale gums, dark stool or other signs might exist to help determine the source of disease and correct it.

If you notice a change in your pet’s water consumption- be sure to mention it during the annual examination with your veterinarian. Routine blood and urine tests will often catch these disorders. Pets over 10 years of age might benefit from blood test screening every 6 months rather than annually.  Any abrupt increase in water consumption that is not explained by hot weather or change in diet or exercise should be investigated since it may be a sign of treatable disease that might respond to earlier intervention.

Blog Post Author: 

Merrianne Burtch, DVM, DACVIM

Weighing In On Your Pet

Just like humans, healthy weight control for our pets can mean a longer healthier life. Especially as our pets age, it’s better for them to carry a little less weight. However, we do not want to keep them so thin that they don’t have some muscle and fat reserves should they become ill. Make certain you discuss your pet’s body condition when you’re in for an annual examination. Your veterinarian can help set a weight goal and caloric intake that’s best for your pet. If there is a concern about your pet’s weight (too high or low) your veterinarian may want you to come in for a weekly or monthly weight check. The first step is measuring and identifying the right amount of calories for a pet and their metabolic rate and exercise habits. This varies from pet to pet so a discussion with your veterinarian  to determine their ideal ‘body condition score’ may be indicated.

Weight loss that is not intentional may be the result of a medical condition. Early intervention and screening increases the chance that a medical condition can be indentified and treated successfully. When pets are losing weight without explanation a physical examination and blood test can help explain the cause. When those tests do not identify the reason and a review of calorie intake indicates that pets are consuming adequate calories, then further investigation is indicated.  Tests such as chest films and abdominal ultrasound can be used to find reasons for weight loss. Your veterinarian will want to consider primary intestinal disease as reason for weight loss in pets whose other tests do not identify a cause.

Most common in older pets are metabolic diseases such as thyroid dysfunction. In dogs, low thyroid—hypothyroid—is more common and causes weight gain. In cats thyroid dysfunction is usually overactive—hyperthyroid—and causes weight loss.  Liver and kidney disease can also cause changes in weight. If an animal has disease that causes fluid retention then weight gain can be seen. Heart and lung disease may influence weight loss because these pets are not feeling well or working hard to breathe and aren’t as interested in their food.  A thorough physical examination of your pet can help identify heart murmurs or lung changes as well as abnormalities that might be palpated in the abdomen. A metabolic screen with a blood test looking at kidney, liver and thyroid function is important when looking for a reason that a pet’s weight may be fluctuating.

When a pet has a normal physical examination and blood tests and the veterinarian and owner have determined that the calorie intake is adequate to maintain weight, then other forces are at work. Those pets might have primary intestinal disease including inflammation, bacterial imbalance in their intestines or poor absorption of nutrition from pancreatic or intestinal disease. Imaging of the intestines using radiographs (xrays) and ultrasound might be indicated in these pets. When there is evidence of intestinal disease such as vomiting, diarrhea, or loss of appetite, then some pets can undergo an endoscopy using digital camera imaging to visualize the inside of the intestines and obtain biopsies. Sometimes additional blood tests evaluating pancreatic enzyme function and B vitamin levels can identify treatable intestinal diseases such as bacterial imbalance in the intestines or inadequate digestive enzymes.

Cancer can be another reason for unexplained weight loss in pets. If you have an older pet that is losing weight without other obvious signs of disease, then xrays of the chest and an ultrasound of the abdomen is the next step in screening.  Ideally this evaluation should be done by a boarded radiologist who is skilled at identifying subtle abnormalities in the intestines and internal organs. The goal of early identification of a cancer process is that treatments including surgical removal, chemotherapy or radiation might be life sparing and in some cases might put that cancer into remission for a long period of time if not cure it. Cancer is no longer always a death sentence in pets and many can live a good quality of life after diagnosis. If your pet is diagnosed with cancer consulting with a board certified oncologist gives you the best opportunity to find out options and success rate of different treatments. The choice to treat cancer is individual and some owners might not chose to treat cancer in their pets. However, being able to make aninformed choice about options lies in knowing the options available and making the best choice for you and your pet.

Any pet over 10 years of age should have a blood test annually and a thorough physical examination with a veterinarian. Educating yourself with the reasons for any changes in your pet’s weight can help give BOTH of you more time together.

Blog Post Author: 

Merrianne Burtch, DVM, DACVIM

Tricky Treats!

Halloween has progressed from a child focused holiday of masked adventure to a full out incognito party for all ages.  Although many of our pets enjoy the extra attention from adoring fans a costume might bring, there are many parts of Halloween that can put your pets at risk.  Monitoring your pet’s reaction to environmental changes is essential to keeping them safe.

Animals that are afraid of people in hats will be particularly frightened by the myriad costumes parading around. If your pet is afraid of flapping material, costumes or loud sounds then it’s best and safest to keep them away from the celebrations. Dogs who feel the doorbell is a call to duty and want to greet or investigate every arrival may be over-stimulated by the number of visitors and frightened by the appearance and behavior of some of the guests reaching in, dressed oddly, and carrying noisy bags or lights.  Animals that are naturally shy or cautious should be given a favorite chew toy and kept away from this excess stimulus. Dogs that are prone to want to protect the family will be particularly stressed by what they see as a threat to you at every ring of the doorbell—so again, keep them in a quiet part of the house.

Candy can be a risk to pets for three reasons: chocolate is toxic, low calorie sweetener is toxic and the wrappers or sticks from lollipops can mechanically traumatize the intestines or cause blockage.  Chocolate contains a substance called Theobromine which is like caffeine and will create vomiting, diarrhea, fast heart rate and if the dose is high enough – death. Darker chocolate and higher doses pose more danger to your pet. If in doubt call an emergency clinic to discuss any dose or exposure.  Xylitol is a non-calorie sweetener that causes a life threatening release of insulin and therefore very low blood sugar in dogs and can be toxic to the liver as well in both dogs and cats. If your pet has been exposed to this substance a visit to the emergency clinic is indicated.  The wrappers, sticks and paraphernalia around Halloween candy can cause obstruction or trauma to the esophagus, stomach or intestines. So keep your pets away from all tricky treats.

Cats can be a little more sensitive to the chaos around the home on Halloween. So if you have a cat that will not be stressed by restriction to a safe part of the house keeping them indoors is best. Unfortunately the world still contains people who might chose to traumatize pets on prank-ridden nights like Halloween. Pets—especially black cats — should be safe and cozy indoors for the night before you go to bed to make sure the entire family has a safe holiday.

Costumes for pets are fun and entertaining but make sure that your pet is not becoming stressed from either wearing a costume or being paraded in front of many people.  Frightened or frustrated animals can become aggressive if they have no other outlet for their emotions.

Halloween is a fun holiday and seeing the creative approach to costumes for both people and pets can be entertaining. Make sure the fun part stays that way for your pet by keeping them safe from stress and harm.

Blog Post Author: 

Merrianne Burtch, DVM, DACVIM

BRRRRRR!!!!

We are so spoiled on the Central Coast with the usual balmy weather that this last blast of arctic air has been a bit of a surprise.  We know where the coats and gloves are kept and can use those opposable thumbs to turn up the thermostat, not so for the pets in our lives. Although the frigid weather may fade, experience now tells us that during these winter months it can come back at any time.

            Dogs that love to be outside and particularly those that are kept outside during the day may need a little more shelter or clothing when the temps drop.  If your dog is an “in the yard” during the day pet then having a shelter like an igloo or dog house will be valuable for them. Heating pads and blankets are NOT safe because dogs may chew the wires resulting in electrical burns in the mouth or worse electrocution.  Also our pet’s skin is a little more sensitive to heat that ours and thermal burns even from a low setting on a heating pad can cause skin damage.  If your pet prefers or needs to stay outside provide a blanket or bed that can be used for nesting and ideally shelter of some sort to allow that pet to trap air under a roof. When the nighttime temperatures drop below freezing, it’s best to bring your furry friends inside.

            Although we seldom get snow on the central coast, these morning of 28 degree weather can be tough on the pads of our pets that are walking or tend to do a lot of running. Be sure to check your dog’s pads for irritation, redness or discomfort particularly if you are a morning runner with your pet. You can get booties for your pet that helps protect their feet. Whether hot or cold weather—or just an increase in the amount of walking for your dog—their feet need conditioning just like ours for change in surfaces and increased friction.  You can also use a coat or sweater to help your dog stay warm when they’re outside. Especially, if you have a short haired dog or one that spends most of their time indoors and is therefore not conditioned to temperature extremes.  Be sure to remove the coat when they arrive back to the cozy house to prevent overheating.

            Cats tend to be more selective in their location during the cold winter. If you have an indoor only cat then most likely they have located the warm spot on your bed, or near the heater registers or fireplace.  If you have roaming cats that enjoy outside try to be sure they are back inside by nightfall. This not only protects them from wild animals but the temperature drops significantly with the sun these days.

Another important part of winter safety for our pets is making sure that they are not exposed to anti-freeze. Traditional anti-freeze has ethylene glycol as an ingredient.  Ethylene glycol has a sweet taste and if left on the ground can be attractive to pets and they will drink it.  It takes less than a teaspoon of antifreeze per 3 pounds of body weight to create toxicity.  Here are some sites to read more about ethylene glycol toxicity:http://www.petmd.com/dog/conditions/urinary/c_dg_antifreeze_poisoning#.UqYB5yfOS8A

http://www.merckmanuals.com/vet/toxicology/ethylene_glycol_toxicity/overview_of_ethylene_glycol_toxicity.html

Ethylene glycol causes severe damage to the kidneys within about 24 to 48 hours of ingestion and can be fatal.  Most anti-freeze has a greenish color and can be identified on the ground so keep your pets out of the garage when you are working on your car and away from puddles in parking lots that might contain this substance.

            Careful attention to our pets will help everyone enjoy the winter weather and have a happy holiday season!

Blog Post Author: 

Merrianne Burtch, DVM, DACVIM