Canine Bladder Infections: Part III

August 17th, 2014

Photo Credit: Susannah Kay

Part I of this series provided you with information about causes and symptoms of bladder infections. Part II addressed how to diagnose this common canine malady. This segment will discuss management of this disease. Those of you who have dogs with recurrent bladder infections will want to pay particularly close attention.

Management of first time offenders

For dogs experiencing their first bladder infection, the treatment of choice is a 7 to 14 day course of an antibiotic. Performing a urinalysis and urine culture is ideal, but antibiotic sensitivity testing really isn’t necessary with first timers as it is unlikely that the bacteria will have developed any antibiotic resistance.

The antibiotic chosen should be one that is known to be effective against bacteria that most commonly infect the urinary tract. Successful treatment is based on the resolution of symptoms along with normal urinalysis results and a negative urine culture performed two to three weeks following completion of antibiotic therapy.

Management of repeat offenders

For some dogs with bladder infections, the minute the course of antibiotics is completed, the symptoms begin all over again. With these guys it’s really important to do some diagnostic digging to hopefully hone in on and eliminate the underlying cause of their recurrent infections. In addition to the urine testing described above, this investigation begins with an extremely thorough physical examination (including a rectal examination) looking for any abnormality that might predispose to bladder infections. In males, such abnormalities might be an enlarged or painful prostate gland or an infection within the sheath (pouch surrounding the penis). In females, one should check for an infection in the skin fold partially covering the vulva.

If the physical exam and urine testing are not revealing, the next step is blood work (complete blood cell count and chemistry profile) looking for any clues. Specific testing to rule out Cushing’s Disease (a hormonal imbalance commonly associated with recurrent bladder infections) may be recommended.

Abdominal ultrasound comes next. This test allows inspection of the kidneys, the prostate gland, and the urinary bladder in search of stones, tumors, polyps, and anatomical defects. Unless they are significantly diseased, ultrasound does not do a good job imaging the “three U’s”: the uterus, the urethra, and the ureters (the ureters are the structures that transport urine from the kidneys to the bladder). Ultrasound creates no discomfort for the dog so sedation is usually not needed. Clipping the hair over the belly is necessary for good visualization (something the dog could care less about, but the human at the other end of the leash may object to). Buyer beware: the information gleaned from ultrasound is extremely user-dependent. This skill has a steep learning curve, and the more experience the ultrasonographer has, the greater the likelihood the results will be meaningful.

If all of the above testing does not reveal the underlying cause of recurrent infections, the final diagnostic steps are contrast studies (urethrogram, pyelogram) in which dye is used to visualize portions of the urinary tract not seen with ultrasound. These studies are performed using x-rays or computed tomography (CT scan).

Antibiotic therapy

The ideal way to manage recurrent bladder infections is to define and remove the underlying cause. In some cases, this underlying problem is not definable and/or treatable. When this happens, the judicious use of antibiotic therapy is key to keeping the dog comfortable and preventing issues that can arise secondary to chronic infection (bladder stones, spread of infection to the kidneys or bloodstream).

Choosing the most appropriate antibiotic regimen relies on multiple urine culture results including bacterial identification and antibiotic sensitivity testing. Just as in human medicine, some urinary tract bugs manage to develop a resistance pattern to multiple if not all antibiotics. Patients with such resistant infections are tricky to manage. They may need big gun antibiotics (many of which have significant potential side effects) or, if feasible, some “time off” from any antibiotic exposure with hopes that the bacteria will revert back to a more normal pattern of antibiotic sensitivity. If your dog has recurrent bladder infections, anticipate multiple urine cultures over time. Without these results a veterinarian is treating “in the dark”, and this is definitely not in the best interest of the patient.

For dogs with recurrent bladder infections, there are a two ways antibiotic therapy is typically managed:

Long-term, low-dose therapy

An antibiotic is selected based on urine culture results and the dog is treated at the standard dosage for 14 days. After 14 days, the total daily antibiotic dosage is reduced by 50 to 75 percent and is administered once daily at bedtime. This time of day is chosen because it precedes the longest stretch of urine retention (assuming the dog does not work the graveyard shift). This regimen will continue for months or even years, following a strict schedule of recheck urine cultures to verify the absence of bacteria. Long-term, low-dose antibiotic therapy is a safe and often effective means to manage recurrent bladder infections (in dogs and in people).

Pulse therapy

An antibiotic is selected based on urine culture results and the dog is treated at the standard dosage for 14 days. Just as with the protocol described above, a urine culture is repeated 7 to 10 days after treatment begins to make sure that the antibiotic has successfully eliminated the bacteria. If not, a different antibiotic is chosen and the process begins again. After 14 days, therapy is discontinued for three weeks after which pulse therapy is begun. This involves treating the dog with the antibiotic (at the standard dosage) for one week each month. There should be three-week, treatment-free intervals between treatment weeks. Pulse therapy may be continued for months to even years. Periodic urine culture results determine if a change in game plan is needed.

Additional therapies

Cranberry extracts may help prevent recurrence of some bladder infections. Cranberries contain compounds called proanthocyanidins (PAC’s) that prevent bacteria from adhering to the inner lining of the bladder wall. If the bugs can’t adhere to the bladder wall they are incapable of colonizing, multiplying, and causing infection. This PAC effect works only against E. coli, the bacteria most commonly cultured from canine bladder infections. Be aware that not just any cranberry formulation will do. Essential for success is the presence and bioactivity of PAC’s within the product. If interested in using cranberry extract, be sure to check with your veterinarian for his or her product and dosage recommendation. By the way, the notion that cranberries prevent infection by acidifying the urine is nothing more than an old wives’ tale.

Probiotics may help prevent recurrent bladder infections. This is based on the notion that altering bacterial populations in the gut will alter bacterial populations in the feces. Given that fecal microorganisms that linger on the hair coat may be the source for some bladder infections, probiotics may (emphasis on “may”) have a beneficial effect. If you decide to try a probiotic get the most bugs for your buck by purchasing a product with the highest concentration of microorganisms.

Methenamine is a drug that may help prevent bladder infections. It is converted to a dilute formaldehyde product within the bladder where it acts as an antiseptic. Methenamine is effective only in a very acidic environment (the urine pH must be low). For this reason, it is often administered with a urinary tract acidifier.

Cleansing the skin area surrounding the vulva two to three times daily provides benefit for some female dogs with recurrent bladder infections. I recommend using baby wipes for this purpose. The hope is that the concentration of normal bacteria hanging out on the skin surface will be lessened, thereby lessening the likelihood of bacterial migration up into the urinary bladder.

If your dog continues to experience recurrent bladder infections despite your family veterinarian’s best efforts, I encourage scheduling a consultation with a veterinarian who specializes in internal medicine. Visit the American College of Veterinary Internal Medicine on line to find such a specialist in your neck of the woods.

Okay, time to lay it on me! If you are struggling (or have struggled) with a dog with recurrent bladder infections I want to hear from you. What have you tried? What has worked well and what has not?

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot and Your Dog’s Best Health.   There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot and Your Dog’s Best Health are available at www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

 

 

Check the Chip Day

August 10th, 2014
Scanning lost pet for microchip

Scanning lost pet for microchip

Please note on your calendar that Friday, August 15th is “Check the Chip Day”. The “chip” refers to your pet’s microchip, and checking it means verifying that the contact information you have on file with the microchip registry is current.

In honor of “Check the Chip Day” here are three ways to ensure a happy ending should you and your pet be separated:

  • If your pet has a microchip, contact the microchip registry to verify that all of your contact information there is current and accurate.
  • If your pet has a microchip that was never registered, get the paperwork squared away right away.
  • If your pet doesn’t have a microchip, schedule an appointment with your veterinarian or local humane society or animal shelter to have one placed just as soon as possible.

There are many databases that allow you to register your pet’s microchip, but the one that is most important – the one that animal shelters and veterinarians will search – is the database maintained by the manufacturer of your pet’s microchip. The American Animal Hospital Association’s Universal Pet Microchip Lookup Tool is an Internet-based application that is linked to the registries of the majority of microchip manufacturers. You can use it to quickly access your pet’s microchip data.

In honor of “Check the Chip Day” I am rerunning a blog post from a couple years back.

Will Your Pet’s Microchip Bring Him Home?

Other than hanging identification tags on collars, I’ve always advised my clients that microchipping their dogs and cats is the best way to ensure that they will be reunited should circumstances cause their separation. As it turns out, microchipping isn’t nearly as foolproof as I’d once believed- not because the chips are defective, rather because of human error. Have a look at the following excerpt from an article in the Journal of the American Veterinary Medical Association:

In the study titled, “Characterization of animals with microchips entering animal shelters,” shelters contacted microchip registries regarding 1,943 animals but found registrations for only 58.1 percent. The registries were unable to find any information on the owner or the person who implanted the microchip for 9.8 percent of the animals. Among other recommendations, the study’s authors suggested that veterinarians and shelter personnel should not only register pet microchips at the time of implantation, but also remind the pets’ owners to update information in the registry.

Here’s the bottom line in terms of achieving the intended purpose of your pet’s microchip. At the time your dog or cat is microchipped, be sure to complete the registration materials and have them processed with the appropriate microchip registry. Ask your veterinarian, or whoever implants the microchip, to do the same. Additionally, update your microchip registry data (telephone number, email address, street address) whenever it changes. I moved to western North Carolina just over a year ago. This prompted me to change my contact information for all of my pets’ registry information, so we are in good shape. How about you and yours? If the unthinkable happens and your dog or cat goes missing, will his microchip enable him to find his way back home? If you know your contact information is not current, or you are unsure, pick up the phone or go online today. It could make all the difference.

If you have a microchip story that brought a four-legged family member home, I would love to hear it.

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot and Your Dog’s Best Health.   There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot and Your Dog’s Best Health are available at www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

Canine Bladder Infections: Part II

August 3rd, 2014

In the first article of this series you were introduced to the causes of canine bladder infections and their associated symptoms. This article will help you understand how canine bladder infections are accurately diagnosed. The process always begins with testing a urine sample.

Collection of urine samples for testing

If a bladder infection is suspected, testing the urine will be one of the first steps your veterinarian takes. There are a few different ways to collect urine from a dog.

A “free catch” sample involves catching some urine in a container as the dog urinates. The presence of bacteria in a free catch sample is nonspecific, meaning the bacteria might have originated anywhere en route to the collection container, including the bladder, urethra, vulva, prostate gland, and even the hair around the opening of the penis or vulva. In other words, bacteria found in a free catch sample may not be all that meaningful. Other possible downsides to collecting free catch urine samples are a wet hand and suspicious looks from the neighbors.

Urine can also be collected via catheterization. A plastic or rubber catheter is inserted into the end of the urethra and advanced forward into the urinary bladder. Once in the bladder, urine is withdrawn through the catheter. There are a few drawbacks to this sampling method. Most dogs experience some discomfort with the process. Additionally, it is tricky business finding the opening to the urethra in female dogs. And because the catheter comes in contact with the urethra and reproductive structures (vagina, penis, prostate gland) before reaching the bladder, one cannot be certain as to the origin of bacteria found in the urine sample.

The preferred method of urine collection is a technique called cystocentesis. This involves introducing a small needle directly into the urinary bladder. Urine is collected into a syringe attached to the needle. Other than the stress associated with restraint, there is typically no more discomfort for the dog than would be associated with a vaccination. The beauty of a cystocentesis sample is that, if bacteria are detected, one can be certain they were living in the bladder.

Diagnosis of infection

A bladder infection is definitively diagnosed when bacteria are identified within a urine sample that has been collected via cystocentesis. Supporting evidence of infection includes the presence of red blood cells and excessive white blood cells and/or protein within the urine. Keep in mind, these ancillary abnormalities can occur with a variety of urinary tract diseases other than infection.

Bacteria in the urine can be documented by two tests: urinalysis and urine culture. The combination of the two is always ideal. A urinalysis measures urine concentration and pH, screens for red blood cells, white blood cells and protein, and involves viewing the urine sample under the microscope. While this test is relatively reliable, it can produce false negative results particularly if the urine sample sits for several hours prior to testing (certainly the case when samples are sent to a commercial laboratory rather than tested in house). Over time, the bacteria have a way of disappearing from view. Additionally, if the urine sample is dilute (more water than sludge), small numbers of bacteria can readily be missed during the microscopic evaluation.

The gold standard method for documentation of bacterial infection is a urine culture. Urine is inoculated onto agar and incubated for 48 to 72 hours. This way, the growth of bacteria can be documented, and identification and sensitivity testing can be performed. These tests clarify the species of bacteria growing as well as which antibiotics the bugs are sensitive to. This is super important information, particularly when treating dogs with recurrent bladder infections.

Part III of this series will discuss the treatment of bladder infections with special attention given to those dogs who are “repeat offenders”. Please stay tuned!

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot and Your Dog’s Best Health.   There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot and Your Dog’s Best Health are available at www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

 

 

Canine Bladder Infections: Part I

July 27th, 2014

“Rocky” – Photo Credit: Shirley Zindler

If you’ve lived your life with dogs, chances are you’ve cared for one with a bladder infection. The normal urinary bladder is sterile, meaning devoid of bacteria. Infection occurs when bacteria find their way into the bladder and set up housekeeping. Bacterial cystitis (medical-speak for a bladder infection) is a super common diagnosis in the canine world. The term urinary tract infection (UTI) is often used synonymously with bacterial cystitis. Technically speaking, a UTI can mean infection anywhere within the urinary tract, and is not specific to the bladder.

Bacterial cystitis occurs most commonly in female dogs. This is attributed to the fact that compared to males, female dogs have a shorter urethra, the conduit through which urine flows from the bladder to the outside world. With only a short distance to travel in female dogs, bacteria have an easier time migrating from the skin surface up into the urinary bladder. There is no breed predisposition for bladder infections. However, small breed dogs are more susceptible to some of the underlying causes of infection described below.

Causes of infection

While not always easy or even possible to diagnose the cause of infection, there are several underlying issues that make it easier for bacteria to colonize and thrive within the urinary bladder. Anything that disrupts the normal architecture of the urinary tract or reproductive tract (the two are anatomically connected) predisposes to infection. Examples include:

  • Stones within the urinary tract
  • Tumors or polyps within the urinary or reproductive tracts
  • Foreign body within the urinary or reproductive tracts
  • Anatomical birth defects within the urinary or reproductive tracts
  • Prostate gland or testicular disease
  • Vaginal, vulvar, or uterine disease

Urine that is less concentrated (more dilute) than normal creates an environment that is bacteria-friendly. So, it‘s not unusual for bacterial cystitis to accompany diseases associated with increased thirst and increased urine volume, such as kidney failure, liver disease, some hormonal imbalances. Bladder infections occur commonly in dogs with diabetes mellitus, a hormonal imbalance that creates dilute urine. The sugar in the urine of diabetic dogs creates an ideal growth media in which bacterial organisms thrive.

Suppression of the immune system caused by disease or medication promotes bladder infections. Prednisone, a commonly prescribed anti-inflammatory medication, causes urine dilution along with immunosuppression. Not surprisingly, approximately one third of female dogs receiving prednisone develop spontaneous bladder infections.

Symptoms of infection

If ever you’ve experienced a bladder infection you know just how miserable the symptoms can be. Dogs vary a great deal in terms of how dramatically they show evidence of a bladder infection. Some exhibit every symptom in the book while others demonstrate none whatsoever. Additionally, symptoms can arise abruptly or gradually. Every dog reads the textbook a little bit differently!

Symptoms most commonly observed in association with canine bladder infections include:

  • Straining to urinate
  • Urination in inappropriate places
  • Increased frequency of urination
  • Blood within the urine
  • An unusual odor to the urine
  • Urine leakage
  • Increased thirst
  • Excessive licking at the penis or vulva

It is unusual for plain and simple bladder infections to cause lethargy, loss of appetite, or fever. Such “systemic” symptoms, in conjunction with documentation of bacteria within the urinary bladder, create suspicion for infection elsewhere within the urinary or reproductive tracts (kidneys, prostate gland, uterus).

It’s important to remember that dogs are creatures of habit, and any change in habit is a big red flag beckoning you to take notice. Filling the water bowl more than usual? Is your girl squatting more frequently than normal on her morning walks? Is she waking you up in the middle of the night to to go outside to urinate? Has your well house-trained dog begun urinating in the house? All such symptoms are worthy of medical attention. For your dog’s sake, please don’t blame urinary issues on negative behavior before first ruling out an underlying medical issue.

Stay tuned for Canine Bladder Infections: Parts II and III. These articles will discuss diagnostic testing and treatment.

Has your dog ever had a bladder infection? If so, what symptoms did you observe?

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot and Your Dog’s Best Health.   There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot and Your Dog’s Best Health are available at www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

 

Puppy Socialization Addendum

July 20th, 2014

My recent article about the pros and cons of early puppyhood socialization solicited some wonderful comments, many of which were from trainers and breeders. Thanks to all of you who responded. Here are some take home messages from our conversation:

-         We are all in agreement that socialization for puppies less than four months of age is a “must-do”.

-         Greta and two Laura’s voiced their belief that inadequate socialization is far more likely than infectious diseases to result in canine unhappy endings (rehoming, relinquishment to shelters, euthanasia). I believe this is often, but not always the case. Infectious disease prevalence varies depending on the level of canine health education within a community. As Susan suggested in her comments, find out what the risk for disease is in your neighborhood (check in on this with your veterinarian) before determining how best to socialize your pup.

-         Several readers made a good case for the argument that the “sensible socialization” I recommended was not enough for puppies to become adult dogs with calm demeanors and good manners. Kat suggested exposing youngsters to the sights, sounds, and smells of the big wide world. Greta and Gail recommended baby strollers, puppy packs, baby slings, and/or shopping carts as ways of transporting puppies out and about for socialization without ever letting their feet touch the ground. I think that this makes great sense as long as one realizes this is not a foolproof means of disease prevention.

-         We are all in agreement that public venues frequented by dogs of unknown vaccination status, such as dog parks and pet stores are to be avoided.

-         Laura directed me to a position statement on puppy socialization crafted by the American Veterinary Society of Animal Behavior. The statement reads as follows: “In general, puppies can start puppy socialization classes as early as 7-8 weeks of age. Puppies should receive a minimum of one set of vaccines at least 7 days prior to the first class and a first deworming. They should be kept up-to-date on vaccines throughout the class.”

-         A 2013 study in the Journal of the American Animal Hospital Association reported on almost 300 puppies attending puppy socialization classes before 16 weeks of age. The data was collected from four different cities. Results demonstrated that vaccinated pups attending early socialization classes (before four months of age) had no greater risk of developing canine parvovirus infection than vaccinated pups who did not attend those classes. Thank you Greta and Dr. Melissa Bain, one of the coauthors of this study, for bringing this information to my attention.

-         Certified dog behavior consultant, Caryl Wolff turned me onto her recently published book, Puppy Socialization: An Insider’s Guide to Dog Behavioral Fitness. She is in advocate of puppy socialization classes and provides her readers with tools to find just the right one.

-         All of this information has nudged me retract my earlier comments advising against socialization classes for pups under four months of age. While I can now encourage them, I cannot overemphasize the importance of performing due diligence to learn how conscientiously the trainer is screening the pups allowed into the class and disinfecting the environment. I encourage you to read the description of dog trainer Jill Kessler Miller’s puppy socialization class as it appeared in the Spring, 2014 edition of the IACP Safe Hands Journal.

Thanks to all of you who contributed your comments. You’ve re-proven the theory that, indeed, you can teach an old dog (vet) new tricks!

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot and Your Dog’s Best Health.   There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot and Your Dog’s Best Health are available at www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

Sudden Acquired Retinal Degeneration Syndrome (SARDS)

July 13th, 2014

Muffin- the inspiration for Muffin’s Halo

Over the years I’ve developed a top ten list of my most despised diseases. Those that make it to this list tend to be diseases that are untreatable, leaving me helpless to help my patient. Such is the case with Sudden Acquired Retinal Degeneration Syndrome (aka, SARDS). In addition to being untreatable, the cause of SARDS is unknown. (Note to reader: the less that is known about a disease, the longer the name of that disease.)

What we do know about SARDS

SARDS is a disease of middle age, and approximately 60% of affected dogs are females. Any breed is susceptible, but Dachshunds, Miniature Schnauzers, Pugs, Brittany Spaniels, Malteses, Bichon Frises, and mixed-breed dogs are particularly predisposed.

SARDS affects the retinas which receive visual input and then transport this information to the brain via the optic nerve. In dogs with SARDS, the photoreceptors (rods and cones) and possibly the nerve fiber layer within the thin-layered retinas undergo degenerative changes. The end result is complete blindness. These changes are microscopic in nature- one cannot detect them by performing a basic eye exam. The diagnosis of SARDS is made based on the patient’s history, the presence of partial to complete blindness in both eyes, normal appearing retinas, and characteristic changes on an electroretinogram (ERG). The ERG is a test used to evaluate photoreceptor function and is performed by veterinarians who are specialists in ophthalmology.

It’s been theorized that SARDS is an autoimmune disease in which a misbehaving immune system attacks the body’s own normal cells. Dogs with SARDS who have received immunosuppressive therapy (the treatment of choice for autoimmune diseases) have not demonstrated any clear improvement in overall outcome compared to untreated dogs.

Symptoms

All dogs with SARDS develop complete and permanent blindness over a rapid course, typically days to weeks. Stumbling, difficulty navigating at night, and failure to track treats are the most commonly reported early symptoms of visual impairment.

During the weeks to months preceding their blindness, most SARDS-affected dogs also experience marked increases in appetite and/or thirst with subsequent weight gain and changes in urinary behavior. Testing for hormonal imbalances (diabetes mellitus, Cushing’s Disease) that classically cause these symptoms is commonly pursued and typically comes up empty. Savvy veterinarians consider the possibility of SARDS before loss of vision becomes apparent. In most cases, it is not until vision wanes that the diagnosis of SARDS becomes suspect.

Long-term outcomes for affected dogs and their human companions

When a dog develops SARDS, a significant period of adjustment is required for everyone involved. Imagine living with a newly blind dog who is begging for food, drinking incessantly, and urinating copious amounts (all that water has to go somewhere).

A study of long-term outcomes in dogs with SARDS surveyed 100 people living with SARDS-affected dogs. In addition to blindness, most of the dogs were reported to have increased thirst, urine output, and appetite along with weight gain. Increased appetite was the only one of these symptoms reported to increase over the course of one year following the SARDS diagnosis.

In this study, 22 of the 100 dogs received some sort of treatment (corticosteroids, nutritional supplements, melatonin, and/or doxycycline) for their blindness. None experienced improved vision in response to therapy.

Eighty-seven percent of the dogs were reported to have moderate to excellent navigation skills within their home environments, and 81% had moderate to excellent navigation skills within their yard environments. Of the people surveyed, 48% reported making special provisions for their dogs such as the use of baby gates, fencing, and ramps, carpeting pathways to important locations, and auditory clues or scents to signify certain locations.

Thirty-seven percent of respondents reported that the relationship with their dog actually improved after the SARDS diagnosis. The authors of the study theorized that the increased time and involvement necessary to care for a blind dog may have been responsible for enhancing the human-animal connection. Only 17% reported that the relationship with their dog worsened.

Seventy-six percent of respondents ranked the quality of their dog’s life to be moderate to excellent. Only nine dogs were reported to have a poor quality of life. Of the 100 people surveyed, 95 indicated that they would discourage euthanasia if advising others caring for dogs with SARDS. One must bear in mind that those who chose to euthanize when SARDS was diagnosed were not surveyed.

This study provides truly uplifting results. While adaptation to a dog’s loss of vision usually proceeds smoothly, when one factors in the other SARDS symptoms that accompany the blindness, the challenge to maintain quality of life for everyone involved increases significantly. Dogs and the people who love them can be amazingly adaptive creatures!

Muffin’s Halo

The photo accompanying this article is of Muffin, a Poodle with cataracts. The halo apparatus he is wearing was designed by his clever companion, Silvie as a means to allow Muffin to explore his environment without bumping his face into things. While I have no direct experience with Muffin’s Halo (I just learned of this product a couple of weeks ago), the concept is intriguing to me. My impression is that this device would significantly boost a blind dog’s confidence level, particularly one who is newly blind. If you have used this product, I would value your feedback.

Have you ever cared for a blind dog? How was the quality of your lives impacted?

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot and Your Dog’s Best Health.   There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot and Your Dog’s Best Health are available at www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

Socializing Your Young Pup: Healthy or Hazardous?

July 6th, 2014

Photo Credit: ©Kathie Meier

If you want to make yourself a little crazy, ask a bunch of dog experts if it’s a good idea to socialize your youngster before completion of his or her puppy vaccinations. Guaranteed you will hear, “Absolutely!” from some and, “Absolutely not!” from others. Why the discord? While we all know that socialization with people and other dogs is developmentally beneficial for youngsters, we also recognize that most pups are not fully protected against that dastardly disease duo (distemper and parvovirus) until they’ve had the last of their puppy vaccinations at four months of age.

The Pros and Cons

Canine distemper is a highly contagious and heartbreaking disease. It spreads from dog to dog via respiratory secretions. Most puppies who contract distemper don’t survive, no matter how aggressively they are treated. Parvovirus organisms are passed in the feces of infected dogs, and they remain contagious in the environment for weeks to months after they are shed. Puppies who are sick with parvovirus disease do survive, but not without aggressive medical care that, in and of itself, can negatively impact socialization (some pups become timid and fearful in response to all of the necessary poking and prodding). Taking puppies out into the world before they have ample immunity to canine distemper and parvovirus is risky business.

On the other hand, puppies who are not well socialized from a very young age are less likely to develop into adult canine good citizens. They are more likely to develop undesirable traits such as inappropriate aggression, fear, and anxiety. Such negative behaviors often lead to dismal outcomes such as backyard isolation, rehoming, and euthanasia.

Sensible Socialization

Clearly, there are perils on both sides of the fence when it comes to early socialization. What’s a puppy raiser to do? My recommendation for pups younger than four months of age is what I refer to as “sensible socialization” involving one-on-one play dates in safe environments. Here’s what’s involved:

  • Avoid the temptation to bring your new puppy home once weaned from its mother. Ideally, littermates should remain together until at least 10 weeks of age. All that rough and tumbling between siblings builds a solid foundation for good socialization skills.
  • Allow your pup to socialize only with dogs who appear overtly healthy and are known to be up to date on their vaccines or have serology results that indicate adequate disease protection against distemper and parvovirus.
  • Your puppy’s playmates should be proven “good sports” who don’t lose their temper when reprimanding clumsy, demanding puppies.
  • One-on-one play dates are best. Interaction with more than one dog at a time can be overwhelming for puppies.
  • Puppy kindergarten classes for dogs under four months of age are risky business. Even when vaccinated “by the book” most pups experience lapses in their immune protection against distemper and parvovirus while in the midst of completing their puppy vaccinations. This has to do with individual variation in the timing of when maternal immunity (protection acquired from the mama dog) tapers off. And, one cannot tell a book by its cover- a pup with parvovirus will be contagious to other dogs several days before showing any outward symptoms of this disease.
  • Socialization should ideally take place in individual home environments rather than places that may be frequented by dogs with unknown vaccination histories. This means avoiding venues such as public recreation areas, pet stores, and dog parks.
  • Socializing with other dogs is great, but don’t forget to socialize your pup with the people you know- ideally individuals of all ages, shapes, sizes, and colors.

Please know that these “sensible socialization” recommendations represent one veterinarian’s opinion. Other veterinarians, breeders, or trainers might provide differing advice based on their experiences. It is ultimately up to you to determine how best to socialize your pup while minimizing health risks.

How have you socialized your puppies? If you are a trainer, behaviorist, veterinarian, or breeder, please do chime in.

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot and Your Dog’s Best Health.   There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot and Your Dog’s Best Health are available at www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

 

Sebaceous Adenomas

June 29th, 2014

Photo Credit: Sumner Fowler

One cannot discuss lumps and bumps in dogs without talking about sebaceous adenomas. These are, far and away, the most common benign skin tumors in dogs. Most dogs will develop at least a couple of them by the time they are senior citizens.

Sebaceous glands are microscopic structures found just beneath the skin surface. They secrete an oily substance called sebum that is transported to the skin surface via microscopic ducts. Adenomas can arise from the gland or the duct, and can develop anywhere on a dog’s body.

Sebaceous adenomas tend to be small, no more than ¼ to ½ of an inch in size. They may appear round or they can have a wart-like appearance. These benign growths occur primarily in middle-aged and older dogs. Any breed can develop sebaceous adenomas, but certain breeds are particularly predisposed: English Cocker Spaniels, Cocker Spaniels, Samoyeds, Siberian Huskies, Alaskan Malamutes, West Highland White Terriers, Cairn Terriers, Dachshunds, Miniature Poodles, Toy Poodles, Shih Tzus, Basset Hounds, Beagles, and Kerry Blue Terriers.

Because of their benign nature, the vast majority of sebaceous adenomas require no treatment whatsoever. Just about as soon as two or three are surgically removed, two or three more will develop. Surgically chasing sebaceous adenomas accomplishes nothing more than turning a dog into a patchwork quilt. There are some exceptions to the general rule of leaving sebaceous adenomas alone, and they are as follows:

- Surgical removal is warranted for those sebaceous adenomas that recurrently bleed or become infected because of self-trauma (the dog bites or chews at them), or because they get in the way of the groomer’s clippers.

- Some sebaceous adenomas secrete oodles of sebum creating the constant appearance of an oil slick on the dog’s hair coat. The grease rubs off on hands, furniture, clothing, and anything else the dog contacts. No fun!

- Some sebaceous adenomas are pretty darned unsightly, looking like warty little aliens poking through the hair coat. Although this is not bothersome for the dog, it can pose a significant psychological issue for the person living with that dog.

- If a mass believed to be a sebaceous adenoma is growing or changing in appearance, it is important to ask your veterinarian to have another look. What was thought to be a benign adenoma may be its less common cancerous cousin, a sebaceous carcinoma.

Does your dog have any sebaceous adenomas?

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot and Your Dog’s Best Health.   There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot and Your Dog’s Best Health are available at www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

Dogs and Lipomas

June 22nd, 2014

Expanding on the topic of tumors discussed last week, this blog is devoted to lipomas, aka fatty tumors. Of all the benign growths dogs develop as they age, lipomas are one of the most common. They arise from fat (lipid) cells and their favorite sites to set up housekeeping are in the subcutaneous tissue (just beneath the skin surface) of the axillary regions (armpits) and alongside the chest and abdomen. Every once in awhile lipomas develop internally within the chest or abdominal cavity. Rarely does a dog develop only one lipoma. They tend to grow in multiples and I’ve examined individual dogs with more lipomas than I could count.

Should lipomas be treated in some fashion? In the vast majority of cases, the answer is a definite, “No!” This is based on their benign, slow-growing nature. The only issue most create is purely cosmetic, which the dog could could care less about!

There are a few exceptions to the general recommendation to let sleeping lipomas lie. A fatty tumor is deserving of more attention in the following situations:

1. A lipoma is steadily growing in an area where it could ultimately interfere with mobility. The armpit is the classic spot where this happens. The emphasis here is on the phrase, “steadily growing.” Even in one of these critical areas there is no reason to surgically remove a lipoma that remains quiescent with no discernible growth.

2. Sudden growth and/or change in appearance of a fatty tumor (or any mass for that matter) warrant reassessment by a veterinarian to determine the best course of action.

3. Every once in a great while, a fatty tumor turns out to be an infiltrative liposarcoma rather than a lipoma. These are the malignant black sheep of the fatty tumor family. Your veterinarian will be suspicious of an infiltrative liposarcoma if the fine needle aspirate cytology reveals fat cells, yet the tumor feels fixed to underlying tissues. (Lipomas are normally freely moveable.) Liposarcomas should be aggressively surgically removed and/or treated with radiation therapy.

4. Occasionally a lipoma grows to truly mammoth proportions. If ever you’ve looked at a dog and thought, “Wow, there’s a dog attached to that tumor!” chances are you were looking at a lipoma. Such massive tumors have the potential to cause the dog discomfort. They can also outgrow their blood supply, resulting in possible infection and drainage from the mass. The key is to catch on to the mass’s rapid growth so as to surgically remove it before it becomes enormous in size and far more difficult to remove.

How can one prevent canine lipomas from occurring? No one knows. Anecdotally speaking, it is thought that overweight dogs are more predisposed to developing fatty tumors. While I’m not so sure I buy this, I’m certainly in favor of keeping your dog at a healthy body weight.

Does your dog have any lipomas?

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot and Your Dog’s Best Health.   There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot and Your Dog’s Best Health are available at www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

Lumps and Bumps

June 15th, 2014

Given the opportunity to examine an older dog, I’ll very likely find at least one or two cutaneous (within the skin) or subcutaneous (just beneath the skin surface) lumps and bumps. Such growths are common by-products of the aging process. In this regard, I liken them to the brown spots that appear on our skin as we get older.

The good news is that most cutaneous and subcutaneous canine tumors are benign. It’s that small population of malignant masses that keeps us on our toes. They are the reason it’s important to have your veterinarian inspect any newly discovered lumps and bumps your dog develops. The smaller a cancerous growth is at the time of treatment, in general, the better the outcome.

Pet your dog!

In terms of “lump and bump patrol,” your first order of business is to pet your dog. No doubt you and your best buddy already enjoy some doggie massage time. What I’m asking you to do is a more methodical petting session. Once a month, slowly and mindfully slide your fingers, palm sides down, along your dog’s body. Move systematically from stem to stern while inspecting for any new lumps or bumps.

Also, look and feel for changes in the size or appearance of those previously discovered. Any new findings should be addressed with your veterinarian who relies upon your help with this surveillance. Imagine your vet trying to find a tiny growth on a shaggy Sheepdog or Sheltie during the course of a single exam. Some lumps and bums are bound to be missed without your assistance.

When to see your veterinarian

Does finding a new growth mean that you must see your veterinarian right away? Not necessarily. Say that you’ve just spotted a new bump in your dog’s skin that is the size of a small pea. She is due for her annual physical examination in three months. Must you go rushing in this week with this new finding, or can it wait the three months? The answer depends on the behavior of this newly discovered growth.

My recommendation is that you continue to observe the new lump once a week. Examining it more frequently can make it difficult to accurately assess change. If the mass is growing, or otherwise changing in appearance, best to have it checked out sooner rather than later. If no changes are observed, waiting to address it at the time of the annual physical exam makes perfectly good sense.

In contrast, say that in the course of examining your best buddy you discover a prune sized, firm, subcutaneous growth that feels attached to her shoulder blade. Based on the larger size and deep attachment of this mass, better to have this one checked out right away. If in doubt, contact your veterinarian to figure out the best course of action. As with most things medical, better to be safe than sorry.

In advance of your veterinary visit, be sure to mark the location of any lumps or bumps requiring inspection. You can clip some hair over the site or mark the fur with a ribbon, hair band, or marking pen. Growths discovered at home when an animal is lying down in a relaxed, comfortable position have a habit of magically disappearing when the dog is upright and uptight in the exam room.

Fine needle aspirate for cytology

If a newly discovered growth is large enough, the usual first step your veterinarian will recommend is a fine needle aspirate for cytology. The purpose of this step is to attempt to noninvasively clarify the cell type within the mass, and whether it is benign or malignant.

Collection of a fine needle aspirate is a simple process that is easy on the dog and rarely requires any sort of sedation. Using a needle no larger than the size of a vaccination needle along with some gentle suction, your vet will remove a smattering of cells from the growth. These cells are then spit out onto a glass slide and evaluated under the microscope.

Some cytology interpretations are a slam-dunk, and can readily be interpreted by your family vet. Others require the eyeballs of a specialist- a clinical pathologist who works in a veterinary diagnostic laboratory. Remember, the goal of the cytology testing is to determine the underlying cell type, therefore whether the growth can be left alone or requires more attention. Fine needle aspirate cytology is often (but not always) definitive. If the results do not provide clarity, a surgical biopsy of the mass may be recommended.

If your veterinarian recommends surgical removal of a mass as the very first step (chooses to forego the fine needle aspirate), I encourage you to consider getting a second opinion. It is always disappointing and frustrating when a veterinarian foregoes cytology, proceeds with surgery, and the biopsy report reveals a malignancy with cancer cells extending beyond the margins of the tissue that was removed. In other words, cancer cells were clearly left behind. Had the veterinarian known in advance from the cytology report that the tumor was malignant, a different approach (much more aggressive surgery and/or radiation therapy) would have been undertaken, almost certainly resulting in a better outcome.

A second “bad news scenario” that can arise from forging ahead with surgery without benefit of fine needle aspirate cytology is failure to identify a cancerous growth that may have already spread elsewhere in the body. If the cytology reveals a malignancy, screening the rest of the body for metastasis (spread) is the logical next step. If metastasis is discovered, removal of the originally discovered mass is unlikely to provide any benefit. Rather, such surgery will only subject the patient (and the client’s pocketbook) to a needless procedure. Leaping into surgery to remove a mass without the benefit of cytology is risky business.

The importance of histopathology

If your veterinarian surgically removes a growth from your dog, do not, I repeat, do not let that tissue sample wind up in the vet clinic garbage can! A far better choice is to have the mass submitted to a veterinary diagnostic laboratory for histopathology (biopsy). There, a veterinary pathologist will evaluate paper-thin slices of the mass under the microscope to confirm the identity of the mass.

Even if a fine needle aspirate cytology indicated that the growth was benign, histopathology is warranted. On occasion, the pathologist discovers something quirky such as a malignant tumor within the center of one that is benign.

If histopathology is not affordable, ask your vet to place the growth that was removed in a small container of formalin (preservative) that you can take home for safekeeping. This way, should multiple masses begin growing at the surgery site or should your dog develop a tumor at another site, you will still be able to request histopathology on the original sample. Formalin is toxic stuff, so keep the container lid sealed tightly.

Lumps and bumps are a very normal part of the canine aging process. Teaming up with your veterinarian to assess them on a regular basis is the very best way to insure that they never create a health issue for your wonderful dog.

Does your dog have any cutaneous or subcutaneous masses? If so, have you had them evaluated by your veterinarian?

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot and Your Dog’s Best Health.   There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot and Your Dog’s Best Health are available at www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.