All the following information on this page comes courtesy of  Dr Mike Richards of www.vetinfo.com   

Acepromazine

Acepromazine is one of the most commonly used tranquilizers in veterinary medicine. It is a phenothiazine compound. Its mode of action is only partially understood but it involves blockage of dopamine nerve receptors in the brain. It causes tranquilization and also has an anti-emetic effect. This makes it especially useful for treating car sickness, since that is often a combination of fear and motion sickness in dogs.

The recommended dosage for acepromazine is 0.25mg to 1mg per pound of body weight. In most cases it is not necessary to use the higher dosages. That is not true for use in trying to control fear based aggression. Acepromazine is considered to be very safe. The average toxic dose is significantly higher than the recommended dosage (at least 20 times the dose). Despite this, acepromazine does have some significant effects that must be considered. It can cause hypotension (lowering of blood pressure). This effect may be exaggerated in Boxers and there have been anecdotal reports of death of Boxers after the use of acepromazine. In addition, acepromazine seems to make it easier for dogs with seizure disorders to have a seizure. This medication should not be used near the time of dipping or treatment with organophosphates for flea control.

Acepromazine doesn't have any pain-killing effects. Many dogs seem to be able to will themselves to overcome its effects, at least temporarily. This makes it less than ideal as a drug for dealing with aggressive or fearful dogs but there have not been better alternatives for medicating prior to the visit. It works often enough that many vets will try this approach first. We do this when we think it has a chance of helping make an office visit go easier. We just remember to continue to be very careful when examining the dog.

Acne

Dogs can get acne, too. Typically it shows up as bumps on a dog's chin that resemble those seen with acne in people. In some cases, this can be the result of allergic reactions. Plastic food bowels may be a source of these reactions in some dogs. Demodectic mange, immunosuppressive disease, drug reactions and trauma are other possible underlying causes.

Canine acne usually occurs on the chin of affected dogs. It resembles acne in humans and it tends to occur in a similar pattern, showing up in adolescence and continuing into adulthood in a small percentage of dogs. Short coated dogs, such as boxers, bulldog and Doberman pinschers are most commonly affected. Usually this is a minor problem but some dogs can develop significant infections.

It is necessary to appropriately treat any underlying disease in order to succeed in eliminating the acne long term. Most cases of canine acne can be controlled.

Mild forms of acne may just appear as reddened bumps on the skin. More severe cases may have larger hard lumps, sometimes associated with a draining tract.

It is not always necessary to treat acne. When it becomes a problem, it will often respond to treatment with a shampoo containing benzoyl peroxide. Dogs may be sensitive to gels or shampoos containing greater than 2.5% benzoyl peroxide. In really severe cases, antibiotic treatment lasting several weeks or even short term treatment with corticosteroids may be necessary.

Anemia

Anemia is the condition in which there are fewer red blood cells than normal. Hemolytic anemia describes the condition in which this loss of red blood cells occurs because the red cells break up (lyse). This can happen inside the blood vessels (intravascular hemolysis) or outside of the blood vessel (extravascular hemolysis). Hemolytic anemia can occur for many reasons, including heat stroke, parasites, viral infections. toxins and other conditions. One of the things that can cause hemolytic anemia is immune system disease --- in this case the disorder is known as immune mediated hemolytic anemia (IMHA). This is the term currently preferred for the condition formerly known as auto-immune hemolytic anemia (AIHA). The reason for the subtle name change is the recognition that much of the time the immune system really is attacking an invader -- it just happens to be one that is stuck on the red blood cell so both get destroyed.

Anemia occurs for a number or reasons but they break down into two major categories. Either blood is not being made in the first place (nonregenerative anemia) or else it is being destroyed in some manner even though it is being made by the body. If the destruction outpaces the production, anemia occurs.

Kidney failure, bone marrow disorders, some cancers, some toxins, inherited disorders, ehrlichiosis, drug reactions and iron deficiency can all lead to non-regenerative anemias.

Liver failure, heat stroke, iron deficiency, trauma, immune mediated hemolytic anemia, drug reactions, babesiosis, hemobartenollosis, inherited hemolytic anemias, intestinal parasites (hookworms, esp.) and bleeding disorders (such as von Willebrand's disease) can all lead to regenerative anemias. Even severe flea infestation can cause significant anemia in young dogs.

Alopecia

Alopecia areata is an autoimmune skin disorder that results in the loss of hair from a person's scalp -- in some cases, on the entire body. Also known as baldness, which is commonly considered a hair-thinning condition on the scalps of men, there are also many forms of baldness that can affect women.

Alopecia androgenetica refers to pattern baldness in males and females; alopecia areata refers to the loss of some hair on the head, while alopecia totalis refers to the loss of all hair on the head, and alopecia universalis to the loss of all hair on the head as well as the entire body.

Pattern Baldness

Male pattern baldness is said to affect roughly 66 percent of all men at some point in their lives. Part of the baldness gene is translated onto the X chromosome and therefore comes from the mother's side; but the mother's lineage should not be the only indicator of whether or not a man will be bald.

Car sickness

Dogs generally become sick in the car because they are frightened, not because they have real motion sickness. It is necessary to reassure your dog that these fears are groundless (which might be hard depending on how you drive). You need to get your dog used to the car by taking trips that are short enough that your dog does not exhibit the typical signs of car sickness- drooling, vomiting, etc. It may be necessary to start out by just sitting in the car together and giving your dog a treat after a few minutes. Then take very short rides followed by a treat - even if you can only make it to the end of the driveway. Gradually increase the length of the trips until your dog enjoys the car rides.

If you don't want your dog in the car, but find it necessary on occasion, you can use tranquilizers to control the nervousness with good success in most dogs. Your vet will have one that works well for him or her.

Some dogs really have motion sickness. It is possible that dramamine will work in these dogs but even in these dogs tranquilizers like acepromazine that also have anti-emetic properties usually work well.

Cataract Surgery

In the past, veterinarians waited for near blindness in both eyes before attempting cataract surgery. I am not sure of the reasoning behind this, but feel that it had a lot to do with the success rate of the surgery. In the past (prior to 1969), the success rate for cataract surgery was generally believed to be poor. Consequently, if the dog had any vision at all, its chances were just as good with or without surgery for long term vision. At this time, it is felt that the long term success rate is 90% or better for cataract surgery, if the patient is carefully selected. A cataract can be a source of visual problems in other areas of the eye if it is left alone -leakage of proteins from the lens can lead to inflammation in the eye, which can lead to glaucoma, which makes removal of the lens (cataract) much less likely to succeed. So currently, the recommendation is to remove the affected lens as soon as significant visual deficit is present. However, there are some criteria for deciding if your dog is a good surgical candidate that you might want to consider:

1. You must be willing to spend a significant amount of money AND provide a significant amount of aftercare!

2. Any inflammation present in the eye must be controlled PRIOR to surgery.

3. The retina should be evaluated prior to surgery to make sure it is functioning - the surgery may not be justified if your dog will not be able to see when it is over.

4. No other disease can be present in the eye.

5. Your dog must be cooperative about being handled and medicated. If not, the outcome of the surgery is seriously jeopardized. Be honest with yourself about this.

6. Your dog should be in good health. If your dog and you are good candidates for this surgery, it is worthwhile.

Chocolate toxicity

Chocolate contains a xanthine compound, theobromine, that is toxic in sufficient quantities. Examples of other xanthine compounds are caffeine and theophylline. The toxicity from all of these compounds is similar.

It takes a fairly large amount of chocolate to cause problems. In "The Handbook of Small Animal Practice" by Dr. Rhea Morgan, the following data is given:

The toxic dose of theobromine is about 100 to 150mg/kg

Milk chocolate contains 6mg of theobromine per ounce. Semi-sweet chocolate contains about 22mg/oz. and baking chocolate about 35 to 45mg/oz.

From this it is pretty easy to see that milk chocolate poses only a minor threat while the other forms of chocolate can be a bigger problem.

Xanthines affect primarily the central nervous system, the cardiovascular system and peripheral nerves. There is a diuretic effect as well. So the sign seen with toxicity include hyperexitablility, hyper irritability, increased heart rate, restlessness, increased urination, vomiting and muscular tremors or tenseness. Under some circumstances these signs can lead to secondary problems like hyperthermia. In severe cases, seizures or cardiac arrest can occur. Death can result from severe intoxication.

There is no specific antidote for this poisoning. Inducing vomiting can help if the ingestion is known and has occurred within one to two hours. Administration of activated charcoal may inhibit absorption of the toxin from the digestive tract. It may be necessary to use medications to control the effects of the poisoning, especially seizure control medications, oxygen therapy, intravenous fluids, and medications to control the effects on the heart.

With ingestion of milk chocolate, diarrhea is a common secondary problem. This may require therapy and often occurs 12 to 24 hours after eating the chocolate.

If you suspect chocolate poisoning and your dog or cat is showing clinical signs of the problem, it is important to contact your vet.

Cushing's Disease or Hyperadrenocorticism

Cushing's disease is probably more accurately referred to as hyperadrenocorticism -- the production of too much adrenal hormone, in particular corticosteroids. It can be naturally occurring or due to over administration of corticosteroids such as prednisone (iatrogenic Cushing's). The latter is easy to cure - just cut out the corticosteroid administration slowly to allow the body to return to normal function. The former is more difficult.

Hyperadrenocorticism occurs for two reasons --- a tumor of the adrenal gland that produces adrenal hormones or stimulation of the normal adrenal glands from the hormones that control it. The primary reason for this to occur is a pituitary gland tumor that produces excessive ACTH, which stimulates the adrenal gland to produce corticosteroids. Adrenal gland tumors account for 15% of the cases of spontaneous hyperadrenocorticism. Pituitary tumors account for 85%.

Cushing's disease causes increased drinking, increased urination, increased appetite, panting, high blood pressure, hair loss - usually evenly distributed on both sides of the body, pendulous
abdomen, thinning of the skin, calcified lumps in the skin, susceptibility to skin infections and diabetes, weakening of the heart and skeletal muscles, nervous system disease and other symptoms. Most owners reach a point where the water consumption and urination become bothersome to them.

The diagnosis of Cushing's can be done with several blood tests. A general hint of Cushing's can be obtained by a blood panel. To confirm it, a test known as a low dose dexamethasone test is done. A baseline blood sample is drawn in the morning, an injection of dexamethasone given and a follow-up blood test done 8 hours later. In a normal dog, the dexamethasone should suppress cortisol levels in the blood stream. In Cushing's disease this effect does not occur. Once the disease is diagnosed, it is possible to differentiate between the adrenal tumors and pituitary gland tumors using a second test, a high dose dexamethasone suppression test. Most dogs with pituitary tumors will have cortisol suppression on this test. There are other tests used, including ACTH response tests and urine cortisol/creatinine ratios to diagnose this disease. X-rays and ultrasonography can help determine if an adrenal gland tumor is present.

If it can be determined that there is an adrenal gland tumor, it can be removed. Many veterinarians prefer to have a specialist attempt this since the surgical risks can be high. Pituitary gland tumors are not usually removed in veterinary medicine. This situation is treated using Lysodren (o'p'-DDD, which is a relative of DDT) or ketaconazole. Some research with Deprenyl for treatment of this is being done, too, I think. Lysodren selectively kills the outer layer of the adrenal gland that produces corticosteroids. By administering it in proper amounts it is possible to kill just enough of the gland off to keep the production of corticosteroids to normal levels. Obviously, close regulation of this using blood testing is necessary since overdoing it can cause severe problems with Addison's disease - hypoadrenocorticism. Adverse reactions to Lysodren occur at times but it is the standard treatment at this time. Over medication with Lysodren can cause inappetence, vomiting, diarrhea, lethargy and weakness. If any of these signs occur then your veterinarian should be immediately notified.

Treatment of Cushing's disease caused by pituitary tumors is symptomatic therapy -- it does not cure the pituitary tumor. The average lifespan of dogs diagnosed with Cushing's, with or without treatment is estimated at 2 years by Dr. Mark Peterson, but in a recent conversation with another endocrinologist I came away with the impression that this was an "educated guess" rather than the result of extensive survey of Cushing's patients. At present, though, I think that treatment should be viewed as a means of providing a better quality lifestyle rather than as a method of extending longevity.

Diabetes Mellitus or Type 1 Diabetes

Type 1 diabetes is by far the most common in dogs. There are probably instances of type 3 diabetes (diabetes secondary to another illness, such as hyperadrenocorticism or pancreatitis) in dogs, but I think this is a relatively uncommon thing.

Corticosteroids used chronically may predispose dogs to diabetes mellitus. I am not aware of any correlation between diabetes and the use of carprofen (Rimadyl Rx). We use a lot of corticosteroids here in the Tidewater area due to the problems with allergies in our area and we do not see a high correlation between the use of corticosteroids and diabetes in our practice.

Diabetes mellitus can lead to a secondary myocarditis (malfunction of the heart muscles). This can eventually cause heart failure. The signs that this is happening include a decrease in activity or weakness associated with normal activities, difficulty breathing or increased respiratory rate,
decrease in appetite and sometimes pain or paralysis of the rear legs. Unfortunately, most of these signs can also occur for other reasons, including other complications of diabetes, like diabetic neuropathy leading to hind limb weakness or decrease in appetite associated with a loss of
control of insulin regulation. With diabetes, it is important to work very closely with your vet to monitor the treatment. Teamwork makes a huge difference in the successful maintenance of a dog or cat with diabetes.

Diabetes Control

Diet is an integral part of the treatment for diabetes. It is important to feed a maintenance diet which meets your dog's individual caloric needs and varies as little as possible. For a dog receiving insulin two times a day, the optimum feeding schedule is to feed four meals a day. One at the time of each insulin injection, one in the early afternoon and one in the late evening. It is probably best to feed a high carbohydrate, medium fiber diet. You can just add fiber to your dog's normal dog food using a fiber source such as psyllium (Metamucil), pumpkin pie filling or other fiber source. There is some difference between fiber sources (soluble vs. insoluble) and how well they work, but it may not be clinically significant. Or you can buy a commercial food containing the proper quantities of fiber. Some of these foods are Prescription Diets w/d, Science Diet Maintenance Light, Theradiet Reducing (dry), Purina Fit and Trim, Purina Dog Chow - Low Calorie Formula and Cycle 3 Light (canned). The canned version of Theradiet Reducing may have more than the optimal amount of fiber and this is also true of Prescription Diet r/d. These food vary in fiber content but no one knows for sure what the optimum amount is.

There are a lot of different recommendations on how to start insulin therapy (dosages to start with) so it is entirely possible that your vet chose a starting value that falls within one of the recommended ranges in the literature. We usually use about 0.25U per pound of body weight as a start but I have used up to 0.5U per pound in situations in which it seemed necessary to gain control of the situation as quickly as possible.

We think that most clients with dogs can learn to draw blood using the devices that come with glucometers and recommend that owners of diabetic animals purchase a glucometer. We usually recommend spot checking the blood glucose the first two to three days after starting insulin and then running a "glucose curve" after that.

A glucose curve is simply a plot of the blood glucose level over the course of an entire day. By taking blood samples and measuring blood glucose at 2 hour intervals for 6 to 8 (or even 12)samples during the day it is possible to get an idea of the effect of the administered insulin. Often it is possible to identify a problem such as overadministration of insulin, which results in very low glucose levels part of the day and very high "rebound" levels another part of the day. The more "level" the curve is during the day, the better. For us, this is the best way to fine-tune the insulin levels. Most of the time our clients catch on to what we are looking for very quickly and do most of the fine tuning themselves.

Not all pets will allow collection of blood easily. For these pets, the glucometers are not useful. It is a real challenge to try to stabilize a diabetic animal using information gathered at long intervals. It is expensive for the owners if we try to do the blood glucose curves too often. Getting the timing of when to do these down is one of the challenges of diabetes regulation.

Some vets do feel that monitoring the glucose in the urine and trying to keep it negative or only very slightly positive is an effective method of monitoring insulin administration. We thought we did OK with this before glucometers were available but we think our clients do better monitoring blood levels. Once a stable state is reached, longer testing intervals are OK. It is tempting to try to constantly fiddle with the insulin dosage but for most of our clients that seems to cause more trouble than just testing at reasonable intervals using glucose curves.

Diarrhea - Chronic

There are A LOT of causes of chronic diarrhea. So many that I am sure I will miss a number of them in the following list, but here goes: malabsorptive diseases (anything causing an inability to absorb food, such as wheat gluten sensitivity or plasmacytic-lymphocytic enteritis), maldigestion syndromes such as pancreatic insufficiency, inflammatory bowel disease, intestinal parasites (protozoans, worms, coccidia), fungal infections (rarely), damage to vital organs such as the liver or kidney leading to secondary diarrhea problems, diabetes mellitus, hypoadrenocorticism, small intestinal bacterial overgrowth, cancer, ulcers, bacterial enteritis or colitis, cecal inversion and irritable bowel syndromes.

It is important to try to decide if this is a small intestinal problem or large intestinal problem. In small intestinal disease the diarrhea tends to be pretty large volume at one time but less frequent episodes of diarrhea. In large intestinal diarrhea the volume of diarrhea tends to be smaller but episodes are more frequent. Knowing which of these is likely to be the problem helps in deciding which tests to run.

In chronic diarrhea it can be very hard to find a diagnosis. The intestinal biopsies were are very good idea. It is too bad they were not more informative. It can take multiple fecal exams to find some parasites, particularly giardia and whipworms. There are pretty good blood tests now to aid in the diagnosis of pancreatic insufficiency (blood trypsin-like immunoreactivity, folate levels, it is always wise to do general lab panels to make sure other organ systems are functioning properly. It can be helpful to rule out food sensitivity/allergy using special diets (elimination diets). Culture of the stool will sometimes reveal a bacteria that is very likely to be pathogenic, such as Salmonella or Clostridium perfringens. Special cultures can be done for Campylobacter.

If sulfasalazine does help, that is a hint that the problem is likely to be in the large intestine. If biopsies did not include the colon it may be possible to obtain the necessary biopsy samples from the colon to make a diagnosis using an endoscope with a biopsy forceps.

 In most cases, it is possible to find a cause for the diarrhea and to successfully treat it, if you are patient enough. You can tell from the long list of possible causes that it can be hard, though.

Canine Distemper Virus

For many years canine distemper virus was the most feared of the viral diseases affecting dogs. Parvovirus may have surpassed it in this regard but it is still a deadly virus that kills dogs and other members of the canine family. It is also infective to ferrets, mink, weasels and their kin among the Mustelidae family as well as raccoons, pandas and other members of the Procyonidae family. Recently it is believed to be the culprit in the death of a number of African lions. Canine distemper virus is an RNA virus from the morbillivirus family. In humans, measles is caused by a member of this virus family. Distemper virus is more likely to affect puppies than older dogs. This is probably due immunity acquired through vaccination or exposure to the virus naturally, leading to immunity. It can affect dogs of any age, though. It causes very variable clinical signs which makes ruling it out in a young sick dog a difficult process. In some dogs a transient fever, perhaps accompanied by a lack of appetite or mild depression may be the only signs of onset of distemper. Other dogs are affected by a systemic illness with nasal and ocular discharges, coughing, fever, depression, lack of appetite, vomiting and diarrhea. It is not uncommon for dogs to have some but not all signs associated with this disease. Since the inapparent infections often go undiagnosed and the severe infections often are present in dogs who die from distemper virus the mortality rate of canine distemper was always thought to be very high. Over time, it was recognized that a number of dogs were surviving the initial infection only to develop neurologic signs from one to a few weeks after infection. Seizures, behavioral changes, walking in circles and other ambulatory problems commonly develop. Many dogs who develop neurologic signs develop rhythmic motions or "tics". These are known as chorea. Sometimes affected dogs appear to be chewing gum due to the steady contractions of the muscles of the head. Dogs that survive both the initial infection and subsequent neurologic disease may go on to develop retinal damage, corneal discoloration or extreme hardness of the skin of the nose or foot pads. Infection with the distemper virus can be hard to diagnose with certainty. It is not uncommon for puppies with suggestive clinical signs to have a recent vaccination for the virus. This makes it hard to judge infection by antibody titers in many instances. There is a latent period from the time the virus enters a dog's body until clinical signs appear of approximately 10 to 14 days which means that puppies already infected may be vaccinated before clinical signs appear. The vaccination is not likely to be effective in preventing the disease when it is given after infection occurs. Sometimes the virus can be identified in infected tissues using immunofluorescent techniques. This works in the white blood cells several days after infection and in conjunctival (the pink part of the eye area) swabs up to 21 days after infection. Inclusion cysts may be seen in conjunctival swabs as well. General blood chemistry and blood cell count values are usually pretty uninformative when distemper is present. Cerebrospinal fluid (CSF) taps may indicate antibodies to distemper virus and increased protein. X-rays may show signs of pneumonia that are typical for viral infection but not definite for distemper virus alone. In many instances the course of the disease finally provides the diagnosis as initial signs of a generalized illness change to neurologic signs over time. At present there is no specific treatment to kill the distemper virus. General supportive care and control of neurologic signs such as seizures may result in a reasonable recovery from this infection. This may be a long term project, though. Prevention of infection is the best way to deal with canine distemper. Adequate vaccination of puppies is necessary. Veterinarians tend to begin vaccinations for this disease at approximately 6 weeks of age and continue until 12 or even 16 weeks of age at 3 to 4 week intervals. The vaccine is repeated due to interference with vaccination from antibodies passed to puppies in the mother's milk. These antibodies prevent the vaccine from working in about 75% of puppies at six weeks of age, about 25% of puppies at nine weeks of age and only a very few puppies at twelve weeks of age. The first vaccination is therefore an attempt to treat the 25% of puppies who are susceptible and the follow-up vaccinations are given to eventually provide protection to almost all puppies who receive vaccination. Some strains of distemper vaccine provide nearly lifelong immunity after the initial series and one-year booster while other strains provide a shorter duration of immunity. Some puppies develop signs of canine distemper following vaccination even though they do not appear to have the disease. In these puppies encephalitis occurs. This can be fatal, although most puppies probably recover. Canine distemper virus is shed in all body secretions from infected animals. Dogs may spread the virus for several weeks during the illness and subsequent recovery period. The virus is not especially stable in the environment, probably lasting no more than a few weeks. It is susceptible to disinfectants, especially the quaternary ammonium compounds such as Roccal (TM). The incidence of canine distemper infections is much lower than in the past. Good vaccination practices are almost certainly a big part of the reduction in cases of distemper. It is still present all over the world and continued vigilance on the part of veterinarians and dog owners is necessary to prevent a resurgence of this deadly illness.

Elbow Dysplasia

Elbow dysplasia is the term for an elbow joint that is malformed on X-rays. The mechanism of the malformation is unclear but it may be due to differences in the growth rates of the three bones that make up the elbow joint, particularly the humerus and ulna. In mildly affected dogs the only consequence may be arthritis. In more severely affected dogs, osteochondritis dissecans (OCD), fragmented medial coronoid processes and united anconeal processes can result from the stress in the joint. Some vets think that these problems may not be secondary but may actually be the primary problems and that the bone changes occur as a result of them. It is difficult to be sure but there does appear to be measurable differences in bone growth in dogs that have elbow dysplasia. There are a number of changes visible on X-rays and the OFA does evaluate X-rays for evidence of elbow dysplasia.

Due to the number of possible complications, it is hard to make predictions about how elbow dysplasia will affect a dog. If it can be identified at a young age before changes are severe, surgical correction has a reasonably good success rate. Once severe changes set in, it is much harder to prevent subsequent arthritic changes. Most dogs with this condition eventually become lame and the lameness can be very severe in some dogs, even to the point of disuse of one leg or severe difficult getting up and walking even short distances.

Treatment consists of surgical correction of whatever complications are present, if possible. Medical management using aspirin or other anti-inflammatory medications is helpful. Weight control is very important over the long term for success of either surgical or medical management of this

Epilepsy and Seizure.

Epilepsy is a term used to describe seizures that can not be explained by identifying a source of the seizure activity. So it is a pretty broad term really. It covers any unidentifiable brain disorder that leads to seizure activity. Congenital epilepsy normally shows up in by the time a dog is two or three years of age.

Brain tumors are possible in almost any case of seizuring but brain tumors often have some other identifiable clinical symptoms since they often damage nerves exiting the brain or the centers that control these nerves. So gait abnormalities, facial paralysis, vestibular disorders, blindness, or other signs of nervous system damage may occur with a brain tumor, helping to identify it. Viral illness, fungal diseases, trauma, vascular disease or other problems can also lead to seizures by direct effects on the brain. Liver disease, kidney disease, and hormonal disorders cause seizures by more indirect effects. When nothing is found we fall back on the term acquired epilepsy to define the problem, even though it really just means we can't identify the problem.

Seizure control is usually possible. When to start is a issue of some debate among veterinarians. The standard rule of thumb has been to use seizure control medications (usually phenobarbital) when seizures occur more than once a month. Some veterinarians feel that it is wiser to start sooner than this because it appears that "mirroring" and "kindling" of seizures can occur in dogs. Mirroring is when a seizure focus occurs in one side of the brain and then an identical site occurs in the other side of the brain after several seizures. Kindling is when the seizure focus in the brain develops strong enough pathways that it makes it easier for the seizure to occur -- almost as if the brain "learns" to seizure. It is possible that by controlling seizures quickly through the use of medications that these effects could be stopped and that may lessen the amount or duration of need for seizure control medications.

We try to decide on an individual basis what the potential for all of these risks are, whether the pet owner can administer seizure control medications on a set schedule and the risks of the medications themselves. Then we decide when to start attempting to control seizure activity. If a dog has a really violent seizure we may start immediately. If there is a mild seizure and then subsequent seizures occur at long time intervals we may never attempt to control them. This decision just has to be made on a patient by patient basis.

Estrus or Heat cycle

The average heat cycle for a dog is approximately 3 weeks and since this an an average, some heats are shorter (as little as 7-10 days), others are longer (4 weeks or more). Average times between heat periods is seven months but some dogs can cycle as early as every 4 months, some once a year. Lengths of heat cycles and intervals between cycles are different for each dog but most dogs hit somewhere close to the averages. The first part of heat you will notice bleeding from the vulva, swelling of the vulva, possible increase in urination and the most noticeable, male dogs hanging around the house. During this period (proestrus), females will not allow the males to breed with them although the males will be very persistent. The second part or estrus is the time in which the female will allow the male to breed her and this can last anywhere from 4-21 days. A female, most of the time, will allow most any male to breed during this time. As the female starts to go out of heat or enter diestrus, she will be less willing to breed. Again this stage can last 4-14 days but averages approximately 7 days. The next cycle usually begins about 7 months from the start of the last heat cycle, not the end of that cycle but again this varies from dog to dog. The interval stays the same even if she becomes pregnant. If you do not intend to breed her, you really should consider spaying her. There are many health benefits associated with spaying such as decreased chance of mammary tumors and you will not have to worry about pyometra, metritis or unwanted litters (overpopulation is a big problem - just take a trip to a humane shelter). If you elect to spay her, this can be done during heat but it may be best to wait until the heat cycle is over to decrease the chance of complications.

Flea Life Cycle

Understanding the life cycle of the flea is necessary in order to control it. The flea has several stages to its life cycle. Adult fleas spend most of their time on the dog or cat - they must be dislodged to leave since they will not do so voluntarily. Despite this, when the flea population on the dog becomes excessive humans tend to be an acceptable alternative to the flea. The average life span of an adult flea is probably about 6 weeks - but fleas can live as long as a year under certain conditions. A female flea can lay 20 to 28 eggs a day. She may lay several hundred eggs over her life span. These eggs fall off the pet and develop where they land. They are small and can even develop in the cracks in wood floors or other small crevices. A larvae hatches from the flea egg. It takes as few as 9 days to as long as 200 days to go through its growth stages. At this time is forms a pupae and waits for the right time to hatch. Fleas prefer temperatures of 65 to 80 degrees and humidity of 75 to 85 per cent. This range determines the period of time that fleas are a problem in your particular area. For some areas of the country, this is all year. In others, the flea season is relatively short. It is estimated that for every adult flea found on the pet, there are about 10 developing fleas in the pet's environment.

Flea Control

Since we know that the flea lays her eggs on the pet and they fall off, it is obvious that they fall off where the pet goes. This means that you must treat your house if your pet comes inside. Many people resist doing this, explaining that they never see fleas in the house. The flea egg does not move and it is very hard to see. The flea larvae does not have legs so it has limited movement. The pupal stage of the flea does not move at all. It is not likely that you would be aware of immature fleas --- until they grow into adults. At this point you will be overwhelmed and the problem will be very hard to control. It is possible to kill the pre-adult stages of the flea in the house. Outside, the flea eggs fall off in areas where the pet does things that dislodge them, like jumping around, sitting and scratching, etc. If these areas are warm and moist throughout the day, the flea can reproduce there. It is not necessary to treat large expanses of lawn that dry out during the day -- concentrate on areas the dog spends time, that stay moist and warm. Make sure you treat around the doors in and out of the house, where your dog or cat is likely to be waiting around and where flea eggs are likely to drop off.

There ar now several "once a month" flea control medications for pets. Lufenuron (Program - tm), makes control of preadult fleas easier than it has been in the past. This medication is approved for both dogs and cats. It is administered once a month and is active in the body for that entire time. At the present time there are no known side effects of the medication other than a small percentage of pets who are nauseous after administration of the pill. It may be administered when other medications are being used. The pill does not affect adult fleas at all. Therefore it is important to start this pill before the flea season or to treat for adult fleas as necessary. There are also "once a month" adult flea control medications. Advantage (tm) and FrontLine (tm) are two new medications that provide long lasting adult flea control. Advantage works for about one month to kill fleas and FrontLine works for one month in cats and up to three months in dogs. These are very effective products. While these products may be combined with Program (tm), their ability to kill adult fleas effectively may make it un-necessary. There are many other products that will kill the fleas on the pet. Shampoos, powders, and sprays tend to kill only the fleas present on the pet at the time of application. Mousses (flea foams) and flea creme rinse products tend to have some residual effect. Dips, which are usually used as pour-on products, have a slighlty longer residual effect and are more likely to be associated with toxicity. Proban, an orally administered flea killing pill has short duration of action but is made to be given twice weekly. There are "spot on" products as well, which have may have a longer duration of action. However, all of these products are more toxic and/or less effective than FrontLine (tm) and Advantage (tm).

Treating the house should involve a two pronged approach. To kill the pre-adult fleas it is necessary to use methoprene (Precor). This can be done by using this product alone, or in combination sprays with an adult killing ingredient. The ingredients that kill preadult fleas are generally effective for 3 to 4 months, indoors. Killing adult fleas can be accomplished using any of the pyrethrins (tetramethrin, pyrethrin, permethrin, etc.), or an organophosphate. The adult flea killing ingredients do not have a residual effect and retreatment every 2 to 3 weeks until the fleas are gone is usually necessary. These products come in sprays and aerosols (foggers). It is very important to read the directions, figure out the square footage you are attempting to treat and use these products properly. Foggers generally are ineffective unless one is placed in each room, so small size foggers may be the most economical approach. An alternative to this approach is to use a sodium borate product for flea control - such as FleaBusters. Some people use diatomaceous earth (food grade) in the house to control fleas.

Flea treatment in the yard can be accomplished using one of the yard sprays specifically made for this purpose. There is a new approach, in which a nematode (worm) that lives on flea larvae is spread in the yard. This is non-toxic and appear to be effective. These worms are sold by various companies. One brand name is Interrupt, available through veterinarians. Remember, it is only necessary to treat areas which stay warm and moist. For some people this will be the whole yard. For others, treatment of much less than the whole yard will be effective.

Prior to this year (1996), we felt that effective flea control meant that you needed to treat the pet, the house and the yard. Not treating any one of these could lead to perpetual flea problems. It appears that FrontLine (tm), Advantage (tm) and Program (tm) may change that situation and allow control of fleas with treatment of the pet, only.

Flea control can be accomplished if you are careful to take a few steps to ensure that your plan works. Treat your pet with one of the new flea control products. If you elect to treat the house, to it right. Measure your house and figure out the square footage -- then apply a proper amount of flea control product. If you are using foggers, make sure that they will cover the area you anticipate -- don't expect them to treat two rooms by placing one in the hall, for instance. Get a fogger for each room. If you use a professional exterminator, make sure they use a product that kills preadult fleas as well as an adulticide. Pay them to come back in 2 weeks the first time, rather than waiting a month. Keep up the treatment until you see no fleas, then use the preadult products 2 or 3 times a year to keep the problem from coming back.

Fleas can be controlled. It can be expensive to take care of a flea infestation but it is usually cheaper than dealing with the complications to your pet's health that fleas can bring about.

Hip Dysplasia

Hip dysplasia literally means an abnormality in the development of the hip joint. It is characterized by a shallow acetabulum (the "cup" of the hip joint) and changes in the shape of the femoral head (the "ball" of the hip joint). These changes may occur due to excessive laxity in the hip joint. Hip dysplasia can exist with or without clinical signs. When dogs exhibit clinical signs of this problem they usually are lame on one or both rear limbs. Severe arthritis can develop as a result of the malformation of the hip joint and this results in pain as the disease progresses. Many young dogs exhibit pain during or shortly after the growth period, often before arthritic changes appear to be present. It is not unusual for this pain to appear to disappear for several years and then to return when arthritic changes become obvious.

Dogs with hip dysplasia appear to be born with normal hips and then to develop the disease later. This has led to a lot of speculation as to the contributing factors which may be involved with this disease. This is an inherited condition, but not all dogs with the genetic tendency will develop clinical signs and the degree of hip dysplasia which develops does not always seem to correlate well with expectations based on the parent's condition. Multiple genetic factors are involved and environmental factors also play a role in determining the degree of hip dysplasia. Dogs with no genetic predisposition do not develop hip dysplasia.

At present, the strongest link to contributing factors other than genetic predisposition appears to be to rapid growth and weight gain. In a recent study done in Labrador retrievers a significant reduction in the development of clinical hip dysplasia occurred in a group of puppies fed 25% less than a control group which was allowed to eat free choice. It is likely that the laxity in the hip joints is aggravated by the rapid weight gain.

If feeding practices are altered to reduce hip dysplasia in a litter of puppies, it is probably best to use a puppy food and feed smaller quantities than to switch to an adult dog food. The calcium/phosphorous to calorie ratios in adult dog food are such that the puppy will usually end up with higher than desired total calcium or phosphorous intake by eating an adult food. This occurs because more of these foods are necessary to meet the caloric needs of puppies, even when feeding to keep the puppy thin.

If clinical signs of hip dysplasia occur in young dogs, such as lameness, difficulty standing or walking after getting up, decreased activity or a bunny-hop gait, it is often possible to help them medically or surgically. X-ray confirmation of the presence of hip dysplasia prior to treatment is necessary. There are two techniques currently used to detect hip dysplasia, the standard view used in Orthopedic Foundation for Animals (OFA) testing and X-rays (radiographs) utilizing a device to exaggerate joint laxity developed by the University of Pennsylvania Hip Improvement Program (PennHIP). The Penn Hip radiographs appear to be a better method for judging hip dysplasia early in puppies, with one study showing good predictability for hip dysplasia in puppies exhibiting joint laxity at 4 months of age, based on PennHIP radiographs.

Once a determination is made that hip dysplasia is present, a treatment plan is necessary. For dogs that exhibit clinical signs at less than a year of age, aggressive treatment may help alleviate later suffering. In the past a surgery known as a pectineal myotomy was advocated but more recent evidence suggests that it is an ineffective surgical procedure. However, administration of glycosaminoglycans (Adequan Rx) may help to decrease the severity of arthritis that develops later in life. Surgical reconstruction of the hip joint (triple pelvic osteotomy) is helpful if done during the growth stages. For puppies with clinical signs at a young age, this surgery should be strongly considered. It has a high success rate when done at the proper time.

Dogs that exhibit clinical signs after the growth phase require a different approach to treatment. It is necessary to determine if the disorder can be managed by medical treatment enough to keep the dog comfortable. If so, aspirin is probably the best choice for initial medical treatment. Aspirin/codeine combinations, phenylbutazone, glycosaminoglycosans and corticosteroids may be more beneficial or necessary for some dogs. It is important to use appropriate dosages and to monitor the progress of any dog on non-steroidal or steroidal anti-inflammatory medications due to the increased risk of side effects to these medications in dogs. If medical treatment is insufficient then surgical repair is possible.

The best surgical treatment for hip dypslasia is total hip replacement. By removing the damaged acetabulum and femoral head and replacing them with artificial joint components, pain is nearly eliminated. This procedure is expensive but it is very effective and should be the first choice for treatment of severe hip dyplasia whenever possible. In some cases, this surgery may be beyond a pet owner's financial resources. An alternative surgery is femoral head ostectomy. In this procedure, the femoral head (ball part of the hip joint) is simply removed. This eliminates most of the bone to bone contact and can reduce the pain substantially. Not all dogs do well following FHO surgery and it should be considered a clear "second choice".

Hip dysplasia may not ever be eliminated by programs designed to detect it early unless some effort is made to publish the results of diagnostic tests such as the OFA evaluation or PennHIP evaluations, openly. This is the only way that breeders will be able to tell for certain what the problems have been with hip dysplasia in a dog's ancestry.

When an older dog is exhibiting signs of pain associated with this condition it is often possible to help them dramatically through medication and simple steps like providing a warm bed or warm spot to rest during the day. There is no advantage to pain and steps should be taken to ensure that the older dog is not in pain. Regular exercise can be very helpful and weight loss can have dramatic effects on the amount of discomfort a dog experiences.

Working with your vet to come to the best solution for your dog and your situation will enable you and your dog to enjoy life to its fullest, despite the presence of hip dysplasia.

Heart murmur

It can be very hard to determine if a heart murmur is present when listening to the chest of an excited dog. Respiratory sounds can mimic a heart murmur when respiration is rapid enough to approximate the heartrate.

Heart murmurs vary widely in their importance. Hearing a heart murmur in a dog that seems normal in all other respects doesn't usually make me want to pursue a lot of immediate testing to determine the cause but it does make it important for the dog owner to watch carefully for signs of heart failure, such as tiring easily, coughing, weight loss and difficulty breathing. If any of these signs are present then it is much more important to try to identify the cause.

Illness - Caring for your pet

1) How can I best administer her current medicine?

Liquids can be hard to administer to dogs but usually it can be done by tilting their head back, holding their mouth shut by putting a hand around their muzzle and then working the tip of the syringe into the fold of the lip (back corner of the mouth) and giving the medication just slowly enough that it doesn't run out all over as the dog swallows. Really bad tasting medications can lead to a big struggle, though. It is possible that some of the medications might be OK in taste and your April only reacts due to the bad tasting ones. In this case, separating them may help since she may readily take the OK tasting ones and then you have a smaller volume of the others to give.

2) What alternative diet can you suggest so she'll finish her food?

Personally, I usually tell clients with sick pets to feed them what they want unless there is a specific reason I think it is necessary not to do that, like if they have pancreatitis. Most of the time I think it is better that they eat something than that they eat what I would like them to eat. You need to check with your vet on this one though -- there very well could be a reason for the special diet.

3) Is it extremely necessary to keep her indoors until she recovers?

Probably not --- except that it is important to make sure that she is home when it is time to give medications, so some sort of confinement is a good idea.

4) At what point do you think I should start force-feeding her? If she eats half her meal, is that good enough?

Usually, eating half the meal for a few days is definitely OK. In most illnesses I think it is best to try things like hand feeding good tasting morsels or coaxing the dog to eat in some other way rather than force feeding. In some situations, it is very important to feed and again, you need to check with your vet on that.

5) What can I use to disinfect the backyard and ensure that it is free of any disease causing bacteria?

Many bacteria are susceptible to sodium hypochlorite bleach (Chlorox is an example). Just general cleaning so that there is no residual stool or other organic material for bacteria to grow in helps a great deal.

Itch Control

Cold water will usually reduce itching and produce temporary relief. It doesn't really matter how the water is applied, but it must be at least cool. This effect doesn't last long, usually less than one-half hour. Adding Episoothe Oatmeal Shampoo, Episoothe Oatmeal Creme Rinse, Aveeno Colloidal Oatmeal, Relief Shampoo or Domeboro's solution helps to prolong the effect. All of these products are available over-the-counter. If you use Aveeno, one to two tablespoons per gallon of water, applied as a rinse, works best. Follow the directions on the Domeboro packet and also apply as a rinse.

Shampooing will sometimes help to control itching. Some shampoos such as Pyoben and Oxydex, act to reduce the bacteria level on the skin, one cause of itching. Seba Lyt and other sulfer/salicyclic acid shampoos reduce scaling. Lytar, Clear Tar and other tar containing shampoos reduce itching and oiliness. An emollient or moisturizer used after shampooing will restore some moisture to the skin and this also reduces itching. Expar Creme Rinse can be used to kill fleas after itching and moisturize the skin.

Antihistamines are useful in the treatment of itching in some dogs and cats. Used alone, about 15 to 25% of dogs will respond to antihistamines. Used in combination with fatty acid inhibitors, such as DermCaps, EFA-Z and Omega EFA capsules, about 25 to 40% of dogs will respond, reducing scratching behavior to acceptable levels. Antihistamines available over-the-counter are Benedryl (diphenhydramine, 25mg capsules) and Chlortrimeton (chlorpheniramine maleate, 4mg tablets). There are prescription antihistamines, notably Atarax (hydroxyzine) that work better in some cases. It is necessary to get a dosage for your particular dog or cat from your vet.

Dogs and cats have individual reactions to antihistamines. Since some dogs will respond better to one than another, it is best to try more than one antihistamine before giving up on them to control itching. Some pets will become drowsy when taking antihistamines. If this is unacceptable, they can not be used, or might be best to use at bedtime. Occasionally a pet will get excited when given antihistamines. These pets should not be given these products.

Fatty acid derivatives compete with aracadonic acid, the trigger for itching in the body. By replacing this compound with an inactive competitor, itching can be reduced. It is important that the fatty acid derivative chosen have gamma-linoleic acid, eicosapentanoic acid, or both. These products work best at high dosage levels and when given with a low-fat canned food such as W/D, which is available through veterinarians. Although they can be fairly expensive, their use is preferable to cortisones if they are effective. It is necessary to use these products for at least 6 to 8 weeks to judge their full effect. EFA-Z and DermCaps are examples of these medications.

Antibiotics are used to control skin infections associated with scratching. The itching leads to scratching, which damages the skin. The damaged skin is easier for bacteria to grow in. The bacteria then contribute to the itching, leading to more skin damage. As this cycle progresses, deeper and deeper layers of the skin are affected, sometimes leading to systemic bacterial infections that can even be fatal. Control of skin infections with antibiotics takes time. The usual defense mechanisms of the body, fever, white blood cells and antibodies do not work as well on the skin surface. Antibiotics must do more of the work alone. For this reason, 3 weeks is the minimum recommended time that antibiotics should be given for skin infections. Often, antibiotics must be continued for up to 8 weeks to consistently control skin disease. Several antibiotics seem to work consistently in skin disease. When these antibiotics fail, it is necessary to culture the skin lesions to identify which antibiotic might be appropriate in an individual case. Occasionally it is necessary to continue antibiotic therapy indefinitely to control severe bacterial skin disease.

Some dogs appear to be unable to prevent penetration of staph (staphylococcus) bacteria into the skin. These dogs can be benefited by the use of a product to promote immune responses. Similar to vaccinations (but short acting), these products help the body learn to fight off staph bacteria. They are Staph Lysate and Immunoregulin. Although somewhat expensive and necessitating weekly injections, these products can cost less to use than frequent or continuous antibiotic therapy. We have better success with Staph Lysate.

Hyposensitization, or allergy "shots", are used in dogs. Their use in cats is very limited due to difficulties testing cats accurately for individual allergens. Similar to their use in people, these injections help many pets, but not all. To be used properly, it is necessary to identify the allergy agents affecting a dog and then treat accordingly. This can be done by skin testing, where small quantities of allergens (allergy causing agents such as pollens), are injected into the skin and the response to this monitored. Often, it is necessary for a general veterinary practitioner to refer a pet to a veterinary dermatologist for this testing. Recently, blood tests have been developed to allow allergy testing without injections into the skin. These have become better understood recently and are correlating with the skin testing fairly well, although it is generally agreed that skin testing is still more accurate. Allergy injections require a consistent effort from the pet owner. They are the preferred treatment for inhalant allergies if that is the only condition affecting dog, when effective. Currently, about 70% of dogs are thought to benefit from this therapy.

Fleas cause most the allergic reactions in pets. Flea control is essential to our success in treating itchy dogs. Please ask for flea control information if you have any problem at all with fleas on your pet!

When itching can not be adequately controlled by one of the above methods, we usually use a corticosteroid, such as prednisone. Cortisones are the most consistently effective anti-itch medications that we have. They do have several drawbacks, however. Cortisones increase the amount of water your pet drinks, making it urinate more, too. Sometimes this becomes a problem. These drugs increase appetite and weight control can be difficult while using them. If proper dosage schedules are not followed there can be long-term side effects such as decrease in bone density or an increased chance of pancreatitis. Cortisones depress lymphocytes, a type of white blood cell, making it easier for bacterial infections to occur. Accidental overdosage with these medications or inappropriate long-term use can lead to medication induced Cushing's disease, a cause of hair loss, muscle weakness and other problems. For these reasons, most vets insist on monitoring a pet on cortisones through follow-up office visits. You may be required to allow examination of your pet prior to refilling prescriptions for these drugs.

In spite of these side effects, cortisones can be the best drugs to make an extremely itchy pet comfortable. If they are the only effective drugs for your pet they are worth the small risk to an individual pet of side effects. These drugs are reasonably safe for long term use if given according to directions. Allowing your pet a good quality of life, by controlling the itching, is worth the small risk of using prednisone and related compounds.

These are the methods we use to treat pruritis, the itchiness that causes your dog or cat to scratch. It may take several tries to work out the proper drug and dosage schedule for your pet, but is worth the effort.

Kennel cough

Kennel cough is most commonly associated with a bacterial infection caused by the organism Bordetella bronchiseptica. While it is hard to be certain in veterinary medicine when discussing statistics, it is estimated that 80 to 90% of the cases of kennel cough are due to this organism. The other 10 to 20% of cases are caused by a variety of other infectious agents, most of them viral. Kennel cough has been associated with parainfluenza virus, adenovirus and canine distemper virus as well as the Bordetella bacteria.

The incubation period from the time a dog is exposed until clinical signs appear varies depending on which infectious agent is the cause. In general it appears to be about 3 to 5 days with Bordetella. The infection tends to be mild except for a very harsh cough that often prompts owners to think that their dog "has something caught in his throat". In some dogs it can lead to pneumonia or more serious signs. Cough suppressants can be used to control the cough and antibiotics may be necessary for stubborn infections or to try to stop the spread of the bacteria in multiple dog households. It is probably a good idea to vaccinate dogs who will be exposed to large numbers of other dogs, such as at shows, obedience classes or the classic cause -- when left in kennels. The intranasal vaccine is pretty fast acting, providing some protection in as little as 5 days. The injectable version of the vaccine may provide longer immunity, though. Some vets use both to get maximum protection. We don't use either one routinely but give the intranasal vaccine to our patients who will be exposed to groups of dogs.

Nosebleeds

Nosebleeds can occur for a lot of reasons. In older dogs a major concern would be nasal tumors or nasal infections. Tumors can be pretty hard to find even with endoscopy and X-rays in some cases but the tests for this make it less likely. In any age dog bleeding disorders need to be considered when nosebleeds occur. Ehrlichia canis, immune mediated thrombocytopenia, immune mediated hemolytic anemia and other causes of bleeding should all be considered. In older dogs a fairly common cause of bleeding disorders is hemangiosarcoma, a type of tumor. Heartworms can cause nosebleeds in the later stages of the disease. It can be difficult to identify the cause of bleeding disorders.

Pancreatitis

One of the functions of the pancreas is production of digestive enzymes. These are the enzymes that break down ingested foods into molecules the body can digest. These enzymes are carefully handled by the pancreas in order to prevent them from damaging the pancreas itself or surrounding tissue. When these self-protective mechanisms break down for any reason, the result is leakage of enyzmes which damage the pancreas and any surrounding tissue they reach. This breakdown is called pancreatitis.

There are a number of things which can initiate or facilitate enzyme leakage, so pancreatitis can occur for a number or reasons. Often, it takes a combination of precipitating factors to cause pancreatitis to occur in a dog or cat. High fat diets, obesity and lack of exercise are the most common "life-style" contributors. Miniature schnauzers are predisposed to pancreatitis due to a tendency to have high levels of lipoproteins in their blood streams. Corticosteroids and azathioprine medications may contribute to the tendency to develop pancreatitis. Hyperadrenocorticism, a naturally occurring overproduction of corticosteriods that is fairly common in dogs may also lead to an increased susceptibility to pancreatitis. Anything that interferes with blood supply to the pancreas or release of digestive enzymes by the pancreas may lead to pancreatitis. For some reason, pancreatitis does not occur, or is not recognized, as often in cats as it does in dogs.

The "typical" pancreatitis patient is middle-aged or older and overweight. There may be a slightly higher prevalence of this problem in female dogs but it does occur commonly in both sexes. Often, the family has just had a party or a big holiday meal when this disease strikes. This is not a disease that restricts itself to any particular scenario, though. It often occurs in patients that do not fit the typical profile and it has highly variable clinical signs.

Any time a dog appears to be exhibiting signs of unexplained pain, pancreatitis must be considered. Vomiting is common with pancreatitis. Depression can be severe. Affected pets may seem restless or be reluctant to move, they may seem weak, irritable, have diarrhea or simply refuse to eat. Many owners recognize that their pet is very ill but may be baffled by a lack of symptoms to explain their pet's discomfort -- they just know they don't feel well.

When your vet examines your dog and suspects pancreatitis, she will look for abdominal pain that seems to be centered in the portion of the abdomen that is partially covered by the ribs. Dehydration is common in patients with pancreatitis. Rapid heart rate and rapid breathing are sometimes seen with pancreatitis. Poor circulation in capillaries may lead to redness of the gums and eye linings.

Confirming a diagnosis of pancreatitis can be frustrating. Currently, there is no single reliable diagnostic test for this disease. Often, amylase and lipase levels are elevated in the bloodstream. Unfortunately, this seems to happen slowly in comparison to the progress of the disease so a pet may be pretty ill before the enzyme levels elevate and in some cases of pancreatitis an elevation in these enzyme levels doesn't occur. Often, blood tests that help evaluate liver and kidney function are slightly elevated as well. White blood cell counts are usually high. Ultrasound exam of the pancreas, if your vet can do this, is helpful in diagnosis. X-rays are often taken to make sure other conditions are not causing the pain, such as intestinal obstruction, but usually it is not possible to be sure a dog has pancreatitis based on X-ray changes. Pancreatitis is harder to diagnose in cats because they are less likely to have high enzyme levels and either hide pain better or experience less pain, making the need for testing less obvious.

Pancreatitis can be acute and only occur once in a dog's lifetime or it can become chronic and keep returning over and over again. It can be a rapidly fatal illness or a mild attack of pain that resolves in a few hours or a day or so. It can cause tremendous side effects, including shock, blood clotting disorders, heart arrythmias, liver or kidney damage and death.

I think that chronic disease with varying levels of pain and secondary side effects is the most common form of pancreatitis. Fortunately, most of the time dogs with chronic pancreatitis problems do not die from the attacks. It is possible to lessen the severity and frequency of attacks in many of these dogs by managing their diet and exercise. Less commonly, pancreatitis strikes with a sudden severe fury that creates severe secondary problems, particularly with blood clotting and shock. In these cases, it can be fatal. It is not clear whether these are entirely separate disorders or different manifestations of the same problem. In cats, chronic pancreatitis is often associated with feline infectious peritonitis or toxoplasmosis and it may be beneficial to try to rule out these conditions if pancreatitis is suspected.

It is important to take pancreatitis attacks seriously, especially the first one. Pain management seems to help a great deal in preventing escalation pancreatic attacks, based on our clinical experience. Totally restricting food intake (no food) for 24 to 72 hours seems to help a great deal as well. This may be due to a decrease in stimulation of the pancreas to release digestive enzymes. Fluid therapy to prevent dehydration and help maintain circulatory function is usually necessary. Medications to control vomiting are often used. Many veterinarians use antibiotics in an effort to ward off secondary infections but this may not be necessary in milder cases as bacterial infections do not commonly accompany pancreatitis. Corticosteroids are not thought to be helpful in treatment of pancreatitis. It may be necessary to use intensive medical therapy for serious side effects of the disease or even surgical intervention in really severe cases of pancreatitis. In miniature schnauzers, medical control of the lipid levels may be beneficial and is sometimes possible using medications.

Once the patient seems to feel better, oral fluids are given. If no vomiting occurs in 12 to 24 hours, food can be offered in small quantities. Most pets can go home once they are willing to eat and drink again. Bland diets may be beneficial in some patients but we usually recommend returning to the patient's normal diet as long as it wasn't likely to be the cause of the problem due to fat content. Diets moderately high in fiber may be beneficial in lessening the number or severity of attacks in chronic pancreatitis. Weight loss and increasing exercise are also very likely to help prevent future attacks. Keeping your pet away from the table during traditional holiday meals can be very helpful, too.

It is very important to remember NOT to feed your dog when it is showing signs of abdominal discomfort or unexplained pain. It is almost painful to think of the number of times dog owners have said to me "she wouldn't eat, so I gave put a couple of tablespoons of bacon fat on her food...... or gave her a bowl of ice cream...... or a bowl of milk....... or a couple of pieces of ham....... " This is the worst thing you can do if your dog has pancreatitis. Learn to let them help themselves heal by not eating when their body is telling them it isn't a good idea! This can be the difference between a 24 hour attack of mild abdominal pain and 5 days in our hospital treating severe pancreatitis.

Parvovirus

Parvovirus is a viral disease of dogs. It affects puppies much more frequently than it affects adult dogs. The virus likes to grow in rapidly dividing cells. The intestinal lining has the biggest concentration of rapidly dividing cells in a puppy's body. The virus attacks and kills these cells, causing diarrhea (often bloody), depression and suppression of white blood cells -- which come from another group of rapidly dividing cells. In very young puppies it can infect the heart muscle and lead to "sudden" death. This is a very serious disease. Some puppies infected with parvovirus will die despite prompt and adequate treatment. While no extremely accurate statistics are available, a good guess is probably that 80% of puppies treated for parvovirus will live. Without treatment, probably 80% or more of the infected puppies would die.

Due to the high death rate, parvovirus gets a lot of free publicity. Many people just assume that any case of diarrhea in a dog is from parvovirus. This is not true. There are a lot of other diseases and disorders that lead to diarrhea. If you have a puppy, don't take any chances. Have your puppy examined by your vet if diarrhea is a factor in any disease. It is better to be safe than to be sorry.

Pregnancy

The best days to palpate (feel for) puppies are about day 28 to day 35 of the pregnancy. Usually it is best to count from the last breeding day as most dogs actually ovulate shortly before they quit standing for the male. X-rays can confirm pregnancy after 45 days. Sometimes it is worthwhile to take X-rays to get an idea of the number of puppies -- usually we do this only if we suspect that there are problems or if the bitch has had trouble delivering puppies previously.

It is best to gradually change the bitch to a puppy formula dog food at about 35 days of the pregnancy (take about a week to slowly make the change, mixing in small amounts of puppy food with normal food the first day and gradually increasing the amount). Most bitches require about 1.5 times the normal amount of food for their maintenance at the time of birth. As the puppies grow, she may require as much as 3 times normal amounts of food to support lactation. You should continue to keep her on a puppy formula until the puppies are weaned.

Do not supplement calcium during the pregnancy. This seems to lead to problems with uterine inertia, increasing the probability that a cesarean section may be necessary. It may also contribute to the frequency of seizure problems associated with low blood calcium levels during lactation (milk tetany).

Know your veterinarian's emergency procedures before the delivery. If your vet refers emergencies to an emergency clinic, make sure you know where it is and how to call if you need help. If your veterinary hospital staff covers its own emergencies it is still important to know the procedure for contacting someone before the need arises. Ask about this. Write the phone numbers down where you can easily find them.

Your vet is likely to have some references that cover construction of breeding boxes to protect the puppies. I can not remember the titles of the ones we have, offhand --- they are from Purina, though. Providing a safe environment for the puppies is important. More puppies die from hypothermia than anything else, probably. Making arrangements to ensure the puppies will stay warm is important. On the other hand, you can't just warm up a whole room to 80 degrees because Mom has to be willing to stay with the puppies. The puppy heating pads are nice and sometimes other arrangements can be made to safely supply a warm spot for the puppies without making it too hot for the mother.

Breeders are a good source of information in most cases and it would be a good idea to continue to try to talk to yours. They often have practical information that vets don't have experience with.

Pregnancy - False

False pregnancy symptoms are normal in dogs that have an estrus and do not get bred, due to the way in which they cycle. It is not usually necessary to treat for symptoms of false pregnancy but they can be so close to those of a real pregnancy that the two can be very confusing.

It is usually possible to feel distinct lumps in the uterus representing individual embryos from about the 28th day of pregnancy to about the 35th day of pregnancy. Before and after that it can be hard to identify a pregnant uterus easily. After 45 days or so when the skeletons begin to calcify it is often possible to feel the distinct hardness of a puppy skull when palpating the abdomen or to identify the puppies on an X-ray, if you wish to take her to the vet's office prior to the home visit, or if your vet has a portable X-ray machine. By now, if your dog is NOT pregnant, your vet will probably be able to tell you that, since she should be pretty far into the pregnancy and at least uterine enlargement should be palpable.

Reproduction - When to Breed

 The behavior of your female usually indicates when she is in true estrus - that part of the heat cycle when the female will allow a male to breed her. Most females growl or snap at the male when they are not quite ready for breeding because they still may be in the proestrus phase of the cycle. The proestrus stage usually lasts from 4-9 days and includes signs of bleeding, vulvular swelling and increased urination but this stage can last up to 2-3 weeks in some animals. Heat cycles vary from dog to dog and most of the numbers written are averages so this needs to be taken into consideration when deciding the time for breeding. Other females will exhibit this behavior when they are frightened, even if they are in true estrus. It is best to keep a log if possible of when the heat cycle starts - when bleeding and swelling is first noticed, when those signs disappear, etc. and time interval between heats if you have not already done so. This may help with determining the length of her cycle. Having your veterinarian perform cytology during the heat cycle will also help determine the optimum time for breeding. Using progesterone and lutenizing hormone testing may allow an even closer estimation of the time of ovulation. Some females would rather be bred at home instead of being taken to the male - feeling more comfortable on familiar territory. Other females may feel more comfortable (if bringing her to the male) to bring her a week or so before the expected heat (reason for the log), boarding her at the male's home so they can see each other and allowing them to breed on "their" terms. Then there are those females that will not breed no matter what. If it is really important to have a litter from a particular female that will not breed no matter what is tried, there is always artificial insemination.

The most common mistake in breeding dogs is simply missing the time when they are receptive to the male. This can happen as early as 2 or 3 days into the estrus and can be as late as 21 days after first signs of bleeding and vulvar swelling. The best approach is to attempt breeding every other day from the first days of the heat period. The only problem with this is that it requires a lot of cooperation from the owner of the stud dog.

Reproduction - When to Neuter

 I don't know what the earliest age for safe neutering is. I only know that it is safe at 6 months or older. I believe the veterinarians reporting that they are having no problems with neutering as young as 8 weeks of age, but I can't support their claims with objective studies. Personally, if there was a strong need to neuter younger, such as exists at humane societies, I would have no qualms about it. I wouldn't neuter my own pet prior to five or six months of age, though.

Reproduction - When to Spay

 It is pretty much universally agreed upon by vets that the best time to spay is BEFORE the first heat period. If a dog is spayed prior to the first heat, the odds of developing mammary cancer later in life are less than 1%. If spayed between the first and second heat periods the risk increases to about 8%. If spayed at any time after the second heat period, the risk of mammary cancer is about 25% in the dog (same as in an unspayed dog). There are no reasons not to spay prior to the first heat that I am aware of. A few dogs do develop incontinence from low estrogen levels after spaying but this does not appear to be affected much by the time the dog is spayed. Some dogs just develop this problem after spaying.

There are some health benefits for the female dog associated with spaying, including freedom from the complications of birthing puppies, reduced risk of mammary cancer and uterine infections. Uterine infections (pyometra) are a serious problem in dogs due to the way in which they cycle and can easily result in death. With the obvious benefit of spaying before the first heat and the lack of any problems that have been proven

There is not a lot to occur as the result of spaying early, there does not appear to be much reason to wait until after a heat cycle.

Early Spay/Neuter

 of data on the effects of spaying dogs and cats at younger ages than the "traditional" 6 months that has actually been published, at least that I am aware of. There are reports of two or three places studying the effects of early spay and neuter at the present time and I have seen references to data from these studies but am not aware of published data. I am only aware of one study of long term effects of spaying and neuter dogs at 7 months of age that followed the dogs for their entire lifetime. In this study, there were no problems attributable to spaying or neutering at this age other than a slight increase in the likelihood of estrogen dependent incontinence in female dogs. A lot

Spine

The most common cause of weakness and pain associated with the spine is intervertebral disc trauma or disease. The unfortunate thing about our choice to build this site in a question and answer format is that the most common diagnoses are often not covered as extensively they should be - because there is less question about the problems at the vet's and because people tend to understand them a little better.

The spine is composed of a long series of bones connected through a series of ligaments with a shock absorber - the disc - between each connection. If support was the only job of the spine there would be a lot less pain associated with injuries to the disc area, probably. But the spine serves as a conduit for the spinal cord, too. This very large bundle of nerves runs through the center of the spine and the individual strands of the bundle exit between the vertebrae at whatever level is necessary to do their job. The nerves pass between the outer edges of the disc and the boney protrusion of the spine. As long as everything is in its place this arrangement works fine. When the disc bulges or is damaged and calcifies it can put pressure on the exiting nerves leading to visible clinical signs of dysfunction in the area served by those nerves. By carefully considering where weaknesses and pain are exhibited it is possible to tell which discs are likely to be damaged.

If the disc is just putting a little pressure on the nerve there may only be pain. If the disc is damaging the nerve more significantly then weakness or paralysis will occur. In the case of pain alone it limiting exercise and utilizing a non-steroidal anti-inflammatory medication may be all that is necessary. If there is is weakness then corticosteroids or even surgery may be necessary to alleviate the problem.

In a dog with pain and weakness in one or both rear legs there is a strong likelihood of an intervertebral disc problem. Other possible causes of problems do include the ones you listed from searching our site as well as localized injuries that sometimes mimic disc problems. When both cruciate ligaments in the knees rupture at the same time the resulting disability can strongly resemble the weakness and disability associated with disc injury. It may be possible that luxation of both patellae at the same time could also produce similar signs.

Seizure Control

 Acepromazine seems to lower the seizure threshold in some animals and can apparently allow a seizure to occur that might not have without the lowering of the seizure threshold. Paradoxically, it can raise the seizure threshold associated with some anesthetic agents (most notably ketamine).

Diazepam (Valium Rx) is helpful in reducing seizure activity in most dogs but it does have a paradoxical excitatory effect in a few animals. I don't know if this stimulates seizure activity but it does occur.

When to medicate to control seizure activity is a really debatable question. The pro treatment side of the argument for early treatment is that "mirroring" and "kindling" of seizures are recognized in dogs. Mirroring is when an area of the brain causing seizures on one side induces the development of an area causing seizures in the same place in the other half of the brain. Kindling is the process in which seizures make it easier for other seizures to occur -- in effect lowering the seizure threshold a little bit every time one happens. The con side of the argument mostly revolves around the side effects of the most consistently successful seizure control medication in dogs, phenobarbital. It can cause incoordination and a general lethargy for several weeks on first administration. Most dogs overcome these effects in a few weeks, though. It also causes increased hunger, often increased water consumption and therefore urination and it causes severe liver damage in some patients. Not many, but enough to be very worrisome.

Primidone (Rx) is commonly used in dogs to avoid keeping controlled substances on hand but it is more likely to be toxic to the liver and is not a good first choice for seizure control. Seizures themselves are very unlikely to kill a dog, but it does sometimes happen as well. So the question is, when are the seizures severe enough or frequent enough to absolutely warrant treatment? I think we work out a different answer in almost every case. We try to make our best guess as to what is best for each individual patient. The traditional guidelines in veterinary medicine have been seizures that last for longer than 5 minutes (actual seizure activity) or seizures that are occurring more than once a month. We probably stick reasonably close to these guidelines but are a little quicker to consider seizure medications now that there is pretty good evidence for the kindling theory. Once it seems pretty apparent that the seizures are going to continue to get closer and closer we sometimes treat now even if they are till more than a month apart.

Ticks

There are a number of ways to deal with ticks. The easiest solution is to use one of the tick killing products that keep them off and/or kill them if they attach. There are three very effective products that we use, fipronil (Frontline or Frontline Topspot, Rx), permethrin (ProTICall, Rx) and amitraz (Preventic collars, Rx).

Frontline kills fleas and ticks effectively. Tick control lasts for 2 weeks to a month. The product should only be applied on a monthly basis but can be used in conjunction with other products for tick control if necessary. It works very well for flea control, so if that is also a problem it may be a good first choice.

ProTICall is a concentrated permethrin topical for tick and flea control. It is a very effective tick control product but a less effective for flea control. It lasts 2 to 3 weeks but may be applied at 2 week intervals so it is possible to keep the problem under control continuously using this product.

Preventic collars are also pretty effective. They have the drawback of being toxic if ingested. This sounds like it wouldn't be a problem but dogs will eat these collars right off of another dog, for some reason. So we don't recommend them for multi-dog households, especially if one of the dogs is prone to playing with the other dog's collar or if one of the dogs chews things up frequently. They seem to last around 6 to 8 weeks in our practice area.

Ticks may be removed using one of the tick-pulling products or a forceps (tweezer). It is best not to touch the tick if possible due to the possibility of tick-borne diseases. If contact does occur, wash your hands thoroughly. There is a lot of fear of leaving part of the tick embedded in the dog when removing them but this rarely causes problems.

Ticks carry a number of diseases, some of which do have zoonotic potential (can be transmitted to people). It is best to use one of the products that kills the ticks continuously without much intervention on your part. The risk is not high but there is some risk for diseases such as Lyme disease, ehrlichiosis and Rocky Mountain spotted fever when ticks are brought into the household by a family pet.

Vision - How dogs see

1) Dogs can see in much dimmer light than humans. This is because the central portion of a dog's retina is composed primarily of rod cells that "see" in shades of gray while human central retinas have primarily cone cells that perceive color. The rods need much less light to function than cones do.

2) Dogs can detect motion better than humans can.

3) Dogs can see flickering light better than humans. The only significance to this appears to be that dogs may see television as a series of moving frames rather than as a continuous scene.

4) Dogs do not have the ability to focus as well on the shape of objects (their visual acuity is lower). An object a human can see clearly may appear to be blurred to a dog looking at it from the same distance. A rough estimate is that dogs have about 20/75 vision. This means that they can see at 20 feet what a normal human could see clearly at 75 feet.

5) Dogs are said to have dichromatic vision -- they can see only part of the range of colors in the visual spectrum of light wavelengths. Humans have trichomatic vision, meaning that they can see the whole sprectrum. Dogs probably lack the ability to see the range of colors from green to red. This means that they see in shades of yellow and blue primarily, if the theory is correct. Since it is impossible to ask them, it is not possible to say that they see these colors in the same hues that a human would. Whether or not the ability to see some color is important to dogs or not is hard to say.

A dog with its eyes about 12 inches off the ground certainly sees the world a different way than a human with eyes about 48 inches off the ground like many 5th graders.

As humans we tend to think of dog's visual capabilities as inferior to ours. It is different but it may suit their needs better than possessing accurate color vision would.

White Dog Shaker Syndrome

That isn't a very scientific name, but it describes the condition exactly.

Small white dogs (Maltese, West Highland white terriers, Bichon Frise) can develop tremors for unexplained reasons that can be very severe. These dogs usually have really bizarre eye movements and get much worse when excited or stressed.

The usual treatment for this is to give diazepam (Valium Rx) to control the tremors and prednisone because we don't know what else to do

 

 A collection of information about Wobblers Disease

SPONDYLOLITHESIS

WOBBLERS SYNDROME

Description

Wobblers syndrome is caused by a narrowing or malformation of the spinal cervical (neck) vertebrae which causes pressure on the spinal cord by the lower cervical (neck) vertebrae due to either a malformation of the vertebra or a malocclusion (when the vertebrae do not come together properly). This causes anywhere from a mild, to a severe affect in the dogs gait.. Other conditions can mimic the symptoms. The only definitive diagnosis of Wobblers Syndrome or Spondololithesis, is a mylogram where dye is injected into the spinal column and then the neck is flexed and x-rayed.

Breeds affected: - Dobermans and Great Danes primarily - young Danes more commonly affected. Dobermans - young and old, can grow through the problem as youngsters, more commonly seen in middle aged to older Dobermans (3 to 9 years of age) Other breeds who have a similar if not identical syndrome described include the Boxer, Basset, Bull Mastiff, St. Bernard, Weimeraner, Labrador Retriever, German Shepherd, Rhodesian Ridgeback, Dalmatian, Samoyed, Old English Sheepdog, Irish Setter, and the Borzoi. Males are affected more often, in a ratio of 2:1

Cause

The cause of Wobblers Syndrome is unknown, although a link to fast growth and genetics is suspected. According to the Merck Veterinary Manual, "The cause is unknown, although rapid growth rates and nutrition, mechanical factors, and genetics may be implicated." Some breeders say that there has been a marked decrease in the incidence of not only Wobblers Syndrome, but other diseases that occur during the early, fast growth stages of Great Danes, when weight is kept down and growth rate has been slowed nutritionally.

Symptoms

Symptoms usually appear first in the rear legs as a mild uncoordination in gait (ataxia) and can escalate to involvement of the forelegs as well. The severely affected dog moves like a drunk and the uncoordination shows up most when the dog is walked and then moved sharply into a turn. An unsuspecting owner might simply conclude that his older puppy was just clumsy. Overly clumsy young Great Danes should be Wobbler suspects.

In Great Danes, Wobblers Syndrome most commonly appears from 10 months to a year and a half of age although it can manifest as old as 4 or 5 years, and as young as 5 weeks. In Doberman Pinschers it usually doesn't appear until the dog is 4 or 5 years old.

Diagnosis

A veterinarian will do a neurological work up on the dog and this often includes not only cervical spine x-rays, but a mylogram x-ray. A mylogram is not only dangerous to the dog, but is expensive. The owner should thoroughly investigate the advisability of this procedure, especially since if it is Wobblers Syndrome, surgery may not be the best option.

Treatment

Treatment of Wobblers Syndrome can include the use of corticosteroids, a neck brace and surgery. The surgery fuses the 2 unstable vertebrae which relieves the pressure on the spinal cord. Unfortunately this also puts further stress on adjoining vertebrae which can cause instability to recur in them. Many Wobblers can live a long and pain free life with little or no treatment. Others deteriorate quickly and euthanasia then becomes the only kind choice.

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Wobbler's Syndrome

                                            by Bruce R. Wittels, D.V.M.

This is the first in a series of articles that will discuss specific disease entities of bone caused, in part, by improper or over nutrition. Some of the
information to be presented in this and future articles will have been discussed previously but will be put into specific consideration to the disease
entity covered. It is my desire to provide an understanding of the total picture of proper nutrition and a well balanced and strong skeleton upon which
these modern day giants are to support their massive bodies. If the foundation of any structure is weak, then the weight which is born by it will cause
this foundation to break and fall.

The principal breed affected with Wobbler's Syndrome is the Great Dane. Cervical Spondylopathy or Canine Wobblers Syndrome as the lay person
knows it, consists of any uncoordination or lameness caused by pressure on the spinal cord as it travels through the neck (at any age for any reason).

In Great Danes, a true wobbler is usually seen between the ages of 3-12 months of age. The outstanding symptom is a slowly developing,
progressive, uncoordination and paralysis of the hind limbs. This paresis and/or uncoordination is caused by pressure on the spinal cord as it passes
through the vertebrae of the neck, the last three being the most prominent sites. The animal may appear clumsy, "wobbling" or display swaying of the
rear legs. On slick surfaces it may be difficult or impossible to walk. The dog may fall when attempting to turn and the toes of the hind feet may drag
when walking. The dog usually has its legs spread out as far as possible trying to better balance itself. Initially front leg involvement is minimal or
undetectable. As the disease progresses, a characteristic short choppy rolling stride is seen on what appears to be somewhat rigid forelimbs. As the
compression of the spinal cord becomes more severe, the front legs can have the same signs as the rear legs. There is usually little or no neck pain
but the dog may stand with the neck flexed which usually alleviates some of the spinal cord pinching. Many dogs will object to neck manipulation and
may even collapse when the movement is forced.

On occasion, there can be an acute onset of signs. They are usually more severe than with the progressive type. Forelimb involvement is usually
present. There is also a higher incidence of neck pain with the acute onset. This type of wobblers is seen most frequently in five to seven year old
Doberman Pinchers and is rarely seen in young Danes. This must be differentiated from similar signs caused by cervical disc protrusion or a
fractured vertebrae.

The pressure of the spinal cord is due to improper formation of the anatomical parts surrounding the spinal cord during growth. The pressure can be
due to one or a combination of the following:

1. weak ligaments which hold the vertebral bodies in place - this allows irregular movement of the vertebral bodies as the neck is placed in various
positions (subluxations) and causes a pinching of the spinal cord.

2.hyperplasia of the yellow ligaments - normally these are thin loose elastic sheets located between the arches of adjacent vertebrae. Just
beneath them is the small epidermal space which is immediately above the spinal cord. With enlargement of these ligaments, the epidermal space is
obliterated and the yellow ligaments push directly on the spinal cord.

3. malformation of the vertebrae - this can happen in various ways i.e.:

    a. Vertibral or spinal canal that is too small for the diameter of the spinal cord

    b. Assymetric cartilage defects which cause vertebral subluxations

    c. Osteochondrosis of the articular facets which also lead to subluxations

    d. Stenosis of the cranial orifices of vertebral foramina which causes a pinching of the nervous system
 

DIAGNOSIS
This is based on the breed, age, history and results of both a physical and neurological examination. Diagnosis is confirmed by radiographic
examination. A minimum of three views should be taken: a side view with the neck in normal position, a side view with the neck in a flexed position
(head pointed towards the feet), and a side view with the head in a skyward position. A subluxation of one or more vertebrae may be the only
causative agent and is often only seen when the neck is in and extended or flexed position. At times, a view of the neck from top to bottom must be
taken. A mylogram might be needed to properly determine the exact compression sites. Other disease entities which can cause similar symptoms
that must be differentiated from are: disc protrusions, infectious, neoplastic, vascular, or traumatic disorders of the spinal cord. Other bone disorders
common to the giant breeds can cause gait abnormalities but are usually presented with a lot of pain and do not show any nervous system
involvement.
 

CAUSES
The exact reasons why the aforementioned vertebral abnormalities occur are unknown. There is probably a genetic factor that comes into play. This
is determined by a high incidence of Canine Wobblers seen in certain families of Danes. It is difficult to separate the genetic from the environmental
factor (nutrition, management and activity) as most of these families are kept in the same environments because many breeders keep the pups for
three to four months thus keeping the family under a similar environment. Deformity and displacement of the cervical vertebrae secondary to a long
neck, large head and rapid growth has been proposed. (Weight et al 1973).

A vertebral canal that is too small for the diameter of the spinal cord could easily be caused by nutritional hypercalcitonism. As discussed in my
second article, Nutrition of the Newly Born and Growing Individuals (GDR Jan/Feb '85). Calcitonin is released from the thyroid gland when the
animal is fed a diet high in calcium. Its function is to retard bone re-absorption and thus decrease blood calcium levels. Remember, calcium is kept
within strict limits in the blood stream. In normal growth, expansion of the spinal canal must be perfectly synchronized with growth of the spinal cord.
Expansion is achieved by resorption of bone inside the vertebral canal. With hypercalcitonism, the retarded rate of bone resorption prevents proper
expansion of the canal - therefore the diameter of the spinal canal is decreased and has an irregular contour. The spinal cord grows independently of
the surrounding bone and is thus pinched by the nonresorbed bone therefore causing Cervical Spondylopathy.

Nerves leave the spinal cord, to go to other parts of the body, through spaces formed by notches is the vertebrae called foramina. A narrowness in
these spaces will cause a pinching of the nerves leaving the spinal cord which in turn causes inflammation and swelling of the spinal cord itself thus
causing wobblers syndrome. Hypercalcitonism causes narrowness in the vertebral canal can also yield a stenosis of the cranial orifices of the
vertebral foramina due to its effect of slowing bone resorption. Hyper or over nutrition can also give the same results as an increased growth rate
without proper mineralization and body controls can cause enlarged or asymmetric bone formation of the vertebrae in the neck as well as in any other
bone in the body. This could easily result in pinching of the nerves as an overabundance of bone can yield improper notch formation.

Although the vertebrae may not be as flexible as other joints in the body - they do move and have joint surfaces as do other bones. The joint surfaces
called "articular facets" are lined with a cartilage the same as those of other joints. Improper formation of these surfaces can cause the vertebrae to
move improperly and cause luxation or subluxation which can cause pinching of the spinal cord. A mechanism that can cause such a situation is
Osteocondritis Dessecans (OCD). For now, let's describe OCD as a disturbance of endochondral ossification (one type of bone formation) which
leaves the joint cartilage thicker than normal. It is therefore further away from the blood supply leaving it more susceptible to injury and cell death
which will cause poor rotation of the joint and hence subluxation. This can happen at all or only one of the facets in the cervical spine. Again the last
three vertebrae are most commonly affected. Osteochondrosis will be more thoroughly discussed in the next issue of the Reporter. The main cause
of OCD is overnutrition or ad-lib feeding. Hedhammer et all (1974) studied the relation between overnutrition and skeletal disease in growing Great
Danes. In general - dogs fed ad libitum had smaller than cervical vertebral foramina (notches) with subsequent spinal cord compression as well as
asymmetric vertebral articular facets. There was also OCD in the facets displayed as defects in the cartilage covering the facets. They concluded
that "excessive intake of food rich in protein, energy, calcium and phosphorous accelerates growth and can induce various skeletal changes including
changes in the cervical vertebrae that result in the wobbler syndrome."
 

TREATMENT
The treatment of cervical spondylopathy depends on the severity of the neurological involvement and the longevity of the disease process.
Treatment is directed at stopping further cord trauma and at decreasing the current neurological deficits.

The acute form of canine wobbler syndrome is truly a medical emergency. The dog is very often quadriplegic and immediate veterinary attention
must be sought in order for the spinal cord to be saved. Generally the veterinarian will treat the animal with diuretics (i.e. mannitol) and high dose
steroids to decrease the swelling and inflammation in the cord as well as ascorbic acid to protect the myelin sheath that surrounds the nerves. This
treatment may last as long as 2 to 3 days. Depending on the degree of improvement, decompressive surgery is usually required to prevent further
trauma to the cord. If via rigorous medical treatment, the animal regains full neurological function, surgery may be delayed from one to three weeks
with the animal probably kept in a neck brace. If, however, little or no improvement is rendered via medical care - surgery must be done within a few
days in order to preserve the integrity of the spinal cord. The more time that passes with the spinal cord compressed and therefore without nutrients
and oxygen, the higher the likelihood of some degree of permanent paralysis. The two most used surgical techniques are Dorsal Laminectomy (where
the top of the spinal canal is removed thus allowing the spinal cord to rise out of the confining environment) and Ventral Decompression which
removes ulcerated disc material as well as certain ligaments under the spinal cord and some of the vertebral body that may be compressing the cord.
Choice of surgical technique is made by the orthopedic surgeon or by someone that has had much experience with spinal surgery as well as the
special instrumentation needed for this complicated procedure. Even with the correct facilities and techniques there are always possibilities of post
operative complications.

Dogs with slowly progressive signs of Wobblers Syndrome often respond well to a combination of cage rest and corticosteroid therapy. I usually
apply a neck brace as well to provide some stabilization of the neck and at the same time some traction as well. This is only if the syndrome is caught
in the early stages. Remember that the above will only alleviate the effects of compression of the cord and does not and will not correct the vertebral
and ligamentous changes. The IMMEDIATE thing to do is to reduce the protein level of the diet. A protein level not to exceed 22-24% should be
fed. Any and all mineral supplements should be discontinued. All food and water must be elevated to further reduce neck tension. Ball playing or any
action where the head is dipped down to snatch up an object is to be eliminated. A very concerted effort to restrain this dog from exercise is to be
instituted as this can easily yield an increase in the likelihood of vertebral subluxation or further damage to the spinal cord. It is a known fact that
signs of joint instabilities are less severe in animals kept in a sedentary environment than those allowed unrestricted exercise. Hopefully if this is
discovered early and the diet is changed while the bones are still forming and little recurrence of cord trauma occurs, the remaining formation of bone
will be normal and the condition can stabilize itself to the point that surgery will not be needed. Surgery for the slowly progressive form of cervical
spondylopathy may not be as rewarding as with the acute form, if it is discovered late since the damage to the spinal cord may be permanent. It may
however, prevent further damage to the cord.

What can we do to prevent canine wobblers syndrome? My own observations and present studies indicate a probable genetic factor that may
predispose certain lines or individuals to producing wobbler offspring. You as breeders must strongly consider the use of these lines or individuals for
breeding purposes. You must answer to your own conscience and morals. The goal of breeders and the purpose of breeding is to strive to ever better
the breed and those of you in breeding solely for the monetary gain must seriously reconsider this motive!!!

One thing that we all must do is to refrain from that archaic urge to supplement the excellent commercial foods available as the main cause of
growing bone disparities in the giant breeds is hypernutrition.. For those of you who have found that one or two pups out of every litter or every other
litter have shown signs or have developed into wobblers, I recommend that you do your very best to eliminate the environmental elements that might
encourage or enhance the pups' chances of developing into a wobbler. This would entail feeding the entire litter the adult form of the high quality food
(22%-24% protein) starting at weaning time. Don't use Iams puppy food or A.N.F. 30 for instance. The extra calcium and protein in these foods could
easily cause signs of the above. I would feed a multiple vitamin and absolutely no additives. Perhaps a little canned food to increase the palatability.
Each litter must be treated individually. Don't equivocate your litter to your friend's. Don't ignore the possibility that your dogs might be more
efficient in digesting foods and utilizing a higher percentage of available nutrients than someone elses. This could give the same effect of overfeeding
without the addition of any supplements. Periodic radiographs may be advantageous to early detection of wobbler development. Again it is very
important to put as little stress on the necks of these pups - directions to be followed as previously described.
 

SUMMARY
There is no cut and dry answer or definition as to why or where this disease entity originates - this is a fairly new area of veterinary science. We are
finding strong evidence suggestive to a genetic entity in this syndrome and have found definite proof that nutrition plays a major role in the
development of wobblers and other bone disorders in the giant breeds. Again this is due to our wanting only the best for our dogs and knowing that
the giant breeds need more nutrition than average dogs. Where we tend to go wrong is in the belief that if a little more is good, than a lot more must be better. Take an honest look at your own feeding program and look for areas where you might be able to improve the lives of your Danes.
 

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Wobbler Syndrome - in large breeds of dogs. (Caudal Cervical Vertebral Malformation and Malarticulation) (Caudal Cervical Spondylopathy and Myelopathy)

(Note #1)

This syndrome has also been called the "wobbler" syndrome, cervical vertebral instability, and cervical spondylolisthesis. The
term "Wobbler" describes a nonspecific clinical picture, and the terms instability and spondylolisthesis do not accurately
reflect the complexity of the syndrome nor the fact that instability is often not demonstrable. The name cervical spondylopathy
more accurately reflects the complexity of the syndrome and therefore has become widely accepted.

The outstanding clinical feature is a slowly progressive upper motor neuron paraparesis and incoordination. Cervical pain may
or may not be present. The neurologic deficit in the thoracic limbs is usually minimal and occassionally nondetectable. The
reason the pelvic limbs seem more affected than the thoracic limbs is unknown, but deLahunta (1977) suggests that the more
superficial position of the pelvic limb spinocerebellar tracts in the spinal cord at the site of the compression may be the reason.
He also suggests that the further distance of the pelvic limbs from the center of gravity of the animal may be important.

Although the spinal cord compression is usually in the caudal cervical area (area of lower motor neuron supply to the forelegs),
upper motor neuron signs predominate in the forelegs. This finding reflects the fact that chronic spinal cord compression
affects the white matter more severely than the gray matter. In some cases there is a lower motor neuron involvement, usually
expressed as bilateral atrophy of the scapular muscles. The foreleg gait observed in many cases is quite characteristic. The
forelegs appear somewhat rigid and the stride is short , choppy , and rolling. With greater degrees of compression the thoracic
limb gait resembles the pelvic limb gait, that is, paretic and incoordinated. Occasionally the onset of signs is acute, and the dog
is quadriplegic when presented to the clinician.

(Note #2)

Diagnosis...Breed, age and clinical signs suggest the diagnosis of cervical spondylopathy, which is confirmed radiographically.
Changes seen on noncontrast radiographs may consist of (1) change in shape of the vertebral body with apparent loss of the
cranioventral corner of the vertebral body. (2) abnormal width and shape of the disc space cranial to the vetebral body defect.
(3) calcification of the affected disc, (4) reactive osteophyte formation and end-plate sclerosis resulting from the instability of
affected disc, (5) malformation of the articular processes. Myelography is required to identiy the nature and precise location of
extra-dural soft-tissue masses: disc hernation, thickening of the ligamentum flavum and joint capsule, or thickening of the
dorsal longitudinal ligament. The use of a hyperextended lateral projection is of great value in demonstrating the maximum
degree of cord compression.
 

Vertebral instability, either alone or in combination with vertebral malformation and/or soft tissue stenosis has been suggested
as an initiating cause of spinal cord compression and associated neurologic abnormalities (VanGundy 1988 - Dobes).

Etiology (causative factors) - still obscure and include - genetics, rapid growth, nutrition. The high incidence in certain breeds
suggests heredity is a contributing factor.

Structural Aspects - combined bone and soft tissue lesions (spinal cord compression) at C6-C7 and C5-C6 are most commonly
seen, however C4-C5, and C3-C4 can be affected.

Malarticulation - allowing ventral displacement. This can be stable or unstable - the unstable cases are often only visible on
flexed lateral views (Spondylolisthesis).

Malformation - changes can be secondary to malarticulation; the cranial edge of the vertebral foramen may be stenotic with or
without deformities of the vertebral body. Arthritic changes, interbvertebral disc degeneration and collapse, disc protrusion etc.
can occur in various combinations in older dogs. Most dogs have a combination of both malarticulation and malformation.
 

Destruction of Neurons - in severe cases, neurons are destroyed at the site of injury, usually at C6 and C7 spinal cord segments.
Milder cases myelin may be lost at the site of injury, causing some loss of function that can be repaired over time if the lesion is
stabilised.

Clinical Signs - vary widely. Seen as early as 2-4 months of age and as late as 8-9 years of age.

Neurologic dysfunction (signs visible) are due to the spinal cord compression exhibited in that dog. Most commonly seen in the
younger dogs is hindquarter incoordination, wide based exaggerated movement and proprio-receptive deficits (stumbling,
scrapping of toes). Frequent turning will often cause the dog to fall over in the hindquarters. Front legs are usually less affected
than the hind-limbs, but affected dogs may have a restricted action, the limbs appearing rigid.

Rate of progression is variable according to the severity of spinal cord compression and the extent of instability and damage.

Young Dogs - especially Great Danes (less than 2 years of age), frequently have dorsal spinal cord compression due to
elongation of the cranial aspect of the dorsal arch of the affected vertebrae. Dobes, Danes may be 6 months or younger when
initial signs are noticed. Bull Mastiffs are generally less than 1 year of age. Affected Bassets are male, generally less than 6
months of age and have a malformation of C3.

These dogs frequently have severe ventral spinal cord compression secondary to collapse of theintervertebral disc and
proliferation of fibrous tissue around the unstable area.

Older dogs often exhibit pain on movement of the neck, particularly during flexion. Signs can be as mild as neck pain to
tetraplegia (paralysis of all 4 limbs).

Diagnosis - When studying this disorder it must be determined that a neurological disorder exists and not one of several
skeletal diseases that occur in young dogs including OCD, HD, HOD. Most of these disorders are asymetrical, the gait appears
stiff and pain can be palpated in affected joints or limbs. Neurological cases with cervical lesions have poor control over the
position of the limbs, hence the wide based stance, stumbling and proprio-receptive deficits (righting relaxes of the feet).

.Disorders such as congestive cardiomyopathy or hypothyroidism are frequently diagnosed in the Great Dane and the
Dobermann. TSH testing is recommended in any Dobermann Pinscher with clinical signs consistent with cervical
spondylonyelopathy. Supplementation of hypothyroid dogs with T4 products is recommended, and in some dogs may result in
dramatic clinical improvement. (Ettinger 1989) Hypothyroid neuromuscular dysfunction symptoms include - weakness,
stiffness, reluctance to move knuckling or dragging of the feet with excessive wear of the dorsal surface of the toenails and
muscle wasting

OCD of the cervical vertebral articular surfaces of young Great Danes may be a causative factor of cervical vertebral
instability in this breed. Lesions seen were similar to those seen in Cervical Osteochondrosis in swine (Olssen 1980).

Plain radiographs are useful for a rough diagnosis if there is vertebral malformation, however a myelogram is necessary for
positive confirmation of the areas of spinal cord affected by compression. Apparent "tipping of vertebrae", or coning of the
vertebral canal can be enormously misleading in demonstrating the involved vertebral interspaces. Without myelograms,
accurate and complete diagnosis cannot be made. If surgery is needed, myelegrams are essential in the selection of the most
appropriate surgical techniques that will stabilise the neck and allow the surgeon to assess the long term prospects of the
affected dog.
 

  Treatment - depends on several factors - severity of the symptoms, age, suddeness of onset, long  term prospects.

Conservative - rest and cortiocosteriods are most effective in many cases. Surgery is advocated where response to
corticosteroids is poor and clinical signs and/or the radiographic signs are severe. Younger dogs are often treated this way
initially, however if signs persist, surgical intervention is necessary if long term improvement is to be gained. Occasionally a
young dog may "grow out" of their problem by enlarging their verterbal canal sufficiently to accommodate the spinal cord.
Older dogs, where the pain is readily controlled with rest and medication, can often be managed on long term cortico-steroid
therap.

Surgical - rule of thumb on this type of treatment is based on the age of the dog i.e.. if 6-8 years- surgery is probably of benefit.
A 10 year dog may be better managed on tablets. Numerous methods are described and can vary depending on the cause and
site of compression - plates, dorsal and ventral laminectory, vertabral body screws etc. Treatment is aimed at stabilisation and
decompression of the effected section of the spinal cord. Neurological deterioration can occur subsequent to surgery (months
or years later) due to invovement of an adjacent disc space. Prognosis - of affected dogs is as varied as their vertabral column
lesions and neurological deficits. In general the more severe the neurological dysfunction, the less favourable the prognosis.
Post surgical improvement depends on the elimination of further injury to the spinal cord and remyelination of the damaged
nerve tissue.

Genetics - A simple recessive mode has been suggested in the Great Dane and Dobermann. Higher incidents are seen in males.
An autosomal recessive mode for the Borzoi (generally affects older adults) has also been suggested. However there appears to
be a gender influence as well (females are primarily affected in the Borzoi).

References: Veterinary Neuroanatomy and Clinical Neurology, De Lahunta 1983 Textbook of Small Animal Surgery, Newton
& Nunamaker 1985 Current Techniques in Small Animal Surgery, Bojrab 1983 Textbook of Veterinary Internal Medicine,
Ettinger 1989 Canine and Feline Endocrinology and Reproduction, Feldman and Nelson 1987