Laurie Anne Walden, DVM Adult heartworms grow up to a foot long, block blood flow around the heart, and cause inflammation within blood vessels. The damage continues as long as the heartworms remain in the body. Heartworm treatment protocols for dogs are designed to remove the worms while reducing the risk of treatment complications. No safe heartworm treatment exists for cats and ferrets. Your veterinarian can recommend appropriate heartworm preventives for your dog, cat, or ferret. Initial Tests Heartworm infection is diagnosed with a blood test. Your veterinarian might confirm the diagnosis with another test before proceeding with treatment. Other tests, like x-ray imaging, echocardiography (heart ultrasound), and other blood tests, are used to assess the extent of damage. The results can affect the treatment plan, so your veterinarian might recommend these tests even if your dog isn’t showing any symptoms of infection. Dogs with blood clotting problems or signs of heart disease need a full diagnostic workup before treatment starts. Exercise Restriction Any activity that increases the heart rate and blood pressure can worsen the problems caused by heartworms. Dogs with heartworms need to stay as quiet as possible to limit the damage. Once treatment begins, pieces of dead worms can break off and lodge in small blood vessels, potentially causing serious problems and even death. Strict exercise restriction is the best way to reduce the risk. The American Heartworm Society (AHS) recommends restricting activity from the time heartworms are diagnosed until 6 to 8 weeks after the last dose of heartworm treatment. Dogs should ideally stay indoors in a small area where they can’t run or jump. Some dogs need to be confined to a crate. They should go outdoors on a leash only long enough to pee and poop. Ask your veterinarian about the level of confinement your dog needs. Before Killing the Heartworms Before dogs begin receiving adulticide (medication that kills adult heartworms), they may need treatment for heartworm-related problems. They should receive a certain type of heartworm preventive to remove larvae, or immature worms, from the bloodstream. They also benefit from a monthlong course of doxycycline, an antibiotic, to eliminate a bacterium that lives inside heartworm cells. This bacterium is partly responsible for the inflammation that occurs when heartworms die. The AHS recommends that dogs start adulticide treatment 2 months after receiving a heartworm diagnosis (30 days after the last dose of doxycycline). Dogs should have limited activity during these 2 months. Adulticide Treatment The only adulticide currently approved for use in the United States is melarsomine. This drug is given by injection in a veterinary hospital. Your dog may need to stay in the hospital for observation after a melarsomine injection. The number and timing of injections may vary depending on the situation. The current AHS recommendation is to give a series of 3 injections: 1 injection followed by a 30-day wait, then 2 injections given 24 hours apart. Your veterinarian will suggest a protocol that’s appropriate for your own dog. Complete exercise restriction is crucial during adulticide treatment and for several weeks after the last dose. Your veterinarian may also prescribe medications to reduce adverse effects of treatment. Retesting Your dog can be retested for heartworms several months after the last melarsomine injection. The goal of treatment is to remove all stages of heartworms. “Slow-Kill” Methods Protocols to manage heartworm infection without using melarsomine are sometimes called “slow-kill” treatments. These protocols consist of giving doxycycline for a month and beginning a specific type of heartworm preventive to remove larvae. Heartworms take from several months to a year or more to die with these protocols. The disadvantage of slow-kill treatment is that it allows adult heartworms to remain in the body for much longer than with adulticide treatment. The worms continue to damage the heart and blood vessels during this time. For this reason, the AHS does not recommend this method as standard treatment. Dogs receiving slow-kill treatment should also have exercise restriction for as long as adult heartworms remain in the body. The advantage of slow-kill treatment is that it costs much less than melarsomine. Slow-kill methods have been proposed for dogs that would otherwise go untreated or be euthanized, like those in shelters or in areas where melarsomine is not available. Slow-kill treatment also offers an option for dogs at high risk of complications from adulticide treatment. For More Information See these resources from the American Heartworm Society: Battling Boredom: Tips for Surviving Cage Rest (PDF) Heartworm Positive Dogs: What Happens if My Dog Tests Positive for Heartworms? Heartworm Treatment Guidelines for the Pet Owner (PDF) Photo by Ryan McGuire Laurie Anne Walden, DVM Hypertension (high blood pressure) is fairly common in older cats. The condition can cause serious health problems but is treatable. Senior cats and cats with kidney or thyroid disease benefit from routine blood pressure screening. Symptoms High blood pressure is silent; it has no symptoms of its own. But high blood pressure damages organs of the body, causing symptoms that cat owners might notice.
Causes In cats, hypertension is usually caused by another disorder. The most common causes in cats are chronic kidney disease and hyperthyroidism (overactive thyroid). Sometimes high blood pressure in cats seems to develop on its own with no known cause, as can happen in humans. Older cats are more likely than younger cats to have hypertension. Blood pressure measurement Current guidelines recommend measuring blood pressure in cats in these categories [2,4]:
In cats, blood pressure is usually measured with an inflatable cuff similar to the cuffs used in people (but much smaller!). The cuff is placed around a leg or the tail. During the procedure cats can lie down or sit upright, whichever is more comfortable for them. Most operators try to position the cuff at the level of the heart, but forcing a cat to lie down can cause agitation and raise the blood pressure. Blood pressure readings are most accurate in calm cats. You might be asked to wait with your cat in the examination room for a few minutes to give her time to settle down and get comfortable. Consider bringing a cat bed, blanket, or towel from home so your cat can rest on something familiar during the procedure. Blood pressure is typically measured several times during each session to account for variation from motion or anxiety. Cats tend to tolerate the procedure well. A systolic blood pressure below 140 mm Hg is considered normal in cats. (In blood pressure readings like “110/70 mm Hg,” systolic pressure is the first number and diastolic pressure is the second number). A systolic blood pressure of 160 mm Hg or higher indicates hypertension and an increased risk of organ damage.[4] Veterinarians often measure blood pressure on more than 1 clinic visit before making a definite diagnosis of hypertension. Cats’ blood pressures can vary from visit to visit depending on their stress levels. However, signs of organ damage can confirm the diagnosis and justify starting treatment after only 1 measurement session. Cats with hypertension (or at risk for hypertension) should have blood pressure checks every few months. Treatment The goal of treatment is to reduce the risk and extent of organ damage. The underlying problem causing the high blood pressure is treated at the same time. Most cats with hypertension receive daily oral medication. The dose is adjusted as needed after blood pressure rechecks. Medication is usually effective in reducing the blood pressure, especially if the underlying disease is also controlled. References 1. Syme H. Systemic hypertension: World Small Animal Veterinary Association World Congress Proceedings, 2013. VIN website. https://www.vin.com/doc/?id=5709837. Accessed March 25, 2019. 2. Taylor SS, Sparkes AH, Briscoe K, et al. ISFM consensus guidelines on the diagnosis and management of hypertension in cats. J Feline Med Surg. 2017;19(3):288-303. 3. Quinn R. Cardiovascular effects of systemic hypertension in cats. MSPCA Angell website. https://www.mspca.org/angell_services/cardiovascular-effects-of-systemic-hypertension-in-cats/. Accessed March 25, 2019. 4. Acierno MJ, Brown S, Coleman AE, et al. ACVIM consensus statement: guidelines for the identification, evaluation, and management of systemic hypertension in dogs and cats. J Vet Intern Med. 2018;32(6):1803-1822. Photo by Hunt Han Laurie Anne Walden, DVM Chronic kidney disease is common in cats. It can affect cats at any age but is most common in older cats.[1] The disease has no cure. The goals of treatment are to slow the progression of the disease and maintain a good quality of life for the cat. Functions of the Kidneys The kidneys filter the blood and excrete waste products into the urine. When the kidneys don’t work properly, these waste products accumulate in the body. The kidneys balance the body’s water level by adjusting the urine concentration. Kidney disease impairs the ability to concentrate the urine and retain water in the body, so animals with kidney disease become dehydrated. The kidneys also help regulate blood pressure, red blood cell production, and acid-base balance. Signs of Kidney Disease Kidney disease is already advanced (at least two-thirds of kidney function lost) by the time signs of illness appear. Cats typically have the following signs:
Keep an eye on the size of the urine clumps in your cat’s litter box. Enlarging urine clumps can mean that urine volume is increasing, which is one of the earliest signs of kidney disease. Other disorders (like diabetes) can also increase the urine volume, so larger-than-usual urine clumps warrant a visit to the veterinarian. As chronic kidney disease progresses, the loss of kidney function leads to further problems:
Causes of Kidney Disease Acute kidney injury is a rapid loss of kidney function over hours to days. Some of the many possible causes are toxins, infections, and shock. Depending on the cause and severity, acute kidney damage can sometimes be reversed with treatment. Chronic kidney disease is more common than acute kidney injury in cats. In chronic kidney disease, kidney function gradually decreases over time. The cause is usually not known. The same entities that cause acute kidney injury can lead to chronic kidney failure. Other possible causes are high blood pressure, abnormal kidney development, infection or inflammation of the kidneys, disorders that alter blood flow to the kidneys, and cancer.[2] Diagnostic Tests Tests are used to diagnose kidney disease, assess the stage of the disease, identify metabolic problems caused by the disease, diagnose other disorders (like thyroid disease) that cats with kidney disease sometimes also have, and possibly reveal the cause of the kidney problem. Blood tests and urinalysis (analysis of urine) are typically the first diagnostic tests for cats with suspected kidney disease. Blood pressure measurement, urine culture to test for bacterial infection, and ultrasound or x-ray imaging of the urinary tract are also commonly performed for cats with kidney disorders. Cats with chronic kidney disease benefit from regular testing to monitor disease progression and adjust treatment. In general, these cats should see a veterinarian for blood tests, urinalysis, and blood pressure measurement every 3 to 6 months.[2] The stage and substage of chronic kidney disease are evaluated with specific tests[3]:
Treatment Chronic kidney disease can’t be cured, but it can be managed. The prognosis is variable; some cats can live with the disease for years. If your cat has kidney disease, work with your veterinarian to craft a treatment plan that will give your cat a good quality of life. Treatment strategies are based on the stage of disease and the individual cat’s needs and may include the following[1,4]:
References 1. Sparkes AH, Caney S, Chalhoub S, et al. ISFM consensus guidelines on the diagnosis and management of feline chronic kidney disease. J Feline Med Surg. 2016;18(3):219-239. 2. Brown SA. Renal dysfunction in small animals. Merck Veterinary Manual website. https://www.merckvetmanual.com/urinary-system/noninfectious-diseases-of-the-urinary-system-in-small-animals/renal-dysfunction-in-small-animals. Accessed February 26, 2019. 3. International Renal Interest Society. IRIS staging of CKD. http://www.iris-kidney.com/pdf/IRIS_2017_Staging_of_CKD_09May18.pdf. Updated 2017. Accessed February 26, 2019. 4. International Renal Interest Society. Treatment recommendations for CKD in cats. http://www.iris-kidney.com/pdf/IRIS_2017_CAT_Treatment_Recommendations_09May18.pdf. Updated 2017. Accessed February 26, 2019. Photo by Nicolas Picard on Unsplash Laurie Anne Walden, DVM Tooth root abscesses are painful and need prompt treatment, but the signs can be easy to miss. Dogs don’t always show that their mouths hurt, and tooth abscesses can mimic other conditions.
Causes Tooth root abscesses are pockets of pus caused by bacteria that invade the deep structures of the tooth. They often occur in teeth with severe periodontal disease or gingivitis (gum disease), especially if the gum has receded around the tooth. Teeth that are cracked or fractured are also at risk for root abscesses. Teeth can fracture when a dog chews on something hard, like a bone, cow hoof, ice cube, hard nylon toy, or rock. Fractures that expose the pulp cavity (the inner part of the tooth) give bacteria a route to the tooth root. Affected teeth The upper fourth premolar—the large cheek tooth on each side of the upper jaw—is a common site of root abscess. This tooth, also called the carnassial tooth, is used to crush food. When a dog crunches something hard, a carnassial tooth can sustain a slab fracture (shearing off a slab from the side of the tooth) or can crack down the center. The roots of the carnassial tooth reach nearly to the eye, so an abscessed root causes swelling just below the eye. Root abscesses can occur in any tooth. The large canine (fang) teeth are frequently broken and are also common sites of root abscesses. Symptoms Although tooth root abscesses are very painful, dogs’ signs of mouth pain can be subtle. Some dogs don’t show any symptoms at all. Signs of a tooth root abscess can include the following:
A veterinarian may be able to find evidence of a tooth root abscess during examination of an awake patient. However, dogs with tooth root abscesses sometimes have too much mouth pain to allow much of an oral examination without sedation. Diagnosis often requires dental radiographs (x-ray images) or at least a full oral examination with the patient under anesthesia. Dental radiographs sometimes reveal tooth root abscesses that can’t be seen any other way. Treatment Untreated tooth root abscesses cause prolonged pain and tooth loss. The infection can spread to other tooth roots and to the face, potentially even affecting the eye. Dogs with tooth root abscesses need antibiotics and pain relief. The source of the infection must also be removed. There are 2 options for treating an abscessed tooth root:
If you think your dog might have a tooth root abscess, make an appointment with your veterinarian as soon as possible. Your veterinarian will examine your dog and, if the signs indicate an abscess, will probably prescribe an antibiotic and an analgesic (pain reliever). The next step will be either another appointment with your veterinarian for tooth extraction or referral to a dental specialist for possible root canal therapy. Both extraction and root canal therapy require general anesthesia. If you would like your dog to keep his tooth, root canal treatment is the best option. Antibiotics alone are rarely enough to treat a root abscess. However, not all teeth are candidates for root canal therapy. The dental specialist will evaluate dental radiographs to see if root canal treatment is a good option and will extract the tooth if necessary. Prevention Sometimes tooth root abscesses are unavoidable. But you can take some measures to reduce your dog’s risk:
Laurie Anne Walden, DVM Brachycephalic (flat-faced) dogs and cats are popular, but those cute squashed noses can cause some serious health problems. If you have a brachycephalic pet, watch for breathing trouble (snoring and grunting are not normal). These pets are also prone to heat stress, especially if they’re overweight. Brachycephalic means “short-headed.” Brachycephalic animals have short noses, round heads, and large, low-set eyes. Examples are English and French bulldogs, pugs, Boston terriers, shih tzus, and Persian cats. If you think these pets are adorable, you're not alone. Studies have shown that many people are attracted to facial features in animals that are similar to those of human infants.[1] Unlike dog breeds that were developed for tasks like hunting, brachycephalic dogs have been bred over time for looks. Unfortunately, breeding for form over function has compromised the health of many of these dogs. Earlier this year the British Veterinary Association released a policy position on the welfare of brachycephalic dogs. Their aims are to improve the health of future generations of these dogs and to increase awareness of the problems caused by breeding for extreme brachycephaly.[2] The association highlighted 5 of the most common medical concerns: respiratory, eye, reproductive, skin, and dental problems. Impaired breathing Many brachycephalic animals cannot breathe normally. Although the bones of the face are shortened, the soft tissues are not, leaving excess tissue that can block the airway. Signs of impaired breathing include snoring, snorting, and exercise intolerance. Brachycephalic animals are at risk for heat stroke, respiratory distress, and collapse. Long-term labored breathing can also cause digestive tract problems like gagging and vomiting. Obesity makes all of these problems worse.[3] Brachycephalic obstructive airway syndrome includes 3 main anatomic abnormalities: narrow nostrils, elongated soft palate (excess tissue at the roof of the mouth), and everted laryngeal saccules (tissue that blocks airflow through the trachea, or windpipe). Some animals require surgery to correct these problems. Brachycephalic animals may also have an abnormally narrow trachea, which gives the effect of constantly breathing through a small straw.[4] Eye disease Brachycephalic animals have shallow eye sockets and large eyelid openings, so their eyes are not as well protected as those of other animals. Many also have impaired tear production (dry eye), reducing their defense against eye irritants. Skin folds at the top of the nose may cause hair to rub against the eyes. These problems can cause eye ulcers and eventual blindness.[5] Reproductive problems Some brachycephalic breeds have trouble giving birth naturally because the puppies’ heads are too large to fit through the mother’s pelvis. One study found that over 80% of English bulldog, French bulldog, and Boston terrier litters born in the United Kingdom were delivered by cesarean section.[6] Skin and dental disease Folds of loose skin give bacteria and yeast a handy place to grow, so brachycephalic animals are prone to skin fold infections. Because of their shortened upper jaw, they often have crowded or maloccluded teeth. If you have a brachycephalic pet:
If you are thinking of getting a brachycephalic pet:
References 1. Archer J, Monton S. Preferences for infant facial features in pet dogs and cats. Ethology. 2011;117(3):217-226. 2. Health and welfare of brachycephalic dogs. British Veterinary Association website. https://www.bva.co.uk/news-campaigns-and-policy/policy/companion-animals/brachycephalic-dogs/. Accessed March 27, 2018. 3. Packer RM, Hendricks A, Tivers MS, Burn CC. Impact of facial conformation on canine health: brachycephalic obstructive airway syndrome. PLoS One. 2015;10(10):e0137496. 4. Brachycephalic syndrome. American College of Veterinary Surgeons website. https://www.acvs.org/small-animal/brachycephalic-syndrome. Accessed March 27, 2018. 5. McNabb NT. Top 5 threats to vision in the brachycephalic dog. Paper presented at: North American Veterinary Conference 2017; February 6, 2017; Orlando, FL. 6. Evans KM, Adams VJ. Proportion of litters of purebred dogs born by caesarean section. J Small Animal Pract. 2010;51(2):113-118. 7. Caring for brachycephalic dogs. MSPCA Angell website. https://www.mspca.org/angell_services/caring-for-brachycephalic-dogs/. Accessed March 27, 2018. Laurie Anne Walden, DVMAccording to the Association for Pet Obesity Prevention, up to 54% of dogs and 59% of cats in the United States are overweight. That’s more than 40 million dogs and 50 million cats. Is your pet one of them? Obesity has been linked to arthritis, diabetes, heart disease, immune system disorders, liver disease, and other health problems in pets. In recognition of National Pet Obesity Awareness Day (October 11), here’s how to tell if your pet is overweight.
Body condition scoring Body condition scoring assigns a number to a pet’s condition to make it easier to track changes over time. Body condition score charts typically use either a 5-point or a 9-point scale. The ideal body condition score is 3 on a 5-point scale or 5 on a 9-point scale. Check out one of these body condition charts to see where your pet falls on the scale:
Medical problems Always bring your pet in for a physical examination before reducing its calorie intake or starting an exercise program. Some medical problems can cause weight gain. Pets with these conditions might need to go on a diet, but they also need treatment:
Other medical conditions can mimic obesity. A pet with one of these conditions might have a big belly but actually be thin overall, and restricting its food could be harmful:
We’re happy to discuss your pet’s weight with you and suggest a diet and exercise plan for your pet that will work for your family. (Telling you “no table food EVER” is not very helpful if you have a toddler in the food-throwing stage). And remember: your pet’s weight is not a reflection of your own health or of how much you love your pet. If we tell you your pet needs to lose weight, it’s only because we want your pet to live a long life and be as healthy as possible. For more information Association for Pet Obesity Prevention website Obesity (dog): American Animal Hospital Association website Obesity: The Cat Community website October 13, 2017 Photo by Almi
With the Fourth of July and frequent thunderstorms, summer can be tough for pets that are afraid of loud noises. Medication and behavior therapy can help, especially when treatment begins early. Noise phobia is common in dogs. In some behavior studies, up to half of dogs show fear responses to loud noises. Some dogs are afraid of only one type of sound; others are fearful of several. Fireworks, thunder, and gunshots are common triggers. Vacuum cleaners, construction noise, sirens, and other sounds can also set off fear reactions. Dogs with noise phobia may also have other anxiety disorders like separation anxiety. Some behavior specialists classify storm phobia separately from noise phobia because affected dogs may be sensitive to environmental factors (like changes in barometric pressure) in addition to noise. Storm-phobic dogs often start acting anxious long before the storm arrives. Noise phobia gets worse with time if not treated. Owners sometimes don't seek treatment until a dog's symptoms become severe, but phobias are usually easier to manage while the symptoms are still mild. Signs of noise phobia Being startled by a sudden loud noise is normal. Dogs with noise phobia develop irrational, ongoing fear responses to noise triggers. They can hurt themselves and damage property. Panicking pets may also hide or freeze, which is less obvious than breaking through a window but is still a sign of fear. Pets with noise phobia can have various reactions:
Treatment options Most behavior specialists suggest treating phobias with environmental modification and behavior therapy, usually combined with medication. However, treatment is tailored to each pet's needs. Before starting treatment, your pet may need diagnostic tests to rule out medical problems that can contribute to anxiety. Environmental modification and behavior therapy Pets should have a safe place to escape the noise. This can be a windowless interior room, a closet, a bathroom, a crate (perhaps with a sound-dampening cover), or any other area you've noticed your pet seeking during loud noises. Providing music or white noise in the safe place helps some pets. If your dog does not have a preferred location, you can create one--but do not force a dog to go to a particular area (like a crate) if it increases his anxiety. Training a dog to settle in the safe zone on command can become a relaxation technique he can use during noise events. Counter-conditioning can decrease fear and provide a distraction. For example, giving a treat-filled toy during thunderstorms can help a dog learn to associate the noise with something positive. Desensitization begins with playing a recording of the problem sound at a very low volume for a very short time (at a level too low to provoke anxiety). The volume is gradually increased until the dog is able to listen without fear. This can take weeks or months. It is less likely to work for dogs with storm phobia. Medication Fast-acting antianxiety medications are used as needed for individual noise events, such as Fourth of July fireworks. Most work best if given at least 30 minutes before the noise begins, although some can reduce anxiety in dogs who are already frightened. Examples are alprazolam, trazodone, and a form of dexmedetomidine placed inside the cheek. Long-term daily medications (such as fluoxetine) can help dogs who have anxieties in addition to noise phobia. They may also reduce overall anxiety in dogs with storm phobia. These drugs can be used in combination with fast-acting medications. Other therapies Antianxiety wraps put gentle pressure on the body. Some owners say these products help calm their dogs; others see little difference. A dog pheromone is available as a collar, spray, or diffuser. A recent study showed that the pheromone decreased signs of noise phobia, although other reports have been inconclusive. What you can do
June 27, 2017 Photo by Robert Larsson Laurie Anne Walden, DVM Key points
You may have read about canine influenza in the news recently. Cases of canine flu have been confirmed in North Carolina, and 2 dogs have died. Here's what you need to know. How canine flu spreads Canine flu is caused by an influenza A virus that is highly contagious among dogs. It spreads through respiratory tract secretions. Sources of infection typically include the following:
Two strains of canine influenza virus have been identified in the United States. H3N8 virus was first seen in this country in 2004. H3N2 virus caused an outbreak in the Chicago area in 2015 and the recent cases in Florida and Georgia. About 80% of dogs exposed to the virus develop clinical signs of infection. About 20% have no symptoms but can still spread the virus to other dogs. Infected dogs are most contagious during the first 2 to 3 days after infection, before they show signs of illness. Dogs infected with H3N2 virus can continue shedding virus, potentially infecting other dogs, for more than 3 weeks. Cats can also contract canine flu and spread it to dogs. To date there has been no evidence of the virus infecting humans. Signs of canine flu Clinical signs typically appear 2 to 3 days after exposure to the virus. Most signs are similar to those caused by canine infectious tracheobronchitis (kennel cough) and other respiratory infections. The mortality rate is less than 10%. Most dogs develop mild symptoms:
Some dogs develop more severe illness:
Diagnosis and treatment Canine flu is diagnosed by sending swabs or blood samples to a diagnostic laboratory. There is no rapid in-house test for canine influenza virus. However, treatment does not depend on having a definite diagnosis. As with human influenza, treatment is supportive and depends on the patient's symptoms. Antibiotics do not affect the virus that causes flu. Most dogs have mild illness that resolves after 2 to 3 weeks. Some dogs need treatment for secondary bacterial infections, dehydration, and other problems caused by the virus. Vaccination As of June 2017, Mallard Creek Animal Hospital uses a new canine influenza vaccine that covers both strains of the virus.
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The contents of this blog are for information only and should not substitute for advice from a veterinarian who has examined the animal. All blog content is copyrighted by Mallard Creek Animal Hospital and may not be copied, reproduced, transmitted, or distributed without permission.
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