Congenital Heart Disease in a Young Dog

He was less than a year old. His shiny black coat indicated he had been well cared for and was ready for the good life Labrador Retrievers enjoy. But as he lay on the examination it was obvious he was very sick. He had become acutely ill and as he turned toward me his eyes seemed to say, “It’s no use, Doc”.

          With mouth halfway opened he gasped for breath, but there was no sound of rushing air. I could not feel the femoral pulse. Nor, could I hear the heart beat with a stethoscope. These two signs indicated the heart was not adequately pumping blood. However, the electrocardiogram was not unusual. It could not define the type of heart disease, and he was too ill to do chest radiographs that might be instructive. There were sounds of air movement in the lungs, vesicular sounds, detectable with the stethoscope but no rates or creptations. This and his gasping for breath suggested the lungs were filling with fluid escaping from his blood. This is called pulmonary edema. The dog was treated for dilated cardiomyopathy, a common form of heart failure. And, although he was not coughing he was also treated for influenza, a virus infection which can cause pulmonary edema even though heart failure was considered to be a more likely primary cause of his symptoms.

          He died during the night. The necropsy next morning showed his lungs were indeed edematous. Enough so that, it was obvious he had drowned in fluids that escaped into his lungs from blood vessels due to stasis of blood flow that complicated inadequate heart function. The heart disease was not dilated cardiomyopathy. Rather, it was hypertrophic cardiomyopathy; a condition in which heart muscle cells proliferate increasing heart wall thickness. Scar tissue may form further compromising cardiac contraction. Eventually these changes lead to heart failure and death of the victim. Rare in dogs, it is common in cats in which it is thought to be inherited. I was told litter mates of this dog all died suddenly but no diagnosis of cause of their deaths was rendered. These deaths suggest hypertrophic cardiomyopathy in this young litter was inherited. As a rule, therapy of dogs terminally ill with this disease is not effective. Management of the disease is by prevention. Avoid mating of known carriers. 

Periodontal Disease

She was brought to the hospital because she had been sneezing for a week and the owner wanted it stopped.  This was the first time I had seen Trixy, an old, overweight Miniature Poodle. At first I thought she might have a chronic infection somewhere in the nasal cavity that was causing her to sneeze or maybe cancer in the back part of the nasal cavity.  With these problems one often sees intermittent bleeding from the nostrils and there may be reverse sneezing as if there was exudate draining backward into the throat, but this hadn’t happened.  Then, when Trixy was put on the floor, she did a forward sneeze trying to clear something from the front of the nasal cavity.  That was different, not what I expected. The teeth were the cause of the problem!  I could see they were massively caked with a greenish-gray scale that had accumulated over years.  It was accompanied by periodontal disease and that infection had progressed down the teeth causing them to become loose and painful.  In Trixy’s case, infection around the roots of the large canine teeth had eroded into the nasal cavity creating fistulas (holes) so that pus drained into the nasal cavity, causing poor Trixy to sneeze.  To treat this condition one can administer antibiotics which may control the infection temporarily only to have it resume when the antibiotic treatment ceases.  Another way veterinarians solve Trixy’s problem is to stop the flow of pus by cleaning the teeth with ultrasound (brushing won’t do), extracting teeth that are loose or infected and then, surgically close the fistulas between the mouth and the nasal cavity. 

Prevention by routine tooth cleaning is the preferred management of this disease.  Twenty years ago many dogs had fistulas between the mouth and the nasal cavity that developed when canine teeth with severe periodontal disease fell out.  This condition was especially common in small lap dogs that lived indoors and ate human table food.  But over time owners of these small dogs have eliminated table food diets and fed nutritionally balanced commercial dog food which has prevented bone degeneration around the teeth from developing.  They also have had their pet’s teeth cleaned routinely by a veterinarian.

Treating Puppies with Parvo virus Infection; A Study

Start of the parvo virus season is just around the corner. It extends through fall, winter and spring and is most prevalent in low desert areas such as the Imperial Valley. Affected puppies vomit, and suffer from diarrhea. If neglected, pups can become very dehydrated and death is a common outcome. Some owners treat sick puppies themselves using over-the-counter remedies too often with disastrous results.  Years ago I learned that the drugs used to treat sick puppies were critical. Sometimes when one of the penicillin drugs was used for treatment the puppy would develop a severe Clostridium difficile diarrhea, a very undesirable consequence.

 I did some studies to see what might or might not work. During the 2016 parvo season 61 pups that had tested positive for parvo were treated. They all got the same regimen: a liquid oral prescription for the gastro-intestinal bacteria, a small injection of a broad spectrum-antibiotic for other bacteria in their bodies and an oral antivirus medicine used in people. Puppies were sent home with instructions to return the following day for further treatment. Most of the sick puppies were treated only once, and only one of them died. Perhaps the antivirus medicine was most helpful I am not certain that it was but I continue to rely on it.

Acute Pancreatitis

This is a story about acute pancreatitis in two small dogs; one was a young male and the other an old female. They had been vomiting for several days, would not eat, their abdomens were tense and painful, and they had low-grade fevers.  The disease developed spontaneously in both dogs.  Serum lipase and amylase, two enzymes normally found in pancreatic cells, were elevated three and ten times the normal level. When pancreatic cells are injured some of the enzymes they contain leak into blood and become important for diagnosing acute pancreatitis. The pancreas is located in the abdomen alongside the small intestine and contains several enzymes that digest food when they are secreted into the intestine.  Normally, while within pancreatic cells, the enzymes are inactive.  However, enzymes can become activated inside the cells. When activated, they injure the cells by digesting them, thereby causing inflammation and the disease, pancreatitis.

            To counter the inflammation and pain from the pancreatitis both dogs were treated morning and night with minocycline, an antibiotic with cytokine-modulating anti-inflammatory properties.  Within 24 hours the dogs appeared to feel better, for they were more active and in less pain.  At 48 hours serum amylase and lipase levels had returned to normal in one dog and near normal in the other. Treatment was continued for 10 days and full recovery was uneventful.  The promptness and extent of response to treatment of pancreatitis were greater than anticipated and suggest there was modulation of inflammatory cytokine effects in the pancreas and/or suppression of intracellular enzyme activation by minocycline.

Image courtesy of Mike Barid - Flickr

Tear Stains in Dogs

It is common to see Shih Tzu dogs, as well as Pugs and Miniature Poodles, with tear-stained faces.  This condition relates to inherited anomalies of facial structure.  The consequence is impaired drainage of tears through the tear ducts.  Instead, tears spill down the face.  Iron in tears stains the hair and the constant wetness results in infections, dermatitis and pain.

            Facial staining can be helped by restructuring the face about the eyes through two-step surgery.  Initially, a small wedge of skin is removed at the medial canthus.  As the edges are sutured together openings of the upper and lower tear ducts are repositioned closer to each other forming a tiny lake where tears collect.  The second surgery is correction of the entropion of the lower eyelid which typically has closed the opening of the ventral tear duct.  By turning the eyelid outward the duct opens and tears flow away from the eye in the tear ducts and staining of facial hair is reduced as is infection and dermatitis.

Low back pain in a dog

The tail didn’t wag-couldn’t or wouldn’t, I wasn’t sure.  He stood there, tail drooping, looking at me with soft brown eyes that seemed to say, “please be gentle”.  He was big, a German Shepherd-cross breed dog that weighed close to 100 pounds.  His tail hadn’t swept the owner’s collectibles off the coffee table for several months.  Recently, she had spoken with me about the dog’s difficulty getting to stand on his hind feet.  I thought he might have cauda-equina compression syndrome, which would cause him pain on standing.  But now that he had come into the hospital it was clear his tail was also affected.   On rectal examination he showed pain when upward pressure was applied to the sacrum.  The spinal cord ends near the end of the lumbar spine and only nerves extend onward. The lumbosacral junction (where the spine attaches to the pelvis) had excessive flexibility and on radiographs there appeared to be new bone deposited in the spinal canal.  This was pressing the terminal spinal nerves against the roof of the spinal canal at the lumbosacral junction.  The dog could have been treated with an anti-inflammatory drug and pain would have been somewhat relieved but still he would suffer and eventually become disabled.

Instead, a dorsal laminectomy was performed.  His back muscles were separated over the lumbosacral junction and the tops of the last lumbar and first sacral vertebrae were carefully cut away with a rongeur to expose underlying nerves so that they were no longer crushed between the underlying new bone deposits and the top of the spinal canal.  The dog was placed in a recovery kennel.  When I checked on him at 10:00 that evening he still lay half asleep, but the next morning when I came in to visit him he jumped up, tail wagging gaily as he bounded out of the kennel.  His pain was gone and he can expect to live out a normal happy life.

Most dogs with cauda-equina compression syndrome require six to eight weeks to recover from surgery.  But the surgery is justified because in most cases it provides dogs prompt permanent relief from intractable back pain.

Seizures In Your Pet

This is the sad story of a seizuring Chihuahua dog that died because of brain damage.  Several weeks ago a midnight call came from a lady that said her little dog had a seizure several weeks ago and had recovered from it.  However, this day the dog had begun having seizures at noon which continued almost constantly since they started.

            My first reaction was, this is bad!  When seizuring becomes constant permanent brain damage will occur unless the seizures are promptly stopped.  It might be hopeless but I had to try to relieve the little dog’s suffering.

            Sure enough, when the dog arrived 15 minutes later it was in status epilepticus, a constant seizuring state.  It was immediately injected with two drugs that are used as anesthetics.  The dog promptly stopped seizuring and was hospitalized for observation for the remainder of the night.  The next morning it was clear the seizuring had resulted in permanent brain damage!  The dog was now blind.  It could stand and walk but when it blundered into a corner of the cage it could not get out of the corner.   It just remained standing in the corner.  It could not eat or drink but was sent home with the admonition that further care would be futile.  He died two days later.

            Seizuring can be a sign of serious brain disease.  If your pet has a seizure contact your veterinarian promptly for advice on how to proceed.  If the pet has more than one seizure in an hour it should be placed on medication to prevent further episodes.  Letting the seizures continue without control in the hope that they will stop without care creates the risk of permanent brain damage.  Also, please be aware that syncope, fainting, as occurs with some heart conditions, can be confused with seizuring but requires different treatment.  Let your veterinarian help you and your pet differentiate between the two conditions.  

Ear Mites!

Crystal, a girl of the backstreets, was a pretty cat.  Several months ago she had a liaison with Horatio.  Her owner wasn’t aware of the clandestine relationship.  Really, there was nothing to tell. Two months later Crystal started scratching her ears.  There was dark- brown, cruddy exudate in them.  When I looked there were tiny white bugs crawling around in her ears.  Ear mites!  I heard of a veterinarian that put some ear mites in his own ears just to experience what a cat goes through with these pests.  They nearly drove him nuts as they crawled around.  These mites spend much of their life crawling around on a cat’s body where ear treatment doesn’t work.  Therefore, treatment in the ears must have a prolonged effect to kill the mites when they periodically visit the ear canals.  We see a lot of cats with mites, treat them, and send home drops to be administered when the cat starts to scratching again.  This is about once a month for indoor-outdoor cats where exposure to feral cats causing re-infestation can occur.  Strictly indoor cats are usually free of mites after two treatments.  But, all cats in the house must be treated.  If not, any untreated cat will be a source of re=infestation of all the others.

Another condition in cats that is clinically similar to ear mite infestation is due to a polyp growing in the ear chambers.  This can be confused with infection or mites and requires surgery for a cure.

Ear problems are very common in dogs.  But mites are rare.  I have only seen one case of ear mites and that was in a pup.  Yeast infections in the ears of dogs are very frequently encountered.  They cause dark brown to black exudate to form in the ears that is similar to that seen with cats that have ear mites.  However, treatment is very different for mites and yeast infections.  If yeast infection of dogs is not treated properly it can result in rupture of the ear drum leading to middle ear infection which is a serious, difficult problem to treat.

Spleenic Torsion

Rosey, an 11-year-old Labrador Retriever was brought to the hospital because she was depressed and had not eaten for 3 days.  She walked slowly with her head held low and showed no interest in her surroundings at the hospital.  On examination, her heartbeat was exceptionally rapid, about 200 beats per minute.  The abdomen was slightly distended and in it I could feel a large, firm tumor that I thought might be the spleen.  The spleen is an organ that blood flows through to be cleansed of defective blood cells and infectious agents.  With a hypodermic needle I pierced the body wall and removed a small amount of the tumor’s content.  Surprise!  All I got was a syringe full of dead and degenerated blood cells.  Whatever the tumor was, it was trapping and holding blood cells, not letting them return to the body’s circulation.  A blood count showed Rosey was anemic.  She had lost 70% of her circulating blood cells, enough so that resulting anemia put her at risk of dying.  It was assumed Rosey’s health problem was related to the abdominal tumor that must be removed.  But as anemic as she was she might not survive the operation.  So, we collected 400ml of blood from Bridger, the in-house blood donor, and while it was flowing into Rosey we opened her abdomen and found the abdominal tumor was, in fact, the spleen which had rotated in the abdomen.  Its blood vessels had been twisted, thus blood could flow into the spleen but not out.  The spleen was removed.  It weighed more than 1000 grams about 10 times more than normal. Rosey recovered and again is a happy healthy dog.

 Spleenic torsion is an unusual disease in dogs.  Success in this case was related to sampling the spleen and knowing its content before surgery.  If I had corrected the torsion instead of removing the spleen the dead-cell content in the spleen would have drained into the circulatory system and killed the dog.  Administration of blood during surgery saved time allowing us to proceed without first stabilizing the dog medically.

"Photo Attributed to emildom74 via flickr.com

Common Household Pain Relievers Could be Harmful to Your Pet

    This is an account of our lab technician John Whitehead’s astute observation.  An old cat had been sick for several days when it was brought to us for treatment.  When first examined I did not know what was wrong, with the cat but John, during the blood count, noticed microscopic bumps on red blood cells.  He identified the bumps as Heinz bodies a degenerative change of red blood cells caused by cats eating onions or being treated with Acetaminophen, the main ingredient in Tylenol, which is often used by people with headaches and other feel-bad conditions.  Heinz bodies results in anemia, illness, and even death.  When John told me of his findings he jogged my memory.  Two weeks earlier an article in a veterinary medical journal reported treating a cat with Acetaminophen poisoning by giving it acetylcysteine.  This was new information to me so right then I ordered an ounce of the chemical just in case it might be needed.

            To keep the cat alive, we had been treating it with intravenous fluids containing nutrients.  Although there was no precedent for doing so we dissolved some acetylcysteine in the intravenous fluids the cat was to receive the following two days.  That old cat gradually improved, recovered, and was sent home.

            A problem veterinarians encounter develops when an owner self-treats a puppy sick with parvovirus infection using Acetaminophen.  This stuff can and does kill pups by injuring the liver and results in sick pups that are difficult for veterinarians to diagnose and treat.  Use of Acetaminophen by owners who treat sick pups themselves may be one reason many of these people think that parvo pups die in spite of treatment.  Actually, most parvo pups survive if properly treated by a veterinarian.

 The point of the story is to urge you to not give sick animals human medicines.  If you do, be sure to tell your veterinarian so he can account for the drug’s toxicity while studying the pet’s illness and can treat it accordingly.