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.

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.

Urinary blockage in a cat

Jack was in last week.  He needed vaccinations and his teeth cleaned.  I hadn’t seen him for a while, but for an old cat, he’s 18 now, he was sleek and vigorous.

     He wasn’t always this way.  One cold winter evening five years ago his owner brought him to me.  She thought he was dead but wanted to be certain.  At the time he was an indoor-outdoor cat and had been missing for several days.  When he came home his owner found his lifeless body on her back porch.  As she gently laid him on the exam table a quick glance convinced me it was time for condolences.  As the comforting words formed in my mind I saw just the slightest hint of a movement of his chest.  Could it be he was still alive?  If so, there surely wasn’t any time so spare.  The examination was hasty.  His heart was beating slowly and the pulse was so weak I could barely feel it.  There were no eye reflexes.  Body temperature was so low the mercury didn’t budge from the bulb.  His belly held a clue; the bladder was grossly distended with urine.  Quickly I performed a cystocentesis and drained the bladder of thick brownish urine.  He had feline urologic syndrome.  The urethra was plugged with exudates and crystals so he couldn’t void.  Metabolic waste products had backed up and accumulated in his blood and he had gone into a coma.  A blood sample showed an extremely high level of urea, confirming that he had uremic poisoning, complicating his condition.

     Jack was catheterized so urine would flow freely.  Intravenous fluids were given to flush the poisons from his system and we put him on a heating pad to warm him.  Amazingly, in an hour he was stirring, six hours later he sat up on his sternum and in two days he went home.  Now in his waning years, he lives the good life indoors.  Perhaps, because it is so easy to become the caretaker of a cat some people view them as expendable.  But not his owner, he has been her valued friend for many years.  A relationship that has grown over time, especially since his close encounter with death.

Illness of a kitten

“Doctor Howard,” Robin called from the intensive care ward, “he ate, the kitty ate, a little.” 

Mrs. Andrews had found a dying kitten in the alley behind her home the previous day.  When she brought him to the hospital he was so weak he could not stand.  About four weeks old, he was mostly bones, frizzy fur, and fleas.  A Siamese, and quite handsome we thought, in spite of his wretchedness, with black outline of his eyes, nose, and mouth.  On closer examination we found the black markings were flea dirt.  There was no outward sign of infection other than the parasites, but the membranes of the mouth and eyes were almost white because he was so anemic.  I supposed the anemia was due to fleas draining his blood as they fed, which was partially correct.

            Our first order of care was to rid him of the fleas.  JoAnn, knowing the little fellow might be killed by routine flea treatment, dampened a piece of cotton with flea spray and gently rubbed the hair against the lay getting the chemical to the fleas but not on the kitten’s skin.  Then, with a flea comb she and Phyllis removed the poisoned pests.  This took more than an hour. 

            In the meantime, John found the kitten’s blood cells had hemoplasma organisms on them.  These bacteria, spread by fleas, sensitize blood cells which are then destroyed by the spleen faster than the bone marrow can replace them.  We had our diagnosis, but what to do?  While JoAnn bathed, dried and warmed the little tyke, we caught Tazz, the clinic cat, varmint control officer, and donor of blood for ailing kittens.  We transferred six milliliters of his blood into the kitten’s abdominal cavity so it would flow into his circulation giving him essential blood cells, protein and immune factors.  Then, just a tiny bit of antibiotic was injected to start controlling the hemoplamas.

            By this time it was getting late in the day so Robin fed him milk replacer with a dropper and put him to rest in a small cage with an insulated heating pad to warm him.  The next day he was able to stand and, as mentioned earlier, eat.  The day following he was released to Mrs. Andrews’ care with two more weeks of antibiotic treatment.  He recovered and grew to be a handsome cat.  Never cross or arrogant, he seemed to understand that he was in debt for his life.

            When you consider adding a new pet from any source to your household, you should realize that the new animal may be carrying a disease that can spread to resident animals.  To help avoid trouble be sure your existing pets are current on vaccinations, and regardless of how healthy it seems, have the new pet examined by your veterinarian before it is introduced to its new home as Mrs. Andrews did.