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.

Cats and Bats!

“Louise, you were right to be concerned when your cats killed a bat.  Fortunately, our records show Calico, Blackie, and Daisy are current on their rabies vaccinations.  If they were bitten by the bat or even if they ate it they should be protected”.

            Rabies in cats is a greater problem in the country than rabies in dogs.  More people are bitten by rapid cats than by rapid dogs perhaps because they tend to befriend and cuddle small, warm, soft animals, i.e. cats and kittens. 

            Although it has not been shown that rabies is spread among cats by biting each other it is well known they can contract rabies from bat and skunk bites.  Both bats and skunks are reservoirs for the infection in the wild.  People can also be infected with rabies by bats and skunks and for that reason should leave these animals alone, for when infected they can survive for long periods with the virus in their tissues and can infect other animals or people months after they themselves have been infected.

            I have worked with rabid animals, but not in the Imperial Valley.  Early in the disease, affected animals seem to have difficulty seeing well or may be a little uncoordinated when moving.  They behave apprehensively as if realizing something is wrong that they do not understand and not knowing what to do, they may seek human comfort and become inordinately affectionate.  As the disease progresses their alarm mounts, they become fearful and may want to hide.  Then, within hours or days affected animals become very depressed or vicious, attacking objects, humans, or animals that move.

            To avoid exposure to rabies people should be skeptical of any abrupt change of attitude in their pets.  As a rule stray animals should be left alone.  Children should be especially careful and avoid them.  If one thinks he or she has an animal with rabies, they can call their veterinarian for advice.

            Vaccination against rabies is the best prevention, although annual vaccination of dogs is required by law, vaccination of cats is even more advisable.

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

Birthing difficulty

Once upon a time, when the world was young, I had a ranch practice in northern Montana.  It was a wonderful time and place for a young man.  Streams were filled with trout, pheasants were in every field, ducks in all the ponds, and every rancher had lovely daughters.  But delivering calves was my livelihood.  Laboring cows taught me a lesson germane to today’s small animal practice.  If a fetus is not positioned in the birth canal it will not be born, nor will the dam strain to deliver it.  The problem is uterine inertia for the uterus will not constrict and start the fetus into the pelvis.  In most cases intravenous administration of calcium will correct the problem.  The uterus can then constrict placing the fetus where it can be expelled normally.  But not always!

            Jessica, a four pound Maltese female had delivered one pup.  Then everything stopped!  For an hour she did not deliver any more pups.  Didn’t even try!  And yet her belly was still distended.  She remained pregnant.  I could palpate a pup out of position in the anterior abdomen.  This seemed to be typical uterine interia so I injected calcium and sent her home.  Often these cases will deliver a pup during the car ride home but not this time, nor during the ensuing hour.  She had to be returned for a caesarian section.  One has to get fetuses out of the abdomen or they will die, start to decompose in the abdomen, and the rotten material will kill the dam.  On reexamination the pup had not been moved.  It was no nearer to the pelvis then when the dog was initially examined.  During surgery I found the wall of the uterus surrounding the remaining pup had ruptured spilling the pup into the abdominal cavity and making it impossible for the pup to be properly positioned.  Why the rupture occurred I don’t know.  Perhaps it was due to incoordination of uterine contractions.  Both pup and mom survived surgery.

            Rarely did I find a cow with uterine rupture and the calf lying free in the abdominal cavity.  If one did surgery in time the cow might live but usually the calf was dead.

"Photo Attributed to S. Fulljames via flickr.com

A case of canine Pancreatitis

Wilbur is a 7-years-old French bull dog whose vomiting started a week ago. He cried when his abdomen was pressed and he had refused to eat for the past several days.  Also, water consumption had declined.

 He was a very sick dog when brought to the hospital.   Several abnormalities of his serum chemistry profile suggested he might have acute pancreatitis, for the blood study showed dehydration, inflammation, and stress.  He was started on intravenous fluids to rehydrate him and sustain kidney function.  An overnight blood test confirmed the diagnosis of acute pancreatitis.  Next morning all food and water consumption was stopped and drugs were administered to depress stomach-acid production.   Acidic stomach contents passing into the small intestine can aggravate pancreatitis so it must be controlled.   Also, he was given a low dose of antibiotics as insurance against infection in the region of the pancreas.  Intravenous fluid therapy was altered to provide essential energy and protein building blocks to help with healing.  He was maintained on this program for two days.  Then, drugs were dispensed to prevent vomiting and continue reduced gastric acidity and he was sent home. Such treatment would permit him to eat and drink without aggravating the pancreatitis and still facilitate continued healing.  

A Big-Stinky Problem

“Doctor, my cat has a big, stinky problem!  Every-once-in-awhile she will leave a small, really foul-smelling spot somewhere in the house.  What is this and what can be done about it?”

            This problem is more common to dogs than cats, but it is the same in both species.  Animals have a gland on each side of the anus that secretes a smelly material thought to be used for marking territory as the animal defecates or rubs against the ground.  Sometimes these glands spill their contents spontaneously resulting in a spot somewhere in their surroundings and a nauseating odor.  Also, sometimes the glands become blocked this irritates the animal which tries to correct the problem by scooting across the floor.

            Permanent correction of the problem demands surgical removal of the glands by a veterinarian.  It takes a few days to a week for healing to occur and the dog or cat forever remains free of the problem.

Diseases of newborn pups

            Weak and stillborn puppies are a common occurrence with Imperial Valley mother dogs.  Owners often claim the cause of death was the mother lying on the young pup.  For the most part this is incorrect.  Most of these pups I have examined were affected by one disease or another.  As such these problems could have been avoided or prevented.

            Several weeks ago a lady brought in a terminally ill three-week-old pup with purulent exudate sealing eyelids of both eyes. She said two litter mates of the pup died shortly after birth.  Cause of this pup’s illness was not readily apparent to me but a scraping of the inflamed conjunctiva showed canine distemper virus in epithelial cells.  I have seen this before: pups being infected with distemper at birth or in the uterus near the termination of pregnancy resulting birth of dead or dying pups.  Had the bitch been given a routine vaccination by a veterinarian a month or so before breeding the chance of her shedding the distemper virus that infected the pups in utero or neonatally would have been greatly reduced.  Note; live virus vaccination very near to conception or during pregnancy can adversely affect the pups before birth.

            There are other diseases causing abortion and neonatal weakness and death that serious dog breeders are advised to prevent if they are seeking healthy litters.  These are venereal diseases transmitted between breeding pairs, canine herpes virus and brucellosis.  Once infected with these diseases dogs can have breeding problems for years.  By having prospective mates tested by a veterinarian a month or so prior to breeding infected brood stock can be identified and avoided.  Thus, valuable breeding stock should be mated only with animals that have tested negative for canine herpes virus and brucellosis.

Canine stroke

A week ago the journal, Science, had a special section on cell metabolism, the chemistry of energy production.  The journal commented that this discipline has been neglected until recently in biology research and medicine.   It has been overshadowed by molecular biology, the complex interrelationships of cell molecules in life’s functions.  The science publication reminded me of a recent stroke case in a Miniature Schnauzer dog where the interplay of both disciplines was involved.

            In stroke cases a clot blocks blood flow to a region of the brain interfering with energy production and function and survival of affected brain cells.  We treat the disease metabolically by giving the dog chemicals to enhance energy production by the stroke-affected cells so they continue to function and survive, but some paralysis may persist.  I think there remains a portion of the stroke-affected zone where more severe metabolic dysfunction has caused cells to release inflammatory molecules that can cause local inflammation that destroys neighboring brain tissue.  These molecules are called cytokines.

             With the Miniature Schnauzer: Recently, another scientific journal, Scientific American, reported that minocycline, an antibiotic, will reduce cytokine production by injured nerve tissue.  In addition to the metabolism-enhancing chemicals, I gave the dog minocycline as part of its treatment regimen.  With recovery, a month later there were no symptoms that it had a stroke. The minocycline may have prevented cytokine-initiated permanent brain-cell damage.  The dog’s disease had been treated both metabolically and molecular biologically.