Category: Dogs

Spleen Hematoma

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This page stresses the importance of routine yearly exams, and close owner observation, on our pets. Large breed dogs can be stoic, and have significant problems brewing without showing any outward signs. When serious symptoms like weight loss and lack of appetite finally show up, the disease process is usually well entrenched, and there is little we can do. We want to see these pets before it gets to that stage.

Pets are masters at hiding illnes, so it can be difficult if they are ill. It might be a good idea to read our short page on symptoms of disease to know what to watch for.

We also have a nice page on teaching you how to do an in-home exam. If you bring your pet to us one of our staff will go over this with you, and do a hands-on demonstration of how to palpate the peripheral lymph nodes. This early warning system is a great way to catch problems early in the course of disease.

History

A beautiful male labrador retriever named Colt came in for a routine Wellness Exam when he was 10 years old. During this exam Colt’s owner told Dr. Palazzolo that Colt vomited on occasion over the last month, but that otherwise he was doing fine. He is a calm dog, and just lays around a lot.

Exam

Colt’s body temperature was normal, and his weight was the same as a previous visit. A pet’s weight is a good idea of how well it is doing, and if it is maintaining its weight that is usually a good sign. In Colt’s problem, this is not the case.

During the physical Dr. P noted a very tense abdomen, so tense that he could not even palpate internal organs. After this was noted, the owner did say that Colt’s abdomen seemed to be distended. The rest of Colt’s thorough physical examination was normal.

The distended abdomen is a significant finding, and warranted a radiograph, in addition to the blood panel which is part of the Wellness Exam.

Diagnostic Tests

ColtRad

You don’t need to be a radiologist to know something is wrong with this abdomen, as evidenced by the large and round whitish structure

NormalAbdDogRad

Here is a normal abdomen for comparison. In this normal radiograph you can see individual organs, unlike the abnormal one above, that looks like it has a beach ball inside of it.

This is a serious finding, and this mass could have many causes, and involve almost any internal organ. Due to its size, shape, location, and the relative lack of symptoms, it was probably the spleen. It could be a benign tumor of the spleen called a hemangioma, a malignant tumor of the spleen called a hemangiosarcoma, or a hematoma of the spleen. A hematoma is a blood filled cavity that is benign.

Its size said it might be a hematoma, which has the best prognosis of the three. To learn much more about spleen tumors please visit our hemangiosarcoma page.

ColtCleanChest

Before we proceed any further we take a radiograph of the chest to make sure there has not been any spread of tumor to the lungs. The white object in the center is Colt’s heart, the dark areas around the heart are the lungs. This is a normal chest radiograph.

You can learn much more about how to read a radiograph if you are interested

Our radiologist, Dr. Ann Reed, performed an ultrasound of the abdomen. This ultrasound lets us know if the mass is actively bleeding, and if there has been any spread of the mass to the right atrium of the heart. If that is the case, the mass is probably a hemangiosarcoma that has already spread. This is not a good prognosis.

ColtUS

Colt’s ultrasound report showing it is probably benign, and consistent with a hemangioma or hematoma

Pre-surgical Preparation

In Colt’s case there was no abdominal bleeding, and the heart was OK. Colt’s blood panel came back normal, so we did a cross match of his blood, and readied a unit of blood for a transfusion in case we needed it during the surgery scheduled for the next day.

Agglutination Crossmatch substrate Crossmatch blood Transfusion kit
BloodCrossMatch2 BloodCrossMatch1 BloodCrossMatch3 spleen-transfusion

Before we do a blood transfusion we do several tests to minimize a transfusion reaction

We were much better prepared for surgery the next morning with all of this information. During the night prior to surgery Colt was given intravenous fluids to stabilize him and make him a better anesthetic risk, and a pain patch was put on. Having the pain medication on board before surgery increases its effectiveness. Colt is now good to go for surgery the next morning.

We have a short page that talks all about how we do surgery at the Long Beach Animal Hospital. You might want to check it out before you see Colt’s surgery.

Graphic and bloody photos of surgery to follow

Colt did great overnight.  We took away his popcorn after the Lassie movie ended (he likes classic movies), and he rested comfortably during the night, monitored by our night crew. He slept well, and dreamed of being a famous movie star like Lassie.

ColtJenn

 Here he is with Jennifer the next morning, keeping an eye on our surgical team as they prepare for his surgery.

KennedyExam

Colt gets some extra petting for being a good boy, by his surgeon, Dr. Kennedy

KennedyExam1

Even though Colt has been thoroughly checked, we always perform a physical exam just prior to inducing anesthesia. An important organ to assess is the heart. If we suspect something is wrong with the heart when we listen to it we will do a pre-anesthetic EKG (electrocardiogram).

If you like heart stuff we have a very detailed page on heart disease in animals. It’s not for the “weak of heart” (pun intended), because it goes into all sorts of anatomy and physiology. If you get through it give yourself a pat on the back, and think of applying to veterinary school!

Propofol

Colt’s anesthesia is initially given by injection. Once he is relaxed we put in a breathing tube and start prepping his abdomen for surgery.

surgery-monitor

This surgical monitor allows us to detect any impending problems, and make adjustments before problems become serious.

Rabbit-femurfx-9

Even though we use these hi-tech machines to monitor important physiologic parameters during surgery, we also use the hands-on approach to make sure we do not miss anything. In this picture our anesthetist is listening to the heart with a stethoscope.

AnesthesiaReport

During the procedure Colt’s vital information is closely monitored and recorded. Our anesthesia page has more details.

Instruments

While Colt is being readied for surgery Dr. K is getting her instruments ready. She will need many clamps to close off the blood supply to the spleen before it can be removed, which required more than one surgical pack.

draping

When Colt is prepped, and under the proper plane of anesthesia, Dr. Kennedy does her draping. This draping is an important part of the surgery, and is doing carefully.

JessicaTerri

It will take more than one pair of hands to get this spleen out, so our surgical assistant, Jessica, stands by waiting for instruction. Terri our anesthetist keeps a close tab on everything.

Incision1

The initial incision is only though the skin. Blood vessels just under the skin are clamped before we go any further.

Incision2

You can see the two clamps that are controlling bleeding in the subcutaneous (SQ) tissue just under the skin. Colt’s spleen is humungous, so it will take a long incision to get a big enough opening to remove it

Incision3

Even though the incision was made as long as possible, the opening was still not big enough to remove the spleen. Dr. K had to make a side incision in the abdomen to facilitate removal.

SpleenBloodSupply

The spleen has an extensive supply of blood vessels that are near the stomach. A large part of this surgery is identifying and ligating these vessels, and doing this without damaging the blood supply to the stomach. These blood vessels are intertwined in tissue that is covering the spleen as the body attempts to wall of this large mass. This is the most meticulous part of the surgery, and Dr. K’s experience and skill at doing this before pays off.

LargeVessel

These blood vessels are large and need to be handled carefully

ClampingVessles

It takes multiple clamps and special suture material to perform this important part of the surgery

JessicaHoldingClamps

Jessica is kept busy holding clamps while Dr. K identifies and continues to ligate the many blood vessels to the spleen

FirstRemovalAttempt

As more of these vessels are ligated Dr. K carefully attempts to get the spleen out of the abdomen. No luck the first time.

Adhesion

An adhesion from the intestines to the spleen was identified and removed. Time to try to get the spleen out again.

SecondRemovalAttempt

 We need to be very careful at this point that we do not rupture the spleen by forcing it out.

FirstRemovalAttempt

With gentle coaxing and manipulating, along with Jessica’s help holding the abdomen open, we almost have it out, but not just yet

ThirdRemovalAttempt

It was time for Dr. P to stop taking photos and assist in surgery. He has removed many spleens in his decades of surgery, and with the help of Dr. K and Jessica, was able to extricate the spleen. Now Dr. K could finish ligating blood vessels (and hopefully Jessica does not need to scratch an itch at her nose)!

JessicaHolding

Here she is doing a great job

FinalCut

The final blood vessel to the spleen is cut while Jessica holds on to the spleen

JessicaHoldingFinal

After almost 2 hours of surgery Colt is now lighter on his feet

FourteenPounds

It’s official, 14.095 pounds!

SpleenHematoma

The vertical and long structure on the left is an enlarged and normal spleen, with the hematoma of this spleen on the right

Lavage

Surgery is nowhere near done. After Dr. K looks for any significant bleeding on the blood vessels she ligated, she flushes the abdomen numerous times with warm saline.

LineaSutures

The long process of putting Colt back together now begins. The most important suture layer is an area called the linea alba. This is where the muscle bellies of the abdomen meet, and is a tendinous area that is very strong. This is where the first and most important layer of sutures is placed.

SkinSutures

After more layers of sutures are placed, and before Dr. K puts in skin staples, Colt now has a bikini scar (OK, maybe not, but once the hair grows back nobody will know his secret)

Local

In addition to the pain patch put on the night before, and the pain injection given during surgery, a long acting local anesthetic is placed at the incision. Now Colt will be comfortable when he wakes up and through the night.

LocalStaples

All of our abdominal surgeries receive therapy laser treatment on their incisions. This aids in both healing and pain control. Notice the staples in Colt’s skin incision.

FirstBandage

Now comes the bandage; the first layer is gauze and telfa pads

SecondBandage

After more pads and gauze are put over the incision, the outer layer is wrapped by Terri while Jennifer and Jessica hold up Colt. They are getting their biceps exercise for the day!

LastBandage

We did the surgery the day after Halloween, so we thought this was an appropriate colored bandage

Trophy

Our dedicated surgical team posing with their trophy. Great job!

Colt was closely monitored for several days, and his red blood cell count was checked to make sure he did not need that blood transfusion. He went home after 2 days and was back to normal in no time. Yea Colt!

HemangiomaReport

Great news on Colt’s histopathology report, confirming it is a hematoma. Colt should make a complete recovery and lead a normal, if not lighter, life.

HemangiomaHisto

Just in case you want to see what a spleen hematoma looks like under the microscope here is your chance

047A8608

Colt with his happy mom two weeks later when he came in for his staples removal

 Case Summary

If you go back to Colt’s initial history the owner stated Colt vomited on occasion over the last month. Looking at the size of this hematoma (a record for Long Beach Animal Hospital), the hematoma was probably brewing over several months. Its a wonder Colt could even eat, and was not vomiting more, with a hematoma of this size in his abdomen. If Colt had not been brought in for his Wellness Exam, this hematoma could have easily ruptured, causing Colt to go into shock. and most likely a rapid death.

 Colt’s weight was the same as a previous visit. It was only because he had such a large mass in his abdomen, and goes to show you cannot go by just one physical parameter to determine health. It also shows you need to be thorough when investigating a medical problem.

The ability to do ultrasound with our highly skilled radiologist, telling us the hematoma was not actively bleeding, allowed us to take the time to prepare Colt for surgery. This made him a much better anesthetic risk, and and allowed him to heal faster with no complications.

The ultrasound told us it was probably a hematoma, and there was no evidence of spread to the heart which would indicate a potential malignant hemagiosarcoma of the spleen. With the blood panel and chest radiographs being normal, it was realistic to proceed with surgery based on the fact that the mass was probably not a malignant cancer.

Now that you have seen a successful hematoma surgery, now might be a good time to learn about hemangiosarcoma, a malignant cancer of the spleen. In this same page you can see another hematoma surgery of a dog with an 8 pound hematoma of the spleen.

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Inflammatory Bowel Disease (IBD)

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IBD is an inflammatory condition of the stomach, small intestines, or large intestines (the gastrointestinal (GI) tract).  It tends to be chronic in nature.  It is one of the most common conditions of the gastrointestinal tract diagnosed in pets, especially in cats. Despite its prevalence, it is one of the least understood conditions, especially regarding cause. Some pets respond well to treatment, others do not.

Some cases of IBD involve the liver and pancreas. In this case there are 3 diseases occurring, and we refer to it as Triaditis. This is more difficult to treat than IBD alone.

The usual symptoms of IBD are poor appetite, vomiting, diarrhea, and weight loss.  In the cat more often they are vomiting, in the dog they oftentimes have diarrhea. These symptoms appear in many other diseases, so you cannot assume your pet has IBD from symptoms alone. To learn the process of how we make a diagnosis of a disease when the symptoms are the same as so many other diseases, we have a methodical and detailed approach. It is called the Diagnostic Process.

We discuss the importance of worms (internal parasites) many times in this page in regards to IBD. With the modern medications we have, including flea products that contain medication to kill worms, it behooves you to treat your pets for worms monthly. Not only will it help prevent IBD from appearing at some time in your pet’s life, it will protect you and your children. Our Internal Parasites page has the scoop on all of this.

Graphic photos of surgeries are on this page. 

Anatomy and Physiology of the Gastrointestinal (GI) Tract

When your pet eats, food from the stomach passes into the small intestine, which is composed of three different sections called the duodenum, jejunum, and ileum.

The majority of nutrient (proteins, carbohydrates, fats) digestion occurs within the small intestines.  The inner lining of the intestines is called the mucosa, and that’s where all the action occurs when it comes to absorbing nutrients. The mucosa has a large surface area because there are microscopic folds called villa.

Ilium-NormalMucosa

This is the lining of the small intestines. The villa are microscopic, so you cannot see them without a microscope.

There are many different types of specialized cells in the lining of the mucosa. Some of these cells specialize in aiding digestion, some are for absorption of these nutrients into the bloodstream, and some are part of the immunes system and defend the body from foreign invaders.

Surgery-SmallIntestines

These are the small intestines during a routine abdominal surgery. Notice the extensive blood supply, necessary to get those nutrients from the lining of the intestines into the bloodstream and off to all of the cells in the body- amazing!

Ilium-Ingesta

This is what the ingesta looks like as it passes through the small intestines

The pancreas secretes digestive enzymes into the small intestines as the food passes through the duodenum. These enzymes are crucial for digestion of fats, carbohydrates, and protein. As the food continues down the small intestines the enzymes from the pancreas continue their breakdown of nutrients, which are then absorbed by the mucosa of the jejunum and ileum and make it into the bloodstream.

Pancreas-labeled

This is the pancreas, a small but mighty organ. Our surgeon is holding the duodenum, showing the pancreas in the center:  D- Duodenun   P-pancreas

Pancreas-Normal

Close view of the architecture on the outside of the pancreas

The gall bladder secretes bile into the duodenum to help in digesting fats. When the liver is a part of IBD the bile can build up in the liver and cause a problem. This is a part of the Triaditis that complicates IBD.

The large intestine is composed of the cecum (our appendix), colon, rectum, and anus.  Water, electrolytes (sodium and potassium), sugars, and vitamins are the main nutrients absorbed by the large intestine. Some vitamins are produced in the large intestine also. Nutrients that were not broken down or absorbed well enough within the small intestine are further digested in the large intestine due to microbial fermentation. The large numbers of these good bacteria that are present in the intestines are crucial to normal health.

The human cecum (appendix) has atrophied to the point that it is no longer needed. Our diet does not have the fiber of our ancestors, so this organ is not needed for normal digestion, which is why it can be removed if appendicitis occurs. As a fun anatomical comparison, the cecum of a rabbit is enormous in relation to the rest of its body. That is because it is a hind-gut fermenter, and contains large numbers of bacteria to help digest food that is high in fiber. Our rabbit GI stasis page has radiographs of the cecum along with actual pictures to give you an idea of just how large it is.

Pathophysiology

Allergens cause inflammation of the mucosa, leading to the symptoms associated with IBD. The allergens that cause this inflammation can be anything, with food (especially protein) as the main culprit.

Intesinte-normal lumen

The size of the lumen thorough with the food passes and intestinal wall thickness of a normal small intestine

ThickenedSmallIntestine

You can easily see the smaller lumen and thickened intestinal wall in this pet with IBD

Inflammation of the pancreas is known as pancreatitis. In pancreatitis, the digestive enzymes that would normally be secreted into the duodenum to digest food are now leaking out of the pancreas into the abdomen, causing tremendous inflammation and pain to surrounding organs. Pancreatitis is a serious disease, and usually requires hospitalization, intravenous fluids, and medication. It can be hard to diagnose in cats because they usually become quiet and sit as if content, when in reality they are in pain and this is how they handle pain. A clue is the fact that are not eating well.

Inflammation of the liver in some cases may be associated with IBD, permitting an infection to creep up the bile duct and into the liver. There are many different sources to this infection, ascending from the GI tract or urinary tract.

The pancreas, liver, and intestines are closely associated, and when one has a problem it causes inflammation in one of the other ones. When all three have a problem it is called Triaditis. As you can see, it all gets quite complicated.

Cause

IBD is one of those conditions where the exact cause might never be identified. The most common causes are dietary allergies, infections, and environmental stress.

Dietary allergies are involved with sensitivity to protein in the diet. Sometimes, an inability to absorb nutrients, called a malabsorption syndrome, is involved. Some pets generate an excessive amount of a specific white blood cell called an eosinophil (eosinophil gastroenteritis) in the lining of the GI tract.

Other dietary causes might include artificial coloring, preservatives, and food additives. Differentiation between the above-mentioned causes is difficult, especially since many IBD cases are associated with several concurrent factors.

It is suspected that puppies with a large amount of internal parasites (worms) are setting the stage for IBD later in life. This is another good reason to have your pet checked for internal parasites at least yearly, and wormed frequently when young.

Pancreatitis is highly associated with pets that are overweight, particularly spayed female dogs. Fatty meals are important components of the clinical history for cases involving pancreatitis. As a result, we tend to see this cause of pancreatitis around the holidays when people are celebrating with turkey (and gravy) and other similar foods that their pets’ eat also.

Inflammation of the pancreas can spread to the liver  due to its proximity.  This can inflame the gall bladder, causing bile to backup into the liver. This can lead to Triaditis mentioned earlier.

Inflammation of the liver and biliary system, known as cholangiohepatitis, is most commonly associated with a bacterial infection.  In cases of Triaditis, it is unknown as to whether the liver is the first organ affected, resulting in secondary inflammation of the pancreas and gastrointestinal tract, or if it is the other way around.  It has been hypothesized that bacterial infections may be the initiating cause of cholangiohepatitis, with IBD and pancreatitis following thereafter.

Dietary Induced

Proteins and grains in the food contribute to dietary intolerance. Intolerance occurs when there is an abrupt change in the diet, resulting in an inability for the gastrointestinal tract mucosa and associated cells to adapt accordingly.  When this happens foods are often not digested or absorbed properly.

Maldigestion is a separate condition of the gastrointestinal tract that generally occurs secondary to exocrine pancreatic insufficiency. The endocrine pancreas secretes insulin to regulate the blood glucose level. The exocrine pancreas secretes the digestive enzymes needed to digest food in the intestines. If the pancreas is not secreting enzymes into the small intestines as the food passes, the nutrients will not be broken down and absorbed into the bloodstream. This leads to weight loss and diarrhea, even in a pet that is eating.

Malabsorption is secondary to numerous disease processes such as food allergies and/or intolerance, protein losing diseases of the gastrointestinal mucosal layer, intestinal parasites, antibiotic responsive disease, cancer, IBD, and immune-mediated disease. The exocrine pancreas is secreting the proper digestive enzymes in this cause. It is an inflammation of the inner lining of the intestines (the mucosa) that prevents absorption of the nutrients into the bloodstream.

Intestinal parasites (worms)

There are numerous intestinal parasites known to cause the same symptoms as IBD. They include roundworms, hookworms, whipworms (dogs only), cryptosporidia (protozoa), toxoplasma (protozoa; cats only), coccidia, and giardia.

Some intestinal parasites are known to affect humans as well (zoonotic potential), including roundworms (organ and eye involvement), hookworms (skin involvement), giardia (gastrointestinal disorders), coccidia (gastrointestinal disorders especially in immune suppressed individuals), toxoplasma (congenital defects in babies), and cryptosporidia (gastrointestinal disorders).

A fecal examination is often one of the first steps when diagnostics are being evaluated in a pet with a gastrointestinal disease. Our intestinal parasites page has detailed information on these parasites (worms).

Cancer – Lymphosarcoma (Lymphoma)

In cats, lymphosarcoma is the most common type of cancer known to affect the gastrointestinal tract. This is not easy to diagnose, since the changes present in IBD are very similar to those in Lymphosarcoma when the pathologist analyzes them under the microscope.

Depending on the type of lymphoma (small, medium or large cell lymphoma), tissue samples must be sent in for further diagnostics in order to definitively differentiate between early cancer and IBD. Proper treatment depends upon a proper diagnosis.

VeryThickenedSmallIntestine

These severely thickened intestines are from cancer.

We have a page that shows an exploratory surgery on a cat with intestinal cancer.

Bacterial infection

Although there are no definitive infectious agents that consistently result in IBD, some organisms such as Giardia, Salmonella, Clostridium, and Campylobacter could be a cause. Some of the “good” bacteria, those that are necessary for life, can become imbalanced and cause the symptoms seen in IBD.

Medications

Any medication can disrupt the lining of the intestines. The most common one is antibiotics, since they disrupt the normal GI bacteria (referred to sometimes as flora).

Other causes

Toxicities (plants, chemicals), hyperthyroidism, FIP, FeLV, FIV .

Diagnosis

Signalment

Both dogs and cats are commonly affected by IBD, although it is much more of a problem in cats. IBD can occur at most any age due to the numerous causes of the condition; however, it is usually observed in pets over the age of two .

Triaditis is more commonly diagnosed in middle to older aged cats.  If it is associated with a food allergy, they tend to be young adults to middle aged. Males and females get IBD in equal frequencies.

Addison’s disease, which is common in Standard Poodles, can cause symptoms similar to IBD.

History

Sometimes pets are affected by IBD for many years while appearing apparently healthy in all other aspects. Typical symptoms are  lethargy, poor appetite (anorexia), weight loss, diarrhea and vomiting.

Depending on the inciting cause, the clinical signs may occur intermittently over a long period of time (i.e. dietary allergy) or abruptly and progressively (immune-mediated, infectious, dietary allergy, cancer). If Triaditis is present clinical signs may range from lethargy and decreased appetite to severe vomiting, diarrhea, abdominal pain, and icterus (jaundice) due to liver compromise).

OLYMPUS DIGITAL CAMERA

This pet has severe icterus (also known as jaundice)

Cats can have variable symptoms compared to dog. Cats that have pancreatitis might sit quietly and appear to have no problems. In reality, these cats are painful, which is why they sit like this.

Physical Exam

In both dogs and cats, palpation of the abdomen might reveal painful and thickened bowel loops. This is not a consistent sign, and just because bowel loops are thickened, does not mean there is a problem. Pain may also be associated with palpation of the pancreas or liver in cases of Triaditis. Lymph nodes deep within the abdomen may be enlarged and palpable as well as painful. Excessive intestinal sounds (called borborygmus ) might be heard on auscultation of the abdomen. In more chronic cases, other subtle signs may be present such as a dull hair coat, mild to moderate dehydration, fever, and overall poor body condition. None of these are consistent findings, and cannot be relied upon for a diagnosis of IBD.

XRays-LymphNode

These lymph nodes, call the sub lumbar, are enlarged on this dog. They are the whitish circles within the red circle. They are due to cancer, but they cannot be palpated.

Diagnostic Tests

Complete blood count, biochemistry panel, and urinalysis, are a starting point for diagnosis. Certain blood values might suggest IBD if in combination with clinical signs. Even “normal values” are clinically diagnostic, as they help to rule out another disease that can cause the same symptoms as IBD.

Some pets will have a chronic anemia (low red blood cells). Sometimes the white blood cells will be elevated, in other cases the protein will be low. There might also be a low cobalamin level.   Cholangiohepatitis (inflammation of the liver) in cats, when Triaditis is present, may be further suspected if bilirubin (hyprebilirubinemia) or liver enzymes are increased.

LiverTests

The blood panel is very thorough and checks many different organs and systems. This is a few of the many tests, the elevated liver tests are circled, and could be a sign of Triaditis in this case.

Fecal examination is an important and inexpensive test to rule out internal parasites (worms). We sometimes give worm medication (called anthelmintics) to pets with a negative fecal if they have and GI symptoms. This is because a pet can have internal parasites that do not show up on a fecal exam. Our intestinal parasites page has much more information explaining this.

Scarlet Ojeda 38765 Gall Bladder Surgery Linda Larsen

A fecal exam, checking for internal parasites (worms) is important in every pet with any signs of illness. In this exam, we are checking for eggs (ova) of the parasite.

Abdominal radiographs are often normal in cases of IBD, but are a necessary tool to rule out other causes of similar clinical signs. Survey abdominal radiographs are also indicated prior to ultrasound  as well.

Xray-PenniesInRectum

This dog had chronic diarrhea.  Nobody took a radiograph prior to treatment. The cause was not IBD, it was the pennies stuck in the rectum.

IBDRadiograph-thickened intestines

This cat has IBD, as evidenced in this case by the thickened small intestines at the arrow. This can also be a normal finding, and it can also be a sign of intestinal cancer. The more common ones in a car are lymphoma, adenocarcinoma, and mast cell.

Prior to the common use of ultrasonography, barium contrast studies were performed in order to reveal disruptions of the mucosal surface along the gastrointestinal tract.  We are looking for filling defects and ulcers of the mucosa and thickening. Barium has lost some of its significance since ultrasonography tends to be much more sensitive. One very nice “side effect” of giving barium to a pet that might be vomiting is its soothing affect on the lining of the intestines (mucosa) to stop the vomiting.

TLI type tests- serum fPLI (pancreatitis), fasting serum TLI (exocrine pancreatic insufficiency), fasting serum cobalamin and folate (small intestinal function and bacterial overgrowth). These are specialized tests and take several days for the results to come back.

Endoscopy is a useful tool since we can observe the lining of the esophagus, stomach, and duodenum for ulcers, lesions, and foreign bodies, that might not show up on a radiograph. Biopsy samples can be taken, although they are not full thickness, and only take the lining of the small intestines. This can lead to a missed diagnosis.

The most accurate way to diagnose IBD is to perform an exploratory surgery and take full thickness intestinal biopsy samples. The samples are analyzed by a pathologist to help differentiate IBD from intestinal cancer. Sometimes  the pathologist cannot tell the difference due to the similar histopathology of the tissue because of the abundance of inflammatory cells. During surgery, samples of other important organs like the liver and lymph nodes can also be obtained. These samples are very informative, and are taken in many cases.

IntestineBiopsy

Surgery has the major advantage of being able to see and palpate the intestines, along with taking a complete (called full thickness) sample of the intestines. This surgeon is using a scalpel blade to take the sample.

These samples are analyzed by a histopathologist. The report might come back with several different terms describing the IBD in specific medical terms, depending on the cell type:

  • Lymphocytic-plasmacyltic (the most common one)
  • Eosinophilic
  • Granulomatous
  • Suppurative
  • Histiocytic

Ultrasonography of the abdomen is an invaluable diagnostic tool in diagnosing IBD. In the case of IBD it should be performed by a specialist in this area. It has revolutionized how we diagnose IBD, pancreatitis, and Triaditis. Prior to the advent of ultrasound, exploratory surgery was needed to make an accurate diagnosis, and that was only after biopsy samples were obtained. Ultrasound is dramatically less invasive and expensive compared to surgery, and the results are obtained immediately in many cases.

Ultrasound-Machine

Ultrasound is rapid and painless, and the only invasive part is shaving your pet’s abdomen

UltrasoundReport-IBD

This is a typical report of a pet with IBD

Ultrasound can be used to measure wall thickness of various segments of the intestinal tract, which yields supportive evidence in the face of clinical signs. However, it cannot be used to differentiate between IBD and other disease processes that result in significant inflammation of the intestinal wall (i.e. lymphoma). This is where surgery has an advantage since full thickness biopsy samples can be taken for analysis

Ultrasound-SmallIntestine

This is what the small intestines look like during ultrasound while they are being measure for size

Ultrasound-Pancreas1

This is what the pancreas looks like, also being measured

Ultrasound-MesLymphNode

All of the abdominal organs are assessed during an ultrasound. This is what an enlarged lymph node looks like.

Fine needle aspirate samples may be obtained with the guidance of ultrasonography.  Sometimes this test is diagnostic, sometimes it is not. Even though it is not a perfect test, we sometimes recommend it due to the simplicity in obtaining it.

A hypoallergenic diet trial may be issued for cases of highly suspected dietary allergies or intolerance. In such cases, some pets respond when the diet is altered and no further diagnostics are necessary. You must feed this food, and only this food, to see if this works. Sometimes results are immediate, other times it might take several months to know for sure.

This can be a risk if the diet trial is attempted before numerous other disease processes are not first ruled out, especially cancer and internal organ diseases like Feline Hyperthyroidism.  This delay in diagnosis can affect outcome. If clinical signs do not improve or resolve within the first two weeks of the diet trial, then further diagnostic work-up is indicated.

Treatment

Depending on the severity of disease at presentation, treatment must first begin with stabilizing the pet. What we do to stabilize depends on the severity and duration of symptoms.

Symptomatic

Stabilization generally includes intravenous  fluids to correct dehydration, correct electrolyte imbalance, and improve kidney function. If the protein level is low we might use a fluid called Hetastarch.

Pets that are not eating are assist fed a special diet called A/D to maintain appropriate caloric intake and to prevent further disruption of internal organ function and get the GI tract back to normal. Probiotics to help stimulate the normal bacterial flora might be beneficial.

Vomiting pets are continued on fluids to maintain normal hydration, and given a specific medication called Cerenia (maropitant) to stop the vomiting. This drug has been a tremendous help in alleviating vomiting in pets due to many different causes. We use it for IBD, put also for other GI problems like parvo virus and pancreatitis without IBD. Cerenia works on the emetic (vomiting) center of the brain.

Cerenia

We use the injectable version in the hospital, and send home an oral version if needed

Diet

Dietary intervention is considered a mainstay for many gastrointestinal cases because a large proportion of cats and dogs with gastrointestinal disease are associated with food-sensitivity. We need to get these pets eating again for the intestines to return to normal function. Dogs and cats with pancreatitis, which is painful and causes severe illness,  do well initially with a low fat diet in the early stages to get them stronger and get the intestines used to digesting food again.  I/D (Intestinal Diet) has been used by our doctors for well over 35 years, and is the gold standard for pets with GI problems. After the pet is stable we look for a long term food.

PrescriptionDiet-ID

I/D comes in many variations, and our doctors will tell you which one is appropriate for your pet’s specific problem

 It is the protein component of the food causing the problem. Hill’s has solved this problem by making a food with a hydrolyzed protein that does not cause a reaction. It is unconditionally guaranteed, and is worth using in every case because it works often, and you can get your money back if it does not work. This is a complete diet and can be fed for the rest of your pet’s life. It is very rewarding when a dog or cat with the signs of IBD improves on only food and does not need medication.

PrescriptionDiet-ZD

The best food we have found overall for dogs and cats with food allergy is called Z/D

Novel proteins are not manipulated protein sources (as compared to hydrolyzed proteins like Z/D), but are simply new proteins that the pet has never ingested before. These foods might contain:

  • Potato
  • Duck
  • Sweet potato
  • Venison
  • Salmon

Many dogs and cats immune systems have not been exposed to venison, duck, or rabbit. Due to the fact that it takes long-term exposure to a protein before the immune system will react against it, then these novel protein diets are often attempted when the protein source is suspected to be the cause of IBD.  If pancreatitis is present (in Triaditis cases), a low-fat diet is critical during the first stages of medical therapy prior to initiating a diet trial.

Vitamin supplementation is a critical component of treatment for some individual pets whose IBD stems from a deficiency in cobalamin (vitamin B12), specifically in cats.  Pets that are sick enough to have a low cobalamin level are generally in need of more than just vitamin supplementation, requiring a combination of other medications and dietary alterations.

Medications

Steroids (corticosteroids) are used in many cases in order to decrease the inflammation. The most common ones include prednisolone or prednisone. Budesonide, is a weaker steroid, that is also used. If the root of IBD or Triaditis is due to an immune-mediated process, then more potent immune system suppressants than steroids are required, such as cyclosporine, chlorambucil, or azathioprine.

Antibiotic therapy is used when Triaditis is present.  Antibiotics should be chosen based on bacterial culture and susceptibility (usually of the urine to check for an U.T.I.) results, especially in cases of Triaditis. A very common antibiotic used for pets with IBD is metronidazole, also known as Flagyl.

When the liver is involved (Triaditis) we might also use Actigall (ursodiol) or Denamarin (s-adenosyl methionine)

Denamarin

IBD can be painful, and it is important to keep the pet as comfortable as possible during an acute episode of IBD or severe case of Triaditis. Prednisone and Flagyl decrease inflammation, which helps minimze pain. Specific pain medications are also used.

Prognosis

The prognosis depends on many factors. This disease is usually not cured, unless there is a food allergy and we find the right diet for your pet. Most cases are controlled with diet and medication. IBD and it’s associated diseases tend to be a long term problem that is usually managed successfully. You increase your chance of success by giving medication consistently and bringing your pet to us for exams and diagnostic tests to look for changes that require a change in treatment.

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C-Section

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A  Caesarean Section (abbreviated as C-Section) is derived from the latin word “caedare”, which means to cut. It is believed that Julius Caesar was the first to be born this way when his mother died during childbirth. Most scholars of ancient history believe this was done long before Julius Caesar was born. Either way, the name sticks.

Our patient is a female dog that was able to deliver 2 pups normally. When we examined her and palpated her abdomen we could feel another puppy. She is exhausted, and has what is called uterine inertia. Her uterus does not have the strength to deliver the last pup.

Her 3rd one was stubborn though and did not want to come out, so we had to go in and convince him the time had come to meet his siblings. We routinely perform a spay (OVH) on these dogs after we remove the pup.

Graphic photos of an actual surgery are on this page. 

Radiograph-pregnant dog lateral

We took a radiograph to confirm the size of the pup and look for any problems

Pup-nursing help

The two that were born naturally had one last meal from their mother before we brought her into surgery

Pups-sleeping in carrier

After their meal they were cozied up with blankets and a hot water bottle (at the bottom of the photo) since they cannot regulate their temperature at this stage

Pups-sleeping

We know they were content because they fell asleep. Now we could concentrate on their mother and the remaining pup

It was time for the C-section. After we gave the mother a thorough pre-anesthetic exam, and administered intravenous fluids, she was ready for surgery. In this procedure we move fast, real fast, so the remaining pup is not depressed by the anesthesia we give the mother for the C-section. While the surgeons are scrubbing in and preparing their instruments we are preparing the mother for surgery.

Joel-mother

After she was clipped Joel brought her in to start the anesthesia

Mother-onside

She is getting sleepy as we administer her anesthetic. As soon as she is out we move her into surgery. Her abdomen has alreadly been clipped, and a local anesthetic has been infused into her abdomen where we will make our incision. This allows us to give her less general anesthetic and not depress the remaining puppy.

Hands

While our patient is being anesthetized our surgeons are scrubbing up

Instruments

As soon as the surgeon’s are gloved and gowned they go right into the surgery suite to get the instruments ready. We do not want our patient waiting for the surgeons, we want the surgeons waiting for the patient.

Surgivet

Our patient is immediately hooked up to our anesthetic machine when brought into the surgery suite. When stable we can start the surgery.

Surgeon-draping

Dr. Wood, our first surgeon, wastes no time draping our patient for the procedure once our anesthetist confirms our patient is stable

Doctor-draping

At this point, our 2nd surgeon, Dr. ridgeway, is scrubbing in and will be in the surgery suite in a few seconds

Doctor-surgery team

We don’t technically need 2 surgeons for this procedure. We do it because we can get the puppy out of the uterus faster this way, which is of utmost importance to us for a pup that has been in the uterus longer than it should be and could be struggling.

Pup- in uterus

This is what the pup looks like in the uterus

Uterus-incision

A quick incision in the uterus, taking care not to cut the puppy

Uterus-pup out

Out he (it’s a boy!) comes covered in a protective membrane

Pup-umbilicus clamp

Once we remove the membrane the first thing we do is clamp and cut his umbilical cord

Pup-suction

We immediately suction out any fluid from his mouth so he can get some air into his lungs

Pup-nurse suction

Then it’s a quick hand-off to our nurses who are eagerly waiting for him with a warm towel and more suctioning

Over several minutes we gently suction out mucous from the nose and mouth

After we are sure the breathing passages are clear we stimulate him to breathe by gently rubbing him

Pup-eating

His mom is still in surgery, so we give him a quick meal until he can nurse. Nursing is important because the milk the mother produces contains antibodies he needs to prevent common diseases like Distemper. He cannot produce these antibodies just yet.

Pups-feeding

While our doctors are finishing the surgery our nursings staff goes to work making sure these puppies are fed and kept warm until the mother is fully recovered and able to nurse all of them


Whitepup-feeding

The nursing instinct is strong and the puppies greedily suck down the milk

Nurse assist feeeding puppy

Pups-resting

After nice meal all 3 of them take a well deserved nap


Mother-recovering

We let the mother recover completely before we let the pups nurse. She is exhausted from trying to get this last puppy out and needs some time to rest.


CSection-surgeons

Once mom was out of surgery and stable our surgeons could not resist, and had to hold the puppies

This was Dr. Wood’s first C-section, and she did a wonderful job! Next time she has to do one in the middle of the night she won’t need to call Dr. P or Dr. R to help her!

Here is a C-Section we did many years ago:

One of the most rewarding surgeries we perform is a Cesarean Section. Usually it is performed on small breed dogs because their pelvic canals are just too small to handle the size of the pups for a natural birth. This is the story of Margarita, a Chihuahua that had 4 large pups in her tank.

The gestation length in most domestic dogs is 63-65 days. When Margarita first came to us one week before she was due we knew a C-Section would be needed from her size and her radiograph.

How many pups do you see in Margarita’s abdomen? The answer to this question will become apparent later on.

On the appointed day Margarita was brought to our hospital for a C-Section by Dr. Palazzolo. On a dog that is this small, and has this many large puppies in its uterus, preanesthetic preparation is important. This consisted of a preanesthetic blood paneland intravenous fluids prior to and during surgery.

We keep a close tab on important physiologic parameters for all of our surgeries. Monitors like this give us an early warning of an impending problem.

Surgery-Monitor

Once our surgeon has scrubbed up and is  in sterile gown, gloves, and mask, the surgery begins

_D2A8630

Here she is on the surgery table. You can see the green tape covering her IV catheter and if you look closely you might be able to tell that her abdomen has already been shaved. She has also been given a local anesthetic where her incision will be. All of these things are done prior to any anesthesia. They will allow us to use less anesthesia for the actual procedure which is important to minimize any anesthesia that depresses the pups.

At this point things start moving fast. Margarita has been given an IV sedative to relax her, the final surgical prep has been applied, and a breathing tube (called an endotracheal tube) is in her windpipe giving her 100% oxygen. Once she is intubated we move fast, and in the next 5 minutes all of the pups will be out of her uterus. While her anesthesia is being monitored the rest of the team is preparing to receive the pups.

She is draped and a rapid incision is made in her skin. By giving her the local anesthetic earlier she does not feel the skin incision and we can keep the anesthetic level to a minimum.

The uterus is rapidly located and gently squeezed out of her incision. We make the incision in her abdomen just big enough to gently exteriorize the uterus because she will heal faster and nurse her pups better with a smaller incision. This is where the experience of our surgeon, Dr. Palazzolo, comes into play.

This is one horn of the uterus and contains 2 of the pups. The other horn of the uterus can be visualized running horizontally at the bottom of the picture.

A scissors is used to cut into the uterus. Special care is taken not to cut the pups,which could be moving in the uterus.

The first pup is gently removed with his umbilical cord still attached.

You can get a better idea of the amniotic sac that completely covers the pups.

The first things our nurses do upon receiving the pups is to rub them gently yet vigorously in a towel. This stimulates them to breathe. They also gently shake them to remove fluid from their lungs.

The nurses use a special bulb syringe to suction fluids from pups that aren’t eliminating fluid from shaking and rubbing.

Any pup that is still not breathing well at this point is giving a drop of respiratory stimulant on the top of its tongue.

Once our nurses feel the pup is breathing on its own they tie its umbilical cord.

After all 4 pups are stable they are put under a heat lamp since at this early stage in their lives they do not have a very strong ability to regulate their body temperature.

Meanwhile back in surgery Dr. P is checking the abdomen to make sure there is no bleeding prior to suturing the abdomen. In Margarita’s case she was also spayed.

Her muscle layer is carefully sewn back together. These sutures are critical to prevent a hernia from occurring, especially when pups vigorously nurse.

With her skin sutures complete Margarita is now taken off the anesthetic machine and a pain injection is given to her.

Our nurses take care of the feeding while Margarita rests and recuperates. We won’t let 4 hungry pups nurse until she is strong enough.

Here are our 4 little piggies all in a row sleeping after their ordeal and their first meal. Their tummies are full and they are keeping each other warm.

In a surgery like this there needs to be close coordination between the surgeon, anesthetist, and nursing staff. You can see how much time and attention our nurses put into doting over these puppies.

Time for a little shut eye, we had a big day!

This is one of those pups several months later with her proud mom! Can you guess which of the above 4 puppies this one is? (Hint-look at the white spot on the forehead).

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Geriatric Medicine

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In the past, we may have accepted a declining quality of life for our aging pets as a fact of life beyond our control. Like humans, older dogs and cats are more likely to encounter health problems than younger pets. Thanks to advances in veterinary medicine, pets are living longer than ever before. A 7 year old dog or cat is equivalent to a 50 year old person. Most humanoids are practicing preventive medicine at this age- routine physical exams, breast exams, prostate exams, blood pressure checkups, blood panels and dietary changes. Dogs and cats need similar preventive medicine at this age. Since they age approximately 7 years for every 1 year of human life, an 8 year old dog or cat is equivalent to a 56 year old person, and a 9 year old dog or cat is equivalent ot a 63 year old person. This rapid yearly increase in equivalent age emphasizes the fact that we need to pay close attention to all dogs and cats as they move beyond 7 years of life.

Just as older people experience a progressive decline in physical condition, so do senior pets. Studies indicate that 36% of senior dogs suffer from osteoarthritis, 18% show signs of Cognitive Dysfunction Syndrome, and the number one diagnosed disease of dogs in all age groups is dental disease. Compared to humans, old age problems may progress up to 7 times faster in senior pets. Having your senior pet examined only once a year is like a senior person visiting the doctor only once every seven years. That is why, as your pet nears 7 years of age (5 years of age in Giant Breeds), preventive senior exams every 6 months can help assess your pet’s current health, provide a baseline for monitoring changes in the years ahead, and help detect health problems in the early stages, when diseases can be treated more effectively.

Senior Care is “geriatric” medicine for pets. Senior health care implies both preventive and therapeutic approaches to medicine, including nutrition, dental care, and exercise as well as therapy for diseases.

Age Chart

Relative age of Your Dog in “Human Years”
Age Dog’s size in pounds
years 0-20 21-50 51-90 90 +
5 36 37 40 42
6 40 42 45 49
7 44 47 50 56
8 48 51 55 64
9 52 56 61 71
10 56 60 66 78
11 60 65 72 86
12 64 69 77 93
13 68 74 82 101
14 72 78 88 108
15 76 83 93 115
16 80 87 99 123
17 84 92 104
18 88 96 109
19 92 101 115
20 96 105 120
= Senior
= Geriatric

 


Symptoms

Changes in behavior or appearance may be the first indication of a problem. However, these signs may not be apparent in the exam room during your veterinary visit. It is important for you to watch for subtle changes, especially in stoic older pets.

Signs of aging:

Difficulty climbing stairs

Difficulty jumping up

Increased stiffness or limping

Loss of housetraining

Increased thirst

Increased urination

Changes in activity level

Excessive panting

Circling/Repetitive movements

Confusion or disorientation

Excessive barking

Less interaction with family

Decreased responsiveness

Tremors or shaking

Skin and haircoat changes

Changes in sleeping patterns

Less enthusiastic greeting or behavior

Altered appetite

Weight change

Common Health Conditions of Senior Pets

Obesity- As their metabolism slows down it is easy to overfeed. This leads to arthritis, sugar diabetes, liver disease, and heart disease.

Dental– Inflammation of the teeth and gums may lead to pain, infection, tooth loss, bad breath, kidney and heart disease, and, as a result, decrease your pet’s life expectancy.

Hormone (endocrine)- cause a vast array of symptoms that are treatable and sometimes curable.

Cushing’s– Excess production of cortisol (cortisone) by the adrenal glands.

Diabetes (sugar) – Excess glucose in the bloodstream due to a lack of insulin

Hyperthyroid– Excess production of thyroid hormone

Hypothyroid– Inadequate amount of thyroid production

Kidney– Failure of this organ can lead to chemical imbalances, anemia, compromised immune function, and blood clotting defects as well as altered mental capacity. Kidney disease is a leading cause of death in geriatric cats.Chronic Urinary Tract Infections can easily occur without you being aware. These are painful, and can predispose your pet to bladder stones.

Liver– Failure can lead to serious disease with chemical imbalances, anemia, compromised immune function, and blood clotting defects as well as altered mental capacity.

Heart– Pets with heart disease can experience difficulty breathing, fatigue, exercise intolerance, and lethargy.

Cancer– Can occur in many different organs. Early detection may improve the prognosis. Many treatments are available and most have few side effects.

Cognitive Dysfunction Syndrome– Similar to senility or Alzheimers in people.

Senior Exam

With frequent checkups, at least twice a year, we can screen for common senior diseases. By diagnosing and treating problems earlier, we may be able to slow the disease process and prevent pain and discomfort.

In addition to a complete physical examinationdiagnostic tests can help detect many diseases before your pet displays signs of a condition. Even if results are normal, the findings give you veterinarian a good baseline to identify and monitor changes in your pet’s health as the years progress.

You can do an in-home exam to help catch problems before they become entrenched.

Physical Examination We can check for physical signs of cancer, arthritis, heart and lung disease, dental disease, or cataracts.
Complete Blood Count
(CBC)
This test helps identify infections, anemia, and certain types of cancer as well as problems with bleeding and the immune system.
Serum Chemistry Profile This blood test can help identify diseases of the liver and kidney, and endocrine disorders such as Diabetes or Cushing’s.
Complete Urinalysis A urine sample can help test for kidney diseasediabetes, urinary tract infections, andbladder stones.
Fecal Exam A fecal sample can be checked for internal parasites and bacterial overgrowth.
Other Tests Depending on your pet’s overall health, we may recommend additional tests such asblood pressure measurementradiographselectrocardiography (ECG or EKG),ultrasound, thyroid (hyperthyroid or hypothyroid) or adrenal gland (Cushing’s or addison’s) testing, as well as liver, pancreas, and small intestine function tests.

Senior Nutritional Needs

Nutritional needs of pets change as they get older. Senior dogs should consume fewer calories due to decreased activity and reduced daily energy needs. This is very important because obesity increases the risk of serious diseases, arthritis, diabetes, cardiovascular disease, respiratory disease, and musculoskeletal disorders in older dogs.

Pet foods, specifically for seniors, are now available with fewer calories, limited phosphorous, more protein, balanced fatty acids, antioxidants, vitamins and minerals to meet the specific nutritional needs of senior pets. These foods have optimum amounts of nutrition, and can help in the progression of common diseases like kidney disease.

We recommend G/D (Geriatric Diet) by Hill’s as a great general food for older pets. Those pets that we suspect as developing kidney disease need K/D (Kidney Diet), also by Hill’s.


References:

1. Survey of Veterinarians, 1998. Sponsored by The Iams Company and Pfizer Animal Health.

Developed for Long Beach animal Hospital, by Glenna M Gobar DVM, MPVM, MS, courtesy of Pfizer animal Health; Sept 2001

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Skin Conditions

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Some of the more common skin conditions we see in dogs and cats at the Long Beach Animal Hospital

Allergic Dermatitis
Cushings (Hyperadrenocorticism)
Hypothyroidism
Lick Granuloma
Ringworm
Sarcoptic Mange (Scabies)

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Dental Disease

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Dental disease is prevalent in almost every dog and cat we examine. This page has a large amount of information that will inform you of this serious and overlooked problem. Please set aside the time to fully understand it due to its importance regarding your pet’s quality of life.

Oral hygiene is one of the most overlooked areas of medical care for animals. Far too many pets come to us with advanced dental disease, requiring anesthesia, x-rays, and the removal of rotten and painful teeth. As we increase our knowledge of animal health we realize that proper dental care does not just make your pet’s breath smell better; it is mandatory for your pet’s long term quality of life.

pddz5

We see too many pets presented in a state similar to this. The periodontal disease in this dog has progressed so far that it is systemically ill, and in danger of a spontaneous jaw fracture. Imagine how this dog feels!

Dental disease is a treatable and preventable problem, and since your pet cannot tell you how it feels, it is up to all of us, as members of your pet’s health care team, to address this problem. Most people wait too long to get their pets teeth cleaned professionally. Teeth cleaning should be considered a preventive measure, not a way to treat a problem that is already present. Good dental care revolves around the control of bacteria under the gumline where it is not visible. We will teach you how to prevent it and how to treat it.

Prevention is the key, so learn how to brush your pet’s teeth. If started at an early age this “bonding time” is an enjoyable time for all. When your pet is young, get it used to your hands around its mouth by petting it on the head and face gently, telling your pet how good he is in a soothing tone. Eventually get him used to your fingers being gently placed in his mouth and rubbing his gums. If you do it slowly and follow your pet’s reaction, you can make this a fun game for all.

At the end of this page on dental disease there is more information on prevention.

When your puppy or kitten still has its baby teeth use our dental wipes to get your pet used to the procedure. By going slowly most puppies and kittens respond positively to the attention. You can dip a cotton-tipped applicator in tuna juice and use this to rub kitten gums.

Start brushing the teeth when the adult teeth are in, which is around 5 months of age. We can tell you when to start if you are not sure, and show you how to do it.

taliabrushteeth

Yes, you can brush your pet’s teeth, and yes, you can make it an enjoyable experience for both of you! Bring your pet in and we will show you how. If you start when your pet is young it will be much easier. This can be started when you do your puppy behavior training.

CET-pets

We have special dental kits for dogs and cats that make the process easier and more effective. They do not like the feel and taste of the toothpaste we use in our mouths, so do not use that. 

If brushing your pet’s teeth is not an option, we have a multitude of products to help replace brushing.  They are designed to aid in slowing down plaque buildup, which is the start of dental disease. They are not as effective as brushing, but are better than doing nothing.

CET-VeggieDent

Dentees-stars

Hills-dental-care-chews

There is also a food called T/D (tartar diet) made by Hill’s which is a significant help in preventing dental disease. It comes in many different kibble sizes for different sized pets.We highly recommend it, especially for the small breed dogs that might be fussy about getting their teeth brushed.

Hills-T:D

This food is unconditionally guaranteed, and can be returned for any reason

If you use some of these products, and have your pet’s teeth cleaned by us without anesthesia (it’s called non-anesthetic dental), you will not encounter the serious and painful dental disease you will learn about later in this page. All of this needs to be started early in your pet’s life, and long before dental disease sets in.

Non-anesthetic-dental

Having your pet’s teeth cleaned professionally, without anesthesia, is the best way to prevent dental disease. After they are cleaned this way you need to brush their teeth, until their next cleaning in 6 months. The effort is worth it, especially later in this page when you see  how bad dental disease can become. 

dental-non-anesthetic-form

The non-anesthetic professional teeth cleaning by Pet Dental Services is thorough, and the person that cleans your pet’s teeth will go over a report like this for your pet. 

The licensed technicians from Pet Dental Services will perform non anesthetic teeth cleaning at our hospital on the 4th Monday and Wednesday of every month. You can make an appointment and wait while it is being performed, or you can drop your pet off and pick it up later. If you wait it takes about 30 minutes.

All legitimate non anesthetic dental people are licensed by the state of California to perform this procedure. This can only be performed legally in the state of California under the direct supervision of a licensed veterinarian, which is why our doctors are present, and review any important dental findings with you after they professionally clean your pet’s teeth. This law is obvious for your pet’s protection.

Many unscrupulous people perform this procedure because they tell you they are saving you money and fooling you into thinking they are actuallly doing something medical for your pet, when they clean your pet’s teeth without the supervision of a veterinarian. This commonly happens at grooming shops and pet stores. They prey upon the irrational fear people have of anesthesia. In reality, since they are not making a correct diagnosis, or doing a thorough job, all they are doing is setting up the stage for the bacteria that is under your pets gumline to to wreak havoc later on, necessitating an anesthetic dental.

People sometimes wonder why pet’s need their teeth professionally cleaned by us, and then brushed by you, when they have memories of growing up with dogs and cats and never doing this. It doesn’t take much to answer this question. Pets nowadays eat diets that makes them prone to plaque. They also live longer, and just like in people, are more prone to disease as time goes on.

More importantly, we did not have the knowledge decades ago to understand how dogs and cats lived lives of chronic pain because we did not know, or could not diagnose, the periodontal disease that is occurring below the gum line. With the advent of digital radiography, and our current body of knowledge, we realize that we did not treat dental disease anywhere near as thoroughly as needed. This ignorance lead to poor quality (painful) and shortened lives for our pets.

dental-rotten-tooth

This is the crux of the problem. When you look at the teeth, and see some tartar, it doesn’t seem like much of a problem. Just scrape the tartar off and the teeth will look and feel better, and your pet’s breath will smell better. Job done right?

dental-rotten-root

Here is the same tooth as it is being removed while this pet is under anesthesia. The root on the right is rotten, compare it to the normal root on the left. We did not know this pet had a rotten and painful root until we probed it and took radiographs. If  this tooth had only been cleaned of tartar and not removed, this pet would have had a painful tooth indefinitely. 

This is a video of a different dog having its teeth cleaned under anesthesia. When our doctor examined the canine tooth it was found to be infected, with pus coming out of the gums. This would never had been found if we were not thorough and checking for this, and this dog would have had a painful mouth long term. Just as importantly, the large amount of bacteria that is entering the bloodstream on a chronic basis causes damage to the internal organs.

You can see the pus on the probe as it is moved around the base of the canine tooth

Cats get a unique dental problem, called neck lesions (also called FORL- Feline Odontoclastic Resportive Lesions), that are painful. When we encounter these problems we need to remove the bad tooth.

Dentistry-FelineNeck

What seems like just a red gum is actually the painful condition of the root called FORL

dental-disease-inflamed-gum

Here is another example of a potential FORL lesion

The short video below is an example of how painful this is. This cat is completely anesthetized, yet when we gently touch  its premolar teeth with a probe it moves its jaw in obvious pain.

It is the periodontal disease that is occurring out of sight and below the gum line that causes the most problem. This is the area we thoroughly need to address when we clean a pets teeth under anesthesia.

We take this problem seriously, and spend considerable time caring for pets with dental disease. Many dogs and cats are brought to us in advanced states of dental disease. Their teeth are infected and rotting out, and they have tremendous odor (severe halitosis) from the infection.  For animals that have such keen senses of smell, this chronic odor is very irritating. The stress on their internal organs due to the tremendous infections in their mouths can cause problems with the liver, kidneys, and heart valves.

canine-dental-radiographs

Dogs and cats with advanced dental disease need to be anesthetized, given a thorough oral exam, and have dental radiographs. They are closely monitored during the procedure, and all their dental problems are taken care of. This takes considerable time and effort on our staff.

The following information on dental disease is very thorough. We have a summary page on dental disease if that suits your needs better.

Normal Tooth Anatomy & Development

The diagram above illustrates some of the structures of the normal tooth. It also shows Stage III periodontal disease, which you will learn more about later. On the left side you can see the bone of the jaw and the blue periodontal ligament. It is this ligament that keeps the tooth attached to the bone in the socket. You can also see the blood supply and nerves to the tooth. They are the vertical finger-like projections in the center of the tooth.

On the right side we have illustrated what happens in gum disease. The brown area between the tooth and gum is tartar and its associated bacteria. Tartar by itself is inert, and does not cause dental disease. Removing it makes the teeth look better, but it does not address the primary problem. It is the bacteria surrounding and within this tartar that we are after. Notice how a significant amount of tartar is below the gumline, and thus cannot be seen. Also, notice how the gum is pulled away from the tooth leaving a pocket.

As the bacteria progresses further down the tooth, the gum is pulled further and further away, the jawbone literally erodes away, and the periodontal ligament can no longer hold the tooth in the socket. The tooth is painful, rots out, or is removed when we professionally clean the teeth. The bacteria that eventually causes this erosion enters the bloodstream and can cause disease in other organs. It is this bacteria below the gumline that is causing all the trouble, and is the bacteria we remove when we professionally clean the teeth.

After the teeth have been professionally cleaned we can use non anesthetic dental from Pet Dental Services to prevent the problem from recurring. You are fooling yourself if you think you can take your pet to a groomer to have them scrape the tartar off once gingivitis is present. The teeth look nice, which means you have done something cosmetically nice for your pet, but you haven’t touched the medical problem.The teeth need to be cleaned by trained professionals from our hospital or Pet Dental Services, depending on the severity of the problem.

This radiograph of a tooth shows the same anatomy as above. We will show it again later when we show radiographs of diseased teeth. Notice how tightly the roots of the tooth fit into the healthy jaw bone. When we show you radiographs of diseased teeth later this jaw bone will be partially gone.

Dogs have 28 deciduous (temporary or baby) teeth and 42 permanent teeth. Anatomically they have 4 different types of teeth: Incisors (I), canines (C), premolars (Pm), and molars (M)

This is an x-ray of the lower jaw (mandible) of a dog. You can see how deep the roots go.

In comparison to dogs, cats have 26 deciduous teeth and 30 permanent teeth. They have the same types of teeth that dogs do, but in different proportions. They lack premolar #1 found in dogs due to a different evolutionary path.

The deciduous teeth start being replaced by the permanent teeth (in this picture they are the 2 large central incisors marked by the arrows) at 4 months of age. The puppy teeth that were there were probably swallowed.

Dogs seldom have problems with teething, although they do tend to chew things during this period. It is advisable to supply them with synthetic bones for this purpose, or else some of your personal items might get recycled! By 8 months of age all the permanent teeth have appeared.

Biofilms

Dental disease is all about bacteria. Due to the unique environment of the mouth, we measure mouth bacteria counts in the billions (yes billions)! Bacteria that adhere to the enamel of teeth colonize and begin synthesizing molecules, the most important of which are carbohydrates. These carbohydrates are sticky and act as a glue to attract more molecules on the teeth, eventually forming plaque. As time goes on calcium carbonate deposits on the plaque, hardens, and then becomes calculus. This is the hard material deposited on teeth people sometimes call tartar.

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This is tartar (plaque) on the teeth of a cat. If we get on top of this plaque now, by cleaning this tooth professionally with non-anesthetic dentistry, and use the prevention measure discussed earlier, we can prevent it from getting gingivitis, and all its associated problems. 

Tartar is made up of calcium salts, food debris, bacteria and other organic matter. It is orange to brownish in color and although soft when deposited, it quickly hardens. It collects primarily on the cheek (buccal) side of the premolars and molars, although it can occur in any tooth.

Periodontal disease results when the bacteria at the center of this plaque move under the gumline. There are many different bacteria in the mouth that start the process of plaque development. Some are aerobic, and live off the rich oxygen supply in the mouth (can you guess why the mouth has a rich oxygen supply?). As mentioned above, some of the bacteria in the plaque that migrate under the gumline go to an area of no oxygen, and are called anaerobic. The anaerobic ones tend to cause the most problem. Here is a list of some of their scientific names (warning-they are tongue twisters, so you better brush up on your Latin):

Actinobacillus actinomycetemcomitans

Bacteroides asaccharolyticus

Fusobacterium nucleatum

Eikenella corrodans

Porphyromonas gingivalis

Actinomyces viscous

These anaerobic bacteria cause an inflammatory reaction, and break down the periodontal ligament. The end result; the tooth rots out. Also, as these bacteria invaded deeper into the tooth cavity they reach the blood supply to the tooth, and can enter the bloodstream where they cause significant damage to the liver, kidney, and heart. It can even predispose to diabetes mellitus (sugar diabetes). The problem does not end there when it comes to periodontal disease. It can also lead to spontaneous jaw fractures, deep seated bone infection, and cancer (neoplasia) at the affected tooth.

Since bacteria are the main culprit in periodontal disease, it makes sense that antibiotics will be used to treat the problem. The two main ones we use are Clavamox and Antirobe. In select cases, where it is impossible to clean the teeth professionally, we will sometimes use one of these antibiotics in what is called pulse therapy. They are given for one week each month indefinitely. They are reserved for cases where the heart or other internal organs are seriously diseased and unable to withstand the sedation needed for professional teeth cleaning. Antibiotics are certainly no replacement for professional cleaning, but have a place in some select cases to help minimize the bacterial load and the halitosis.

How do you prevent these bacteria from starting the problem all over again after the teeth are professionally cleaned? Use the preventive care products mentioned at the beginning of this page, and get your pet’s cleaned professionally without anesthesia (non-anesthetic dental) every 6 months.

Symptoms

Symptoms of dental disease can range from subtle to extreme. One of the most common symptoms is bad breath (halitosis). Sometimes a pet with dental disease will cry in pain when you touch it anywhere near its muzzle. Another symptom is a partial or complete inability to eat (anorexia). A pet that has this problem may eagerly go to the food bowl, and either just look at the food or drop the food out of its mouth after only a few bites. Other pets might drool from one or both sides of the mouth, or paw at the mouth. Unfortunately, many pets are stoic (do not show outwards signs of pain when it exists on the inside), and do not show any symptoms until the problem is well entrenched, and the roots are rotting and painful.

The important point to remember is the fact that once you notice any of these symptoms, your pet’s dental disease is already causing discomfort or pain, and even affecting other body organs. Therefore, it is important for you to be aware of the existence of this problem, to learn how to perform a basic oral exam at home, learn how to brush its teeth,  and to bring your pet in for regular (every 6 months) dental exams by one of our veterinarians. An exam every 6 months might seem like a lot to some people. Compared to the typical lifespan of a dog or cat, it is not very frequent. Your pet cannot tell you its mouth hurts, it is up to us, as a team, to ensure that this inevitable problem is properly monitored and treated before it causes discomfort and pain, and sometimes premature organ failure.

Stages of Gum Disease

The close up shot of the gums of this normal dog are how healthy gums should look. Click on them to enlarge, and look at the detail of the gingiva (where the gums meet the tooth), and how adhered the gingiva is to the tooth.

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Nature has a beautiful design with our teeth. The enamel on teeth is the hardest organ in the body, and it adheres to one of the most sensitive parts of the body, the gums. 

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This is a healthy canine tooth with healthy gums

Stages of Periodontal Disease

There are 4 stages of periodontal disease. The first stage occurs when bacteria cause an invisible film of plaque to form on the teeth. The bacteria react with minerals and other debris that accumulate in the oral cavity, eventually causing tartar. You learned about his already in the biofilms section.

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This lower canine tooth has tartar and gingivitis, as evidenced by the inflamed gum at the base of the tooth. This means bacteria are already causing trouble below the gum line

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As the gingivitis and periodontal disease continues,  the underlying gum is pulled further away from the tooth.  The pocket of bacteria under the gumline in this tooth is significantly weakening the periodontal ligament and weakening the bone of the jaw.

Left untreated, the teeth eventually progresse to Stage IV periodontal disease. This tooth shows advanced periodontal disease as evidenced by the ulcerated gums (blue arrow), pus along the gum line, and severe tartar. When this happens your pet will experience pain and might be internally ill from the bacteria spreading to internal organs via the bloodstream. Pet’s with this problem are in jeopardy of internal organ failure.

Here is another dog with a similar problem. The tartar is so thick that it is literally holding the teeth in place! Notice how far up the inflamed gums are. In Stage IV periodontal disease the tartar can be so extensive that it is the only thing holding the teeth in the socket in some cases. When we remove the tartar the teeth literally fall out.  Its hard to believe that someone would let their dogs teeth progress this far. Unfortunately, this is not an uncommon situation.

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Some dogs that chew on their skin due to allergies will get the hair wrapped around their teeth and erode the gums

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When we remove the hair the roots of the teeth are exposed due to the erosive nature of the hair on the gums.

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The arrows point to the exposed roots. This is painful, and the teeth need to be removed.

In some cases the infection under the gumline has eroded away the gum tissue that normally covers the root. If the tooth has 2 roots it will cause a hole to appear between the roots where the gum has eroded- this is called a furcation lesion. The cat in the picture below is well on its way to getting this problem.

This is one potential outcome when pets with periodontal disease are not treated. The teeth in this cat literally rotted out of its mouth. This situation is completely preventable. Fortunately, pets that have no teeth can still eat well, but that is small consolation for this cat. The years of chronic bacteria that were released into this cats bloodstream when the periodontal disease progressed from Stage I to Stage IV can seriously affect the internal organs and cause this cat to have premature organ failure.

This is another potential outcome for a pet that has periodontal disease. This dog’s lower jaw (mandible) is fractured at the chin because of long term periodontal disease. You can see this fracture (the arrow points to it) as a separation where the two lower jaw bones meet at the chin.

This jaw had to be wired back together after the teeth were cleaned. It will also need to be on long term antibiotics. Unfortunately, the problem might get worse as time goes on. The wire (marked by the arrow) can be visualized just to the right of the tongue at the very center of the picture. It is wrapped all the way around the jaw and anchored under the chin. It will need to stay in place at least one month.

Here is another cat with the same problem, click on the picture to enlarge it

There are other serious complications that can occur when proper oral hygiene is neglected. This dog had a seriously infected tooth that created a fistula (arrow) into its upper jaw. Food will go into the passage and end up in the nasal cavity, which is not a place where food belongs. This dog will have chronic infections because of this, which can even lead to life threatening pneumonia.

Heart Problems Secondary to Periodontal Disease

The heart is one of the internal organs that can be affected in advanced dental disease, because bacteria from the mouth infection can readily deposit on the heart valves (especially the mitral valve). Our heart page has extensive information if you would like to learn more.

This picture is from our heart page. The top arrow points to a normal valve leaflet. The bottom arrow points to a thickened valve leaflet, which could be the result of chronic bacteria from the mouth. The thickened and rounded lower leaflet causes the problem.

The thickened valve can malfunction and leak blood backwards through one of the chambers of the heart, instead of forward like intended. This turbulence of blood as it flows through this leaky valve can often be heard as a heart murmur. The potential result of this back pressure is congestive heart failure- a buildup of fluid in the lungs (pulmonary edema). Fluid in the lungs will cause your pet to start coughing and feel very ill- it is a serious sign that requires immediate veterinary care.

In addition to heart (cardiac) problems, dental disease can affect the kidneys and the liver. These are both vital organs, and require a pet free from dental problems if they are to function properly. Some pets do not live a full life due to the chronic affect the bacteria has on their internal organs, leading to premature organ disease.

Diagnosis

As with any illness, the diagnostic process is carefully followed so that a correct diagnosis is made, and other problems that are a result of the dental disease (ex-heart murmur), or are occurring simultaneously (ex-kidney disease), are not overlooked. Since there are numerous diseases and conditions that can mimic dental disease, the diagnosis of dental disease must be performed by a veterinarian.

During a routine physical exam we will be be performing a complete examination, including the oral cavity. If dental disease is present, it is during this exam that we determine if your pet needs an anesthetic professional cleaning or a non-anesthetic professional cleaning. We can only perform a complete oral exam, looking at the tonsils, tongue, and back of the mouth, when your pet is anesthetized. This allows us to find oral foreign bodies, stomatitis, and cancers of the mouth, that we cannot see when your pet is awake.

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We never would have diagnosed the severe stomatitis in the back of this cat’s mouth without an oral exam under anesthesia. This is a painful condition and not a diagnosis that should be delayed. 

A complete oral exam is also performed during non-anesthetic dentals.  Due to the thorough nature of the non-anesthetic professional cleaning, we sometimes find problems that require an anesthetic professional cleaning.

We will also show you how to perform a basic oral exam so that you can monitor your pet’s progress at home. The oral exam is not complete until we exam your pets mouth (the medical term for the mouth is oropharynx) under anesthesia. Only then can we check for tumors, ulcers, gum disease, foreign bodies, and infections, and enlarged tonsils.

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A basic oral exam, which you can do at home, would have found this tumor on the gums long before it got this large

Pre-anesthetic Preparation

The first step in the process is yearly exams by one of our doctors, and more often if there is a medical problem of any kind or you pet is on chronic medication. Many people will have this yearly exam performed when their pet comes in for yearly vaccines. We will look inside the mouth and determine if any oral disease is present. If there is enough gum disease to warrant professional cleaning, pre-anesthetic tests will be ordered. We will also try to identify teeth that might need removal if there is an obvious problem.

For pets under 5 years of age a routine in-house blood panel will suffice in most cases. For older pets, or those with other problems, a more thorough blood panel will be ordered. These blood panels will let us know if your pet is ready for anesthesia, will check your pets health in general, and will allow us to assess any damage to the liver or kidneys from the chronic bacteria in the bloodstream. In addition, our doctors will sometimes recommend other tests prior to anesthesia. These tests commonly include radiographs of the lungs or abdomen, along with an electrocardiogram to assess the heart.

Our pre anesthetic diagnostic tests page covers these tests in more detail. Our doctor will analyze the results of the pre-anesthetic diagnostics tests and customize an anesthetic protocol for your pet. In many cases Intravenous fluids will be given prior to and during the professional cleaning. These fluids, when used in combination with pre-anesthetic tests, dramatically minimize the risk of anesthesia. as a final preparation prior to professional teeth cleaning one of our doctors might put your pet on antibiotics.

Anesthesia

When significant gingivitis is present proper dental care involves more than just scraping tartar off the teeth. Just scraping the tartar may temporarily make the teeth look better, but it is not addressing the real problem that occurs under the gumline. Thorough dental care involves scaling, probing, radiographing, flushing, measuring, fluoride and polishing. You will learn more about these in the next section. These treatments can only be accomplished on an anesthetized pet. It is not realistic to think that all of this can be accomplished on an awake pet, and be as thorough as we can on an anesthetized pet.

When these procedures are performed properly we can reverse the periodontal disease in some cases, and keep the teeth and gums healthier for a longer period of time. Since the risk of anesthesia is negligible with the precautions we take and the precise method available to administer and monitor anesthetic, it is well worth the negligible risk in order to clean the teeth and gums properly. In reality, the risk of disease occurring by not cleaning your pet’s teeth professionally is greater than the risk of anesthesia.

We have extensive experience in anesthetizing pets, especially the geriatric pets that so commonly have advanced dental disease. To minimize any anxiety you have over anesthetizing your pet, one of our doctors will personally discuss our anesthetic protocol with you and set up an anesthetic plan that is specific for your pet’s condition. Our anesthesia page has extensive detail on how we anesthetize animals.

Surgery-Monitor

We keep a close tab on important physiologic parameters for all of our surgeries. Monitors like this give us an early warning of an impending problem.

Professional Cleaning

This cleaning has four main components:

  1. Cleaning above the gum line with the ultrasonic scaler
  2. Cleaning under the gum line with special instruments
  3. Probing and examining of each tooth, with dental radiographs, to look for root decay and loss of bone
  4. Removal of rotten teeth
  5. Deep cleaning under the gum line with a curette, called root planing, to get at the bacteria and plaque in deep pockets
  6. Placing antibiotics on teeth with deep pockets in order to save them
  7. Antimicrobial medication to control the periodontal disease
  8. Oral sealants to prevent plaque buildup and the recurrence of the problem

Every pet is different, and we might do some or all of these procedures.

Oral Exam and Charting

The first aspect of the cleaning process is an examination of the complete oral cavity. It is only when a pet is sedated can this be completed thoroughly.

The arrow is pointing to a cyst in the mouth of this dog that was not seen until it was sedated. The owner did not know it was present, nor did this dog show any symptoms. We were able to remove it before it became a problem.

After our thorough oral exam we chart the problems encountered

Dental Unit

The equipment you will find in our hospital is the most advanced available. It allows us to provide a wide array of dental services.

We use a specialized ultrasonic scaler that is made for animal teeth

Radiology

Radiography is an important part of dental care and is commonly performed as the next step after the oral exam. During your pet’s oral exam under anesthesia our staff will measure the depth of the pocket on the teeth that have disease. If the depth is 4 mm or greater we might take a radiograph of the tooth to make sure the underlying jawbone and root are healthy. If the root or jawbone are not healthy the tooth needs to be removed or a root canal at a specialist needs to be performed.

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If there is a large pocket or bleeding occurs when we probe the tooth, we will radiograph it to see the roots

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Our dental x-ray machine is made specifically to radiograph animals

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The machine is automated, allowing us to rapidly take high quality radiographs

The high definition of these radiographs allows us to see problems that are not apparent during the oral exam. Here is the normal tooth radiograph you saw at the beginning of this page.

This radiograph shows a problem around the root. Do you see the dark, semicircular area around the root of the tooth in the very center of the picture? Compare it to the other root of this same tooth just to its right. This dark semicircular area radiographically is called lucency, and is an indication of deep seated infection in the tooth. It is painful and needs removing.

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In this radiograph the jaw bone has been eroded down to expose parts of the roots on both teeth. This is the furcation lesion shown earlier.

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Do you see the damage to the two teeth at the top right of this radiograph ?

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These are the incisor teeth of the lower jaw, notice the missing ones that have rotted out?

Calculus Removal above and Below the Gumline

If the tartar is extensive, as it is with this dog, a special dental instrument is used to crack off large pieces of tartar before we use the scaler.

This enables us to clean the teeth faster, another method to minimize anesthetic time. It also reduces wear on the ultrasonic scaler tip.

Scaling teeth is greatly facilitated by a special instrument called an ultrasonic scaler, which you learned about earlier in this page. By vibrating tartar off the teeth with the scaler we cause minimal trauma to the tooth enamel. In addition, the rapid manner in which it removes the tartar minimizes anesthetic time. The gentle nature of the scaler allows us to clean under the gumline and not irritate the gums.

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The tip vibrates 18,000 times per second, and literally vibrates tartar off the teeth. It does not harm the enamel, and lets us clean the teeth faster than doing it by hand. It continually sprays water to minimize heat buildup which could irritate the gums.

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It has a special light to give us good visualization so we do not miss anything or harm the gums

Probing and Measuring

Here is a close-up of the probe. Each of the notches is 1 mm, the total length being 10 mm. Anything more than a 3 mm pocket under the gums in dogs, and 0.5 mm in cats, is significant.

Lets have a little fun and show you just how small 10 mm is, courtesy of Uncle Abe

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When we measured the depth of the pocket on this tooth it was obvious from the bleeding and the depth of the probe that periodontal disease is present and a radiograph is needed

If we think the bone loss seen on the radiograph is manageable, and the gum pocket is not too large, we can place a long acting local antibiotic, called Clindoral®, under the gumline. This will continually kill the bacteria causing the gingivitis. The ultimate goal is to save the tooth from advanced periodontal disease and the need to remove a rotten tooth. If the problem is too advanced for this treatment, we will remove the tooth.

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It contains an antibiotic called Clindamycin

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It comes in a prepackaged syringe

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It allows for precision placement of this antibiotic under the gums, with the long term goal of saving the tooth

In some pets the tooth problem is so severe that removal of the tooth is necessary. We make this determination only after probing, taking a radiograph, and exploring the option of using Doxirobe or Clindoral

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Before we extract a tooth we use a short acting and long acting local anesthetic, in addition to the general anesthetic currently being used. 

After removal of a tooth we suture the gums over the opening for faster healing, and to prevent food particles from going in the socket.

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This is the opening that remained after removing a severely infected canine tooth in this cat. The gums are hardened and the opening cannot be sutured closed. 

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If the opening cannot be sutured, we pack the opening with a special bone graft

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This is the opening with the bone graft in place

Root Planing

For the remaining teeth, root planing is probably the most critical step in the professional cleaning proces. By scraping the bacteria under the gumline with this special instrument we take care of the problem at its core. This can only be done on your pet when it is under anesthesia.

We use a specially designed instrument that is gentle yet thorough

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Root planing allows us to get at those bacteria under the gum line

Flushing the Gums

After the teeth are scaled and probed, and the roots have been planed to remove the originating bacterial cause, we spray them with chlorhexidine to further help eliminate the bacteria that are causing gingivitis. It is only after this point in the professional cleaning process that we have significantly decreased those billions of bacteria.

This special antibacterial reduces the bacteria burden in the mouth

Polishing

Polishing the teeth makes them look whiter. It also smoothes off the enamel surface and makes it more difficult for bacteria to adhere. Once bacteria get reestablished, the cycle of plaque leading to tartar and eventually gingivitis gets started all over again.

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The teeth are polished with the same instruments dentists use on us

Fluoride Treatment

One of the final steps in the cleaning process is the application of fluoride to prevent cavities. We bathe the teeth in fluoride for a few minutes, then rinse it off. It has a very nice smell, too bad we can’t transmit smells over the Internet. We even put fluoride on the teeth of pets when they are spayed or neutered to help protect their teeth when they get older.

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It smells good and is fun to watch as it foams up and covers the teeth

If the enamel on your pet needs a sealant, we use Oravet. It significantly reduces plaque and tartar formation by creating an invisible barrier that helps prevent bacteria from attaching to your pet’s teeth.

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Prevention

Just like in people, routine preventive care is critical to proper dental hygiene. This was discussed at the very beginning of this page. This saves your pet from extended periods of pain and unnecessary tooth loss, and can save you the expense of the veterinary care needed to treat advanced dental disease. Your pet’s teeth should be checked every 6-12 months by one of our doctors, especially if it has already had gingivitis and had its teeth cleaned. Any pet that has had periodontal disease should be checked every 3 months. One of these check ups can be accomplished when your pet is brought to our hospital for yearly booster vaccinations.

One of the most important things you can do to slow down the recurrence of dental disease is to brush your pets teeth. This will help keep the gums healthy and prevent tartar buildup on the teeth on the cheek side (buccal) of the mouth, although it does not work as well on the teeth on the tongue (lingual) side of the mouth. Even though this may sound like an impossible feat for an uncooperative pet, it is one of the best ways to prevent dental disease. Even though the teeth will eventually need professional cleaning again in the future (most people get their teeth cleaned several times per year), proper brushing will decrease the amount of dental disease that occurs and the number of times we will have to clean your pet’s teeth over its lifetime.

Due to the short life span of pets in relation to people, proper home care of your pet’s teeth becomes an important health measure. When brushing the teeth there are some common sense things to do to make the process go smoother. One of our technicians will demonstrate some of these techniques with one of our hospital cats (they love the attention). It is important to remain calm and patient, since for most pets having something put into their mouths is a new experience. With a little tincture of time, the procedure progresses smoothly. also, it is highly advantageous to start the brushing process at an early age.

Patience is the key! Try to do something positive (feeding it, playing or walking)  with your pet just after brushing to condition the behavior for the future. Try to make the whole process fun, and don’t ever let on that you are doing something good for your pet (kinda like child psychology- if its good for them they won’t do it). With your pet near you or on your lap, maybe while watching TV, let your pet get used to your finger near its mouth. Dipping your finger into a food or liquid your pet has acquired a taste for helps start the process smoothly. When it is comfortable with your finger, use a soft gauze to massage the gums and gently rub the teeth. a cotton tipped applicator can also be used. Eventually you want to progress to a toothbrush.

In smaller pets, especially cats, proper restraint is important. There needs to be a proper balance between too little and too much restraint, a balance that varies with each pet. This is especially true with cats. For smaller pets, placing them on a table will make the process go smoother. Larger pets can also be placed on a table, if feasible, or can be restrained on the ground. Only one or two people should be involved in the cleaning process, usually without children present. We have a complete page demonstrating this restraint technique.

Eventually, introduce a soft bristled toothbrush. These toothbrushes are available in our dental kits. A rubber finger brush can be used but a toothbrush is preferred. You should not use your personal toothpaste to brush your pet’s teeth because the taste can upset their stomachs. Our dental kit has toothpaste that is specially made to be palatable to animals. These kits also have suggestions to make it easier to brush your pets teeth.

If you consider daily tooth brushing a chance to enhance your bond with your pet, you and your pet will find it more enjoyable. Brush the teeth in a slow and circular motion with a small amount of toothpaste. Its important to brush the outside of the teeth (the teeth up  against the lips and not the teeth up against the tongue) since that is where the plaque is most prevalent. If your pet is cooperative brush the insides next. Your goal is to brush at least 3 times per week. This will decrease plaque by 90%.

If you encounter resistance on a pet that normally lets you brush, or see blood or there are blood tinges on the toothbrush, smell any odor, see any inflamed area or swelling, or a buildup of tartar or inflamed gums, you should bring your pet in for an exam. If the tartar is significant it is time for a professional cleaning.

In some cases brushing is just not feasible. In these situations you can use the dental treatments recommended at the beginning of this page.

Congenital Abnormalities

Small breed dogs tend to have dental problems more often than large breed dogs. This may be due to the fact that they have smaller oral cavities and the teeth are forced closer together. Cats get comparatively few congenital problems regarding their teeth. Any condition where the teeth are not normally positioned is called a malocclusion.

Malocclusions are corrected only if there is a problem with mastication (chewing). Undershot jaw (lower jaw protrudes beyond the upper jaw) is seen on occasion, and is prevalent in small dogs and in breeds like Bulldogs, Shih Tzu’s, and Lhasa apso’s. Overshot jaw (upper jaw protrudes beyond lower jaw) is similar to buck teeth in people.

Occasionally, a dog will not shed a deciduous tooth when a permanent tooth starts to come through the gums in the same location. These retained deciduous teeth, along with any extra teeth, should be removed because they will result in displacement of the permanent teeth. Problems of this nature are discovered by our doctors on routine exams. This enforces the importance of bringing in young pets for vaccines and exams at an early age.

Miscellaneous Dental Problems

Carnaissal Tooth abscess

The carnaissal tooth (upper 4th premolar) may become infected and result in the formation of an abscess around the root. This is a very painful condition and is often accompanied by fever, loss of appetite and depression. a classic symptom of the problem is discharge through the face below the eye. This tooth needs to be removedfor the problem to be corrected. It has a deep root and needs careful extraction to correct the problem.

Lymphoplasmocytic Gingivitis

This disease, seen almost exclusively in cats, is a specific inflammation of the the gum tissue. It is a painful and debilitating condition that is controlled but not cured. It is treated in various ways, including surgery with a laser.

Cracked Teeth

It is very common for pets, especially dogs, to break or loosen their teeth while playing or chewing. This can cause significant discomfort and predispose your pet to dental problems later on in life. Injured teeth are usually removed, under general anesthesia, to ensure that the whole tooth is removed, including the root. If the root is not removed there will be a continual problem. In some cases we will refer you to a specialist that will determine if the tooth can be saved.

This dog fractured its tooth by chewing rocks

It was so badly traumatized it had to be removed to prevent pain and infection going into the root of this tooth. This tooth has 2 deep and strong roots, so it has to be split in half with a high speed drill.

The tooth just after removal

Cavities (caries)

Due to the nature of their enamel, dogs and cats do not routinely develop cavities. If they do, the cavity looks like a black area on the tooth, usually seen at the gum line or on top of the molars. Cavities can lead to pain and difficulty in chewing. The usual treatment is extraction of the tooth, although we can refer you and your pet to a specialist in veterinary dentistry to fill the cavity and save the tooth.

Discolored Teeth

Discolored teeth are seen in some pets. This can be caused by diseases like Distemper, the administration of certain antibiotics during the first few months of life, or trauma. If you notice discolored teeth please bring your pet in for an exam to determine the cause of the problem and if treatment should be instituted. Teeth that are red stained or red tinged have internal bleeding and need dental care.Antibiotics like tetracycline, if used when your pet is young, can stain the teeth permanently

Worn Down Teeth

Worn down teeth are usually caused be chewing rocks, chains, and fences. This is a behavioral problem that should be corrected to prevent long term problems. also, dogs that continually chew or bite at the skin due to allergies or fleas will cause the incisor teeth to be worn down, sometimes all the way to the gum line.

This problem can be detected during a routine exam and corrected by prevention of chewing on itchy skin before the teeth get worn down too far

At this stage there is no way to correct the problem without extensive dental work with a specialist

Growths

Pets can get growths in the oral cavity, some of them can be benign, some malignant. Any growth or inflamed area in the mouth should be biopsied.

A benign gum growth that occurs usually in older dogs is called an epulis. The growth of the gum sometimes become so large that it covers a tooth almost completely.

This is the same growth as above 1 week after removal using the laser

What is the next step?

If one of our doctors feels your pet needs to have its teeth professionally cleaned there are several steps you should take:

  1. Make an appointment to have the teeth cleaned before you leave our office. This will give you greater flexibility in your scheduling and allow us to accommodate you as much as possible. One of our receptionist’s will give you a written price estimate based on the doctor’s written instructions.  An estimate will be given that covers all anticipated costs. Even though our estimates are very accurate, there may be slightly greater, and more often lesser, charges on the final bill. This might be because some teeth need removal or medication needs to be sent home, or even finding something on the oral exam while under anesthesia that was not readily visualized during the initial exam. If there is any significant change in the price we will call you before proceeding. Please leave a phone number where you can be reached.
  2. If one of our doctors feels your pet needs pre anesthetic diagnostic tests, have them obtained while you are here, or drop your pet off and return to pick it up later when the tests are complete. Any test samples sent out to our outside laboratory will be available the following morning. Please call our office after 10 AM the next day for these test results.
  3. The night before the teeth cleaning take away all food and water before you go to bed, and make sure your pet does not eat anything in the morning. Our office opens up at 7:30 AM for drop offs. We appreciate having your pet in for its teeth cleaning by 8 AM.
  4. We will anesthetize your pet and clean its teeth sometime in the morning or early afternoon. One of our doctors will call you as soon as the procedure is complete.  It is very rare for a pet not to go home on the same day its teeth are cleaned. Your doctor will let you know if he plans on keeping your pet overnight. This might be because your pet is older or has a medical problem that requires us to monitor its progress in the hospital for an additional night. The best time to pick up your pet is in the late afternoon or early evening.  We are open until midnight every night for your convenience.You will be given written post dental instructions when you pick up your pet. If you have any questions after reading these instructions please let us know. Your pet may be groggy the first night. This is not because of the anesthesia, it is because of the pain injection many pets are given after their professional cleaning.
  5. Contact with children and other pets should be supervised by an adult the first night. Give it a small amount of water and soft food an hour after getting home. If it eats and there is no vomiting, give it some more food and water. It might experience some grogginess that evening because of the pain shot we give (some people welcome this, especially with young and active pets), but should be back to normal by the next morning. Please call us the next morning if you have any questions or you feel there is a problem (ex.-not eating, very lethargic).
  6. If we send your pet home with pain medication or antibiotics use them exactly as prescribed.
  7. Call us if your pet does not resume its normal activity and eating habits within 24 hours.
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Symptoms of Diseases

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Here are 5 basic areas you should observe on a daily basis.

Eating

Watch your pets daily eating habits for :

  • difficulty chewing
  • odor
  • swelling
  • pawing at its muzzle

Since dental disease is so prevalent please follow the link to learn how this can affect your pet’s eating.

Breathing

When your pet is at rest count the number of times it breathes per minute (watch it for 15 seconds and multiply that number by 4). A typical dog or cat breathes 30-40 times per minute, although this can be variable based on breed and external temperature. The important thing to watch for is an increase in its respiratory rate over a period of time. Trend this on a piece of paper weekly so you can see this trend as it gets going. This can be a subtle but very important parameter to measure since an increase here can be for many serious reasons.

Urination

Look for any changes in the following:

  • Urinating more often or in greater amounts than normal
  • Urinating small amounts frequently
  • Straining to urinate
  • Inability to urinate
  • Licking at genitals

In female dogs it can be difficult to assess some of these parameters, so try to pay close attention when she squats to urinate.

Defecation

Any significant change here is important:

  • Continual diarrhea of any type
  • Straining to defecate
  • Licking at anus
  • Scooting
  • Any blood on feces

Walking

Obvious lameness is readily noticed. Also look for a pet that is leaning more towards one leg or the other, tires easily after walking or playing, is slow at getting up after resting, or is reluctant to go up or down any type of elevation like stairs or jumping into a vehicle.

Now that you have observed your pets daily habits lets look at how you can look for problems that are not so apparent by going to our In Home Exam page.

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Heart Diseases And Their Treatment

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  1. Chronic Atrioventricular Valve Disease (Myxomatous AV Valvular Degeneration)

    This disease goes by several names. They include endocardiosis, mucoid valvular degeneration, chronic valvular fibrosis and acquired mitral regurgitation/insufficiency. It is the most common cause of heart disease and congestive heart failure (CHF) in the dog. Tricuspid valve regurgitation can also occur with this disease. It is rarely seen in cats.

    Cause

    The exact cause is unknown. It effects the mitral valve more commonly than the tricupid valve, although both can be involved. It probably affects the mitral valve more commonly because of the high pressure in the left ventricle. As dogs age nodules form along the edge of mitral and tricuspid valves. When they get thicker the valves begin to leak (regurgitation), and as the disease progresses, the valves become deformed and shrink. You saw this previously in the necropsy pictures of the dog heart. As the problem progresses the chordinae tendinae might even rupture.

    As the blood regurgitates abnormally backwards into the left atrium it increases the pressure in the atrium, making it harder for blood to flow from the lungs into the heart (from the pulmonary vein to the left artium). As the back pressure increases, the pressure in the veins of the lungs increases to a point (pulmonary hypertension) where the fluid leaks out, leading to pulmonary edema. This regurgitating flow of blood through the left atrium eventually causes it to enlarge (you saw this in the radiograph pictures). The regurgitating blood can go from the left ventricle through this valve and into the left atrium with such force that it causes “jet” lesions in the wall of the left atrium. The left atrium might also develop an arrhythmia as it continues to dilate. The enlarging left atrium can actually tear and cause blood to leak within the pericardial sac.

    Since some of the blood that would normally be ejected by the left ventricle is now regurgitating back into the left atrium there is less flow of blood out of the left ventricle and into the aorta. This can begin the process of poor perfusion, leading to the cascading series of events culminating in congestive heart failure (CHF). Not every case of chronic atrioventricular valve disease will lead to heart failure though. Some dogs can have thickened and deformed valves and never show any symptoms.

    You learned all about this in the anatomy, physiology, and pathophysiology sections……

    Signalment

    It usually occurs in smaller breed dogs, notably:

    History

    Symptoms might include exercise intolerance, weakness, syncope (passing out), cough, shortness of breath, and lethargy.

    Physical Exam

    A heart murmur along with an arrhythmia is a clue to this disease. As the problem progresses the murmur becomes louder. In the later stages of the disease the fluid that builds up in the lungs (pulmonary edema) can be heard with the stethoscope also. An irregular rhythm and increased heart rate might also be present as the disease progresses. In the early stages of this disease there might not be any abnormalities on the physical exam.

    Diagnostic Tests

    Blood samples are usually normal if only the heart is having a problem. Since these are geriatric patients usually, a blood sample is still indicated to check for other problems in pets this age.

    Radiographs are used commonly to help in the diagnosis. The left atrium is enlarged, and sometimes the left ventricle. We might also find enlargement of the pulmonary veins and even evidence of pulmonary edema.

    An echocardiogram can also give us significant information. The abnormal valves can be seen, along with rupture of the chordae tendinae in some cases. The doppler can actually view the blood regurgitating through the abnormal valve. The left ventricle might also be enlarged.

    This is what mitral regurgitation looks like during a doppler echocardiogram

    In the early stages the ECG might be normal. As the problem progresses arrhythmia’s might be present.

    Treatment

    Surgery and balloon catheter dilation are helpful but may be of limited value. Medical therapy is used to treat this problem if it progresses to CHF.

    Medical therapy is utilized to slow the progression of the disease (minimize the compensation mechanism we describe earlier), control the fluid that builds up in the lungs, and decrease the heart rate as the problem worsens. The advent of ACE inhibitors (afterload reducers) has given us the opportunity to help slow the progression of this incurable problem.

    Therapy might depend on the stage of the disease. If there is a murmur in one of the affected breeds, but the left atrium is not enlarged, then minimizing sodium (salt) in the diet might be of help. As the murmur intensifies and the left atrium enlarges we will start Enalapril, and continue with the low sodium diet. As the murmur intensifies and the problem progresses we might increase the dose of Enalapril.

    When a cough appears lasix will be used, and when the heart starts racing we might add digoxin. If pneumonia occurs or other lung problems become apparent we will also use antibiotics and bronchodilators.

    Prognosis

    Mildly affected dogs can have a good quality of life for years. It all depends on when the diagnosis is made and when therapy is instituted.

    All dogs on therapy for CHF should be monitored every 3-6 months to adjust for changes. This includes a blood panel with thyroid, a chemistry panel, ECG, and chest radiographs.

    Chronic atrioventricular Valve Disease can mimic infectious endocarditis, which is an actual infection of these valves caused by a bacteria. This is a serious disease that can cause significant illness.

    Some of the more common bacteria are:

    Strep. spp.

    Staph. spp.

    E. coli

    Pasteurella spp.

    Klebsiella

    These bacteria arise from infections of the gums, skin, urinary tract, prostate, lungs, and internal organs. The infection can spread to the spinal cord, causing a disease we call diskospondylitis. It is treated the same way, since CHF is present. In addition we will use antibiotics for up to several months to control the infection.

  2. Cardiomyopathy

    Cardiomyopathy is a disease where the actual heart muscle (myocardium) becomes weak and unable to contract with sufficient force (decreased contractility leading to a decreased stroke volume) to provide adequate perfusion (reduced cardiac output) for the cells of the body. Pets that get cardiomyopathy have a poor prognosis in general.

    There are three types of cardiomyopathy:

    1. Dilated

      The heart muscle is weak and flabby, and does not have the strength to contract with enough force to provide adequate perfusion of the cells. This form is rare in cats now because of supplementation with Taurine.

      This is the heart of a cat with this disease. The forceps are pushing on the ventricles and showing how flabby they are.

      Feline-DilatedCardiomyopathyHeart

    2. Hypertrophic

      The heart muscle has become so thickened that the left ventricle chamber is too small to allow an adequate amount of blood to flow into it (diastole) before it contracts (systole) and perfuses the cells of the body. It is like a bodybuilder who is too buff to move efficiently.

      This is the form of the disease that is prevalent in cats. The heart muscle might hypertrophy due to hypertension or problems with the outflow tract of the aorta.

       The bottom tiny opening (arrow) is the left ventricle surrounded by excessive thickened heart muscle.  The opening should be 4x this size. You can see it is just too small to hold enough blood to be pumped out of the aorta to the cells of the body.

      Feline-HypertrophicCardiomyopathyArrow

      This increase muscularity of the left ventricle increases pressure in the left atrium, causing it to dilate. This increases the pressure in the pulmonary veins leading to pulmonary edema. Pulmonary edema (congestive heart failure) is fluid in the lungs, and is a serious end consequence of cardiomyopathy.

      This arrow points to the dilated left atrium, which is 2x larger than it should be

      Feline-HypertrophicCardiomyopathyArrowLA

    3. Restrictive (Intermediate)

      This form has characteristics similar to dilated and hypertrophic. Cats with this problem have scar tissue instead of normal heart muscle. The scar tissue decreased the strength of the heart, so it pumps out less blood at each beat (decreased stroke volume).

      The diseased heart muscle beats irregularly (arrhythmia) and does not have the contractility to pump blood to the rest of the body (decreased cardiac output). This leads to the congestive heart failure we described in the pathophysiology section. In some cases there is sudden death from the arrhythmia that occurs.

    Cause

    Viruses, toxins, drugs, and taurine deficiency are suspected as causes. In most cases, especially in the breeds that are prone to this problem, the cause is unknown.

    Signalment

    This disease occurs in large breed dogs like the Great Dane, Labrador, German Shepherd, St. Bernard, Irish wolfhound, English cocker spaniel, Scottish deerhound and Boxer. It is especially prevalent in Doberman pinschers. Most of these dogs are males and get the dilated version of cardiomyopathy.

    Even though dogs of any age can get this problem, the tend to me middle aged. Dilated cardiomyopathy also occurs in Burmese, Siamese, and abyssinians.

    History

    The symptoms noted are those of congestive heart failure (CHF). Typical symptoms include weakness, poor appetite (anorexia), cough, breathing difficulty (dyspnea), weight loss collapse (syncope) and distended abdomen (ascites). In some cases sudden death occurs before any symptoms.

    Some Doberman pinschers can have this disease and not show symptoms for several years. By then the prognosis is poor.

    In cats the symptoms are similar. Unfortunately, a significant number of cats do not show any symptoms, they just have a sudden death. Cats also get paralyzed in their back legs because of a blood clot (thrombus) that enters the blood vessels to the back legs. This is called a “saddle thrombus” because it occurs at the point where the abdominal aorta branches into each of the arteries that supplies the rear legs with blood. The blood clot arises from the pooling of blood that occurs in the left atrium secondary to the hypertrophy of the left ventricle (described above in the hypertrophic section). These cats are in significant pain, and palpation of the rear legs might reveal a cooler temperature than the rest of the extremities. The prognosis is poor for this form of feline cardiomyopathy.

    To get you oriented, this cat’s head is towards the left and the back legs are towards the right. Blood coming from the heart flows down the abdominal aorta (labeled as artery in this picture) and towards the rear legs. at the vertical arrow the abdominal aorta branches into the internal and external iliac arteries. From there it goes into the femoral arteries to supply the rear legs with freshly oxygenated blood. The poorly oxygenated blood returns to the heart through the femoral vein, then the iliac veins, and eventually the caudal vena cava (labeled as Vein in this picture). At the vertical arrow is where the saddle thrombus forms.


    The thrombus (vertical arrow) is now apparent when we open up the arteries

    This is the way the artery is supposed to look when there is no thrombus

    You can see why it is called a “Saddle Thrombus”

    Here is a different cat with the same problem. In this picture the head is to the right, the snake-like clot is getting started at the right side. The large clot blocking the entrance to the blood vessels that supply the rear legs is apparent in the middle of the picture. The blue color to the rear leg vessels on the left is due to a clot that extends into them from the main clot in the center.

    Removing the large clot

    You can see the very smooth wall of the aorta with the clot removed

    The heart with a large clot in one of the chambers is the source of the clot in the aorta and legs. The clot is the dark structure in the middle of the heart towards the top.

    Physical Exam

    Abnormalities found during an exam are similar to other heart diseases and even other diseases in general. Auscultation of the thorax might reveal an arrhythmia and high heart rate. There might even be a pulse deficit if atrial arrhythmia is present. a murmur might be found in some pets with cardiomyopathy, although not every pet with a murmur has this disease.

    Cats with a saddle thrombus might have weak or non existent femoral pulses. They will be painful and might not be able to use the rear legs.

    Diagnostic Tests

    The ECG can pick up arrhythmia’s caused by cardiomyopathy, in some cases prior to the onset of congestive heart failure. In breeds that are highly prone to this problem like the Doberman pinscher, it is advised to perform an ECG yearly to monitor for these changes.

    On a radiograph the heart will appear enlarged because of the dilatation of all the chambers. Pulmonary edema and congested veins are indications of congestive heart failure secondary to cardiomyopathy.

    The radiograph of this cat with cardiomyopathy and saddle thrombus shows the classic signs of an enlarged heart

    Feline-HypertrophicCardiomyopathyLateral

    Feline-HypertrophicCardiomyopathyDV

    Some Boxers with cardiomyopathy will have normal appearing hearts on a radiograph.

    In many pets an echocardiogram is the most conclusive means of diagnosing HCM.

    This is an echocardiogram of the cat with the enlarged heart above. The echocardiogram showed an enlarged papillary muscle in the ventricles. We could even visualize the blood swirling around as it formed a pre-clot that would eventually become a thrombus and expelled from the ventricle to large in some artery in the body.

    We could even visualize the thrombus at the end of the aorta just before it branches into the iliac arteries

    Treatment

    Routine treatment for congestive heart failure and arrhythmias is used. The effectiveness of therapy depends on the severity of the disease and how long the problem has been present. Some dogs and cats can do well for several months and even years if treated early enough.

    Since the arrhythmia that occurs with cardiomyopathy can be detected before the onset of congestive heart failure, it is obvious that checking for this problem is important, particularly in Doberman pinschers and Boxers. Doberman pinschers with atrial fibrillation and dilated cardiomyopathy have a poor prognosis.

    Cats might also be treated with aspirin to prevent a saddle thrombus. It is imperative that cats are kept in a relatively stress free environment.

    The best long term approach for dogs and cats is not to breed lines that are prone to this problem.

  3. Heartworm

    Cause

    Heartworm is caused by a parasite called dirofiliaria immitis. It is spread to dogs, and recently cats, by a mosquito. The mosquito is a necessary part of the life cycle.

    In an affected dog or cat, female heartworms that reside in the pulmonary artery release small larval forms called microfilaria. Microfilaria circulate in the bloodstream for many months, and even sometimes years. If a mosquito bites a dog or cat that has circulating microfilaria it ingests them. These larva go through changes in the mosquito over the next 2 weeks. When this mosquito bites a dog it injects this larvae into a new dog. The larvae continue to develop in this dogs tissue and eventually become adult heartworms in the heart or pulmonary arteries 6-7 months later.

    Traditionally this disease only occurred in hot and humid states that were essential to mosquito breeding. The disease occurs throughout our country now, although heatworm preventive medications have had a significant effect in lowering the incidence of heartworms.

    Pathophysiology

    The degree of heart disease that occurs depends on the number of heartworms, how long they have been present, and how the immune system reacts to them.

    The actual presence of the worms in the arteries induces an inflammatory reaction causing blood clots (thrombi) to form. It also causes fluid to leak out of the artery into the surrounding tissue. Eventually pulmonary hypertension develops leading to an enlarged right ventricle as it works harder to pump the blood against all this pressure (afterload).

    If a large number of worms are present they can literally fill up the right atrium and caudal vena cava. Not only does this interfere with the proper flow of blood through the heart, it also causes changes in the red blood cells and clotting system. In serious cases this can cause a bleeding disorder called disseminated intravascular coagulation (DIC).

    The immune system can destroy the microfilaria released by adult heartworms in the pulmonary capillaries, resulting in a negative heartworm test. This is called occult heartworm disease.

    Signalment

    Dogs and cats of any breed can be infected, although we tend to see it more in large male dogs. Since it takes at least 6 months from the time a mosquito injects microfilaria into a dog until these microfilaria become adult heartworms, puppies must be at least 6 months of age before adult heartworms are present. Most dogs are diagnosed at middle age.

    History

    Many dogs do not have any symptoms until heart failure progresses. This emphasizes the need for yearly testing. When symptoms occur they can include:

    Poor appetite

    Weight loss

    Coughing

    Lethargy

    Difficult breathing

    Exercise intolerance

    Distended abdomen

    These are the symptoms of general heart failure, yet they can also occur in other diseases besides heartworm.

    Physical Exam

    In many cases the physical exam is normal. As the disease progresses the following exam findings might occur:

    Cough when the windpipe (trachea) is palpated

    Increased respiratory rate (tachypnea)

    Increased lung sounds (crackles) when ausculting the chest with a stethoscope

    Diagnosis

    Radiographic changes that might occur include an enlarged right heart along with an enlargement of the pulmonary artery. Several smaller arteries might be dilated, tortuous, or pruned. Other changes are similar to those that occur with right heart failure.

    An EKG might show changes indicative of right heart enlargement.

    A routine blood panel might reveal an elevation of certain types of white blood cells called eosinophils and basophils. There might even be an elevated protein level and evidence of kidney problems.

    Microfilaria detection is the best and most accurate way to diagnose adult heartworms. We can see them microscopically when we look at a blood smear from an infected dog. Unfortunately, this diagnostic method is unreliable due to the small size of the microfilaria in relation to the large amount of blood in the bloodstream. Several tests were developed to increase our ability to see these microfilaria on the blood smear. They made a major improvement in diagnostic ability, but are still not as good as immunodiagnosis.

    Immunodiagnosis involves looking for antigens of microfilaria or antibodies against the microfilaria using monoclonal antibody techniques. Several of these tests can be used in our office, therefore you get the report within 30 minutes. If the test is negative, then your dog or cat probably does not have heartworm. Unfortunately, reproductively inactive female adult heartworms, along with male heartworms, will also show up negative on these tests. This is called occult heartworm disease. On occasion, false positives can occur, particularly if other parasites (roundworms, etc.) are present or there is another nonpathogenic heartworm present called dipetalonema reconditum.

    Approximately 15% of the heartworm infected dog have occult heartworm disease. In occult heartworm disease there are adult heartworm parasites in the pulmonary arteries yet there are no microfilaria circulating in the bloodstream. Since the primary method of diagnosis is detection of these microfilaria, either visually, or with monoclonal antibody tests, it is possible to miss a diagnosis.

    There are several reasons why occult heartworm disease might occur. It happens early in the course of infection when adult female heartworms have not had enough chance to release microfilaria to any significant extent. At the other end of the spectrum, old adult heartworms might not release microfilaria. It can occur if mostly male heartworms are causing an infection, since they do not release microfilaria. It can also occur if adult heartworms are present and your dog is on heartworm preventive medication. Finally, it can occur if the immune system produces antibodies to microfilaria, suppressing their numbers so low that they are not detected with current monoclonal antibody techniques. Unfortunately, in this scenario there is significant pathology to the lung tissue because of this immune system reaction. These dogs usually present with severe breathing problems.

    In general, we are starting to encounter dogs with adult heartworms that have minimal circulating larvae. This is making diagnosis more difficult.

    Treatment

    This is a disease where the treatment is almost as bad as the disease. No treatment is completely effective although the dog or cat feels substantially better. The worms that are killed can block small blood vessels and cause thrombosis. If large numbers of heartworms are present there can be a massive amount of thrombosis. This can increase pulmonary hypertension and lead to additional fluid buildup in the lungs, even leading to disseminated intravascular coagulation. The inflammatory reaction that occurs can also affect the glomeruli of the kidneys. All treated dogs need to rest to minimize a reaction from the dead heartworms.

    If a dog is already in heart failure it needs to be stabilized prior to treating the adult heartworms. This includes the routine treatment for CHF, particularly diuretics, digoxin, Enalapril, exercise restriction, and aspirin.

    The primary drug used to treat adult heartworms is melarsomine. It has arsenic as its active ingredient, although side effects are less than previous arsenic treatment for heartworms. It still has the potential to cause problems with the kidneys (nephrotoxicity) and liver (hepatotoxicity), so close monitoring is vital. Dead heartworms can still cause a pulmonary allergic reaction with its associated problems. This problem is partially mitigated by giving melarsomine over a 2 day period of time instead of all at once. If your dog has severe heartworm disease it might be given one treatement, then sent home to rest for one month. At that time, it is given a full dose over 2 days.


    Another treatment modality used by some veterinarians is to use heartworm preventive medications at a modified dose to slowly kill adult heartworms over 16 months. The theory is that the slow killing of the worms will minimize reaction from the death of adult worms. The disadvantage to this slow killing involves the damage the adult heartworms can cause during that time.

    In some cases we use aspirin or cortisone as an adjunct to our routine therapy. These drugs minimize blood clots, platelet problems, and inflammation.

    Once the adult heartworms are killed the microfilaria that are circulating in the bloodstream are our next target. The drug of choice, except in Collie breeds who can have a serious reaction, is Ivermectin. In Collie breeds we use a drug called Levamisole.

    Since heartworm is such a serious disease, and treatment has potential toxicity, it is obvious that prevention is the best way to go. There are many products that are highly effective at preventing heartworms. They all should be started within one month of the mosquito season, and continued to the end of the mosquito season. Since many of these preventatives also control fleas and internal parasites, we recommend their use year round. Except for Revolution, your dog must be tested negative for heartworms prior to instituting these preventive medications.

    These preventive medications need to be given monthly. If your dog does get adult heartworms because you did not follow the montly schedule you set up a diagnostic problem. These dogs will have so few circulating microfilaria that we might not be able to make an accurate diagnosis.

    Some of the more popular ones are:

    Trifexis- It prevents heart worm, kills fleas, and treats for roundworms, hookworms, and whipworms. Its one of most recommend and used products.

    Heartgard and Heartgard Plus- They contain Ivermectin, and can be safely used in Collies over 10#. In addition, Heartgard Plus kills internal parasites. It is given on a monthly basis.

    Interceptor- It contains milbemycin, which in addition to preventing heartworms also kills circulating microfilaria and sterilizes adult heartworms. It is also given on a monthly basis.

    Sentinel- It contains milbemycin and lufeneron, so in addition to its ability to prevent heartworms, it controls roundworms, hookworms, whipworms and flea eggs.

    Revolution- It contains the drug Selamectin, which is similar to Ivermectin, but much more broad spectrum in action. An advantage of Revolution is no adverse reaction if the dog already has microfilaria circulating from a current adult heartworm infection. In can be used safely in Collies, and treats and controls fleas in dogs and cats, ear mites in dogs and cats, sarcoptic mange and ticks in dogs. It even treats hookworms and roundworms in cats.

    In general, the prognosis for dogs with heartworm disease is good. As is usually the case, it depends on the number of worms present, how long the disease has been occurring, and how the immune system is reacting. Although all of the worms are not usually killed, their decrease results in significant breathing improvement in almost all dogs.

    Feline Heartworm Disease

    Heartworm disease in cats is similar to dogs, yet there are some significant differences. Symptoms can range from none to sudden death or chronic illness. Most do not have any symptoms. If they are present, they usually include breathing problems (similar to asthma) and vomiting. They usually have less worms and more occult heartworm disease. Circulating microfilaria are not detectable with the microscope, and diagnosis using other means is difficult. Melarsomine is not used to kill adult heartworms, Thiacetarsamide, the original drug used to treat dog heartworms, is used in place of melarsomine. Preventive medication should be used for cats in addition to dogs. These include Revolution and HeartGard for Cats.

  4. Aortic Stenosis

    Cause

    This disease of dogs arises when abnormal tissue near the aortic valve obstructs the flow of blood out of the left ventricle. If severe enough it can eventually lead to CHF and ventricular arrhythmias.

    Signalment

    It usually occurs in large breed dogs, notably:

    Newfoundland’s

    Golden Retrievers

    Rottweiler’s

    Boxers

    German Shepherds

    History

    Symptoms include exercise intolerance, rear limb weakness, syncope (passing out), cough, shortness of breath, and even death.

    Physical Exam

    A heart murmur along with an arrhythmia is a clue to this disease.

    Diagnostic Tests

    Radiographs and electrocardiograms are of help in the more advanced cases. Echocardiograms are helpful in the moderate to severe cases.

    Treatment

    Surgery and balloon catheter dilation are helpful but may be of limited value. Medical therapy is used to treat CHF.

    Prognosis

    Mildly affected dogs can have a good quality of life. If the problem is more severe the prognosis is not as good.

  5. Pulmonic Stenosis

    Cause

    This disease of dogs arises when abnormal tissue near the pulmonic valve obstructs the flow of blood out of the right ventricle. If severe enough it can eventually lead to an enlarged right heart and regurgitation of blood through the tricupid valve and into the right atrium. If severe enough right sided CHF might occur.

    Signalment

    The following breeds are know to be prone to pulmonic stenosis:

    Beagle

    Chihuahua

    English bulldog

    Keeshond

    Samoyed

    Mastiff

    Newfoundland

    Boxer

    Terrier breeds

    Spaniel breeds

    History

    Many dogs have no initial symptoms. If symptoms are present, they might include exercise intolerance, ascites, syncope (passing out), shortness of breath, and even death.

    Physical Exam

    A heart murmur along with distended jugular vein might be present.

    Diagnostic Tests

    Radiographs and electrocardiograms might show right ventricular enlargement. Echocardiograms are helpful in many cases.

    Treatment

    If the problem is severe enough surgery is used to correct the problem. This depends on exactly where the problem is in this valve along with other blood vessels to the heart. Balloon catheter dilation can also be used.

    Medical therapy is used if CHF is present. When the CHF is stabilized surgery might be utilized.

    Prognosis

    Mildly affected dogs can have a good quality of life. If the problem is more severe the prognosis is not as good. These dogs should be monitored yearly for changes in their condition.

  6. Pulmonic Stenosis

    Cause

    In this disease an abnormal opening occurs between the ventricles, which allows blood to flow directly from the left ventricle (higher pressure) to the right ventricle (lower pressure). This disease occurs in dogs and cats. The severity of this disease depends on exactly where the opening is located and how big it is. Eventually left sided CHF can occur because of an overload of blood to the left ventricle as more blood is shunted through the right ventricle, leading to more blood flowing through the lungs, leading to more blood flowing back into the left atrium and left ventricle.

    Signalment

    The following breeds are know to be prone to PDa:

    English bulldog

    English springer spaniel

    History

    Many pets have no initial symptoms. If symptoms are present, they might include coughing and shortness of breath as CHF develops

    Physical Exam

    A heart murmur is commonly present.

    Diagnostic Tests

    Radiographs and electrocardiograms might show left ventricular enlargement and distention of the pulmonary vessels. Echocardiograms are used to confirm the diagnosis.

    Treatment

    Many pets need no treatment at all. Surgery is difficult to perform. Medical Therapy is used to treat CHF if it occurs.

    Prognosis

    Prognosis is good if the opening is small. Larger defects need to be monitored yearly.

  7. Patent Ductus Arteriosis (PDA)

    Cause

    In the uterus the mother of the dog supplies the dog with its oxygen since obviously a puppy in the uterus is not breathing. One of the mechanisms of the body to bypass the lungs of the pup is to flow the blood directly from the pulmonary artery to the aorta. When the pup is born, this direct communication between these vessels closes, the blood now flows from the pulmonary artery to the lungs to get its oxygen. This disease of dogs occurs when the communication between the descending aorta and the pulmonary artery fails to close after birth. This abnormal flow of blood overloads the left side of the heart, leading eventually to CHF.

    Signalment

    The following breeds are know to be prone to PDA:

    Collie

    Maltese

    Poodle

    Pomeranian

    English springer spaniel

    Keeshond

    Bichon frise

    Yorkshire terriers

    Shetland sheepdogs

    German shepherds

    History

    Many dogs have no initial symptoms. If symptoms are present, they might include coughing and shortness of breath.

    Physical Exam

    A heart murmur called a continuous (occurs during systole and diastole) murmur, is a clue to this disease.

    Diagnostic Tests

    Radiographs and electrocardiograms might show left ventricular enlargement and distention of the pulmonary vessels. Echocardiograms are helpful but not needed in many cases.

    Treatment

    A surgical procedure that closes this abnormal connection is used to treat PDA.

    Prognosis

    Prognosis is good if surgery is performed before the symptoms of CHF start appearing.

Medical Treatment of Heart Disease

The medical management of animals with CHF (congestive heart failure) is aimed at controlling the deleterious effects of the underlying pathology. These effects typically include pulmonary congestion and edema, cardiac arrhythmias, reduced cardiac output, and excessive vasoconstriction. Many medications are used to treat heart disease. In almost every case they can only control the symptoms, and hopefully, slow down the progression of the disease. In general, medications used to treat cardiac disease, especially CHF, are highly beneficial. The goal of therapy is to improved the quality of life of these pets while simultaneously minimizing the side effects of the drugs used. Most pets will not go back to being able to exercising vigorously, as a matter of fact, too much exercise can destabilize compensated dogs and cats.

Therapy needs to be tailored made to each pet, and again, constant monitoring is needed to adjust for any changes that are occurring. This means that blood panels, radiographs, ECGs, and blood pressure need to be checked weekly initially, then every 3-6 months, assuming the heart failure is under control.

Cardiac disease is commonly diagnosed in geriatric patients that have other problems simultaneously. Some of the medications used to treat heart disease can exacerbate other medical problems common in geriatric patients. Using these medications properly tends to be a balancing act, minimizing their deleterious affects while maximizing their advantageous properties. This is particularly true if a pet has kidney disease along with heart disease. This balancing act requires constant monitoring.

Many drugs are used in cardiovascular disease. We will go over the more common treatments, especially in regards to congestive heart failure.

ACE (Angiotensin Converting Enzyme) Inhibitors

These drugs are a part of the treatment plan of almost every dog with CHF. The addition of Enalapril or Benazapril to conventional therapy in dogs with chronic congestive heart failure resulted in a significant decrease in clinical signs and a 92% increase in survival time. The use of vasodilators, such as Enalapril, increase the survival time of dogs with CHF. This is especially true in CHF from cardiomyopathy, but does not necessarily apply to dogs with CHF from mitral insufficiency.

They add to the quality of your dogs life by minimizing the fluid buildup in the lungs (pulmonary edema) and abdomen (ascites).

In general, ACE inhibitors lower the blood pressure (decrease afterload) and decrease salt and water retention. They work by inhibiting the conversion of angiotensin I to angiotensin II in the lungs. We discussed this in the Cardiac Anatomy and Physiology section of our heart disease page. This decreases fluid buildup in the lungs, thorax, and abdomen, and it also makes it easier for a weakened or enlarged heart to pump the blood out into the bloodstream. Kidney values and electrolytes should be monitored while on ACE Inhibitors.

The more common ACE inhibitors we use are Enalapril, benazepril, and captopril. Enalapril is approved for use in the dog by the FDA, and is the most common ACE inhibitor we use. ACE inhibitors can take up to 7 days to produce beneficial effects, and need to be constantly adjusted to maximize their benefits.

ACE inhibitors are commonly used in people that have high blood pressure (hypertension), even if they do not have heart failure.

Diuretics

Diuretics (usually lasix) are the mainstay of treatment for CHF, and should be used in conjunction with ACE inhibitors. Lasix is a loop diuretic. That means it has its effects on a section of the kidney called the loop of Henle. It is here that lasix causes more sodium (salt) to be excreted from the body. Sodium pulls water with it when it is excreted, so urination increases and fluid level of water in the bloodstream decreases. This decreases the blood pressure in the capillaries, so less fluid leaks out into the lungs (pulmonary edema) and abdomen (ascites). Another medication, called spironolactone, is also used with lasix, or in place of it.

Overuse of diuretics can cause dehydration and can interfere with normal kidney function. As was already mentioned, lasix use should be monitored with a blood panel every 3-6 months to assess kidney function. As a geriatric pet ages, the kidneys and heart can both have disease, so the use of lasix is a balancing act between these two diseases. It is rare for a dog to need potassium supplementation (K+) while on a diuretic, unlike people. Your pet will drink more than usual, so make sure fresh water is available at all times.

As a rule of thumb, if a dog or cat in congestive heart failure increases its respiratory rate routinely beyond 30 breaths per minute, we give additional lasix. It is better off to remove the fluid from the lungs and let the red blood cells get oxygen to deliver to the cells, at the expense of the kidneys, than to treat the kidneys with extra fluids to flush waste products out, and have the lungs fill up with more fluid. The more we are able to run diagnostic tests to monitor this, the better we can titrate the diuretics and fluids.

Pimobendan (Vetmedin)

This FDA approved drug is in a class of drugs called indodilators. This means it increases the strength of the contraction of the heart muscles (ventricles).  This is called a positive inotropic effect.

It also helps dilate the peripheral blood vessels, decreasing afterload, and making it easier on the heart to push the blood into the arteries. If you review our heart anatomy and physiology page you will learn much more about all of this.

This drugs has been a major help in the treatment of congestive heart failure due to dilated cardiomyopathy or endocardiosis. It increases survival time and quality of life in these patients.

Diet

Minimizing salt in the diet is beneficial in preventing fluid buildup (ascites of pulmonary edema) only when the fluid is present. If you start a restricted sodium diet too soon you can actually cause the opposite effect.

Typical food include Hills K/D and H/D. Many pets eat these foods well, but if they have diminished appetite on these foods then they are of no benefit, since they will continue to lose weight and be lethargic.

Supplements

Supplementation with Omega 3 fatty acids might be of help, along with carnitine and taurine in specific cases of dilated cardiomyopathy. Carnitine will only be effective in a small number of dogs. To know for sure if a dog is carnitine deficient, a biopsy of the heart muscle is needed.

Coenzyme Q10 is also used, although this has not been proven to be effective either.

Exercise Restriction

If your dog or cat has heart failure it needs to stay relatively inactive. The heart is already compromised and working at maximum capacity, and does not have the capacity to increase cardiac output.

Cardiac Emergency

Some pets are presented to us having severe difficulty breathing from pulmonary edema. They need to be handled very carefully since they are literally drowning in the own fluids and unable to get air. It would be like a person firmly holding a pillow over your face.

These pets might need:

100% Oxygen

Nitroglycerin to dilate the blood vessels and decrease the after load.

We use gloves to put the nitrogylcerine on the ears since it is absorbed through the skin


Intravenous lasix to reduce pulmonary edema

Intravenous morphine to dilate the blood vessels and decrease the afterload

Intravenous sodium nitroprusside- potent arterial and venous vasodilator, needs constant blood pressure monitoring. Reduces afterload

We might use low levels of low sodium intravenous fluids to help the kidneys if they are failing also. We cannot thoroughly flush out kidney waste products because this much fluid given intravenously will exacerbate the pulmonary edema that is already present. Once the emergency is under control we might be able to slowly increase these fluids.

Oral medications have no place in these dogs since they are usually anorectic and likely to have minimal GI motility. In addition, they are unable to absorb the medication through their intestines and into the bloodstream because blood is being shunted away from the intestines and to the vital organs.

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Asthma

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Asthma is a problem we tend to see much more often in cats than dogs, with the Siamese cat being the most prevalent breed. Anyone who has ever had an asthmatic attack has an idea of what these cats go through when they can’t get their breath. Its like trying to breathe with a pillow pressed against your nose and mouth.

This disease goes by several names- feline bronchial disease, allergic bronchitis, and allergic airway disease.

Graphic photos on this page.

A glossary of medical terms will be used in this page:

dyspnea- difficult breathing tachypnea- fast respiratory rate
pneumothorax- excess air in the thorax bronchi- large breathing tubes in the thorax
alveoli- where oxygen goes from lungs to the blood thorax- chest
pneumonia- infection in the lungs hypertrophy– excessive growth of a cell or organ
necropsy- animal autopsy bronchiole- small breathing tubes in thorax
bradycardia- low heart rate

Normal Physiology

In the normal thorax inhaled air is brought to the lungs through progressively smaller breathing passages. It starts with the trachea (windpipe) and progresses to bronchi and bronchioles, eventually ending at the actual lung tissue called alveoli. It is at the alveoli that oxygen is absorbed by red blood cells on inhalation and carbon dixode is excreted on exhalation.

These breathing passages contain smooth muscle that controls their size. This is the type of muscle that works automatically without you consciously telling it what to do as part of the autonomic nervous system. Our VNA page has spinal anatomy to show the nerve pathways that accomplish this. When these muscles are relaxed the air passages and lung tissue are fully open and breathing is effortless. When they contract (called constriction) the airways narrow dramatically and it is difficult for air to make it all the way to the lung tissue where it exchanges oxygen for carbon dioxide. The size of these breathing passages, especially the bronchioles since they are small in diameter, can have a substantial influence on how much air makes it all the way to the alveoli.

These are the lungs taken during a necropsy. The lungs are sponge-like and have an extensive blood suppy. You can see just a small portion of the blood supply- it is the three vertical and bluish vessels going from the heart to the lungs at the bottom of the picture. Within the actual spongey lungs there is an extensive network of small blood vessels.

The lungs have an extensive network of passages and blood vessels. This barium radiograph illustrates just some of those breathing passages. The barium outlines the major bronchi, the 4 large white breathing passages below. All the fainter  diffuse whitish area in the lungs below are barium in the small bronchi and alveoli. You can see how extensive this network is.

Since we are an exotics practice, we thought it might be fun to show you the air filled lungs of a bearded dragon. The heart is the purplish and round structure to the upper left of the picture. The lung is the air filled and mesh appearing structure in the middle of the picture.

The lungs are very sensitive and easily damaged. The dark areas on this lung were caused by trauma- this pet was hit by a car. This is called a pulmonary contusion.

Pathophysiology

Something (smoke, pollen, perfume, pollution) stimulates the bronchi and bronchioles, causing them to become inflamed and swell (edema). This sets up a hypersensitivy reaction causing the smooth muscle in them to constrict.   Sometimes the smooth muscle hypertrophies (gets larger) and causes long term problems.

When the smooth muscle in the bronchi and bronchioles constrict  breathing becomes harder. In addition, cells that normally produce mucous in small quantities might increase their production and literally clog up the air passages. If enough mucous production and constriction occurs the alveoli are unable to exchange oxygen and carbon dioxide to the red blood cells. Obviously, this is a serious problem because your pet can no longer exchange oxygen and carbon dioxide at the alveoli. This is crucial to say the least.

A type of white blood cell called eosinophils starts releasing chemicals known as mediators. These chemicals cause scarring of the breathing passage adding to the problem.

Unfortunately, chronic asthma can increase the blood pressure (hypertension) in the lungs leading to potential failure of the right side of the heart. It can also progress and cause emphysema.

Cause

In most cases we do not know the cause, which of course is frustrating. Risk factors include cigarette smoke, marijuana smoke, dusty cat litter, air or scented fresheners, and any aerosol-like deodorant or hair spray.

Litter that is scented, is dusty or finely ground and has clay in it, can be a problem. Some cats get the problem when exposed to litter made from pine or cedar, especially if they have been treated.  Sometimes litter that is made from newspaper, corn, wheat, or wood pellets can be helpful.  Clean the litter pan more often to prevent noxious odors.

Tobacco and marijuana smoke are very toxic to animals. In additon to predisposing dogs and cats to respiratory disease in general, this smoke is a potent stimulator of asthma in cats. Even the smoke that lingers on your clothes and breath can cause a problem, so smoking elsewhere does not prevent this problem. Scented candles and the burned wood in your fireplace are also implicated.

Our households are drowning in a world of chemicals. These chemicals can trigger and allergic reaction. This includes cleaning products, fabric softeners, carpet cleaners and air fresheners, shampoo and soap, hair dye, baby powder, furniture polish, paint, perfume and cologne- you get the picture.

A type of allergy, called allergic inhalant dermatitis, is caused by grasses, trees, shrubs, pollen particles, house dust molds, bed bugs and mites. These allergens usually cause a skin condition, manifested by excess itching and licking. These same allergens can set off an asthmatic attack.

Food allergies can also be a significant factor with asthma and skin conditions in cats. The allergy can be due to the beef, fish, corn, milk, wheat, or gluten that is in many foods. Even foods that have not caused a problem in the past can trigger an allergic reaction some time in the future. One of the foods we have found most beneficial when we suspect a food allergy is Hills Z/D or Ultra. It must be fed for up to two months to see if it is working. To confirm the food allergy you need to feed the original food and see if the asthmatic or skin problem recurs.

Stress can add to the problem. Cats do not like abrupt change in their daily routine, so take it slow whenever you make a change. Children, travel, fireworks, guests, repairmen, gardeners, maids, etc can all be a source of stress that adds to the problem. Diseases like diabetes mellitus and kidney disease can add chronic stress, especially when giving insulin injections or SQ fluids.

Symptoms

Symptoms of asthma can be chronic, acute, or intermittent. The classic signs of a cat with asthma are wheezing or coughing. If you are observant you might have noticed an slight increase in your cats respiratory rate or effort prior to the wheezing or coughing. Other symptoms are sneezing and labored breathing. As time progresses you might even observe a poor appetite (anorexia), weight loss, or lethargy, although these are not common symptoms.

The wheezing or coughing can vary in severity. Your cat might extend its neck or even breathe with an open mouth when severe. If mild all you might notice is an increased respiratory rate when your cat is at rest.

This cat has severe dyspnea due to asthma. It is in a special cage that supplies 100% oxygen. We will not touch this cat for treatment or diagnostic tests until the 100% oxygen has had a chance to help.

We will constantly monitor this cat using a Pulse Ox (Pulse Oximeter).  It measures the percentage of oxygen in the hemoglobin of the red blood cells (rbc’s). It should be in the mid to high 90’s.We usually take a quick baseline pulse ox on a cat presented during an emergency, then compare it later after it has been on 100% oxygen to determine when it is OK to remove the cat from the 100% oxygen.

Our human volunteer is showing you how it works, and her readout. She is normal, although she was nervous when we filmed her, which is why her heart rate is 83 beats per minute.  Her oxygen saturation (SpO2) is 98% percent, so we don’t have to put her in the oxygen cage!

As a comparison, birds can get many breathing conditions. When presented in this advanced state the problem has been present for a long period of time usually, and the prognosis is poor.

Diagnosis

Cats are masters at hiding problems, so by the time a diagnosis of asthma is made the disease process has usually been present for a significant period of time. This emphasizes the importance of close observation of your cat and a physical exam if you suspect a problem. Our In Home Exam section can show you what to monitor at home before you pet is ill.

Numerous other diseases cause similar symptoms, so the diagnostic process should help differentiate them. Some of these diseases that have similar symptoms include:

  • Heartworm
  • Pulmonary contusion (you saw a picture of this above)
  • Diaphragmatic hernia – a tear in the diaphragm, the muscle of respiration
  • Pleural effusion- fluid build up in the thorax and around the lungs
  • Chylothorax- lymphatic fluid build up in the thorax and around the lungs
  • Lung worms
  • Heart disease
  • Cancer
  • Heart failure (cardiomyopathy)
  • Pneumonia

Signalment

Mostly cats, with Siamese cats being the most prevalent breed. Most of these cats are young to middle aged.

History

The classic signs of wheezing and coughing, for a variable period of time prior to exam. Sometimes these cats cough in a crouched position while extending their necks. Other diseases like lungworms, heartworms, heart failure, foreign bodies, tumors in the lungs and fluid in the thorax can all cause coughing in cats. Asthma is the most common cause of coughing though in the cat.

Physical Examination

The findings of the physical exam depend on how severe the asthma is, how long it has been present, what caused it, and if there are any other disease processes occurring simultaneously.

The trachea (windpipe) might be sensitive and elicit a cough upon palpation. An increased respiratory rate might be noted, along with increased lung sounds on auscultation with the stethoscope. The lungs sounds might be crackles or wheezes. There might even be normal lungs sounds in the presence of asthma.

More expiratory effort vs inspiratory effort might be noted. This could even include an abdominal push. Heart rate can be low (bradycardia), normal, or high (tachycardia).

In severe cases there might be open mouth breathing and blue discoloration of the mucous membranes (cyanosis). Cyanosis is a serious sign and needs immediate attention.

Diagnostic Tests

Blood Panel

A blood panel might show an increase in a white blood cell called eosinophil. This is not a consistent finding though.

This is what a typical CBC (complete blood count) reports. This cat has elevated eosinophils as can be seen in the underlined areas. The top underlined area shows 22% eosinophils when up to 12% is normal. The bottom underlined area shows 4906 eosinophils per cc when the maximum should be 1500.  Sometimes this is a sign of parasites or asthma, sometimes there is no significance to it. If it goes higher it even could be a sign of hypereosinophilia syndrome.

Radiography

Radiographs are an important tool in diagnosis, although a normal radiograph is not uncommon even if your cat has asthma.

This is a normal chest radiograph in a cat. All the dark areas are lung or windpipe. They are dark because they are filled with air. This is what we want to see. The picture below labels the organs.

The anatomy is labeled for better understanding
T- trachea (windpipe)
L- lung
A- aorta
H- heart
B- Main bronchi

This is a typical radiograph of a cat with asthma. Notice how the lung is not as dark, and has a a moth-eaten appearance. This is feline asthma.

Our digital radiography might give you a better view of the moth eaten appearance in a different cat. Click on it to enlarge.

This cat has asthma also, but the radiograph is not typical. The arrow point to the lesion in the lungs.

A different view of the radiograph you see above. You can see the problem area in the lungs at the arrow. Compare it to the other side where the lungs are dark (normal).

We cannot assume that just because a cat is breathing hard it has asthma.
This is what fluid looks like in the thoracic cavity. Notice how little dark lung there is. There are several different causes of this- they include diaphragmatic hernia, heart disease, pleural effusion, FIP, pyothorax and chylorthorax to name some of the more common ones.

Some of the fluid was drained from this thorax. In this case it is called chylorthorax. You can tell by the milky fluid in the syringe.

After draining the dark lung tissue becomes more apparent. There is still a substantial problem, but at least now the lung can expand and the cat can get some air.

Bronchial Wash

Bronchial wash is a secondary diagnostic test.  For this test a small amount of sterile saline is flushed into your cats trachea (windpipe). This saline is retrieved and analyzed for cell type. An excess of a type of white blood cell called an eosinophil could indicate asthma. Eosinophils can also be found in normal cats, so this is not a perfect test.

In addition to analyzing the cells a culture and sensitivy can be performed to look for pathogenic bacteria. It is common to grow bacteria in this culture, so this test is not always helpful. If the bacteria are grown in large amounts, or if a Mycoplasma is present, we will sometimes treat with antibiotics.

Special Tests

Heartworm antibody and antigen tests can also be used to eliminate the possibility of feline heartworm disease.

Fecal

Fecal exam to check for worms ( internal parasites). Many of these replicate or migrate through the lungs, and can cause coughing.

Treatment

Acute- when your cat all of a sudden has a severe problem

100% oxygen

Cats that are having a severe breathing problem, called dyspnea, are placed in 100% oxygen. This calms them down and allows them to get the oxygen they are starving for. We usually do this before we proceed with any diagnostics or treatment.

We can monitor the ability of the lungs to provide oxygen to the red blood cells with our pulse oximeter. This detects the oxygen saturation of the red blood cells. We like to see this in the mid to high 90’s. This is a good way to monitor if our treatment is working.

This cat, under anesthesia to have its teeth cleaned,  has a pulse oximeter reading of 96%- this is excellent. As you can see, our machine also monitors carbon dioxide levels.

Injectible bronchodilators are also used when the respratory problem is severe.

Chronic- for long term control

Earlier in this page we talked about causes of asthma in the cat. Eliminating those causes can be highly beneficial. That would be the first step in controlling chronic asthma whenever possible. In most cases, this is just not feasible. So we need to rely on medication.

  • Salbutamol inhaler

    This has proven to be the most effective treatment for long term control of asthma in cats.

    Asthma-inhaler-2


    Asthma-inhaler

    It is a short acting beta 2 adrenergic receptor agonist, which means it is a bronchdilator. This opens up the breathing passages in the lungs.

    Asthma-inhaler-3

    A special kit is available for cats that has a mask (on the left) to place over your cats face

    Asthma-inhaler-4

    The inhaler is put on the back of the kit and your cat breathes in the medication

  • Prednisolone

    This is cortisone, and it is highly effective in controlling symptoms. It is a life saver for most cats with asthma. Compared to other species, cats are tolerant of this drug. Overuse can cause diabetes mellitus and urinary tract infections, so it needs to be used under our supervision.
    It can be given by injection, pill, or in a liquid form, and should be given on a steady basis.
    Most people use the pill from because of the ability to control the dose- giving extra only when needed, using a low level when the problem seems stable. There is an inhaled version that can be helpful in some cats.

  • Terbutaline

    This is the most common bronchodilator used for this problem. Most cats respond well, which means we can lower  their prednisolone dose.  If all goes well, we might even be able to stop prednisone. It is given as a pill, usually every  12 hours.

  • Cyclosporine

    If the above medications are not working it might be helpful to try this class of drugs.

  • Antibiotics

    We will use antibiotics on occasion, especially if we suspect pneumonia or if prednisolone and Terbutaline are not helping. Common antibiotics are Clavamox and enrofloxacin.

  • Weight reduction

    This is common sense if your cat is obese. We have high fiber diets to help. The two primary ones we recommend are Hills R/D and W/D. There is a significant benefit to the asthma problem when an overweight cat gets to its normal weight.

  • Avoiding allergens

    If you can identify the specific allergen in the environment causing the problem this could be highly beneficial. The problem is in identification. A high quality HEPA air filter could be beneficial.

    Clean any air filters for your house, heater, or air conditioner

  • Food Trial

    Feeding a low molecular weight protein (Hills Z/D and ultra) will be effective if your cat has a food allergy. You have to feed for up to 2 months to know for sure, and you cannot feed any other food or snacks.

Summary

Most cats with asthma are kept well controlled with medication. Be on the alert for subtle breathing patterns that signal the problem could become acute. This needs immediate attention by us. Try to keep stress to a minimum, and make sure your pet is not overweight. This is an all too common problem, and predisposes your pet to other problems besides asthma.

For most cats the prognosis is good for the long term if caught early enough and medication is used consistently.

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Carnaissal Tooth Abscess

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The upper 4th premolar (carnaissal tooth) has two deep roots that must be properly removed, or the abscess will remain, and the tooth will continue to drain under the eye. The tooth and its root are large in comparison to the other teeth, and must be removed in segments.


Drainage Tract

A chronic drainage tract usually is present just under the eye. Sometimes there is an actual hole in the skin, other times there is only swelling or discharge matted to the hair. Most pets resist when you pet them on the muzzle. An odor might be present also.


Drilling Tooth

A high speed drill is needed to cut through the tooth enamel. It is a precision instrument that is powered by our dental unit. The high speed means there is little trauma to the surrounding tissue.


Splitting Tooth

The tooth is split in half with the high speed drill. This allows us to remove each half of the tooth separately, aiding in root removal. We use a dental elevator to remove this tooth just like a retained deciduous tooth. Each half of the tooth is gently elevated out.


Removing Tooth

The split tooth is gently removed with the elevator. This is the most arduous part of the procedure and can take 15 minutes or more to complete. It is important to remove all of the root for the problem to resolve. After removal the opening in the gums is flushed with an antibacterial solution to remove all of the infection.


Healing Process

The hole that remains can be sutured or left to heal on its own. The healing time is within 1-2 days, whether it is sutured or not. The drainage under the eye disappears within a few days also. Antibiotics are usually administered at home for 7 days.

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