Category: Dogs

Ringworm

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An occasional cause of skin conditions in pets is caused by Ringworm. The scientific name for this disease is Dermatophytosis. It is caused by a fungus not a worm, and the lesion is not always in the shape of a ring. Since fungi are everywhere in our environment, it is difficult to determine which pets will develop the problem. The fungus that causes Ringworm can be cultured from the hair coats of normal dogs and cats. These pets might be carriers of the disease to other pets along with people. We tend to see the problem more in young animals.

People will sometimes pick up a case of Ringworm from their pet, but just because a pet has Ringworm does not necessarily mean that the people that interact with that pet will develop the problem. A dog or cat can transmit Ringworm to a person without showing any symptoms at all.

Cause

There are 3 specific fungi of significance in this disease.

  • Microsporum canis

The source of this species of Ringworm is almost always a cat.

  • Microsporum gypseum

This species of Ringworm is usually from dogs and cats that dig into contaminated soil.

  • Trichophyton mentagrophytes

This species infects dogs and cats when they are exposed to rodents or the burrows they live in.

In cats, almost all cases of Ringworm are caused by Microsporum canis. In dogs the majority of cases are caused by Microsporum canis. Which of these 3 main dermatophytes causes the Ringworm in dogs depends on geographic location.

Symptoms

The skin lesions that appear with Ringworm are variable, and do not necessarily form a ring. There will be hair loss, usually in small patches at first. as time goes on the patches may disappear or appear at other locations on the skin. There might be scratching due to itchiness. If the hair loss occurs on the face or feet there is a chance it is due to digging habits or exposure to rodents.

This patch is typical of the lesion seen in Ringworm. A diagnosis of this disease can not be made based just on the appearance of this lesion because other skin conditions (Demodex for example) can show similar lesions.

Diagnosis

There are several different ways to diagnose Ringworm. All require some type of test because it is impossible to make the diagnosis just by looking at the skin. This concept holds true for all skin conditions; making a diagnosis of a skin disease requires all of the aspects of the diagnostic process.

If a person in a household has been positively identified with Ringworm by their physician it is possible they obtained it from their pet, even if their pet has no symptoms of the disease. This is especially important in multiple cat households. We will culture these pets using the culture technique we describe below, but in this case, we might run a new toothbrush over the hair coat to obtain a sample for culture.

One of the simplest ways to diagnose Ringworm is with the Woods lamp, which is an ultraviolet lamp, also know as a black light. 50% of the Microsporum canis species will fluoresce when the Woods lamp is placed near the area of hair loss.

The lamp emits a purple/blue glow from the tube, and when there is fluorescence on the skin, it has a greenish appearance. Other material on the skin (dander, medication, etc.) can also fluoresce, so interpretation is important.

Since only 50% of a certain species of Ringworm fluoresces under the glow of the Woods lamp, a culture is used to verify the diagnosis:

The first step in the culture process is to gently remove hair follicles in the area of the lesion

These hairs are cultured in a special media that inhibits bacterial growth and enhances fungal growth. This culture can be sent to our outside lab or done in house. Since a fungus is a slow growing organism it can take up to several weeks to determine if there is growth or not.

The positive culture on the right, from our in house lab, demonstrates two findings that are needed for a positive diagnosis. The first is the cottonish fungal growth, and the second is the reddish color of the culture media. This color change must occur at the same time the fungal growth appears.

The culture media prior to the start of the test. Positive fungal growth after 10 days of incubation at room temperature.

Treatment

Topical shampoo therapy is used in almost every case, especially in longer haired pets. It is common to clip some or all of the hair in some pets to make it more effective. These baths will also remove infected hairs that can be the source of an infection to people or other animals.

Specific anti fungal cremes are also used when a pet is infected in an area that already has sparse hair growth, or there are small, discrete lesions.

Oral anti fungal medications are also used in select cases. They have the potential to cause side effects, so their use is confined to specific situations.

In some pets the disease may resolve by itself.

Prevention

Since fungi are everywhere it is almost impossible to prevent exposure. Pets that chase rodents, especially into burrows, might be at an increased risk.

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Allergic Dermatitis

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Allergies are a common cause of skin conditions in dogs and cats, along with other species. This type of allergy goes by several names; the most common are atopy, allergic skin disease, or allergic inhalant dermatitis (AID).

The main difference between us and pets is that allergies in pets tend to cause skin conditions, as opposed to the  runny eyes, runny noses, and sneezing we encounter in people. Symptoms typically include scratching and itching, although many other skin conditions can cause itching. Medically, this itching is called pruritus.

Allergies can be hard to control and are chronic in nature. This causes significant frustration for pet owners and discomfort for pets. A correct diagnosis, along with proper therapy instituted early in the course of the disease, will minimize this frustration. Many pet stores and groomers will give advice on a “food” to feed to cure your pet’s skin condition. It is irresponsible for them to be giving any advice of this nature due to the numerous causes of skin conditions, let alone the complexity of this disease, and also the fact they have not examined your pet and do not have any important physical information about your pet. We have a short page on Nutrition Advice that addresses this issue of people giving medical advice when they have no business doing so.

This page summarizes and generalizes the complex problem know as allergic skin disease. It is detailed, and will take a few minutes of your undivided attention to help in understanding this problem.

In the beginning of this page we will give you the background of their causes and how we diagnosis them. We will take about treatment towards the end.

Pathophysiology of Allergies

When the immune system encounters an allergen that has the potential to cause disease (ex. parvo virus) it produces antibodies called IgG (immunoglobulin G, previously known as gammaglobulin) and IgM (immunoglobulin M). For the first 7-14 days of infection the virus spreads throughout the body because not enough antibodies are produced to stop them. Within 7-14 days enough antibodies are made to neutralize the virus, and the pet eventually recovers from the disease, all other things being equal.

As time goes on, the now sensitized immune system is ready to produce large amounts of antibodies rapidly the next time it encounters this virus. The rapid antibody response neutralizes the virus immediately, instead of taking the 7-14 days that occurs the first time it encountered the virus. This is called the anamnestic response, and is why a pet that recovers from parvo virus does not get the disease again.

A different scenario presents itself when the immune system encounters an allergen that is not necessarily pathogenic (ex.- a pollen particle). A different part of the immune system kicks into high gear when these non pathogenic allergens invade the body.

When a pollen particle enters the body for the first time (through the skin or respiratory passage) it stimulates the body to produce antibodies also, this time they are called IgE (immunoglobulin E). This IgE antibody attaches to the allergen in order to neutralize it, just like IgG would do to a parvo virus. This process, called sensitization, occurs in the first season a pet encounters a specific allergen in its area. Without this sensitization there is no allergy. This type of allergy is the most common type, and is called atopy or atopic dermatitis.

The next time a pet encounters these pollen particles (usually the next allergy season), the immune system produces large amounts of IgE antibodies rapidly because it has been sensitized to them from the previous season. Again, this is similar to what happens when the immune system makes IgG and IgM antibodies against parvo virus.

IgE, with attached allergens, circulates throughout the bloodstream to a type of cell called the mast cell. Mast cells contain many chemicals that can cause inflammation, the most important of which, in relation to allergies, is called histamine. When an IgE antibody (even IgG can be involved) with an attached allergen encounters a mast cell under the skin, it alters the membrane of the cell, and histamine leaks into the surrounding tissue. Histamine causes inflammation, noted as redness (erythema) and itching (pruritus) on the skin surface. The reaction that is seen on the skin surface is called a wheal or a hive. This causes your pet to lick, scratch, or bite at this area which now itches.

It is the mast cell, that releases histamine when it encounters an IgE antibody with a pollen particle attached, that is a major component of allergies. This is what occurs in atopy and is suspected to occur in food allergy. In flea allergies, it is an allergic reaction to the flea saliva that causes the immune system reaction.

Other immune mediators are impliacated in atopy. They include cytokines, neuropeptides, peptides, proteases, and leukotrienes. They can affect nerve fibers to the skin, causing itchiness.

As if that is not enough, there are other immune mediators called Interleukin 31 (IL-31) that are involved. It’s an understatement to say that the immune system is very complicated. Add the ever present skin bacteria to this equation and it is easy to see how this can become a frustrating problem.

Food allergies have a slightly different pathophysiolgy then atopy in some cases. In food allergies, the offending allergen (usually a protein) is absorbed through the lining of the small intestines and proceeds right into the bloodstream.  This causes a different immune system reaction. If the intestines are inflamed from some other disease process, for example IBD (inflammatory bowel disease) in cats, the normal barrier lining the intestines is compromised and more allergens can enter the bloodstream.

Types

There are 3 main types of allergies in relation to skin conditions. It is possible for a pet to have a combination of all 3 allergy types:

Flea Allergy Dermatitis (FAD)

This is a very common cause of skin allergies, even if you do not see a flea on your pet. When a flea bites a dog or cat it is looking for a meal of blood in which to nourish itself. In order to suck this blood it inserts an anticoagulant into its saliva to prevent the blood from clotting while it sucks it through its small proboscis. It is the allergens in this saliva that cause an allergic reaction to occur.With the advent of new treatments that are convenient and very effective, this problem, while still important, has diminished in importance. The products we recommend are oral Nexgard, Comfortis or Trifexis in dogs and topical Revolution in cats. In addition to excellent flea control these products also prevent heartworms and internal parasites like Roundworms. Revolution in cats even controls mites. Our staff has detailed information to give you on these products along with others to help you make the right decision for your circumstances.Since we live in a flea infested area we recommend using these monthly flea products year round. They have the added advantage of worming your pet every month for Roundworms, Hookworms, and Whipworms.Fleas are a common cause of skin allergies in cats.

Atopy or Allergic Inhaled Dermatitis

Another common cause of skin allergy is atopy. It is a genetically determined predisposition to produce IgE antibodies when exposed to an allergen. Re-exposure to this same allergen in the future causes allergic skin disease (you learned the mechanism above). Depending on the study, it is estimated that between 3% and 15% of dogs have atopy.Common allergens that cause this reaction are ragweed, pollen, house dust, house dust mites, mold, animal dander, feathers inside the house. Outside its grasses, trees, and shrubs. The allergens can be inhaled, pass through the pads of the feet, and even possibly ingested. Since these compounds are in abundance everywhere, it is apparent that preventing exposure in the first place is difficult.If fleas are not a factor, atopy accounts for up to 90% of the allergies that cause allergic dermatitis.  A certain number of pets with atopy also have a food allergy concurrently, which compounds the diagnosis and treatment.

Food Allergy

The least common cause of skin allergies is food allergy, although pets stores and groomers are under the impression that this is the sole and most important cause of skin allergy, which is why they give amateur advice on what to feed. They are in the business of selling food, which is why they only see food as a solution to atopy, when it is the least common cause.  Our page on Nutrition Advice has much more information on this topic.

It is important to distinguish food intolerance from an actual food allergy. They are not the same, but many people giving amateur advice on this problem do not understand the difference.

In the vast majority of cases, food allergies are caused by an allergic reaction to proteins in food. The size of the protein particle is important. They have a molecular weight of between 18 and 70 kilidaltons (kD). In laymens terms, they are very, very tiny.

Heredity is a major predisposing factor in people, and probably so in animals.

Some of the more common food allergens in dogs and cats are:

horse meat eggs
beef fish
pork corn
lamb soy
chicken wheat
dairy products rawhide chews and dog biscuits/treats

In dogs, beef, dairy products, and wheat tend to cause most of the problems, with chicken, lamb, and soy following. In cats, beef, dairy products, and fish account for most of the food allergies. Premium dogs foods can contain these products, so just because you are feeding a higher quality or more expensive food doesn’t mean that food will not cause a food allergy.

Many pet stores are there to sell food, so they will tell you a certain type or brand of food will cure your pet’s skin (and other) conditions. The employees of these stores have no business giving their advice unless they are licensed nutritionists for animals, or are licensed veterinarians,  and have discussed with you the following points that are so important in making a diagnosis of any disease, including allergic dermatitis:

      • Your pet’s predisposition to certain diseases, including allergies
      • Your lifestyle and your pet’s lifestyle
      • The specific history of your pet’s skin condition- time of year, where they are itching, etc.
      • Results of a thorough physical exam checking all organs besides skin
      • Routine blood panel to assess the status of your pets internal organs along with protein levels, blood glucose, electrolytes, red blood cells, and white blood cells.
      • Your pet’s vaccine status
      • Diagnostic tests to eliminate internal (hormonal etc.) and external (mites for example) causes of skin conditions.
      • The efficacy of prior treatments
      • The effects a change in diet will have on other organs besides the skin

Most of the symptoms of food allergy involve inflammation and scratching of skin or ears, but might also include vomiting or diarrhea. These gastrointestinal symptoms tend to occur more in cats.

In those pets that truly have food allergy, a high percentage also have atopy at the same time. Cats might have more food allergies than dogs, although fleas are a common cause of skin allergy in cats.

Symptoms

The most consistent symptom in pets with allergic skin disease is excessive itching. The medical term for this is pruritus. High strung dogs might itch more than placid dogs. Chewing, biting, or licking, or rubbing the skin can all be manifestations of pruritus.

Dogs can chew so incessantly that they wear down their incisor teeth to the gumline

In dogs some of the more common areas for pruritus to occur are the face, feet, and armpit areas. As the problem progresses the whole body might be involved. Some pets will scratch excessively but not show any problems with their skin.

If your pet has an allergy to fleas you might find tiny blood spots where it has layed down. These are the result of flea dirt that has fallen off your pet and become wet. Since flea dirt is made up mostly of blood that the flea has sucked out of your pet and has passed through its digestive tract, they appear as small blood spots on the floor or table tops when wet.

Other symptoms can include:

The slight redness (erythema) to the face of this dog

The dark, stained areas on this poodle’s foot are due to excessive licking. The color change is due to the chronic saliva on the hair, and the changes it causes on the hair coat.

This dog’s skin is oily from chronic rubbing. This loss of hair is called alopecia.

This Golden Retriever has significant redness (erythema) on its ear flaps. Chronic ear inflammation or infections can be a sign of atopy or a food allergy.

The above pictures were all caused by atopy. They could have been caused by other diseases though, so you cannot make a diagnosis of a skin condition just by looking at them.

Cats get skin allergies also, although not as frequent as in dogs. They might exhibit the same or different symptoms. Different symptoms include tiny bumps throughout the body, ulcers on the lips, excoriation of the neck, and even patches of missing hair (alopecia) without any skin lesions. Ear problems related to allergies are rare in cats compared to dogs. Cats get a problem called psychogenic alopecia that can be similar in appearance to atopy.

It can be difficult to tell pruritus from normal feline grooming. Vomiting hair balls, hair in feces, and hair in your cat’s mouth when you brush its teeth (you are doing this aren’t you?) are all clues.

This cat has an allergy that caused it to irritate the skin above its eye by rubbing its face

This is a severe version of an ulcer on the lips. It is called the Eosinophilic Granuloma Complex, and sometimes known as rodent ulcer.

Diagnosis

Since the symptoms of allergic skin disease mimic those of other skin diseases, a thorough approach is needed to differentiate them. In every disease we encounter we follow the tenets of the “diagnostic process” to ensure that we make an accurate diagnosis, and that we do not overlook some of the diseases that are also encountered in conjunction with skin diseases.

It is too easy to jump to the conclusion as to what is causing your pet’s pruritus. Here is a list of  possible causes of scratching and itching in pets in random order:

  • Atopy
  • Drug reaction
  • Flea allergy dermatitis
  • Food allergy
  • Lice
  • Autoimmune disease
  • Pyoderma
  • Contact Dermatitis
  • Viral infection
  • Fungal infection (Malassezia)
  • Mites
  • Seborrhea

Signalment

Typically, atopy occurs in mature dogs between 1- 3 years of age, although it can occur earlier (Shar pei’s can get it as early as 3 months). The condition rarely starts in dogs over 6 years of age. Most dogs get their first exposure to an allergen and develop sensitization in their first exposure to a pollen season.

Symptoms usually occur during their second season of exposure to the pollen allergen when the immune system has its exaggerated response to the allergen and produces high levels of IgE. Dogs that are highly allergic can show signs of atopy during their first season of exposure to pollen allergens. It depends on how long the pollen season lasts and how rapidly their body produces the IgE antibodies.Several canine breeds are prone to getting atopy. They include, but are not limited to:

Terriers Beagle
Retrievers Setters
Lhasa apso Miniature schnauzer
Shih Tzu Pug
Cocker spaniel Boxer
Dalmatian Shar Pei

History

Atopy, in it’s initial stage, tends to be a seasonal problem. This can be a help in differentiating it from food allergy, which would be a non-seasonal problem. Atopy tends to be a progressive disease with worse symptoms each allergy season. Many dogs will be more affected during a specific season. As time goes on dogs can have allergies year round. It is not a contagious disease, so other dogs, cats, and people in the same household do not usually have symptoms (unless of course it is another dog that is highly prone to allergies).

The progeny of atopic dogs are more prone to developing atopy than other dogs. Careful breeding therefore can help minimize the occurrence of this problem. Pets that have been treated with cortisone in the past, and did not improve, give us a clue that something else besides an allergic disease is involved. Food allergies in dogs and cats can start at any time in a pet’s life, even those on the same diet for a long period of time. Non-seasonal allergies bring food allergies to mind, along with vomiting or diarrhea, although these are not consistent findings. The skin lesions in food allergy are indistinguishable from atopy, but have a propensity to show only inflammation of the ears.

Feeding dog and cat foods that contain ingredients that pets are routinely allergic to might also clue us in to a food allergy. This includes the premium foods and those that contain lamb. Flea allergies are suspected whenever we are presented with a pet that has a skin condition, especially towards the back end,  and is not on routine flea control. This is true even for pets that never go outside. Other pets in the household that are itching might also indicate fleas in the environment. Flea allergies routinely cause hair loss at the lower back area (called the dorsal-lumbar area), which is not typical of atopy and food allergy.

Physical Exam

The physical exam of a dog with a skin condition is the same as any other sick pet. We examine the whole body for clues as to the cause of the skin condition. The distribution of the skin lesions gives us a clue as to the cause, but is not consistent in all skin conditions. Some of the more common exam findings are:

Pyoderma

This dog has licked so much it has maimed itself, and now has pyoderma, which is a skin infection, typically a Staph (usually staphylococcus pseudointermedius) infection

Conjunctivitis

This is an inflammation of the eyes. The green discharge in the corner of the eye is from fluorescein stain that was checking for a scratch on the cornea.

Lichenification and hyperpigmentation

Chronic licking and scratching can cause thickening and dark pigmentation of the skin. The white arrow points to mild hair loss, hyperpigmentation, and lichenification in a Yorkie.

Acute Moist Dermatitis

Commonly know as a hot spot, it is an area of skin that has been maimed from intense pruritus. Pyoderma is also present, and the skin is very painful. Hot spots occur rapidly and can encompass a large section of skin in a short time. Affected areas usually include the rump and the side of the face. Other common causes of hot spots include anal gland problems, ectoparasites like mange, grooming, and deep skin infections. Golden and Labrador retrievers, St. Bernards, Collies, and German shepherds are more prone than other breeds.

The serum that is exuded from the inflamed skin matts the hair and causes the problem to progress under the hair coat without anyone realizing how serious it is. These pets can be so painful that we need to sedate them prior to clipping the hair and cleaning the wound.

Hot spots can progress and cause serious skin conditions. What looks like a minor skin wound with matted hair can actually be a serious and painful infection.

Once the hair is shaved away the seriousness of the problem is apparent

Otitis externa

This is an infection of the outer ear canal. Sometimes this is the only symptom of allergy, especially food allergies. This ear is so severely infected that it is difficult to ascertain the normal anatomy. The ear canal is completely occluded, necessitating surgery to correct it. This dog is painful.

Pododermatitis

Infection of the feet can occur from chronic licking

Acral Lick Dermatitis

These are commonly known as lick granulomas. There are many causes, allergies being a primary one. Other causes include arthritis, skin tumors, inflamed nerves, fungal infections, ectoparasites, and psychological factors like boredom and stress. Once the licking starts the problem is difficult to control. In some cases we have found that the use of the laser has been a significant help. The most effective treatment is the use of antibiotics for many months.

This small lick granuloma is on the front leg of a Golden Retriever

Fleas or flea dirt

Flea dirt is literally droppings from the flea after is has bitten a pet and the blood has passed through the flea’s digestive tract. It looks like pepper, and is easily visualized on a pet with a white hair coat.

This is an example of lots of flea dirt

Flea eggs are small white particles, similar in size to flea dirt, that fleas lay in a pet’s hair coat. They eventually drop off and contaminate the environment. A pet can have fleas, yet show no evidence of fleas, flea dirt, or flea eggs.

Flea allergy dermatitis typically does not cause hair loss around the face, eyes, and ears like in atopy, although this is not a hard and fast rule.

Diagnostic Tests

Diagnostic tests are important even if we strongly suspect an allergy. In some situations other skin diseases can occur simultaneously with the allergy. It is impossible to make a diagnosis in any skin condition just by looking at it. This is because there are many diseases that affect the skin, yet the skin has only a limited number of ways to exhibit signs of disease.For food allergies we want to completely remove the offending protein and see if the problem (skin disease or GI signs) completely resolves. At that point we again feed the offending protein and see if the problem recurs. This is called a trial elimination diet, and is the only way to confirm a diagnosis of food allergy.The diagnosis of food allergy is not complete until we cause the allergy again by feeding the original food. This is because there are many allergens in the environment that can cause pruritus after the food allergy is controlled. Also, it is easy to assume the food allergy is under control when your pet is on medication simultaneously.

Skin Scraping

It is important to do a skin scraping in many cases of allergy because the lesions of atopy commonly mimic those of other diseases. Ectoparasites like demodex or scabies can cause skin lesions and itching.

Fungal Tests

Ringworm can mimic allergy symptoms. Lesions from Ringworm tend not to be as pruritic as allergies.

Malassezia, another fungus, is commonly associated as a secondary problem when the skin is infected. Even though it is a normal part of an animals hair coat, it will add to the itching if other conditions are present. Common areas for Malassezia include the ears, lips, muzzle, between the toes, and the anal area. Indications that Malassezia is present include pruritus, erythema, and greasy skin with an offensive odor. These symptoms can occur with other diseases besides Malassezia.

Malassezia is diagnosed by the above symptoms and by looking for the organism under the microscope after swabbing the skin and placing the discharge on a microscope slide. Many pets respond to shampooing with specific antifungal shampoos twice weekly. These topicals will only work when the underlying allergy and its associated skin infection are under control. In some cases we use oral antifungal medications to control the problem.

Thyroid Test

Hypothyroidism can cause skin conditions, although dogs with only hypothyroidism are not terribly pruritic.

Fecal Exam

Hypersensitivity to internal parasites can cause symptoms similar to atopy. This is not a common situation.

Skin Biopsy

In some cases it is difficult to make a diagnosis. When we are presented with this situation we will biopsy several small pieces of infected skin and have them analyzed by a veterinarian that specializes in tissue analysis of the skin.

Here is a typical report from one of them. All of the big words mean that in this skin biopsy an allergy is most likely, but autoimmune disease cannot be ruled out for sure.


Allergy Testing

Allergy tests are performed in cases where we already have a diagnosis of allergy. The main purpose of allergy testing is to find exactly what your pet is allergic to, and also to set up a protocol for allergy injections. If giving allergy shots is not contemplated then this test is of less value, although it will let us know what allergens we want to avoid. Trying to avoid these allergens though is the hard part because they are in our houses and almost everywhere outside.

There are two main types of allergy tests that are performed. Neither one is perfect, and they can have false positives and false negatives. They are not accurate in diagnosis a food allergy.

Intradermal (skin) Test

Most of us are familiar with the first one. In this test, called the allergy skin test or intradermal test, small amounts of materials that routinely cause allergies in dogs are injected under the skin. The reaction, if any, is graded, and a determination is made as to whether or not a pet is allergic to that specific allergen.

This test is very subjective, and therefore prone to errors in interpretation, and therefore requires significant experience. Many different techniques are used.

Your pet must be off of oral cortisone medication for at least 1 month before testing. If injectable cortisone is given, the waiting time is longer. Your pet must not be on any tranquilizers at the time of testing and must be off of any antihistamine medication for 10 days.

Pets usually are given a sedative to calm them and to minimize the release of cortisone due to stress, which will affect the outcome. The hair on the side is clipped where there is no current dermatitis occurring. A tiny amount of histamine is injected first. If there is no reaction to histamine, the full test is postponed. A small amount of sterile saline is also injected as a control.

The areas where the allergen is injected are marked

Numerous allergens are injected into the skin and a reaction is noted at 15 minutes and again at 30 minutes. The reaction we are looking for is called a wheal. A positive test to a specific allergen occurs when the reaction is in between the saline and histamine tests in size.

In some cases the wheal is obvious, in others it is subtle, which is part of the interpretation process

RAST (in vitro test)

The second type of test that is performed is called the RAST test. RAST stands for radioallergosorbent test. Another in vitro test is called the ELISA (enzyme linked immunosorbant assay) test. RAST tests for the levels of allergen specific IgE. In this test a blood sample is taken and submitted to a special lab for analysis.

The RAST test has advantages over the intradermal test. There is no clipping, sedating, and there is no potential to have an adverse reaction to an allergen injected into the skin. There is less of a chance that prior drug therapy (cortisone) will influence the outcome, and it can be used in patients that have dermatitis.

The primary disadvantage is the fact that false positives are more common when compared to the intradermal test

The RAST test is very thorough and checks for many different allergens in the home, outside, and in your pet’s food. Here is an example of one of their reports:

Here are 4 of the dozen household allergens they tested. This dog is borderline for orris root and human epithelial cells, and positive for jute/sissal and tobacco smoke.

These are a few of the food allergens tested in this sample. There was no allergy to venison, eggs, or milk, but this dog was allergic to soybean. This give us a rough idea of what food your pet might be allergic to, and can only be confirmed with the trial elimination diet.

This is a tiny sample of the numerous allergens found in the environment tested for on the same dog as above

Allergy tests can be unreliable at diagnosing food allergy. A better way to diagnose food allergies is using a technique called the elimination trial. By taking away a food that is suspected of causing the food allergy you can determine if the problem resolves. This might take up to several months to know for sure. To verify the diagnosis you need to feed the suspected food again to see if the skin condition returns. Commercial diets that contain rice, venison, fish, and potato are commonly used for the elimination trial. There is a food manufactured by Hills called Z/D that has been a big help in diagnosing and treating food allergies.

Routine Blood Panels

On occasion a specific type of white blood cell, called an eosinophil, is elevated in allergic conditions. Other conditions, notably worms, can also cause this elevation in eosinophils.

A routine blood panel can also give an indication of internal or hormonal problems that might show up as a skin condition. The most important of these are hypothyroidism and Cushing’s Disease.

This blood panel shows an elevated alkaline phosphatase level. This could be an indication of a hormonal problem called Cushing’s Disease.

Treatment

In the early years of atopy the pruritus is more easily controlled. As the problem progresses treatment is not as rewarding. Chronic changes to the skin can occur, especially lichenification and hyperpigmentation.

Treatment is aimed at all the factors that contribute to pruritus. For example, a pet that is normally not atopic might become so if exposed to fleas, or if it gets a pyoderma, or is allergic to a protein in its diet. This concept is called summation of effects, and might push the pet over what is called the pruritic threshold. By minimizing one of these components you might keep your pet under the pruritic threshold and minimize its skin or GI symptoms.

Food Allergy

Hypoallergenic means foods that your pet has never eaten, which technically, it cannot be allergic to. We recommend using these foods in some cases when we feel the pruritic threshold has been reached and any decrease in allergen load will put your put under this threshold. It might take up to 2 months to know if the food is working. You cannot feed any other foods or treats during this trial period, so plan on rewarding your pet with something else besides food.

There are 3 different diets to help:

    • Homemade
    • Commercial Novel Protein
    • Commercial Hydrolyzed Protein

Homemade diets can be beneficial, and have the advantage of controlling the protein and carbohydrates sources. It is important to pick a protein source your pet has never been exposed to. To be sure of this we sometimes need to resort to diets that contain some unusual ingredients.

Homemade diets have the substantial drawback of time, expense, guesswork, and being nutritionally incomplete. Some pets do not accept the food, and some of them develop diarrhea. For these reasons most pet owners do not use this treatment method.

Commercial Novel Protein Diets are a popular treatment for food allergies. Novel protein means your pet has never eaten this protein in the past.  For them to work, just like homemade diets, the protein source has to be a food your pet has never been exposed to, which can be difficult to determine. Traditionally they have contained fish, lamb, potato, or venison. Many pets react to several different proteins compounded the problem. Compared to homemade diets commercial diets have the advantage of being nutritionally complete and convenient. It is becoming more and more difficult to find a food that conatins a protein that is truly novel.

In many cases these foods work well to eliminate or decrease the food allergy. It takes up to 8 weeks to know if they are working, and your pet needs to be fed only these foods and nothing else, and be off all medications to decrease scratching. You might have to try different foods to find one that works for your pet. Unfortunately, its possible for some pets to eventually develop and allergy to one of the novel proteins in the food you are feeding.

Commercial Hydrolyzed Protein diets are the best option in most cases. The advent of these diets for food allergies has been a big step in eliminating the problem. Instead of trying to find a novel protein, these foods have literally decreased the size of the protein particle that gets absorbed in the intestines into the bloodstream. This reduced size is now too small to cause a food allergy, no matter what the protein source initially. These foods are nutritionally complete, convenient, and the ones we tend to recommend in most cases of food allergy. The brand we use most is Hill’s z/d. Hill’s was the first manufacturer to identify this solution and z/d is still the gold standard. This food is  unconditionally guaranteed and you will get your money back if you are not satisfied.

It is important that you do not have your pet on cortisone or antihistamines while trying to determine if your pet has a food allergy, since they will decrease the scratching and lead to an erroneous conclusion on the effect of the food. This causes a dilemma for those pets that have significant scratching, since they need immediate relief. In these cases we recommend using medication initially and starting your pet on a hypo-allergenic diet at the same time. If the itching is decreased after 1-2 months you can start weaning your pet off the medication to determine if the scratching is still diminished while on the hypo-allergenic diet also. In some cases we find the use of this food will allow us to use less medication to control the scratching.

Compliance is important, so make sure that everyone that even remotely feeds your pet knows about the diet change. If you give your pet food with medication, or treats, make sure it is not the original food that might have caused some allergy. Some pets need time to make the transition to a new food so be patient. Never let a cat go more than a few days without eating due to potential problem with the liver. Mix their new food in with their original food and make the transition over 7 days.

Avoidance

Obviously, if it is exposure to an allergen that causes the problem in the first place, then logic will dictate that we eliminate this exposure. In reality though, these allergens are everywhere. Minimizing exposure can be beneficial since it will decrease the allergen load, and hopefully keep your pet under the pruritic threshold.

Pets that are allergic to kapok, wool, cotton, feathers, animal dander, newspaper, and tobacco smoke all might benefit from limiting exposure. Limiting the number of houseplants could be helpful, and use synthetic material for your pets bedding. Pets allergic to house dust mites might do better kept out of bedrooms or placed outside more often.

Being outside though might expose them to more pollens. Grass is a common allergen causing skin allergy, so if possible, try to minimize exposure.  Keep the grass cut short, and keep pets out of the yard when cutting the grass. Rinse your pet’s feet and face off thoroughly after being exposed to grass can be beneficial in some cases.

Mold allergies might be helped by dusting and cleaning more thoroughly, especially house plants and bathroom carpets. Even think about replacing your carpets with wooden flooring. Keep your pet away from damp areas like basements (in California that’s easy since we don’t have many) and use humidifiers and air conditioners in humid weather. Rinse their filters frequently and clean with chlorine bleach. To truly filter most of the dust, mites, pollens, bacteria, and molds in your house you need to use a HEPA (high efficiency particulate air) filter. Upright vacuum cleaners return most of the dust back into the air, so use canister or cylindric type machines.

Routine and thorough washing, cleaning, and vacuuming of your household will keep mold, house dust, and house dust mites to a minimum. Keep your pet out of the house when doing thorough cleaning and vacuuming to minimize allergens that are stirred up by the cleaning. Put flea powder or a flea collar in the vacuum bag. Put plastic over bedding that might harbor house dust. Keep pets indoors at dusk and early morning during heavy pollen seasons.

Flea Control

Since we live in a flea endemic area year round, we cannot emphasize the importance of proper flea control in any pet that has a skin condition. Even pets that are 100% indoors are possible flea victims. This is especially important in cats, both indoor and outdoor cats.

The products available today are a significant improvement over flea control products in the recent past. They are economical, safe, effective, and very convenient. The product we recommend for dogs is Trifexis©. It prevents fleas, heart worms, and internal parasites, and is given orally instead of a topical gel.

The flea control product of choice for cats is called Revolution©. In addition to treating fleas, it treats heartwormear mites, and internal parasites (depending on the species).

Both of these products are used monthly. In some situations one of our doctors will have you use it more often. We also have detailed brochures on these products.

There are many  flea products that also can be used. Some are oral, some are topical, some are long lasting collars. Here are some of our recommendations:

Topical- Canine

Advantage Multi

Frontline Tritak

Vectra

         Oral- Canine

Comfortis

Nexgard

Sentinel

Trifexis

Bravecto

      Collar- Canine

Serestro

      Topical- Feline

Advantage II

Revolution

Vectra

       Oral- Feline

Comfortis

Bravecto

       Collar- Feline

Serestro

Medical Therapy

Every pet reacts differently to the medication used in atopy, so we might need to try different ones, at the lowest dose possible, to find the medication, or medications, that work best. Since treatment tends to be long term, so our goal is always to substatntially minimize the itching whilel using as little medication as possible. We use a multmodal approach, utilizing topicals, antibiotics, nutrition, and anti-inflammatories, to give the best possible outcome.

Cortisone

One of the mainstays of therapy for treating atopy is cortisone, commonly know as steroids. These steroids fit in the class of drugs called corticosteroids, which are not the same thing as anabolic steroids used by bodybuilders. Cortisone use is usually reserved for flare-ups, since long term use has the potential for causing side effects. Long term use of high doses of cortisone can lead to hair loss, thinning of the skin, liver problems, stomach problems, and muscle weakness. The overuse of cortisone can also cause iatrogenic Cushing’s disease.

Cortisone is a potent drug used in human and veterinary medicine literally thousands of times each day. Without this drug we would not be able to treat a large number of diseases. Cortisone has been abused by some people, leading to a bad name for this drug in some people’s minds. When used judiciously, and under a doctor’s supervision, it is one of the most important drugs we have. It is our first line of defense when a pet is scratching so severely it is maiming itself.

Cats are more resistant to the side effects of cortisone than dogs. Some cats are difficult to pill, so it is not uncommon to use an injectable version of cortisone that lasts for several  weeks to months. Older cats need to be checked for underlying problems like sugar diabetes and heart disease before instituting cortisone therapy. Cortisone will raise the blood sugar level, making it more difficult to control the problem. It can also cause the body to retain more sodium. This is only a problem in a cat that is in congestive heart failure.

Cortisone is usually given on an every other day basis and eventually decrease the dose even further as your pet improves. This minimizes side effects yet still gives an adequate amount of the drug to minimize scratching. In many cases we give an injection first to give your pet immediate relief from the scratching. We routinely use cortisone for 1-2 weeks to help get the scratching problem under control. Since cats are more tolerant to cortisone, and can be difficult to pill, it is not unusual to use the injectable version of cortisone in them.

While on cortisone you will notice that your pet drinks and urinates more than usual. It might also have an increased appetite and might show some behavioral changes. These symptoms will go away, in the meantime make sure your pet has access to fresh water at all times and can go outside to use the bathroom frequently.

Antihistamines

Antihistamines can be effective in treatment in some cases. They counteract the release of histamine (that’s why they are called antihistamines) from the mast cell, which as you know is the source of the itching. They are the mainstay of our long term medical treatment for skin allergies. Occasional side effects include drowsiness and dry mouth, both of which tend to resolve. In general, they are safe to use on a long term basis.

We will initiate an antihistamine trial to determine which one, if any, is most effective for your pet. We do a trial for up to 2 weeks to determine if one is effective or not. It is helpful not to have your pet on cortisone at the same time we are trying a new antihistamine, since we will not know if a decrease in pruritus is due the cortisone or the antihistamine. If we find one antihistamine that works well we stay with it on a long term basis. Eventually this might change, and if there is a significant flare up we will use cortisone to control the problem for several weeks. In the long run, even if antihistamine use has only minimal effects on decreasing pruritus, its use can help us decrease the use of cortisone.

Some of the common antihistamines we use are:

Benadryl A

Atarax

Tavist

Chlorphenaramine

Amitryptiline

Medications used to treat allergic dermatitis are used on a long term basis. We will refill medications as needed, and require a complete physical exam every 6 months to verify we are still treating the correct problem and to check for potential side effects to medication. A blood sample will be recommended periodically to verify the health of internal organs that might be affected by long term medication.

There is a combination antihistamine and cortisone called Temaril-P that has been use for decades. The two drugs in combination haven proven to be highly effective, and since each of these drugs is at a low dose side effects are rare.

Cortisone/Antihistamine Combination

A popular remedy we use commonly and successfully is called Temaril-P. The cortisone and antihistamine are in a low dose (trimeparizine -5 mg, prednisolone-2 mg), but when combined in the same medication have the effect of a larger dose. We get the best of both worlds in this case because the low amount of medication means less chance for side effects when used long term. This drug is also effective for pets that are coughing and vomiting.

Apoquel

Apoquel is a member of a class of drugs called Janus Kinase (JAK) inhibitors. It is an immune mediating drug that suppressed cytokine function. Cytokines are implicated in the cause of itchiness (pruritus).

A very small amount of dogs had diarrhea, vomiting, and excess drinking, which went away eventually.

It should  not be used in dogs with history of cancer (neoplasia), demodectic mange, or that have severe immunoseppresion. Its simultaneous use with cortisone (prednisone) has not been evaluated.

Apoquel has proven to be highly effective, and has been the treatment of choice in many cases of atopy.

Cytopoint

This is an injectable version of Apoquel that has also proven highly effective in controlling atopy. An injection lasts up to 2 months.

Antibiotics

Some dogs scratch so severely they cause a secondary bacterial infection of the skin called pyoderma. The bacteria that commonly causes this is called Staphylococcus intermedius or pseudointermedius.This secondary bacterial infection intensifies the itching. These dogs need treatment with antibiotics for several weeks to several months. In addition, they need to be bathed with shampoo that will help the skin infection. Long term use of antihistamines are not effective if a skin infection (pyoderma) is allowed to persist.

If a hot spot is present it will be gently clipped and cleansed. Pets with hot spots must be put on antibiotics and usually short term cortisone to prevent the problem from progressing. Hot spots are very painful, and oftentimes require sedation if the wound is to be clipped and cleansed properly.

Antibiotics that work best for pyoderma include:

  • Cephalexin
  • Baytril
  • Clavamox

There is a new version of injectible antibiotic called Convenia that lasts for 2 weeks. This is especially useful in cats due to the difficulty in giving them a pill.

Antifungals

Secondary fungal infections can occur, especially when the feet are licked constantly. The most common one is called Malassezia. It is treated with topical antifungals in most cases.

Cyclosporines

An effective long term treatment for atopy relies on cyclosporines, the medication that prevents organ transplant rejections. It is called Atopica© 

 Your dog must weigh at least 4 pounds for it to be used. Its main advantage is the fact it works without any side effects on a long term basis that can be encountered in drugs like cortisone.

It has recently been approved for us in cats in a liquid form

Atopica is highly effective, and we recommend it as one of our important long-term treatments for atopy. It does not contain cortisone so we do not have the side effects associated with cortisone.

Initially it is given once daily for 30 days, and should be given one hour prior or two hours after a meal. If a response is achieved we will decrease the dose slowly, with the ultimate goal of giving it 3X per week. It becomes cost effective at this twice per week dosing, and it is warranted to try this medication if your pet is on chronic cortisone use or you want an effective treatment without cortisone.

Allergy Shots

If an allergy test is performed on your pet we will know what it is allergic to, and allergy shots can be custom designed for your pets specific allergy. Giving allergy shots is called hyposensitization or immunotherapy. Theoretically, hyposensitization stimulates the production of IgG, which subsequently attaches to the allergen, preventing IgE from attaching to this same allergen. If there is no IgE attached to the allergen, then the mast cells do not release histamine.

Even if you do not give the allergy shots, knowing what your pet is allergic to can be beneficial in some cases, assuming you can remove the offending allergen (see previous section on avoidance). We tend to rely on allergy shots when avoidance methods and medication are unsatisfactory in minimizing pruritus. The company that performs the RAST test also supplies us with the allergens to give the allergy shots.

Giving allergy shots can be a significant way to minimize your pets scratching, although just like in people, no guarantee can be given to the outcome. Estimates vary, but in general, you can expect some improvement 60% of the time. In some cases we will still keep your pet on an antihistamine or cortisone, or Atopica©, but at a reduced dose. A decision to undertake this treatment modality takes a commitment to a lifetime of giving these injections in most cases.

Giving the injection is very easy since it is a small amount with a tiny needle. We will teach you how to give them, and if need be, will give them for you. Initially, the injections are given every few days for several months. It takes at least several months to know if the injections are working, and up to a year for full effectiveness. Eventually, they are only given from once every few weeks to only a few times per year. Each pet’s response is different.

Allergens are made specifically for each pet. This dog is allergic to many things, so three vials are needed to treat its problem.

Room Purifier

If your pet is kept in a confined area, the use of a room purifier that filters out pollen particles can be of big help.

Food Supplements

Some allergic dogs and cats scratch less when supplemented with essential fatty acids.  Essential fatty acids tend to work best when combined with an antihistamine. The main ones we use are Derm Caps and EFA-Z. As with other therapeutic options, essential fatty acids will not work when the skin has pyoderma. It will take at least several weeks of supplementation to see any improvement. In some cases the need for inflammatory medication will be reduced when a pet is put on essential fatty acids supplementation.


Bathing

Bathing in cool water several times per week is beneficial. Do not use hot water because it can intensify the itching. Proper bathing will help remove allergens and eliminate dry skin, both factors that affect the pruritic threshold. Bathing your pet too often will dry its skin out and increase its itchiness.

We have many different shampoos that will help you- please ask one of our receptionists to show you. We have had best results with oatmeal shampoos and rinses, along with antihistamine shampoos and rinses. Use a mild shampoo once weekly to keep the hair coat clean without drying it out. For hot spots we use Oxydex shampoo. If we suspect a secondary fungal infection caused by Malassezia we will use an antifungal shampoo called chlorhexidine.

This is an allergic reaction to shampoo in the arm pit area of a 8 month old female pit bull named Pumpernickel. This illustrates the principal that many things can cause an allergic reaction, even treatments for allergies.

Topical Medications

There is a strong tendency on the part of pet owners to use topical medications for allergic skin disease. They are used, and are helpful, but should not be relied upon as the primary source of treatment. Topical medications we use usually have an antibiotic, an antihistamine, or cortisone as ingredients. We tend to use topical agents most often when presented with pets with hot spots. In these cases we use antibacterial creme in addition to antibiotics that are given orally.

Prognosis

Allergic Dermatitis is a chronic disease that is not cured, only controlled. It can be the cause of significant frustration, and will wax and wane in some cases. Understanding this disease will help you formulate a long term plan that suits your needs and minimize the chance of side effects when medications are used on a long term basis.

Return to Search by Disease page.

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Spay Canine

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One of the most common surgical procedures we perform on dogs is a spay, known medically as an ovariohysterectomy (removal of the ovaries and uterus). We usually abbreviate it as an OVH.

It is performed for several medical reasons:

It prevents dogs from going into heat

It prevents dogs from getting pregnant

It significantly helps prevent dogs from get breast cancer later in life

The arrows point to two lumps at the mammary glands that are cancerous

It prevents dogs from getting uterine infections later in life. An infected uterus is called a pyometra, and is a serious disease. After you view the pictures of a routine surgery on this page you will be given an chance to see a picture of the uterus of a dog that has a pyometra at the end of this page.

In addition to these medical reasons, it prevents unwanted pregnancies, a significant problem in our society. Millions of dogs are euthanized every year because they are strays.

We usually spay a dog when it is around 6 months of age. This timetable is variable, the important point is to perform the surgery before it goes into heat. The ongoing old wives tale that states dogs should go into heat before spaying is incorrect. Most dogs go into heat starting around 9 months of age, and do it twice each year.

On the day of surgery we need your dog in the hospital between 7:30 AM and 8 AM. Please take away all food when you go to bed the evening before surgery. Let your pet have water during the night. Do not give your dog anything to eat or drink the morning of surgery.

Our surgeon will call you after the surgery is complete and your dog is awake. It can go home in the late afternoon the day of surgery. Please call our office at 4 PM for pickup time, you will be given written post operative instructions then. We are open in the evening if you need to pick up later.

This area contains graphic pictures of an actual surgical procedure performed at the hospital. They are put here to show you that this is major abdominal surgery, and not “just a spay”.

Pre-surgical Preparation

We need you to come in to our hospital so one one of our doctors can examine your pet several days prior to surgery, go over any questions you have, and submit a blood panel to our lab to make sure all important organs are functioning normally and your pet is ready for anesthesia and surgery.

Dr. Wood  is carefully checking the heart rate on this dog as part of this exam

The blood panel is very thorough and checks many organ systems

Surgery Day

Pre-anesthetic preparation is important in every surgery we perform, no matter how routine, because surgery is not an area to cut corners. On the day of surgery all of our spays receive a physical exam just prior to surgery.

Talia and Dr. Kennedy are performing this exam just prior to giving anesthesia

 When everything is to our satisfaction we will administer a sedative. This will calm your pet down and make the administration of the actual anesthetic, along with post operative recovery, much smoother. Once your pet is anesthetized, prepared for surgery, and had its monitoring equipment hooked up and reading accurately, the surgery can begin.

_D2A8630

Once our surgeon has reviewed lab data and performed a physical exam he starts his sterile scub while our patient is being anesthetized

After scrubbing and gowning instruments are prepared.

When our surgeon first opens up the pack he checks to make sure the gauge confirms that the instruments have been properly sterilized by our autoclave

OVH-rabbit-3

After this confirmation the instruments are organized and the scalpel is put on the scalpel blade handle

Our surgeon is ready to start before our patient is at a proper plane of anesthesia. Once the anesthetist gives the green light the surgery starts immediately. We want our surgeon waiting for his patient, not the other way around.  All of this is to minimize anesthetic time.

Anesthesia

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

This machine monitors:

Temperature

Heart Rate

Heart rhythm

Oxygen saturation

Carbon dioxide level

Respiratory rate

Rabbit-femurfx-9

In addition to our monitoring equipment our anesthetist stays “hands on” in monitoring important physiologic parameters like heart and respiratory rate and quality

She also checks something called Capillary Refill Time to make sure the heart is pumping enough oxygenated blood to the organs. When she presses on the gums to make them blanch white for a second, she measure how long it takes them to go back to their original pink color. It should be less than two seconds. 

We have a detailed page on anesthesia to learn more.

Surgery

Every major surgery we perform begins with proper patient preparation. This will help prevent infection, which could be a serious complication in this surgery because during a spay we have an opening into the abdomen.

Our nurse is using a special cleaning agent and scrubbing the skin 3x in a circular motion. After our patient is clean our surgeon completes the draping. 

When our surgeon is comfortable that everything is in order he starts the sterile draping procedure

The surgeon makes an incision near the umbilicus (the belly button). We try to make our incisions as small as possible to minimize anesthetic time when we suture the incision, decrease post operative discomfort, and minimize healing time.

The final layer we need to cut before we are actually into the abdomen is called the linea alba. It is an area of muscle in the center of the abdomen that is covered by a tough layer of tendinous tissue. This is the most important layer resutured at the end of the surgery because it is the only layer strong enough to hold the abdominal muscles together to prevent a hernia. In this picture the linea is being held up with a forceps and a scalpel blade (held upside down) is being used to make the incision.

A scissors is commonly used to extend the linea incision and facilitate exposure to the abdomen. Care has to be taken not to puncture internal organs like the bladder.

The incision is complete and our surgeon is holding up the cut linea, and now has access to the abdomen

 A special instrument called a spay hook is utilized to gently pull one of the uterine horns through the abdominal incision. This lets us keep the incision small.

The spay hook is traced into the body cavity until the ovary is found. It has to be gently teased from its location near the kidneys in order to be able to pull it out through the abdominal incision. In older dogs this part of the procedure is more difficult.

The ovaries and uterus are buried in fat. The arrow points to the ovary.

Once the ovary is completely exteriorized two clamps are put below the ovary. You can see the ovary above the top clamp. These clamps are were the sutures will go and allow us to cut the ovary away. 

A third clamp is put above the ovary to control bleeding when we cut the ovary away

The two lower clamps have been removed and you can see where our surgeon is tying the second of two ligatures. We always use two ligatures for safety reasons, and is one of the ways we do not cut corners on this surgery. 

You can see the knots from our two ligatures

When our surgeon has confirmed that both knots are secure the ovary is cut away. This is repeated for the ovary on the other side.

With both ovaries removed our surgeon works on the body of the uterus at the cervix. The arrow points to the cervix where two sutures will be placed.  Everything above the arrow, which includes both ovaries under the surgeon’s thumbs, will be removed. 

You can see the extensive blood supply to the body of the uterus

The uterine body is double ligated just like the ovary. Everything above the top suture in this picture will be cut away. 

Our surgeon checks to make sure there is no bleeding before placing the remainder of the uterine horn back in the body cavity

Suturing the muscle layer back together at the linea alba is crucial in order to prevent a hernia. You can see the needle coming through the linea alba, which is the whitish area. The abdominal muscles do not have the strength to hold the suture like the linea alba. 

This is what the linea alba incision looks like a after all of the sutures have been carefully placed. The subcutaneous (the fatty area just under the skin) is now sutured as a second layer of strength to prevent a hernia.

The third layer of sutures are called subcuticular because they are put just under the skin. These will dissolve on their own and your pet does not need to come back for suture removal. Being just under the skin they are also harder for your pet to pull out. 

All of our pets that have abdominal skin incisions are given cold laser treatment before they wake up from anesthesia. This decreases post operative pain and swelling and aids the healing process.

We use the companion laser in many different surgeries. In this video it is being used after a laser neuter.

During the procedure your pet is given a pain injection, which will be in full effect when it wakes up. This pain injection, along with oral pain medication you will receive when you pick up your pet, works well to keep your pet comfortable during the night. Your pet might seem quiet and groggy during the night because of this medication.

Post Operative Care

After surgery our surgeon will call you. When you pick up your dog you will be given a chance to talk to one of our staff and you will also be given detailed post operative instructions.

Most dogs go home late in the afternoon on the day we perform the surgery. They might be groggy from the pain injection which is advantageous because they will remain calm and allow the healing process to start immediately. By the following morning the grogginess will have worn off. If your pet has an E-Collar leave it on until healing is complete.

When you first get home do not be in a big rush to feed. After 1 hour at home offer a small amount of food and water. If the appetite is good, offer more several hours later. Do not over do the feeding the first night because anesthesia can make them nauseous.

Keep contact with children and other pets to a minimum the first night, and restric activity for several days to allow the incision to heal. Do not let your dog go outside until healing is complete.

We have a page called Home Care of the Surgical Patient to give you much more information.

Infected Uterus (pyometra)

This is a picture of a uterus in a female dog that has an infected uterus, called a pyometra. The uterus is completely filled with pus, and this dog is very ill.

It turns out that the uterus in this case had already ruptured before the owner brought it in for diagnosis and surgery. This causes sepsis, and can easily lead to death. This patients need intensive medical care prior to surgery, which includes intravenous fluids and antibiotics, in addition to pain medication.

This is the original incision in the dog above. The inner lining of the abdomen, called the peritoneum, is severely inflamed and infected. This is called peritonitis. This is painful, and can lead to shock and death. 

There is so much inflammation that the abdomen is filled with fluid (called ascites) and our surgeon needed to suction this fluid before she could visualize the internal organs properly and bring out the grossly distended uterus you saw above. 

A diagnosis of pyometra is made based on several findings. There is a history of being in heat a few months prior, along with lethargy, lack of appetite, and sometimes even vomiting. Most dogs will be drinking and urinating excessively because of the toxic effects of the infection on the kidneys. These toxic effects on the kidneys are usually from an anaerobic bacteria called E. coli (Escherichia coli).

A blood sample will commonly show a very elevated white blood cell count. This is called leukocytosis, and is a major clue to a pet that has pyometra.

This blood panel is from the dog with the ruptured uterus above. It has 30,000 white blood cells (WBC’s), when the high end of normal is 16,000

Abdominal radiographs (X-rays) are also used to make a diagnosis. Normally you cannot see the uterus on a radiograph. Click here to learn why from our X-ray page.

The enlarged and pus filled uterus can be seen in the red circle. 

If you would like to learn more about how we do surgery at the Long Beach Animal Hospital on a wide variety of animals please follow this link.

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Anesthesia

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One of the most important tools available to veterinarians to thoroughly and painlessly treat pets is the advent of modern day anesthetics. These anesthetic agents allow us to sedate and anesthetize a wide variety of animals with negligible chance of serious side effects.

Modern anesthetics allows us to safely anesthetize high risk animals like this duck with a fractured wing. You can see her surgery in our Wildlife Care page.

The lack of significant complications from anesthesia is due to a combination of expertise, thorough pre-anesthetic testing, and state of the art anesthetic and monitoring equipment. We are equipped to anesthetize any pet from a finch that weighs 15 grams (it takes 454 grams to make up one pound), to pets that weigh several hundred pounds. We are also particularly proficient in anesthetizing senior pets and pets with medical problems like liver and kidney disease.

The most important part of monitoring your pet while it is under anesthesia is our nurse technician that is with your pet the whole time it is under anesthesia

The goals of anesthesia are to minimize anxiety and eliminate pain. In addition, from the surgical point of view, anesthesia allows profound muscle relaxation. This is helpful in every surgery because the procedure will go quicker and incisions can be made smaller when the muscles are relaxed. In certain types of surgery like fracture repair, this muscle relaxation is crucial for success.

It is normal for you to have concern if your pet is about to undergo a procedure that requires anesthesia. Because of this fact, we invite you to be a part of our anesthetic team. Your primary responsibility is to let us know of your concern. You will have access to your doctor to discuss any of your concerns and to set up a custom protocol for your pet, taking its specific needs into consideration. Only when you are comfortable with the situation will we proceed any further. Also, to alleviate your concern on the day of actual anesthesia, we will call you immediately after your pet wakes up, if you so desire. Please leave a number where we can reach you on the day of surgery.

Pre-Anesthesia

A pre-anesthetic exam is performed just prior to anesthetizing any animal. We are looking for any problems, particularly with the heart and lungs.

We perform this exam just prior to anesthetizing your pet

Even our more unusual patients get an exam prior to surgery

One of the precautions we take to minimize the risk of anesthesia is to perform pre-anesthetic diagnostic tests. A pet can pass its pre anesthetic physical exam and still have significant internal problems, so it is important that we perform more than just a physical exam. This is because animals cannot tell us of their problems, have high pain thresholds in comparison to people, and have defensive mechanisms allowing them to hide symptoms. Pre-anesthetic diagnostic tests are designed to alert us to internal problems that are occurring without any symptoms.

We prefer to perform an exam and blood panel about one week prior to surgery. We send this blood panel out to our lab for a thorough analysis of important organs like red blood cells, liver, and kidney.

 This report is showing a kidney problem

 

In an emergency, or when we cannot send the blood out to our lab several days prior to surgery, we can perform an analysis in our hospital by our blood analyzer

We can have this report in 30 minutes. This is how it checks the CBC (Complete Blood Count). It also gives us a biochemical report like the one above that checks the internal organs like the kidneys.

Those pets that have infections (especially tooth infections) might be put on antibiotics ahead of time. They make pets feel better, and help support internal organs.

Older pets, or those with medical problem,s are given intravenous (IV) fluids prior to and during the anesthetic procedure. Giving fluids prior to the surgery greatly reduces anesthetic risk. This is particularly important in older pets and those with kidney or liver disease. Most pets that have significant dental disease will also be given IV fluids.

IV fluids are one of the most important treatment modalities we have for a wide variety of medical situations in addition to surgery

Pre-Anesthetic ECG

For elderly pets, those with heart murmurs or heart conditions, we perform an electrocardiogram just prior too surgery.


This one has a potential problem that needs to be addressed

Blood Transfusions

For those pets that are anemic, or in surgeries where we anticipate significant blood less, we give whole blood before, during, and after the surgery. This is important in surgeries like splenectomies.

This is what anemia looks like in a CBC from our in house blood machine

Dog do not have iso antibodies, so in an emergency, and if the dog has never received blood before, we can give blood from most any dog donor. It is not our preferred way of doing a blood transfusion.

Before we give the blood we prefer to do a cross match

We use whole blood that is specially prepared and stored

Injectable Anesthesia

Injectable anesthetics are used for many purposes. One of their primary uses is to sedate pets before giving the actual anesthesia (called pre-anesthetic). By sedating ahead of time we dramatically minimize anxiety, cause a smoother recovery, and minimize how much anesthetic we need to administer during the actual procedure. In addition, some injectable anesthetics minimize vomiting, a common problem when waking up from anesthethesia.

Injectable anesthesia is given intravenously, and rapidly induces relaxation so that we can put in a breathing tube

Injectable anesthetics are also used to give complete anesthesia for short periods of time. This is used for C-sections and minor surgical procedures. Injectable anesthetics are ideal to sedate a pet for radiographs (x-rays).

As new anesthetic agents evolve, the trend is towards using injectable anesthetics more and more for complete surgical anesthesia. They are very effective, very safe, and allow for rapid recovery from anesthesia. They also protect the environment because there are no anesthetic gases vented into the atmosphere.

Gas Anesthesia

The mainstay for general anesthesia is gas anesthesia because it is very safe and highly controllable. We use a safe and effective gas anesthesia  called Isoflurane. It is so safe it can be used in creatures as small as tiny birds.

Lisa is watching carefully as this budgie is being anesthetized for a surgery to remove a growth on its cloaca

Gas anesthesia requires specialized equipment and training. Several precision components are used to administer and monitor anesthesia:

Oxygen

All pets put under gas anesthesia are given 100% oxygen from the moment they are anesthetized until they wake up, dramatically increasing the safety of the procedure.

We have a special machine in surgery that generates 100% oxygen

As a backup,  oxygen is stored in large tanks under high pressure. The oxygen in these tanks is delivered to the anesthetic machine via special piping throughout the hospital. This allows us to have anesthetic machines in several hospital locations.

A pet can be brought into radiology after its surgery and still be kept under gas anesthesia, while the surgeon reviews post operative radiographs to ensure everything is in order. This is especially helpful when orthopedic surgery is performed.

Keeping a pet under anesthesia is important in orthopedic surgery to make sure the plates, pins, or screws are properly placed and in alignment. If they are not, this can be corrected before a pet wakes up completely. 

Endotracheal Tube

Oxygen is routinely delivered to your pet by a breathing tube (endotracheal tube) in its windpipe. It is the preferred method to administer oxygen because it is very efficient, will prevent any vomitus from entering the trachea (vomiting rarely happens because of fasting and pre-anesthetic sedation), and allows us to gently inflate the lungs during surgery so that they work at maximum efficiency. Besides oxygen, the anesthetic gas (Isoflurane) is also administered through the endotracheal tube. Medications can even be administered via this special tube.

 

The endotracheal (ET) tube is placed directly into the windpipe

This x-ray shows the breathing tube (follow the arrow) as it passes over the tongue and down the trachea (windpipe)

We can easily breathe for your pet and inflate your pet’s lungs by gently squeezing the bag connected to the tube, monitoring the amount of pressure we are exerting with a gauge on the anesthetic machine. Each size and species of pet requires a different sized endotracheal tube. The tube is not removed from your pet until it is literally waking up. This ensures that the swallowing reflex is present, and your pet is now safely able to breathe on its own.

Vaporizer

An instrument called a precision vaporizer is used to deliver the Isoflurane anesthetic gas within the oxygen. It is a very precise instrument allowing us to make fine adjustments in anesthetic level. Without this vaporizer we would not have the wide safety margin that we currently enjoy.

We can precisely and easily change the level of anesthesia during the procedure as needs change

For most surgeries we administer the anesthetic at a setting of 1-3 %. This small percent of anesthetic, added to the 100% oxygen the pet is breathing, is all that is needed to achieve complete surgical anesthesia. Before the surgical procedure is finished the anesthetic is lowered before it is turned off completely. As the surgeon is finishing the procedure your pet is in the beginning stages of waking up. This decreases anesthetic time,  another way we minimize anesthetic risk.

Monitoring

Our surgeon is one of the best monitors, because he/she is literally visualizing the blood in the circulatory system. Any change in the blood is readily noticed because pets that are breathing 100% oxygen should have bright red blood.

In addition to all the high tech monitoring equipment we have, our anesthetist is hands-on in monitoring your pet. Here Brianna is using  her stethoscope to check the heart, even though the heart monitor behind her is doing the same thing. 

After listening to the heart she keeps a close tab on oxygen flow and the anesthetic level of our precision vaporizer

We keep detailed records of fluid rate rates, anesthetic and oxygen levels, and physiologic parameters, during the surgery

We keep a close tab on the heart with the stethoscope on all of our more unusual surgical patients

Since our small patients can easily become hypothermic due to the anesthesia and surgery, we monitor temperature continuously.

Surgery-GPigWaterBlanket

Surgery-GPigWaterBlanket1

All of our patients, especially the smaller ones like this guinea pig, are kept on warm water water blankets to prevent hypothermia before during, and after any anesthetic procedure.

Anesthetic Monitor

This highly accurate and sensitive monitor gives us detailed information on your pets physiologic status while under anesthesia.

It is a sophisticated instrument that gives us an early warning sign of impending problems with your pet’s physiology

It is calibrated prior to surgery to ensure accuracy

Watch it in action, and see if you an figure out what all these numbers mean

We sometimes use other instruments to monitor you pet while it is under anesthesia, even though the Surgical monitor does this also. It pays to be redundant. The two most important additional instruments we use are:

Pulse Oximeter (Pulse Ox)

The portable pulse oximeter is an instrument that measures the oxygen saturation of you pet’s red blood cells (to be more specific, its hemoglobin). It is an extremely sensitive instrument that gives us an indication of problems that may be arising long before your pet suffers any ill effects. In addition to measuring oxygen saturation, it measures heart rate, pulse character, and respiration.

This instrument does its magic by measuring the hemoglobin that is oxygenated, and comparing it to the hemoglobin that is not oxygenated. It does this by shining a light on an artery, and then measures how much of this light is absorbed. It gives us an answer in PaO2– the partial atmospheric pressure of oxygen.

This Guinea Pig has the pulse oximeter sensor attached to his foot in preparation for surgery

The Pulse Oximeter measures oxygen saturation of 92%  and a heart rate of 87 beats per minute (BPM). Both of these are normal on this pet, which is a pot bellied pig.

The pulse oximeter has several different types of sensors that can be attached in various locations depending on the procedure being performed.The pulse oximeter can also be used on pets that are not anesthetized. It is useful for pets that are having difficulty breathing (dyspnea) from many different causes. It is also used to monitor pets that are in a state of shock. One of the most common reasons for pets to be presented to us in a state of shock is from trauma, especially being hit by a car (HBC).

Blood Pressure Monitor

We also monitor the blood pressure when pets are under anesthesia for the longer surgical procedures. This is done with our anesthetic monitor.

Blood pressure can also be checked manually at any time

Our hypertension page has a video of the doppler blood pressure monitor in action when we use it in an exam room.

Capillary Refill Time

To complement these high tech methods of monitoring, our anesthetist technician uses several hands-on techniques as a backup. One of the easiest of these is called capillary refill time (CRT). By pressing on the mucous membranes in the mouth, and noting how long it takes for the blanched area to turn pink again, we get a basic assessment of your pets cardiovascular status. A normal pet’s pink color returns within 2 seconds. This technique is used in other situations besides anesthetic monitoring. It is especially helpful when a pet is in shock or is dehydrated.

Capillary refill time on this pet is less than one second

Pain Medication

We complete the anesthetic process by giving your pet a pain injection before it wakes up from the anesthetic. Since the gas anesthesia has a small amount of residual analgesia (ability to kill pain), the pain shot kicks in as the gas anesthetic is wearing off. This allows for a very smooth and pain free recovery. We monitor this closely, and will give additional injections as needed. This pain injection will keep your pet calm its first night home from any surgery. We will also send you home with oral pain medication also for several days.

Local Anesthesia

Another excellent way to prevent the pain encountered when your pet first wakes up is to use a long acting local anesthetic at the incision site. We administer it prior to completion of the surgery so it is in full effect when your pet wakes up.

We use the long acting version of this drug which eliminates pain for up to 8 hours

We even have a local anesthesia patch that is used in some cases to bring long term relief for several days if needed.

Pain Patch

We also use Duragesic (Fentanyl) patches for general pain control in the more serious cases. It is preferable to apply it 12 hours before the surgery for maximum effect postoperatively. It provides pain relief for 3 days. It is important to make sure that no children or other pets are allowed to contact the patch in any way. Bring your pet back to us for proper removal and disposal.

The patch is applied in different locations depending on the surgery. Wrapped around one of the legs and between the shoulder blades are common locations. If we put it on the leg it is covered with a bandage. It will be bandaged for protection and to minimize the chance of contact with other pets and children. Please return in 3 days for us to remove it and dispose of it properly.

One of our nurses is applying it in this picture using gloves to ensure she does not come into contact with the active ingredient.

We will commonly staple the patch to the skin if we put it between the shoulder blades

Our surgical patients are monitored closely immediately after surgery. We will verify the pain medication is working, and that there are no ill effects from the anesthetic. It will also allow your pet to completely wake up and walk normally in a controlled environment where it cannot hurt itself.

Our technical staff monitors your pet post operatively until we are certain it is ready to go home

Long term pain control at home is also important during the next several days. We will routinely send you home with an anti-inflammatory medication or pain suspension for long term pain control. The two most common medications we use are Rimadyl and Torbutrol suspension.

Laser Surgery

Even though it is not an actual pain medication, using our carbon dioxide laser when indicated during a surgical procedure dramatically minimizes pain because it decreases inflammation, swelling, and cauterizes nerve endings. By using the laser and stopping the pain cascade before it even begins there is a dramatic influence on decreasing post operative pain.

This video shows you how we calibrate and set the laser for a neuter surgery

Companion Laser Surgery Post Op

For additional pain control we use our  Companion Laser on the incision line before your pet wakes up from anesthesia. This decreases post operative swelling and pain, and makes your pet much more comfortable.


You get to wear cool glasses when we use this laser

Watch it in action

Returning Home after anesthesia

When you bring your pet home after anesthesia it is helpful to follow some common sense suggestions:

Keep contact with other pets and children to a minimum for at least the first 12 hours. Confine it to an area where it cannot hurt itself  because it may not be steady on its feet for up to 24 hours. It might be groggy the first night due to the pain injection it was given.

Use pain medication as prescribed and keep your pet in a warm and quiet area. You can spend time giving unlimited TLC

Even though your pet has probably been fasted for the anesthesia, feed it only a small amount of food and water when first returning home. Give it more later if it eats well and does not vomit (emesis). Most pets return to a normal appetite within 24 hours. If your pet has not fully recovered from the anesthetic by the next day then please call our office.

Please call us in the evening if you have any questions when your pet returns home from surgery or any anesthetic procedure.

To learn much more about how we do surgery at the Long Beach Animal Hospital please visit our Surgery Page and our Diseases Page.

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Worms (Internal Parasites)

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The study of parasites is called parasitology. It is an important discipline because internal parasites cause death and disease worth billions of dollars in animals each year. These parasites have highly evolved life cycles that make their elimination impossible. In addition, many internal parasites affect people with the potential for serious consequences.

Dogs and cats (especially puppies and kittens) are routinely infected with internal parasites, sometimes without apparent evidence of the infestation until it is too late. This means that a pet can have internal parasites even though the fecal sample is negative. It is suspected that internal parasites predispose your pet to IBD (Inflammatory Bowel Disease) later in life.

Fortunately, we have effective medications to treat most parasites. Many of the medications we use to treat internal parasites, called anthelmintics, treat more than one parasite. The advent of these broad spectrum anthelminitcs makes treatment much more effective. We recommend all dogs and cats get a treatment for internal parasites every 6 months.

This best method for treatment is to use flea products on a monthly basis that also kill internal parasites and prevent heart worms. We have several medications, some oral and some topical, to achieve this.

This section will discuss internal parasites that are commonly found in dogs and cats in our area. This includes:

  • Tapeworms
  • Roundworms
  • Hookworms
  • Whipworms
  • Coccidia
  • Giardia

These internal parasites differ from external parasites, which usually affect the skin and ears of dogs and cats. Click here to learn more about external parasites.


Symptoms

Symptoms manifested by pets that are infected with internal parasites can vary, and depend on a pet’s age, nutritional status, parasite load, duration of infestation, etc. One of the most common symptoms of internal parasitism is diarrhea. Other symptoms include poor appetite, lethargy, coughing, and abdominal distention. Some pets don’t show any symptoms while others can die from their infestation. Internal parasites tend to infest older and younger animals most commonly. Internal parasites can also make a pet more susceptible to other diseases. It is not uncommon for a puppy with Parvo virus to have internal parasites simultaneously.

Due to the prevalence of internal parasites in dogs and cats, their lack of symptoms in some cases, and the potential for humans to become infested also, your pets feces should be checked for internal parasites twice a year. Dogs and cats that are outside and exposed to other animals should have their feces checked more often. Routine worming should be performed on all dogs and cats every 6 months, even if the stool check for parasites is negative.


Diagnosis

The majority of internal parasites are diagnosed by microscopic examination of the feces for eggs that are released by the adult female in your pet’s intestine. The number of eggs released in a given fecal sample can be variable, sometimes there aren’t any even though your pet has an adult female parasite in its intestines. This means that a negative fecal report does not guarantee that your pet is free from internal parasites. In many cases we need to run numerous samples to feel comfortable that your pet is free of internal parasites. In some cases our doctor’s will treat for a specific parasite, even on a negative fecal sample, when they feel there is a likelihood of infestation, because some internal parasites eggs are notoriously hard to detect.

In some parasites a diagnosis is made by observation of the mature parasite in your pet’s feces or during an autopsy in your pet’s intestines. This is especially true for Tapeworms. Tapeworm eggs are difficult to detect during microscopic fecal analysis, so observation of the actual worm is how they are routinely diagnosed.

The two primary methods of fecal analysis are direct observation and fecal flotation. In direct observation a smear is made of some fecal material on a microscope slide and the slide is analyzed by one of our nurses for parasite eggs. It is used to detect eggs that don’t show up well during the fecal flotation.

Fecal flotation is the most accurate way to detect most internal parasites. A sample of fresh feces is put into a special solution that causes any eggs that might be present to float to the top and adhere to a cover slip. The cover slip is put on a microscope slide for analysis. This concentration of eggs substantially increases the chance of finding any eggs that might be present. Some eggs, notably Tapeworm eggs, dissolve during this process and might be undetected. This is the reason you can see Tapeworms in your pets stool yet the fecal analysis came back negative.

We have sanitary containers for you to use to obtain a fecal sample from your pet. Once the sample is obtained it should be kept cool until we analyze it. Analysis should be within 12 hours to increase accuracy.

The flotation solution has been added to the fecal container and a cover slip has been placed on the top to collect any eggs that float to the surface after a 5 minute wait

The cover slip is put on a microscope slide and carefully scanned for the eggs of any parasite. High magnification is needed because the eggs are microscopic in size.


Treatment

Internal parasites have very sophisticated life cycles that can make treatment difficult. Some of these life cycles involve mandatory maturation processes in other animals, including insects. Specific treatment modalities are set up to address these life cycles and will be discussed for each individual parasite in the following sections. It is important to follow these treatment regimens precisely.

Some parasites can only be controlled, not eliminated. In these cases it is important to check your pet’s feces routinely and to use medication on a long term basis.

There are new treatments for internal parasites that are very broad spectrum. They kill a wide variety of parasites, and are the medications we use as a routine wormer.

Revolution, will kill fleas, heartwormsear mites, and even internal parasites. We recommend it for cats.

Trifexis kills internal parasites, heartworms, and fleas, and is recommended for dogs.

Please ask our receptionist for brochures on these products.


Tapeworms

By far the most common internal parasite we encounter is Tapeworms. The scientific name for the Tapeworm we encounter in our area is called Dipylidium.

Life cycle

The source of the infestation is a flea that has been swallowed by your pet or a cat that eats infected rodents. The flea gets the Tapeworm in its system by swallowing it during its larval stages, when the larvae eat the eggs that have been passed from pets that are already infested with Tapeworms.

The lifecycle of the Tapeworm is simple compared to other internal parasites

Symptoms

In spite of their prevalence Tapeworms are not a significant cause of disease in dogs and cats. Most pets do not have any symptoms, and if symptoms are present, are mild in nature. Some pets will itch at their anus or scoot on the ground when the worms cause irritation as they pass.

Diagnosis

Most Tapeworms are diagnosed by visualizing the worm in your pets feces, crawling around its anus, or in its bedding. Tapeworms segments crawling on your dog’s anus might cause scooting, although full anal sacs are a much more common cause of scooting. They come in long attachments that usually break off into individual pieces when they exit from your pet. They usually look like pieces of white rice and turn yellow after they have been out of the body for a while.

This is a packet of Tapeworm eggs as viewed under a microscope. It is rare for us to see them in this packet because the fecal flotation solution causes this packet to burst.

 Treatment

Several medications are available that are highly effective at ridding you pet of Tapeworms. The most common treatment is an oral medication that rids your pet of all Tapeworms within 24 hours. This medication also kills rounds, hooks, and whipworms. It does nothing to prevent your pet from re-infecting itself. Proper flea control does.

Prevention

Since fleas are directly responsible for this infestation their control is apparent. We recommend advantage and Program for safe, economical, convenient, and highly effective flea prevention. A new product, called Revolution, will kill fleas, heartworms, ear mites, and even internal parasites. Please ask our receptionist for a brochure.

Public Health Significance

Children can pick up Tapeworms from eating fleas, but it rarely causes any problem. Other species of Tapeworms exist that have significant potential to cause serious disease in people. Fortunately, we do not encounter them in our local area in dogs and cats.

 Roundworms

A common parasite of dogs and cats, especially puppies and kittens, is Roundworms. The scientific name for their group is called ascarids. We routinely treat puppies and kittens for this parasite for 2 reasons. The first is their prevalence, the second is their potential to infest humans. The larval form of this parasite has the potential to cause serious disease in children. Fortunately it is a rare problem, and can be prevented by worming all puppies and kittens early in life. It is all prevented by monthly use of flea and heart worm prevention products like Trifexis for dogs and Revolution for cats, since these products also kill roundworms.

Life cycle

The life cycle of this parasite almost ensures that a puppy or a kitten will be exposed. They can get it from their mother while they are in the uterus (dogs), during nursing, and through contamination with infected feces. Larval forms of this parasite migrate through internal organs, get coughed up and swallowed, and become mature parasites in the small intestines. Intermediate hosts like rodents can become infected by eating eggs, and can then infect a dog or cat when they are eaten. Some larvae migrate to the tissues of internal organs and remain dormant until pregnancy where they become active and infect the developing puppies in the uterus.

 Symptoms

Common symptoms are a distended abdomen and diarrhea. Some puppies and kittens will be vomiting, lethargic and not eating well, while others will not show any symptoms. On rare occasions the parasite load can be so heavy that the intestines become obstructed. Coughing, fever, nasal discharge and even pneumonia can occur in pups that have large numbers of larvae migrating through their respiratory tract.

Diagnosis

In some cases the Roundworm will be present in your pet’s feces, vomitus or crawling around its ansu. This is not a consistent finding, and worms that might be present one day might not be there the next.

It looks like a curled up piece of spaghetti

The vast majority of Roundworm infestations are diagnosed on fecal analysis for eggs. Young puppies can be infected before the eggs of the parasite appear in the feces.

This is one type of Roundworm egg when viewed under the microscope. The thick membrane around the eggs prevent them from drying out when they are laid in the environment.

 Treatment

There are several effective treatments for Roundworms. We can easily treat your pet with an oral version given during a routine office visit. It has to be retreated in 2 weeks due to the migrating larvae since the medication does not kill the larvae. Some pets require several more treatments for a full cure. If you keep your pet on Trifexis or Revolution year round you are treating for this problem monthly. This is the best way to go.

Prevention

Roundworm eggs can remain viable for a long time in the environment. Children will get this parasite by eating dirt contaminated with the eggs, therefore cleaning up your pet’s feces immediately, and eliminating exposure to the feces of other animals when your pet goes for a walk, are important treatment modalities. Litter pans should be changed frequently and washed thoroughly and then allowed to dry in the sun. Keeping cats indoors also eliminates exposure to the feces of infected pets and the eating of infected rodents.

Public Health Significance

Children are of particular vulnerability to infestation because of their propensity to put things in their mouths and their attractions towards puppies. areas that might be contaminated with dog or cat feces should be off limits to children. This might include public areas such as parks or playgrounds. Even though these infestations in children are relatively uncommon, if they occur there can be significant damage to the internal organs like the liver, heart, brain, lungs, and eyes. This reason alone is why all puppies and kittens should be routinely treated for Roundworms, whether or not their fecal exam indicates they have parasites. also, teach your children to wash their hands frequently after handling pets, and not to put anything unnecessary in thier mouths.

Hookworms

Hookworms are blood sucking parasites that live in the small intestine. The scientific name for the Hookworm we encounter in our area is called Ancylostoma. They can be very pathogenic and even cause death due to anemia and low protein level.

Life cycle

Hookworms are spread by eating infected larvae that are in the environment. These infective larvae can also penetrate the skin and enter the blood stream where they mature into adult Hookworms in the small intestine. Puppies can also get infected while nursing or in the uterus prior to birth. Some Hookworm larvae migrate to muscles where they serve as a source of future infections.

 Symptoms

Pets with Hookworms have the potential to be very ill,especially in dogs. Symptoms include lethargy, dark stools or diarrhea, weakness and vomiting. In severe cases they are anemic and debilitated, especially the older and younger pets. The larvae might even irritate the skin when they penetrate between the toes and pads.

Diagnosis

Adult Hookworms are small so they are usually not seen passed in the feces. This diagnosis is made primarily by finding the distinctive egg in your pet’s feces. Any pet that is anemic should have its feces checked for this parasite.

These eggs are more oval than Roundworms, and the membrane is thinner

 Treatment

Infected pets might require hospitalization and even a blood transfusion if their symptoms are severe. There are different types of worming medications used, some require retreatment several weeks after the initial treatment because of the larvae that migrate through the body. All require checking your pet’s feces to make sure the parasite has been eliminated. Long term treatment and surveillance in the form of fecal exams are necessary. Dogs with chronic problems are put on heartworm preventive medication on a monthly basis since this medication also kills Hookworms. Any dog put on heartworm preventive medication needs to be checked for heartworm disease before we start preventive medication.

If you keep your pet on Trifexis or Revolution year round you are treating for this problem monthly. This is the best way to go.

Prevention

Fecal exams should be performed frequently on pets that have a history of Hookworm infestation. Prompt removal of feces helps prevent contamination of the yard with larvae. Larvae are killed in cold climates when exposed to freezing temperatures.

Public Health Significance

Hookworm larvae can penetrate the skin of people and cause significant irritation. These larvae can migrate through the body and cause damage to internal organs. Just like in Roundworms discussed above, puppies should be routinely treated for this parasite at a young age.

Whipworms

Whipworms are blood sucking parasites that live in the large intestine, usually only in dogs. They are called Whipworms because they have a slender end and a thick end, hence the appearance of a whip. The scientific name for the Whipworm we encounter in our area is called Trichuris. They can be as pathogenic as Hookworms, and also cause death due to anemia and low protein level.

Life cycle

Female Whipworms lay eggs in the environment that eventually turn into larvae. Pets ingest these larvae when they ingest soil that is contaminated. These larvae take 3 months to develop into adults capable of causing disease.

 Symptoms

Symptoms of Whipworm infestation include chronic diarrhea, anemia, and weight loss.

Diagnosis

Like most internal parasites Whipworms are diagnosed by looking for the eggs in the feces. They are oval in shape and have a plug at each end that aids in identification. Their thick membrane gives them significant protection. The eggs are shed intermittently, so a negative fecal sample does not guarantee that your dog is free of Whipworms. Adult Whipworms can sometimes be visualized when an endoscope is passed into the rectum of a pet with chronic diarrhea.

 


Treatment

Various oral medication are also used to treat Whipworms. Treatment is commonly repeated in 3 weeks and 3 months due to the life cycle of this parasite. If you keep your pet on Trifexis or Revolution year round you are treating for this problem monthly. This is the best way to go.

Prevention

Control of reinfections is difficult because eggs that have been laid in the environment are very resistant. Feces need to be rechecked and a long term plan for surveillance and treatment needs to be initiated.

Public Health Significance

Human infections with this parasite might occur, although this controversial. Common sense dictates prompt removal of feces from your pet’s environment and washing your hands any time there is a potential exposure.

Coccidia

Coccidia are not technically a worm, but a protozoan parasite that infect dogs and cats primarily, but can be seen in other species.

Life cycle

Coccidia life cycles are complex and involve many stages of development. Coccidia produce cysts instead of larvae and eggs. Dogs and cats usually get the infection from ingesting the cysts in the environment or eating animals like mice that are already infected.

Symptoms

Symptoms usually occur in young animals and include diarrhea and abdominal pain. These young animals can become severely dehydrated and the infection can be life threatening. This is especially true in pets that are stressed or have other parasites. Many pets, especially the older ones, do not show any symptoms when infected.

Diagnosis

Diagnosis of Coccidia infection is made by identifying the very small eggs in a fecal sample. They can be very difficult to detect due to their small nature and variable shedding by a pet. This is why our doctors will occasionally treat a pet for Coccidia even though the fecal exam is negative for this parasite.

 Treatment

Sulfa type medications or sulfa and antibiotic combinations are used to affect a cure. They need to be given for up to 3 weeks.  There is also a medication that requires only 3 days of treatment. Kittens that are very ill require hospitalization and intravenous fluids to help them fight off the infection.

Prevention

Prompt removal of feces helps prevent continued environmental contamination.

Public Health Significance

A version of Coccidia, called Toxoplasmosis, is of particular significance to pregnant women since it can cause disease in unborn children. The most common source of infection for pregnant women is eating improperly cooked meat (especially pork, lamb, and venison), not necessarily from the feces of cats. In a cat that does have Toxoplasmosis, the eggs that are laid in the environment (litter pan) do not become infective until 24 hours have passed. If the litter pan is cleaned twice daily the eggs will not have time to become infective to pregnant women. Wear gloves when you change the litter pan. Better yet,have someone else clean the litter pan. When you garden you should also wear gloves since stray cats may use the soil as a litter pan. Keeping your cat indoors and not feeding it raw meat will prevent it from getting Toxoplasmosis and passing it on.

According to the Centers for Disease Control and Prevention more than 60 million people in the United States are infected with the Toxoplasmosis parasite. Few have symptoms because a healthy immune systems keeps it in check. You may feel like you have the “flu,” swollen lymph glands, or muscle aches and pains that last for a few days to several weeks. However, most people who become infected with toxoplasmosis don’t know it. On the other hand, people with immune system problems, such as those with HIV/AIDS, those taking certain types of chemotherapy, or persons who have recently received an organ transplant, and infants, may develop severe toxoplasmosis, which results in damage to the eye or the brain. Infants who became infected before birth can be born retarded or with several other serious mental or physical problems.

Giardia

Giardia are also protozoal parasites that live in the small intestines. Giarida are found every where in the world, Infection rates are variable, with younger animals having a higher rate of infection. There are various strains that differ in their potential to cause disease. The strain called Giarda lamblis (also called intestinalis or duodenalis) is the primary strain of people, companion animals. and livestock.

This parasite can be found on fecal exams of healthy pets that don’t have any symptoms. It is probably under diagnosed due to the chronic nature of the problem it presents and the difficulty of coming up with a positive diagnosis.

Giardia exists in 2 forms; trophozoites and cysts. The active and motile form, called trophozoites, are the stage which lives in the intestines of an affected mammal. These trophozoites produce non-motile cysts which are shed into the environment. The cysts remain viable in the environment for months, especially in cool and moist areas. They thrive in clear and cool water, a good reason not to drink running water in the outdoors, no matter how pristine it looks. The cysts are killed by freezing, boiling, and extended contact with disinfectants.

It is theorized that giardia make pets prone to food allergies. By interfering with the intestinal lining they let in proteins that stimulate the immune system to cause an allergic reaction.

Life cycle

The cysts in a contaminated environment are transmitted to mammals or birds upon ingestion. Gastric acid and pancreatic enzymes work on these cysts in the stomach and intestines, causing them to release 2 trophozoites. These motile trophozoites attach to the lining of the small intestine where they interfere with digestion. Within 2 weeks they encyst and are passed in the feces to contaminate the environment and await another host.

 Symptoms

In many pets there aren’t any symptoms, while in others that do show symptoms, the problem might resolve by itself. The most susceptible pets are puppies and kittens, pets with other internal parasites, and debilitated pets. Diarrhea that occurs can be severe and can be accompanied by poor appetite and dehydration. Vomiting, weight loss and blood in the stool are occasional symptoms.

Diagnosis

Giardia can be hard to diagnose because the parasite cysts become shriveled in the routine fecal solution that is used to bring eggs to the surface and adhere to the cover slip. Special fecal flotation solutions (zinc sulfate) are a more accurate manner to make the diagnosis. Cysts can be shed intermittently, so several samples are sometimes needed to make this diagnosis.

Fresh fecal samples that are not put in the fecal solution can sometimes show the parasite. We sometimes send fecal solutions to our outside lab for special tests when we suspect the problem yet we don’t find the parasite. Just like Coccidia, our doctors might treat for this disease even on negative fecal samples.

 Treatment

Flagyl is the drug routinely used to treat Giardia, although it does not cure all Giardia infections. The usual course of therapy is for 5 days, although our doctors will vary this dose depending on specific circumstances. Other medications are sometimes used if the Flagyl is not effective. There is no drug that is 100% effective against Giardia.

We recommend treating pets that are positive for Giardia even if they don’t have any symptoms. This helps eliminate environmental contamination, and helps minimize spread to people. If one pet in a household has Giardia we recommend treating all pets.

Prevention

Giardia cysts in a kennel are relatively easy to destroy with routine disinfectants, and are susceptible to drying and heat. Once an environment like a lawn is contaminated though, it can be almost impossible to eliminate this parasite.

  1. Treat all in contact animals in the household.
  2. Recommend to bathe all pets every 7-14 days with mild hypoallergenic  shampoo like Hilyte or and oatmeal shampoo.  If unable to bathe then to wipe down with separate clean damp cloths/towels once a day or once every other day especially around the anal area (please save this area for last).
  3. Wipe feet and anal area  of affected pet at least once a day especially after going outside with a clean damp cloth/towel.  OK to use baby wipes around anal area.
  4. Prevent licking on surfaces outside, prevent from eating grass, and prevent from drinking water from communal water dishes at dog parks or from ponds or ditches as much as possible.
  5. Give bottle water or filtered water or water that has been boiled.  This filters should filter out up to Giardia and Cryptococcus organisms from tap water.  Boiling the water  will kill any organisms present in the tap water.
  6. Thoroughly clean food and water dishes daily with soap and hot water and sterilize the food and water dishes weekly.
  7. Pick up feces immediately or as soon as possible.  Recommend to thoroughly clean out litter boxes daily and to disinfect and sterilize the boxes at least once a week.
  8. Once done with medications bathe all pets or at least bathe both dogs and wipe down all feline pets in the house with separate clean damp cloths/towels. Also clean and vacuum entire house and clean all bedding.
  9. Once done with course of medications please bring a fecal sample the same day or the next day that the medications are finished.  If the fecal results are negative then do another fecal analysis in 30 days post-treatment.  If the fecal results are still  positive for Giardia then will recommend to proceed with other possible causes of this persistently high infestation with Giardia i.e. immune system problems that are preventing her from getting rid of this protozoal parasite.

Good nutrition, avoiding overcrowding, general parasite control, and proper sanitation procedures are all critical in prevention. Cleaning up feces on a daily basis goes a long way to preventing contamination.

A vaccine available for dogs is very helpful in persistent infections

Public Health Significance

According to the Centers for Disease Control and Prevention, Giardia is one of the most common causes of waterborne diseases in humans in the United States. Many people get Giardia from other people and and contaminated water. Symptoms in people include diarrhea, abdominal cramps and nausea. They appear within 2 weeks of exposure to the parasite.

Exposure comes from many sources. They include swallowing water from swimming pools, lakes, rivers or streams that have been contaminated with animal or human feces. Fruits and vegetables that have not been washed (with Giardia free water!), along with accidental ingestion from hands contaminated by using toys, bathrooms, changing tables, etc., are also sources of infection. This emphasizes the importance of routine washing of hands. Boiling drinking water for one minute will kill this parasite.

We routinely treat pets with Giardia in their feces, even if they are not showing any symptoms, because of the potential for people to pick up this disease. Washing your hands frequently after touching your pet and bathing your pet frequently will help minimize exposure. We have a vaccine for dogs that do not respond to routine treatment. This will help prevent human exposure.

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Heart Disease

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The purpose of the cardiovascular system (heart and blood vessels) is to provide the cells of the body with oxygen, nutrition, and essential fluids. It also helps these same cells rid themselves of waste products, and distributes hormones and enzymes to allow for normal physiologic processes. It is even a big part of temperature regulation.All of this is no small feat when you consider the fact that the cardiovascular system must supply these needs to a body that contains billions of individual cells.

The cardiovascular system is very complicated and does not lend itself to a simple explanation and categorization of its functions. Therefore, the sections on physiology and pathophysiology are a little complex, but if you get through them it will help in your understanding when we talk about specific diseases along with their diagnosis and treatment. You may need to go through them more than once. You might notice that we repeat important concepts, and from different angles.

Hopefully this will help put it all together.You can bypass all the background information and go directly to specific diseases like HeartwormCardiomyopathy, and Valve disease, the most common heart diseases we encounter. We also have a summary page on Heart Disease if you find this page contains more detail than you need. It will give you background information but in a condensed format.

This page has actual pictures of the heart and the organs of the chest. Most people will not be bothered by their graphic nature, and will actually find them fascinating. The mechanisms of heart failure in the dog and cat are very similar to humanoids. The explanation of congestive heart failure applies directly to people in many cases. The main drugs used to treat heart failure are almost identical in people and animals.

Heart disease and its diagnosis is complicated stuff. We commonly call in our cardiologist Dr. Fred Brewer to assist in many cases. He specializes only in cardiology, and has extensive knowledge that he is willing to share.

Here is Dr. Brewer explaining heart sounds to one of our externs

Cardiology-Teaching

We work on a wide variety of species that get heart disease in addition to dogs and cats. This guinea pig has heart failure.

Cardiology-GuineaPig

This is the heart of a 50 pound dog. It is about the size of your fist. You can easily see some of the coronary arteries that supply blood to the heart muscle in the same manner that the heart supplies blood to the rest of the body.

The pericardium has been removed for better visualization

This is a ferret heart, obviously much smaller. You can see the pericardium, the layer over the heart as it is pulled away.

Rocky Walker 21218 Ferret Gastric tumor Picture of normal pericardiumThe heart starts beating before birth, and continues until death. Think of how many beats that is in the lifetime of any living organism. Lets have fun with math and play with some basic numbers:

Average heart rate in a cat- 150 beats per minute

This is 9,000 beats in one hour

This is 216,000 beats in one day

This is 78,840,000 beats in one year

This is 788,400,000 beats in 10 years.

Many cats have a heart rate greater than 150 beats per minute, and live much longer than 10 years. They will have over a billion heart beats in their lifetimes!

Later in this page we will be referring to the right heart and left heart, which might give you the impression there are two hearts. There is only one heart- we do this only because it helps to understand the flow of blood through the heart.

Glossary of heart terminology

cardiac– pertaining to the heart aerobic– dependent on oxygen for normal physiology
arrhythmia– irregular heart beat anaerobic– not dependent on oxygen for normal physiology
murmur-abnormal flow of blood through the heart valves anemia– low number of red blood cells
atrium-two of the smaller heart chambers systole– when the heart muscle contracts and ejects blood to the arteries
ventricles– two of the larger heart chambers diastole– when the heart relaxes after systole and fills up with blood
hypertrophy-abnormally thickened heart muscle ascites- fluid buildup within the abdomen
cardiomegaly- an enlarged heart pleural effusion– fluid buildup within the thoracic cavity
pulmonary edema– fluid buildup within the lungs polycythemia- excess number of red blood cells
myocardium– the heart muscle microcardia– a small heart

We will repeat this terminology throughout this page to help you eventually get your Latin down pat. Just as it starts making sense we will add more later!

Follow the links to continue on with our heart page:

Vascular Anatomy & Physiology

Heart Anatomy & Physiology

Causes and Symptoms of Heart Disease

How We Diagnose Heart Disease

Cardiac Diseases and Treatments

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How to Read a Radiograph (X-Ray)

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This is a fun section designed to test your diagnostic abilities. Periodically we will show new x-rays (the proper word is radiograph) for you to test your skills, so remember to come back and see what new rads (that is the slang word we sometimes use) are posted on our site.

Before we get started, lets get some basics out of the way. There are five radiographic densities:

Soft tissue– internal organs like the liver and kidneys with a whitish color

Fat– the fat around the internal organs, also with a whitish color. Without this fat you would not be able to differentiate the different internal organs like the liver or kidneys, since they are soft tissue, and have the same radiographic density.

Air– this is black, and is what you see for the lungs in a chest radiograph

Bone– which is brighter than soft tissue or fat

Metal– Vivid, very bright, and hard to miss

Look at each x-ray closely (sometimes very closely) and see if you can figure out what is wrong. We have a couple of clues to help you make an interpretation:

  • Use symmetry when you can. Compare both sides, legs, or whatever else that might be useful.
  • Pull your face away from the screen and scan the whole x-ray before you jump into the details.
  • After you have scanned the whole radiograph look very closely for subtle changes.

First we will show a bunch of fun radiographs of the more unusual pets we see at our hospital. After that we will do some radiograph reading lessons, teaching you about the normal anatomy of dogs and cats. After that is a little test to see how you did. We will stick to abdominal radiographs for the test to make it easier. Good luck, and have fun!

Exotic Animal Radiographs

These first few rads are for a little fun, and to get your eyeballs warmed up for later.

Pregnant Guinea Pig

Iguana bladder stones. Click here to see the surgery to remove a bladder stone in an Iggie. 

Female rabbit with mummified fetuses that are several months old

California Desert Tortoise (CDT) with eggs

Two white bladder stones in a Guinea Pig

 

Normal hawk from our Wildlife Care Program

Calcium sludge in the bladder of a rabbit. This is called hypercalciuria, and you can read our detailed page on it

Did you also see the microchip and the calcium in the kidney?

Chinchilla incisor and molar teeth

 Snake with eggs

Rabbit with a fluid filled uterus

Do you see the two pellets in this hawk’s wing?

Did you also see the fracture in this wing? How should this be handled? You can see what we did in our Wildlife  Care Page

Normal X-Rays of dogs and cats

This is a radiograph of the abdomen of a normal cat that is laying on its right side. The head is towards the left. Use the diagram below to identify the organs.

The stomach has food in it, and the large intestine contains feces. All five radiographic densities are present in this abdominal radiograph. Do you see all of them? 

Air- is in the lungs along with gas in the intestines

S.T. -soft tissue is the liver and kidney

Fat- this is abdominal fat

Bone- lumbar vertebrae

Metal- the R marker to indicate this cat is laying on its right side is made of metal

Here is another normal cat abdominal radiograph, this time with an empty stomach

Here is another one, this time with the spleen and metallic sutures from a spay.

You can easily see the liver (L), stomach (S) kidneys (K) , the small intestines (SI), the large intestine (LI), the urinary bladder (UB), and the Spleen (Sp). The arrow points to stainless steel sutures in the muscle layer from a spay operation.

Abnormal X-Rays

This dog is having a difficult time urinating. Can you tell what is wrong?

Look towards the right side of this abdominal radiograph

Does labeling the organs help in your diagnosis?

The bladder is huge, because this dog is having a difficult time urinating. It is probably due to nerve dysfunction, since the spinal cord has changes called spondylosis. The circle points this out on one of the vertebrae

You can learn more about this problem, called spondylosis, from our arthritis page

This is a dog abdominal radiograph. Notice anything unusual?

Again, look towards the right side

You can see the circle around the numerous stones (called calculi) in the urinary bladder

Did you also notice the stones in the kidney and pelvic urethra?

Our web page on bladder stones has lots of good information

This cat is labeled for you. Anything fishy?

Look towards the left side of the radiograph this time

Did you see the pellet in the neck? Look again at the radiograph above, its plain as day.

Now that you are an expert at reading radiographs give the following one a try. It is from a cat that is straining to urinate and has blood in its urine. The answer is below, along with a picture with arrows pointing to the abnormalities.

This cat has 2 stones in its urinary bladder (click here to learn more about them and see a surgery of how they are removed). The stones are radiopaque, which means they show up easily on the radiograph. Some bladder stones are radiolucent, and can only be seen by injecting dye or air into the urinary bladder.

The arrows point to the bladder stones, along with the faint metallic sutures from a spay

Pretty easy so far, huh? Don’t get too confident just yet, our next few are a little harder. Look over the next few abnormal radiographs and send us an e-mail with your answer. If you aren’t sure and just need some clues e-mail us also and we will help you. Good Luck!

Abnormal X-Rays

Now that you are experts at reading x-rays, you can put your newfound skills to work. Email us at vet@lbah.com for the answers.

  1. What do you think about this cat radiograph?

2. This radiograph is an abdomen view from a very sick dog. It is 13 years old and losing weight

 

3. This is from an elderly dog that is losing weight

3. This dog is limping on its rear leg

 

 

 

 

 

 

 

 

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Home Care of the Surgical Patient

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When you pick up your pet after surgery you will be given a chance to talk with our staff or surgeon, and be given post operative instructions specifically for your pet and the surgery performed. These are the instructions to follow. The information on this page is good general information on other things to do at home, as long as they don’t contradict your post operative instructions.

When your pet first returns home from surgery let it have a calm and quiet spot away from other pets and children. Put it in a warm area without any drafts, and make sure it is able lay down on something comfortable.

It might be lethargic from anesthesia and the pain medication it has received, which is what we want so that it is comfortable and does not bother the incision site.

After it is home and settled, offer a small amount of water. Even though most pets are fasted prior to surgery, at our hospital they are give intravenous fluids before, during, and after surgery, so do not worry if your pet does not drink initially.

If it drinks, and does not vomit, offer small amounts of water periodically over the next several hours, and then offer small amounts of food the same way. Give it a chance to go outside to the bathroom several times.

Use all medication, especially pain medication, as directed. What might seem like pain can sometimes be confusion after the day’s activities and surgery. It is rare for a pet to be painful after surgery. We take special precautions so that does not happen. Some of these precautions include:

Preanesthetic pain patch and sedation

Local anesthetic at the surgical site

Laser surgery

Post operative pain injection

Post operative pain medication at home

We go overboard on pain control, and in addition to all the pain medications already mentioned, we use the cold laser to minimize swelling and post operative pain at the incision site while your pet is still under anesthesia. This cat is getting this treatment after its spay (OVH) surgery

Here it is in action after a dog neuter

 Indications that your pet is in pain include:

Crying

Excess panting

Unable to find a comfortable place to sit or lay down

If your pet seems painful several hours after returning home please call us. Our anesthesia page has more on pain control and the precautions we take to minimize pain.

Many pets will go home with an E-Collar (Elizabethan Collar) to prevent them from licking or chewing at the incision site. Leave this collar on at all times until sutures are removed, unless you are in direct supervision. Some people take the collar off after a few days when healing is progressing well and the collar seemingly is not needed. This coincides with the itchy phase of the healing process, and pets can cause damage to the incision, or worse.

IMG_7070

Make sure you put your E-Collar on your pet and not on yourself!

Observe the incision site several times per day. A minor amount of redness and swelling is usual. If it seems excessive call us and we can check it if necessary.

 

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