Encyclopedia of Veterinary Medical Information Page

Please do not use our site to attempt to diagnose or treat your pet. Your veterinarian is the best source of health advice for an individual pet.

Remember that veterinarians often disagree about the best treatments for pets. There are often several perfectly acceptable ways to treat the same condition. Just ask a lot of questions!

Encyclopedia of Veterinary Medical Information
(Index coming soon)

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

A

Acepromazine
Acepromazine is one of the most commonly used tranquilizers in veterinary medicine. It is a phenothiazine compound. Its mode of action is only partially understood but it involves blockage of dopamine nerve receptors in the brain. It causes tranquilization and also has an anti-emetic effect. This makes it especially useful for treating car sickness, since that is often a combination of fear and motion sickness in dogs.
The recommended dosage for acepromazine is 0.25mg to 1mg per pound of body weight. In most cases it is not necessary to use the higher dosages. That is not true for use in trying to control fear based aggression. Acepromazine is considered to be very safe. The average toxic dose is significantly higher than the recommended dosage (at least 20 times the dose). Despite this, acepromazine does have some significant effects that must be considered. It can cause hypotension (lowering of blood pressure). This effect may be exaggerated in Boxers and there have been anecdotal reports of death of Boxers after the use of acepromazine. In addition, acepromazine seems to make it easier for dogs with seizure disorders to have a seizure. This medication should not be used near the time of dipping or treatment with organophosphates for flea control.

Acepromazine doesn't have any pain-killing effects. Many dogs seem to be able to will themselves to overcome its effects, at least temporarily. This makes it less than ideal as a drug for dealing with aggressive or fearful dogs but there have not been better alternatives for medicating prior to the visit. It works often enough that many vets will try this approach first. We do this when we think it has a chance of helping make an office visit go easier. We just remember to continue to be very careful when examining the dog.

Acne
Dogs can get acne, too. Typically it shows up as bumps on a dog's chin that resemble those seen with acne in people. In some cases, this can be the result of allergic reactions. Plastic food bowels may be a source of these reactions in some dogs. Demodectic mange, immunosuppressive disease, drug reactions and trauma are other possible underlying causes.

Canine acne usually occurs on the chin of affected dogs. It resembles acne in humans and it tends to occur in a similar pattern, showing up in adolescence and continuing into adulthood in a small percentage of dogs. Short coated dogs, such as boxers, bulldog and Doberman pinschers are most commonly affected. Usually this is a minor problem but some dogs can develop significant infections.

It is necessary to appropriately treat any underlying disease in order to succeed in eliminating the acne long term. Most cases of canine acne can be controlled.

Mild forms of acne may just appear as reddened bumps on the skin. More severe cases may have larger hard lumps, sometimes associated with a draining tract.

It is not always necessary to treat acne. When it becomes a problem, it will often respond to treatment with a shampoo containing benzoyl peroxide. Dogs may be sensitive to gels or shampoos containing greater than 2.5% benzoyl peroxide. In really severe cases, antibiotic treatment lasting several weeks or even short term treatment with corticosteroids may be necessary.

Acral Lick Granulomas
Acral lick granulomas are a common problem in dogs. There are a number of treatments that have been advocated for this problem, mostly because none of them is consistently successful in eliminating all cases of lick granuloma.

Lick granulomas can occur secondary to allergies -- in this case, treatment for the allergy is often successful. It is a good idea to consider allergy testing in dogs with persistent lick granulomas or recurrent ones. The standard treatments for allergies are itch control medications or hyposensitizing "allergy shots". Skin testing is the most accurate way to diagnose allergies. Veterinary dermatologists frequently do this. Blood testing for allergies is considered to be less accurate but can be substituted when skin testing is hard to arrange.
Acral lick granulomas can occur secondary to injuries, underlying bone infection (this is a tricky diagnosis because the persistent licking can lead to periosteal inflammation around the bone making it seem like an infection was the cause), bacterial skin infection, parasites and other physical causes.

These lesions are thought to be due to stress or boredom in some dogs and even to be an obsessive/compulsive disorder in others.

So the first step in treatment is to do a thorough examination for an underlying cause. If one can be identified, it should be treated. If a bacterial infection is suspected antibiotics must be used for at least 6 to 8 weeks. If an underlying cause can not be found then the lick granuloma itself should be treated. There are a number of ways of doing this. Topical treatment with a combination of Synotic and Banamine has been advocated. Local anesthestic preparations like DermaCool or Relief can be helpful. Application of aversives like bitter apple or chloramphenicol ophthalmic ointment is sometimes done. Bandaging or using a sock to cover the lesion helps in some cases. A good adjunct to this type of therapy appears to be administration of hydrocodone to cut down on the irritation and/or fill the need for endorphins that the dog may be experiencing.

The psychological cases can respond to simple changes in environment (reducing stress or boredom). In more difficult cases, amitriptyline (Elavil), naltrexone (Trexane), clomipramine (Anafranil) and fluoxetine (Prozac) have been advocated. Acupuncture is reported to work well in some dogs, anecdotally.

For really desperate situations, radiation therapy, casts over the area, cryosurgery, and surgical excision have all been attempted.

TThis condition is frustrating and often will take several approaches to find the one that will work. Keep working with your vet to find a solution to the problem for your dog.

Addison's disease (Hypoadrenocorticism)
Addison's disease is also known as hypoadrenocorticism. It is an insufficient production of adrenal hormones by the adrenal gland. Since these hormones are essential for life, this is an extremely serious disease and it must be treated as such.

Adrenal insufficiency can be primary or secondary. Primary adrenocorticism affects salt/potassium balance in the body and glucorticoid as well. Secondary adrenocorticism usually only affects the glucocorticoids. It is not known why primary adrenocorticism occurs but it may be an immune mediated process. Secondary adrenocorticism probably occurs most often when prednisone or other cortisone being administered for medical reasons are suddenly withdrawn. It can occur as a result of pituitary cancer or some other process that interferes with production of hormones that stimulate the adrenal glands.

Most dogs with Addison's disease initially have gastrointestinal disturbances like vomiting. Lethargy it also a common early sign. Poor appetite can occur as well. These are pretty vague signs and it is extremely easy to miss this disease. More severe signs occur when a dog with hypoadrenocorticism is stressed or when potassium levels get high enough to interfere with heart function. Dogs with this problem will sometimes suffer severe shock symptoms when stressed, which can lead to a rapid death. When potassium levels get high heart arrythmias occur or even heart stoppage which also is fatal. In some cases, especially secondary Addison's disease, there are no detectable electrolyte changes.

This disease can be picked up by changes in the ratio between sodium or potassium by accident at times. When this happens it is still extremely important to treat for it. It is confirmed by an ACTH response test -- administration of this hormone should stimulate production of adrenal hormones. If this does not occur then hypoadrenocorticism is present. In cases in which the electrolyte levels are normal this is the only test for the problem and it will be missed unless it is looked for specifically. At times this disease can be hard to differentiate from renal failure because the symptoms and even the bloodwork can be similar ---- so the ACTH response test may be necessary to differentiate them.

Treatment for this disease is usually done by oral administration of fludrocortisone acetate (Flurinaf), salting the food, and administration of corticosteroids like prednisone. In a crisis situation this disorder must be treated more aggressively with intravenous fluids, IV glucocorticoids and correction of acid/base balances.

You have to pay close attention to a dog with this problem. Don't ignore any changes in appetite, GI disturbances or anything else that makes you think your dog is ill. If you work with your vet and are careful about following his or her directions this disease has a good prognosis when it is discovered before a crisis occurs./p>

Adenovirus Type 2
This virus causes a form of kennel cough and also protects against hepatitis in dogs. This is fortunate because there were more vaccine reactions using the hepatitis virus itself , even in a weakened state. While viral hepatitis is not as common as it once was in dogs, it has not been eliminated as a threat.

Anemia
AAnemia is the condition in which there are fewer red blood cells than normal. Hemolytic anemia describes the condition in which this loss of red blood cells occurs because the red cells break up (lyse). This can happen inside the blood vessels (intravascular hemolysis) or outside of the blood vessel (extravascular hemolysis). Hemolytic anemia can occur for many reasons, including heat stroke, parasites, viral infections. toxins and other conditions. One of the things that can cause hemolytic anemia is immune system disease --- in this case the disorder is known as immune mediated hemolytic anemia (IMHA). This is the term currently preferred for the condition formerly known as auto-immune hemolytic anemia (AIHA). The reason for the subtle name change is the recognition that much of the time the immune system really is attacking an invader -- it just happens to be one that is stuck on the red blood cell so both get destroyed.

Anemia occurs for a number or reasons but they break down into two major categories. Either blood is not being made in the first place (nonregenerative anemia) or else it is being destroyed in some manner even though it is being made by the body. If the destruction outpaces the production, anemia occurs.

Kidney failure, bone marrow disorders, some cancers, some toxins, inherited disorders, ehrlichiosis, drug reactions and iron deficiency can all lead to non-regenerative anemias.

Liver failure, heat stroke, iron deficiency, trauma, immune mediated hemolytic anemia, drug reactions, babesiosis, hemobartenollosis, inherited hemolytic anemias, intestinal parasites (hookworms, esp.) and bleeding disorders (such as von Willebrand's disease) can all lead to regenerative anemias. Even severe flea infestation can cause significant anemia in young dogs.

Autoimmune hemolytic anemia (AIHA) Immune or Mediated Hemolytic Anemia (IMHA)
In hemolytic anemias, a loss of red blood cells (rbcs) occurs due to destruction of the rbcs. The destruction occurs due to antibodies which stick to the the rbc and cause the body to react, leading to destruction of the cell. This can be the direct result of a drug, toxin, blood parasite, virus or other primary cause or it can be an unexplained immune mediated reaction. It can occur inside the blood stream (intravascular hemolysis) or outside the bloodstream (extravascular hemolysis). In most cases in dogs, hemolysis occurs outside the blood stream in the spleen, liver and bone marrow. The destruction of red blood cells often leaves recognizable cellular debris in the blood stream. In particular, a form of damaged rbc known as a spherocyte occurs. Finding spherocytes on a blood smear almost guarantees that some form of hemolytic anemia is occurring. It does not really give a clue as to whether the IMHA is due to a primary cause or if it is occurring for no apparent reason, though. Since this disorder does not stop the production of red blood cells, there are usually immature red blood cells in the bloodstream which can be detected on the blood smears as well (a regenerative anemia).
The mechanism by which the immune system mistakes red blood cells for a "foreign invader" varies somewhat according to the cause. It usually involves adherence of the offending agent (parasite, drug, toxin, etc) to the surface of the rbc. The immune system wishes to attack this agent but manages to injure the rbc as well.
Dogs with IMHA usually experience a sudden onset of clinical signs, including depression, lethargy, pale gums or conjunctiva, sometimes jaundice or a heart murmur and bruising. Vomiting or abdominal pain may be present. It is unusual for overt blood loss to occur, such as nose bleeds or excessive bleeding from a minor injury. Death can occur rapidly, even with appropriate treatment.

Whenever hemolytic anemia is present it is wise to carefully rule out initiating causes that might be treatable. Examples of problems that can lead to hemolytic anemia include ehrlichiosis (a blood parasite), reactions to sulfa antiseptics or penicillin antibiotics, zinc toxicosis -- which can occur due to the ingestion of pennies. If any of these problems can be identified and treated the prognosis is much better.

The combination of clinical signs and spherocytes on a blood smear give a strong indication of this condition very rapidly. It can be confirmed using a Coomb's test to check for antibodies adhered to red blood cells. This test is usually done at body temperature and at a colder temperature (4 degrees Celsius). A small percentage of dogs that have IMHA will not test positive on the Coomb's test.

This condition will often respond well to very high doses of corticosteroids, such as prednisone. These medications suppress the immune system, allowing the rbcs to escape destruction. Improvement usually occurs within 1 to 3 days, if the dog is going to respond. If signs of icterus (jaundice) are present, the prognosis is usually worse. Dogs with this symptom may benefit from very aggressive treatment with anticoagulants and cyclophosphamide, a potent immune system inhibitor. Blood transfusions can be used in dogs with IMHA if necessary but they can make the condition worse so most vets reserve this approach for dogs that appear to be in imminent danger of dying due to severe anemia. It is necessary to treat most dogs for a fairly long time to prevent recurrence of the disease and some dogs seem to require lifelong use of corticosteroids or other immunosuppressants. Splenectomy is done in resistant cases since it is a major site of red blood cell destruction.

The Basenji, West Highland White terrier, English springer spaniel, Alaskan malamute, poodle and beagle breeds can be congenitally predisposed to this condition due to defects in enzymes (such as pyruvate kinase) or in the red blood cells.

Bordetella
Bordetella is the most common cause of tracheobronchitis (kennel cough) in dogs. It is a bacterial illness that is most common among dogs that congregate at things like shows, kennels or other places frequented by large numbers of dogs at once. It does not appear that this bacterin gives a full year of immunity in many instances. For dogs that are often exposed to situations in which the infection is likely probably should be vaccinated twice a year. There are intra-nasal as well as subcutaneous bacterins available for this disease. The intra-nasal bacterin confers immunity more quickly but the injectable version may last longer.

Brucellosis
Brucellosis is a disease caused by a bacteria, Brucella canis. It is found throughout the world. It is spread through contact with aborted fetuses and discharges from the uterus of infected bitches, during mating, through maternal milk and possibly through airborne transmission in some cases. The bacteria enters the body through mucous membranes and spreads from there to lymph nodes and the spleen. It also spreads to the uterus, placenta and prostate gland as well as other internal organs at times.

In female dogs, infection leads to abortion or early death of infected puppies. Infected females may have no other clinical signs. In some cases there may be decreased fertility rather than abortion. This may be due to resorption of fetuses early in their development.

In male dogs, infection of the testicles can lead to infertility due to anti-sperm antibodies developed as the body attempts to fight off the bacterial infection. The testes may atrophy after the initial period of swelling. Scrotal enlargement or infection of the skin over the scrotum may be seen.

In both female and male dogs there may be infection of spinal discs (diskospondylitis) which can cause back pain and rear leg weakness or even paralysis. Eye inflammation may be seen in either sex.

It is not usually possible to culture Brucella canis bacteria from the blood or affected tissues so diagnosis is usually done by titer testing. There is a kit available to veterinarians for testing in their office. It is usually best to retest any dogs found positive on this test with other testing methods since there is a fairly high rate of false positives using the in-house test kit.

Brucellosis is very difficult to treat successfully. A combination of minocycline and streptomycin is thought to be most effective but is expensive. Tetracycline can be substituted for the minocylcine to reduce costs but also lowers the effectiveness of treatment. All infected animals should be neutered or spayed to prevent sexually related transmission. All infected animals should be considered to be lifelong carriers of the disease, even if treated.

It would probably be best not to breed dogs without testing both the male and female for this disease. Breeding should be a deliberate choice -- not a random event! For breeding kennels, routine isolation of new dogs would be a very good idea. After isolation and negative tests at entry into the kennel and one month later, it should be safe to let the new dog mix with the others in the kennel. If infection is suspected at any time, quaternary ammomium (like Roccal Rx) and iodophor (Betadine Rx) disinfectants can kill Brucella organisms in the kennel to limit spread of the disease.

One last thing. It is possible that brucellosis caused by Brucella canis may be a zoonotic disease -- meaning that people could potentially be infected by this organism. It is something to think about when handling infected dogs. Wear gloves around any body fluids and be careful about contaminating yourself in any way.

Car sickness
Dogs generally become sick in the car because they are frightened, not because they have real motion sickness. It is necessary to reassure your dog that these fears are groundless (which might be hard depending on how you drive). You need to get your dog used to the car by taking trips that are short enough that your dog does not exhibit the typical signs of car sickness- drooling, vomiting, etc. It may be necessary to start out by just sitting in the car together and giving your dog a treat after a few minutes. Then take very short rides followed by a treat - even if you can only make it to the end of the driveway. Gradually increase the length of the trips until your dog enjoys the car rides.

If you don't want your dog in the car, but find it necessary on occasion, you can use tranquilizers to control the nervousness with good success in most dogs. Your vet will have one that works well for him or her.
Some dogs really have motion sickness. It is possible that dramamine will work in these dogs but even in these dogs tranquilizers like acepromazine that also have anti-emetic properties usually work well.

Cataract Surgery
In the past, veterinarians waited for near blindness in both eyes before attempting cataract surgery. I am not sure of the reasoning behind this, but feel that it had a lot to do with the success rate of the surgery. In the past (prior to 1969), the success rate for cataract surgery was generally believed to be poor. Consequently, if the dog had any vision at all, its chances were just as good with or without surgery for long term vision. At this time, it is felt that the long term success rate is 90% or better for cataract surgery, if the patient is carefully selected. A cataract can be a source of visual problems in other areas of the eye if it is left alone -leakage of proteins from the lens can lead to inflammation in the eye, which can lead to glaucoma, which makes removal of the lens (cataract) much less likely to succeed. So currently, the recommendation is to remove the affected lens as soon as significant visual deficit is present. However, there are some criteria for deciding if your dog is a good surgical candidate that you might want to consider:

   1. You must be willing to spend a significant amount of money AND provide a significant amount of aftercare!
   2. Any inflammation present in the eye must be controlled PRIOR to surgery.
   3. The retina should be evaluated prior to surgery to make sure it is functioning - the surgery may not be justified if your dog will not be able to see when it is over.
   4. No other disease can be present in the eye.
   5. Your dog must be cooperative about being handled and medicated. If not, the outcome of the surgery is seriously jeopardized. Be honest with yourself about this.
   6. Your dog should be in good health. If your dog and you are good candidates for this surgery, it is worthwhile.

Cerebellar Hypoplasia
The cerebellum is the portion of the brain responsible for the control of motion. When a puppy or kitten is born with an underdeveloped cerebellum, the condition is known as congenital cerebellar hypoplasia. There are infectious causes of this condition in both cats (panleukopenia infection prior to birth) and dogs (herpes virus infection prior to birth). Improper development of the cerebellum may occur due to injury, poisoning or just from an accident in development in the uterus. It is generally possible to see signs of this condition almost as soon as the puppy or kitten is born. Affected animals have tremors and unusual jerky movements or may fall down when they try to move. The symptoms do not get worse as they age. As the kitten or puppy grows it will learn to compensate for its condition but there are usually lifelong signs of a decreased ability to coordinate movement. Almost all dogs and cats with congenital cerebellar hypoplasia can live happily as pets with a little special care to compensate for their disabilities. This condition can be confused with cerebellar abiotrophy, a different disorder in dogs in which the puppy has a normal cerebellum at birth but it gradually dies. Signs of disease identical to cerebellar hypoplasia occur but the timing is different. Puppies with this condition seem normal at birth but usually start to show signs of problems after they are 2 months or more of age.

Chocolate toxicity
Chocolate contains a xanthine compound, theobromine, that is toxic in sufficient quantities. Examples of other xanthine compounds are caffeine and theophylline. The toxicity from all of these compounds is similar.
It takes a fairly large amount of chocolate to cause problems. In "The Handbook of Small Animal Practice" by Dr. Rhea Morgan, the following data is given:

The toxic dose of theobromine is about 100 to 150mg/kg

Milk chocolate contains 6mg of theobromine per ounce. Semi-sweet chocolate contains about 22mg/oz. and baking chocolate about 35 to 45mg/oz.

From this it is pretty easy to see that milk chocolate poses only a minor threat while the other forms of chocolate can be a bigger problem.

Xanthines affect primarily the central nervous system, the cardiovascular system and peripheral nerves. There is a diuretic effect as well. So the sign seen with toxicity include hyperexitablility, hyper irritability, increased heart rate, restlessness, increased urination, vomiting and muscular tremors or tenseness. Under some circumstances these signs can lead to secondary problems like hyperthermia. In severe cases, seizures or cardiac arrest can occur. Death can result from severe intoxication.

There is no specific antidote for this poisoning. Inducing vomiting can help if the ingestion is known and has occurred within one to two hours. Administration of activated charcoal may inhibit absorption of the toxin from the digestive tract. It may be necessary to use medications to control the effects of the poisoning, especially seizure control medications, oxygen therapy, intravenous fluids, and medications to control the effects on the heart.

With ingestion of milk chocolate, diarrhea is a common secondary problem. This may require therapy and often occurs 12 to 24 hours after eating the chocolate.

If you suspect chocolate poisoning and your dog or cat is showing clinical signs of the problem, it is important to contact your vet.

Chronic immune mediated keratoconjunctivitis sicca (CIKS)
Chronic immune mediated keratoconjunctivitis sicca (CIKS) is the newer name for pannus. It is most common in German shepherds, greyhounds and Siberian huskies. The cause of this condition is not known, at present. This may be an immune response to changes brought on by ultraviolet radiation. This is based on the increased prevalence of the disease at higher altitudes. Usually immune mediated CIKS starts at the outer edges of the cornea as blood vessel infiltration and then pigmentation of the cornea. As the disease progresses it spreads across the cornea to the nasal side of the eye and blindness can result from the condition. The third eyelid may become thickened and depigmented, which makes the eye look even worse. If the disease appears early in life (less than 2 yrs. old) it has a tendency to be very severe as it progresses. When it shows up later in life (4 to 5 yrs. or older) it usually is less severe. CIKS can be controlled with medical therapy, usually very successfully. It can not be cured, however. Medication is necessary lifelong for dogs with this condition. In areas of low elevation, it is usually possible to treat this with corticosteroid eye drops. In severe cases, injections of corticosteroids into the tissues surrounding the eye can be necessary. In areas of higher elevation it can be necessary to go to much greater lengths to control this problem. Irradiation of the cornea, surgical removal of the affected areas of the cornea and other measures may be necessary to provide relief from this problem.

Coomb's test
A Coomb's test is a test for antibodies or complement (another protein/enzyme that works with antibodies) attached to the surface of red blood cells. It is possible to do a general test for these without knowing the specific antibody due to similarities between most of the antibodies that attach to red blood cells.

When a bacteria, a drug or anything else attaches itself to red blood cells (rbcs) the body tries to attack it with antibodies as it would if it wasn't attached to rbcs. This can lead to lysis of the red cells, which is usually referred to as immune mediated hemolytic anemia (IMHA). So a positive Coomb's test indicates a strong possibility of IMHA. This test can also be positive for other reasons, including ehrlichia, demodecosis and severe infections. It is possible to have a negative Coomb's test and still have IMHA, as well.

Even though the most commonly run Coomb's test is kind of a general screen, it is possible to test for specific types of antibodies, if desired. Sometimes this helps in establishing a prognosis if IMHA is suspected.

Coprophagia
Coprohagia is the technical term for eating feces. This has been studied in dogs by several people with no definitive answer for "why" being found.

Nutritional deficiencies may be present in some dogs, but not very many. This may be boredom related in many dogs. It has some "natural" roots in the fact that dams often eat their pup's stools, apparently as a method of hiding their presence from predators. Dogs will eat the stools of other species, especially cats and rabbits, too. Dogs obviously do not find the taste of feces objectionable or the behavior would be self correcting. So I think of this as a natural behavior that upsets people. Since dogs have to live with people, it is becomes an issue. There is a product sold that is supposed to help with this habit -- Forbid. It doesn't work in all cases (it might not even work in most cases). Another alternative is putting meat tenderizer in the dog's food. This works for some dogs. Walking a dog on a leash and working hard to keep it from turning and eating its stool is helpful. It is sometimes possible to distract the dog by running a short distance after the dog has a bowel movement or by taking a couple of rapid steps then telling the dog to "sit" and giving it a treat. These behaviors may stay on as substitutes to eating the stool. If you can keep the dog from eating stool for a month or so it is sometimes long enough to break the habit. Picking up stool to prevent its ingestion works in dogs that don't quickly eat their own stool but do so when put in the yard alone. "Booby trapping" a sample of stool by cutting it in half lengthwise, and putting some Tabasco type sauce on the inside of the stool, then putting it back together so that the dog is not aware of the hot sauce until it eats the stool can help in some cases. This can be a hard habit to break.

Coronavirus Vaccination
Coronavirus may cause viral diarrhea and may make fatality from parvovirus more likely if the infections occur concurrently. On the other hand, this virus causes minimal damage to the intestines and may not cause clinical illness on its own. It just depends on whose studies you believe. Personally, I do not recommend the use of coronavirus vaccine.

Craniomandibular Osteopathy
Craniomandibular osteopathy is a disorder that occurs in young dogs, primarily terriers. The most commonly affected breeds are West Highland White Terriers, Scottish Terriers and Cairn Terriers. It has been recognized in other terrier breeds and in Boxers, Labs, Great Danes and Dobermans. It usually shows up before 10 months of age.

Excessive bone development occurs along the mandible (jaw) and the temporal region. Affected dogs have difficulty chewing and swallowing and may drool as a result of this. There can be great pain on opening the mouth but some dogs do not seem as pained as others. There is often fever accompanying this disorder. Weight loss can occur from the difficulty in eating. Atrophy (shrinking) of the muscles over the head and jaw areas can occur. X-rays show excessive bone production, sometimes very severe.

Cushing's Disease or Hyperadrenocorticism
Cushing's disease is probably more accurately referred to as hyperadrenocorticism -- the production of too much adrenal hormone, in particular corticosteroids. It can be naturally occurring or due to over administration of corticosteroids such as prednisone (iatrogenic Cushing's). The latter is easy to cure - just cut out the corticosteroid administration slowly to allow the body to return to normal function. The former is more difficult.
Hyperadrenocorticism occurs for two reasons --- a tumor of the adrenal gland that produces adrenal hormones or stimulation of the normal adrenal glands from the hormones that control it. The primary reason for this to occur is a pituitary gland tumor that produces excessive ACTH, which stimulates the adrenal gland to produce corticosteroids. Adrenal gland tumors account for 15% of the cases of spontaneous hyperadrenocorticism. Pituitary tumors account for 85%.

Cushing's disease causes increased drinking, increased urination, increased appetite, panting, high blood pressure, hair loss - usually evenly distributed on both sides of the body, pendulous abdomen, thinning of the skin, calcified lumps in the skin, susceptibility to skin infections and diabetes, weakening of the heart and skeletal muscles, nervous system disease and other symptoms. Most owners reach a point where the water consumption and urination become bothersome to them.

The diagnosis of Cushing's can be done with several blood tests. A general hint of Cushing's can be obtained by a blood panel. To confirm it, a test known as a low dose dexamethasone test is done. A baseline blood sample is drawn in the morning, an injection of dexamethasone given and a follow-up blood test done 8 hours later. In a normal dog, the dexamethasone should suppress cortisol levels in the blood stream. In Cushing's disease this effect does not occur. Once the disease is diagnosed, it is possible to differentiate between the adrenal tumors and pituitary gland tumors using a second test, a high dose dexamethasone suppression test. Most dogs with pituitary tumors will have cortisol suppression on this test. There are other tests used, including ACTH response tests and urine cortisol/creatinine ratios to diagnose this disease. X-rays and ultrasonography can help determine if an adrenal gland tumor is present.

If it can be determined that there is an adrenal gland tumor, it can be removed. Many veterinarians prefer to have a specialist attempt this since the surgical risks can be high. Pituitary gland tumors are not usually removed in veterinary medicine. This situation is treated using Lysodren (o'p'-DDD, which is a relative of DDT) or ketaconazole. Some research with Deprenyl for treatment of this is being done, too, I think. Lysodren selectively kills the outer layer of the adrenal gland that produces corticosteroids. By administering it in proper amounts it is possible to kill just enough of the gland off to keep the production of corticosteroids to normal levels. Obviously, close regulation of this using blood testing is necessary since overdoing it can cause severe problems with Addison's disease - hypoadrenocorticism. Adverse reactions to Lysodren occur at times but it is the standard treatment at this time. Over medication with Lysodren can cause inappetence, vomiting, diarrhea, lethargy and weakness. If any of these signs occur then your veterinarian should be immediately notified.
Treatment of Cushing's disease caused by pituitary tumors is symptomatic therapy -- it does not cure the pituitary tumor. The average lifespan of dogs diagnosed with Cushing's, with or without treatment is estimated at 2 years by Dr. Mark Peterson, but in a recent conversation with another endocrinologist I came away with the impression that this was an "educated guess" rather than the result of extensive survey of Cushing's patients. At present, though, I think that treatment should be viewed as a means of providing a better quality lifestyle rather than as a method of extending longevity.

Diabetes Control
Diet is an integral part of the treatment for diabetes. It is important to feed a maintenance diet which meets your dog's individual caloric needs and varies as little as possible. For a dog receiving insulin two times a day, the optimum feeding schedule is to feed four meals a day. One at the time of each insulin injection, one in the early afternoon and one in the late evening. It is probably best to feed a high carbohydrate, medium fiber diet. You can just add fiber to your dog's normal dog food using a fiber source such as psyllium (Metamucil), pumpkin pie filling or other fiber source. There is some difference between fiber sources (soluble vs. insoluble) and how well they work, but it may not be clinically significant. Or you can buy a commercial food containing the proper quantities of fiber. Some of these foods are Prescription Diets w/d, Science Diet Maintenance Light, Theradiet Reducing (dry), Purina Fit and Trim, Purina Dog Chow - Low Calorie Formula and Cycle 3 Light (canned). The canned version of Theradiet Reducing may have more than the optimal amount of fiber and this is also true of Prescription Diet r/d. These food vary in fiber content but no one knows for sure what the optimum amount is.
There are a lot of different recommendations on how to start insulin therapy (dosages to start with) so it is entirely possible that your vet chose a starting value that falls within one of the recommended ranges in the literature. We usually use about 0.25U per pound of body weight as a start but I have used up to 0.5U per pound in situations in which it seemed necessary to gain control of the situation as quickly as possible.

We think that most clients with dogs can learn to draw blood using the devices that come with glucometers and recommend that owners of diabetic animals purchase a glucometer. We usually recommend spot checking the blood glucose the first two to three days after starting insulin and then running a "glucose curve" after that.
A glucose curve is simply a plot of the blood glucose level over the course of an entire day. By taking blood samples and measuring blood glucose at 2 hour intervals for 6 to 8 (or even 12)samples during the day it is possible to get an idea of the effect of the administered insulin. Often it is possible to identify a problem such as overadministration of insulin, which results in very low glucose levels part of the day and very high "rebound" levels another part of the day. The more "level" the curve is during the day, the better. For us, this is the best way to fine-tune the insulin levels. Most of the time our clients catch on to what we are looking for very quickly and do most of the fine tuning themselves.

Not all pets will allow collection of blood easily. For these pets, the glucometers are not useful. It is a real challenge to try to stabilize a diabetic animal using information gathered at long intervals. It is expensive for the owners if we try to do the blood glucose curves too often. Getting the timing of when to do these down is one of the challenges of diabetes regulation.

Some vets do feel that monitoring the glucose in the urine and trying to keep it negative or only very slightly positive is an effective method of monitoring insulin administration. We thought we did OK with this before glucometers were available but we think our clients do better monitoring blood levels. Once a stable state is reached, longer testing intervals are OK. It is tempting to try to constantly fiddle with the insulin dosage but for most of our clients that seems to cause more trouble than just testing at reasonable intervals using glucose curves.

Diabetes Insipidus
Diabetes insipidus is a disorder in which the kidney is insensitive to a hormone, called anti-diuretic hormone (ADH) or in which there is not sufficient quantity of this hormone available. The result is excessive drinking and urination, or polydipsia and polyuria. This is one cause of changes in urinary habits that leads to problems with urination inside the house in dogs in which "housebreaking" seemed to be satisfactory prior to the disease onset.

ADH is secreted by the body when it has a need to conserve water. It makes the kidneys work harder to conserve water, which makes the urine more concentrated. When the dog can not respond to this hormone or doesn't make enough of it, the dog can not concentrate its urine. This can lead to serious problems, including death, if the dog does not have access to large quantities of water. On the other hand, it may not cause any significant problem if there is always plenty of water available. This problem can occur for a number of reasons and for no reason at all. Examples of predisposing causes are kidney failure, hyperadrenocorticism, liver disease, pyometra and others. These things affect the kidney's ability to respond. Head trauma or brain cancer can affect the body's ability to produce ADH.

This condition is treated using desmopressin acetate (DDAVP), which is a replacement for the anti-diuretic hormone. It can be administered intra-nasally or on the conjunctiva (the inside lining of the eyes). It is pretty effective. Unfortunately, it is also somewhat expensive. Some dogs benefit from therapy with other medications, including chlorpropamide and chlorothiazide diuretics.

The prognosis for this condition varies with the underlying cause. Dogs that have diabetes insipidus due to trauma often recover in a short time and the same is true after successful treatment of pyometra. The prognosis is good for spontaneous occurrences of diabetes insipidus as well. When it occurs for other reasons the prognosis is usually less favorable.

Diabetes Mellitus or Type 1 Diabetes
Type 1 diabetes is by far the most common in dogs. There are probably instances of type 3 diabetes (diabetes secondary to another illness, such as hyperadrenocorticism or pancreatitis) in dogs, but I think this is a relatively uncommon thing.

Corticosteroids used chronically may predispose dogs to diabetes mellitus. I am not aware of any correlation between diabetes and the use of carprofen (Rimadyl Rx). We use a lot of corticosteroids here in the Tidewater area due to the problems with allergies in our area and we do not see a high correlation between the use of corticosteroids and diabetes in our practice.

Diabetes mellitus can lead to a secondary myocarditis (malfunction of the heart muscles). This can eventually cause heart failure. The signs that this is happening include a decrease in activity or weakness associated with normal activities, difficulty breathing or increased respiratory rate, decrease in appetite and sometimes pain or paralysis of the rear legs. Unfortunately, most of these signs can also occur for other reasons, including other complications of diabetes, like diabetic neuropathy leading to hind limb weakness or decrease in appetite associated with a loss of control of insulin regulation. With diabetes, it is important to work very closely with your vet to monitor the treatment. Teamwork makes a huge difference in the successful maintenance of a dog or cat with diabetes.

Diabetes - sudden onset or ketoacidotic diabetes
There are times when diabetes occurs secondary to another problem, particularly immune mediated disorders and other hormonal illnesses. Genetic factors, obesity, some medications such as progesterones and chronic pancreatitis have also been associated with diabetes. Diabetes can be a really insidious disease. The weight loss would be a good hint her. Diabetic dogs do reasonably well until they lose most of their ability to utilize sugar. Once this happens, they burn body fat for energy almost exclusively. Fat accumulates in the liver leading to liver problems. By products of fat metabolism include ketone acids which cause acidification of the blood and severe metabolic problems. This part of the process does happen very rapidly - often within a few days. If the initial signs of diabetes are masked or missed the onset of severe diabetes can seem to be extremely sudden. We have also seen sudden onset of diabetes after severe attacks of acute pancreatitis in our practice and vomiting does occur in this case.

It can be very expensive to treat ketoacidotic diabetes. Even with intensive care there is a possibility of death. I am very reluctant to give up on these patients but sometimes wish that I had after losing one. These dogs are so sick and seem so miserable that I really regret attempting to treat them when they do die. . This is not a situation in which you are making a choice to return a pet to full health. They are still diabetic even if the treatment for the ketoacidosis is successful. In many instances it is not possible for people to care properly for a diabetic dog and that has to be considered in the initial decision to treat or not treat the ketoacidosis. Secondary damage that is already present also has to be considered.

Diarrhea - Chronic
There are A LOT of causes of chronic diarrhea. So many that I am sure I will miss a number of them in the following list, but here goes: malabsorptive diseases (anything causing an inability to absorb food, such as wheat gluten sensitivity or plasmacytic-lymphocytic enteritis), maldigestion syndromes such as pancreatic insufficiency, inflammatory bowel disease, intestinal parasites (protozoans, worms, coccidia), fungal infections (rarely), damage to vital organs such as the liver or kidney leading to secondary diarrhea problems, diabetes mellitus, hypoadrenocorticism, small intestinal bacterial overgrowth, cancer, ulcers, bacterial enteritis or colitis, cecal inversion and irritable bowel syndromes.

It is important to try to decide if this is a small intestinal problem or large intestinal problem. In small intestinal disease the diarrhea tends to be pretty large volume at one time but less frequent episodes of diarrhea. In large intestinal diarrhea the volume of diarrhea tends to be smaller but episodes are more frequent. Knowing which of these is likely to be the problem helps in deciding which tests to run.

In chronic diarrhea it can be very hard to find a diagnosis. The intestinal biopsies were are very good idea. It is too bad they were not more informative. It can take multiple fecal exams to find some parasites, particularly giardia and whipworms. There are pretty good blood tests now to aid in the diagnosis of pancreatic insufficiency (blood trypsin-like immunoreactivity, folate levels, it is always wise to do general lab panels to make sure other organ systems are functioning properly. It can be helpful to rule out food sensitivity/allergy using special diets (elimination diets). Culture of the stool will sometimes reveal a bacteria that is very likely to be pathogenic, such as Salmonella or Clostridium perfringens. Special cultures can be done for Campylobacter.
If sulfasalazine does help, that is a hint that the problem is likely to be in the large intestine. If biopsies did not include the colon it may be possible to obtain the necessary biopsy samples from the colon to make a diagnosis using an endoscope with a biopsy forceps.

In most cases, it is possible to find a cause for the diarrhea and to successfully treat it, if you are patient enough. You can tell from the long list of possible causes that it can be hard, though.

Distemper Virus - Canine
For many years canine distemper virus was the most feared of the viral diseases affecting dogs. Parvovirus may have surpassed it in this regard but it is still a deadly virus that kills dogs and other members of the canine family. It is also infective to ferrets, mink, weasels and their kin among the Mustelidae family as well as raccoons, pandas and other members of the Procyonidae family. Recently it is believed to be the culprit in the death of a number of African lions.

Canine distemper virus is an RNA virus from the morbillivirus family. In humans, measles is caused by a member of this virus family. Distemper virus is more likely to affect puppies than older dogs. This is probably due immunity acquired through vaccination or exposure to the virus naturally, leading to immunity. It can affect dogs of any age, though. It causes very variable clinical signs which makes ruling it out in a young sick dog a difficult process. In some dogs a transient fever, perhaps accompanied by a lack of appetite or mild depression may be the only signs of onset of distemper. Other dogs are affected by a systemic illness with nasal and ocular discharges, coughing, fever, depression, lack of appetite, vomiting and diarrhea. It is not uncommon for dogs to have some but not all signs associated with this disease.

Since the inapparent infections often go undiagnosed and the severe infections often are present in dogs who die from distemper virus the mortality rate of canine distemper was always thought to be very high. Over time, it was recognized that a number of dogs were surviving the initial infection only to develop neurologic signs from one to a few weeks after infection. Seizures, behavioral changes, walking in circles and other ambulatory problems commonly develop. Many dogs who develop neurologic signs develop rhythmic motions or "tics". These are known as chorea. Sometimes affected dogs appear to be chewing gum due to the steady contractions of the muscles of the head.

Dogs that survive both the initial infection and subsequent neurologic disease may go on to develop retinal damage, corneal discoloration or extreme hardness of the skin of the nose or foot pads. Infection with the distemper virus can be hard to diagnose with certainty. It is not uncommon for puppies with suggestive clinical signs to have a recent vaccination for the virus. This makes it hard to judge infection by antibody titers in many instances. There is a latent period from the time the virus enters a dog's body until clinical signs appear of approximately 10 to 14 days which means that puppies already infected may be vaccinated before clinical signs appear.

The vaccination is not likely to be effective in preventing the disease when it is given after infection occurs. Sometimes the virus can be identified in infected tissues using immunofluorescent techniques. This works in the white blood cells several days after infection and in conjunctival (the pink part of the eye area) swabs up to 21 days after infection. Inclusion cysts may be seen in conjunctival swabs as well. General blood chemistry and blood cell count values are usually pretty uninformative when distemper is present. Cerebrospinal fluid (CSF) taps may indicate antibodies to distemper virus and increased protein. X-rays may show signs of pneumonia that are typical for viral infection but not definite for distemper virus alone. In many instances the course of the disease finally provides the diagnosis as initial signs of a generalized illness change to neurologic signs over time. At present there is no specific treatment to kill the distemper virus. General supportive care and control of neurologic signs such as seizures may result in a reasonable recovery from this infection. This may be a long term project, though. Prevention of infection is the best way to deal with canine distemper.

Adequate vaccination of puppies is necessary. Veterinarians tend to begin vaccinations for this disease at approximately 6 weeks of age and continue until 12 or even 16 weeks of age at 3 to 4 week intervals. The vaccine is repeated due to interference with vaccination from antibodies passed to puppies in the mother's milk. These antibodies prevent the vaccine from working in about 75% of puppies at six weeks of age, about 25% of puppies at nine weeks of age and only a very few puppies at twelve weeks of age. The first vaccination is therefore an attempt to treat the 25% of puppies who are susceptible and the follow-up vaccinations are given to eventually provide protection to almost all puppies who receive vaccination.

Some strains of distemper vaccine provide nearly lifelong immunity after the initial series and one-year booster while other strains provide a shorter duration of immunity. Some puppies develop signs of canine distemper following vaccination even though they do not appear to have the disease. In these puppies encephalitis occurs. This can be fatal, although most puppies probably recover. Canine distemper virus is shed in all body secretions from infected animals. Dogs may spread the virus for several weeks during the illness and subsequent recovery period.

The virus is not especially stable in the environment, probably lasting no more than a few weeks. It is susceptible to disinfectants, especially the quaternary ammonium compounds such as Roccal (TM). The incidence of canine distemper infections is much lower than in the past. Good vaccination practices are almost certainly a big part of the reduction in cases of distemper. It is still present all over the world and continued vigilance on the part of veterinarians and dog owners is necessary to prevent a resurgence of this deadly illness.

Distemper Vaccination
Distemper vaccination is important for all puppies. This disease is still present in most areas and it is still hard to treat successfully. Even when a puppy is nursed through the acute phase of the disease there can be long term health problems. The most common of these is a tendency to develop seizures.

Distichiasis
Distichiasis is the abnormal growth of an eyelash from the meibomian glands along the eyelid margin. This positions them directly out of the lid margin and they contact the eye surface due to this. The harm this causes depends on the stiffness of the eyelash that grows, the number of them and their exact position. This condition is most common in cocker spaniels, Chesapeake Bay Retrievers, Lhasa Apsos, miniature Poodles, Golden Retrievers, Shelties, and Shih Tzus.

Untreated, distichiasis can lead to corneal ulcers, chronic eye pain, excessive tearing, and eyelid spasms. It is almost certainly uncomfortable for the dog and permanent removal of the offending eyelashes is best when any clinical signs are present.

Surgery is done in a number of ways, depending on the number of lashes present and the preferences of the surgeon. Cryosurgery (freezing of the lid margin at the affected sites) can sometimes be done with a local anesthetic in a cooperative dog. There are other surgical options. Almost any surgery for this condition should be done with an operating microscope or good magnification so many general practitioners refer these cases to veterinary ophthamologists.

Postoperative care of inflammation from the surgery is usually necessary and should be planned for. There are usually two or three follow-up visits to check for regrowth of the eyelashes and removal of any that return or persist. In most cases, this can be treated with success. This makes life much more comfortable for your dog.

Ehrlichiosis
Ehrlichiosis is caused by the rickettsial organism Ehrlichia canis. Other examples of rickettsial organisms are Riskettsia rickettsi, which causes Rocky Mountain Spotted Fever and Ehrlichia risticii, which causes Potomac Fever in horses. These organisms tend to be carried by ticks and other insect vectors, in some cases. For ehrlichiosis, the most common vector is the brown dog tick. For this reason, ehrlichiosis occurs anywhere this tick occurs. At present, it has been reported in 34 states, with the northern states being spared in most instances. The southeastern and south central states are the most heavily affected. A few cases of Ehrlichia canis infection have been reported in people after tick bites.

Ehrlichia infection can cause a number of clinical signs. It can be extremely hard to diagnose due to the wide range of symptoms that can occur. Most dogs infected with this organism will have be lethargic, lose weight, show less interest in food and become anemic. Other possible clinical signs include hemorrhages under the skin or in around the gums, swollen lymph nodes, muscular or joint soreness, nasal discharges or nosebleeds, severe neck or back pain, blood in the urine and eye problems ranging from exudates to severe inflammation of the internal eye structures. Neurologic signs such as seizures and difficulty walking can occur. Respiratory or heart related signs can occur due to hemorrhaging and compensation for anemia if it becomes severe. Hemorrhaging occurs primarily due to decrease in platelet counts from the infection. While most dogs show a number of symptoms when first infected with Ehrlichia, there is also a chronic infection that can occur if the acute infection is not treated. In this case, the dog may appear to be normal or may show vague signs of illness occasionally. This is one cause of the complaint that "my dog just isn't doing right". The chronic illness can suddenly become very severe again if the dog is stressed in some manner or become less immune competent for some reason.

The best method of diagnosing this disease is through testing of serum from the dog using an immunofluorescent antibody (IFA) test. unfortunately, a positive test only indicates exposure. Still, in the presence of clinical signs or if the titer rises after treatment or stays consistently high, infection is strongly implied by the lab results.

Ehrlichia canis is normally susceptible to treatment with tetracycline antibiotics, including doxycycline. In some situations the organism will not respond to these antibiotics or their use is contraindicated due to the young age of a dog or pregnancy. In this case, chloramphenicol can be used and there is anecdotal evidence of success using cephalosporin antibiotics. The bleeding tendencies in this disease are related to a drop in platelets (thrombocytopenia) so it can be necessary to use corticosteroids to treat this condition if the platelet counts are low. While this can be life saving, the use of corticosteroids should be discontinued as quickly as possible so that their immunosuppressive effect does not interfere with successful treatment. Extensive supportive care, including intravenous fluids, administration of blood products and hospitalization may be necessary to treat this problem in some dogs. The survival rate is good if the disease is recognized and treated aggressively.

Elbow Dysplasia
Elbow dysplasia is the term for an elbow joint that is malformed on X-rays. The mechanism of the malformation is unclear but it may be due to differences in the growth rates of the three bones that make up the elbow joint, particularly the humerus and ulna. In mildly affected dogs the only consequence may be arthritis. In more severely affected dogs, osteochondritis dissecans (OCD), fragmented medial coronoid processes and united anconeal processes can result from the stress in the joint. Some vets think that these problems may not be secondary but may actually be the primary problems and that the bone changes occur as a result of them. It is difficult to be sure but there does appear to be measurable differences in bone growth in dogs that have elbow dysplasia. There are a number of changes visible on X-rays and the OFA does evaluate X-rays for evidence of elbow dysplasia.

Due to the number of possible complications, it is hard to make predictions about how elbow dysplasia will affect a dog. If it can be identified at a young age before changes are severe, surgical correction has a reasonably good success rate. Once severe changes set in, it is much harder to prevent subsequent arthritic changes. Most dogs with this condition eventually become lame and the lameness can be very severe in some dogs, even to the point of disuse of one leg or severe difficult getting up and walking even short distances.
Treatment consists of surgical correction of whatever complications are present, if possible. Medical management using aspirin or other anti-inflammatory medications is helpful. Weight control is very important over the long term for success of either surgical or medical management of this condition.

Epilepsy and Seizure
Epilepsy is a term used to describe seizures that can not be explained by identifying a source of the seizure activity. So it is a pretty broad term really. It covers any unidentifiable brain disorder that leads to seizure activity. Congenital epilepsy normally shows up in by the time a dog is two or three years of age.

Brain tumors are possible in almost any case of seizuring but brain tumors often have some other identifiable clinical symptoms since they often damage nerves exiting the brain or the centers that control these nerves. So gait abnormalities, facial paralysis, vestibular disorders, blindness, or other signs of nervous system damage may occur with a brain tumor, helping to identify it. Viral illness, fungal diseases, trauma, vascular disease or other problems can also lead to seizures by direct effects on the brain. Liver disease, kidney disease, and hormonal disorders cause seizures by more indirect effects. When nothing is found we fall back on the term acquired epilepsy to define the problem, even though it really just means we can't identify the problem.
Seizure control is usually possible. When to start is a issue of some debate among veterinarians. The standard rule of thumb has been to use seizure control medications (usually phenobarbital) when seizures occur more than once a month. Some veterinarians feel that it is wiser to start sooner than this because it appears that "mirroring" and "kindling" of seizures can occur in dogs. Mirroring is when a seizure focus occurs in one side of the brain and then an identical site occurs in the other side of the brain after several seizures. Kindling is when the seizure focus in the brain develops strong enough pathways that it makes it easier for the seizure to occur -- almost as if the brain "learns" to seizure. It is possible that by controlling seizures quickly through the use of medications that these effects could be stopped and that may lessen the amount or duration of need for seizure control medications.

We try to decide on an individual basis what the potential for all of these risks are, whether the pet owner can administer seizure control medications on a set schedule and the risks of the medications themselves. Then we decide when to start attempting to control seizure activity. If a dog has a really violent seizure we may start immediately. If there is a mild seizure and then subsequent seizures occur at long time intervals we may never attempt to control them. This decision just has to be made on a patient by patient basis.

Estrus or Heat cycle
The average heat cycle for a dog is approximately 3 weeks and since this an an average, some heats are shorter (as little as 7-10 days), others are longer (4 weeks or more). Average times between heat periods is seven months but some dogs can cycle as early as every 4 months, some once a year. Lengths of heat cycles and intervals between cycles are different for each dog but most dogs hit somewhere close to the averages. The first part of heat you will notice bleeding from the vulva, swelling of the vulva, possible increase in urination and the most noticeable, male dogs hanging around the house. During this period (proestrus), females will not allow the males to breed with them although the males will be very persistent. The second part or estrus is the time in which the female will allow the male to breed her and this can last anywhere from 4-21 days.

A female, most of the time, will allow most any male to breed during this time. As the female starts to go out of heat or enter diestrus, she will be less willing to breed. Again this stage can last 4-14 days but averages approximately 7 days. The next cycle usually begins about 7 months from the start of the last heat cycle, not the end of that cycle but again this varies from dog to dog. The interval stays the same even if she becomes pregnant. If you do not intend to breed her, you really should consider spaying her. There are many health benefits associated with spaying such as decreased chance of mammary tumors and you will not have to worry about pyometra, metritis or unwanted litters (overpopulation is a big problem - just take a trip to a humane shelter). If you elect to spay her, this can be done during heat but it may be best to wait until the heat cycle is over to decrease the chance of complications.

Feeding your pet
The bottom line on pet foods is simple. We have a rough idea of the essential nutrients necessary for pets. We know some of the toxic levels for nutrients. Other than that, it is hard to be sure about any nutritional claims.
Studying nutrient needs is extremely complex. There are a great number of theories about what constitutes "proper" nutrition. For every good thing you hear about a food, there are likely to be as many bad things. Making sense of this is very difficult. There is no single food that is "best" for all makes and models of dogs.

Some things seem to be clear, though. Pets do require certain nutrients. A good way to ensure that the pet foods you feed your pets contain adequate nutrients is to look for a statement that the food meets AAFCO Food Trial testing standards. This is an organization which sets standards for pet foods. Most good quality foods will have this statement on their label. It is at least a good start in ensuring that your pet's diet is adequate.

Some people are currently advocating diets containing raw meat for pets. Before feeding raw meat, please stop to consider the health warnings for humans concerning raw meat. Dogs get the same illnesses from E. coli, Salmonella, Toxoplasmosis and other health hazards associated with raw or undercooked meat. Is the perceived benefit worth the risk of one of these diseases?

Don't let your pet teach you to feed it a poor diet. It is very easy, especially with small dogs and cats, to fall into the trap of feeding your pet what he or she wants instead of what he or she needs. Dogs are very patient trainers of human beings. If you're not paying attention, you could find that Spot is on an all meat diet in no time. It can be hard to ignore those pleading eyes, but your pet IS better off if you feed a balanced diet!

Femoral Head Ostectomy
The weight of the dog has some bearing on the outcome on this surgery. In the surgery, the ball portion of the hip joint (the femoral head) is removed and the bone smoothed, if necessary, so that no bone to bone contact occurs between the pelvis, which contains the now empty socket and the remaining portion of the femur. The joint is not stabilized, it is destroyed. While that sounds bad, in almost all dogs under 40 to 50 lbs in weight, this surgery will provide reasonable comfort. A "false joint" forms, consisting of fibrous scar tissue around the bone end. This forms in the muscles over the hip, which fortunately are strong enough to provide some stability. It is less painful than leaving the dislocated femoral head rubbing against the pelvic bone.

The shoulder joint is naturally constructed in a similar fashion, although it has more stabilization. In dogs over 50 pounds of body weight there is more concern that the joint will not be functional due to the need for more weight bearing capacity. Most of the time, there is still reasonable comfort even in big dogs but the outcome is more questionable in these dogs.

There are alternatives.

1) Stabilization of the joint can be attempted. Many vets are reluctant to do these surgeries because some of them are technically difficult and all of them have a moderate failure rate. It is disconcerting to do surgery, collect a large fee, have to explain the failure to the client and then have to go back and do a femoral head ostectomy anyway. There are several possible stabilization procedures, including pinning the femoral head to the hip socket, moving the portion of the bone where muscle attachment occurs to a different site on the femur to provide more stability, toggle pinning the femoral head and several other stabilization techniques. It may be necessary to ask for referral to a surgical specialist for these procedures as many general practitioners are not comfortable doing them.

2) Total hip replacement. This is an option in some cases when hips can not be stabilized but it is necessary to consider this on a case by case basis. Again, this surgery requires referral to a surgical specialist in most cases. Very few veterinary practices have the capability of doing hip replacement surgery.

If an alternative stabilization technique doesn't work, femoral head ostectomy remains an option. You do end up paying for two surgeries when one of the other stabilization methods fail but if they work, the outcome is better for your dog. The success rates of the various surgeries would depend a lot on the individual surgeon's experience and skill.

Flea Life Cycle
Understanding the life cycle of the flea is necessary in order to control it. The flea has several stages to its life cycle. Adult fleas spend most of their time on the dog or cat - they must be dislodged to leave since they will not do so voluntarily. Despite this, when the flea population on the dog becomes excessive humans tend to be an acceptable alternative to the flea. The average life span of an adult flea is probably about 6 weeks - but fleas can live as long as a year under certain conditions. A female flea can lay 20 to 28 eggs a day. She may lay several hundred eggs over her life span. These eggs fall off the pet and develop where they land. They are small and can even develop in the cracks in wood floors or other small crevices. A larvae hatches from the flea egg. It takes as few as 9 days to as long as 200 days to go through its growth stages. At this time is forms a pupae and waits for the right time to hatch. Fleas prefer temperatures of 65 to 80 degrees and humidity of 75 to 85 per cent. This range determines the period of time that fleas are a problem in your particular area. For some areas of the country, this is all year. In others, the flea season is relatively short. It is estimated that for every adult flea found on the pet, there are about 10 developing fleas in the pet's environment.

Flea Control
Since we know that the flea lays her eggs on the pet and they fall off, it is obvious that they fall off where the pet goes. This means that you must treat your house if your pet comes inside. Many people resist doing this, explaining that they never see fleas in the house. The flea egg does not move and it is very hard to see. The flea larvae does not have legs so it has limited movement. The pupal stage of the flea does not move at all. It is not likely that you would be aware of immature fleas --- until they grow into adults. At this point you will be overwhelmed and the problem will be very hard to control. It is possible to kill the pre-adult stages of the flea in the house. Outside, the flea eggs fall off in areas where the pet does things that dislodge them, like jumping around, sitting and scratching, etc. If these areas are warm and moist throughout the day, the flea can reproduce there. It is not necessary to treat large expanses of lawn that dry out during the day -- concentrate on areas the dog spends time, that stay moist and warm. Make sure you treat around the doors in and out of the house, where your dog or cat is likely to be waiting around and where flea eggs are likely to drop off.

There ar now several "once a month" flea control medications for pets. Lufenuron (Program - tm), makes control of preadult fleas easier than it has been in the past. This medication is approved for both dogs and cats. It is administered once a month and is active in the body for that entire time. At the present time there are no known side effects of the medication other than a small percentage of pets who are nauseous after administration of the pill. It may be administered when other medications are being used. The pill does not affect adult fleas at all. Therefore it is important to start this pill before the flea season or to treat for adult fleas as necessary. There are also "once a month" adult flea control medications. Advantage (tm) and FrontLine (tm) are two new medications that provide long lasting adult flea control. Advantage works for about one month to kill fleas and FrontLine works for one month in cats and up to three months in dogs. These are very effective products. While these products may be combined with Program (tm), their ability to kill adult fleas effectively may make it un-necessary. There are many other products that will kill the fleas on the pet. Shampoos, powders, and sprays tend to kill only the fleas present on the pet at the time of application. Mousses (flea foams) and flea creme rinse products tend to have some residual effect. Dips, which are usually used as pour-on products, have a slighlty longer residual effect and are more likely to be associated with toxicity. Proban, an orally administered flea killing pill has short duration of action but is made to be given twice weekly. There are "spot on" products as well, which have may have a longer duration of action. However, all of these products are more toxic and/or less effective than FrontLine (tm) and Advantage (tm).

Treating the house should involve a two pronged approach. To kill the pre-adult fleas it is necessary to use methoprene (Precor). This can be done by using this product alone, or in combination sprays with an adult killing ingredient. The ingredients that kill preadult fleas are generally effective for 3 to 4 months, indoors. Killing adult fleas can be accomplished using any of the pyrethrins (tetramethrin, pyrethrin, permethrin, etc.), or an organophosphate. The adult flea killing ingredients do not have a residual effect and retreatment every 2 to 3 weeks until the fleas are gone is usually necessary. These products come in sprays and aerosols (foggers). It is very important to read the directions, figure out the square footage you are attempting to treat and use these products properly. Foggers generally are ineffective unless one is placed in each room, so small size foggers may be the most economical approach. An alternative to this approach is to use a sodium borate product for flea control - such as FleaBusters. Some people use diatomaceous earth (food grade) in the house to control fleas.

Flea treatment in the yard can be accomplished using one of the yard sprays specifically made for this purpose. There is a new approach, in which a nematode (worm) that lives on flea larvae is spread in the yard. This is non-toxic and appear to be effective. These worms are sold by various companies. One brand name is Interrupt, available through veterinarians. Remember, it is only necessary to treat areas which stay warm and moist. For some people this will be the whole yard. For others, treatment of much less than the whole yard will be effective.
Prior to this year (1996), we felt that effective flea control meant that you needed to treat the pet, the house and the yard. Not treating any one of these could lead to perpetual flea problems. It appears that FrontLine (tm), Advantage (tm) and Program (tm) may change that situation and allow control of fleas with treatment of the pet, only.

Flea control can be accomplished if you are careful to take a few steps to ensure that your plan works. Treat your pet with one of the new flea control products. If you elect to treat the house, to it right. Measure your house and figure out the square footage -- then apply a proper amount of flea control product. If you are using foggers, make sure that they will cover the area you anticipate -- don't expect them to treat two rooms by placing one in the hall, for instance. Get a fogger for each room. If you use a professional exterminator, make sure they use a product that kills preadult fleas as well as an adulticide. Pay them to come back in 2 weeks the first time, rather than waiting a month. Keep up the treatment until you see no fleas, then use the preadult products 2 or 3 times a year to keep the problem from coming back.

Fleas can be controlled. It can be expensive to take care of a flea infestation but it is usually cheaper than dealing with the complications to your pet's health that fleas can bring about.

Giardia
Giardia is a protozoan parasite that lives in the intestine of affected animals. It is unclear whether there are several species of this parasite or whether there is one species that affect several different animals, including people. These small parasites are very easy to miss on a fecal exam and may not be present in the stool of animals infected with the organism. Repeated fecal exams are sometimes necessary to identify this parasite. Not all animals in which infection can be demonstrated have clinical signs. This leads some people to believe that the parasite may not cause disease . Most vets think that there may just be other factors, like the animal's immune response to the parasite that cause some animals to develop disease and not others. Clinical signs of giardia include weight loss, inability to gain weight appropriately during growth, diarrhea, vomiting, lack of appetite and greasy appearing stools. Them most commonly used medication for giardia infection is metronidazole (Flagyl). The organisms come from the environment and live in moist to wet areas. They are susceptible to quatenary ammonium disinfectants, Lysol and dilute chlorine bleach. Keeping the dog's environment dry helps a lot.

This disease may be contagious to people from infected dogs so good sanitary practices, like washing your hands after handling an infected puppy, are very important. If a family member develops similar clinical signs, a physician should be consulted.

Heart murmur
It can be very hard to determine if a heart murmur is present when listening to the chest of an excited dog. Respiratory sounds can mimic a heart murmur when respiration is rapid enough to approximate the heartrate.
Heart murmurs vary widely in their importance. Hearing a heart murmur in a dog that seems normal in all other respects doesn't usually make me want to pursue a lot of immediate testing to determine the cause but it does make it important for the dog owner to watch carefully for signs of heart failure, such as tiring easily, coughing, weight loss and difficulty breathing. If any of these signs are present then it is much more important to try to identify the cause.

Heartworm Disease
Heartworms live in the right side of the heart and the large arteries running from the heart to the lungs (the pulmonary arteries).

Heartworm disease causes damage to the pulmonary arteries which eventually leads to heart failure. If you have any acquaintances with chronic heart failure, ask them how much joy there is in their lives. Heart failure robs the dog of its ability to play comfortably. Eventually it becomes difficult to just participate in normal activities. Serious damage begins to occur in other organ systems affected by the heart failure. Treatment of the symptoms alone fails to resolve the problem over the long term and the dog eventually dies -- after having been miserable for some time. Some dogs do manage to live almost normal lifespans despite infection with heartworms but they are very lucky. A rough estimate from our practice experience: 80% of dogs affected with heartworms probably die from the heartworm disease before something else causes them to die and 90% eventually show some or all of the symptoms of the disease.

Heartworm Disease Testing
There are several ways to test for heartworms. The first method developed was to put a drop of blood on a microscope slide and look for baby heartworms, which are microscopic and are known as microfilaria. This works if there are adult heartworms producing babies and if the dog's immune system is not killing the babies. It is probably an accurate test for adult heartworms in about 50 to 60% of infected dogs (just an educated guess on the percentages). The accuracy of this type of testing was improved by using "concentration" techniques --- methods of increasing the likelihood of finding microfilaria if only a few were present. Originally this involved centrifuging blood but later special microfilters were developed to allow filtering of baby heartworms out of a bigger blood sample.

This was a better test but still was inaccurate if the heartworms weren't producing babies or if the dog's immune system was killing them. Estimates of the inaccuracy of this testing varied widely but the general consensus was that it missed between 20 and 30% of heartworm cases and I personally think it was probably higher than that. Testing for microfilaria was critically important when daily heartworm medications were in use. Ironically, the presence of microfilaria was actually more important than the presence of the adult heartworms when using these preventatives because reactions could occur that could cause death when daily preventatives were given to dogs with microfilaria in their circulation. There was not much incentive to get more accurate in testing for heartworms in order to use preventative but a number of dogs still had clinical signs of heartworm disease and yet tested negative on available blood tests. Tests for antibodies to heartworms were developed. These were problematic because they indicated exposure to the heartworms, so dogs remained positive on these tests even if heartworms had died naturally or after successful treatment. Finally, tests were developed that test directly for adult heartworm antigen -- but only from adult, sexually mature female heartworms.

So now there are two situations in which the testing remains inaccurate -- all male heartworm infections and heartworm infections in which there are female heartworms present that are less than 6 or 7 months of age. There is also a small possibility of a false positive test with the antigen test kits -- estimates are that it is about 1 in 1000.

So how does this apply to your dog? The first test could be accurate and the second test a false positive. The odds of this are low but it is possible. The presence of clinical signs makes the odds very very low, in fact. The test may have been a filtration or concentration test for microfilaria and your dog may not have microfilaria despite having adult heartworms. The test may have been an antigen test and your dog may have been infected at the time of the first test but for less than 6 months -- so there were no adult females to make the test positive. Now, months later, the females have grown up and are causing problems. In any case, treatment is now indicated.

Heartworm Treatment
Heartworm treatment should be much safer for dogs now that a new medication, Immiticide (rx), is available to veterinarians. This medication has fewer side effects and kills a higher percentage of heartworms than Caparsolate (rx), which has been the only medication available until now.

Heartworms live in the heart and the large blood vessels which go to the lungs from the heart. When they are killed by medications, a danger of embolism results if the dead worms block the flow of blood to the lungs. This is a common cause of death during a heartworm treatment. This risk still exists with Immiticide, but to a much lesser extent, due to differences in the timing of heartworm deaths. In addition, Immiticide does not appear to damage the liver or kidneys, which was sometimes a problem with Caparsolate.

If your dog has heartworm disease and you have been putting off treatment due to the higher risk of complications associated with Caparsolate, it would be a good idea to call your vet and discuss this new treatment. Dog feel better after heartworm treatment and their expected life span is the same as a dog that was not affected with this parasite if treatment is successful. Even though there is a small risk of death during treatment, it is still usually a much better choice than not treating for heartworms.

Heat cycle or Estrus
The average heat cycle for a dog is approximately 3 weeks and since this an an average, some heats are shorter (as little as 7-10 days), others are longer (4 weeks or more). Average times between heat periods is seven months but some dogs can cycle as early as every 4 months, some once a year. Lengths of heat cycles and intervals between cycles are different for each dog but most dogs hit somewhere close to the averages. The first part of heat you will notice bleeding from the vulva, swelling of the vulva, possible increase in urination and the most noticeable, male dogs hanging around the house. During this period (proestrus), females will not allow the males to breed with them although the males will be very persistent.

The second part or estrus is the time in which the female will allow the male to breed her and this can last anywhere from 4-21 days. A female, most of the time, will allow most any male to breed during this time. As the female starts to go out of heat or enter diestrus, she will be less willing to breed. Again this stage can last 4-14 days but averages approximately 7 days. The next cycle usually begins about 7 months from the start of the last heat cycle, not the end of that cycle but again this varies from dog to dog. The interval stays the same even if she becomes pregnant. If you do not intend to breed her, you really should consider spaying her. There are many health benefits associated with spaying such as decreased chance of mammary tumors and you will not have to worry about pyometra, metritis or unwanted litters (overpopulation is a big problem - just take a trip to a humane shelter). If you elect to spay her, this can be done during heat but it may be best to wait until the heat cycle is over to decrease the chance of complications.

Hemangiosarcoma
Hemangiosarcomas are a form of cancer which originates in the endothelium, which is the lining of blood vessels and spleen. As might be expected of a tumor arising in the blood system they are highly malignant and can be found almost anywhere in the body since blood vessels are necessary in almost all body tissues. There is a strong predilection for the spleen, pericardium and heart. These tumors are most common in middle aged or older dogs which are medium sized or larger but can occur in any breed. German shepherds are reported to be more susceptible to this tumor than most dog breeds. In our practice golden retrievers also seem to have a higher than normal incidence.

Because these tumors arise in internal organs there is often little warning that they are present prior to time they cause severe clinical signs of disease. A common estimate of the average time from discovery of the tumor until death occurs in affected dogs is six to eight weeks but death occurs more rapidly than this in a number of cases.

Visible bleeding, usually in the form of nosebleeds, and signs associated with blood loss, such as tiring easily, episodes of unexplained weakness, pale color to the mucous membranes of the mouth and eyes, increased respiratory rates, abdominal swelling and depression are the most common presenting signs for patients with hemangiosarcoma. A few dogs just suddenly die with no clinical signs having been noted by their families prior to death. Bleeding disorders associated with hemangiosarcoma are sometimes confused with immune mediated hemolytic anemia (IMHA) because the type of anemia caused by the two conditions is very similar and early clinical signs are often very similar, as well. Hemangiosarcomas can cause very large tumors, sometimes as large as ten or more pounds, when they affect the spleen.

In most instances tumors of this size in this location are found on physical exam. In other cases the tumor affects the heart and is hard to find on a physical exam and even easy to miss or X-rays. Sometimes there are hundreds of small tumors spread throughout the body and surgical exploration or an autopsy are the only ways to identify the problem.

The blood disorder that most commonly accompanies the presence of hemangiosarcoma tumors is disseminated intravascular coagulation (DIC). This is blood clotting that is occurring inappropriately inside the blood vessels. It uses up all of the blood clotting elements rapidly and dogs with this condition usually have platelet deficiencies, increased blood clotting times, decrease in fibrin content in the blood and an increase in fibrin degradation products (FDPs). This is probably the cause of death in most dogs affected with hemangiosarcoma.

Diagnosis of hemangiosarcoma can be accomplished in a number of ways.Identification of a tumor in the spleen or heart raises a high degree of suspicion for this tumor. Abdominal swelling is also highly suggestive in an older large breed dog. If fluid is aspirated from the abdomen and it looks like blood it is even more suggestive of hemangiosarcoma. If blood is drawn and will not clot when left in the syringe it is another sign that a dog may have this tumor. In some cases careful evaluation of the type of bleeding disorder present is necessary to raise the suspicion of hemangiosarcoma.

If a tumor is identified when it is small it may be possible to remove the spleen if the tumor is there or even to remove tumors found near the heart and prolong the pet's life. Most of the time this will not make much difference, though. These are highly malignant tumors and most have spread by the time they can be identified. To the best of my knowledge there is not a very successful hemotherapeutic or radiation protocol for this cancer at this time but dogs treated with chemotherapeutic agents do live a little longer than dogs that do not receive this treatment.

Treatment for the bleeding disorders and aggressive supportive care also prolong the life of patients with hemangiosarcoma. If treatment for IMHA or immune mediated thrombocytopenia (ITP) are instituted due to confusion over the underlying cause of clinical signs early in the diagnostic process there is not likely to be any harm to the dog.

Due to the tendency to look for an inciting agent in IMHA and ITP it is a good idea to consider an autopsy exam if a dog dies before a definite diagnosis of any of these conditions can be made. Finding hemangiosarcoma saves a lot of agonizing over possible causes of the death of a friend. There are no known predisposing factors other than size and breed that I am aware of for hemangiosarcoma.

Hemolytic Anemia
Hemolytic anemia describes the condition in which this loss of red blood cells occurs because the red cells break up (lyse). This can happen inside the blood vessels (intravascular hemolysis) or outside of the blood vessel (extravascular hemolysis). Hemolytic anemia can occur for many reasons, including heat stroke, parasites, viral infections. toxins and other conditions. One of the things that can cause hemolytic anemia is immune system disease --- in this case the disorder is known as immune mediated hemolytic anemia (IMHA). This is the term currently preferred for the condition formerly known as auto-immune hemolytic anemia (AIHA). The reason for the subtle name change is the recognition that much of the time the immune system really is attacking an invader -- it just happens to be one that is stuck on the red blood cell so both get destroyed.

Hemorrhagic Gastroenteritis (HGE)
Hemorrhagic gastroenteritis (HGE) usually causes a very sudden onset of vomiting, bloody diarrhea, dehydration and depression. Dogs affected by this condition get very sick, very fast.

To the best of my knowledge, the exact cause of this disease is unknown. It appears that Clostridium species bacteria may be part of the cause. The disease is more frequent in small breed dogs but can occur in any dog. I am not sure what the general impression is among veterinarians, but dogs that have this problem seem to have a high risk of getting it again in our practice.

Most dogs respond very well to treatment with fluids to restore hydration. In some cases it is necessary to give plasma to correct loss of protein and antibiotics to combat the suspected Clostridium infection. In a few dogs, it is necessary to give fast acting cortisones to counter shock, which is a problem due to the very rapid onset of dehydration in dogs with HGE.

It is generally necessary to totally restrict oral food and water for one or two days when treating this problem. This makes hospitalization necessary for several days for most dogs with HGE.

Hip Dysplasia
Hip dysplasia literally means an abnormality in the development of the hip joint. It is characterized by a shallow acetabulum (the "cup" of the hip joint) and changes in the shape of the femoral head (the "ball" of the hip joint). These changes may occur due to excessive laxity in the hip joint. Hip dysplasia can exist with or without clinical signs. When dogs exhibit clinical signs of this problem they usually are lame on one or both rear limbs. Severe arthritis can develop as a result of the malformation of the hip joint and this results in pain as the disease progresses. Many young dogs exhibit pain during or shortly after the growth period, often before arthritic changes appear to be present. It is not unusual for this pain to appear to disappear for several years and then to return when arthritic changes become obvious.

Dogs with hip dysplasia appear to be born with normal hips and then to develop the disease later. This has led to a lot of speculation as to the contributing factors which may be involved with this disease. This is an inherited condition, but not all dogs with the genetic tendency will develop clinical signs and the degree of hip dysplasia which develops does not always seem to correlate well with expectations based on the parent's condition. Multiple genetic factors are involved and environmental factors also play a role in determining the degree of hip dysplasia. Dogs with no genetic predisposition do not develop hip dysplasia.

At present, the strongest link to contributing factors other than genetic predisposition appears to be to rapid growth and weight gain. In a recent study done in Labrador retrievers a significant reduction in the development of clinical hip dysplasia occurred in a group of puppies fed 25% less than a control group which was allowed to eat free choice. It is likely that the laxity in the hip joints is aggravated by the rapid weight gain.

If feeding practices are altered to reduce hip dysplasia in a litter of puppies, it is probably best to use a puppy food and feed smaller quantities than to switch to an adult dog food. The calcium/phosphorous to calorie ratios in adult dog food are such that the puppy will usually end up with higher than desired total calcium or phosphorous intake by eating an adult food. This occurs because more of these foods are necessary to meet the caloric needs of puppies, even when feeding to keep the puppy thin.

If clinical signs of hip dysplasia occur in young dogs, such as lameness, difficulty standing or walking after getting up, decreased activity or a bunny-hop gait, it is often possible to help them medically or surgically. X-ray confirmation of the presence of hip dysplasia prior to treatment is necessary. There are two techniques currently used to detect hip dysplasia, the standard view used in Orthopedic Foundation for Animals (OFA) testing and X-rays (radiographs) utilizing a device to exaggerate joint laxity developed by the University of Pennsylvania Hip Improvement Program (PennHIP). The Penn Hip radiographs appear to be a better method for judging hip dysplasia early in puppies, with one study showing good predictability for hip dysplasia in puppies exhibiting joint laxity at 4 months of age, based on PennHIP radiographs.

Once a determination is made that hip dysplasia is present, a treatment plan is necessary. For dogs that exhibit clinical signs at less than a year of age, aggressive treatment may help alleviate later suffering. In the past a surgery known as a pectineal myotomy was advocated but more recent evidence suggests that it is an ineffective surgical procedure. However, administration of glycosaminoglycans (Adequan Rx) may help to decrease the severity of arthritis that develops later in life. Surgical reconstruction of the hip joint (triple pelvic osteotomy) is helpful if done during the growth stages. For puppies with clinical signs at a young age, this surgery should be strongly considered. It has a high success rate when done at the proper time.

Dogs that exhibit clinical signs after the growth phase require a different approach to treatment. It is necessary to determine if the disorder can be managed by medical treatment enough to keep the dog comfortable. If so, aspirin is probably the best choice for initial medical treatment. Aspirin/codeine combinations, phenylbutazone, glycosaminoglycosans and corticosteroids may be more beneficial or necessary for some dogs. It is important to use appropriate dosages and to monitor the progress of any dog on non-steroidal or steroidal anti-inflammatory medications due to the increased risk of side effects to these medications in dogs. If medical treatment is insufficient then surgical repair is possible.

The best surgical treatment for hip dypslasia is total hip replacement. By removing the damaged acetabulum and femoral head and replacing them with artificial joint components, pain is nearly eliminated. This procedure is expensive but it is very effective and should be the first choice for treatment of severe hip dyplasia whenever possible. In some cases, this surgery may be beyond a pet owner's financial resources. An alternative surgery is femoral head ostectomy. In this procedure, the femoral head (ball part of the hip joint) is simply removed. This eliminates most of the bone to bone contact and can reduce the pain substantially. Not all dogs do well following FHO surgery and it should be considered a clear "second choice".

Hip dysplasia may not ever be eliminated by programs designed to detect it early unless some effort is made to publish the results of diagnostic tests such as the OFA evaluation or PennHIP evaluations, openly. This is the only way that breeders will be able to tell for certain what the problems have been with hip dysplasia in a dog's ancestry.

When an older dog is exhibiting signs of pain associated with this condition it is often possible to help them dramatically through medication and simple steps like providing a warm bed or warm spot to rest during the day. There is no advantage to pain and steps should be taken to ensure that the older dog is not in pain. Regular exercise can be very helpful and weight loss can have dramatic effects on the amount of discomfort a dog experiences.

Working with your vet to come to the best solution for your dog and your situation will enable you and your dog to enjoy life to its fullest, despite the presence of hip dysplasia.

Hot Spots or Acute Moist Pyoderma
"Hot spots" are also known as "acute moist pyoderma". What that means is that they are rapidly appearing, oozing, skin infections. This is just a description of a symptom, sort of like saying "your dog has scabs".
A hot spot starts because something irritates the dog's skin. The body's response is to either itch or create an inflammatory response at the site. In cases of itching, the dog then rubs, licks or chews the site and adds to the problem. These sores can develop into severe problems in an hour or two at times.

The most common irritants are probably fleas and allergies. These cause the itching that leads to the skin infection. There are many other possible sources of irritation. Tick bites, besetting, burrs, mats, mosquitos, summer heat and other problems all contribute to the initial irritation that can develop into a hot spot.
The best treatment for these is prevention. Keep fleas off your dog. Groom and bathe your dog as necessary to keep the haricot in good condition. Limit other sources of irritation to the best of your ability. If allergies are a problem for your dog, work with your vet to control the itching they cause. In some dogs, all of this won't be enough and you will occasionally see hot spots anyway. The first step in treating a hot spot is to get it dry. Bacteria like the hot moist environment of irritated skin.

Using something to dry the sore makes it harder for bacteria to grow. Clipping the hair over and around a hot spot can help a great deal in allowing it to dry. There are lots of astringents that will help dry the sore, as well. My favorite is NeoPredef powder because it dries the sore, has an antibiotic that acts locally and a corticosteroid to control the itching and inflammation. Other vets and pet owners have their own favorites. People have advocated using athlete's foot powders, over-the-counter medicated powders, Listerine, rubbing alcohol and many other drying agents. Personally, I think rubbing alcohol is too irritating. Antiseptic solutions can also be helpful, especially if they are also a little astringent. Butadiene solution is a good antiseptic. If the hot spot doesn't respond very quickly to efforts to keep it dry, then you should seek help from your vet. Small areas of acute moist pyoderma can become large area quickly. Some dogs will continue to dig and scratch until they really damage their own skin. Your vet can help make your dog comfortable pretty quickly in most cases.

Hygroma
Hygromas are thought to be the body's reaction to repeated trauma to an area in which bone lines close to the surface of the skin. Usually they occur on elbows. They are a collection of serum in a thick capsule that the body builds to cushion the area. Affected dogs are not usually lame. If these are small, just providing padding over the area can allow them to either maintain their present size or even shrink. However, since they can get to be pretty large and will occasionally get infected, it is not uncommon for veterinarians to recommend surgical drainage, usually with post-operative bandaging to protect the area. If they get really large and then infected, it can be necessary to do skin grafting to fix the defect made in removing the hygroma.

Hyperadrenocorticism or Cushing's Disease
Cushing's disease is probably more accurately referred to as hyperadrenocorticism -- the production of too much adrenal hormone, in particular corticosteroids. It can be naturally occurring or due to over administration of corticosteroids such as prednisone (iatrogenic Cushing's). The latter is easy to cure - just cut out the corticosteroid administration slowly to allow the body to return to normal function. The former is more difficult.
Hyperadrenocorticism occurs for two reasons --- a tumor of the adrenal gland that produces adrenal hormones or stimulation of the normal adrenal glands from the hormones that control it. The primary reason for this to occur is a pituitary gland tumor that produces excessive ACTH, which stimulates the adrenal gland to produce corticosteroids. Adrenal gland tumors account for 15% of the cases of spontaneous hyperadrenocorticism. Pituitary tumors account for 85%.

Cushing's disease causes increased drinking, increased urination, increased appetite, panting, high blood pressure, hair loss - usually evenly distributed on both sides of the body, pendulous abdomen, thinning of the skin, calcified lumps in the skin, susceptibility to skin infections and diabetes, weakening of the heart and skeletal muscles, nervous system disease and other symptoms. Most owners reach a point where the water consumption and urination become bothersome to them.

The diagnosis of Cushing's can be done with several blood tests. A general hint of Cushing's can be obtained by a blood panel. To confirm it, a test known as a low dose dexamethasone test is done. A baseline blood sample is drawn in the morning, an injection of dexamethasone given and a follow-up blood test done 8 hours later. In a normal dog, the dexamethasone should suppress cortisol levels in the blood stream. In Cushing's disease this effect does not occur. Once the disease is diagnosed, it is possible to differentiate between the adrenal tumors and pituitary gland tumors using a second test, a high dose dexamethasone suppression test. Most dogs with pituitary tumors will have cortisol suppression on this test. There are other tests used, including ACTH response tests and urine cortisol/creatinine ratios to diagnose this disease. X-rays and ultrasonography can help determine if an adrenal gland tumor is present.

If it can be determined that there is an adrenal gland tumor, it can be removed. Many veterinarians prefer to have a specialist attempt this since the surgical risks can be high. Pituitary gland tumors are not usually removed in veterinary medicine. This situation is treated using Lysodren (o'p'-DDD, which is a relative of DDT) or ketaconazole. Some research with Deprenyl for treatment of this is being done, too, I think. Lysodren selectively kills the outer layer of the adrenal gland that produces corticosteroids. By administering it in proper amounts it is possible to kill just enough of the gland off to keep the production of corticosteroids to normal levels. Obviously, close regulation of this using blood testing is necessary since overdoing it can cause severe problems with Addison's disease - hypoadrenocorticism. Adverse reactions to Lysodren occur at times but it is the standard treatment at this time. Over medication with Lysodren can cause inappetence, vomiting, diarrhea, lethargy and weakness. If any of these signs occur then your veterinarian should be immediately notified.

Treatment of Cushing's disease caused by pituitary tumors is symptomatic therapy -- it does not cure the pituitary tumor. The average lifespan of dogs diagnosed with Cushing's, with or without treatment is estimated at 2 years by Dr. Mark Peterson, but in a recent conversation with another endocrinologist I came away with the impression that this was an "educated guess" rather than the result of extensive survey of Cushing's patients. At present, though, I think that treatment should be viewed as a means of providing a better quality lifestyle rather than as a method of extending longevity.

Hypertrophic Osteodystrophy (HOD)
Hypertrophic osteodystrophy causes lameness and extreme pain in young growing dogs, usually of a large breed. Great danes, German shepherds, dobermans, retrievers and weimaraners are examples of breeds that may be affected by this condition. It appears to occur in weimaraners as a vaccine reaction and this may also affect mastiffs and great Danes. In this case, it usually occurs a few days after vaccination and may appear to be worse than the "average" case on radiographs.

HOD usually shows up as an acute lameness, often seeming to affect all four legs simultaneously. Affected dogs may stand in a "hunched up" stance or refuse to stand up at all. They may have a fever but this is not consistently present. They usually have painful swellings around the lower joints on the legs. Some puppies will die from this disease, some suffer permanent disability but many recover later. The disease is so painful that many owners elect to euthanize the puppy rather than watch it suffer, despite the reasonably good chance for recovery, long term. Affected dogs may be so ill that they refuse to eat.

X-rays confirm this diagnosis in most cases. There are very typical X-ray changes, although it can look a little like bone infection from a septic condition. There is some evidence at this point that viral or bacterial infections may underlie some cases of HOD as canine distemper virus has been found in the affected areas in some dogs. There can be high white blood cell counts and the alkaline phosphatase level in the blood stream is often elevated.

There is also a theory that this condition may occur with excessive dietary levels of calcium or protein. I am not sure what the current status of this theory is.

Treatment usually consists of analgesic medications such as aspirin or carprofen (Rimadyl Rx). Since a viral or bacterial agent may be involved in this problem the use of corticosteroids is questionable. Many people try switching to a diet that is lower in calcium (the puppy foods for large dogs may be a good choice now that they are available. Previously many people switched to adult dog foods which didn't always result in lower total calcium in the diet). Even more potent pain relief medications may be indicated in some puppies. Hydrocodone and aspirin may be a more effective combination than either one alone. Antibiotics are often given for this condition. There is a persistent rumor that vitamin C supplementation is beneficial in dogs with HOD. This appears to be a false rumor and there is some evidence that vitamin C may actually promote abnormal calcification in these puppies. It is not a good idea to supplement vitamin C.

Hypertrophic osteodystrophy may resolve spontaneously in as short a time as a week or so. It can be a recurrent, cyclic infection that goes on for a long time, too. If there are severe secondary bone changes, surgical correction of these may be necessary for normal future function of the limbs.

There is no reason not to control pain as effectively as possible with this condition. That definitely needs to a primary goal of treatment.

Hypoadrenocorticism or Addison's disease
Addison's disease is also known as hypoadrenocorticism. It is an insufficient production of adrenal hormones by the adrenal gland. Since these hormones are essential for life, this is an extremely serious disease and it must be treated as such.

Adrenal insufficiency can be primary or secondary. Primary adrenocorticism affects salt/potassium balance in the body and glucorticoid as well. Secondary adrenocorticism usually only affects the glucocorticoids. It is not known why primary adrenocorticism occurs but it may be an immune mediated process. Secondary adrenocorticism probably occurs most often when prednisone or other cortisone being administered for medical reasons are suddenly withdrawn. It can occur as a result of pituitary cancer or some other process that interferes with production of hormones that stimulate the adrenal glands.

Most dogs with Addison's disease initially have gastrointestinal disturbances like vomiting. Lethargy it also a common early sign. Poor appetite can occur as well. These are pretty vague signs and it is extremely easy to miss this disease. More severe signs occur when a dog with hypoadrenocorticism is stressed or when potassium levels get high enough to interfere with heart function. Dogs with this problem will sometimes suffer severe shock symptoms when stressed, which can lead to a rapid death. When potassium levels get high heart arrythmias occur or even heart stoppage which also is fatal. In some cases, especially secondary Addison's disease, there are no detectable electrolyte changes.

This disease can be picked up by changes in the ratio between sodium or potassium by accident at times. When this happens it is still extremely important to treat for it. It is confirmed by an ACTH response test -- administration of this hormone should stimulate production of adrenal hormones. If this does not occur then hypoadrenocorticism is present. In cases in which the electrolyte levels are normal this is the only test for the problem and it will be missed unless it is looked for specifically. At times this disease can be hard to differentiate from renal failure because the symptoms and even the bloodwork can be similar ---- so the ACTH response test may be necessary to differentiate them.

Treatment for this disease is usually done by oral administration of fludrocortisone acetate (Flurinaf), salting the food, and administration of corticosteroids like prednisone. In a crisis situation this disorder must be treated more aggressively with intravenous fluids, IV glucocorticoids and correction of acid/base balances.

You have to pay close attention to a dog with this problem. Don't ignore any changes in appetite, GI disturbances or anything else that makes you think your dog is ill. If you work with your vet and are careful about following his or her directions this disease has a good prognosis when it is discovered before a crisis occurs.

Hyposomatotrophism or Pituitary Dwarfism
In Pituitary dwarfism / hyposomatotrophism a deficiency in pituitary stimulation of growth hormone production leads to dwarfism. This occurs most commonly in German shepherds but has been reported in several other breeds. It is an inherited disease in German shepherds (autosomal recessive trait). This disorder must be distinguished from other conditions leading to stunted growth, including malnutrition, congenital hypothyroidism and other congenital defects leading to poor growth. Dogs with this condition do not grow like their litter mates. Their hair retains its "puppy" appearance, feeling soft to the touch. Hairloss along the sides that is symmetrical often occurs. Abnormalities in bone growth lead to a deformed appearance to the legs. As other puppies in the litter appear to mature, affected dogs continue to have a puppy-like appearance and bark.

Dogs with this condition may be deficient in other hormones in which the pituitary gland controls part of the process of stimulating the hormone's production. It is a good idea to check for hypothyroidism and hypoadrenocorticism in dogs with hyposomatotrophism. Human growth hormone will work to treat affected dogs but it is expensive and may be hard for the average veterinary practitioner to obtain.

Illness - Caring for your pet
   1) How can I best administer her current medicine?

Liquids can be hard to administer to dogs but usually it can be done by tilting their head back, holding their mouth shut by putting a hand around their muzzle and then working the tip of the syringe into the fold of the lip (back corner of the mouth) and giving the medication just slowly enough that it doesn't run out all over as the dog swallows. Really bad tasting medications can lead to a big struggle, though. It is possible that some of the medications might be OK in taste and your April only reacts due to the bad tasting ones. In this case, separating them may help since she may readily take the OK tasting ones and then you have a smaller volume of the others to give.

   2) What alternative diet can you suggest so she'll finish her food?

Personally, I usually tell clients with sick pets to feed them what they want unless there is a specific reason I think it is necessary not to do that, like if they have pancreatitis. Most of the time I think it is better that they eat something than that they eat what I would like them to eat. You need to check with your vet on this one though -- there very well could be a reason for the special diet.

   3) Is it extremely necessary to keep her indoors until she recovers?

Probably not --- except that it is important to make sure that she is home when it is time to give medications, so some sort of confinement is a good idea.

   4) At what point do you think I should start force-feeding her? If she eats half her meal, is that good enough?

Usually, eating half the meal for a few days is definitely OK. In most illnesses I think it is best to try things like hand feeding good tasting morsels or coaxing the dog to eat in some other way rather than force feeding. In some situations, it is very important to feed and again, you need to check with your vet on that.

   5) What can I use to disinfect the backyard and ensure that it is free of any disease causing bacteria?

Many bacteria are susceptible to sodium hypochlorite bleach (Chlorox is an example). Just general cleaning so that there is no residual stool or other organic material for bacteria to grow in helps a great deal.

Immune Mediated Hemolytic Anemia (IMHA) or Autoimmune hemolytic anemia (AIHA)
In hemolytic anemias, a loss of red blood cells (rbcs) occurs due to destruction of the rbcs. The destruction occurs due to antibodies which stick to the the rbc and cause the body to react, leading to destruction of the cell. This can be the direct result of a drug, toxin, blood parasite, virus or other primary cause or it can be an unexplained immune mediated reaction. It can occur inside the blood stream (intravascular hemolysis) or outside the bloodstream (extravascular hemolysis). In most cases in dogs, hemolysis occurs outside the blood stream in the spleen, liver and bone marrow. The destruction of red blood cells often leaves recognizable cellular debris in the blood stream. In particular, a form of damaged rbc known as a spherocyte occurs. Finding spherocytes on a blood smear almost guarantees that some form of hemolytic anemia is occurring. It does not really give a clue as to whether the IMHA is due to a primary cause or if it is occurring for no apparent reason, though. Since this disorder does not stop the production of red blood cells, there are usually immature red blood cells in the bloodstream which can be detected on the blood smears as well (a regenerative anemia).

The mechanism by which the immune system mistakes red blood cells for a "foreign invader" varies somewhat according to the cause. It usually involves adherence of the offending agent (parasite, drug, toxin, etc) to the surface of the rbc. The immune system wishes to attack this agent but manages to injure the rbc as well.
Dogs with IMHA usually experience a sudden onset of clinical signs, including depression, lethargy, pale gums or conjunctiva, sometimes jaundice or a heart murmur and bruising. Vomiting or abdominal pain may be present. It is unusual for overt blood loss to occur, such as nose bleeds or excessive bleeding from a minor injury. Death can occur rapidly, even with appropriate treatment.

Whenever hemolytic anemia is present it is wise to carefully rule out initiating causes that might be treatable. Examples of problems that can lead to hemolytic anemia include ehrlichiosis (a blood parasite), reactions to sulfa antiseptics or penicillin antibiotics, zinc toxicosis -- which can occur due to the ingestion of pennies. If any of these problems can be identified and treated the prognosis is much better.

The combination of clinical signs and spherocytes on a blood smear give a strong indication of this condition very rapidly. It can be confirmed using a Coomb's test to check for antibodies adhered to red blood cells. This test is usually done at body temperature and at a colder temperature (4 degrees Celsius). A small percentage of dogs that have IMHA will not test positive on the Coomb's test.

This condition will often respond well to very high doses of corticosteroids, such as prednisone. These medications suppress the immune system, allowing the rbcs to escape destruction. Improvement usually occurs within 1 to 3 days, if the dog is going to respond. If signs of icterus (jaundice) are present, the prognosis is usually worse. Dogs with this symptom may benefit from very aggressive treatment with anticoagulants and cyclophosphamide, a potent immune system inhibitor. Blood transfusions can be used in dogs with IMHA if necessary but they can make the condition worse so most vets reserve this approach for dogs that appear to be in imminent danger of dying due to severe anemia. It is necessary to treat most dogs for a fairly long time to prevent recurrence of the disease and some dogs seem to require lifelong use of corticosteroids or other immunosuppressants. Splenectomy is done in resistant cases since it is a major site of red blood cell destruction.

The Basenji, West Highland White terrier, English springer spaniel, Alaskan malamute, poodle and beagle breeds can be congenitally predisposed to this condition due to defects in enzymes (such as pyruvate kinase) or in the red blood cells.

Insulin Regulation
Urine glucose monitoring is not adequate, alone, for regulating insulin, in the opinion of most of the endocrinologists I have spoken with or whose information I have read. The problem with it is that you only really know if the glucose level is negative, slightly positive or strongly positive.

Negative may indicate good control or it may indicate that the insulin dosage causes hypoglycemia part of the day and you are measuring the glucose during that time (most commonly this would happen with twice daily measurements, for the evening sample).

Slightly positive results in the morning urine when insulin is given once a day is the ideal that everyone is looking for. It indicates that control of the diabetes is probably pretty good. Slightly positive results in the afternoon/evening urine sample when taking samples twice a day could indicate reasonable control or may indicate the need to slightly increase insulin dosage since this would be a little early for the insulin effect to be gone.

Strongly positive results in the morning urine glucose test can indicate that the insulin dose is inadequate or that it is excessive. If the glucose is not controlled at all, then the insulin dose is too low. In this case, an afternoon/evening sample should also show slight to strongly positive. If the insulin level is too high, the blood sugar drops to hypoglycemic levels during the day and the rebounds to very high levels in the morning. In this case, an afternoon/evening sample is likely to show a negative urine glucose level or a slight positive level.
It is much more accurate to use blood glucose curves to evaluate insulin needs since a graph of the glucose levels gives a pretty good picture of what is happening. This is especially good for detecting hypoglycemia/rebound reactions to insulin dosage.

One common mistake with insulin regulation is too frequently changing the insulin dose -- "chasing the glucose level". It takes a little time for the body to adjust to insulin dosage changes and for beneficial effects to be measurable. It is best to change the level and then leave it alone for two or three days before changing it again, when that is possible. Sometimes, in early regulation of insulin levels it isn't possible to be that patient as glucose levels skyrocket or hypoglycemia occurs.

Sometimes insulin loses some effectiveness due to inappropriate handling. Insulin should not be shaken, even though that is very tempting. The bottle should be gently rolled between the palms until the insulin is mixed in solution well again. The site of the insulin injection may need to be changed in order to allow consistent absorption. Usually it is pretty consistent if given on the sides of the trunk somewhere. Changing sites daily is a good idea (at least a little).

Many dogs require twice daily insulin dosages to regulate diabetes. Some dogs need twice daily dosing and mixtures of different types of insulin. Usually when things get this complicated we refer our cases to a internal medicine specialist or veterinary school.

Intussusception
Intussusception occurs when a section of intestine over-rides another section, trapping it inside in a telescoping effect. This cuts off the circulation to the sucked up section of intestine and it dies if the situation is not relieved. The dead section of intestine then leads to the death of the affected dog as infection and shock occur.
Intussusceptions generally occur as a secondary problem to some disorder or disease that causes increased intestinal mobility or inflammation. Chronic parasite infestation may be the most common cause but anything that causes chronic intestinal disease can lead to an intussusception. There are times when intussuceptions occur for no apparent reason so it is likely that primary intussusception can occur. They have been reported following ingestion of foreign bodies, trauma, ovariohysterectomy surgery, infiltrative or inflammatory bowel diseases and other conditions that cause intestinal irritability.

Intussusception can be chronic sometimes. It can also be a "come and go" problem -- intussuscpetions occasionally will resolve on their own and then recur. I have removed one surgically, put the remaining intestinal ends back together and watched a new intussusception form right at the same site.

Itch Control
Cold water will usually reduce itching and produce temporary relief. It doesn't really matter how the water is applied, but it must be at least cool. This effect doesn't last long, usually less than one-half hour. Adding Episoothe Oatmeal Shampoo, Episoothe Oatmeal Creme Rinse, Aveeno Colloidal Oatmeal, Relief Shampoo or Domeboro's solution helps to prolong the effect. All of these products are available over-the-counter. If you use Aveeno, one to two tablespoons per gallon of water, applied as a rinse, works best. Follow the directions on the Domeboro packet and also apply as a rinse.

Shampooing will sometimes help to control itching. Some shampoos such as Pyoben and Oxydex, act to reduce the bacteria level on the skin, one cause of itching. Seba Lyt and other sulfer/salicyclic acid shampoos reduce scaling. Lytar, Clear Tar and other tar containing shampoos reduce itching and oiliness. An emollient or moisturizer used after shampooing will restore some moisture to the skin and this also reduces itching. Expar Creme Rinse can be used to kill fleas after itching and moisturize the skin.

Antihistamines are useful in the treatment of itching in some dogs and cats. Used alone, about 15 to 25% of dogs will respond to antihistamines. Used in combination with fatty acid inhibitors, such as DermCaps, EFA-Z and Omega EFA capsules, about 25 to 40% of dogs will respond, reducing scratching behavior to acceptable levels. Antihistamines available over-the-counter are Benedryl (diphenhydramine, 25mg capsules) and Chlortrimeton (chlorpheniramine maleate, 4mg tablets). There are prescription antihistamines, notably Atarax (hydroxyzine) that work better in some cases. It is necessary to get a dosage for your particular dog or cat from your vet.

Dogs and cats have individual reactions to antihistamines. Since some dogs will respond better to one than another, it is best to try more than one antihistamine before giving up on them to control itching. Some pets will become drowsy when taking antihistamines. If this is unacceptable, they can not be used, or might be best to use at bedtime. Occasionally a pet will get excited when given antihistamines. These pets should not be given these products.

Fatty acid derivatives compete with aracadonic acid, the trigger for itching in the body. By replacing this compound with an inactive competitor, itching can be reduced. It is important that the fatty acid derivative chosen have gamma-linoleic acid, eicosapentanoic acid, or both. These products work best at high dosage levels and when given with a low-fat canned food such as W/D, which is available through veterinarians. Although they can be fairly expensive, their use is preferable to cortisones if they are effective. It is necessary to use these products for at least 6 to 8 weeks to judge their full effect. EFA-Z and DermCaps are examples of these medications.

Antibiotics are used to control skin infections associated with scratching. The itching leads to scratching, which damages the skin. The damaged skin is easier for bacteria to grow in. The bacteria then contribute to the itching, leading to more skin damage. As this cycle progresses, deeper and deeper layers of the skin are affected, sometimes leading to systemic bacterial infections that can even be fatal. Control of skin infections with antibiotics takes time. The usual defense mechanisms of the body, fever, white blood cells and antibodies do not work as well on the skin surface. Antibiotics must do more of the work alone. For this reason, 3 weeks is the minimum recommended time that antibiotics should be given for skin infections. Often, antibiotics must be continued for up to 8 weeks to consistently control skin disease. Several antibiotics seem to work consistently in skin disease. When these antibiotics fail, it is necessary to culture the skin lesions to identify which antibiotic might be appropriate in an individual case. Occasionally it is necessary to continue antibiotic therapy indefinitely to control severe bacterial skin disease.

Some dogs appear to be unable to prevent penetration of staph (staphylococcus) bacteria into the skin. These dogs can be benefited by the use of a product to promote immune responses. Similar to vaccinations (but short acting), these products help the body learn to fight off staph bacteria. They are Staph Lysate and Immunoregulin. Although somewhat expensive and necessitating weekly injections, these products can cost less to use than frequent or continuous antibiotic therapy. We have better success with Staph Lysate.
Hyposensitization, or allergy "shots", are used in dogs. Their use in cats is very limited due to difficulties testing cats accurately for individual allergens. Similar to their use in people, these injections help many pets, but not all. To be used properly, it is necessary to identify the allergy agents affecting a dog and then treat accordingly. This can be done by skin testing, where small quantities of allergens (allergy causing agents such as pollens), are injected into the skin and the response to this monitored. Often, it is necessary for a general veterinary practitioner to refer a pet to a veterinary dermatologist for this testing. Recently, blood tests have been developed to allow allergy testing without injections into the skin. These have become better understood recently and are correlating with the skin testing fairly well, although it is generally agreed that skin testing is still more accurate. Allergy injections require a consistent effort from the pet owner. They are the preferred treatment for inhalant allergies if that is the only condition affecting dog, when effective. Currently, about 70% of dogs are thought to benefit from this therapy.

Fleas cause most the allergic reactions in pets. Flea control is essential to our success in treating itchy dogs. Please ask for flea control information if you have any problem at all with fleas on your pet!

When itching can not be adequately controlled by one of the above methods, we usually use a corticosteroid, such as prednisone. Cortisones are the most consistently effective anti-itch medications that we have. They do have several drawbacks, however. Cortisones increase the amount of water your pet drinks, making it urinate more, too. Sometimes this becomes a problem. These drugs increase appetite and weight control can be difficult while using them. If proper dosage schedules are not followed there can be long-term side effects such as decrease in bone density or an increased chance of pancreatitis. Cortisones depress lymphocytes, a type of white blood cell, making it easier for bacterial infections to occur. Accidental overdosage with these medications or inappropriate long-term use can lead to medication induced Cushing's disease, a cause of hair loss, muscle weakness and other problems. For these reasons, most vets insist on monitoring a pet on cortisones through follow-up office visits. You may be required to allow examination of your pet prior to refilling prescriptions for these drugs.

In spite of these side effects, cortisones can be the best drugs to make an extremely itchy pet comfortable. If they are the only effective drugs for your pet they are worth the small risk to an individual pet of side effects. These drugs are reasonably safe for long term use if given according to directions. Allowing your pet a good quality of life, by controlling the itching, is worth the small risk of using prednisone and related compounds.
These are the methods we use to treat pruritis, the itchiness that causes your dog or cat to scratch. It may take several tries to work out the proper drug and dosage schedule for your pet, but is worth the effort.

Kennel cough
Kennel cough is most commonly associated with a bacterial infection caused by the organism Bordetella bronchiseptica. While it is hard to be certain in veterinary medicine when discussing statistics, it is estimated that 80 to 90% of the cases of kennel cough are due to this organism. The other 10 to 20% of cases are caused by a variety of other infectious agents, most of them viral. Kennel cough has been associated with parainfluenza virus, adenovirus and canine distemper virus as well as the Bordetella bacteria.

The incubation period from the time a dog is exposed until clinical signs appear varies depending on which infectious agent is the cause. In general it appears to be about 3 to 5 days with Bordetella. The infection tends to be mild except for a very harsh cough that often prompts owners to think that their dog "has something caught in his throat". In some dogs it can lead to pneumonia or more serious signs. Cough suppressants can be used to control the cough and antibiotics may be necessary for stubborn infections or to try to stop the spread of the bacteria in multiple dog households. It is probably a good idea to vaccinate dogs who will be exposed to large numbers of other dogs, such as at shows, obedience classes or the classic cause -- when left in kennels. The intranasal vaccine is pretty fast acting, providing some protection in as little as 5 days. The injectable version of the vaccine may provide longer immunity, though. Some vets use both to get maximum protection. We don't use either one routinely but give the intranasal vaccine to our patients who will be exposed to groups of dogs.

Legg-Calve-Perthes Disease (aseptic or avascular necrosis of the femoral head)
Avascular necrosis occurs when the bone that makes up the ball portion of the hip is damaged from lack of blood supply. The reasons this occurs are not clear. Since a higher incidence of this disorder is noted in several dog breeds, including terrier breeds, miniature pinscher, poodles and possibly schipperkes, it is assumed that there may be a genetic component to the problem. In Manchester terriers, the genetic component appears to be a strong influence and heritability is pretty high for this problem.

Most of the time the clinical signs of this disease occur in 4 to 11 month old dogs and usually consist of lameness of one leg only. Pain may be mild to very severe. Some dogs have mild forms of this condition and do not require medical care. In other dogs, the condition cause sufficient pain and deformity of the hip joint to require surgical intervention. The disorder can usually be confirmed with X-rays. Atrophy of the muscles of the affected leg is not uncommon. If this is severe it can slow the recovery period considerably and may make medical therapy less likely to work.

Treatment of this condition varies according to the severity of the signs seen. In mild cases, enforced rest may be sufficient to allow healing of the damaged areas to occur. In some cases, immobilization of the affected limb using an Ehmer sling may be beneficial to recovery. Many dogs have advanced cases of this disease by the time they are examined by a veterinarian and medical treatment is not likely to work. In these dogs, excision of the femoral head (ball portion of the hip joint) is often beneficial. Removal of this section of the bone diminishes painful bony contact in the hip joint. Recovery from this surgery can be slow with recovery periods of up to one year sometimes occurring before good use of the affected leg returns. If muscle atrophy is not present at the time of surgery the recovery time is usually much less. Pain relief and anti-inflammatory medications may be beneficial.

There is a stronger tendency to treat this as a medical condition prior to surgery right now. A general rule of thumb is to allow non-surgical therapy a month to show a beneficial response. If one is not seen, surgical repair should be considered more carefully.

Leptospirosis Vaccination
This is actually a bacterial disease, so the protective "vaccination" is actually a "bacterin". In many areas of the country, this disease is not common and the leptospirosis portion of the vaccine combinations is thought to be the most common cause of reactions. For this reason, many veterinarians no longer include it in their vaccination recommendations, IF they practice in an area in which it is not common. Your vet can tell you whether or not it is necessary in your area.

Leishmaniasis
Leishmaniasis is caused by a protozoan in the Leishmania species. Skin disease, polyarthritis (arthritis in multiple joints), mucosal disorders (lumps on tongue, gums, etc.), damage to internal organs and possibly bleeding disorders. It is diagnosed by examination of tissues from affected dogs or by serology through antibody titers. I am not sure if there is a consistently effective medical treatment for this condition since there appear to be a lot of semi-effective medications listed in the veterinary literature.

The skin signs seen with this disease include loss of hair, scaling of the skin, ulceration of the skin on the limbs or ears, formation of nodules on the body and sometimes pustules.

Lipoma
Lipomas are fatty cell tumors that are quite common in dogs. They usually show up in older dogs but we have seen them in puppies as young as 5 or 6 months on occasion. One of the younger dogs we saw did have the malignant form of this tumor which is very rare. For the most part these are benign tumors that do not cause problems. We usually aspirate (draw up some of the lump through a needle) and examine the cells from these tumors to confirm that they are just lipomas. We remove them only if they are causing problems with movement or the owners feel the need to remove them for cosmetic reasons.

Liver shunt
Liver shunts are a congenital problem in some dogs. During gestation the placenta delivers blood with food and oxygen from the mother through the umbilical vein. This means that in the fetus, circulation is the reverse of circulation after birth, because the fetus' veins have the oxygenated blood and arteries return unoxygentated blood to the heart. In order to make this work, there is a shunt from the liver venous circulation to the arterial circulation. At birth, the pressure within the circulatory system changes as respiration occurs and this shuts the shunt, which eventually disappears. If this reverse in circulation doesn't happen for some reason, the liver is deprived of a blood supply and doesn't develop properly after birth. Many puppies can live with the small functioning portion of the liver for some time but eventually have problems and usually die if the situation is uncorrected. It is possible to surgically close the shunt and the surgery works well. I can remember hearing of one sheltie that was 6 years of age (or possibly older) before a congenital liver shunt was recognized, so some dogs can live a long time with this problem.

Lupus Erythematosus
This is a rare disease of the immune system. In this disease, the immune system forms antibodies against the nuclear component of its own cells. This can cause a variety of effects but the most common ones are arthritis, kidney disease, skin disease and blood disorders (anemia and/or decreased in platelet numbers). A great number of other effects and side effects of this disease can occur so it is hard to rule in or rule out when faced with a multi-systemic disease. In general, this disease is not considered to be present unless testing to determine if antibodies against the nuclear elements of the cells are present (positive ANA test) AND clinical signs of at least two of the common disorders are present. Even then, it is hard to be sure that this disease is actually the problem. Some drug reactions and cancers can produce almost identical clinical signs and many problems produce some of the clinical signs. Treatment usually involves the use of immunosuppressive medications, most commonly corticosteroids such as prednisone. Often, a second immunosuppressive agent must also be used. Azathioprine, cyclophosphamide and cyclosporine are examples of these medications. Lupus is not curable but it is often possible for a dog to live with it successfully. Some of the disorders that resemble lupus are curable, especially if a cause can be identified. Continuous monitoring of patients suspected of having lupus should be part of the treatment, due to the possibility of another problem, the multitude of side effects that can occur and the potential for problems from the medications used to treat it.

Lupus, Discoid
Discoid lupus is an immune mediated skin disease that is probably related to systemic lupus erythematosus (SLE) but instead of affecting the whole body as SLE does, it primarily affects the nose and face. As far as I know, there is no known cause of this problem but it does seem more frequent in dogs of the German Shepherd, Collie, Brittany Spaniel. Shetland Sheepdog, Siberian Husky and German Shorthaired Pointer breeds.

The disease normally starts as loss of pigment around the nose. There may be scabby sores or just scaling of the nasal tissue. The surface of the nose may change from its typical cobblestoned appearance to a smooth surface. As this disease progresses it can cause deep sores on the borders of the nose where it meets normal skin and the sores start to progress up the bridge of the nose. Some dogs seem to be really bothered by this condition and others show little reaction to the sores.

Ultraviolet light seems to make the sores worse, so the disease may appear to be seasonal. It is more common in areas in which exposure to ultraviolet light is increased, such as high altitudes. If the depigmentation leads to sunburn, squamous cell carcinoma becomes more likely than in other dogs. Topical sunscreens can be very beneficial, although it is hard to get dogs to leave them on. Keeping the dog in during the peak sunlight hours is probably the most effective way to prevent excessive exposure to UV light.

Treatment depends on the severity of the disease. In many cases, topical treatment will be all that is necessary, using a corticosteroid ointment (Panalog, Synalar and others). It is usually necessary to use a fairly potent corticosteroid. Vitamin E supplementation is sometimes beneficial but can take several months to show much effect. Severe cases require treatment with corticosteroids. It is possible that other immunosuppressive therapy such as gold salts or azathioprine (Immuran) could be beneficial but this is rarely necessary to consider. In people, this condition is often responsive to antimalarial medications but I do not know if this is safe or effective therapy for dogs.

Lyme Disease (Borrelia) Bacterin
Lyme disease is caused by a bacterial organism, Borrelia burgdorferi . It is carried by Ixodes species of ticks and may have other tick or insect carriers. It is more common in some areas of the United States than in others. Your vet can tell you whether it is necessary to protect against this disease in your area.

There is a new Lyme bacterin on the market that Rhone-Merieux has produced using recombinant gene techniques. This bacterin only uses a portion of the bacteria which the body defenses recognize and form antibodies against. Because the whole Lyme bacteria is not present, it appears that there will not be the problem of the vaccine causing symptoms of Lyme disease. In addition, this bacterin does have a validated one year duration of immunity. It is a new product and like all new products there is a period when everyone looks hard for previously unknown reactions but if "vaccination" against Lyme disease seems necessary in your area, I'd definitely use this one.

Megaesophagus
This is a condition in which the esophageal muscles lose their strength and the esophagus dilates to a much larger size. Usually dogs with this condition regurgitate food as well as water but I have seen at least one other dog that started out just regurgitating when it drank water. Sometimes the enlarged esophagus is visible on plain X-rays of the chest but often it is necessary to use some kind of contrast medium like barium to make the enlargement visible.

There are other possible problems like esophageal diverticuli, hiatal hernia, esophagitis, pylorospasm, esophageal tumors and probably others. In addition, there are about thirty disorders that can cause a secondary megaesophagus problem.

Moist Pyoderma (Acute) or Hot Spots
"Hot spots" are also known as "acute moist pyoderma". What that means is that they are rapidly appearing, oozing, skin infections. This is just a description of a symptom, sort of like saying "your dog has scabs".
A hot spot starts because something irritates the dog's skin. The body's response is to either itch or create an inflammatory response at the site. In cases of itching, the dog then rubs, licks or chews the site and adds to the problem. These sores can develop into severe problems in an hour or two at times.

The most common irritants are probably fleas and allergies. These cause the itching that leads to the skin infection. There are many other possible sources of irritation. Tick bites, besetting, burrs, mats, mosquitos, summer heat and other problems all contribute to the initial irritation that can develop into a hot spot.
The best treatment for these is prevention. Keep fleas off your dog. Groom and bathe your dog as necessary to keep the haricot in good condition. Limit other sources of irritation to the best of your ability. If allergies are a problem for your dog, work with your vet to control the itching they cause. In some dogs, all of this won't be enough and you will occasionally see hot spots anyway. The first step in treating a hot spot is to get it dry. Bacteria like the hot moist environment of irritated skin. Using something to dry the sore makes it harder for bacteria to grow. Clipping the hair over and around a hot spot can help a great deal in allowing it to dry. There are lots of astringents that will help dry the sore, as well.

My favorite is NeoPredef powder because it dries the sore, has an antibiotic that acts locally and a corticosteroid to control the itching and inflammation. Other vets and pet owners have their own favorites. People have advocated using athlete's foot powders, over-the-counter medicated powders, Listerine, rubbing alcohol and many other drying agents. Personally, I think rubbing alcohol is too irritating. Antiseptic solutions can also be helpful, especially if they are also a little astringent. Butadiene solution is a good antiseptic. If the hot spot doesn't respond very quickly to efforts to keep it dry, then you should seek help from your vet. Small areas of acute moist pyoderma can become large area quickly. Some dogs will continue to dig and scratch until they really damage their own skin. Your vet can help make your dog comfortable pretty quickly in most cases.

Myasthenia Gravis
Myasthenia gravis is a neuromuscular disease in which weakness is the primary sign. This disease is caused by an inability of the certain nerve receptors (nicotinic acetylcholine receptors (AChRs) to function properly. This prevents the stimulus for muscles to contract which leads to the weak appearance. This disease occurs congenitally in some dog breeds. Jack Russell terriers, springer spaniels and smooth fox terriers are affected. It can also occur as an acquired problem in older dogs. In this case, it is thought to be an immune mediated disease. In older dogs, the first sign of problems may be megaesophagus -- enlargement of the esophagus due to the muscular weakness, leading to problems swallowing. This can cause regurgitation and lead to inhalation pneumonia.

Myasthenia gravis can be very variable in the way it looks. Only a few muscle groups may be affected or the dog may be nearly immobile. A dog can be almost normal after a rest and then lose strength very rapidly when it exercises at all.

Whenever megaesophagus is diagnosed, myasthenia gravis (MG) should be suspected. Conversely, whenever myasthenia gravis is diagnosed, chest X-rays should be done to evaluate the esophagus, in case megaesophagus is present.

MG can be presumptively diagnosed by a rapid response to injection of edrophonium hydrochloride (Tensilon). Dogs usually show an immediate improvement in muscle strength that is of short duration. Specific lab tests for this disease are available to confirm the diagnosis.

Dogs that acquire MG later in life usually have a fairly good prognosis with treatment. It is important to prevent aspiration pneumonia, so dogs should be fed from elevated food bowls and encouraged to remain standing for 10 minutes or so after eating. Anticholinesteras medications are very helpful. Pyridostigmine bromide (Mestinon syrup) is the most commonly used medication. If it is not effective, injections of neostigmine (Prostigmin) will sometimes work. In severe cases, corticosteroids may be necessary. It is very important to make sure that there are no other illnesses and no aspiration pneumonia signs prior to using corticosteroids.
Dogs can be maintained well for a long time with this disease. The more attention paid to prevention of aspiration pneumonia, the better the long term prognosis. In addition, many other medications interfere with the actions of the anticholinesterase drugs, so careful thought must be given to the choice of medications to treat other problems in dogs affected with myasthenia gravis.

A number of dogs with acquired MG will have remissions from the disease. Therefore, it is very important to monitor the antibodies to anticholinesterase receptors prior to treatment and at regular intervals during treatment. Recurrences of the disease after remission can occur, so vigilance is required throughout the lifespan of affected dogs.

Nosebleeds
Nosebleeds can occur for a lot of reasons. In older dogs a major concern would be nasal tumors or nasal infections. Tumors can be pretty hard to find even with endoscopy and X-rays in some cases but the tests for this make it less likely. In any age dog bleeding disorders need to be considered when nosebleeds occur. Ehrlichia canis, immune mediated thrombocytopenia, immune mediated hemolytic anemia and other causes of bleeding should all be considered. In older dogs a fairly common cause of bleeding disorders is hemangiosarcoma, a type of tumor. Heartworms can cause nosebleeds in the later stages of the disease. It can be difficult to identify the cause of bleeding disorders.

Pancreatitis
One of the functions of the pancreas is production of digestive enzymes. These are the enzymes that break down ingested foods into molecules the body can digest. These enzymes are carefully handled by the pancreas in order to prevent them from damaging the pancreas itself or surrounding tissue. When these self-protective mechanisms break down for any reason, the result is leakage of enyzmes which damage the pancreas and any surrounding tissue they reach. This breakdown is called pancreatitis.

There are a number of things which can initiate or facilitate enzyme leakage, so pancreatitis can occur for a number or reasons. Often, it takes a combination of precipitating factors to cause pancreatitis to occur in a dog or cat. High fat diets, obesity and lack of exercise are the most common "life-style" contributors. Miniature schnauzers are predisposed to pancreatitis due to a tendency to have high levels of lipoproteins in their blood streams. Corticosteroids and azathioprine medications may contribute to the tendency to develop pancreatitis. Hyperadrenocorticism, a naturally occurring overproduction of corticosteriods that is fairly common in dogs may also lead to an increased susceptibility to pancreatitis. Anything that interferes with blood supply to the pancreas or release of digestive enzymes by the pancreas may lead to pancreatitis. For some reason, pancreatitis does not occur, or is not recognized, as often in cats as it does in dogs.

The "typical" pancreatitis patient is middle-aged or older and overweight. There may be a slightly higher prevalence of this problem in female dogs but it does occur commonly in both sexes. Often, the family has just had a party or a big holiday meal when this disease strikes. This is not a disease that restricts itself to any particular scenario, though. It often occurs in patients that do not fit the typical profile and it has highly variable clinical signs.

Any time a dog appears to be exhibiting signs of unexplained pain, pancreatitis must be considered. Vomiting is common with pancreatitis. Depression can be severe. Affected pets may seem restless or be reluctant to move, they may seem weak, irritable, have diarrhea or simply refuse to eat. Many owners recognize that their pet is very ill but may be baffled by a lack of symptoms to explain their pet's discomfort -- they just know they don't feel well.

When your vet examines your dog and suspects pancreatitis, she will look for abdominal pain that seems to be centered in the portion of the abdomen that is partially covered by the ribs. Dehydration is common in patients with pancreatitis. Rapid heart rate and rapid breathing are sometimes seen with pancreatitis. Poor circulation in capillaries may lead to redness of the gums and eye linings.

Confirming a diagnosis of pancreatitis can be frustrating. Currently, there is no single reliable diagnostic test for this disease. Often, amylase and lipase levels are elevated in the bloodstream. Unfortunately, this seems to happen slowly in comparison to the progress of the disease so a pet may be pretty ill before the enzyme levels elevate and in some cases of pancreatitis an elevation in these enzyme levels doesn't occur. Often, blood tests that help evaluate liver and kidney function are slightly elevated as well. White blood cell counts are usually high. Ultrasound exam of the pancreas, if your vet can do this, is helpful in diagnosis. X-rays are often taken to make sure other conditions are not causing the pain, such as intestinal obstruction, but usually it is not possible to be sure a dog has pancreatitis based on X-ray changes. Pancreatitis is harder to diagnose in cats because they are less likely to have high enzyme levels and either hide pain better or experience less pain, making the need for testing less obvious.

Pancreatitis can be acute and only occur once in a dog's lifetime or it can become chronic and keep returning over and over again. It can be a rapidly fatal illness or a mild attack of pain that resolves in a few hours or a day or so. It can cause tremendous side effects, including shock, blood clotting disorders, heart arrythmias, liver or kidney damage and death.

I think that chronic disease with varying levels of pain and secondary side effects is the most common form of pancreatitis. Fortunately, most of the time dogs with chronic pancreatitis problems do not die from the attacks. It is possible to lessen the severity and frequency of attacks in many of these dogs by managing their diet and exercise. Less commonly, pancreatitis strikes with a sudden severe fury that creates severe secondary problems, particularly with blood clotting and shock. In these cases, it can be fatal. It is not clear whether these are entirely separate disorders or different manifestations of the same problem. In cats, chronic pancreatitis is often associated with feline infectious peritonitis or toxoplasmosis and it may be beneficial to try to rule out these conditions if pancreatitis is suspected.

It is important to take pancreatitis attacks seriously, especially the first one. Pain management seems to help a great deal in preventing escalation pancreatic attacks, based on our clinical experience. Totally restricting food intake (no food) for 24 to 72 hours seems to help a great deal as well. This may be due to a decrease in stimulation of the pancreas to release digestive enzymes. Fluid therapy to prevent dehydration and help maintain circulatory function is usually necessary. Medications to control vomiting are often used. Many veterinarians use antibiotics in an effort to ward off secondary infections but this may not be necessary in milder cases as bacterial infections do not commonly accompany pancreatitis. Corticosteroids are not thought to be helpful in treatment of pancreatitis. It may be necessary to use intensive medical therapy for serious side effects of the disease or even surgical intervention in really severe cases of pancreatitis. In miniature schnauzers, medical control of the lipid levels may be beneficial and is sometimes possible using medications.

Once the patient seems to feel better, oral fluids are given. If no vomiting occurs in 12 to 24 hours, food can be offered in small quantities. Most pets can go home once they are willing to eat and drink again. Bland diets may be beneficial in some patients but we usually recommend returning to the patient's normal diet as long as it wasn't likely to be the cause of the problem due to fat content. Diets moderately high in fiber may be beneficial in lessening the number or severity of attacks in chronic pancreatitis. Weight loss and increasing exercise are also very likely to help prevent future attacks. Keeping your pet away from the table during traditional holiday meals can be very helpful, too.

It is very important to remember NOT to feed your dog when it is showing signs of abdominal discomfort or unexplained pain. It is almost painful to think of the number of times dog owners have said to me "she wouldn't eat, so I gave put a couple of tablespoons of bacon fat on her food...... or gave her a bowl of ice cream...... or a bowl of milk....... or a couple of pieces of ham....... " This is the worst thing you can do if your dog has pancreatitis. Learn to let them help themselves heal by not eating when their body is telling them it isn't a good idea! This can be the difference between a 24 hour attack of mild abdominal pain and 5 days in our hospital treating severe pancreatitis.

Panosteitis
Panosteitis is a spontaneously occurring lameness that usually occurs in large breed dogs. German Shepherds seems to be particularly predisposed to this condition. Due to this, it is possible that the disease may have genetic causes. Some veterinarians feel that this disease may be induced or worsened by stress.

Affected dogs are usually in the 5 to 14 month age range and male dogs are more commonly infected than female dogs. The disease has been reported in dogs as young as 2 months and can occur in young mature dogs. The lameness tends to occur very suddenly, usually without a history of trauma or excessive exercise. In most cases one or the other front leg is affected first and then the problem tends to move around, making it appear that the lameness is shifting from leg to leg. There are often periods of improvement and worsening of the symptoms in a cyclic manner. This makes evaluation of treatment difficult since many dogs will spontaneously recover with or without treatment and then relapse.

X-rays usually reveal that the bones have greater density than is normally found. If pressure is applied over the long bones, pain is usually present. The X-ray signs do not always match the clinical signs.

In most cases, the worst pain lasts between one and two months but may persist in a cyclic nature for up to a year. Analgesic medications like aspirin can be be helpful. In severe cases, corticosteroids may provide relief.
Currently, a common rumor is that low protein, low calcium diets may prevent this condition. It should be noted that the energy level of low protein/calcium diets is often lower as well. If this is the case, a puppy will eat much more of the diet in order to meet its energy needs, resulting in higher total calcium consumption. It may be preferable to feed a puppy diet and restrict total quantity to keep the dog lean than to use a low protein/low calcium adult dog food.

This condition is self limiting, meaning that it will eventually go away, with or without treatment. Pain control can go a long way towards helping your pet feel more comfortable and should be used, though.

Parainfluenza Vaccination
Parainfluenza must be an inexpensive virus to include in vaccines. It is in almost all the combination vaccines even though it is probably only a minor contributor to the problem of tracheobronchitis (kennel cough) in dogs. Vaccine reactions to this virus seem rare.

Paroxysmal Respiration
Dogs have a condition called "paroxysmal respiration". It is also sometimes called a "reverse sneeze" because it really sort of looks like the dog is trying to inhale a sneeze. They tend to look almost like they are having difficulty catching their breath and there is usually a snorting type sound. It is unusual for dogs to do this more than once or twice a day when they are affected with the problem, though. This problem does seem to be exacerbated by allergies and it can be difficult to determine exactly what they are allergic to. Most of the time, it is not possible to determine if there is an underlying cause for this problem. There are a number of theories about why it occurs, including abnormalities in the soft palate, allergies, "post-nasal" drip and any other condition that might irritate the palate/laryngeal area.

Parvovirus
Parvovirus is a viral disease of dogs. It affects puppies much more frequently than it affects adult dogs. The virus likes to grow in rapidly dividing cells. The intestinal lining has the biggest concentration of rapidly dividing cells in a puppy's body. The virus attacks and kills these cells, causing diarrhea (often bloody), depression and suppression of white blood cells -- which come from another group of rapidly dividing cells. In very young puppies it can infect the heart muscle and lead to "sudden" death. This is a very serious disease. Some puppies infected with parvovirus will die despite prompt and adequate treatment. While no extremely accurate statistics are available, a good guess is probably that 80% of puppies treated for parvovirus will live. Without treatment, probably 80% or more of the infected puppies would die.

Due to the high death rate, parvovirus gets a lot of free publicity. Many people just assume that any case of diarrhea in a dog is from parvovirus. This is not true. There are a lot of other diseases and disorders that lead to diarrhea. If you have a puppy, don't take any chances. Have your puppy examined by your vet if diarrhea is a factor in any disease. It is better to be safe than to be sorry.

Parvovirus - Transmission
Canine parvovirus is carried by dogs. Adult dogs may be infected carriers without showing any clinical signs. Dogs with the typical diarrhea that parvovirus causes shed the virus as well. It can last a long time in the environment, perhaps as long as 9 months or so.

There is a parvovirus of cats, the panleukopenia virus. Researchers seem to think that this virus may have mutated to become canine parvovirus. This is not a confirmed theory but there is some supporting evidence for this.

Parvovirus Vaccination
Parvovirus is probably the most common viral illness of dogs at the present time. It is much more common in puppies than it is in adult dogs. It can be very hard to successfully vaccinate a puppy for this disease because the antibody protection the puppy acquires from its mother can interfere with vaccination. It is important to vaccinate puppies every three to four weeks for this virus starting at 6 weeks of age and continuing until they are at least 16 weeks of age and preferably 20 weeks of age. It is possible that this vaccine confers lifelong immunity once it does work but most veterinarians continue to recommend every three year vaccination for it. It seems prudent to at least get the vaccination at one year of age.

Pemphigus
Pemphigus foliaceus, pemphigus vulgaris, pemphigus erythematosus and pemphigus vegetans There are several related immune mediated skin disorders called pemphigus complex. These have a common mechanism of action in which the body produces antibodies against the outer layer of the skin (the epidermis). Pemphigus foliaceus is the most common of these diseases in the dog. It is seen more often in Akitas, chow chows, dachshund, bearded collies, Doberman pinscher, Schipperke, Finnish Spitz and Newfoundland dogs. Pemphigus erythematosus is second most common and may just be a milder form of pemphigus foliaceus. It is seen more commonly in collies, Shetland Sheepdogs and German shepherds. Cats are also susceptible to phemphigus disorders. These diseases look exactly alike except that pemphigus erythematosus usually only affects the head and feet.

The more common forms of pemphigus produce scaling skin, scabbiness and sometimes pustules (pus filled sores that look like pimples). Early in pemphigus foliaceus the disease may be confined to the head and feet, making it hard to distinguish from pemphigus erythematosus. Later it spreads to more of the body. Careful examination of the skin may reveal the presence of blisters, which are very indicative of these diseases. The blisters rupture quickly and may not be seen. If the sores become infected it is possible for severe illness to develop but this is not a common complication. Pemphigus vulgaris is the most severe form of the disease. In this disorder, there is severe ulceration of the skin, usually where "normal" skin meets "specialized" skin --- around the mouth, anus, prepuce, nose and vagina. The mouth is almost always affected.

Secondary complications are more common with pemphigus vulgaris than other forms of pemphigus and can be very severe. Pemphigus vegetans may be a less severe form of pemphigus vulgaris but it does look different. In this form of pemphigus there are warty growths that may ulcerate. There are a lot of diseases that can look like pemphigus disorders. Drug eruptions (skin reaction to administered medications) are probably the most common "look alike" disorder but systemic lupus erythematosus, discoid lupus and skin cancers are other fairly common diseases that may be confused with pemphigus. Diagnosis of pemphigus is best done by skin biopsy. Sometimes specialized testing must be done on the biopsy samples -- which often means doing them again. Treatment of pemphigus vulgaris and pemphigus foliaceus can be pretty frustrating.

Usually it is necessary to use prednisone (a corticosteroid) for the life of the dog to control the symptoms of skin scabs and scaling for pemphigus foliaceous and ulceration of skin around mucous membranes (the more "specialized" skin). Prednisone often will not work alone, though. It is usually necessary to use a second immune suppressive medication like azathioprine or chemotherapeutic agents to get complete control of the disease. Treatment of pemphigus erythematosus and pemphigus vegetans may not be necessary or is usually possible with topical corticosteroids or low to medium dosages of prednisone. Due to the serious immunosuppressive tendencies of the medications used to treat pemphigus diseases it is usually necessary to closely monitor the health of pets under treatment. To succeed in keeping a dog comfortable when affected by the more severe pemphigus diseases takes close cooperation between the client and veterinarian. Teamwork is important in treating pemphigus.

Perianal Adenoma
Perianal adenomas are usually a benign tumor that affects older, intact, male dogs. In male dogs these occur in tissues around the rectum that are responsive to androgens (like testosterone) and develop into benign tumors under the effect of these hormones. Unfortunately, when these tumors occur in spayed female dogs they are much more likely to be malignant than not. A malignant version of this tumor is known as a perianal adenocarcinoma. There is no way I know of to tell them apart based on appearance visually. The tumor should be removed and sent to a pathologist for histopathologic examination. Careful examination of the surrounding tissues might reveal metastasis of the tumor. If your female dog is unspayed, there is a greater chance that the tumor would be benign but it would still be more likely to be malignant than in a male dog.

Pituitary Dwarfism or Hyposomatotrophism
In Pituitary dwarfism / hyposomatotrophism a deficiency in pituitary stimulation of growth hormone production leads to dwarfism. This occurs most commonly in German shepherds but has been reported in several other breeds. It is an inherited disease in German shepherds (autosomal recessive trait). This disorder must be distinguished from other conditions leading to stunted growth, including malnutrition, congenital hypothyroidism and other congenital defects leading to poor growth. Dogs with this condition do not grow like their litter mates. Their hair retains its "puppy" appearance, feeling soft to the touch. Hairloss along the sides that is symmetrical often occurs. Abnormalities in bone growth lead to a deformed appearance to the legs. As other puppies in the litter appear to mature, affected dogs continue to have a puppy-like appearance and bark.

Dogs with this condition may be deficient in other hormones in which the pituitary gland controls part of the process of stimulating the hormone's production. It is a good idea to check for hypothyroidism and hypoadrenocorticism in dogs with hyposomatotrophism. Human growth hormone will work to treat affected dogs but it is expensive and may be hard for the average veterinary practitioner to obtain.

Pneumothorax
Pneumothorax refers to air accumulation in the chest cavity. As odd as this sounds, the chest cavity must have a vacuum (no air) to work properly. There should be no air pressure outside the lungs. This enables them to inflate when the muscle of the chest are relaxed and it expands. The air is then forced out of the chest by contraction of the muscle of the chest. When the lung is damaged and leaks air, it collapses the lung. The same thing happens when there is a hole in the chest allowing air in. Either situation can be the cause of pneumothorax after a traumatic even like being hit by a car. If there is only a small amount of air accumulated it can be reabsorbed. This is commonly the case with blunt trauma in which the lung ruptures, then heals itself quickly. If there is a lot of air or continuous leakage of air, it is usually necessary to place a drain in the chest to remove the air and maintain a vacuum. There are several ways of doing this to ensure continuous evacuation of air. We use a Heimlich valve (same guy as the Heimlich maneuver, I'm sure) attached to a silicon tube in the chest.

Pregnancy
The best days to palpate (feel for) puppies are about day 28 to day 35 of the pregnancy. Usually it is best to count from the last breeding day as most dogs actually ovulate shortly before they quit standing for the male. X-rays can confirm pregnancy after 45 days. Sometimes it is worthwhile to take X-rays to get an idea of the number of puppies -- usually we do this only if we suspect that there are problems or if the bitch has had trouble delivering puppies previously.

It is best to gradually change the bitch to a puppy formula dog food at about 35 days of the pregnancy (take about a week to slowly make the change, mixing in small amounts of puppy food with normal food the first day and gradually increasing the amount). Most bitches require about 1.5 times the normal amount of food for their maintenance at the time of birth. As the puppies grow, she may require as much as 3 times normal amounts of food to support lactation. You should continue to keep her on a puppy formula until the puppies are weaned.
Do not supplement calcium during the pregnancy. This seems to lead to problems with uterine inertia, increasing the probability that a cesarean section may be necessary. It may also contribute to the frequency of seizure problems associated with low blood calcium levels during lactation (milk tetany).

Know your veterinarian's emergency procedures before the delivery. If your vet refers emergencies to an emergency clinic, make sure you know where it is and how to call if you need help. If your veterinary hospital staff covers its own emergencies it is still important to know the procedure for contacting someone before the need arises. Ask about this. Write the phone numbers down where you can easily find them.

Your vet is likely to have some references that cover construction of breeding boxes to protect the puppies. I can not remember the titles of the ones we have, offhand --- they are from Purina, though. Providing a safe environment for the puppies is important. More puppies die from hypothermia than anything else, probably. Making arrangements to ensure the puppies will stay warm is important. On the other hand, you can't just warm up a whole room to 80 degrees because Mom has to be willing to stay with the puppies. The puppy heating pads are nice and sometimes other arrangements can be made to safely supply a warm spot for the puppies without making it too hot for the mother.

Breeders are a good source of information in most cases and it would be a good idea to continue to try to talk to yours. They often have practical information that vets don't have experience with.

Pregnancy - False
False pregnancy symptoms are normal in dogs that have an estrus and do not get bred, due to the way in which they cycle. It is not usually necessary to treat for symptoms of false pregnancy but they can be so close to those of a real pregnancy that the two can be very confusing.

It is usually possible to feel distinct lumps in the uterus representing individual embryos from about the 28th day of pregnancy to about the 35th day of pregnancy. Before and after that it can be hard to identify a pregnant uterus easily. After 45 days or so when the skeletons begin to calcify it is often possible to feel the distinct hardness of a puppy skull when palpating the abdomen or to identify the puppies on an X-ray, if you wish to take her to the vet's office prior to the home visit, or if your vet has a portable X-ray machine. By now, if your dog is NOT pregnant, your vet will probably be able to tell you that, since she should be pretty far into the pregnancy and at least uterine enlargement should be palpable.

Pruritis
Pruritis is the name for itchiness that causes pets to scratch. Several chemical reactions occur in the skin that stimulate the nerves, causing the brain to feel the itch. We treat a scratching pet by attempting to eliminate these reactions at the source and controlling the body's response to them as well.

Some of the chemicals involved in itching are prostglandins, arachodonic acid (a specialized fatty acid) and leukotreines. By using treatments that inhibit the action of these factors at the skin level, such as antihistamines and fatty acid competitors, we can sometimes control the itching without using corticosteroids such as prednisone. If we work to control other irritating factors such as fleas, dry skin and secondary bacterial infections we can also further reduce itching. Each of these steps is very important because pets have an "itch threshold". This is the point where all of the sources of itching finally add up to enough irritation to cause the irresistible urge to scratch. Just like pain thresholds, these levels vary from pet to pet. Control of every factor that possible is important to your dog's health and comfort. Pruritis is a complication of many diseases. Only by careful examination, diagnostic tests and sometimes even trial and error can we come to understand what causes the itching in a particular pet and how we can best control it.

Rabies Vaccination
In all states, rabies vaccinations are required by law. The first rabies vaccination is good for one year. In many states subsequent vaccinations are good for three years. In other states, they are only valid for one year by law. Please check with your vet to determine the legal requirements in your state. Vaccinating your pet for rabies may literally save its life for two reasons. Rabies is a threat in many areas and it is a horrible disease.

In addition, an unvaccinated pet who bites a human being, even by accident, is subject to long quarantine periods or even death for the purpose of testing for rabies infection. Don't risk your pet's life. Get its rabies vaccination.

Radial Nerve Paralysis
radial nerve paralysis or avulsion of the nerves in the brachial plexus, or possibly a nerve root problem at the spinal cord level considering the possible severity of the forces involved in the injury. Usually most of the progress is made towards recovery in the first 6 weeks or so following injury so it seems unlikely to me that you have much hope of increased nerve function at this point. Another complicating factor in these cases is muscle fibrosis. When a muscle does not get signals from the nerves it doesn't flex. After awhile, it can't flex anymore and just gets fibrosed in one position. Once this happens the leg is not functional even if the nerve function does return.

Reproduction - When to Breed
The behavior of your female usually indicates when she is in true estrus - that part of the heat cycle when the female will allow a male to breed her. Most females growl or snap at the male when they are not quite ready for breeding because they still may be in the proestrus phase of the cycle. The proestrus stage usually lasts from 4-9 days and includes signs of bleeding, vulvular swelling and increased urination but this stage can last up to 2-3 weeks in some animals. Heat cycles vary from dog to dog and most of the numbers written are averages so this needs to be taken into consideration when deciding the time for breeding.

Other females will exhibit this behavior when they are frightened, even if they are in true estrus. It is best to keep a log if possible of when the heat cycle starts - when bleeding and swelling is first noticed, when those signs disappear, etc. and time interval between heats if you have not already done so. This may help with determining the length of her cycle. Having your veterinarian perform cytology during the heat cycle will also help determine the optimum time for breeding. Using progesterone and lutenizing hormone testing may allow an even closer estimation of the time of ovulation. Some females would rather be bred at home instead of being taken to the male - feeling more comfortable on familiar territory. Other females may feel more comfortable (if bringing her to the male) to bring her a week or so before the expected heat (reason for the log), boarding her at the male's home so they can see each other and allowing them to breed on "their" terms. Then there are those females that will not breed no matter what. If it is really important to have a litter from a particular female that will not breed no matter what is tried, there is always artificial insemination.

The most common mistake in breeding dogs is simply missing the time when they are receptive to the male. This can happen as early as 2 or 3 days into the estrus and can be as late as 21 days after first signs of bleeding and vulvar swelling. The best approach is to attempt breeding every other day from the first days of the heat period. The only problem with this is that it requires a lot of cooperation from the owner of the stud dog.

Reproduction - When to Neuter
I don't know what the earliest age for safe neutering is. I only know that it is safe at 6 months or older. I believe the veterinarians reporting that they are having no problems with neutering as young as 8 weeks of age, but I can't support their claims with objective studies. Personally, if there was a strong need to neuter younger, such as exists at humane societies, I would have no qualms about it. I wouldn't neuter my own pet prior to five or six months of age, though.

Reproduction - When to Spay
It is pretty much universally agreed upon by vets that the best time to spay is BEFORE the first heat period. If a dog is spayed prior to the first heat, the odds of developing mammary cancer later in life are less than 1%. If spayed between the first and second heat periods the risk increases to about 8%. If spayed at any time after the second heat period, the risk of mammary cancer is about 25% in the dog (same as in an unspayed dog). There are no reasons not to spay prior to the first heat that I am aware of. A few dogs do develop incontinence from low estrogen levels after spaying but this does not appear to be affected much by the time the dog is spayed. Some dogs just develop this problem after spaying.

There are some health benefits for the female dog associated with spaying, including freedom from the complications of birthing puppies, reduced risk of mammary cancer and uterine infections. Uterine infections (pyometra) are a serious problem in dogs due to the way in which they cycle and can easily result in death. With the obvious benefit of spaying before the first heat and the lack of any problems that have been proven to occur as the result of spaying early, there does not appear to be much reason to wait until after a heat cycle.

Rimadyl (Carprofen)
Rimadyl (Rx) (Carprofen)was recently approved for use in dogs in the United States. It has been available in other countries for some time. It is reported to be much less likely to cause gastrointestinal upset and kidney damage than older non-steroidal anti-inflammatory (NSAID) medications such as aspirin or phenylbutazone. It is reported to be very effective in conversations on the veterinary mailing lists and bulletin boards. With all new medications there is a period of time when everyone is worried that an unforeseen side effect may occur. The U.S. is a huge market compared to other countries and the really rare problems tend to show up faster here than in smaller markets. The presently available data suggests that this is a safer and possibly more effective treatment than other NSAID medications, though.

Gastric upset is less common with carprofen than with other non-steroidal anti-inflammatory medications but it still can occur.

Rimadyl will cause liver damage in some dogs. There have been some deaths in dogs with this reaction. This effects 0.02% of dogs and 70% of those are geriatric. More information can be found by consulting the Small Animal Clinics of Pharmacology's latest edition.. This is a remarkable drug for many dogs. Blood work however should be done prior to beginning treatment and one or two weeks into treatment to monitor liver values.

Spay/Neuter - Early
There is not a lot of data on the effects of spaying dogs and cats at younger ages than the "traditional" 6 months that has actually been published, at least that I am aware of. There are reports of two or three places studying the effects of early spay and neuter at the present time and I have seen references to data from these studies but am not aware of published data. I am only aware of one study of long term effects of spaying and neuter dogs at 7 months of age that followed the dogs for their entire lifetime. In this study, there were no problems attributable to spaying or neutering at this age other than a slight increase in the likelihood of estrogen dependent incontinence in female dogs. A lot of vets are spaying pets at 4 months of age pretty routinely now and humane organizations have been spaying animals in their care as early as 8 weeks for several years. Soon, there will be enough of these early spay and neuter patients and they will be old enough to figure out if there are long term effects. At present, no one is reporting any problems as far as I can tell.

Seizure Activity
Dogs definitely have a wide variation in seizure activity but it is hard to say whether seizures which might not cause recognizable clinical signs occur because it is so hard to judge the mental state of the dog. I assume that almost any type of seizure possible in a human probably occurs in dogs as well, though most people use the terms seizure and convulsion interchangeably but it is probably more accurate to say that the seizure is the brain activity that leads to the physical symptom of convulsing.

Convulsions can occur as the result of toxins and there have been reports of them occurring due to allergies in people. I am not sure if this has been documented in dogs. If there is a problem with food or with the stuff your dog eats on her runs, allergy to a plant or a particular ingredient of the dog food is the most likely problem. In this case, changing foods will only help if the offending ingredient (like beef, chicken, food coloring, etc.) is not found in the new food.

It isn't unusual at all for primary epilepsy (seizures for no discernible cause) to begin as late as 3 years of age or even later. However, it is always good to maintain a high degree of suspicion that there is a discoverable cause of the seizure activity. To help in your thought processes, here is a list of some causes of seizures:
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trauma -- even if it happened a long time ago, primary epilepsy, infectious diseases, shunts in the liver circulatory system, low blood calcium levels, low blood sugar levels, high blood sugar levels (diabetes), kidney damage, toxic substances (antifreeze, lead, insecticides and strychnine are the ones we have seen causing seizure activity), liver failure and possibly hormonal disorders such as Cushing's disease and hypothyroidism.
There are also things that people sometimes mistake for seizures. These are heart disease causing fainting, sleep disorders (narcolepsy), peripheral vestibular syndrome, inapparent sources of pain leading to odd behaviors, muscle tremor disorders and obsessive/compulsive disorders that lead to repeated behavior patterns.

Seizure Control
Acepromazine seems to lower the seizure threshold in some animals and can apparently allow a seizure to occur that might not have without the lowering of the seizure threshold. Paradoxically, it can raise the seizure threshold associated with some anesthetic agents (most notably ketamine).

Diazepam (Valium Rx) is helpful in reducing seizure activity in most dogs but it does have a paradoxical excitatory effect in a few animals. I don't know if this stimulates seizure activity but it does occur.
When to medicate to control seizure activity is a really debatable question. The pro treatment side of the argument for early treatment is that "mirroring" and "kindling" of seizures are recognized in dogs. Mirroring is when an area of the brain causing seizures on one side induces the development of an area causing seizures in the same place in the other half of the brain. Kindling is the process in which seizures make it easier for other seizures to occur -- in effect lowering the seizure threshold a little bit every time one happens. The con side of the argument mostly revolves around the side effects of the most consistently successful seizure control medication in dogs, phenobarbital. It can cause incoordination and a general lethargy for several weeks on first administration. Most dogs overcome these effects in a few weeks, though. It also causes increased hunger, often increased water consumption and therefore urination and it causes severe liver damage in some patients. Not many, but enough to be very worrisome.

Primidone (Rx) is commonly used in dogs to avoid keeping controlled substances on hand but it is more likely to be toxic to the liver and is not a good first choice for seizure control. Seizures themselves are very unlikely to kill a dog, but it does sometimes happen as well. So the question is, when are the seizures severe enough or frequent enough to absolutely warrant treatment? I think we work out a different answer in almost every case. We try to make our best guess as to what is best for each individual patient. The traditional guidelines in veterinary medicine have been seizures that last for longer than 5 minutes (actual seizure activity) or seizures that are occurring more than once a month. We probably stick reasonably close to these guidelines but are a little quicker to consider seizure medications now that there is pretty good evidence for the kindling theory. Once it seems pretty apparent that the seizures are going to continue to get closer and closer we sometimes treat now even if they are till more than a month apart.

Separation Anxiety
Separation anxiety may be the most common behavioral problem in dogs. Dogs can not ask you where you are going and when you will be home. They can't be comforted by leaving a phone number where you can be reached. If they are worriers, their only option is to worry. This can lead to behavioral problems related to their stress if they exhibit it as inappropriate defecation or destruction of your home or possessions. It is a tough situation.

A dog is a social animal. It wants to be with the family and being alone is not an entirely natural situation. Some dogs can not adjust to this situation without help. As a puppy, a dog learns that making sounds brings its mother to it. So barking, whining and crying are natural reactions when the dog wants to be reunited with its family. It may also consider digging, scratching at the door or window and other behavior designed to allow it to escape the house and rejoin its family to be "normal". Dogs may become so anxious that they tear up objects indiscriminately, defecate or urinate without control. If a dog is punished for these actions, the resulting increase in anxiety can make the whole situation worse. It is best just to ignore the destruction if at all possible. In order to treat the disorder, it is necessary to set aside some time to figure out exactly what is happening and to help your dog adjust to separation.

   1) The first thing you need to do is spy on your dog to figure out how long he or she waits before tearing up stuff in your absence. Some dogs literally start in one minute or less. Others wait a half hour or an hour or whatever. Once you have an idea of this you can work on the problem. It is also necessary to teach your dog at least to "sit" and hopefully to "stay" prior to working on the actual behavioral problem.

   2) A dog that is so nervous that it must be in the same room with you all the time requires working with sit and stay until it can tolerate you being out of the room -- then start to work on leaving the house. It can help a great deal with steps 2 and 3 in this process to use an anti anxiety medication, such as amitriptylline (Elavil Rx) or buspirone (Buspar Rx). Talk to your vet about this. It is also very helpful to consider asking about referral to a certified veterinary or animal behaviorist for assistance

   3) Leave for short periods and come right back -- sometimes all you can do is stand outside the door for a few seconds. Don't stay away long enough for your dog to get upset. The idea is to lengthen the time gradually. It may help to vary the time some so your dog can't keep track of a "routine". Keep this up until your dog is comfortable with you gone for a reasonable length of time. Don't make a big deal over coming back in -- it is best to greet the dog quietly or ignore it.

   4) Once your dog can tolerate you being gone for an hour or two, it will probably be possible to make the jump to longer durations without much problem. Usually, about the time your dog is very comfortable with being left alone, it is best to begin a slow taper off of any behavioral medications used to help in the treatment of the separation anxiety. Abruptly stopping the medications can lead to a relapse, so take a little time to wean your dog off according to your veterinarian's directions.

Schnauzer Comedone Syndrome
This is a condition affecting Schnauzers that produces comedones, or pus filled bumps that are usually mostly on the back of affected schnauzers. This is an inherited condition that will be present throughout the dog's life if it is the problem. There is no cure but good nursing care can make this much less of a problem. Applying benzoyl peroxide shampoos or gels can help a great deal. Usually twice weekly bathing or gel application is sufficient. Clipping the hair over the affected areas and keeping it short can help in some cases. Application of astringents such as witch hazel has been recommended by some vets and may be beneficial as well. Some Schnauzers will respond to isotretinoin (Accutane Rx) but I think this is still a pretty expensive treatment, especially considering the need for long term use.

Spay/Neuter - Early
There is not a lot of data on the effects of spaying dogs and cats at younger ages than the "traditional" 6 months that has actually been published, at least that I am aware of. There are reports of two or three places studying the effects of early spay and neuter at the present time and I have seen references to data from these studies but am not aware of published data. I am only aware of one study of long term effects of spaying and neuter dogs at 7 months of age that followed the dogs for their entire lifetime. In this study, there were no problems attributable to spaying or neutering at this age other than a slight increase in the likelihood of estrogen dependent incontinence in female dogs. A lot of vets are spaying pets at 4 months of age pretty routinely now and humane organizations have been spaying animals in their care as early as 8 weeks for several years. Soon, there will be enough of these early spay and neuter patients and they will be old enough to figure out if there are long term effects. At present, no one is reporting any problems as far as I can tell.

Spine
The most common cause of weakness and pain associated with the spine is intervertebral disc trauma or disease. The unfortunate thing about our choice to build this site in a question and answer format is that the most common diagnoses are often not covered as extensively they should be - because there is less question about the problems at the vet's and because people tend to understand them a little better.

The spine is composed of a long series of bones connected through a series of ligaments with a shock absorber - the disc - between each connection. If support was the only job of the spine there would be a lot less pain associated with injuries to the disc area, probably. But the spine serves as a conduit for the spinal cord, too. This very large bundle of nerves runs through the center of the spine and the individual strands of the bundle exit between the vertebrae at whatever level is necessary to do their job. The nerves pass between the outer edges of the disc and the boney protrusion of the spine. As long as everything is in its place this arrangement works fine. When the disc bulges or is damaged and calcifies it can put pressure on the exiting nerves leading to visible clinical signs of dysfunction in the area served by those nerves. By carefully considering where weaknesses and pain are exhibited it is possible to tell which discs are likely to be damaged.

If the disc is just putting a little pressure on the nerve there may only be pain. If the disc is damaging the nerve more significantly then weakness or paralysis will occur. In the case of pain alone it limiting exercise and utilizing a non-steroidal anti-inflammatory medication may be all that is necessary. If there is is weakness then corticosteroids or even surgery may be necessary to alleviate the problem.

In a dog with pain and weakness in one or both rear legs there is a strong likelihood of an intervertebral disc problem. Other possible causes of problems do include the ones you listed from searching our site as well as localized injuries that sometimes mimic disc problems. When both cruciate ligaments in the knees rupture at the same time the resulting disability can strongly resemble the weakness and disability associated with disc injury. It may be possible that luxation of both patellae at the same time could also produce similar signs.

Sublaxation, Hip
Luxation and dislocation are roughly the same term when discussing joints. So subluxation and partial dislocation would be analogous as well. The most common cause of subluxation of the hip joint in young dogs is hip dysplasia. It is sometimes possible to identify the subluxation as early as 3 to 4 months of age with X-rays. It can take up to two years for there to be clear evidence of subluxation sufficient to diagnose hip dysplasia although the great majority of dogs with this problem show signs much earlier. In dogs with moderate subluxation, it is often possible to surgically alter the hip socket so that the luxation is corrected and reasonably normal hip function returned, using a procedure known as a triple pelvic osteotomy. This procedure requires considerable orthopedic surgical skill and equipment and is often done at referral centers and veterinary hospitals in the United States, rather than at a general practitioner's facility.

It is also possible to replace the hip joint. In large breed dogs this can be done at an early age due to their size. Both of these procedures are expensive enough that many owners find themselves in the position of having to consider euthanasia when the problem is severe and funds for surgical repair low. There are some other causes of abnormal development of the hips. Infection with Neospora caninum causes muscular atrophy sufficient to prevent normal development of the hip joints in some dogs. Trauma can do this and there are probably other causes.

Ticks
There are a number of ways to deal with ticks. The easiest solution is to use one of the tick killing products that keep them off and/or kill them if they attach. There are three very effective products that we use, fipronil (Frontline or Frontline Topspot, Rx), permethrin (ProTICall, Rx) and amitraz (Preventic collars, Rx).
Frontline kills fleas and ticks effectively. Tick control lasts for 2 weeks to a month. The product should only be applied on a monthly basis but can be used in conjunction with other products for tick control if necessary. It works very well for flea control, so if that is also a problem it may be a good first choice.

ProTICall is a concentrated permethrin topical for tick and flea control. It is a very effective tick control product but a less effective for flea control. It lasts 2 to 3 weeks but may be applied at 2 week intervals so it is possible to keep the problem under control continuously using this product.

Preventic collars are also pretty effective. They have the drawback of being toxic if ingested. This sounds like it wouldn't be a problem but dogs will eat these collars right off of another dog, for some reason. So we don't recommend them for multi-dog households, especially if one of the dogs is prone to playing with the other dog's collar or if one of the dogs chews things up frequently. They seem to last around 6 to 8 weeks in our practice area.

Ticks may be removed using one of the tick-pulling products or a forceps (tweezer). It is best not to touch the tick if possible due to the possibility of tick-borne diseases. If contact does occur, wash your hands thoroughly. There is a lot of fear of leaving part of the tick embedded in the dog when removing them but this rarely causes problems.

Ticks carry a number of diseases, some of which do have zoonotic potential (can be transmitted to people). It is best to use one of the products that kills the ticks continuously without much intervention on your part. The risk is not high but there is some risk for diseases such as Lyme disease, ehrlichiosis and Rocky Mountain spotted fever when ticks are brought into the household by a family pet.

Tracheobronchitis
Tracheobronchitis is also known as "kennel cough". This is probably a misnomer, since most dogs that get this disease have not been in kennels. Still, when dogs are placed in group situations, they are often exposed to the organisms that cause tracheobronchitis. It is sort of like all the colds that are seen in kindergartners.

There are a number of possible causes of tracheobronchitis but most cases are probably caused by the bacteria Bordetella bronchiseptica. Other causes are canine distemper virus, parainfluenza virus, adenovirus infection and possibly Mycoplasmal organisms.

A dry hacking cough is the most common sign of this disease. Most vets assume that a dog has tracheobronchitis when the owner calls on the phone and says "my dog has a bone caught in his throat". The type of cough really does cause many people to assume that there must be something caught in the dog's throat and many dogs retch at the end of the coughing. In some cases, pneumonia may occur as a complication of this disease.

It is probably OK to treat this condition by simply using medications to control the cough but most owners are more content if antibiotics are used and most vets therefore put the dogs on an antibiotic for seven to ten days. Hydrocodone or butorphenol cough suppressants work best and every vet seems to have a personal favorite antibiotic for this condition.

All of the organisms that cause this disease appear to be pretty contagious so it is not unusual for all the dogs in a household to rapidly become infected.

Triple Pelvic Osteotomy (TPO)
There are several surgical options for hip dysplasia, depending on the size and age of the dog. In young dogs, with hips still in the development stage, a triple pelvic osteotomy (TPO) may be the best approach. There are other surgeries done at this age, as well. The advantage of these surgeries done during development is that they can resolve the problem lifelong in many instances. They are technically complex surgeries and are usually done by specialists or at larger veterinary hospitals.

Urination, submissive and excitement
Urination, submissive
Puppies that have very submissive personalities tend to urinate small amounts when greeting people or when someone makes sudden movements or assumes a dominant position, even inadvertently. These puppies are generally showing other submissive signs, such as head down postures or rolling over. It can help to just ignore these puppies at first and let them get used to your presence in the house prior to greeting them. Many dogs will outgrow this behavior but some do not. For some dogs, treatment with anti-anxiety medications or phenylpropanolamine can be helpful. Unfortunately, not all dogs will respond to medical therapy or behavioral therapy for this condition. Strategically placed throw rugs or plastic runners are the next line of defense since the behavior often occurs at predictable times and places.
- Excitement:
Some puppies can not control urination when they are very excited. They just get so worked up that they leak urine. Most puppies will outgrow this problem, too (at least based on the ones we see). Some dogs don't, though. We have some success treating these dogs with phenylpropanolamine. It seems to give them just enough control to get them through the excitement. It doesn't always work, though. I have never tried any other therapy for this condition. I think this is because I practice in a rural area and it is easy for my clients to adjust to making these dogs "outside dogs" and living with the problem. If there is an animal behaviorist in your area, your vet may be able to refer you to him or her for help with this problem.

Vaginal prolapse
Vaginal prolapses are often confused with vaginal hyperplasia, also known as vaginal edema. So the first thing to do is make sure it is a prolapse. Vaginal hyperplasia is treated by removing the protruding tissue surgically. Vaginal prolapse is more difficult to treat if retaining breeding ability is desired -- although this is considered to be a possibly inherited trait so there is some question about the advisability of breeding. Ovariohysterectomy (spaying) is usually curative. Some prolapse will regress on their own as the dog goes out of heat but it probably isn't a good idea to count on that if there is a significant prolapse. I have seen recommendations for treating this with gonadotrophic releasing hormone but do not know of the success rate. Surgical repair by entering the abdomen, retracting the prolapse and suturing the uterus to the body wall may work but it does make future breeding questionable and possibly even dangerous.

Vascular Ring Anomaly
Vascular ring anomaly constricts the esophagus. This is a situation in which the fetal blood vessels are still present when they should not be. The most common form of this is a persistent right aortic arch, but there are other possible ring anomalies. The vessel passes over the esophagus and captures it between the persistent aortic arch and other structures, constricting it. This can be cured surgically if many cases. In some cases, the esophageal motility is permanent impaired and it is necessary to feed liquid or semi-solid meals from a standing position for life.

Vena Caval Syndrome
Vena caval syndrome occurs when heartworms reside in the vena cava (the big vein returning blood from the liver and lower body to the heart). Heartworms do not normally inhabit this vein. Their presence seems to really muck things up and breakdown of red blood cells occurs, leading to the red discoloration of the urine. This is a serious complication in heartworm disease. It is sometimes necessary to surgically remove the worms from the vena cava to allow the dog to get stable.

Vestibular Syndrome
There is a syndrome, variously referred to as peripheral vestibular syndrome (the current "preferred name"), geriatric vestibular syndrome and idiopathic vestibular syndrome. This disorder is more common in older dogs and thus the name geriatric vestibular syndrome -- but it can occur in middle aged dogs, too, so the name was changed. Idiopathic just means "happens for no known cause" -- so it is a good name but not the preferred one. It does sum up the situation well, though. For some reason dogs can suddenly develop vestibular disease. The problem seems to be due to inflammation in the nerves connecting the inner ear to the cerebellum (which controls balance and spatial orientation). It usually lasts between a couple of days and three weeks. A few dogs have residual signs beyond this time, such as a head tilt. This disease normally affects dogs that seem normal up until the signs appear. Then there is sudden loss of balance with many dogs unable to even stand up. Rythmic eye motion known as nystagmus is usually present. Dogs may be nauseous from the "sea sickness" effect of vestibular disease. Most dogs will not eat or drink unless hand fed or given water by hand because they have a hard time with the fine motor movements necessary to eat or drink from a bowl. As long as they are nursed through this condition almost all dogs will recover. There is no known treatment. Some dogs do have relapses but most do not.

Peripheral vestibular disease can be confused with anything that will cause cerebellar damage or inner ear disease. Inner ear infections are probably the most common cause of similar symptoms and if recovery does not progress satisfactorily it is a good idea to do whatever testing seems necessary to rule out inner ear problems, such as ear examination and X-rays. Cancer affecting the cerebellum, the peripheral nerves to the cerebellum or the inner ear can cause similar signs. In golden retrievers lymphoma is a common cancer problem that can cause CNS signs. Trauma is a possible problem that could be confused with peripheral vestibular syndrome if brain damage occurs. Granulometous meningoencephalitis (GME). Infarcts (blood clotting leading to lack of circulation in part of the brain) occur in some dogs. If the damage to the brain is minimal then recovery may occur quickly. If the damage is severe, recovery may not occur at all. I do not know the incidence of infarcts affecting the brain in dogs but I think it is pretty low.

Even when dogs do not recover fully from peripheral vestibular syndrome they normally have a good life. They adjust to residual problems like head tilts and do not seem all that bothered by them. If progress towards recovery is not evident, then the other disorders mentioned above need to be considered.

Vision - How dogs see
   1) Dogs can see in much dimmer light than humans. This is because the central portion of a dog's retina is composed primarily of rod cells that "see" in shades of gray while human central retinas have primarily cone cells that perceive color. The rods need much less light to function than cones do.

   2) Dogs can detect motion better than humans can.

   3) Dogs can see flickering light better than humans. The only significance to this appears to be that dogs may see television as a series of moving frames rather than as a continuous scene.

   4) Dogs do not have the ability to focus as well on the shape of objects (their visual acuity is lower). An object a human can see clearly may appear to be blurred to a dog looking at it from the same distance. A rough estimate is that dogs have about 20/75 vision. This means that they can see at 20 feet what a normal human could see clearly at 75 feet.

   5) Dogs are said to have dichromatic vision -- they can see only part of the range of colors in the visual spectrum of light wavelengths. Humans have trichomatic vision, meaning that they can see the whole sprectrum. Dogs probably lack the ability to see the range of colors from green to red. This means that they see in shades of yellow and blue primarily, if the theory is correct. Since it is impossible to ask them, it is not possible to say that they see these colors in the same hues that a human would. Whether or not the ability to see some color is important to dogs or not is hard to say.

A dog with its eyes about 12 inches off the ground certainly sees the world a different way than a human with eyes about 48 inches off the ground like many 5th graders.
As humans we tend to think of dog's visual capabilities as inferior to ours. It is different but it may suit their needs better than possessing accurate color vision would.

White Dog Shaker Syndrome
That isn't a very scientific name, but it describes the condition exactly.
Small white dogs (Maltese, West Highland white terriers, Bichon Frise) can develop tremors for unexplained reasons that can be very severe. These dogs usually have really bizarre eye movements and get much worse when excited or stressed.

The usual treatment for this is to give diazepam (Valium Rx) to control the tremors and prednisone because we don't know what else to do.

Encyclopedia of Veterinary Medical Information Page

Encyclopedia of Veterinary Medical Information (Index coming soon)

Encyclopedia of Veterinary Medical Information
(Index coming soon)