Allergies getting your pet down?

First of all, if you have a pet with allergic skin disease, please know that we feel your pain and understand how miserable it can make your pet and your family. Constant scratching is a huge source of discomfort and frankly, as an owner of an allergy dog myself, makes everyone in the vicinity of an itchy pet crazy. Late nights with your pet constantly scratching, licking and break dancing on the carpet are the perfect recipe for grumpy mornings.

Allergies are one of the most common complaints we see as veterinarians in this part of the country. There have been some days when itchy dogs and cats are literally the only cases I see all day. Some of the most important considerations with allergies are that the majority are environmental or food related and that THERE IS NO CURE. Luckily, there are many options available to keep your pet comfortable. Before we go into a few treatment options, lets discuss the basics of allergic skin disease.

Allergies (also known as atopy or atopic dermatitis) usually develop in early adulthood around 1-2 years old and are the body's inappropriate immune response to normal environmental substances. Nearly anything can become a source of itchiness or "pruritus" to your pet if they have atopy. Pollens from weeds, grasses and trees are common sources of allergies but so are molds, dust and dust mites within the home and even insects. Our pets don't typically respond to seasonal allergies the way we do. The classic "Hay Fever" signs with sneezing, runny noses and eyes can occur to some degree but are not the prominent manifestation of this disease. Allergens come in contact with your pet's skin and a cascade of immune-mediated events occur which leads to progressively increased itchiness as well as skin and ear infections. Unfortunately, without allergy testing it is very difficult to determine the actual source of your pet's allergies. 

Atopy is often further complicated by food allergies, otherwise known as ARF or adverse food reaction. In most cases, food allergies will develop after many years of being on the same food and then suddenly your pet develops chronic ear infections or very itchy skin that is, in many cases, unresponsive to medical therapy. To further confuse matters, most dogs with ARF also have atopy. The only way to diagnose a food allergy is with a feeding trial. Let me repeat that. The ONLY way to diagnose food allergies is with a feeding trial. There are blood tests available which will include a panel on common food allergens but these are not reliable in determining the true source of a food allergy. To quickly break this down, the most common source of sensitivity to a component of the food is in relation to the protein source first and the carbohydrate source second. Be very careful if you buy "grain-free" or "novel protein" over-the-counter foods to treat a presumptive food allergy as these will usually still include beef or chicken as the top ingredient which are the most common offenders for pets with ARF. Your veterinarian can go over a feeding trial and the recommended diets for the best response to therapy.

Well, what do we do about allergies? The best way to quickly squash the inflammation is with a short course of oral corticosteroids. Don't fear steroids! In most cases, when the skin is on fire, the ears are filled with goo and the toes are constantly wet from licking, steroids are the only option to get it quickly managed. BUT, we don't want to jump to steroids as the only treatment option as they come with their own set of negative side effects. Anyone experienced the suddenly incontinent dog while on prednisone? Steroids will often make your pet drink a lot more water than normal and that water needs to go somewhere:) Luckily, with a low enough dose of prednisone or another oral steroid that tapers over time, this and other frustrating side effects (like an increased appetite) will subside over the course of therapy. BUT, we need to decrease the dependency on steroids and the best way to do that is by initiating antihistamine therapy.

Antihistamines like Benadryl and Claritin are not great at decreasing symptoms when there is an acute flare up but the hope is that you can keep your pet maintained on them instead of steroids to prevent major flares in the future. I have mentioned a few of the most common ones but there are many available if one seems to not work as well or stops working as well as it used to. Call us and we can get you a more complete list and dosing information.

Another easy option to reduce exposure to outside substances is to wipe your pet down with hypoallergenic baby wipes when they come in from outdoors. Focus on the feet, legs, chest and belly or any area that routinely comes in contact with the grass. By removing the allergens topically, you decrease the exposure time and may reduce the severity of symptoms.

When antihistamines lose their effectiveness and steroids become the only option, there are other therapies to explore. Cyclosporine is a medication that tends to be a little expensive at first but is usually as effective as steroids and with fewer side effects. Thankfully it is tapered or decreased to the most effective dose which greatly impacts the cost.

The best possible treatment for atopy is hyposensitization therapy. Diagnostics similar to intradermal skin testing that you receive at your dermatologist's office are performed by a veterinary dermatologist on your pet. Once the specific allergies have been determined, these substances are combined and given to your pet in small doses which gradually lessen the allergic symptoms. I'm sure many of you are wondering about the cost of this option and while it is not cheap, when you consider all of the money most clients typically spend on repeated office visits and steroid medications with little to no lasting effectiveness, the money spent on that visit becomes minimal in comparison.

One particularly simple way to lessen an acute flare of allergies is to always keep your pet on flea and tick prevention. Flea bites can cause an intense inflammatory response, especially in pets with atopy or any allergic skin condition.

It may not have seemed brief but I truly have only scratched the surface of allergic skin diseases. For any additional information, please feel free to call Heritage and speak with one of the doctors or make an appointment for your pet to be seen.  

Thanks for reading!

Dr. Jessica Zink

Heart Disease in Dogs and Cats  

Heart disease affects as many as 60% of our older canine patients and although it is very hard to know the extent of heart disease in cats, it is estimated to be present in up to 15% of them.  The reason it is so hard to get a more accurate statistic in cats is that it often goes undiagnosed.  Heart disease is also estimated to affect about 15% of young dogs.

     Unfortunately heart disease can be very difficult to diagnose in both dogs and cats.  They can not tell us when they are feeling bad or lethargic or if they are having any unusual pains in their chest.  That is why this disease is often undetectable until they are showing signs of heart failure, at which point treating is less beneficial because the disease is not reversible.

     There are some breeds that are more prone to heart disease. These include but are not limited to the Cavalier King Charles Spaniel, Chihuahua, Poodle, Dachshund, Doberman pinscher, German Shepherd, Golden Retriever, Great Dane, Weimaraner, and Boxers.

     Although it is quite complex, heart failure occurs when the heart is unable to pump out the amount of blood it is receiving, therefore supplying inadequate amounts of oxygenated blood to the body.  The problem can be attributed to valves that become leaky, allowing blood to flow through the heart in the wrong direction, or because the muscle itself becomes weak and stretched over time. The end result is the same however with fluid "leaking" from vessels into the lungs or abdomen, depending on which side of the heart is affected.  This buildup of fluid causes obvious symptoms of difficulty breathing (if fluid is accumulating in the lungs) or abdominal distension (if fluid is accumulating in the abdomen).   Other symptoms that may or may not be present early in the disease process include exercise intolerance, reluctance to play, and general lethargy.  Many times, signs of heart disease are so mild that the owner doesn't even realize there is a problem. It is easy to attribute "slowing down" to old age.  Your veterinarian may detect a heart murmur or abnormal rhythm during your pet's physical exam and discuss further diagnostics with you.

         Once heart disease is suspected your veterinarian will probably recommend chest radiographs to determine if the heart is enlarged and if there are any changes present in the lungs. This may help stage the heart disease somewhat and help the doctor determine a treatment protocol and prognosis.  There are more extensive diagnostics such as an electrocardiogram or echocardiogram that may be indicated as well.  These things may have to be done multiple times through the course of the disease to monitor progression and response to treatment.

     The goal of treatment is to help the heart function more efficiently. Medications are available to allow the heart to contract more strongly thereby pushing more blood out and through the body.   Diuretics may be needed as fluid starts to accumulate in the lungs or abdomen.

     There are also congenital heart anomalies that can occur in puppies and kittens. Examples include Patent Ductus Arteriosis (PDA), Ventricular Septal Defect (VSD) and Pulmonic Stenosis, just to name a few. Many of these can be corrected surgically by a board certified veterinary surgeon.

     Cats too can be affected by heart disease. Hypertrophic cardiomyopathy is a condition that occurs most often in young cats. They may often be asymptomatic until it is very end stage. At this point they may have  acute respiratory distress or sometimes they pass away suddenly without warning. 

     Routine visits to your veterinarian will give your pet the best chance at detecting this disease and starting a treatment protocol before they are symptomatic.  Frequent monitoring will ensure that they are responding well to treatment and have the best quality life possible.

Thanks for reading!

Dr. Stephanie Bradley

Oh no, my pet is limping! Now what?

Environmental Enrichment for CATS:

"Cats are NOT small dogs" was the first sentence on the first day of feline medicine lectures by my professors in Veterinary school.   And how true this has proved to be over the years.  There are lots of similarities but some of the most notable differences of cats from the canines is behavior.  So as more cats are living together indoors it is more important to be aware of their living conditions and to improve their health and welfare by making sure their needs are met in the environment.

There are several areas that can be of concern to our cats that are often not obvious to us but can become behavioral problems exhibited by unacceptable actions (i.e. urinating outside the litter box).  One of the most important areas is access to the three basic resources (food, water, and litter box).  These should be located in quiet area (not next to washing machine), semi private area (low foot traffic area), and in multiple sites (especially in multi-cat household where one member "guards and teases" others at the resource for "fun or spite"). A key point with "litter box etiquette"  is to always have the same number of litter boxes as the number of cats in the household "plus 1". For instance, if you have 3 cats there should be 4 or more litter boxes available in the home.

Another important area to consider is structures for the cats within the environment.  This includes scratching posts, places to climb, perch, rest and hide.  There are several commercially made "cat condos" which most cats like and we encourage clients to start kittens early so they know it's "theirs".  Some cats like to explore so owners could also hide toys for them to search for.

Social contact (with the owner as well as other cats in the household) is a very important area as well.  Cats are nomadic by nature and do not form packs or groups in the wild.  So when put indoors some have a harder time adjusting to this closeness.  Therefore each one should be observed and if necessary be separated for a while if need be.  A lot of cats enjoy alone time too. If they are being a bully then a time-out in a spare bedroom is good to give the others a break.  Remember just because you love them does not mean they will like each other (very few people would let their ex-spouse rent a room from them no matter how cordial their relationship).

One area that will be different for every cat is their human interaction.  Most cats will play games  (feather on a stick, laser pointer light chasing, small fake mice, etc).  Some prefer the petting or grooming (brushing) interaction.  Our job is to see what they enjoy the most and to avoid interactions that may stress them (i.e.: chasing the cat). For those of you that have kitties that tend to bite when being petted, keep in mind that to many cats petting should be on their terms. Most cats will not object to petting that stays around the head and neck region. When you go beyond that "magic line" between the neck and shoulders, some cats will consider that too much and give you a little warning nip. That will be your cue that this particular cat prefers a "less is more" approach to contact.

Also consider audio, visual and olfactory areas too.  These are things like a radio or television playing while the owner is away.  Access to a window or fish tank can be very beneficial as well.  Cats often will like catnip or pheromones which are commercially available.

Lastly, it is a good idea to rotate toys on a regular basis (weekly) to provide some novelty.

Dr. Joe

Buster today

Hello all! It has been a bit of a rollercoaster over the course the week. Buster?s pressure has flucuated a great deal and despite 3 emergency efforts to reduce it which were only briefly successful, I think we have finally achieved a good, steady pressure level. Unfortunately, this may be more optimism than is really appropriate as the pressure has only been reliably down for around 24 hours. Nevertheless, I?m going to maintain this positive outlook because he has been unable to maintain a decent pressure for even this amount of time.

The details of this week are pretty scary and pretty remarkable at the same time. The emergency procedures I am referring to involve giving a medication called Mannitol which is typically used in head trauma cases to remove excess pressure on the brain. This medication is a concentrated salt solution and causes fluid to shift away from normal tissues quickly and by itself comes with its own amount of risk. For this reason it is typically reserved for the most critical of cases and unfortunately Buster fit that criteria. He had Mannitol on Tuesday m0rning and his pressure was reduced a great deal pretty quickly but went back up by the next day so had to be repeated. Unfortunately, the second time the pressure was only reduced for a few hours and went right back up into the mid 60 range. As a reminder, normal intraocular pressure should be under 20 and humans have described pressures in the 40-60 range as the most excrutiating migraine pain they have ever experienced. At that point, I became extremely worried and so with the help of his opthalmalogist, Buster was anesthetized and fluid was physically removed from the front chamber of his eye using a small syringe. This is not a commonly performed procedure but with a pressure as high as Buster?s was and without the ability to administer more Mannitol safely, it was our only remaining option to hopefully preserve vision in that eye. After having gone through all that, poor Buster again had very high pressures the following day. At that point, the opthalmalogist and I discussed the last and final option to preserve the eye. Cryotherapy was his recommendation.

Cryotherapy is a procedure that freezes portions of the structures that produce fluid (the ciliary bodies) in the front portion of the eye. This procedure has many potential complications. It nearly always causes a great deal of inflammation within the eye (uveitis) which by itself can cause many problems that may have future consequences on the ability to retain vision. Another set of potential issues is if too much of the ciliary body is damaged,  the eye is unable to keep filled and retain its shape and if too little is damaged, there is still too much fluid being produced and the glaucoma is not resolved. The good news is that approximately 70-75% of animals will have function following this surgery despite the potential for complications. I was still very nervous as it would involve yet another round of anesthesia for Buster and given his previous poor luck, I was concerned that Buster may again be in that 25-30% range. I made plans to leave the office early to make a trip out to the surgeon?s office and then, miraculously, something happened. Buster?s pressure started dropping. Neither myself nor Buster?s ophthalmologist are quite sure as to what may have changed to drop his pressure after previous efforts had failed but after arriving at his office, Buster?s pressure was still just under 10 so we decided to postpone the surgery. I am happy to report that his pressure this morning was 11 and seems to be holding. I am still unsure as to whether he will retain his ability to see as his pupil has been very constricted this entire time which prevents vision and I have also been unable to assess the health of his retina, but at least the excruciating pain has passed and that is something to celebrate. I will keep updating as things progress but for now, I will just enjoy his happier attitude and hope for the best.

Jessica Zink, DVM

The Joys and Struggles of Cataract Surgery: From an Owner and Veterinarian?s Perspective