Hepatic Lipidosis (Fatty Liver Disease) by Dr. Dana Lewis

UNEXPLAINED WEIGHT LOSS IS NEVER GOOD, SO HAVE THE CAT EVALUATED BY YOUR VETERINARIAN ASAP.

Lipidosis (abnormal fat metabolism) is a cause or contributing cause of liver failure when a cat that was once overweight loses weight too quickly. (While it is more common to occur in an overweight cat, it can happen in any cat who loses a considerable amount of weight suddenly). Cat owners don’t realize the danger with this rapid weight loss, and are pleased to see the chunky cat becoming “healthier” weighted. The good news is that there is a good recovery rate for this condition provided it has not progressed too far, but this will require aggressive support to reverse the disease process, and also if the underlying reason for the problem is not serious in itself.  If a cat has gone missing and returns feeling unwell or without an appetite, have it evaluated immediately.

Fatty Liver (Hepatic Lipidosis)

Approximately 2 weeks of eating 1/2 - 3/4 the normal amount of food is needed to develop a fatty liver.  Cats evolved as predators of small birds and rodents, eating multiple small meals throughout the day. As carnivores in the wild, cats would be lean and never develop extensive fat stores.

This changed when cats became domestic. The modern housecat has the opportunity to become overweight and should the cat get sick or lost, and stop eating, a very big problem occurs since the cat liver was never intended to handle huge amounts of mobilized fat. The liver becomes infiltrated with fat and fails. Complicating matters are the high dietary protein requirement that is unique to cats; protein malnutrition develops fast when cats do not eat.

But My Cat Loves to Eat!  Why Did the Feeding Frenzy Stop?

Initially there was an underlying cause of the decrease in food intake that started the cat down the slippery slope to lipidosis. Keep in mind that hepatic lipidosis rarely happens for no apparent reason. If there is an underlying cause, it must also be addressed.  If you’re lucky, the underlying cause has resolved (such as the cat was lost/starved and has now been found).

Cornell University looked at 157 cats with lipidosis and looked at what conditions occurred first. Here is a summary of what they found:

• 28% had inflammatory bowel disease
• 20% had a second type of liver disease (usually cholangiohepatitis)
• 14% had cancer
• 11% had pancreatitis
• 5% had social problems (new cat, new home, threatening other pet or person at home)
• 4% had some kind of respiratory disease
• 2% were diabetic

Liver Disease vs. Liver Failure

About 70% of cats in liver failure are jaundiced (yellow); they are also frequently nauseated, will not eat, and are obviously ill. The jaundice (also known as icterus) is often not noted by the pet owner but can often be seen by carefully examining the whites of the eyes, the gums, or in the ear flaps. Sometimes the yellow color is not evident to the naked eye but is picked up as a blood test elevation in bilirubin, a yellow pigment normally processed by the liver.  The average cat with lipidosis is middle-aged, has lost at least 25% of its original body weight, and 38% will have vomiting, diarrhea or constipation.

Liver disease may be picked up as an elevation in a blood test enzyme called alkaline phosphatase, or ALP. This enzyme should never be elevated in a cat. There are several forms of this enzyme in the body, not just the liver version, so an elevation is suggestive of liver disease and usually requires follow up testing of actual liver function.  Other liver enzymes on routine blood panels are alanine aminotransferase (ALT) and aspartate aminotransferase (AST).   We also look at other blood values that the liver has a role in processing or producing, such as BUN and albumin.  A lab test that might be helpful in determining underlying cause is the GGT (gamma-glutamyl transpeptidase) level. It is usually not elevated in lipidosis but would be elevated if there is an underlying additional liver disease or in the event of pancreatitis.

It is important to distinguish tests of liver damage, like enzymes, versus tests of liver function, like bile acids. The enzymes ALT and AST are normally held inside liver cells; when their presence is detected free in the bloodstream, this is an indicator of liver cell death. A liver can have damage without any decrease in its overall function, so elevations don’t equal liver failure.  Also, liver enzymes can be really low in end-stage failure due to so few living cells producing these enzymes anymore, so normal enzymes do not equal a healthy, functioning liver.

A liver function test is different. In a liver function test, the liver is actually asked to do something and we measure whether it does the job sufficiently or not.  In this way, we can see if the liver is actually in need of support.  The one frequently used is called a Bile Acids Test.  Testing bile acids is not necessary if bilirubin is already elevated.

Tissue sampling such as biopsy or needle aspirate is crucial to the diagnosis of liver disease. Without a tissue sample, all we can tell is whether or not the liver is in failure and specific therapy for a specific type of liver disease is not possible (though general support of the failing liver may still be possible.) A needle aspirate or tissue biopsy shows hepatic lipidosis +/- other forms of liver disease.

Treatment of Fatty Liver Disease:

THIS IS THE KEY CONCEPT IN HEPATIC LIPIDOSIS: WITHOUT AGGRESSIVE NUTRITIONAL SUPPORT, MOST CATS WILL DIE.

The cornerstone of treatment for lipidosis involves aggressive nutritional support. (In other words, a high protein diet must get into the cat to reverse the metabolic starvation state.) If this is done carefully, the recovery rate approaches 90%.  Cats that show a 50% drop in total bilirubin level within 7 to 10 days are statistically likely to survive.

Many people are reluctant to place or work with feeding tubes and want to try feeding the cat at home. There is no room for tentative treatment when it comes to this disease. Force-feeding at home can work but one must have a specific amount of food to feed and that amount must be successfully fed if the patient is to recover.  Generally, by the time a cat has gotten into trouble with hepatic lipidosis, most owners have already tried tempting cats with assorted favorite foods and gotten no results. At the point where lipidosis has developed, the cat CANNOT be given a choice about eating; there are several methods of providing food you can enlist.  Ask your veterinarian about diets that fit the high protein profile best for lipidosis cats, and if they have a feeding tube, use the diet recommended to reduce the likelihood of clogging issues.

For a few cats, force-feeding is non-stressful and easily performed. To provide nutrients, you have to understand how much of the food product should be fed daily and how much may be fed per meal. Food is generally canned and of a consistency like hamburger. Generally, food can be fed by syringe or meatball method.  Using a syringe can be stressful and you risk aspiration of the food into the lungs.  Canned food meatballs can be made of approximately a one-inch diameter and given to the cat in the same way you would give a pill. Be careful to give the cat enough time to fully swallow the first meatball before proceeding to the next one. An entire 3 oz can of cat food can be fed in this way. If struggling results or if the cat attempts to scratch or bite, this feeding method may be too stressful.  It is also quite messy.

Feeding Tubes:

Once the cat comes home, you can do this!  It might look intimidating, but the cat has to eat in order to recover.

(Jack from Chocolate and Crossants blog)

A nasogastric feeding tube can be passed by your veterinarian through the nose, into the stomach and sewn into place to allow feeding of a liquid diet. Placement of this kind of tube does not require anesthesia, and the tube is relatively easy to use. The tube can be dislodged by the cat, so an Elizabethan collar is necessary to protect the feeding tube. Only liquid diets can be fed through the tube due to its small diameter. The tube can also be pushed backward if the cat vomits, so that it opens towards the mouth instead of the stomach. All of these problems make the nasogastric tube the least popular of all the feeding tubes when it comes to long-term use; however, often this form of feeding is used for the first few days as this is when bleeding risk is highest and the patient is least stable for anesthesia. One of the other tubes can be placed when the patient is more stable.

(Eddie from esheley.wordpress.com)

Esophagostomy tubes are larger and stick out of a bandaged incision in the neck. Food must be blenderized but does not have to be fully liquid. The larger diameter of the tube makes feeding easier and the tube is more comfortable but the tube does require general anesthesia for placement.

(Tennessee.bluepearlvet.com)

Gastrostomy tubes can be placed via an endoscopy or a special applicator called an ELD gastrostomy applicator. This tube is placed under general anesthesia but thought to be the most comfortable to wear. A bandage around the belly protects the tube which enters directly into the stomach through the body wall, and which must stay in place a minimum of two weeks but can stay in place as long as a year (maybe longer, though the treatment of lipidosis requires generally 4 to 6 weeks or so of tube feeding).

When a patient has been in starvation mode for a while and then begins to eat, some serious metabolic problems may occur in the first few days as metabolism changes, such as low potassium or phosphate.  So expect the cat to be monitored in the hospital for the few days following initiation of nutritional support.

Some Feeding Tips:

• Know how much of the food should be fed per day-size of meals and total amount per day gradually are increased over a couple days.  Follow your veterinarian’s guidelines.
• Tube feeding should be expected to continue 4 to 6 weeks.
• The feeding tube should be cleared with warm water prior to and again after food administration, or if it clogs during feeding.
• Food must be warmed and administered slowly to avoid inducing vomiting.
• Medication should not be administered through the feeding tube unless directed by your veterinarian. Many tubes are easily clogged this way.

Other Support
There are several medications that are supportive to the liver that might be used.  These might assist the body in excreting bile, supporting liver function, removing toxic bile acids, or replacing vitamins that are low.  Your veterinarian will let you know which ones are indicated for your kitty.

Written by Dr. Dana Lewis

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Read more or contact Dr. Dana:
Dana Lewis, DVM
Lap of Love Veterinary Hospice
Raleigh, North Carolina
drdana@lapoflove.com  |  www.lapoflove.com

Dr. Dana assists families with Pet Hospice and Euthanasia in the Raleigh North Carolina area (Raleigh, Durham, Chapel Hill and the greater Triangle, as well as Wake, Durham, Orange, and Chatham counties. 

Summertime Threats to Pets by Dr. Dana Lewis

Cookouts and Potlucks 

The food people consume can cause mild vomiting and diarrhea to potentially fatal pancreatitis in our beloved pets. Corn cobs, bamboo skewers, and bones can cause foreign bodies requiring expensive life-saving surgery.

Keep them away from the grill because of the risk of burns and also many dogs will lick up any grease from the grill and give themselves pancreatitis.

Most people know that some foods are toxic to pets like chocolate, but so are the artificial sweetener, xylitol, as well as grapes, raisins, onions, alcoholic beverages, and others. (See our post on holiday hazards). Keep them indoors when company comes over and keep them away from the trash after everybody calls it a day.

Pool Chemicals 

Undiluted pool chemicals can be corrosive to the eyes, skin, mouth, esophagus, etc., and result in permanent injury. Always keep pool chemicals and cleaners safely out of the reach of pets and children. Also, not all pets can swim, so supervise them at the pool just like the kids.

The Beach

If large amounts of ocean water are ingested while playing on the beach, hypernatremia (an elevated salt level) can occur. Salt poisoning leads to vomiting, diarrhea, lethargy, excessive thirst or urination, tremors, seizures, coma and even death.

Instead of allowing dogs to drink from the ocean, provide them with fresh water. Also, do not let them eat beach sand as that can cause a blockage of the intestines requiring surgery. Again, be cautious letting them swim. Consider a life jacket for all swimmers whether at the pool, beach, or lake. And be aware that pets can also become sunburned as well as suffer from heat stroke even if they are enjoying the water. Short nosed dogs and dogs exercising a lot are at greater risk. Pets cannot dissipate heat like we do by sweating so watch them for heavy panting and difficulty breathing, a bright red tongue and gums, saliva is thick and tenacious, and the dog often vomits. The dog becomes lethargic and unsteady, and passes bloody diarrhea. The dog goes into shock and the lips and mucous membranes turn gray. Collapse, seizures, coma, and death rapidly ensue.



Fireworks 

Besides being potentially frightening to your pet, unused fireworks can be toxic if ingested. The chemicals in fireworks that make them pretty can cause kidney damage, seizures, liver damage, blood cell toxicity, and vomiting and diarrhea. They can also burn themselves or be injured by exploding fireworks so keep them indoors during the festivities. If your pet is frightened by the noise, talk with your veterinarian about what can be done for noise phobia (See our post on thunderstorm phobia).

Article written by Dr. Dana Lewis

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Read more or contact Dr. Dana:
Dana Lewis, DVM
Lap of Love Veterinary Hospice
Raleigh, North Carolina
drdana@lapoflove.com  |  www.lapoflove.com

Dr. Dana assists families with Pet Hospice and Euthanasia in the Raleigh North Carolina area (Raleigh, Durham, Chapel Hill and the greater Triangle, as well as Wake, Durham, Orange, and Chatham counties. 

Wild Baby Birds – How Can You Help? by Dr. Dana Lewis

It's bound to happen if you're out and about. You are going to find a baby bird in a low branch or on the ground. Wondering what can be done when you find one or more is a question veterinarians often get every Spring. Many baby birds are thought to be abandoned when someone finds them in their yard, but the truth is few young birds just fall from their nest unless a storm has occurred.

If you find a young bird and it is injured, seek medical care immediately from a veterinarian who sees birds. If it is uninjured, you will need to determine whether or not it is really an orphaned bird. The best way is to determine if it is a nestling or a fledgling. Most young birds that are found are really just young fledglings that can't fly well yet. Many people don't realize that when birds leave the nest they jump and glide between tree branches while learning the basics of flying. In order to determine whether the bird is a nestling or a fledgling allow the baby bird to perch on your finger. If it is able to grip your finger firmly then it is a fledgling. The best thing to do in this case is to place it in a nearby tree or shrub and leave it alone. The parents will continue to care for it and feed it.

If the bird is not able to cling to your finger, then it’s a nestling. Try to locate the nest. Most of the time, the nest will be close by and well hidden. Place the bird back in the nest. If the nest cannot be found or is too high for you to safely reach it, make a temporary nest (example- a berry container with tissues inside it) and attach it to a nearby tree or in a shrub to protect it from predators. Place the young bird in the basket and leave it alone. The parents will take care of it once you leave. It is a myth that once you touch a baby bird the adult birds will abandon it.

Should you attempt to hand-feed nestling birds that you have found? Young birds are fed by their parents about every 20 minutes during daylight hours. Most people are not able to provide this much time and effort in raising young birds. You also need to have some education in what is the proper diet to feed nestlings, and then as they grow their diets often change. Never force water or other liquids down their throats; you will actually drown the bird. The adults do not bring water to the nest. Water comes from the insects or fruit they eat. Instead, contact your local veterinarian or call your nearest wildlife rehabilitator. You can find them on the internet. Also you usually have to be licensed to hold wild birds and other wildlife in captivity.

Written by Dr. Dana Lewis

Read more or contact Dr. Dana:
Dana Lewis, DVM
Lap of Love Veterinary Hospice
Raleigh, North Carolina
drdana@lapoflove.com  |  www.lapoflove.com

Dr. Dana assists families with Pet Hospice and Euthanasia in the Raleigh North Carolina area (Raleigh, Durham, Chapel Hill and the greater Triangle, as well as Wake, Durham, Orange, and Chatham counties.

Ringworm is not a worm, by Dr. Dana

Ringworm is not a worm.

Well, then, what is it?

Ringworm is the common name for a skin infection caused by a group of fungi; it is not caused by a worm at all. The fungi feed on skin cells and/or hair. In people it causes round, red lesions with a ring of scale around the edges and normal healing skin in the center. Due to the itchy nature and appearance, people once believed it was a worm living in the skin. The fungi responsible are called dermatophytes, “dermato” meaning skin and “phytes” meaning plants. The correct term for ringworm is really dermatophytosis. In animals, ringworm frequently looks like a dry, grey, scaly patch but can also mimic any other skin lesion and have any appearance, and it is usually not itchy.

How did my pet (or my kids) get ringworm?

The spores of dermatophyte fungi are extremely hardy and they can live for years. There are several species of dermatophyte fungi. Different species of fungi come from different kinds of animals or from soil. The fungus can only invade skin that is irritated or abraded; it cannot infect healthy intact skin. This means that freshly shaved, scraped, or scratched skin is especially vulnerable. So, kids with scraped knees, and grownups gardening without gloves, or anyone with dry skin are all very attractive to the fungi.

Infected animals (including people) shed spores into the environment as infected hairs break off and skin flakes off. Some animals are carriers, which means their skin is infected but shows no visible lesions and they can infect others. Ringworm patients undergoing treatment commonly fit in this category towards the end of their care; the skin is still dropping spores but the visible signs of infection have cleared up.

Some people are at greater risk of becoming more seriously infected than others. The fungus takes advantage of people with reduced immune function. This puts young animals and children, elderly people and pets, people who are immune compromised: HIV+, on chemotherapy, steroids like prednisone, or organ anti-rejection medication, as well as highly stressed or significantly ill people and animals are at higher risk.

If you do not already have ringworm at the time your pet is diagnosed, you probably will not get it. Some people become immune to the different strains of ringworm once infected.

How do you diagnose ringworm?

Ringworm lesions on animal skin are rarely the classic ring-shape as in people. Pets are usually not itchy like people either. Some testing is necessary to determine if it is ringworm.

Wood's Light Fluorescence: Microsporum canis, the most common ringworm fungus, will fluoresce (glow) apple green in approximately 50% of cases. Fluorescence is easy to perform and may provide a strong clue that there are dermatophytes on the skin. Further testing is usually indicated to confirm diagnosis especially if it is not fluorescing.

Microscopic Examination: Your veterinarian may wish to examine some hairs for microscopic spores. If spores can be seen on damaged hairs then the diagnosis of ringworm is confirmed. Spores are difficult to see, so many veterinarians skip this step.

Fungal Culture: With this test, some hairs and skin scales are placed on a culture medium to try and grow one of the ringworm fungi. The advantage of this test is that it can confirm ringworm but and it tells us which species of fungus is there. Knowing the identity of the fungus may help determine the source of infection. The disadvantag is that fungi require at least 10 days to grow out.

Also, this is the only test that is helpful in determining if animal is a carrier. The other tests require an apparent skin lesion to test. A pet with no apparent lesions can be combed over its whole body, and the fur and skin that are removed can be cultured. Carrier animals are usually cats. When there is a pet with ringworm in the home, all other pets should be tested.

Biopsy: Sometimes the lesions on the skin are so uncharacteristic that a skin biopsy is done to obtain a diagnosis. Fungal spores are quite clear in these samples and the diagnosis may be ruled in or out.

Treatment:

Depending on the outcome of preliminary tests and how your pet appears, or if there are multiple pets or people affected, your veterinarian may begin ringworm treatment right away before the culture or biopsy results are completed.

Commitment is the key to success especially if you have more than one pet. Infected animals are constantly shedding spores into the environment (your house) thus disinfection is just as important as treatment of the affected pet. Ideally all pets should be cultured. Limiting access of the pet(s) to one area of the home makes it easier to reduce the area needing repeated disinfection.

Infected pets often require oral medication, which should be supplemented with topical treatment to prevent further environmental contamination. Localized lesions might get away with topical treatment only.

There are several medications being used to treat ringworm. The medications can be expensive, and have significant potential to cause birth defects in pregnant pets. Pregnant owners should speak with their doctor regarding their pet. Treatment with medication typically is continued for 6 to 8 weeks and should not be discontinued until the pet cultures negative. Stopping when the pet simply looks well visually frequently leads to recurrence of the disease.

Griseofulvin must be given with a fatty meal in order for an effective dose to be absorbed by the pet. Persian cats and young kittens are felt to be sensitive to its side effects, which usually are limited to nausea but can include liver disease and serious white blood cell damage. Cats infected with FIV (feline immunodeficiency virus) commonly develop life-threatening blood cell changes and should never be exposed to this medication. Despite the side effects, which can be severe for some individuals, griseofulvin is less expensive than itraconazole and is often used in multipet situations.

Itraconazole is highly effective in the treatment of ringworm but is available in capsules that are too strong for our smaller pets. This means that a compounding pharmacy must make it into a more useful size. Nausea is a side effect for this medication and it is more expensive than griseofulvin.

Terbinafine and Fluconazole are both less expensive than the above medications and less likely to have side effects so more veterinarians are starting to use these drugs.

Topical treatment for ringworm and disinfecting the environment:

We also would like to reduce contamination of the environment. This means actually killing the fungus on the pet so that the hairs dropped will not be infectious. Killing the fungus on the pet means topical therapy. Lime Sulfur Dips are recommended usually twice a week and can be performed either by the hospital or sometimes the veterinarian let’s you do it at home. If you attempt this kind of dipping at home, you should expect:

• Lime sulfur will stain clothing and jewelry, and metal bathroom fixtures 
• Lime sulfur will cause temporary yellowing of fur 
• Lime sulfur smells strongly of rotten eggs The dip is mixed according to the label instructions and is not rinsed off at the end of the bath. The pet should be towel dried.

Miconazole (a topical antifungal) and chlorhexidine (a disinfectant) work together when combating ringworm. They are available as a combination rinse as well as shampoo. The rinse, which is allowed to dry on the pet, is effective in killing ringworm spores though lime sulfur seemed associated with faster cure.

The problem with decontaminating the environment is that few products are effective. Bleach diluted 1:10 with water will kill 80% of fungal spores with one application and any surface that can be bleached should be bleached, with the solution remaining on the cleaned surface for 10 minutes. Vigorous vacuuming and steam cleaning of carpets will help remove spores. Vacuum bags should be discarded. To reduce environmental contamination, infected pets should be confined to one room until they have cultured negative. Most of the time, we perform two cultures during treatment, more if either comes back positive. The rest of the house can be disinfected during this confinement period. The hairs and skin particles from the infected individual literally forms the dust and dirt around the house and are the basis for reinfection. Affected animals should be confined to one room which should be cleaned twice a week. It is recommended to clean all areas thoroughly at least 3 times.

Can ringworm go away by itself?

There have been several studies that showed this fungal infection can eventually resolve on its own. Typically, this takes 4 months, a long time in a home environment for contamination to be occurring continuously. I recommend treatment for this infection rather than waiting for it to go away.

What to change if the ringworm infection doesn’t go away:

After a couple of months of medication and dipping, the outbreak is generally over. If the pet is still culturing positive, then it is time to look for where you may have cut corners (not giving oral medication consistently, not dipping, not treating environment thoroughly, not treating carrier pets), if you use generic itraconazole it might not work, your pet may not be responding to the medication you are using so consider changing the oral medication, or consider that perhaps the pet has a defective immune system. This disease can be tricky to eradicate so work closely with your veterinarian. If you become infected, contact your doctor to receive treatment. Veterinarians are not able to make recommendations for human disease or infection, even if the infection came from your pet.

Written by Dr. Dana

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Read more or contact Dr. Dana:
Dana Lewis, DVM
Lap of Love Veterinary Hospice
Raleigh, North Carolina
drdana@lapoflove.com  |  www.lapoflove.com

Dr. Dana assists families with Pet Hospice and Euthanasia in the Raleigh North Carolina area (Raleigh, Durham, Chapel Hill and the greater Triangle, as well as Wake, Durham, Orange, and Chatham counties. Special arrangements can be made for other surrounding counties and for the Triad area.

Degenerative Myelopathy in Dogs, by Dr. Dana Lewis

Degenerative Myelopathy (DM) is a slowly progressive disease that affects the spinal cord and a dog's ability to walk. DM results in lost coordination of the hind legs, which progresses to weakness and then to paralysis of the hindquarters. It may cause problems with elimination. It will ascend to the front limbs and also interfere with breathing eventually. Once the dog reaches the point where he can no longer walk, pressure sores, urine leaking and scalding, and loss of bowel control are likely to develop if the patient is not attended to.

The nerves in the mid to lower spinal cord are affected first, and the myelin sheaths that protect the nerves degenerate in this disease. The cause is a DNA mutation in a gene called superoxide dismutase 1 (SOD1). The neurologic disease is similar to some forms of human amyotrophic lateral sclerosis (ALS, often called Lou Gehrig's disease). The DNA test does not determine if a pet is suffering from DM but if he is at risk of developing signs. The test identifies dogs that are clear and have two normal copies of the gene, carriers who have one normal copy and one mutated copy, and those who are at much higher risk for developing DM because they have two mutated copies. But just because a dog has two mutated copies of the gene, it does not mean he will definitely develop the disease. Unfortunately, the only way to confirm the diagnosis is after the pet passes by examination of the spinal cord.

It affects older large breed dogs, particularly German Shepherds, but also Bernese Mountain Dogs, American Water Spaniel, Bloodhound, Borzoi, Canaan Dog, Chesapeake Bay Retriever, English Cocker Spaniel, Great Pyrenees, Kerry Blue Terrier, Sealyham Terrier, Whippet, Collies, Mastiffs, Setters, Old English Sheep Dogs, Huskies, Ridgebacks, and the only small dog that is more commonly affected is the Pembroke Welsh Corgi.

Dogs who are mixes of any of these breeds are also at risk. Other dog breeds can get it, but it’s less likely. Most small dogs and cats rarely are affected.

Typically, degenerative myelopathy isn't seen in dogs under the age of five, and more often it is between 8 and 14 years that it occurs. Because the disease is found in specific breeds, responsible breeding is the only way to prevent degenerative myelopathy. If you plan to get a purebred puppy of an affected breed, ask the breeder about history of DM in the kennel’s line. Understand that clinical signs don't develop until long after sexual maturity.

Symptoms

Often the first signs noticed are difficulty in the hind quarters when the dog is getting up particularly on a smooth surface. As the disease progresses, the dog becomes uncoordinated, will sway, the limbs may criss-cross each other and will scuff or drag the rear feet, knuckle over and not be aware of it, causing excessive wearing of the toenails. The muscles waste away and become weaker.

Sometimes one side is more uncoordinated than the other. The disease can wax and wane or progress steadily. It usually takes a few months to a year after onset for a dog to become unable to walk. Fortunately, dogs with DM do not appear to be in pain. However, if the pet falls she can hurt herself, or if she also has orthopedic problems complicating the situation, she could have concurrent worsening pain.

Diagnosis

Since the clinical signs of DM can appear the same as those for other diseases such as a herniated disk, cancer, infection, spinal stenosis, etc. the diagnosis in a live animal is based on excluding these diseases. Diagnostic testing is needed, including physical and neurological examinations, routine blood work, spinal radiographs, as well as possibly myelography, spinal fluid analysis, computed tomography (CT) or magnetic resonance imaging (MRI) scans. Orthopedic problems should also be evaluated.

Treatment

Unfortunately no treatment has been shown to reverse the signs. DM can be managed but not cured. Supportive treatment can help. A study evaluating combination therapy with aminocaproic acid, N-acetyl- cysteine with vitamins B, C, and E failed to detect a benefit. Minocycline, a tetracycline antibiotic with anti-inflammatory properties, is still being evaluated as part of therapy.

Exercise such as walking and swimming should be encouraged. Physical therapy helps to maintain muscle mass and quality of life. In one study of 50 dogs with DM, those that received intensive physiotherapy had longer survival time (mean of 255 days), compared with dogs that received moderate (mean of 130 days) or none (mean of 55 days). Dogs receiving therapy also maintained their ability to walk significantly longer than those that did not.

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Read more or contact Dr. Dana:
Dana Lewis, DVM
Lap of Love Veterinary Hospice
Raleigh, North Carolina
drdana@lapoflove.com  |  www.lapoflove.com

Dr. Dana assists families with Pet Hospice and Euthanasia in the Raleigh North Carolina area (Raleigh, Durham, Chapel Hill and the greater Triangle, as well as Wake, Durham, Orange, and Chatham counties. Special arrangements can be made for other surrounding counties and for the Triad area.  

The Pitfalls of Buying Pet Medication from Someone Other than Your Veterinarian, by Dr. Dana Lewis

Internet pharmacies and big box store commercials would have you believe that you're just throwing your money away if you buy your prescription medications, or heartworm and flea preventatives from your veterinarian. But these pharmacies have some drawbacks that you should be aware of: You still need a prescription from your veterinarian in order to get your medications, some pharmacies use questionable products, products might not be guaranteed by the manufacturer if complications arise, if you purchase non-prescription medications from an online pet pharmacy or any other pharmacy or pet store you need to make sure to talk with your veterinarian to avoid harmful medication interactions, and one more thing that is going to surprise a lot of people- these other pharmacies are making veterinary care more expensive , not less. Let’s start with that shocker first.

Pharmacies are making veterinary care more expensive – not less

Running a veterinary hospital is a business. Yes, we love animals, and yes we want to take care of them and make you happy but it costs money to pay the staff, the rent/mortgage, utilities, all the infrastructure (anesthesia machines, blood analyzers, microscope, computers, etc.) that makes a hospital run smoothly. We do nearly all the medicine and surgery stuff done in human hospitals but without the headaches and profits from having to deal with insurance companies.

Unfortunately, some things have changed in veterinary medicine that makes other costs go up, including losing a lot of the pharmacy revenue; changes in vaccine recommendations which eliminated some of the yearly vaccination revenue, and drug companies selling directly to pet owners rather than through veterinarians (this is why you see flea medications that you used to get only through your vet being sold in big box stores).

How veterinarians used to pay the bills: Get as many pet owners in the door as possible by charging a small fee for an office visit to keep the costs to access to veterinary care low. If an animal was ill and needed diagnostics or procedures to work-up a problem, procedures and diagnostics were performed and pet owners with sick animals were charged accordingly. If medications were needed, they were dispensed to the pet owner at a reasonable profit. The veterinarian had a lot of clients and patients coming in and bonding with the practice, ensuring the bills would be paid, and pet owners came to the vet for minor problems. The quicker a problem is dealt with, the less it often costs because it has not grown in significance to a much bigger issue.

But since people are filling more of their prescriptions outside our offices, the fees have to change. The office fee has gone up. Procedures, diagnostics, and preventative care are more expensive to help defray the costs previously recouped by selling medication. Or the vet feels they cannot afford to keep those diagnostic machines in office anymore and refer you to a specialty hospital, costing you time and more money.

What does a prescription mean?

Per the guidelines of the American Veterinary Medical Association, "Veterinary prescription drugs are to be used or prescribed only within the context of a veterinarian- client-patient relationship." This means that you and your pet must have a valid relationship with a veterinarian in order for them to prescribe medication for you. As a result, when veterinarians get faxes for pet pharmacies requesting medication for animals we have never examined, or haven't examined in over a year, these requests will be denied. Human medicine works the same way. Your doctor is not going to risk your health and their license and call in a prescription for you if they don’t see you first. Veterinarians need to know your pet and what we are treating before we prescribe.

Beware of foreign and counterfeit products

Some online pet pharmacies are more reliable than others. If the pharmacy is offering you a deal that seems to be too good to be true, it probably is. Some online pharmacies have sold medicines that are counterfeit, outdated, mislabeled, incorrectly formulated, or improperly made or stored. These medicines may not contain the actual drug, may contain contaminants, or the incorrect amount of drug, may not work as well due to age, or being stored in conditions that were too hot, cold, etc. Be aware of the pharmacy’s return or refund policies. The pharmacy should be easy to contact- an address, phone number and an e-mail address should be listed on the website. One way to check an internet pharmacy's reputation is to look for the VIPPS (Verified Internet Pharmacy Practice Sites) seal of approval. It is a service of the National Association of Boards of Pharmacy. The VIPPS web site (www.nabp.net) lists qualifying on-line pharmacies.

Some disreputable pharmacies may sell foreign or counterfeit products. Items like flea and heartworm preventatives are more common targets for this problem. Luckily this isn't too widespread at the moment but it does still happen. On more than one occasion I’ve had a client complain about a flea product that didn't work, and when they showed me the product, it was a counterfeit.

Another problem with on-line pharmacies is that they may not be selling drugs approved in the US. These products have different strengths and labeling than US products. Look closely at medicine ordered online. I had this happen when someone ordered heartworm prevention and they were confused because the weight limit on the medication was in kilograms instead of pounds. They brought it in for me to see and the pharmacy was dispensing product from Australia. This is illegal in the US.

Use caution combining prescription and over the counter medications.

Just like when you go to the doctor and then to your pharmacy, inform your veterinarian if you give your pet any natural, holistic, homeopathic, or other over-the-counter (OTC) medications or supplements. It is important to avoid any harmful medication interactions with prescriptions your pet is already taking, or that your veterinarian may prescribe in the future.

An example of what can go wrong: a client administered the prescription that we recommended for her dog’s arthritis. What she failed to tell us, was that she was giving her pet an OTC product containing a salicylate, which is related to and has side effects like aspirin. She didn’t think of that as a medication because it was not a prescription. Luckily for her dog, it didn’t cause a fatal gastrointestinal bleeding ulcer because we found out when the dog started vomiting that she was giving this other product. As your pet’s health care advocate, you lovingly assume responsibility for their welfare and provide them with the best care possible, so, medicate them wisely.

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Dana Lewis, DVM

Read more or contact Dr. Dana:
Dana Lewis, DVM
Lap of Love Veterinary Hospice
Raleigh, North Carolina
drdana@lapoflove.com  |  www.lapoflove.com

Dr. Dana assists families with Pet Hospice and Euthanasia in the Raleigh North Carolina area (Raleigh, Durham, Chapel Hill and the greater Triangle, as well as Wake, Durham, Orange, and Chatham counties.

Lymphoma by Dr. Dana Lewis

Cancer is a fascinating disease. No, really. It is amazing how our genes can betray us on their own, or due to us abusing them by choice (smoking, sun worshipping, etc.) or inadvertently (all the other stuff our bodies are exposed to). If you want to read an excellent book, I recommend The Emperor of All Maladies, by Siddhartha Mukherjee. It is a biography of cancer and is really amazing.

lymphoma cells in a RBC background
from a bone marrow biopsy.
Source: Nature.com

Lymphoma, also called lymphosarcoma, is a highly malignant tumor of the lymph system. It is the most common form of cancer in both humans and small animals. Dogs, cats, and young ferrets are hard hit by this cancer.

What is Cancer?

We do not know how pets and people get cancer most of the time. Cancer starts with a cell that has mutated due to genes turning on or off, and growth starts to run amok. These cells are being born in our bodies all the time and we have an assortment of mechanisms to destroy them before they get out of hand. Sometimes these cancer cells escape destruction and cancer grows. It begins to divide quickly and without control. The organ where the abnormal cells live may be destroyed as the cancer cells take over. Other tissues may become invaded as the tumor cells grow into them. Cancer cells break away from the primary tumor and travel via blood or lymph vessels to other areas of the body. Wherever these cells lodge, they can start new tumors. This form of cancer spread is called metastasis.

What is the Lymph System?

The lymph system is a network of vessels that intersect with the blood stream and direct foreign material and organisms (bacteria, viruses, etc.) to the lymph nodes that then process this debris. The lymph nodes are full of the cells of the immune system. There are many different types of immune-related cells; some produce antibodies, some circulate and destroy the foreign materials they encounter, some regulate the activity of other cells. Lymphocytes, a type of white blood cell, are the primary cells of the lymph system. The spleen and liver are also heavily involved with the lymph system. Lymphoma can occur anywhere in the body.

What is Lymphoma?

lymphocytes smeared out
from a node aspirate.
Source: BiomedicalCentral.com

When lymphocytes become cancerous within a lymph node, the node swells and hardens. Malignant lymphocytes readily travel through the lymph vessels to nearby lymph nodes. Soon all the nodes are enlarged. Ultimately, the bone marrow where are blood cells are formed becomes obliterated with these abnormal cells, the immune system is destroyed, and severe anemia, organ failure, and/or infection usually claim the victim's life. (Leukemia is another type of white blood cell cancer with circulating blood cells-these can be immature lymphocytes or other white cell lines. Leukemias are usually detected from a blood sample while lymphomas are detected from taking a sample from a node or biopsy of other affected tissues. However, lymphoma is also the most common cancerous cause of hypercalcemia (high blood calcium levels) in dogs, so that may be detected on bloodwork).

Dog with swollen lymph nodes.
Source: NCSU College of Veterinary Medicine

The typical dog lymphoma patient is a middle-aged dog who goes to the veterinarian because one or more lumps have been found. In dogs, the most common lymphoma form is the multicentric form, where all the lymph nodes of the body seem to enlarge at once. Certain breeds of dogs are more likely to develop lymphoma, especially the Golden Retriever, but also the Boxer, Scottish Terrier, Basset Hound, Airedale Terrier, Chow Chow, German Shepherd, Poodle, St. Bernard, Bulldog, Beagle, Rottweiler. While multicentric lymphoma can occur in cats, the most common feline form of lymphoma is currently intestinal. This was not always the case. Years ago, prior to the widespread use of the feline leukemia vaccine, the mediastinal form (a tumor in the chest cavity) was the predominant lymphoma form and the leading cause of lymphoma was the feline leukemia virus. Now the virus has become less common, thanks to more cats living indoors, effective vaccination, and readily available testing procedures. The average intestinal lymphoma patient is an elderly cat with a history of vomiting, diarrhea, weight loss, appetite loss or any combination thereof. A mass may develop with intestinal lymphoma or the tumor may be more infiltrative. A mass can potentially cause obstruction in the intestine and lead to a crisis that must be promptly resolved surgically. Cigarette smoke in the home has been found to double a cat's risk of developing lymphoma.

WITHOUT TREATMENT, ANIMALS WITH LYMPHOMA ARE EXPECTED TO LIVE 4-8 WEEKS FROM THE TIME OF DIAGNOSIS.

Many patients are not feeling particularly sick at the time of diagnosis. It may be tempting to hold off on treatment until the pet seems more ill. Waiting can drastically reduce the chance for long-term survival; better remission quality is obtained if the patient is treated while still feeling healthy.

What is Remission?

Remission is the state in which symptoms have been abated, the tumor cells are undetectable for the moment, and the patient doesn’t appear to have cancer. Prolonged remission is the goal of cancer therapy which, for most lymphoma cases, means chemotherapy. How long a remission lasts depends on what protocol is used and a number of other factors. Numerous protocols are available and there is one to fit every budget and every schedule.

What is Cure?

Cure is the permanent removal of all traces of tumor such that no further treatment is needed. In effect, it is a permanent state of remission. While this is a possibility for your pet, it is more constructive and realistic to focus on increasing quality time. With lymphoma, remission is likely but cure is not.

Chemotherapy

Chemotherapy means therapy using medication (as opposed to surgery or radiation, which can also play a role in lymphoma therapy). The word chemotherapy conjures images of people losing their hair and suffering chronic overwhelming nausea. It is unfortunate that many pets (and probably people, too) do not receive chemotherapy based upon these unpleasant images that poorly represent the current state of treatment. Decades of research has gone into patient comfort, minimizing side effects, and maximizing response. There is a lot of research going on to tailor therapy to the specific genes that are out of control, and several chemotherapeutic agents on the market for other cancers that target specific gene activity, and which greatly minimizes side effects.

Only 7% of pet patients require hospitalization due to side effects of chemotherapy. 75% of lymphoma patients go into remission with chemotherapy protocols beyond prednisone alone. In cats, protocols using multiple drugs yield much better results, but high grade lymphoma, FeLV+ cats, and cats with lymphoma in the kidneys have a poorer response to therapy with median survival of 6-9 months. Low grade intestinal lymphoma cats can live for years while on chemotherapy. The median survival time for most dogs on chemotherapy (again not just prednisone) is approximately one year with 25% of dogs surviving two years. T-cell lymphoma is less responsive to medication than B-cell lymphoma. Luckily, B-cell lymphoma accounts for 75% of canine lymphoma. Several facilities also are doing bone marrow transplants with their chemotherapy dogs who have gone into remission and are appropriate candidates. This can be curative in about 30% of dog patients.

Blog written by:
Dr. Dana Lewis

Posted by Dr. Mary Gardner

Read more or contact Dr. Dana:
Dana Lewis, DVM
Lap of Love Veterinary Hospice
Raleigh, North Carolina
drdana@lapoflove.com  |  www.lapoflove.com

Dr. Dana assists families with Pet Hospice and Euthanasia in the Raleigh North Carolina area (Raleigh, Durham, Chapel Hill and the greater Triangle, as well as Wake, Durham, Orange, and Chatham counties.

Medication Nightmares: or why you shouldn't give medication to your pet without talking to a vet first, by Dr. Dana Lewis

Always ask your veterinarian before administering any medications, supplements, herbal remedies, etc. to your pet. Here are some common household meds you might think are safe but they are NOT.

Aspirin: While dogs can be given aspirin with caution, this can cause major GI ulceration if given inappropriately, and also disrupt clotting leading to your pet hemorrhaging. It is a huge NO-NO in cats. They cannot metabolize it fast enough. Signs of aspirin toxicosis may include fever, rapid breathing, vomiting, melena (black digested blood in stool), abdominal pain, seizures, and coma.

Pepto-Bismol and Kaopectate: Again, proceed with caution in dogs, and a huge NO in cats as this product contains bismuth subsalicylate which is an equivalent to ASPIRIN!

Ibuprofen (Advil): I don’t recommend it in dogs due to great risk for GI ulcers and kidney failure. And never in cats.

Acetaminophen (Tylenol): The active ingredient in Tylenol® and other commonly used over- the-counter medications, such as Percocet®, aspirin-free Excedrin®, and various sinus, cold, and flu medications, is acetaminophen. Lots of human doctors no longer recommend this for people. We don’t use it in our house. I would never give it to a pet: Can cause liver failure in dogs, in cats it will KILL them. Yes, kill them. One tablet. Bad news, Causes damage to red blood cells and liver failure.

Topical steroid creams: If ingested, and pet is on an NSAID it increases the risk of GI ulcers. Also, even if pet is not on an NSAID, chronic consumption or absorption through the skin can cause iatrogenic Cushing’s disease. (iatrogenic means caused by you, and Cushing’s disease is when you have too much cortisol in your body and you become more prone to infection, poor wound healing, liver damage, thin coat and thin skin, loss of muscle mass, and a bunch of other problems.) Also, some topical steroids are in combo with calcipotriene which can cause elevated blood calcium that can result in kidney failure, heart failure, and possibly death. 

Garlic: not only does it not work on fleas, as a member of the onion family it is toxic to red blood cells and destroys them.

Imodium (loperamide): Some collies and other breeds cannot metabolize this drug properly (the same dogs who cannot metabolize ivermectin). It causes neurotoxicity (dog becomes depressed/confused/comatose).

Benadryl and other antihistamines: Can cause hyperexcitability, increased heart rate, fever, and seizures.

Expectorants and antihistamines (many have pseudoephedrine): Pseudoephedrine causes tremors, elevated heart rate and/or blood pressure. It doesn’t take much to kill a pet.

Desitin and some other diaper creams: Contain zinc and ingestion can lead to zinc toxicosis which causes destruction of red blood cells.

Holistic stuff to prevent heartworms: not only do they not prevent heartworm disease they aren’t safe. Stick with what the veterinarians recommend.

Hydrogen Peroxide: Kills healthy skin cells and can cause aspiration pneumonia if in the process of administering it orally it gets into the lungs.

So please do not let your pet become a statistic as a result of the medicine cabinet.

Blog written by:
Dr. Dana Lewis

Dr. Dana assists families with Pet Hospice and Euthanasia in the Raleigh North Carolina area (Raleigh, Durham, Chapel Hill and the greater Triangle, as well as Wake, Durham, Orange, and Chatham counties.)

Click here for Dr. Dana's bio link

DrDana@LapofLove.com

www.lapoflove.com

Laryngeal Paralysis

“What is it and how does it affect my pet?”  

The larynx is the guardian of the airways, keeping whatever we want to swallow out and directing air in. Laryngeal paralysis is a condition recognized mostly in larger, older dogs that can develop slowly over a year or more until it reaches a stage that causes significant breathing emergencies. The opening to the trachea (“wind pipe”) normally is pulled open on two sides when breathing in, and then these cartilages relax when breathing out. With laryngeal paralysis, the muscles that normally pull these open do not function properly. This means no expanding and opening of the larynx for a deep breath; the laryngeal folds simply flop weakly and flaccidly. When an affected dog breathes in, the cartilages do not pull open—rather, they are sucked into the opening, or in severe cases sucked shut. Early in the condition, this creates increased noise when they breathe (called “stridor”); later, it can completely obstruct their airway, and they can suffocate.

 The early signs of laryngeal paralysis can be quite subtle. They may be such things as a slight harshness in their panting. Very early there might be a simple voice change, usually a hoarse or raspy-sounding bark. Later, people report that they see their pet working harder to breathe, they have exercise intolerance and tire quickly, their facial expression is a bit anxious, and their chest is vigorously expanding. The pet may also look like he/she is “smiling” when they pant, with their lips pulled way back.

Because animals use their breathing as a means to cool themselves naturally, laryngeal paralysis patients are more prone to heatstroke under conditions that would not make a normal dog hot. This may be a simple walk outside on a sunny day or vigorous play on a cool day. When the paralysis is quite pronounced, it is very obvious that the animal is really working to breathe. The extra noise they create with each breath is harsh and easy to hear. Their tongue may be a darker red purple or blue. They are in “respiratory distress” and need medical assistance. Ironically, the airway compromise gets worse when they breathe harder, similar to asthma. Fast-moving air will suck the airway shut, while slow moving air will pass more easily. But the feeling of “air hunger” is a powerful drive, and will make an animal try to breathe harder. Additionally, some dogs will trigger their own crisis by simply barking. The vocal cords are in the larynx; when the dog tries to bark, they contract other neck muscles and narrow their airway and may incite a distress episode.

 Medical care during a breathing crisis often entails oxygen therapy, external cooling, sedation to take the anxiety away, and possibly intubation and artificial respiration for a short period. Unfortunately, most patients that have reached a crisis point will continue to suffer these breathing episodes because their airway is ineffective.

“Can we treat this problem?”

After your veterinarian confirms that your pet has laryngeal paralysis (the vocal cords are observed under light sedation to monitor if they are moving correctly, and sometimes a drug is given to stimulate breathing to see if the folds move properly during the exam) then you and your veterinarian have to decide when and if to do surgery to “fix” the problem without causing worse problems. The reason they confirm the diagnosis is to make sure the pet doesn’t have a problem that similarly interferes with breathing such as collapsing trachea or a laryngeal or tracheal tumor.

Laryngeal paralysis is a problem of anatomy. The anatomy is interfering with the airflow necessary for breathing. Ironically, the larynx is also responsible for protecting the airway and lungs from fluids and food that should only go down the esophagus into the stomach. So, the correction is simply to move or remove the interfering anatomy without causing any new problems with airway protection.

Image courtesy of the Animal Surgical Clinic of Seattle

Many different approaches have been used to surgically treat laryngeal paralysis. Most veterinarians feel that out of the list of surgical procedures with good success and few complications, the Unilateral Cricoarytenoid Lateralization or “Tieback” is the best choice for most patients. Perhaps newer techniques will come along with better success in the future. To minimize the chance of fluids or food entering the airway, the surgeon will only pull open one side enough to prevent airway compromise and future breathing crises.

While any surgery can have some post-op complications, the biggest concern with this surgery is aspiration of regurgitated stomach contents into the lungs resulting in mild to severe pneumonia. Dogs with chronic vomiting or regurgitation issues (including dogs with megaesophagus) are not good surgical candidates for this procedure. There is a medication called Doxepin that can be tried to improve laryngeal motion if your pet is not a surgical candidate or if you choose not to pursue surgery. Ask your veterinarian if this might be an option for your pet. 

While laryngeal paralysis and its post-operative complications can be quite severe, the majority of families living through this with their pets are happy with the quality of life that is restored with surgery. Restrictions following surgery are few; no neck collar/ leash indefinitely, minimize barking for 6 weeks, elevated feeding station indefinitely, and use of caution when swimming.

It is less and less common for aspiration pneumonia to be fatal, and patients can make a full recovery even in severe cases. The majority of patients do not suffer these complications and go on to live well with the ease of breathing restored. Good to excellent long term results are reported in 90-100% of patients. Complications (10-27%) include aspiration pneumonia (24- 25%) after excessive abduction; infection; and tearing of the tissues with subsequent laryngeal collapse. Voice change is common. Complications are less frequent with more experienced surgeons and with unilateral (versus bilateral) tieback procedure. Each patient must be considered individually though; talk through these potential complications with your veterinarian and choose the most appropriate plan for your pet. It is less and less common for aspiration pneumonia to be fatal, and patients can make a full recovery even in severe cases. The majority of patients do not suffer these complications and go on to live well with the ease of breathing restored. Good to excellent long term results are reported in 90-100% of patients. Complications (10-27%) include aspiration pneumonia (24- 25%) after excessive abduction; infection; and tearing of the tissues with subsequent laryngeal collapse. Voice change is common. Complications are less frequent with more experienced surgeons and with unilateral (versus bilateral) tieback procedure. Each patient must be considered individually though; talk through these potential complications with your veterinarian and choose the most appropriate plan for your pet.

BLOG WRITTEN BY:

Dr. Dana Lewis

Dr. Dana assists families with Pet Hospice and Euthanasia in the Raleigh North Carolina area (Raleigh, Durham, Chapel Hill and the greater Triangle, as well as Wake, Durham, Orange, and Chatham counties.)

Click here for Dr. Dana's bio link

DrDana@LapofLove.com

www.lapoflove.com

Blog posted by:
Vet Mary Gardner

Heat Stroke in Dogs and Cats

HEAT STROKE

Hyperthermia, also known as heat stroke, is a life-threatening condition, and requires immediate help.  A dog or cat’s normal body temperature is 101.5°F plus or minus 1 degree, and any time the body temperature is higher than 105°F, it is an EMERGENCY.  The most common cause of heatstroke occurs in summer when dogs are left within cars.  However, heatstroke may also occur in other conditions, including:

1. When any animal is left outdoors in hot/humid conditions without adequate shade.
2. When the animal is exercised in hot/humid weather.  
3. When left in a car on a relatively cool (70°F) day; a recent study found the temperature within a vehicle may increase by an average of 40 degrees Fahrenheit within one hour regardless of outside temperature.  Yup, you read that right, 110 degrees or more!!!

Other predisposing factors may be obesity and/or conditions affecting a pet’s airway, including laryngeal paralysis and other diseases of the throat region and having a brachycephalic (short-nosed) breed: (Pekingese, Pug, Lhasa apso, Boston terrier, Persian, Himalayan, etc.) These pets may suffer from heatstroke more readily due to their inability to move air properly through their short crowded noses and throats.

SIGNS:

Initially the pet appears distressed, and will pant excessively and become restless.  As the hyperthermia progresses, the pet may drool large amounts of saliva from the nose and/or mouth.  The pet may become unsteady on his feet.  You may notice the gums turning blue/purple or bright red in color, which is due to inadequate oxygen.

WHAT TO DO:

• Remove your pet from the environment where the hyperthermia occurred. 
• Move your pet to a shaded and cool environment.
• Begin to cool the body by placing cool, wet towels over the back of the neck, in the armpits, and in the groin region.  You may also wet the ear flaps and paws with cool water. 
• Direct a fan on the pet for evaporative cooling, especially helpful if you can wet the pet down. 
•  Transport to the closest veterinary facility immediately.

What NOT to Do:

• Do not leave your pet unattended in a car or outdoors.
• Do not use cold water or ice for cooling. 
• Do not overcool the pet.  Most pets with hyperthermia have body temperatures greater than 105°F, and a reasonable goal of cooling is to reduce your pet’s body temperature to 102.5-103°F while transporting her to the closest veterinary facility. 
• Do not attempt to force water into your pet’s mouth, but you may have fresh cool water ready to offer should your pet be alert and show an interest in drinking.

While ice or very cold water may seem logical, it fails to cool the inside of your pet where all the vital organs are its use is not advised.  Ice or cold water will cause the blood vessels in the skin to shrink in response to the extreme cold and cooling will actually be slower. Cool tap water is more suitable for effective cooling.   

It is important to seek medical care immediately to prevent further organ damage and to address complications that result from heatstroke.

BLOG WRITTEN BY:

Dr. Dana Lewis

Dr. Dana assists families with Pet Hospice and Euthanasia in the Raleigh North Carolina area (Raleigh, Durham, Chapel Hill and the greater Triangle, as well as Wake, Durham, Orange, and Chatham counties.)

Click here for Dr. Dana's bio link

DrDana@LapofLove.com

www.lapoflove.com

Blog posted by:
Vet Mary Gardner