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What is Cushing’s Disease?

Cushing’s disease otherwise known as hyperadrenocorticism is characterized by several common clinical symptoms. These signs include increased urination and thirst, increased hunger, hair loss and thin skin, potbellied appearance, and panting.

This condition results from increase production of cortisol from the adrenal glands. As many older dogs exhibit some of these symptoms, Cushing’s disease is often being considered as a possible diagnosis for our patients.

Typically there is a step wise progression of exam and testing that leads to the diagnosis of Cushing’s disease. In the early stages of diagnosis for Cushing’s disease; patient history, exam findings, and basic blood and urine results are used to determine if more specific tests should be completed.

The following are five findings that would point toward a patient having Cushing’s disease.

The first finding is called a stress leukogram. This refers to the interpretation of the complete blood count. The complete blood count known as a CBC is part of most basic blood panels. This is the counting of white and red blood cells as well as platelets. Typically patients with Cushing’s disease will have lower than normal lymphocyte counts and higher than normal platelets counts.

The second finding will be elevated liver enzymes. The liver enzyme alkaline phosphatase (AP) is produced primarily in the liver. But when cortisol levels increase, the cortisol induces the AP to become higher. And this increase in AP is found in about 90% of patients with Cushing’s disease.

The third finding is mild elevation in blood glucose known as hyperglycemia. Cortisol increases the production of glucose from the liver and also blunts the effect of insulin in some patients. About 35% of patients with Cushing’s disease will have hyperglycemia.

The fourth finding is elevated cholesterol known as hypercholesterolemia. Cortisol increases the breakdown of fat and adipose tissue, releasing fats into the blood stream. Approximately 90% of Cushing’s patients will have hypercholesterolemia.

The final finding is the presence of dilute urine. The increased level of cortisol interferes with the kidney, and the kidney is no longer able to save water. This inability of the kidney to reabsorb water leads to water loss in the urine; and the need to drink more water to replace the water that is being lost. This occurs in 90% of patients with this disease.

If your elderly pet is panting, has hair loss, and is drinking and urinating more than usual, then he or she could have Cushing’s disease. Start by letting your veterinarian know of these symptoms and collecting samples for basic blood and urine tests.

If several of the above findings are present then specific testing for Cushing’s disease should be completed. This would include further blood testing and likely abdominal ultrasound.

If Cushing’s disease is diagnosed then treatment should be considered. This disease is not cured, but managed, and can require intensive monitoring. Having said that, in the right cases, very satisfying results can be accomplished by the veterinarian and client working together.

Should I be worried if my pet's eye has redness?

 
Redness of the eye can have many causes, and is not always a cause for alarm especially if the redness is transient. For example transient redness can simply be
caused by anxiety or excitement.
That being said redness or conjunctivitis can indicate something more serious such as glaucoma or uveitis {inflammation of the inside of the eye). Therefore any persistent redness (conjunctival hyperemia) should be investigated by a veterinarian. Because treatments and reasons for redness can vary, it is important to have a systematic approach to the eye.

Often conjunctival hyperemia will also include swelling of the conjuctival tissue and drainage from the eye. These patients need a complete opthalmic exam to identify the problem. This exam should include testing for "dry eye", staining of the corneal surface to look for ulceration, and tonometry to check the eye pressure for glaucoma.

By completing these tests the presence of concurrent corneal or intraoccular disease can be determined. Because the eye is delicate delaying treatment for these conditions could lead to permanent eye damage or blindness.


Further the eye can be effected by systemic diseases as well, and therefore a thorough physical exam should be completed on the patient. This exam may include blood work and testing for infectious diseases that might influence the eye.

If the patient has simple conjunctivitis, then the next step is to determine the cause. In dogs the condition is rarely caused by a bacterial infection; rather allergies and
environmental irritation are the more common etiologies.

In addition to allergies, there can be foreign particles that get trapped in the eye that need to be removed or flushed out of the eye. And rarely there can be growths associated with the conjuntiva or the third eyelid which should be sampled and biopsied.


Some patients will form small bubbles on the back side of the third eyelid called follicular conjunctivitis. This is usually from particle irritation and occurs in younger dogs. In these cases rinsing the eyes can be helpful as well as topical medication over the course of several weeks.

Some chronic conjunctivitis cases can be driven by allergies and may require long term eye meds. In these cases the use of cyclosporin is likely safer long term than drops
containing steroids. Interestingly these patients may only have involvement in one eye. If these patients have systemic allergies where the eyes are involved, often the treatment for the systemic allergies will keep the eyes under control at the same time.

In conclusion persistent red eyes should be evaluated by a veterinarian within 24-48 hours. There are many possible causes for eye redness, and thorough evaluation is always warranted to determine the correct diagnosis and treatment.

Should pets have their teeth cleaned without anesthesia?

Most pets at some time in their life will develop plaque deposition on their teeth and associated gingivitis. Many pets will further develop periodontal disease, which is the loss of tooth attachment. Some pets will develop dental abscesses and or cavitation’s on the surface of a tooth.

As veterinarians, we identify these types of dental conditions in our patients every day of practice. Most clients want to provide dental care for their pets, but are concerned about the need for anesthesia. Unfortunately, professional level periodontal therapy must be completed under general anesthesia.

Studies show that dental procedures done with sedation or with non-anesthetic options have little to no medical benefit. General anesthesia is needed to complete a safe thorough cleaning as well as a thorough oral exam. Dental work done any other way is cosmetic at best and deleterious to the patient’s welfare at worst. In fact when dental procedures are completed without anesthesia it hastens the progression of periodontal disease.

In order to complete a beneficial and thorough cleaning, the space under the edge of the gum must be cleaned; and the tooth must be cleaned 360 degrees around. Further, periodontal probing for pockets and dental radiology are needed for a complete exam.

In dental procedures using sedation only or no anesthetic, it is not possible to clean the entire tooth; especially the sub-gingival space and the inner surface of the tooth. Without proper probing for pockets and dental X-ray most dental pathology will be missed.

Commonly, oral cavity exams on awake patients, grossly underestimate the amount of dental disease that is present in the patient. Dental X-ray, probing, and seeing the entire oral cavity often reveals root abscesses, gingival growths, and moderate to severe periodontal disease. Once identified these conditions can be treated. In fact, one recent study showed that patients receiving dental evaluation and cleaning under general anesthesia live longer than patients that do not receive this treatment.

To further support dentistry under general anesthesia versus “non-anesthetic dentistry”; several veterinary bodies have come out with position statements against dentistry without anesthesia. And some states have made the practice of dentistry illegal outside of a veterinary hospital.

In regard to anesthesia risks, a decision is usually made between the veterinarian and the pet owner based on health of the patient, blood work on the patient, and records of previous anesthetic events. In veterinary hospitals with “best practices” the risk with anesthesia is extremely low.

The reason for the low risk with anesthesia is related to good drug choices for each patient; along with proper supportive care during the procedure, and extremely thorough monitoring of vitals during the procedure.

When patients are screened carefully, anesthetic protocols are customized to the patient, and monitoring is detailed and exquisite; patient outcomes are excellent. There is a clear health benefit to keeping the oral cavity in top condition. It is advised to have a conversation with you veterinary professional about dental procedures, along with the risks and benefits for your pet.

Because my pets are Maltese, they have benefited from perio-therapy every year and have always done well!!

Do dogs get esophagitis; sometimes known as: “GERDS” (gastro-esophageal-reflux disorder)?

Esophagitis is more common than most veterinarians and pet owners might think. Most cases of esophageal irritation and inflammation are caused by the reflux or back flow of stomach fluid up into the esophagus. Stomach fluid is very acidic and the esophageal lining is not equipped to handle the acidity.

Other causes of esophagitis include ingestion of caustic material and certain medications like doxycycline. In fact doxycycline that is in capsule form can cause esophageal stricture in cats.

Esophagitis can be difficult to recognize even though it occurs commonly. In mild cases there may be minimal symptoms. These symptoms might include missing an occasional meal, odd lip smacking and licking at things more than usual, and perhaps regurgitation. More severe cases could include drooling, lack of appetite, neck pain, and refusing to swallow.

The vague symptoms and range of symptoms can make esophagitis difficult to recognize. Looking at the esophagus with an endoscope is the only way to definitively diagnose esophagitis. Endoscopy does involve anesthesia, but can be completed quickly. In the evaluation of esophagitis a visual inspection is often enough to make the diagnosis. This means collecting biopsy samples is often not needed.

One common event that can lead to esophagitis is prolonged anesthesia; especially when the patient is laying on their back. With anesthesia the tone of the esophagus is weaker and hence stomach fluid can reflux more easily; and pool in the esophagus. Therefore it is important to monitor post op patients for any gastrointestinal symptoms that might relate to acid reflux.

Mild cases of GERDS can be treated successfully with medication. Severe cases, especially if not recognized early on, can be difficult to treat, and may lead to strictures in the esophagus.

Treatment involves three tactics. First and foremost is to neutralize the stomach acid. This requires the use of drugs known as proton pump inhibitors like omeprazole. These drugs inhibit gastric acid secretion and need to be given twice daily. Mild cases are treated for 7 days and severe cases are treated for 30 days.

Second, is the mucosal protectant, sucralfate. This drug is best used in the slurry form, and will bind to ulcerated areas to protect the healing bed.

Thirdly are the use of prokinetic drugs like cisapride. These drugs help the stomach to stay empty and also tighten the lower esophageal sphincter. Omeprazole and cisapride are the most important of the three medications.

In order to diagnose esophagitis one has to first consider the condition as a possible differential. Unfortunately, esophagitis can be overlooked or confused with more common stomach problems. Delay in treatment can lead to a worsening condition. Hopefully this article will increase awareness of esophagitis and lead to earlier treatments, as well as less pain for our patients.

Lyme is a tick borne disease caused by infection with the bacteria Borrelia burgdorferi. This bacteria has a spiral shape or cork-screw shape, and is known as a spirochete. The disease is primarily in the dog. The tick that carries the bacteria is known as the Deer tick or Ixodes. The Borrelia organism attaches to the salivary gland of the tick; and then is transmitted to the dog in the saliva of the tick. The tick saliva actually helps protect the Lyme bacteria from the host’s immune system.

Once under the skin the bacteria proliferates and then begins to spread through tissue. The organism moves through connective tissue into joints and stays extracellular (outside the cell). The bacteria is very good at avoiding the immune system and can change shapes if needed to prevent detection by the host defenses. Note that 90% of dogs exposed to the Lyme bacteria do not develop any symptoms. For those dogs that develop symptoms; the host immune response to the connective tissue migration of the bacteria; is likely a big part of the disease process.

Again clinical signs develop in 10 percent of dogs exposed. Signs usually develop 2-5 months after exposure. These signs can include fever, enlarged lymph nodes, joint swelling and pain and lameness. The first leg and joint affected is usually closest to the tick attachment site and then spreads from there. Further some patients will develop kidney disease known as Lyme nephritis. Eighty percent of people with Lyme disease will get a red bull’s eye lesion on their skin; yet this is much less apparent in dogs.

Lyme nephritis develops in 1-2% of dogs with an antibody response to the Lyme organism. This is usually a serious and sometimes fatal condition. The condition leads to kidney failure and is over represented in Labrador and golden retrievers. Other less common disorders related to Lyme disease include heart disease, eye problems, and neurological problems.

Diagnosing Lyme disease usually starts with an Accuplex 4 test that screens for heartworm disease, Lyme, and 3 other tick borne diseases. If this test is positive for Lyme, then further testing is done to look for kidney problems and extra protein in the urine. Many dogs may be clinically normal but simply experienced exposure and an immune response to the Borrelia organism. For dogs with a positive test and clinical symptoms like swollen joints or protein in the urine; appropriate antibiotic therapy should be started.

If Lyme disease is diagnosed early on, then antibiotic therapy can be successful. However when the condition is detected late in the disease and especially when there is kidney involvement the prognosis is guarded even with antibiotic therapy.

In general Lyme disease and other tick borne diseases are on the rise especially in the upper Midwest of this country. Lyme disease is commonly seen in pets living in Dupage County. The disease is mostly preventable by using effective flea and tick prevention throughout the year. The newer monthly oral flea and tick preventatives such as Nexgard and Simparica are highly effective and available through veterinarians.

Lyme can be an insidious disease as well as life threatening. If as a pet owner you are out and about with your dog it is important to be informed of the risk of tick borne diseases. Surveys show these disease are on the increase in our neighborhood.

 

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