This is an unindexed assortment of questions that I really didn't have a category for or are about several completely different issues and may be found in some parts of the site but the rest of the information needs to be worked in elsewhere or there is simply not at topic page yet and I need to create one.
For an alphabetical index see Dog Index
Orthopedic books , hygromas and hyperflexation of carpus in bloodhound pup
Question: Dr. Richards,
You know how there are very few text books out that are very useful in the orthopedic world, well there is a new one that has just been translated from German and published. It is terrific. A good friend of mine is a Vet and she is thrilled by it.
Diagnosing Lameness in Dogs
forgot the authors name but it is available at amazon.com for $79.95. Anita (Vet) paid about $130.00 for it from Iowa.
Also, what first drew me to your site was my search for information about Hygroma's. I later found out a very helpful tip from another breeder. If you vigorously massage the hygroma several times a day, it will decrease it's size about 50% faster than if you do nothing. So far, I have followed her advise and I have found that it really works. I will have a few questions for you later. A pup that I bred, who is now four months old, has developed what seems to be a hyperflexion of the tendon just below the carpal joint. The carpal has been x-rayed and seems to be normal at this time but he looks like he has a flipper instead of a paw. I have been involved in veterinary medicine for some time and I have never seem something as bad as this. We have an appointment on the 28th with a specialist and I really want to get this taken care of ASAP. He is already 60lbs and I can only see this becoming worse as he grows.
Thank you for your time, Marcia
Answer: Marcia-
There is a condition in which hyperextension of the carpus occurs, causing the back of the carpal joint (wrist) to drop down towards the ground, or even to contact it. Most puppies with this condition overcome it without treatment. Veterinary nutritionists recommend making sure that the puppy is on large breed puppy food (lower calcium to energy ratio) and that it is not overfed. There seems to be some disagreement over whether to encourage exercise or not, but my personal opinion is that moderate exercise is a good idea. When this condition occurs in puppies the prognosis is usually good. When it occurs in older dogs it can be very frustrating and may require surgery to arthrodese and stabilize the carpal joint in order to prevent secondary problems.
Hopefully the puppy you are concerned with will stick with the majority and do OK in the long run.
Mike Richards, DVM 9/5/2001
Adrenal gland enlargement and Mitotane (Lysodren Rx) treatment
Question: Dr. Richards,
Thank you for the quick response to my last question. We just received news that our 13 year old golden retriever does not have Cushing's disease. He was tested (dexamethasone and other tests) and all was negative. He has been drinking and urinating excessively. Now after an ultrasound it seems the adrenal gland is slightly enlarged. He has no tumors and our vet (who we think is terrific) wants to start a program of lysodren which we were informed kills the cells of the adrenal cortex selectively. I wanted to know your thoughts on this drug and problem. Thanks again, Gina
Answer: Gina-
There are several possibilities when adrenal gland enlargement is identified. The most likely problem is hypertrophy of the adrenal gland due to stimulation from the pituitary gland, which is one of the two major causes of hyperadrenocorticism (HAC, Cushing's disease). In this case, there is not an adrenal gland tumor. The adrenal gland is doing exactly what it should do in response to stimulation from the pituitary gland.
If an adrenal gland tumor is present, it may be one of several types. (metastasis from another site, adrenal gland adenoma, adrenal gland adenocarcinoma, pheochromocytoma). In this case, the problem is identifying the type of tumor present.
Ultrasonagraphy of the adrenal glands seems to be difficult, based on conflicts among the reported findings in adrenal gland tumors among the clinical studies that I can find. I do not do ultrasonagrahic examinations in my practice and my personal experience with this technique is minimal, so this is simply my impression based on reviewing the available literature. Given the conflicts in the literature, though, I think that I would be cautious about using mitotane (Lysodren Rx) for an adrenal gland tumor unless there was support for the diagnosis of hyperadrenocorticism (Cushing's disease) in the lab work, since this therapy is directed at adrenal gland carcinomas and adenocarcinomas and won't work for the other types of tumors. The classic case of an adrenal gland adenoma or carcinoma would be one large adrenal gland and one atrophied (smaller than normal) adrenal gland, but in several studies this didn't always hold true. The opposite adrenal gland can be enlarged because there is concurrent pituitary dependent Cushing's disease, because of a tumor affecting that gland too (adrenal origin or other origin) and also simply because it didn't atrophy as expected.
There are approximately 20 possible causes of increased drinking and increased urination in dogs. Many of these can be ruled out quickly based on the dog's sex, the medical history and general chemistry profiles. The remaining possibilities are then usually the hormonal diseases (hyperadrenocorticism, hypoadrenocortisicm, diabetes insipidus), infections (pyelonephritis both sexes, pyometra in females) and cancers (pheochromocytomas and metastatic cancers producing pseudohormones). Sorting through these conditions can be very difficult.
If both a low dose dexamethasone suppression test and ACTH response test fail to show the presence of hyperadrenocorticism, the likelihood that this is the problem is low, but unfortunately, not totally ruled out. There are dogs who have Cushing's disease who do not test positive for it on either of these tests. When this happens, an effort should be made to eliminate the other possible causes of increased drinking and increased urinating. If no other cause can be found and if there are other signs of Cushing's disease, such as thinning of the hair coat, thinning of the skin, a pendulous abdomen, panting, muscular weakness, calcinosis cutis (calcium deposits in the skin), recurrent bladder infections or other less common clinical signs, then it is reasonable to treat for Cushing's disease to see if a response to therapy can be obtained. This has to be done very carefully, since mitotane does kill adrenal gland tissue, which can cause significant problems if hyperadrenocorticism is not present.
With all of that in mind, there is still the question of what to do. It is important to be sure that an effort has been made to rule out as many of the other causes of increased drinking and urinating as possible. If this has been done to your vet's satisfaction (and yours) and if he or she still believes that Cushing's disease is most likely even without the positive test results it is considered to be reasonable by many internal medicine specialists to attempt treatment to see if it will help. On the other hand, if the only symptom is increased drinking and urinating and if that doesn't bother you or your dog too much, it is also reasonable to do nothing and wait to retest at a later date. Sometimes, over time, further symptoms develop or lab results finally match a disease process.
Mitotane (Lysodren Rx) does selectively destroy adrenal gland tissue. As long as that is appropriate for the disease process, it is a good medication. Some dogs do react adversely to it and we have had one death using it that we really feel was a direct result of the medication and not from creating hypoadrenocorticism accidentally. We have also had several dogs that we have treated with mitotane who did ultimately develop hypoadrenocorticism that required therapy. Some of these eventually returned to a Cushingoid state but we did treat one dog life long for Addison's disease that we created with the medication. In a few dogs who have Cushing's disease, mitotane brings a sudden worsening of clinical signs when it is used but this is a complication of the disease more than of the medication since it is likely this would have happened quickly, anyway. If you and your vet do elect a therapeutic trial of the medication you should watch carefully for signs of problems, such as a loss of appetite or weakness and it would be best to monitor water intake as closely as possible so that you can alert your vet when water intake starts to decrease so that dosage adjustments can be made accordingly. I am sure that your vet will go over this type of thing with you again but do remember that you play a big role in the success or failure of Lysodren therapy.
I think that there are several notes with the list of possible differentials for increased drinking and urinating on our site but if you can't find them, let me know and I'll send you a new one as I am working on this for next month's VetInfo Digest.
Mike Richards, DVM 9/4/2001
Severe spinal damage
Q: Hi, I was just "surfing the net" for people with knowlege of dogs/animals for veterinary assistance, and found your address at http://www.k9web.com/dog faqs/. I hope you are able to give me an opinion on my dog's condition. The problem is my dog, (a Portuguese Water Dog) has the slipped disc, and at first she limped a little about a week ago, and now it has resulted in her inability to stand up. She is under intensive care at the vet, and has been there since last Friday. I have heard that there are carts/wheels that dogs can travel around in so they can continue on with their life. Have you seen dogs "on wheels" continue on with a happy and healthy life? I want to do everything I can in order to save my dog. She just turned 10 years old, and before this happened she was the liveliest and happiest dog. Do you know if it there would be good results if we put her under surgery? Have you ever operated on a dog of this age and had successful results? She still has the will to live, when we visit her at the vet she tries so hard to get up, but her back legs won't do it. They aren't completely paralysed, but they could get worse with time. Basically what I need is some advice and a second opinion because there has already been talk of putting to her to sleep but I refuse and think there has to be more to help her before we reach that ultimate decision. She is just not the type of dog that you give up on and put to sleep.
Thanks so much for listening and I appreciate any information you can give me.
Lauren
A: Lauren-
It can be hard to take care of a dog with severe spinal damage. In many instances dogs that are paralyzed have also lost bladder function. It is necessary to empty their bladder regularly and to provide a high level of nursing care to ensure that they do not develop urine burns, cystitis or other problems as a result of urine leakage or urine retention. I have had several very committed owners who took care of dogs who were paralyzed or partially paralyzed with good success. We have had two or three owners purchase or make carts for their dogs and they seem to work well enough to provide a reasonable quality of life.
Surgery works best for disc problems causing paralysis if it is done within 24 hours of onset of the clinical signs. As time goes on the value of surgery seems to diminish. It is not too late to consider it but there would be less chance of it helping after several days. The best option if you are considering surgery is to have your dog evaluated by a neurologist or orthopedic surgeon who does back surgery and get his or her opinion on how much benefit you can reasonably expect from surgery.
Dogs can recover satisfactorily from severe disc disease in which paralysis or partial paralysis has occurred without surgery in many instances. Sometimes there isn't any recovery or there isn't enough recovery but it is worth waiting a while to see what happens, I think. During the time you are waiting you will have time to learn the nursing care requirements. This will allow you to make a more objective decision about your capability of handling the nursing care long term.
A second opinion is probably a good idea. It would be best to get it from a board certified neurologist or orthopedic surgeon if possible (or at least an experienced surgeon). Your vet should be able to refer you to a veterinary school or specialist in your area for an evaluation of your dog's condition.
Good luck with this.
Mike Richards, DVM
Problems in Older Lab
Q: I have a 11 yr old lab, spayed female. Two weeks ago, she "fainted" for about 10 minutes. Took her to vet next day and the following two weeks. Her PCV was down to 15, Amalase over 2000. She jaundiced and we cleared that up. Ultrasounded abdomen, no "Sure" sign of tumor. Had an emergence blood transfusion and put on prednisone/antibiotics. She is extremely lethargic, with just enough energy to go potty. If she even mildly exerts herself, ie: barking, climing stairs, her pulse nearly doubles along with her respirations. The vets ( seven total, including three specialists) have no idea what is wrong and they are assuming autoimmune problems. I have found several other possibilities such as Addison's. Also several months ago, I noted she was panting all the time, which she never did...seems I should have had her checked then, because it did get my attention. Any ideas?
Andrea
Q: Andrea-
My first thought with the symptoms you have seen so far, in an elderly Labrador retriever, is hemangiosarcoma, a form of cancer. It can be very hard to find this cancer as it does not always for large tumors. I have been involved in cases of hemangiosarcoma in which three or four veterinarians examined a dog and all assumed it must have immune mediated hemolytic anemia or some other bleeding disorder, including me. When we did an exploratory surgery with the idea of performing a splenectomy we discovered several hundred small tumors scattered all over the dog's abdomen.
This is not the only possibility. Many diseases can cause anemia and panting can be associated with heart disease, respiratory problems, Cushing's disease, pain from any source and probably a number of other conditions that don't come to mind right away. If you live in an area in which ehrlichiosis (a disease caused by a blood parasite) is a problem, that would also be something to consider.
Sometimes you just have to keep working with your vets as the symptoms evolve until it becomes possible to put all the pieces together and nail down a diagnosis.
I hope that my first impression is wrong. Good luck with this.
Mike Richards, DVM
Pseudomonas and Oliver - continued
Q: Dr Mike,
I apologize for having to reach out to you again but I remain concerned (terrified). You may recall that Oliver is the dog who had (has?) pseudomonas and was treated with both Gentamicin (sp?) and Geocillin. He was on the Geocillin 2 weeks after I last wrote to you, a total of 4 weeks. He went back to the vet who listened to his lungs and did x-rays. Based upon these two exams he determined the pseud. was gone, I was not so sure. I was not settled with this conclusion because his lungs have always "sounded" clear and the x-rays have never been bad (cloudy). Actually, before he had the endoscope the vet took x-rays and said "we don't need to do the endocope his lungs look fine." I insisted on the procedure and sure enough the lil' buggers were in his lungs. As such, I do not trust the notion that he is better. FUTHERMORE, while Oliver was outside playing last evening, on a sandy beach, jumping in and out of the water, he started to honk, with a gag at the end (the kennel cough type), the type of cough that he has had since January.
Also, FYI, Oliver has allergies (grass, weeds etc), we have not started the kit yet because I want him to be healthy first.
He has been somewhat lethargic lately (but probably the humidity), he is eating fine. Has discharge from his eyes (probably allergies) and seems alert. Sometimes he seems a bit weary though.
I just spoke with my vet who says to put him back on the theophylline (theochron) b/c he may be coughing b/c of the scar tissue. He said to try that for a couple of days, run him around as I did yesterday, and then we will decide what to do next if the coughing persists.
I am angry that my original vet did not send us to the specialist well before they did because I believe he would not have scar tissue today. Yikes!!
Please, if you will, tell me what you think about what is going on. Could he cough from scar tissue (which apparently is not real bad)? Could he cough like this from allergies? Could it just been sand in his trach (doubtful)? Or, should we just decide to do a course of Batryl and then do an endoscope shortly thereafter to see if it is gone. I hate to do another endoscope and find that it is there, then put him on Batryl and possible have to do another down the road again.
Thank you in advance for whatever insight you may have.
Suzanne (and Oliver)
A: Suzanne-
There is some reason to be concerned, since you feel that Oliver is acting tired. This is a symptom often associated with pneumonia or other conditions in which oxygenation of the blood is not occuring properly. However, we practice very close to the Chesapeake Bay and we get a lot of phone calls about dogs coughing when they are playing in the water, so I think that may be fairly normal. In addition, I have noticed that pets that have pneumonia will often cough when first exercising, or when exercising hard, for as long as two or three months after treatment. So I would be concerned enough to advise keeping a very close eye on Oliver's condition based on these signs. At present, the best method for determining if pneumonia persists is probably to have endoscopy done again. A follow-up transtracheal wash is another option.
It is best to try to make as objective an evaluation of his overall condition as you and your vet can. Then decide if you are worried enough to warrant further diagnostics. Since there is some risk associated with anesthesia for endoscopy it is necessary to make a careful decision on the necessity of this procedure.
Allergies do not make dogs cough as often as they make cats and people cough but it is a possible symptom of allergies. Runny eyes seems to occur fairly frequently in allergic dogs and I do consider this to be a symptom that is closely associated with allergies, although there are other causes such as eyelid deformities, distichiasis and tear deficiency.
Another possible problem is allergic bronchitis. We have two patients with this condition who respond really well to antibiotics, most of the time, but who constantly get reinfected. They both cough a lot when there is a secondary bacterial infection on top of the allergies and they cough less frequently at other times. One of these dogs seems to go much longer between crises when we use a low dose of prednisone every other day to control the allergic inflammation.
I know that it is frustrating not to know for sure what the situation is. Sometimes this can be downright frightening. Try hard to evaluate Oliver's overall health and if you remain worried after doing that, talk to your vet about referring Oliver for a follow-up endoscopic exam.
I know that this really confuses the issue, but in reviewing information on Pseudomonas species infection in order to reply to your letter I found a brief statement in Dr. Plumb's Veterinary Drug Handbook which says that Geocillin Rx (carbenicillin, generic) is not effective for infections other than urinary tract infections when given orally. I was not aware of this and your vet may not have been, either.
Mike Richards, DVM 7.27.98
Pitbull Puppy
Q: Hello my name is Maria . My neightboor just gave me a baby pitbull. I'm not sure what to feed it. The previous owner was feeding him orange juice, and milk. I don't think that milk and orange juice is the proper diet. The puppy bites alot. I gave him some toys and he does bite the toys but I'm not sure if that is very good for him. Could you help me or guide me to the right direction.
Thank you very much.
Maria M
A: Maria-
The best thing to feed the puppy, as long as it is at least 4 weeks old, is a good puppy food. If the puppy is not used to solid food it may be necessary to soak the puppy food in water to soften it so that the puppy tolerates it better. It is not necessary to supplement the puppy food with anything, including milk.
Please make an appointment with a vet in your area and explain that you are a new puppy owner who needs information on feeding, housebreaking, vaccination schedules and deworming. Your vet or your vet's staff will be able to give you a lot of guidance on puppy care.
Mike Richards, DVM
Anemia
Hi, my name is Alvaro, I live in Bogota, Colombia. I have a one-year old black labrador who in the past two weeks has been diagnosed with different diseases. Two weeks ago I took him to the vet because he was sick. The vet gave him a shot, one of the three shots you are suppose to give dogs, and sent him some drugs. The veterinarian diagnosed him with a respiratory problem. Since this monday my dog showed problems again. I took him again to the vet but she was not working, so I decided to take him to another vet. He diagnosed him with a kidney disorder, he gave him two shots and then sent him home. He did not show any signs of getting better so I took him to a vet my current vet recommened. He diagnosed him with anemia. The problem I have is that the vet doesnt know what the cause for his anemia is. He told me that my dog is not able to produce red blood cells. From what I've read on your website I beleive he suffers aplastic annemia, how could I be certain he is suffering this type of anemia?? What do you recommend me to do?? And if there is anything the vet and I could do to make him get better??
He has already been transfused blood, and he is currently on serum for the past two days.
I hope you can help me with my problem.
Sincerely, Alvaro
A: Dear Alvaro-
It would be a lot easier to give you a list of possible conditions if you can provide the various lab values from the vets you have seen.
A condition that could cause virtually all of the symptoms you have seen so far is ehrlichiosis, a blood parasite infection. This is a world-wide parasite so it seems likely that it could occur in Columbia but it is more prevalent in some areas than in others. It causes anemia in which the body does not make red blood cells (non-regenerative anemia).
Other causes of non-regenerative anemia include iron deficiency, severe malnutrition, severe inflammatory diseases, kidney failure, liver failure, severe hormonal disease, drug reactions to estrogens, trimetophrim/sulfa antibiotics, chloramphenicol, phenylbutazone and probably some other medications. Aplastic anemia is lack of production of red blood cells because the cell lines that produce them die or do not develop.
It is not possible to tell you what to do next with the information you have given so far. If the kidney disease is severe it could cause the anemia and it would be necessary to work hard to control the kidney disease while possibly considering the use of erythropoetin, a hormone that the kidney normally would produce that stimulates blood production. If there is a risk of ehrlichiosis then treatment with tetracycline or doxycycline plus blood tests to confirm the diagnosis would be a good idea. A bone marrow biopsy may be necessary to diagnose aplastic anemia if it seems most likely after evaluation of all of the lab work.
Your best bet is to work closely with whichever vet you feel the most comfortable with. It may take several tries to find the answer to your dog's problem. Make sure the vet you choose has all the labwork done so far and do not be too upset if it is necessary to do more to really confirm the problem.
Good luck with this.
Mike Richards, DVM
Chronic colon problems
Q: hello DR. I HAVE A GERMAN SHEPPARD ABOUT TWO YEARS OLD,OUR VET DID A SCOPE AND BIOPSY,AND IT CAME BACK THAT HE HAS A LOWER BOWL DISORDER..HE WAS PUT ON 50MG PREDNISONE EVERY 12 HOURS FOR 3 WEEKS THEN 1 EVERY DAY..OUR $ 2,000 DINNING ROOM SET AND $5,000 CARPET IS IN BAD SHAPE...HE IS NOT TAKEING TO THE PILLS SO I TOOK HIM OFF OF IT FOR NOW,HE WAS GOING STOOL MOVEMENTS MORE ON THE PILLS THAN HE WAS WHEN HE WAS OFF...THE FOOD HE IS ON IS SOILD GOLD...BEFORE THE PILLS HE WOULD HAVE A FLARE UP ABOUT EVERY 3 MONTHS..ANY ADVICE ON WHAT WE SHOULD DO NOW..NEEED YOUR HELP..COREY
A: Dear Corey
It is not possible to offer much advice without more information on the diagnosis. It is important to let your vet know that the treatment is only partially successful, though. Chronic colon problems often require several attempts at therapy to hit the one that works for a particular dog. Sometimes a diet designed to be hypoallergenic helps. Checking for digestive enzyme deficiencies is often a good idea in shepherds but may already have been done. Replacement therapy is necessary if they are missing. There are medications such as sulfasalzazine that are sometimes effective for colitis. In some cases using an immunosuppressive agent such as prednisone is necessary. If that is the case but it isn't successful alone it may be necessary to add a second medication such as azathioprine (Immuran Rx). Your vet will probably continue to try various combinations of these treatments until something works. If nothing is working it can sometimes be helpful to consult with an internal medicine specialist. Your vet can refer your dog if that becomes necessary.
Good luck with this. Keep in contact with your vet.
Mike Richards, DVM
Tumor and skin problems
Q: Dr. Mike, I have a 2 yr old pitbull who has constant skin problems ranging from a small tumor on his back leg which is being investigated by my vet to large black spots on his back. His hair is sparse in these areas and they seemed to have developed in response to scratches or nips when playing with other dogs. Could these dark spots be considered scars? The areas are very dry and seem to itch mildly but the spots have been there for months. Is it possible that the tumor is somehow associated with his skin irritations? Also, my vet said that the tumor is probably benign. How can he tell by the appearance of the "lump"? Are there general characteristics of benign tumors? It seems to be painful to the touch as he snapped at the vet for the first time when he (the vet) touched it. Could that be indicative of a benign tumor? The lump is a dark pink color that looks like a "ball" on the surface of the skin. Thank you in advance for your reply. Danielle
A: Dear Danielle
The bottom line answer to your question is that it is not possible to tell if a lump is a benign tumor, a malignant tumor, or something else, in most cases, without doing a biopsy or removing it and having a pathologist examine it.
On the other hand, there are an awful lot of lumps that appear on dog's skin and from a practical standpoint the expense and risk to the dogs of removing every single lump that appeared makes it impractical to consider doing this. So most vets pick and choose which lumps to remove based on appearance, on the dog's age, on the breed and on other aspects of the case which help to determine if the lump is benign.
The lump you are describing sounds like a histiocytoma. Most of the time these are benign. Sometimes they itch. Itchy tumors are sometimes mast cell tumors. Mast cell tumors sometimes look like histocytomas. Mast cell tumors tend to be malignant. Since this is a case where mistaken identity is possible, I remove lumps that look like histiocytomas if they stick around more than a few weeks and if they are itchy I tend to remove them sooner. Histocytomas will often go away on their own, so if the lump isn't itchy and has the typical appearance of a histocytoma I wait a while to see if it will go away.
Obviously, I can't see the lump on your dog, so I can't give my personal evaluation of whether or not I think the problem is a benign one. I do that, just like your vet does and I am wrong sometimes. Over the years I have gotten a lot more likely to remove lumps since I discovered that most dogs will let me do it with a sedative and local anesthetic and since I figured out that I wasn't as good at guessing what the lump was as I thought. If you are worried about this lump, ask your vet to remove it and have it examined, even if he thinks it is benign. After all, this is your pet and your money, not his.
The other skin disorder is a lot harder to give you advice about. It may be worth asking for referral to a veterinary dermatologist if the problems persist.
Mike Richards, DVM
Distemper possible
Q: I've lived in Vancouver, Canada for 2-1/2 years now. My 12 year old baby (Pekingnese) in Manila, Philippines is very ill. I talked to his veterinarian there yesterday via overseas call and was informed that he has distemper. I am not well informed on this illness, but he said that it is slowly attacking his brain. My sister told me that my dog sways and falls down when he walks, shakes his head and his body trembles. He still eats but he has slowed down a lot, he's not responsive anymore. He goes to my sister for pats when he's in pain. His vet informed me that he'll be in pain and it's gonna get worse and will be a slow and painful death for my baby. It has been very painful for me since I cannot be with him in his time of pain. I wish I could be with him to assure him that he will be okay. He's a very special dog and has become a part of our family. His vet suggested that he'd be put to sleep this week. I and my brother and sister in Manila have already discussed this matter and have accepted that fact that his time has come, that he has lived a good life, that he has brought us so much joy and happiness, that he's already lived his life to the fullest and therefore time to let him go.
Please help me, I want to know what is wrong with him and if he has hope to live longer. I do want to see him again. I live him so dearly, it's already painful being away from him, and I don't think I can bear not seeing him again. My mother who is also away for a 2 month holiday loves him and has been taking care of him since I left. I also want to know if putting him to sleep soon is necessary. I really don't want to do this.
My baby's time is coming and I hope to hearing from you SOONEST.
Thank you.
Gigi C
A: Gigi-
I am sorry, but I can not tell you what might be going on based on the information in your email. If your peke has been vaccinated for distemper anytime in the last few years I would be suspicious of the diagnosis but that doesn't help you much. There are a number of possible problems, including distemper. Peripheral vestibular syndrome is possible if the signs have been present for less than three weeks. That would be good, because most dogs recover from that condition. On the other hand, a brain tumor is also possible, as is liver failure, kidney failure, other cancers, heart disease, diabetes, hyperadrenocorticism and many other illnesses. If it is possible to have labwork run (a blood chemistry analysis could be very helpful) that would help clarify the situation. If this is not possible then it may be best to rely on the vet's judgement since he has been able to examine your dog and therefore has the best ability to judge the overall situation.
I know this must be hard for you. This is one instance in which separation is extremely frustrating.
Mike Richards, DVM
Laryngeal paralysis
Q: My dog is a chocolate lab-springer spaniel mix, 14 years old. He has been diagnosed with laryngeal paralysis. The Dr. I took him to recommended surgery but considering his age and the fact that it would be very tramatic for him, I do not want to put him through that. I have have heard of medications that might help but can't remember the name. Can you recommend anything that might help my dog?
Thank you for any help you can give me.
A: S- I know of no medication that will help much with laryngeal paralysis unless an underlying disorder can be found. Hypothyroidism may cause laryngeal paralysis but current evidence suggests that happens rarely. Hypoadrenocorticism (Cushing's disease) has been associated with laryngeal paralysis and so has myasthenia gravis. If your vet has ruled out these conditions as a cause for the laryngeal paralysis it is very unlikely that medication will help, as far as I know.
Mike Richards, DVM
Kidney failure in Chow
Q: My wife has a three-year old Chow that is like a daughter. She has lost about 10lbs in about a month. We took her to the vet, and he has told us that she has kidney failure and possibly liver disease. He put her on an IV of some-sort, but I'm not sure. I know that her bloodwork showed high levels of at least Phosphorous and Creatine. He said that the "Cadillac" treatment is to take her to a specialty vet in Dallas. He won't give us any other information about how serious this is. He only says that we will have to keep bringing her in for IV treatment. What is the honest prognosis? Do dogs live relatively long with kidney problems? How much money might be involved with a "specialist" Do dogs have multiple kidneys as humans do?
Bill
A: Bill, your situation is serious and you must make some decisions quickly. In dogs, aggressive treatment is necessary in order to have a reasonable chance of treating kidney disorders successfully. There is a possibility that this will be expensive. If the cost of the initial visit is reasonable, spend that much and then decide what to do after consulting with the specialist. He or she will be able to tell you much more about what needs to be done and what it will cost.
Mike Richards, DVM
Subject: Dr Mike's info PDE
I'm not sure if I would want to subscribe to your digest when Dr. Mike is giving out bad info. Re: PDE . The name Pug Dog Encephalitis came from the first research of this disease being done on Pugs. It has been a known fact that several breeds also get this form of encephalitis. All the Pugs were from one kennel - Is it genetic? Is it a virus? It can not be replicated to date. Check your info before misinforming!
A : K-
In any effort to produce a reference source of the size of the VetInfo site there are going to be some errors. To think otherwise is to ignore both human nature and common sense. The advantage of providing this sort of information on the Internet is that it is easy for people to contest the information presented and for us to make corrections when they seem to be warranted.
I am slightly mystified by the tone of your note. You seem to be implying that we should not publish information suggesting that there may be an encephalitis problem in pugs, as if that somehow diminishes the breed. It is important to consider all possible problems, particularly those with some breed predilection, when drawing up a list of differential diagnoses for an ill pet. While there may be disagreement, I strongly feel that it is better to include and consider a differential than to leave it out becauseof ignorance of its existance. From an editorial standpoint, I do intend to continue publishing with that philosophy.
In the initial study published in 1989 by Drs. Cordy and Holliday at UCD, there were 17 dogs reported to have the condition, 11 of which were from the same kennel. The condition has been reported in another pug from Germany by Hinrichs, et. al. from the Institut fur Pathologie in Hannover. It seems reasonable to assume that this dog was not related, although that it not certain. I did find a reference to necrotizing meningoencephalitis occurring in Maltese dogs with the same pathological findings, indicating that it is likely to be the same disorder, published by I.H. Stalis, et. al. from the University of Pennsylvania (references cited were located using the Veterinary Information Network database, 1-800-700-4636). There is also a reference to a similar, but definitely distinct necrotizing encephalitis condition in Yorkshire terriers by B. Jull, et. al., from the University of Tennessee. If there are other references that you are aware of suggesting that this occurs in more than the Maltese and pug breeds please send information on them.
At present the causes of this condition are not clear, as far as I know.
We will add the Maltese to the list of breeds known to be affected by this condition. I do appreciate you taking the time to write and hope that you will provide further references.
Mike Richards, DVM
Mange
Q: Mike, I have a 81/2 week old puppy who has been Dx with mange. I got a Rx of Mitaban for her and hope that it will help her. I lost an adult dog to the mange when I was a child and I'm very nervous about this. Could you tell me how effective this treatment is and how aggressive I should be. Thanks.
A: It would be very very unusual for a puppy of 8.5 weeks of age to have generalized demodectic mange, which is the type of mange that Mitaban is most frequently used to treat. If your puppy has sarcoptic mange the odds of success with treatment are nearly 100%. Mitaban (Rx) will kill sarcoptic mange but so will many other medications, some of which are safer to use in a puppy of this age. It would not be unusual to find Demodex mange mites on a puppy this young but it would be unusual for them to have spread to the point that generalized mange is present.
Amitraz (Mitaban Rx) is effective about 80% of the time for the treatment of demodecosis. When it does not work there are alternative treatments so it is possible to treat most, but not all, cases of demodecosis.
It is important to know which one of the mites is present and then to treat appropriately. If your vet feels that generalized demodecosis is present at this age it would be a good idea to get a second opinion, or at least to talk with your vet to confirm that this is the case. Most cases of generalized demodecosis occur in dogs that are over 12 weeks of age.
Mike Richards, DVM
Lab breed related problems
Q: Dear Dr. Mike: I've read through your Web site and you seem to have a lot of knowledge about breed-specific health problem propensities. I plan to adopt a rescue or shelter labrador next year, and as this will be my first dog (although I grew up around dogs), I am trying to get as informed as I can beforehand. Because I am unlikely to know much about the lineage or health records of a dog I adopt, can you tell me anything about what kinds of health problems are specific to Labbies, or things I should look out for? There's no rush on this, but since Labbies are so popular, it would probably be useful info for others as well. Thanks, Jill
A: We are going to develop a section for breed related problems over time, so you may want to recheck the site before you adopt but these are the things that I can remember offhand:
Hip dysplasia is very common in Labs. If you adopt a young Lab be sure to keep him or her thin during growth. This helps to prevent the development of this condition.
Labs are prone to progressive retinal atrophy (PRA). This is a cause of blindness. It may be a good idea to check on this if you adopt an older dog. Ophthamologists can often see the signs of this very early and many general practitioners are pretty good at it too.
Labs have a congenital muscle disorder ( a myopathy).
Food allergies may be genetic in Labs. I am of the opinion that atopy (inhalant allergies) are inherited in Labs but have not seen a reference to this effect.
Oculoskeletal dysplasia (dwarfism) occurs in Labs but I don't think that you'll miss that one.
Many people believe Labs are prone to hypothyroidism.
There are undoubtedly other conditions that are not coming to mind right off. We'll try to add more as we can.
Mike Richards, DVM
Possible neoplasia
Q: Kim has beaten aspiration pneumonia...had temps up to 107 after the myelogram anesthesia..about a week later..but ,now that the pneumonia is cleared , we cant get the fever to drop...runs 102.6 to a high of 107....ran mostly 104.6 to 105.1 today...she has been on primaxin for 5 days, now on ciftriaxone..(rocephin) as a lyme titer came back postive..despite the fact that a csf tap was negative for lyme... temperatures have been like this since the pnuemonia..Aug 11th..., no one seems to know what do do next..she has had an echocardiogram..negative, an ultra sound..no masses, no tumors.., no vegetative heart nor mumers...we just dont know what to do next...
and the csf tap cell cytology..it doesnt add up to degenerative myelopathy..for all intensive purposes..Kim should be up and walking..
any ideas..this has been posted to the vet info network..for ideas... perhaps you have some insight that may help...(oh, both doxycyline, and baytril were used the first week during the pneumonia..then the other drugs..nothing cultures out..yet..)now the rocephin with some sulfa drug too is being tried...
Any insight would be greatly appreciated, dr. mike
sincerely Scott
A: Scott- I am sorry for the delay in responding to you. I was trying to figure out the significance of the protein levels. I am not sure what I would do in your dog's case at this point. My instincts still lean towards suspecting neoplasia, even in the absence of obstruction of the dye on the myelogram. However, I am not sure how to prove or disprove this suspicion since you have already done the recommended testing for these situations. An MRI might be helpful but I have heard conflicting opinions on the usefulness of this procedure for spinal cord evaluation in dogs. A samoyed may be big enough for it to be useful, though. I wish I knew how to help more.
Mike Richards, DVM
Soft palate and Pugs
Q: Pugs are really human.Dr Mike, could you tell me is the operation for a large soft palate in a 1yr old pug simple or are there dangers?She was spayed recently and while under the anaseithic was found to have a very large soft palate.She is very nervy and tense for a pug and at times quite growly towards our other pug.She showed signs of this behavior before being speyed and has started doing this again, also i don't know if it is normal or not but her nails are changing from black to white,still good and strong just changing colour.Where we are in New Zealand there is not much information available about conditions like soft palate's etc;as pugs aren't all that common.I would appreciate any advise you can give me. Sharon
A: Sharon-
Soft palate surgery seems to be pretty safe when done by someone who is experienced in the procedure. I have only operated on soft palates when trauma or other situations made it necessary. Surgery does not seem to be technically difficult in this region. However, determining whether or not surgery is necessary does seem to be difficult to me, as well as deciding which surgery is best in many situations which obstructive airway disease is present. So I tend to refer these cases to surgical specialists. If this was not possible and a patient had obvious signs of respiratory distress, did not have have obstruction of the nostrils (pretty common in pugs) and seemed like a good candidate for surgery I think I'd be willing to try it. Since I have access to surgical specialists close by I think my patients are better served by referral, though.
We have done a number of the procedures for opening up nostrils and a couple of these dogs did seem to have positive behavioral changes associated with the increased ability to breathe.
I don't think I'd worry over the nails changing color unless there is inflammation around the nailbeds or other signs of problems.
Mike Richards, DVM
Diabetic Cushing's death
Q: I lost a diabetic cushioned dog 4 days after surgery for hind leg parlyses due to disk injury (not known if from natural circumstances or injury). I am looking for info on dopamine loss and adverse reaction drugs.Has anyone done any scientific research on any of the following drugs which were given together(at the same time):Reglan(a dopamine antagonist),Ranitidine(HCL),Sulcralfate,Baytril ,Valium and increased insulin(dog wasn't eating,but there was vomiting and diarrhea after drug medications).After the first drug combination the dog also experienced seizure like activity and later at night what appeared to be a grand mal seizure and was given valium.The following morning all drugs (except Valium) and increased insulin were given again.The dog became comatose and remained so until I arrived and asked for corn syrup (approx.1.00 -1.30 p.m. I brought him around and asked for water .He was extremely thirsty but had difficulty getting it as his mouth was stiff and pointed. I got him sitting up but he was extremely weak and did everything possible to try sitting.He was like he was drunk.His head was flattened on one side from lying on it and the eyes were wide open with an upward stare. He had gone from 8k down to 1.8k over the 4 days.(no food ,but lots of drugs and vomiting and diarrhea.) An hour later he tried to take a few sips of clear soup but was too weak.He took a fit and I asked a student to get the vet because he appeared very still and lifeless.He was dead. I have read info with regard to Reglan being toxic in an animal pretreated with an MAO inhibitor and have also found a warning on the internet about giving it to small children.There are precautions in drug books also. I always found his blood glucose elevated after Baytril.When the hospital gave him Baytril his glucose went up to 22 and they increased his insulin even though he wasn't eating .They also had changed the type of insulin.He was on a 40 i.u.before admittance and they changed it to a 100 i.u. insulin(which when previously tried on him made him lethargic).They also thought that they were giving him one half of his regular dosage.I do not believe that 3.5 of a 100i.u. insulin is the same as one half of a 40 i.u. insulin which he was receiving at home. They were also jumping from one insulin to another(NPH,Lente and Ultralente) The medical society has informed me that drugs given were within acceptable standards.Due to the severity of his case they had to try to stablize him. It is my felling that they did not treat his cushing's disease and gave him the incorrect insulin.By doing what they did I feel that they gave him drugs that increased the cushing's disease symptoms ,increased his ACTH which drove his glucose higher causing increased vomiting,diarrhea and eventual seizure ,coma and death.Since there was no food intake I also feel that he was living on his body's toxic fat which also contributed to the enormous weight loss and toxicity . His reports show his tests after drugs on the third .Many of the cushing disease symptoms appear there. I would like to get any info on anything relating to this type of case.I also would not want anyone else to experience this trauma. E.C
A: I am sorry to hear of the loss of your dog. I don't think I can answer all of your questions but can help with some of them.
Enrofloxacin (Baytril Rx) will react in some cases with sucralfate but in this instance the sucralfate interferes with absorption of the enrofloxacin and lowers the antibiotic's blood concentration. I have not heard of an interaction between enrofloxacin and blood glucose levels but this does occur with some antibiotics and falsely elevated levels appear in some instances when antibiotics are present in serum being tested for glucose. We have had difficulty with this problem in evaluation of diabetes when using cephalexin in diabetic pets.
Sucralfate is not absorbed well from the digestive tract, so most of its actions occur at the local level in the GI tract. It can decrease the absorption of several medications (including Baytril) so it is usually used several hours before or after administration of these medications.
Metoclopramide (Reglan Rx) is used for its ability to stimulate intestinal activity and to decrease vomiting. The method of action for the decrease in vomiting is probably dopamine antagonism. It may cause extreme hypertension in patients with pheochromocytoma (this is a cancer that is an unusual cause or concurrent problem in some cases of Cushing's disease in dogs) but patients with this problem seem to be prone to sudden death even without drug interference. It is very difficult to tell if pheochromocytoma is present (it is an adrenal gland tumor) without computerized tomography (CT) or magnetic resonance imaging (MRI). Metoclopramide may increase the absorption of diazepam (Valium Rx) from the small intestinal tract but probably not sufficiently to cause toxicity problems. It is also possible that metoclopramide would enhance the sedative effect of diazepam (or vice versa). Despite this, I can not find any warnings in the pharmcological references about using these medications concurrently.
I had a hard time following two parts of your note. It seems almost impossible for him to lose 6kg (13 lbs) of body weight in four days but that was the only interpretation I could make of the change from 8k to 1.8k. Perhaps I am misinterpreting this.
On the insulin dosing, if 0.35cc of U100 insulin was given, that would be 35 units. If 0.5cc of U40 insulin was given, that would be 20 units. If there was this much difference in the dosing then insulin shock does seem like a possible problem but there may be labwork supporting the need for the change or suggesting that it did not have an effect since you didn't mention low blood glucose in the labwork. I don't understand dosing with differing types of insulin except that changing from U40 to U100 of the same type of insulin should have no effect if the dosage is adjusted so the units are the same.
If you continue to believe that there was a medical error the best advice I can give is to contact your state board (I am not good with internet addresses -- I am hoping you live in the U.S.). They have the authority to review these cases and to take action if it seems appropriate. It is also a good idea to take your concerns to your vet and discuss them, if this is a feasible option. Ultimately, everyone gains if the research and discussion leads to a deeper understanding of the situation and it may help prevent problems for someone else or help you to resolve your concerns which would also be a good and important outcome.
Mike Richards, DVM
Ehrlichea
Q: We have just been informed by our vet that our dog (a black lab mix) has ehrlichea. We found this out because we were having her tested to try to find out the cause of seizures she was having. How successful are the antibiotics usually used to combat this disease? Where can I find out more info on the disease? Any help would be greatly appreciated. Thank you, Glen
A: Glen-
Tetracyclines, especially doxycycline, seem to be very effective for ehrlichiosis. Once in a while there is a recurrence of the condition despite apparently successful treatment. I hope this was the cause of the seizuring but suspect that it was not -- you may need to continue to treat that problem separately. Your vet will work with you that, I'm sure.
I'm pretty sure we have information on ehrlichia in our Dog Information area.
Mike Richards, DVM
Chest Trauma
Q: hi. i have a 12lb Pekinese that was just hit by a car.the vet said that she has no internal bleeding but she has chest trauma. she is gasping for breath and is very brusied.she is in alot of pain.can you tell me how serious chest trauma is. the vet said we will just have to wait and see if she pulls through,but the wait is so hard.my question is are there an symptoms that would indicate if this will be fatal.she has cracked vertebrae in her back but no broken bones.she has been gasping for breath for 24hrs now.i feel she is in bad shape. the life is gone from her little eyes.i am looking for some sort of answer if she could die from this. can you help?
thank you Tammy
A: Tammy-
I wish that I knew a good way to predict the outcome of chest trauma other than just waiting and seeing what happens but I do not. Most dogs do OK if there is not hemorrhage or air leakage from the lungs into the chest or a tear in their diaphragm, all of which show up pretty well on X-rays. Sometimes it is necessary to retake X-rays several times in the first 24 to 48 hours after chest trauma to be sure that air leakage is not occurring or that bleeding has not started, since both problems can occur for several hours after the initial trauma. Some dogs that I really thought would be fine have developed problems during the first day and some dogs that I really thought had little chance of survival are still coming in to the clinic years later.
I am hoping that you know more by now and that Gizmo is doing much better.
Mike Richards, DVM
Pancreazyme and Viokase
Q: Dear Dr. Mike,
I just subscribed to your newsletter and I look forward to recieving it. In the meantime I have a question regarding an enzyme product. Are you familar with viokase or panrezyme? Both products contain lipase, protease, and amylase. Is there another enzyme or ingredient you would suggest including that would improve these products? Or are you aware of any research addressing this topic? Any help or suggestions would be greatly appreciated.
Thank you,
Lisa
A: Lisa-
Pancreazyme (Rx) and Viokase (Rx) are approximately (or possibly exactly) the same product. Both are pancreatic enzyme preparations made from porcine pancreatic tissue and they do contain protease, lipase and amylase. These are the major digestive enzymes produced by the pancreas and the product is meant to be a replacement for these enyzmes in dogs that are not producing adequate quantities on their own. The powder form of the products is generally considered to work better than the tablets. The enymes do best if they are mixed with the food about 30 minutes prior to feeding.
If pancreatic insufficiency is the only problem that a pet has it may not be necessary to use any other products in conjunction with a pancreatic enzyme replacement. It is often necessary to adjust the amount of the powder used and it can take more than the label directions call for to achieve the desired effect. Some vets feel that the enyzmes are less likely to break down in the stomach if cimetidine (Tagamet Rx) or another H2 antagonist is used try to reduce the acidity of the stomach environment.
In many instances dogs with pancreatic insufficiency suffer from a number of other problems and it is often necessary to use medications to control the concurrent problems to get really good control of the diarrhea, weight loss and other problems that occur with pancreatic insufficiency. A particularly common problem is bacterial overgrowth with undesirable bacteria. It may be necessary to control the bacteria with an antibiotic like metronidazole (Flagyl Rx), tylosin (Tylan Rx) or sulfasalazine (Azulfidine Rx). When bacterial overgrowth occurs there can be a decrease in Vitamin B12 absorption and supplementing B12 may be necessary. If the pancreatic insufficiency is associated with inflammatory bowel disorders (IBD it may be necessary to use an immunosuppressive agent such as prednisone or azathioprine (Immuran Rx) to control the IBD.
Some veterinarians prescribe pancreatic enzyme supplementation for conditions other than pancreatic insufficiency. This is most commonly done in cases of chronic diarrhea or digestive disorders when nothing else seems to be helping much. Some vets use a product that is a mix of vegetable origin enzymes (Prozyme TM) that is reported to be helpful in a number of vague conditions such as poor haircoat, weight loss, chronic illness, etc. This is less expensive than the pork origin pancreatic enzyme supplements. If something like this is the reason your dog is on pancreatic enzyme supplementation the best approach would be to continue diagnostic efforts until an underlying cause for the symptoms seen can be identified and treated. If Prozyme seems to help during this process or as a maintenance medication then it may be continued, obviously.
If you need more specific literature references I can try to find some for you.
Mike Richards, DVM
Holiday problems
Q: Hi Dr. Richards -
I'm just about beside myself.... I went to the "Dog Pound" to rescue a puppy for my children (11 & 12)... I ended up with two darling puppies...
It wasn't bad enough that I'm now housebreaking 2 puppies, had to have both vaccinated and wormed ($$$$$), now my Australian Shepherd is coughing and it sounds like croop. He has all the symptoms of Kennel Cough, but last night, he chewed up my Christmas Twinkle lights and I'm afraid he may have glass in his throat, since he wasn't coughing before that. I owe the vet $70 dollars from my initial visits just last week and I REALLY can't afford to go back unless it's absolutely a necessity ! How do I know if it's Kennel Cough or Glass ? If it's glass, what can I do to help my poor puppy..... he could have eaten as man
Michael Richards, D.V.M. co-owns a small animal general veterinary practice in rural tidewater Virginia. Dr. Richards graduated from Iowa State University's College of Veterinary Medicine in 1979, and has been in private practice ever since. Dr. Richards has been the director of the PetCare Forum...