Category: Handouts

What is Addison’s disease?

Addison’s disease is a hormonal disorder named after Thomas Addison, a British scientist, who is credited for being the first person to demonstrate that adrenal glands are necessary for life. Dogs, cats, people, and other species have a pair of small glands located in the abdomen, one next to each kidney. In Latin, “kidney” is “renal” and “next to” is “ad.” These small glands are therefore called the adrenal glands because of their location. They are so-named because they were recognized by anatomists long before their vital (life saving) function was understood. The glands produce two substances that are critical for life:

1. Glucocorticoids
2. Mineralocorticoids

These substances are placed into the blood stream after they have been synthesized and circulate throughout the body. As such, they are classified as being hormones. Both these hormones have an effect on the function of cells everywhere in the body. To look at it another way, cells everywhere in the body need some glucocorticoids and some mineralocorticoids to be healthy. They suffer if there is too much or too little of either or both.   Glucocorticoids are natural cortisone. Cortisone is necessary for life and is important in ensuring that individuals feel well. Glucocorticoids have many functions, including an effect on appetite and immune system function. Doctors commonly use both natural and synthetic cortisones. Cortisone can be beneficial as a medical treatment for relatively minor problems (poison oak, for example) and for serious life-threatening medical disorders (some cancers, for example). If an individual chronically has too much or too little cortisone in his or her system, serious medical problems can result. Too little cortisone is one of two components of Addison’s disease.   Mineralocorticoids are another vital substance produced by normal adrenal glands. Mineralocorticoids control two of the body’s critically important “salt” concentrations: they control the levels of both sodium and potassium. As with glucocorticoids, too much mineralocorticoid in the system usually results in serious medical problems. Too little mineralocorticoid is a life-threatening condition. Addison’s disease occurs when the body contains too little glucocorticoids and too little mineralocorticoid.

What causes Addison’s disease?

The onset of Addison’s disease is usually the result of some destructive process affecting both adrenal glands and the cells that produce both of these critically important hormones. The most common cause of Addison’s disease is destruction of both adrenal glands by the individuals’ own immune system. The immune system functions primarily by constantly being on the lookout for foreign objects and upon seeing something not recognized as “self,” this system immediately tries to kill whatever that might be. The best examples of foreign bodies that the immune system wants to kill are bacteria and viruses. For reasons that are not well understood, the immune system occasionally sees normal body parts as “foreign” and sets out to kill these tissues. In this uncommon instance, the immune system sees the adrenal glands as foreign and kills these cells. Less common causes of Addison’s disease are cancers or infections that can invade and kill the adrenal glands.

What are the symptoms of Addison’s disease?

Addison’s disease is relatively uncommon in dogs and is considered rare in cats. The disease is most common in young to middle-aged female dogs. The condition has been diagnosed in dogs and cats of all ages, either gender, and in both intact and neutered animals. A few dogs seem predisposed to Addison’s disease. These breeds include the following:

• Portuguese water dog
• Standard poodle
• Bearded collie

Addison’s disease, however, can affect any breed and mixed breed dogs. In general, the symptoms of Addison’s disease seem to come on quickly, usually over what seems to be just a few days. It can develop over weeks or months as well. Most owners note that their pet develops several problems at about the same time. In no particular order, these problems include the following:

• Loss of appetite
• Extreme lethargy
• Vomiting
• Diarrhea
• Weight loss
• Muscle weakness

Less common owner observations include weakness and loss of appetite that seems to come and go a few times before the symptoms persist. Some dogs have been observed to shiver, tremble, or shake as if they are cold. Some dogs suddenly collapse and quickly seem to develop a shock-like condition.

What tests are needed?

Vomiting, diarrhea, loss of appetite, and weight loss are extremely nonspecific problems. These can be the symptoms of a dog or cat that has stomach, intestinal, heart, liver, or kidney disease. Other conditions can also cause these types of symptoms. To further complicate this issue, diseases of other organ systems are much more common than Addison’s disease. Therefore your veterinarian may or may not suspect Addison’s disease after talking with you and after completing a physical examination. It is most likely that your veterinarian will believe that your pet is ill and will recommend a battery of tests that will assess various organ systems simultaneously.   One of the hallmark abnormalities seen in dogs with Addison’s disease is an increase in blood concentrations of potassium and decreases in blood concentrations of sodium. However, such changes are also nonspecific. Since your veterinarian suspected Addison’s disease and because this is a condition that requires life-long therapy, a specific test for Addison’s disease was recommended. This test, called the ACTH stimulation test, is the “gold standard” for diagnosing Addison’s disease in people, dogs, and cats. If the result is typical of Addison’s disease, your pet will require life-long treatment for survival.

What treatment is needed?

Long-term treatment of Addison’s is not nearly as difficult as making or suspecting the diagnosis in the first place. Further, long-term treatment is not nearly as difficult as the intensive care required initially in the hospital that saved your dog’s life. Once your dog is ready to be sent home, however, your role will be much less difficult. There are both glucocorticoids and mineralocorticoid replacement medications. The glucocorticoids used in the treatment of Addison’s disease are not special in any way. Rather, these are the same medications used for a variety of conditions in both human and veterinary medicine. The only unique aspect regarding glucocorticoids replacement therapy for Addison’s disease is the fact that affected pets require relatively tiny doses as compared with the doses used for pets with immune-mediated disease, cancer, or other conditions. Two different mineralocorticoids are available. Both of these medications are specific for patients with Addison’s disease. The pill form is commonly used in people with this disease and is effective at low doses. Dogs and cats seem relatively resistant to the pills, and, therefore, they may require relatively large doses. This, in turn, results in an expensive commitment. There is a once every 25-day injectable medication specifically made for dogs and cats. This drug is effective and is the recommended mineralocorticoid. Some dogs require injections once every 21 days and others can get by with one injection each month. Most, however, respond better with injections every 25 days. Owners can usually administer these injections. It may take 2 to 6 months to establish a dose. Once the current dose is established for your pet, it will remain relatively constant.

Conclusion

Addison’s disease is a relatively uncommon syndrome. Dogs and cats correctly diagnosed and properly treated live healthy and happy lives. Although some significant expense is associated with the long-term care of affected pets, their treatment is almost always successful and rewarding.

Feeding tubes are used to facilitate feeding of dogs and cats that refuse to eat on their own or that have a specific need for feeding directly into the esophagus, stomach, or intestine.

What kind of feeding tubes are used?

There are many different types of feeding tubes, all of which have an external (outside the body) feeding port connected to a tube that ends in the gastrointestinal tract. Esophagostomy tubes enter the esophagus and terminate in the lower portion of the esophagus, whereas gastrostomy tubes enter the left abdominal wall directly into the stomach. PEG tubes (percutaneous endoscopic gastrostomy) are gastrostomy tubes that have been placed using endoscopy. Low profile gastrostomy tubes are often used for long term feeding of dogs and cats, and are short gastrostomy tubes that have an external feeding port that fits flush with the skin. Feeding tubes are usually secured to the body with sutures, bandages, or elastic stockinette material. An Elizabethan collar (or E-collar) is usually placed around your pet’s neck to prevent it from removing the tube.

How to Feed?

1. Prepare and warm the food to room temperature before feeding
2. Unscrew or remove the cap at the end of the tube, place an empty syringe on the end, and open the clamp on the tube.
3. Aspirate (pull the plunger out a bit) the tube with an empty syringe to check for residual food left in the stomach from the previous feeding. Replace any of the food pulled out. If more than half of the last feeding is pulled out of the stomach, skip this feeding.
4. Give all medications before feeding, then feed the designated amount of food via the syringes. Each time you change syringes on the end of the tube, close off the clamp to make sure food does not leak out of the end of the tube. Give the food slowly over 10 to 15 minutes, so that your pet can adapt to their stomach filling up. If your pet begins to salivate or seems uncomfortable, feed more slowly. If the signs worsen, or there is some vomiting during the feeding, stop feeding.
5. Once all of the food or medications are administered, flush the tube with 5-10 mL water (depending on the size of the tube). This will help prevent the tube from clogging. Every time you administer anything through the tube other than water, you must flush the tube with a water rinse.
6. Close the tube clamp, screw or replace the plug back on to the feeding adapter, and place the tube back under the mesh netting.

GASTROSTOMY TUBE (Stomach Tube)

1. The feeding tube exits from the inside of your pet’s stomach to the outside body wall on the left side. There are several parts to the feeding tube. The long tube that extends out is the actual tube that the food will pass through.
2. At the body wall, there is a cross piece (or “stent”) that is the same color as the long feeding tube. This piece is there to help keep the tube in place and to prevent it from slipping in or out of the stomach. There is a dark pen line drawn around the outside of this small piece of tubing. It is important that you look and make sure you see this line every day. If the line disappears, this may mean that the feeding tube has slipped too far into the stomach and could be a problem. Please call the hospital immediately if this occurs.
3. Adjacent to the crosspiece of tubing, there is a cable tie wrapped around the tube. This cable tie helps make sure that the tube does not slip. These should be firmly attached. You should not be able to move them up and down. The tube should also be sutured to the skin about halfway up the tube, which helps stabilize the tube.
4. Above the white circles of plastic is a clamp. This should be closed (or clamped) off at all times unless you are in the process of feeding through the tube. This clamp helps keep the food from backing out or leaking out of the stomach.
5. There is a feeding adapter at the end of the tube held in place by another cable tie. The feeding syringe will attach to the end of the tube when you open the plugs that are attached to the adapter. These plugs can be removed just prior to feeding. The type of syringe used will determine which plug site will need to be opened.
6. Near the entrance of the tube through the left side there may be a gauze sponge that has an antibiotic ointment underneath it. This ointment will help keep the tube site from becoming infected. Your veterinarian may have you change this gauze sponge on a scheduled basis.
7. Most dogs and cats with a feeding tube have a white mesh netting around their body that keeps the tube in place. It is important the tube stays underneath this netting to keep it from getting caught in a floor heater, in a door, etc. which could possibly pull the tube out. You can remove the netting temporarily, as needed, to keep it clean. They can be hand washed and reused. You can also purchase replacement netting, or design your own holding material (a T-shirt, stockings, etc.).

ESOPHAGOSTOMY TUBE

1. 1. Your pet’s esophagostomy tube is a red rubber catheter that is placed in the esophagus and exits through the skin. To secure the tube, suture is placed around the tube in an “X” pattern and is sutured to the skin. The tube should not move in and out of the placement site. If the tube appears loose or is moving freely in and out of the skin, do not feed and notify your veterinary hospital.
2. At the top of the tube a feeding adapter is usually placed and secured with a white cable tie. The feeding adapter has two different sized ports with plugs attached to the ports. The larger port is usually used for feeding. The feeding syringe can be attached to the end of the feeding adapter after removing the plug. In some cases, a feeding adapter will not be included and you will be attaching the feeding syringe directly to the esophagostomy tube.
3. At the placement site (against the skin), there should be a gauze square with an antiseptic ointment placed around the esophagostomy tube. The ointment will help prevent the placement site from becoming infected. There will also be a gauze bandage applied around your pet’s neck. This keeps the placement site clean and stabilizes the tube. Your pet’s veterinarian may have you clean the placement site and change these bandages on a regular basis.

TUBE CARE

Change the gauze sponge at the entry site of the tube as instructed by your veterinarian. Each day, inspect the entry of the tube site in the skin for abnormalities such as tenderness, redness, discharge or foul odor. If any of these symptoms are noted, please contact your doctor as soon as possible. Clean the area underneath the tubing that is next to the body with some antiseptic scrub daily. Try to keep the entire tube as clean as possible and make sure that food and debris do not build up on the tube, especially around the area that is next to the skin and body wall.

CLOGGED FEEDING TUBES

Check to make sure the tube clamp is open. If you are feeding food through the tube, it may be too thick and have caused a clog in the tube. Try to flush the tube with water. If the feeding tube flushes well, check to see if the clog is actually at the tip of the syringe that you are currently feeding with. Try to aspirate back after trying to flush with water. This often unblocks the tube. If this doesn’t work try to massage the outside of the tube before or while you are flushing the tube. If you cannot unclog the tube with firm, but not excessive pressure, leave the tube filled with the water and close off the tube as you normally would do. Leave the water in place for 20 minutes. Again, try to flush the tube. If the tube is still clogged, instill a carbonated beverage into the tube (2-5 mls) and leave in place for 20 minutes and then attempt to flush again with water. If this does not unclog the tube, close off the tube again and call your pet’s veterinarian as soon as possible. If a clog is noted at night, do not attempt further feedings through the tube.

WHEN TO CALL THE HOSPITAL

1. The tube position has changed or the tube is no longer secure or falls out any time. Call immediately.
2. If the entry site into the stomach or esophagus is irritated, painful, or a discharge is present from the entry site.
3. The tube cracks, or its attachments (feeding port, external stent) become detached.
4. Your pet coughs or develops breathing problems. Call immediately.
5. Your pet vomits, develops fever, or becomes lethargic.
6. The tube clogs and you are unable to unclog it after following the directions above.

FEEDING INSTRUCTIONS

In a mixer, blend ____ (mL or cups) of ________________________ (type of food) with ____ (mL or cups) of water until the consistency is smooth. Food can be blended and stored in the refrigerator for up to 3 days. The food should be warmed to room temperature either by using a microwave or by warming it in boiling water. Feed __________mL of the food mixture slowly over 10 to 15 minutes

____________ times daily. After each feeding is complete, flush the tube with ________ mL of water. The tube must be flushed at least twice daily with as least 10 mL of water even if it is being used only once a day or not at all. This will help prevent the tube from clogging.

Factors that may predispose your pet to develop otitis externa include ear structure (long floppy ears, heavily haired ears, long narrow ear canals), errors in treating or cleaning ears (aggressive use of Q-Tips deep in the ear canal), and diseases that obstruct the ear canal (growths, swelling of the ear canal tissue). Factors that usually cannot cause otitis externa by themselves but can be a significant problem in need of treatment are bacterial and yeast ear infections. Sometimes pets with chronic otitis externa have problems beyond the ear drum (middle ear—otitis media), and these problems also need to be aggressively treated.

Many factors may come together in development of your pet’s ear problem. Recognition and subsequent treatment of all factors are the keys to successful clinical management of the otitis externa.

What are the symptoms of atopic dermatitis?

Atopic animals usually rub, lick, chew, bite, or scratch at their feet, muzzle, ears, armpits, or groin, causing hair loss and reddening and thickening of the skin. In some cases, several offending substances can “add” together to cause an animal to itch where each individual substance alone would not be enough to cause an itching sensation. These substances include not only airborne allergens (e.g., pollens) but allergens in food and from parasites (e.g., fleas) as well. Itching can also be exaggerated by bacterial or yeast infections of the skin. Sometimes, eliminating some but not all of the problems, a pet’s itchiness may go away. Therefore it is important to treat any other problems that could be making your pet itch while dealing with allergy.

What tests are needed?

A variety of tests may need to be performed. These may include culture or microscopic examination of the discharge from your pet’s ear. In addition, blood testing or skin testing for allergy may be needed. A dietary change may be recommended to determine of a food allergy is the cause of your pet’s ear disease. X-rays of the skull can aid in diagnosing middle ear problems.

What treatment is needed?

One or more in-hospital ear cleaning procedures may need to be performed on your pet. This may be as simple as an ear cleaning requiring just a few minutes with no or minimal sedation to more involved ear cleaning requiring more time and general anesthesia.

Attaining the goal of complete resolution of your pet’s ear disease depends heavily on your ability to clean and medicate your pet’s ears, follow through with therapy based on the results of the various tests, and faithfully return your pet for serial reevaluations at your veterinarian’s clinic.

Recurrent otitis externa not managed properly can cause chronic irreversible changes in the ear canal, most notably a narrowing of the ear canal diameter. This narrowing does not allow medication or cleaning solutions into the affected area. Further narrowing will not allow the normal ear wax secretions to exit the ear canal. Even though your pet’s ear may seem to be improved (less discharge, less smell, less discomfort), the ear disease may not be completely resolved and premature discontinuation of therapy can be detrimental to the chances for final resolution of the ear problem.

Sometimes, the underlying problem cannot be found or corrected. In these cases, a maintenance cleaning and medicating protocol may need to be formulated for your pet. If this protocol is followed, many ear problems can be controlled with minimal time and effort on your part and minimal discomfort for your pet.

Appropriate cleaning is a vital part of the overall program to appropriately address ear disease. The ear canal should be thoroughly cleaned of all debris before any medication is instilled in the canal. Your pet may object to having its ears cleaned initially, but better acceptance usually occurs with time. If your pet’s ear canal is red and uncomfortable at the beginning of treatment, gentle but thorough cleaning will help. After filling the ear canal with the ear cleaning solution, massage of the canal will help loosen the debris and discharge. The debris can then be massaged up from the base of skull (where the ear meets the head) to a cotton ball that is seated firmly in the opening of the canal. This procedure should be repeated until no more debris is recovered on the cotton ball. Medication is then placed in the canal and massaged down to the base of the ear. Q-Tips should never be used to clean the ear, except on the very outer ear folds. The key to successful cleaning is being consistent and thorough.

Reevaluations at the clinic are also a vital part of successful clinical management. Your pet’s ears may appear normal to you but may need continued medication and cleaning for complete resolution of the inflammation or infection. In dogs with chronic otitis externa, a maintenance cleaning or medicating protocol may need to be formulated based on the information obtained from the reevaluation visits.

If the ear disease has progressed beyond the outer ear canals, past the eardrum into the middle ear cavity, aggressive use of topical as well as oral medication may be needed. In addition, surgery to access the middle ear area for cleaning and identification of any infection may be necessary.

What are the symptoms of food hypersensitivity?

Dogs and cats with food hypersensitivity may exhibit some or all of the following symptoms:

• Pruritic (itchy) year-round
• Gastrointestinal problems, such as vomiting and diarrhea
• Rubbing or scratching at the face
• Chewing at feet
• Recurrent skin infections
• Red, painful ears and recurrent ear infections

The onset of food hypersensitivity can be sudden and it will continue as long as the offending food source is ingested. Once a pet is allergic to a food product, it may take weeks to months for the symptoms to resolve once the allergenic food item is removed from the pet’s diet.

What testing is needed and what is the treatment?

Unfortunately, no reliable skin or blood test is currently available to diagnose food hypersensitivity. The diagnosis of food hypersensitivity requires that your pet undergo an elimination diet trial. An elimination diet trial is a challenging exercise for most owners and if it is not done correctly it will fail to provide the needed information to answer whether or not your pet has food hypersensitivity. An elimination is either homemade or a commercial prescription diet that contains a protein and a carbohydrate source that your pet has never been exposed to previously.

Alternatively, newer, hydrolyzed or low molecular weight diets contain more common ingredients that have been molecularly altered to be below the allergenic threshold. These and other diets used to diagnose food allergy are “veterinary prescription only” diets and must be used under the supervision of a veterinarian.

A home-cooked elimination diet in a ratio of one cooked pound of protein (fish, pork, tofu, pinto beans, rabbit, and venison) to 6 cups carbohydrate (potato, oatmeal, rice, tapioca grain, but not the packaged pudding mix) can be considered if owners are able to cook for their pet. Most pets can be fed daily about a cup of this diet for every 10 pounds of body weight. A home-cooked diet allows preservatives and other food additives to also be avoided during the elimination trial. A home-cooked diet is not usually nutritionally balanced for long-term use.

The elimination diet trial must be completely strict. Potential pitfalls to avoid during the diet elimination trial include the following:

• Your pet cannot have any treats of any kind, including rawhide, pigs’ ear, or other animal-product chew toys.
• Your pet cannot be given any flavored vitamin products or flavored heartworm preventative or use toothpaste or other flavored medication or products. Be sure to discuss all medications or supplements you might give to your pet with your veterinarian. Some may need to be discontinued during the elimination diet trial or your veterinarian may prescribe non-flavored alternatives to give during the elimination diet trial.
• You cannot use cheese, hot dogs, or any other food item to hide medications.
• Outdoor dogs and cats that can roam may need to be kept confined to ensure that they are getting nothing to eat except the diet chosen for the diet trial.
• If there are multiple pets in the household it is vital that you are sure that there is not an opportunity for the animal undergoing the elimination diet trial to have access to another animal’s food, treats, toys, or medication(s).

Switching to a new diet should happen gradually over several days by feeding more of the new diet and less of the old diet each day. Cats can be particularly challenging to get to accept a trial diet. It is important to not allow your cat to go more than 48 hours without eating. It may be necessary to try several different diets before your pet finally accepts a trial diet. Once your pet has transitioned onto the trial diet your pet should only be allowed to eat the prescribed diet and to drink water. NOTHING ELSE SHOULD PASS YOUR PET’S LIPS.

It is useful to keep a diary of any changes you may note during the diet trial. These changes may include changes in the following:

• Appetite
• Elimination
• Scratching
• Appearance of the skin
• Appearance of the ears
• Weight changes

In addition, record any instances when the pet may have cheated by consuming food items not permitted during the food trial. The diet trials usually continue for 8 to 12 weeks, at which point you should have your pet re-examined and discuss any observations you have made during the elimination diet trial with your veterinarian. Your pet may not have 100% resolution of clinical signs during the elimination diet trial yet still have food hypersensitivity. Animals with food hypersensitivity may continue to exhibit some degree of itchiness during an elimination diet trial if they have still had access to the offending food item, if they have concurrent secondary skin infections, or if they have concurrent other skin allergies.

To confirm the presence of food hypersensitivity, a re-challenge with the original diet is performed. You will be instructed to begin feeding your pet the original diet plus any treats or food items that were routinely fed to your pet prior to starting the elimination diet trial. If your pet is food allergic, the clinical signs, specifically itching, should worsen within hours to days of beginning the previous diet. Most animals with food hypersensitivity will experience an exacerbation of their clinical signs within 2 weeks of being fed their previous diet. Should this occur, your pet would need to be fed the elimination diet again. Once the clinical signs have again resolved (usually very rapidly), your veterinarian will instruct you as to the next step in discovering the offending allergen. The good news is that if your pet has food hypersensitivity, so long as the offending substance is eliminated from your pet’s life this will decrease or control the clinical signs.

Many pets with food hypersensitivity may have an “allergic personality.” This means that they may also be predisposed to other allergies, such as flea allergy dermatitis or atopic dermatitis (environmental allergens, i.e., pollens, molds, house dust). It is strongly recommended that all pets with suspected or confirmed food hypersensitivity be kept on strict flea control and be monitored closely for the development of secondary skin infections, increased itching or other evidence of a concurrent allergic dermatitis. However, with food hypersensitivity controlled, your pet’s itch threshold will be substantially reduced, allowing your pet a more comfortable and higher quality of life.

Atopic animals usually rub, lick, chew, bite, or scratch at their feet, muzzle, ears, armpits, or groin, causing hair loss and reddening and thickening of the skin. In some cases, several offending substances can “add” together to cause an animal to itch where each individual substance alone would not be enough to cause an itching sensation. These substances include not only airborne allergens (e.g., pollens) but allergens in food and from parasites (e.g., fleas) as well. Itching can also be exaggerated by bacterial or yeast infections of the skin. Sometimes, eliminating some but not all of the problems, a pet’s itchiness may go away. Therefore it is important to treat any other problems that could be making your pet itch while dealing with allergy.

How is the diagnosis made?

Diagnosis of atopic dermatitis is based on clinical signs (areas of itching) and often, an initial seasonality to the skin problem. However, some dogs will have no seasonality to their itching from the onset of their symptoms. In addition, many seasonally allergic dogs soon begin to scratch and rub year round.

What treatment is available?

Treatment can include avoidance of the substance, therapy to control the itching (symptomatic therapy), or specific therapy (desensitization vaccine) in an attempt to desensitize your pet to the specific substances to which he/she is found to be allergic. Specific therapy will be based on the results of a skin or blood test to detect reaction to the specific allergic substance.

Complete avoidance of the allergic substance may not be practical, but decreased exposure may be feasible. If your pet is allergic to pollen, decreasing the outdoor exposure especially at dusk and dawn is helpful. Your pet should never be walked through fields with high grass or weeds and should not be outside when the lawn is cut. If your pet has an allergy to fungi or molds, it should not be keep in rooms with high moisture levels (bathroom or laundry room) or allowed to be in areas of increased dust (crawl spaces under the house). Control of house dust or mites in the home can be a major undertaking, consisting of removing carpeting, covering mattresses, regular washing of the bedding, high-efficiency vacuums, avoiding stuffed toys, and frequent damp mopping of the areas most frequented by your pet.

Antihistamines and fatty acids are two therapies, when given in combination that can decrease the itching sensation in about 10% to 20% of atopic pets. Your pet can be on antihistamines and fatty acids for life with no long-term problems. The only side effect usually seen with antihistamines is drowsiness. Several different types of antihistamines may need to be tried to find the one that works the best. These two combined therapies should be given for a few months before a decision is made concerning their effectiveness.

The use of other nonsteroidal drugs besides antihistamines and fatty acids to control your pet’s itching may be warranted. Some of the drugs that have been effective in controlling the itch include cyclosporine, misoprostol, and pentoxifylline.

Steroids (prednisone, cortisone) can also be used to alleviate the itch. However, these drugs have potential side effects and are reserved for pets for where other therapy is not possible, therapy is ineffective or to control a severe itch for a short period of time.

Products applied topically to the skin (shampoos, cream rinses, leave-on conditioners, gels, lotions, sprays) with anti-itch properties may also be of benefit. These products will usually need to be applied daily (sprays, gels, lotions), or a few times weekly (shampoos, cream rinses, leave-on conditioners). It is most important that your pet be bathed in cool water because warm/hot water increases the itch sensation.

Desensitization vaccines can be formulated for your pet on the basis of results of a skin test or blood test. After an initial series of injections, periodic boosters are needed (every few weeks) for the remainder of your pets’ life. 60% to 80% of animals improve with such vaccines. However, desensitization takes time. Improvement may not be seen for 3 to 6 months or longer. If results are not seen within 9 to 12 months, a reevaluation of the vaccine usage is necessary.

Allergies are a lifelong problem and tend not to just go away. The best chance for success in treatment is seen when you can spend the time and effort in utilizing symptomatic therapy on your pet or utilizing symptomatic therapy while your pet is undergoing the process of desensitization. Only by trial and error can the optimal therapy be formulated. Time and patience is the key!

The pancreas is a dual functioning gland that is located in the front part of the abdomen. It lies just below the stomach and directly beside the upper part of the small intestine.

The pancreas performs two important functions:

• The main endocrine or hormonal function of the pancreas is responsible for blood sugar regulation through its production of important hormones, one of which is insulin.
• The other function involves the production of special chemicals, or enzymes, that are essential for food digestion. These enzymes are normally inactive in the pancreas until they are needed during mealtime. At meals, the enzymes are released into ducts that empty into the small intestine. Once there, they become activated into potent chemicals that break down ingested food into smaller particles, thus allowing for their normal passage through the bowel wall and into the circulation.

Acute pancreatitis occurs when the digestive chemicals are activated inside the pancreas instead of inside the intestine. Activating enzymes inside the pancreas causes severe inflammation and potential destruction of this vital abdominal organ. This can also have far reaching adverse effects on many organ systems in the body. The process can be compared to a forest fire burning in the front part of the abdomen while simultaneously spreading its damage to other more distant structures in the animal’s body. Imagine that these rage one day and then die down to smolder on the following day while awaiting the next opportunity to revert into raging flames the next day. This is how acute pancreatitis can behave in your pet. The disease process places you, your veterinarian, and your pet at the mercy of its unpredictable course.

What causes pancreatitis?

Statistically, obesity and the ingestion of fatty meals are the two main predisposing factors in the dog. Other suspected predisposing causes in the dog and cat are abdominal trauma, certain drugs and metabolic disease. It is also possible for certain conditions to compromise blood supply to the pancreas. In many cases, the cause is listed as unknown or “idiopathic” because of the absence of any of the known predisposing conditions.

What are the symptoms of pancreatitis?

Dogs characteristically display sudden onset of some of the following symptoms:

• Vomiting, usually yellow in color due to bile content
• Abdominal discomfort
• Complete loss of appetite
• Varying degrees of mental depression, depending on the severity of the condition
• Loose stools
• Depression
• Fever
• Dehydration

Cats can show similar signs, but many cats are more subtle in their illness, with nothing more than:

• Mental depression
• Loss of appetite
• Marked inactivity
• Vomiting may or may not be present

In its worse form, acute pancreatitis can cause a complete state of collapse because of a severe drop in blood pressure which can go on to cause adverse effects on other organ systems in the body including the heart, liver, kidneys, and blood vessels.

How is pancreatitis diagnosed?

The diagnosis of pancreatitis is not easy because the symptoms and the test results can mimic other abdominal disorders. Therefore, the diagnosis is usually tentative and based on the results of several diagnostic tests. Somewhat like a mathematical model, the whole of the diagnosis is composed of the sum of the parts of diagnostic data available.

The most helpful tests include:

• Abdominal x-rays
• Abdominal ultrasound
• Complete blood count
• Serum biochemistry panel
• Levels of certain pancreatic enzymes in the blood

Some of these blood tests might have to be sent out to an outside lab, thus causing a delay in the diagnosis. This delay should not postpone immediate and aggressive supportive treatment measures when the circumstantial evidence is strong. Sometimes despite the availability of many diagnostic tests, the diagnosis of pancreatitis can remain elusive, calling for the gold standard of diagnostic tests: the surgical exploratory where the doctor can visualize and perhaps even biopsy the gland.

What treatment is needed?

Treating pancreatitis should begin as soon as possible:

• The most severely ill patients are placed in intensive care where they will receive an intravenous catheter to allow for the intravenous delivery of fluids, which will help restore normal blood pressure.
• All food and water will be restricted for 5-7 days in order to “rest” the pancreas. Nutrition can be given by vein in cases where the disease lasts more than 5 days.
• Other drugs that might be indicated are antibiotics, insulin, certain anti-vomiting and anti-ulcer medications, and special drugs to help restore normal gut movement.

There will be times when the pancreatitis patient will benefit from surgery. The surgeon will have the opportunity to remove any unhealthy tissue, remove any accumulations of pus, and may insert a special feeding (J-tube) into the small bowel which will exit from the body wall, thus allowing a simple means of providing important nutrition for your pet while healing occurs.

The duration of treatment will hopefully be only 5-7 days, but in the more severe cases it has been shown to be necessary to treat for as long as 4-5 weeks. What this means to the patient is a significant amount of time away from home, and what it means to the pet owner is worry over the unpredictability of this terrible disease and the unfortunate large expense that will accompany the prolonged stay in intensive care. This can add up to an extremely frustrating experience for all concerned, especially when the outcome can be the animal’s death. As many as 50% of dogs and cats with pancreatitis do not survive.

Because of the special needs required for the pancreatitis patient, your veterinarian might suggest that your pet be referred to a specialty facility that is adequately staffed and equipped for providing around-the-clock care of the critically ill animal.

Home care and possible long term after effects:

Your pet will be released from the hospital once the vomiting has ceased for approximately 5 days and a general sense of well-being has returned. Home treatment will vary according to how ill your pet was. In many cases, an antibiotic will have to be given orally for a prescribed period of time.

Dietary changes are essential for the dog, but not for the cat. The dog must receive a low fat diet, which is best provided with one of several commercially available low fat prescription diets. The feedings will be evenly divided into 3-4 small portions and be given throughout the day. The low fat will hopefully ease the workload on the dog’s pancreas and therefore hopefully avoid a recurring episode of acute pancreatitis. The decreased calories in these special diets will benefit your pet if it was overweight before becoming ill. If obesity was not a problem, then adjustments in total intake will be necessary in order to avoid any unneeded weight loss

In some cases, the dog and cat that survive acute pancreatitis can be affected with either one or any combination of the following disorders:

• Insulin-dependent diabetes mellitus
• Exocrine pancreatic insufficiency (EPI)
• Recurrent pancreatitis

The diabetes is usually manageable with injectable insulin and a proper diet. The EPI is treated long term with commercially obtained pancreatic enzymes that will be added to your pet’s food to facilitate proper digestion. The threat of recurrent pancreatitis can pose the same concerns as the original illness. This is why it is imperative that your dog never receives any fatty foods for the rest of its life. Avoiding high fat foods will hopefully spare your dog from a relapse of this dreaded disease.

What are the signs of seizures?

The first and most important level of assessment is to be sure that an epileptic seizure has occurred, and if so, the seizure type(s) manifested. An epileptic seizure is the clinical sign of excessive, abnormal activity in the brain.

The clinical features of epileptic seizures can be separated into three components:

• The aura is the initial manifestation of a seizure. During this time period, which can last from minutes to hours, animals can exhibit recurrent pacing or licking, excessive or unusual salivating or vomiting, and/or even unusual psychic events, such as excessive barking or increased or decreased attention seeking. Some owners even report that they know that their own dog is going to seizure days in advance by changes in the animal’s behavior.
• The ictal period is the actual seizure event manifested by involuntary muscle tone or movement and/or abnormal sensations or behavior lasting usually from seconds to minutes.
• Following the ictal event is the post-ictal period. During this time, an animal can exhibit unusual behavior, disorientation, inappropriate bowel/bladder activity, excessive or depressed thirst and appetite, and actual neurologic deficits, such as weakness or blindness.

Single seizures can be classified into two categories: partial and generalized.

• Partial seizures are the result of a focal abnormal electrical event in the brain. This seizure type may be associated with a higher prevalence of focal diseases, such as a tumor. Animals with simple partial seizures have a sudden change in activity without any changes in awareness, such as twitching of facial muscles. Animals with complex partial seizures often show unusual behavioral activity, such as running wildly around the house.
• Generalized seizures are either convulsive (“grand mal”) or non-convulsive (“petit mal”) seizures. By far, generalized convulsive seizures are the most common seizure type seen in animals and are characterized by impaired consciousness coupled with symmetric stiffening, paddling, or even loss of movement of the limb muscles. The severity of the disease does not necessarily match the causes because dogs with brain tumors may have very mild partial seizures, whereas dogs with idiopathic epilepsy, meaning that no obvious cause of the disease exists, may have severe generalized seizures.

What tests are needed?

The second level of assessment is diagnosing the cause of the seizures. Like a cough signals a problem in the airway, a seizure tells us there is a problem in the brain, but not the cause. The goals of a diagnostic evaluation are to determine the underlying cause, evaluate the chance for recurrence, and establish if medication is necessary for treatment. Idiopathic epileptic (IE) seizures are diagnosed if no underlying cause for the seizure can be identified. These are usually primary epileptic seizures (PEI).

Some purebred dog breeds that have a high prevalence of an inherited component to their seizures include the following:

• Beagles
• Belgian tervurens
• Keeshonds
• Dachshunds
• Siberian huskies
• German shepherds
• Border collies
• Irish setters
• Golden retrievers

A diagnosis of idiopathic epilepsy is most common when a dog is between 1 and 5 years of age at the first seizure, is a large breed (> 15 kg), and/or when the interval between the first and second seizure event is long (> 4 weeks).

Secondary epileptic seizures (SES) are the direct result of an abnormal brain structure. Some conditions include developmental brain problems, inflammation, tumors, or strokes. An animal is categorized as having epilepsy if recurrent PES or SES is diagnosed indicating the presence of a chronic brain disorder.

Reactive epileptic seizures (RES) are a reaction of the normal brain to transient systemic insults or physiologic stresses. A patient with recurring RES is not defined as having epilepsy because no primary chronic brain disorder underlies the seizure activity.

A higher suspicion for an underlying identifiable cause (SES or RES) for the seizures is found in dogs that have an initial seizure at less than 1 or greater than 5 years of age, an initial interval between the first and second seizure event of less than 4 weeks, or a partial seizure as the first observed seizure.

Cats, in general, do not suffer as frequently from seizures as compared with dogs. Seizures in cats indicate a highly likely underlying problem in the brain.

What treatment is needed?

Maintaining a seizure-free status without unacceptable adverse effects is the ultimate goal of antiepileptic drug (AED) therapy. This optimal balance is achieved in less than half of epileptic people, and probably just as many dogs. Prior to starting AED treatment, owners and veterinarians should have a realistic expectation of what to expect over the course of therapy. First and foremost is that seizure control does not equal elimination. A decrease in the number of seizures, the severity of individual seizures and post-ictal complications while increasing the time period between seizures is the realistic goal. Once started, you should realize that there is a daily treatment regimen with time restrictions, re-evaluations are required, and there is a potential for emergency situations to arise, along with the inherent risks of the drug.

The decision to start AED therapy is based on the underlying cause, seizure type and frequency, and post-ictal effects. Selection of the appropriate AED is based on the pharmacokinetic properties, the effectiveness, and the adverse effects of that drug. Acceptable criteria of an AED is one that can be given 2 to 3 times per day, has a documentable benefit, and is well tolerated by the animal.

In this sense, the two most widely used AEDs in the dog are phenobarbital and potassium bromide. Bromide has the benefit of reduced chance of liver toxicity but may not be as effective as phenobarbital to stop all types of seizures or work as quickly. Bromide should be used with caution in cats because of the risk of respiratory problems. Several newer AEDs used by epileptic people are now also available for both dogs and cats that do not respond well to standard treatments. These newer drugs are designed for better control and less side effects but are more expensive. Ask your veterinarian about possible alternative treatment options.

Over time, periodic measurements of the amount of drug present in the blood stream is necessary to determine that an acceptable level of medication is present. At the same time, blood tests to evaluate liver function may be necessary. These periodic evaluations are important to try to maximize the benefit of drug therapy, whereas monitoring for early detection of possible complications.

Treating each animal as an individual, applying the philosophy that seizure prevention is better than intervention, and consulting your veterinarian to help formulate or revise treatment plans will lead to improved success in treating seizure disorders in your pet.