Management of two chronic diseases in a German Shepherd-meet Cooper!

This case study is a tribute to one of our special patients who will be moving on shortly to new adventures up north with his family. Cooper is an eight-year old German Shepherd who has dealt with two significant health issues since coming to our practice. His current problems highlight the way that our doctors may sometimes partner with other animal health care workers with good success.

Our veterinarians first worked with Cooper when he began to develop open sores on the skin under his tail. As time went on, he was diagnosed with a chronic medical condition called perianal fistulas; this severe skin condition is common in his breed, but poorly understood (see http://www.acvs.org/AnimalOwners/HealthConditions/SmallAnimalTopics/PerianalFistulasinDogs/). Control of the perianal fistulas involved systemic medications, topical treatments, and a change in diet (to a strict hypoallergenic formula).  The hard work of his team paid off and Cooper has been symptom free of this problem for a number of months.  Thanks to Paul for all of his hard work in keeping Cooper’s skin clean!

In the spring of 2011, Cooper’s owners noticed that he was sometimes slipping when trying to get up and that his hind legs seemed weaker, despite the fact that he was still able to go for long walks. Our examination at that time revealed that Cooper had some pain in his lower back, and we identified some arthritis in that same area on x-rays. Over time, Cooper’s hind end weakness has progressed. By January, 2012 he was dragging his left hind foot and as of spring, 2012, Cooper has issues placing both hind feet in the proper position. He now needs ramps and other assistance to reach the places that he needs to go.

We believe that Cooper is suffering now with a second inherited disease called degenerative myelopathy. This occurs in German Shepherds and a list of other breeds and is a progressive neurological disease with no known treatment or cure (see http://www.caninegeneticdiseases.net/DM/basicDM.htm). Despite his challenges, Cooper has managed to maintain a good quality of life by working with the team at the Canine Wellness Center in Toronto. There he is able to swim, and they have been able to develop special ‘booties’ for Cooper to allow him better traction and stability while walking.  Here are some fabulous photos of Cooper in action:

Cooper’s continued quality of life is testament to his owners, Sharon and Paul. His story is a good example of how pet owners, veterinarians and other experts can work together to achieve wellness, even in the face of difficult disease. We will miss you all very much and can’t wait to see photos of Cooper enjoying life up north!

A collection of dental cases

Most people are well aware of their own dental health, but are surprised when they are faced with oral disease in one of their pets. Our team checks your pet’s mouth at every visit to our clinic and we treat dental problems daily. In honour of ‘Dental Health Month’, we have put together a description of the dental problems that we saw in the month of February.  On a daily basis we would treat patients with periodontal disease and feline resorptive lesions. The other cases noted here are less common.

Periodontal disease: This is the most common disease in pet animals, affecting eighty percent of dogs and seventy percent of cats over the age of three (statistic from the American Veterinary Dental Society).  Periodontal disease is an infection resulting from build-up of soft dental plaque (a thin film of food particles and bacteria) on the surfaces of the teeth around the gums. When periodontal disease is not treated, bacteria under the gums continue to reproduce, creating deeper periodontal pockets and bone destruction. Eventually, this progression can cause tooth loss and other internal medicine problems as bacteria have the potential to spread around the body. When recommended, a cleaning of the teeth above and below the gumline helps to control the progression of periodontal disease. Care of the teeth at home is also incredibly important in the management of this disease.

Dental abscesses:  An abscess occurs when bacteria gain access to the root of a tooth by working their way under the gum line or arriving there via the bloodstream. By destroying the root's attachment to the jaw, the bacteria deprive the root of its blood supply, leading to the death of affected tissue. We see abscesses most commonly in dogs following fracture or trauma to the teeth. 

Oral foreign bodies: Dogs and cats may put objects in their mouths that puncture the gums or become lodged in between the teeth. Owners are typically unaware that their pet has a foreign body in its mouth until they detect a foul odor. Sometimes foreign objects can be removed easily from the mouth and throat, but in many cases this may be done under anesthesia or surgically.

Fractured teeth: Broken or fractured teeth are a common finding in veterinary practices. They may be caused by the significant biting force animals can generate coupled with the items they chew (dogs commonly break teeth on things such as cow hooves, real bones, rocks, and ice), or by other trauma.

Oral cancer: There are a number of cancers which do affect the oral cavities of dogs and cats. The most common and aggressive of these is a tumour called a squamous cell carcinoma.  If we are suspicious of oral cancer when doing an assessment under general anesthesia, we will take a small sample of the abnormal tissue to be sent away to a pathologist and remove as much of the worrisome tissue as possible.

Feline stomatitis: Cats can be affected by inflammation of the entire mouth, called stomatitis or lymphocytic-plasmacytic syndrome (LPGS).  Due to the cells seen upon microscopic examination of the inflamed tissues, the condition is thought to be caused by abnormal activation of the  immune system. Many cats affected with this will be unable to eat, develop weight loss, and have excess salivation. Examination of the mouth often reveals a "cobble stone"-like redness in the throat area and severe inflammation where the tooth and gums meet. Treatment includes a thorough dental cleaning, possible tooth extraction and/or the use of medications.

Feline oral resorptive lesions:  This is a condition commonly seen in adult cats, with possibly 50% of cats over the age of 3 years having at least one lesion in the mouth. The process of tooth resorption starts with erosion of the tooth (usually starting at or just below the gumline where it cannot be easily seen) and continues with progressive loss of tooth structure. This eventually results in the exposure of the sensitive portions of the tooth, which makes this condition very painful. If we do find one of these lesions below the gumline of a tooth during an assessment, we will x-ray that tooth to determine the level of damage to the tooth. In many cases, extraction of a tooth undergoing resorption is the best option for the comfort of the cat.



Laparoscopic spay surgery on a mature Boxer

In North America, a ‘spay’ is an ovariohysterectomy, with the removal of both ovaries and the whole uterus. Traditionally, this surgery is done via an incision on the midline of the abdomen to allow the surgeon access to the reproductive tract; incision sizes vary depending on the type of pet, size of pet and age. Regardless of the size of incision, pets typically need a full day to recover from anesthesia and to process the pain medications necessary during and following the surgery, and then they need to rest for a further 7-14 days at home. Most pets also need to wear an Elizabethan collar for that rest period to keep them from licking their incision.  

Most dogs and cats in North America are spayed around the age of 6-months. When they are young, anesthesia is safer and we believe that they heal more quickly. More importantly, if the spay occurs prior to an animal’s first “heat”, they do not experience the undesirable behaviours associated with a heat, and their risk of mammary cancer is reduced dramatically. Obviously, animals that are destined to have puppies or kittens have this surgery delayed. Being spayed older increases the complexity of the surgery a lot for the surgeon (more blood vessels, abdominal fat and swollen reproductive tissues), and a large incision and/or complicated surgery means that these animals typically take longer to recover.

Case Study:  ‘Gigi’ is a mature female boxer (shown here on the right sitting with her friend Tucker) who presented to us at the age of 6.5 years for an ovariohysterectomy after having had one litter of puppies approximately 2 years prior. This type of surgery has traditionally been a nightmare for both the dog (large incision, long recovery time in terms of pain, rest and collar) and for the surgeon (large dog, mature and swollen tissues).

Gigi was one of the first mature animals to undergo her spay using Eglinton Vet’s surgical laparoscope, and is a great example of why our doctors, patients and clients have embraced the technique. Despite her size and age, Dr. Hodges was able to perform the surgery via a small, 11mm incision and visualize tissue well (see photo), meaning that the surgery could be done safely, with minimal bleeding (usually a major issue during a mature spay). 

Like all of the dogs who have a laparoscopic spay, Gigi was standing up only 2-3 hours after the surgery, looking for some food and a walk. Rather than staying in the clinic overnight or longer, Gigi was home with Tucker and her family that same afternoon, with no E-collar to wear. We do ask that that the animals are monitored closely and rest for 2 days following surgery, but after that they are back in the park. Our team loves the fact that dogs like Gigi come through their spay surgeries so quickly and so comfortably!



Pancreatitis case studies

We have chosen to highlight the issue of pancreatitis here and in our most recent clinic newsletter, as we have seen an unusual number of patients suffering from pancreatitis in the past few weeks. We have had 1-2 dogs hospitalized per week with pancreatitis through the months of November and December, and prior to that we were dealing with pancreatitis in a number of cats.

We invite you to read about the patients and information below, and also to visit our Facebook page to find an interesting link to more information on pancreatitis.

Case #1: Foxie   Foxie is an 11-year old Fox Terrier presented to us after suffering with bloody diarrhea for a couple of days. Her owners suspected that she had ingested something unknown outside prior to falling ill; Foxie is known for looking for unusual things to eat while out on walks, but her owners had not ever seen symptoms like this. On our screening tests in hospital, Foxie was found to have pancreatitis and she was hospitalized for three days on IV fluids and injectable anti-nausea medications. Foxie responded well to our treatment plan and is at home looking for more things to eat! We have recommended that she remain on a prescription low-fat diet over the long term in hopes of preventing another bout of pancreatitis.

Case #2: Ryley    Ryley is a 10-year old Springer Spaniel who presented to us because he had not been eating well and seemed uncomfortable at times over a period of a few weeks (the owner was unsure as to where the discomfort was coming from). Blood testing again revealed pancreatitis and Ryley was hospitalized for supportive care. Unfortunately, his condition did not improve the way that we had anticipated, and we proceeded with an abdominal ultrasound to evaluate whether he had any concurrent problems. This ultrasound, as well as additional blood testing, revealed that Ryley was indeed suffering concurrently with a problem called Cushing’s Disease.  This case is an example of how pancreatitis is often diagnosed along with other medical problems. We are currently treating Ryley for both pancreatitis and Cushing's disease and he is off to Florida for the winter. We wish Ryley and his family well in the sunny south!

What is pancreatitis?     The pancreas is a glandular organ, tucked alongside the stomach and small intestine. It contains two types of active tissue and is responsible for: (a) releasing enzymes needed to digest food and (b) producing hormones such as insulin, which is responsible for the regulation of an animal’s blood sugar levels. When the pancreas is inflamed, the condition is called pancreatitis. Pancreatitis can occur in both dogs and cats, but is more common in dogs, especially the acute form.  

What do pets with pancreatitis look like?            Pancreatic inflammation can be mild, moderate or severe, and can also occur as an acute problem or as a chronic low-grade problem. This means that there are many presentations of pancreatitis. Our doctors see dogs with very mild clinical signs barely recognizable to the owner, and other cases in which signs are severe and life threatening.   Cats most commonly have the chronic form, and present with very subtle clinical signs, therefore, pancreatitis can be difficult to diagnose and manage in a cat. 

Why does pancreatic inflammation occur?  Certain breeds of dogs (e.g. Schnauzers) are prone to developing it, and dogs that ingest anything abnormal (especially something high in fat) or animals that have underlying intestinal or hormonal diseases (such as diabetes mellitus) are at risk. In the majority of cases of pancreatitis, the cause is never known.

How is pancreatitis diagnosed and treated?   Our doctors will likely recommend blood testing for pancreatitis in any dog or cat that presents with signs of gastrointestinal illness such as a decreased appetite, vomiting, diarrhea or signs of abdominal pain (panting, restlessness, etc.).  As there are many, many other problems that can cause the same signs (some mild and some serious) our testing recommendations become very important. Aside from blood tests, we may also recommend abdominal x-rays, fecal testing for parasites or more specialized testing such as an ultrasound study.

The treatment plan for an animal suffering from pancreatitis will be tailored to that animal and depend on the suspected cause, the extent of illness and the existence of other underlying disease.  All pets who have suffered one bout of pancreatitis are at risk of another at any time, and we will suggest that they eat a diet very low in fat for the remainder of their life.