Kennel Cough (CIRD): What is it?

BY KERRI WIEDMEYER, DVM, WVRC

Kennel cough is characterized by an infection of typically more than one of the following infectious agents: Bordetella bronchiseptica, canine adenovirus type 2, canine distemper virus, canine herpesvirus, canine influenza, canine parainfluenza, canine pneumovirus, canine reovirus, canine respiratory coronavirus, Mycoplasma spp, and Streptococcus spp.

Kennel cough causes a persistent hacking cough that is typically self-limiting in mild cases and may not require any treatment. These infectious agents can be transmitted through the air, direct contact with an infected dog and through fomites. Thus when dogs are in a crowded or enclosed area such as kennels, boarding facilities and dog parks, these infectious agents have an opportunity to spread like wild fire.

Clinical signs:
Dogs can have a variety of signs associated with kennel cough, but the most common is a dry, hacking cough. It is not uncommon for dogs to hack and have a terminal retch with the aggressive coughing that can occur. Dogs with kennel cough may have bouts of coughing when excited and pulling on their leash. Some of the infectious agents causing kennel cough can lead to pneumonia, fever, lethargy and nasal discharge/congestion. These clinical signs are more commonly found in dogs that are either very young, very old or immunocompromised.

Diagnosis:
Kennel cough is often diagnosed based on physical exam findings and the dog’s recent history. A veterinarian will often palpate the trachea, which can elicit a coughing fit in dogs with kennel cough. Recent history of being boarded or at the dog park can help tie together a presumptive diagnosis. Thoracic radiographs should be normal unless pneumonia is present. PCR testing or amplification of pathogen DNA, can be done for a number of the infectious agents listed above. This type of testing is typically reserved for severe cases that are not self-limiting or responding to treatment.

Treatment:
In the majority of cases, kennel cough is self limiting, and no treatment is required. Dogs will often have a cough for 1-2 weeks. Cough suppressants can be prescribed if a dog is unable to get comfortable or sleep due to the bouts of coughing. Cough suppressants should be avoided if a dog has pneumonia. It is not uncommon for antibiotics to be prescribed if a bacterial infection is thought to be part of the cause. Dogs that progress to pneumonia may require hospitalization, intravenous fluids, injectable antibiotics and oxygen supplementation.

Prevention:
Preventing the spread of kennel cough can be challenging as there are many infectious agents that cause it. There are vaccines available for a number of the infectious agents that can help decrease spread. Bordetella bronchiseptica has a vaccine available in both injectable and intranasal forms. This vaccine has to be given every year. For canine parainfluenza virus, canine influenza virus, canine distemper and canine adenovirus type 2, there is a vaccine series that puppies receive and then subsequent boosters. Environmental changes or precautions should be considered as well. Dogs going to dog parks or boarding should be fully vaccinated. Stressful situations, smoke and poor ventilation can also play into the spread and severity of kennel cough.

Overall, the prognosis for dogs that get kennel cough can be very good. That being said, it can be pretty annoying when both you and your poor dog cannot get any sleep because of the loud coughing.

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Diseases A To Z: That Every Dog Owner Should Know About

BY MEGAN TREMELLING, DVM, LVS

Acute hemorrhagic diarrhea syndrome is a combination of vomiting and bloody diarrhea that can seem to come on in a matter of minutes. The resulting fluid shifts rapidly cause dehydration. The most serious cases can be fatal. Fortunately, most dogs do very well with hospitalization and appropriate care.

Brachycephalic obstructive airway syndrome (BOAS) is a polite way of saying “Bulldogs can’t breathe.” Brachycephalic dogs are the ones that are bred to have extremely short muzzles and flat faces like Pugs and Bulldogs. They frequently come with a set of anomalies including narrow nostrils; soft palates that are long enough to choke on and larynxes that are under so much pressure that they collapse. Lots of brachycephalic dogs have surgery to open up their airways so that they can breathe more easily. Do you own and love a smushy-faced dog? Ask your veterinarian whether BOAS surgery would improve your pet’s quality of life. See also Heat Stroke.

Cranial cruciate ligament (CCL) rupture is an extremely common injury that destabilizes a dog’s knee. In most cases, the ligament has worn out as much as it has been torn. Some dogs manage to hobble around on a CCL injury, but arthritis is almost inevitable. Just to make matters worse, it is quite common for dogs to rupture the ligament in both knees. Luckily, a surgical repair can restore function and reduce the development of arthritis.

Dystocia is difficulty giving birth. While many bitches whelp their puppies without drama, there are others who cannot get the job done on their own. Causes include calcium deficiency, malpositioned fetuses and several other problems, but the most common cause is that the bitch has been purposefully bred to have a tiny body. This causes difficulty accommodating the passage of a puppy especially in breeds with disproportionately big heads. A C-section then becomes a necessity.

Endocrine disease is a whole group of diseases and disorders including diabetes, hypothyroidism and Cushing’s disease. A dog’s endocrine system, like a human’s, uses chemical messengers to coordinate body functions. When the system breaks down, the results can be catastrophic. Many endocrine diseases can be diagnosed with bloodwork, and many can be successfully managed though most cannot be cured. Is your dog suddenly drinking and urinating far more than usual? Ask your veterinarian to make sure the endocrine system is on point.

Fleas are tiny, wingless insects that spend most of their lives hiding in an animal’s haircoat feeding on blood. Fleas are tough little critters. They have survived for 60 million years. They transmit diseases and parasites, trigger allergies, make animals miserably itchy and in some cases literally bleed them to death. Fleas are not the least bit impressed by old-fashioned flea collars or home remedies like cedar oil, garlic and brewer’s yeast. It is difficult to even squish them because they have such hard exoskeletons. Sometimes you can’t even see them hiding in your dog’s coat. If you do see fleas, or if your dog seems itchy for any reason, job one is ensuring that fleas are under control. Ask your veterinarian which modern flea control product is best for your pet.

Gastric Dilatation and Volvulus (GDV) is sometimes called “the mother of all emergencies.” For reasons that are not always clear, a dog’s stomach sometimes fills with gas and twists on its axis, not only preventing the vomiting that would relieve the pressure but also preventing normal blood flow. It is most common in large, narrow-chested dogs like Great Danes and Standard Poodles. Classic signs of GDV include tense, painful abdominal swelling and unproductive retching that sounds like the dog is trying to vomit but can’t. Unfortunately, it isn’t always that easy to see. If you suspect GDV, the dog should be assessed by a veterinarian immediately. Minutes count!

Heat stroke can occur whenever a dog can’t pant enough to cool themselves down. This may be when the weather is hot or humid, when the dog is exercising, when the dog has some kind of respiratory problem or—the worst—any combination of the above. Dogs are not as good at cooling themselves as humans are, and they are not at all good about knowing their limits. If you think your dog may have become overheated, wet down their coat, get in the car to the emergency clinic and turn the air conditioning on full blast!

Intervertebral disk disease or IVDD occurs when the cartilage pads that separate the bones of the spine become worn out, swollen or slip out of place. The main reason this is a problem is that the spinal cord and nerve roots can be pinched or crushed, causing anything from pain to paralysis. Dachshunds are the poster children for this disorder, but any dog can get it.

Jaundice technically is not a disease, but a symptom and is known also by the professional term “icterus.” It refers to the yellow color that develops in animals whose bilirubin level is too high. You can see it in the whites of their eyes, in their gums and anywhere the skin is bare and thin. There are two main causes: liver disease and red blood cell destruction. If your dog is looking sallow, it needs to be seen by a veterinarian right away.

Kennel cough is a catch-all term for acute infectious respiratory disease in dogs and commonly consists of laryngitis, tracheitis and bronchitis. It may be caused by any one, or a combination, of viruses and bacteria such as canine parainfluenza virus, canine adenoviruses types 1 and 2, canine herpesvirus and Bordetella bronchiseptica. Affected dogs usually have a harsh cough. Particularly in puppies, more severe illness sometimes occurs. Treatment depends on the details of each case.

Laryngeal paralysis occurs mostly in older dogs. What it means is that the vocal folds which are supposed to open wide with every inward breath don’t do so any more. You might notice that your dog’s bark is harsher or softer. You might notice a wheezing, snoring sound when he exercises. Sometimes owners notice nothing at all until the dog gets overheated or excited and tries to pant to cool down. The harder the dog tries to pant, the more the vocal folds get in his way. This is a life-threatening emergency that requires immediate veterinary attention. Luckily, a surgical procedure can improve the situation. See also Heat Stroke.

Mitral valve disease is probably the most common form of heart disease seen in dogs. It usually happens when, over time, one of the valves in the heart starts to get a bit leaky. Many, many dogs, especially small ones, develop a heart murmur in their senior years as a result of mitral valve disease. For some of them, but not all, it becomes a life-threatening problem. If your dog has a new heart murmur or a chronic cough, ask your veterinarian whether a chest x-ray is warranted.

Neoplasia, better known as cancer, is not one disease but a whole category of diseases characterized by uncontrolled cell growth. It is the main cause of death in well-cared-for older dogs, partly because most types can’t be prevented and because it usually doesn’t respond as well to treatment as some other diseases. Exceptions do exist, though, and veterinary oncologists (cancer specialists) work every day to help canine cancer patients live the longest, happiest lives possible.

Osteoarthritis is, unfortunately, extremely common in older dogs, especially large ones. Your veterinarian may call it DJD or degenerative joint disease. You might notice that your pet is stiff and slow to get up after a nap, especially after hard exercise but seems better after they move around a bit. Osteoarthritis cannot be reversed, but your veterinarian can help your dog to stay functional and pain-free as long as possible.

Pyometra is an infection of the uterus. In dogs, it has an unfortunate tendency to turn into a catastrophe very quickly, so by the time an owner realizes the dog is sick, her life is in danger and she needs emergency surgery. Pyometra is unfortunately very common, so all owners of unspayed females need to be on the lookout for the slightest signs of illness, and be prepared to deal with the emergency. In most cases, the best prevention is a routine spay.

Quadriceps contracture can happen as a complication of a fracture of the femur (thighbone). The quadriceps femoris is a group of muscles that extends the stifle (knee) joint, so it is necessary for normal standing and walking. When the thigh is injured, sometimes the quadriceps heals by turning into rigid scar tissue, resulting in a stifle that cannot flex and a leg that cannot be used. Contracture can occur in any circumstance, but it is more common when the fracture is not treated properly. Surgical repair of the fracture not only allows the bone to heal correctly but also allows for critical rehabilitation exercises that keep the joints flexible and the muscles moving.

Rabies remains a serious health concern for dogs and for humans, even though a robust canine vaccination program can protect both populations. In countries where canine vaccinations are prohibitively expensive, rabies kills dogs and humans, horribly and indiscriminately. Fortunately, rabies vaccinations are within the means of most dog owners in the United States, to say nothing of being required by law.

Seizures, or convulsions, can occur in dogs from a variety of causes. The most common cause is epilepsy which in dogs is partly genetic in origin and manifests in young adult dogs, ranging from brief focal seizures to longer, full-body convulsions. Other causes include brain diseases, poisons and metabolic disorders. Unless your dog has a known and well-managed seizure disorder, any kind of seizure activity should warrant prompt veterinary attention.

Tracheal collapse is just what it sounds like. The trachea, or windpipe, is supposed to be round like a pipe for good airflow, but if it becomes soft, it can collapse on itself making it hard for the dog to breathe. And, just like a straw when you suck on it too hard, the harder you try to move air, the more stubbornly it stays collapsed. Unfortunately, tracheal collapse is very common in small dogs and in brachycephalic breeds. If your dog tends to cough or wheeze when he gets excited, ask your veterinarian to take an x-ray to look for signs of collapsing trachea. You can’t make it go away, but there are strategies to reduce its effect on the dog. See also Heat stroke.

Urinary tract disease in dogs often appears as blood in the urine, straining to urinate or marked increase in frequency of urination. The causes may include bacterial infections, bladder stones, anatomic anomalies or any combination of the above. It’s tempting to just ask your veterinarian for an antibiotic, but tests will be needed to pin down a diagnosis and keep problems from progressing.

Vestibular disease refers to any problem that affects the vestibular system meaning that part of the brain and inner ear that controls balance. When humans experience vestibular disease, we often describe it as vertigo. Dogs can develop vestibular disease from serious problems like tumors or strokes but also from ear infections and a benign problem called Idiopathic Vestibular Disease. Owners often assume that a dog that is suddenly too dizzy to stand up has suffered a serious stroke and must be euthanized, but this is not always the case.

Worms are internal parasites that find a way into your pet’s intestines, lungs or, worst of all, heart and blood vessels. Most can be identified through blood or fecal testing, and most can be treated. However, many worm infestations go unnoticed meaning that pets who appear healthy can go around shedding microsopic worms and eggs to infect other hapless dogs… and, sometimes, their humans too! Do your neighbors a solid and ask your veterinarian to review your pet’s worm control plan, especially if you and your pet are regular dog park visitors.

Xylitol toxicity is just an example of the environmental hazards that can poison your pet. Xylitol is an artificial sweetener that is apparently harmless to humans but can cause serious harm to dogs including seizures and liver damage. No sugar-free gum for Max and Bella, please!

Yeast infections in dogs most commonly occur in the ears and skin. Usually the yeast is the kind that lives in small numbers on all dogs’ skin, but in some dogs, at some times, the population grows like gremlins in a rainstorm. There is often an underlying problem such as an allergy. Your veterinarian can identify a yeast infection and provide the proper treatment to relieve your dog of this itchy, stinky misery.

Zoonotic disease is defined by medical doctors as a disease of humans that is transmitted to them by animals. Veterinarians, however, define it as a disease that can be transmitted from animals to humans or vice versa. Unfortunately, we can be as much of an infection hazard to animals as they can be to us. For example, some influenza viruses can hop species, and while we know that some types of avian and swine influenza can cause serious illness in humans, we should also be aware that some animal species, like cats and ferrets, can catch some forms of influenza from us. Luckily for our pets, it is uncommon for humans to transmit serious infections to animals.

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Heartworm Disease: An International Problem

BY KERRI WIEDMEYER, DVM, WVRC

Let’s Test Your Knowledge!

1. Can a dog infected with heartworm
give it to another dog in the same household?

2. Should you treat your pet with
heartworm prevention all year?

3. Can humans get heartworm?

4. When should heartworm prevention start?

Read on to find out more!

Heartworm or “Dirofilaria immitis” is parasitic worms that are transmitted by mosquitoes to certain mammals and cause severe disease. Adult heartworms are very long worms (females up to 12 inches and males up to 6 inches long) that live in the heart, lungs and blood vessels of the mammals they infect. Common mammals that can become infected include dogs, cats, wolves, coyotes, ferrets and foxes. There are several rare cases of human infections. Heartworm disease can be found on almost every continent in the world. This truly makes it an international problem. Where there are mosquitos, there are heartworms!

Transmission: The only way for heartworm to be transmitted is through a mosquito. An infected animal has immature worms, microfilaria, in the bloodstream. When a mosquito bites the animal, it sucks up the microfilaria in the blood. Once in the mosquito, the microfilaria develop over a few weeks, and when the mosquito bites the next animal, the worms infect that animal. Over the next six months, the worms in the newly-infected animal will mature into adult worms and settle in the heart and lungs. These adult worms will produce more immature worms, and the cycle will continue. The adult worms can live for several years in the host leading to years of increased spread of infection.

Heartworm Disease in Dogs

Disease: Canines are the preferred host for heartworms, and unfortunately that means the greatest amount of damage can occur in these animals. Heartworms thrive in dogs and reproduce at high numbers. Dogs can have hundreds of heartworms living in them at one time! Thus, the damage that these worms can do to the heart and lungs can quickly become irreversible and cause lifelong problems. The worms cause inflammation, scarring and obstructive problems and lead to pulmonary hypertension and congestive heart failure.

Clinical signs: Clinical signs can vary depending on how severe the worm burden is. Commonly, the first signs noticed are a cough and exercise intolerance. Signs then progress to coughing up blood, lethargy, difficulty breathing, ascites (fluid in the abdomen) secondary to heart failure and then caval syndrome. Caval syndrome occurs when the amount of heartworms is so numerous that normal blood flow cannot occur in the heart. This leads to a series of problems including anemia, liver and kidney failure and potential death.

Testing: A simple blood test can be performed that detects antigens to adult female worms. This test can be performed in any dog older than seven months as it takes the worms six months to become adults.

Treatment: If a dog is positive for heartworm disease, more testing will likely be warranted to see how severely the dog is infected. Dogs that are severely infected will need to be stabilized prior to treating the heartworms themselves. Treatment then consists of a series of injections, antibiotics and commonly steroids. Treatment is not only painful and expensive but has risks as well. During the course of treatment, which is typically over several months, dogs have to be strictly exercise restricted. Exercise can lead to the heart and lungs working harder, which can cause the worms to act as emboli, thus stopping blood flow to organs, causing organ failure and potentially sudden death.

Prognosis: Dogs that have low worm burdens or minor symptoms typically have a good prognosis with treatment. Dogs with large worm burdens can also successfully be treated but may have more complications and are more at risk for unsuccessful recovery.

Heartworm Disease in Cats

Disease: Cats are not the primary host of heartworms, and thus the disease process is very different. Heartworms are much less likely to make it to the adult stage in cats. While fewer adult worms means less disease, it also means many cats that are infected with heartworms will not show up positive on tests. The immature worms can still cause significant lung disease and, unfortunately, cats are more likely than dogs to die from a heartworm infection.

Clinical signs: Cats infected with heartworms will commonly cough, have respiratory changes, lethargy, weight loss and decreased appetite. However, if a cat has an adult worm and that worm dies, the body’s reaction to that worm can cause respiratory distress, shock or sudden death.

Testing: Testing for heartworm disease in cats is more challenging as the commonly-used antigen test is only positive with adult worms, and cats will often only be infected with immature worms. An antibody test would come back positive with immature worms but is much less commonly performed unless clinical signs are present.

Treatment: Unfortunately, the medication used to treat dogs for heartworm disease is not safe for cats. Treatment is generally supportive care and can include hospitalization and sometimes surgical removal of the adult worms, if possible. This is why heartworm prevention is so very important.

Prognosis: Cats with heartworm disease can survive with treatment, but prognosis varies depending on the severity of disease at the time of treatment.

Prevention: PREVENTION IS KEY! The good news is that heartworm disease is completely preventable! Heartworm preventative is recommended year-round as it only takes one bite from one mosquito to infect your dog or cat. There are many forms of heartworm prevention at this time such as topical treatments, chewable pills and injectable medication. These products do have to be prescribed by a veterinarian as there is currently no “holistic” or “natural” heartworm preventative. An added benefit of many of the heartworm preventative medications is that they will kill other parasites such as fleas, ticks and intestinal parasites. These preventatives are generally safe and inexpensive in comparison to the cost and severity of disease your pet could have if they become infected with heartworms.

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Veterinary Medicine: A Worldly View

BY MEGAN TREMELLING, DVM, LVS

Most people, when they think of veterinarians, think of a doctor who works in a clinic or makes house calls to take care of small companion animals, horses and livestock. But there are many different ways to be a veterinarian.

As a profession, veterinary medicine had its earliest beginnings in the care of horses. These days in the United States and many other developed nations, veterinarians work in animal shelters, farms, racetracks, laboratories, meatpacking facilities and military bases caring for all kinds of species. With advanced training there are dozens of specializations and certifications that veterinarians can achieve, such as surgery, internal medicine, emergency/critical care, dermatology, cardiology, rehabilitation, oncology and so on. A single pet in the US can have a whole team of veterinarians to care for its every need. But it is clear that not every country can afford, for example, kidney transplant capabilities for companion animals. What do veterinarians do there?

Consider Cambodia. It is considered a “least-developed country” by the United Nations, and one could hardly blame the people of Cambodia if they chose to focus their resources on human needs instead of those of animals. But it turns out that in Southeast Asia as well as in the United States, human needs and animal needs go hand in hand.

The Royal University of Agriculture in Phnom Penh has a Department of Animal Science and Veterinary Medicine. Rather than emphasizing care for individual animals, they work to develop livestock and feed sources that can thrive in Cambodia’s climate and provide extension services to help farmers take better care of their animals. Along with university-trained veterinarians, Cambodia has 12,000 village animal health workers who are trained to vaccinate livestock, deal with common animal diseases and teach good animal husbandry to the farmers. In a country where 80 percent of the labor force works in agriculture, recognizing the interconnection between people and animals is critically important. For a smallholder farmer, the loss of a single animal can be financially devastating, so a veterinarian or animal health care worker who prevents that loss is protecting the family food supply. This is no small matter in a country where 21 percent of the households cannot afford a nutritious diet.

The connection between human and animal health is most striking in the area of rabies control. Cambodia is regarded as a high-risk country when it comes to rabies exposure. Cambodians own more dogs per human than any other country, and most of them have not been vaccinated against rabies. Bites to humans are unfortunately frequent. There is no coordinated rabies surveillance in Cambodia, so true prevalence is impossible to judge. Fewer than 5 percent of the people who are bitten by dogs there receive post-exposure prophylaxis (PEP–the treatment that prevents the development of rabies in a human that has been bitten). This is partly because even though medical care is subsidized by the government, traveling to an urban center to receive PEP costs more than a month’s wage for the average rural Cambodian. Without PEP, a bite from a rabid dog inevitably leads to a gruesome death. Official estimates of 800 deaths per year in Cambodia are likely to be low.

The most efficient way to keep humans from dying of rabies is to control rabies in the canine population, thus greatly reducing the need for PEP. In the developed world, canine vaccination programs have nearly eradicated rabies as a disease in humans. In Cambodia and other areas of need, veterinarians are working hard to vaccinate dogs, thus saving human lives as they do so.

Approximately 3,400 miles away from the moist forests of Cambodia, some of the desert nations that border the Persian Gulf have much less trouble from rabies, but veterinarians are still important. Falconry, which is a rare and highly-regulated hobby in the United States, is a more common pastime in the Arab world with the fierce birds living as family pets, as hunting companions, as status symbols, as racing competitors and as an emotional connection to the region’s ancient Bedouin culture. Although the Persian Gulf area is considered “developing” in terms of industrialization, it is a world leader when it comes to the medical care of falcons.

There are no less than a dozen veterinary hospitals in the Gulf States that cater to falcons and their owners. The largest one, the Abu Dhabi Falcon Hospital in the United Arab Emirates, is a public institution and sees around 11,000 falcons a year. The veterinarians and their staff tend injured and ill birds, provide wellness care, replace damaged feathers, perform prepurchase exams and attach high-tech tracking devices. The reason for the latter becomes clear when you realize that while a starter kestrel can be had for a few hundred dollars, the most valuable gyrfalcons and peregrine falcons can sell for over $100,000.

Most falcon hospitals remain devoted exclusively to the care of these magnificent birds, but veterinarians continue to adapt to changing times. In 2007, the Abu Dhabi Falcon Hospital moved to accommodate the more Western tastes of some local citizens when they opened a new Pet Care Center… to treat dogs and cats.

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Can My Pet Get Covid-19?

BY MEGAN TREMELLING, DVM, LVS

Short answer: It’s unlikely.

Long answer: This is going to take a while.

By now, everybody has heard the basics of this story repeatedly: A previously undocumented virus was discovered at the end of 2019, and unfortunately the way it was discovered was that it was killing people. Since then it has spread around the world, sickening millions of people and killing hundreds of thousands. Throngs of scientists have been studying it to try to learn how it travels, who gets it, how it causes harm and how we can stop it. New information becomes available every day, and sometimes it conflicts with previous information. It’s bewildering and frightening. In the midst of it comes the information that COVID-19 may, possibly, be able to infect household pets.

Should we be worried about our dogs and cats?
Can they get sick? Should they be tested?

Possibly the most important thing to understand about SARS-CoV-2, the virus that causes COVID-19, is that nobody has the full story on it yet and won’t for a while. Medical research is a complicated subject. A positive test is not the same thing as an active infection. An infection is not the same as illness. Being ill is not the same thing as being contagious. All these factors, and more, make it challenging to know how worried we should be. Collecting and interpreting data, unfortunately, takes time and expertise. And while it seems like every journalist and politician pretends to be an epidemiologist or infectious disease specialist, really, most of the people you are hearing from are not experts. This includes me.

This is what we know so far:

Some dogs and cats have tested positive for the virus. In the case of pets, they are thought to have been exposed to the virus by their owners. However, many animals that have been exposed to ill owners have tested negative. It seems likely that the number of animals that have had the virus is very small compared to the number of humans who have had it. Although it is quite contagious among humans, we don’t seem to be efficient at infecting our pets.

Some animals, including ferrets and tigers, have shown signs of illness that may have been COVID-19. In experimental situations, cats have shown signs of COVID-19, but this has not been observed under natural conditions. So far, COVID-19 does not appear to cause serious illness in dogs; as a matter of fact, it may cause no disease at all. Not enough animals have tested positive for us to know. Thus if a dog or cat is feeling ill, it is extremely unlikely that it is due to COVID-19. They are much more likely to have one of the other viruses or bacteria that can affect them.

So, if you are sick, should you worry about your pet? The CDC suggests that if you are sick, it would be best to have someone else care for your pet while you keep a wide berth. If this is not possible, wear a facemask, hold off on snuggles and kisses and wash your hands before and after interacting with your pet. Testing pets for COVID-19 is not routinely recommended.

Whenever people are stressed, it is natural to worry. The possibility of illness occurring to a beloved pet is one of the things we worry about. However, so far it does not seem that the COVID-19 virus poses anywhere near the threat to our pets that it does to our human loved ones. As always, if your pet is feeling ill, you should contact your veterinarian and explain your concern. They can evaluate your pet and provide care regardless of the cause.

For the most up-to-date information about COVID-19 in humans or in pets, you can trust the experts at the Centers for Disease Control and Prevention: cdc.gov.

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Cognitive Dysfunction Syndrome

BY KERRI WIEDMEYER, DVM, WVRC

What it is:
Cognitive Dysfunction Syndrome (CDS) is degeneration of brain activity that occurs with age. Commonly, these changes occur slowly with time, typically in dogs and cats over the age of 11 years old, with prevalence increasing the older the pet becomes. CDS is commonly compared to dementia in humans as many clinical signs can be similar and also worsen with age.

Causes:
Brain atrophy, or degeneration, occurs with age. This means the actual size of the brain decreases as well as the number of neurons. These changes are more notable in the cerebellar and cerebral areas of the brain. As atrophy occurs, cerebrospinal fluid fills in the empty areas.

Levels of neurotransmitters such as dopamine have been found to decrease with age. This results in decreased neurologic signaling and activity.

Beta amyloid plaques, which are proteins that damage neurons, increase with age, causing further cognitive dysfunction.

Vascular changes are common with age, and micro-bleeds and infarcts can occur that stop the normal blood flow to the brain and thus decrease oxygen and glucose to the brain.

Signs:
1. Confusion. Examples include staring off, getting stuck in a certain location in the house such as a corner or closet.
2. Loss of memory, changes in ability to learn. This includes accidents in the house or problems with training or known commands.
3. Activity changes like excessive licking, pacing and repetitive behavior.
4. Changes in response to stimuli/interactions with people. For instance, excessive barking, lack of interest and separation anxiety.
5. Change to sleep cycle. This may include pacing at night, deep sleep during the day, anxiety and restlessness.

Diagnosis: Diagnosis of CDS is made based on clinical signs, the pet’s history and how they respond to treatment. Other disease processes that can cause similar signs should be ruled out or treated prior to diagnosis of CDS.

Treatments: Diets containing omega-3 fatty acids, antioxidants and mitochondrial cofactors have been shown to improve cognitive function related to age. These diets may take several weeks before improvement is noted.

Medications: Selegiline is an enzyme blocker that slows down the breakdown of catecholamines such as dopamine, norepinephrine and epinephrine. It can also increase the production of dopamine. Most of the time, improvement is noted in 2-4 weeks after the medication has been started.

S-adenosylmethionine (SAM-e) is a supplement more commonly used for liver support. It has been shown, however, to have benefits in treating cognitive dysfunction.

Anti-anxiety calming medications and medications that increase cerebral blood flow have also been shown to help with the clinical signs associated with cognitive dysfunction.

Environmental Therapy: Environmental enrichment is a very important part of improving and maintaining cognition. Teaching new tricks can benefit both the owner and the pet and establish routines. New toys and consistent exercise are recommended as well. If hearing loss is a part of the aging process, then working on hand signals can be very beneficial and make for an easier transition if deafness occurs.

Prognosis: At the end of the day, age should not be thought of as a disease. Many of these dogs can have a good quality of life with the proper care from their loving owners.

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How a Good Boy Named Scout Will Save Some Lives

BY MEGAN TREMELLING, DVM, LVS

There was a big game on TV this year. I didn’t see it, but I’ve heard that one of the commercials featured a beautiful Golden Retriever named Scout. Last year, Scout had a form of cancer called cardiac hemangiosarcoma. He was treated at the University of Wisconsin School of Veterinary Medicine. He is doing well, and his owner was so grateful that he paid for this ad in hopes people would donate money to the UW School of Veterinary Medicine. Apparently it is working quite well, and hundreds of thousands of dollars have been donated. It’s a very sweet story and a pleasant change from the usual headlines.

Hemangiosarcoma is unfortunately a very common cancer in dogs. Two of its commonest forms, splenic and cardiac, tend to be extremely aggressive. What typically happens is this: A middle-aged dog (a Golden Retriever as often as not) is happily going about their typical day when it suddenly starts to feel tired. Over a few minutes to a few hours, the dog goes from bouncing and playing to collapsed, unable to get up and gasping for breath. This is because hemangiosarcomas, which develop from the walls of blood vessels, have an unfortunate tendency to burst, causing internal bleeding that can be rapidly fatal.

If the hemangiosarcoma is in the heart (a cardiac hemangiosarcoma), the amount of blood lost is usually not extremely large, but it causes problems because of its location. A protective fibrous sac called the pericardium encloses the heart. When a tumor bleeds, it can fill up the pericardium and cause so much pressure that the heart cannot fill and pump properly. The term “pericardial effusion” refers to any fluid that is in the pericardium, and a bleeding tumor is not the only possible cause. We sometimes see effusions caused by inflammation or infection, bleeding disorders, heart disease and so on. Whatever caused it, if it is causing problems, we want to get it out of there. We do this by placing a long needle or catheter into the chest and into the pericardium to drain out as much fluid as possible, relieving the pressure on the heart so that it can fill properly.

Of course, having once solved that problem, we want to do our best to prevent it from coming back. Sometimes, analyzing the fluid will tell us about a cause, such as an infection, that we can treat. Most of the time, it is just blood, and that puts the owners and us in the uncomfortable position of trying to figure out what to do next. If the effusion is benign, meaning it is caused by inflammation rather than cancer, it may never come back again or may improve with medication. If it is caused by cancer, however, it will bleed again. It’s important to know what we’re up against.

A mass on the heart doesn’t show up well on x-rays, but sometimes a skilled ultrasonographer can identify it. We can also look for circumstantial evidence. Hemangiosarcoma is a cancer that is often found in several organs at once, so we look for it in the liver and spleen with an ultrasound exam or in the lungs with a chest x-ray. If we find masses in those organs, it makes diagnosis easier. Whether it has spread to other organs or not, cardiac hemangiosarcoma has a grave prognosis, with most patients surviving less than a month from diagnosis. Many owners elect to euthanize their pets at the time of diagnosis because the prognosis is poor even with treatment.

For those owners who decide to give cancer a fight, veterinarians, like medical doctors, have many tools to offer. Surgically removing some kinds of masses can be extremely successful, but surgery is rarely possible with cardiac tumors. Chemotherapy (medication to slow down or destroy cancer) is regularly administered by veterinarians and can be very beneficial for some types of cancers. In the case of hemangiosarcoma, it can extend average life expectancy up to 6-7 months. Some other forms of treatment are less routinely used and less well-studied by veterinarians due to issues with the cost, the availability and the advanced training required to use them. However, veterinary oncologists (cancer specialists) do have access to these tools. Here in Milwaukee, for example, we have access to stereotactic radiation therapy that allows the precise targeting of tumors with minimal damage to nearby healthy tissue. Our oncologists then use immunotherapy which works like a vaccination to help the patient’s own immune system fight the tumor.

A diagnosis of cardiac hemangiosarcoma is never a good thing, but Scout was very fortunate to have an owner with the resources and the drive to do anything that could be done to help his dog. Fortunately, Scout and his owner lived not far from Madison, where the UW School of Veterinary Medicine has an excellent oncology program. Scout was treated with chemotherapy, radiation therapy and immunotherapy. He is reportedly doing well at home for now. Treatment is not likely to cure him, but it is buying him quality time. His owner apparently was grateful for the care Scout had received and wanted the oncologists to be able to treat the disease more effectively, so he took out the ad soliciting donations for the veterinary school.

With his owner’s decision to take out the ad, everyone wins. The veterinary school obviously benefits from the donations. It wasn’t a bad choice for Scout’s owner either as this ad has attracted far more attention to his company than any traditional commercial touting its products.

And here’s the beauty of supporting veterinary cancer research: Dogs, it turns out, are excellent models for the study of cancer in humans. What we learn treating dogs with cancer can be useful when studying human disease and sometimes far more useful than other models such as mice.

There’s no final word on how much money has been raised as a result of the ad, but it is likely to be a substantial amount. Scout’s doctors, the veterinary oncologists you see in the ad, are brilliant research scientists and will put it to good use. I look forward to someday having more options to offer the many dogs that I see with hemangiosarcoma.

https://news.wisc.edu/lucky-dog-scout-and-uw-school-of-veterinary-medicine-star-in-weathertech-super-bowl-commercial/

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Hard Truths: Vets & Suicide

BY KERRI WIEDMEYER, DVM, WVRC

It is not uncommon to think veterinary medicine consists of playing with rambunctious puppies and purring kittens. Unfortunately, these interactions are a rare highlight in what can be a grueling profession. A study published by the American Veterinary Medical Association (AVMA) in January 2019 showed that veterinarians are 3.5 times more likely to commit suicide than the general population. This may come as a shock to most people. How can someone around animals all day long be sad or depressed or have suicidal thoughts?

This increased rate of suicide in the veterinary field can partially be attributed to the personalities of those individuals who are drawn to the veterinary field. Veterinary school is a very rigorous program. Those who apply are typically very driven and hardworking, and many may even consider themselves to be perfectionists. Unfortunately, these qualities are also linked to increased personal performance standards, stress and anxiety. Veterinary school also comes with a huge financial burden, and it is not uncommon for veterinarians to be hundreds of thousands of dollars in debt after their schooling is complete.

For most veterinarians, our days consist of examining animals, assessing their problems and diagnostics, coming up with and discussing treatment options with owners, and record keeping. While that does not sound like a stressful day, it is compounded by the fact that pets cannot communicate what is wrong or where they hurt. This can add another layer of complexity and stress to the practice of veterinary medicine.

The wide range of emotional situations encountered by veterinarians on a daily basis also contributes to high suicide rates. For example, a veterinarian could be in an exam room where they had to patiently examine an overzealous, wiggly puppy, only to walk into the next exam room containing an older dog who, after examination, is found to have an abdominal mass which means a discussion of possible cancer with his owners. It can be quite the emotional rollercoaster. Breaking difficult or unexpected news to owners can be a very taxing part of the job, as is carrying out the difficult task of euthanasia. Veterinarians are trained to exude empathy and compassion in these situations, but this can take a toll over time. It may lead to an increased incidence of compassion fatigue in the field.

Client interactions also add an additional layer of stress to the profession. Often, clients will try and research symptoms on the internet and come to a presumptive diagnosis, which can lead to confusion as to why veterinarians may recommend certain diagnostics to determine the cause of their pet’s symptoms. In cases where even vast testing does not lead to a specific diagnosis, clients can become angry and frustrated that their veterinarian cannot figure out what is wrong with their pet. Long wait times at emergency facilities is another source of irritation for clients that can impact client-veterinary interactions. Clients are also typically emotionally distraught when dealing with difficult news about their pet. Sometimes, these feelings can be redirected as anger towards their veterinarian.

Finally, another reason the field has high suicide rates is that struggles with work/life balance can compound these other stressors for the veterinarian. They tend to work very long hours to accommodate clients and their pets, and they often stay longer than they’re scheduled to perform procedures, complete surgeries and finish paperwork. Over time, this increases emotional burnout that, if not corrected or treated, can increase the potential for suicidal tendencies.

When faced with feelings of suicide, unfortunately, veterinarians are also equipped with the knowledge of how to do it. They have access to anesthetic, pain and euthanasia drugs, as well the knowledge of how to combine them to be lethal; this can be used to facilitate suicide in a different or debatably easier way than the general population.

How Can You Help?

Finances are a large factor of stress for both the pet owner and the veterinarian. Owning a pet comes with its own financial burden. Vaccines, diagnostics, treatments, medications and procedures cost money, and owners should be prepared for possible costs that may occur over the years. Please keep in mind that most people do not become veterinarians for the money. It is not the lucrative job often associated with having “Dr.” before one’s name. Thus, it is unjust to think that a veterinarian is recommending a diagnostic treatment or procedure to pad their pocketbook. Payments go toward running a clinic, staff, equipment, medicine and upkeep. So having a separate emergency savings account for your pet and understanding the potential medical costs that come with pet ownership is ideal. Pet insurance is also a growing market and can be a cost effective option for routine wellness and emergency pet expenses.

Be patient. Your veterinarian is not making you wait on purpose. They are likely running around treating as many animals as efficiently as possible. This means they might not have not had lunch, gone to the bathroom or even had a drink of water.

Remember that your veterinarian is a human being who is just trying to do their job to the best of their ability. Treat them as you would want to be treated; with respect and kindness. Remember that they took an oath to do no harm, and they just want what is best for your pet. And please—the next time you talk to or see your veterinarian, say thank you. Those words mean more than you might think.

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When Childhood Dreams Come True

BY MEGAN TREMELLING, DVM, LVS

When people find out I am a veterinarian, many of them say, “Oh, I always wanted to do that!” They then go on to relate all the reasons it didn’t work out. Surprisingly, none of them have so far admitted that the reason was that they couldn’t pass organic chemistry.

The next thing they say is, “You’re so lucky! You must love it!” Well, yes and no. I feel about my job the way a parent may feel about a highly spirited toddler: I always love it, but I don’t always like it, and there are times when I wonder how long I can keep up with it.

Becoming a veterinarian is challenging, there’s no doubt about it. This is not a career you wind up in accidentally like real estate appraisal or furnace duct cleaning. It’s more of a calling than a job. Most veterinarians either knew from early childhood onward that it was their future or had some kind of epiphany later on. The process of answering that calling is long and sometimes painful. As the famous choreographer Twyla Tharp says about becoming a professional dancer, “[To devote years of your life] working very seriously, with complete commitment, for not a penny… You have to be either hopelessly passionate or very stupid.”

Getting into veterinary medical school is a challenge as there are more qualified people interested in going than there are seats available. Once you have gotten in, it is four years of very hard work to try to learn enough to take good care of every animal species on the planet except humans. It culminates in a crushing exam for licensure that not everybody passes. Tuition is a burden in most university programs; the days are long gone when a summer job could earn enough money to pay a year’s tuition and living expenses. I was fortunate enough to graduate with a debt load that was only about twice my first year’s salary. Costs have gone up since then. I regularly hear of young veterinarians graduating with $200,000 or more in student loans. Passion, it seems, has a price.

Fast forward a couple of decades, and my passion for taking care of animals hasn’t faded. Of course, there is nothing quite like the feeling of being presented with a miserable or dying pet, providing it with the skilled care to fix the problem and returning it to a grateful owner to live happily ever after. Routine care, like vaccinating puppies, doesn’t provide much excitement, but it’s still rewarding because I’ve seen what happens to the animals that don’t get that care, and it isn’t pretty. You only have to watch one puppy suffer through parvo or hear stories from the older generation who tried to treat dogs before the parvo vaccine existed to know that giving that vaccination is good and important work.

I don’t delude myself that I’m some kind of hero. I am not feeding the hungry or pulling children out of burning buildings. But I do see value in helping the critters that can’t help themselves and thereby helping the humans who love them. Pets are a source of companionship, stability and affection in a world that needs them desperately. By helping people to keep and enjoy their pets, I like to think I’m making the world a better place in my own small way.

As an emergency veterinarian, I work nights, weekends and holidays. This was my choice, and so there’s a limit to how much sympathy I can expect for it, but to be fair, somebody’s got to do it; so if I were not there at 2 am to help your pet, it would be some other veterinarian, equally sleep-deprived, over-caffeinated and vitamin D-deficient. Most veterinarians can only work nights for a couple of years before they burn out. I’ve been doing it for 20.

I enjoy problem-solving, and there is no shortage of problems at my job, but sometimes it becomes less of a fun puzzle and more of a frustrating labyrinth. There are patients that defy diagnosis. There are patients that don’t respond to treatment the way you expect them to. Living organisms are complex enough that it will never, ever be possible to know every variable in the system. This means that I am provided with ample opportunity to look like an idiot on a regular basis. The only consolation I have is that all veterinarians everywhere have the same problem. I’m in good company.

No sensible person becomes a veterinarian for the purpose of getting rich; that would be like moving to Seattle for the purpose of getting a good suntan. There are certainly veterinarians who do very well for themselves; there are also those who will never be able to scrape together enough money to buy a home or provide for a family. We could have made more money as engineers, lawyers, dentists or medical doctors. There’s no doubt about that. I have to admit that I seriously considered not going to veterinary school when I found out I could make more money as an optometrist. In my experience, optometrists are usually not working at 2 am. On the other hand, my patients are mostly cuter than humans are.

And then there are the clients. Most of them are wonderful people who want to do what’s best for their pets and appreciate my help. A few of them, sadly, seem to regard me as an obstacle rather than an ally.  Then there are always the ones who think that a Google search is an adequate substitute for four years of medical school (it isn’t) or that having owned several dogs in their lifetime provides equivalent experience to treating thousands of dogs in a career (it doesn’t). And lastly, there are those who just can’t understand why we veterinarians have to charge for our services. Unfortunately, unlike a dancer, no matter how passionate I may be, I can’t do my job for free. The tools and supplies we use cost enormous amounts of money. And ultimately, I also need to eat.

Lastly, being a veterinarian takes an emotional toll in many ways. I believe that performing euthanasia is a privilege that spares animals from suffering, but that doesn’t mean it’s easy for me. I’m not a fan of having people lash out at me because I’m a handy target for their grief, guilt or frustration.There are certainly times when I wonder why I have invested years of my life, endless hard work and large sums of money all to earn the privilege of being yelled at by a client who doesn’t understand that I’m trying to help.  And I could happily go the rest of my life without ever again having to call a devoted owner in the wee hours of the night to give them heartbreaking, bad news.

Do I Like Being a Veterinarian?

Overall, yes. Would I do it again? Some days yes; some days no. There are easier paths I could have chosen. Would I recommend it to anyone else? Maybe not. For those who think they might maybe enjoy being a veterinarian, I recommend considering other options. But there are those who hear the call, who feel the passion and who are willing to make the sacrifices. You know who you are. And it can be rewarding—assuming you can pass organic chemistry.

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What is DCM? Is it Diet Related?

BY MEGAN TREMELLING, DVM, LVS

Dilated cardiomyopathy (DCM) is a disorder in which the heart muscle becomes too weak to pump properly. Treatments exist, but many cases are fatal. It is, unfortunately, very common in Dobermans, Pinschers, Boxers and Great Danes and also occurs in other medium to large dogs such as Irish Wolfhounds, Saint Bernards and Newfoundlands as well as one small breed, the Cocker Spaniel. Because of the breed’s predisposition, we believe that there is a genetic component to some forms of the disease.

DCM can also be caused by some other problems including a deficiency of certain nutrients: the amino acids taurine and carnitine. In some cases, for example, when a dog is being fed a completely unbalanced diet, it is a simple question of dietary deficiency.

However, there are other cases in which the problem seems to be the dog’s ability to absorb or metabolize taurine properly. Cocker spaniels, in particular, can develop the disease while eating a diet that many other dogs consume without a problem. Taurine levels in the blood can be tested to prove there is a deficiency. Treatment with extra taurine and/or carnitine in these cases has enormous benefits to the heart.

Recently, veterinary cardiologists have been finding DCM at higher rates than expected in breeds that ordinarily don’t get the disease. Most of these dogs had normal taurine levels. Another thing they have in common is that the majority were eating what became known as “BEG” diets which fit into one of three categories:

1. Boutique foods such as homemade diets or those made by small pet food companies.

2. Exotic ingredients not traditionally found in dog food such as potatoes, legumes (peas and lentils), buffalo, venison, tapioca and so on.

3. Grain-free diets of any kind.

Some of the dogs got better when switched to different, more traditional food.

Could there be a connection between these BEG diets and the unusual cases of DCM? A link seems likely. What that link might be remains a mystery since taurine levels were not low in most of these dogs. Veterinary nutritionists and cardiologists are hard at work to sort out all the possibilities. The investigation starts with finding out which foods are most often connected with DCM.

The FDA has released the names of the brands most commonly implicated. Ultimately, we still have more questions than answers about diet-related DCM in dogs. We do, however, have some information that lays out a course for getting some answers as well as protecting our pets.

If you are worried that your dog may have DCM, see your veterinarian. Unfortunately, the signs of DCM in dogs can be vague. Some dogs have no signs at all. Others may have weakness, weight loss, cough, difficulty breathing and fainting episodes. Some dogs with DCM have heart murmurs, while many do not. Of course, not every dog that coughs or has a heart murmur has DCM.

Your veterinarian can take an X-ray of the chest to screen for DCM if your dog is showing signs that worry you. Other tests that may be useful include ECG (also known as EKG), bloodwork and blood pressure measurement. Measuring taurine levels may be useful in some dogs, particularly Cockers and Golden Retrievers.

The definitive test for DCM is an echocardiogram, also known as an ultrasound exam of the heart. Some veterinarians in general practice can perform this test while others refer patients to a veterinary cardiologist or other specialist. Once DCM has been confirmed, testing the patient’s blood for a taurine deficiency is appropriate, but even dogs with normal taurine levels can develop DCM as a result of their diet.

If your dog is diagnosed with DCM, in addition to treating with medications, you should follow your veterinarian’s instructions for feeding. This is likely to mean a traditional commercial dog food. By this, I mean one made by one of the big old-fashioned companies like Purina and Waltham. These are brands containing standard ingredients like chicken, beef, corn and wheat. Even if your dog does not have DCM, veterinarians involved with the research recommend avoiding BEG diets until we understand more about the problem.

Many dog owners are taken aback at suggestions that they should give their pets food made with ingredients like chicken and corn. Heavy advertising by some of the BEG manufacturers has led owners to believe that traditional ingredients are harmful to dogs or that there is some nutritional benefit to feeding an exotic or grain-free diet. There is no truth to this belief. While the idea of feeding your dog like a wolf is appealing, the fact is that dogs are not wolves. I have never heard of a pack of Pugs taking down an elk and eating it. Dogs have adapted to eat chicken and grains, and most of them do very well on them, with the exception of the minority which have allergies or food intolerances.

Some dog owners don’t trust the large dog food companies, especially after hearing about contamination and recalls. Personally, I feel safer giving my dog food from a large company. While the big dog food companies have certainly had some quality control problems over the years, they actually have fewer problems of this type than the small boutique companies. As much as I love the idea of my dog’s food coming from a family-owned startup—cooking in their home kitchen with the recipe that always kept Grandpop’s dogs in fine trim—when it comes down to it, I want my dog eating food that has been made by a company that has a research laboratory with veterinarians on staff. I want nutritional expertise. I want them testing their product for safety, decreasing the chance that any problems make it to market. I want them doing feeding trials to see what happens to a dog that eats their food, and only their food, for months at a time. I want them doing research to figure out what new tweaks they can offer to give my dog a wholesome food that will keep her healthy.

Feeding a dog food made by a large company may not be as satisfying as boutique food. It may not make me feel as if I’m treating my girl like the unique and integral family member she is. But ultimately, it’s not about my feelings; it’s about what’s good for her. I won’t risk her life to follow trends and marketing ploys at the expense of nutritional expertise.

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