Tag Archive for: Dr. Kerri Wiedmeyer

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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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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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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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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Why is My Dog Drinking so much Water?

BY KERRI WIEDMEYER, DVM, WVRC

There are many factors that determine how much water a dog drinks in a given day, but if you notice that your dog is drinking bowl after bowl, there may be a cause that warrants investigation.

Thirst is regulated by several different components in the body including blood vessel volume, parts of the brain (pituitary gland, thirst center, hypothalamus) and the kidneys. For example, if a dog is dehydrated, hormones are released from the brain that communicate to the kidneys to keep water in the body and activate the thirst center. If a dog is urinating excessively, the body then responds by having the dog drink more to make up for that loss of water. Unfortunately, certain diseases can interfere with how thirst and urination are regulated, causing your dog to gulp down bowl after bowl of water. Below is a list of a few of these causes.

Kidney Disease: The function of the kidneys is to filter blood and balance electrolytes. They also regulate blood pressure and red blood cell production. Kidneys can become damaged for a multitude of reasons such as chronic disease, infection, toxins or cancer. When they become damaged, they cannot do their job properly and excessive urine is produced. Excessive urination then leads to excessive drinking.

Diabetes Mellitus: Diabetes occurs when there is not enough insulin produced to regulate glucose in the body. This results in excessive amounts of glucose in the bloodstream. When the glucose is excreted from the body, water follows it, producing excessive urine. As with kidney disease, the excessive urination causes excessive thirst/drinking.

Cushing’s Disease (Hyperadrenocorticism): Cushing’s is a disease in which the body overproduces cortisol. Cortisol, in turn, blocks other hormones from doing their job and results in excessive urination and, thus, excessive drinking.

Liver Disease: The liver has many different jobs including protein and hormone production, detoxifying the blood, and metabolism of fats, carbohydrates and drugs. As a result, if the liver is failing, there are several different pathways that can lead to a dog urinating excessively and drinking excessively.

Medications: Unfortunately, some of the medications prescribed for our pets can have side effects that make them drink and urinate more frequently. Examples include steroids, diuretics that are commonly used for heart failure treatment and some anti-seizure medications.

Psychogenic Polydypsia: Psychogenic polydypsia is drinking excessive water without any underlying cause or illness. Many think this is done from boredom or for attention, but it is overall a very rare cause for excessive thirst.

If this sounds like your beloved pup, then consider having him or her checked out by your veterinarian.

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