Posts

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.

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.

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/

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.

By MEGAN TREMELLING

Nobody wants fleas and ticks on their dog. Even people who don’t like spending a lot extra on caring for their dogs don’t want those parasites getting into their homes and biting the humans. Therefore, valuing your dogs’ health and comfort and preventing external parasites is an important part of their overall care. Many people were worried to hear that the FDA had issued an alert in September about a potential danger associated with some flea and tick products that are part of the isoxazoline group: Nexgard (afoxolaner), Bravecto (fluralaner), Simparica (sarolaner) and Credelio (lotilaner).

What exactly is the problem? It seems that some dogs that have been treated with isoxazolines have developed neurologic symptoms, including tremors, ataxia (wobbly gait) and seizures. It is important to understand that millions of doses of these medications have been given to dogs, and that the fact that some dogs developed neurologic signs does not prove that the symptoms were always, or ever, caused by the medication. After all, some of those dogs probably broke a toenail after receiving the treatment, too. The reason this is different is that it is possible that in some cases the medication did cause the problem. We just don’t know enough to be sure. As with every new group of drugs, pre-release clinical studies can only teach us so much, and we learn much more when the medications are approved and used in large numbers of pets with a wide variety of concurrent medical conditions and medications on board. The FDA has more data on these medications than anyone else, and so far their official word is that “the isoxazoline class [is] safe and effective for dogs and cats.”

To get to a more complete understanding, veterinarians are researching possible adverse effects from isoxazolines and similar drugs, including neurologic changes and vision changes. In the meantime, for very young dogs and for dogs that have a history of seizures, tremors, ataxia, or vision loss, isoxazolines may not be the best choice. For dogs with no history of those problems, there is less reason to believe that these medications cause any significant danger.

As with so many things in life, all medical treatments come with risks and benefits. Veterinarians think in terms of minimizing risk because it is impossible to eliminate it. Isoxazolines have the advantage of being very convenient and very effective at killing fleas and ticks and, for most dogs, the benefits far outweigh the risks. I use one for my own dog.

Of course, if you are not comfortable using an isoxazoline for any reason, you should talk to your veterinarian about whether it is the right choice for your dog because many other options exist, with their own benefits and risks. If you think your dog may be having problems caused by an isoxazoline, you need to talk to your vet about that, too. It isn’t as simple as saying “it’s safer not to give the medication” because most of the time that just isn’t true. The benefits of flea/tick medications are enormous and very well documented; they reduce sickness and death from very common diseases that are transmitted by these parasites.

Stories like these sometimes cause people to reach for “natural” remedies in hopes that they will be safer. Unfortunately, they can be, in some cases, far more dangerous than carefully-tested and properly-prescribed medications. Herbal extracts and essential oils may have their uses, but flea and tick control is not among them. On the other hand, harmful effects, including death, are well-documented, especially when used incorrectly. Safety aside, I do not condone putting anything with a strong smell on your dog if you can help it. A dog’s nose is so sensitive that applying any strong smell to their bodies, where they cannot get away from it, is unlikely to be appreciated.

You may feel that your dog is at low risk for getting fleas and ticks, but if he ever sets paw on the ground or comes in contact with dogs that do, then he has the potential to be exposed to them no matter how meticulous your yard care. Never seen a flea or tick on him? You might not; they are pretty good at hiding. However your veterinarian can tell you whether you have a problem and help you find the solution that is right for your pet.

By KERRI WIEDMEYER, DVM, WVRC

Bloated may be how we all feel after a nice holiday meal, but Bloat in a dog is a very different kind of bloat. Bloat, otherwise known as gastric dilatation and volvulus (GDV), is a very serious condition that occurs when the stomach fills with gas and then rotates, causing further distension and a series of severe complications.

How Do Dogs Get Bloat?

That is the million-dollar question. No one knows the exact cause of bloat; however large breed, deep-chested dogs are more likely to bloat than other breeds. Older dogs are also more commonly seen with bloat than younger dogs. In some cases, eating or drinking large amounts and then being active is thought to cause bloat. There is also thought that eating out of elevated food dishes may increase chances of bloat as dogs may swallow more air when eating.

Unfortunately, there are many times when dogs present with bloat with no predisposing cause; and, although it is much less common, small breed dogs can bloat.

What Does Bloat Look Like?

Dogs with bloat can be restless and unable to get comfortable or lay down. They will hypersalivate/drool and try to vomit, but nothing will come out. They can have very distended abdomens that can be very painful. They may also have very fast heart rates and changes in breathing. In severe cases, they may collapse or be unable to stand. It is very important that if you see any of these signs that you have your dog evaluated by a veterinarian immediately. As veterinarians, we understand that each dog can show different variations of these signs; if there is any concern, an owner can always call a veterinary clinic and ask their opinion.

Why is Bloat an Emergency?

Bloat sets off a cascade of damaging events to the body. As the stomach fills with air, it expands and starts to cut off blood returning to the heart. The expansion of the stomach then puts pressure on the diaphragm, making it difficult for the dog to breath. The stomach then starts to rotate, cutting off the blood supply to the stomach. When the stomach rotates, it can entrap the spleen and thus cause damage or cut off blood supply to the spleen and even rupture blood vessels. All of these changes lead to the dog going into shock. Blood pressure drops, arrhythmias and internal bleeding can occur as well as sepsis. Unfortunately, death can occur in a matter of hours if bloat goes undetected and untreated.

All of these changes happen very quickly, which is why it is so important for an owner to recognize the signs of bloat and get them to a veterinarian as soon as possible.

How do you Treat Bloat?

Unfortunately, there is nothing that an owner can do at home. It is imperative that the dog gets to a veterinarian as soon as possible. Typically, a radiograph will be performed to diagnose a GDV. These dogs then require pain medication, intravenous fluids and emergency surgery immediately. The surgery consists of de-rotating the stomach back to its normal position and then tacking it to the body wall. This is called a gastropexy. If the spleen was involved in the twisting, then it may have to be removed as well. Even after the surgery is performed, these dogs are not out of the woods. There are many complications that can still arise after surgery and it is very common for these dogs to be in the hospital for multiple days. As many as 15 to 30 percent of dogs will not survive bloat even with immediate care and surgery.

Preventing Bloat

Today many people are putting their minds at ease early on by getting prophylactic treatment done. If you own a large breed dog that is more likely to bloat, a gastropexy can be performed when the dog is spayed or neutered.

This procedure will not prevent the stomach from distending with gas, but it will prevent the stomach from twisting/ rotating. The “twisting” is what makes a GDV a surgical emergency. Preventing this by tacking the stomach at an early age will likely save an owner from some sleepless nights and an expensive emergency surgery.

Other considerations to try and prevent bloat are feeding several small meals a day, discouraging drinking large amounts of water at one time, allowing some time between eating and activity, and feeding on the floor.

Hopefully knowing some of these preventative tips will decrease the chances of your furry family member bloating; however, if you see the signs listed above do not wait! Get that loved one to a veterinarian.

By MEGAN TREMELLING, DVM, LVS

In January, someone tried to take a peacock on a United Airlines flight, claiming it was an emotional support animal (ESA). Last June, a 50-pound dog that was traveling on Delta as an ESA badly mauled the face of another passenger. So much for the friendly skies.

Don’t get me wrong here. I’m not opposed to the idea of ESAs. Animals can be an incredible balm to the human psyche even when it is in perfect working order. Mental health is extremely complex, and if somebody needs their dog with them to be able to manage, I’m not going to criticize. Fortunately, the TSA views ESAs as aids that allow people to live their lives, going a step beyond the job of “pet,” and so ESAs are allowed in airports and airplanes. Traveling with a disability can be challenging enough without the airlines placing undue burdens on the people who need these animals to get by.

On the other hand, when an airplane cabin starts to resemble a petting zoo, and passengers are being taken away by ambulance, clearly there is a flaw with the system. A big part of the problem, of course, is the irritating phenomenon of people pretending their dogs are ESAs, or even service animals, when they really aren’t.

Why would someone pretend to have an ESA or service dog, instead of admitting that their dog is a pet? For one thing, traveling with a pet can be challenging. People are understandably wary of putting their pets in cargo, given some tragedies that have occurred there. Whether in cargo or in the cabin, there are fees to be paid, and the airline may turn your pet away if there are already too many animals on the flight. ESAs and service dogs, however, sometimes travel for free, and are more likely to be accommodated in the cabin regardless of the number of animals on the airplane or the size and weight of the dog.

This does not change the fact that pretending your pet is an ESA is clearly unethical in all cases, and is criminal in some areas. There is quite simply a limit to the number of animals that can fit on a given airplane before things get disruptive. Like disabled parking permits, those spaces should be reserved for people who actually need them.

In an attempt to reduce abuse of the system, some airlines have begun to use more stringent restrictions on ESAs. Delta, for example, has quite an extensive list of animal species that are not permitted on board. United now requires customers with ESAs to bring “a veterinary health form documenting the health and vaccination records for the animal as well as confirming that the animal has been trained to behave properly in a public setting.”

Owners are notoriously bad at assessing their own animals’ behavior, so I can see why the airlines want to get a third party to vouch for the dog, but many veterinarians are wary of going on record stating that their patients have been trained to behave properly. For one thing, even a dog that is well-mannered under ordinary circumstances may find the conditions on an airplane to be a little much. Let’s face it, after standing in line at security, navigating the hubbub of the airport, and then getting squeezed for hours into a cramped space that makes deafening noises and ear-popping pressure changes, even the humans are just about ready to bite somebody. There is no way that I or any other veterinarian can tell whether a dog that behaves nicely in the clinic will continue to do so in flight.

People who genuinely need ESAs will be the ones to suffer if they can’t produce the paperwork the airlines now expect. Even service dogs from an accredited training program, which are expertly-trained to tolerate quite challenging conditions without causing trouble, may find it hard to get on board.

It remains to be seen how to best balance the needs of people with disabilities who rely on their animals to function and the other passengers’ basic expectation of reasonable safety. Veterinarians, representatives of the air travel industry, and disability advocates are attempting to work together to find a way to ensure that genuine service dogs and ESAs are accommodated without putting other passengers at risk. But one thing is clear: pretending your pet is a service animal is not okay.