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ABOUT THE DIAGNOSIS

Atopic dermatitis (also called atopy) is an allergy to substances from the environment. Substances that can elicit such allergic reactions are called allergens or antigens.

Atopic dermatitis is a common problem in dogs and cats, although dogs are more likely to have it than cats. A genetic basis is suspected since it occurs more commonly in certain breeds and lines. Allergens that are well-recognized triggers for atopic dermatitis include pollens, molds, dander (shed skin cells), house dust mites, tobacco smoke, and a variety of other substances.

The primary symptom of atopic dermatitis is itching, and the problem typically first becomes apparent when a pet is between 6 months and 3 years old. Early symptoms in dogs may be mild and can include foot-licking, face-rubbing, ear problems, and scratching behind the elbows, all without any visible reason (no visible fleas, no plant material caught in the haircoat, etc.). The problem is often seasonal. As time goes on, the allergy worsens and more areas of the body become involved. Itching that at first occurred only seasonally may become present all year round.

Cats with atopic dermatitis can show several different types of skin problems. Some show hair loss on the abdomen (belly) and inner thighs or on the back. This hair loss is from overgrooming (licking, chewing) due to itching. Others may scratch around the face and neck. A condition called miliary dermatitis may develop, where small crusts (scabs) can be felt through the haircoat on the surface of the skin. Eosinophilic granuloma complex is another manifestation of allergies in cats; signs include raised, flat, reddened areas (plaques) on the skin or sores on the upper lip.

Diagnosis of atopic dermatitis may be challenging because many other types of skin problems produce the same degree of scratching, hair loss, and redness of the skin. For your veterinarian to reach the conclusion that atopic dermatitis is present (i.e., establishing the diagnosis), a combination of elements usually needs to be present:

  • The typical history of the onset of itching (often seasonal, since pollens are a common cause of atopic dermatitis), plus
  • Finding a typical pattern of skin lesions over affected areas, and
  • The exclusion of other causes of itching.

Your veterinarian will use a thorough physical examination and often will need to perform several tests to rule out other skin problems such as mange mites, ringworm, bacterial infection, or flea allergy, any of which can cause itching and scratching that is identical in initial appearance to atopic dermatitis. Once the diagnosis of atopic dermatitis is made, treatment can be undertaken for comfort and relief of itchiness, or further tests can be conducted to determine which substances in the environment are triggering the atopic dermatitis in order to remove them or desensitize your pet to them as a part of treatment. These advanced tests include intradermal skin allergy tests and serum (blood) allergy tests.

LIVING WITH THE DIAGNOSIS

Atopic dermatitis cannot be cured, so efforts should be directed at managing your pet’s symptoms. See the options discussed under Treatment. For a second opinion, the latest treatment options, or if initial efforts to control itching are not successful, consider consulting a veterinary dermatologist (www.acvd.org) for North America or www.ecvd.org for Europe

Atopic dermatitis can be a profoundly frustrating disorder both for the pet and the owner, since relentless chewing and licking can be intensely bothersome to both. With a proper diagnosis and with appropriate treatment, however, the majority of pets with atopic dermatitis become comfortable and lead normal lives.

TREATMENT

Several approaches can be taken for treatment. The best option for the pet’s health is to perform tests to determine which allergens are causing the problem. Then, if possible, you can take steps to minimize or eliminate exposure to the allergens in your pet’s environment. If the allergens cannot be avoided (such as when pollens from plants or trees are the cause), a series of injections of small amounts of the allergens can be used for gradually causing desensitization to the allergen. It is also important to look for other problems that may be contributing to the itching.Many pets with atopic dermatitis are “polyallergic” and also have other sorts of allergies such as food allergy or flea bite allergy. These allergies compound the symptoms of itching and scratching. Therefore, working with your veterinarian to determine whether your pet has an allergic disorder beyond atopic dermatitis can be important if your pet is allergic both to airborne allergens and fleas, certain food ingredients, or other trigger substances.

Skin that is inflamed due to scratching and chewing from atopic dermatitis is prone to bacterial or yeast infections that can themselves also cause even more itching. A simple sampling off the surface of the skin (skin cytology) and examination of the harvested skin cells under a microscope can identify whether these complications exist; antibiotic or anti-yeast treatment can make an enormous difference in such cases.

Finally, long-term and/or high-dose treatment with cortisone-like medications may limit the skin’s natural defenses and allow opportunistic infections, such as sarcoptic mange and demodectic mange, to develop. This, too, causes more itching and scratching; the simple skin scraping procedure described above is the test of choice for identifying mites when it is present, and elimination of these parasites is straightforward and highly effective.

Therefore, elimination of as many causes of itching as possible (e.g., fleas, food allergies, secondary skin infections) can control a pet’s symptoms, even if the atopic dermatitis itself is not treated. Consult your veterinarian on carrying out these steps and also to have your pet checked for skin infections.

Several medications are used for treating itching caused by atopic dermatitis or allergies in general. Antihistamines are helpful in some pets. Omega-3 fatty acids can help ease skin inflammation. Corticosteroids (cortisone-like medications) are often used for reducing inflammation and itching and are usually very effective. However, corticosteroids are powerful medications that can have serious side effects when used long term, so they should be used at the lowest dose possible and for as limited an amount of time as possible, or on an intermittent, as-needed basis. Cyclosporine is a powerful immunosuppressive medication that has been approved for the treatment of itching caused by atopic dermatitis in dogs. It works as well as corticosteroids in controlling itching and produces far fewer side effects but is more expensive. The newest medication for treating atopic dermatitis, oclacitinib, is very effective in many dogs. Consult your veterinarian about the various medications that are available. Often the best response is individualized and some degree of trial and error is needed to find the best combination for a particular pet.

DOs

  • Realize that tests are needed to look for other skin disorders that mimic atopic dermatitis, and to look for complicating or secondary disorders that are occurring on top of atopic dermatitis. The value of these tests lies in identifying anything other than atopic dermatitis that would require a specific, different treatment.
  • Realize that atopic dermatitis itself often is a diagnosis of exclusion, meaning it is the explanation for itching and scratching when no other cause can be found.
  • Give all medications exactly as instructed.
  • If your pet has been tested to determine what substances it is allergic to, try to avoid contact with those substances.
  • Eliminate as many other causes of itching and skin inflammation as possible.

DON’Ts

  • Don’t assume that “cortisone pills” (glucocorticoids) are the only solution to treating an allergic disorder like atopy. Although the simplest and most effective in the short term (days), they only suppress the allergy and can cause serious health problems long term.
  • Don’t forget the value of a second opinion. Veterinary dermatologists are experts at skin diseases of dogs and cats, can differentiate atopic dermatitis from other disorders, and are aware of the latest treatments. Veterinary dermatologists are known as Diplomates of the American College of Veterinary Dermatology and can be recommended by your veterinarian; see www.acvd.org for a complete listing in North America, or www.ecvd.org for Europe.

WHEN TO CALL YOUR VETERINARIAN

  • If symptoms suddenly worsen.
  • If signs of ear disease are noticed (head shaking, pawing at ears, pain on touching the ears), because atopic dermatitis may produce otitis externa (inflammation of the ear flap and/or the ear canal) as part of allergic skin disease.

SIGNS TO WATCH FOR

  • The following is to be expected as a common response to medication: if your dog receives corticosteroids (cortisone), it is common that he/she will drink more water than usual, be hungrier than usual, and may pant more than usual (dogs).
  • Sudden increase in itching; this could result from the onset of secondary bacterial or yeast infections.
  • Ear problems, such as redness, head shaking, odor; many allergic pets are prone to ear disease.

ROUTINE FOLLOW-UP

  • The frequency of recheck examinations depends upon the severity of your pet’s symptoms and the treatment methods used. If corticosteroids (cortisone) are part of your pet’s treatment program, periodic blood tests may be recommended to look for problems that can result from corticosteroid use.

ADDITIONAL INFORMATION

  • Since atopic dermatitis is an inherited condition, pets affected with this disease should not be used for breeding.

Other information that may be useful: “How-To” Client Education Sheets:

  • How to Deal with Incessant Scratching
  • How to Assemble and Use an Elizabethan Collar

From Cohn and Côté: Clinical Veterinary Advisor, 4th edition. Copyright © 2020 by Elsevier Inc. All rights reserved.



ABOUT THE DIAGNOSIS

Arrhythmogenic right ventricular cardiomyopathy is also called ARVC for short, or boxer cardiomyopathy, because it occurs predominantly in boxer dogs. ARVC is a heart disease that affects the heart muscle tissue, is almost always of genetic origin (inherited from the father, the mother, or both), and is usually first detected in adult dogs, not puppies. That is, the genetic defect that causes ARVC is inherited from one or both parents, but the first detectable sign (typically on an electrocardiogram [ECG] or Holter monitor) is usually only detected after the age of 2 or 3 years old.The heart tissue is made up mainly of muscle cells. In the normal, healthy heart, the heartbeat is triggered by a normal, organized wave of electricity that travels through these muscle cells to cause the heart to pump. When the heart pumps, the blood within the heart chambers moves to the rest of the body, providing oxygen and various nutrients to the body’s tissues. In the heart affected by ARVC, the origin of some heartbeats may be abnormal, causing an erratic—and often very fast—beat of the heart (abnormal rhythm, “arrhythmia”). Boxers with this disease may have episodes of collapse that may or may not be triggered by excitement or exercise. Some boxers faint (syncope) when the heart begins to beat irregularly because it may beat so irregularly and so fast that the pumping action of the heart is compromised and not enough circulation reaches the brain to maintain consciousness. Between these episodes, a dog with ARVC usually appears healthy, comfortable, and externally normal. Much less commonly, and as a more serious form of ARVC, the heart muscle tissue may hamper the circulation such that fluid accumulates in the dog’s lungs and causes breathing problems, or in the abdomen/belly causing abdominal enlargement.

The problem is recognized in the boxer breed internationally, but not all boxers have ARVC. Many boxers have perfectly healthy hearts. Some boxers with ARVC have an abnormal heart rhythm but no symptoms; these may be carriers of the disease who go on to develop symptoms later in life. The diagnosis is serious, because any boxer with this disease has an increased risk of sudden cardiac death.

Diagnosis:

Boxer cardiomyopathy may be suspected by your veterinarian based on your dog’s history and symptoms, if any. A cardiac arrhythmia may be present at the time of examination, An electrocardiogram (ECG, EKG) is the definitive test. For this test, small metal clips are gently attached to the dog’s skin in several places as the dog rests quietly. These clips are attached to a machine that can convert the heart’s electrical impulses to a graphic representation on paper; it is the same type of ECG/EKG as in human medicine. The abnormal heart rhythm that is characteristic of ARVC is sporadic, however: it comes and goes with no predictable pattern. In some dogs with ARVC, the abnormal heart rhythm (an arrhythmia called premature ventricular complexes) is much worse with excitement, whereas excitement makes no difference to some other dogs with ARVC. Therefore an electrocardiogram performed in the clinic may or may not reveal the abnormality. If there is uncertainty, portable heart monitors (Holter monitor, cardiac event monitor) may be used for assessing the heartbeat over 24 hours or intermittently over several days, respectively. Finally, since many other disorders unrelated to ARVC can cause irregularities in the heart rhythm, an accurate diagnosis usually requires further assessment (e.g., x-rays of the chest and abdomen, ultrasound of the abdomen and heart, blood tests), which can be tailored based on the veterinarian’s initial findings.

Cause: The specific cause of ARVC is unknown. It is genetic in origin. Striatin is a protein in normal cardiac muscle cells and a mutation in this protein is present in many boxer dogs with ARVC. There is a blood test available for this mutation, but it is not perfect because some dogs with ARVC do not have the mutation. The genetic test can be used to help screen for the disease, reducing or eliminating ARVC depends on screening adult boxers prior to breeding using a Holter monitor (24-hour portable ECG/EKG monitor that the dog wears at home for a day), and excluding dogs that have a high number of irregular heartbeats from any breeding program. Importantly, healthy boxers may have a heartbeat that is irregular but healthy (“respiratory sinus arrhythmia”), a common finding in healthy human athletes. Therefore, be sure not to jump to conclusions if you notice that your boxer’s heart rhythm seems irregular: only an ECG/EKG can tell whether this is healthy or abnormal.

LIVING WITH THE DIAGNOSISA

diagnosis of ARVC carries a guarded prognosis (life span may be shortened) because a sudden deterioration or even a fatal event is possible if the heart rhythm suddenly becomes very erratic. Depending on the results of the diagnostic tests (see above), different medications can be given, including omega-3 fatty acids (all cases) and cardiac antiarrhythmic medications (some cases, based on the veterinarian’s assessment). However, because ARVC is genetic in origin, these drugs only treat symptoms and are not a cure. Despite taking drugs, the disease may continue to progress and the goal of treatment is to reduce the symptomatic episodes. Since no two dogs are the same, it may be necessary to give several medications until one is found that helps your dog best.

Boxers diagnosed with this disease should not be bred. Breeding restriction like this is in order to avoid perpetuating the problem in offspring. If your boxer is involved in a breeding program, your veterinarian may recommend regular (perhaps annual) testing with a Holter monitor to make sure there are no signs of ARVC.

If possible, dogs diagnosed with ARVC should avoid stressful situations or events that cause excitement. This can be a difficult task for owners, but common-sense attention to minimizing environmental triggers of excitement (without severely compromising quality of life) may reduce the risk of severe or even life-threatening complications. Examples include disconnecting a doorbell and posting a “please knock” sign if the doorbell makes the dog very agitated and limiting the intensity of play with other dogs. This can be difficult in a happy-go-lucky dog like the boxer, so the point is to limit, not abolish, physical activity; to make the dog active and playful in a slow, consistent way (slow, longer leash-walks, for example); and to avoid sudden bursts of intense physical exertion (cut back on sprinting, ball-chasing, etc.).

TREATMENT

Medications are available to help control the abnormal cardiac rhythm caused by ARVC. Your veterinarian can prescribe medications based on the results of x-rays, ultrasound exam, and/or electrocardiogram. These medications help some dogs but not others, and unfortunately some dogs continue to exhibit symptoms related to this diagnosis even after taking medications. In such cases, other types of antiarrhythmic medications may be used, or further testing may be recommended to ensure that another disease process is not to blame.Omega-3 fatty acid supplementation (fish oil; 780 mg eicosapentaenoic acid [EPA] and 497 mg docosahexaenoic acid [DHA] per dog, given by mouth or with food once a day) has been shown to reduce the number of erratic heartbeats in boxers with ARVC and should be given to every dog with ARVC.

Each dog diagnosed with this disease requires a tailored treatment regimen that may need to be changed periodically, depending on the dog’s response. Your veterinarian will determine the best plan for your pet.

DOs

  • If your boxer has periods of weakness and/or fainting, take him or her to your veterinarian for an evaluation. Be sure to keep the dog as calm and comfortable as possible.
  • Remember that even though boxers with ARVC look normal for more than 99% of the time, having ARVC means a risk of sudden collapse and even death and excessive excitement may increase the risk.
  • Give medications exactly as directed. If you are concerned that the medications are not working, or are working differently than expected, contact your veterinarian before making any changes yourself.
  • Talk to your veterinarian about having your boxer tested regularly for this disease, especially if involved in a breeding program.
  • Remember that ARVC can be a complex and difficult disease, and you may wish to seek a second opinion from a veterinary cardiologist: see www.acvim.org or www.vetspecialists.com (North America) and www.ecvim-ca.org (Europe) for a list of veterinarians that are board-certified specialists in veterinary cardiology.

DON’Ts

  • Do not breed a boxer that is diagnosed with this disease.
  • Do not assume that your boxer does not have this disease if no symptoms are evident, because it is common for irregular heartbeats to go unnoticed if an ECG/EKG or Holter monitor has not been performed.
  • Do not stop giving a drug without talking to your veterinarian. Some drugs must be gradually decreased or serious side effects can result.
  • Do not allow a dog with ARVC to swim in deep water or walk/hike near ledges or cliffs. When ARVC produces symptoms, fainting is the most common one. Fainting when swimming (risk of drowning) or when near a ledge or cliff (risk of disastrous fall from a height) can only be prevented by avoiding those locations.

WHEN TO CALL YOUR VETERINARIAN

  • If your dog shows negative reactions to the drugs including weakness, anxiety or nervousness, vomiting, diarrhea, hives (bumps under the skin), constipation, seizures, etc. These are uncommon with the medications used for treating ARVC.
  • If you cannot return for a scheduled visit.

From Cohn and Côté: Clinical Veterinary Advisor, 4th edition. Copyright © 2020 by Elsevier Inc. All rights reserved.



ABOUT THE DIAGNOSIS

A rodenticide is a product used for killing rodents such as rats and mice. Rodenticides are commonly referred to as rat or mouse bait, rat poison, or mouse poison. Rodenticides are poisonous to cats and dogs. The effects depend on the type of rodenticide that is ingested. Many rodenticides contain anticoagulants, which are poisons that work by causing the animal to bleed internally. The poison interferes with the blood’s ability to clot (coagulate). Symptoms of accidental ingestion of anticoagulant rodenticides include sluggishness and mental dullness, weakness, bloody vomit and/or diarrhea, bleeding from the nose, bleeding into joints that can cause limping (lameness), hematomas (pockets of blood that collect under the skin), excessive bruising on the skin, breathing difficulty caused by bleeding into the chest and lungs, coughing, collapsing, and even death. The earliest symptoms only start to occur about 2 days after a dog or cat eats the poison. Therefore, if you see your pet consume anticoagulant rodenticide, do not panic, but bring him/her promptly to the veterinarian to receive the antidote.

Warfarin is one type of anticoagulant. It has been used in rodenticides for many years and is still found in some products. However, newer anticoagulant rodenticides are available that are even more potent. These include fumarin, diphacinone, bromodiolone, brodifacoum, and others. The names of these poisons are found on the package, and bringing the package and/or name of the rodenticide with you to the veterinarian will help greatly. There are more and more rodenticide types that are not anticoagulants, but work by an entirely different mechanism. By knowing what kind of poison your pet ate, the right antidote can be used. By knowing the specific type of anticoagulant rodenticide was ingested, and it tells the veterinarian how long treatment will likely need to be continued.

Diagnosis: Your veterinarian will perform a thorough physical examination and take a complete history, inquiring especially about the active ingredient in the rodenticide. Of course, you may not realize that your pet could have been exposed to a rodenticide (meaning that you won’t know the ingredients, either). In these cases the diagnosis depends on testing. Several tests may be performed to help make the diagnosis. Some tests are important to rule out certain problems that mimic anticoagulant rodenticide poisoning. They have nothing to do with anticoagulant rodenticide poisoning, but the symptoms they produce can be virtually identical. For example, immune-mediated hemolytic anemia and immune-mediated thrombocytopenia are diseases in which the pet’s own immune system inappropriately destroys its own red blood cells and platelets, respectively. Some dogs can be born with hemophilia, which is a bleeding disorder. Liver or kidney diseases can cause bleeding disorders. The tests are necessary to tell rodenticide poisoning apart from all these other disorders because the symptoms of all of them are similar.

To test for these and other problems, blood and urine samples may be taken. The veterinarian may take x-rays of the chest to look for potential causes of any breathing problem. The ability of the blood to clot can be measured from a blood sample.

LIVING WITH THE DIAGNOSIS

When the diagnosis of anticoagulant rodenticide poisoning is made, treatment must begin immediately (see Treatment below). It is very helpful identify the type of rodenticide that was ingested because some have longer-lasting effects and may require a longer course of treatment. If possible, bring the package to your veterinarian so that the toxic ingredient can be identified. It is safest to seal the package in a zip-type plastic bag or watertight plastic container to reduce the risk of any more of it being eaten.

Pet owners can prevent future exposure to these poisons by placing them in areas that are inaccessible to cats and dogs. Dogs should be kept in a fenced-in yard and on a lead during walks to reduce the possibility of ingesting rodenticides on the neighbors’ properties.

TREATMENT

Treatment depends on the type of anticoagulant, how much was consumed, how long ago, and how much and where in the body bleeding has occurred (if bleeding has occurred). If you know that your pet ingested the poison within the last few hours, some or all of it may still be in the stomach. Your veterinarian may give your pet a medicine to induce vomiting. The pet’s stomach may be further emptied by gently passing a tube into it and flushing it with warm water to “pump the stomach” (gastric lavage). A liquid called activated charcoal can be given through this tube or by mouth. Activated charcoal is a “universal antidote” that binds any poison remaining in the intestines to help prevent it from being absorbed. The activated charcoal containing the poison is then eliminated from the body when the pet has a bowel movement. The antidote, vitamin K1, is also given because the poison works by depleting the body of vitamin K1. Vitamin K1 is needed for normal blood coagulation. Vitamin K1 works slowly: depletion takes 2 days to produce bleeding and hemorrhage, but likewise giving vitamin K1 will take 1-2 days to work. Therefore, if the pet is having a severe bleeding crisis, a plasma or blood transfusion may need to be given to immediately help with blood coagulation (normal blood clotting). Depending on the type of anticoagulant rodenticide ingested, you may need to give vitamin K1 at home as tablets or liquids for up to six weeks. Your veterinarian can determine the effectiveness of treatment by periodically performing a blood test to measure how well the blood coagulates.

It is important that the pet rests during the 3 to 6 weeks of oral medication treatment because even minor trauma (bumping into objects, chewing on anything that scratches the gums, and similar mild trauma) can cause bleeding.

DOs

  • Call your veterinarian or the local emergency clinic immediately if your pet has eaten any type of poison.
  • Give medication exactly as directed.
  • Inform your veterinarian if your pet has ever been diagnosed with a medical condition and is taking medication, as some medications may interact with the antidote (vitamin K1).
  • Bring any remaining rodenticide packaging to the veterinary clinic.
  • Be sure to avoid re-exposure: dispose of any remaining rodenticide in a safe manner (seal in a plastic container before putting in the trash) so the same pet, or other pets, cannot be poisoned by it.

DON’Ts

  • Do not stop giving medicine without instructions to do so from your veterinarian. When vitamin K1 works, you should see no difference from your pet in a normal state. Stopping it just because “he/she looks normal now” is a potentially catastrophic mistake because anticoagulant rodenticides can become reactivated for up to 6 weeks after the day they were ingested, and 2-3 days after premature discontinuation, a bleeding crisis can occur again. Fortunately, after 6 weeks post-ingestion it is safe to stop vitamin K1 regardless of the type of anticoagulant rodenticide that was ingested.
  • Do not leave rodenticides in places accessible to your pets.

WHEN TO CALL YOUR VETERINARIAN

  • If you cannot keep an appointment.
  • If you are unable to give medicine as directed.
  • If your pet may have eaten any type of poison, or if you are not sure if something is poisonous.
  • If your pet is not improving after starting treatment.

SIGNS TO WATCH FOR

  • Weakness, decreased appetite, bloody vomit or diarrhea, constipation, hives (bumps under the skin), bruising, nosebleed, excess salivation, or seizures, as indicators of poisoning 2 days earlier or as a result of premature discontinuation of vitamin K1 treatment 2-3 days earlier.

ROUTINE FOLLOW-UP

  • Typically, a blood sample is taken 2 days after vitamin K1 therapy ends to monitor the pet’s response to treatment. This test is important to help determine if treatment needs to be continued.


ABOUT THE DIAGNOSIS

Cause: Anemia is a condition where the blood is too “thin,” as a result of a lower than normal number of red blood cells in the bloodstream. Red blood cells are important because they supply oxygen to all parts of the body, and when severe anemia is present, all of the body’s tissues are oxygen-starved, leading to symptoms such as sluggishness, loss of appetite, and even collapse and unconsciousness.

Immune-mediated hemolytic anemia (IMHA) is a particular cause of anemia in which the number of red blood cells is low because they are destroyed (hemolyzed) by the body’s own immune system. In the healthy body, the immune system attacks foreign invaders such as bacteria and viruses. However, in immune-mediated hemolytic anemia, the body misidentifies normal healthy red blood cells as foreign and destroys them faster than the body can replace them. In some pets, the onset of this disease appears to be somehow connected to or triggered by severe generalized infections, medications, cancer, and other immune-mediated problems. However, if and how these events cause immune-mediated hemolytic anemia remains unknown, and in the majority of cases of immune-mediated hemolytic anemia, an actual trigger for the whole process is never found.

This disease is diagnosed far more commonly in dogs than in cats. In dogs, it occurs more often in females. Cocker spaniels, poodles, springer spaniels, Old English sheepdogs, and Irish setters are affected more often than other breeds, although any dog, including mixed breeds, can develop this disease. Symptoms range from mild, vague symptoms to severe, life-threatening problems such as respiratory difficulty (see Signs to Watch For). Mild symptoms can quickly progress to severe, advanced disease, and a patient with these symptoms needs to be screened for anemia with a blood test performed by a veterinarian.

Diagnosis: Anemia (whether immune-mediated or not) can be suspected by a veterinarian when the oral mucous membranes (gums and tongue) are paler than normal. A definitive diagnosis of anemia comes from a standard blood test, which shows a lower than normal red blood cell count (hematocrit or packed cell volume are other measures of red blood cells). There are many causes of anemia in general, and the results of several tests as well as a complete history and thorough physical exam help to arrive at the diagnosis of immune-mediated hemolytic anemia. Be sure to share all information with your veterinarian regarding your dog’s or cat’s medical history, including the kinds of symptoms you have seen and how long they have been present, whether you have given your pet any medications in the preceding days, and so on.

Spherocytes are a type of deformed red blood cell that can be detected on a routine blood test in many dogs with IMHA but not in healthy dogs; the presence of spherocytes is strongly suggestive of IMHA. An autoagglutination test is performed to determine if red blood cells clump together, which is a positive indicator of this disease. The Coombs’ test reveals if certain molecules are present on the red blood cells’ surface. Other tests may be appropriate for your dog or cat, including tests to try to find a trigger for IMHA. Your veterinarian will discuss medical tests with you because this type of anemia requires them for confirmation.

During treatment, one or more of these exams may be repeated to help assess the effectiveness of treatment and to determine if adjustments are necessary. Subsequent test results may also make the long-term course of the disease clearer (help to arrive at an outlook, or prognosis).

LIVING WITH THE DIAGNOSIS

Immune-mediated hemolytic anemia is a disease that often begins with a critical, potentially life-threatening crisis, producing symptoms that prompt a visit to the veterinarian. The anemia may be difficult to control, and hospitalization, possibly with intensive care, is necessary for several days in many cases. After this period, or else right away in milder cases, oral medications are started and given daily for several weeks to months. Immune-mediated hemolytic anemia is a disease that can respond very well to treatment (all symptoms are abolished and the animal enters a clinical remission) or that may produce recurrent problems despite treatment—this varies from one dog to another. With IMHA, there is always a risk of recurrence, such that affected dogs need to be followed closely with veterinary rechecks.

TREATMENT

If your dog or cat is taking medication that might be triggering this disease, it must be discontinued. This needs to be discussed with your veterinarian first. If an infection is suspected, an appropriate medication is given to lessen or eradicate the infection. Intravenous fluids are often given to control dehydration. Corticosteroids (cortisone-like drugs, such as prednisone or dexamethasone) are commonly administered to subdue the excessively active immune system that is destroying the red blood cells. Other immunosuppressive drugs are often given in addition to corticosteroids for greater effect, and to eventually allow a more rapid reduction in dose of corticosteroid (NOTE: corticosteroids have many side effects, including increased thirst, urination, appetite, weight gain). Whole blood or red blood cell transfusions are sometimes necessary in moderate and severe cases to replace red blood cells that have been destroyed. Oxygen may be given. Because a serious complication of this disease is the formation of blood clots, blood thinners (anticoagulants) are likely to be given as well. Some of these anticoagulant drugs are given as pills, and others are given by injection.

Other treatment options are available, depending on how advanced the immune-mediated hemolytic anemia is. Not all of these treatments may be necessary for your dog or cat. Your veterinarian will tailor the treatment regimen for your pet. Immune-mediated hemolytic anemia is a life-threatening disease that can change and progress quickly. Although many affected dogs recover completely, they will require medications and frequent rechecks for months or even years. Sadly, many dogs with the disease succumb to the illness and die either in the first critical days after diagnosis, or are euthanized later on as a result of complications or relapse related to the disease or its treatment. There is a significant investment of effort and money in treating a dog with this disease. You should have a realistic conversation with your veterinarian about the outlook for your pet; it is not unreasonable to consider euthanasia (lethal injection to cause a painless death) either at the time of diagnosis, or if there is not a rapid response to treatment.

DOs

  • Inform your veterinarian if your dog or cat has ever been diagnosed with a medical condition and is taking medication.
  • Give medication exactly as directed by your veterinarian. For example, corticosteroids and other immunosuppressive drugs must be given in gradually decreasing doses when the decision is made to discontinue them. Suddenly stopping them without medical support for doing so can have severe, life-threatening consequences for your pet. Be sure you ask for prescription refills well before the drugs run out.
  • Follow your veterinarian’s instructions to limit your pet’s activity level if necessary.
  • This disease may recur weeks to months after your dog or cat is apparently healthy. Continue to observe closely for symptoms.
  • If your dog or cat has pale gums and is weak or if you suspect a relapse, take your pet to your veterinarian or to the local veterinary emergency clinic immediately.
  • Realize that immune-mediated hemolytic anemia can be very serious and even life-threatening in some cases, but dogs that respond to the first several days’ worth of treatment can do well in the long term (months to years).
  • Understand that IMHA can be difficult to treat, and that a second opinion from a veterinary internal medicine specialist may be helpful. You can discuss this with your veterinarian and a list of these specialists is available at www.acvim.org or www.vetspecialists.com for North America, www.ecvim-ca.org for Europe.

DON’Ts

  • Do not postpone visiting your veterinarian if you observe any symptoms of immune-mediated hemolytic anemia (see Signs to Watch For below). Prompt diagnosis and treatment may prevent complications that become more severe.
  • Do not give medication that you have at home that has been prescribed for human use; some of these may interfere with treatment and cause even more severe problems.
  • Do not jump to conclusions about what may have triggered IMHA in your pet. There is much hearsay about this disease, and your veterinarian can help you see clearly through it.

WHEN TO CALL YOUR VETERINARIAN

  • If you cannot keep a scheduled appointment.
  • If you are unable to give medication as directed.
  • If you notice any of the Signs to Watch For listed below.

SIGNS TO WATCH FOR

  • General signs of illness, which could indicate a beginning (or relapse) of immune-mediated hemolytic anemia. These include vomiting, diarrhea, decreased appetite, changes in behavior such as hiding more than usual (cats), weakness, lethargy, pale gums, exercise intolerance, labored breathing, yellow-tinted gums and/or skin (icterus, jaundice), and dark red/brown urine.
  • Reduction in symptoms, especially return of appetite to normal and a normal energy level, are significant indicators of improvement.

ROUTINE FOLLOW-UP

  • Follow-up appointments are always necessary to monitor progress, to determine if treatment should be adjusted or discontinued, and to pursue any abnormalities on previous blood tests. The exact interval varies from dog to dog, but the first recheck typically takes place 1 to 2 weeks after immune-mediated hemolytic anemia is first identified, and then the rechecks are spread out according to how well the problem is regressing.


ABOUT THE DIAGNOSIS

The anal sacs (also called anal glands) are two small pockets located just inside the anus, on the left and right sides of the anal canal in dogs and cats. Normally they produce a smelly, clear to light yellow liquid secretion, which is expressed from two small pores when the animal defecates. They can also discharge this odorous secretion spontaneously, or when the dog or cat is startled, injured, or excited. Several different types of problems can arise from the anal sacs. These include inflammation, infection, and even tumor formation. Dogs, especially small breeds, are more commonly affected than cats. The most common anal sac problems are:

  • Impaction—failure of the anal sacs to discharge, resulting in inspissation (drying out and hardening) of the contents, which then accumulate, causing discomfort as for hemorrhoids in people.
  • Abscessation—bacterial infection of the sacs, usually following an impaction. Inflammation and pain in the area will be present. The abscess can often burst through the sac, draining pus and blood onto the skin and haircoat around the anus.

The diagnosis of anal sac disease is made based on history (what you have observed as your pet’s symptoms) and the physical exam performed by the veterinarian. In terms of symptoms, dogs with anal sac impaction or abscessation are often reported to “scoot,” meaning they drag their rear end across a floor or carpet by pulling themselves along with their front legs while sitting upright. They also may attempt to lick the area frequently or seem “bothered” by discomfort. You might notice a change in their stool habits. This can be either a variation in the shape of the feces (thin, like a ribbon) or pain when attempting to defecate. On physical examination, your veterinarian will perform a digital rectal palpation to check the anal sacs. He or she will attempt to express (empty) the anal sacs manually by applying gentle but firm pressure. If this is too difficult or too painful for the dog, sedation may be necessary in order to expel the contents and be sure impaction is not present. Various degrees of inflammation (redness, heat, swelling, pain) of the region around the anus may be apparent when a dog or cat has anal sac disease, and the material in the sacs may be dark and flocculent (with chunks) or firm like clay. There may be pus and/or blood present in the sacs, or draining through the skin beside the anus from an abscess that has already burst.

LIVING WITH THE DIAGNOSIS

Luckily, anal sac impaction or abscessation generally is not a serious illness. It can, however, be a chronic problem and can recur frequently, causing discomfort. Many dogs are affected for no apparent reason. There are no preventative measures to guarantee that the problem never returns. The most important thing is to monitor your pet’s behavior and defecation habits and seek veterinary attention if constipation or pain becomes apparent.

TREATMENT

In the case of impaction, your veterinarian can often help by expressing the anal sac material. During a rectal palpation, pressure is applied the sac to empty it. If this is painful or the material is too hard, sedation of the dog or cat is recommended so the emptying can be done without discomfort. Occasionally, a small tube (catheter) is placed into the sac through the pore, and the sac is irrigated with saline to flush it. This can help soften very hard material if present. Depending on the degree of inflammation, your veterinarian may prescribe antibiotics or antiinflammatories. These medications should be given as directed.

Often, the first sign of an anal sac abscess is when you see pus and/or blood draining from the anal area beneath the tail after the abscess has burst through the skin. Owners of affected dogs or cats report seeing blood staining around their pet’s anus. If the abscess has not yet burst, your veterinarian will often lance the infected anal sac while your pet is under sedation and flush the area with saline. It is important that the lanced abscess remain open for as long as possible to fully drain the infected material. Warm compresses can help, and your veterinarian may recommend that you apply warm-packs to the area two or more times a day. A good way to do this is to take a moist facecloth and place it in the microwave for 10-20 seconds, then remove it and carefully (handle carefully, to not burn yourself) check it to make sure it is not too hot. Then this lukewarm facecloth can be put in a Ziploc-type bag and applied to the affected area. Antibiotics and antiinflammatory medications (in the form of pills to be given by mouth) will likely be prescribed.

If the problem recurs, the anal sacs may have to be expressed repeatedly. Some dogs require this procedure every 1 to 2 weeks after having an episode of impaction, gradually decreasing the frequency to whenever necessary. Your veterinarian may be willing to show you how to do this at home. It has been reported that a change in the diet, such as increasing the fiber content, can be beneficial. By altering the stool, the anal sacs may express themselves without intervention. Your veterinarian may recommend a different dog food or additives such as bran or Metamucil to your pet’s regular food.

In refractory (nonresponsive) cases where symptoms persist despite treatment, it may be advised to have the anal sacs removed altogether (anal sacculectomy). This is a surgical procedure in which one or both sacs are removed under general anesthesia. It is not a difficult operation, but there is always a small risk of complications such as infection or compromise of the anal sphincter, resulting in fecal incontinence. It is a delicate but short procedure, and the patient usually goes home the next day with some home care such as warm compresses and pain medication (antiinflammatories) and antibiotics.

DOs

  • Follow your veterinarian’s instructions regarding medication and recheck appointments.
  • Become familiar with your pet’s defecation habits. Be aware of any changes in stool shape (thin and pencil-like) or behavior (pain or straining to defecate, scooting, looking anxiously at hind end).
  • Have your pet examined if you notice repeated “scooting” (more than once every few months), recurrent licking at the anal area, or any sign of discomfort when defecating.
  • Understand that anal sac disorders can be difficult to treat, and that a second opinion from a veterinary internal medicine specialist may be helpful. You can discuss this with your veterinarian and a list of these specialists is available at www.acvd.org, www.acvim.org, or www.vetspecialists.com for North America; or at www.ecvim-ca.org or www.ecvd.org for Europe.

DON’Ts

  • Don’t wait until the problem recurs to have a recheck appointment if your pet has had an anal sac problem requiring treatment. Since anal sac problems often return, it is best to have your veterinarian continue to monitor your pet until the anal sacs are functioning normally and not causing symptoms.

WHEN TO CALL YOUR VETERINARIAN

  • If you are unable to give any medication prescribed as directed.
  • If you notice signs of severe pain or straining to defecate, or if your pet fails to produce any stool in 24 hours.

SIGNS TO WATCH FOR

  • Scooting, licking at the hind end, pain on defecation, swelling or drainage around the anus.

ROUTINE FOLLOW-UP

  • Your veterinarian will offer recheck appointments based on the severity of the case. As mentioned, many dogs require routine expression of their anal sacs. The frequency will depend on the patient.

ADDITIONAL INFORMATION

  • Inflammation of the anal sacs is called anal sacculitis and can include impaction or infection/abscessation. Other more serious conditions can result in similar symptoms and should not be mistaken for anal sac impaction or abscessation:
    • Perianal fistulas—a severe, chronic disease of the area around the anus. Multiple draining tracts are present, which are deep fissures in the skin surrounding the anus. The anal sacs themselves are not involved. German shepherds are most commonly affected.
    • Anal sac tumors (adenocarcinomas)—malignant tumor of the anal sac, occurring more commonly in older dogs.

These tumors can often spread to regional lymph nodes, which enlarge and obstruct the path of feces. If this type of cancer is suspected, your veterinarian will likely recommend blood work and x-rays to confirm and check for spread of the disease. Removal of the anal sacs and possibly the lymph nodes may be offered, followed by chemotherapy. Consultation with a veterinary oncologist (see www.acvim.orgor www.vetspecialists.com for listings of these specialists) is an excellent option for obtaining a second opinion and the most comprehensive information on treatment options and outcomes. Anal sac tumors are much less common than anal sac impaction or abscesses.


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ABOUT THE DIAGNOSIS

Aggression can be a normal behavior in dogs and cats. Cats and dogs in pain, frightened, stressed, or under duress often show signs of aggression. However, aggression that occurs with some regularity toward known or unfamiliar people or dogs/cats may be abnormal and problematic for both the patient and people. Aggressive dogs and cats are dangerous to themselves and others, yet many have a treatable behavioral pathology. Early intervention is always best because it will always involve the simplest treatment.

Often, aggression is a sign of anxiety and distress that is best addressed by either your veterinarian or a specialist in veterinary behavioral medicine working with you as the pet owner. Remember, the owners of aggressive pets are ethically and legally liable for their pets’ aggression. Clients should ask their veterinarians for an assessment and help at the first signs of any concerning or aggressive behavior. Treatment usually involves some environmental changes, behavioral interventions and treatment, and medication that will decrease anxiety and help the patient to acquire new behaviors more easily.

Dogs:

There are several recognized classes of aggression in dogs:•Impulse control aggression (sometimes called conflict aggression)involves aggression to people by dogs when the dog perceives that humans attempt to control the dog’s behavior or access to the behavior. These dogs dislike manipulation (for example, including being pushed from furniture, disturbed while sleeping, etc.). These dogs are anxious and attempt to control all interactions as a way of controlling their anxiety.

  • Territorial aggression involves dogs that forbid access to an area they feel they must protect. Most dogs will exhibit some protective responses to houses, properties, et cetera. Dogs with territorial aggression forbid access regardless of the context and the behavior of the person approaching. Furthermore, the response of the individual approaching may not matter if they are near the boundary—the affected dog reacts profoundly, regardless.
  • Anxious dogs become aggressive if they perceive risk. Fearful dogs choose to withdraw and not participate in social situations. If they can’t get far enough away from someone worrisome to them, these dogs will exhibit some or all of the behaviors associated with both fear and aggression: piloerection (hackles raised up), growling, snarling, staring, lunging, and biting, which usually occurs as someone moves. Dogs who bite when fearfully aggressive tend to do so from behind and may then withdraw after biting. For these dogs, biting is a last resort. If such dogs continue to be or feel threatened they will bite earlier in the sequence.
  • Food aggression describes dogs that react aggressively in the presence of food, when anticipating food, or when food is taken from them. This aggression could be directed at humans or at other animals. Some dogs will guard only what they perceive as valuable food items (e.g., real bones). The easiest and safest way to handle these dogs is to feed them undisturbed, behind a gate or door if needed, and only offer them special foods when they can be left to enjoy them unmolested.
  • True interdog aggression involves more than squabbling. This diagnosis can indicate a serious pathology when one dog will not tolerate the presence of another dog (or dogs, which is less common). It almost always involves dogs going through social maturity who are changing their social behaviors

GETTING HELP

  • The safety of humans and other animals is paramount. Accordingly, seek the help of your veterinarian immediately if your pet shows any signs of aggression. If your veterinarian feels that the behavioral problem is beyond the scope of his or her competence, referral to a specialist in veterinary behavioral medicine (in the US: www.dacvb.org or www.vetspecialists.com) or a veterinarian with a special interest in behavior (https://avsab.org) may be recommended.

TREATMENT

Treatment requires expert help. The information here is general and is not adequate to deal with most aggressive pets. Seek help early!

  • There are many tools that can make it easier to manage the behavior of dogs and cats. All such tools must be used in a humane fashion – harnesses, head collars (dogs), and Sherpa bags are very helpful. Tools such as shock collars and prong collars are to be avoided. No device that relies on force, fear, or pain should ever be used (www.petprofessionalguild.com; https://avsab.org; https://www.sfspca.org/prong).
  • Avoid situations likely to cause an aggressive reaction. Avoidance will keep everyone safe and will minimize practice of the pathologic behavior.
  • Simple training is not sufficient to treat pathological behaviors. Most certified, positive trainers now can recognize when behaviors will benefit from specialist intervention and are often willing to work with you and your veterinarian and/or specialist as part of the treatment. Behavioral and environmental modification will need to be geared to each unique animal, diagnosis, and settings.
  • Reward normal/good behavior but never punish the pathologic behavior. Veterinarians and specialists can help with this and may include in the treatment team a trainer who uses only positive methods and has special training to help with distressed dogs and cats. Not only does punishment increase the risk of aggression, but it tells the cat or dog only what you do not want them to do. To improve, cats and dogs need to know what behaviors will be rewarded and what behaviors will help them to feel calmer and happier.
  • Medication is a common component of treatment because all double-blind, placebo-controlled studies in companion animals have shown that patients taking medication acquire new behaviors taught through behavior modification more quickly. Premedication blood testing to assess medical risk is always recommended. Routine follow-up will involve repeated laboratory testing if treatment continues.
  • Remember that pain can cause aggression as a normal behavior. While most behavioral problems are not due to a medical problem, some are, which is why it is essential that you start by consulting your veterinarian. Furthermore, if your dog or cat becomes physically ill, this will often worsen a behavioral problem
  • The goals of treatment are to keep everyone safe, improve the patient’s quality of life and welfare, and ensure a happier household overall. Stressed and distressed cats and dogs do not have good mental health, and the preservation of mental health is at the core of behavioral medicine.
    AUTHOR: Karen L. Overall, MA, VMD, PhD, DACVB

 

From Cohn and Côté: Clinical Veterinary Advisor, 4th edition. Copyright © 2020 by Elsevier Inc. All rights reserved

 



ABOUT THE DIAGNOSIS

“Hot spots,” also called acute moist dermatitis, are rapidly developing skin sores under the haircoat. They are common in thick-coated or long-haired dogs, less so in cats. They most often develop in areas where the haircoat is heavy, such as the back, tail base, and side of the thigh, neck, or face. Hot spots tend to occur more frequently in hot, humid weather. The dog often will scratch or chew at the area, although it can be quite painful (the condition is also called pyotraumatic dermatitis for this reason). When the hair is parted, the skin is seen to be moist and reddened. A pus-like discharge coats the skin and the base of the hairs.

Hot spots begin with a superficial skin injury that causes some moisture to be caught under the haircoat. Bacteria grow in the fluid, causing more skin inflammation, and the affected area rapidly expands as more fluid oozes from the skin, promoting more bacterial growth. The speed of onset of hot spots is often striking, and a large and painful lesion can develop from previously normal skin in a few hours. Fortunately, other than being uncomfortable, hot spots are not life-threatening and they tend to heal very well.

LIVING WITH THE DIAGNOSIS

Several skin conditions may be underlying causes of hot spots. Anything that causes skin injury or encourages the dog to scratch or chew its skin may start the disease process. Skin parasites such as fleas, ticks, or mange mites; allergies; hair mats; or foreign material caught in the coat are common inciting factors. Preventing reoccurrence of hot spots involves controlling (and, ideally, eliminating) these conditions.

TREATMENT

The most important step in treatment is to clip away the hair in the area and then clean the skin of all discharge with a mild antiseptic. The hair should be clipped for at least 1 inch (2-3 cm) beyond the edge of the visible lesion or sore. This is best done with electric animal hair clippers, since scissors often damage or cut the skin of dogs with acute moist dermatitis—avoid doing this hair clipping at home. Your veterinarian may need to sedate your pet for this step if the area is painful, because the skin may be excruciatingly sensitive. After the area is clean, an astringent (drying agent) may be used on the inflamed skin. Preparations containing an antibiotic or antiseptic are applied directly to the area to stop bacterial growth; these topical medications also often contain an analgesic or corticosteroid to alleviate pain. Spray-on products are preferred over ointments. Most hot spots heal rapidly (days) since the infection is only on the surface of the skin.

Some hot spots are associated with a deeper skin infection. In these cases, red, raised bumps often are found scattered in the healthy skin surrounding the hot spot. Golden retrievers seem more prone to this form than other breeds. Antibiotics given by mouth every day for 2 weeks or more are needed to cure this type of hot spot, in addition to the treatment mentioned above

DOs

  • Keep your pet free of skin parasites, especially fleas.
  • Groom long- or thick-coated pets regularly; remove foreign bodies such as plant material from the haircoat, so these do not cause mats nor penetrate the skin directly.
  • Treat underlying skin diseases, such as allergies, if present.
  • If a hot spot develops, have it treated immediately and use medications as directed.
  • Expect that over the first 48 hours of beginning treatment, the hot spot will look “quieter”: less red, with less fluid oozing from its surface, and it should be less painful. Scabbing and return of normal skin usually occur over a 7-10–day period after that.
  • Consult with a veterinarian specialized in skin disorders (veterinary dermatologist; see www.acvd.org) if acute moist dermatitis is a recurrent or severe problem. These specialists are best able to identify triggering causes and to prescribe the best treatments

DON’Ts

  • Do not touch the hot spot directly with your fingers except to apply medication (and then, use disposable latex medical gloves). Touching a fresh hot spot can be painful and can carry bacteria into it, causing an infection.
  • Do not apply medication to the sore without first clipping and cleaning the area.
  • Do not cut the hair over a new hot spot using scissors, as this is a common cause of severe skin injury (the scissors cut the skin) in dogs.

WHEN TO CALL YOUR VETERINARIAN

  • After treatment, if the area still looks red after 48 hours, or if the problem is spreading to new areas of skin

SIGNS TO WATCH FOR

  • Intense scratching or chewing at an area, sometimes accompanied with whimpering

From Cohn and Côté: Clinical Veterinary Advisor, 4th edition. Copyright © 2020 by Elsevier Inc. All rights reserved


About CVC

Chappelle Veterinary Clinic is a full service Veterinary Clinic which offers a wide range of veterinary care for cats and dogs, including routine exams, vaccinations, preventative care, diagnostics, surgery, spay and neuter, wellness services, dental cleaning, emergency and more.

Working Hours

Monday 8:00 AM – 6:00 PM
Tuesday 12:00 PM – 9:00 PM
Wednesday 8:00 AM – 9:00 PM
Thursday 8:00 AM – 6:00 PM
Friday 8:00 AM – 6:00 PM
Saturday 8:00 AM – 3:00 PM
Sunday Closed

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