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Archive for the ‘Medical Issues’ Category

Study upends understanding about joint injuries

Thursday, October 15th, 2020

From the Cornell University “Chronicle”

An injury to the anterior cruciate ligament (ACL) can lead to severe osteoarthritis in both animal and human patients. Now, a new interdisciplinary study on the protein that lubricates our joints says that lubricant may actually be a precursor of joint disease.

The paper, published Oct. 7 in Scientific Reports, is the first that investigates the role of a protein, known as lubricin, in ACL-type injuries in dogs. It may also have larger implications for similar injuries in humans as well as the potential for treatments and therapeutics.

“Lubricin is crucial for normal joint function and the lubrication of cartilage,” said Heidi Reesink, Ph.D. ’16, the Harry M. Zweig Assistant Professor in Equine Health at the College of Veterinary Medicine (CVM) and senior author on the paper. “We know that if a person or animal doesn’t make that protein, they will develop devastating joint disease affecting all the major weight-bearing joints.”

Lubricin is universal to mammals, including humans, though there is conflicting data regarding its role in joint injuries. Reesink’s study found that, in canine patients that had suffered a ligament tear in the knee, lubricin increased within the joint – the opposite of conventional assumptions in medicine. “The dogma in this field has been that lubricin decreases in joint disease,” Reesink said.

In three canine patients that had a joint injury, lubricin dramatically increased in the time between their initial injury but before any signs of arthritis in their X-rays.

“This indicates that the presence of increased lubricin might actually be a biomarker for predicting future osteoarthritis,” said Reesink. “We also saw increased lubricin in dogs months to years after they injured their ACLs, suggesting that lubricin might be an indicator of ongoing joint instability.”

Reesink said increased lubricin could consequently be a signal for clinicians to intervene or try a different treatment approach.

Reesink and her collaborators laid the groundwork for this new study by completing a systematic review of the literature surrounding lubricin in both human and veterinary medicine. The review waspublished this summer in the journal Osteoarthritis and Cartilage.

The overall finding of the review: There is no unified consensus on how lubricin is altered in other domestic veterinary species and in human joint injury, demonstrating the need for further study – which Reesink’s new paper has done.

“In looking at horses and dogs, we’re seeing the same pattern,” she said. “The strongest piece of data would be to show it in humans as well.”

Reesink and her collaborators worked with the Cornell Veterinary Biobank to obtain samples. The biobank supports CVM researchers as well as scientists across the globe, using biological samples collected from both ill and healthy animals at the Cornell University Hospital for Animals (CUHA). The samples are processed, catalogued and provided to researchers, which accelerates biomedical research.

Among the motivators for this study, said Reesink, is that a large number of cases in the small animal orthopedic section at CUHA is knee ligament injury, which is common in dogs.

“We can help both animals and humans by potentially coming up with better diagnostics, by more fully understanding how these molecules work and designing therapies beneficial to both, by taking advantage of these naturally occurring cases and improving orthopedic care,” Reesink said.

In the veterinary realm, Reesink’s team plans to do a follow-up longitudinal study in dogs, examining multiple time points in a patient’s injury, treatment and recovery process. They also hope to draw similar connections in human ACL and other orthopedic injuries.

Currently, Reesink is examining parallel samples from both the Cornell Veterinary Biobank and the Hospital for Special Surgery, using funding from a pilot grant from the Weill Cornell Medicine Clinical and Translational Science Center.

CVM authors on the paper include Dr. Bethany Cummings, assistant professor in the Department of Biomedical Sciences; professors and small animal surgeons Dr. Kei Hayashi, Dr. Ursula Krotscheck and Rory Todhunter, Ph.D. ’92; and Dr. Philippa Johnson, assistant professor in the section of diagnostic imaging. Co-lead authors are David Gludish, a combined D.V.M. and Ph.D. student, and Yuyan Wang, a doctoral student in the College of Engineering.

Melanie Greaver Cordova is managing editor at the College of Veterinary Medicine.

Making sense of genetic disease in dogs and cats

Thursday, October 15th, 2020

From Journal of the American Veternary Medical Association (JAVMA)

Making sense of genetic disease in dogs and cats

Published on October 14, 2020

Understanding genetic disease in mixed-breed and purebred dogs and cats can bring about more effective treatments and better client service, says clinical geneticist and general practitioner Dr. Jerold Bell.

French bulldog

“If we understand the genetic background of our patients, we’re better positioned to prevent, to mitigate, or to alter the expression of genetic disease, allowing our patients to be healthier in their lifetimes as well as to breed healthier dogs and cats,” Dr. Bell said.

An adjunct professor at the Cummings School of Veterinary Medicine at Tufts University, Dr. Bell spoke about genetic diseases during the AVMA Virtual Convention 2020 this August. In addition to his teaching duties, Dr. Bell works as a solo practitioner, and he sees “dogs and cats all day long and sees genetic disease in our patients all day long.”

He explained that common genetic disorders are caused by ancient disease liability genes that preceded breed formation. Since these mutations occurred long before the separation of breeds, these diseases are seen across all breeds and in mixed breeds.

The most common hereditary diseases in dogs are allergies, followed by hip and elbow dysplasia; inherited cancers such as lymphoma, hemangiosarcoma, mast cell tumor, and osteosarcoma; patella luxation; nonstruvite bladder stones; hypothyroidism; mitral valve disease; inflammatory bowel disease; diabetes mellitus; retained testicles; and umbilical hernias.

In cats, the most prevalent genetic diseases are inflammatory cystitis, then feline urological syndrome, diabetes mellitus, lymphoplasmocytic gingivostomatitis, nonstruvite bladder stones, allergies, eosinophilic skin disease, and inflammatory bowel disease.

Disease is not a function of homozygosity, which happens when identical DNA sequences for a particular gene are inherited from both biological parents, nor is it a consequence of inbreeding. Rather, Dr. Bell explained, hereditary diseases are a result of the accumulation and propagation of specific disease liability genes. Breed-related deleterious genes accumulate in various ways, including direct selection for disease-associated phenotypes, linkage to selected traits, carriage by popular sires, genetic drift, and—most importantly—the absence of selection against deleterious phenotypes.

“If we don’t select for healthy parents to produce offspring, then we have no expectation of health in those offspring,” Dr. Bell said. “Not selecting for health is selecting for disease, and we need to understand that and pass that on to our breeder clients.”

On the topic of disease and extreme phenotypes, Dr. Bell said brachycephalic obstructive airway syndrome is frequently diagnosed at veterinary clinics on account of the popularity of certain brachycephalic dog breeds, namely Pugs, French Bulldogs, and Bulldogs. Most breed standards do not call for the expression of extreme phenotypes, he said, nor do they select for the most extreme size or the most extreme brachycephalic trait.

“Moderation away from extremes that cause disease should be the guiding principle in breeding,” Dr. Bell noted, and in judging dog shows.

Common genetic diseases seen in mixed-breed dogs and cats occur randomly because of dispersed ancient liability genes, according to Dr. Bell. Uncommon and breed-specific recessive or complexly inherited disease is far less likely to occur in mixed-breed individuals.

Dr. Bell said designer-bred dogs and cats often have inherited diseases common in random-bred populations. They can also inherit disease liability genes shared by the parent breeds or parent species. “So if you’re breeding short-statured breeds together, it wouldn’t be surprising to see patellar luxation, or in smaller toy size breeds, to see mitral valve disease,” he said.

Hereditary disease manifests as a result of anatomical mismatch between parent breeds. “We see a lot of this in dental disease, where we see crowding of teeth and malocclusions and misplaced teeth,” Dr. Bell continued. “Even in the musculoskeletal, if you breed two breeds with different body types together, we may see degenerative joint disease and poor joints. All of these things, all need to be monitored.”

Assessing Canine Pain

Tuesday, October 6th, 2020

 

Chronic pain can significantly affect daily living activities in our pets. In a previous blog I posted photos and descriptions to determine pain in cats. Determining pain in dogs can be more difficult, as there can be wide variability between pet owner and veterinarian observations, as well as variability in how dogs express pain. Dogs may act differently at home and in the veterinary exam room.

Currently there are no biomarkers (biochemical or physiologic parameters) that reliably correlate to chronic pain. Physiologic biomarkers, such as blood pressure, heart rate, and cortisol levels, have very low specificity because circumstances other than pain such as fear, anxiety, and stress can also affect these markers.

Objective measurements are not widely used in veterinary practice. These might include force plate measurements, computerized gait analysis, and activity monitors. Unfortunately, even if these were utilized widely, they may only give insight into mobility parameters, with no measurement of internal pain. The most common chronic pain condition encountered in dogs and cats is osteoarthritis (OA); other conditions that can cause chronic pain include intervertebral disk disease, chronic pancreatitis, cancer, and other illnesses.

Things to consider when determining pain level in your dog include:

  • Ability to play
  • Appetite
  • Gastrointestinal function
  • Hygiene (ability to maintain cleanliness, urine or stool incontinence)
  • Interaction with family members
  • Presence of pain (flinching when touched, tension in the body, vocalizing)
  • Sleep (increased, decreased, interrupted by pacing or wandering)

One owner assessment questionnaire that has been widely used was developed in Finland by the University of Helsinki researchers. By filling out the questionnaire weekly, a pet owner can determine whether their dog’s mobility is improving or declining from week to week. Another assessment questionnaire has been developed by the canine arthritis association.

A more complete assessment of pain may be made using the BEAP Pain Scale created for pet hospice patients. By assessing appetite, ability and desire to move around, facial expressions, body weight, and vocalizations a pet owner can determine changes in pain scores from week to week.

Determining quality of life can be difficult for pet owners and veterinarians. By using these tools weekly it is possible to document changes in pet comfort that may help make decisions regarding improved pain management to improve quality of life.

There are many treatment options available for pain. Don’t let your pets suffer in silence.

About Dr. Morgan

Angel Fund Supplies Clarity for Dog With Terminal Cancer

Saturday, May 9th, 2020

In the fall of 2017, a young Laguna Niguel family had a sick dog on its hands.  Rikku, a shepard mix, had been in the family for some 13 years and was loved by mom and dad and two young children.

“She had been sick for a few months,” Lindsay, the mother, said in an interview.  (She asked that her last name not be used.)  “We were unsure of the cause.  At first we thought it might be behavioral. But then . . . she started having potty accidents in the house, which was so unusual for her.

“We took her to the vet [Dr. Rachel Tuz at Aliso Niguel Animal Hospital].  After a few visits and really no conclusive idea what the diagnosis was, we shrugged our shoulders and decided, ‘Well, she’s 13 years old and pushing 14, should we even pursue this any further?’

“The doctor had suggested a couple of other tests,” Lindsay said. “At that point, we had run dry on money.”  But Dr. Tuz called and said that Angel Fund might be able to help.  Lindsay successfully submitted an application with the hospital’s help. “They did the tests and found that she had a massive tumor in her bladder.  And it was basically inoperable.  There was nothing we could do about it.

“”We didn’t know what to do next, other than wait it out,” Lindsay said. “The next few months the dog got worse quickly and was losing weight, two pounds or more a month.  And we finally reached the point where Dr. Tuz said that this wasn’t fair to Rikku. She was not able to be in the house because she was having so many accidents.  So we had to choose to put her down.  That was in November.”

The experience was wrenching for all the family.  “My husband, Ryan, and I had owned her since we were kids,” Lindsay said.  “It was very hard.  “My son, Finnegan, was very sad.  He still is.  He still talks about her.”  He is five years old.  She and her husband also have a two-year-old daughter, Molly, is two.

The family got a new dog – a puppy – in January.  “We were going to wait but Finnegan kept saying he missed not having a dog,” Lindsay said.  “It’s different, though.  The new dog doesn’t replace the dog you had.  They’re just totally different personalities.”

Angel Fund was “fantastic,” Lindsay said, and she wrote a thank you letter to the fund after receiving the grant.  “They helped us in a serious time of need.  It’s hard when your pet is sick and you feel like you can’t do anything else about it.”

Lindsay had opted to be a stay-at-home mom after her first child was born.  And she and Ryan felt financially overburdened, she said, with a mortgage, two young children and hefty student loans for two college educations.

A Pet Owner’s Guide to Flowers and Plants

Thursday, April 23rd, 2020

BROUGHT TO YOU BY KREMP.COM

We love our pets! The family cat or dog is vital part of our family, and we do everything we can to help ensure that they have what they need. Pet owners need to be certain that they provide the correct food and preventative medical care. While pet safety needs to be a big concern around the house, one of the most common dangers for pets are with the plants and flowers that can be redily found in the home.

Most homes have various types of plants and flowers inside the home. These plants and flowers help brighten up a home and provide a decorative flourish. While the addition of plants and flowers in a home are helpful in making the house attractive, it can also be a danger to pets. Knowing which plants are non-toxic and which plants are toxic to your dog or cat is important for the continued good health of your pet.

There are a number of plants that are commonly found around the home that are toxic to animals. Some of the plants that should be kept away from the family pet include Lilies, Tulips and Azaleas. All of these plants could have an impact on the health of pets if ingested. Therefore, it is important that prevention of potential danger is very important.

If you have a home with pets, and you have flowers and plants, it is imperative to keep an eye out for the possibility of the animal being poisoned. Some of the symptoms that you should look out for include diarrhea, vomiting, weakness and not behaving as normal. If you suspect that your pet may have been accidentally poisoned, it is important to contact your vet as soon as possible. The early the treatment for the poison the better chance of getting them back to health.

To learn more about which plants and flowers are toxic and what to do in the event of a poisoning, please review the following information.

  • Poisonous Plants – Informative web page from Cornell University which provides information on which plants are poisonous to animals.
  • Animal Toxins – Listing of items that are considered poisonous to all animals.
  • Plants Toxic to Animals – Helpful database of plants that are toxic to domesticated animals.
  • Toxic Plants for Pets – In this page you will learn about the plants that animals should avoid.
  • List of Poisonous Plants – Useful article which contains a listing of plants that are toxic to cats and dogs.
  • Pet Safe Gardening – Information from the Animal Health Foundation which offers ideas on having a pet safe garden.
  • Pets and Toxic Plants – This article from UC Davis discusses pets and plants that could be toxic to them.
  • ASPCA Information – Information on plants and flowers that are toxic and non-toxic to pets.
  • Keeping Pets Safe – Article from HGTV which offers ideas on how to keep pets safe from plants and flowers around the home.
  • Safe Indoor House Flowers and Plants – Helpful article from Better Homes and Gardens which provides information on plants and flowers that are safe for pets.
  • Signs of Poisoning – Useful information on how to tell if your dog has been poisoned.
  • Top Dog Poisons – This article informs dog owners about the top potentially harmful items that are poisonous to dogs.
  • Antifreeze Poisoning in Cats – Article which provides general information on how to determine if you cat was poisoned.
  • Poisoned Dog – In this helpful article you will find information and steps to treat a poisoned dog.
  • Treating a Poisoned Cat – Article which lists steps that can be taken to treat a cat suspected of being poisoned.
  • Poison Prevention Tips (PDF) – Publication which lists the top tips on how to keep your pet from being poisoned.
  • Pet Poison Prevention Tips – Information for pet owners on ways to prevent pet poisoning from occurring.
  • Poison Prevention Tips for Pets – Informative information on how to avoid pets being poisoned around the home.
  • Poison Prevention Publication (PDF) – Helpful brochure which provides pet owners with preventative measures to keep poisons away from pets.
  • Poison Control and Prevention – Information on how to keep pets safe from potential poisons.
  • Pets and Poisons – In this article from the American Humane Association you will find information on pet poisoning.
  • Pet First Aid – Red Cross information and class material on learning the basics of pet first aid.
  • Basic Pet First Aid – Useful information for pet owners which provides a basic understanding of first aid.
  • Pesticide Poisoning in Pets – Article which offers information on what to do if your pet is poisoned by pesticides.
  • Poison Information and Resources – Resourceful page with information about pet poisoning.
  • Pets and Poison – Web page which informs pet owners about the dangers around the home for pets.
  • Poison Safety for Pet Owners (PDF) – General information about poison safety from the University of Virginia.
  • Preventing Pet Poisoning – Information about pet poisoning prevention with outdoor pesticides.
  • Pet Poisoning Information – Helpful information about the basics of pet poisoning.
  • Plants and Household Products – Informative fact sheets with information about normal plants and products around the house that can be poisonous to pets.

Disabled Woman Turns to Angel Fund for Help With Dog’s Heart Problem

Tuesday, March 17th, 2020

In 2004, Galina Coleman slipped and fell at work not far from where she lived in Petaluma.  She had five surgeries for the injuries she suffered.  In the wake of that personal catastrophy and disillusioned with her marriage, she got a divorced and moved to Southern California.

Today, estranged from her former husband and two sons, she lives in Aliso Viejo and struggles to pay her bills. She was declared totally disabled in 2006 and lives on a Social Security disability check.

“I’m just really struggling,” she said.  “I’m in affordable housing.  My rent is $1,398 a month, which is ‘very affordable’ here. However, for me it’s just really, really difficult.  I’ve tried to get jobs but it just hasn’t worked out for me.  I have two senior dogs and a senior cat and I know they’re basically at the end of their lives.”

Late last November, her struggles came into clear perspective when Abby, her nearly 14-year-old Dachshund, appeared to be having a digestive issue.  “When I took her to a veterinarian, the doctor discovered a heart murmur. She thought it was pretty serious and prescribed medication for Abby after doing an x-ray,” Galina said.

Later, she took the dog to Dr. Lynn Sanchez, a veterinarian she said she likes and trusts at Garden Grove Dog and Cat Hospital.  Dr. Sanchez recommended an electrocardiogram to get a clearer idea what Abby’s problem was.  But Galina could not handle the cost.  She applied for an Angel Fund grant and was awarded $451, a sum that was matched by the hospital.

Abby got the electrocardiogram in late December – and with it some good news: the murmur was not as bad as originally suspected.  “Dr. Sanchez said that everything looked pretty good and prescribed three medications,” Galina said.  A week later, when she took Abby back for a recheck, two of the medications were discontinued.  “One of them was really hard on her kidneys,” she said, “so I was really glad to get rid of it.”

After another recheck early in January, the dog is continuing to take Vetmedin.  “She’s not in heart failure but has some damage to a mitral valve,” Galina said.

When Galina divorced, she took her animals with her.  “I have tried to help them on a piecemeal basis,” she said. “I’ve had to rely on charity.  They’ve all been in pretty good health but now they are at the point where that’s starting to change [because of their ages].”

Augie, Abby’s brother, is two years younger at 12.  Aurora, her cat, also is 12.  Galina believes that Augie will need a dental treatment soon.

“I’ve been given the blessing of having these animals – they are just truly a blessing for me.  I am their steward and I need to make sure they get whatever is needed to take care of them. I have to do that.

“Had I not been able to do this [echocardiogram], I would either have been giving Abby way too much medication or no medication at all.  It wouldn’t have been good either way.  it was going to be detrimental to her health one way or the other.”

Galina is grateful to Angel Fund.  “They really helped me out,” she said.  “It is a wonderful thing to help people because things can be so expensive.  I think it’s a really great thing for veterinarians to give back.  I admire them for doing that.  I think that’s what we’re all here for – to give back.”

She is thinking about moving with her animals to a place – perhaps New Mexico – where her disability check would go further.  She is 58 years old.

“I have ignored a lot of my life for these dogs.  But, in return, they’ve provided me with something,” she said.  That something is love and support.

A Kiss Changes Everything

Sunday, March 8th, 2020

Animal Health Foundation’s Caring Creatures Pet Partners Team Jane Horsfield and Kiss are celebrated in Pet Companion Magazine!

From  Pet Companion Magazine  http://digital.petcompanionmag.com/publication/?m=40178&i=651393&p=38    “Reprinted with permission from Pet Companion Magazine, Spring 2020.”

Just like the rock band for which she’s named, the black-and-white­masked Kiss never gives up, even when people might count her out.

Like KISS, whose members have been rocking for 4 7 years, she keeps coming back, stronger each time, just when you think she’s thrown in the towel. KISS the band is traveling the world throughout 2020 on their The End is Near tour-this time, they say, they’re really going to retire. We’ll believe it when we see it.

Kiss the border collie, however, has no plans to throw in any towel or slow down, and certainly not to retire. This rock star therapy dog/athlete has a can-do attitude that won’t quit, and all the curve balls she’s been thrown so far haven’t taken her down. She’s tough as nails, and yet sweet as the pink swipe of a gentle doggie smooch. She’s one special dog who has defied unthinkable odds to not just survive but also stay at the top of her game.

And what game is that? Well, for starters, she used to give other dogs a run for their money in flyball, agility, dock diving, nosework, and Frisbee catching. But being a top athlete wasn’t where Kiss found her calling. It turns out her best talents emerged during her 11-year career (so far) as a therapy dog-part of the Animal Health Foundation, an affiliate of Pet Partners. Kiss visits hospital patients, helps elementary school children learn to love reading, and appears at many public service events benefiting various causes for pets and children, including her local Rotary Club’s fundraising efforts to raise awareness of skin cancer. Since 2013, she has served as a crisis response dog, sent on deployments where she has helped people affected by disasters or other crises cope with their losses. But her best trick yet? Beating her own cancer, a soft-cell sarcoma on her front left leg, and now living with a complex disease called immune-mediated hemolytic anemia (IMHA). This 13-year-old takes it on the chin, but she never takes it lying down. Despite a grim diagnosis and multiple complications, Kiss is making steady progress and will soon be back visiting her local hospitals and elementary schools, putting smiles on the many faces she loves.

Kiss was six months old when she was given to Jane Horsfield and Dan Balza of Fountain Valley, California, by a fellow flyball enthusiast. Horsfield and Balza previously owned several dogs involved in the sport-which, heartbreakingly, they had lost to various forms of cancer. A lover of border collies, Horsfield was all in for taking Kiss home. However, she and Balza had recently discussed how their household was definitely at its maximum dog capacity. Grudgingly, Balza agreed to take a look at a photo of the striking black and white little furball. It wasn’t long before Kiss became part of the family.

Horsfield describes young Kiss as “one wild little banshee.” She recalls, “She barked, she chased, she screamed … and she ate everything in sight. She chewed clothes, glasses, furniture, walls (not kidding!), and the oak baseboard. I’d get home from work and, with drywall hanging from her mouth, she’d look at me with those big, brown, loving eyes. Who could be mad? Eventually, the bad behavior faded, and a wonderful ‘teenaged’ doggy emerged.”

At that time, Horsfield was doing pet therapy work with another of her beloved athletic dogs, who was 11 and nearing retirement age. All of her dogs do dog sports, but therapy work-that’s a raised bar that Horsfield says only a few dogs can reach. Because Kiss was proving to be a loving and sensitive dog, she began to train her. At just 2 years old, Kiss passed her Pet Partner evaluation, and with that opened
a new chapter in her life. Although her primary job was now therapy work, Kiss still enjoyed participating in dog sports in her spare time.

In 2017, Kiss’s image was featured on a surfboard that was part of a fundraiser by the Huntington Beach Rotary Club. Local artists were paired with local surfboard shapers, and 22 surfboards were decorated and auctioned off, with the money donated to local hospitals benefiting skin cancer research, prevention, and care. At the unveiling of her surfboard, a participant visiting with Kiss felt a swelling on her front left leg and alerted Horsfield to it. It turned out to be a soft-tissue sarcoma, and Kiss was referred to a specialty hospital.

Having lost four previous dogs to cancer, Horsfield and Balza were devastated, fearing the worst. But after 18 months of treatment, including 6 months of rehabilitation, Kiss was declared free of cancer and cleared to go back to work.

Horsfield got word of a grant from the Petco Foundation and Blue Buffalo that was available to therapy dogs with cancer. The foundation donated $3,000 to help cover some of the costs ofKiss’s treatment, and Petco Foundation and Blue Buffalo shared Kiss’s story on their websites for the 2018 Pet Cancer Awareness campaign. The two companies have invested more than $15 million into pet cancer research since the campaign began in 2010. Asked to participate again in 2019, Kiss’s face was featured on ads in People magazine, on Petco’s Pet Cancer Awareness website, on posters in nearly every Petco store, and even on a reuseable tote bag, a gift for donating $10 to the campaign in any Petco store nationwide.

Sadly, between the time she was declared cancer free and the start of the 2019 Pet Cancer Awareness campaign in May 2019, Kiss was diagnosed with immune-mediated hemolytic anemia, or IMHA. “It’s a horrible, not-so-common disease where the immune system goes haywire and starts destroying its own red blood cells,” explains Horsfield. “She liter­ally was fine on Saturday, then on Sunday morning she didn’t want to eat her break­fast.” While that symptom didn’t seem particularly alarming, Horsfield discovered discoloration in Kiss’s mouth and imme­diately took her to a veterinary specialist. From there, her condition went downhill fast, but thankfully Kiss’s condition today has been mostly stabilized through medica­tion. But not before she suffered an intes­tinal blockage that required emergency sur­gery and a severe bout of pneumonia. The road has been long, and it’s been rough. But Kiss is not a quitter. She fights on.

And Horsfield, who “researches absolutely everything” but was too terrified to even look up this disease at first, is fighting along with her. Every day, she’s learning and, more importantly, educating others about IMHA. It’s a complicated disease with no “one-size-fits-all” treatment-veterinarians must try protocol after protocol to find one that strikes the right balance for Kiss. “This story is far from over, and she has not been ‘cured.’ Knowledge is everything when treating this disease,” Horsfield points out. She says if she’d waited a day to take Kiss to the vet or not gone straight to a specialist, Kiss likely would have died, according to her doctors. “Dog owners need to be aware of what IMHA is and know the warning signs” she cautions. “IMHA packs quite a punch, and Kiss’s life has taken a drastic side road.” Younger dogs who make it through this disease are generally more able to get back to normal, says Horsfield. “Kiss got this ugly disease at 12. She’s not a young dog, but she was in great shape before this hit, which is probably why she’s been able to fight it. I am just grateful to still have her with me 12 months after diagnosis.”

While Horsfield admits that Kiss probably won’t be competing in flyball or dock diving anytime soon, she still enjoys her nosework and catching the occasional ball or Frisbee. A pivotal moment in her recovery was when she was finally able to take a swim once again in the family’s backyard pool with her pack, the other family dogs. She’s also back to visiting hospital patients, and will head back to school for the elementary reading program very soon. In December, when a student from Rim of the World High School in Lake Arrowhead was tragically murdered, Kiss was there to lend support. In January, she helped deploying military service men and women and their families prepare for the year ahead.

With all she’s been through, you might expect Kiss to just bask in the sun and take life easy for the rest of her days. But that’s not who she is. That little banshee who barked her head off, ate everything in sight, and chewed her way through puppyhood (and the drywall) isn’t resting on her laurels or her haunches. She’s forging ahead, mending hearts and spreading joy and kisses along the way. Because, sometimes, a kiss changes everything.

Immune-Mediated Hemolytic Anemia
By Julie Stegeman, DVM 

Immune-mediated hemo­lytic anemia (IMHA) is an autoimmune condition wherein the patient’s immune system attacks their own red blood cells as if they were a foreign invader. IMHA is more common in dogs than in cats, and it is an almost daily occurrence in the caseload of a referral hospital because of the need for inpatient support­ive care and often the need for blood transfusion. It is most often seen in middle-aged dogs and in young cats, and some breeds are more at risk ( cocker spaniels, miniature schnauzers, miniature dachshunds, etc). IMHA represents a loss of immune system “tolerance of self.” Our immune system has checks and balances built in, but when there is a disturbance in that balance, a red blood cell can “look” like a virus to an immune system cell. It then be­comes a target for destruction, leading to severe anemia and death if left untreated.

Symptoms ofIMHA initially can be vague. Lethargy, poor appetite, even a fever may be seen. Pet owners might notice a red or orange discoloration to the pet’s urine, or they might notice pale gums. The gums and skin might even appear yellow (“jaundiced”) due to buildup of bilirubin, which is a byproduct ofred blood cell destruction. Orange stool is also commonly seen. These symptoms lead to taking the pet in to their veter­inarian. Blood tests will show anemia and may or may not show elevated bilirubin levels, elevated white blood cells, low platelets, or elevated liver or kidney values. If the platelet count is low, the pet may have autoimmune destruction of their platelets as well-this is called Evan’s syndrome.”

It is recommended to screen for a variety of immune system triggers in an IMHA patient, such as various tick-borne illnesses, viral infections, other infectious diseases, and cancer. Other triggers can include a variety of medications and even (rarely) vaccinations. If there is an underlying triggering con­dition, the immune destruction will continue until the trigger is eliminated. This is especially important because treatment for IMHA requires immune suppressive medications, and if there is an infectious disease present, the immune suppres­sant medications will allow the triggering infectious disease to overcome the patient. It is very important to provide a full medical and travel history to the attending veterinarian, so that these issues can be discovered right away. Various blood tests, chest radiographs, and abdomi­nal ultrasounds are usually per­formed to screen for underlying conditions, depending on the patient and their exact history.

If no inciting cause is identi­fied, then immune suppressive treatment is begun. The corner­stone of immune suppressive treatment is glucocorticoid (ste­roid) treatment, most commonly in the form ofprednisone or as injectable dexamethasone. High doses of steroids are required at first, because the immune reac­tions in IMHA are very intense, and progression is rapid if left unchecked. It can take several days to start to see the benefits of the immune suppressive treatments. In some patients, if the immune system is attacking red blood cells at the level of the bone marrow ( where they are being produced), it can take 4 to 6 weeks for stabilization of the red cell levels to occur. Until the red cell level ( often determined with a Packed Cell Volume [PCV]) stabilizes and starts to increase, blood trans­fusions are often necessary. Transfusions help “buy time” until the steroids can control the situation. Unfortunately, the transfused red blood cells are often destroyed as quickly as the pet’s own red blood cells, so repeated transfusion may be needed.

In addition to steroids and transfusions, sometimes other treatments are used. Intrave­nous gamma globulin treatment (IVIgG) is an expensive but often effective way to shorten a hospital stay. This treatment binds to auto-antibodies and keeps them from attacking the red blood cells. It also may reduce antibody production by the patient’s body. It helps “win the battle” but is not proven to improve long-term outcomes. Plasmapheresis is another treatment available at a few referral hospitals in the nation, with a similar end result as IVIgG. Other immune suppressive medications such as cyclosporine, mycophenolate, azathioprine, or leflunomide, often started in conjunction with prednisone, take longer for full effect and are most helpful to reduce how much prednisone is given over the long run.

Patients with IMHA have a high risk for development of abnormal blood clots, and pulmonary embolism is actually one of the leading causes of death in these pets. Therefore, it is common to prescribe blood thinners such as aspirin, clopi­dogrel (Plavix), and/or heparin. A blood thinner is often given as long as the prednisone is given.

Because anemia affects the entire body, gastrointestinal support is often needed, in the form of antacids, anti-nausea medications, and coating agents.

Survival ofIMHA is, un­fortunately, not 100 percent. Estimates vary, but the author’s experience is that approxi­mately 75-percent survival is expected. Not all pets respond completely to treatment. Others succumb to pulmonary embo­lism. Rarely, they develop sec­ondary opportunistic infections, such as fungal infections, due to chronic immune suppressive therapy.

Close monitoring is critical after the patient is discharged from the hospital. A patient may need to be rechecked a couple of times a week at first, gradual­ly reducing to once every 2 to 3 weeks. The medications are ta­pered over time, and usually by 4 to 6 months after diagnosis, the pet is either off medication entirely or is on the minimum dose of medication required to maintain a normal red blood cell level. Relapses can occur, as can other immune-mediated diseases.

In summary, IMHA is a life-threatening but treatable disease, which most but not all patients survive. A thorough evaluation of the patient is needed initially, and most re­quire hospitalization to survive the initial part of the illness. Long term, the pet owner will need to work closely with their veterinarian to adjust medica­tions and watch for relapses.

The Benefits of Coconut Oil for Your Pet

Friday, February 28th, 2020

Innovative therapy puts Blaine, WA dog’s cancer into remission

Monday, February 24th, 2020
The Northern Light Community Newspaper, Bellingham, WA
Blaine dog Wiley with his veterinary team at Bellingham Veterinary. From l., Brittany Grant, Sebastian Grant, Dr. Kevin Steele, Sharon Pozzi and Dr. Edmund Sullivan.
Blaine dog Wiley with his veterinary team at Bellingham, WA Veterinary. From l., Brittany Grant, Sebastian Grant, Dr. Kevin Steele, Sharon Pozzi and Dr. Edmund Sullivan.
  • by Jami Makan

When Jackie Craig got her dog Wiley from a ranch when he was eight weeks old, she expected him to have a long, healthy life. That’s because he’s a Blue Heeler, a type of Australian Cattle Dog known for its long, healthy lifespan and lack of predisposed conditions. Wiley quickly became a beloved figure at The Hair Shop on Martin Street in Blaine where Craig works. “He’s the barbershop dog,” she said. “Everybody knows him.”

So it came as a shock when Wiley, at the age of seven and a half, was diagnosed with lymphoma in August last year. Craig first noticed that Wiley was gaining weight and would start coughing when he drank. She took him in for an appointment at Bellingham Veterinary, where Dr. Edmund Sullivan performed blood work and diagnosed Wiley with B-cell lymphoma, a type of blood cancer. It is also known in people as non-Hodgkin’s lymphoma. “It turns out the lymph nodes in his neck were extremely enlarged,” Craig said. “He was in very sorry shape, and they said he would’ve died within two weeks.”

Although she didn’t have pet insurance – “My biggest mistake,” Craig said – she decided to pay for chemotherapy for Wiley. “I did not think he was going to make it,” she said. “I just wanted to prolong his life. It was agonizing trying to decide whether to put my dog to sleep.”

At first, Dr. Sullivan performed chemotherapy on Wiley once a week. Unfortunately, it wasn’t working well. “Wiley had a very poor response to standard chemotherapy,” said Dr. Sullivan. “On the standard therapy, he didn’t get into any kind of remission at all. He quickly would relapse.”

That’s when Dr. Sullivan decided to try a new approach being developed around the country. Through a separate Bellingham company named Aurelius Biotherapeutics, of which his wife Dr. Theresa Westfall is the CEO, Dr. Sullivan has been working for years in conjunction with the Fred Hutchinson Cancer Research Center in Seattle, as an off-campus research partner. “We have developed therapies for dogs as patients through that relationship,” said Dr. Sullivan. One of those therapies is known as adoptive T-cell therapy. It is a therapy that is also used on some human patients, and Dr. Sullivan decided to try it on Wiley.

“Basically, it is a method where we first take blood out of the dog,” explained Dr. Kevin Steele, Dr. Sullivan’s Blaine-based lab researcher. “We take anti-tumor T-cells away from the influence of the tumor. The T-cells, the anti-cancer cells, they are in culture now. We give them dead tumor to attack. They expand and get very anti-tumor. All of this is happening in culture. Then we inject them back into the dog.”

Dr. Steele said that adoptive T-cell therapy is typically used in conjunction with standard chemotherapy. First, the chemotherapy kills off rapidly dividing tumor cells, and then the T-cells, after being “jazzed up” in the laboratory, are injected to “hunt down” any surviving cancer cells. The first time Dr. Steele and Dr. Sullivan tried the technique was in 2016, and since then, they have treated about a hundred dogs together. They have conditional USDA approval to provide the treatment, and they are currently working on overcoming additional levels of regulatory hurdles to expand their facility.

“With standard therapy, we don’t have any cures,” said Dr. Sullivan. “So none of them survive. This immunotherapy, meanwhile, has resulted in a fair percentage of dogs living for long periods of time, and some of them being cured,” which he defines as being cancer-free for longer than two years after a diagnosis. Some dogs he has treated have gone as long as four and a half years (and counting) without relapsing. “We believe there’s something to this.”

The experimental treatment was performed at no cost to Craig. The doctors grew T-cells for Wiley and then gave him an additional dose of standard therapy followed by two infusions of the T-cells. Wiley went into remission and has gone without additional chemotherapy for several months now. “Just last week, we did an analysis and he was free of disease – there was no detectable disease,” said Dr. Sullivan. “We will generate another batch of T-cells for him to see if we can extend his remission even longer. There’s a chance he may be cured – we don’t know that until he’s gone two years since his diagnosis – but we’re already six months in. We’re a quarter of the way there.”

During the entire process, Craig said that Wiley’s suffering was minimal, and that he didn’t lose hair. “Now he’s got the puppy bounce,” said Craig. “He was pretty sick when he was going through chemo. I could only get him to eat steak. Now he’s eating completely normal and he’s right back to his old self, playing with other dogs.”

Craig is extremely grateful to Dr. Steele and Dr. Sullivan, who will continue to monitor Wiley’s condition. “Kevin is an angel,” she said. “And Dr. Sullivan, he sits on the floor and talks to the animals. He loves the animals. His entire staff is just very compassionate.”

Craig said that with so many dogs getting cancer, these treatments have come a long way and are worth it. “It gives other people with dogs hope,” she said.

Pancreatitis in Dogs

Tuesday, February 18th, 2020
Date Published: 01/02/2006
Date Reviewed/Revised: 05/07/2019

The Normal Pancreas and What it Does

We eat food, chew it up into a slurry, and swallow it. It travels down the esophagus to the stomach where it is ground up further and enzymes are added to begin the break-down of dietary nutrients (digestion). When the food particles are small enough, they are propelled into the small intestine for further digestive treatment and ultimately nutrient absorption. The upper part of the small intestine (the duodenum) is for further digestion/break down of nutrients while the lower parts of the small intestine are for absorption of the digested nutrients.

Normal Pancreas

Graphic by MarVistaVet

The pancreas is a pale pink glandular organ that nestles cozily just under the stomach and along the duodenum. As a glandular organ, the pancreas is all about secretion and it has two main jobs: the first job is to secrete digestive enzymes to help us break down the nutrients we eat, the second job is to secrete insulin and glucagon (to regulate how we use the nutrients we eat). It’s the first job (the digestive enzyme part) that concerns us in pancreatitis.

Canine Pancreas

Graphic by VIN

Pancreatitis is Inflammation of the Pancreas

In pancreatitis, inflammation disrupts the normal integrity of the pancreas. Digestive enzymes are normally stored safely as inactive forms within pancreatic granules so that they are harmless. In pancreatitis they are prematurely activated and released internally, digesting the body itself. The result can be a metabolic catastrophe. The living tissue becomes further inflamed and the tissue damage quickly involves the adjacent liver. Toxins released from this rampage of tissue destruction are liberated into the circulation and can cause a body-wide inflammatory response.  If the pancreas is affected so as to disrupt its ability to produce insulin, diabetes mellitus can result; this can be either temporary or permanent.

Specific Pancreatitis Disasters

  • A syndrome called Weber-Christian syndrome results, in which fats throughout the body are destroyed with painful and disastrous results.
  • Pancreatitis is one of the chief risk factors for the development of what is called disseminated intravascular coagulation or DIC, which is basically a massive uncoupling of normal blood clotting and clot dissolving mechanisms. This leads to abnormal simultaneous bleeding and clotting of blood throughout the body.
  • Pancreatic encephalopathy (brain damage) can occur if the fats protecting the central nervous system become digested.
    Inflammed Pancreas

    A swollen, inflamed pancreas with areas of hemorrhage. Graphic by MarVistaVet

The good news is that most commonly the inflammation is confined to the area of the liver and pancreas, but even with this limitation pancreatitis can be painful and life-threatening.

Pancreatitis can be acute or chronic, mild or severe.

What Causes Pancreatitis

In most cases we never find out what causes it, but we do know some events that can cause pancreatitis.

  • Backwash (reflux) of duodenal contents into the pancreatic duct. The pancreas has numerous safety mechanisms to prevent self-digestion. One mechanism is storing the enzymes it creates in an inactive form. They are harmless until they are mixed with activating enzymes. The strongest activating enzymes are made by duodenal cells which means that the digestive enzymes do not actually activate until they are out of the pancreas and mixing with food in the duodenum. If duodenal fluids backwash up the pancreatic duct and into the pancreas, enzymes are prematurely activated and pancreatitis resuls. This is apparently the most common pancreatitis mechanism in humans, though it is not very common in veterinary patients.
  • Concurrent hormonal imbalance predisposes a dog to pancreatitis. Such conditions include: Diabetes mellitus, hypothyroidism, and hypercalcemia. The first two conditions are associated with altered fat metabolism, which predisposes to pancreatitis, and the latter condition involves elevated blood calcium that activates stored digestive enzymes.
  • Use of certain drugs can predispose to pancreatitis (sulfa-containing antibiotics such as trimethoprim sulfa, chemotherapy agents such as azathioprine or L-asparaginase, and the anti-seizure medication potassium bromide). Exposure to organophosphate insecticides has also been implicated as a cause of pancreatitis. Exposure to steroid hormones have traditionally been thought to be involved as a potential cause of pancreatitis but this appears not to be true.
  • Trauma to the pancreas that occurs from a car accident or even surgical manipulation can cause inflammation and thus pancreatitis.
  • A tumor in the pancreas can lead to inflammation in the adjacent pancreatic tissue.
  • A sudden high fat meal is the classic cause of canine pancreatitis. The sudden stimulation to release enzymes to digest fat seems to be involved.
  • Obesity has been found to be a risk factor because of the altered fat metabolism that goes along with it.
  • Miniature Schnauzers are predisposed to pancreatitis as they commonly have altered fat metabolism.

Signs of Pancreatitis

The classical signs in dogs are appetite loss, vomiting, diarrhea, painful abdomen, and fever or any combination thereof.

Making the Diagnosis

Lipase and Amylase Levels (no longer considered reliable)

A reliable blood test has been lacking for this disease until recently. Traditionally, blood levels of amylase and lipase (two pancreatic digestive enzymes) have been used. When their levels are especially high, it’s reasonable sign that these enzymes have leaked out of the pancreas, and the patient has pancreatitis, but these tests are not as sensitive or specific as we would prefer. Amylase and lipase can elevate dramatically with corticosteroid use, with intestinal perforation, kidney disease, or even dehydration. Some experts advocate measuring lipase and amylase on fluid from the belly rather than on blood but this has not been fully investigated and is somewhat invasive.

Pancreatic Lipase Immunoreactivity

A newer test called the PLI, or pancreatic lipase immunoreactivity, test has come to be important. As mentioned, lipase is one of the pancreatic digestive enzymes and only small traces are normally in the circulation. These levels jump dramatically in pancreatitis, which allows for the diagnosis to be confirmed with a non-invasive and relatively inexpensive test. The PLI test is different from the regular lipase level because the PLI test measures only lipase of pancreatic origin and thus is more specific. The problem is that technology needed to run this test is unique and the test can only been run in certain facilities on certain days. Results are not necessarily available rapidly enough to help a sick patient.

The PLI, or pancreatic lipase immunoreactivity, test has come to be important. Photo courtesy of National Institutes of Mental Health, Department of Health and Human Services

Spec CPL and DGGR Lipase Assay

More recently a new test called the SPEC cPL (specific canine pancreatic lipase) test has become available. This test is a newer generation immunological test for canine pancreatic lipase and can be run overnight by a reference lab. This test is able to detect 83 percent of pancreatitis cases (the test is 83 percent sensitive) and excludes other possible diseases in 98 percent of cases (i.e. the test is 98 percent specific for pancreatitis). The CPL test has been adapted into an in-house test kit and can be run in approximately 30 minutes. Some kits provide a numeric value while others are simply positive or negative depending on whether the CPL level surpasses the normal level. These kits have made diagnosis of pancreatitis much more rapid and convenient.

A similar lipase assay called the DGGR Lipase Assay (Precision PSL® test). This test can be run at a reference laboratory with results obtained usually overnight; there is no in-hospital test kit.

The diagnosis of pancreatitis is not made solely on the basis of a lab test. These tests are not used to screen patients that are not sick; the entire clinical picture of a given patient is considered in making this or any other diagnosis.

Imaging

Dr. Jon Perlis of DVMSound performs an ultrasound exam on a dog. Photo by MarVistaVet

Radiographs can show a widening of the angle of the duodenum against the stomach, which indicates a swelling of the pancreas. Most veterinary hospitals have the ability to take radiographs but this type of imaging is not very sensitive in detecting pancreatitis and only is able to find 24 percent of cases.

Ultrasound, on the other hand, detects 68 percent of cases and provides the opportunity to image other organs and even easily collect fluid from the belly. Since pancreatitis can be accompanied by a tumor near the pancreas, ultrasound provides the opportunity to catch such complicating factors.

In some cases, surgical exploration is the only way to make the correct diagnosis.

Treatment

The most important feature of treatment is aggressively rehydrating the patient with intravenous fluids as this restores the circulation to the pancreas and supports the natural healing mechanisms of the body.  This means that the best route to recovery involves hospitalization. Fluids are continued until the patient is able to reliably drink and hold down adequate fluid intake, a process that commonly takes the better part of a week. Pain and nausea medication are needed to keep the patient comfortable, restore interest in food, and prevent further dehydration.

Plasma transfusion is somewhat controversial in treating pancreatitis. On one hand, plasma replenishes some of the natural blood proteins that are consumed by circulating digestive enzymes and would seem to make sense. In humans with pancreatitis, however, no benefit has been shown with plasma transfusion. Whether or not the protection afforded by plasma is real or theoretical is still being worked out. Higher mortality has been associated with patients receiving plasma but this may be because they were sicker than patients who did not receive plasma to begin with.

Drawing by Dr. Wendy Brooks

In the past, nutritional support was delayed in pancreatitis patients as it was felt that stimulating the pancreas to secrete enzymes would encourage the on-going inflammation, but this theory has been re-thought. Currently, earlier return to feeding has been found to be beneficial to the GI tract’s ability to resume function. If nausea control through medication does not give the patient a reasonable appetite, assisted-feeding is started using a fat-restricted diet. Return of food interest and resolution of vomiting/diarrhea generally means the patient is ready for return to the home setting. Low-fat diets are crucial to managing pancreatitis and their use should be continued for several weeks before attempting return to regular dog food. Some dogs can never return to regular dog food and require prescription low fat foods indefinitely.

How Much Fat is Okay?

There are several ultra-low fat diets made for pancreatitis patients and your veterinarian will likely be sending your dog home with one of them. Remember that pancreatitis is a diet-sensitive disease so it is important not to feed unsanctioned foods or you risk a recurrence. If your dog will not eat one of the commercial therapeutic diets, you will either need to home cook or find another diet that is appropriately low in fat (less than 7 percent fat on a dry matter basis). In order to determine the fat content of a pet food, some calculation is needed to take into consideration how much moisture is in the food.

The Guaranteed Analysis on the bag or can of food will have two values that we are interested in: the % moisture and the % crude fat. To determine the % fat in the food, you must first determine the % dry matter of the food. This is done by subtracting the moisture content from 100. For example, if the moisture content is 15%, the dry matter is 85%. If the moisture content is 75%, the dry matter is 25% and so on.

Next, take the % crude fat from the label and divide the % crude fat by the % dry matter. For example, if the moisture content is 76%, this means the dry matter is 24%. If the crude fat content is 4%, the true fat content is 4 divided by 24 which =0.16 (16%). Such a food would be way too high in fat for a dog with pancreatitis. You want the number to be 0.07 (7%) or less. Simply reading the fat content off the label does not take into account the moisture content of the food and will not tell you what you need to know. If this is too much math, the staff at your vet’s hospital can help you out.

When in doubt, canned chicken, fat-free cottage cheese and/or boiled white rice will work in a pinch.

Beware of Diabetes Mellitus

When the inflammation subsides in the pancreas, some scarring is inevitable. When 80% of the pancreas is damaged to an extent that insulin cannot be produced, diabetes mellitus results. This may or may not be permanent depending on the capacity for the pancreas’ tissue to recover.