Many dogs, especially small breed dogs, as they age will develop degenerative changes to their mitral valve. The mitral valve is composed of three leaflets which open and close to control the blood flow between the left ventricle and left atrium.

With the aging process these valve leaflets deteriorate and then begin to leak, which allows for the back flow of blood from the left ventricle to the left atrium. As this progresses the backflow of blood eventually builds and leads to fluid buildup in the lungs. Once fluid begins to accumulate in the lungs, the patient becomes symptomatic, and the condition is called congestive heart failure (CHF).

The first indication of CHF noted at home would be an increased Resting Respiratory Rate (RRR). This can be measured by counting the number of breathes per minute when the patient is at rest. A normal RRR should be 20 breathes or less per minute. If the RRR gets to 30 or more this is a clear sign of lung congestion and warrants a visit to the veterinarian. This is usually the time at which heart medications are discussed and started.

The veterinary visit will likely include physical exam, chest radiographs, and possibly blood work and ultrasound of the heart and lungs. Once the appropriate data base is collected then traditionally three heart medications would be started.

These heart meds include a diuretic, an ACE inhibitor, and a drug called Pimobendan. The diuretic helps to pull fluid away from the lung, angiotensin converting enzyme inhibitor relaxes the veins and arteries and lowers blood pressure, and the Pimobendan helps the heart be a stronger pump.

These meds have worked very well together over the past 10 years, and now the “The American College of Internal Medicine” is recommending a fourth medication. This additional med is called spironolactone. Spironolactone is an old drug but has come back into popularity. Spironolactone helps to block aldosterone, a hormone made in the adrenal gland, which can cause increase sodium levels and heart fibrosis.

It turns out this combination of all four drugs provides better outcomes for heart patients and is the newest recommendation by specialists in the veterinary field. Cardalis is a new FDA approved heart medication that combines spironolactone and the ACE inhibitor, benazepril, in one tablet. This is a once per day medication and will make the administration of these four medication easier for the pet owner.

In general patients with CHF secondary to mitral valve disease can improve on medication, and some will live nicely for several years.

What is Cushing’s Disease?

Cushing’s disease otherwise known as hyperadrenocorticism is characterized by several common clinical symptoms. These signs include increased urination and thirst, increased hunger, hair loss and thin skin, potbellied appearance, and panting.

This condition results from increase production of cortisol from the adrenal glands. As many older dogs exhibit some of these symptoms, Cushing’s disease is often being considered as a possible diagnosis for our patients.

Typically there is a step wise progression of exam and testing that leads to the diagnosis of Cushing’s disease. In the early stages of diagnosis for Cushing’s disease; patient history, exam findings, and basic blood and urine results are used to determine if more specific tests should be completed.

The following are five findings that would point toward a patient having Cushing’s disease.

The first finding is called a stress leukogram. This refers to the interpretation of the complete blood count. The complete blood count known as a CBC is part of most basic blood panels. This is the counting of white and red blood cells as well as platelets. Typically patients with Cushing’s disease will have lower than normal lymphocyte counts and higher than normal platelets counts.

The second finding will be elevated liver enzymes. The liver enzyme alkaline phosphatase (AP) is produced primarily in the liver. But when cortisol levels increase, the cortisol induces the AP to become higher. And this increase in AP is found in about 90% of patients with Cushing’s disease.

The third finding is mild elevation in blood glucose known as hyperglycemia. Cortisol increases the production of glucose from the liver and also blunts the effect of insulin in some patients. About 35% of patients with Cushing’s disease will have hyperglycemia.

The fourth finding is elevated cholesterol known as hypercholesterolemia. Cortisol increases the breakdown of fat and adipose tissue, releasing fats into the blood stream. Approximately 90% of Cushing’s patients will have hypercholesterolemia.

The final finding is the presence of dilute urine. The increased level of cortisol interferes with the kidney, and the kidney is no longer able to save water. This inability of the kidney to reabsorb water leads to water loss in the urine; and the need to drink more water to replace the water that is being lost. This occurs in 90% of patients with this disease.

If your elderly pet is panting, has hair loss, and is drinking and urinating more than usual, then he or she could have Cushing’s disease. Start by letting your veterinarian know of these symptoms and collecting samples for basic blood and urine tests.

If several of the above findings are present then specific testing for Cushing’s disease should be completed. This would include further blood testing and likely abdominal ultrasound.

If Cushing’s disease is diagnosed then treatment should be considered. This disease is not cured, but managed, and can require intensive monitoring. Having said that, in the right cases, very satisfying results can be accomplished by the veterinarian and client working together.

The name parainfluenza may sound familiar because it is part of your dog’s regular distemper and parvo vaccine. This virus is also part of what is called (canine infectious respiratory disease complex), otherwise known as kennel cough.

Canine parainfluenza virus (CPIV) is a highly contagious RNA virus that causes respiratory disease worldwide. CPIV as part of kennel cough is commonly spread in group housing and social situations like dog parks and dog day care.

Dogs with CPIV may show no signs or exhibit a dry harsh cough for about 7 days, with or without fever and nasal discharge. However the virus also suppresses the immune system and causes loss of cilia and ciliated epithelium. These negative impacts of the virus makes coinfections more likely; and in some cases may lead to a pneumonia.

The incubation period for this virus is 3-10 days and patients can shed the virus for 6-8 days after infection. Therefore in an asymptomatic patient there could be viral shedding that was unexpected. The virus is easily killed with disinfectants, but can live on nonporous surfaces for 4-12 days.

The CPIV disease can be mostly prevented by vaccination. The vaccines are not 100 percent effective but clearly lessen the number of viral particles and hence the impact of the virus. As mentioned one form of the vaccine is injectable and often is included in the regular distemper and parvo vaccine. This vaccine stimulates systemic immunity and likely protects for less than 3 years. Since the distemper and parvo vaccine is given on a 3 year interval another complimentary vaccine should be considered.

For dogs that have social activity like a boarding facility, dog park, or dog day care the intranasal vaccine should be considered. This is an annual vaccine that incorporates both CPIV and the Bordetella respiratory pathogen.  The vaccine is given as a single nose drop for each nostril; and stimulates mucosal immunity right at the level of the nose.

The combination of the injectable and intranasal vaccine provides the most robust immune response and is appropriate for dogs that have social opportunity.

CPIV is a worldwide pathogen that causes mild disease by itself, but can create weaknesses that allow more serious opportunistic pathogens to infect the respiratory tract. So check with your veterinarian for the best vaccine protocol for your pet.

On a side note, with this being the season for both fireworks and storms, be aware that many pets have serious anxiety issues related to these types of noises. Check with your veterinarian for suggestions to help and possibly medications to get through this tough time period.

Should I be worried if my pet's eye has redness?

 
Redness of the eye can have many causes, and is not always a cause for alarm especially if the redness is transient. For example transient redness can simply be
caused by anxiety or excitement.
That being said redness or conjunctivitis can indicate something more serious such as glaucoma or uveitis {inflammation of the inside of the eye). Therefore any persistent redness (conjunctival hyperemia) should be investigated by a veterinarian. Because treatments and reasons for redness can vary, it is important to have a systematic approach to the eye.

Often conjunctival hyperemia will also include swelling of the conjuctival tissue and drainage from the eye. These patients need a complete opthalmic exam to identify the problem. This exam should include testing for "dry eye", staining of the corneal surface to look for ulceration, and tonometry to check the eye pressure for glaucoma.

By completing these tests the presence of concurrent corneal or intraoccular disease can be determined. Because the eye is delicate delaying treatment for these conditions could lead to permanent eye damage or blindness.

Further the eye can be effected by systemic diseases as well, and therefore a thorough physical exam should be completed on the patient. This exam may include blood work and testing for infectious diseases that might influence the eye.

If the patient has simple conjunctivitis, then the next step is to determine the cause. In dogs the condition is rarely caused by a bacterial infection; rather allergies and
environmental irritation are the more common etiologies.

In addition to allergies, there can be foreign particles that get trapped in the eye that need to be removed or flushed out of the eye. And rarely there can be growths associated with the conjuntiva or the third eyelid which should be sampled and biopsied.

Some patients will form small bubbles on the back side of the third eyelid called follicular conjunctivitis. This is usually from particle irritation and occurs in younger dogs. In these cases rinsing the eyes can be helpful as well as topical medication over the course of several weeks.

Some chronic conjunctivitis cases can be driven by allergies and may require long term eye meds. In these cases the use of cyclosporin is likely safer long term than drops
containing steroids. Interestingly these patients may only have involvement in one eye. If these patients have systemic allergies where the eyes are involved, often the treatment for the systemic allergies will keep the eyes under control at the same time.

In conclusion persistent red eyes should be evaluated by a veterinarian within 24-48 hours. There are many possible causes for eye redness, and thorough evaluation is always warranted to determine the correct diagnosis and treatment.