Hypothyroidism

Hypothyroidism

Also Known As: Underactive Thyroid

Transmission or Cause: This condition is a result of a decrease in production and release of the T4 and/ or T3 hormones that are produced by the thyroid gland. The most common cause of Hypothyroidism is degeneration or inflammation of the thyroid gland. Other causes of this condition may include: congenital (hereditary) disease, iodine deficiency, malignancy (cancer) or the lasting response of some medical treatments. 

Diagnosis: Blood work will be submitted to the laboratory to measure the level of the thyroid hormones. Further laboratory work or diagnostics may be imperative for diagnosis. 

Treatment: Treatment involves the synthetic supplementation of the thyroid hormone by administration of an oral medication for the duration of the pet’s life. Further diagnostics will be warranted if limited response is observed, which will be decided by the treating veterinarian. 

Predisposed Dogs: There are several breeds of dogs that are predisposed to this condition. These breeds include: Golden Retrievers, Labrador Retrievers, Boxers, Poodles, Great Danes, Cocker Spaniels and Doberman Pinchers. This condition is more commonly diagnosed in middle aged, sexually altered dogs. 

Symptoms: Some of the symptoms of Hypothyroidism include: drastic and unexplained weight gain, dull and brittle hair coat, alopecia (hair loss), recurrent pyoderma (skin infection), excessive dander, lethargy/low energy and neurologic deficits. 

Prognosis: The prognosis of this condition is dependent on the cause. Generally, this condition has a very good prognosis. This condition will likely need long term daily treatment. When the thyroid hormone has become regulated with treatment, the symptoms will decrease and the pet’s quality of life will improve over time. 

Long Term Management: Medication will need to be given once to twice daily long-term for the control of this condition. Initially, blood work will need to be preformed every 4-6 weeks until the levels are within an acceptable range for improvement. Long term, blood work will be required at least every 6 months to measure levels to determine appropriate dosing. It is probable that the dose of medication may need to be adjusted at some point during this process.

Anal Sac Disease/Infections

Anal Sac Disease/Infections 

Also Known As: Anal sac impaction, anal sacculitis, anal sac abscess 

Transmission or Cause: The cause of anal sac infections is unknown. Excessive anal gland fluid production, soft feces or diarrhea, poor muscle tone, and obesity contribute to higher risk of developing anal sac infections. 

Affected Animals: Although any dog may be affected, small breeds such as Chihuahuas, dachshunds, and miniature or toy poodles are more commonly examined for anal gland problems. Cats are rarely affected by this condition. 

Overview: Anal sacs are the reservoirs for the discharge of anal glands which are located on either side of a dog’s anus. These sacs contain liquid secretions from the anal gland, which, in healthy animals are normally pale yellow-brown to grayish in color. The contents are usually emptied during normal bowel movements or when a dog is nervous or scared. In most animals, these sacs empty easily and regularly. However, some dogs, especially small breed dogs, are not able to empty the sacs properly and become susceptible to anal sac disease. There are three progressive stages of anal sac disease which include: anal sac impaction, anal sacculitis (inflammation), and anal sac abscess. 

Description: Impaction of the anal sacs occurs when the anal gland secretions thicken inside the sac and becomes unable to empty during a bowel movement. Anal sacculitis, or inflammation of the anal sac, is an infection usually resulting from impaction but may also be caused by bacterial growth within the anal sac. During the sacculitis stage, the impacted fluid may become thinner and fill with pus. Abscess occurs when the inflammation of the anal sac has reached an extreme stage. At this point, a red-brown substance will be seen coming from the sac. The sac will usually be enlarged, warm, red, and painful. Usually, the abscessed sac will rupture, leaving a hole near the side of the rectum that oozes a foul-smelling liquid. The tissue surrounding the abscess will swell, causing more inflammation and pain. 

Clinical Signs: Symptoms of anal sac disease include scooting across the floor, licking the area around the anus, straining to defecate, biting at or chasing the tail, discharge, swelling, and/or pain around the area. A dog with anal sac disease may scoot their rear end on the ground in an attempt to relieve the sensation of pressure and irritation around its rectum. When an abscess ruptures, pus discharge may be seen draining from the lesion. The area surrounding the abscess may appear red, swollen, and painful. 

Diagnosis: Diagnosis of anal sac disease is made clinically with a rectal examination. Infected anal sacs are often very painful and some dogs may need sedation before a thorough examination can be done. Normal anal sac fluid varies in color but brown, yellowish-green, or red tinged secretions are typical of animals with anal sac disease. 

Prognosis: Most often antibiotics will resolve the anal sac infection. In many cases, expressing the anal sacs must be performed on a regular basis to prevent recurrence. 

Treatment: When the anal sac disease is at the impaction stage, the most common treatment is an outpatient procedure called expression in which the veterinarian applies pressure to the anal glands until the thickened secretions are expelled from the sacs. For the anal sacculitis stage of the disease, the same expression procedure is performed and afterwards, an antibiotic-steroid combination ointment is applied directly to the anal sac. In addition, the examining veterinarian may prescribe oral antibiotics to help fight infection. When anal sacs have abscessed, a surgical procedure is sometimes necessary. After sedating the dog or placing it under general anesthesia, the veterinarian will surgically open the infected anal sac to clean out the infected material and drain the remaining liquid. An oral antibiotic will usually be prescribed post-surgery. If infection continues after the surgery, surgical removal of the anal sac may be required. 

Prevention: Expression of the anal sacs every few weeks or months often will help prevent anal gland fluid from accumulating and becoming thickened. High fiber diets are suggested to help prevent anal sac disease in some dogs, especially those that are obese.

Why Does My Dog Get Ear Infections?

Why Does My Dog Get Ear Infections?

Also Known As: Otitis externa, otitis media, and otitis interna, inflammation of the external ear canal, middle ear infection, inner ear infection.

Transmission or Cause: Possible causes of otitis externa, which may lead to infections of the middle and inner ear, include allergies, hormonal diseases, excess moisture in the ears due to swimming or bathing; inappropriate treatment or cleaning of the ears such as may be caused by the use of cotton-tipped applicators; excess wax production in the ears; or a foreign body or tumor that is obstructing the ear canal. 

• Additionally, otitis externa can be caused by parasites, (including ear mites or mange mites), and by autoimmune diseases. The most common cause of the development of otitis media and otitis interna is a bacterial infection resulting from otitis externa.

Affected Animals: Dogs and cats. Cocker spaniels and other long-eared or floppy-eared breeds may be more predisposed to developing infections.

Overview: An ear infection, or otitis, is an inflammation of the outer, middle, or inner ear canal. Most frequently, an animal will develop otitis in the outer ear that may worsen and spread into the middle ear. Once in the middle ear canal, the inflammation can move into the inner ear or, in cases in which the otitis has originated in the middle ear, the infection can instead progress outward to the external ear. Otitis can be caused by a tremendous array of factors, including allergies, hormonal diseases, excess liquid in the ear from swimming, autoimmune diseases, skin parasites, and excess wax production.

• Generally, animals that develop ear infections have reddened ears that are painful to the touch and ooze a foul-smelling liquid. A punctured eardrum is not an uncommon result of a middle ear infection, and the more severe cases of otitis can lead to partial deafness, lack of balance, nausea and vomiting, and problems with the nerves of the eye.

Clinical Signs: Clinical signs can vary depending on the severity and location of the infection, but typical symptoms of otitis include pain and erythema of the pinna (earflap), head shaking and scratching of the ears, and pus and malodorous exudate coming from the ear canal. The animal may tilt the affected ear downwards and may roll or lean to the affected side. If both sides are affected, the animal may be deaf or wobbly. Some animals may be nauseated, vomit, and have Horner’s syndrome (constricted pupil of the eye on the same side as the ear infection). Any neurological clinical signs indicate significant middle ear or inner ear disease.

Symptoms: Ears that are red, painful to the touch, and produce a foul-smelling discharge are symptomatic of otitis. Typically, a animal with an ear infection will scratch and shake the ears or may tilt the affected ear downwards. Animals that are affected more severely may show some neurological signs such as rolling or leaning to one side. If both ears are affected, the animal may be deaf or off balance and uncoordinated. Some animals may be nauseated and vomit. Also, some animals may get a condition called Horner’s syndrome in which the pupils are sized differently and the nictitating membrane (third eyelid) is raised. This condition indicates that a nerve has been affected by the inflammation from the middle ear. Any neurological clinical signs indicate significant middle ear or inner ear disease.

Description: Typically, ear infections begin with otitis externa and then progress deeper into the canal to the middle ear. When the inflammation in this region of the ear is chronic, the eardrum may rupture and the infection may spread to the inner ear or, the infection may begin in the middle ear and progress outward to the external ear.

• Of the three types of otitis, infections in the inner ear are often the most severe and can lead to partial deafness and neurological problems.

In serious cases of otitis, the skin begins to form into folds in which the infection can become trapped, making cleaning and use of topical treatments very difficult. In addition, the skin will secrete more wax and debris that allows yeast and bacteria to overgrow, causing further disease. Severe inflammation leads to permanent skin thickening, mineralization, and narrowing of the ear canals. Once this occurs, the only viable treatment will be surgical removal of part or all of the ear canal.

Diagnosis: The veterinarian will make a diagnosis based on the clinical signs, physical exam findings, and through the use of several other diagnostic tools. One such tool is cytology, which involves taking a swab of the ears and looking at the material collected under a microscope for the presence of bacteria, yeast, mites, and other substances that might cause an infection. Bacteria and yeast are normally present in low numbers in all animals’ ears, but a large presence will lead to an ear infection.

• Allergy testing or a hypoallergenic diet trial may be needed to identify underlying allergies. Blood testing may help investigate hormonal abnormalities. Skin biopsies may be needed to determine any diseases such as an autoimmune disorder that could cause a skin abnormality affecting the ear. Skin scrapings may be needed to detect mites, tiny parasites that can infect the ears and cause skin diseases. X-rays of the skull or CT scan can be used to examine the middle and inner ear for signs of disease. In addition, cultures of an infected ear help determine the presence and type of bacteria, as well as antibiotics that are appropriate for treatment. The majority of animals with ear problems have such pain in their ears that they cannot withstand having them examined, cleaned, cultured, or x-rayed without the use of general anesthesia.

Prognosis: With proper treatment, otitis externa usually will resolve within three to four weeks, although it may recur in certain animals. Animals with otitis media or otitis interna may need 1-3 months of systemic antibiotics. The key for long-term success is correcting or treating the underlying problem that led to the development of the otitis.

Treatment: After the cause of the otitis has been diagnosed, the veterinarian usually will perform a thorough cleaning of the ear canals while the animal is under sedation or general anesthesia.

• The use of topical medications, which are placed into the ear canal, is often very beneficial in killing yeast, bacteria, and mites. Oral medications also may be used in conjunction with other treatments to help kill bacteria, yeast, and mites. The technician or doctor will teach the animal’s owner how to clean and medicate the ears properly to ensure successful treatment of otitis. 

The surgical correction of the ear canals may be necessary in cases of severe infection. One type of surgery, called a lateral ear canal resection, allows the ear to drain more easily, decreases the amount of humidity in the ear, and makes topical treatments easier to apply. A total ear canal ablation, a complete removal of the ear canal, is performed on animals with severe, chronic ear disease that is nonresponsive to medical therapy.

Prevention: Prevention is best accomplished when the veterinarian is able to determine the underlying factors that can lead to development of otitis.

• Proper cleaning of the ears is also critical. A veterinarian can explain how to clean the ears, as well as how to apply any medications that have been prescribed to treat the otitis.

HOT SPOTS!!!

HOT SPOTS!!!

Also Known As: pyotraumatic dermatitis 

Transmission or cause: Potential underlying causes for hot spots include parasites (especially fleas or scabies mites), allergies (flea, pollen, food), skin infections by bacteria or fungus, or trauma. 

Affected Animals: Hot spots can affect dogs of any age, breed, or gender, but they occur most commonly in thickcoated/longhaired breeds, and in dogs with underlying causes such as parasites or allergies. Hot, humid weather can contribute to the development of hotspots. Hot spots occur rarely in cats. 

Clinical signs: Hot spots start when a dog incessantly licks, chews or scratches a focal area of the body in response to a painful or itchy sensation. The result is a rapidly developing area of redness, hairloss, oozing and eroded skin that is often painful and infected with bacteria. Hot spots occur most frequently on the trunk, base of the tail, outer thigh, neck or face. 

Diagnosis: The diagnosis of hot spot is by clinical presentation and history, and by ruling out other causes of hairloss and red skin such as skin parasites or fungal infection. Diagnostics may include close examination for fleas, skin scrapes for microscopic analysis, or fungal cultures. Additionally, it is important to identify and address the underlying cause of the hot spot, and in recurrent cases diagnostics may also include trial therapy for fleas or scabies, allergy testing, or a hypoallergenic diet trial. 

Prognosis: The prognosis for cure of hot spots is good, although they will tend to recur if the underlying cause is not addressed. 

Treatment: The treatment for hot spots often includes clipping and gently cleaning the affected area (this may necessitate sedation), then application of topical antibacterial and/or steroid-containing products to the area (products that contain alcohol should be avoided). Additionally, many cases need 2-3 weeks of systemic antibiotics for secondary bacterial infection, and/or a short course of oral steroids to stop self-trauma. Some dogs will need an Elizabethan collar to restrict contact with the area for several days. Treatment of the underlying cause is also important, and may include trial therapy for fleas or scabies, a hypoallergenic diet trial, or allergy hyposensitization injections based on allergy testing. 

Prevention: Prevention of hotspots is done by keeping the dog clean and parasite free, and the hair coat brushed and free of mats. It is often helpful to clip long coated dogs down in the warm months. Animals with underlying allergies must have these allergies addressed to avoid hot spot recurrence. 

Sebaceous Adenitis

Sebaceous Adenitis 

Transmission or cause: The cause of sebaceous adenitis is unknown but the end result is inflammation of the sebaceous or oil gland associated with the hair follicles. Loss of the sebaceous gland leads to dysfunction of normal hair growth which results in hair loss. The underlying cause is probably a combination of genetic predisposition and immune-mediated sebaceous gland inflammation.

Affected animals: Sebaceous adenitis is an inflammatory disease that mostly affects young adult to middle aged dogs. Cats are rarely affected. Some breeds of dogs that are prone to sebaceous adenitis include Standard Poodles, Akitas, Vizslas, Samoyeds, and Belgian Sheepdogs. It is believed to be a recessive inherited trait in Standard Poodles.

Clinical signs: Most dogs will show a bilaterally symmetrical hair loss and excessive scaling especially around face, head, ears and trunk. Some dogs may develop a bald “rat-tail”. Many dogs may have a secondary bacterial infection of the skin with pimples, crusting and possible odor. Belgian Shepdogs may have a severe draining ear infection. Vizslas and Dachshunds often have circular areas crusting of hair loss that can spread and eventually merge together. The hairs of affected animals often have adherent surface debris surrounding the base of the hair called ‘hair casts’. Akitas often have more severe disease with red inflamed skin and greasy crusting and matting. Sebaceous adenitis is usually not itchy but can be if there is secondary infection.

Diagnosis: Sebaceous adenitis is suspected when the history and clinical signs are consistent. Microscopic examination of hairs from dogs with sebaceous adenitis often shows obvious hair casting. The definitive diagnosis of sebaceous adenitis is made by taking a skin biopsy which involves removing small pieces of skin after numbing the area with anesthetic and submitting the skin samples to a pathologist.

Prognosis: Some dogs can spontaneously improve but most dogs need lifelong control of their sebaceous adenitis. It is mostly a cosmetic disorder with no internal manifestations of disease.

Treatment: The treatment for sebaceous adenitis may involve anti-inflammatory therapy, retinoid drugs or vitamin A along with anti-scaling shampoos and emollient rinses. Treatment of secondary infections, if present, is also important. Some dogs respond better to some treatments than others, and trying different therapies may be necessary. The goal of therapy is to alleviate and slow progression of symptoms, but only partial improvement may be seen.

Prevention: Prevention of sebaceous adenitis involves not breeding affected animals.

Zinc Responsive Dermatosis

Zinc Responsive Dermatosis

Transmission or Cause: Two distinct syndromes have been recognized: 

Syndrome I zinc-responsive dermatosis: is associated with a defective intestinal absorption of zinc despite being fed a nutritionally well-balanced diet. 


Syndrome II zinc-responsive dermatosis: occurs in rapidly growing puppies / young dogs being fed zinc deficient diets or diets which have high phytates (plant proteins), diets high in minerals, such as calcium, which can interfere with zinc absorption, and/or are fed cereal or soy based diets. Prolonged gastrointestinal disease resulting in chronic enteritis and diarrhea can also interfere with zinc absorption. 


Affected Animals: Syndrome I zinc-responsive dermatosis – This syndrome has been recognized primarily in Alaskan malamutes and Siberian Huskies. Skin lesions typically develop in young adults but onset of disease has been described in older pets. Syndrome II zinc-responsive dermatosis – This syndrome has been described in a plethora of breeds, including the Great Dane, Doberman pinscher, beagle, Boston terrier, German shepherd, and standard Poodle, amongst others. 

Clinical Signs: 

Syndrome I – Skin lesions tend to first occur in September through January and can worsen during estrus or times of stress. Lesions present as red skin with hair loss and crusting around the mouth, chin, eyes and ears. The scrotum, vulva, prepuce and pressure points, such as the elbows and footpads, can also be affected. Lesions are typically itchy.

Syndrome II – Skin lesions typically form on pressure points, nasal planum and footpads and present as thickened, crusted plaques. Fissures can form in thickened, crusted areas. Affected dogs can also have enlarged lymph nodes and develop secondary skin infections. 


Diagnosis: Diagnosis in both syndromes is made through physical examination, a thorough history and biopsy. Hair and serum levels of zinc may also be abnormal; however, analysis of zinc can be difficult and unreliable and so this test is not typically performed.



Treatment: 


Syndrome I – Oral zinc supplementation typically brings rapid resolution of the clinical signs. Some dogs do not achieve clinical resolution with oral zinc supplementation alone; in those cases, low doses of corticosteroids are beneficial. Some dogs also benefit with the addition of fatty acids in addition to zinc. Intact female dogs should be spayed. Treatment is generally lifelong. 


Syndrome II – Treatment is focused on dietary correction and treatment of secondary bacterial and yeast skin infections. Generally lesions should resolve within 2-6 weeks with dietary manipulation, but concurrent zinc supplementation can hasten the resolution. Unlike Syndrome I, zinc supplementation can be discontinued after a few weeks. 


Prognosis: Prognosis is good with response to therapy. 

Pemphigus foliaceus (PF)

Pemphigus foliaceus (PF)

Transmission or Cause: Pemphigus foliaceus is an autoimmune disease whereby antibodies produced by an animal’s own immune system attack the bridges that hold skin cells together. It is the most common autoimmune disease diagnosed in dogs and cats. Affected Animals: Dogs and cats of any age or gender can be affected. In dogs, Akitas, Chow Chows, Doberman Pinschers, Dachshunds, and Newfoundlands may be predisposed. No breed predilections exist with cats. Three forms of Pemphigus foliaceus exist in the dog. The first and most common is the spontaneous form which develops in dogs with no history of skin disease or drug history. The second form of Pemphigus foliaceus is initiated via a drug reaction. The third form occurs in dogs with a history of chronic skin disease (e.g. allergies). 

Clinical Signs: The primary lesion of Pemphigus foliaceus is a pustule. These lesions typically begin along the nasal bridge, around the eyes, and ear pinnae. It is typical for the lesions to spread and occur along the trunk, feet, clawbeds, groin, and footpads. In cats, the nail beds and nipples can also be commonly affected. In most cases, the pustules form and rupture very quickly, so that all that there is left to observe are areas of hair loss, yellow-brown dried crusts, redness and scale. Severely affected animals may become anorexic, depressed and have a fever. The disease itself often displays a waxing/waning course. 

Diagnosis: The diagnosis of Pemphigus foliaceus is made by clinical signs, cytology, and biopsy. Other diseases that can appear similar to Pemphigus foliaceus include infection (bacterial, parasitic, fungal), seborrheic skin disease, and varying forms of lupus. Skin scrapes would be performed to rule out external parasites via microscopic analysis. A fungal culture would be done to rule out ringworm (a type of common fungus). Samples of debris from intact pustules or crusts can allow for a diagnosis of Pemphigus foliaceus. In some cases, multiple skin biopsies are required to confirm the diagnosis of Pemphigu foliaceus. 

Treatment: Localized cases of Pemphigus foliaceus can be treated with varying strengths of topical steroids. The mainstay of therapy for more generalized cases in both dogs and cats Pemphigus Foliaceus are oral glucocorticoids (e.g. Prednisone). In order to minimize the potential side effects of glucocorticoids (e.g. weight gain, excessive drinking and urinating, liver enlargement), nonsteroidal immunosuppressive drugs are added to the regimen. In dogs, azathioprine and/or cyclosporine can be utilized, while in cats leukeran and/or cyclosporine are the most popular supportive drugs. Other nonsteroidal immunosuppressive drugs include gold salts (dogs and cats) and tetracycline/niacinamide (dogs). Affected animals are started at higher dosages initially until remission is achieved (4-12 weeks), and then are tapered to the lowest possible dosages that maintain remission. 

Prognosis: The prognosis is fair to good, but lifelong therapy is usually required to maintain remission. Cases of Pemphigus foliaceus that are induced by a drug reaction, are the most likely to be cured. Regular monitoring of clinical signs, hemograms, serum biochemistry profiles, urinalyses, and urine cultures with treatment adjustments as needed are essential.