E-Vet Clinic - Dog Health Care

On Saturday the clinic was very busy. We had our scheduled appointments along with two emergencies. Those two emergencies were limping dogs, which ended up being anterior cruciate ligament ruptures or cranial cruciate ligament ruptures.

The first dog I had seen before with the same limp unfortunately now it had gotten worse. My initial visit with the dog, a 100 lb Bullmastiff, he was still using the leg but had a noticeable limp on the right hind. Palpation and flexion showed minor discomfort in the knee. Attempts to exhibit a drawer sign on the dog were met with a relatively painful but stable joint. This suggested to me a partial tear or strain of one of the cruciate ligaments in the knee. So we sent the dog to physical therapy. However today the poor thing was only toe touching his leg and barely using it. Repeating the tests showed more discomfort in the knee as well as a cranial drawer sign. I sent the dog to an orthopedic surgeon for repair, the same orthopedic surgeon that had fixed the left hind knee a couple of years ago.

The second dog, a collie mix about 40 lbs, came in not using the leg at all, completely holding the leg up. Attempts to palpate the leg were rather difficult as the dog decided to lunge at me every time I even came close to the knee. Palpation of the quadricep muscles were also met with snarling and snapping. So we sedated the dog, upon sedation and examination of the knee a complete drawer sign was noted. This means the dog has a complete tear of the cranial cruciate ligament allowing the tibia to slide back and forth along the femur. Very painful! This dog was also sent to an orthopedic surgeon for cranial cruciate ligament repair.

So what is the anterior or cranial cruciate ligament anyway?

Here is a picture of the normal knee of a dog taken from Hills Veterinary Atlas. Click on it for a larger view. You are looking at the knee from the front. Do you see on the inside of the knee how there are two ligaments. these ligaments cross. For the Anterior or Cranial Cruciate ligament the top part of the ligament attaches to the femur at the back of the knee and the bottom part of the ligament attaches to the tibia at the front part of the knee. the caudal or posterior cruciate ligament does the opposite so it criss crosses with the anterior ligament. This allows the knee to be able to bend however prevents it from sliding back and forth stabilizing the joint. When one of these ligaments tears or ruptures the knee becomes unstable and is allowed to slide back and forth. This will set up some major inflammation and if left untreated will cause some major degeneration and arthritic changes in the knee. A partial tear can be medically managed for a few months allowing the ligament to heal. Treatments such as underwater treadmill therapy (Underwater Treadmill info) , passive range of motion exercises, electrostimulation, chiropractic, acupuncture and eventually quadricep muscle building exercises all play a role in helping heal a partial tear. Little dogs meaning under 30 lbs can sometimes even with a complete tear be managed comfortably with this type of treatment. However, dogs over 50 lbs or dogs with a very active lifestyle more than likely will require surgery to repair a complete tear.

Here is some more info on Cranial Cruciate Ligament Tears…

TPLO Surgery - Repairing Your Dogs Bum Knee
Big dogs have knee problems, too
Anatomy of the Cranial Cruciate Ligament
Surgical Repair Options for Cranial Cruciate Ligament Repair
Canine Cruciate Injuries in Dogs
Some Common Human Injuries Also Common In Dogs

Here’s an update on the Lhasa with the Congestive Heart Failure - He is doing Great!

The one shot of Lasix improved his condition immensely. No fluid in his lungs, his attitude was much improved actually fiestier than before. So he was given one more shot of Lasix and then we have him taking oral Lasix for the next two weeks along with a medication called Enacard. At that time we will be able to reevaluate and choose a course of action from there.

Yesterday a dog came into the clinic coughing and gasping for breath. The 9 year old Lhasa Apso had no history of being around other dogs and had not been in a kennel or dog class.

Physical exam revealed a temperature of 101.5 (normal) and a bluish tint to the mucus membranes. Listening to the lungs determined that they were full of fluid and an extremely loud heart murmur heard on the first beat (mitral valve insufficiency). Questioning the owner he said yes the dog has had a heart murmur since it was a puppy. The veterinarian that first heard it said it was so bad that he did not expect the dog to live for longer than two years. Well here he was 9 years later in my office with his heart finally failing in congestive heart failure.

I would have liked to taken radiographs however I could not sedate the dog and I did not want to stress the dog without sedation in either case the dog may die on the xray table. So we opted to take care of the fluid in the lungs by using furosemide (Lasix). Ideally this dog should be put in ICU with Oxygen and Lasix and digoxin or other heart contractility drug given every couple of hours until the breathing improved and the fluid reduced in the lungs, enough so that an EKG and radiographs or preferably an echocardiogram (ultrasound) can be used to further diagnose the extent of the heart condition. The owner of this dog was not willing to put the expense into his pet, looking at it as, he has had a great 9 years 7 more than expected and he did not want to put the dog through any heroics only to try and extend his life a few more months. He opted to try and see if the one lasix shot was going to be enough to get him through the night and he would bring him back in the morning for another shot and for oral medication to try and see if the minimum would allow him to continue his dogs life.

I did not go into the clinic today but I will find out tomorrow morning what happened with this little 9 year old dog with congestive heart failure.

So what happens how did this dog all of a sudden end up in this condition. In Mitral Valve insufficiency the valve between the top portion of the heart and the bottom part of the heart does not close all the way. So when the heart pumps it is unable to pump with enough force to get the blood out to the body, much of the blood escapes back into the upper chambers of the heart. What this does in the long run is that the heart has to work twice as hard to do its job, and in some cases 3 to 4 times as hard. This obviously wears the heart out to the point where it can no longer function appropriately. When the heart can not perform correctly blood begins to pool throughout the body. When blood pools the actual fluid can separate out and pools in different areas of the body in this case in the lungs making it impossible for the dog to breath and also increases the load on the heart even more!

Medications can be given to help with congestive heart failure or better yet improve the heart before congestive heart failure occurs by reducing the amount of fluid in the blood and others can be given to help the heart muscle improve its ability to contract. Other treatment or rather lifestyle changes can include adding Co-Q10 to the diet as well as adding other antioxidants to help the heart and the overall health and immune system of the dog.

I’ll post tomorrow good or bad on what happened with the Lhasa, stay tuned.

More Information on Congestive Heart Failure in Dogs…

When a Big Heart Is a Bad Thing

Congestive Heart Failure Common in Older Small Breeds Such as the …

Heart Failure in Dogs

I am not sure exactly how to take this story. My emotions and my intellect are conflicting on this one.

Lets start out with the story. A little minature pinscher named Fester, escaped from his owner and ran out onto the road. Fester was unfortunatley hit and killed by a man driving a Honda Civic. That man is suing the owners of Fester for the damage done to his car.

To quote my wife on this story - “Well I guess he has a right to sue as the dog was not on a leash, the inconsiderate butthead.”

This quote does explain well what I am thinking and feeling about this story. Yes the little dog was off the leash and yes he may have damaged the car, not sure how much damage a 13 pound min pin could actually cause, so the people should pay for the damages. However my heart tells me what kind of compassion does this man have that he just kills the family dog and wants $1,100 for damages to his car, time he had to take off from work, and court fees. What a nice guy?!?

He claims that pieces of the bumper flew up and stuck into the radiator which caused it to have to be replaced. Personally I would like to have some tests done because I do not believe his story. It is a 10 year old car in Minnesota! Can we say rusted out radiator and an opportunity to have someone else pay for the replacement? Pieces of the bumper flying off from hitting a 13 lb little dog - again I say prove it.

Anyway here is the story, tell me your opinion…

Driver kills dog, sues owners - Soon after a car struck and killed a dog just north of Cloquet, MN the driver added insult to the injury: He filed suit against the family for the damage done to his vehicle…

Yesterday I discussed the conventional diagnostics and treatment of chronic ear infections in your dog. Well of course you may have been all through that before and the ear infection still comes back. Do you know what that means? It means the underlying cause of the disease has not been found. It means that the ear infection is a secondary problem not the primary problem. It means that your dog has not been completely diagnosed yet. It means something else is wrong with your dog not just ear infections. So what could this be?

It is a problem with the immune system. This is the primary cause. The immune system is either hypersensitive or hyposensitive. You may know it as two other diseases - allergies or hypothyroidism. The most common for chronic ear infections, however,n is allergies and more specifically food allergies. It is what your dog is eating that is causing the problem with the ears. OK I know that is hard for you to imagine but let me explain. However first lets examine the thyroid issue.

Is your dog overweight no matter how little you feed? Is the dog lazy, lies around a lot, tends to sleep more than you would think? Tends to want to sleep on cold surfaces? Has fat deposits? Has skin problems or chronic ear infections? Your dog may be hypothyroid. A blood test will need to be taken by your veterinarian to determine if your dog does in deed have hypothyroidism. If it does then it is an explanation for the chronic ear infections and if the underlying hypothyroidism is not treated then your dog will continue to have ear infections.

Now back to allergies - If your dog is allergic to his food one of the consequences is that the ears will become inflammed. This in turn will close down the ear canal by the swelling of the internal structures. It will also tend to produce more fluid and ear wax. This produces an environment suitable for bacteria and yeast to proliferate and grow. So what occurs is that you treat the infection but because you continue to feed the dog the same food the inflammation, fluid accumulation and wax buildup continues so the ear infection never goes away or it comes back.

Here are the steps to take to help clear up the allergies and prevent the ear infection from returning….

1. Limit the amount of vaccines your dog is receiving.Annual vaccination is not necessary and can in fact be detrimental to your dogs health. For example in this case your dogs immune system is hypersensitive thats what allergies are a hypersensitive immune system. A vaccine is a substance that stimulates the immune system. It makes no sense to stimulate something that is already overstimulated and hypersensitive??? It has been proven that the core vaccines of Distemper, Parvo, and Hepatitis last many years and are not necessary to be giving every year year after year. Your dog will be much happier and healthier without receiving annual revaccination.

2. Dog food - your dog food will need to be of a higher quality protein than the normal dog. Actually I find it best to feed my dog who does not have allergies a higher quality protein. Dogs allergies tend to come from being allergic to protein sources and a lower quality protein is one that stimulates the immune system more than one that is easier to digest and clear through the digestive system easier. So this means avoid grains. Your dog food needs to be meat based. Look at the ingredients, is corn, wheat, rice, or oats high on the list of ingredients? Is it the first product? This is not an appropriate dog food. I prefer to feed an allergic dog a raw based diet or if you are not comfortable with feeding that type of diet or you need the convenience of a kibble diet then you need to purchase one that has a high quality protein and is grain free. There are many dog foods on the market that are duck and potato, venison and potato or just grain free.

3. Dog treats - when first starting out with the new diet I would recommend using the dog food as treats as well. Just take a handful of the new dog food and place it in a bag or in a jar and use them as treats your dog will not know the difference except in his immune system. After the immune system and allergies are under control then you can attempt to use something other than the dog food as treats. I would recommend a high quality freeze dried meat based product.

So the steps to fix your dogs chronic ear infections - 1. Proper diagnosis, 2. Proper treatment, 3. Diagnosis of underlying disease, 4. proper treatment of underlying disease. If you are able to do these steps then your chronic ear infections will be a thing of the past. Your dog and his health will appreciate it.

One of the most common “dis-eases” that I see as a dog veterinarian is ear infection. In fact, I see a lot of chronic ear infections. You know… the dog that has ear infection after infection after infection, maybe this is your dog? You start the medication and the ear clears up and as soon as the medicine is finished the ear infection comes back. Or maybe the ear infection never really clears up. Are you tired of cleaning the ears once a week with ear cleanser, putting drops in the dogs ears every day, your dog shaking his head constantly, or scratching his ears all the time? Well in this two part series I am going to take you through the steps necessary to finally “fix” this disease once and for all.

The first step is actually proper diagnosis and treatment —

1. The first step is physical examination of the infected ear. An otoscope is necessary to look inside the ear to examine the internal structures. Is the inside of the ear red and inflammed, is the ear canal closed over, is there a lot of fluid in the ear, is the ear drum still intact?

2. Your veterinarian needs to do an ear cytology. Which means he/she will take an ear swab, collect a sample of the infected ear, roll it onto a microscope slide and examine the “gunk”  under the microscope. This should be done without your dog on antibiotics and prior to cleaning the ear that day. This will provide information as to whether your dog has a bacterial infection or a yeast infection.

3. A culture and sensitivity must be performed if your dog has experienced multiple ear infections. The reason being is that yes we may know what bacteria it is by checking out the ear cytology however we would not know exactly what antibiotic would actually kill the bacteria. So any dog that has experienced multiple ear infections must have a proper diagnosis and treatment to clear up the infection properly.

After proper diagnosis and an appropriate antibiotic is found to treat the ear, then proper treatment must be applied. First oral antibiotics may be necessary especially in the case of a Staph infection, not just the topical antibiotics, ie ear drops. So with the culture and sensitivity the appropriate oral antibiotics are given (rememeber to use probiotics as well to help with the affect of the antibiotics on the intestinal bacteria) and will be needed every day for at least a week if not up to four weeks for some infections. Next be sure to have the ears cleaned very well, this will need to be done twice a week. Then everyday the ears will need to be swabbed out with a cotton ball and the appropriate antibiotic drops applied, this may need to be done twice daily. If there is a lot of fluid accumulation in the ears, then an astringent will need to applied every other day until the fluid accumulation has subsided. A typical astringent made for ears would be found in swimmers ear medication.

The above is the appropriate conventional diagnosis and treatment for ear infections. There are alternative treatments as well however the proper diagnostics need to be completed just as was stated above. Tomorrow I will go into how to prevent the ear infections from reoccurring, you may be surprised at what the actual underlying cause usually is for chronic ear infections. To give you a hint - it will be food for thought and will help your entire dogs health.

Remember when I wrote about one of my clients experiences with an underwater treadmill —> Underwater Treadmill

Well I ran across a news article discussing using the treadmill for weight loss in dogs and to improve the overall health of the dog by having a great exercise program. The article has video check it out here —> Plump pups become water dogs for health 

I can see many uses for this type of exercise - rehab for orthopedic injuries as well as weight loss in dogs.  It is a great tool.

I also posted this on my Twitter - I usually post quick things like this with a link to the article on my Twitter so be sure you are following my Twitter —> Dr_Dan_DVM

Lately there are dog toothpastes on the market that contain flouride. Is this for real? To be honest it is a marketing ploy, there is no need for flouride in toothpaste for dogs in fact it can be harmful if too much is applied.

Here is a good article found in the San Fransisco Chronical Online today - Ask the vet: Is fluoride OK for dogs

The statement from Dr. Larry Gilman in this article that you need to really remember is “Don’t forget that people rinse after brushing, but dogs just swallow the toothpaste. An overdose of fluoride can cause vomiting and at higher levels can lead to kidney damage.” Flouride is toxic to humans as well as dogs and you certainly would not want to give your dog kidney damage because you are trying to keep his teeth healthy.

Now he does make a mistatement in this article stating that dogs do not get cavities. Dogs have a high pH in their mouth which does prevent the demineralization that occurs in cavity formation, usually. However this changes when a dogs teeth are covered in plaque and the bacteria can create an acidic environment underneath the plaque. Also in chronically ill dogs the pH of their saliva is lowered allowing for the formation of dental caries/cavities.  Approximately 5 to 10% of dogs with dental issues have cavities.

Brushing your dogs teeth everyday will help prevent the formation of plaque and keep your dog healthy. Just do not use any flouride toothpaste it is just a gimmick to get you to buy their toothpaste. Dogs are not people, which is why they can chew raw bones to help with dental issues and we can not. The only problem I have with bones is that many dogs will break teeth on them, another dental issue. Stick with brushing them everyday for the best dental health for your dog, most dogs learn to enjoy it.

Yes another long time patient of mine has gone from this earth and her owner has written a very beautiful email to let us all know. She has given me permission to post it here. Dallas we will miss you!

Balanced on the thin blade that separates the intense pain of loss and the overwhelming joy of love experienced, I helped my dear Dallas go home today. Her lively spirit eagerly broke loose from the confines of her painful body…and she soared to the big herding field in the sky.

She is my teacher, my mentor, my hero, my model for living life…and because of her, Dancing Hearts was born and carries on her torch of compassion and joy.

One short month ago, we discovered she had advanced bone cancer. 4 weeks goes by so fast. We all prepared ourselves for the parting this weekend and her desire was that I not remember her painful days, but her happy playful days…so she rallied for a beautiful couple of hours on Sunday afternoon, playing and running in the sun. It was a miracle, really. And a gift of unforgettable magnitude.

I came home this afternoon with her quiet body, and Joe prepared her final resting place on the farm. When I got home, Joe greeted me with a teary grin, saying: Dallas sent us a message, and it’s on the kitchen table. So, I went inside, and indeed, there was Dallas, comforting and teaching us, even after she was gone with her “message”. We had ordered personalized license plates for my new van, back in January, and when I called a couple of weeks ago to find out why they hadn’t arrived yet, the Sec of State said wait one more week or so, then call us back if you don’t get them, they’re probably lost in the mail…but no, the plates were not lost, they were just waiting to arrive on a special day. So, there on the kitchen table, today, 2 months late, was the miracle message from Dallas. The plates are the ones with the white dove, and the message is PEACE.

Everyone loved Dallas. My most beautiful champion, my Boo Boo girl. Bringing joy and laughter was her special gift, with her peaceful and playful heart. Our sweet bringer of joy.

I will miss you with all my being, Dallas. And, I am more grateful than words can ever describe for the gift of having you in my life.

For my readers- Kathy is the owner of Dancing Hearts a Holistic Learning Center to which Dallas was a big part of helping Kathy find her niche.

Are you on Twitter? It is one of the fastest growing websites on the internet today. It is a way of keeping in touch with people. At first I did not quite get it…now I do and so I am inviting you to follow my twitter - http://twitter.com/Dr_Dan_DVM which is my professional twitter. I will be posting quick tidbits about dog and horse health here and you can really make comments back ask questions really interact with me very quickly anytime I am in front of the computer. Almost instant access, because I have a small program called Twhirl which keeps me connected to my twitter account anytime I am on the computer. It is excellent. So go ahead follow my Twitter @Dr_Dan_DVM