Cruciate disease

What is the cruciate ligament?
Like people, dog's have cruciate ligaments.  These are ligaments in the knee that prevent the thigh and skin bone from moving forward and backward independently of one another.  The one that causes particular problems in the dog is the cranial cruciate ligament.  This ligament spans from the back of the femur (thigh bone) to the front of the tibia (skin bone).

Unlike with people where most cruciate injuries occur during activity (sports in particular), dogs tend to tear their ligament due to chronic, degeneration of the ligament which leads to weakness.  When dogs do tear their ligament, an owner could notice signs ranging from a subtle lameness to holding the hind-limb up completely.

How is a cruciate tear diagnosed?
In most cases, a cruciate tear can be diagnosed with a thorough orthopedic exam of the knee.  In particular, a veterinarian is looking for either the "drawer" sign or tibial thrust. 

Drawer is when the tibia (shin) can be moved forward independently of the femur (thigh)

Thrust is when the ankle is flexed, which then moves the tibia forward

If a pet is particularly anxious, he/she may need to be sedated to fully evaluate the knee.  X-rays of the knee may also be performed, which can show swelling of the knee consistent with injury.  It is rare to perform an MRI to confirm a cruciate tear as many tears can be diagnosed with just the physical exam.

The ligament is torn, what now?
If the ligament is torn, then surgery to explore the joint and then stabalize the knee should be considered. 

Exploration:
Exploration of the knee joint can be done is one of two ways.  The first, less invasive way to explore the knee is through arthroscopy (camera in the knee).  Small incisions are made into the knee joint to allow for a camera and instruments to be inserted.  Once inside, the ligaments and meniscus can be evaluated.  If the cruciate ligament is torn, the remnants of the ligament are typically removed, as they can be a source of inflammation.  The meniscus (cartilage in the knee) is also evaluated because many times a meniscal tear is also found with cruciate tears.  If torn, that section of the menincus may be removed or a release of the meniscus is performed.  The benefits of arthroscopy are that it is less invasive than tradition arthrotomy (opening the knee joint completely) and the camera allows for magnification of the ligaments.  The cons are that not everyone has the equipment to perform this and it adds cost to the procedure.

The other way to explore the knee is to open the joint with a scapel, which is called arthrotomy.  Prior to arthroscopy cameras being available, this was the traditional way to evaluate the knee.  Since a larger incision is needed, it is more invasive.  Similar to athroscopy, the ligaments are evaluated, remnants are removed, and the meniscus is evaluated.  The con of this procedure is it is more invasive, however, no special equipment is needed for it.

Stabilization:
Once the joint has been explored and the ligament is confirmed as torn, the knee must then be stabilized.  Unlike with people where the cruciate ligament is reconstructed using a tendon, in dogs veterinarians stabilize the knee in a different way.  The two most common procedures are either the lateral stabilization technique or the TPLO surgery.  There is a lot of information about these procedures at other websites, but this one from Colorado State does a good job of explaining things.

In some situations surgery may not be an option for a pet, whether it be due to financial restrictions or due to other health problems with the pet.  In these situations, the knee will start to develop arthritis which then can be managed in other ways.

Reuniting with a Lost Pet

We see it a lot at our clinic:  A family comes in with a picture of their lost pet and wants us to put up a flier trying to reunite them with their beloved animal.  We are happy to oblige, but unfortunately, many times the owner isn't able to recover their animal.  What can be done to increase the chances of finding their pet?  One word: MICROCHIP.  

 Microchipping pets has been around for a couple of decades, but is becoming more common in each passing year.  There are a number of companies that produce microchips, which is good and bad.  It is good as it gives many options and can keep costs low due to competition, but bad as not all companies use similar frequencies for their chips, so not every scanner will pick up every microchip.

The good news is that there are now scanners that pick up multiple frequencies of chips, so hopefully won't miss a pet who is microchipped.

How do the microchips work?

The chips are about the size of a grain of rice and are implanted under the skin using a needle.  Once implanted, the body will produce scar tissue around the chip that holds it in place.

The chips use RFID technology (radio-frequency), so do not require an internal battery source.  They are powered by the scanner when it is slide a few inches over the chip.  The chip is encoded with a unique number, which the scanner picks up and then can be matched to the owners information.  Using the website http://www.petmicrochiplookup.org/ the number is matched to the microchip company and then the company can be contacted to recover the the owner's information.

The most important thing besides microchipping your pet is making sure that your information is registered to the microchip number and up to date.  If the pet owners information isn't linked to the number encoded in the chip, then the microchip is worthless.  At our clinic, we register the owner's information for them to ensure that this step isn't forgotten.

We use HomeAgain (www.homeagain.com/) microchips at our clinic.  We typically try to implant them during a pet's spay or neuter, since the pet is asleep and won't feel the needle used during implantation.  However, we can also implant the chip when pets are awake, using treats to distract them while the injection takes place.

Once registered, the number is in the system for the life of the pet.  There is no additional charge unless your information changes.  Home Again does offer an annual renewal, which gives access to additional resources including producing fliers if your pet is lost, access to a poison control hotline, and help with transportation back home if your pet is found more than 500 miles away.

Bottom line is that a microchip will give you your best chance at finding your pet if it is lost.

Spring Is Here, and It’s Time To Prepare For Heartworm Season

Spring has arrived! The temperatures are rising, the sun is shining, and the mosquitos and ticks have already been spotted hanging around our four-legged friends. You know what that means… time to get your dog tested for Heartworm Disease if their test is not current and get them on their monthly preventative if they are not on a year round prevention plan!

The Heartworm test is a core part of your canine’s annual wellness examination. Heartworm testing is important for the following reasons:

  1. The Heartworm preventative we recommend giving your dog on a monthly basis is most safely administered after we know your dog is negative for heartworm.

  2. If you have your dog tested once a year for Heartworm disease and give them monthly Heartworm preventive purchased from our clinics and your dog STILL gets Heartworm disease, the company that manufacturers the preventative guarantees their product’s efficacy and will cover the very high cost of treatment. 

  3. We run our Heartworm tests in the clinic, it requires just a few drops of blood, and just about 10 minutes to give us a result for your dog.

Lily Poisoning in Cats

Lily

Nephrotoxicity

reposted from PetMd

There are many different species of plants called “lily”: Easter lily, day lily, Asiatic lily, tiger lily, peace lily, calla lily, and lily of the valley, among others. And though they may be beautiful to look at, a cat could die of kidney failure if he should eat any part of these toxic species and not receive treatment immediately. In fact, as little as two leaves can make your cat sick, and if left untreated, can become fatal in as little as three days.

WHAT TO WATCH FOR

 

• Drooling
• Vomiting (pieces of plant in the vomitus)
• Loss of appetite
• Increased urination, followed by lack of urination after 1 to 2 days
• Dehydration

PRIMARY CAUSE

When determining if a lily plant you want or have is toxic, always look at the scientific name of the plant. The scientific name is a two-part name: the “first name,” which is capitalized, is the genus; the “second name” is the species, and it is not capitalized. You may see additional names following the first and second; these are subdivisions of the species and are not important for determining toxicity. The second name is sometimes abbreviated sp. or spp. This means that the actual species has not been identified. Sometimes the first name is abbreviated, usually with just the first letter of the name. This is usually done when there is a list of several species from the same genus.

The lily plants of greatest concern are any from the genus Lilium (Lilium sp.), which includes Easter lilies, tiger lilies, and Asiatic lilies, and any from the genus Hemerocallis (Hemerocallis sp.), which includes day lilies.

IMMEDIATE CARE

1. If your cat has recently eaten a lily and has not vomited, call your veterinarian to see if you should induce vomiting before bringing her to an animal hospital.
2. Call the nearest animal hospital or the Pet Poison Helpline at 1-855-213-6680.
3. The sooner she gets treatment, the better her chances are for survival. And if you can, bring a piece of the lily plant to the hospital.

VETERINARY CARE

 

Diagnosis

Finding a chewed-on lily plant or pieces of plant in the vomit allows for a definitive diagnosis. Because the toxic principle in lilies attacks the kidneys, blood and urine tests will be taken to evaluate kidney function.

Treatment

If your cat has only recently ingested the plant material and has still not vomited, your veterinarian will try to induce vomiting. Activated charcoal will be given orally to absorb any toxin that might remain in the gut. The key to survival is high volumes of fluids given intravenously (IV) to try and prevent dehydration and the kidneys shutting down. The fluids will be given for 1 to 2 days, while monitoring your cat's kidneys as well as urine output. Lack of urine production is a sign that the treatment was unsuccessful.

OTHER CAUSES

Calla or arum lilies (Zantedeschia aethiopica) and peace lilies (Spathiphyllum sp.) contain crystals that are extremely irritating to the mouth and digestive tract, causing drooling, vomiting, and diarrhea; however, they do not affect the kidneys.

Lily of the valley (Convalaria majalis) affects the heart, causing irregular heartbeat and low blood pressure, and can progress to seizures or coma.

LIVING AND MANAGEMENT

If treatment is successful, there are no reported long-term consequences. Monitor your cat for changes in his urination habits, especially frequency of urination.

PREVENTION

If at all possible, do not have lilies in your house, not even as cut flowers. If you do have lilies in the house, make sure your cat cannot reach them and inform everyone in your household of the dangers lilies pose to the cat.

Cats are less likely to chew on lilies in your yard, especially if there are more appealing things to chew on, like grass and catnip; however, it is best not to have any lilies in your yard.

Are Annual Exams Really Necessary?

Reposted from VetStreet, BY DR. ANDY ROARK DVM, MS

In a much-discussed New York Times article titled "Let’s (Not) Get Physicals," a physician reporter named Elisabeth Rosenthal argued that annual physical examinations for human patients are pointless. She cited a Canadian government task force recommendation to abandon annual physical examinations because they are “nonspecific,” “inefficient” and “potentially harmful” (in that they may lead to unnecessary tests). The task force said examinations should be replaced with intermittent screening tests for age- and risk-specific conditions (mammograms, Pap tests, etc.). Dr. Rosenthal argued that this logic is sound in the United States as well.

Scrutiny of annual physical examinations for people does not come as a surprise. Health care costs are soaring, and research consistently shows annual physicals don’t save lives. Most treatment is started because a patient feels sick and comes to the doctor — not because of findings in a routine examination.

So, do these human-side rumblings mean that we should re-evaluate the annual or biannual examinations that veterinarians recommend for pets? Are those trips to the vet with seemingly happy, healthy pets really worth the stress and effort for all involved? I’ve asked myself those questions repeatedly. Here are the key points I always return to.

Patient Risks and Lifestyles Change

The strongest argument I have heard for continuing annual physical examinations on the human side of medicine has nothing to do with taking temperatures, running lab tests, listening to chests or asking patients to turn their heads and cough. The single most important reason for a physical examination is making time to review patients’ medical histories and to discuss health risks associated with their individual lifestyles and activities.

Likewise, these discussions in regard to pets have great benefit, I believe. Vaccination decisions, food choices, exercise routines, parasite control products and behavioral training measures should all be based on each pet’s lifestyle. The activities that your pet participates in, the environment where he or she lives and his or her specific health risks all change over time and with age. These issues need to be reviewed with a veterinarian on a regular basis to help ensure long-term wellness.

History Is Important

Understanding what is “normal” for a pet is of great importance when veterinarians are faced with potentially abnormal findings. When I treat patients who have not been to a veterinarian for extended periods of time, I find myself wondering things like “Is this pet losing weight? If so, how much?” and “Are these blood chemistry levels increasing?” The unfortunate truth is that if no one has investigated or recorded these values previously, I don’t have any basis for comparison. That makes finding meaningful health trends more difficult. Having routine examinations helps establish a normal baseline for each pet, making it much more obvious when something happens that is abnormal.

Managing Canine Joint Pain

Winter is definitely a more common time to start noticing joint pain and discomfort in your pet.  Your dog may experience a more difficult time getting up, or down, may have more difficulty on slick, slippery surfaces, or stairs, or seem stiff after resting.  Arthritis is the most common cause of these signs.  The most common type of canine arthritis is degenerative joint disease, affected approximately 1 out of every 5 dogs in the united states.

Osteoarthritis occurs when the cartilage cushion protecting the bone surface in the joints is degraded and destroyed.  This causes friction, and leads to pain, and ultimately decreased mobility.  The most commonly affected joints in the dog are the hips, elbows, lower back, knees and wrists.  The common factors that can lead to a dog developing arthritis include aging, joint disorders such as hip dysplasia, repeated injuries or trauma, high activity levels, obesity, and some metabolic disorders such as diabetes or Cushing’s disease.

Common canine symptoms of arthritis can include stiffness, limping, changes in activity or appetite, reluctance to walk, run or climb stairs, and sometimes behavioral changes and irritability.  Often, owners are not even aware that their pet is suffering from arthritis, but a veterinarian can often diagnosis arthritis based on your dog’s age, medical history, and a physical exam. X-rays of the joints may be necessary to determine severity of disease.

There is no one single effective treatment for arthritis.  It is often a combination of medications, exercises, diet, and weight loss.  Every pet responds differently.  Important non-medical approaches to minimizing arthritis pain can include weight control, diet changes, exercise, and sometimes focused rehabilitation treatments.  Weight control is important because if your dog can achieve a more healthy weight for their size, it will decrease the load the affected joints have to bear, minimizing lameness, and improving mobility.  There are dietary supplements that can help alleviate some minor arthritic aches and pain, similar to people.  There are many canine friendly formulations of glucosamine, chondroitin sulfate, and fatty acids that can help reduce some joint inflammation.  There are even special prescription diets, with these formulations built in to improve joint health.  Regular, light to moderate exercise can help keep stiff joints more mobile.  Different levels of exercise may be recommended depending on the pet, and how much discomfort they are experiencing.   Canine physical rehabilitation is an emerging area for joint arthritis.  Rehabilitation therapies can include underwater treadmills, massaging, laser therapy, ultrasound therapy, electric stimulation, massage, stretching and range-of-motion therapies.





Medical management of canine arthritis is geared toward alleviating the pain your pet is experiencing due to the joint degradation, but also reducing the inflammation inside the joint due to the cartilage loss; slowing down the disease and improving your pets mobility.  The most helpful medical plans often include Non-steroidal Anti-inflammatory drugs, or NSAIDs, which promote pain relief and reduction of inflammation.  However, because this prescription drug may have long term side effects, veterinarians will often monitor your pet’s liver and kidney function with bloodwork on a regular basis.  Other pain medications do not reduce the inflammation, but can be used to reduce the pain and discomfort while additional steps are implemented.  Chondroprotectants such as Adequan can help protect the cartilage as it repairs itself, by blocking the enzymes responsible for cartilage destruction, leading to an overall improvement in the joint’s structure and function.  Surgery is also an option for some pet’s, with a goal of reducing cartilage debris and cleaning up the joint, repairing deformities, or rebuilding the joint.  

Cold Weather Safety Tips 

reposted from the ASPCA

Exposure to winter’s dry, cold air and chilly rain, sleet and snow can cause chapped paws and itchy, flaking skin, but these aren’t the only discomforts pets can suffer. Winter walks can become downright dangerous if chemicals from ice-melting agents are licked off of bare paws. To help prevent cold weather dangers from affecting your pet’s health, please heed the following advice from our experts:

• Repeatedly coming out of the cold into the dry heat of your home can cause itchy, flaking skin. Keep your home humidified and towel dry your pet as soon as he comes inside, paying special attention to his feet and in-between the toes. Remove any snow balls from between his foot pads.
• Never shave your dog down to the skin in winter, as a longer coat will provide more warmth. If your dog is long-haired, simply trim him to minimize the clinging ice balls, salt crystals and de-icing chemicals that can dry his skin, and don’t neglect the hair between his toes. If your dog is short-haired, consider getting him a coat or sweater with a high collar or turtleneck with coverage from the base of the tail to the belly. For many dogs, this is regulation winter wear.
• Bring a towel on long walks to clean off stinging, irritated paws. After each walk, wash and dry your pet’s feet and stomach to remove ice, salt and chemicals—and check for cracks in paw pads or redness between the toes.
• Bathe your pets as little as possible during cold spells. Washing too often can remove essential oils and increase the chance of developing dry, flaky skin. If your pooch must be bathed, ask your vet to recommend a moisturizing shampoo and/or rinse.
• Massaging petroleum jelly or other paw protectants into paw pads before going outside can help protect from salt and chemical agents. Booties provide even more coverage and can also prevent sand and salt from getting lodged between bare toes and causing irritation. Use pet-friendly ice melts whenever possible.
• Like coolant, antifreeze is a lethal poison for dogs and cats. Be sure to thoroughly clean up any spills from your vehicle, and consider using products that contain propylene glycol rather than ethylene glycol.
• Pets burn extra energy by trying to stay warm in wintertime. Feeding your pet a little bit more during the cold weather months can provide much-needed calories, and making sure she has plenty of water to drink will help keep her well-hydrated and her skin less dry.
• Make sure your companion animal has a warm place to sleep, off the floor and away from all drafts. A cozy dog or cat bed with a warm blanket or pillow is perfect.
• Remember, if it’s too cold for you, it’s probably too cold for your pet, so keep your animals inside. If left outdoors, pets can freeze, become disoriented, lost, stolen, injured or killed. In addition, don’t leave pets alone in a car during cold weather, as cars can act as refrigerators that hold in the cold and cause animals to freeze to death.