Map

The Job of the Heart

The heart is simply a pump. It pumps blood. The left side of the heart receives fresh oxygenated blood from the lungs into its upper chamber or atrium. The atrium pumps blood into the lower chamber or ventricle, which with great force, pumps blood out into the body through arteries.

     The right side of the heart, also with an upper and lower chamber (atrium and ventricle), receives blood from the body through the veins and pumps it into the lungs. In the lungs carbon dioxide is exchanged for oxygen. The capillaries are a fine network of blood vessels fed by the arteries, oxygenating the tissues of the body, and then draining into the veins.

     The upper and lower chambers of the heart and the outflow arteries have valves that prevent blood from flowing backward. These are what cause the familiar “lub-dub” sound during the heartbeat.

What is Congestive Heart Failure?

If the heart cannot pump blood adequately throughout the body a number of things happen which are referred to collectively as congestive heart failure. The causes can vary from congenital defects, to valve abnormalities or leaks, disease of the heart muscle itself, rhythm abnormalities, to heartworm disease. When the heart is diseased the output or amount of blood pumped is lowered. This lowers the amount of blood circulating and therefore the amount of oxygen the tissues receive. When oxygen levels drop, the nervous system stimulates the heart to pump harder and faster and stimulates the peripheral blood vessels to constrict in an attempt to raise the blood pressure.

     The kidneys respond to low oxygen level and low arterial blood pressure by retaining more water and sodium (salt) than they normally would. This is an attempt to increase blood volume. The heart itself will respond by increasing in size so that it can pump a larger volume of blood. The heart working harder and harder, gradually becomes more stressed until it is incapable of maintaining proper blood dynamics.

The Signs of Heart Failure

The signs or symptoms of congestive heart failure may include exercise intolerance, intermittent coughing (especially at night), shortness of breath, and enlargement of the abdomen with retained fluid. Early on the signs can be very mild.

Treatment

All the medicines that we might use are an attempt to make the heart a more efficient pump and to decrease the congestion that occurs in the lungs and liver. One mainstay of treatment is the diuretic drugs like Lasix. They mobilize the excess retained water and salt and move it out by stimulating urine production. Another group of drugs is the vasodilators such as Enacard. They allow the blood to flow more easily through the tiny arteries and capillaries, reducing the work load on the heart. Bronchodilators can relax the airways and reduce the intensity of the cough.

     Diet is important too. It should be carefully balanced to be low in salt and produce minimal urinary wastes. Obese animals are at greater risk, yet exercise must be limited to avoid stressing the heart, so proper diet is essential.

     Most cases of congestive heart failure have no cure, but careful attention to treatment and diet can reduce the clinical signs and add years to the life of a pet that otherwise would not be able to live very long. Because the disease never really leaves, frequent reexaminations are important and the medicines will have to have their doses adjusted

according to changes in the pet.

Call Us If…

• Your pet loses its appetite or seems very tired.

• You notice any degradation in your pet’s general health

• Your pet is coughing more than usual.

Why is My Pet’s Eye Red?

A “red eye” is usually inflamed. Eye inflammation can be the result of many different abnormalities. One type of eye inflammation is conjuctivitis, which is an inflammation of the mucous membrane that covers the front portion of the eyeball and lines the third eyelid at the inside corner of the eye and underside of the upper & lower lids.

      Conjunctivitis can be primary (e.g., allergic, infectious, environmental, or “dry eye”) or secondary to an underlying eye or systemic disease (e.g., glaucoma, uveitis, immunemediated disease, tumors). Many problems can start in one eye and quickly involve the other eye.

      Breed Predilections: Dog breeds predisposed to allergic or immune-mediated skin diseases (e.g., atopy or allergic dermatitis) tend to have more problems with allergic conjunctivitis or dry eye. Purebred cats seem predisposed to infectious viral conjunctivitis.

How Do We Know What Caused It?

The history and physical examination can sometimes tell us what the specific cause is. The signs of conjunctivitis can include: eyelid spasms, eye redness and swollen blood vessels, eye discharges, swelling of the eyelids, and symptoms of upper respiratory infection (in cats). There are a great number of causes of conjunctivitis. These can include: bacterial infection; viral infection (including canine distemper, feline herpes virus or calicivirus), allergic reactions, various immune-mediated conditions, tumors, conditions secondary to the surrounding tissues (like “dry eye” or keratoconjunctivitis sicca, lid diseases such as entropion or ectropion, and extra or abnormal eyelashes, obstruction of the tear drainage duct), foreign bodies, irritation from dust, chemicals, or secondary to other eye diseases (corneal ulcer, deeper inflammation, or glaucoma). Often we will have to perform some diagnostic tests to determine the cause of the inflammation.  

     These tests vary according to the physical condition of the affected eye and the pet’s general health. They may include staining the eye, testing the internal pressure, testing tear production, looking into the eye with an ophthalmoscope, examining discharge under the microscope, and sending blood samples to the laboratory for specific tests.

How Can We Treat It?

Naturally the treatment will vary according to the cause and the resulting eye condition. We try to treat as specifically as possible for each cause. Some aspects of eye treatment may include:

• Medications may be indicated and frequent reexaminations are often needed to ensure a proper response.

• Some eye diseases may require surgery.

• Some eye diseases may require treatment of the whole pet, not just the eye (i.e. Valley Fever, Distemper, and Ehrlichia).

• If your pet wants to rub its eye, an Elizabethan collar will help to protect the eye.

• Bright light is painful to your pet’s eye, so keep it indoors until the eye is normal.

Call Us If…

• Your pet’s eye(s) appears to be getting worse.

• You notice any degradation in your pet’s general health.

• You have trouble giving the prescribed medicine.

Constipation is infrequent, incomplete, or difficult defecation with passage of hard or dry feces (stool or “poop”). Obstipation is intractable constipation caused by prolonged retention of hard, dry feces; defecation becomes impossible.

What Causes This?

Constipation can develop with any disease that impairs passage of feces through the colon. Delayed fecal transit allows removal of additional salt and water producing drier feces. Intestinal contractions may increase during constipation, but eventually motility diminishes due to muscle degeneration secondary to chronic overdistention.

What Symptoms are Seen with Constipation?

This syndrome is more common in cats. An owner may see the pet straining to defecate with small fecal volume, hard, dry feces, infrequent defecation, small amount of liquid feces produced after prolonged straining, occasional vomiting, loss of appetite, and depression.

What Causes It?

There are many causes, and they can include:

• Dietary: Bones, hair, foreign material, and excessive fiber.

• Environmental: Lack of exercise, change of environment (e.g., hospitalization and dirty litter box), and inability to move about.

• Drugs: Anticholinergics, antihistamines, opioids, barium sulfate, sucralfate, antacids, kaopectolin, iron supplements, and diuretics.

• Painful Defecation.

• Anorectal disease: anal sac disease, anal sac abscess, perianal fistula, anal stricture, anal spasm, rectal foreign body, and rectal prolapse.

• Trauma: fractured pelvis, fractured limb, dislocated hip, bite wound or laceration, and perineal abscess.

• Mechanical Obstruction: Outside the rectum or colon (healed pelvic fracture with narrowed pelvic canal, prostate disease, pelvic tumor, and other swellings or masses in the pelvic area); Inside the wall of the rectum or colon (colonic or rectal tumor or polyp, rectal stricture, rectal diverticulum, perineal hernia, rectal prolapse, and congenital defects.

• Neurologic Disease: Brain and spinal cord (paraplegia, spinal cord disease, intervertebral disc disease, and cerebral disease (e.g., lead toxicity and rabies): Peripheral nervous system (dysautonomia and sacral nerve disease); Intrinsic colonic nerve dysfunction (idiopathic megacolon in cats).

• Metabolic and Endocrinologic Disease: Impaired colonic smooth muscle function (hyperpara-thyroidism, hypothyroidism, and hypokalemia as in chronic renal failure); Debility (general muscle weakness, dehydration, and cancer).

• Behavioral risk traits: Low tail carriage causing perianal fistula; Pica (eating foreign material); Excessive grooming (hair).

How is Constipation or Obstipation Diagnosed?

The history and physical examination may be diagnostic. Often laboratory tests are needed to determine the underlying cause. Radiology (x-rays) may reveal a colonic or rectal foreign body, colonic or rectal mass, prostatic enlargement, fractured pelvis, or dislocated hip. Ultrasonography may help define a mass outside the wall of the colon or rectum or prostatic disease. Colonoscopy may be needed to identify a mass, stricture, or other colonic or rectal lesion; biopsy specimens can also be obtained at that time.

How is It Treated?

We would try to remove or ameliorate the under-lying cause if possible. It may need to be treated as inpatient if it has severe impaction of feces or dehydration; adequate hydration and electrolyte balance are important, especially before enemas. Manual removal of feces with the animal under general anesthesia may be required if enemas and medication are unsuccessful. Surgery may be required as a last option in cats with recurring obstipation (acquired megacolon) or idiopathic megacolon.

HOME CARE

Dietary supplementation with a bulk forming agent is the mainstay of home treatment. Bran, methylcellulose, canned pumpkin, and psyllium can be used Home care may also include: Laxatives and cathartics can be given as needed; Emollients (docusate sodium and docusate calcium); Lubricants (mineral oil and white petrolatum are not recommended because of danger of lipoid aspiration pneumonia due to lack of taste, but they may be safely mixed with some canned food); Stimulant laxatives (bisacodyl); Saline laxatives (isosmotic mixture of polyethylene glycol and poorly absorbable salts; mainly used to prepare the colon for colonoscopy or surgery; Disaccharide laxatives

(lactulose) Enemas may be needed, either in hospital or periodically by the owners at home. Use warm water with a small amount of mild soap, mineral oil, or docusate sodium. Do not use sodium phosphate retention enemas (e.g., Fleet, C.B. Fleet Co., Inc.) because of their association with severe blood electrolyte alteration. Mineral oil enemas are safe (but messy); Suppositories can be used as a replacement for enemas (glycerol, bisacodyl, or docusate sodium products). Motility modifiers can also be tried. Cholinergics such as urecholine may aid in evacuation but are contraindicated in animals with obstruction. Cisapride may also stimulate motility in patients with megacolon.

NOTE:

• Chronic constipation or recurrent obstipation can lead to acquired megacolon.

• Overuse of laxatives and enemas can cause diarrhea.

• Colonic mucosa can be damaged by improper enema technique, repeated rough mechanical breakdown of feces, or sores secondary to pressure of hard feces.

• Anal irritation and ulceration can lead to fecal incontinence.

• Please monitor the frequency of defecation andconsistency of feces.

What is the Cornea?

The cornea is the clear window in the front of the eyeball that allows light to enter the eye. It is quite thin, has no blood vessels, and is composed of four distinct layers. It is very sensitive and readily reacts to irritants from inside or outside of the eye. The outermost layer is the surface epithelium or “skin.”

     Since there are no blood vessels of any kind in the cornea, it must get its oxygen and nutrients from the air outside the eye and the liquid immediately behind it inside the eye.

What is a Corneal Ulcer?

If the superficial epithelium is cut or otherwise opened, this condition is called a corneal ulcer. The depth that the ulcer goes into the cornea is very significant. With proper treatment shallow ulcers may heal rapidly, whereas deep ulcers may be very difficult to heal. If the ulcer perforates the cornea, the entire eye may become infected and infection can travel up the optic nerve to the brain. Because of this possibility, even shallow ulcers are considered a very serious condition.

ALL corneal ulcers are very painful.

What Causes a Corneal Ulcer?

Trauma is the most common cause of corneal ulcers. Trauma includes scratches from plants or other pets, foreign bodies in the eye, shampoo irritation, and abrasion from rubbing the eye on the carpet or lawn. Other causes of corneal ulcers include bacterial infection, congenital defects, virus infection, and nutritional abnormalities. An open cornea is very vulnerable to bacterial infection and tissue degradation.

What are the Signs of a Corneal Ulcer?

Because they are painful, the most obvious sign of a corneal ulcer is a pet that is squinting or otherwise acting like its eye is tender. There may be mucus or pus in the eye. The eyelid undersides may be red and inflamed. The ulcer may be visible on the cornea, but confirmation requires that we stain the eye with fluorescein dye. This dye will enter the cornea only if the epithelium has an opening in it. The dye glows under a ultraviolet light (“black light”). Sometimes the cornea may be milky or cloudy when it is ulcerated, but it is often clear.

How are Corneal Ulcers Treated

The treatment will vary according to the severity and the cause of the ulcer. Treatments may include topical eye medicines, oral or injectable medicines, and even surgery.

     If your pet wants to rub its eye, an Elizabethan collar will help to protect the eye. Bright light is painful to your pet’s eye, so keep it indoors until the eye is normal. Weekly or more frequent reexaminations until the ulcer heals are important in the treatment of corneal ulcers.

Call Us If…

• Your pet’s eye appears to be getting worse.

• You notice any degradation in your pet’s general health.

• You have trouble giving the prescribed medicine.

What is Cushing’s Syndrome?

It is a disorder caused by the effects of abnormally high circulating cortisol (natural cortisone) concentrations. Spontaneous hyperadrenocorticism is caused by excessive production of cortisol by the adrenal glands. In 85-90% of patients, the cortisol excess is caused by adrenal enlargement resulting from a tiny pituitary tumor producing excessive amounts of adrenocorticotropic hormone (ACTH).

     The remaining 10-15% of patients have cortisol-secreting adrenal tumor, approximately one half of these are cancer. Induced hyperadreno-corticism is caused by excessive administration of gluco-corticoids(cortisones). It is one of the most common endocrine disorders in dogs, but is rare in cats. Breed predilections include: poodle, dachshund, Boston terrier, boxer, and beagle, and none in cats. There is no sexual predilection in dogs with pituitary dependent hyperadrenocorticism (PDH), but two thirds to three quarters of dogs with an adrenal tumor are female. In general, hyperadreno-corticism is a disorder of middleaged to old animals; however, PDH can be seen in dogs as young as one year.

What Are the Symptoms of Cushing’s Syndrome?  The severity of the signs varies depending on the duration and degree of cortisol excess. Some of the signs may include: increased water consumption and urine production, pendulous abdomen, enlarged liver, hair loss, lethargy, muscle weakness and atrophy, loss of estrus cycles, obesity, blackheads, panting, testicular atrophy, and hyper-pigmentation and calcification of the skin.

How is It Diagnosed?

The history and symptoms may suggest the disease but blood tests are required to confirm it.

How is It Treated?

Intensity of treatment is dictated by the severity of clinical signs, the animal’s overall condition, and any complicating factors (for example diabetes). Mitotane (o, p'-DDD) is the drug of choice for the medical management of both PDH and adrenal tumor in dogs. The initial loading dosage of mitotane is given daily until both basal and post-adrenal stimulated (ACTH) cortisol concentrations are in the normal resting range (1-5 mg/dl); then, the maintenance dose is divided into 2-3 doses per week.

     Side effects of mitotane are fairly common but are mild in most dogs and include lethargy, weakness, loss of appetite, vomiting, diarrhea, dizzyness, and induced hypoadrenocorticism.

     Response to treatment by ACTH response testing determines dosage and when to convert to the 2-3 times per week dose. Testing is done after the initial 7-10 days of mitotane administration to assure adequate response, then at 1, 3, and 6 months and every 6-12 months thereafter.

     Adequacy of any necessary mitotane reloading period is also checked by ACTH response test before a higher maintenance dosage of mitotane is initiated. Some alternative medicines that can be used instead of mitotane include the antifungal agent Ketoconazole (over 25% of dogs fail to respond adequately to Ketoconazole), and L-deprenyl (Anipryl) (a newly-described alternative for treatment of PDH in dogs, but has not been used in cats).

What is the Long-term Prognosis?

Untreated hyperadrenocorticism is generally a progressive disorder with a poor prognosis, but depending on the degree of the problem, clinical signs resolve within several days to several months of treatment. Once stabilized, most Cushnoid pets can lead normal lives providing they are treated regularly and have periodic  blood ACTH tests (once or twice yearly).

Call Us If…

• You have trouble giving your pet its medicine.

• Its general health seems to diminish.

• It loses it appetite.

• It is very lethargic and inactive.

• It’s water consumption and urine production increases.

What is the Cystitis?

Cystitis means simply an inflammation of the urinary bladder. In the dog it is most commonly caused by bacteria swimming up the urethra from the vagina in the female or the opening of the penis in the male. Because the female has a shorter urethra, it is more common in females. Any problem that causes impaired urination or incomplete bladder emptying will predispose the animal to cystitis (like back problems or paralysis). Trauma to the bladder (i.e. being hit by a car), the presence of tumors, and bladder stones may also be contributing factors.

      Bladder stones (cystic calculi) may develop with chronic cystitis. They are rocklike formations inside the bladder (or kidneys). They can prevent the elimination of infection even with very effective antibiotics, because bacteria can hide inside them.

What are the Signs of Cystitis?

The most common signs of cystitis are straining when urinating and passing frequent, small amounts of blood-tinged urine. Some pet will act generally uncomfortable and may lose their appetite. Occasionally small stones may obstruct the urethra so a pet cannot urinate. They will strain to urinate, but nothing comes. These pets become rapidly critically ill, and require immediate emergency care.

How is Cystitis Diagnosed?

The history and physical examination findings will suggest cystitis as a possible problem, but a urinalysis is needed for confirmation. Under the microscope the urine is evaluated for the presence of blood, pus cells, bacteria, protein, crystals, and kidney “casts.”

      A bacterial culture from the urine may be recommended, especially if the infection persists after the initial treatment. Radiographs (X-rays) may be indicated to find stones in the bladder and kidneys. Some stones are invisible to X-rays, so dye and air may be injected into the bladder to allow a contrast to make the stones more visible.

How is Cystitis Treated?

The treatment can include antibiotics, urinary acidifiers or alkalinizers, special prescription diets, and fluid therapy. Surgery may be needed to remove stones or tumors. Stones can be of several different kinds and the treatment can vary depending on the particular kind. For this reason the stones should be analyzed and cultures taken from inside them. This information will be very valuable in determining the best treatment and the overall long-term prognosis.

Call Us If…

• Your pet’s urinating habits appear to be getting worse.

• You notice any degradation in your pet’s general health.

• You have trouble giving the prescribed medicine.

• Your pet loses it appetite or refuses to eat the medically prescribed diet.

Desert Hills Animal Clinic

1039 East Carefree Hwy, Suite A, Phoenix, AZ 85085

Phone: 623-581-1558    Email: DesertHillsAnimalClinic@hotmail.com