Chapter 5: Important Canine Diseases and How to Treat Them 6 CE Hours

By: Staff Writer Learning objectives Upon completion of this course, the learner will be able to: and ability to overcome the disease. Table 1 presents an overview of ŠŠ Explain the interaction between host and pathogen. the canine diseases most frequently found during visits to standard ŠŠ Identify canines’ defense mechanisms. veterinary clinics and some of the medications available for their ŠŠ Describe pathogens’ weaknesses and strengths. treatment that are discussed in this course. A comprehensive ŠŠ Identify medication used to treat these diseases. bibliography is provided at the end of this discourse, as well. Diseases In this course we will examine some of the more important diseases preventable by vaccination such as parvo, corona, hepatitis, rabies, affecting dogs. We will review how the disease interacts with dogs’ parainfluenza viruses, Lyme disease, leptospirosis, and kennel cough bodies and what how to strengthen and fortify a dog’s resistance are not included in this course.

TABLE 1: OVERVIEW OF MAJOR CANINE DISEASES, SOME TREATMENT OPTIONS DISEASE MEDICATIONS Heartworm Macrolides (macrocyclic lactones), diethylcarbamazine. Flea infestation Advantage II, K9Advantix II, BioSpot, Frontline, Frontline Plus Certifect, FiproGuard. Worm infestation Dog Worms 3, Nemex 2, Pro Wormer 2, Safe-Guard, D-Worm. Joint pain Rimadyl, Tramadol, Metacam, Cosequin DS, Etodolac, Aspirin. Ear infection Zymox Otic, Revolution, Panolog Ointment, Animax. Eye disease Terramycin, Vetericyn, Opticlear. Skin disease Animax, Fungisan, Betadine, Vetericyn, Ketochlor, Panolog, Zymox. Bladder infection Amoxicillin, Zeniquin, Baytril, Cephalosporine, Tetracycline. High blood pressure Amlodipine, Enalapril, Inderal, Tenormin. Giardiasis Ornidazole, Tinidazole, Metronidazole, Nitazoxanide, Albendazole.

Heartworm (Dirofilariasis)

CAUSE: Dirofilaria Radiography of the thorax will confirm the diagnosis and provide an immitis, a nematode, is indication of the extent and severity of the nematode burden. carried by mosquitoes The disease process goes from: (culex, aedes, ●● Stage 1: Early infestation, often asymptomatic with the occasional anopheles, and others) cough. The physical examination, and even radiography, may find as intermediate hosts. nothing. Wild animals (foxes, ●● Stage 2: In a more advanced stage, symptoms include dyspnea, wolves, coyotes, some coughing, slowing down, and disinclination to exercise. raccoons, seals, or sea Radiography will show some enlargement of the pulmonary artery lions) may serve as and interstitial lesions. There will be minor anemia and evidence reservoir in of protein in the urine. geographical regions ●● Stage 3: Frequent coughing, unwillingness to move and exercise, conducive to the multiplication of mosquitoes. After entering the weight loss, increasing enlargement of the pulmonary artery, often mosquito and only with outside temperatures remaining above 13.9°C affecting the right ventricle of the heart and arteriolar infiltration, (57°F), the microfilaridae develop through Larval Stages 1 and 2 and and pronounced anemia and proteinuria. are passed on as Larval Stage 3 to the next blood donor, usually the ●● Stage 4: There may be hundreds of worms invading the heart, dog. In the dog’s subcutaneous and sub-muscular tissues, the worm lungs, and caval veins, obstructing the vasculatory system, which develops to its mature stage (Larval Stage 5) and enters the circulatory results in pronounced dyspnea, tachycardia, anemia, and dark system, ending up in the pulmonary artery and, usually, the right heart hemoglobinuria. The dog may be close to collapse and death. ventricle. The mature male dirofilariae grow to about 6 inches while In a dog without obvious signs of the disease, the presence of a the female may reach more than 1 foot. They may reside in the heart specific antigen will confirm the diagnosis using the Enzyme- and the pulmonary artery for years. Linked ImmunoSorbent Assay (ELISA) procedure. ELISA test kits Diagnosis: Clinical symptoms of the disease include coughing, are available from a variety of manufacturers. They can also be hemoptysis, and epistaxis, breathing difficulties, lethargy and produced in-house. In short, they consist of: unwillingness to move, unthriftiness, cyanosis, fainting, and ascites.

veterinarians.elitecme.com Page 42 1. An antibody specific to the antigen that is being looking for, the result of prior preventive treatment and not necessarily indicate fixed onto a surface; absence of active infestation. 2. The antigen to confirm the presence of the antibody (positive Prevention: Prevention of infestation is, obviously, preferable to control), the test sample, and a diluent sample (negative treatment of the established disease. Reducing exposure to mosquito control); bites is a positive step. Prevention is possible by regular application of 3. Diluent to wash off controls and unadhered test sample; macrocyclic lactones, such as Ivermectin, Milbemycin, Moxidectin, 4. Antigen-specific antibody, which has been combined with an and Selamectin (Table 2), followed by appropriate veterinary check- enzyme to indicate the presence of an antigen attached to the ups and serology. Macrolides, derived from Streptomyces Sp., stop known antibody; the development of larvae early after infection, and prevent the further 5. Enzyme substrate to indicate the presence of the enzyme development of microfilariae to the mature female thus breaking the by changing its color (only present when there is a positive nematode’s replication cycle. Preventive treatment should commence antigen residue on the test sample). early in the life of the pup, about 6 to 8 weeks of age, and ideally There are many varieties of this testing procedure in many different continue monthly, year-round. At the very least, it should start 1 month test kits, too many to be discussed in this context. One can expect before the mosquito season and continue until at least 1 month after to detect the antigen with at least three developed female worms, the end of the mosquito threat. In the latter case, and when there was about 6 to 7 months after onset of the infestation. However, if there a chance of an earlier mosquito contact, the animal should be tested are only immature worms or males, there will be no antigen-positive for the presence of dirofilaria antigen or the parasite itself. This is results. In the blood of microfilaremic dogs, one might find circulating important because of the possibility of allergic shock following the microfilariae. To improve chances of finding them, the blood sample destruction of significant numbers of the nematode and its larvae can be centrifuged and the sediment examined microscopically, or subsequent to treatment, thus presenting the host suddenly with large after lysing the blood cell population, the circulating larvae can be amounts of allergenic foreign protein. collected on a filter. Not finding any, on the other hand, may only be

TABLE 2: MACROLIDES FOR HEARTWORM PREVENTION BRAND AGENT DOSAGE EFFECTIVENESS Heartgard Ivermectin 6-12 µg/kg/mth/po Heartworm. HeartgardPlus Ivermectin/Pyrantel 6 µg/5 mg per kg/mth/po Heartworm, roundworm, hookworm. Interceptor* Milbemycin oxime 0.5-1 mg/kg/mth/po Heartworm, round-, hook-, whipworm. Sentinel* Milbem. ox./ Lufenuron 0.5-1 mg/kg/mth/po Heartworm, fleas, round-, hook-, whipworm. ProHeart 6* Moxidectin 0.17 mg/kg/6mths/im Heartworm, hookworm. Advantage Multi Imidacloprid/Moxidectin 20 mg/5mg/kg/mth/top Heartworm, fleas, round-, hook-, whipworm. Revolution Selamectin 6-12 mg/kg/mth/top Heartworm, fleas, ticks, mites. * manufacturer suspended production

Action of preventatives: Macrolides encompass biologicals with active ingredient of ivermectin, abamectin, doramectin, eprinomectin, macrocyclic lactone rings. They are derived from Streptomyces selamectin, and others. Even low doses are highly effective Sp., an actinobacterium. This group of agents includes, along with against immature dirofilaria both in preventive and treating modes. highly effective antinematodal and insecticidal drugs, antibiotics, Avermectins do not kill the adult worm, although extended prophylaxis antifungals, gastroprokinetics (affecting gastrointestinal motility), and with this drug will clear up the infestation eventually. Prophylactic immunosuppressants. Avermectins and milbemycins, in particular, potency persists for more than a month, justifying the recommended are mentioned here as the most effective means of fighting dirofilaria monthly dosage. nematodes. Avermectin, isolated from Streptomyces avermitilis, is the

TABLE 3: HEARTWORM DEVELOPMENTAL PROGRESS Dirofilaria Stages: L1 L2 L3 (infective) L4 Adult Mosquito Host: Mosquito Mosquito Mosquito (labia) - - Canine Host: - - Dog (skin) Abdomen-Thorax Pulmonary/Heart Duration of Growth: 4 wks (2 if amb.T° >27°C) 3-12 days 50-70 days 70-120 days Duration of Existence: 7-9 months 3-5-10 years Treatment: Mosquito Control Macrolides Melarsomine

Dosage can be oral, parenteral, or topical. Spreading throughout pH, cell migration, cell proliferation and differentiation, cell volume, the body via any of those routes, it will be concentrated quickly in epithelial fluid secretion and solute transport, smooth muscle action, the fatty connective tissue of skin, gastrointestinal tract, and lungs. and neuro-excitation. Glutamate-gated chloride channels do not Oral dosage can be improved by reducing food intake at the time of exist in mammals, making the activity of this drug in microfilariae treatment. The drug interacts with GABA receptors and glutamate- highly selective and safe. Effectiveness against Onchocerca volvulus, gated chloride channels thereby interfering with the chloride ion Strongyloides stercoralis, Trichinella spiralis, as well as various exchange. This leads to changes in biomembrane potentials of muscle arthropods (fleas, mites, etc.) has been described. If preventive and nerve cells, increasing the passage of chloride ions across them, treatment is delayed or commenced after start of the mosquito leading to paralysis and death of the parasite. Glutamate-gated chloride season, the veterinarian should check for the presence and extent of channels, only found in protostomes, are essential for the regulation of heartworm infestation. Other macrolides, such as Milbemycin oxime

Page 43 veterinarians.elitecme.com (Interceptor, Trifexis, Sentinel) have similar effects. Macrolide-based Thiacetarsamide is an arsenic-containing drug that kills the mature drugs are gradually replacing diethylcarbamazine citrate, which was heartworm in only about half of the dogs treated. It is administered among the early drugs employed in the treatment of heartworm. intravenously twice a day for 2 days. Its occasional side effects are Diethylcarbamazine (DEC) must be given daily per os (3-6 mg/kg) damage to the kidney and liver. Since this drug does not kill the during and until 2 months after the mosquito season. The combination immature heartworm, it must be followed a month later with the above with anthelmintics (pyrantel) and flea control agents (imidacloprid, described prophylactic procedure. Melarsomine dihydrochloride, lufenuron) produces wide-ranging effects against both internal and being considerably more effective, is essentially today’s mainstay of external parasites. Selamectin, which is a more recent development adulticide treatment. It also is based on arsenic as the active ingredient. of the avermectins, exterminates heartworms, fleas, and mites. While It is given deep into the lumbar muscular region (2.5 mg/kg) and again ProHeart-6 was withdrawn by the manufacturer from the U.S. market the following day. The injection is painful and may produce local in 2004, it is still used in triple strength in Australia in the form of reaction and the occasional abscess. Alternately, one dose may be ProHeart-12 with once-a-year dosage. given once followed by two doses 30 days later, again with a 24-hour NOTE: Some dog breeds have adverse reactions to macrocyclic interval. The latter process is recommended, as it removes part of the lactones, including Collies, Whippets, various Shepherds, and worm load gradually and reduces the risk of thromboembolism and Sheepdogs. shock. The same effect can be achieved by preceding the double dose Treatment: Treatment is very much dependent on the results of the with a 3 months’ course of one of the above macrolides. preceding diagnosis and the stage of the disease. The number of Veterinary practitioners are reluctant to use these powerful adulticides worms in the body will affect the extent of vascular obstruction, and in the more advanced stages of heartworm infestation, fearing clogging the amount of breakdown products and antigen load generated by the of arteries and thromboembolism, antigenic overload, and shock. They use of such adulticides as DEC, thiacetarsamide, or melarsomine. will usually precede treatment with anti-inflammatory corticosteroids. As foreign proteins, all of the breakdown products are antigenic and During and after treatment, the animal should stay in the clinic and may induce anaphylactic shock and its consequences. Thus, a very remain under close observation for a few days. Exercise should be effective adulticide, releasing a great deal of microfilarial protein very restricted for 1 to 2 months. To deal with microfilarae, not removed by quickly into the bloodstream, is, as a rule, contraindicated. Ivermectins this process, the regular prophylaxis with macrocyclic lactones should and milbemycin products that are slower acting over time are usually be continued for at least 12 months after treatment. Effective removal preferable. Surgical removal of a large nests of worms should be of the heartworm must be confirmed by checking for the presence of considered before employing any adulticide, thereby reducing the antigen and microfilaria 6 months post treatment. opportunity for thromboembolism and anaphylactic shock. Whatever Wolbachia pipientis: An important complicating factor in heartworm the case, treatment of severe heartworm infestation should be preceded treatment is wolbachia, a gram-negative intracellular bacterium, that by anti-inflammatory steps and close observation during and following grows symbiotically in the heartworm. Wolbachia occurs widespread treatment. throughout more than half of all insect species, including spiders, Action of treatment agents: While the above described preventive mites, and nematodes. In dirofiliariae, it resides within the female agents will kill immature and adult worms, they do so more reproductive system, but remains absent from the male sperm of the slowly and less aggressively and will deal with stragglers over the worms. Interfering with spermatogenesis and killing the infected male, preventive seasons. The more aggressive adulticides, such as DEC, it causes an increasing proportion of females and is passed on with the thiacetarsamide, or melarsomine, could produce more damage by mature egg to the next generation. The symbiotic nature of wolbachia exposing the body suddenly to considerable loads of antigenic matter. is suggested because removal of wolbachia with tetracycline will DEC is a piperazine derivative. Piperacine hydrate and some salts are render the female sterile and reduce the rate of population growth of known for their effectiveness against ascariasis. They produce muscle the filariae. Although wolbachia by itself is not harmful to the dog, cell hyperpolarization, paralysis, and death. Due to its immediate it will aggravate post treatment arterial clogging, inflammation, and and short-term action, it must be given twice daily for 2 days. allergenicity by adding its proteins to the filarial breakdown products.

Current Canine Guidelines for the Diagnosis, Prevention, and Management of Heartworm (Dirofilaria immitis) Infection in Dogs (revised January, 2012); Prepared and approved by the Executive Board of the American Heartworm Society (AHS). ●● Diagnostics: AHS recommends annual antigen testing. Antigen-positive dogs should be tested for the presence of microfilariae. ●● Prevention: AHS recommends year-round administration of chemoprophylactic drugs to prevent heartworm disease, enhance compliance, and control pathogenic and/or zoonotic parasites. ●● Adulticide therapy: AHS recommends use of the three-dose regimen of melarsomine (one injection of 2.5 mg/kg body weight followed at least 1 month later by two injections of the same dose 24 hours apart) for treatment of heartworm disease in both symptomatic and asymptomatic dogs. Any method utilizing only macrocyclic lactones as an adulticide is not recommended.

Flea infestation There are fleas everywhere, with more than 2,200 species worldwide. 1. Eggs are being produced by the female flea as soon she had her Ctenocephalides first blood meal on the host. One flea can produce as many as 40 to canis is the dog flea. 50 eggs per day and as many as 2,000 to 5,000 in a lifetime. The It essentially feeds eggs are white oval, being dropped on the bedding, carpet, soil, on the blood of and other surroundings. Within 3 to 4 days they turn into dogs. To effectively 2. larvae (1 to 2 mm long, thin, white) feeding on adult flea feces, combat the flea flakes of dead skin, and other organic waste matter. Larvae are nuisance in dogs, soft-skinned and seek out dark spaces for protection. In stage it is important to 3. the larva becomes a pupa, which constructs a cocoon made up understand the flea’s of lint, dust, hair, fibers, and other environmental debris within lifecycle. The flea’s which to encloister itself. The cocoon-protected pupa is resistant four-stage lifecycle to disinfectants and environmental influences and can survive for lasts 2 to 3 weeks:

veterinarians.elitecme.com Page 44 many months. When the pupa is triggered by movement, body Prevention and treatment: With an optimal relative humidity of heat, and the exhaling of carbon dioxide the ≥70 percent and temperatures above 60°F, the flea may survive 6 to 4. adult flea emerges, starts to feed on the warm host blood and 12 months, living most of this time on the host animal and feeding produce eggs. Flea bites cause itching and skin irritation. Frequent from its blood. Larvae prefer to hide in dark spaces and crevices scratching and biting of irritated areas lead to open wounds, since they must protect themselves from drying out. The pupa can bleeding, secondary infection and other contamination and, survive for as long as a year and low temperatures allow the pupa to frequently, oozing open sores. There will be hair loss, smelliness, remain in its pupal stage over winter. Avoiding the entry of fleas into and spotty hot, inflamed areas. Extreme cases of flea infestation the dog owner’s home is obviously preferable over treatment and may lead to blood loss and anemia. In dogs that are allergic to house cleanup after flea infestation. Considering the concern of the the saliva of fleas, allergic reactions may exacerbate and worsen dog owner with heartworm prevention, it is almost a prerequisite to local reactions. Flea allergy dermatitis is the most common allergy combine the heartworm prevention process with flea prevention. The observed in dogs and is found in all breeds of dogs. Not many flea number of insecticides available to kill fleas is indicative of the great bites are required to induce a major reaction in the allergic dog. problem flea infestation presents to the dog owner (Table 4). There are more than 15 allergenic proteins in the flea saliva liable to induce immediate or delayed type allergic responses. Another complication of flea infestation is the high likelihood of tapeworms (Dipylidium caninum) being passed on by the flea. Summer and warm climates are likely to produce a greater incidence of flea bite and flea allergy dermatitis.

TABLE 4: FLEA TREATMENT AND PREVENTION NAME AGENTS APPLY TARGET ACTION Advantage Imidacloprid Topical/month Nervous system. Kill fleas, heartworm, intestinal worms. Imidacloprid 10 Nervous system. Kill fleas, heartworm, intestinal worms Advantage Multi Topical/month Moxidectin 2.5 percent Nerve, Muscle cells. Inhibits immature forms. Etofenprox Nervous system. Kills fleas, ticks, immature forms. Biospot (S)-Methoprene Topical/month Insect growth regulator. Piperonyl Butoxide Enhances activity. Capstar Nitenpyram Oral /day CNS. Adult fleas, not immature forms. Fipronil CNS. Adult flea, ticks, lice, mange FrontlinePlus Topical/month (S)-methoprene) Insect growth regulator. Inhibits immature forms Imidacloprid Nervous system. Kill fleas, heartworm, intestinal worms K9 Advantix Topical/month permethrin Nerve cells. Neurotoxin. Imidacloprid Nervous system. Kill fleas, heartworm, intestinal worms. K9 Advantix II Permethrin Topical/month Nerve cells. Neurotoxin. Pyriproxyfen Insect growth regulator. Inhibits immature forms. Program Lufenuron Oral/month Insect development inhibitor*. Block flea development and maturation. Revolution Selamectin Topical/month Nerve cells. Neuromuscular paralysis, death. Sentinel Milbemycin oxime Adult flea. Kills fleas, heartworm, intestinal worms, Per os/month Program Plus Lufenuron Insect development inhibitor*. immature stage. Pyriproxyfen, Insect growth regulator. Inhibits immature forms. Dinotefuran, Nervous system. Inhibiting nicotinic acetylcholine Vectra 3D Topical/month Permethrin. Nerve cells. receptors. Neurotoxin. * Insect Development Inhibitor: inhibiting chitin synthesis, exoskeleton assembly and the development to mature, egg-producing flea

While preventive care is fairly effective, the occasional invasion action by warmer temperatures, humidity, motion, or carbon dioxide. of fleas into the dog habitat will require major house cleaning and Professional pest control operators are the most likely to use effective disinfection. Eggs and larvae fall off the host animal and contaminate products for extermination. Since the bulk of the infesting population its immediate habitat. Thorough vacuuming will be helpful, but not consists of immature stages of the flea, only about 2 percent are mature eliminate all fleas or their immature stages. Larvae tend to hide in adults, the blocking of further development and maturation of the dark spaces, cracks, and crevices, which are difficult to reach. Once immature stages is crucial to the control of egg-producing fleas and in the water, cocooned pupae are protected from outside influences the spread of the infestation. Insect growth regulators (IGRs) interfere and may lie dormant for many months until they are stimulated into with the molting and feeding process of the immature stages of the flea

Page 45 veterinarians.elitecme.com (Table 5). They simulate or block the production of juvenile hormones, on the other hand, interfere with chitin synthesis, i.e., the construction which are required for larval molting and the development to the adult of the parasite’s exoskeleton and its maturation to the egg- producing flea. Insect development inhibitors (IDIs) (lufenuron, diflubenzuron), flea.

TABLE 5: FLEA CONTROL (INSECT GROWTH REGULATORS [IGRs])* NAME ACTIVE AGENT APPLICATION Gentrol Hydroprene Inhibits maturation of fleas, ticks, roaches, ants, bedbugs. Gencor Pivot 10 Archer Pyriproxyfen Photostable for indoor and outdoor use, liquid, aerosol form. Nylar A Pyridine derivative Inhibits maturation of fleas, ticks, roaches, crickets, mosquitoes, flies, flying insects. Fleafix Nyguard Starycide Triflumuron Insect development inhibitor: inhibits molting, chitin synthesis. Precor Methoprene Photosensitive: indoor use only (liquid, aerosol). Precor 2000 * IGRs interrupt and block egg and larval development prior to maturation and egg production; they do not kill adult fleas.

It does not take many flea bites to affect the allergic dog and to create allergic dermatitis. Pyrethrins are organic plant derivatives (African allergic dermatitis, skin inflammation, red spots, and open sores. chrysanthemum) that are neurotoxic and kill fleas and many Flea allergies are usually prevalent during the summer season, since other arthropods by affecting their nervous system. Some experts warm climates are conducive to greater flea activity. Attempts to have suggested the use of natural homeopathic remedies, such as desensitize allergic dogs with minimal doses of flea antigens require chamomile, witch hazel, marigold, and other plant extracts for the extended treatment and are only partially successful. Corticosteroids treatment of skin diseases and dermatitis. and antihistamines have been used with some success to mitigate

Worm infestation If you ever owned a dog you learned about worms that may be found with a more focused approach. Dirofilaria immitis, the heartworm, is in the dog: tapeworms, roundworms, hookworms, and whipworms. a nematode and the medicines dealing with nematodes will also affect Some of the treatments mentioned above will apply here, although gastrointestinal worms.

TABLE 6: GASTROINTESTINAL WORMS OF THE DOG ROUNDWORM TAPEWORM HOOKWORM WHIPWORM WORM Ascarids Dipylidium/Taenia Ancylostoma/Necator Trichuris Loss of luster, weight loss, Vomiting, abdominal pain, Pale mucosae, anemia, anal itching, Anemia, blood, mucus in SYMPTOMS swollen abdomen, diarrhea, agitation, licking anus, diarrhea, blood in feces, lethargy, stool, diarrhea, flatulence, vomiting. weight loss. weight loss. straining, weight loss. In feces, in vomit, white White rice-like links, in Worm eggs in stool (2-8 cell stage). Eggs in stool (not always). DIAGNOSIS worms 7” long. feces, bed, around anus. Fenbendazole, Nitroscanate Fenbendazole, Fenbendazole, Nitroscanate, Fenbendazole, Piperazines, Mebendazole Nitroscanate, Pyrantel Pamoate, Benzimidazole, benzimidazole, TREATMENT Pyrantel Pamoate. Benzimidazole, Mebendazole. Febantel, Mebendazole. Praziquantel Dichlorophene, Epsiprantel. Dog Worms 3 Combines Pyrantel Pamoate and Praziquantel Drontal Plus Combines Pyrantel Pamoate, Praziquantel, and Febantel

Similarly, removal of the arthropod carrier of Dipylidium caninum, Diagnosis: Table 6 gives details about the four types of gastrointestinal a tapeworm, will reduce the spread of this type of worm. Dogs get worms found in dogs. Indicative of gastrointestinal parasites is poor, infested with gastrointestinal parasites through contact with other scrawny, lack luster appearance, dull fur, lack of energy, as well as infested animals, with flea-infested cohorts, eating the feces with eggs disinterest in exercise and play. In more advanced cases the animal from an infested animal, and catching and consuming infested animals shows lack of growth, boniness and extended, bloated stomach. (rats, mice, moles, etc.). Puppies can get it from the infested mother.

veterinarians.elitecme.com Page 46 ROUNDWORM TAPEWORM HOOKWORM WHIPWORM

There may be weight loss, anemia, and diarrhea with blood and mucus Treatment: The large number of “dewormers” available on the market in the stool and the appetite may be affected—overeating, not eating, (Table 7 not being all-inclusive) is suggestive of the widespread lack of appetite. Weakening of the dog’s constitution and resistance incidence of gastrointestinal parasitism in pets and its considerable will be reflected in the exacerbated expression of complicating nuisance value, not only in the pet’s health but also its likelihood to diseases. Identification of a particular parasite rests on the detection of infest humans, if only temporarily. eggs or worms or parts of worms in the stool of the infested dog.

TABLE 7: SOME DEWORMERS AGENT ACTIVE INGREDIENT EXAMPLE TARGET DOSIS Fenbendazole Benzimidazole Panacur C Hook-, round-, whip-, and 50 mg/kg/po for 3 days. tapeworms. Nitroscanate Diphenylether Lopatol Hook-, round-, tape-, and 50 mg/kg/po. whipworms. Praziquantel Isoquinoline Droncit Tapeworm immature and adult 5-12.5 mg/kg/po; 5-11.4 mg/kg/ forms. sc,im. Piperazine Hydrate Piperazine Worm Away Roundworm. 47-133 mg/kg/po. Dichlorophene Phenol Tapeworms. 220 mg/kg/po. Pyrantel pamoate Pyrantel+pamoic acid Nemex 2 Roundworms, hookworms. 5-10 mg/kg/po. Mebendazole Benzimidazole Telmintic Hook-, round-, whip-, and 22 mg/kg/po for 3-5 days. tapeworms. Diethylcarbamazine Piperazine Filaribits Roundworms. 50-100 mg/kg/po. COMBINATIONS OF THE ABOVE DE-WORMERS BROADENS THE ACTIVITY SPECTRUM Ivermectin + pyrantel Heartgard Plus Round-, hookworm. pamoate Praziquantel + pyrantel Virbantel Round-, hook-, tapeworm. pamoate Milbemycin + Lufeneron Sentinel Round-, hook-, whipworm, immature stages of the flea. Moxidectin + Imidacloprid Advantage Mlti Round-, hook-, whipworm, immature stages of the flea. Praziquantel+pyrantel Drontal Plus Round-, hook-, whip-, tapeworm. pamoate+Febantel Praziquantel+pyrantel Iverhart Max Round-, hook-, tapeworm. pamoate+ivermectin

Deworming medications are based on their activity against the Similarly, once worm larvae are encysted in the host’s body tissue, individual parasite and/or its various stages of development: egg – they are pretty much protected from the effects of medication, which larva – adult worm. Roundworm eggs, for example, are very resistant. normally works on the adult worm residing in the lumen of the They must survive stomach acid, which has a pH of 2-3. The eggs can intestine. Encysted larvae are activated and released at times of stress survive in soil for years. Bag stool and remove, keep dog from other (e.g., late phase of pregnancy, disease, excessive activity, medication dogs, keep them from eating other dogs’ feces or licking other dogs. stress). The aim of treatment is keeping the mature female worm from Steam-cleaning is the only effective means of killing eggs. producing eggs.

Page 47 veterinarians.elitecme.com TABLE 8: MECHANISM OF ACTION OF DEWORMERS* ACTIVE AGENT EXAMPLES MECHANISM OF ACTION Diphenyl Ether (Isothiocyanate) Nitroscanate, Lopatol. Effective against adult and immature forms of roundworms; Tapeworms: Interferes with the oxidative phosphorylation of cell mitochondria and the creation of adenosine triphosphate, essentially blocking all energy management and paralyzing the parasite. Benzimidazole Fenbendazole (Panacure C), Hook-, round-, whip-, and tapeworms: Kills eggs, larvae, and adult worms; (benzene+imidazole) mebendazole, oxfendazole, must be given for 3 consecutive days; binds to microtubules that are oxibendazole, flubendazole, responsible for motility, cell division and secretion, blocking glucose uptake, thiabendazole, thiophanate, thereby depleting glycogen supply and energy levels: worms are paralyzed, febantel, albendazole. digested, and expelled. Praziquantel Epsiquantel, Dogworm3, Tapeworms: Effective against adults of most species as well as the immature (isoquinoline) cestocur, droncit, forms of some; interferes with calcium ion exchange, damages skin of worm, parkevermin. facilitates digestion and removal of worms. Pyrantel pamoate banminth, exhelm, strongid, Inhibits acetylcholine esterase, thus interfering with the hydrolysis of (tetrahydropyrimidines) morantel, oxantel. acetylcholine and the transmission of signals in neuromuscular junctions and cholinergic brain synapses of the roundworm. The worms are paralyzed, detach from the intestine, die, and are expelled.Depolarizes neuromuscular blocking agent: sudden contraction, paralysis. Piperazine Diethylcarbamazine, various Inhibits acetylcholine esterase, thus interfering with the hydrolysis of piperazine salts (Piperazine acetylcholine and the transmission of signals in neuromuscular junctions hydrate, piperazine citrate). and cholinergic brain synapses of the roundworm. The worms are paralyzed, detach from the intestine, die, and are expelled. * The mechanism of action mentioned requires more detail and specifics to be discussed in another treatise.

Joint pain The dog has difficulty rising, does not want to play, exercise, jump, or activity, gait, length of stride, and range of motion require familiarity climb stairs: arthritis strikes about every fifth dog. Affecting synovial with the dog and the normal behavior at home or during exercise. joints, it will get progressively worse. There will be pain, discomfort, Sports dogs may not perform as expected. Radiography and synovial restricted mobility, and muscle atrophy. Lack of movement will result fluid chemistry help confirm apparent impairment. Radiography in reduced flexibility, stiffening of joints, and generally weakened will visualize osteophytes (bone spurs), a frequent companion of unused musculature. Basically, a joint is where bones meet and move, osteoarthritis. held together by ligaments and the articular capsule, separated and Causes: There are various origins or causes for joint pain requiring cushioned by cartilage covering each bone end and lubricated by differential diagnosis: synovial fluid within that capsule. Any damage to any part of the joint ●● Infectious. can be the cause of joint pain. On the other hand, not all limping is due ●● Traumatic. to diseased joints: Road salt, foreign objects, trauma, and interdigital ●● Genetic and Developmental. pyoderma all may cause temporary lameness. Early recognition of ●● Degenerative, they may be immune-mediated. mobility problems is the essence of diagnosis. Once the vet sees the ●● Inflammatory (arthritis). expressions of lameness, moving the head up and down and raising the ●● Non-inflammatory (arthralgia). hip, it is already late in the progress of the disease. Early changes in

Infection Borrelia burgdorferi , is a bite area). Lameness may last for a few days, then disappear and tick-borne (Ixodes scapularis, reappear days or weeks later in the same or another leg. The affected Ixodes pacificus) spirochete joint is painful when touched, and is swollen and warm. On rare producing Lyme Disease. It will occasions, glomerulopathy occurs. This is more likely to happen in cause polyarthritis, inflammation, Labrador Retrievers, Golden Retrievers, and Bernese Mountain dogs. as well as swelling of the joints Antibody to the pathogen will form immune complexes that can block and recurring, shifting lameness. the glomeruli similar to cases with autoimmune reactions. If not The greatest incidence of cases is in the Northeast, the upper Midwest, recognized in time, it can develop into glomerulonephritis, kidney and the Pacific coastal regions. The incubation period is several weeks dysfunction, and total kidney failure. Symptomatology includes to months after the tick bite. The tick needs to have been attached for increased water uptake, loss of appetite, vomiting, diarrhea, weight at least 2 days for an infection to occur. This makes it important for loss, more frequent urination, as well as fluid build-up in abdomen, dogs to be checked for the presence of ticks immediately after a walk under the skin, and in the extremities. Because there are a variety of in or near woods and brush. When removing the tick from the dog, causes for inflammatory joint disorders, Borreliosis must be confirmed make sure to extract the head as well. Attempt to identify the tick with by the presence of its antibody or antigen in the blood. SNAP 3Dx a magnifying glass: eight legs, flattened body unless ballooned by the tests will identify antibody to B. burgdorferi C-6, to Dirofilaria ingested blood, hard dorsal shield, and mouthpart attached to it. immitus (heartworm), and Ehrlichia canis. SNAP 4Dx, in addition to Increasing with age, they will be 1.5 to 5 mm in length. In addition to those three, will also detect Anaplasma phagocytophilum. Enzyme- limping, the dog may exhibit inappetence, lack of interest in play and linked immune-sorbent assays, as well as the Western blot test, will exercise, fever, and swollen local lymph nodes (those draining the tick- confirm the presence of antibody to the pathogen. Detection of the

veterinarians.elitecme.com Page 48 spirochete presence itself can be attempted by biopsy of the tick-bite and treatment must be extended. Sometimes the disease will go into area. The presence of antibody to Borellia does not necessarily predict remission and later reappear a. Borellia seem to lay about in latent the existence or development of the disease. Quite often, Borrelia may form in many of their hosts, never to make them sick. Thus, the be present without causing disease. Indeed, to diagnose Lyme presence of antibody, without symptoms of the disease, does not borreliosis, the vet must find: suggest the need for treatment. The use of corticosteroids, which 1. Evidence of exposure to ticks; suppress the immune system and may reactivate dormant infections, is 2. Symptoms of the disease; contraindicated. When the disease has not been recognized in time and 3. Specific antibody to B. burgdorferi; and treatment start has been late or never started, progressive degenerative 4. A response to antibiotics usually effective in the treatment of arthritis may develop with little promise of full recovery. borreliosis (tetracyclines, penicillin, macrolides). Prevention: Keep dogs away from tick-prone areas and carefully Treatment: The treatment of Lyme borreliosis relies on the inspect them after walks in the woods. Whole-cell inactivated vaccines susceptibility of spirochetes to tetracycline and penicillin: Doxycycline present all the spirochetal proteins for antigenic stimulation and may should be given for at least 30 days (10 mg/kg per os, daily). If elicit undesirable reactions. A recombinant vaccine containing only administered early enough, there will be noticeable improvement, purified outer surface protein, free of non-essential proteins and free i.e., confirmation of diagnosis. Amoxicillin or ceftriaxone can be of adjuvant components (Recombitek Lyme) is less likely to produce used as well and for the same period of time. Non-steroidal anti- such reaction. Initially, it is given twice subcutaneously (1 ml) with inflammatories (NSAIDs) should help mitigate joint pain. While a 2- to 3-week interval, and then annually. There are mixed reviews there is significant improvement with antibiotic therapy, it will not about the use of vaccines against Lyme borreliosis because of efficacy always lead to the complete resolution of the disease. Azithromycin, and possible side reaction concerns. Vaccination should be considered a macrolide (see above), is also effective in reducing the disease only for outdoor dogs in tick-prone areas. syndrome. Thirty days of treatment may, occasionally, not be sufficient

Trauma Caused limping is more often found in outdoor dogs, in particular as anterior cruciate ligament injury. Removing the source of trauma working and sports dogs: cuts, bone fractures, and ligament tears such and symptomatic treatment should resolve this problem.

Congenital joint complaints Hip dysplasia, which consists of misshapen hip joints: poor fit of plate. Like all other primary joint damage, it may lead eventually caput (femur head) into acetabulum (socket in pelvis receiving femur to osteoarthritis. head), if one or both of them are misshapen there will be friction, 2. Elbow dysplasia is a developmental anomaly of the elbows of very aggravated wear and tear, and pain. The ligament holding the joint young, rapidly growing medium to large size dogs. The elbow together enlargens and the synovial fluid amount increases. It tends joint, as well as the knee joint, represent weight-bearing high- to occur around age 4 to 12 months. The symptoms range from stress points of the body: weight support and pressure, ligaments unsteady wobbling to crippling gait. If not repaired, the front quarter keeping bones together, and tendons pulling. Any disruption of musculature will overdevelop while leaving the rear end weakened ossification and bone completion will seriously affect the joint. and atrophied. The puppy will be stiff in the morning, find it difficult The number of conditions producing lameness are essentially to rise, stand up, and climb stairs and will refuse to run and exercise. the result of the multitude and variety of growth plates that are The pain may make it snappy and irritated. In the growing pup, with meeting at joints and may not come to complete ossification or of bone growth plates still in flux, the surrounding soft tissue mass processes which may break while not yet fully ossified. Included will affect joint development. Muscle mass, tendons, and ligaments in the Elbow dysplasia syndrome are: may be inadequate in bracing and holding the joint together and in a. Ununited anconeal process (UAP): When the growth plate place. Biomechanical stress factors, excessive weight load, softening between ulna and the anconeal process does not close and by muscle-relaxant medication, unusual muscle pull, trauma, and fuse the two parts together, this occurs.. This seems to be a stress may have aggravating effects. Underuse results in decreased hereditary condition for certain large breed dogs, German muscle mass, the joint capsule is inflamed, the joint cartilage becomes Shepherds in particular, as well as Saint Bernhards and degraded and loses its function of facilitating joint movement and Bassets. It is more common in the male. A pup of these breeds osteophytes develop from the bone. The disease will progress to going lame intermittently at about 6 months of age and older osteoarthritis, a very painful degenerative joint disease. Selection and progressively getting worse is suggestive of UAP. The of certain breeds for size, rapid growth, and overfeeding have been elbow usually is swollen, painful, and often cannot be used at correlated with the incidence of the disease. Indeed, an experimental all. If left untreated, severe arthritis will follow. study comparing a group of pups receiving liberal amounts of food b. Ununited medial epicondyle: is the result of incomplete at will with a group receiving one-quarter less food showed that the fusion and ossification of medial epicondylar epiphysis dogs receiving the restricted diet lived longer and had significantly on the humerus with similar results. The lame animal will lower incidence of hip dysplasia and subsequent osteoarthritis. In present a swollen joint and manual examination of the medial other studies, the incidence of the disease could be bred out of strains epicondyle will be painful. of a breed of dogs by selecting parents without signs or history of c. Ununited medial coronoid process/fragmented coronoid the disease. For breeding purposes, the Orthopedic Foundation for process: may be separated from the body of the ulna altogether Animals has procedures to grade hip joint quality of dogs 2 years or or in part, reducing support and strength of the elbow joint. older, from poor to excellent, in seven steps, and provide certification d. Sesamoidal fragments of the elbow: calcified fragments that for dogs graded fair to excellent. The dorsolateral subluxation (DLS) may be free-floating or attached to joint capsule or ligament, test for younger dogs measures the caput fit into the acetabulum. can become extremely painful when getting into the moving 1. Another disease affecting the hip joint is Legg–Calvé–Perthes joint. Changes resulting from elbow dysplasia are the primary syndrome. It consists of avascular necrosis of the head of the cause of osteoarthritis. femur resulting from blocking the supply of blood to its growth

Page 49 veterinarians.elitecme.com 3. Patellar luxation is another problem that causes lameness. In a c. The patella will luxate following stifle joint flexing and floating patella or floating kneecap, also called trick knee, the extending and will not return automatically to its normal patella is dislocated from its normal position and may lock leg position, but can be returned after extension and manipulation. mobility. Medial patellar luxations are fairly common in the d. Permanent luxation. miniature and toy breeds. In large breed dogs, it usually is a lateral 4. Spinal stenosis: Cervical spinal column problems due to patellar luxation. In one study, 8 out of 10 luxation cases were of malformed vertebrae and vertebral facets, as well as prolapsed congenital nature, while the rest were acquired. It has four levels intervertebral discs, may narrow the vertebral canal (stenosis), of severity: compressing the spinal cord and producing a wobbling gait a. The patella can be moved by hand and will return to its normal (cervical vertebral instability). Again, this is more likely to happen position. in larger breeds such as Great Danes, Dobermans, St. Bernhards, b. After luxation, the patella can be returned to its proper position and Borzoi, although Basset Hounds and Boxers may be affected by hand or will return on its own after stifle joint extension and as well. rotation.

Degenerative joint diseases 1. Osteoarthritis, which is the result of joint breakdown (hip, elbow 4. Osteochondrosis interferes with endochondrial ossification, i.e., dysplasia, etc.), as well as the degradation of the cartilage essential normal bone development and growth. Obviously limited to the for smooth joint operation and the protection of epiphyses and very young with growing bones, it causes epiphyseal cartilage to the subchondral bone. An irreversible progressive degenerative grow and thicken, rendering the bone less resistant to mechanical disease, it is usually non-inflammatory. stress. Cause not being certain, fast growth, nutritional supply, 2. Intervertebral disc disease consists of herniated, prolapsed discs faulty vascularization leads to abnormal maturation, synovitis, and the compression of the spinal cord. The intervertebral disc is a arthritis and cartilage breakdown. pressure cushion separating vertebra from vertebra and stabilizing 5. Panosteitis is also referred to as temporary growing pains. It the entire vertebral column. In aging dogs, the discs degenerate occurs in the long bones of large breed dogs that are between with time and lose their buffer and slip capacity. In radiography, 5 and 18 months of age and can be very painful. Episodes may the condition will appear as spondylosis. As the discs deteriorate, occur suddenly and last a couple of weeks and are sometimes the vertebrae develop osteophytes, or bone spurs. These spurs may accompanied by fever. The medulla ossium flava (fatty marrow) impinge upon nerves exiting from the spinal nerve canal and cause is replaced by fibrous tissue, which is transformed into “woven pain and lameness. bone” replacing and pushing aside the hematopoietic tissue. As the 3. Osteochondritis dissecans (OCD) is a disease that affects pup matures, the bone reforms itself to normal and the symptoms shoulders, elbows, and knees. It is often found in puppies of the disappear with no further recurrence. Some experts theorize viral larger breeds of dogs, although less so in Doberman Pinschers, causation since it is occasionally accompanied by fever, tonsillitis, Collies, and Siberian Huskies and less often in females than in and an increased white cell population. Its restriction to certain males. While the occurrence in certain breeds of dogs suggests breeds of dogs suggests possible genetic origins and it is advisable hereditary origins, complicating factors are trauma to the joint, to make sure the pup did not come from parents with similar rapid growth, hormonal imbalances, undue stress, reduced history. nutritional supply to the cartilage (avascular necrosis), and 6. Lumbosacral instability/stenosis is the result of the narrowing of overweight, followed by inflammation and erosion of the joint the spinal canal in the lumbosacral region, i.e., where the spinal cartilage. Bits of cartilage or bone may break off and float around column meets the pelvis. The pressure on the spinal cord elicits loose in the synovial chamber (called “joint mice”), often causing difficulty in rising, lifting the tail, limping hind quarter, and often very painful events. Attempt to limit strenuous exercise and incontinence of bladder and bowel. Causes maybe congenital jumping in young animals of large or giant breeds with a history of or acquired, such as trauma, tumor, infection, or degradation of the disease. Be choosey in what you feed your dog, make sure it is intervertebrate discs. conducive to good bone growth and do not overfeed. In the same complex of diseases you can find.

TABLE 9: JOINT DISEASE DIAGNOSIS Cervical Stenotic Wobbler’s disease: Ataxia, bilateral paresis of hind limbs, hyperreflexia, stiff front legs, toenails abraided; MRI, x-ray/ Myelopathy myelography to locate and identify sites of spinal cord compression. Starting mildly, intermittent longterm lameness until ligament tears then suddenly inability to use leg, holding up affected Cranial Cruciate leg, swelling of knee join; Compare right and left knee joints: atrophied? swollen? Palpate patellar tendons; drawer test; Ligament x-ray: osteophytes?, position femur vs tibia. Discoid Lupus Discoloration of hairless areas of face and body, erythema, scaling, sores, ulceration, occasionally painful, itchy leading Erythematosus to scratching and pyoderma, exacerbated by sun light; biopsy. See: Osteochondritis dissecans, ununited anconeal process fragmenteded coronoid process; differential diagnosis requires Elbow Dysplasia radiography and myelography, computed tomography, arthrocentesis. Fragmented Coronoid One or both of the two coronoid processes of the ulna separated; Decreased range of motion, swelling; x-ray both elbows, Process if necessary computed tomography, arthrocentesis.

veterinarians.elitecme.com Page 50 Dog stands with hindlegs close together, all breeds affected some more than others: Spaniels, Setters, Retrievers, St. Ber- nhard, Old English Sheep Dog, Welsh Corgi, German Shepherd, Bloodhound, Boxer, Rottweiler; wobbly unsteady gait to Hip Dysplasia severe crippling, dragging atrophied hind quarter, bunny hop, usually lameness on both legs, occasionally only one, one worse than the other, poor fit of hip joint: manually palpate hip joint and surrounding tissue mass, X-ray to confirm. Legg-Calvé-Perthes Miniature, toy Poodle; very painful, lame hindlegs, palpation, manipulation; X-ray: widening of space between femur syndrome head and socket, change of bone density, change of shape of head and neck. Intervertebral Disc Dachshunds, Beagles with neck/back pain, wobbly, swaying rearend gait; locate via myelogram, computed tomography, Disease magnetic resonance imaging. Lumbosacral Pressure on spine, rear leg lameness, palpation motion testing, lift/extend tail, often painful; x-ray, myelography, com- instability/stenosis puted tomography, magnetic resonance imaging. X-ray: bone spurs at ligament or capsule attachment points, joint degradation, cartilage breakdown, variation in bone Osteoarthritis density and joint space. Age of patient, painful manipulation of joint, loose parts of cartilage in joint capsule due to incompleted bone formation; Osteochondritis limping on one paw or leg when walking or lying down, localized swelling, painful motion, extension (shoulder, elbows, Dissecans knees), sudden, often very painful episodes of large-breed dogs during their growing phase suggesting panosteitis. X-ray, CT scan or MRI: necrosis of subchondral bone, formation of loose fragments. Palpate/move through complete range of motion: pain when extreme extension: X-ray, CT scan or MRI: necrosis of Osteochondrosis subchondral bone. Inflammation of long bones in growth phase, bouts of lameness shifting from one leg to the other in large-breed dogs. Panosteitis Although painful initially this condition passes and corrects itself eventually. Progressive radiography showing changing bone opacity will confirm the diagnosis. X-ray to exclude other causes. Patellar Luxation Manual palpation, x-ray to identify additional joint damage. Shifting lameness, swollen, painful joints, muscle atrophy, kidney disease, enlarged lymphnodes and tonsils; x-ray: Rheumatoid Arthritis changes in bone density; synovial fluid: cloudy with inflammatory cells, thinner consistency; biopsy: tissue inflammation; ANA test: Antinuclear antibody (indicative not decisive). Uncoordinated, wobbly gait, weak hind quarter, dragging toenails; X-rays, myelogram, computed tomography, magnetic Spinal Stenosis resonance imaging. Antinuclear antibody and two of the following symptoms: poly-arthritis, shifting leg lameness, aching muscles, stilted Systemic Lupus gait, loss of appetite, increased thirst, water intake and polyuria, bouts of fever, lethargy and depression, pale mucosae, Erythematosus hemolytic anemia and other bleeding problems, facial skin lesions often complicated by pyoderma, ulceration, thickened, ulcerated footpads, swollen lymphnodes, liver, spleen. Ununited Anconeal Large-breed dogs, 6-12 months old, decreased range of motion, stiff gait following rest, worse with exercise, usually both Process legs, rotating leg outward; swollen joint, painful, x-ray confirms anconeal process separated from ulna. Non-Joint related Bone fractures, onychomadesis, torn muscle/ligament, osteosarcoma, splinters. lameness

7. Malformation of cervical vertebrae (spondylopathy) or Cervical and eventually paresis of two, or even all four, legs. Genetics and Stenotic Myelopathy is also called Wobblers Disease. Relatively nutritional factors and excessive feeding appear to have some common in Great Danes and Doberman Pinschers, it causes poor causative input. coordination in the young, ataxia, unsteady and wobbling gait,

Autoimmunity-caused diseases 1. Rheumatoid arthritis in which autoimmune complexes, or the may also be found in the absence of the disease. Antinuclear “rheumatoid factor,” are formed and deposited in multiple antibody is usually present and detectable by the fluorescent joints throughout the body, thus eroding the joint cartilage and antinuclear antibody (FANA) and the ELISA test. The ELISA test subchondral bone. Clinically, there may be lameness; swollen, was described earlier. The fluorescent antinuclear antibody test hot, and painful joints; fever; swollen lymph nodes; anorexia; consists of: and general malaise. Radiography shows periarticular cuffing, a. Dilutions of the patient serum being added to a nuclear antigen fluid accumulation surrounding the affected joints, erosion, and substrate, destruction of the cartilage and subchondral bone. Samples of the b. Reaction time, synovial fluid show cloudiness, due to increased white blood cell c. Rinsing off of non-attached test serum, and count, and thinner consistency, while the synovial tissue itself d. Identifying remaining attached antibody by combining it with exhibits varying degrees of inflammation and inflammatory cell specific fluorescein-conjugated anticanine antibody. invasion. The rheumatoid factor can be determined serologically; A positive result at dilutions greater than 1/80 to 1/160 indicates however, it is not always present when there is the disease and the presence of antibody; however, the presence or absence of

Page 51 veterinarians.elitecme.com antibody per se is not diagnostic proof of the disease. While the lameness, decreased blood cell numbers, fluctuating fever, or skin disease occurs infrequently, when it does, it seems to appear more sores). often in the young of smaller breeds. 3. Discoid lupus erythematosus (DLE), which is the cutaneous form 2. Systemic lupus erythematosus (SLE) is a nonerosive, nonseptic of lupus, usually presents on the dog’s face, nose, lips, ears, and arthritis, which usually appears in middle-aged dogs and is around the eyes (and occasionally on feet and genitalia). The found in both females and males. The disease is often expressed cutaneous lesions range from discoloration to erythema, scaling, by shifting lameness, which is the result of joint and muscle flaking, sores, and ulcerations. When there is skin irritation and inflammation. Occasionally, lesions may occur on the skin in the itching, the animal tends to scratch, causing cuts and secondary face, ears, and nose. Autoimmune antibodies will attack various bacterial infection and pyoderma. This disease usually remains parts of the body, in addition to the joints, skin, muscle, nerves, relatively benign and may eventually disappear, leaving the kidneys, and the vasculatory system. The immune-mediated occasional scar. destruction of blood cells leads to hemolytic anemia. In addition Diagnosis of joint diseases: Early recognition of mobility problems to swollen and painful joints, there may be fever; alopecia; is the essence of diagnosis. Once the vet sees lameness, moving the discoloration; and ulceration of the facial skin, ears, eyelids, head up and down and raising the hip, it is already late in the progress and oral cavity; pleuritis; pericarditis; and kidney and nervous of the disease (Table 9). Early changes in activity, gait, length of system problems. The feet might be swollen and ulcerated, and stride, and range of motion require familiarity with the dog and his/her usually there will be increased water intake, lymphadenopathy, normal behavior at home, work, or play. Sports dogs do not perform as hepatomegaly, and splenomegaly. The animal becomes sleepy, expected. Diagnostic procedures of all joint and bone disease include lethargic, and lacks appetite. The prevalence in certain breeds manual palpation and mobility, arthroscopy, computed tomography, of dogs and their crosses (Afghans, German Shepherds, Irish and/or radiography. Gradual changes in bone opacity and growth Setters, Beagles, Old English Sheepdogs, Poodles, Collies, and lines, radiodense outgrowths, bone fragments, and joint mice can be Shetland Sheepdogs) suggests a congenital background. Summer seen. Some synovial changes, such as cloudiness, can be detected by and exposure to the sun seem to aggravate symptoms. Serological radiography as well. Softened, woven bone is recognized by lower confirmation of SLE is possible by determining the presence of bone opacity. Often there is swelling of the soft tissues involved, as antinuclear antibody—proof of antibody attacking the body’s own well as heat and pain when moving the joint. cells. For a final decision, in addition to finding antibody, the vet Treatment: In general, conservative medical treatment includes pain should look for at least two more symptoms of the disease (shifting control through analgesics, non-steroidal anti-inflammatory drugs (NSAIDs) and, if necessary, corticosteroids (Table 10).

Table 10: JOINT DISEASE MEDICATIONS Active Agent Mechanism Dosage Acetaminophen (Tylenol) Analgesic, antipyretic, anti-inflammatory. As needed Chlorphenesin carbamate Muscle relaxant: muscle pain/spasms; antifungal, antibacterial. 50 mg/kg-first day )* (maolate, musil) Cimicoxib (Cimalgex) Analgesic, anti-inflammatory. 2 mg/kg po Corticosteroid (prednisone) Anti-inflammatory, immunosuppressant. 1-2 mg/kg po 2x/day* Dexamethasone Anti-inflammatory, immunesuppressant. 2 mg/kg IV 2-3 days* Glucosamine/chondroitin sulfate Cartilage-building blocks: Questionable benefits. Food supplement Methocarbamol (Robaxin) Muscle relaxant. 10 mg/kg po * NSAID: Aspirin, Ibuprofen, Naproxen Analgesic, antipyretic, anti-inflammatory. As needed Omega-3 fatty acids Questionable benefits. Phenylbutazone Analgesic, antipyretic, anti-inflammatory. 15-20 mg/kg po 2/day Phytodolo ( Plant extract) Anti-inflammatory, antioedematous, antioxidative, analgesic. Polysulfated glycosaminoglycan Anti-Inflammatory, helps repair cartilage and synovial fluid, blocks 4.4 mg/kg/im 2x/week/x4 (Adequan Canine) enzyme-digesting cartilage. weeks Prednisolone Anti-inflammatory, antioedemic, anti-autoimmunity. 0.5-1.0 mg/kg po SAMe (S-Adenosyl methionine) Analgesic, antidepressant, liver repair, anti-inflammatory. 15-20 mg/kg po SKI 306X (oriental herbal extract) Anti-inflammatory, antioedematous, antiarthritic.

Attempt to provide rest and immobilization of joints and take steps to myelogram, computed tomography (CT), or magnetic resonance reduce the weight on damaged joints. Provide conditions conducive imaging (MRI) are prerequisites for surgery. Surgery and surgical to the healing of cartilage and bone, including nutritional supplements procedures are not part of the parameters of this course and will be such as glucosamine and chondroitin sulfate. Although effectiveness discussed in another course. Other treatment procedures include of these supplements has mixed feedback, some experts agree that acupuncture and TENS machine (Transcutaneous Electrical Nerve providing building blocks for cartilage renewal and repair should Stimulator), which have been used with mixed success regarding pain facilitate and speed up cartilage repair in damaged joints. All bone- and disability. Cervical Stenotic Myelopathy: Administer Prednisone and joint-related diseases are accessible to surgery; however, surgery 1 to 2 mg/kg orally twice a day and reduce dosage to a maintenance is very much dependent on the individual circumstances including level once effectiveness has been confirmed. type and health of the dog, as well as its size, weight, and bone and The treatment of cranial cruciate ligament complaints should joint conformation. Obviously, careful differential diagnosis, as well as concentrate on stabilizing the affected joint, which may be achieved by localization and identification of the damaged area using radiography,

veterinarians.elitecme.com Page 52 surgery: extracapsular stabilization, tibial plateau leveling osteotomy, keep its weight under control. Everything should be done to make its tibial tuberosity advancement followed by 3-day hospital stay and pain life comfortable: soft bedding, ramps instead of steps, elevated feeding management. At home, restricted activity in a cage or small room and bowls. Warm compresses and massages have been tried. leash walking for about three months after surgery, avoiding floors Osteochondritis dissecans can be treated conservatively in minor cases, with slippery surfaces. especially if in young dogs, by activity restriction (small room or cage) Discoid lupus erythematosus will be exacerbated by UV light. Dogs and leash walking over non-slip surfaces, thereby giving the affected affected by the disease should be kept away from exposure to sunlight cartilage surfaces time to heal and restructure. Surgery includes the as much as possible. Creams or ointments containing corticosteroids removal of floating ossified fragments, “joint mice”, from the joint and and Vitamin E can be applied topically and can be additionally repairing complicating lesions. Activity restriction and leash walking reinforced by nutritional supplements containing Vitamin E, Omega-3 to follow. fatty acids. Extended treatment with nicotinamide (Vitamin B3), Osteochondrosis: Like all the other joint diseases, restrict activity, tetracycline, doxycycline, has been reported effective in many cases. keep confined in cage, use anti-inflammatory drugs, NSAIDs. Tacrolimus ointment, used for human atopic dermatitis, has been Corticosteroids to be used if the other medications remain ineffective. shown effective in cases of DLE and safe even if licked by the dog being treated with it. Panosteitis: Restrict activity, keep patient confined in cage, use anti- inflammatory drugs, NSAIDs. Corticosteroids to be used if the other Elbow dysplasia is complicated insofar as different bones are involved medications remain ineffective. in the syndrome. Surgery is the most promising option. Conservative treatment includes anti-inflammatories, pain medications, weight Patellar luxation: Surgery is required for Severity Grades three and control and restricted exercise. Stabilize the affected joint to allow four. Rest, restricted activity and pain management have been found cartilage repair and provide nutritional supplementation. effective for Grade one and occasionally Grade 2. Leg braces help stabilize the knee joint and provide the required rest. Weight control Hip dysplasia: Surgical treatment options are to reshape or replace to reduce unnecessary weight stress on the joints, a balanced diet, the hip joint. The conservative approach rests on weight reduction, chondroitin and glucosamine supplements. restricted activity and medication. While reducing rambunctious activity, reasonable mild exercise is necessary to maintain cartilage Rheumatoid arthritis: Anti-inflammatories like aspirin, steroids with growth and regeneration and to maintain muscle mass. Medications or with adjuvants, gold injections have been used. Restricted activities of choice include NSAIDs: carprofen, meloxicam, tepoxalin, can be relaxed gradually, as soon as treatment shows improvement. prednoleucotropin. Try a different one for two to four weeks to find the Weight control is important to keep the weight off already damaged optimum one for the particular patient. Monthly to half-yearly blood joints. Fatty acid supplements are thought to be anti-inflammatory. tests should be considered to keep a check on potential toxicity of the With no cure likely, the emphasis must be on controlling the symptoms drug. Nutritional supplements, glucosamins, facilitate joint repair and and limit joint stress. are thought to be effective within weeks. Spinal stenosis: The common treatment: rest, restriction to cage and Intervertebral disc disease treatment requires rest and confinement analgesics and anti-inflammatory medications. in a small cage and anti-inflammatory medication (dexamethasone, Systemic lupus erythematosus: Immunosuppressive and anti- phenylbutazone, prednisolone). To contend with the often severe inflammatory drugs, including corticosteroids (prednisone), muscle spasms, muscle relaxants are recommended: Methocarbamol adjuvated by azathioprine, cyclosporine, or cyclo-phosphamide are and chlorphenesin carbamate. the medications of choice. Anti-malaria drugs, such as Treatment of the Legg-Calvé-Perthes syndrome, or avascular hydroxychloroquine (Plaquenil, Axemal, Dolquine, Quensyl) have also osteonecrosis of the femur head, essentially consists of stabilizing been used against lupus. The multilevel variety of symptoms of this and resting the affected limb. Radiographic improvement of the joint disease, often including damage to heart, liver, lungs, kidneys, spleen, promises resolution of the disease. Otherwise surgical removal of head must be treated symptomatically. Sunlight, ultraviolet light should be and neck of the femur is indicated. avoided or kept to a minimum, it tends to cause the disease to flare up. Lumbosacral instability/stenosis: Restrict activity, confinement to Ununited anconeal process: Rest, strict confinement in cage, cage, employ anti-inflammatories and analgesics. immobilization of joint, analgesics, non-steroidal anti-inflammatory drugs, corticosteroids if necessary. In summary, all joint disease is Osteoarthritis: Corticosteroids as well as NSAIDs are effective accompanied by pain, often leads to deterioration of joint formation against the painful symptoms. Acetaminophen is considered the and cartilage involved in the smooth operation of those joints. Aside main medication to mitigate pain and facilitate the dog’s mobility. from surgery, analgesics, anti-inflammatories, weight reduction and Nutritional supplements, such as glucosamine and omega-3 fatty acids, extended rest periods are the main stays of the treatment of joint are generally recommended. It is important to exercise the animal and disease.

Ear infection Otitis, inflammation of the ear, covers otitis externa, which may lead Causation: The multiple causes of otitis include trauma, foreign to middle ear (otitis media) and inner ear (otitis interna) infection. bodies (plant awns, burrs, grass seeds, foxtails, careless cleaning When caught in the early acute stage, healing and clean-up is possible of ear canal, Q-tips, water), bacteria (Staphylococcus, Proteus, and fairly straightforward. Left untreated, it will turn chronic and Pseudomonas, Escherichia, Enterococcus, Corynebacterium), parasites more difficult to treat and cure. Predisposition for otitis include flappy (ear mites, scabies, Demodex, fleas, ticks, fly and chigger bites), yeast ears, excess hair growth, and depth and size of ear canal. Frequent (Malassezia and Candida), allergies (canine atopy, food allergy), swimming and bathing are also factors, as is careless cleaning. hormone (hypothyroidism, hyperadrenocorticism, sex-hormone Indications of ear disease consist of shaking the head, tilting it to imbalances, adenitis), autoimmunity (discoid lupus erythomatosis, one side, rubbing the head along the carpet or in the grass, increased pemphigus erythematosus, pemphigus foliaceus, cutaneous vasculitis, secretion, an odorous smell coming from the ear canal, purulent bullous pemphigoid, mucous membrane pemphigoid) and cancer exudate, waxy build-up, scratching, build-up of discharge in the ears, (polyps, malignant tumors). redness, irritation, swelling, depression, snappiness, and irritability when touched on the head.

Page 53 veterinarians.elitecme.com Diagnosis and treatment: Clean and clear ear canal to make it to middle ear infection, often through a broken tympanic membrane, accessible to otoscopic examination of the ear drum. Confirm but infection may also pass through the Eustachian tube from the contiguity of the ear drum before using medication. Identify causes nasopharyngeal area. In fact, middle ear infection is frequently found of the irritation to decide treatment course. Otitis externa may lead with the tympanic membrane intact.

Table 11: DIAGNOSTIC INDICATORS Purulent, thick, tenacious, pale, sweet smelling Gram-negative bacteria Creamy, light brown Gram-positive bacteria Dark brown to black, crumbly, odorous Ear mites Dark brown, sweetish smell Yeasts

Otoscopy will be complicated because the inflamed and ulcerated long as 3 weeks, before examination and treatment can be attempted. surfaces of the ear and ear canal require local or general anesthesia If a middle ear infection is suspected, myringotomy may be necessary for access and examination. Cerumenolytics, such as oil, glycerine, for diagnosis and treatment. Obviously, all otitis not accessible to the carbamide peroxide, and triethanolamine polypeptide oleate may topical administration of therapeutics requires systemic treatment. be necessary to soften sticky and hardened cerumen. The color and Trauma and foreign body removal are followed by basic wound appearance of the ear wax is indicative of the likely cause of the disinfection and wound care. inflammation. Standard microscopic cytology and cultural methods Bacterial infections, while occasionally the primary cause of otitis, are will permit identification of the pathogen. It is important to quantify often the secondary response to the original damage or inflammation the number of organisms, since some of them can be found normally in caused by other objects or pathogens. Bacteria most often identified the healthy ear canal. Ulcerated or hypertrophic ear canals may require are Staphylococcus intermedius, Pseudomonas aeruginosa, corticosteroid treatment, topically and systemically, sometimes for as Enterococcus, and Proteus.

TABLE 12: ANTIBACTERIALS FOR USE IN OTITIS PATHOGEN ANTIBIOTICUM MECHANISM Staphylococcus 1-Polymyxin B 1-Bind to cell membrane, make it leaky: water uptake kills cell. Intermedius 2-Lincomycin 2-Interrupt synthesis of essential proteins. 3-Amoxicillin-clavulanic acid 3-Inhibits cell wall synthesis. 4-Ampicillin/Cloxacillin 4-Inhibits transpeptidase thus blocking cell wall synthesis. 5-Chloramphenicol 5-Inhibits protein synthesis. 6-Doxycycline 6-Interrupts protein synthesis. Pseudomonas aeruginosa 7-Fluorfenicol 7-Binds to ribosomal subunits, blocks peptidyl transferase. 8-Ciprofloxacin 8-Inhibits DNA gyrase and cell division. 9-Gentamicin 9-Inhibits and misdirects protein synthesis. 2-Lincomycin 2-Interrupt synthesis of essential proteins. 10-Spectinomycin 10- Interrupt synthesis of essential proteins. 4-Ampicillin/Cloxacillin 4-Inhibits transpeptidase thus blocking cell wall synthesis. Proteus mirabilis 6-Doxycycline 6-Interrupts protein synthesis. Escherichia coli 4-Ampicillin/Cloxacillin 4-Inhibits transpeptidase thus blocking cell wall synthesis. 11-Enroflaxin 11- Inhibits DNA gyrase and cell division. Streptococcus beta-haemolyticus 1-Polymyxin B 1-Bind to cell membrane, make it leaky: water uptake kills cell.

Treatment effectiveness requires identification of the target organism debris, made up of blood and mite feces; and build-up of earwax. because of the differences in antibacterial sensitivity of different The mites live in the ear canal and feed on the debris found there. bacteria. Treatment may be topical or systemic. Gram-negative The ears itch, leading to ear scratching, which often opens the skin bacteria can be treated effectively with gentamycin, polymyxin B, and causes bleeding. Both the primary inflammation caused by the and other aminoglycosides. Gram-positive bacteria are a different mite itself and the secondary damage, due to the dog clawing at its story—while many are susceptible to amoxicillin-clavulanic acid and ears, may elicit secondary bacterial or yeast infections. Mite presence similar treatments, there are strains that have developed resistance can be confirmed with magnifying glasses or low-power microscopy. due to selection pressure. Broad-spectrum antibiotics, such as The allergenicity of the parasite in certain dogs aggravates the fluoroquinolones, facilitate the selection of multi-drug resistant disease, eliciting an Arthus-type phenomenon, i.e., a localized, type bacterial strains and can change the balance of the essentially III hypersensitive reaction. All treatment must continue throughout symbiotic bacterial population of the healthy gut. In particular, note the 3- to 4-week lifecycle of the mite—the time it takes the egg to the emergence of “superbugs” such as MRSA (methicillin-resistant mature into the adult mite. The entire lifecycle takes place on the Staphylococcus aureus), MRSE (methicillin-resistant Staphylococcus host. Demodex canis is another mite that will occasionally cause otitis epidermidis), Clostridium difficile, and drug-resistant Streptococcus (see below: skin disorders). The spinous ear tick (Otobius megnini) pneumoniae in hospitals throughout the country. The implication of is more likely to be found on outdoor dogs. Larval ticks, which are veterinary antibiotica in the spread of drug resistant strains should be produced outside the host, will crawl on plants that are high off the considered by the veterinary community. ground to wait for a passing host and fall onto anything warm-blooded Parasites: Ear mite (Otodectes cynotis) infestation is characterized and moving. They can survive for months without feeding. After by a foul odorous smell; dark reddish, brown to black exudates and dropping onto the host animal, the larval tick will attach to the lining of the outer ear canal and suck blood for about 6 to 8 days. It will

veterinarians.elitecme.com Page 54 molt twice, the first stage nymph remaining without feeding, to the will cause severe itching for several days on human skin. Other mites second nymphal stage which will suck blood for months, frequently occasionally involved are Cheyletiella spp and Eutrombicula spp causing otitis, before it drops to the ground to hide while continuing (chiggers). Flea-bite induced allergies have to be considered when to mature to adult tick. Sarcoptic mange (Sarcoptes scabiei) is a mite investigating otitis. Topically applied miticides (ivermectin, pyrethrin, that burrows under the skin and causes severe itching. It can be passed thiabendazole, carbaryl, rotenone) and systemically introduced to humans but cannot remain for a complete lifecycle. However, it ivermectin and selamectin have been found effective.

TABLE 13: ANTIFUNGALS CLASS EXAMPLES MECHANISM Candicin Binds sterols, including ergosterol, in fungal cell walls renders them leaky. Hamycin Polyenes* Nyastatin Amphoteracin B Clotrimazole “Lotrisone” Inhibits lanosterol-14 alpha-demethylase: enzym blocks conversion of lanosterol to Ketoconazole “Nizoral” ergosterol which is essential for fungal cell wall contiguity. Itraconazole “Sporanox” Treatment until cytology confirms clearance of infection. Fluconazole “Diflucan” Azoles* Voriconazole “Vfend” Posaconazole “Noxafil” Thiabendazole “Mintezol” Miconazole Terbinafine Blocks squalene epoxidase: inhibits ergosterol synthesis. Butenafine Allylamines Amorolfine Naftifine** Cancidas Inhibits 1,2-beta glucan synthase: blocks glucan synthesis in cell wall. Echinocandin Mycamine Eraxis * may be toxic in high concentrations: effecting animal cell walls also; ** only topical activity *** with months of bioavailability after administration

Yeast (Malassezia pachydermatis) can be isolated from healthy, to relieve the itching and scratching. A topical anesthetic, Pramoxine, non-otitic dogs. In dogs with otitis, the yeast occurs more frequently. has been combined effectively with hydrocortisone, Hydrocortisone- Other yeast organisms that can be found occasionally are: Aspergillus, Pramoxin-Aloeps, for topical application. If nothing else works, the Candida, Microsporum, Trichophyton, Sporotrhrix schenkii, last treatment is desensitization of the atopic dog, which is a costly Paecilomyces, and Dermatophytes. Yeast may be the primary cause process that requires many desensitizing injections over many months of otitis; however, more often, it is secondary to other damage to the with the suspected allergens without a guarantee of success. ear canal. Antifungals, which are usually applied topically, may have Autoimmunity may appear in the form of systemic lupus and discoid to be given systemically in severe cases. Some dogs will have an lupus erythomatosis, both mentioned above as causing nonerosive allergic reaction and care must be taken not to aggravate the situation. polyarthritis, and present otitis as part of the cutaneous symptoms Among the variety of fungicides available are polyene antifungals of the disease. Pemphigus in dogs causes fluid-filled blisters on the (nystatin, amphotericin B), azoles (clotrimazole, thiabendazole, skin, pustules, and ulceration. Depending on the severity and depth of miconazole), allylamines (butenafine, naftifine, terbinafine, damage to the skin, pemphigus occurs in four forms—from superficial amorolfine) and echinocandins (Cancidas, Mycamine, Eraxis). Topical erythematosus via foliaceus and vegetans to, finally and most severe, combinations include Panalog, a formulation of Neomycin, Nystatin, pemphigus vulgaris with more severe and deeper ulceration. Cutaneous Thiostrepton, and Triamcinolon, effective against fungal and bacterial vasculitis (inflammation of cutaneous vascularization) causes fluid- infections, allergy, pruritus, inflammation, Tresaderm (thiabendazole, filled blisters, red spots, edema, itchy skin, some ulceration, and dexamethasone, neomycin sulfate solution), and Otomax (gentamicin occasionally elevated temperature. Bullous pemphigoid, a type II sulfate, betamethasone valerate, betamethasone, and clotrimazole). hypersensitivity reaction, expresses itself through the formation of Allergies (canine atopy, food allergy): Atopic dermatitis is a result hives, advancing to serous to hemorrhagic skin blisters and open of allergenic stimulation and an increase of IgE. Environmental sores. Similarly, mucous membrane pemphigoid is an autoimmune antigens such as pollen, house dust, molds, grain dust, and other blistering dermatosis that is characterized by vesicles, ulceration, debris will stimulate reactions, some seasonally, some year-round and and scar formation. The use of immunosuppressants (corticosteroids, not necessarily confined to ears, but all over the body, underbelly, prednisone) requires careful monitoring of the patient to anticipate and and paws. There may be tearing eyes and rhinitis-like symptoms. preclude the reoccurrence of secondary diseases and latent infections. Excessive scratching may lead to open wounds, scabs, crusts, and Cancer: Squamous cell carcinoma is an invasive malignant tumor of secondary infections. With atopic otitis, the pinnae appear red and the epidermis usually found in older dogs (>6 years). Occurring more inflamed, sometimes scratched and rubbed bloody, and the ear canal is frequently in outdoor dogs, white dogs, and dogs with white ears, it filled with seborrheic exudates and brown cerumen. Before proceeding is thought that exposure to the sun and ultraviolet radiation may be a with treatment, other likely causes of the disease must be excluded. contributing factor. The edges and tips of the ears may show redness Scrapings, growth cultures, fleas and other parasites, and food-caused and develop ulcerated sores or nodules that occasionally appearing allergies must be examined and excluded. Adverse food reactions wart-like. They gradually recede and regrow, usually bigger than play a significant role in recurrent external otitis. After the removal of before. Similar sores may appear elsewhere on the body. Biopsy will extraneous causes of the otitis, antihistamines and corticosteroids tend confirm the diagnosis. Not being very invasive, excision would be the

Page 55 veterinarians.elitecme.com treatment of choice. However, sustained-release chemotherapy gel pink, ulcerating, and occasionally bleeding. Hypothyroidism affects implants containing collage, epinephrine, 5-fluorouracil, or cisplatin cerumen consistency and facilitates the replication of microorganisms given intralesionally has shown effectiveness. conducive to inflammatory otitis. Polyps are fibrovascular connective Adenocarcinoma is the cancer of the ceruminous gland in the ear tissue growths that result from chronic overstimulation of ceruminous canal. It occurs more frequently in older animals. Enlargement of glands, from chronic and food allergies. Growing slowly, they may the local lymph node may be observed. The early stages appear extend from the Eustachian tube and the tympanic bulla and eventually cause hearing loss and equilibrium disturbances.

Eye infections The dog presented to the clinic had swollen red eyes, and was discharge. Topical and systemic antibiotics often used are gentamicin, tearing, blinking, and squinting. The discharge may be clear to tobramycin, chloramphenicol, oxytetracycline, or ciprofloxacin (Table mucoid and purulent. The dog was restless, itching, and scratching, 14). Brucella canis usually affects the reproductive system of both and may be feverish. Bacterial and viral infections are often the males and females and causes reproductive failure (stillbirths, male source of conjunctivitis. Allergies can also cause inflammation of infertility) in dog-breeding kennels. Very rarely, it will cause ocular the conjunctivae. Demodex occasionally encroaches onto the eyelids disease and can be spread via nasal and oral secretions. and complicates matters. In addition to the above causes, there are Ehrlichiosis: The ocular form of canine monocytic ehrlichiosis many other eye diseases: Canine Uveitis, Corneal Dystrophy, Corneal caused by Ehrlichia canis, a rickettsia, is expressed by lesions to the Endothelial Degeneration, Ehrlichiosis, Eye Worm, Foreign Body, eyes, detachment of the retina, retinal exudation, anterior uveitis, Fungus, Glaucoma, Horner’s Syndrome, Inherited Eye Disease and inflammation of the optic nerve. Being a tick-borne disease, it (Collies), Keratoconjuntivitis Sicca. Lenticular Sclerosis, Pannus, usually occurs in spring and summer months. In addition to supportive Progressive Retinal Atrophy, Sudden Acquired Retinal Degeneration care and intravenous fluid therapy and steroids, an 8-week course of Syndrome, Ulcerative Keratitis, and Prolapsed Nictitans Gland. tetracycline or doxycycline isindicated. Rocky Mountain spotted fever, Bacterial infections: Conjunctivitis, blepharitis, and keratitis may also a rickettsial disease (rickettsia rickettsii) transmitted by ticks, be caused by Staphylococcus aureus and epidermidis, alpha- and can produce ocular symptoms including conjunctivitis, hemorrhages beta-haemolytic Streptococcus, Escherichia coli, Proteus, or in the retina, anterior uveitis, retinal spotting, and optic disc edema. Pseudomonas. There may be redness, swelling, pain, or mucopurulent Treatment will be similar to that of Ehrlichiosis.

TABLE 14: OPHTHALMIC MEDICATIONS BRAND NAME COMPONENTS Maxitrol Neomycin Sulfate (aminoglycoside); Polymyxin B (Polypeptide) Dexamethasone (Corticosteroid). Neosporin, Neobacimyx Bacitracin (Polypeptide), Neomycin, Polymyxin B. Gentocin, Garamycin, Genoptic Gentamicin Sulfate (Aminoglycoside). Pred Forte, Econopred Plus Prednisolone Acetate Ophthalmic Suspension. Ciloxan Ciprofloxacin Ophthalmic Solution (Fluoroqinolone). Noroxin, Chibroxin Norfloxacin Ophthalmic (Fluoroqinolone). Ocuflox Ofloxacin (Fluoroqinolone). MECHANISM OF ACTION FOR ABOVE MEDICATIONS Aminoglycosides (amikacin, arbekacin, Bind to four nucleotides of 16S rRNA, a single amino acid of protein S12 and interfere gentamicin, kanamycin, neomycin, netilmicin, with the initiation process, misreading the mRNA and misdirecting polypeptide assembly, paromomycin, rhodostreptomycin, streptomycin, producing malfunctioning, toxic proteins. tobramycin, apramycin) Polypeptides (Pololymyxin B1 and B2) Interfere with osmotic equilibrium of cells, change permeability of bacterial outer membrane, leading to increased water uptake and cell lysis; no effect on Gram-positive bacteria (bacterial cell wall too thick). Fluoroqinolones (...oxacins) Inhibit topoisomerase, DNA gyrase and block DNA replication, transcription, synthesis. Corticosteroids (Dexamethasone) Anti-inflammatory will reduce swelling, heat, redness, pain.

Viral infections include adenovirus, influenza, respiratory viruses, Parasites include: herpes, and canine distemper virus as being implicated in eye diseases. 1. Thelazia californiensis, the eye worm, which can be found living There are no effective antivirals. The goal must be to fight secondary in tear ducts, the conjunctival sac, and under the nictitating bacterial complications. Although the purpose of antiviral vaccines membrane. Thelazia californiensis is a nematode, larvae of is not primarily the prevention of viral eye infections, they may do which are carried by houseflies and other flies feeding on tears. so as a byproduct of the canine distemper vaccine, canine hepatitis They develop within the fly’s gut for about 30 days and are then vaccine (adenovirus-2), or the canine parainfluenza virus vaccine.The redeposited into the eyes of the new host animal. After developing treatment of virus-caused eye infections will essentially have to remain there within 4 to 6 weeks to a thin adult worm, less than 1-inch symptomatic. long, they will start producing eggs. Symptoms are sensitivity Allergies are the result of the same causes mentioned above (drugs, to light, tearing, irritation, inflammation, and conjunctivitis and food, soap, shampoo) and are treated accordingly. may be complicated by secondary bacterial infections. Treatment includes the removal of the adult worms under local anesthesia

veterinarians.elitecme.com Page 56 and subcutaneous administration of a macrocyclic lactone, such as as Latanoprost (Xalatan), a prostaglandin analog, will facilitate ivermectin. If left untreated, it may lead to keratitis, cataract, and the drainage of fluids from the eye. It is often used in combination ulceration. with timelol, a beta-adrenergic-blocking drug. 2. Dirofilaria immitis, the heartworm, may also appear in the 3. Hyperadrenocorticism (Cushing’s Disease), a less frequently conjunctiva of the diseased dog and may have to be removed occurring disease of the eye, is the overproduction of and treated like the Thelazia nematode described here. See also glucocorticoid steroid hormones, which can cause glaucoma, Chapter 1 on heartworms. cataracts, corneal disease, and reduced field of vision and 3. Toxocara canis, ocular toxocariasis, a consequence of ocular larva peripheral vision. It usually occurs in the older dog, 6 years and migrans, affects the eye and the optic nerve: third-stage larvae older. If due to overtreatment with corticosteroids (hydrocortisone, damage retina, inducing granulomas, which may lead to vision prednisone), reduction of dosage is an obvious remedy, if due to a loss, keratitis, endolphthalmitis, ulceration, and uveitis. It usually tumor in the pituitary, surgery may be indicated. Medication that remains confined to one eye. For treatment, consider albendazole can be tried includes Lysodren (Mitotane), an antineoplastic which combined with a systemic corticosteroid. suppresses adrenal cortex function reducing the production of 4. Fungal infections such as blastomyces dermatitidis or cortisol and Trilostane (Vetoryl), a non-hormonal steroid analog, Cryptococcus neoformans are treated with antifungal antibiotics, interfering with the production of adrenal end products. including Fluconazole (Diflucan), Griseofulvin (Fulvicin), 4. Hypothyroidism results in lowered thyroid hormone production. Ketoconazole (Nizoral), or Amphotericin B (Fungizone). This may be result of congenital defects, lack of dietary iodine, or Treatment should be continued for at least one month after thyroid atrophy due to autoimmune destruction. Among various disappearance of symptoms. other symptoms of the eye are corneal dystrophy, i.e., white spot Among the non-infectious diseases of the eye are: or circle on the cornea, and occasionally, bubble formation and 1. Glaucoma, which is predominantly found in Cocker Spaniels, ulceration. Thyroid hormone replacement therapy with synthetic Chow Chows, Siberian Huskies, Poodles, and Samoyeds. L-thyroxine must be considered for the rest of the dog’s life. Glaucoma is a result of inadequate fluid drainage and increasing Frequent testing of thyroid hormones will be necessary to maintain pressure within the eye and upon the optic nerve. This is likely to effective levels. produce lasting damage to the eye and blindness in as many as 4 5. Other eye diseases include diabetic cataracts and diabetic out of 10 cases. Symptoms include high eye pressure, blinking, retinopathy, resulting from hyperglycemia, calcium deficiency- receding and, later, enlarged, hard eyeballs, cloudiness and red caused cataracts, blood leakage into the eyeball, detachment of capillaries in white of eye, extended pupils, and loss of vision. the retina, and papilloedema (swelling of the optic disc). There 2. Secondary glaucoma, i.e., secondary to other causes such as are physical changes of eyelids, including cherry eye (prolapse infections, local inflammation, lens luxation, tumors or trauma, of tear gland under third eyelid), entropion (inversion of the edge exhibits elevated pressure in the eyeballs, bloodshot eyes, of an eyelid), ectropion (outward turning of eyelid), blepharitis cloudiness, and inflammatory matter in the front of the eyes and (inflammation of the outer skin of the eyelid), trichiasis and stickiness of iris. In addition, there may be disinclination to play districhiasis (ingrowth of eye lash), nuclear sclerosis (clouding and exercise, inappetence, and headache. Treatment of secondary of older and denser lenses) in aging dogs, corneal dystrophy, glaucoma must rely on removal of the primary cause. Pressure- corneal ulcers), and Chalazion (granuloma in the eyelid, blocked relieving surgery is an option. Pressure-lowering eye drops, such Meibomian gland). They must be treated and corrected case by case. Skin diseases Itching, excessive scratching, lack of luster and dullness of fur, sore epithelial cells to strengthen the epidermis and to transfer spots due to scratching and licking, hair loss, flaking, smelly skin and materials and signals from cell to cell. These fibers connect to the chewing on skin, paws, groin, armpits are indicative of a diseased proteinaceus plaques under the plasma membrane of adjacent cells. skin. Areas being scratched may develop irritated, inflamed, often Hemidesmosomes, on the other hand, attach the basal surface bloody, hot spots. of the cell to the basal matrix on which it sits. Antibody to the 1. Allergy-based skin diseases include atopic dermatitis caused by intercellular cell-adhesion proteins will dissolve them and produce hypersensitivity to pollen, dust mites, flea bites, or ingested and epidermal detachment and cell separation. Accordingly, it exhibits inhaled allergens. There is a predilection for Boxers, Bulldogs, blistering, fluid-filled vesicles and cysts, crusted purulent pustules, Dalmatians, Irish Setters, Beagles, and Retrievers. Hypersensitivity often ulcerating, and crusting and matting of the fur. The presence to seasonal allergens seems to increase with increased frequency of antibody in the acantholytic lesion confirms the diagnosis. of allergen exposure. The very nature of the origin of the disease Cytology of a pemphigus foliaceus lesion will show acantholytic suggests an underlying chronicity of the disease and lifelong keratinocytes and the invasion of neutrophils. Although therapeutic efforts. Anti-itch shampoos, antihistamines, and complement has been found and may be facilitating the corticosteroids can mitigate effects of the disease but long-term, pathological picture of acantholysis, absence of complement in the vet may try to desensitize the dog to the allergen to reduce, if complement-depleted mice did not stop acantholysis in mice. not control, hypersensitivity and its effects. Of course, reducing the There are four types of pemphigus with increasing severity, the dog’s exposure to likely allergens should be of primary concern. first three remaining mostly superficial, confined to the skin, 2. Autoimmunity: While hypersensitivity to foreign antigens is especially around the body orifices: responsible for skin allergies, the body’s response to its own protein will lead to autoimmune reactions such as pemphigus, 1. Pemphigus vegetans with localized oozing lesions, no lesion in bullous pemphigoid, and systemic and discoid lupus mouth area, minor general systemic effects; erythematosus. Pemphigus is the most common autoimmune skin 2. Pemphigus erythematosus with loss of lip color and lesions disease in dogs, where antibodies against the own body produce usually confined to head, face, footpads; blistering acantholytic dermatosis. Circulating antibodies attack 3. Pemphigus foliaceus shows fluid-filled vesicles, itching and the desmosomal proteins that are responsible for keratinocyte pain, scaling and crusting, pustules, ulcers, redness; the most cohesion and keeping the epidermis intact. Desmosomes, also affected parts of the body are head, ears, and footpads, and called macula adherens, are patches of discrete fibers connecting sometimes gums and lips. Pemphigus foliaceus affects the

Page 57 veterinarians.elitecme.com whole body and there may be fever, depression, lameness, and 6 to 8 weeks. The rooms and surroundings of the infested dog must swollen lymph nodes. Open sores invite secondary infections; be treated as well. 4. Pemphigus vulgaris is a deep pemphigus disease, the Demodex canis, the “red mange,” live in the lumen of hair follicles most severe type of the disease, showing most of the same and ducts of sebaceous glands and feed on dead cells, sebum, and symptoms in aggravated form. Certain medications such epidermal breakdown products. They are part of the commensal as cimetidine, cephalexin, amoxicillin and clavulanic acid, biosphere of the normal dog’s skin. Their entire lifecycle, 3 to ampicillin and trimethoprim-sulfonamide combinations, 5 weeks from egg to mature mite, proceeds on the same host. metaflumizone and amitraz have been suspected to trigger The mites are smaller than Cheyletiella and must be placed pemphigus foliaceus. Withholding the triggering drug and under the microscope to be identified. Changing conditions in a quick hypersensitive response after readministration the dog, such as heat cycle, stress, underlying systemic disease, should confirm the suspicion. Treatment consists of topical and immunological changes may trigger the development of the glucocorticoids, systemic immunosuppressive, and anti- disease. The mites will replicate and multiply and overgrowth inflammatory medication. In severe pemphigus foliaceus, it of mites will cause serious irritation and disease including may be necessary to initially give intraveneously high doses comedones (blackheads, small bumps in the skin), papules, of methylprednisolone for several days before reducing it to patchy alopecia, and bald, reddening spots in the skin. There a low level oral maintenance dose. Antimicrobial therapy is will be scaling and oozing sores may develop and crust the skin. reserved for secondary bacterial infections. In localized cases, usually juvenile-onset demodicosis in dogs Another autoimmune skin disease is Bullous Pemphigoid, younger than 18 months, the infestation may remain confined to “pemphigus-like” disease, which presents initially urticaria-like isolated small hairless blotches in the dog’s face and forearms. In hives, progressing to fluid-filled blisters, crusting pustules, open many instances, this may resolve without treatment. To be called circular sores and ulcers on the skin, soft inner parts of extremities, generalized demodicosis, it must cover five or more affected between toes and around the body’s orifices and mucosae. There areas, if not a large part or the whole body and/or more than two may be fever, inappetence, and lack of interest in exercise. extremities. Considerable itchiness, swelling, ulceration, and Sunlight may aggravate the situation. It occurs more frequently in secondary bacterial infections and pyoderma make the generalized rough and smooth Collies, Shetland Sheepdogs, and Doberman form more serious and difficult to treat. More severe demodicosis Pinschers. Aside from gentle antibacterial shampooing and may be cause for deep pyoderma, where there will be fever, cleansing, immunosuppressants and anti-inflammatories should be painful, peripheral lymphadenopathy, and risk of septicaemia. used. Keep affected dogs out of the sunlight. Cleansing shampoos, such as benzoyl peroxide shampoos followed Lupus produces skin lesions on the face on nose, lips, eyes, by treatment with Amitraz (“Mitaban”) Dip or macrocyclic and ears. There is loss of hair, scaling and discoloration of the lactones (see above) has been shown to be effective. It may take nose, ulceration, and scarring. It may extend to the skin around several weeks, months, or even years of repeated treatments. After the genitals. While systemic lupus spreads throughout the body elimination of mites, treatment should be continued for several and affects many systemic parts of the body, discoid lupus weeks to confirm elimination and avoid recurrence. Secondary erythematosus is the milder form remaining confined to the skin. bacterial pyoderma requires antibacterial therapy. Again there is a preponderance for certain breeds of dogs (German Demodex pododermatitis causes inflammation of the foot often Shepherds, Collies, Shetland Sheepdogs, Siberian Huskies, complicated by secondary bacterial infections. There will be skin Malamutes, Beagles, and Chow Chows) suggesting the need for irritation, reddened skin, swelling between the toes, pustules selective breeding. Treatment, as mentioned earlier, consists of and, occasionally, hyperkeratosis of the footpads. This disease is the administration of glucocorticoids, such as prednisone, and painful, leading the dog to gnaw and lick its feet. Some breeds nutritional supplements vitamin E, niacinamide, and fatty acids seem to be more susceptible than others (Bulldogs, Bull Terriers, (omega-3 and omega-6). Since exposure to the sun may aggravate Dalmatians). the disease, it is important to avoid the sun and UV lighting. Demodex cornei, a shorter more stubby mite, resides in the More severe cases require the use of antibiotics (tetracycline) and corneal, the most superficial layer of the skin. Corneal demodicosis immunosuppressants (azathioprine, chlorambucil). exhibits symptoms like those produced by demodex canis except 3. Bacterial diseases: Pyoderma is the result of pus-producing for appearing more pruritic. Demodex injai, more often found in bacteria that may infect open sores caused by trauma including terriers, is found in sebaceous glands and causes hyperplasia and bites from parasites and following allergies, hypersensitivity greasy fur on the back and neck. Sarcoptes Scabei is responsible reactions, and autoimmune diseases. Swollen inflamed pus-filled for scabies, i.e., the sarcoptic mange. The adult female burrows pustules and open wounds, localized hair loss, lusterless fur, into the skin to lay eggs that will produce larvae within a few and matting are the result. Removal of underlying causes, anti- days, turning into nymphs and finally, to adult mites ready to inflammatories, and antibacterial treatment are indicated. recommence the month-long cycle. Their crawling under the skin 4. Parasitic infestations include mites and fleas and will result in is very itchy and aggravated by allergic reactions to mites and itchy, dry, flaky skin. Depending on the severity of infestation, eggs. Symptoms for sarcoptic mange are itchiness, inflammation, there will be matting of fur, hair loss, and red, bleeding, itchy and red scaly areas in the softer, hairless parts of the skin—under areas leading to increased scratching. Cheyletiella dermatitis is arms, elbows, underbelly, earflaps, and in particular, earflap a small red mite that can be seen with the magnifying glass and margins. Macrocyclic lactones are effective in treating scabies. causes cheyletiellosis, also called walking dandruff, with the mites However, Collies, Australian Shepherds, and Shetland Sheepdogs moving around loose flakes of dry skin. It wanders all over the should be monitored for possible side effects. Anti-inflammatory body causing flaking and a red, papular rash. It is most often found and immunosuppressive corticosteroids are available for the on the head, neck, and back. The mite is highly contagious, easily itching problem. Lice have a 3-week lifecycle on their canine moving from animal to animal, as well as humans, which passes host. Lice and eggs (nits: attached to the hairshaft) are visible on the infestation. In humans, an itchy, red, papular rash will with the naked eye and easily identifiable. There are two types develop on arms and the trunk. Treatment with a mild pyrethrin of lice (1) the skin chewing Trichodectes canis and (2) the blood shampoo or lime-sulfur dips should clear up the infestation within sucking Linognathus setosus. The second one is more annoying and irritating, penetrating the skin to suck blood. Depending on

veterinarians.elitecme.com Page 58 the severity of the infestation, blood loss may be significant and, animal. In the subcutaneous form, single or multiple nodules if neglected, may lead to anemia and shock. Lice cause severe will appear in the skin that may ulcerate with bloody or purulent itching and there will be rubbing, pawing, and chewing of the discharges. Excision of the individual lesion and the above affected areas—ears, back, groin, and anal area. The fur may be antifungal regimen is recommended. matted and should be shaved to facilitate treatment. Surrounding 5. Hormone-related skin disorders: Hair loss and dermatosis can be areas and equipment must be cleaned and disinfected to allow part of a hormonal imbalance of a variety of systemic hormones successful eradication. Insecticide shampoos, sprays, or powders including those affecting the reproductive system. While the dog’s (fipronil, Selamectin) should be used in 1- to 2-week intervals at endocrine system regulates and coordinates all parts of the body least four times to be effective. and its interactions, the concentration here is on the resulting Fungal skin infections include Malassezia pachydermis, a yeast skin disorders. Growth hormones are produced by the pituitary organism causing inflammation of the skin and ears, skin irritation and mammary glands. Underproduction of growth hormone and patchy redness, hair loss, oily and scaly skin, smelly discharge, will lead to a thin hair coat while overproduction may produce hyperpigmentation and, in later stages, thickening of the skin. thickening and excessive folding of the skin in the neck and face. Basset Hounds, Dachshunds, Poodles, Spaniels, and terriers seem Hypothyroidism results in loss of hair, in which the hair turns dry to be predisposed. Other predisposing factors are high humidity, and brittle and falls out. Main areas of hair loss are the neck and high temperatures, hypersensitivity, and various allergies. chest, back of thighs, and tail. The skin appears darker, dry, thick Medicated shampoos and antifungal treatments are suggested. and puffy and, like with dandruff, there will be flakes of dead skin Ringworm is a fungal skin infection, dermatophytosis, caused and hair follicles. by Microsporum gypseum, Trichophyton mentagrophytes, or Hyperadrenocorticism, also called Cushing’s disease, is the Microsporum canis-invading hair follicles, skin, and nails and chronic overproduction of glucocorticoid, which leads to hair feeding on keratinized breakdown products, hair, dead cell debris. loss, among other effects on the body’s system and functions. It is Picked up as spore from the soil, from another infected animal, a disease of middle age for the dog (~ 6-7 years). The effects on or its surroundings, it is more frequently found in younger dogs. the skin are alopecia, thinning of the skin, increased fragility, and Stressed animals, those underfed, or immunosuppressed are inability to heal. Hyperestrogenism is expressed by discoloration more likely to be affected than a healthy adult. It produces round of gums, bleeding, thinning of hair, and alopecia. Correcting the hairless lesions with circular red, often crusty, scaly centers, underlying hormonal imbalances should be the main approach located on head, ears, front legs, paws, and tail. It may invade nails to these disorders. In general terms, the early recognition of skin and make them dry, brittle, and deformed. In severe cases, lesions disorders is prerequisite to successful treatment and recovery from may cover a large part of the body. Secondary bacterial infections the disease. may lead to itchiness, licking, gnawing, and biting the irritated 6. Congenital skin disorders are manifold, yet rare, and most often spot. Transmission is possible through contact with other infected limited to certain breeds of dogs. There are too many to be animals and from their bedding and equipment, especially in discussed here in detail. It is important to consider the familial kennels and shelters. Ringworm can be treated with griseofulvin, breeding pool background of the dog. miconazole ointment or lotion, or a lime-sulfur dip. Continue a. Aplasia cutis (eptheliogenesis imperfecta or incomplete skin treatment even after skin lesions have cleared and confirm development) is found very rarely in the newborn. Parts of the effective clearance. whole skin, or its layers, is not developed. If the area of skin Dermatophyte spores are hardy and will survive outside the host missing is small, it can be repaired surgically. Large areas of for many months, even a year. All dog bedding and surrounding missing skin will lead to death. equipment should be removed and sterilized. Ten-percent bleach b. Areas or spots of the skin may be discolored (nevus) and or fungicides containing Captan have been used successfully. occasionally, remain hairless. Surgical skin replacement Blastomyces dermatitidis produces another fungal infection of is possible. Other inherited discoloration includes color the skin, although eyes and lungs are more often affected. There dilution alopecia, which may result in the discoloration of will be swollen lymph nodes and multiple small abscesses or open black hair mostly in Dobermans, Dachshunds, Greyhounds, ulcerations on the skin. Like all the other fungal infections, they and Whippets. Albinism (inability to produce melanin, i.e., prefer moist soil and elevated temperatures and are more likely lacking pigment in skin, hair, and eyes), vitiligo in Rottweilers, to be found in the southern United States, in riverbanks, swamps, (bleached areas on skin, fur, found on nose, around eyes woods, and decaying matter. The spores are hardy, surviving claws), acanthosis nigricans in Dachshunds (darkening of the outside the host animal for many months. They can enter via skin). lungs or through open wounds with wet dirt or construction dust. c. Dermoid cysts can be found on the backs and occasionally Antifungal therapy should commence at once after recognition faces of Rhodesian Ridgebacks and some other breeds. and should consider “Azoles,” such as Itraconazole (Sporanox), They are single or multiple bumps, skin pockets often filled Ketoconazole (Nizoral), Fluconazole (Diflucan), and Polyene with skin debris (skin flakes, dander, hair and hair follicles, antifungals (Amphotericin B, Filipin, Nyastatin). Antifungal secretions of sweat and sebaceous matter, other cellular treatment should be left to veterinary supervision due to possible debris). The cysts should be removed surgically. side effects. Sporotrichosis, aside from affecting the skin, also d. Alopecia (hereditary hair loss) may be bred by design affects lungs, bones, and brain. Sporothrix schenckii enters the (Mexican Hairless, American Hairless Terriers, Chinese body via open wounds, scratches, abrasions in the skin, or by Cresteds). It may occur sporadically in patches and patterned inhalation. Like other fungi, it is found in the soil, plants, and form. decaying matter. It may be weeks before signs of cutaneous e. Follicular parakeratosis (Rottweilers, Siberian Huskies) results sporotrichosis appear as nodular reddish lesions on the skin at the in skin thickening, scalings and flaking often in the trunk head and trunk area. They will turn into bumps, boils, open sores area, faces and ears. The coat will be flaky, dulls and greasy. with draining tracts and, eventually, into chronic ulcers. Treatment Antiseborrheic shampoos and emollients may be tried. consists of potassium iodide and antifungal therapy. Zygomycetes f. Ichthyoses, so-called because their scaling appearance exist on the skin of healthy dogs. Zygomycosis will develop in the (fish scales) are the result of the faulty development of the immunodepressed or otherwise systemically disabled or weakened epidermis, in particular the stratum corneum. There is the

Page 59 veterinarians.elitecme.com epidermolytic form, with keratinocyte vacuolization and lysis, When they get infected they will become inflamed and are and the non-epidermolytic form, found in Golden Retrievers, destroyed in the process. Head, neck, and back are the first Norfolk and Jack Russell Terriers, and various other breeds affected areas, scaling skin, matted coat, and spotty hair loss (Dobermans, Rottweilers, Collies, Spaniels, etc.). The body are result of the loss of sebaceous glands. Topical treatment, may be covered with large sheets of flaking skin. There may frequent bathing, medical shampoos, and control of secondary be a thickening of the skin of paws and face. Emollients and infections are indicated. Fatty acid supplementation has been antiseborrhoeic shampoos can be tried. Secondary infections tried. may occur and must be treated as such. i. Psoriasiform-lichenoid dermatosis is very rare, usually found g. Familial footpad hyperkeratosis occurs occasionally in Irish, only in English Springer Spaniels. There is local patchy skin Bedlington, and Kerry Blue Terriers, Bordeaux Mastiffs, thickening, lump formation, and reddening in the soft skin Labradors and Golden Retrievers. Footpads thicken, get hard, areas (ears, groin). The skin may become hyperkeratotic and crack, and develop fissures. Secondary infections usually scaly. Changes may be intermittent, occasionally receding. occur, requiring special treatment of the infecting agent. Topical treatment and antibiotics are used when necessary. Soaking of affected feet, softening lotions, and emollients will j. Cutaneous asthenia (Ehlers–Danlos syndrome) result of failure provide some relief. to produce collagen affecting all parts of the body requiring h. Granulomatous sebaceous adenitis has been observed in collagen for proper function including skin elasticity, joints, Standard Poodles, Akitas, Samoyeds, Old English Sheepdogs, and joint capsules. The skin is loose and droopy, often hanging and less often in many other breeds. Sebaceous skin glands down in folds, and is fragile and easily damaged. Joints may produce sebum, an oily substance, that protects the skin, be misshapen and not function well. keeping it moist and free from fungal and bacterial infection.

Bladder disease Bacterial infection, inflammation, uroliths, and tumors can affect the oxalate ones appear more than twice as often as shruvite stones. bladder. Symptoms of cystitis include straining to urinate and frequent Uroliths may be present in the bladder without outward symptoms, painful urination, usually in small quantities. There may be cloudiness, may obstruct the urethra, may become infected and lead to cystitis. If blood in urine, wetting indoors, increased water intake, and continued they are too large to be dissolved or flushed out of the bladder, surgery licking of genital area. Likely bacteria involved are Staphylococcus, is the quickest way to resolve the issue. E.coli, Proteus, and less so Streptococcus, Klebsiella, Pseudomonas. Bladder cancer: Defects in the wall of the bladder are fairly frequent. Antibacterial treatment will depend on the causative agent. Bladder cancer, usually a transitional cell carcinoma (TCC), is not a Uroliths are concretions of bladder crystals and dietary minerals frequent occurrence in dogs, appearing in maybe 2 out of 100 of all (calcium oxalate, struvite, urate, cystine, calcium phosphate, silicate) canine cancers. A malignant tumor, TCC arises from the bladder lining, in the urine. Excessive concentration of urine, frequency of urination, penetrates the bladder wall into the underlying musculature. Tumor urine pH, certain medications, and urinary tract infection may growth may obstruct urinary flow passing through the bladder. It may contribute to the formation of bladder stones. Cells, bacteria, or any spread through the urinary tract (kidneys, ureters, prostate, urethra) particulate matter can serve as nidus or nucleus for the developing to lymph nodes, lungs, liver, and other organs. There is a greater urolith. Calcium oxalate stones are a result of oversaturation of incidence in Scottish Terriers, Beagles, and Shetland Sheepdogs. calcium, citrates, and oxalates in urine and a pH in the acid range (pH The wide use of herbicides, insecticides, and pesticides are thought <6.5). Males of miniature breeds (Lhasa Apsos, Shih Tzus, Miniature to be contributing factors. Frequent attempts and straining to urinate Schnauzers, Bichon Frises) are more likely to develop calcium oxalate combined with blood in the urine are suggestive of TCC. Diagnostic bladder stones. Dogs with Cushing’s disease overproduce cortisone, procedures include urinalysis, blood work, endocrine tests, x-rays which, in turn, increases calcium concentration in urine. Long-term and contrast x-ray, ultrasound, cytoscopy, and biopsy. A rapid latex medication with corticosteroids will have similar effects. Antibiotic agglutination test (V-BTA) allows the detection of TCC-associated reduction or removal of Oxalobacter formigenes, a bacterium of the glycoproteins in the urine of TCC carriers. Surgical removal of the normal intestinal flora that consumes oxalates, leads to an increase tumor is only advisable if there is no generalization throughout the of oxalates and increased likelihood of bladder stones. Struvite body and if excision will allow full bladder function. If surgery bladder stones are made up of magnesium ammonium phosphate is not indicated, NSAIDs alone or combined with mitoxantrone hexahydrate. Normally contained in urine, it will remain in solution and vinblastine can be tried. The combination of NSAIDs with as long as it is sufficiently dilute and in an acidic pH. An increase mitoxantrone, a DNA synthesis and repair inhibitor that is also used in of concentration and rise of pH to alkalinity may result in struvite various human cancers, does seem to extend survival times. So does fallout and precipitation. Bladder infections with bacteria that produce Vinblastine when given intravenously every 2 weeks. Vinblastine, urease, an enzyme breaking down urea, can produce ammonia and a vinca alkaloid, is an anticancer drug used in Hodgkin’s disease, raise the alkalinity sufficiently to allow crystallization and stone Kaposi’s sarcoma, non-Hodgkin’s lymphoma, histiocytosis, head and buildup. Ammonia in the urine will also affect the lining of the bladder neck cancer, and cancer of the breast or testicles. It is directly involved wall causing inflammation. Other causes for alkalinization and stone in the mitotic processes of the cell. Vinca alkaloids are antimitotic by formation are extended antacid and diuretic medication, other sources interfering with tubulin and the assembly of microtubules, which are of ammonia and phosphorus in the urine. While the miniature breeds responsible for the formation of mitotic spindles, chromatid separation, susceptible to bladder stones are the same, shruvite stones are more and cell division. As cancer cells multiply more rapidly than normal likely to occur in the female. Calcium oxalate and shruvite stones cells, more cancer cells will be affected than normal cells. cover most of the bladder stones found in dogs although calcium

veterinarians.elitecme.com Page 60 Hight blood pressure Systemic hypertension may produce seizures, disorientation, damage effect that causes blood vessel constriction. The blood vessels dilate, of eyes (glaucoma, separation of the retina from its basal matrix, lowering the blood pressure and increasing blood flow and oxygen blindness), nose bleeds, heart murmur, eyeball rolling, capillary supply to the heart and other organs. Other ACE inhibitors with similar bleeding, hemorrhages, blood in urine, and proteinuria. There is no action include perindopril, captopril, lisinopril, and ramipril. If found known cause. However, there seems to be a hereditary background, as to be not effective enough, calcium channel blockers (Verapamil, hypertensive dogs sometimes tend to produce hypertensive offspring. Amlodipine, Nifedipine, Diltiazem) can be employed. Calcium Fewer than 1 out of 10 dogs will have high blood pressure and usually channels are embedded in the cell membrane and control the selective in dogs 2 to 14 years of age. After age 7, dogs should get a routine passage of calcium ions and intracellular calcium concentration. blood pressure check. About 8 out of 10 high blood pressure cases are Calcium channel blockers (calcium antagonists) block entry of calcium secondary to underlying diseases such as diabetes, hyperthyroidism, into muscle cells of heart and blood vessels. Calcium ion levels in the hyperactive adrenals, renal disease, and other hormonal imbalances. resting smooth muscle cell are low. For the myosin-regulated muscle Hypertension, of course, will have a generalized systemic effect cell contraction, calcium ions must enter the cell and activate the throughout the body on the heart, liver, kidneys, eyes, and the nervous calmodulin-myosin light chain kinase which hydrolyzes ATP to ADP system. Blood pressure readings are done with an inflatable cuff while releasing orthophosphates to activate myosin. Exit of calcium around the paw or tail. Eye examination may show cloudy lenses, from the cell and release of orthophosphate from myosin renders the swollen capillaries, capillary bleeding, swollen retina, and detachment myosin inactive and returns the muscle cell to its relaxed phase. Beta- of the retina. Blood chemistry confirms increased blood urea nitrogen adrenergic blockers, like propranolol and atenolol, are sympatholytics. levels and elevated levels of creatinin suggesting kidney problems They block epinephrine (adrenalin) and norepinephrine thus blocking and increased blood pressure. Treatment of the underlying cause the sympathetic involuntary nervous system. Epinephrine, a hormone is the obvious approach for secondary hypertension. First to mind and neurotransmitter, is vasoconstrictive and regulates heart rate and come angiotensin-converting enzyme inhibitors (ACE) and calcium its blockage will reduce blood pressure. Decreasing the blood volume channel blockers (CCB) to lower blood pressure. ACE inhibitors such with diuretics (furosemide, spironolactone) and the use of low-sodium as Enalapril, inhibit the angiotensin-converting enzyme required to diets are additional antihypertensive tools. convert angiotensin I to angiotensin II thus blocking the angiotensin II

Giardiasis Giardia intestinalis (duodenalis, lamblia) are protozoa, unicellular nutrient supply. Infestation may cover most of the intestinal lining and flagellated eukaryotic organisms, that can infect man (Traveler’s interfere with nutrient uptake. As the trophozoites travels through the Diarrhea) and animals. Five to 10 percent of all dogs in the United colon, it will encyst and will be excreted. In a large number of infested States are thought to have or have had giardiasis at some time and canines, the disease appears subclinical, i.e., without major symptoms. may be carriers. While both trophozoites and cysts are shed with the However, when the numbers attached to the mucosa become large host’s feces in the environment, only the cysts survive for any length enough to damage the intestinal lining, they will interfere with the of time. They can resist heat, cold, and chemical disinfectants such nutrient uptake and digestion. The young, the very old, and the as chlorine and ozone and can survive for several months outside immunologically compromised are most affected. There will be the body. Stale, standing water, ponds, wells, water systems, storm inappetence, lethargy, loss of weight, dehydration, weakness, straining, water drains, city reservoirs, contaminated food, and feces of infested abdominal pain, cramping, gastrointestinal distress, and the stool animals are the primary sources of infection. After being picked may be bloody, greasy, pale, often loose to watery, and evil smelling. up and entering the small intestine, excystation will produce two Unless treated, the disease will continue for weeks if not months. The motile-feeding trophozoites. The released trophozoites then replicate diagnosis can be confirmed by recognizing organisms or cysts in the asexually through longitudinal binary fission. Some of the trophozoites stool or by detecting the antigen with the ELISA test. Treatment relies may remain free in the lumen of the intestinal tract, while many will on Metronidazole (“Flagyl”), Albendazole (“Valbazen”), Fenbendazole attach by means of their sucking disc to the intestinal mucosa for (“Panacur”), tinidazole, or quinacrine.

MEDICATION TARGET SIDE EFFECTS GLUTAMATE-GATED CHLORIDE Target immature stages of nematodes and other helminths Does not affect tapeworms, adults, CHANNEL BLOCKER (dirofilaria immitis, onchocerca volvulus, strongyloides macrofilariae; Neurotoxicity in some (AVERMECTIN/ MILBEMYCIN): stercoralis, trichinella spirales, Wuchereria bancrofti, dogs (collies, dogs with MDR-1 Avermectins (Ivermectin, Milbemycin, Ancylostoma caninum); and insects (head lice, mites, bed gene mutation): lethargy, tremors, Moxidectin, Selamectin etc.) bugs), antibiotic, antifungal, gastroprokinetic (gastrointestinal discoordination; motility immunosupressants). Kills bees (Colony Collapse Disorder). Blocks chloride channels on neuromuscular system (pharyngeal muscle cells, neurons): paralysis, starvation, death. ARACHIDONIC ACID Dirofilaria immitis, Toxocara, lymphatic filariasis Less effective for larvae migrans; only METABOLISM BLOCKER (Wuchereria bancrofti, Brugia malayi, Brugia timori; tropical of short duration: must be repeated. (PIPERAZINE): Diethylcarbamazine pulmonary eosinophilia, and loiasis). Blocks arachidonic acid metabolism: rendering microfilariae more sensitive to immune attack and phagozytosis. ACETINCHOLINESTERASE Hookworm, roundworm, whipworms; INHIBITOR (TETRAHYDRO- Inhibit acetylcholesterase which blocks acetylcholine PYRIMIDINES): Levamisole, hydrolysis, thus blocks nervous signals in neuromuscular Pyrantel, Morantel, Oxantel junctions and brain synapses leading to muscle cell contraction, paralysis, death.

Page 61 veterinarians.elitecme.com CALCIUMFLUX MODULATOR Tapeworms, Schistosoma. (ISOQUINOLINE): Enhances cell membrane permeability, interferes with glucose Praziquantel (Droncit, Drontal) uptake depleting energy reserves, causes muscle contraction, vacuolization, disintegration of tegument and inability to resist digestion thereby being more easily digested and absorbed. AchE MIMETICS Adult and larval roundworms, lungworms, eyeworms. Stimulating immune system, anti cancer (IMIDAZOTHIAZOLES): Levamisole Cholinergic agonists bind to nicotinergic acetylcholine effects. receptors on roundworm muscle cells cause spastic paralysis, affect reproductive system of the male and block copulation. AchE INHIBITORS Roundworms, whipworms. (TETRAHYDROPYRIMIDINES): Acetylcholine is not produced, it is essential for the morantel, pyrantel, oxantel transmission of nervous signals in neuromuscular junctions and brain synapses. ATP BLOCKER (ARSENICALS): Kill pre-adult and adult dirofilaria immitis. Melarsomine has fewer side effects than Melarsomine, Thiacetarsamide Interfere with glutathion reductase, cell respiration, glucose thiacetarsamide, which causes local uptake and metabolism, ATP production: function of intestinal swelling and pain at site of injection; if epithelium. given while dogs are heavily infested, may lead to thromboembolism, allergic shock and death. MICROTUBULE INHIBITORS Roundworms, hookworms, tapeworms, whipworms, fungi, There are reports of resistance (BENZIMIDAZOLES): Giardia. development by many of these Febantel (fenbendazole, oxfendazole Binds to tubulin and blocks microtubule assembly inhibits parasites affecting large animals to and febantel sulphoxide, albendazole, mitosis; affects glucose uptake and depletes cell ATP, benzimidazoles, less so in dogs cambendazole, oxibendazole, exhausting energy reserves and death. parbendazole, thiabendazole, tinidazole, metronidazole) ERGOSTEROL SYNTHESIS Yeast, fungi. Monitor liver and renal function, BLOCKERS (AZOLES): Itraconazole, Ergosterol is essential for the living fungal cell wall. Its gastrointestinal upsets Miconazole, Ketoconazole, blocking will affect assembly and permeability of the fungal Fluconazole cell membrane. MEMBRANE STEROLE BLOCKER Yeast, fungi. (POLYENES): Amphotericin B, Interacts with ergosterol in fungal membrane causing to leak Amphotericin B, most of the potassium ions and macromolecules leading to Candicidin, Hamycin, Natamycin, cell death. Nystatin MITOSIS BlOCKER: Yeast, fungi . Griseofulvin A fungistatic, breaks down mitotic spindle via polymerized microtubules, blocks nucleic acid synthesis.

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veterinarians.elitecme.com Page 64 Important Canine Diseases and How to Treat Them Choose the best answer for each question and mark your answers on the Final Examination Sheet found on Page 68 or take your test online at Veterinarians.elitecme.com. 41. Once taken up by the flea, microfilaridae are protected from 47. Glaucoma pressure in the eye and upon the optic nerve causes environmental temperature changes and can develop unimpeded to blindness in almost half of affected dogs. Larval Stage 3 and become infective. ¨¨ True ¨ ¨ True ¨¨ False ¨¨ False 48. Hypersensitivity to seasonal allergens seems to increase with 42. All dogs should be vaccinated yearly to prevent the occurrence of increased frequency of allergen exposure. Lyme disease. ¨¨ True ¨ ¨ True ¨¨ False ¨¨ False 49. Pemphigus vegetans is the most serious of the four stages of 43. The use of corticosteroid drugs, which are immunosuppressive, pemphigus. may reactivate dormant infections. ¨¨ True ¨ ¨ True ¨¨ False ¨¨ False 50. Calcium channels are embedded in the cell membrane and control 44. A Great Dane with wobbling gait is likely to have spinal stenosis. the selective passage of calcium ions and intracellular calcium ¨¨ True concentration. Calcium channel blockers (calcium antagonists) block entry of calcium into muscle cells of heart and blood vessels. ¨¨ False ¨¨ True 45. Panosteitis requires surgery for quick resolution. ¨¨ False ¨¨ True ¨¨ False

46. Thelazia californiensis is nematode infecting tear ducts, the conjunctival sac, and under the nictitating membrane in the eye. Treatment includes the removal of the adult worms under local anesthesia. ¨¨ True ¨¨ False

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