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Pet Care News From Your Veterinarian ®

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SPRING 2011 | Volum e 8, No. 2

Heartworm Disease: Protect Your Cats Know the Signs of Cushing’s Disease Is Your Cat Sending You Signals? Keep Your Pet’s Gums Healthy

Spring 2011 | VOL.8, No 2

Picture-Perfect Pets Pet Care News From Your Veterinarian

IN THIS ISSUE

Healthy Gums 2 Protect your pet from

Jerzy Stuart

Shores Animal Hospital Gainesville, Fla.

Freddie

Sebring Animal Hospital Sebring, Fla.

periodontal disease. Heartworm Prevention 4 Keep your cat safe from this deadly disease.

Unleash the complete

Buster Snowball Medina

Good Hands Veterinary Hospital Athens, Ga.

Litter-Box Detective 8 Is your cat sending you

killing force

Cali

Sheeler Road Animal Hospital Apopka, Fla.

important signals?

against fleas and ticks.

12 Diagnosis: Cushing’s Disease

Snickers

Midway Animal Hospital Seminole, Fla.

How your veterinarian will manage this disorder. Pet Tales 1 5 Kitten wellness tips and more.

Dante

Nokomis Veterinary Clinic Nokomis, Fla.

Maggie Pet Quarterly® is an educational resource provided by your veterinary hospital.

Garden Grove Animal Hospital Winter Haven, Fla.

Comments are welcome at info@petquarterly.com ©Copyright 2011. All rights reserved. Pet Quarterly® magazine does not make any representations as to opinions or facts as presented. Reproduction of contents in any form is prohibited without prior written permission of the publisher.

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completekiller.com

Postmaster: Send address changes to: Pet Quarterly, 2951 34th Street South St. Petersburg, FL 33711

Mike and Molly

Golden Animal Hospital East Montgomery, Ala.

Nana

Cohen Veterinary Center Deltona, Fla.

Share your photos with other PQ readers. Email your best shot and the name and location of your veterinary hospital to PetQuarterly@yahoo.com. To be published, images should be at least 3 inches at 300 dpi. We’ll publish as many as we can.

*Data on file at Merial. Data.

† Vet-dispensed, MDI

Pet Quarterly | Spring 2011 1

Dental Health

Healthy Gums for Healthy Pets Professional checkups and treatment will help protect your pet from periodontal disease. By Jan Bellows, DVM, Diplomate American Veterinary Dental College

Periodontal disease can affect more than just your pet’s mouth. The prevention and treatment of dental disease is important to your pet’s overall health. By knowing the symptoms, causes and treatments for this common condition, you can help keep your pet’s teeth and gums healthy for life.

What is periodontal disease?

Key Points Periodontal disease affects the tissues and bones that keep teeth in the mouth. Inflammation and infection occur when plaque and tartar accumulate on the teeth and gum line. Periodontitis can cause pain and tooth loss, and can harm pets’ internal organs. Early diagnosis and treatment can help keep periodontal disease in check.

2 Spring 2011 | Pet Quarterly

Periodontal disease is an illness of the tissues and bones that keep teeth in the mouth. Periodontal infection is the most common disease affecting small animals, because they do not brush their teeth. More than 85 percent of dogs and cats older than four years have periodontal disease. Periodontal disease starts with the formation of plaque, a transparent, adhesive fluid composed of bacteria. When plaque is not removed, it turns into hard calculus (also called tartar), irritating the pet’s gum tissues. By-products of the bacteria “eat away” the tooth’s support structures, eventually causing pain and periodontal disease. Minimal gum line inflammation is called gingivitis. Gingivitis does not involve loss of tooth support, but if the plaque and calculus are not removed, it may lead to inflammation and destruction of your pet’s periodontal ligament. This leads to pain and tooth loss. At the onset of a pet’s periodontal disease, the gums around the affected tooth become swollen and red. As in people, bleeding is common. Bad breath is a likely sign of periodontal disease.

How does periodontal disease affect my pet’s health? When periodontal disease takes hold, it can affect your pet’s overall health. As with humans, dogs and cats with periodontal disease have pockets that form around the tooth root and fill with infection. This chronic infection can adversely affect the pet’s kidneys and heart valves. Inflammation that occurs around the gum line is painful. Animals feel pain, although they often hide it. When periodontal disease is left to progress, the affected teeth become loose in their sockets. Trying to eat with loose teeth hurts.

Brushing: First Line of Defense Regular brushing helps prevent peridontal disease. Visit the American Animal Hospital Association’s website for tips on how to brush your pets’ teeth. www.healthypet.com. Click on “pet care.”

What breeds are at risk for periodontal disease? The majority of dogs and cats older than three years have periodontal disease. Most of these cases are gingivitis, which can be treated and cured. Older dogs and cats are often affected by advanced periodontal disease. Small breeds are also more prone, because their teeth are closer together compared to long-muzzled breeds. The Maltese is the number-one breed affected by periodontal disease. Dogs and cats with flat faces (Bulldogs, Pugs, Boxers, Persian cats) are also more prone. Because their oral cavities are compressed, their teeth are placed very close together, increasing the chance of debris building up between the teeth.

normal, while others need additional care. Gingivitis care includes thorough cleaning and daily brushing to control plaque. Gingivitis will usually resolve within weeks of the oral hygiene visit, as long as plaque is controlled.

How are stages of periodontal disease treated? Stage 2 early periodontal disease and stage 3 established periodontal disease, with a diagnosis of minimal to moderate pockets, can be treated with the addition of deep plaque and tartar removal from the tooth root. This is done with specially manufactured periodontal ultrasonic instruments that were first used on humans and later adapted for dogs and cats. An antibiotic sensitive to periodontal pathogens can also be applied below the gum line to cleaned periodontal pockets. This helps shrink the size of the periodontal pockets. Stage 4 advanced periodontal disease, where more than half of the tooth’s support is lost, is best treated with tooth extraction. Fortunately, dogs and cats do not need their teeth to catch and kill wild animals for sustenance. What they do need is a healthy, pain-free mouth, which can be accomplished by removing the teeth that are causing gum inflammation. n Dr. Jan Bellows specializes in veterinary dentistry.

How is periodontal disease diagnosed? The first stage of periodontal disease, gingivitis, appears as inflamed gum tissues. If the disease is allowed to progress to stage two (early periodontitis), the gums appear inflamed and the dog or cat will have bad breath. To diagnose the loose teeth typical of periodontal disease, the veterinarian or trained dental assistant will place a periodontal probe below the gum line to measure support loss while the dog or cat is resting under general anesthesia. Established periodontitis (stage three) is diagnosed when up to half of the tooth support has been lost. Advanced periodontitis (stage four) occurs when more than half of the tooth’s support is lost.

Plaque accumulation on a dog’s premolar.

A probe measures a periodontal pocket caused by hair caught below the gum line of a Bulldog.

This x-ray reveals stage 4 periodontal disease in the lower premolar and molar.

Ultrasonic scaling removes tartar.

What are treatment options? Professionally conducted oral examinations and treatment are performed under general anesthesia. The goal of teeth cleaning is to remove irritating tartar from the tooth crown and gum pocket. Because it is coated with bacteria, tartar left on the root surface contributes to the progression of disease. If cleaning under the gum line is not performed, the teeth have not been adequately cleaned. After the teeth are cleaned with an ultrasonic scaler, the veterinarian evaluates them one by one with the help of a dental probe and x-rays. Usually, most teeth are

Pet Quarterly | Spring 2011 3

Parasite Control/Dermatology

Protect Your Cat from

Heartworm Feline heartworm disease is deadly—but easily preventable. Talk to your veterinarian about how to keep your cat safe. By James Randolph, DVM

As Mr. Jones walked in his front door, he called to his cat, Fuzzy, who loved to curl up on the couch with him. Oddly for Fuzzy, she didn’t respond. As Mr. Jones entered the kitchen, he saw Fuzzy curled up on a rug. He knelt down and touched her, and found that her body was cold and stiff. That evening when a grieving Mr. and Mrs. Jones came to my office to find out the cause of death, they reported that Fuzzy had been following them around the apartment earlier that morning, seemingly as healthy as ever. The previous month’s pre-anesthesia laboratory testing showed that Fuzzy was metabolically healthy. She had good kidneys and a good liver. She wasn’t diabetic or anemic. And her physical examination was normal. The necropsy report showed that the cause of death was heartworms. Despite being urged for years to keep Fuzzy on her heartworm preventive, the owners had downplayed the risk and stopped the medication. Sadly, this is a true story, and it’s a story repeated all over the United States every single day. Your cat is at risk for heartworm disease even if it lives indoors. The good news is that heartworm disease in cats is easily and inexpensively prevented with medication.

How Heartworm Is Transmitted

Key Points Feline heartworm disease is easily prevented with monthly medication. Feline heartworm disease is almost always fatal. Some cases of heartworm may mimic feline asthma, with coughing and difficulty breathing. There is no heartworm-killing treatment for cats, as there is for dogs.

of cardiopulmonary events begins, involving both the heart and lungs. First the young adult heartworms make their way to the right ventricle of the heart, then into the pulmonary arteries. Instantly, the cat’s body recognizes these intruders as foreign and reacts to them. The immune system produces both cells and protein complexes in an attempt to eradicate the parasite. The worm physically pounds against the wall of the artery, causing the wall to react to protect itself—the artery wall swells, thickens, becomes scarred and is >>

Heartworm is transmitted through mosquitoes carrying heartworm larvae. If a cat is bitten by an infected mosquito, the microscopic larvae slowly make their way through the cat’s body. Months later, adult heartworms reach the heart, lungs and pulmonary arteries. When a cat becomes a host for heartworms, a cascade

Risk Factors for Heartworm Disease What is your cat’s risk of heartworm disease? The disease can strike cats at almost any age. Cases have been reported in cats from nine months to 17 years of age, the average being four years at diagnosis or death, according to the American Heartworm Society. Cats living in the southeastern United States, where winters are mild and heartworm-transmitting mosquitoes are active year-round, are at high risk for heartworm. All cats in all states are at risk. Indoor cats experience the same infestation rate as outdoor cats. Why? Because the mosquito that carries infective heartworm larvae also likes the indoor environment.

Pet Quarterly | Spring 2011 5

Parasite Control/Dermatology

Did You Know?

Heartworms have been documented in

each of the contiguous 48 states, Hawaii, Puerto Rico, the U.S. Virgin Islands and Guam. Source: American Heartworm Society

infiltrated by some of the products the immune system has made, all attempts at self-preservation. On the lung side, fluid pours into the alveoli, tiny sacs in the lungs where gas exchange takes place. The volume of fluid determines whether the cat breathes with difficulty or starts to drown in his own fluids. The immune system mediates most of this reaction, and many immune-system cells arrive in an attempt to deal with the foreign body reaction. These cells only make matters worse, exacerbating the buildup of fluid and resulting in inflammation.

Deadly Symptoms Symptoms of this slow, chronic disease progression include coughing and difficulty breathing. In the earliest stages, patients may be misdiagnosed and treated symptomatically for respiratory tract infection or feline asthma, although the correct diagnosis is Heartworm Associated Respiratory Disease (HARD). At first, this symptomatic therapy may help. Antibiotics will control the abnormal bacteria growing in the lungs’ fluid, and anti-inflammatories used for asthma will reduce the immune-system response, resulting in temporary relief. When the medications end, however, the damage resumes, along with the clinical signs. As the disease progresses, the cat is ill more and more often, and symptomatic medications help less and less. If a

See the cover reminder for an important message from your veterinarian.

6 Spring 2011 | Pet Quarterly

veterinarian begins to suspect there may be more going on than feline asthma alone, he or she will take a radiograph of the cat’s chest and discover pulmonary arteries that are several times their normal size and fluid in the cat’s lungs.

No Treatment Options

At a Glance: Heartworm Disease in Cats Parasite

Dirofilaria immitis

Transmission Mosquito Susceptibility to infection

61% to 90% of cats exposed to infective larvae become infected

Duration of worms

2-3 years

Organs most typically affected Lungs Diagnosis Complex Treatment

None approved High risk of complications

Compounds for prevention

4 approved in U.S. Source: American Heartworm Society

At this point, all the veterinarian can do is to prepare the pet owner for what eventually will happen: death of the cat, the heartworm’s host. More commonly, though, sudden death is the outcome for cats infested with heartworms. In this scenario, the cat tolerates the presence of heartworms as long as the worms are alive. At the point of heartworm death, the cat’s body is showered with heartworm proteins, triggering a massive and sudden allergic reaction from the cat’s body. The cat’s lungs fill with fluid and its heart stops. The cat will appear healthy until the time of death. The death of a single adult heartworm can take the life of a cat in less than 30 minutes. Currently, there are no products that are approved in the United States for treating feline heartworm infection. The best we can hope for is to use symptomatic treatment for cats with asthma-like signs.

Prevention Is the Key Since there’s no approved treatment for heartworm in cats, prevention is the only way to keep your cats safe. It’s vitally important to give cats heartworm preventive year-round. Heartworm preventives are administered monthly. Talk to your veterinarian about the best form of heartworm prevention to keep your cat safe. n Dr. James W. Randolph is a small-animal veterinarian with special interests in dermatology and internal medicine. Pet Quarterly | Spring 2011 7

General Wellness

De-stress Your Cat

Litter-Box

Detective Litter-box problems may signal a serious feline medical condition. Or your cat may just be stressed out! Watch for important signs.

By Geneva Keene Acor, DVM

My sister-in-law called to ask me a few questions about her cat, Captain. The cat, who lives primarily inside with two other cats, had started urinating on the bed and in the dirty clothes hamper. My sister-in-law asked me to diagnose what was wrong with Captain. Could he be mad at them? There is not an easy answer to her question, except that Captain is signaling that something is wrong. Is this a behavioral problem or is there a medical cause? To find this out requires a complete physical examination, possibly some tests and a discussion of the cat’s home and any possible changes.

cat’s urinary bladder. Another possible cause is a urinary tract infection caused by bacteria. (These infections are similar to human urinary tract infections, or UTIs, although veterinarians use the acronym FLUTD, or Feline Lower Urinary Tract Disease.) A more serious urinary issue for cats is urethra blockage, which is a medical emergency. In male cats, the urethra (the transport tube leading from the bladder to discharge urine outside the body) significantly narrows as it passes through the penis. Urinary stones formed either in the kidney or the urinary bladder may block the urethra, making it

Many things can cause stress for an indoor cat. With one patient of mine, a new ceiling fan seemed to be the culprit. A ceiling fan may not seem very stressful, unless you consider that your cat may associate it with circling hawks or predatory birds. Three leading causes of feline stress are: 1. Litter boxes. Cats are very choosy about their litter pans, including the size, height of the sides, covered or not-covered, type of litter and especially cleanliness. Also, in multiple-cat households the magic number is 1+1, or one litter box for each cat, plus an extra box. 2. New cats. A new cat in the household not only challenges ownership of the litter box, but also creates stress around ownership of sleeping areas, patrolling areas and eating areas. Ask your veterinarian for tips on introducing a new cat into your household. 3. Changes in routine. Consider all changes, including new carpet, new cleaning solutions, new visitors, new feeding location and anything that interrupts your cat’s daily routine. In preparation for your visit to the veterinarian, consider if any of these issues could be contributing to your cat’s stress and be ready to answer questions from your veterinary team.

Possible Problems There are many causes for feline urinary problems. If a cat starts to urinate outside of its litter box, the most likely culprits are urinary stones (similar to human kidney stones) and stress-related diseases affecting a

Key Points Continuous straining and failure to produce urine or producing only a small amount of urine is a feline medical emergency. Urinary problems in cats have many (and possibly multiple) causes. A complete physical examination by your veterinarian and clinical tests are needed. Never attribute a symptom to a psychological cause until you have eliminated all possible physical causes. Specific nutrition changes are effective in managing some urinary problems in cats.

8 Spring 2011 | Pet Quarterly

impossible for the cat to pass urine. Rarely, blockage also can occur in female cats. In some cases, blood cells and mucus from infection or inflammation in the bladder can also cause a urethral plug. The resulting backup of urine produces toxic effects that may cause death in 24 to 72 hours. If your cat is straining to urinate and not producing urine, take your cat to your veterinarian immediately.

The First Step: A Complete Exam Cat owners often would like a simple answer to the question, “What is causing the urinary problem?” The answer is not always simple and is often like solving a jigsaw puzzle. Pieces of the puzzle may include urinary stones, bacterial infection and stress-related irritation of the bladder. Your veterinarian will likely recommend several tests, including blood tests for kidney function, a complete urinalysis, and possibly radiographs (x-rays) and an ultrasound. The urinalysis determines if bacteria are present and identifies other components that may contribute to urinary-stone formation or urethral plugs. Radiographs and ultrasound can identify the presence of urinary stones. As you can imagine, obtaining an acceptable urine >>

Top 10 Reasons for Feline Veterinary Visits 1. Lower urinary tract disease 2. Stomach upsets/gastritis 3. Renal failure 4. Intestinal inflammation/diarrhea 5. Skin allergies 6. Diabetes 7. Colitis/Constipation 8. Ear infections 9. Upper respiratory virus 10. Hyperthyroidism Urinary disease is the leading cause of insurance claims for cats. Source: VPI Pet Insurance

Pet Quarterly | Spring 2011 9

General Wellness episodes, the uncomfortable cat may be treated with pain medications, anti-inflammatory drugs or sedatives.

sample from a cat can be challenging. Urine from a litter box or cat carrier is contaminated and is not useful for diagnosis. Your veterinarian can obtain an uncontaminated urine sample in the office. Prior to your visit to the veterinarian, remove the litter box for several hours to increase the chance that your cat’s urinary bladder will be full. Your veterinarian may suggest that the cat remain in the hospital for several hours to increase the urine amount in its bladder.

Preventive Measures

Stress-related Causes In the past decade, researchers at The Ohio State University have shown that stress is a contributing cause for urinary problems in cats. In humans, we know that stress can cause or increase the severity of headaches, fibromyalgia, inflammatory bowel disease and even a related urinary disease, interstitial cystitis. Similarly, the research indicates that certain neurologic changes occur when a cat is under stress, and these neurologic changes have an effect on the urinary bladder. The medical name for this condition is feline idiopathic cystitis, and it accounts for an estimated 55 percent to 64 percent of all urinary problems in cats.

Your veterinarian may prescribe a therapeutic food for your cat’s urinary health.

Several universities have ongoing studies to develop specific tests and treatment for the urinary problems in cats associated with stress, although no specific treatment has been consistent. Further complicating this, the condition is often transitory: It may occur for several days to several weeks and then go away. In acute

Dr. Acor’s Litter Box Detective Agency Is your cat trying to tell you something? Frustrating behaviors often have simple solutions with some detective work. Here are some examples. Always talk to your veterinarian about your cat’s specific circumstances. Problem: Pumpkin, a 4-year-old female calico, refused to use her litter box after it was moved next to the washing machine. Solution: Provide two litter boxes—one in the original location and another one in a quieter area.

In the case of both urinary tract infections and urinary stones, after initial treatment, preventive measures can be used to reduce the recurrence. Often, the preventive measure is to change to a cat food made specifically for maintaining urinary health. Be sure to follow your veterinarian’s recommendation for specific dietary changes. Therapeutic foods designed specifically for an individual cat’s condition are only available through veterinarians. Exercise and proper weight, too, may help your cat avoid urinary problems. Just as we are encouraged to maintain a healthy weight and to receive regular exercise for our general well-being, the advice is similar for your cat. Overweight cats and cats that get little exercise have a higher incidence. Monitor your cat’s weight and invest in toys. Play with your cat to increase exercise.

Resolving Captain’s Problems After an appointment with his veterinarian, my sisterin-law’s cat Captain took an oral medication for about 10 days. He was gradually transitioned to a therapeutic food as an aid to manage his urinary conditions. Also, after further discussion, I discovered that a visiting friend and her cat were staying at the house. To relieve Captain’s stress, the visiting cat was restricted to one section of the house and provided a separate litter box. Captain seems to have regained his “indoor manners,” and my sisterin-law is aware that changes in the household must be considered from Captain’s point of view. Ask your veterinary team for brochures or take-home information. Avoid miracle cures or recommendations—especially nutritional—that are not from reliable veterinary websites. n

Don’t Mess With My Litter Box Cats are picky about their litter boxes. Here are a few things they may find upsetting that could lead to stress-related urinary problems.

T oo small for my big bones n S ides too tall for my old bones n C overed and I want a view n N ot secluded and I need privacy n In noisy area and I can’t focus n W rong litter for my preference n Too smelly for me n T oo dirty for me n C leaned with smelly disinfectant n U sed by another cat! n

For More Information To learn more, visit: Feline lower urinary tract disease (FLUTD): www.vet.cornell.edu Feline stress and behavioral issues: www.indoorpet.osu.edu and www.catvets.com

Dr. Geneva Keene Acor is an independent consultant in small-animal nutrition and practice procedures.

Problem: Clyde, a 10-year-old male domestic shorthair, urinated on baby blankets after a new baby arrived home from the hospital. Solution: Spend more time with Clyde in organized play. Problem: Tigger, a 10-year-old male Siamese, urinated on a bathroom rug when a new roommate moved in. Solution: Give the roommate a “territorial space” in one bathroom and keep the door closed to prevent Tigger from entering that bathroom. 10 Spring 2011 | Pet Quarterly

Pet Quarterly | Spring 2011 11

Senior Wellness

Diagnosis:

Cushing’s Disease With proper monitoring and care, this disease can often be managed to improve the quality of a pet’s life. By Brian J. Luria, DVM, DACVIM and Melinda J. Larson, DVM

When a dog feels stress, its body releases a hormone called cortisone. This naturally occurring hormone elevates the blood sugar for a quick burst of energy, preparing the dog’s body to flee or fight. Cortisol is produced by the adrenal glands, located near the kidneys, in response to a signal from a part of the brain called the pituitary gland. This useful system helps the dog stay alive when it encounters danger. Sometimes, though, the body starts producing too much cortisol, often because of a tumor in the pet’s adrenal or pituitary gland. This condition is called Cushing’s disease, or hyperadrenocorticism, and it’s one of the most common endocrine disorders in middle-aged to elderly dogs. If you notice signs of Cushing’s disease in your dog, talk to your veterinarian. With proper medication and monitoring, the condition can be managed. The most common sign of Cushing’s disease that you may note in your pet is an increase in thirst and urination, along with a strong appetite. Other possible clinical signs include excessive panting, a “pot-bellied” appearance, thinning hair coat, recurring skin infections and muscle weakness. Not all of these symptoms have to occur at once, however; the presence of any of these signs is enough to warrant diagnostic tests by your veterinarian.

Cushing’s Causes There are three possible causes of Cushing’s disease: a tumor of the pituitary gland, a tumor of the adrenal gland, or excess or prolonged administration of a steroid medication. An estimated 80 percent to 85 percent of naturally occurring canine Cushing’s disease is caused by a type of pituitary tumor. A pituitary tumor causes excess production of adrenocorticotrophic hormone (ACTH), which then signals overproduction of cortisol by the adrenal glands. Most pituitary tumors are benign. The remaining 15 to 20 percent of naturally occurring cases are caused by a tumor in the adrenal gland. These tumors usually affect only one adrenal gland, and benign and malignant tumors occur with equal frequency. Pituitary-dependent Cushing’s disease occurs most commonly in small breed dogs, whereas larger dogs are more likely to get adrenal-dependent Cushing’s disease. About half of dogs with adrenal tumors are larger breeds. While any dog can be affected, some breeds are at a greater risk. (See sidebar on pg. 14.)

Diagnostic Testing Your veterinarian will likely start with some basic diagnostic tests, including bloodwork, a urinalysis and possibly radiographs. Certain changes present on the bloodwork results may heighten your veterinarian’s suspicion for Cushing’s disease, but these changes alone cannot be used to diagnose the disease. The actual diagnosis occurs in two steps. First, a screening

12 Spring 2011 | Pet Quarterly

The most common sign of Cushing’s disease that you may note in your pet is an increase in thirst and urination, along with a strong appetite.

test determines if Cushing’s is present. Next, tests help determine if the excess cortisol is due to an adrenal tumor or a pituitary tumor. Types of screening tests include a urine cortisolcreatinine ratio, ACTH stimulation test and a low-dose dexamethasone suppression test. Your veterinarian will select the screening test that is best for your pet. Once the diagnosis of Cushing’s disease has been established, the next step is to determine if the Cushing’s disease is pituitary-dependent or adrenal-dependent. Tests for this include a high-dose dexamethasone test >>

Key Points Cushing’s disease occurs when there is excess circulating cortisol, which can be caused by a pituitary tumor, an adrenal tumor or excessive steroid administration. The most common signs are an increase in thirst, urination and appetite. The diagnosis of Cushing’s disease requires numerous tests. Long-term management of Cushing’s disease requires frequent veterinary visits, regular blood tests and close monitoring at home.

Pet Quarterly | Spring 2011 13

Senior Wellness and/or an ACTH level. Abdominal ultrasound might also help with the diagnosis; enlargement of both adrenal glands is often associated with pituitarydependent disease, whereas enlargement of one gland is consistent with an adrenal tumor. If the tests indicate a pituitary gland tumor, advanced imaging of the brain, such as with an MRI, can determine the size of the tumor. Large tumors could eventually result in neurological signs such as seizures.

Treatment Options The treatment for Cushing’s disease depends on the underlying cause, the severity of disease and your veterinarian’s preference. The most common treatment is an oral medication that decreases cortisol levels. Several drugs are available, and all require very close monitoring. The first few months of treatment involve numerous recheck examinations, blood tests and fine-tuning your pet’s medication dose until the Cushing’s disease is appropriately managed. It is very important that you watch for signs at home that may indicate that your pet’s cortisol level may be getting too low, such as a decreased appetite or lethargy. If you notice either of these, contact your veterinarian as soon as possible. More severe signs of low cortisol include vomiting, diarrhea and weakness; if any of these occur, your pet should see a veterinarian immediately for treatment. Once your pet’s Cushing’s disease is being properly controlled on oral medications, it will need recheck examinations and blood tests at least twice yearly, as low cortisol levels may occur at any point during treatment. The best treatment for an adrenal tumor is surgical removal of the affected gland. However, adrenalectomy

Pet Tales is a challenging procedure that has a high rate of complications, and intense monitoring of the patient in a veterinary ICU is imperative following surgery. For some pets, surgical removal of the adrenal tumor is not an option, due to the invasiveness or spread of the tumor to other organs. If this occurs, oral medication can help control the symptoms of disease, but high doses may be needed. Again, these pets should be monitored closely at home for any of the adverse side effects listed above (such as decreased appetite, lethargy or weakness, vomiting or diarrhea). Left untreated, Cushing’s disease can lead to serious infections, high blood pressure, bladder stones, excessive loss of protein through the urine, weakened ligaments that can lead to orthopaedic problems, seizures and even, rarely, life-threatening blood clots. Long-term management of Cushing’s disease requires frequent veterinary visits, regular blood tests and close monitoring at home. Even though there is no cure for Cushing’s disease, treatment can significantly improve the quality of life for both the pet and the pet owner. For example, in the case of nine-year-old Jessie, a Boston Terrier, months of “accidents” in the house and getting up twice a night to let Jessie outside had left her owners extremely frustrated. After just four weeks of treatment, Jessie is back to drinking and urinating normally, and her owners report she is playing with her toys like she did years ago. Treating Jessie’s Cushing’s disease drastically improved the dog’s day-to-day life. n Dr. Brian Luria specializes in internal medicine. Dr. Melinda Larson is an associate veterinarian.

Breeds at Risk for Cushing’s Disease Pituitary-dependent: n S mall

breed dogs

n P oodles

mark your

calendar

Go Green on Earth Day Commemorate Earth Day on April 22 by incorporating a few earth-friendly practices into your pet care. The ASPCA points out these tips for helping to develop a green routine. Spring cleaning: Reduce and reuse. Consider donating old towels, bedding and pet toys to a local animal shelter.

Hello Kitty! Did you know that cats receive less veterinary care than dogs? Dog owners take their pets to the veterinarian twice as often as cat owners, according to the American Veterinary Medical Association. If a new kitten is joining your family, get on the right track with wellness care right from the start. The American Animal Hospital Association has published guidelines for the care of your cat in every stage from kitten to senior citizen. For example, cats are considered kittens from birth to age six months. At age seven months (until age 2 years), they graduate to the “Junior” life stage. Ask your veterinarian to walk you through the stages and set up a wellness plan for your cat. All cats, for instance, need parasite control. For kittens, this means regular deworming and fecal exams during the first year of life.

Allergies to fleas and seasonal environmental allergies–caused by pollen, trees, grass, wheat and mold–are the most common in pets, reports the American Animal Hospital Association. Always use flea preventatives suggested by your veterinarian to fight fleas and flea allergies. While you might sneeze or get a runny nose in response to an allergy, excessive scratching and licking could be a sign of allergies in your pets. Contact your veterinarian if you see these signs of allergies in your pets:

n Miniature

n Difficulty breathing

breeds

Buy in bulk: Purchase large bags of food and other pet supplies. Fewer trips cuts down on both energy use and excess packaging.

Spring and summer bring out allergies in pets, just like in people.

n Swollen and itchy skin

n Terrier

Quick clean-ups: Vinegar diluted with water is an environmentally friendly cleaner that can kill pet odors, mold and bacteria on carpeting and floors.

Allergies Awakened

n Boxers n Dachshunds

schnauzers

Biodegradable bags: Try using earthfriendly bags to scoop up after your dog.

n Vomiting and diarrhea

Adrenal-dependent: n Both

14 Spring 2011 | Pet Quarterly

small and large breeds

Pet Quarterly | Spring 2011 15

Pet Tales

Spring Cleaning Tip Spring cleaning is an annual tradition to clear out the cobwebs in many households. Before you fling open the windows to welcome a change in seasons, make sure screens are safely secured to keep your animals safe. An open, unscreened window is an invitation for a curious pet—especially a cat—to jump or fall out. Make sure all screens are safely secured, and keep all household cleaners and chemicals away from your pets.

AKC Welcomes New Breeds The American Kennel Club (AKC) added three new breeds this year— the Entlebucher Mountain Dog, Norwegian Lundehund and the Xoloitzcuintli (pronounced show-low-etz-queent-lee). The Norwegian Lundehund is known to have six toes on each foot and the ability to tip its head backward until it reaches its backbone! Read more about the new additions to AKC’s litter of breeds at www.akc.org. When choosing a dog breed or mix of breeds, carefully evaluate the breed’s natural instincts and exercise needs to know if it’s the right dog for you and your family. When bringing a new pet into the family, set up a wellness check with your veterinarian to discuss the unique wellness requirements of each breed.

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C H E WA B L E S CAUTION: Federal (U.S.A.) law restricts this drug to use by or on the order of a licensed veterinarian. INDICATIONS: For use in dogs to prevent canine heartworm disease by eliminating the tissue stage of heartworm larvae (Dirofilaria immitis) for a month (30 days) after infection and for the treatment and control of ascarids (Toxocara canis, Toxascaris leonina) and hookworms (Ancylostoma caninum, Uncinaria stenocephala, Ancylostoma braziliense). DOSAGE: HEARTGARD® Plus (ivermectin/pyrantel) Chewables should be administered orally at monthly intervals at the recommended minimum dose level of 6 mcg of ivermectin per kilogram (2.72 mcg/lb) and 5 mg of pyrantel (as pamoate salt) per kg (2.27 mg/lb) of body weight. The recommended dosing schedule for prevention of canine heartworm disease and for the treatment and control of ascarids and hookworms is as follows:

Dog Chewables Ivermectin Weight Per Month Content

Up to 25 26 - 50 51 - 100

Entlebucher Mountain Dog

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16 Spring 2011 | Pet Quarterly

1 1 1

68 mcg 136 mcg 272 mcg

Pyrantel Content

Color Coding 0n Foil-Backing and Carton

57 mg 114 mg 227 mg

Blue Green Brown

HEARTGARD Plus is recommended for dogs 6 weeks of age and older. For dogs over 100 lb use the appropriate combination of these chewables. ADMINISTRATION: Remove only one chewable at a time from the foil-backed blister card. Return the card with the remaining chewables to its box to protect the product from light. Because most dogs find HEARTGARD Plus palatable, the product can be offered to the dog by hand. Alternatively, it may be added intact to a small amount of dog food.The chewable should be administered in a manner that encourages the dog to chew, rather than to swallow without chewing. Chewables may be broken into pieces and fed to dogs that normally swallow treats whole. Care should be taken that the dog consumes the complete dose, and treated animals should be observed for a few minutes after administration to ensure that part of the dose is not lost or rejected. If it is suspected that any of the dose has been lost, redosing is recommended. HEARTGARD Plus should be given at monthly intervals during the period of the year when mosquitoes (vectors), potentially carrying infective heartworm larvae, are active. The initial dose must be given within a month (30 days) after the dog’s first exposure to mosquitoes. The final dose must be given within a month (30 days) after the dog’s last exposure to mosquitoes. When replacing another heartworm preventive product in a heartworm disease prevention program, the first dose of HEARTGARD Plus must be given within a month (30 days) of the last dose of the former medication. If the interval between doses exceeds a month (30 days), the efficacy of ivermectin can be reduced. Therefore, for optimal performance, the chewable must be given once a month on or about the same day of the month. If treatment is delayed, whether by a few days or many, immediate treatment with HEARTGARD Plus and resumption of the recommended dosing regimen will minimize the opportunity for the development of adult heartworms. Monthly treatment with HEARTGARD Plus also provides effective treatment and control of ascarids (T. canis, T. leonina) and hookworms (A. caninum, U. stenocephala, A. braziliense). Clients should be advised of measures to be taken to prevent reinfection with intestinal parasites. EFFICACY: HEARTGARD Plus Chewables, given orally using the recommended dose and regimen, are effective against the tissue larval stage of D.immitis for a month (30 days) after infection and, as a result, prevent the development of the adult stage. HEARTGARD Plus Chewables are also effective against canine ascarids (T. canis, T. leonina) and hookworms (A. caninum, U. stenocephala, A. braziliense).

ACCEPTABILITY: In acceptability and field trials, HEARTGARD Plus Chewables were shown to be an acceptable oral dosage form that was consumed at first offering by the majority of dogs. PRECAUTIONS: All dogs should be tested for existing heartworm infection before starting treatment with HEARTGARD Plus which is not effective against adult D. immitis. Infected dogs must be treated to remove adult heartworms and microfilariae before initiating a program with HEARTGARD Plus. While some microfilariae may be killed by the ivermectin in HEARTGARD Plus at the recommended dose level, HEARTGARD Plus is not effective for microfilariae clearance. A mild hypersensitivitytype reaction, presumably due to dead or dying microfilariae and particularly involving a transient diarrhea, has been observed in clinical trials with ivermectin alone after treatment of some dogs that have circulating microfilariae. Keep this and all drugs out of the reach of children. In case of ingestion by humans, clients should be advised to contact a physician immediately. Physicians may contact a Poison Control Center for advice concerning cases of ingestion by humans. Store at controlled room temperature of 68°F - 77°F (20°C - 25°C). Excursions between 59°F - 86°F (15°C - 30°C) are permitted. Protect product from light. ADVERSE REACTIONS: In clinical field trials with HEARTGARD Plus, vomiting or diarrhea within 24 hours of dosing was rarely observed (1.1% of administered doses). The following adverse reactions have been reported following the use of HEARTGARD: Depression/lethargy, vomiting, anorexia, diarrhea, mydriasis, ataxia, staggering, convulsions and hypersalivation. SAFETY: HEARTGARD Plus has been shown to be bioequivalent to HEARTGARD, with respect to the bioavailability of ivermectin. The dose regimens of HEARTGARD Plus and HEARTGARD are the same with regard to ivermectin (6 mcg/kg). Studies with ivermectin indicate that certain dogs of the Collie breed are more sensitive to the effects of ivermectin administered at elevated dose levels (more than 16 times the target use level) than dogs of other breeds. At elevated doses, sensitive dogs showed adverse reactions which included mydriasis, depression, ataxia, tremors, drooling, paresis, recumbency, excitability, stupor, coma and death. HEARTGARD demonstrated no signs of toxicity at 10 times the recommended dose (60 mcg/kg) in sensitive Collies. Results of these trials and bioequivalency studies, support the safety of HEARTGARD products in dogs, including Collies, when used as recommended. HEARTGARD Plus has shown a wide margin of safety at the recommended dose level in dogs, including pregnant or breeding bitches, stud dogs and puppies aged 6 or more weeks. In clinical trials, many commonly used flea collars, dips, shampoos, anthelmintics, antibiotics, vaccines and steroid preparations have been administered with HEARTGARD Plus in a heartworm disease prevention program. In one trial, where some pups had parvovirus, there was a marginal reduction in efficacy against intestinal nematodes, possibly due to a change in intestinal transit time. HOW SUPPLIED: HEARTGARD Plus is available in three dosage strengths (see DOSAGE section) for dogs of different weights. Each strength comes in convenient cartons of 6 and 12 chewables. For customer service, please contact Merial at 1-888-637-4251.

Unleash the complete

killing force against fleas and ticks.

1 Of

dogs showing a preference in three studies conducted by independent investigators, dogs preferred HEARTGARD® (ivermectin) Chewables over INTERCEPTOR® (milbemycin oxime) FlavorTabs® by a margin of 37 to 1; data on file at Merial.

®HEARTGARD and the Dog & Hand logo are registered trademarks of Merial. ®INTERCEPTOR is a registered trademark of the Novartis Corporation. ®FLAVOR TABS is a registered trademark of Novartis AG. ©2010 Merial Limited, Duluth, GA. All rights reserved. HGD10CNPETQTRAD.

completekiller.com *Data on file at Merial. Data.

† Vet-dispensed, MDI

Photo provided by Dr. Stephen Jones.

What makes heartworm disease in dogs even harder to take...

...is that this is so easy to take.

Ask your veterinarian for the ONLY Real-Beef Chewable. Important Safety Information: HEARTGARD is well tolerated. All dogs should be tested for heartworm infection before starting a preventive program. Following the use of HEARTGARD, digestive and neurological side effects have rarely been reported. For more information, please visit www.HEARTGARD.com.

Buy 12 doses* of HEARTGARD Plus (ivermectin/pyrantel), get $12 back! ®

To help ensure rebate redemption, the coupon should be fully completed.

• FOR VETERINARY CLINIC USE ONLY •

• TO BE COMPLETED BY PET OWNER •

Merial Account Number:__________________________________________________________

Available only on purchase from your veterinarian. | Coupon expires 09/01/2011. RECEIPT MUST ACCOMPANY FORM.

Veterinary Hospital: ______________________________________________________________

PLEASE PRINT THE FOLLOWING INFORMATION:

Address:_______________________________________________________________________

Name: ________________________________________________________________________ Street Address: ________________________________________________________________

City: __________________________________________State: ______ Zip: ________________ Staff Rewards #:_________________________________________________________________

City: ______________________________________ State: ______________ Zip:____________

Staff Member Name: _____________________________________________________________

E-mail Address: ________________________________________________________________

Receipt must be included and dated on or before 09/01/2011. Rebate request must be received on or before 12/31/2011. Merial reserves the right to amend, substitute, or withdraw this offer at any time without notice. Receipts must indicate a HEARTGARD product purchase. Offer may be redeemed only by pet owner. Good only in continental U.S. and Hawaii. Void where prohibited or restricted by law. All federal, state and local laws and regulations apply. This form must accompany request; reproductions or other copies will not be accepted. Fraudulent submission could result in Federal prosecution under mail fraud statutes (Title 18, United States Code, Section 1341 and 1342) and applicable state laws. May not be combined with any other offer for HEARTGARD products.

By providing your e-mail address, you are requesting receipt of convenient monthly e-mail reminders to give your pet HEARTGARD, as well as to receive other special offers and pet care tips from Merial.

Is this your first purchase o Yes o No of HEARTGARD?

Pet’s Age in Years_________

10HGPQTR

Redeem this coupon by returning it to: HEARTGARD Program Headquarters • PO Box #4040 • South Bend, IN 46634 NOTE: Merial respects your privacy. We will not share, sell or rent the information you provide on this form. Rebate request must be received on or before 12/31/2011 and must be accompanied by a receipt. One coupon required for every 12-pack purchased. Please allow 6 to 8 weeks for delivery.

*of the same product at the same time

Stamp Clinic Information Here