Dry Eye (KCS)

Hey Doc, my dog has red eyes that really itch. They look like the eyes are made from velvet. They are always dull or crusty or "goopy". Can you help him?

Approximately 1% in the dogs presented to veterinary colleges in North America have a condition called "dry eye". We see this condition in older dogs a few times a month. The $30 dollar name for "dry eye" is Keratoconjunctivitis sicca (KCS)

The causes:

Tears are required to lubricate the cornea and remove any debris or infectious agents that may contact the eye. The tear film is a mixture of mucus, fatty liquid and water and are produced in the lacrimal glands and nictitans glands.

Any condition that impairs the ability to produce adequate amounts of tear film can result in "dry eye". Some of the common causes of KCS include:

·         Immune-mediated diseases that damage the tear producing glands. This is the most common cause of KCS and is poorly understood. The body's immune system attacks the cells that produce a portion of the tear film resulting in decreased production. This is thought to be an inherited disorder.

·         Systemic diseases such as canine distemper virus or feline herpes virus infections.

·         Medications such as certain sulphonamides (sulfa drugs).

·         Hypothyroidism

The breeds most affected by dry eye are:

American cocker spaniel

Bloodhound

Boston terrier

Cavalier King Charles Spaniel

English bulldog

English springer spaniel

Lhasa apso

Miniature schnauzer

Pekingese

Pug

Samoyed

Shih Tzu

West highland white terrier

Yorkshire terrier

That doesn't mean other breeds can't be affected. Also consider "mixed breed" dogs that are partially part of the above breeds.

The Clinical Signs:

Most dogs have painful, red and irritated eyes. They often squint, blink excessively or hold the eyes shut. There is often a thick, yellowish, mucoid discharge present as a result of the decrease in the aqueous (watery) component of the tear film.

 
The eyes often have a dull, lusterless appearance due to the corneal drying. KCS most commonly affects middle aged to older dogs. Both eyes are usually affected although one eye may appear worse than the other.


The Diagnosis:

Diagnosis is based on medical history, clinical signs and decreased tear production tests. The most common tear production test is the Schirmer tear test (STT). This simple test uses a special wicking paper to measure the amount of tear film produced in one minute. Additional diagnostic tests that may be performed include corneal staining to check for corneal ulcers, intraocular pressure (IOP) to determine if glaucoma is present and tear duct examination or flushing to ensure normal tear drainage.

The Treatment:

The treatment of "dry eye" has two objectives: to stimulate tear production and to replace tear film, thereby protecting the cornea. There are two commonly used ophthalmic medications to stimulate tear production, cyclosporine and tacrolimus. Both are easily placed in the eyes once or twice daily. These drugs are very safe and most pets improve dramatically with their consistent use.

Gently cleaning the eyes several times a day with a warm, wet washcloth will help your dog feel better and may help stimulate tear film production. We will demonstrate the correct way to administer your pet's medications and address any questions you may have about caring for your pet's condition.


The Prognosis:

With today's tear stimulating drugs, the prognosis for dogs diagnosed with KCS has never been better. "Dry eye" requires life long medical care. With diligent attention and monitoring, most dogs are able to enjoy a pain-free life.

The Providence Veterinary Hospital Blog is a publication of Peter Herman, VMD, at the Providence Veterinary Hospital, 2400 Providence Ave. in Chester, PA. Contact Dr. Herman at 610-872-4000 or visit us at http://www.providencevet.com. Some of this Blog is based on material written by: Ernest Ward, DVM

 

 

 

 

 

 

 

 

 

New Pet Health Care Plans

The Pet Health Care Plan started at Providence Veterinary Hospital over thirty years ago. The Plan has given many pet owners the opportunity to fix their costs for pet health care.

It is not an insurance policy. It is a promise to deliver necessary and predictable health care to your special pet at a reduced fixed cost.

Generally, pet owners have been able to save  40 %  and more on predictable  care, while doing the necessary procedures to keep your pet  healthy. Over thirty years, our Pet Health Care Plan has been a resounding success.

 

Each pet owner is different and each pet will have different needs. However, there is a common denominator for puppies and kittens and one for adult dogs and cats. Basically puppies and kittens need certain basic care like initial  vaccinations. As pets get older, their needs change, but the basic needs mixed with preventive health care are predictable.

If we could discount those predictable needs 40 % or more, would that interest you?

 

Introducing 2016 Canine and Feline Health Care Plans

Providence Veterinary Hospital is pleased to introduce our new dog and cat heath care plans.  Purchase the plan up front and enjoy a saving of up to 40% off your pet’s essential veterinary care while providing excellent preventative care.

Here is brief outline of the plans we are excited to offer.  Ask our receptionists or a veterinarian for details.

Adult Canine

 

Canine Gold Care Plan – Covers complete basic health care needs for your dog. Includes:  base line vaccines and routine care

Canine Platinum Care Plan – Covers comprehensive preventative health care for your dog   Includes:  Full vaccine protection, complete Annual Wellness Exam costs, and a routine dental cleaning and exam, along with extended routine care

 Puppy Canine

Puppy Gold Care Plan – Covers complete basic puppy health care needs.  Includes: basic vaccination series, deworming and routine care.

Puppy Platinum Care Plan - Covers comprehensive health care for your new addition.  Includes:  full vaccine protection, disease screening, microchip implantation and extended routine care

 

Adult Feline

 

Feline Platinum Care Plan – Covers comprehensive preventative health care for your cat Includes:  full vaccine protection, complete Annual Wellness Exam costs and a routine dental cleaning and exam, along with extended routine care

Kitten Feline

Kitten Platinum Care Plan - Covers comprehensive health care for your new addition.  Includes:  full vaccine protection, disease screening, microchip implantation and extended routine care

 

These plans may be purchase during November and December 2015 to lock in 2015 rates.

The Providence Veterinary Hospital Blog is a publication of Peter Herman, VMD, at the Providence Veterinary Hospital, 2400 Providence Ave. in Chester, PA. Contact Dr. Herman at 610-872-4000 or visit us at http://www.providencevet.com. 

 

 

A Follow Up On Ricky



A Follow Up on Ricky' Ear Surgery

Remember Ricky? He's the dog with the closed ear canals discussed on our Blog last month. He had both ears done at the same time. Both ears looked about the same. Please see the Blog published on July 16, 2015 entitled "Chronic Otis Externa, Surgery For Ricky"

Ricky's Ear Canal prior to surgery showing a closed ear canal

 

 

Here is the promised follow-up after surgery. This is a picture of Ricky's ear 5-6 weeks later. Thank you Ricky for being such a good patient!





Ricky's ear canal 5-6 weeks post operatively.
Notice the open vertical ear canal.



The Providence Veterinary Hospital Blog is a publication of Peter Herman, VMD, at the Providence Veterinary Hospital, 2400 Providence Ave. in Chester, PA. Contact Dr. Herman at 610-872-4000 or visit us at http://www.providencevet.com. 

Taking Your Cat To The Vet

Keep Your Cat At Ease At The Vet

Providing regular health care for your cat is essential for a longer, healthier, and more comfortable life for your cat. Many cats, however, don’t get the regular veterinary care they need due to the amount of stress caused by simply trying to get them to the veterinary hospital. Here, a few tips to make the trip to your veterinarian less stressful—for both your cat and you.

 

A Cat Carrier

 

Always use a cat carrier both for transporting and while waiting for your appointment.. The cats feel safer and less threatened. Picture your cat peacefully on your lap in the vet's waiting room. Now picture a playful puppy or child wanting to play with your cat. Your cat could go ballistic!

Trips to the veterinarian should not be the only time your furry friend encounters his carrier. You want your cat to associate the carrier with positive experiences. Have your cat enter the carrier on a regular basis so he or she is more comfortable in it. Leave the carrier in a room where your cat spends lots of time and give him or her time to become familiar with it. Placing soft bedding or clothing inside may help your cat feel more secure.

Getting in the Carrier

Treats, toys, or catnip placed inside her carrier will help to encourage your cat to enter. It could take days, or maybe even weeks, for your cat to begin to trust the carrier, so be patient. Always reward your cat for the behavior you want so if he or she is sitting near or exploring the carrier, give your cat a treat.

If your cat is not yet used to the carrier, but needs to go to the veterinarian right away, try putting your cat in a small room that has few hiding places with the carrier. Put a special treat in the carrier to encourage your cat to enter. If the treat doesn’t entice your cat and your carrier has an opening at the top, try to gently cradle your cat and lower him or her into the carrier. If your carrier allows, remove the top half, place your cat into the lower half, and calmly replace the top.

Picking the right carrier
Before deciding which of the many cat carriers on the market is best for your cat, consider your cat’s size, how well it tolerates handling, and which carrier is easiest to transport. It should be safe, secure, sturdy, and easy for you to carry. Some of the best carriers are hard-sided and open from both the front and the top. An easily removable top allows a cat who is fearful, anxious, or in pain to stay in the bottom half for exams by the veterinarian.

While Driving To The Vet

 

Your furry friend will be safest in the car if you secure the carrier using a seat belt. If your cat seems anxious, it sometimes helps to cover, either partially or completely, the carrier with a blanket or towel, although some cats would prefer to be able to see what’s going on outside of the carrier. There are also products that you can spray into her carrier to help with anxiety.

 

The Exam At The vet

 Your veterinarian will examine your cat's teeth and mouth for signs of gingivitis (inflammation of the gums) and/or dental disease, as well as looking for any abnormal growths in the mouth. The color of your cat's gums will be examined, making sure they a normal pink color and are not pale (from anemia), yellow (as a result of icterus, often due to liver failure), or cyanotic (as a result of breathing difficulties).

The eyes will be checked for signs of cataracts, glaucoma, corneal injuries, or other abnormalities.

Your cat's ears will be examined to make certain they are healthy and that there is no evidence of infection, inflammation, or other abnormalities such as polyps.

The externally palpable lymph nodes will be examined to make sure they are of normal size.

Your veterinarian will use a stethoscope to listen to your cat's heart and lung sounds, looking for heart murmurs, abnormal heart rhythms, and abnormally harsh or abnormally quiet sounds in the lung fields.

He/she will also check your cat's pulse rate to make sure it is not too fast or too slow and that there are no "missed" beats.

Your veterinarian will palpate your cat's abdomen to make certain he/she cannot feel any abnormal masses within the abdomen.

Your cat's genitalia will be  examined to make certain there are no abnormal discharges or swellings.

If you have noticed any abnormal lumps or bumps on your cat's body, this would be a good time to point them out to your veterinarian.

You should also advise your veterinarian of any changes in your cat's behavior or eating habits. If your cat is acting abnormally in any way, your veterinarian will need to know about it. This may include such things as diarrhea or vomiting, coughing or sneezing, runny eyes or a runny nose, difficulty urinating or defecating, difficulty chewing food, difficulty going up and down stairs or rising from a sitting position.

If your cat is urinating or defecating outside of his/her litter box or in abnormal places, you should inform your veterinarian. Likewise, if your cat is urinating involuntarily and leaving pools of urine where he/she sleeps or rests, your veterinarian will need to be informed.

This information will allow your veterinarian to focus on specific body systems in order to reach a diagnosis regarding the cause of the abnormalities. The physical examination is the place where any such diagnosis needs to start, although additional testing (blood tests, x-rays, etc) may be necessary to accurately diagnose some conditions.
Physical examinations are important for cats of any age. However, as your cat starts to age, they become even more important. Our cats age much faster than we do, and regular physical examinations will help you and your veterinarian detect any abnormalities which may affect your cat's quality of life.

By finding these abnormalities early, it is often possible to make changes in your cat's routine which eliminate or slow the progress of diseases such as heart failure, kidney failure, arthritis pain, dental disease, and many more. Your veterinarian may even advise more frequent non-stressful physical examinations for your cat as he/she ages.

The Providence Veterinary Hospital Blog is a publication of Peter Herman, VMD, at the Providence Veterinary Hospital, 2400 Providence Ave. in Chester, PA. Contact Dr. Herman at 610-872-4000 or visit us at http://www.providencevet.com. 

 

 

 

Chronic Otitis Externa - Surgery for Ricky

Chronic Ear Infections

Ricky, (his name may have been changed to protect his true identity) a male Shar pei from Maryland was seen at our hospital in Chester, PA  with a severe long term ear infection in both ears. The ear canals, which are “L” shaped, do not allow air to dry the canals nor allow fluid to escape once the canals begin to close down due to infection.

Ricky's Ear Canal prior to surgery showing a closed ear canal

Ricky had severe discomfort, smelly ears, and was very afraid of even being touched. He could only be examined with a little sedation.

The medical term for Ricky’s condition is called Otitis externa or an inflammation of the ear canal.

This occurs when the lining of the ear becomes inflamed and thickened, thereby blocking air and fluid flow in and out of the canal. Animals with otitis externa can also develop otitis media (middle ear inflammation).  

In puppies and kittens, otitis externa is often caused by ear mites. These tiny parasites cause terrible itching and a thick brown discharge. In adult dogs, the most common underlying cause is allergies- sensitivity to something in the environment or to food. In older animals, tumors can cause blockage of the ear canal and secondary infection.   Other predisposing causes may include foreign bodies (such as grass seeds), or small ear canals (often seen in Shar Pei) or long floppy ear flaps (for example, Basset hounds) that prevent air flow.  

Dogs with otitis externa may start out with mild signs, but symptoms can progress with time or from failed treatment attempts, such as: 

• ·         scratching their ears or shaking their heads

• ·         ears may be thick or red on the underside or hairless part

• ·         ears may have a strong, unpleasant smell

• ·         ear canal will eventually be blocked and have a cauliflower-like appearance  

• ·         white thick discharge from the ears of dogs if bacterial infections are present

Because the condition is painful, particularly when the middle ear is affected, pets may have personality and behavioral changes. They may shy away from being petted on the head, and may be uncomfortable opening their mouth wide or chewing food. Additionally, blockage of the ear canal muffles their hearing and makes them less responsive to their owners. 

In Ricky’s case, we obtained samples of the discharge, did a culture & sensitivity and decided what antibiotics to put him on. Additionally, we added multiple Cold Laser Therapy sessions to make Ricky more comfortable and possibly open the ear canals prior to the planned surgery. 

Medical management is sufficient and preferred in pets that have inflammation and discharge of the ear canals, but no blockage. The ear canals are cleaned and flushed, and your veterinarian may even need to drain the middle ear to relieve the fluid buildup. Pets are treated with a medication that kills mites, bacteria, or yeast, depending on what type of organism is found in the canal. In Ricky's case, just medical treatment was not enough. He needed a Lateral Ear Resection. Picture a cylinder pipe with only one end open. Now picture the pipe full of moisture and dirt. The only way to dry the pipe out and have access to the inside of the pipe is if you cut the pipe open length-wise.  Now air can dry the pipe and you can get a cloth onto the entire pipe to clean it out. This is what we did for Ricky's ear canals.

 

·        Lateral Ear Canal Resection (“Zepp”) Procedure

      Opening the lateral and vertical part of the ear canal opens it up to air and the owners     accessibility in cleaning the canal.

 

    Ricky had his Zepp procedure today and did very well. Just the vertical canal was     opened. In a few months, we will assess Ricky's actual progress.

 

    Owners of certain breeds of dogs, such as Cocker spaniels, Shar Pei, and Bassett hounds should be prepared for ear problems.   These dogs should have their ears checked once or twice a year, and any ear infections should be treated promptly to prevent inflammation and thickening of the canal. Any dogs prone to skin or food allergies should also be checked annually.

The Providence Veterinary Hospital Blog is a publication of Peter Herman, VMD, at the Providence Veterinary Hospital, 2400 Providence Ave. in Chester, PA. Contact Dr. Herman at 610-872-4000 or visit us at http://www.providencevet.com. 

 

 

 

 

 

Urinary Issues In Cats

Most of the time, we expect a cat to take care of its own toilet needs. Most of the time, we pay little attention to when a cat urinates, how many times, time in the litter box, etc. The attention getter is when your cat urinates on your freshly folded laundry or in your favorite chair.

Your cat is having trouble urinating in the litter box when he or she spends more time than expected urinating or is having accidents around the house. As a cat owner, you should be aware of a urinary disease that could have several different names, but are in fact the same disease.

Feline lower urinary tract disease (FLUTD) was formerly called 'feline urologic syndrome' or
FUS, and is now more commonly called 'feline idiopathic cystitis' or 'FIC'. 'Cystitis' is the term commonly used to describe bladder inflammation. 'Idiopathic' means the cause is unknown or more accurately, us idiots don't know the precise cause. Idiopathic cystitis in cats is similar to interstitial cystitis in humans. FLUTD affects the cat's urinary bladder and sometimes the urethra (the tube-like structure that leads from the bladder to the outside of the body).

Since it can be confusing at best, we will refer to it as Feline Urologic Syndrome or simply as FUS. 

FUS in cats is a serious disease. It can kill a cat. Signs of FUS include:

• Prolonged squatting or straining in or out of the litter box and not producing urine or only a small amount (some owners may confuse this with signs of constipation) 

• Frequent urination or straining 

• Pain while urinating (meowing or howling) 

• Urinating outside of the litter box 

• Blood in the urine

• Frequent licking of the genital area

It is thought that stress may play a major role in the development of FUS. Stressors may include changes in the number of family members (both human and animal); changes in the litter box location, litter type, or cleanliness; changes in diet; a new neighbor cat in the back yard or changes in the routine (e.g., no longer goes outside, owner no longer plays with cat). Remember to think like a cat, not a human. Cats do not need to file taxes on April 15th! That is not the stress I am talking about. What may seem unimportant to you may be the stressor for your cat.

Although the exact cause of FUS is not completely understood, it encompasses four common disorders:

•  Cystitis: Inflammation of the lining and wall of the bladder.

• Infections: Blood or mucous in the inflamed urinary tissues indicate bacterial infections.

• Urethral Blockage: Crystallization of minerals in the bladder plug up the urethra leading to blockage of urinary outflow. This is a life threatening condition.

•  Uremia: Buildup of toxins in your cat's blood stream when wastes are prevented from  being eliminated due to a blocked urethra.

The most serious symptom of this feline medical problem is caused when small crystals made up of calcium and magnesium form in the bladder. Occasionally these crystals or stones will pass from the bladder to the urethra. When the urethra is blocked, the situation can become critical very rapidly. If left untreated, a feline with a blocked urethra who is unable to urinate can die within 48 hours (worth repeating). If you have a cat who shows signs of painful urination (they will usually cry inside the litter box), or blood in the urine, your pet should be taken to the animal hospital for examination immediately.  

If your cat shows signs of FUS it will always be considered a medical emergency. A completely blocked urethra can lead to death in as little as two days.

At your veterinarian or animal hospital, the following steps will most likely be taken:

• Catheterization to remove the stones and crystals causing the blockage so the urine can flow again.   

•  Antibiotics to kill any bacteria that may have formed in the bladder. Known as cystitis, a bacterial infection in the bladder is often noted in cats with FUS.  

•  Oral urinary acidifiers are often prescribed to maintain your cat's urinary health. Crystal formation is less likely to form in urine that is more acidic and more likely to form in urine that has a high pH (alkaline). Cat owners can use pH sticks to test urine in the cat box to monitor levels for cats who have exhibited FUS  

• Chronic urinary obstruction in male cats may require surgery to widen the urethral opening. This procedure is known as a perineal urethrostomy, and while it will not prevent the reoccurrence of crystals in cats who are prone to FUS, it will lessen the possibility of a life-threatening blockage.

As a note of interest, we have been using Cold Laser Therapy (January 3, 2015 Blog) as an instrument to decrease inflammation and pain with good success in addition to the standard treatments.

We will send these cats home on a strict diet to address urinary pH, stress, and minerals in the urine. Some of the prescription diets we use are Hill's Science Diet products and Royal Canin.

What ever you want to call it, FUS is a disease you should be aware of if you own a cat. Too many times, the words, "if I had only known sooner" is muttered by the owner when a patient is brought in to the hospital in renal failure or has irreversible damage to the bladder caused by FUS.

 The Providence Veterinary Hospital Blog is a publication of Peter Herman, VMD, at the Providence Veterinary Hospital, 2400 Providence Ave. in Chester, PA. Contact Dr. Herman at 610-872-4000 or visit us at http://www.providencevet.com.