To all of our Loyal Clients, Lovely Patients
 and Regular Followers,

 We wish you all Happy Holidays, Merry Christmas 
  and A Joyous New Year

 The year is once again drawing to a close and the festive season is upon us. Again, in lieu of Christmas cards, we will be donating to our favorite animal and wildlife charities, listed below, with a view to helping these organizations continue with their fabulous work:

• The Companion Animal Fund of the University of Calgary
• The Companion Animal Fund of the University of Saskatchewan
• Calgary Humane Society
• Animal Cancer Therapy Subsidization Society (ACTSS)
• Canadian Wildlife Federation
• Canadian Parks and Wilderness Society (CPAWS)

During this holiday season while celebrating with our family, friends and pets, we would like to thank all of our wonderful clients and patients for all your support throughout the past year. Some of our most rewarding moments continue to come from the help we've been able to provide both to our patients and clients.

Throughout the year we've assisted in training a number of foreign graduate veterinarians, animal health technologists and veterinary receptionists. We’ve also been able to provide volunteer opportunities to high school students and have given presentations to children at local schools.


We have set up a veterinary blog at http://bridlewoodvc.blogspot.com/ and a presence on Facebook. We would be happy if you would visit us online, scan through some of our articles, and “Like” us on Facebook.

The doctors and staff of Bridlewood Veterinary Clinic would like to take this opportunity to wish all of our clients the very best of compliments of the season and a happy, healthy and wonderful New Year.

Clostridial Diarrhea and Colitis in Dogs

Clostridium perfringens is a common cause of diarrhea in our canine patients. Clostridium is a soil dwelling bacterium which can be cultured from the feces of many normal dogs. Under certain circumstances it overgrows the normal colonic bacteria and forms spores which produce an endo-toxin. The toxin causes an inflammation of the colon resulting in diarrhea. This begins as a watery and mucus covered diarrhea progressing to include some blood and can become very serious. Some dogs will experience intermittent and recurrent bouts of diarrhea while being completely fine in between. On presentation to the clinic these dogs are often happy and healthy, excepting for the history of chronic watery persistent diarrhea and straining. Any age or breed of dog can be affected.

Diagnosis always begins with a clinical examination of the dog and rule out other causes of diarrhea. Fecal testing is performed to eliminate other causes of infectious and parasitic infestations. Microscopic examination will readily demonstrate a huge overgrowth of sporulating clostridial bacteria. Fecal samples can be submitted to a veterinary laboratory for PCR testing which can specifically identify the Clostridium perfringens toxin.

Treatment entails the use of an antibiotic. Generally we begin with metronidazole or amoxicillin. These antibiotics are typically used for a period of 7 to 10 days if it is a first occurrence. For recurrent cases we significantly extend the time for which we use the antibiotics.

Probiotics are used in an attempt to improve the intestinal and colonic flora. We now have specific dog products available to us and these have proved helpful. Dietary management is very useful adjuvant and we may recommend a specific gastrointestinal diet. Fortunately many commercial veterinary prescription diets are available to us. Occasionally we might also recommend the use of specific home prepared diets.

 

The majority of clostridial colitis patients responded quickly to the use of antibiotics and recurrences are infrequent. However, a number of dogs seem to be particularly susceptible to recurrence once the antibiotics are ceased. Typically the cause is an underlying immune incompetence or bowel sensitivity on the part of the dog, and ongoing medication is required. Fortunately even for patients requiring ongoing medication, we find the antibiotics are well tolerated and a return to full health occurs shortly after a return to antibiotic treatment.

Seeing Eye Dog

This was forwarded to me and I like it so much that I have posted it here - Dr Mark Rubensohn.

 A thousand words couldn't begin to tell the story in these pictures.

Lily is a Great Dane that has been

blind since a bizarre medical condition required that she have both eyes

removed. For the last 5 years, Madison, another Great Dane, has been

her sight. The two are, of course,

inseparable.





"People will forget what you said; People will forget what you did.
But people will never forget how you made them feel."   

Dog Attacks

The recent, very unfortunate event in Didsbury, Alberta, where two Akitas attacked and seriously injured two young people who were know to them as well as their dog, highlights the problem of dog attacks and what brings it about, once more.
There is no doubt that there are a number of facts leading to this particular attack:
1. The fact that there were new born (4 days old) puppies and that therefore the mother dog would have been increasingly protective
2. That the owner, who would have had the most control over the Akitas, was away.  Also she would instill a sense of trust and calm into her dogs, which was not there due to her absence.
3. The couples beagle dog coming into the environment of the bitch with the new born puppies would almost surely have aggravated the protective instincts of the mother Akita
4. Dog aggression will be compounded by the flight and panic of the object of their attack.  If the beagle and its owners were yelling in flight, then the aggression would have be aggravated.

What has made this incident even more sinister is that the couple and there beagle were well known to the Akita’s and that despite their attempts to escape they were persued by the Akitas until they could fight their way out of the garage.

The reality remains however, that despite the fact that we are talking about peoples pets, our “best friends”, and constant companions, animals that they love dearly, pets that are regarded as part of the family, that we experience aggression, biting, nipping and dominant behavior continuously from our dogs.  As a veterinarian it is of great concern to me that so many of our dogs can not be controlled by their owners.  That so many dogs are out of control and undisciplined, regardless of their size or breed.  One need only tune into an episode of “Caesar Milan’s Dog Whisperer” on TV to see how dogs are ruling the behavior of their people, rather than the other way around.

The statistics of dog attacks show without exception that dogs that have been trained and are obedient have a statistically hugely lower incidence of attacks on people.  This includes all breeds both large and small.  In the UK Labradors have been one of the top listed breeds of dogs involved in attacks.  Here in the US and Canada, German Shepherds were for a long time on top of the list but have now been replaced by the power breeds of Pit Bulls, Cane Corso’s and here we have a case of Akitas.  The big difference with the power breeds of course is that they do more harm than the smaller breeds.

As a society we can do well to remember that the happiest dogs are those to which we assign jobs and work and from which we demand respect of our rules.  No matter what the breed, all of our dogs have been bred to work and we need to not only allow them, but to teach them how to do this.  All dogs should know how to sit on command.  Also how to heel, lie down, stay, come and walk on a leash without pulling.  No dogs should jump up on us without being invited to do so, or jump onto the furniture without invitation.  Food should not be available all day, but should be given twice daily with the requirement that the dog sits obediently and only take the food on command.  Praise and reward should be earned, and not unconditional.  And the best “love” that you can give your dog is to give it adequate exercise and attention.  If you need help in how to do this just tune in to an episode of “The Dog Whisperer” and if necessary enroll in training classes, which are available all over, and conveniently for us with the Calgary Humane Society.  If you want to see a happy dog just attend a show of “Super Dogs” or go to any dog agility trial.  All of this is available in Calgary.  Empower your pet to attain it’s true potential with your help.  That is what loving your pet is really about!


PS:  After jotting down the above I requested feedback from three dog trainers with whom I work closely.
The following are their replies.


Janine:

I think there is a problem with the power breeds and biting it is quite inflammatory (and yes, they certainly happen but get spectacular press).  This gives people the impression that their biting Dachshund or Cocker Spaniel isn't an issue as hospitalizations don't happen as often.  A far bigger problem I feel is dogs in the home biting - usually the small breeds and although these don't make the headlines, yet they create an environment of owner terror and helplessness where the dogs rule the household.  



Dave:

Well done Mark!  I agree with your position and feel you have expressed it well.  The Akita is breed that was bred to guard and this is an important fact that may help people understand why the dog might react in a certain way, even without the presence of new puppies, which as you mentioned would certainly escalate the situation.  Often people tend to misread, or not pay attention, to what a dog is telling us through its body language.

It seems you are putting the responsibility on the owner and not the dogs, with which I agree with as well.   It seems as though the dogs and those unfortunate people were placed in a horrible position by the owner.  The situation was not the same as it was before the pups had arrived and they should have all thought about that before having the dogs with their puppies in the “passage way” to get into their home.  Especially as you mentioned with another dog being present.  So why should these dogs even be considered for being put down when they reacted with a normal animal behavior to protect their pack?  The owner should be the one to suffer the cost to ensure the humans safely heal mentally and physically and the cost to rehabilitate the Akita's and place them in a proper environment with a human who knows how to handle a “power breed”.

I worked with an Akita who was on guard all the time and it only took 3 minutes for me to remove that with her.  It took the owners a few months but they are now with a dog that has not attacked in over 8 months and has dog friends.  Before the dog had attacked 3 dogs in 4 months.  The dogs can be trained most of the time to be under control, but the owners have to want that for their pet, and to put in the required effort in.



Gail:

Great points Mark.  I think that you've covered most of the basic issues with this horrible and tragic attack, especially in regards to why the Akitas were motivated to attack.

I'm a big believer in leadership as you know, and to me that is the foundation of proper and healthy dog ownership. I think that pet owners are often conflicted by this need to provide leadership and direction and for the usual reasons of needing the dog to meet their needs, be that as substitute children, security or friendship. I have often told my clients that they don't respect their dogs if they are unable or unwilling to treat their dogs as dogs and not as people.

I support your views of training and jobs one hundred percent. I would like to stress over and over, that dogs are dogs, and that they communicate with body language and voice tone. They have strong instinct, and that is what motivates their behavior. Therefore, in order to be good and responsible dog owners, we must learn to view life from the perspective of the dog and not dump our human thoughts and emotions on them. We've put them in a situation where for the most part, they are dependent on us to survive. Therefore, we need to provide them with their needs, not ours.

Marijuana Toxicity

I came across this very interesting article in the "Veterinary Practise News" Journal and reproduce it here in it's entirety.  I found it to be informative, comprehensive and in line with my experience with these cases which have been handled in a similar manner, usually while working at after hours emergency clinics.  
Dr Mark Rubensohn

Treating Marijuana Toxicity
Posted: June 23, 2011, 3 p.m., EDT

By Patrick Mahaney, VMD
For Veterinary Practice News

When veterinarians think of regionally specific illness, toxicity caused by consumption of native plants and exposure to infectious organisms typically comes to mind.

In preparation for a move to Southern California, I studied the effects of sago palm ingestion and inhalation of Coccidioidomycosis with the anticipation of the conditions I would be diagnosing and treating in my clinical practice.

I did not anticipate that I would end up treating such a large number of dogs presenting with clinical signs consistent with marijuana (cannabis sativa) consumption. As the sale of medical marijuana is legal in many California cities, dispensaries provide human patients with smokable or edible products.

Unfortunately, humans can carelessly leave these products in locations accessible to their curious pets, leading to ingestion.

Clinical Signs

Although a pet could show signs of marijuana toxicity post-inhalation, the majority of cases I see are due to suspected or known oral ingestion. I have treated dogs almost exclusively, yet cats can be similarly affected. A 2002 study of 250 cases of marijuana exposure showed dogs to be the primary cannabis consumption culprits (96 percent). Cats followed in a distant second place (3 percent), and other species made up the smallest portion (1 percent).1

Mild cases present with lethargy, altered response to visual or verbal stimuli, injected (blood engorged) conjunctiva and behavior changes.

More severe cases display ataxia, hypothermia, hypotension, bradycardia, ptyalism, emesis, anorexia, urinary incontinence, diarrhea and dysphoria (vocalization). Coma and death are also possible in severe cases.

Clinical signs can occur within minutes to hours and can last for hours to days, in part due body fat storage of the active ingredients in marijuana.

A 2004 study of 213 dogs with oral marijuana exposure showed neurologic signs (lethargy, ataxia, dilated pupils, etc.) in 99 percent of patients. Gastrointestinal signs, such as vomiting, were seen in 30 percent of patients.2

Although marijuana can have an anti-nausea effect, the volume consumed in proportion to the patient’s body weight, other ingested ingredients, and the induced release of “feel-good” hormones like serotonin, can cause vomiting.

In a video available at VeterinaryPracticeNews.com/MarijuanaToxicity, an Italian greyhound that ingested marijuana overreacts to visual and audible cues, appears to have difficulty standing and walking, and ultimately ends up lowering itself to a sternal position on the ground in a staggered fashion.

Mechanism of Action

Marijuana contains delta-9-tetrahydrocannabinol (THC), which causes the release of the neurotransmitters acetylcholine, dopamine, norepinephrine and serotonin in the brain’s frontal cortex and cerebellum. The increased release of these neurotransmitters leads to the various clinical manifestations.

As the attending veterinarian, I consider the possibility of other factors contributing to the overall picture of health or illness. Did the pet consume only cannabis? Could prescription or over-the-counter human or veterinary medications, other recreational drugs or unknown intoxicating substances be involved?

Differential Diagnoses

Cannabis toxicity has a variety of differential diagnoses. Options include stimulants (ephedrine and ephedrine-like compounds, amphetamines, nicotine and methylxanthines found in chocolate), opioids, benzodiazepines, antidepressants, amitraz (such as that used in anti-parasitic collars), ivermectin (from heartworm preventives), bromethalin (rodenticides), ethylene glycol (antifreeze), and alcohol (ethanol from rotting fruit, bread dough, etc.).
The majority of cases I have treated presented with multiple clinical signs, leading to the top differential diagnosis of cannabis consumption. The diagnosis, however, may not necessarily be confirmed by the owner, who may be completely unaware that a pet was exposed to the drug.

Others are up front about their pets’ ingestion of cannabis. Most are somewhat reluctant to share the truth, but ultimately concede under gentle, direct questioning.

I always ask questions in a manner conveying my intention to help the pet and its treatment. In doing so, I create an environment where the owner can tell the truth, a realistic diagnosis can be achieved and I can expeditiously start the diagnostic and treatment process.
Besides the effects of THC, “edibles” can contain substances potentially adversely affecting a pet’s health. These include carbohydrates, fat, proteins, and other ingredients. Vomiting, diarrhea, anorexia, pancreatitis and other clinical signs can ensue and lead to further complications. The Italian greyhound in the video that ate the chocolate-, sugar- and butter-filled marijuana brownie created a rather unfavorable situation for itself after inquisitively snatching the goodie from the owner’s bag.

Treatment

Having treated innumerable cannabis toxicities, I feel comfortable that my patients will make a full recovery with the appropriate care. If other toxins are suspected or known, I start a case file with the National Animal Poison Control Center (use weblink aspca.org/pet-care/poi
son-control/).

I perform baseline blood diagnostics to evaluate organ function. Knowing the status of the liver, kidneys and other body systems helps to rule out other underlying metabolic derangement that could contribute to the presenting clinical signs. I also recommend abdominal radiographs to look for gastrointestinal foreign bodies or other abnormalities.
For exposures occurring less than two hours before presentation, emesis is induced to clear the stomach of the intoxicant.

Once vomiting is under control, administration of activated charcoal can reduce absorption of certain toxins and speeds their evacuation through the gastrointestinal tract.

Provided a pet is not vomiting or comatose, administration of activated charcoal is a component to treating many cases of toxic exposure because of its ability to reduce enterohepatic recirculation of a toxic substance. Enterohepatic recirculation occurs after a toxin enters the bloodstream through the digestive tract, gets processed by the liver, then is excreted back into the small intestine via bile from the gall bladder.

Patients showing more profound sedation, ataxia, hypothermia, vomiting or other clinical signs are hospitalized for supportive care. Intravenous fluids, thermoregulatory support and anti-nausea and antacid medications promote a more rapid recovery and positive outcome.
Marijuana toxicity patients are typically discharged upon resolution of clinical signs and once they can hold down water and food.

Prevention is Best

The best way to avoid illness secondary to toxic exposure to any substance, including marijuana, is through prevention. Owners must pet-proof their homes with the same effort and attention to detail as they would baby proof for a human child.

Pets are intrigued by all sorts of smells, sounds and appearances, often curiously using their nasal and oral openings to evaluate anything within  reach.

Clients can help prevent a pet’s toxic exposure by not bringing specific substances into the home or at least storing foods, medications and other household products where the animals can’t get them.

Dr. Mahaney is a Southern California veterinarian offering integrative veterinary medicine on a house call and in-facility basis through his business, California Pet Acupuncture and Wellness (CPAW) Inc., including acupuncture, Chinese herbs, nutritional and environmental modification and emergency medicine.

FOOTNOTES

1. Janczyk P, Donaldson CW, Gualtney S: Two hundred and thirteen cases of marijuana toxicoses in dogs. Vet Hum Toxicol 2004 Vol 46 (1) pp. 19-21.
1. Shell, L: Marijuana Poisoning. Veterinary Information Network, 2006.

Chicken Jerky Treats

IMPORTANT ALERT !!!!!! Chicken Jerky Treats manufactured in China have been implicated in causing disease in dogs in Ontario. Signs include decreased activity, vomiting and increased drinking and urinating. Blood tests may show increased kidney enzymes and increased blood glucose levels. Therefore at this stage we are recommending that all jerky type treats that come from stores be stopped till further information is available.

Fluoridation of Drinking Water

It over the past 50 years one of the greatest public health advances and medical improvements that have been made in out society is the fluoridation of public drinking water. It has been a major factor responsible for the decline in tooth decay. Although other fluoride containing products are available, addition of fluoride to drinking water has proven to be the most cost-effective and efficient method of providing fluoride to all members within the community regardless of age, education, or level of income. The safety, efficiency and effectiveness of adding fluoride to water has been extensively and scientifically studied across numerous continents encompassing hundreds of cities and millions of people.

It has been shown that a community can expect to save $40 for every $1 invested to fluoridation of its public drinking water. In the review of numerous studies on the rate of tooth decay, it has been shown to be valuable not only for children but also for adults, with each new age group of older adults retaining more natural teeth than the generations before them. Safety has not been in question with the exception of abuse, generally in children who are swallowing toothpaste or over ingesting fluoride containing supplements, both generally occurring due to poor parental supervision. Dental staining or spotting has been reported where mild excess of fluoride has been ingested over time, with no damage to either the teeth or the subject.

Guidelines to the addition of fluoride have changed over the past 10 years due to the universal addition of fluoride to toothpastes. This has resulted in the increased exposure of individuals to fluoride. Thus Calgary City and Alberta Health Services as part of their ongoing review of the water fluoridation program reduced the level of fluoride to 0.7 mg/L (from the previous 1 mg/L) in 1998. (Fluoride naturally occurs in the Bow and Elbow Rivers, in concentrations varying throughout the year, between 0.1 and 0.4 mg/L).

As of  May 2011, Calgary city Council has voted to remove the fluoridation of the city’s water due to pressure of self interest groups and against advice and recommendations of the region's chief medical officer of health, of Alberta health region, and they opted not to consult with the expert panel that was offered by the University of Calgary for free. Interestingly Major Nenshi was absent during this critical Council vote which impacts the health of all Calgarian's. Reasons for the vote to stop fluoridation included the cost to the city of $750,000 a year for implementation, plus additional costs to upgrade the fluoridation equipment. Other factors claimed included the rights of counsel to impose addition of fluoride to drinking water which might not be approved by 100% of the population.

References:

1. City of Calgary  “Fluoride discontinued in Calgary’s drinking water”
2. Community Water Fluoridation and Dental Health in the U.S

      http://www.healthyteeth.us/documents/FluoridationWilliamMaaspublicstatement.pdf

Recommended Sources for further information:

1. http://en.wikipedia.org/wiki/Water_fluoridationhttp://www.cdc.gov/fluoridation/index.htm

Free Nature Walks | Birds Calgary

Free Nature Walks | Birds Calgary: "Sun May 8, 8am: Visit Frank Lake to look at the birds – and the insects that support them! Learn the reason for the varied birdlife – and the diverse aquatic invertebrates that the lake supports. Meet Anderson LRT Station, Macleod Tr., S of pedestrian overpass, or at 8:45am, at the gate to Frank Lake, S off Hwy 23, about 5 km E of High River. Bring lunch. Leaders, aquatic specialist, Danita Mazlankowski, 403-771-2461 and Greg Wagner, 403-601-3893."

Urine Grass Burn

At this time of the year our grass is most susceptible to urine burn from our dogs.  Also, unfortunately the bluegrass that is our most common lawn grass, is also the most susceptible to urine burn.  The cause is the high nitrogen concentration of urine, due to it’s the ammonium content.  Just as over fertilization will kill the grass, so does the urine.  The only real cure is to liberally water the lawn where your pet is urinating.  Once we get into the wetter and warmer time of the year, and we actually get into the growth phase of the grass, this is no longer such a problem.  During the snow covered winter months the urine is often sufficiently diluted by the snow cover and so causes less damage.  So if you are concerned about the spots of killed lawn, now is the time to start watering where your dog urinates. 

Females dogs are more damaging to the lawn as they squat and localize their urine.  Male dogs often urinate up against objects and so are urinating into the flower beds or have a disseminated stream.

For the most part many of the products that are recommended to prevent grass burn which are sold for dogs are poorly effective or potentially harmful.  After many years of experience with a variety of products, we have yet to find anything that works any better than water, re-seeding and time. 

Raw Food Diets

We at Bridlewood Veterinary Clinic have used home prepared and raw food diets for many years (Dr Mark has fed his own and clients pets for over 20 years) with the greatest success.  We have found our pets to not only love this diet, but to gain many benefits.  It can be used for both weight loss and gain with good results.  The pet’s coats are always shinier and softer, they display increased energy, this food is good for allergies, dogs at risk for gastric torsion, and stool volume is hugely decreased.  Dental condition improves, especially where raw bones are used as part of the protocol.

In the past we have fed Mountain Dog Food which is mainly a chicken based diet.  Currently we are using Farm Fresh Pet Foods which comes as either cooked or raw preparations.  It is also available as a beef base with oatmeal which is our preference.  However for dogs that have allergies there is a Bison and Berry formulation and there is also a grain free beef formulation, where this is a requirement.

Ranula (Sialocele) in a Cat

This is a very uncommon condition to be found in a cat. In fact after 35 years in veterinary practice this is the first one that I have ever seen. This condition is more commonly seen in dogs, and even then we would not commonly see more than 1-2 in a year.

This is caused by the inflammation of the sublingual and sub-mandibular saliva glands. It is generally associated with trauma, but could also be associated with inflammation or infection. The condition causes a large swelling under the tongue. It is usually only on one side, however it could also be bilateral. This particular cat was presented with the typical very large swelling under the tongue, and inability to swallow due to the swelling and thus an inability to eat. The mouth was wet with excess saliva due to the inability to swallow. The cat had a fever, was lethargic and dehydrated. Antibiotics anti-inflammatories and pain medication was administered, but after 24 hours there was very little improvement. Therefore, after discussion with a medical and surgical specialists, we performed surgery on this patient. The large inflamed and edematous salivary ducts were resected on both sides below the tongue, using a method called marsupialization.

Within hours there was a huge improvement, the patient displayed a significant increase in it’s amount of comfort and was able to begin eating within 12 hours. Shortly thereafter it was in a sufficiently stable condition to be able to bedischarged, and on subsequent follow-up it has continued to do well, is able to eat well, and is returning to full and normal activity.

This was a rare and very interesting case particularly because it was in a cat, and we are all very gratified that the results which turned out so favorably. 

Anal Sacculitis of dogs and cats

One of the more common conditions that we see in our patients is problems to do with the anal glands. All canines and felines have these glands under the tail, and in the wild they would serve the purpose of territorial marking and individual identification. The purpose would be to let other animals that may inadvertently enter into their territory know that they do so at your own risk. In the case of our domestic pets, these glands are actually redundant. However they are prone to pathology which includes impaction, infection and abscess formation.

To put this into perspective, we would be expressing anal glands on a daily basis in our practice. We treat three to four infected or abscessed glands in a week, and are only required to surgically remove chronically infected glands three or four times in a year.

Anal glands become impacted when the secretion becomes thickened or the glandular ducts become narrowed. At this stage they can easily be manually expressed by external or internal rectal digital pressure. Our groomers would typically perform this procedure on most dogs that come into the grooming salon on a daily basis. In a lesser degree of cases we see glands that have become infected and the discharge becomes particularly fetid, yellowish and pussy looking. In this case we would be required to use antibiotics in addition to the manual expression of the glands. Occasionally, the first sign that we become aware of, is once the gland has already formed an abscess, or an anal gland abscess has already burst. In this case cleaning the affected area and antibiotics would be required.

In all cases of anal gland problems the signs would be similar in that it would be a dog that is scooting, licking or biting at its rear end, is experiencing discomfort, and occasionally owners will report difficulty with defecation. Some authors would suggest that this condition is more common in small dog breeds, however we have found it to be not uncommon in all breeds including and less frequently in cats.

In dogs where recurrence is frequent and discomfort is persistent the recommendation is to remove the glands surgically. This is relatively easily done, and we experience a very good prognosis for a full and complete recovery, and resolution of the problem.

As far as prevention of the condition, there is unfortunately very little that one can practically do. As previously mentioned routine expression during grooming is always recommended. Also, at the first signs of scooting or rear end discomfort it is recommended that your pet be checked by your veterinarian, and the anal glands expressed if that is the problem. Antibiotic treatment, where required, will sometimes reduce the rate of recurrence of this problem. Unfortunately dietary management and/or weight control or reduction is rarely of any benefit.

Coccidiomycosis in a Dog in Calgary

Abstract:

A diagnosis of Coccidiomycosis has been made in a Greyhound in Calgary. This dog was introduced from Arizona. She was presented with a mild fever, unilateral hind leg lameness, and later with a suppurating peri-anal fistula. Swabs revealed fungal spherules, and fungal titres were positive for Coccidioides immitis. Treatment was started with ketoconazole at 5mg/kg bid and an immediate improvement was achieved. It is expected that this dog will receive medication for a minimum of one year, and possibly for life.

Case History:

A 2-year-old spayed female Greyhound “Cabby” was presented for a post adoption examination on March 9,2002. She was adopted via the Greyhound Rescue Society and had originated in Arizona.

On presentation “Cabby” was bright, alert, and responsive. The right submandibular lymph node was enlarged (¾” diameter), she had a right otitis externa and a nail bed infection (L/F D2). She was placed on antibiotics (Cephalexin 250 mg bid) for 2 weeks. She was then re-examined and the lymph node had reduced in size (½ “ diameter) and the nail bed infection and ear were healed.

On July 13, 2002, “Cabby” was presented with a fever (39.5 C) and limping on the left hind leg. Clinical examination was unremarkable and she was placed on Metacam (Meloxicam 0.1 mg/kg sid). On July 23, 2002, the limp had not improved (painful upon extension of the left hind and sensitive in the groin area), “Cabby” had developed a draining fistula at the site of the left anal gland. She was placed on antibiotics (Amoxicillin 500 mg bid for 1 week) for a suspected anal gland abscess, and appeared to improve after 3 days with decreased discharge and discomfort. On August 6, 2002, “Cabby” was checked again. The left hind lameness was worse, she was again febrile (40.5 C), with persistent peri-anal fistula drainage.

The fistula was probed to a depth of 3.5 cm.  A swab from the fistula showed a pyo-granulomatous discharge containing spherules of Coccidiodes immitis.  Hematology revealed a monocytosis of 1.730 10e9/L (0.000-0.980) as well as a basophilia of 0.111 10e9/L (0-0.100).  Blood chemistry revealed severe hyperproteinemia of 86 g/l (54-71) due to an exaggerated hyperglobulinemia of 62 g/l (20-40).  Radiographs showed granulomatous pelvic osteomyelitis.  The systemic fungal panel was positive for antibodies to Coccidiodes (+1:16).  As low grade infections with Ehrlichia canis is not uncommon in dogs of the southern USA, an E. canis titre was run and found to be negative.

After discussion with the owner, “Cabby” was started on ketoconozole at a dosage of 100mg every 12 hours (5mg/kg bd). She was also placed on a diet of canned puppy food (Medi-Cal Development) to augment her diet as ketoconozole can act as an appetite suppressant. “Cabby” responded well to treatment. Her fever reduced (39.2C); she is bright and eats well. The treatment will continue for a minimum of one year, after which her condition will be reassessed.

DISCUSSION: (Courtesy of Suzanne Stack, D.V.M.)

The desert southwest (Arizona, N. Mexico, S. California) is the hotbed for Coccidiomycosis (Coccidiodes immitis) in the U.S.  “Cocci” or "Valley Fever" is a fungus that lives in the desert soil and forms spores when released into the air. Events such as the digging of building foundations and pools help to release the spores more quickly.   Periods of rain, which cause fungal growth, are usually followed by more cases of Valley Fever being diagnosed. The spores are inhaled by man, dogs, and horses (cats seem to be resistant), causing the disease, VF. Any dog that breathes air in an endemic region can become infected. There is no vaccine or prevention in existence short of moving away from the area.

Greyhounds seem particularly susceptible to VF, perhaps due to their normally low white blood cell numbers. Natural immunity plays a part in which dogs contract VF (a new arrival to the area is more susceptible than a dog that grew up there). We see as many cases of VF in indoor dogs that are out only briefly to do their duty as in outdoor dogs that run around all day with their noses to the ground. Additionally, if one dog in a household gets VF, there is no increased risk to other dogs in that home.

Symptoms:

Valley Fever is a disease that can be obscure and may progress before the owner sees sufficient reason to visit a veterinarian. Some dogs display no specific signs, especially early on; they may not feel as well, eat inconsistently, or lose weight. Despite the name, half of Valley Fever dogs have normal temperatures at presentation. They may, however, run fluctuating fevers at home and have times of feeling well interspersed with times of lethargy.

These ADR ("Ain't Doin' Right") dogs inevitably go on to develop more specific signs if undiagnosed and untreated. The most common signs are poor appetite, weight loss, lameness, bone pain, spinal pain, and coughing. This is because in the early ("primary") form, the fungus infects the lungs, then moves on to infect the bones ("secondary" form). Lungs and bones account for most cases; other systems VF can affect are the central nervous system, eyes, and less commonly, the heart or skin.

With Greyhounds, we seldom see the coughing stage. In most cases, the Greyhound presents with bone involvement or nonspecific illness/weight loss. While other dogs tend to present with equal proportions of lung vs. bone form, Greyhounds run approximately 10% lung, 30% ADR, 60% bone, and the odd neurological case.

Of particular concern with Greyhounds is how much the VF bone lesions resemble bone cancer (osteosarcoma) on radiographs. Lesions can be either osteoproliferative or osteolytic.  If your Greyhound is ever diagnosed by radiography with "bone cancer," be sure a Coccidiosis antibody titre is done. I strongly recommend a titre be done early on any Arizona Greyhound, sick for any reason. Catching the disease a few weeks early may save months or years of treatment down the road. Additionally, be sure to also check the Greyhound for Ehrlichia, as some Greyhounds have both diseases together.

Treatment:

Ketoconazole is the first line of treatment.  It is used at a dose of 5 mg/kg every 12 hours with food. MINIMUM treatment time is one year, unless there is only lung involvement, in which case a minimum of 6 months. In reality, most Greyhounds are on anti-fungal medications for years. Treatment is continued until titers are negative and radiographs are clear (if bone involvement).

In the first 2-3 weeks of treatment, the Greyhound is usually anorexic, due both to the disease and to the ketoconazole.  Ketoconazole is an appetite killer – it depresses steroids in the body which is why it can be used as a treatment for Cushing’s Disease (fun fact). We usually force-feed the dogs through the first few weeks. That way a full dose of medication can be administered, thereby keeping them from losing any more weight until they begin to improve. From there on it's usually smooth sailing. Relapses are rare in a dog that is on full dose medication; they are more common when medications are being discontinued. So, while the Greyhound may be on ketoconazole for years, he is not necessarily sick for years.

Ketoconazole is absorbed better with a fatty meal, so it helps to feed substantial amounts of canned dog food at least in the beginning of treatment. Once they are stable, I usually just feed mostly dry food and a few spoons of canned.  If you don't get food into the dog, don't give the ketoconazole because he will likely vomit. That's why the force-feeding is so important.

Though ketoconazole is labeled as hepato-toxic, I cannot think of having to take a dog off it for that reason. If we have to try medications other than ketoconazole, it is usually because of appetite suppression. With the adoption dogs we muscle our way through the first few weeks with force-feeding until things start to improve.

If a dog vomits even when ketoconazole is given with food, you can try using itraconazole (Sporonox) at a dose of 2.5 mg/kg every 12 hours.  Itraconazole does not generally have any advantages over ketoconazole except to reduce side-effects.  The premium VF medication (if you can afford it) is fluconazole (Diflucan) at a dose of 2.5 mg/kg BID.   With really sick dogs sometimes it is helpful to use it for the first month or two, then revert back to ketoconazole for the long haul. The main advantage is that most dogs tolerate fluconazole much better than the other two (however even fluconazole can be an appetite suppressant). Although it is the drug of choice for CNS involvement, we have treated cases successfully with ketoconazole and amphotericin B before fluconazole was available. Whether or not fluconazole actually shortens the treatment period is uncertain. Regardless of which medication you use, I think it's critical to keep calories in the dog. He can't win this battle if he is not eating and is losing weight.

Some veterinarians recommend MSM to help with VF, some add Program (kills VF skeletons as well as flea skeletons), but this makes treatment relatively expensive. The dosage is one white (409.8 mg) Program tablet daily.  Others give a Vitamin C (500 mg) with the medication as antifungals work better in an acidic stomach.

Lastly, with really sick dogs, amphotericin B is an option. It is a potent drug with the possibility of serious side effects.  (It is known for kidney damage but I had one Greyhound become icteric after just one treatment.) Interestingly enough, this Greyhound had to discontinue amphotericin B and go right onto ketoconazole while still icteric.  He stayed on ketoconazole for 4 years with no liver problems. Therefore amphotericin B (“amphoterrible") is usually reserved for seriously sick dogs. The drug itself is very inexpensive, but it has to be given over a period of 12 hours, first with a liter of 0.9% saline to flush, followed by a liter of 5% dextrose. Before each treatment, a urinalysis and blood urea nitrogen should be run. Full treatment course is twice weekly for 2 months. I've used it on perhaps 20 dogs that failed to improve with ketoconazole treatment, and many of them survived because of it, including two Greyhounds. Some dogs will still need to be maintained on oral medication after finishing the amphotericin B.  Veterinarians who have actually used it get a sense of risk vs. benefit. It certainly is a stronger and faster working drug for seriously ill patients.

Prognosis:

VF can relapse even if the titres are negative. Some veterinarians consider VF to only be in remission and not cured, until the dog has gone several years without a relapse. One of my first Greyhounds had a vertebral lesion and was on ketoconazole for 4 years. His titres finally became negative, but every time I tried to take him off ketoconazole, his neck would start hurting again in a month or two, so we continued medicating. He eventually died at the fair age of 7 from right-sided heart failure - somewhat unusual, but I didn't autopsy to find out if it was from VF (titres were negative at the time). I do know of another Greyhound that started out terribly sick who also died of right-sided heart failure 2 years into ketoconazole treatment.  (He was doing well on his medication until his heart gave out).

The Greyhounds do seem to have a worse time with VF than other dogs.  Weaning dogs off the medication seems preferable to stopping medication entirely and risking a relapse, which can sometimes get the better of them.

Approximately 1/3 of VF dogs will die, 1/3 are cured, and 1/3 are OK as long as medication is continued.

References:

1.      Suzanne Stack, DVM, Ironwood Veterinary Clinic, Yuma, Arizona

2.      Central Laboratory for Veterinarians, Calgary, AB

3.      R.V. Morgan:  Coccidiomycosis.  pp. 1119-1121.   Handbook of Small Animal Practice, 3^rd Edition, W.B. Saunders, Philadelphia, 1997

4.      Ettinger SJ, Feldman EC: Coccidiomycosis. pp.  444-448.  Textbook of Veterinary Internal Medicine, 4^th Edition, Volume 1, W.B. Saunders, Philadelphia, 1995

Chapter 71, Wolf, Troy: Deep Mycotic Diseases

Laboratory Results:

			Calgary-Central Lab for Vets
			Unit 19, 5080 12A Street SE
			Calgary, Alberta T2G 5K9
			(403) 214-1506
BRIDLEWOOD VET CLINIC			PATIENT:   CABBY
1-403-201-6427			AGE:       2 Y	SEX:  F
26-17107 JAMES MCKEVITT RD SW			SPECIES:  CANINE			DRWN:    08/06/02   17:50
CALGARY, ALBERTA						RCVD:     08/06/02   17:50
T2Y 3Y4						PRNT:      08/07/02   10:43
* * COMPLETE REPORT * *	ATTENDING VET:  RUBENSOHN
TEST NAME	NORMAL		OUT OF RANGE		UNITS		REFERENCE RANGE
General Panel	. . . . .
cbc with differential	. . . . .
White cell cnt	11.7				10.9/l		4.0 - 15.0
CD-NEUTR	8.91				10e9/L		2.80 - 10.56
CD-LYMPHS			0.937  L		10e9/L		.960 - 4.800
CD-MONOCYTES			1.730  H		10e9/L		0.000 - 0.980
CD-EOSINOPHILS	0.012				10e9/L		0 - 1.231
CD-BASOPHILS			0.111 H		10e9/L		0 - 0.100
MORPHOLOGY	T
	This is an automated differential, all absolute number are in SI units.
	Platelet numbers are adequate.  Platelets clumped.  Variability
	in platelet size apparent.  Rbc morphology normal.
Red cell cnt			8.12 H		10.12/l		5.50 - 8.00
Hemoglobin	188				g/l		138 - 199
Hematocrit	0.545				l/l		0.390 - 0.560
Mean Corp Vol.	67				fl		63 - 77
Mean Corp Hemoglobin	23.1				pg		22.0 - 27.4
Mean Corp Hemoglobin Conc	345				g/l		326 - 374
RDW	16.6						10.0 - 19.0
Platelet cnt	INV				10.9/l		170 - 400
Mean Platelet Volume	INV				fl		7. - 14
Chemistry Screen	. . . . .
Glucose	4.2				mmol/l		3.0 - 6.6
Grey Glucose	4.0				mmol/l		3.0 - 6.1
Blood Urea Nitrogen	4.9				mmol/l		2.5 - 9.20
Creatinine	110				umol/l		68 - 141
Bun/Cr Ratio	11
Sodium	150				mmol/l		140 - 151
Potassium	4.7				mmol/l		4.0 - 5.4
Na/K Ratio	32
Calcium	2.37				mmol/l		2.24 - 2.83
Phosphorus	1.56				mmol/l		0.72 - 2.08
Total protein			86 H		g/l		54 - 71
Albumin			24 L		g/l		31 - 42
Globulin			62 VH		g/l		20 - 40
Albumin/Globulin Ratio			0.4 L				0.8 - 2.3
Bilirubin total	5				umol/l		0 - 7
Alkaline phosphatase	82				iu/l		04 - 113
Sgpt (alt)	35				iu/l		0 - 113
Gamma gt	9				iu/l		2.- 20
Chloride	118				mmol/l		108 - 118
Carbon Dioxide	20				mmol/l		15 - 26
Calculated Osmolality	296.8				mmol/kg		278 - 306
Anion Gap	17						10.- 22
Creatinine Phosphokinase	59				iu/l		00 - 314
Cytology	T
	THE ONE SMEAR FROM THE PERIANAL REGION REVEALED
	A HIGH NUCLEATED CELLULARITY WITH A PREDOMINANCE
	OF NEUTROPHILS AND MACROPHAGES A LOW NUMBER OF
	VARIABLE SIZED SPHERULES WITH THE RARE CLUMP AND
	INDIVIDUAL ENDOSPORES WERE NOTED.  THESE STRUCTURES
	MOST CLOSELY RESEMBLE COCCIDIOMYCOSIS ORGANISMS
	SUGGEST SYSTEMIC FUNGAL PANEL SEROLOGY AND BIOPSY
	TO HELP CONFIRM THESE INITIAL FINDINGS RADIOLOGY
	IS RECOMMENDED ANY LAMENESS OR RESPIRATORY SIGNS?
	Dr. Norman Lowes
COMMENT	TO15
	STRESS LEUKON WITH MONOCYTOSIS INCREASED TISSUE
	DEMAND FOR PHAGOCYTOSIS SHIFT IN AG RATIO CHECK
	ELECTROPHORESIS IF NOT RESOLVING WITH SURGICAL
	INTERVENTION?
	Dr. Norman Lowes
	SYSTEMIC FUNGAL PANEL, SUSPECT COCCIDIOMYCOSIS
Systemic Fungal Panel	T	A		TITER
	BLASTOMYCES AB:		NEGATIVE
	COCCIDIOIDES AB:		POS 1 : 16
	HISTOPLASMA AB:		NEGATIVE
	APERGILLUS AB:		NEGATIVE
	CRYPTOCOCCUS AG:		NEGATIVE
COMMENT	TO15
	Dr. Lily Edwards
Ehrlichia canis	NEG
COMMENT	TO15
	Dr. Sally Lester