Saturday, June 1, 2013

Some Toxic Foods for Dogs


This is a portion of the full article which can be viewed by clicking on the title above.
Recognition is hereby given to the NCIB and the authors of this article.




Chocolate, caffeine and other methylxanthines

Chocolate is derived from the roasted seeds of Theobroma cacao and its toxic principles are the methylxanthines theobromine (3,7-dimethylxanthine) and caffeine (1,3,7-trimethylxanthine). Theobromine is also found in tea, cola beverages, and some other foods.
Chocolate toxicoses occur especially at holidays: Valentine's day, Easter, Halloween, and Christmas and may result in potentially life-threatening cardiac arrhythmias and CNS dysfunction (Stidworthy et al.,
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Sources

Most poisonings from methylxanthines occur as a result of chocolate ingestion. Chocolate is toxic to all species, especially to smaller dogs, though a toxic dose will vary depending on factors like whether the dog ate the chocolate on an empty stomach, if the dog is particularly sensitive to chocolate, and the type of chocolate, since dark chocolate is more toxic, whereas milk chocolate less so, and white chocolate must be consumed in extremely large quantities to cause a serious problem. Contributing factors include indiscriminate eating habits and readily available sources of chocolate. Deaths have also been reported in livestock fed cocoa byproducts and in animals consuming mulch from cocoa-bean hulls. Cocoa bean hulls or waste used as bedding for animals has caused toxicosis primarily in horses. Third most prevalent poisoning from these agents is a result of caffeine tablets ingested by dogs or hype race horses (tablets often contain 100 mg each). Theophylline tablets or elixirs are also used as human or veterinary medication.

The methylxanthine content

The most important toxic component of chocolate – the methylxanthine alkaloid theobromine is present in variable concentrations dependent on the quality of the chocolate – the darker or richer in cocoa solids the more dangerous the preparation. Cocoa powder and cooking chocolate are the most toxic forms (Sutton, 
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Destroy user interface control). Table 1 shows the total methylxanthine concentration in chocolate (www.merckvetmanual.com).
Table 1
The total methylxanthine concentration in chocolate (www.merckvetmanual.com).
The amount of theobromine found in chocolate is small enough that chocolate can be safely consumed by humans in large quantities, but animals that metabolize theobromine more slowly can easily consume enough chocolate to cause poisoning. Although the concentration of theobromine in chocolate is 3–10 times that of caffeine, both constituents contribute to the clinical syndrome seen in chocolate toxicosis.

Toxic doses

A 10-kilogram dog can be seriously affected if it eats a quarter of a 250 g packet of cocoa powder or half of a 250 g block of cooking chocolate. These forms of chocolate contain ten times more theobromine than milk chocolate. Thus, a chocolate mud cake could be a real health risk for a small dog. Even licking a substantial part of the chocolate icing from a cake can make a dog unwell. A dog needs to eat more than a 250 g block of milk chocolate to be affected. Obviously, the smaller the dog, the less it needs to eat. A typical 20 kg dog will normally experience intestinal distress after eating less than 240 g of dark chocolate, but will not necessarily experience bradycardia or tachyarrhythmia unless it eats at least a half a kilogram of milk chocolate. According to the Merck Veterinary Manual (
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The negative effects depend on the dosage, the size of the dog, and the type of chocolate. LD50 of methylxanthines in animals are summarised in Table 2 (www.actionagainstpoisoning.com).
Table 2
LD50 of methylxanthines in animals (www.actionagainstpoisoning.com).

Absorption, distribution, metabolism, excretion (ADME)

Theobromine and caffeine are readily absorbed from the GI tract and are widely distributed throughout the body. They are metabolized in the liver and undergo enterohepatic recycling and then excreted in the urine as both metabolites and unchanged parent compounds. Methylxanthines also readily pass in the milk of exposed lactating animals. Very little parent compound is passed in the feces. The half-lives of theobromine and caffeine in dogs are 17.5 h and 4.5 h, respectively.

Mechanism of action

Methylxanthines cause a competitive antagonism of cellular adenosine receptors. Inhibition of adenosine receptors causes CNS stimulation, constriction of some blood vessels, diuresis, and tachycardia. Methylxanthines also increase intracellular calcium levels by increasing cellular calcium entry and inhibiting intracellular sequestration of calcium by the sarcoplasmic reticulum of striated muscles. The net effect is increased strength and contractility of skeletal and cardiac muscle. Methylxanthines may also compete for benzodiazepine receptors within the CNS and inhibit phosphodiesterase, resulting in increased cyclic adenosine monophosphate (AMP) levels. They may also increase circulating levels of epinephrine and norepinephrine (www.merckvetmanual.com).

Clinical signs

Clinical signs of toxicosis usually occur within 6–12 h of ingestion, e.g. nausea, vomiting, diarrhoea, dyspnoe, thirst, and increased urination. These can progress to dehydration, restlessness, hyperactivity, cardiac arrhythmias, internal bleeding, heart attacks, tachypnea, ataxia, tremors, seizures, weakness, coma, cyanosis, hypertension, hyperthermia, and eventually death. The high fat content of chocolate products may trigger pancreatitis in susceptible animals. In general, mild signs (vomiting, diarrhoea, polydipsia) may be seen in dogs ingesting 20 mg/kg, cardiotoxic effects may be seen at 40–50 mg/kg, and seizures may occur at doses ≥60 mg/kg (www.merckvetmanual.com). A dog, which ingested a lethal quantity of garden mulch made from cacao bean shells, developed severe convulsions and died 17 h later. Analysis of the stomach content and the ingested cacao bean shells revealed the presence of lethal amounts of theobromine (Drolet et al., 
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Treatment

Once animals have stabilized, or in animals presenting before clinical signs have developed (e.g. within 1 h of ingestion), decontamination should be performed. Induction of emesis using apomorphine (0.08 mg/kg i.m. or s.c.) or hydrogen peroxide should be initiated; in animals that have been sedated due to seizures, gastric lavage may be considered. Activated charcoal (1–4 g/kg, p.o.) should be administered; because of the enterohepatic recirculation of methylxanthines, repeated doses should be administered every 3 h for up to 72 h in symptomatic animals (control vomiting with metoclopramide, 0.2–0.4 mg/kg, s.c. or i.m.). Erythromycin and corticosteroids should be avoided because they interfere with excretion of methylxanthines. For ventricular-origin tachyarrythmias lidocaine is applicated (1–2 mg/kg i.v. until effect, followed by 25–80 mg/kg/min infusion rate to effect to maintain). However, lidocaine cannot be used in cats. If lidocaine fails, metoprolol injection is preferred over propranolol, since metoprolol does not slow renal excretion of methylxanthines as propranolol can. Suggested starting dose for injectable form of either metoprolol or propranolol is 0.02–0.06 mg/kg slow i.v., which can be repeated and increased if needed. The rate of administration should not exceed 1 mg/2 min i.v. For bradycardia (less prevalent) atropine is used at 0.01–0.02 mg/kg i.m. or s.c. Artificial respiration is applicated if needed. To release seizures diazepam (0.5–2.0 mg/kg, slow i.v.) or barbiturates are applicated. Fluid diuresis may assist in stabilizing cardiovascular function and hasten urinary excretion of methylxanthines. Other treatment for symptomatic animals includes thermoregulation, correcting acid/base and electrolyte abnormalities, monitoring cardiac status via electrocardiography, and urinary catheter placement (methylxanthines and their metabolites can be reabsorbed across the bladder wall). Clinical signs may persist up to 72 h in severe cases.

Grapes, raisins and sultanas

One of the more striking poisonings to have emerged as a potential concern over the last few years has been that of raisin poisoning in dogs. The ingested doses involved in these fatal cases ranged from 10 to 57 g of fruit per kg b. wt. There are now several reports that confirm that ingestion of these fruits can cause renal failure in dogs. Grapes contain an unknown toxin (Gwaltney-Brant et al., 
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Mechanism of action

The toxic mechanism remains to be elucidated, and the apparent lack of a reproducible dose response relationship has led some authors to suggest this may reflect either a component of the fruits that is present in varying quantities, or the existence of an extrinsic compound that may not always be present. Individual variations in response may also occur (McKnight, 
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Toxic doses

The general consensus at present is that potentially any dose should be considered a problem. Estimated amounts of grapes associated with renal injury in dogs are about 32 g/kg; amounts of raisins associated with signs range from 11–30 g/kg (www.merckvetmanual.com).

Clinical signs

Clinical effects usually become apparent within 6 h of ingestion, and always within 24 h. Early signs are vomiting (in almost all cases), diarrhoea within 6–12 h of ingestion, anorexia, abdominal pain, weakness, dehydration, tremors and lethargy. Ingesta may be present in the vomitus or faeces. Polydipsia may also be apparent. Oliguric or anuric renal failure develops within 24–72 h of exposure; once anuric renal failure develops, most dogs die or are euthanized. Urinalysis may reveal proteinuria, glucosuria, microscopic haematuria and, rarely, crystalluria. Urine and blood tests will provide definitive evidence for it. Transient elevations in serum glucose, calcium, phosphorus, liver and pancreatic enzymes develop in some dogs (Eubig et al., 
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Destroy user interface control). It is generally agreed that prognosis in dogs with oliguria or anuria is poor.

Necropsy

In some of the cases with fatal outcomes proximal renal tubule necrosis and renal calcification was described (Morrow et al., 
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Therapy

Ingestion of any quantity of grapes, raisins or sultanas by a dog should be considered treatable. Digestion of the fruits appears to be slow and decontamination several hours post-ingestion may be worthwhile as whole grapes and swollen raisins have been recovered after remaining in the stomach overnight. Gut decontamination should be considered by means of emesis or gastric lavage. Emesis can be induced with 3% hydrogen peroxide (2 ml/kg; no more than 45 ml), followed by activated charcoal. Activated charcoal may be of benefit, but care should be taken to ensure bowel sounds are regular before this is administered. If spontaneous vomiting is protracted it must be consider to use anti-emetics such as metoclopramide (0.5–1 mg p.o., s.c. or i.m. 6–8 h or 1–2 mg/kg per day by slow i.v. injection). Aggressive i.v. fluid therapy for at least 48 h for rehydration and support of renal function is important (Campbell, 
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Destroy user interface control). Renal function and electrolytes should be monitored for at least 72 h post-ingestion. Where necessary the use of furosemide (2 mg/kg i.v. initially followed by i.v. infusion of 5 mg/kg/h), dopamine (0.5–3 μg/kg/min, i.v.) or mannitol (0.25–0.5 g/kg i.v. over 5–10 min) may be considered to re-establish urine output in oliguric dogs (McKnight, 
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Destroy user interface control). However, the efficacy of these therapies remains unproven and that there is evidence that tubular necrosis or renal tubule obstruction may prevent urine flow. Anuric dogs are unlikely to survive unless peritoneal dialysis or hemodialysis is performed, and even then the prognosis is guarded.

Onion toxicosis

The onion (Allium cepa) is one of the oldest crops. Its world production has increased by at least 25% over the past 10 years with current production being around 44 million tonnes making it the second most important horticultural crop after tomatoes. Because of its storage characteristics and durability for shipping, onion has always been traded more widely than most vegetables. Onion is versatile and is often used as an ingredient in many dishes and is accepted by almost all traditions and cultures. Onion consumption is increasing significantly and this is partly because of heavy promotion that links flavour and health. Onion is rich in two chemical groups that have perceived benefits to human health – flavonoids and alk(en)yl cysteine sulphoxides. Apart from its culinary uses – fresh, cooked or dehydrated – medicinal properties have been attributed to both since ancient times, prompting in recent years an accurate chemical analysis of the most characteristic active ingredients. Compounds from onion have a range of health benefits which include anticarcinogenic properties, antiplatelet, antithrombotic activity, antiasthmatic, antidiabetic, hypocholesterolaemic, fibrinolytic and various other biological actions, and antibiotic effects (Augusti, 
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Destroy user interface control). On the other hand, onion contains the toxic components which can damage red blood cells and cause haemolytic anaemia accompanied by the formation of Heinz bodies in erythrocytes of animals (Desnoyers, 
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Heinz body anaemia is an uncommon finding in dogs, and few other toxicants, e.g. methylene blue, acetaminophene, zinc, benzocaine, vitamin K, phenylhydrazine (Houston and Myers, 
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Mechanism of action

Various factors are implicated in the wide variation in species susceptibility, including differences in hemoglobin structure and protective enzyme systems. The mechanism of onion toxicity has been known for several decades, but recent studies have shown that more than one toxin is involved. The toxic components in all type of onions, garlic, leeks, shallots, and other plants of the Allium family, are sulfoxides and aliphatic sulfides, specifically allyl and propyl di-, tri-, and tetrasulfides. Onions contain also the relatively rare amino acids S-meth and S-prop (en)ylcysteine sufoxides (SMCO). It is widely agreed that n-propyl disulphide is the principal toxin that reduces the activity of glucose-6-phosphate dehydrogenase in red blood cells; thereby interfering with regeneration of reduced glutathione needed to prevent oxidative denaturation of haemoglobin (Thrall, 
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Destroy user interface control). Denaturated haemoglobin, when developed, precipitates on the surface of red blood cells (named Heinz bodies) and triggers intra- and extravascular haemolysis (Lincoln et al., 
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Destroy user interface control; Tang et al., 
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Destroy user interface control). The haemolytic effect of sodium n-propylthiosulphate, which had been isolated from boiled onions, was studied in dogs by Yamato et al. (
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Destroy user interface control). The oral administration of 500 mumol/kg b. wt. of the compound to dogs resulted in a haemolytic anaemia associated with an increase of Heinz body formation in erythrocytes, which was more severe in dogs with the hereditary condition which results in erythrocytes with high concentrations of reduced glutathione and potassium than in normal dogs. In the affected dogs there was a 10-fold increase in the concentration of oxidised glutathione in their erythrocytes 12 h after the administration of the compound, whereas in normal dogs there was almost no change.

Toxicity

Consumption of as little as 5 g/kg of onions in cats or 15 to 30 g/kg in dogs has resulted in clinically important hematologic changes (Cope, 
The following popper user interface control may not be accessible. Tab to the next button to revert the control to an accessible version.
Destroy user interface control). Onion toxicosis is consistently noted in animals that ingest more than 0.5% of their b. wt. in onions at one time. A relatively high dosage (600–800 g) in one meal or spread apart over a few days can damage red blood cells and cause haemolytic anaemia accompanied by the formation of Heinz bodies in erythrocytes.
All forms of onion can be a problem including: dehydrated, raw or cooked onions, table scraps containing cooked onions or garlic, left over pizzas, chinese dishes, any feeding stuff containing onions.
Humans are the most resistant species studied. On the other hand, there is some concern about the susceptibility of certain ethnic groups that have a genetic deficiency of glucose-6-phosphate dehydrogenase.
Although the dog appears to be one of the most susceptible species, there are very few reports in the scientific literature concerning accidental canine poisoning associated with onion ingestion. Cats are more susceptible than dogs. Since baby food is often used in sick cats that are not eating (to stimulate their appetite), there was concern that the onion powder would cause a Heinz body anemia in these cats (Robertson et al., 
The following popper user interface control may not be accessible. Tab to the next button to revert the control to an accessible version.
Destroy user interface control). Many baby food manufacturers add onions or onion powder to increase palatability. It is generally accepted that sheep, goats, rats and mice are more resistant to onion toxicosis than other domestic animals (Thrall, 
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Destroy user interface control; Aslani et al., 
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Destroy user interface control). The safety of feeding culled onions to livestock depends upon species susceptibility and the toxic potential of the onions. Sheep can be maintained on diets of up to 50% onions with no clinical abnormalities or detrimental effects on growth. Even when onions are fed free choice, sheep have only transient hemoglobinuria and anemia, with few deaths even reported. In contrast, cattle should be fed onions with caution, due to the relative susceptibilty of their erythrocytes to oxidative damage. Daily feeding of onions could have a cumulative effect due to ongoing formation of Heinz bodies versus a single exposure with a wide gap until the next exposure, allowing the bone marrow time to regenerate the prematurely destroyed red cells.

Clinical signs

The first symptoms are usually of gastro-enteritis: vomiting, diarrhoea, abdominal pain, loss of appetite, depression and dehydration. It will take a few days for the dog to display the symptoms associated with the loss of red blood cells: pale mucous membranes, rapid respiratory rate, difficulty to breath, lethargy, dark coloured urine – reddish or brown, jaundice, weakness, rapid heart rate. Haematology may reveal neutrophilia, lymphopenia, Heinz-body anaemia and methaemoglobinaemia.

Therapy

There is not any antidote, however, supportive care may be helpful: hospitalisation, administration of intra-venous fluids, blood transfusions. Treatment is advocated of ingestion of any quantity. For recent ingestions gastric decontamination should be considered, and use of adsorbents, but thereafter management is largely supportive. It is important that the animals remain hydrated; antiemetics may be given to control persistent vomiting. Nonenzymatic reductants such as ascorbic acid may also be useful (in dog 30 mg/kg b. wt. i.v. each 6–8 h). Antioxidant prevention (by N-acetylcysteine, vitamin E, ascorbate) of Heinz body formation and oxidative injury in cats was recommended by Hill et al. (
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Destroy user interface control). In severely poisoned animals blood transfusions have been successfully employed.
Nevertheless, even taking into account that lethal effects are infrequent in dogs, avoiding exposure to any kind of A. cepa in this and other domestic animal species seems to be the best preventive health strategy.

Garlic

Garlic (Allium sativum) is considered to be less toxic and safe for dogs than onion when used in moderation. Allicin and ajoene, pharmacologically active agents in garlic, are potent cardiac and smooth muscle relaxants, vasodilators, and hypotensive agents (Malik and Siddiqui, 
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Garlic is toxic also for horses, at a daily dose of >0.2 g/kg causes Heinz body anemia in them (Pearsonet al., 
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Avocado

Avocado fruit, pits, leaves and the actual plant are all potentially poisonous to dogs, along with other pets like cats, mice, rats, birds, rabbits, horses, cattle and goats, among others.
Persin is a fungicidal toxin found in both the fruit and leaves of the avocado tree (Persea americana). It has been isolated only recently and discovered to kill breast cancer cells. It has also been shown to enhance the effect of the breast cancer fighting drug Tamoxifen. This could potentially reduce the necessary dosage of current cancer drugs. Persin is however highly insoluble, and more research will be needed to put it into a soluble tablet form.
Feeding avocados to any non-human animal should be completely avoided. The lethal dose is not known; the effect is different depending upon the animal species. Avocados will trigger fluid accumulation in the lungs and chest, leading to difficulty breathing and death due to oxygen deprivation. Fluid accumulation can also occur in the heart, pancreas and abdomen (Buoro et al., 
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Destroy user interface control). High fat content of avocado can lead to pancreatitis.

Clinical signs

The symptoms include gastrointestinal irritation, vomiting, diarrhoea, respiratory distress, congestion, fluid accumulation around the tissues of the heart and even death. Birds seem to be particularly sensitive to this toxic compound and the symptoms are the increased heart rate, myocardial tissue damage, labored breathing, disordered plumage, unrest, weakness, and apathy. High doses cause acute respiratory syndrome (asphyxia), with death approximately 12 to 24 h after consumption. In lactating rabbits and mice non-infectious mastitis and agalactia after consumption of leaves or bark was observed. In rabbits cardial arrhythmia, submandibular edema and death after consumption of leaves occur. In cows, horses and goats mastitis after consumption of leaves or bark was observed.

Macadamia nuts

Macadamia nuts originate from the trees Macadamia integrifolia in the continental USA andMacadamia tetraphylla in Hawaii and Australia. They are commonly present in cookies, so owners should be careful what they feed their dog. Macadamia nuts (both raw and roasted) as well as macadamia butter contain an unknown toxin that affects the muscles, digestive system and nervous system and can cause locomotory difficulties, weakness, dyspnoe, tremors and swollen limbs. Macadamia nuts and walnuts can also trigger pancreatitis and peanuts a deadly allergic reaction (Knottet al., 
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The mechanism of action

The mechanism of toxicity is unknown; but may involve a constituent of the nuts, processing contaminants or mycotoxins.

Toxicity

The toxic dose to dogs ranges from 2.4–62.4 g per kg b.wt. This is a very large range and can mean that some dogs will get ill with just a small amount of nuts ingested, while other dogs need to eat a lot of nuts to show signs (Hansen et al., 
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Clinical signs

Dogs are the only species in which signs have been reported (www.merckvetmanual.com). Within 12 h of ingestion, dogs develop weakness (more pronounced in hind limbs), depression, vomiting, abdominal pain, ataxia, muscle tremors, swollen and painful limbs, paralysis of the hindquarters, hyperthermia (with rectal temperatures up to 40.5 °C), an elevated heart rate, lameness, stiffness and recumbency. Tremors may be secondary to muscle weakness. Macadamia nuts may be identified in vomitus or feces. Mild transient elevations in serum triglycerides, lipases, and alkaline phosphatase were reported in some dogs experimentally dosed with macadamia nuts; these values quickly returned to baseline by 48 h after experimental dosing (Hansen et al., 
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Destroy user interface control). Signs generally resolve within 12–48 h (Hansen et al., 
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Destroy user interface control; Hansen, 
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Destroy user interface control). The onset of clinical signs was reported as <12 h in 79% of the cases. The duration of clinical signs for the majority of cases was <24 h. The amount of macadamia nuts ingested was estimated in 72% of the calls with a mean of 11.7 g/kg bw. All field and experimental dogs recovered uneventfully within 1 to 2 d whether treated by a veterinarian or not. No mortality has been reported.

Therapy

For asymptomatic dogs with recent ingestion of more than 1–2 g/kg, emesis should be induced; activated charcoal may be of benefit with large ingestions. Fortunately, most symptomatic dogs will recover without any specific treatment. Severely affected animals may be given supportive treatment such as fluids, analgesics or antipyretics (www.merckvetmanual.com). Use of mild laxatives may assist the passage of ingesta through the gastrointestinal tract. Luckily, the muscle weakness, while painful, seems to be of short duration and the patients do recover from the toxicity.

Effects of xylitol ingestion

Xylitol, an artificial sweetener, is present in many products, such as candy, sugar-free chewing gums, toothpaste and baked goods. Ingestion of these foods by dogs results in a significant, and often sustained, insulin-mediated hypoglycemic crisis (Cope, 
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Destroy user interface control). In both humans and dogs, the levels of blood sugar are controlled by the body's release of insulin from the pancreas. In human xylitol ingestion does not cause any significant changes in insulin levels or, therefore, blood glucose (Dunayer, 
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Destroy user interface control). However, in dogs, xylitol is a strong promoter of insulin release, which results in a rapid decrease in blood glucose (hypoglycemia) (Asano et al., 
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Destroy user interface control). This compound can cause liver damage and death. This information was first published in July 2004.

Clinical signs

Clinical signs of xylitol toxicity can develop in as few as 30 min after ingestion and may include one or more of the following: vomiting, weakness, ataxia, depression, hypokalemia, seizures, coma, liver dysfunction and/or failure. Dunayer and Gwaltney-Brant (
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Treatment

The induction of vomiting is recommended if performed very soon after ingestion of the xylitol-containing product but before clinical signs develop. Frequent small meals or an oral sugar supplement may be used to manage dogs that have not yet shown clinical signs. Following the appearance of clinical signs intravenous dextrose can be used to control hypoglycemia. It may also be necessary to treat the patient for hypokalemia, if indicated. Treatment should be continued until the blood glucose levels return to normal levels.
Dunayer and Gwaltney-Brant (
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Destroy user interface control) revealed that binding of xylitol to activated charcoal is relatively low; however, activated charcoal administration may still be beneficial in some canine acute oral xylitol exposures.

Alcohol toxicoses

Serious intoxications have occurred when dogs have been given alcohol to drink as a „joke“. Also, dogs seem to be attracted to alcoholic drinks, so drinks should not be left unattended. Dogs cannot tolerate alcohol, even in small amounts.
Ethanol is the alcohol in alcoholic beverages, perfumes and mouthwashes. Ethanol toxicosis in dogs occurred after ingestion of rotten apples (Kammerer et al., 
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Mechanism of action

The mechanism of action on the CNS is related in part to its interactions with biomembranes and its probable inhibition of gamma-amino butyric acid (GABA) receptors (Valentine, 
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Clinical signs

Clinical signs include ataxia, lethargy, sedation, hypothermia, metabolic acidosis, vomiting, diarrhoea, poor breathing, liver failure, coma, and death. And the hops in beer are also potentially toxic to dogs and cause dyspnoe, increased heart rate, elevated temperature, seizures and death.

Therapy

Severe ethanol intoxication requires mechanical ventilation. Electrolyte and acid-base status should be also corrected (Richardson, 
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Conclusion

There are also other human foods that may cause intoxications in pets, e.g. tomato, pottato, rhubarb, persimons, etc. The best advice must surely be to give animals foodstuffs and or treats specifically developed for their diets.

Saturday, November 24, 2012

Anterior Cruciate Ligament Rupture

Veterinary Partner.com is an excellent rescourse for veterinary information. It is free and written by well recognised authors. This is an article which I am posting here with thanks and acknowledgement to the authors of this article. This article discusses the causes, diagnosis and surgical options for treatment.The procedure that we typically perform in our hospital with a great deal of success is the extracapsular technique using a nylon or mersilene (soft flexible synthetic material) band. 






Ruptured Anterior (Cranial) Cruciate Ligament 
First, the Basics
The knee is a fairly complicated joint. It consists of the femur above, the tibia below, the kneecap (patella) in front, and the bean-like fabellae behind. Chunks of cartilage called the medial and lateral menisci fit between the femur and tibia like cushions. An assortment of ligaments holds everything together, allowing the knee to bend the way it should and keep it from bending the way it shouldn’t.
There are two cruciate ligaments that cross inside the knee joint: the anterior (or, more correctly in animals, cranial) cruciate and the posterior (in animals called the caudal) cruciate. They are named for the side of the knee (front or back) where their lower attachment is found. The anterior cruciate ligament prevents the tibia from slipping forward out from under the femur.
Finding the Rupture
The ruptured cruciate ligament is the most common knee injury of dogs; in fact, chances are that any dog with sudden rear leg lameness has a ruptured anterior cruciate ligament rather than something else. The history usually involves a rear leg suddenly so sore that the dog can hardly bear weight on it. If left alone, it will appear to improve over the course of a week or two but the knee will be notably swollen and arthritis will set in quickly. Dogs are often seen by the veterinarian in either the acute stage shortly after the injury or in the chronic stage weeks or months later.
The key to the diagnosis of the ruptured cruciate ligament is the demonstration of an abnormal knee motion called a drawer sign. It is not possible for a normal knee to show this sign.
The Drawer Sign
The veterinarian stabilizes the position of the femur with one hand and manipulates the tibia with the other hand. If the tibia moves forward (like a drawer being opened), the cruciate ligament is ruptured.
Another method is the tibial compression test where the veterinarian stabilizes the femur with one hand and flexes the ankle with the other hand. If the ligament is ruptured, again the tibia moves abnormally forward.
If the rupture occurred some time ago, there will be swelling on side of the knee joint that faces the other leg. This is called a medial buttress and is a sign that arthritis is well along.

It is not unusual for animals to be tense or frightened at the vet’s office. Tense muscles can temporarily stabilize the knee, preventing demonstration of the drawer sign during examination. Often sedation is needed to get a good evaluation of the knee. This is especially true with larger dogs. Eliciting a drawer sign can be difficult if the ligament is only partially ruptured so a second opinion may be a good idea if the initial examination is inconclusive.
Since arthritis can set in relatively quickly after a cruciate ligament rupture, radiographs to assess arthritis are helpful. Another reason for radiographs is that occasionally when the cruciate ligament tears, a piece of bone where the ligament attaches to the tibia breaks off as well. This will require surgical repair and the surgeon will need to know about it before beginning surgery. Arthritis present prior to surgery limits the extent of the recovery after surgery though surgery is still needed to slow or even curtail further arthritis development.
How Rupture Happens
Several clinical pictures are seen with ruptured cruciate ligaments. One is a young athletic dog playing roughly who takes a bad step and injures the knee. This is usually a sudden lameness in a young large-breed dog.
A recent study identified the following breeds as being particularly at risk for this phenomenon: Neapolitan mastiff, Newfoundland, Akita, St. Bernard, Rottweiler, Chesapeake Bay retriever, and American Staffordshire terrier.

On the other hand, an older large dog, especially if overweight, can have weakened ligaments and slowly stretch or partially tear them. The partial rupture may be detected or the problem may not become apparent until the ligament breaks completely. In this type of patient, stepping down off the bed or a small jump can be all it takes to break the ligament. The lameness may be acute but have features of more chronic joint disease or the lameness may simply be a more gradual/chronic problem.
Larger overweight dogs that rupture one cruciate ligament frequently rupture the other one within a year's time. An owner should be prepared for another surgery in this time frame.

What Happens if the Cruciate Rupture is Not Surgically Repaired


Without an intact cruciate ligament, the knee is unstable. Wear between the bones and meniscal cartilage becomes abnormal and the joint begins to develop degenerative changes. Bone spurs called osteophytes develop resulting in chronic pain and loss of joint motion. This process can be arrested or slowed by surgery but cannot be reversed.
  • Osteophytes are evident as soon as 1 to 3 weeks after the rupture in some patients. This kind of joint disease is substantially more difficult for a large breed dog to bear, though all dogs will ultimately show degenerative changes. Typically, after several weeks from the time of the acute injury, the dog may appear to get better but is not likely to become permanently normal.
  • In one study, a group of dogs was studied for 6 months after cruciate rupture. At the end of 6 months, 85% of dogs less than 30 pounds of body weight had regained near normal or improved function while only 19% of dogs over 30 pounds had regained near normal function. Both groups of dogs required at least 4 months to show maximum improvement. 
What Happens in Surgical Repair?
There are three different surgical repair techniques commonly used, and a fourth method that has fallen out of favor in recent years.
Extracapsular Repair

This surgery is currently favored as it can be performed in a relatively shorter time than the other procedures and does not require specialized equipment. The knee joint is opened and inspected. The torn or partly torn cruciate ligament is removed. Any bone spurs of significant size are bitten away with an instrument called a rongeur. If the meniscus is torn, the damaged portion is removed. A large, strong suture is passed around the fabella behind the knee and through a hole drilled in the front of the tibia. This tightens the joint to prevent the drawer motion, effectively taking over the job of the cruciate ligament.
  • Typically, the dog may carry the leg up for a good 2 weeks after surgery but will increase knee use over the next 2 months, eventually returning to normal.
  • Typically, the dog will require 8 weeks of exercise restriction after surgery (no running, only outside on a leash, including the backyard).
  • The suture placed will break 2 to 12 months after surgery and the dog's own healed tissue will hold the knee.
Tibial Plateau Leveling Osteotomy (TPLO)
This procedure uses a fresh approach to the biomechanics of the knee joint and is meant to address the lack of success seen with the above technique long term in larger dogs. Unfortunately, the technique has not yielded clearly superior results and controversy continues. With this surgery, the tibia is cut and rotated in such a way that the natural weight-bearing of the dog actually stabilizes the knee joint. As before, the knee joint still must be opened and damaged meniscus removed. The cruciate ligament remnants may or may not be removed depending on the degree of damage.
This surgery is complex and involves specific training in this technique. Many radiographs are necessary to calculate the angle of the osteotomy (the cut in the tibia). This procedure typically costs substantially more than the extracapsular repair as it is more invasive to the joint.
  • Typically, most dogs are touching their toes to the ground by 10 days after surgery, although it can take up to 3 weeks.
  • As with other techniques, 8 to 12 weeks of exercise restriction are needed.
  • Full function is generally achieved 3 to 4 months after surgery and the dog may return to normal activity.
Tibial Tuberosity Advancement (TTA)
The TTA represents another take on how to use the biomechanics of the knee to create stabilization. The theory behind this procedure is that when the cruciate ligament is torn, the tibial plateau (the top of the tibia) and the patellar ligament should be repositioned at 90 degrees to one another to combat the shear force generated as the dog walks. To make this happen, the tibial tuberosity (front of the tibia where the patellar ligament attaches) is separated and anchored in its new position by a titanium or steel cage, “fork,” and plate. Bone grafts are used to assist healing. This procedure was developed in 2002 at the University of Zurich and since then over 20,000 patients worldwide have had this surgery. Some experts prefer it to the TPLO while others prefer the TPLO. Both procedures require specific equipment and expertise and, again, no procedure has demonstrated clear superiority; controversy continues.
  • Typically the leg is bandaged for a week after surgery.
  • The patient's activity must be restricted and confinement is a must with gradually increased activity over 3 to 4 months. Most dogs can return to normal activity by 4 months after surgery.
Intracapsular Repair (sometimes still called over the top method)We mention this procedure for its historical significance although it is not one of the "big three." This procedure has fallen out of favor lately as it has been unable to demonstrate results superior to those of the extracapsular technique described above, though apparently it is still a popular repair method in the U.K.
Intracapsular repair intuitively seems like it should do better as it uses living tissue (rather than an artificial material) to essentially make a new ligament. This takes more time surgically. As with the extracapsular repair, the knee joint is opened, fragments of the ligament are removed, as is damaged meniscus. After this a strip of connective tissue is dissected locally and passed through the middle of the joint exactly where the cruciate ligament used to be. The new ligament is attached at the opposite end to an implant or simply sewn into place.
  • Bandaging for a couple of weeks after surgery is commonly recommended.
  • Again, the dog may not bear weight for a good 2 weeks after surgery and will likely require 2 months to return to normal function.
  • Again, 8 to 12 weeks of exercise restriction will be necessary for healing.
General Rehabilitation after Surgery
Rehabilitation following the extracapsular repair method can begin as soon as the pet goes home. The area can be chilled with a padded ice pack for 10 minutes a couple times daily. (Do not try to make up for a skipped treatment by icing the area longer; prolonged cold exposure can cause injury.) Passive range of motion exercise where the knee is gently flexed and extended can also help. It is important not to induce pain when moving the limb. Let the patient guide you. Avoid twisting the leg. After the stitches or staples are out (or after the skin has healed in about 10 to 14 days), water treadmill exercise can be used if a facility is available. This requires strict observation and, if possible, the patient should wear a life jacket. Rehabilitation for patients with intracapsular repair is similar but slower in progression.
Rehabilitation after TPLO or TTA is gentler. Icing as above and rest are the main modes of therapy. After 3 to 4 weeks, an increase in light activity can be introduced. A water treadmill is helpful. No jumping, running or stair-climbing is allowed at first. Expect the osteotomy site to require a good 6 weeks to heal.
What if the Rupture Isn't Discovered for Years and Joint Disease is Already Advanced?
A dog with arthritis pain from an old cruciate rupture may still benefit from a TPLO surgery and possibly from the TTA. Ask your veterinarian if it may be worth having a surgery specialist take a look at the knee. Most cases must make do with medical management. Visit our section on arthritis treatment.
Meniscal Injury
We mentioned the menisci as part of the knee joint. The bones of all joints are capped with cartilage so as provide a slippery surface where the bones contact each other (if the bones contact each other without cartilage, they grind each other down). In addition to these cartilage caps, the stifle joint has two “blocks” of cartilage in-between the bones. These blocks are called the menisci and serve to distribute approximately 65% of the compressive load delivered to the knee. The only other joint with a meniscus is the jaw (tempero-mandibular joint).
When the crucial ligament ruptures, the medial (on the inner side of the knee) meniscus frequently tears and must either be removed, partly removed, or ideally repaired. This is generally done at the time of cruciate ligament surgery and we would be remiss not to mention it.
Pets with meniscal damage may have an audible clicking sound when they walk or when the knee is examined, but for a definitive diagnosis the menisci must actually be inspected during surgery. It is difficult to access the menisci and thus repairing a tear in the meniscus is problematic; furthermore, poor blood supply to the menisci also makes good healing less likely. For these reasons, removal of the damaged portion of the meniscus is the most common surgical choice. This leaves some meniscus behind to distribute the compression load on the knee but removes the painful, ineffective portion.
Areas of current research include techniques to improve blood supply to the healing meniscus so that repair can be more feasible. If meniscal damage has occurred in a cruciate rupture, arthritis is inevitable and surgery should be considered a palliative procedure.
Another Link for more Information
Watch the Vetstoria video explaining diagnosis of ruptured cruciate ligament.



http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=1975

Saturday, November 10, 2012

Alberta Spay Neuter Task Force


The Alberta Spay Neuter Task Force (ASNTF) Team spayed, neutered, vaccinated, tattooed, and treated for parasites 187 dogs and cats. Our appreciation to the compassionate and caring medical team of 18 Veterinarians, 12 Animal Health Technicians and 4 veterinary students who provided great care for the animals that came to the clinic.


Thank-you so much to all of the awesome volunteers who assisted with our spay and neuter clinic for the Piikani First Nation, in Brocket, Alberta in October 2012!

Dr. Mark Rubensohn and Bridlewood Veterinary Clinic were pleased to once again be involved in this excellent program with the ASNTF.

For more information on this group and about there wonderful work visit the Alberta Spay Neuter Task Force Facebook page.

Saturday, November 3, 2012

Caution – Jerky Treats from China

Caution – Jerky Treats from China

In the light of increasing cases and information of illness in dogs that have been exposed to “Jerky Treats” manufactured in China, we would like to make sure that our clients are aware of this potential problem. We advise the use of pet foods and treats that are manufactured locally by recognized and trusted companies.
Signs to look out for that may be associated with jerky pet treats include decreased appetite and activity, vomiting, diarrhea and increased drinking and urinating. Laboratory findings may include signs of kidney problems including glucose and/or protein in the urine. Some of the reported cases may be the result of causes other than the consumption of jerky treats. This concern has not been definitively isolated to jerky treats so caution is indicated with all pet food products that originate from China. Currently the US FDA and numerous veterinary authorities are investigating this problem. Should you have a concern that your pet has become ill after exposure to imported treats, please notify your veterinarian immediately.

More information can be found at the following sites:

Sunday, August 26, 2012

Beyond the reflection: the dangers of windows

by birdscalgary

Posted by Matthew Sim
As the fall migration starts to heat up and southbound warblers, vireos, flycatchers, sparrows and more pass through Calgary, birding can become quite exciting. While for us, this is a great time to be out and about, for the birds, it is dangerous; very dangerous. Migrating passerines (perching birds), for example, have to travel long distances all while on the lookout for predators such as hawks and cats, try to get food themselves and hope they don't get caught in an early cold-snap which could potentially kill them. And this is just the beginning, there are even more dangers; one of them which is the most lethal of them all.
According to Sibley Guides Bird Mortalities, window strikes (when a bird hits a window) kill between 97 and 976 million birds each year, more than any other cause of birddeaths. (http://www.sibleyguides.com/conservation/causes-of-bird-mortality/).  I was in my neighbor's yard when I noticed one of these fatalities on his patio. While I had been there, a migrating Ovenbird had struck his window and had died. Though birds can crash into  windows at any time of the year, window strikes tend to happen more frequently during migration as an influx of migrants come through unfamiliar territory, passing from tree to tree. As you can see in the photo below, it is quite easy for a birdto see its habitat reflected in a window and believe that it is simply another tree they are heading to; I'm sure most don't know what hit them.

If I were a bird, I would probably fly towards these trees too.
Many bird populations are declining already due to a number of reasons and we don't need to help them along with  reflective windows when we could easily prevent window strikes occurring.

This Ovenbird had struck my neighbor's window while I was in his yard.

A closer look at the detail on the Ovenbird's feathers
Probably the worst part of all this is that window strikes are senseless; it's not like natural selection where it was meant to happen, window strikes are part of our devastating side effects on nature; however, they can also be easily prevented.
There are many ways to prevent birds from striking windows. If you are having birds fly from your feeders or bird baths into windows, you can either move these bird attracting features further away (25-30 feet) from the window or closer (1-3 feet) to the window so that if the birds do hit the window at just 1-3 feet they will not be going fast enough to do any harm to themselves.
Apparently, there is also a material called CollidEscape which can reduce reflectivity and transparency on the outside but still leave the windows transparent from the inside. You can check it out here.
Here are a few more options:
  • plant shade trees outside windows to break down reflections
  • install snap-on window dividers
  • put a hanging plant outside of the window
These are just a few of the ways you can avoid window strikes and help reduce the number of avian mortalities each year. Often, preventing window strikes can be as simple as closing the curtains or blinds when not using the windows. You can see even more solutions here.
If you have birds hitting your windows, there are many ways to stop it; help out bird populations!



I would like to thank Birds Calgary and Matt Sim for this insightful article which I have re-posted here in full.