THYROID CONDITIONS IN PETS

During the holiday season overindulgence in food can lead to the bathroom scales suggesting a Jenny Craig or Weight Watchers critical list patient. In pets, mild to severe swings in weight can be to a variety of reasons: overeating, under eating, lack of exercise, and metabolism issues. One common condition involves the hormones of the thyroid gland.

WHAT IS THE MOST COMMON THYROID CONDITION IN CATS? SIGNS?

Hyperthyroidism, an overactive thyroid condition due most commonly to a benign thyroid tumor. Signs include one or more of the following: weight loss, increase in thirst & urination, hyperactivity, racing heart, change in personality, vomiting, and diarrhea.image.jpeg


How is it diagnosed? At what age?

A blood test where a thyroid level T4 is measured. Typically the condition is first seen in middle-aged cats.

Do owners have more than one option for treatment?

Yes. Oral medication for life (methimazole), surgery to remove offending gland, and a one-time radioactive iodine injection that cures the patient in most cases.

Are there risks with lack of treatment?

Yes, severe weight loss, heart conditions, and death.

WHAT IS THE MOST COMMON THYROID CONDITION IN DOGS? WHAT ARE THE SIGNS?

Hypothyroidism, an under-active thyroid condition. Signs include one or more of the following: weight gain, sleeping more, dull coat, symmetrical hair loss, seeking warm places, and thickened/darkened skin.  Occasionally facial paralysis of one side of the face is noted called Bell’s Palsy.

HOW is it diagnosed? At what age?

Blood test to measure thyroid levels of T4, Ft4 by equilibrium dialysis, and occasionally thyroid stimulating hormone levels. Patients on certain medications may have falsely low thyroid levels and that must be taken into account.  Typically middle-aged dogs develop the condition, although it has been seen as early as three years of age at this practice.

Are there any breeds of dogs that seem more at risk?

Golden Retrievers and Doberman Pinchers







What is the treatment for hypothyroidism in dogs?

Levothyroxine that replaces missing hormone

Betsy Sigmon, DVM, Diplomate American Board of Veterinary Practitioners, Canine & Feline

Creature Comforts Animal Hospital

Cary, NC

NC Chinese Lantern Festival

For interesting and inexpensive ways to create  toys for cats visit
https://www.purinaone.com/cats/enrich-feeding-time-for-your-cat-make-a-puzzle-feeder

In addition:
An empty box with or without a ball, toy, or catnip
Ping pong ball in an empty tissue box or bath tub
Paper bags

Pain Management: The Creature Comforts Difference

This past weekend, I took a road trip to Richmond and Williamsburg, Virginia to see an exhibit at the Virginia Museum of Fine Arts, stroll the light show in the Lewis Ginter Botanical Gardens, 

participate in the “Tacky Christmas House Tour”,

visit Yorktown, and walk the streets of Colonial Williamsburg. 

Although I missed the Grand Illumination in Williamsburg that occurs the first Sunday in December, there were plenty of other beautiful and fun sightings.

My biggest question was which direction to go home?  I elected to take the Jamestown Ferry home via the Courtland, Virginia route. 

It brings to mind the many directions to approach pain. What is time tested versus new?

WHAT IS PAIN?

Pain is an unpleasant and emotional experience associated with actual or potential tissue damage. Pain is a constant concern of all pet owners during any dental, medical, or surgical procedure, as well as for age-related conditions.  In simple terms, it HURTS! As a member of the International Veterinary Academy of Pain Management, Dr. Sigmon’s objective is to promote the interdisciplinary approach to animal pain management by WORKING with experts all over the country in the area of pain management. 

SINCE PETS CANNOT SPEAK FOR THEMSELVES AND RARELY VOCALIZE PAINFUL CONDTIONS AT HOME, HOW DOES AN OWNER RECOGNIZE SIGNS OF PAIN?

Hiding, not eating, curled up in a corner, stiffness on rising, difficulty posturing to urinate/defecate, and guarding the back, abdomen, or limbs. In dental disease, rubbing the mouth, drooling, and dropping of FOOD are among those on a checklist that CCAH utilizes.

Creature Comforts offers the following options to lower pain.

SURGICAL AND DENTAL PRE-EMPTIVE PAIN CONTROL

_____Lidocaine gel patch 20 minutes prior to catheter placement

_____ Pre-surgical, Pre-dental pain medications tailored to your pet’s needs and thus decreasing depth of anesthesia as much as 20%

____Pre-emptive(interventional) pain medications during surgical procedure

____ Local blocks of surgical sites to further decrease depth of surgical requirements

____Injectable pain meds post operatively to allow your special pet to “snooze” or rest post-operatively

____ Oral pain medications dispensed and discussed at discharge 

WHAT ARE SOME OF THE NEWER COMBINATIONS++ OF ORAL PAIN MEDS FOR DOGS?

1.      NSAIDS- rimadyl, previcox, and metacam (or generics) 

2.      GABAPENTIN (also for nerve pain, seizures) – may take up to 2 weeks to be effective

3.      AMANTADINE (also for Parkinson’s disease) 

++ Multi-modality (many different combinations) of pain medications using recommendations and recent developments of experts from veterinary research facilities

ARE THERE SOME HOLISTIC OPTIONS?

_____Diet management (ROYAL CANIN MOBILITY DIET) and weight control (cut intake 1/3^rd & add veggies)

_____ Omega 3 fatty acids 1000 TO 2000 MG PER 20 LBS, START SLOW

_____ joint supplementations injectable (Adequan)

_____ Dasuquin, Cosequin, oral, natural joint supplements

____ Rehabilitation, physical therapy-written plan, not just free play in back yard

____Acupuncture

____Herbal supplements

HOW MANY LONG TERM PAIN MEDICATIONS ARE APPROVED IN THE UNITED STATES FOR CATS?

ZERO. Currently all pain medications for cats used long term are considered extra-label usage.

 WHAT’S NEW ON THE HORIZON FOR PAIN MANAGEMENT IN 2015?

______Prozac

______Elavil or Clomicalm (medications prescribed for depression & anxiety)

______Capsaicin (think Liquid Heat home remedy)

______Resveratrol in red wine and how much pain control is new study

______Minocycline antibiotics

______Steroids

_____Tanezumab ( utilizes the immune system via monoclonal antibodies to attack a mediator of pain- nerve growth factor) – not on market , allowed 6 weeks of pain control from a single injection

_____Aratana –grapiprant

____Fentanyl patch or gel-Recuvyra fentanyl gel lasts 4 days (keep away from children

____Exparel (liposome encapsulated) and lasts 72 hours

Betsy T. Sigmon, DVM, Diplomate American Board of Veterinary Practitioners, Canine & Feline

Creature Comforts Animal Hospital

Cary, NC

Many thanks to Memphis Woodall's family for the holiday photos. Below are some of the door decorations from Colonial Williamsburg.

SNEEZING CATS: HERPES VIRUS INFECTIONS

I am back from Kanas City to see the son of a Kernersville friend win with his horse at the American Royal Horse Show. In addition, I saw a parade horse class similar to that seen in the Tournament of Roses Parade, traveled to see President Harry Truman’s home place & library,

witnessed a Sicilian donkey race,

and had a private tour of one-hundred-year old mansion decorated by the same group out of NYC that did the Vanderbilt mansions. As a side trip I went to see a Museum of Natural History touring exhibit on the horse at the Prairie Fire Museum in Overland Park, Kansas

and visit a coffee roaster that had a DC-3 as their symbol on the top of the building.

All were very cool stuff!


My only complaint was the dry air caused a lot of sinus irritation and nose bleeds. It took several days to return to normal. Unfortunately, many of my kitty patients do not have such short courses of sinus discharge and sneezing.

WHAT IS THE MOST COMMON COMPLAINT IN NEWLY OBTAINED CATS OR KITTENS FROM RESCUE GROUPS, HUMANE SOCIETIES, FERAL COLONIES, OR OTHER FACILITIES INHABITED BY LARGE NUMBERS OF CATS?

Discomfort associated with crusty/snotty noses and weepy/red eyes. These problems are commonly ASSOCIATED with viral Herpes upper respiratory infections(URI). Often they develop secondary opportunistic bacterial infections. Herpes viruses are mainly life threatening in weak kittens that stop eating or develop secondary pneumonia. Other signs may include any combination of the following.

• Sneezing “attacks”

• Eye ulcers

• Fever (NORMAL IS 101 TO 102.8F)

• Loss of appetite (loss of sense of smell)

• Drooling

• Squinting

HOW DOES HERPES VIRUS INFECT CATS?

The virus invades the nose, eyes, sinus, throat, mouth and tonsils of a cat which causes inflammation and fever. This is life threatening in kittens.


ARE FELINE HERPES VIRUS CONTAGIOUS TO OTHER CATS? PEOPLE? DOGS?

Yes, they are highly contagious (shared litter boxes, grooming), so it is always wise to isolate a cat under treatment, and to feed and water your sick kitty separately in multi-cat households. Even with careful isolation, because the stress factor (ex. Neutering), relapses are common. These problems usually resolve within a few weeks of good care but some cases linger and continue to shed for months.

It is not contagious to humans and dogs.

HOW IS IT DIAGNOSED?

Most commonly by signs as viral isolation is reserved for more persistent cases.

DO VACCINES PREVENT THE VIRAL HERPES INFECTION?

There are vaccines, however, most kittens are already infected with the herpes (rhinotracheitis) before they leave their mothers. Immunizations do not prevent infection, rather they lower the severity of the infection.

ARE SOME CATS PERMANENTLY INFECTED AND PERSISTENT SHEDDERS OF THE HERPES VIRUS?

Yes, once infected, the virus remains in a cat’s body for the rest of their life.


WHAT ARE SOME OF THE MOST COMMON TREATMENTS?

Supportive care as there are no cures for viruses, only the secondary bacterial infections. Some will remain infected the remainder of their lives. Treatment of the eye infections with topical medications is critical, especially if painful corneal eye ulcers (herpetic ulcers). Flare ups of herpes virus can return with the stress of boarding, changes in the house routine, and other illnesses. Here are some additional approaches to care:


• Keeping the nostrils and eyes clear of discharges. Use cotton balls dipped in warm water to wipe away any discharge.

• Antibiotics may be prescribed, but these are ineffective against the herpes virus, but may be used to treat secondary infections that can occur.

• Antiviral drugs: Famcyclovir, anti-nausea drugs: Cerenia

• Ensuring the cat is receiving food and liquid intake. Force feeding, IV fluids or sub cutaneous fluids if necessary.

• L-Lysine is an essential amino acid which has been shown to suppress viral replication.

• Intranasal vaccine 2 to 3 times a year

• Human alpha 2b interferon

• Probiotics

• Zyrtec once a day as an anti-histamine




Dr. Betsy T. Sigmon, Diplomate American Board of Veterinary Practitioners, Canine & Feline

Creature Comforts Animal Hospital

Cary, NC



Many thanks for the kind works, and many purchases of the new children’s book, CHA CHA Chacobelle and the Canine Conga. Let me know if you would like me to do a reading at your elementary school or library.

I have learned in the presentation last Thursday at West Lake Elementary School that when you imply that every child has a gift, do not be surprised if the ask “where is our present” at the end of the reading. I think next time I will substitute the word “talent” for gift.



Here is the link to an electronic version of the article
http://www.newsobserver.com/news/local/community/cary-news/article42609009.html



Fall night at dusk over Dutchman Down Lake area

RETINAL DETACHMENT, RETINAL TEARS: WHEN THE DOCTOR BECOMES THE PATIENT

Last Thursday started no different from any other day. With my slightly “frizzy’ hairdo, I commonly removed stray, out-of-control hairs from my face and eyes. In this case, however,  I noted that even with my eyes closed, the hair remained. I called the ophthalmologist for an afternoon examination. As the day progressed, my outlook morphed into that spectrum similar to looking through a lava lamp. I reflected on the knowledge that I had two sisters with spontaneous retinal detachments, both needing surgery in the past 5 years. 

Fortunately, Wake County citizens are blessed with talented medical care. By 4p.m., my ophthalmologist, Dr. Christopher Rusinek, had diagnosed a retinal tear and referred me five minutes down the road to Dr. John Denny at North Carolina Retina. Thirty minutes later, after a minor laser procedure, my condition was treated, and hopefully, I can avoid more major surgery for retinal detachment. I was back at work the next day with limited restrictions on reading, lifting, and bending for a few days. 

This event made me revisit retinal conditions in pets. I consulted with Dr. Jennifer Fontenelle at Animal Eye Care in Cary and Dr. Cynthia Cook at Veterinary Vision in San Francisco. Below are some of the questions and the specialists' responses.

Do you ever see early/ partial detachment in dogs or almost always complete detachments?

Yes, partial detachments occur and can progress. When partial, they are amenable to barrier laser retinopexy (laser assisted tacking) to prevent progression. See web page referenced below.

What is difference between human detachments and those seen in dogs? 

The causes and the duration. The causes in dogs are more related to congenital retinal dysplasia; where humans experience cystoid degeneration and multiple other aging changes). As for  duration, people present earlier for obvious reasons (i.e. early & sudden changes in vision).

In cats with detached retinas, is the cause almost always due to high blood pressure?

Yes, systemic hypertension is the most common cause of retinal detachment in cats.

For retinal detachments in dogs is it normally one eye or both?

It depends on cause.  Once again, the web reference below is an excellent source.

In dogs, if the retina is detached, what are treatment options?

It depends on cause, duration, and prognosis for vision.

Is it most commonly associated with glaucoma or cataract surgery in dogs?

It could be a complication of any intraocular surgery. Glaucoma surgical techniques are both intraocular (ECP) and extra ocular (TSCP). Cataract surgery is a more common intraocular procedure and is thus associated with an overall greater number of post-op detachments.

For more detailed information as to the causes and  treatment, visit the following web page.http://veterinaryvision.com/for-veterinarians/clinical-forum/specific-disease-topics/retinal-detachment/

Dr. Betsy T. Sigmon, DVM, Diplomate American Board of Veterinary Practitioners, Canine & Feline

Hospital Director, Creature Comforts Animal Hospital PLLC

Cary, NC

This is a normal back of the eye ( fundus) with a round optic nerve in a canine

This is a normal fundus with a triangular shaped optic nerve head in a canine

This is a husky with retinal hemorrhages, small

This is a detached retina in a dog.

Here is another patient with a detached retina.

Below  is a  photo of a cat with retinal bleeding due to high blood pressure (hypertensive retinopathy.

This is a laser.

Here is Dr Cook operating on a patients's eye.

Once again, many thanks to Drs. Cynthia Cook and Jennifer Fontenelle for sharing their photos.

BLOAT (GASTRIC DILATION) IN DOGS

  

There has always been an assortment of great food choices when traveling throughout our state. I recently traveled up to Butner, NC to visit Architectural Trees to obtain some specimens for a conifer garden at the house. On the way home, Bill’s Bar-Q enticed me into getting some southern comfort food, topped off by coconut pie. Yes it was quite good!

Unfortunately, many times pets, either by choice or by accident, present with over distended stomachs.  Sometimes it is by getting into extra food or the trash cans. In other cases there is no obvious cause of the swelling.  In the case below, a young puppy overate, then vomited, and aspirated food into his lungs.  

WHAT IS CLASSICAL BLOAT/DILATION?    HOW IS THIS DIFFERENT FROM VOLVULUS?                                               

Bloat, a veterinary emergency in dogs, is a condition in which the stomach is distended with air, more scientifically called Gastric dilation. When the dilated stomach rotates 90 to 360 degrees it called gastric dilation and volvulus (GDV).

It is more common in large breeds of dogs over seven years of age.   The most commonly affected breeds are the Great Dane, Weimaraner, Saint Bernard, Gordon setter, Irish setter, Doberman Pinscher, Old English sheepdog, and Standard Poodle. The Bassett hound is at greatest risk among smaller breeds.  The underlying causes for GDV are poorly understood, although there are several recognized risk factors which are described below. 

WHAT ARE THE SIGNS NOTED BY OWNERS?

 They are often that of acute distress: distended abdomen, pain, drooling, retching, increased heart rate, and difficulty breathing. 

EXPLAIN THE SEQUENCE OF EVENTS LEADING TO THE RAPID CRISIS?

 Due to a compromise of the circulatory system from a compression of vessels by the dilated stomach, acute collapse, shock, and even death may come quickly. The severe shock comes quickly and is accompanied by death of the stomach lining, enlarged spleen, and even stomach rupturing which releases toxins into the abdomen and general circulation. Death may happen in as little as 4 to 6 hours, and it the second leading cause of death in large breeds of dogs, second only to cancer. 

ARE THERE COMMON FINDINGS ON RADIOGRAPHS (X-RAYS)?

 Radiographs demonstrate a severely enlarged, gas-filled stomach that if twisted has several compartments called a “double bubble” that may ping when thumped.

EMERGENCY CARE STEPS?

 In many cases, the patient is so compromised that emergency treatment to tap off the gas from the stomach is required by placing catheters in two to three veins to administer lifesaving IV fluids for shock. Emergency surgery supersedes the ability to take time for diagnostics. Definitive treatment involves surgery to correct the position of the stomach, remove devitalized, non-viable tissue (spleen and portions of stomach if necessary), and to perform a gastropexy (stomach tack) to lower the risk of reoccurrence. Intensive 24-hour post-surgical care is critical to decreasing mortality. Treatment for infection, electrolyte abnormalities, shock, pain, and heart arrhythmias can be emotionally and financially draining.

RISK/PROGNOSIS?

The prognosis is up to a 15% mortality rate for patients with GDV treated surgically with a viable stomach lining. However, if circulation to the stomach wall has been compromised with delays of five or more hours, there is an increased risk of death. Other factors associated with a guarded prognosis include low body temperature and low blood pressure at presentation.

NAME THE ACTIONS THAT MAY LOWER THE RISK?

Prevention is an evolving target with no solid definitive answers. It is strongly recommended to perform a Prophylactic gastropexy (stomach tacking) in breeds at high risk for GDV to lower the risk of stomach twisting. Some surgeons perform the procedure via laparoscopy. Several recommendations have been made to prevent gastric bloat after discharge or to prevent GDV in dogs that have not had a gastropexy such as dividing feedings into several small meals a day, do not feed dry foods that contain an oil or fat ingredient listed as one of the first four ingredients,  or feed a small kibble size (<30mm). Avoid stress during feeding. Do not elevate feeding bowl during eating and discourage rapid consumption. Restrict exercise before and after meals.

Betsy Sigmon DVM

Hospital director/owner Creature Comforts Animal Hospital

Special thanks to Dr. Kyle Mathews, Professor, Small Animal Surgery at NCSU for his assistance in review of this article

The Chi is Caroline Sheremeta

The French Bull dog is Soho Dettelbach

The Shepherd cross featured in this article is Murphy Lauberts.