RINGWORM IS NOT A WORM AND RARELY A RING

It is that time of year when new kittens and puppies abound, and there is nothing cuter. As many are available at shelters and rescue organizations, clients often present with “cuddling creatures” circled around their bare arms or neck. 

In a few weeks, on rare occasions, a phone call to Creature Comforts will question the cause of some hair loss in one or more areas on their pet's body. Slightly more concerning is unexplained circular redness on the skin of a family member, especially children. 

WHAT IS RINGWORM?

 Also called Dermatophytosis, ringworm is widely known as a common, fungal, skin disease of cats and some dogs. It is zoonotic, meaning it can be transmitted to people from their pets. Although NOT life threatening, it can be difficult and very time consuming to rid a pet and the home environment from spores (infection) of this disease.

ARE THERE COMMON CLINICAL SIGNS?

Local or widely spreading hair loss, scaling, and skin lesions are the most common complaints by owners to veterinarians.  Some cats may concurrently have chin acne and very waxy ears. The fungus feeds on the dead cells leading to crusty margins and a red center. It can be quite itchy! The ring is more common in people rather than pets. Unfortunately, some animals are carriers, meaning they show no signs; rather, they are a source that simply infects other animals. 

ARE THERE RISKS/COMMON DENOMINATORS THAT MAY PLAY A ROLE?

Some of the more common causes are young puppies & kittens (actively dividing cells more likely to grow fungal spores), underlying disease, poor nutrition, warm/moist climates, stress, exposure to a large number of other cats/dogs, and exposure to the outdoors (dirt).

DID I HEAR THAT RINGWORM CAN LIVE IN THE ENVIRONMENT/HOUSE/ CATTERY FOR YEARS?

Yes, all it takes is skin contact with one spore to develop an infection; however, the skin has to already have an irritation as the spore normally cannot invade healthy skin. Itchy pets will be more at risk. 

HOW IS IT DIAGNOSED?

Fungal cultures of plucked or brushed hair from the suspected areas (i.e. takes 1 to 2 weeks) are the most common.  Direct microscopic identification or special black (ultraviolet) light examinations of fur are other methods.  In rare cases, a skin biopsy is indicated. 

I AM STILL CONCERNED THAT PEOPLE CAN DEVELOP RINGWORM ON THEIR SKIN. ARE THERE SOME RISK FACTORS?

Children, elderly, and people on chemotherapy or with compromised immune systems are the most common population of concern to obtain infections. 

WHAT ARE THE COMMON TREATMENTS AVAILABLE FOR ANIMALS?

 - Itranconazole or fluconazole oral tablets daily 

- Lime Sulfur Dip (smells and yellow discoloration to the coat). The dipping is to lower the contamination of the household or facility. 

-Shampoo’s such as Chlorihexiderm, malaseb (miconazole), and ketaconazole (Ketochlor) are suggested to wash off superficial spores

HOW CAN THE HOUSE OR CATTERY BE DISINFECTED TO CUT THE RISK OF RE-INFECTION?

Treat the environment's hard surfaces with 1:10 diluted bleach (spot check first and do not use on wood floors). A poultry house disinfectant enilconazole  (Clinifarm) is available in some areas. Also, vacuum frequently and change air filters. 

Repeat fungal cultures every two to four weeks, until 2 are negative while staying on the anti-fungal treatment. 

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

Creature Comforts Animal Hospital 

Cary, NC

A NEW WAVE HAS HIT NORTH CAROLINA: CANINE INFLUENZA

North Carolina is known for its beautiful lakes, many of which are a short drive from Cary. I personally take advantage of the gracious invitations from friends to escape to a couple of these magical places: Lake Gaston and Hyco Lake.

Sitting dockside, swimming, riding on a pontoon boat to a lake side hamburger joint, watching wake surfacing, or night-time cruising are wonderful summer memories this month.  My friends involve their dogs in many of the lake activities.Seeing happy, healthy dogs engaged in pure fun is summertime bliss. 

Unfortunately, this week has been marred by the news that the Canine Influenza, H3N2, first noted in Chicago in March of 2015 (see CCAH blog “flu” or” influenza” on this website side column) that afflicted over 1600 dogs, has appeared in North Carolina.  It also has been reported in Atlanta, Chicago, Miami, and New York City.  http://www.ncagr.gov/vet/aws/canineflu/

WHY IS THIS A CONCERN?

There is no vaccine to protect against this new virus and dog fatalities may be up to 10% in exposed animals. There is no risk to humans at this time. 

ISN’T THERE A VACCINE FOR CANINE INFLUENZA?

As noted previously, the current H3N8 flu vaccine lowers risk – but it does not prevent the H3N8 flu. This vaccine does not appear to offer any direct protection to the H3N2 flu variety, but it may offer some cross protection.

SHOULD MY DOG BE VACCINATED WITH THE H3N8 VACCINE?

The H3N8 flu strain is still a risk. For active, social dogs involved in dog park socials, day care, grooming, or freely socializes with neighborhood dogs it should be a vaccine consideration.

CAN CATS GET THIS DISEASE?
Yes, there have been reports of sick cats with the H3N2 influenza virus in some shelters.

WHAT IS THE INCUBATION PERIOD OF THIS FLU VIRUS? Where is it in North Carolina?

Two to four days, and that is also when the virus is most contagious to other pets. It has been reported in Asheville, Winston-Salem, and Greensboro.

http://www.ncagr.gov/paffairs/release/2015/7-15-canine-influenza-confirmed-in-NC.htm

PLEASE REVIEW THE SIGNS OF THE INFLUENZA VIRUS?

Low grade fever, eye discharge, depression, lack of appetite, nasal discharge, cough, and in rare cases pneumonia. 

IS THE FLU VIRUS IN DOGS UNDER-REPORTED OR PERHAPS IS THERE A HIGHER NUMBER OF DOGS INVOLVED?

Yes, because this disease is not required to be reported to authorities, nor are pet owners required to test.

HOW LONG IS A DOG CONTAGIOUS?

Up to 20 days, with a cough persisting in some dogs for months.

IS THERE A TEST FOR THE H3N2 VIRUS?

YES, several laboratories (Idexx, Cornell, and Iowa have tests) that can test nasal secretions in the first four days of exposure. After that nasal swabs are less reliable, and then two blood samples submitted three weeks apart are recommended to confirm diagnosis. 

SINCE THE VIRUS HAS BEEN REPORTED IN NORTH CAROLINA, WHAT PRECAUTIONS SHOULD BE TAKEN?

Watch closely for reports of sick dogs in the area. For the moment, it is likely more stringent recommendations may be suggested by the Creature Comforts Team if the situation migrates to our area. That would  mean no dog parks, no visits to pet stores, and perhaps avoiding dog day care, boarding, and grooming (unless mobile comes to your home). In the event of an outbreak in Wake County, even skipping group dog training classes may be needed. Private lessons may be preferred. 

Betsy T. Sigmon DVM, Diplomate ABVP Canine & Feline Practice

Creature Comforts Animal Hospital

Cary, NC

Creature Comforts salutes Michelle Widmann for Rescue Recognition for volunteering  with Saving Grace Pet Adoption in Wake Forest. She fostered “Megamind” during his recent health issue with a jaw infection. 

THE ROAD LESS TRAVELED, ALTERNATIVE MEDICINE/ ACUPUNCTURE

     

When I was recently in California riding a Segway named “Bend & Snap”, a takeoff from the Legally Blonde movie. I have to say a five hour+ plane ride in each direction resulted in some significant joint pain. As a traditional, Western Medicine Practitioner, I wanted to explore other, alternative ways to treat pet conditions.

Responding to the great interest by our clients, Creature Comforts is introducing an Acupuncture/Holistic Practice service as of Thursday, July 9th. The following blog is written by our newest veterinary team member, Dr. Allison Schnoke. 

WHO IS ALLSON SCHNOKE DVM?

My name is Allison Schnoke, and I am the newest addition to the veterinary family at Creature Comforts. I graduated from the College of Veterinary Medicine at the University of Florida in 2011 with a focus in small animals (dogs and cats). After receiving my Doctorate in Veterinary Medicine, I completed a yearlong rotating internship at Affiliated Veterinary Specialists in Maitland, FL.

WHERE DID YOU TRAIN IN THE METHODS OF ALTERNATIVE THERAPIES?

 I studied Traditional Chinese Veterinary Medicine (TCVM) at the Chi Institute and became certified in Veterinary Acupuncture in 2013.  It is this portion of my medical training that makes me unique, and the part that I would like to familiarize you with a little more. Since this ancient field of medicine (acupuncture has been practiced for thousands of years) is becoming more popular,  yet is still widely unknown, I have decided to give you a brief introduction to this fascinating topic. 

What can veterinary Acupuncture do for my dog or cat?

1.    The goal of veterinary acupuncture is to use tiny metal needles (about the width of a hair) placed in strategic and specific points on an animal to help stimulate the body to heal itself. Veterinary acupuncture stimulates the release of your animal’s own pain relieving and anti-inflammatory substances.  Veterinary acupuncture improves tissue blood flow and oxygenation, decreases inflammation, and helps regulate the immune system. Unlike prescription and over the counter medications, veterinary acupuncture very rarely has negative side effects. 

Why use Veterinary Acupuncture?

The good news about veterinary acupuncture is that it works very well with conventional (western) medicine and surgery. In fact, the two disciplines can be utilized together and can work synergistically, since each discipline has it’s own pros and cons.  Additionally, by using a more holistic ideology, this integration of old and new can help a veterinarian achieve a more thorough evaluation of a pet’s entire body, environment, diet, medical history, and temperament, to appropriately implement a combination of treatment and strategies for prevention.

Traditional Chinese Veterinary Medicine (TCVM) can benefit all life stages (juvenile, adult, and senior) and a large variety of conditions.  The term TCVM encompasses more than just acupuncture. It also includes herbal medicine and food energetics (changing the diet to help treat and prevent disease). 

What types of diseases can potentially be treated with Veterinary Acupuncture and Traditional Chinese Veterinary Medicine (TCVM)? 

Disclaimer: TCVM should be used only when conventional medicine and/or surgery are not effective or possible. TCVM therapy will not work for every animal and certain conditions have a higher response rate than others.

1. Musculoskeletal disorders (arthritis, hip dysplasia, cranial cruciate ligament disease, soft tissue injury, lameness, back or neck pain, joint disease, unexplained pain)

2. Neurological disorders (Intervertebral disc disease/slipped disc/bulging disc, paralysis and paresis, weakness, ataxia (wobbliness), vertigo, seizures)

3. Gastrointestinal disorders (vomiting, diarrhea, inflammatory bowel disease, inappetence, constipation, megacolon)

4. Dermatological disorders (itching, scratching, hair loss, hot spots, lick

granulomas, ear infections)

5. Behavioral disorders (aggression, stress, anxiety, fear, inappropriate elimination)

6. Cancer and any side effects of chemotherapy

7. Internal medicine disorders (liver disease, renal failure, asthma, coughing, laryngeal paralysis, immune mediated disease or dysfunction, urinary and/or fecal incontinence)

If I choose Veterinary Acupuncture for my pet what is the time commitment and how will I know if it is working?

The first consult and treatment together takes about 1.5 hours.  Each subsequent treatment takes about 45 minutes. Your pet can be “dropped off” for this treatment at no additional charge. It depends on the reason for therapy, but a schedule of subsequent rechecks and treatments will be discussed with you at the first appointment.   The response to treatment will manifest and be monitored in different ways depending on your pet. It takes three consecutive treatments (anywhere from one week to three weeks apart) in order to determine if your pet is having a positive response to the therapy. Some pets with acute disease (disease that happens quickly and is treated quickly) may only require a few (three to six) treatments to resolve the issue.  Other pets with more chronic (long standing) or complicated disease may require long term or even life long therapy.  

Creature Comforts Welcomes Dr. Schnoke and invites our veterinary clients to call for information regarding scheduling appointments combining traditional with alternative medicine protocols.

Betsy T. Sigmon DVM, Diplomate ABVP Canine & Feline Practice

Hospital Director

Creature Comforts Animal Hospital

Cary, NC

DOES MY DOG’S LIVER HAVE BAD PLUMBING (CIRCULATION)?

I spent the Fourth of July Holiday week end in the Mountains of North Carolina with a dear friend. In the process, we visited the Boone Farmer’s Market. I especially loved the truck bed loaded with chickens for sale.

On the way home we passed the Independence Day Puppet Parade in the small river town of Todd, NC. http://www.examiner.com/article/fourth-of-july-nc-liberty-parade-todd

Otherwise it was a weekend of hikes alone on the creek beds that cross property surrounding the cabin.

With the dogs, Kate, Lola, and Duke, we crossed streams, chased tennis balls, and collected wild flowers. 

For Bear, the 12 yr. old Chesapeake Bay retriever, all is not as it seems. He is missing his right eye as a complication to glaucoma, is arthritic, and has some changes in his liver. 

For his age, infirmities are anticipated and treated accordingly to support a good quality of life.

As a child, I would be forced to eat liver (flavored with bacon) that I found extremely foul and a form of punishment. Upon entering college and learning the filtration function the liver serves, my theory of its nastiness as a meal was confirmed. The packaged version at the meat counter confirmed my distaste.

 However, I am intrigued by the many hepatic(liver) functions.

In younger dogs, abnormal liver bloodwork values can be an unexpected surprise. To help explain one common liver (hepatic) disease, I will focus on a condition called microvascular dysplasia. 

I KNOW MY DOG HAS A LIVER, BUT WHAT DOES IT DO?

The liver performs an amazing list of duties. It acts as a sewer treatment plant, works to help store sugar, and manufactureskey proteins. To accomplish these tasks, most of the blood that is carried to the liver for these processes arrives via the portal vein from the intestines.

OKAY, BORE ME WITH AN ANATOMY LESSON OF BLOOD FLOW TO THE LIVER. 

The MAIN TRANSPORT BLOOD VESSEL TO THE LIVER ( portal vein ) drains the intestines, stomach, pancreas, and spleen. Within the liver, the portal vein branches into many smaller vessels so that the blood can filter throughout the tissues to each liver cell.

WHAT IS MICROVASCULAR DYSPLASIA (MVD) OF THE LIVER? 

When these mini vessels are abnormal on liver biopsy, the condition is called "hepatic microvascular dysplasia (HMD or MVD)" or "portal atresia". This means the microscopic vessels within the liver are underdeveloped or absent; subsequently, the liver becomes smaller and stops processing toxins, sugars, and proteins normally. It is also called PORTAL VEIN HYPOPLASIA. 

 When larger vessels outside or inside the liver are involved it is called a portosystemic shunt.

WHAT ARE THE CLASSICAL SIGNS OF THIS LIVER SHUNTING DISORDER I SHOULD LOOK FOR WHEN SELECTING A PUPPY FROM A BREED AT RISK?
A young dog less than 1 year of age that is a “poor doer” or not as big or as strong as litter mates are common denominators.  Some would call these puppies the “runt of the litter “with a “sensitive stomach”. Others will have difficulty in housebreaking with an increase in thirst and urination. They may lay around a lot or seem tired due to toxins not being eliminated by the liver and subsequently accumulate and insult the brain. In more advanced cases, seizures and distended “pot bellies” will be noted.   Unfortunately, in some cases, especially Schnauzers, the disease may not manifest until five to seven years of age.  It should be noted that many dogs with the condition show no signs. 

ARE CERTAIN BREEDS MORE COMMONLY AT RISK?
Some breeds are more commonly affected: Yorkshire Terriers, Cairn Terriers, Maltese, West Highland Terriers, Dachshunds, Pugs, Schnauzers, Poodles, Shih Tzu, Lhasa Apso, Havanese, and Cocker Spaniels. It has rarely been reported in Irish wolfhounds, Golden Retrievers, and Labrador Retrievers,  although any breed may be afflicted. 

THE BLOODWORK AND URINE SAMPLES ARE OFTEN ABNORMAL. CAN YOU BE MORE SPECIFIC?  Added tests needed?
Reported findings when the liver is not doing its job include normal to elevated liver enzyme ALT (biomarker generated by abnormal liver cells), low protein ALBUMIN, and low BUN (a break down product of protein metabolism). In severe cases, when URATE bladder stones form with high ammonia levels when the liver is not detoxifying the breakdown of protein properly, and a liver function test may be recommended as well. Added testing includes a combination of radiographs, ultrasound, and liver biopsy.

ONCED IT IS DIAGNOSED, HOW IS THIS HEPATIC DISEASE TREATED? 

-lower protein diets specifically recommended for patients with this condition

-probiotics such as Proviable

-neutriceuticals (holistic type supplements) to help improve liver function such as Denamarin

THE PROGNOSIS IS often GOOD FOR DOGS WITHOUT SIGNS OF THE LARGER PORTOSYSTEMIC SHUNTS. 

Betsy T. Sigmon DVM, Diplomate ABVP, Canine and Feline Practice
Creature Comforts Animal Hospital
Cary, NC

Cavalier King Charles Spaniel and Blenheim Palace: The Trail to Syringomyelia or Chiari Syndrome

On my recent tour of Blenheim Palace while visited London,  I traced the journey of a 19 year old railroad heiress, Consuelo Vanderbilt, and her 1895 marriage to become the Duchess Of Marlborough.  The marriage  – forced by her mother Alva – came with a $2.5 million dowry. The 9th Duke, a first cousin of Winston Churchill, used the money to upgrade the palace and the grounds.

The 1st Duke of Marlborough kept red and white (Blenheim) spaniels for hunting.  While at war, his duchess kept a vigil by pressing her thumb on the top of the brood dog’s head to release her tension. When this dog had her puppies, the brood dog’s puppies each had a red thumbprint of mistress on the head. This is now called the “Blenheim Spot”.

 The 9th Duke kept a mistress, Gladys Deacon, that would become his second wife. As one enters Blenheim palace there are strange, large pictures of her blue-green eyes artistically painted in the ceiling of the entrance portico. http://littleaugury.blogspot.com/2010/01/devastating-beauty-v-lady-gladys-in.html?m=1  In the water garden there was a pair of sphinxes with her head profile. 

In the end, she slept with a gun as she was afraid of the Duke, and he cut off the power and water to the palace to run her off. She drove him crazy, enough that he was committing to enter a catholic order but passed away prior to his entry. 

 Gladys was quite an eccentric character. Some say it started after she had paraffin injected into the bridge of her nose to improve her profile. Unfortunately, the paraffin migrated to cause a deformed chin.  In her spare time she continued the raising of Blenheim Spaniels (the red and white colored version of the Cavalier King Charles Spaniel). It is reported that at times she had over 50 roaming the palace, and that was part of the reason many suspected she was slightly insane. 

http://www.newyorksocialdiary.com/social-history/2011/gladys-deacon-an-eccentric-duchess

World War II caused quite a setback as the Cavalier King Charles Spaniel breed numbers dropped to six as a vast majority of the breeding stock was destroyed because of the hardship of the times.  All Cavalier King Charles Spaniels arise from those six dogs. Many genetic diseases are easily expressed with this narrow gene pool breed; one is Chiari formation (Syringomyelia). 

WHAT IS CHIARI SYNDROME OR SYRINGOMYELIA?

It is a neurological condition when there is not enough room in the skull for the brain. Consequently the brain is forced backwards to the spinal cord. Pockets of fluid (syrinxes) develop within the spinal column.  It is suspected that more than 90% of the breed has the condition. Chiari formation has also been reported in the Brussels griffon dog.  http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=2415

  

ARE THERE COMMON SIGNS? HOW IS IT DIAGNOSED

 Signs include: phantom scratching of the air with hind legs when excited or walking on a leash “neck scratcher’s disease," neck pain, weakness, stumbling and depression. DIAGNOSIS is via history of signs and an MRI to confirm. It may be confused with a mucous pus in the middle ear called Primary Secretory Otitis Media (PSOM).  See the site www.chiariinstinstitute.org for more information. 

WHAT ARE THE MOST COMMON TREATMENTS?

In dogs, surgery is a risky proposition, so most are treated with pain medications such as rimadyl, gabapentin for neuropathic pain, with some taking Prilosec (omeprazole) to lower spinal fluid accumulation and steroids(if the rimadyl is not helpful). 

Betsy Sigmon DVM, Diplomate ABVP Canine and Feline

Hospital Director, Creature Comforts Animal Hospital

Cary, NC 27518

These cat sculptures were at Strawberry Hill Estate outside of London and I could not resist some cat playtime.