Eye Medications: What’s in the tube?

On a recent visit to the town of Todd in the mountains of North Carolina, I participated in leisurely tubing run down the South Fork of the New River with some dear friends. It was a beautiful, slow pace determined by the current of the water, taking in all the visuals of the mountains. 

A few weeks later I was in Charleston, South Carolina checking out the CSS H.L.Hunley, a Civil War era, hand-cranked powered submarine. 

It was hard to image being in a tube only 4 feet tall by 40 foot long, these men torpedoed the mighty USS Housatonic in Charleston Harbor on February 17, 1864. This action didn't change the course of the Civil War, but by becoming the first combat submarine to sink an enemy warship, it altered naval warfare forever.

For the best in breakfast treats in the Charleston area, forget the breakfast rolls in a tube. 

Head to WildFlour Pastries for a Cinnamon or Sticky bun that is the best. Simply cross the Arthur Ravenel Bridge on a Sunday morning, and be in line at 8 AM, as that is the only day they are available.

So what is all this connection to tubes and eye problems in pets?

Pet owners are presented eye (ophthalmic) tubes and bottles of medications every day both from veterinarians and over the Internet advertisers. Some are well documented in studies while others are sketchy at best. At a recent seminar at North Carolina State College of Veterinary Medicine, ophthalmologist Dr. Brian Gilger, presented an update on some new eye products. 

ARE THERE EXCLUSIVE  VETERINARY APPROVED EYE PRODUCTS FOR PETS?

There is one main one, Optimmune that treats dry eye of pets (lack of tear production). All others utilized by veterinarians are principally human approved products.

I SAW AN AD FOR AN EYE DROP THAT TREATS CATARACTS? IS THAT A PROVEN PRODUCT?

The product is N-acetyl carnosine drops developed in Russia about a decade ago. It is marketed under various trade names such as Bright eyes, Clarity, and Can-c. The results are questionable improvement in a mild aging change of the lens called lenticular sclerosis as an anti-oxidant, but not other causes of cataracts. It costs $39+ a bottle. Note that such products are considered supplements and are not regulated by the FDA. This allows manufacturers to make a variety of claims without clinical trials to substantiate. NOT RECOMMENDED

DISCUSS SOME NEW OPTIONS TO CONSIDER TREATING EYE CATARACTS.

1.       Lanosterol (naturally occurring steroid) eye drops slows defective proteins from clumping and forming cataracts. Experimentally, this could be a game changer to lower the need for cataract surgery in people and animals. According to the CDC, cataracts are the leading cause of vision loss in the USA. It may be years before this product is commercially available and would be a lifelong treatment twice a day. RECOMMENDED 

2.       Kinostat (aldose reductive inhibitor) for prevention of diabetic cataracts is an eye medication applied 2 to 3 times a day for life. It needs to started early in the diagnosis. Huge fluctuations in blood glucose lead to cataracts as sugar gets into the lens, converted to sorbitol and the lens swells. . At NCSU college of Veterinary Medicine, 30% of cataract surgery is related to diabetes.  It will be commercially available in the next 2 years. RECOMMENDED

3.       Remend by Virbac, is a good artificial tear and anti-inflammatory eye drop. It contains a cross-linked hyaluronic acid lubricant. Although promoted as a corneal (ulcer) repair drop, there is no documentation and is not FDA approved. A much cheaper version is OTC Blink, artificial tear. NOT RECOMMENDED

Ocean Course club house on Kiawah Island

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

Hospital Director, Creature Comforts Animal Hospital

Cary, NC

Sunset over Charleston Harbor

SKIN TUMORS: IT IS NOT OBVIOUS WHAT IS INSIDE

I was at a recent charity horse show in Raleigh this past weekend and watched a white faced, Capuchin monkey named “Whiplash” dressed as a cowboy, riding a border collie as he hereds a wild Barbados Sheep.  www.whiplashthecowboymonkey.com

I was intrigued by the monkey’s ability to hold on by his tail like a saddle girth. His favorite treat was Oreo’s and encouragement from his trainer was a handshake. What was hidden under the chaps?

Clients often note a lump on their pet’s skin and question if it is something of concern. In discussions with clients I often go “round and round” as to the need to remove a mass versus the risk. 

WHAT ARE THE TWO MAIN CATAGORIES OF SKIN GROWTHS OF PETS?

The simplistic versions are either benign (no risk of going other places) or malignant (risk of spreading). 

OF THE BENIGN TUMORS, WHAT ARE THE MOST COMMON ONES?

Fatty tumors (lipomas) are the most common lump found on dogs, followed by oil gland tumors (sebaceous epitheliomas/cysts).

MALIGNANT (cancerous) TUMORS ARE CONCERNING! CAN YOU NAME A FEW?

The most common one in dogs and cats is a Mast cell tumor followed by sarcomas and carcinomas.

HOW ARE THEY DIAGNOSED?

When possible, cells from the mass are drawn (aspirated) into a syringe and then examined under a microscope after special staining on a slide. In cases when that is non-diagnostic, a biopsy (sample of the actual mass) is obtained and submitted to a veterinary lab.

ARE MOST GROWTHS RECOMMENDED TO BE REMOVED?

No, many of the benign ones, unless in a location that could make irritation a concern are left alone. It is the malignant ones that are recommended to be removed with 1.5 inch margins around growth when possible. 

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

Hospital Director, Creature Comforts Animal Hospital

Cary, NC

NOISY BREATHING: SIGNS OF BRACHYCEPHALIC AIRWAY SYNDROME

In August of each year the signs are right to take a road trip to Louisville and the Kentucky State Fair. While there I consume my two corn dogs with mustard, watch the sheep being sheared for competition, observe the show cow stalls, and attend the horse show each night.

These are familiar signs of the end of summer. Especially noteworthy is the “fancy costume turnout” Harry Potter themed miniature horse class. 

Speaking of signs, I think it is perceived as acceptable that dogs with smashed faces (English Bulldogs, Pugs, Boston Terriers, Lhasa Apsos, Shih Tzu’s) normally snort to breathe. From the dog's perspective, there is often a fight to breathe through two very small holes similar to a chip bag clip on your own nose.

WHAT ARE “STENOTIC NARES” AND THE RELATIONSHIP TO BRACHYCEPHALIC AIRWAY SYNDROME?

 Stenotic nares are a genetic malformation of the cartilage in the nasal openings that worsen with age. They are a one part of a larger issue called brachycephalic airway syndrome. The other components are an elongated soft palate (too long roof of the mouth) and hypoplastic trachea (too small diameter windpipe).  In some dogs the damage is so severe it causes eversion of the lining of the voice box (laryngeal saccules) so that swollen tissue is blocking the airways.  There are varying degrees of obstruction between dogs.

The left photo is a dog with stenotic nares. The photo below is normal nasal opening.

WHAT HAPPENS?Over time the “pinched nostrils” can lead to an increased effort to breathe during inspiration (breathing inward). This can lead to collapse of the voice box (larynx) leading to significant respiratory distress. 

ARE THERE SIGNS THAT CAN ALERT OWNERS TO POTENTIAL RESPIRATORY DISTRESS? 

Dogs with mild disease will have noisy breathing with exercise or excitement. Others simply snore when relaxed or asleep. Severely affected animals have more pronounced nasal sounds, appear to tire easily with exercise, and may faint after exercise. Other symptoms may include coughing, gagging, retching and vomiting. Symptoms are often worse in hot or humid weather.

WHY DO GI SIGNS DEVELOP CONCURRENTLY WITH THE AIRWAY DISEASE?

The negative pressure created with restricted breathing suctions stomach acid into the esophagus (reflux/heartburn). This leads to coughing, gagging, vomiting, and aspiration pneumonia is some cases.

HOW IS IT DIAGNOSED?Diagnosis is BASED externally on the diameter of the nasal passage opening. Other testing will require sedation with radiographs, and measurement of the length of the roof of the mouth (soft palate), and visual of the larynx (voice box).


 WHAT IS THE TREATMENT?

 SURGERY as early as 6to 9 months of age to correct the stenotic nares (to dilate opening) and possibly shortening the roof of the mouth (soft palate) are key components of treatment. Keeping pets in a healthy weight range, avoiding  high heat and humidity, use of a harness to keep pressure off the trachea are key. In emergency situations, steroids, oxygen therapy, and even temporary tracheostomies may be needed.

WHAT IS THE PROGNOSIS?
Dogs under two years of age at the time of surgical correction have better post-operative results than dogs that are older. Dogs that only require surgical correction for stenotic nares and/or an elongated soft palate have a better prognosis that those with multiple issues.  Concurrent complications  such as allergic bronchitis or heart disease have a poorer prognosis. 

WHAT ABOUT BREEDING THESE AFFECTED DOGS?

They should not be bred to lower propagation of the anatomical defects. For examples of how breeds have changed over the last 100 years that have increased the risk of these and other issues, review the websites below.


https://dogbehaviorscience.wordpress.com/2012/09/29/100-years-of-breed-improvement/

http://www.dailymail.co.uk/news/article-2519314/How-century-breeding-improvement-turned-healthy-dogs-deformed-animals.htmlhttp://www.dogster.com/the-scoop/dog-breeds-breeding-photos-dogs-of-all-nations

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

Hospital Director, Creature Comforts Animal Hospital 

Cary, NC