Medical Conditions

Canine Addison’s disease, or hypoadrenocorticism, is a hormonal disorder caused by a dog’s inability to produce sufficient amounts of the adrenal gland hormones cortisol and aldosterone.

Adrenal glands are very small glands located next to your dog’s kidneys and are responsible for regulating several body functions, in addition to producing cortisol and aldosterone. Cortisol, which is also commonly referred to as the stress hormone, is critical in helping your dog’s body adapt to everyday stressors, while aldosterone plays an important role in water and electrolyte regulation.

Addison’s disease can have a variety of causes, the most common of which is due to your dog’s immune system attacking and destroying the adrenal glands directly. The cause for this immune-mediated adrenal gland destruction has yet to be identified in dogs. Addison’s disease can also be caused secondary to medications, toxins, or certain cancers. 

Symptoms:

• Lethargy
• Weakness
• Poor appetite
• Vomiting
• Diarrhea
• Weight loss
• Increased thirst
• Shaking/Trembling
• Collapse

Diagnostics:

Your veterinarian will start by collecting a detailed history and performing a thorough physical examination. Addison’s disease can present with vague clinical symptoms, and diagnostic testing will be needed to rule out other possible diseases as the cause for your dog’s illness. Additional testing will likely include:

• Complete Blood Count (CBC)
• Blood chemistry
• Complete urinalysis
• Tick-Borne disease antibody testing
• Abdominal ultrasound
• ACTH stimulation test

Treatment:

Addison’s disease is treated by replacing your dog’s insufficient levels of adrenal gland hormones. Most commonly, this is achieved with both oral and injectable steroids. Once stabilized, the prognosis is generally good as most dogs respond to therapy very well and go on to live normal, active lives.

Regular follow-up with your veterinarian is necessary to ensure that your dog’s disease is being adequately managed. This is generally achieved through blood and urine testing. Stressful situations, such as travel or kenneling, may require adjustments in your dog’s medications. Be sure to address any anticipated stressors with your veterinarian.

Atopic dermatitis is an allergic reaction that triggers itchiness in cats and dogs. Much like human “hay fever” it is caused by a sensitivity to environmental substances, such as pollen, mold, and dust mites. Food allergies can also result in atopic dermatitis, however, it is important to note that true food allergies are exceedingly rare and, despite popular misconceptions, are rarely in response to grains. Management of symptoms can often be challenging and often requires a multi-modal approach. 

Symptoms:

The most common symptom is extreme itchiness, but you may also note:

• Raised rashes
• Reddened skin
• Red, acne-like bumps
• Scaly areas
• Darkened, thickened skin
• Fur loss
• Stained fur due to excessive licking
• Frequent shaking of the head
• A foul odor emanating from your dog’s skin and/or ears

Diagnostics:

Atopic dermatitis is often a diagnosis of rule-outs, meaning that other disease processes, such as skin mites, fleas, or a skin infection, need to be ruled out in order to diagnose atopic dermatitis. In addition to a thorough physical examination, your veterinarian may look for skin mites, examine a skin swab to look for signs of infection, and/or perform a culture to isolate specific bacterial or fungal organisms. Blood and urine testing may also be recommended to rule out underlying systemic disease. Once your pet has been diagnosed with atopic dermatitis, there are additional diagnostics that can be performed to help identify the allergic source(s), such as environmental allergy testing and/or a prescription hydrolyzed diet trial.

Treatment:

Treatment ultimately consists of trying to manage your pet’s response to the allergen(s) through various immunomodulatory therapies. There are a variety of options available, ranging from immunosuppressants, such as prednisone and cyclosporine, to anti-itch medication, such as Apoquel and Cytopoint. Some pets with environmental allergies may also benefit from allergen-specific immunotherapy to help desensitize them to known allergens that were identified based on blood or skin allergy testing. Where possible, avoiding the known allergens may also be helpful. This isn’t always possible with environmental allergens but can be a very successful strategy for managing food allergies.

Anaplasmosis is a tick-borne disease found throughout the United States, most frequently in the Northeast, Mid-Atlantic, North-Central US, and California. Both the black-legged deer tick and brown dog tick carry and transmit the bacterial species responsible for causing anaplasmosis.

Symptoms:

• Joint pain
• Stiffness
• High fever
• Lethargy
• Loss of appetite
• Vomiting
• Diarrhea
• Neurologic signs, such as neck pain or seizures (infrequent)

Diagnostics:

Anaplasmosis is generally diagnosed when there is a history of exposure combined with clinical signs. Antibody tests can readily demonstrate whether or not your pet has been exposed to anaplasma and clinical signs. Also, specific changes in a complete blood count can be indicative of an active infection. PCR tests can also be helpful to confirm an active infection.

Treatment:

Treatment consists of antibiotic therapy, most common with doxycycline. While dogs with severe clinical signs may require hospitalization, the prognosis is generally excellent with a return to normal activity within the first few days of treatment.

Prevention:

Prevention is key when it comes to tick-borne diseases. It is thought that ticks are able to transmit the bacteria responsible for causing anaplasmosis within the first few hours of attachment. It is, therefore, important that any preventive method result in as fast a tick kill as possible. While repellants can be helpful in preventing tick bites, their efficacy is highly variable and often does not last a full month. Oral tick preventives, such as Simparica and Credelio, have a very fast kill time and have been shown in studies to reduce the risk of anaplasma transmission.

Nearly one-third of all adult cats and dogs suffer from arthritis. Arthritis can affect any joint but is most commonly seen in the hips, knees, and elbows. Obesity, as well as previous injury, are predisposing factors in the development of arthritis.

Symptoms:

• Reluctance to walk
• Reluctance to jump
• Muscle loss
• Difficulty going up or downstairs
• Reluctance to play
• Vocalizing
• Restlessness
• Decreased grooming (cats)

Diagnostics:

A diagnosis of arthritis is generally based on physical examination and radiographic findings, although blood tests may be useful in ruling out other possible disease processes, such as tick-borne disease or a ligament tear. Analysis of joint fluid can also be helpful in differentiating arthritis from other diseases that may affect joint health, such as infection or an immune-mediated process.

Treatment:

Treatment for arthritis involves a multi-modal approach, including such treatments as:

• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Neuropathic pain relievers (gabapentin)
• Acupuncture
• Joint and spine manipulations
• Weight loss
• Exercise modification
• Laser therapy
• Massage therapy

Unfortunately, cancer is something that we are all too familiar with in pets. Most commonly seen in our senior and geriatric pet populations, cancer is essentially the abnormal growth of a specific cell type and can occur anywhere in the body. It often presents as a lump or mass commonly referred to as a tumor.

Cancer can be divided into two different categories: benign and malignant. Benign cancers grow relatively slowly and in a very localized manner. On the other hand, malignant cancers tend to be much more aggressive and are far more likely to metastasize or spread to other parts of the body.

Cats:

By far, the most commonly diagnosed cancer in cats is lymphoma, followed by mammary cancer and oral cancer, such as squamous cell carcinoma. Most cats are between 10 – 15 years of age at diagnosis.

Dogs:

Dogs can develop a variety of different cancers as they age, and certain breeds, such as Golden Retrievers, Boxers, Bernese Mountain Dogs, and Greyhounds, are genetically predisposed to the development of certain cancers. Lymphoma, along with abdominal and skin cancers, are the most common cancers found in dogs. However, we also see bone, mouth, and urinary tract cancers with moderate frequency as well.

Symptoms:

• Abnormal swellings
• Persistent and/or growing lumps
• Non-healing sores
• Weight loss
• Decreased appetite
• Bleeding
• Bad odor
• Difficulty eating or swallowing
• Lethargy
• Weakness
• Persistent lameness/stiffness
• Difficulty eliminating
• Cough or difficulty breathing

Diagnostics:

Cancer can only be definitively diagnosed based on the identification of cells from a direct sample. Cell samples are generally obtained by either a needle stick or a small biopsy. In addition to sampling, bloodwork, urine tests, and imaging, such as X-rays, ultrasound, and CT/MRI, may be helpful in obtaining additional information.

Treatment:

Treatment for cancer depends entirely on where the cancer is located, whether or not it has spread to other parts of the body, how amenable it is to surgical removal, and whether or not the cell type involved responds well to chemotherapy. Treatment generally involves surgery, radiation therapy, and/or chemotherapy. Certain tumors, such as melanoma, can also be treated with vaccination. Pain management is a critical part of any treatment protocol.

Prevention:

There is no single cause for cancer, so it is nearly impossible to prevent. However, certain reproductive tumors, such as testicular cancer, ovarian cancer, uterine cancer, and potentially mammary cancer can be prevented through spaying and neutering. Feline leukemia can also be prevented through vaccination.

Chronic valvular disease is a degenerative condition that affects the valves of the heart. It is a progressive disease that will worsen over time and can eventually result in congestive heart failure.

Heart valves are designed to act as gates within the heart. They close, allowing blood to fill into the heart chambers prior to the heart muscles “pumping” the blood into the body. They also work to keep blood flowing in one direction throughout the heart and body by preventing the backward flow of blood. With chronic valvular disease, the valves do not function in a normal fashion and allow blood to “leak” through when they are supposed to be closed. The mitral valve is the most commonly affected, and older, small breed dogs are genetically predisposed, including:

• Lhasa apsos
• Toy and miniature poodles
• Yorkshire terriers
• Cocker spaniels
• Chihuahuas
• Cavalier King Charles spaniels
• Miniature schnauzers
• Small mixed-breeds

Symptoms:

Early in the course of the disease, your dog may be symptom-free as his or her body is generally able to compensate for minor decreases in heart function. However, as the disease progresses, you may note:

• Coughing
• Difficulty breathing
• Unable or reluctant to exercise
• Fainting or collapse
• Pale gums
• Decreased appetite
• Lethargy

Diagnostics:

A thorough physical examination, which includes listening to your dog’s heart and lungs, will likely reveal a heart murmur. A heart murmur is a sound that a leaky valve makes. This indicates that a valve is not working properly but doesn’t necessarily mean that chronic valvular disease is present as there are a number of other diseases that can cause heart murmurs, including severe anemia. What it does indicate is that additional evaluation of the heart is warranted. Additional diagnostics include:

• Blood and urine tests
• Chest radiography
• Electrocardiography
• Echocardiography
• Blood pressure measurement

Treatment:

Chronic valvular disease is primarily treated by medical and dietary management. Depending upon the severity, there are a number of medications that can both slow the progression of the disease and improve your pet’s quality of life. A diet low in sodium may also be recommended. Canine valve replacements are still under development in dogs, with only one or two surgical teams worldwide able to perform the procedure at significant cost.

In the event that your pet has progressed to congestive heart failure, hospitalization may be required prior to instituting other therapies. 

Congestive heart failure can have a variety of different causes but ultimately results from the heart’s inability to effectively pump blood throughout the body. Any condition that affects heart function can result in congestive heart failure. It is characterized by blood and fluid accumulation in and around the lungs and can also result in fluid accumulation in the abdomen. 

Symptoms:

• Excessive panting
• Coughing, especially at night
• Coughing blood
• Reluctance to walk, play or exercise
• Rapid and/or difficult breathing
• Blue colored gums 
• A distended abdomen
• Collapse
• Sudden death

Diagnostics:

Heart failure is generally diagnosed based on clinical signs, history, and the presence of fluid in the chest and/or abdomen on X-ray. However, in order to better characterize the underlying cause for congestive heart failure, your veterinarian will likely recommend additional diagnostic tests, such as:

• Blood and urine tests
• A BNP or troponin level
• Electrocardiography
• Echocardiography

Treatment:

Treatment of congestive heart failure is based on increasing the amount of available oxygen and removing excess fluid from the body. Most patients in congestive heart failure require aggressive treatment and may need to be hospitalized for stabilization. Once the condition has been resolved, regular medication will likely be necessary to treat the underlying cause. Congestive heart failure generally carries a poor prognosis, and most patients previously diagnosed with congestive heart failure will likely experience it again.

Cushing’s disease, also known as hyperadrenocorticism, occurs when the adrenal gland produces too much cortisol. Cushing’s disease is most often seen in dogs, although it can rarely affect cats.

In most cases, Cushing’s disease is caused by a benign tumor in the pituitary gland. The pituitary gland is responsible for signaling the adrenal glands to produce cortisol. In the event of a pituitary tumor, too much of that signal is sent to the adrenal glands, resulting in the overproduction of cortisol. A less common cause of Cushing’s disease is the overproduction of cortisol by a malignant tumor within one of the adrenal glands. It is also possible to cause Cushing’s disease with long-term, high dosing of steroid immunosuppressants, such as prednisone.

Symptoms:

• Increased thirst
• Increased urination
• Increased panting
• Thin skin
• Hyperpigmentation or darkening of the skin
• Distended abdomen
• Recurrent skin or urinary tract infections
• Fur loss along the back and tail (rat-tailed appearance)

Diagnostics:

Cushing’s disease can sometimes be difficult to differentiate from other hormonal diseases, such as hypothyroidism. Your veterinarian will likely recommend baseline blood and urine tests, which include a thyroid hormone level. Additional diagnostics may include:

• Urine cortisol levels
• Blood cortisol levels
• Dexamethasone suppression test
• Abdominal ultrasound (to evaluate the adrenal glands)
• Blood pressure measurement

Treatment:

Treatment of pituitary-dependent Cushing’s disease is based on medically managing the body’s ability to produce cortisol. Cushing’s disease is generally well controlled through medication. However, regular follow-up with your veterinarian is necessary to ensure that the disease is being adequately managed, as overtreatment can destroy the adrenal gland and the subsequent onset of Addison’s disease. Undertreatment will fail to resolve the clinical symptoms.

Treatment of Cushing’s disease secondary to an adrenal tumor is best treated by surgical removal of the affected adrenal gland.

Dental disease is the single most common disease seen in our pet population, and it affects approximately 80% of dogs and 70% of cats over the age of three. Not only can dental disease cause bad breath, but it can lead to dental infections, tooth root abscesses, and other painful mouth conditions. If left untreated, dental disease can also lead to infection of internal organs.

Symptoms:

• Bad breath
• Bleeding gums
• Painful chewing
• Loose teeth
• Yellow or brown teeth
• Vomiting (due to failure to chew and subsequent decreased production of digestive enzymes)
• Poor coat (due to decreased grooming)
• Facial swelling along the jaw or under the eye (due to tooth root abscess)
• Decreased appetite
• Pawing or rubbing at the mouth

Diagnostics:

Diagnosis of dental disease is generally made during a thorough physical examination. However, dental X-rays are necessary to determine the extent of periodontal disease below the gumline. 

Treatment:

Depending upon the severity, dental disease may be treated by a thorough dental cleaning, both above and below the gumline. More advanced cases will either require root planing (cleaning of the root and gum) or extraction of the affected tooth. 

Prevention:

Dental disease is preventable! Regular home care, consisting of daily tooth brushing, enzymatic dental chews, antiseptic oral rinses, and dental diets, can significantly delay the onset of dental disease. When home care is combined with veterinary assessment, treatment. and cleaning, dental disease can be nearly 100% prevented. 

Canine diabetes is almost exclusively caused by a decrease in insulin production by the pancreas. It is thought to be an autoimmune condition in which the dog’s immune system attacks and destroys the pancreas’ insulin-producing cells. It can also be caused by severe pancreatitis and, in rare cases, estrus cycles in intact females.

Diabetes generally affects older to middle-aged dogs and is more common in females. Certain breeds are predisposed, including:

• Samoyed
• Beagle
• Bichon Frise
• Australian Terrier
• Schnauzer
• Cairn Terrier
• Keeshond
• Poodle
• Fox Terrier

Symptoms:

• Increased drinking
• Increased urination
• Increased appetite
• Weight loss
• Vomiting
• Lethargy
• Loss of vision (due to diabetic cataracts)

Diagnostics:

As the symptoms of diabetes are very similar to other disease processes, such as Cushing’s disease, hypothyroidism, kidney in addition to a thorough history and physical examination, your veterinarian will likely recommend:

• Complete Blood Count (CBC)
• Blood chemistry
• Thyroid hormone level
• Urinalysis
• Urine culture
• Blood pressure
• Pancreatic lipase testing (to rule out underlying pancreatitis)
• Abdominal ultrasound
• Blood and/or urine cortisol levels

Treatment:

Insulin replacement is the single most important treatment of diabetes in dogs. Various insulins have been successfully used to manage Canine diabetes, the most common being medium-acting insulins such as Humulin N or Novalin. There is also veterinary-approved insulin commercially available, called Vetsulin.

Dietary management is not as critical in dogs. Most dogs do well when fed a complete and balanced diet. Meal feeding is preferred as food intake can be more closely monitored and timed with insulin administration.

Feline diabetes is caused by a decreased response to the insulin that is being produced by the pancreas. Older, less active, and overweight cats are predisposed.

Symptoms:

• Increased drinking
• Increased urination
• Increased appetite
• Weight loss
• Vomiting
• Lethargy

Diagnostics:

As the symptoms of diabetes are very similar to other disease processes, such as Cushing’s disease, hypothyroidism, kidney in addition to a thorough history and physical examination, your veterinarian will likely recommend:

• Complete Blood Count (CBC)
• Blood chemistry
• Thyroid hormone level
• Urinalysis
• Urine culture
• Blood pressure
• Pancreatic lipase testing (to rule out underlying pancreatitis)
• Abdominal ultrasound

Treatment:

While diabetic cats can produce insulin, they still benefit from insulin therapy to improve the body’s response to circulating insulin. Cats generally respond best to long-acting insulins, such as Lantus (glargine) and Levemir (detemir).

Cats also require dietary management, which generally consists of high protein/low carbohydrate diets. Studies have shown that over 60% of diabetic cats fed a high protein diet will have a decrease in their insulin requirements, some even going into insulin-dependent remission. Canned food tends to be preferred over dry as most high protein dry foods are very calorically dense and will most likely lead to increased weight gain.

Ear infections, particularly in dogs, are one of the most common reasons for a visit to the vet. They can have a variety of underlying causes, including:

• Conformation (large, floppy ears, as well as excessively hairy ears, are prone to infection)
• Bacterial or yeast overgrowth (usually due to another underlying condition)
• Ear mites
• Allergies
• Growths or tumors in the ear canal
• Self-inflicted trauma from rubbing and scratching
• Excessive moisture from bathing or swimming
• Endocrine disorders such as hypothyroidism or Cushing’s disease

Symptoms:

• Bad odor
• Painful to the touch
• Excessive moist sounds when touched
• Shaking of the head
• Scratching at the ears
• Scabs or reddened ears

Diagnostics:

In addition to a thorough history and physical examination, your veterinarian will likely perform:

• Ear swab cytology 
• Ear culture 
• Blood work to rule an underlying disease process, such as hypothyroidism

Treatment:

Treatment should be targeted based on the results of the diagnostics that were performed. Ear infections are generally best treated with topical medications rather than oral. It is important to keep the ear clean and free of debris during the course of treatment. Some ear infections can take several weeks to fully resolve. Regular follow-ups with your veterinarian during the course of treatment are critical to ensuring successful resolution.

Ehrlichiosis is a tick-borne disease that is caused by a rickettsial organism, a type of bacteria that can infect dogs, humans, and, rarely, cats. Brown dog ticks are responsible for the transmission of Ehrlichia canis, the most common cause of ehrlichiosis in North America. Transmission generally occurs within several hours of tick attachment, with clinical signs appearing 1 – 3 weeks later.

Symptoms:

Ehrlichiosis is generally broken down into three different stages.

Acute Stage: 1 – 3 weeks after exposure

• Fever
• Lethargy
• Decreased appetite
• Enlarged lymph nodes
• Decreased platelets

Subacute Phase: Months to years after exposure

• Few, if any, clinical signs
• Elevated blood proteins (globulins)
• Low platelet count
• Low red blood cell count

Chronic Phase:

• Lethargy
• weight loss
• Decreased platelets
• Decreased red blood cells
• Bone marrow suppression
• Bleeding
• Death

Though much less common, infected dogs can also exhibit eye and nervous system symptoms. The severity of the disease likely depends upon the disease strain, immune compromise, and co-infection with other tick-borne diseases. German shepherds also appear to be predisposed to developing more severe, chronic forms of ehrlichiosis.

Diagnostics:

Diagnosis is generally based on clinical signs, a history of tick exposure, and positive antibody testing. Additional diagnostics include:

• Complete Blood Count (CBC)
• PCR testing for organism DNA

Treatment:

Treatment with tetracycline antibiotics, such as doxycycline, for 4 weeks is the recommended treatment course for ehrlichiosis. When caught early in the acute phase, treatment generally carries a good prognosis.

Epilepsy is a generalized term for neurologic conditions that cause seizures. In pets, epilepsy is generally considered idiopathic, meaning that we don’t know why it occurs. It is most often diagnosed in young dogs, although it can be seen in older to middle-aged dogs and cats.

Symptoms:

Seizures are the most recognizable symptom of epilepsy. They can either be generalized, also called grand mal, in which case the seizure involves the entire body, or localized, also called petit mal, where only a certain part of the body is involved.

Generalized seizures are relatively straightforward to identify but can be similar to other collapse episodes, such as syncope, a cardiac event, or a vasovagal episode, similar to fainting. They can be quite distressing to witness as pets will experience convulsions and thrashing, yelps and cries, and sometimes excessive drooling, urination, and pooping. Seizures are also often accompanied by a pre-ictal and post-ictal period, during which your pet may seem particularly disoriented, quiet, or “dull”.

Localized seizures, on the other hand, can be much more challenging to identify. They may be as subtle as a repeated eye twitch or jaw chattering.

Diagnostics:

Epilepsy is a diagnosis of rule-outs, meaning that all other possible causes have to be ruled out prior to making a diagnosis. In order to diagnose epilepsy, your veterinarian will likely recommend:

• Complete Blood Count (CBC)
• Blood chemistry panel
• Urine testing
• Specialist consultation
  • Cerebrospinal fluid analysis
  • MRI

Treatment:

Treatment for epilepsy is generally initiated once seizures start occurring every 4 – 6 weeks or sooner and consist of oral anticonvulsant medication. There is also a veterinary therapeutic diet for dogs that can be helpful in reducing seizure frequency. Most pets are well managed on a single anticonvulsant, but some do require multiple medications for adequate control. Anticonvulsants generally require regular lab work to ensure appropriate dosing.

Feline lower urinary tract disease is a very common condition in cats, particularly amongst indoor cats. It is thought to be a painful, inflammatory condition of the bladder and lower urinary tract. Most cases are idiopathic, meaning that we do not understand why they occur, although stress is thought to play a significant role.

Symptoms:

• Urinating outside the litter box
• Frequent urination with little or no urine
• Vocalizing during urination
• Blood in the urine
• Frequent licking of the genitals, especially immediately after urinating
• Straining to urinate

Diagnostics:

Diagnosis can be challenging, and other possible causes, such as urinary tract infection and bladder stones, need to be ruled out first. Recommended diagnostics include:

• Urinalysis with urine culture
• Blood chemistry panel
• Complete Blood Count (CBC)
• Thyroid hormone level
• Bladder X-rays
• Bladder ultrasound

Treatment:

Treatment for lower urinary tract disease tends to be multifactorial and is aimed at:

• Diluting the urine, either by increasing water intake (adding water to canned food) or administering fluids under the skin
• Reducing inflammation
• Pain management
• Stress management, either through environmental enrichment and/or pharmacologic management with anti-anxiety medication
• Dietary management to both reduce inflammation and prevent urinary crystal and/or stone formation

Feline lower urinary tract disease is most likely an age-limiting disease in most cats as clinical signs tend to resolve as cats age and their urinary becomes more dilute due to age-related changes within the kidneys and/or the onset of kidney dysfunction.

Bloat is a serious and life-threatening condition that is brought about by excess food, gas, fluid, or other material in the stomach. Bloat can occur very quickly and is a true veterinary emergency as bloat can progress to twisting of the stomach, known as gastric dilation & volvulus (GDV). GDV is ultimately fatal if not addressed quickly. 

Risk factors for bloat include:

• Large and/or giant breed dogs
• Deep chested dogs
• Dogs feed exclusively dry food (in particularly dry food with fat in the first 4-5 ingredients)
• Dogs who exercise rigorously after eating
• Dogs who gorge themselves on food
• Dogs with underlying gastrointestinal disease, such as delayed gastric emptying, may also be predisposed to bloat.

Symptoms:

• Swollen or distended abdomen
• Retching and nonproductive vomiting 
• Restlessness
• Depressed attitude
• Sudden weakness
• Collapse
• Pale mucous membranes

Diagnostics:

Bloat is generally diagnosed based on history, physical examination, and abdominal x-rays. However, your veterinarian may also recommend additional tests to determine severity, such as:

• Complete Blood Count (CBC)
• Blood chemistry panel
• Urinalysis
• Blood pressure measurement

Treatment:

Depending upon the severity, bloat may be managed by supportive care, such as intravenous fluids and pain medication, or it may require decompression of the stomach, either with a large needle or stomach tube. 

If GDV has developed, immediate surgical treatment to resolve the volvulus is indicated, and hospitalization postoperatively will likely be indicated to further stabilize your dog.

Heartworm disease is caused by the parasite Dirofilaria immitis, a type of roundworm that lives in the heart and larger blood vessels of the chest and lungs. It is transmitted by mosquitoes and can cause serious heart disease if left untreated. Heartworm disease is most often seen in dogs but can rarely affect cats, in which case it causes severe inflammation of the lungs, resulting in an asthma-like condition. 

Symptoms:

The early stages of heartworm are often symptom-free. As the number of worms multiples within the body, you may note:

• Coughing
• Lethargy
• Exercise intolerance
• Decreased appetite
• Weight loss
• Sudden death (cats)

Diagnostics:

Heartworm disease is diagnosed by a relatively simple and quick blood test. Most veterinarians routinely run this test on a yearly basis. If your pet is positive for heartworm, your veterinarian will likely also recommend:

• Complete Blood Count (CBC)
• Blood chemistry panel
• Chest X-rays

Treatment:

There is currently only one recommended treatment option for canine heartworm disease, and it consists of a series of potent injections designed to kill adult heartworm. Treatment generally takes six months to complete, and your dog must be exercise-restricted during the course of treatment. Doxycycline and heartworm prevention are also important parts of treatment and work to prevent re-infection.

There is currently no approved treatment for cats. Most cats are able to clear the heartworm infection on their own, but those that go on to develop an asthma-like condition will need lifelong treatment to control the associated clinical signs.

Prevention:

Heartworm is 100% preventable with regular monthly medication. Monthly preventives are available in both oral and topical formulations. An injectable option, now approved for 12 months duration, is also available for use in dogs. 

Hip dysplasia is one of the most common orthopedic diseases seen in dogs. It is caused by poor development of the hip joint, resulting in looseness or laxity of the joint and poor fit of the “ball” of the hip into the “socket.”

Large breeds are genetically predisposed to hip dysplasia, but dogs of all breeds and sizes are susceptible. Obesity and nutritional factors may also play a role in the development and worsening of hip dysplasia.

Symptoms:

• “Bunny-hopping” in the hind limbs
• Swinging gait the hind limbs
• Weakness in one or both hind legs
• Pain when hips are touched
• Difficulting jumping up onto furniture or going up stairs
• Decreased range of motion in the hips
• Muscle loss in the hind limbs

Diagnostics:

Hip dysplasia is generally diagnosed by X-ray and/or physical manipulation of the hips resulting in palpable dislocation of the hip joint, called ortalani sign. Due to your dog’s anatomy and the painful nature of hip dysplasia, hip X-rays and orthopedic examinations are best performed under heavy sedation.

Treatment:

Hip dysplasia is best treated by medical management, which is geared toward:

• Pain relief
  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Neuropathic pain relief (gabapentin)
  • Acupuncture
  • Spinal manipulations
• Weight management (maintaining an ideal body condition can significantly benefit dogs with hip dysplasia)
• Exercise moderation, specifically maintaining good muscle mass in the quadriceps and gluteal muscles to better support the hip
• Surgical therapies can be considered if medical management fails to adequately manage pain

Hyperthyroidism is the most common hormonal disease in cats. It is due to the enlargement of one, or both, of the thyroid glands and subsequent over-production of thyroid hormone. It affects both male and female cats of middle-to-older age.

Thyroid hormone plays an important role in metabolic regulation and can negatively impact multiple organ systems if left untreated. In particular, the heart and kidneys can experience significant adverse effects when exposed to elevated levels of thyroid hormone for long periods of time.

Symptoms:

• Weight loss
• Increased appetite (it is important to note that a small percentage of cats will present with decreased appetite)
• Restlessness
• Unkempt coat
• Vomiting
• Diarrhea
• Increasing drinking
• Increased urination
• Increased vocalization

Diagnostics:

Hyperthyroidism can be relatively easily diagnosed with a blood test for thyroid hormone. However, as the symptoms of thyroid disease mimic those of other disease processes, your veterinarian will likely recommend:

• Complete Blood Count (CBC)
• Blood chemistry panel
• Urine tests
• Blood pressure measurement

Treatment:

The goal of treatment is to reduce the amount of circulating thyroid hormone. This can be achieved with a medication, methimazole, or by destroying part of the overactive thyroid gland(s) with radioactive iodine therapy. Your veterinarian can best counsel you on which option will be best for you and your pet.

Feline hypertrophic cardiomyopathy (HCM) is characterized by an abnormal thickening of the heart muscles. These enlarged muscles significantly inhibit the heart from being able to pump blood efficiently throughout the body, leading to both abnormal heart rhythms and blood-clot formation. It is the most common form of heart disease in cats and is most often diagnosed in young to middle-aged cats. Maine Coons and Ragdolls are predisposed to HCM. It can often present with no other clinical symptoms than sudden death and is often referred to as “silent” cardiomyopathy.

Symptoms:

HCM often goes undiagnosed. A heart murmur or abnormal rhythm may be heard by your veterinarian and can sometimes be the first indication of an abnormal heart. Other symptoms include:

• Severe lethargy/weakness
• Collapse
• Sudden paralysis in one or more limbs due to a blood clot
• Rapid breathing
• Difficulty breathing (open-mouthed breathing)
• Blue-tinged gums
• Decreased appetite
• Weight loss
• Sudden death

Diagnostics:

If your veterinarian is concerned about a risk for HCM, he or she will likely recommend:

• Blood and urine tests to rule out other possible causes, such as elevated thyroid hormone
• A BNP or troponin test, which helps to assess if the heart is working harder than normal
• Chest radiographs
• Electrocardiograph
• Echocardiogram
• Blood pressure measurement

Treatment:

Treatment consists of medical management to try to slow your cat’s heart rate, improve heart function and decrease the risk of blood clot formation. A low sodium diet may also be recommended. In the event that your cat progresses to congestive heart failure, hospitalization may be necessary before the use of other therapies.

Hypothyroidism occurs when a dog’s thyroid gland is unable to produce sufficient amounts of thyroid hormone. It is the most frequently diagnosed hormonal disorder in both male and female dogs and is more commonly seen in large breed dogs.

Symptoms:

• Weight gain 
• Lethargy
• Fur loss or excessive shedding, particularly along the sides of the body
• Recurrent skin and/or ear infections

Diagnostics:

A comprehensive thyroid panel is generally necessary to diagnose hypothyroidism in dogs as dogs with concurrent illness can have low-to-low normal thyroid hormone levels. Hypothyroidism can also present in a similar way to other hormonal disorders, such as Cushing’s disease, so your veterinarian will also likely recommend:

• Complete Blood Count (CBC)
• Blood chemistry panel
• Urine testing
• Skin cytology and/or skin cultures

Treatment:

Treatment consists of replacing your dog’s insufficient levels of thyroid hormone. It is important to note that dogs have a significantly higher dose requirement for thyroid hormone supplementation than humans. If you choose to have your dog’s prescription for thyroid medication filled at a human pharmacy, please call to confirm that they have the necessary dose in stock and that no adjustments have been made to the dose without your veterinarian’s approval. 

Inflammatory bowel disease (IBD) is an immune condition that results from your pet’s body attacking the lining of his or her intestinal tract. This results in an inability to absorb nutrients and digest food effectively. IBD is one of the most common causes of chronic vomiting and diarrhea in pets. The underlying cause remains unclear.

Symptoms:

• Diarrhea
• Bloody stool
• Black, tarry stool
• Gas
• Straining to defecate
• Weight loss
• Increased or decreased appetite
• Lethargy
• Vomiting 
• Abdominal pain
• Bloating
• Defecating outside the litter box (cats)

Diagnostics:

Either endoscopic or surgical intestinal biopsies can only make a definitive diagnosis of IBD. Additional diagnostics that may be of benefit in confirming suspicion for IBD, or to rule out other disorders, include:

• Blood chemistry panel
• Complete Blood Count (CBC)
• Abdominal X-rays
• Abdominal ultrasound
• Viral testing: parvovirus in dogs and FeLV/FIV in cats
• Fecal tests, including fecal cultures

Treatment:

Treatment for inflammatory bowel disease is directed at reducing the body’s inflammatory response through the use of steroids and/or other anti-inflammatories/immunosuppressant medications. Dietary management can also be helpful in reducing the risk of your pet’s gastrointestinal tract reacting to various proteins. Some pets will also benefit from vitamin B12 and probiotic supplementation.

Intestinal parasites are “worms” that live within your dog or cat’s gastrointestinal tract. The most common intestinal parasites are roundworms, hookworms, whipworms, tapeworms, giardia, and coccidia. Intestinal parasites are generally transmitted when your cat or dog ingests eggs or spores from contaminated soil, food, or feces, and tapeworms can be transmitted when cats or dogs eat infected fleas. Puppies and kittens are generally infected in utero or from nursing from an infected dog.

Symptoms:

• Scooting
• Vomiting
• Diarrhea
• Distended abdomen
• Weight loss

Diagnostics:

A diagnosis is made through fecal testing or by the visualization of worms in the stool. Veterinary fecal testing has advanced significantly in the past several years. Testing is far more sensitive than previous, with some tests resulting in positive infection before the onset of clinical signs.

Treatment:

Intestinal parasites are treated with targeting dewormers specifically prescribed to treat the parasite that your pet has been diagnosed with. Certain parasites, such as giardia and hookworms, may be more challenging to eliminate and required prolonged or repeat treatments.

Prevention:

Most intestinal parasites can be prevented with the same monthly preventive that protects against heartworm infection! Ask your veterinarian for more information.

Kennel cough, or infectious tracheobronchitis, is a highly contagious upper respiratory infection. Dogs in densely populated situations, such as boarding kennels, doggie daycare, and dog parks, are most likely to get kennel cough. There are a variety of infectious organisms responsible for causing kennel cough, the majority of which are viral. Transmission generally occurs by air or contact with infected particles. Like most common colds, kennel cough generally resolves on its own over the course of a few weeks. While the cough can sound particularly harsh, most dogs will continue to eat and behave normally during the course of infection.

Symptoms:

• Harsh, hacking cough
• Irritated eyes
• Runny nose
• Sneezing
• Loss of appetite
• Depression
• Fever
• Breathing difficulty in severe cases

Diagnostics:

Kennel cough is generally diagnosed based on a history of exposure and physical examination. In some cases, your veterinarian may also recommend blood tests and chest X-rays to rule out other disease processes or assess severity.

Treatment:

Kennel cough is generally self-limiting and doesn’t require treatment beyond cough suppressants if the cough is particularly severe. If a bacterial infection with Bordatella bronchiseptica is suspected, a course of antibiotics may be prescribed.

Prevention:

There is a vaccination against two of the more common organisms responsible for causing kennel cough, Bordatella bronchiseptica, and parainfluenza.

Kidney disease is much more common in cats and dogs as they age. It is estimated that 1 in 10 dogs and 3 in 10 cats will develop kidney disease within their lifetime. The kidneys are normally responsible for:

• Eliminating protein waste
• Conserving water
• Maintaining electrolyte and acid-base balance
• Signaling the body to make more red blood cells
• Regulating blood pressure

Certain factors, such as age and breed, may predispose pets to develop kidney disease. Underlying conditions, such as kidney infection, inflammation, and cancer, may also decrease kidney function. Tick-borne diseases, such as Lyme disease, have also been associated with the development of kidney disease in dogs.

Symptoms:

• Increased drinking
• Increased urination
• Decreased appetite
• Weight loss
• Bad breath
• Back pain/painful kidneys on palpation

Diagnostics:

Kidney disease is diagnosed based on a combination of blood and urine tests. Kidney disease can be staged based on certain blood values, urine values, and substage based on the presence of protein in the urine and/or high blood pressure. In order to diagnose and properly stage kidney disease, your veterinarian will recommend:

• Complete Blood Count (CBC)
• Blood chemistry panel
• Urinalysis
• Urine protein: creatinine ratio
• Urine culture
• Blood pressure measurement

In addition, imaging, such as an abdominal X-ray or ultrasound, may be beneficial in looking for signs of kidney infection, cancer, or stones. Testing for infectious diseases, such as Lyme disease, may also be recommended.

Treatment:

Kidney disease is a progressive disease, and treatment is directed at management. The goals of therapy include:

• Maintaining adequate hydration, which in some cases may require administration of fluids under the skin
• Restricting dietary intake of protein and phosphorus, which, as the course of disease advances, can only be achieved through veterinary therapeutic diets
• Controlling nausea
• Maintaining appropriate electrolyte and acid-base balance
• Controlling high blood pressure
• Reducing protein loss through the kidneys

Regular monitoring and follow-up with your veterinarian will be necessary to monitor progression and stay on top of any changes in your pet.

Leptospirosis is an infectious disease that is transmitted in the urine of wildlife.  It is important to note that leptospirosis can be transmitted by rats, making dogs in urban environments just as much at risk as those in more rural areas. Leptospirosis is a zoonotic disease and has the potential to infect humans as well.

Symptoms:

• Decreased appetite
• Fever
• Muscle pain/stiffness
• Weakness
• Lethargy
• Depression
• Vomiting
• Diarrhea
• Jaundice
• Cough
• Liver and/or kidney failure

Diagnostics:

Leptospirosis can present in a similar manner to many other disease processes. In addition to routine blood and urine tests, your veterinarian will likely recommend serology tests, which can detect antibodies against the organism, or real-time PCR tests, which can detect the actual organism in blood and urine samples. 

Treatment:

Leptospirosis is treated with antibiotics, generally doxycycline. If caught in the early stages of the disease, a full recovery can be expected. However, advanced cases that progress to organ failure carry a very poor prognosis.

Prevention:

There is a vaccination available against leptospirosis.

Lyme disease is caused by a spiral-shaped bacteria, or spirochete, called Borrelia burgdorferi. It is transmitted by the Eastern and Western black-legged deer ticks. Commonly referred to as deer ticks, these ticks preferentially use both deer and white-footed mice as hosts. Once thought to be a primarily Northeastern disease, Lyme disease has now been found in every state in the United States and even parts of Canada.

Symptoms:

• Recurrent joint pain
• Lameness in alternating limbs
• Reluctance to move
• Stiff, painful gait
• Swollen joints
• Leg and/or body pain
• Fever
• Fatigue
• Lethargy
• Decreased appetite
• Swollen lymph nodes

Diagnostics:

A diagnosis of Lyme disease is based on a history of exposure, clinical symptoms, a thorough physical examination, as well as a positive antibody response. As Lyme disease can progress to affect the kidneys, and as ticks often carry and transmit more than one disease, in addition to antibody testing, your veterinarian will likely recommend:

• Complete Blood Count (CBC)
• Blood chemistry panel
• Urinalysis
• Urine protein-creatinine ratio, if indicated by the presence of protein in the urine
• Additional tick antibody titers

Treatment:

Lyme disease is treated with antibiotics, generally for a 28-day course. Prognosis is generally good as long as there are no complicating factors, such as Lyme nephritis. Lyme nephritis is an infection of the kidneys that often carries a poor prognosis.

Prevention:

Multimodal prevention is key in preventing Lyme disease. Both vaccination and the regular monthly administration of oral flea and tick prevention are the best options currently available. Regular tick checks and prompt removal of any attached ticks, using safe removal methods such as a tick spoon or long-nosed tweezers, will also help to reduce the likelihood of Lyme disease transmission.

Obesity is defined as an accumulation of excess fat resulting in excess body weight of 15% above optimal, and it is the most common nutritional disorder seen in cats and dogs. While there are rare instances of metabolic disorders causing obesity (hypothyroidism in dogs is an excellent example), in the vast majority of cases, it is simply a matter of excess caloric intake and insufficient exercise that results in pet obesity.

Much like in humans, pet obesity can lead to a number of other disease processes and can exacerbate inflammatory conditions, such as arthritis. Studies have also shown that dogs maintained at an ideal body weight live 15% longer lives.

Before embarking on a weight loss plan for your pet, it’s important to set goals and check in regularly with your veterinarian. Excess restriction of over-the-counter diets beyond 70% of the recommended daily amount may actually result in severe and potentially critical nutritional deficiencies. If your pet needs to reduce calories significantly, a veterinary therapeutic or prescription diet may be indicated. It’s also important to keep weight loss at a reasonable pace with a goal of decreasing your pet’s weight by approximately 3 – 4% per month.

Pancreatitis is characterized by inflammation of the pancreas. It can happen suddenly or acutely, as well as chronically over longer periods of time. Pancreatitis can be caused by a variety of underlying conditions, such as:

• Genetics: Miniature Schnauzers, English Cocker spaniels, Cavalier King Charles spaniels, Collies, Boxers, and Siamese cats have a predisposition to developing pancreatitis
• Diet: diets high in fat are known for potentially causing pancreatitis, although even something as simple as a new or unusual food can trigger pancreatitis
• Trauma
• Medications 
• Infection
• Cancer

Symptoms:

• Abnormal posturing or “prayer” position in dogs
• Restlessness
• Decreased appetite
• Vomiting
• Hiding/Avoidance behaviors (cats)
• Jaundice

Diagnostics:

Pancreatitis can be challenging to diagnose. A CT scan is the gold standard in humans, but it has proven less useful in cats and dogs. As the signs of pancreatitis are rather vague and can mimic other disease processes, your veterinarian will likely recommend:

• Complete Blood Count (CBC)
• Blood chemistry panel
• Urine tests
• Abdominal X-rays and/or abdominal ultrasound
• Pancreatic specific lipase tests

Treatment:

If an underlying cause is evident, such as an infection, treatment is generally geared toward resolving the underlying cause, in addition to providing supportive care. In cases where no underlying cause is evident, or there is no specific treatment, supportive care is the only treatment available. Some cases can be managed on an outpatient basis with diet, anti-nausea medications, and pain relief, while severe cases may require hospitalization.

Prevention:

For pets prone to pancreatitis or with a history of previously diagnosed pancreatitis, a long-term veterinary therapeutic or prescription diet that is highly digestible and low in fat may be necessary to prevent a recurrence.

Rabies is caused by a virus that is spread through the saliva of infected animals, most commonly foxes, skunks, raccoons, and bats. Despite the fact that we rarely see Rabies in our pet population, it is a serious and fatal disease if contracted. It is also a zoonotic disease, meaning that it is capable of being transmitted to humans.

Symptoms:

• Fever
• Seizures
• Paralysis
• Change in voice
• Incoordination
• Behavioral changes (classically aggression)
• Excessive salivation
• Inability to swallow

Diagnostics: 

As the clinical symptoms of Rabies can mimic other disease processes, your veterinarian will likely recommend:

• Complete Blood Count (CBC)
• Blood chemistry panel
• Urine testing
• Infectious disease testing

Rabies can only be diagnosed after death by analyzing brain tissue for the virus. However, any animal exhibiting neurologic signs (see above) must be considered a possible Rabies suspect, and precautions must be taken to limit human exposure as best as possible.

Treatment: 

There is no treatment for Rabies. Once contracted, Rabies is ultimately fatal.

Prevention:

There is a vaccination available against Rabies, and all pets must be up-to-date as mandated by Massachusetts State law, regardless of their exposure risk.

Urinary incontinence can be a very frustrating condition for pet owners to manage. A previously house-trained dog is unlikely to revert, so any changes in urination behavior should be addressed with your veterinarian as there is more than likely an underlying medical cause.

Urinary incontinence can be caused by a variety of factors, some hormonal, some anatomical, and other neurologic. The most common causes are:

• Urinary tract infections cause inflammation of the bladder and an increased sense of urgency in dogs. While there is conscious urination, unlike true incontinence, the discomfort associated with a urinary tract infection makes it difficult for dogs to resist the urge to urinate.
• Ectopic ureters are a congenital abnormality in which urine flows directly from the kidneys without being collected in the bladder. It is often diagnosed in puppies and can be surgically corrected.
• Neurologic or spinal conditions can lead to incontinence due to decreased nervous system control over the bladder muscles and urinary sphincter.
• Paradoxical incontinence occurs when there is a partial mechanical obstruction to urine flow, such as a bladder stone or tumor.
• Dementia and senility can lead to urinary incontinence as these dogs become unaware of when they need to urinate.
• Estrogen responsive incontinence is the most commonly diagnosed form of incontinence. It is most often seen in older, spayed female dogs and is thought to occur secondary to decreased levels of estrogen, which result in a loss of tone of the detrusor muscle (the detrusor muscle acts as a valve controlling urine flow). Estrogen responsive incontinence generally presents as nocturnal incontinence.

Diagnostics:

Diagnosis of urinary incontinence is generally based on history. Urine tests should be performed to rule out infectious causes, and bladder imaging is helpful in ruling out anatomical causes.

Treatment:

Treatment is directed at the underlying cause of urinary incontinence wherever possible.