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Addison’s Disease

Addison’s Disease
By Dr. Karen Burgess

What is Addison’s disease?
Addison’s disease, or hypoadrenocoticism, occurs when the adrenal gland fails to produce adequate amounts of hormone.  Dogs and cats have two adrenal glands that are found next to the kidneys.  These small glands have different layers that are responsible for releasing several hormones and substances that profoundly impact the whole body and are essential for life.  Addison’s disease is a deficiency of cortisol and aldosterone.  Cortisol is necessary to deal with stress and aldosterone is essential for water and electrolyte balance.

How do pets get Addison’s disease?
While infection or trauma to the adrenal gland can cause Addison’s disease, the most common cause is immune related.  The immune system is very powerful, designed to “fight off” anything identified as foreign.  In cases of auto-immune disease, the immune system for unknown reasons attacks itself, or in the case of Addison’s disease the adrenal gland.  Addison’s disease also occurs secondary to drug therapy for another condition called Cushing’s or with long-term use of steroids.  When pets receive steroids orally or topically it can cause the adrenal glands to stop producing steroid or go dormant.  If therapy is stopped suddenly the adrenal glands do not automatically turn on and start producing hormone again, thus creating a crisis situation.  Pituitary disease rarely causes Addison’s disease.

What does a pet with Addison’s disease look like?
Unfortunately Addison’s disease does not have one “look”.  It is more commonly recognized as a disease that mimics or masquerades with vague and non-specific symptoms.  Owners may notice gastrointestinal signs (vomiting, diarrhea, weight loss) that come and go, changes in thirst or urination, or even shaking at odd times.  Mild signs often self-resolve.  When a pet is experiencing an Addisonian Crisis it is a medical emergency.  This is when the disease has affected hydration or electrolytes to the point of potential collapse and sudden death.  Hospitalization and emergency supportive care are necessary to treat the Crisis situation.

How is Addison’s diagnosed?
While testing of electrolyte values may hint at the presence of Addison’s, an ACTH test specifically diagnoses the disease by measuring cortisol levels.

How is Addison’s treated?
Fortunately the prognosis with Addison’s is good and there is essentially a cure in the form of medication that replaces lacking hormone.  Depending on the type of Addison’s disease present, there are oral and injectable treatment options.  Monitoring of electrolytes will be necessary on a regular basis.  Special attention should be paid during stressful times as these are common times of decompensation and may require extra supplementation.

Reverse Sneeze, Canine

Reverse Sneezing
By Dr. Karen Burgess

What is a reverse sneeze?
A reverse sneeze is a sneeze, snort, gagging sound that some pets make for no apparent reason.  Some owners may think their pet is choking while experiencing a reverse sneeze episode.  Dogs will stand with their necks stretched and their chest will often heave but they do not appear to be in any real distress.

What causes reverse sneezing?
The exact cause of this process is not completely understood, but it is typically attributed to an irritation of the throat and/or soft palate that results in the subsequent spasm.  Common contributing factors include allergic disease, excitement, irritants, pressure from a color, inhaled foreign material, and eating or drinking.  Short-faced (brachycephalic), small breed, and overweight dogs may have more incidence of reverse sneezing.  Rarely nasal mites are found in dogs that are reverse sneezing.

How are reverse sneezes treated?
No treatment is required.  In some cases offering food or water may interrupt an episode.  Offering a toy, command, or walk outside may also help.  If the problem progresses additional diagnostics including scoping of the nose may be indicated.


Hot Spot, Canine

Hot Spot
(Self-inflicted acute moist dermatitis)
By Dr. Karen Burgess

hot spot

A hot spot is an area of self-trauma typically secondary to a local area of irritation that a pet then excessively chews or scratches.  The typical appearance is a red, moist lesion that may be hairless of have the appearance of matted wet fur.  These lesions are typically acute in nature with owners reporting that they were not present even hours earlier.  Common causes include flea bite allergy, inhalational or food allergies, and ear infections.

Treatment for hot spots involves treating the wound and any subsequent infection, relieving discomfort, and if possible identifying the underlying cause.  Because these wounds are often painful, sedation or injectable pain medication may be required.  The area is then shaved to remove all fur and cleaned to remove debris over the affected area and to allow better airflow for healing.  Medical treatment may involve topical sprays, antibiotics, and pain medication.  An Elizabethean collar is often necessary to prevent further self-trauma.  Additional testing may be necessary to better determine contributing factors to the hot spot.


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Coccidiosis, Canine

By Dr. Karen Burgess

What is Coccidia?
Coccidia are in a family of microscopic parasites called protozoa and are not visible to the naked eye like other worms.  There are several species of coccidia but Isospora is the most commonly seen in dogs and cats.  Coccidia reside in the small intestine, can cause severe watery diarrhea, particularly in the very young, and are not susceptible to commonly used dewormers.  While potentially life threatening in the very young, coccidian is typically of no concern in healthy adults.

How do cats and dogs get coccidia?
An animal infected with coccidia passes eggs or oocysts in their fecal matter.  Once in the environment oocysts mature (sporulate) and become infective to animals.  In some cases dogs or cats eat other animals (ex. mice) that are infected with coccidia thereby becoming infected themselves.  Pets from high density housing situations such as kennels, shelters, or breeders are commonly infected with coccidia.

What clinical signs do coccidia cause?
Once inside the body, sporulated oocysts burst open releasing smaller versions that then attach to a cell lining the intestine and start reproducing.  Eventually too full to be contained, the infected intestinal cell bursts releasing even more coccidia to infect additional intestinal cells.  Ultimately infected intestinal cells are destroyed preventing an animal from being able to absorb nutrients from their food and leading to bloody, watery diarrhea.  Puppies, kittens and the debilitated are particularly susceptible to coccidia infection and can develop life threatening dehydration from an infection.

How is coccidia diagnosed?
Coccidia is found on a microscopic examination of a fecal specimen.  It is important to note that it may be difficult to diagnose coccidian on a single fecal test.  If symptoms persist in a patient, repeated fecal exams may be necessary.

How is coccidia treated?
The immune system is often able to keep numbers of coccidia under control, thus why healthy adult animals often do not develop disease.  In the very young, the immune system can become overcome thus requiring treatment.  Albon is the drug of choice to treat coccidia.  Typically given once daily for ten days, albon slows down coccidia reproduction giving the pet’s immune system a chance to resolve the infection.

Is coccidia contagious to people or other pets?
The species of coccidia that most commonly infects dogs and cats (Isospora) is not infectious to people (other species of coccidia  including Cryptosporidium and Toxoplasmosis are contagious to people).  While other pets can be infected by exposure to coccidia that have matured in the environment, it is typically only a concern in the very young or debilitated.  Good hygiene and cleaning the environment with dilute bleach (1 cup bleach to 1 gallon water) can help prevent reinfection.


Bloat, Canine

 Bloat (Gastric Dilatation Volvulus)
By Dr. Karen Burgess

What is bloat?
GDV (gastric dilatation and volvulus) is commonly referred to as bloat.  Technically bloat is when the stomach becomes overly distended with air or material (food typically).  Bloat alone can be range from causing abdominal pain to being life threatening.  In some cases, particularly in large or deep chested breeds, the bloated stomach can then twist upon itself thereby cutting off its blood supply and in some cases that of the spleen too.  This would be a case of torsion or volvulus is always an emergency and potentially life threatening.

Why do dogs develop GDV?
There is not one reason that dogs develop gastric torsion.  It is more common in giant breed (60% of Great Danes and 20% of dogs over 100# will experience GDV during their lifetime), deep chested, older and stressed or excited dogs.  There is also thought to be some correlation with eating a large meal and bloat occurring two to three hours later.

What problems does bloat and GDV (torsion) cause?
Both syndromes can affect blood supply to the stomach.  With torsion this is typically more severe and in a very short time circulation can be diminished to a point where the stomach wall actually dies.  Shock and severe pain are also common with GDV leading to potential circulatory collapse and death.

What are the signs of bloat and GDV (torsion)?
To the naked eye both will look very similar.  A distended abdomen may be noted and typically the pet will repeatedly vomit or appear to dry heave.  Sudden sever pain, lethargy, weakness, or collapse may also occur.  Testing is necessary to accurately differentiate between the two syndromes.  If symptoms are noted the pet should be taken immediately to a veterinarian.

What will the veterinarian do?
GDV is a life threatening emergency and immediate intervention is essential to improve chances of treatment success.  Dogs suspected of being bloated will often be triaged and immediately taken to a treatment area for care and diagnostics.  An intravenous catheter will be placed and large volumes of fluids administered to reverse signs of shock.  Pain medication is often provided and evaluation of vital signs performed to evaluate for life threatening heart arrhythmias.  The stomach may be trocarized (have a needle placed externally) or a stomach tube passed to allow immediate release of pressure.  Radiographs are taken to help differentiate between the two conditions.  Labwork is performed to determine the impact on the remainder of the body systems.  A discussion will be had on treatment options.

How is GDV (torsion) treated?
Unfortunately the stomach does not often return to normal position even if pressure is released externally.  There is also often secondary damage to the spleen or stomach wall.  Surgery is the only definitive treatment for GDV.  An abdominal exploratory is performed and internal organs examined.

The stomach is untwisted and evaluated.  It is not uncommon for the spleen to also be affected and require removal.  The stomach wall is then sutured to the body wall (gastropexy) thereby preventing future episodes.  While the pet may still experience bloat, torsion is unlikely.  Without a gastropexy nearly all dogs that experience GDV will have another episode.

What is the prognosis?
This depends a great deal on many factors.  There are several expected complications associated with GDV and mortality rates in uncomplicated cases can be as high as 20%.

How can GDV be prevented?
Prophylactic gastropexy (tacking the stomach to the body wall thereby preventing torsion) is often recommended at the time of spay or neuter in breeds considered at risk.