Labwork, Complete Blood Count

Complete Blood Count
By Dr. Karen Burgess

 

What is a CBC (complete blood count)?
A CBC quantifies the number of red and white blood cells and platelets a pet has.  It also describes the cells qualities including how they physically look (ex. too small, too large)

What are red blood cells and what tests are done on them?
Red blood cells make up almost half of the blood’s volume.  They give blood its red color and contain hemoglobin which is responsible for carrying oxygen from the lungs to all of the cells in the body.  Common tests performed include:

  • RBC (red blood cell count), HCT (hematocrit), Hgb (hemoglobin)-measures red blood cell mass and quantity. A decrease in these counts would be suggestive anemia, a potentially serious medical problem.
  • MCV, MCH, MCHC, RDW-measurement of red blood cell size. The size of the red blood cells can give clues about specific disease processes.
  • Retic-quantification of reticulocytes or immature red blood cells. Helps determine whether the bone marrow is working properly.

What are white blood cells and what tests are done on them?
There are five types of white blood cells.  These cells respond to bacteria, viruses, and foreign material in the body.  White blood cell types include:

  • Neutrophils-most common white blood cell, typically fight bacterial infections. Can also be elevated with stress.
  • Lymphocytes-components of immune system
  • Monocytes-are involved with damaged tissue typically
  • Eosinophils-often involved with parasitic and allergic disease
  • Basophils-also related to parasitic and allergic disease, uncommon.

What are platelets and what tests are done on them?
Platelets are the body’s first line of defense in the body’s clotting process.   Low platelet counts can be indicative of potentially life threatening bleeding problems in a pet.

Labwork, FAQ

FAQ’s About Laboratory Work
By Dr. Karen Burgess

Why should laboratory work be performed on a pet?
There are many reasons to perform testing on a pet, some of the more common include:

  • As part of a wellness examination-our goal with annual labwork is to prove that a pet is healthy and not find abnormalities. The idea is to establish a baseline so that if and when a problem develops there is a “normal” reference point to refer back to.  This becomes increasingly important with age, thus why it is recommended that senior pets have labwork done twice a year.  In some situations a pet may seem healthy and an unknown medical condition may be identified thus allowing earlier intervention and possibly a better prognosis.
  • With illness-labwork allows further evaluation of the sick pet in an effort to further isolate the problem, assist with treatment, and provide prognosis.
  • Prior to anesthesia-the key to safe anesthesia is to plan ahead. A key component of this is preanesthetic labwork which helps to determine safe drug and dose selection.

How are labwork samples obtained?
Bloodwork is performed on a blood sample.  This sample is drawn from a neck or leg vein using a syringe and needle.  Urine is either collected in a clean container while a pet is naturally voiding or while being restrained using a syringe and needle.

Where are blood tests performed?
Bloodwork can be done either by an automated analyzer in the hospital providing results within the hour or at a commercial laboratory yielding results within a day or so.  Urine evaluation is done by automated analyzers and under the microscope visually.   Some samples are also evaluated by trained personnel under the microscope.

Canine Influenza – Update

Update- Dr. Burgess on Canine Influenza
in the Crystal Lake, Algonquin and Lake in the Hills area

This week new information has become available concerning the current Influenza outbreak.  Cases of this upper respiratory infection (symptoms may include fever, lethargy, cough, nasal discharge, pneumonia) have been reported now in various locations outside of the city.  The strain of Influenza causing most of these cases has not been previously diagnosed in the United States which is making testing and treatment more complicated.  The current Influenza vaccination may not have any efficacy against this new Asian strain.  This Influenza virus while not contagious to humans is highly contagious to dogs and possibly cats (no reported cases as of yet) staying alive on surfaces for forty eight hours, clothing for twenty four hours, and hands for twelve hours.  Current recommendations include:

  1. Be aware that any exposure to any other dog that is infected may put your pet at risk.  Dogs are able to spread the infection several days prior to showing any symptoms.
  2. If planning to board, use doggie daycare, visit a dog park, participate in group dog classes, or attend dog events, be aware that your pet may be at greater risk for contracting this infection.
  3. Contemplate vaccination for Canine Influenza.  While the currently available vaccine may not prevent this strain, it does still prevent the original strain which has also been found in some affected Chicago pets.  Bottom line is we just do not know enough yet about this new strain, but vaccination for Bordetella and Influenza is what we have available at this point in time.
  4. Avoiding exposure is the number one preventative.

Below is the American Veterinary Medical Associations thoughts on Canine Influenza:

https://www.avma.org/KB/Resources/Reference/Pages/Canine-Influenza-Backgrounder.aspx

Canine Influenza

 Canine Influenza
By Dr. Karen Burgess

  

What is Canine Influenza?
Canine Influenza is a virus that primarily affects a dog’s respiratory system causing a cough, fever, and in some cases pneumonia.  The infection is often difficult to differentiate from other more common causes of respiratory disease in dogs (i.e. kennel cough).

How common is Canine Influenza diagnosed?
First diagnosed at Greyhound racetracks in 2004, Influenza has subsequently been diagnosed sporadically in pockets throughout the United States.  The occurrence is much less frequent in nature than other causes of “kennel cough” or infectious respiratory disease.  In spring 2015 there was an increase in respiratory disease seen in downtown Chicago; several of these cases tested positive for Canine Influenza.  It is important to remember that while the broadcast news may report “thousands affected” this has not been confirmed and many of these cases may in fact be from other more common causes of kennel cough.

How is Canine Influenza spread?
The virus is spread in respiratory secretions that have been aerosolized or landed on objects that another dog then comes in contact with.  Canine Influenza is highly infectious with 80% of exposed dogs developing some form of infection.  The 20% that do not become infected can however still spread the disease.  Group dog situations (daycare, boarding, dog classes, dog parks, veterinary hospitals) are more apt to encourage the spread of the disease.  Objects used with or by infected dogs (bowls, grooming utensils, leashes) can also spread infection.

What are the symptoms of Canine Influenza?
Most dogs infected with Canine Influenza develop minimal signs of a persistent cough lasting for two to three weeks.  Nasal discharge, loss of appetite, fever, breathing difficulties, and pneumonia may develop in more severely affected patients.  It is thought that the very young and very old are more susceptible.  In rare cases, infection and its subsequent complications may be fatal.  Any pet that develops signs of an upper respiratory infection that has been recently exposed to other dogs in particular in an area where an outbreak is or has occurred would be considered at higher risk for infection.

How is Canine Influenza treated?
For most dogs, at home care with possible antibiotics and cough suppressants is sufficient.  For more severely affected patients, hospitalization for fluid therapy, injectable antibiotics, and oxygen therapy may be necessary.

How is Canine Influenza exposure prevented?
The most reliable prevention is not having exposure to other dogs during an outbreak.  Avoiding group dog situations for several weeks until the risk has passed or vaccination is performed would be recommended.  It is important to remember that even with vaccination disease will likely not be 100% prevented.  From a hygiene standpoint, Canine Influenza stays alive on surfaces for forty eight hours, clothing for twenty four hours, and hands for twelve hours.  Cleaning with standard disinfectants such as dilute bleach kills the virus.  Dogs that have been exposed to the virus can shed or pass the virus on for two weeks after exposure.  More importantly, dogs will shed the virus most in the days prior to showing clinical signs.  This emphasized the importance of limiting exposure to other dogs if Canine Influenza has been identified in a region.

What about vaccination?
While there is a vaccine for Canine Influenza, it requires two injections and protection is not provided for two weeks minimum after the second dose is administered.  This means if the first vaccination is given today, a pet would not be protected for at least four weeks.  The vaccine does not 100% prevent disease or the spread of disease.  Considered a non-core vaccination (meaning only recommended for at risk dogs), Canine Influenza has not been a vaccine routinely given in this area.  With this recent outbreak vaccination of dogs frequently exposed to other dogs may be recommended.  In a large degree, this will depend on the extent the disease spreads and the duration of the outbreak.   Healthy Paws Animal Hospital is in the process of obtaining the vaccination for owners that are interested.  There are no major side effects associated with vaccination.

Adequan

Adequan
By Dr. Karen Burgess

 

What are symptoms of arthritis in pets?

“Slowing down”, fatigue, difficulty rising, reluctance to go up and down stairs or jump, abnormal aggression, and lagging behind on normal length walks may all be signs of joint pain and/or arthritis.

What is Adequan?

Adequan is an injectable polysulfatated glycosaminoglycan (PSGAG or GAG). In common terms, it is an injectable medication that when given regularly, acts as a lubricant and inhibitor of proteins that damage joint cartilage. Adequan provides the joints with chondroitin, a GAG that helps with compression in the joint. It also allows for production of collagen which helps create building blocks to make new cartilage. In summary, Adequan protects and helps rebuild joints slowing down the development of osteoarthritis

How is Adequan given?

Adequan is given as an injection either in the muscle or under the skin (subcutaneously). The dose is tapered down from twice weekly initially, to once monthly. These shots are typically not painful and relatively easy for owners to administer at home with some instruction. It is important to understand the annual cost of Adequan is significantly less than the initial four months due to this tapering dose.

What benefits are seen with Adequan usage?  What are the potential risks?

Adequan is a chronic joint pain supportive medication. Pets that benefit from Adequan typically show increased mobility, decreased pain, and overall improvement in arthritis symptoms. This improvement can take several weeks to appreciate. In cats, Adequan is one of the safest available arthritis management tools available. Very rarely, pets are sore at the site of injection for a short period after administration. This is much less likely with subcutaneous injection.

 

Heart Failure

Heart Failure
By Dr. Karen Burgess

What does heart failure mean?
The heart is a muscular organ that contains four separate blood holding chambers.  The heart muscle functions to push or pump blood held in these chambers through the body’s blood vessels.  When the heart is unable to push blood forward at a rate that keeps up with the body’s demand it is considered heart failure.  Heart failure typically leads to fluid backing up into the lungs.

What causes heart failure?
There are a variety of diseases that can lead to heart failure.  Pets with a heart murmur, or leaky heart valve account for 80% of heart failure cases in dogs.   In some cases the heart muscle is abnormal, either too thick or too thin.  Lung disease can also put added stress on heart muscle.

What is the significance of heart failure?
Heart failure can be chronic disease with symptoms waxing and waning or acute in nature leading to sudden death.  When blood flow to the body is affected energy level, organ function, and the ability to breathe can all be affected.  Owners may also notice an enlarged belly (from fluid buildup), gums that are blue or paler than usual, and weight loss.

What are symptoms of heart failure?
Pets experiencing heart failure are often first seen for coughing, in particular after exertion of first thing in the morning.  Other signs include exercise intolerance, reluctance to go for walks, and change in sleep pattern or position.

What tests are indicated if heart failure is suspected?
If a pet is experiencing collapse or severe breathing issue from heart failure it may be life-threatening within minutes to hours and immediate medical attention is necessary.   Hospitalization and oxygen support along with medications may be required in these situations.  Radiographs (x-rays) are often used to evaluate for heart failure which will often produce an enlarged heart shape of evidence of fluid buildup in the lungs.  Blood pressure, EKG evaluation, and blood tests are often recommended to further evaluate the impact of heart failure on the rest of the body.  Ultimately an echocardiogram (ultrasound of the heart) allows a veterinarian to understand the specific disease affecting the heart.

What is involved with treatment for heart failure?
Often pets with heart failure are able to be managed with oral medications for some time period after diagnosis allowing them to live a relatively normal quality of life.   It is helpful in managing heart failure patients to monitor their breathing rate while sleeping; changes in this number may indicate that a pet is having more troubles related to their heart function.

Is heart failure the same as a heart attack?
Heart attacks are common in humans and occur when blood flow to the heart muscle is interrupted thus leading to death of the heart muscle known as a myocardial infarct.  This is not a common cause of death or heart disease in cats and dogs.

Bandage Care

Bandage Care Guidelines
By Dr. Karen Burgess

  1. Protect the bandage from self-mutilation, other pets, and the environment.  It is not uncommon for pets to chew at bandages, whether it is their own or a housemate’s.  Keeping an Elizabethean Collar (E-Collar) on at all times may be necessary to prevent self-destructive behavior.  Limiting activity including play is also recommended.  A pet with a bandage should never be allowed unsupervised around other pets or in the yard.  Confinement in a crate or small room in an owner’s absence is recommended.  When going outside the bandage should be protected from the elements by either wrapping with a plastic bag or using a protective cover specifically designed for bandages.
  2. Ensure the bandage stays dry.  Wet bandages can harbor bacteria and lead to tissue damage.  The padding used in bandages and casts is soft allowing a cushion effect but at the same time is very absorbent and any moisture will not dry due to diminished airflow.  A wet bandage should be replaced immediately.  Pets are often more clumsy with elimination while wearing a bandage or cast and may unintentionally soil themselves.  When going outside the bandage should be protected from the elements by either wrapping with a plastic bag or using a protective cover specifically designed for bandages.
  3. Monitor tightness of bandage.  Bandage material can be constrictive affecting blood flow to an area.  In addition the loss of blood flow is often hidden by the bandage itself.  Watch for any swelling, increase in pain, or sudden increase in chewing as signs of a possibly too tight bandage which should be evaluated immediately.
  4. Watch for bandage slippage.  Take note of where a bandage or cast is positioned initially and watch for any signs of slippage.
  5. Do not attempt to modify a bandage at home.  Safely applying a bandage or cast should only be done by trained professionals.  It is very easy to cause damage with an improperly applied bandage often leading to more problems than a pet started with.  Do not be tempted to cut, add tape to, or reapply a bandage at home. 

Seek veterinary assistance immediately if a bandage is wet, slipping, has an odor, is causing swelling or increased pain, or in general appears to be malfunctioning.

 

Ear Mites..

Ear Mites
By Dr. Karen Burgess

What exactly are ear mites?
Ear mites are microscopic bugs that physically resemble ticks and reside in the ear canal and skin of cats and dogs.   The adult ear mite may be visible using a magnifying glass as a small moving white dot.  Ear mites produce debris and discharge in the ear canal that can easily be misdiagnosed as a yeast or bacterial ear infection if not looking specifically for ear mites.

What are the signs of ear mite infection?
Ear mites live and breed in the ear canal, specifically on the surface of the skin.  During this process the mites feed on oils and ear wax and subsequently cause inflammation in the ear canal producing a black discharge and general ear inflammation.  Infected pets will often have painful itchy ears, head shaking, crusting on the skin around the ears, and notable ear discharge.  The adult ear mite can travel outside of the ear canal to the surrounding skin and fur making systemic treatment preferable to treating just the ears.

How do dogs and cats get ear mites?
Ear mites are highly contagious and transmitted by direct contact.  Cats contract ear mites more commonly then dogs.  It is not uncommon to diagnose ear mites in pets coming from shelter or group housing situations.

How are ear mites diagnosed?
A microscopic examination of debris from the ear will typically show actual ear mites or their eggs.

How are ear mites treated?
There are a variety of treatments for ear mites.  Topical ear drops have been a common ear mite treatment with some products available even over the counter.  A disadvantage of topical treatment is that they do not kill ear mite eggs and thus involve twice daily ear drops for a minimum of three weeks.  For some pets this can be uncomfortable and difficult to accomplish.  Tresaderm is a prescription topical that does kill eggs and only requires twice daily treatment for two weeks.  Neither topical product addresses mites that have migrated out of the ear canal.  Alternatively the topical product Revolution can be applied twice (one month between doses) to the skin between the shoulder blades.  This treatment effectively kills mites in the ears and on the skin.  Another treatment option is the dewormer ivermectin which can be given as an injection or orally.  This treatment is considered off-label meaning it is not appropriate for all pets.  All pets in the household (including ferrets and rabbits) should be treated simultaneously.  Pet bedding should also be washed. 

Can humans contract ear mites?
Ear mites are not considered contagious to humans.

Kennel Cough

Infectious Tracheobronchitis (Kennel Cough)
By Dr. Karen Burgess

What is infectious tracheobronchitis?
Infectious tracheobronchitis is often also referred to as kennel cough.  The trachea or windpipe is the major airway that divides into smaller bronchi in the lungs.  Finally bronchi become bronchioles and alveoli where oxygen is ultimately exchanged with red blood cells in blood circulating through the body.  A variety of bacteria and viruses (likely more than fifteen) are capable of causing inflammation in the trachea and bronchi thus leading to a typical dry hacking cough.  While often described as one disease, kennel cough is actually a generalization that would be similar to a person saying they have a cold or the flu but not knowing the specific causative virus or bacteria.  Kennel cough is considered highly contagious from dog to dog.

What are symptoms of kennel cough?
Kennel cough is notorious for causing a dry hacking, non-productive, or honking cough that is easily exacerbated by excitement, exercise, or pressure on the neck/trachea.  Owners will often note that coughing is worse after barking or pulling on a collar.  Dogs with uncomplicated kennel cough do not show signs of general illness and are typically eating, drinking, and active.  Symptoms may only last for days or a mild cough may be present for weeks after infection.  If a pet is acting sick in any way other than a cough the problem may be more serious than kennel cough.

How is kennel cough spread?
Kennel cough is easily spread to healthy dogs from aerosolized cough droplets originating from an infected dog.  Objects such as toys and food bowls can also be methods of transmission.  Symptoms can develop anywhere from two days to two weeks after exposure.  Large numbers of dog in small confines with poor ventilation all contribute to risk.  Dogs that have had kennel cough can technically be contagious for two to three months after exposure.  Some dogs may not even show signs themselves of infection but still be able to spread the disease to other dogs.

What is the significance of a kennel cough?
Kennel cough is typically more of an inconvenience than a true medical problem.   Sleep for the pet and owner may be interrupted and severe cases.  Very young, very old, or immunocompromised dogs may be more prone to developing pneumonia from kennel cough.  The contagious nature of kennel cough requires infected dogs to be confined even after symptom free for some time.  Kennel cough is a not uncommon risk to boarding or exposing dogs to group situations.

How is kennel cough diagnosed?
Kennel cough is typically diagnosed by physical examination and review of patient history (recent exposure to other dogs, no other signs of illness).  Testing for the specific bacteria or virus responsible for an infection is typically not warranted and tests available are limited.  In some cases radiographs of the lungs may be recommended to help rule out other possible causes of a cough.

How is kennel cough typically treated?
Assuming no other symptoms are present, supportive care and time are often the only treatment required.  Rest, avoiding irritation of the trachea (ex. using a harness), and monitoring appetite are all recommended.  If the cough is such that it is keeping an owner or pet from sleeping through the night a cough suppressant may be recommended.  In some cases a course of antibiotics may be recommended, although this will not help if the original problem is viral in nature.

Can kennel cough be prevented?
Vaccination for distemper, adenovirus, Bordetella, and Parainfluenza (all potential causes of kennel cough) are available.  Distemper and adenovirus are core vaccinations recommended for all dogs and typically given as a puppy and adult in combination with parvovirus.  Bordetella and Parainfluenza are non-core vaccinations recommended only for dogs considered at increased risk for exposure to kennel cough.  Vaccination is available in both an intranasal and injectable formulation, however the intranasal is thought to be slightly more effective.  Surfaces exposed to kennel cough should be disinfecte with dilute bleach.

Can a dog get kennel cough even if they are vaccinated?
It is important to note that no vaccine is 100% effective against kennel cough and that if a vaccinated pet develops the disease this does not mean that the vaccine was “bad” or a place of business where exposure occurred “dirty”.  It just means that similar to the human flu vaccination, the vaccine was not effective against the particular disease strain a dog was exposed to.  In some cases vaccination will not prevent the disease 100% but shorten its course or lessen the severity of symptoms.  The most effective way to prevent kennel cough is to not expose a dog to any other dogs.

 

Heartworm Disease

Heartworm Disease
By Dr. Karen Burgess

What is heartworm?
Heartworm disease is caused by Dirofilaria immitus, an up to foot long spaghetti-like worm that grows to maturity in the heart and pulmonary artery (blood vessel connecting the heart to the lungs).  Dogs become infected with heartworm disease when they are bitten by an infected mosquito that acts as an intermediary host.

What are symptoms of heartworm disease?
Dogs with heartworm disease range in showing no symptoms to experiencing heart failure.  More common symptoms include exercise intolerance or a cough.  The adult heartworm can clog blood vessels and cause dangerous inflammation within the lungs.  Symptoms often do not develop for several years after initial infection, but by this time extensive and permanent damage to the lungs has often already developed.

What is the life cycle of the heartworm?
Heartworms develop through five different life stages.  The adult heartworm resides in an infected dog’s pulmonary artery (blood vessel connecting the heart to the lungs).  After mating, adult female heartworms produce microfilaria, or microscopic larva that travels through the blood stream.  When a mosquito bites an infected dog, they ingest microfilaria along with blood.  The heartworm larva goes through two life stages in the mosquito over a several week timespan before being infectious to another dog via mosquito bite.   After a dog is infected, the heartworm must then go through three more lifestages before becoming an adult in the heart.  Ultimately it takes approximately four months from time of mosquito bite to when a mature heartworm is found in the heart.

How is heartworm disease diagnosed?
There are several blood tests readily available to screen for heartworm disease.  The biggest limitation being that most tests are only able to detect more than three adult female heartworms.  Since it takes four months from time of infection to having an adult heartworm, some dogs may test falsely negative for heartworm disease initially.

How is heartworm disease typically treated?
There are several components to successful treatment for heartworm disease.

The microfiliaria (baby heartworms, L1) and recently injected and developing heartworms (L3 and L4) are killed by ivermectin based heartworm preventatives (Heartgard Plus).  This prevents other dogs from being infected and recently injected larva from growing into adult heartworms in an exposed dog.  Injected heartworms (L3) remain in the skin for three months developing to the larval stage that ultimately migrates to the heart (L5).  Developing larval heartworms (L3, L4) are killed by ivermectin based (Heartgard Plus) heartworm preventatives.

Treatment for the adult heartworm (L5) involves a very specific medication called immiticide, a derivative of arsenic.  Prior to treatment, dogs should have their overall health and stage of disease determined.  Blood tests and thoracic (chest) radiographs are recommended at a minimum.  If there is evidence of lung or heart disease on radiographs, a modified treatment regimen or further testing may be necessary in an effort to prevent complications.  Current recommendations for treatment involve an initial one month course of doxycycline.  Research has shown that doxycycline kills a specific bacteria associated with the adult heartworm thus making it more susceptible to immiticide and potentially decreasing side effects of treatment.  After the course of doxycycline, there is a month delay prior to treatment with immiticide.  This allows time for immature heartworms to either be killed by preventative or mature to adulthood allowing immiticide to kill them.  A confirmatory heartworm test should be performed after this eight week delay and prior to immiticide therapy.

Immiticide is administered as an injection in the back muscle.  One month after this first injection, the same injection is given again twice over a two day period.  Each injection of immiticide kills a certain percentage of heartworms.  By dividing the treatment over a two month period, the total number of dead worms a dog is exposed to at any one time is limited.

What is follow-up care after treatment for heartworms?
Dying adult heartworms and the ensuing inflammation they cause in the lungs is a potentially life-threatening problem for dogs undergoing heartworm treatment.  There is no way to completely prevent complications secondary to heartworm treatment.  Anti-inflammatories are often administered immediately after treatment to assist with any local pain at the injection site which can be severe enough to cause a dog to bite.  An estimated 30% of dogs will experience some sort of reaction secondary to the injection.  Strict rest is required for four weeks after each injection; this means short leash walk to go to the bathroom in the yard, no running, walks, playing, or excessive excitement.  The dying adult heartworm can be very dangerous and the more the heart is rested the safer it is for the dog.  It is better to error on the side of caution (crating a pet) than risk a possible complication.  A heartworm test should be performed again six months after treatment.

What are signs of complications from treatment?
Cough (often closely resembling vomiting but with no food present), lethargy, vomiting, difficulty breathing, loss of appetite, or collapse are all possible complications and warrant immediate medical attention.

Can heartworm be prevented?
There are several different products available to prevent heartworm disease.  These are typically a pill that is administered once monthly year round.  Care should be taken to purchase a reliable product from a trusted brand as several product lines have experienced recalls over the years.

Can a dog get heartworm disease while on preventative?
Heartworm treatment is nearly 100% effective.  Reasons for breakthrough include failure of pet to ingest pill, poor owner compliance in giving pill monthly, resistant strains of heartworm (not a current problem in this region), and an animal that had immature worms that were not detected on a previous heartworm test.

Why do dogs need to be tested for heartworm disease prior to giving preventative?
Heartworm preventatives quickly kill off microfilaria.  In rare instances this can lead to a potentially fatal anaphylactic reaction in a dog.  Heartworm positive dogs with microfilaria should be monitored in a hospital setting when first being given preventative.