Food Allergies in Cats

Do you suspect that your cat has food allergy? Pets, like people, can be allergic to certain types of foods. We commonly diagnose this during annual wellness examinations. Food allergy can be tricky to diagnose. It often requires several months to manage symptoms and get a final diagnosis.

What Are the Signs of Food Allergies in Cats?

Food allergy in cats presents mostly commonly as miliary dermatitis or small crusting scabs on the neck and body. Many cats will also have a history of frequent hairballs.

Common Signs:

    Red, hot, or irritated skin
    Chronic or recurrent skin infections
    Chronic or recurrent ear infections
    “Stinky” skin
    Hair loss

Less Common Signs:

    Sensitive stomach
    Vomiting
    Soft stool or diarrhea (intermittent)
    Infection between the toes

What Foods Commonly Cause Allergy in Cats?

Beef and chicken are the most common sources of food allergy in cats. Beef, chicken, beef by-products, and chicken by-products are high-quality sources of protein commonly used in cat foods. By-products may include bone meal and fats from both beef and chickens.

Many commercial pet food companies advertise corn and grains as causes of food allergy. However, research overwhelmingly does not support this claim.

How is Food Allergy Diagnosed?

There is no single test that is specific to diagnose food allergy. A thorough history, including diet and treats, and physical examination are vital to this diagnosis. Often, food allergy is suspected or diagnosed with this alone. Other skin tests such as cytology and culture may be conducted to rule out other causes. Fleas, mange, and bacterial or fungal infections may be present as well. Blood work may be performed to rule out other causes, particularly when symptoms of diarrhea and vomiting are present. However, none of these tests specifically identify food allergy. To definitively diagnose food allergy, we must complete a dietary elimination trial.

How Do We Complete a Dietary Elimination Trial?

Eliminate ALL beef and chicken in the diet.
Choose a new diet that does not contain beef or chicken. This includes treats, table scraps, flavored toys, rawhides, supplements and vitamins. Some heartworm preventative prescription medications are flavored and may need changed as well. We are happy to discuss alternative medication sources and brands for food allergy patients.

Eliminating beef and chicken can be tricky.
This requires close inspection of each food label. Many labels advertise “turkey” or “fish” but still contain beef by-product or chicken meal. Ingredients that do not indicate source, such as “animal fats” or “bone meal” are usually from beef and chicken sources and must be avoided, too.

“Grain free” diets are not recommended – and not necessary.
Since food allergy is most commonly caused by beef and chicken, these are the target proteins eliminate.

Choose a diet that the pet has never had before.
Choose a diet that is affordable and easy to find. This does not necessarily need to be a prescription diet. These ingredient-specific diets are generally more expensive as they guarantee exclusive protein sources such as fish or lamb.

Complete a trial period with the new diet.
Feed the new diet for minimum of 12-16 weeks. During this time, you should note decreased itchiness and improvement in the clinical signs. Note that if your pet is inadvertently fed something with beef or chicken during this trial period, the trial must start over. At the end of the trial period, your pet should be re-evaluated for response to treatment. Occasionally, several food trials are required to identify the allergy culprit and manage the allergy.

How Is Food Allergy Treated?

Most importantly, food allergy is treated by identifying the allergen and eliminating it from the diet. Some pets can suffer relapses of clinical signs when the smallest amount is consumed. This is similar to a person with peanut allergy. Only a small amount is needed to trigger the allergy. Once an appropriate diet has been determined, the patient should remain exclusively on that diet. It is possible the patient may do well on the new diet for several years and later develop an additional allergy. In these cases, we recommend repeating the elimination food trial with a new protein or a prescription hydrolyzed diet.

What if We Can’t Find a Diet That Improves Signs?

Occasionally, pets do not improve, or do not adequately improve, with ingredient-specific diets. These pets may require a prescription diet or additional therapy to control allergy symptoms.

Prescription Hydrolyzed Protein Diets: These diets are relatively new. Hill’s Science Diet Z/D Ultra, Purina HA, and Royal Canin Duck and Pea or Royal Canin HP are all acceptable diets. Your pet may have a preference for palatability. An elimination diet should be repeated with a hydrolyzed protein diet. If the diet helps resolve allergy signs, it should be fed indefinitely.

Investigate Other Allergies: It is very common for pets that suffer from food allergy to also have concurrent seasonal, flea or environmental allergy. In these patients, we recommend additional blood or skin testing. Dust mite and pollen allergies are common. Desensitization therapy is recommended in these patients.

Flea & Tick Treatments: We recommend year-round flea and tick preventative in all of our patients. This is especially important in patients with allergy.

Symptomatic Treatment: Additional therapies are available for treatment of symptoms such as itch that are not completely controlled by diet and desensitization. This includes:
Zyrtec (Cetirizine): This is an over-the-counter allergy medication that is safe for administration to your cat. Do NOT use Zyrtec-D. Please ask about specific dosing for your cat.

Can I Feed My Pet Treats?

As part of the elimination trial, pets cannot be fed treats. Once the trial is over, and an appropriate diet has been determined, the veterinarian may recommend specific foods that comply with the special diet. One food that can be utilized for administering medications is marshmallows.

Food Allergies in Dogs

Do you suspect that your dog has food allergy? Pets, like people, can be allergic to certain types of foods. We commonly diagnose this during annual wellness examinations. Food allergy can be tricky to diagnose. It often requires several months to manage symptoms and get a final diagnosis.

What Are the Signs of Food Allergies in Dogs?

Food allergy in dogs presents mostly commonly as itchy skin. Affected dogs will chronically lick their feet. Many dogs with white feet will have pink to red staining on the hair around the feet from excessive licking.

    Common Signs:
    Red, hot, or irritated skin
    Chronic or recurrent skin infections
    Chronic or recurrent ear infections
    “Stinky” skin
    Hair loss
    Rubbing lips or face (especially after eating)

    Less Common Signs:
    Sensitive stomach
    Vomiting
    Soft stool or diarrhea (intermittent)
    Infection between the toes

Which Dogs Are Most Commonly Affected?

Food allergy is commonly diagnosed in both male and female dogs of all ages, including young dogs and puppies. Although this has been diagnosed in many breeds, our doctors commonly diagnose this in Labrador retrievers, cocker spaniels, Yorkshire terriers and Maltese patients.

What Foods Commonly Cause Allergy in Dogs?

Beef and chicken are the most common sources of food allergy in dogs. Beef, chicken, beef by-products, and chicken by-products are high-quality sources of protein commonly used in dog foods. By-products may include bone meal and fats from both beef and chickens.

Many commercial pet food companies advertise corn and grains as causes of food allergy. However, research overwhelmingly does not support this claim.

How is Food Allergy Diagnosed?

There is no single test that is specific to diagnose food allergy. A thorough history, including diet and treats, and physical examination are vital to this diagnosis. Often, food allergy is suspected or diagnosed with this alone. Other skin tests such as cytology and culture may be conducted to rule out other causes. Fleas, mange, and bacterial or fungal infections may be present as well. Blood work may be performed to rule out other causes, particularly when symptoms of diarrhea and vomiting are present. However, none of these tests specifically identify food allergy. To definitively diagnose food allergy, we must complete a dietary elimination trial.

How Do We Complete a Dietary Elimination Trial?

Eliminate ALL beef and chicken in the diet.
Choose a new diet that does not contain beef or chicken. This includes treats, table scraps, flavored toys, rawhides, supplements and vitamins. Some heartworm preventative prescription medications are flavored and may need changed as well. We are happy to discuss alternative medication sources and brands for food allergy patients.

Eliminating beef and chicken can be tricky.
This requires close inspection of each food label. Many labels advertise “turkey” or “fish” but still contain beef by-product or chicken meal. Ingredients that do not indicate source, such as “animal fats” or “bone meal” are usually from beef and chicken sources and must be avoided, too.

“Grain free” diets are not recommended – and not necessary.
Since food allergy is most commonly caused by beef and chicken, these are the target proteins eliminate.

Choose a diet that the pet has never had before.
Choose a diet that is affordable and easy to find. This does not necessarily need to be a prescription diet. These ingredient-specific diets are generally more expensive as they guarantee exclusive protein sources such as fish or lamb.

Complete a trial period with the new diet.
Feed the new diet for minimum of 12-16 weeks. During this time, you should note decreased itchiness and improvement in the clinical signs. Note that if your pet is inadvertently fed something with beef or chicken during this trial period, the trial must start over. At the end of the trial period, your pet should be re-evaluated for response to treatment. Occasionally, several food trials are required to identify the allergy culprit and manage the allergy.

How Is Food Allergy Treated?

Most importantly, food allergy is treated by identifying the allergen and eliminating it from the diet. Some pets can suffer relapses of clinical signs when the smallest amount is consumed. This is similar to a person with peanut allergy. Only a small amount is needed to trigger the allergy. Once an appropriate diet has been determined, the patient should remain exclusively on that diet. It is possible the patient may do well on the new diet for several years and later develop an additional allergy. In these cases, we recommend repeating the elimination food trial with a new protein or a prescription hydrolyzed diet.

What if We Can’t Find a Diet That Improves Signs?

Occasionally, pets do not improve, or do not adequately improve, with ingredient-specific diets. These pets may require a prescription diet or additional therapy to control allergy symptoms.

  • Prescription Hydrolyzed Protein Diets: These diets are relatively new. Hill’s Science Diet Z/D Ultra, Purina HA, and Royal Canin HP are all acceptable diets. Your pet may have a preference for palatability. An elimination diet should be repeated with a hydrolyzed protein diet. If the diet helps resolve allergy signs, it should be fed indefinitely.
  • Investigate Other Allergies: It is very common for pets that suffer from food allergy to also have concurrent seasonal, flea or environmental allergy. In these patients, we recommend additional blood or skin testing. Dust mite and pollen allergies are common. Desensitization therapy is recommended in these patients.
  • Flea & Tick Treatments: We recommend year-round flea and tick preventative in all of our patients. This is especially important in patients with allergy.
  • Symptomatic Treatment: Additional therapies are available for treatment of symptoms such as itch that are not completely controlled by diet and desensitization. These include:
    • Cytopoint: An injection that can be given every eight to twelve weeks that treats the inflammation from allergies. This is very effective and provides relief from symptoms within 24 hours of administration. This may cause some suppression of the immune system.
      Apoquel: This is a prescription pill that is given daily to treat itchiness.
      Zyrtec (Cetirizine): This is an over-the-counter allergy medication that is safe for administration to your dog. Do NOT use Zyrtec-D. Please ask about specific dosing for your dog.

    Can I Feed My Pet Treats?

    As part of the elimination trial, pets cannot be fed treats. Once the trial is over, and an appropriate diet has been determined, the veterinarian may recommend specific foods that comply with the special diet. One food that can be utilized for administering medications is marshmallows.

    Foal Care – The First Year

    Feed

    The foal will nurse up to twenty times an hour during the first week of life. As the foal grows nursing will become less frequent but more milk will be ingested with each feeding. It is important to monitor the mare’s body condition during this time as lactating for a 1-2 month old foal will require more calories. Within the first month, you will note the foal beginning to mimic the dam by grazing or even trying to share her feed. Sharing of grazing is beneficial to establishing normal gut bacteria in the foal. You may also note coprophagia (eating fecal balls). This is normal and also believed to help establish normal gut bacteria. Sharing of grain between the mare and foal should be avoided. This may cause growth problems and epiphysitis (inflammation of the growth plates of the bones).

    Deworming

    Begin deworming with Safe-Guard or Panacur at 6 weeks of age. This is a very safe dewormer and pleasantly apple flavored. Continue deworming every 4-6 weeks until at least 6 months of age. Foals can develop a lethal worm burden in a very short period, therefore deworming strategies in foals are very aggressive.

    Vaccinations

    Vaccinations will begin at 4-6 months of age. At this age immunity acquired from the dam will be waning and the foal’s immune system is beginning to develop. Exact timing will depend on each foal, vaccination history of the dam and whether the foal received adequate colostrum or had a troubled start. In most cases, two sets of vaccinations will be given. In rare cases, three sets will be given to ensure appropriate immunity.

    Handling

    Generally, foals should be turned out to bond with the mare for the first few weeks and will need very little handling. This will allow the foal to grow and become stronger. Handling, halter breaking, leading and learning to tie are all basic ground manners that can be taught quite early. It is important to work with your foal to introduce these basic manners as it greatly reduces stress as the foal grows and is handled for general care, farrier care and veterinary care.

    “Imprinting” right after birth is not recommended. Behavioral research has not shown any benefit to imprinting.

    Do not leave a halter on the foal unattended. Foals often scratch their face with a hind foot and could easily become entangled in a halter if left unattended.

    Too much handling can make a foal too intrusive and although adorable as a newborn, can produce dangers as he/she grows to become an adult 1,000 lb animal. Handling for 5-10 minutes 3-4 days a week is very effective in teaching manners. During this time, catch the foal, gently run your hands over the foal and down the legs. Eventually, begin picking up the feet and holding them for just a few seconds. Do not force or fight the foal, but slowly increase the interval that you are able to hold the foot. Once a halter has been introduced you may begin lead training.

    Weaning

    The best time to wean will depend on each individual (mom’s body condition, housing, foal’s immune status). Weaning is best completed by allowing the foal to socialize and develop relationships with other horses. Turnout with a small group of docile geldings is generally safe, but will obviously depend on the individuals. As the foal develops confidence, you will see the foal spending more time away from mom and venturing out to spend time with herdmates. This behavior will depend on each individual but usually occurs between 4 and 6 months of age. At least one set of vaccinations should be given prior to weaning.

    Exercise

    Exercise is important to allow proper growth and development. However, too much exercise can be damaging and overstress tendons. Recommendations will depend on the individual foal and whether any contracted tendons or tendon laxity was present at birth.

    Castration

    Contrary to popular opinion, testicles are present at the time of birth. If you do not wish to maintain the foal as a stallion there is no proven advantage to leaving the foal intact until a certain age. Testosterone actually influences closure of the growth plates. Therefore, early castration may actually result in a slightly taller horse. Of course, genetics play the primary role in overall build and height.

    Castration may be completed before 1 year of age and before puberty. In most cases we prefer to castrate between 4-6 months of age. At least one round of vaccinations should be given prior to castration. Foals castrated prior to puberty generally do not show any signs of sexual behavior as the testosterone influence is removed prior development of sexual behavior.

    Equine Recurrent Uveitis

    Equine Recurrent Uveitis

    Other Names: Moonblindness, panophthalmitis, iridiocyclitis, periodic ophthalmia

    Equine recurrent uveitis is a painful inflammatory response involving the gel (uvea) inside of the eye. This inflammatory response can occur as a primary problem, particularly in certain breeds, or as a consequence of other infection or injury to the eye. Uveitis may occur as a low-grade insidious disease or have a sudden onset after a specific event. Trauma, severe ulcers and severe infections can all cause uveitis. In many cases the recurrent uveitis may not be evident until long after the original issue is resolved.

    Causes

    Uveitis can occur as a result of infections from rickettsial bacteria, Leptospira spp., and Borrelia burgdorferi (the agent that causes Lyme disease). Leptospira bacteria is shed in urine from infected mammals such as rodents and deer. Most horses become infected with Leptospira through contact with contaminated water or feed sources. In horses, Leptospira infection often clears the rest of the body on its own, but may linger in the eye. Borrelia burgdorferi is carried by ticks and is quickly becoming more prevalent in our area.

    Genetic Predisposition

    Certain breeds have a genetic predisposition to uveitis. Uveitis is diagnosed more frequently in Appaloosas, Rocky Mountain, and Paso Fino horses. Appaloosas have a particularly tricky and severe type of uveitis that is related to their mottled skin color, known as pigmentary uveitis. Appaloosas showing signs of pigmentary uveitis may show very little sign of pain and go unnoticed until the disease has progressed to blindness.

    Immune Dysfunction

    Regardless of the original cause, uveitis progresses to an autoimmune disorder. In a normal state, the immune system perceives the eye as a separate compartment from the rest of the body. Anything that disrupts this relationship can result in uveitis. Once the immune system has been triggered, it will periodically attempt to “attack” the eye, resulting in Equine Recurrent Uveitis.

    Clinical Signs

    Early signs of uveitis are primarily related to pain and may be overlooked as an “allergy” or “cold” in the eye. Signs of eye pain include squinting, excessive tearing, redness and swelling around the eyelids. Tearing is usually clear to cloudy and creates a wet streak down the face. More obvious signs of uveitis include a blue, silver or gray hue to the eye. In some cases, the eye may appear larger than the normal eye. Vision may be temporarily decreased or lost, but may be recovered with appropriate treatment. Often, horses suffering from acute flare-ups of uveitis will be nervous, “jumpy,” or exhibit behavior problems related to pain from the eye. Imagine having a throbbing migraine headache with no relief. Uveitis usually occurs in one eye at a time. However, it is possible for it occur in both eyes, either alternating or in both eyes simultaneously.

    Recurrent Uveitis

    It is important to note that this condition is naturally cyclic. Often owners recall that the horse may have expressed eye pain or discharge in prior instances that appeared to resolve. Over time, the severity of uveitis flare-ups will increase while the intervals of flare-ups will decrease. This results in more severe and more frequent flare-ups until the eye is in a continued state of inflammation and pain. With each recurring flare-up of uveitis, the eye will sustain more permanent damage, decreasing the overall longevity of a functioning and visible eye.

    Diagnosis

    A physical exam including a complete ophthalmic evaluation is the most valuable tool for diagnosing uveitis. Many flare-ups can be complicated with corneal ulceration or glaucoma. It is important to know if an ulcer or glaucoma is present, as it will affect the treatment protocol. In addition, blood samples are often collected to test for complications of Leptospira or Borrelia infections. Results of Leptospira testing will also help determine a prognosis and likelihood of the opposite eye becoming affected.

    Treatment

    Acute Flare-up: During the acute flare-ups, treatment is aimed at aggressively reducing pain and inflammation, and treating any ulcers or glaucoma that were noted during the exam. Treatment consists of topical medications (steroids, NSAIDS, antibiotics, and atropine for pain) and systemic NSAIDS. The length of treatment for each flare-up will depend on how long it has been going on. The longer the eye has been flared the longer it will take to treat.

    Long-Term Management: There is NO CURE for this disease and it will continue to progress over time. However, many horses may live comfortably and continue successful careers for many years. Others may fail to respond to even aggressive therapy. It is extremely difficult to predict how quickly the disease will progress.

    CAUTION: Eye medications with steroids (prednisolone, dexamethasone, or hydrocortisone) can be harmful and CATASTROPHIC in the presence of an ulcer on the eye. Do not treat the eye with steroids without a prior consult to ensure that an ulcer is not present.

    Some horses will require regular maintenance treatment while some will only require treatment of flare-ups. As an alternative to topical treatment a long-term medicated implant can be surgically placed in the “white” of the eye. This implant will release medication slowly over time. At this time, we do not offer this procedure. However, we are happy to refer to a board certified veterinary ophthalmologist. The implant is not lifelong and will need replaced every few years.

    Treatment-Resistant Uveitis

    Unfortunately, in some cases, uveitis will not respond to treatment. Removal of the eye (enucleation) should be considered in cases with intractable pain or that are blind. Once the eye is non-visual, it serves only as a source of pain. Enucleated horses function very well in many disciplines.

    Causes of Flare-Ups

    Patients with uveitis should be monitored carefully during any illness or when vaccinations are given. Any stimulation of the immune system may trigger a flare-up. This is not a reason to skip vaccines. In fact, vaccination and prevention are even more important in uveitis patients. However, a pre-treatment may be given to reduce the chance of a flare-up from vaccination.

    Recognizing Early Signs of Flare-Up

    One of the most important aspects of controlling this disease is recognizing early signs of flare-up and seeking treatment immediately. Any sign of eye pain, excessive tearing, red eyelids, swelling or squinting should be taken seriously. Treating immediately shortens the treatment time and reduces damage caused by each episode of flare. Owners are encouraged to keep some medications available for sudden episodes.

    Prevention

    Genetic Testing: Unfortunately, there is currently no genetic testing available to predict this disease in horses.

    Pre-Purchase: It is impossible to guarantee that a horse will not develop uveitis and very difficult to detect when the eye is “quiet”. However, there are a few signs that veterinarians look for during a pre-purchase exam to help determine whether uveitis has been present in the past.

    Vaccination: A vaccine is available for prevention of uveitis caused by Leptospira pomona. Unfortunately, it only protects against one type of Lepto (there are at least 6 types) and offers no protection against other causes of uveitis. In our practice, we generally use this vaccine in AT-RISK cases, such as horses with eye abnormalities or farms where Lepto has been identified as a problem before.

    Equine Metabolic Syndrome / Insulin Resistance / Insulin Dysregulation

    Clinical Signs

    Patients with equine metabolic syndrome/insulin resistance/insulin dysregulation will often be overweight or have a tendency to be overweight. Often, the patient does not have any trouble until they have a sudden episode of laminitis.

    Diagnosis

    Diagnosis if often made based on a clinical syndrome or clinical “picture” based on the horse being an “easy keeper” or always having a tendency to be overweight. In some cases, we will run blood work including a resting glucose and resting insulin. This will help distinguish whether the horse is affected by insulin dysregulation.

    Treatment

    Treatment is primarily through dietary management and exercise. However, is some cases where elevated insulin has been confirmed, medication may be recommended to target insulin levels.

    Management of Equine Metabolic Syndrome

    There are several steps in dietary and daily management that are crucial in overall management of equine metabolic syndrome (EMS) and obesity. Horses that have a history of laminitis or develop laminitis will require more intense podiatry management.

    Pasture Management

    Horses with EMS are extremely sensitive to sugar (simple carbohydrates) and more specifically fructans. Fructans are the horse equivalent of high fructose corn syrup. Fructan content in pasture grasses varies by type of grass, length of grass, weather conditions and time of day.

    Type of Grass: Cool season grasses have periods of particularly high sugar content. These include orchard grass, fescue and Kentucky bluegrass – all of which are very common in West Virginia. Sugar content in these grasses rises seasonally when we have cool nights and warm days (Think, 35-45 degree nights and 65-70 degree days of spring and fall). This is the main reason we see more episodes of laminitis during the spring and fall. In our practice, the exact timing of this critical risk period ranges from March to May and August to November, but depends on county of residence and elevation. For your own location, consider when you see frost while still having nice weather through the day.

    Length of Grass: New grass has soft tender structure and more sugar compared to older, taller grass. As the grass grows it develops more lignin (fiber) which provides strength and structure. Therefore, as the grass gets taller it has proportionately less sugar in each bite (Think, tender sweet baby vegetables compared to large older vegetables that are tough and chewy). Access to pasture should be avoided in the spring when you see the young bright green grass starting to emerge. Pasture access should be restricted until the grass has reached at least 8 to 10 inches in height and the fiber content is higher.

    Time of Day: Research conducted at Virginia-Maryland College of Veterinary Medicine found that fructan content in the grass changes within the same day. Fructan content is highest in the grass during the afternoon after a cool night. Based on this, we recommend avoiding grazing times in the afternoons, or turn out at night and restrict daytime grazing during the grazing season.

    Fertilizer: Generally, good pasture management is great for increasing yield. Unfortunately, this is exactly what you don’t need for EMS horses. Reconsider your pasture management, you may find that you actually need to decrease treatments to reduce grazing quality.

    Muzzles vs Drylot vs Timed Turnout

    We encourage as much turnout as possible for mental well-being, socialization and exercise. Ultimately you will need to choose a method that works with your property and lifestyle.

    Muzzles: Must be left on anytime the horse is grazing. Monitor the face for rubs and the bottom of the muzzle for being worn out and grazing hole enlargement. Muzzles often hard to keep on if there are multiple horses in the pasture as they will play and rip them off.

    Drylot (or reduced pasture size): This is a more expensive but more permanent option. In some cases, just increasing the number of horses on the property to “overgraze” the pasture will be helpful. In other cases, you will need to cross fence and reduce access to a smaller area. This is convenient because it does not require a muzzle or daily maintenance but may be difficult if you have “hard keepers” and “easy keepers” in the same pasture. In our area, this seems to be the most successful long term management plan. Reducing the pasture requires an investment of fencing but requires less day to day management in the long term.

    Timed Turnout: This works well in boarding stables where turnout is often limited anyway. However, it is important to note horses can eat an entire day’s worth of calories in short period of time. Therefore, if using this method, you must use a drylot or still use a muzzle to restrict intake during the turnout.

    Dietary Management

    Hay: Ideally, hay should be tested prior to feeding to ensure a low starch count (NSC). Hay testing can be done through Equi-Analytical. Information can be found at https://equi-analytical.com/.

    However, keep in mind that hay quality may vary within the same farm and even the same field. If tested hay is not available, generally first-cutting hay will be a more appropriate choice than second-cutting hay. Just as the pasture length described above, second-cutting hay is more sugar-dense. First-cutting hay must grow longer and go to seed before it is cut, which lowers the sugar content in the stem.

    Overweight Horses: Feed first-cutting hay at a rate of 2-3 % of bodyweight or 20-30 lbs per day. Use a scale to weigh the flakes of hay. Hay should be fed in a slow feeder. Slow feeders will mimic more natural feeding and help keep the horse occupied as you reduce their overall calorie intake. When introducing the slow feeder, offer the full ration as normal and then extra ration in the slow feeder. Slowly increase the portion offered in the slow feeder and decrease the portion that is free fed until eventually the entire ration is offered in the slow feeder. Gradual transition to the slow feeder will prevent stress and hunger panic from the horse as it becomes accustomed the new feeding method. There are many slow feeders available on the market and several versions that can be hand made. We recommend NibbleNets. As an alternative, you may place the hay in several piles around the lot instead of one large pile. However, this generally produces more waste than a NibbleNet or other homemade slow feeder. Caution: some horses will cause abnormal wear on their incisor teeth from chewing at nylon or metal grates on the slow feeders. This should be monitored.

    Concentrate Feed (grain): Avoid feeding any grain with excessive starch such as sweet feeds or corn. Feed only a ration balancer pellet. Ration balancers offer all the benefits of much needed protein and minerals without any excess sugar. Search for a product with a minimum 28% protein content. Ration balancer pellets are readily available from many brands at many feed stores. However, many brands will refer to them by different names such as “grazing pellet, hay stretcher pellet or protein supplement” which certainly makes it difficult to choose. Locally available balancer pellets include: Enrich (PurinaMills), Empower Topline Balance (Nutrena), Essential K (Tribute), and 30% Ration Balancer (Triple Crown). Note that with any of these protein supplements, you will feed much less than with a senior feed or sweet feed. Generally, these protein supplements are designed to feed at a rate of 1-2 lbs per 1,000 lbs of bodyweight.

    Supplements: There are tons of supplements marketed for both PPID and IR (or ID) horses. Most of these supplements contain chromium and/or magnesium. Research has not proven any benefit from these supplements. Therefore, we do NOT recommend any particular supplements.

    Persistent Resistance to Weight Loss

    If management changes have not been sufficient to induce weight loss, the overweight patient should have further testing for insulin dysregulation. Testing for a related endocrine disorder, Pituitary Pars Intermedia Dysfunction (Equine Cushing’s Disease or PPID) should be conducted. These can occur as concurrent problems or independently. If insulin abnormalities are present, additional medications, such as metformin and levothyroxine, can be prescribed for continuous or seasonal therapy to help manage the patient.

    Farriery/Hoof Care

    Horses with EMS (particularly obese horses) are at great risk of developing laminitis and chronic founder. Hooves should be regularly trimmed to maintain appropriate angles and a shortened toe. Special care or special shoes may be recommended for patients with discomfort from chronic laminitis. Monitor patients closely for foot abscesses. Recurring foot abscesses are a sign of micro-episodes of laminitis.

    Monitoring

    Horses with EMS should be continually monitored for signs of laminitis and obesity. Signs that they are not appropriately regulated include recurrent foot abscesses, laminitis, obesity, difficulty losing weight, and being an “easy keeper.”

    Long-Term Management

    Most horses with EMS will continue to live comfortably and have long successful careers with proper management. Many owners comment that their horses seem to be more active, more energetic and generally “feel” better once they are managed appropriately.

    Equine Pituitary Pars Intermedia Dysfunction (Cushing’s Disease)

    Pituitary Pars Intermedia Dysfunction (AKA Cushing’s Disease; PPID) in horses is caused by an abnormal pituitary gland. Overgrowth of the gland results in production and release of excessive stress hormone circulating in the body.

    Signs of PPID

    Classic clinical signs are long shaggy hair, laminitis, chronic founder, pot-bellied appearance, excessive drinking, excessive urination and a big cresty neck. However, recent improvements in diagnostic testing have allowed us to diagnose this disease much earlier. Now we associate this disease with much more subtle clinical signs such as: Failure to completely shed out the hair coat in the spring (long hairs may linger on the neck) recurrent foot abscesses (particularly in the spring and fall), muscle loss, poor topline, and lameness due to suspensory ligament desmitis.

    Diagnosis

    In severely affected patients, diagnosis may be made based on clinical signs alone. In the past, blood testing for PPID was difficult to perform due to cumbersome protocols and results were often inconclusive. However, since 2015 we have been using a new test known as the TRH Response test. The protocol for this new test is easy and fast. Samples can be collected over a ten-minute period during a regular appointment and then mailed to a lab for testing. Ideally, this test should not be run in the fall from mid-September to mid-November as the shortening day length can affect hormone release and thus the result of the test. Most importantly, the TRH Response test has been crucial in allowing us to diagnosis this disease in horses as young as 10 years old! Now we can begin treatment YEARS before the patient progresses to a point of chronic founder and life threatening complications.

    Treatment

    At this time there is NO CURE for PPID. Fortunately, there is a very effective treatment. Prascend (pergolide) is the only FDA-approved product to treat PPID in horses. Prascend is a tablet given daily that acts on the pituitary gland to reduce the excessive hormone secretion that causes clinical signs. This medication is lifelong and will require adjustments over time. Once treatment begins, patients should be retested in 60 days to determine whether the dosage is adequate or whether an adjustment is needed. During that time, you should notice that hair length decreases and abnormal fat deposits are reduced. Once regulated, a test should be conducted once yearly or anytime that the clinical signs appear. Since this disease cannot be cured, it WILL worsen over time. However, with proper treatment and management, many horses will have an excellent quality of life and continue their normal level of use.

    Management of PPID

    There are several steps in dietary and daily management that are crucial in overall management of PPID.

    Pasture Management

    Horses with PPID are exquisitely sensitive to sugar (simple carbohydrates) and more specifically fructans. Fructans are the horse equivalent of high fructose corn syrup. Fructan content in pasture grasses varies by type of grass, length of grass, weather conditions and time of day.

    Type of Grass: Cool season grasses have periods of particularly high sugar content. These include orchard grass, fescue and Kentucky bluegrass – all of which are very common in West Virginia. Sugar content in these grasses rises seasonally when we have cool nights and warm days (Think, 35-45 degree nights and 65-70 degree days of spring and fall). This is the main reason we see more episodes of laminitis during the spring and fall. In our practice, the exact timing of this critical risk period ranges from March to May and August to November, but depends on county of residence and elevation. For your own location, consider when you see frost while still having nice weather through the day.

    Length of Grass: New grass has soft tender structure and more sugar compared to older, taller grass. As the grass grows it develops more lignin (fiber) which provides strength and structure. Therefore, as the grass gets taller it has proportionately less sugar in each bite (Think, tender sweet baby vegetables compared to large older vegetables that are tough and chewy). Access to pasture should be avoided in the spring when you see the young bright green grass starting to emerge. Pasture access should be restricted until the grass has reached at least 8 to 10 inches in height and the fiber content is higher.

    Time of Day: Research conducted at Virginia-Maryland College of Veterinary Medicine found that fructan content in the grass changes within the same day. Fructan content is highest in the grass during the afternoon after a cool night. Based on this, we recommend avoiding grazing times in the afternoons, or turn out at night and restrict daytime grazing during the grazing season.

    Fertilizer: Generally, good pasture management is great for increasing yield. Unfortunately, this is exactly what you don’t need for PPID horses. Reconsider your pasture management, you may find that you actually need to decrease treatments to reduce grazing quality.

    Muzzles vs Drylot vs Timed Turnout

    We encourage as much turnout as possible for mental well-being, socialization and exercise. Ultimately you will need to choose a method that works with your property and lifestyle.

    Muzzles: Must be left on anytime the horse is grazing. Monitor the face for rubs and the bottom of the muzzle for being worn out and grazing hole enlargement. Muzzles often hard to keep on if there are multiple horses in the pasture as they will play and rip them off.

    Drylot (or reduced pasture size): This is a more expensive but more permanent option. In some cases, just increasing the number of horses on the property to “overgraze” the pasture will be helpful. In other cases, you will need to cross fence and reduce access to a smaller area. This is convenient because it does not require a muzzle or daily maintenance but may be difficult if you have “hard keepers” and “easy keepers” in the same pasture. In our area, this seems to be the most successful long term management plan. Reducing the pasture requires an investment of fencing but requires less day to day management in the long term.

    Timed Turnout: This works well in boarding stables where turnout is often limited anyway. However, it is important to note horses can eat an entire day’s worth of calories in short period of time. Therefore, if using this method, you must use a drylot or still use a muzzle to restrict intake during the turnout.

    Dietary Management

    Hay: Ideally, hay should be tested prior to feeding to ensure a low starch count (NSC). Hay testing can be done through Equi-Analytical. Information can be found at https://equi-analytical.com/.

    However, keep in mind that hay quality may vary within the same farm and even the same field. If tested hay is not available, generally first-cutting hay will be a more appropriate choice than second-cutting hay. Just as the pasture length described above, second-cutting hay is more sugar-dense. First-cutting hay must grow longer and go to seed before it is cut, which lowers the sugar content in the stem.

    Overweight Horses: Feed first-cutting hay at a rate of 2-3 % of bodyweight or 20-30 lbs per day. Use a scale to weigh the flakes of hay. Hay should be fed in a slow feeder. Slow feeders will mimic more natural feeding and help keep the horse occupied as you reduce their overall calorie intake. When introducing the slow feeder, offer the full ration as normal and then extra ration in the slow feeder. Slowly increase the portion offered in the slow feeder and decrease the portion that is free fed until eventually the entire ration is offered in the slow feeder. Gradual transition to the slow feeder will prevent stress and hunger panic from the horse as it becomes accustomed the new feeding method. There are many slow feeders available on the market and several versions that can be hand made. We recommend NibbleNets. As an alternative, you may place the hay in several piles around the lot instead of one large pile. However, this generally produces more waste than a NibbleNet or other homemade slow feeder. Caution: some horses will cause abnormal wear on their incisor teeth from chewing at nylon or metal grates on the slow feeders. This should be monitored.

    Concentrate Feed (grain): Avoid feeding any grain with excessive starch such as sweet feeds or corn. Feed only a ration balancer pellet. Ration balancers offer all the benefits of much needed protein and minerals without any excess sugar. Search for a product with a minimum 28% protein content. Ration balancer pellets are readily available from many brands at many feed stores. However, many brands will refer to them by different names such as “grazing pellet, hay stretcher pellet or protein supplement” which certainly makes it difficult to choose. Locally available balancer pellets include: Enrich (PurinaMills), Empower Topline Balance (Nutrena), Essential K (Tribute), and 30% Ration Balancer (Triple Crown). Note that with any of these protein supplements, you will feed much less than with a senior feed or sweet feed. Generally, these protein supplements are designed to feed at a rate of 1-2 lbs per 1,000 lbs of bodyweight.

    Weight Issues

    Overweight Horses: Many horses with PPID are overweight. Once the PPID is appropriately managed, patients that remain overweight should be tested for concurrent insulin resistance (IR) or insulin dysregulation (ID). IR or ID can occur as a result of PPID or as an independent problem. If insulin abnormalities are present, additional medications, such as metformin and levothyroxine, can be prescribed for continuous or seasonal therapy to help manage the patient.

    Underweight/Poorly Muscled Horses: In recent years, we have grown to appreciate more and more that not all PPID horses are obese. Many PPID horses will have chronic muscle loss, failure to gain weight and weak toplines.

    For weight gain, add a fat supplement to increase calorie intake. Omega-3 fatty acids are an excellent source of dietary fat for horses. In horses, flaxseed, rice bran and flaxseed oil or rice bran oil are the most commonly recommended sources. These are generally very palatable and easy to find in feed stores. Omega-3 fatty acids offer several benefits such as anti-inflammatory effects that benefit horses with arthritis, inhalant allergies and skin allergies. Note that fats may get rancid in storage, so ensure that you have a fresh source. In addition, fat is not always palatable to every horse, particularly when given in high amounts, and it may cause some loose stool. Search for a product that has a minimum 22% fat. Locally available fat supplements include: Essential Omega Blend liquid (Triple Crown), Amplify pellets (Amplify), or K Finish (Tribute). Feed as a directed on the product label. Generally, since these products are very calorie dense, you will not need to feed a very high volume.

    Supplements: There are tons of supplements marketed for both PPID and IR (or ID) horses. Most of these supplements contain chromium and/or magnesium. Research has not proven any benefit from these supplements. Therefore, we do NOT recommend any particular supplements.

    Farriery/Hoof Care

    Horses with PPID are at great risk of developing laminitis and chronic founder. Hooves should be regularly trimmed to maintain appropriate angles and a shortened toe. Special care or special shoes may be recommended for patients with discomfort from chronic laminitis. Monitor patients closely for foot abscesses. Recurring foot abscesses are a sign of micro-episodes of laminitis. Foot abscesses, particularly recurring foot abscesses, in a horse with PPID are an indicator that the patient’s PPID is not well regulated.

    Monitoring

    Horses with PPID should be continually monitored for signs that they are not appropriately regulated (i.e.: recurrent foot abscesses, dental disease, laminitis, failure to shed their hair coat in the spring, abnormal sweating, etc.). Annual blood tests should be conducted during the spring.

    Long-Term Management

    Most horses with PPID will continue to live comfortably and have long, successful careers. Many owners comment that their horses seem to be more active, more energetic and generally “feel” better once they are regulated. This may be due to the general decrease in “stress” hormone and/or decrease in foot pain related to micro-episodes of laminitis.

    Diabetes Mellitus in Dogs and Cats

    What Is Diabetes?

    Diabetes mellitus (DM) is an endocrine disorder that results in abnormally elevated blood sugar (glucose). Glucose is a critical energy source for the body and comes from food that is ingested. The pancreas is a small but important organ next to the digestive tract. The pancreas secretes insulin that helps cells absorb and process glucose. In patients with diabetes mellitus, there is an imbalance in the insulin and glucose where either the pancreas is unable to produce enough insulin or the cells do not respond to insulin.

    What Are the Clinical Signs?

    • Weight loss (especially weight loss with a great appetite)
    • Excessive urination – Excess glucose in the blood is filtered into the urine by the kidneys. This results in increased urination and frequent urinary tract infections.
    • Excessive drinking
    • Cataracts (especially dogs)
    • Weakness (especially in the hind limbs)

    How Is Diabetes Mellitus Diagnosed?

    Fortunately, diabetes mellitus can be diagnosed with routine bloodwork and urine samples done in our hospital. Occasionally, other tests are performed to determine whether there is other underlying disease or infection. Normal ideal blood glucose should be between 70-120 mg/dL. It is common for cats to have a blood glucose up to 250 mg/dL due to stress just from entering the hospital. Therefore, cats often need repeat bloodwork or additional tests to determine whether an elevated blood glucose is due to stress or diabetes.

    How Is Diabetes Treated?

     
    Hospital Treatment
    Some patients are very sick when they present at our hospital and require admission for treatment of diabetic ketoacidosis. This is a life-threatening condition that occurs from chronic unregulated diabetes mellitus.

    At-Home Treatment & Long-Term Care
    Treatment for Diabetes is Lifelong. Some cats may experience remission and can be managed strictly with diet, eliminating the need for insulin injections. It is important to note that many of these cats may need insulin injections again at a later time.

    Insulin – Most patients can be controlled with insulin injections given 1-2 times daily. This may sound intimidating, but most owners quickly become comfortable with administering the injections to their pet. We are happy to coach you through this!
    • Please note that insulin must be kept refrigerated.
    • There are several types of insulin available for treatment. Insulin is chosen based on effectiveness, length of action (short-acting vs long-acting), availability and cost.
    • Be sure that the insulin syringe matches the insulin you are using. Most insulins used in pets are U-40. Human insulin syringes are U-100. Using a U-100 syringe with some veterinary insulins may result in an overdose!
    • To administer an insulin injection: Pull the loose skin between the shoulder blades with one hand. With the other hand, insert the needle directly into the “tent” that is created by holding the skin up. Draw back on the plunger to check for blood. If you see blood, remove the needle and do not inject. If no blood is noted, depress the plunger on the syringe and complete the injection.
    • It is helpful to feed a small treat at the time of the insulin injection. This serves as a reward to the pet and will help prevent resentment of the treatment.

    Diet – Proper diet is essential to management of diabetes. Several prescription diets are available to help reduce blood sugar. The daily ration should be split into two meals that are fed after each insulin treatment.

    Cats: Purina DM, Hill’s m/d Glucosupport, Royal Canin Glycobalance, Hill’s Multi-benefit W/D

    Dogs: Purina OM, Royal Canin Glycobalance, Hill’s W/D, Royal Canin Diabetic

    Treats & Snacks – Diabetic patients should adhere to a strict diet. Treats are not recommended unless specifically approved by one of our veterinarians. In most cases, we recommend the following options:
    • Use an approved diabetic canned food to make small meatball treats. These may be kept in the freezer and fed as needed. These also make great treats for hiding medications.
    • Green beans may be fed raw or steamed to dogs. These are a great healthy snack that are well liked by most dogs. Do not feed green beans cooked or canned in bacon or pork fat.

    Monitoring Response to Treatment

    Clinical Signs: It is important to always monitor your pet’s clinical signs. Should you note an increase in thirst or urination, this may indicate that the diabetes is no longer regulated or has a concurrent urinary tract infection. Recurrence of clinical signs should always prompt a medical progress checkup.

    Regular Checkups: Diabetic patients will require regular visits to monitor them for appropriate management. During these visits we will perform a blood glucose check and a urine check. In some cases, we may choose to perform a blood fructosamine. This test is not performed on-site and thus, results are not immediately available. Fructosamine helps determine if the blood glucose has been consistently high over the prior week.

    Urine Test Strips: Urine test strips can be provided for at-home screening of glucose in the urine. These strips are only effective if the glucose is over 250 mg/dl. However, they are quick and easy to use, and thus, a great at home screening tool if you are concerned that your pet is experiencing high glucose. Pets with a positive urine test strip should be examined.

    Continuous Blood Glucose Monitor: Our preference for monitoring is to install a continuous blood glucose monitor. The continuous monitor is a small painless disc that is attached to the patient and then worn at home for a period of 7-14 days. This is much more accurate than spot checks, gives us a much more accurate reading from the pet in their natural environment and regular schedule, and reduces the number of needle punctures. A scanner is used to relay the measurements to an app on a smart phone. This has revolutionized our treatment of diabetes!

    Preventative Care

    As diabetic, your pet’s immune system will be more stressed and thus more susceptible to infection. Thus, it is imperative that your pet receive regular physical examinations, dental care and preventative care.

    Signs of Low Blood Sugar (Hypoglycemia)

    It is important to become familiar with signs of hypoglycemia as this can be a serious complication that can result in death. Hypoglycemia may occur from an insulin overdose or if your pet does not eat. Signs of hypoglycemia include: lethargy, weakness, sleepiness, drunken walking, stumbling or seizure and loss of consciousness.

    If you note these signs: try to get your pet to eat. If your pet will not eat or is unconscious you may give light Karo syrup, honey or even sugar water. Rub the mixture on the gums or place on the tongue. This will absorb through the mouth and does not need to be swallowed. A ¼ teaspoon or less is usually sufficient for a cat. Large dogs may require more than a tablespoon. You should note improvement within a few minutes. We recommend trying a small amount and then contacting our office for further instruction.

    Difficult to Regulate Diabetics

    Some patients are particularly difficult to manage. This occurs most often in dogs. Often these patients have concurrent underlying disease such as hypothyroidism or hyperadrenocorticism (Cushing’s). Therefore, if the patient is persistently difficult to regulate we may recommend further testing.

    Canine Cranial Cruciate Ligament Injury

    Stifle Anatomy

     
    The stifle, or knee, is a fairly complicated joint. It consists of the femur above, the tibia below, the kneecap (patella) in front, and the bean-like fabella behind. Chunks of cartilage called the medial and lateral menisci fit between the femur and tibia like cushions. An assortment of ligaments holds everything together, allowing the knee to bend the way it should and keep it from bending the way it shouldn’t.
     
    There are two cruciate ligaments that cross inside the knee joint: the anterior (or, more correctly in animals, cranial) cruciate and the posterior (in animals, the caudal) cruciate. They connect from one side of the femur on top to the opposite side of the tibia on the bottom, the two ligaments forming an X (hence the name cruciate) inside the knee joint. They are named for their attachment site on the tibia (the cranial cruciate attaches to the front of the tibia and the caudal cruciate attaches to the back of the tibia). This may be hard to visualize based on the description but the illustration above shows the orientation of the two crossing ligaments effectively. The anterior/cranial cruciate ligament prevents the tibia from slipping forward out from under the femur.
     

    Finding the Rupture

     
    The ruptured cruciate ligament is the most common knee injury of dogs; in fact, chances are that any dog with sudden rear leg lameness has a ruptured anterior cruciate ligament rather than something else. The history usually involves a rear leg suddenly so sore that the dog can hardly bear weight on it. If left alone, it will appear to improve over the course of a week or two but the knee will be notably swollen and arthritis will set in quickly. Dogs are often seen by the veterinarian in either the acute stage shortly after the injury or in the chronic stage weeks or months later.
    The key to the diagnosis of the ruptured cruciate ligament is the demonstration of an abnormal knee motion called a drawer sign. It is not possible for a normal knee to show this sign.
     

    The Drawer Sign

     
    The drawer sign is exhibited when the tibia is able to forward from underneath the femur (similar to a drawer opening). If this action is demonstrated, the cruciate rupture is confirmed. The motion is exaggerated here for the purposes of illustration.
     
    The veterinarian stabilizes the position of the femur with one hand and manipulates the tibia with the other hand. If the tibia moves forward (like a drawer being opened), the cruciate ligament is ruptured.
     

     
    Another method is the tibial compression test where the veterinarian stabilizes the femur with one hand and flexes the ankle with the other hand. If the ligament is ruptured, again the tibia moves abnormally forward.
     
    If the rupture occurred some time ago, there will be swelling on side of the knee joint that faces the other leg. This is called a medial buttress and is a sign that arthritis is well along.
     
    It is not unusual for animals to be tense or frightened at the vet’s office. Tense muscles can temporarily stabilize the knee, preventing demonstration of the drawer sign during examination. Often sedation is needed to get a good evaluation of the knee. This is especially true with larger dogs. Eliciting a drawer sign can be difficult if the ligament is only partially ruptured so a second opinion may be a good idea if the initial examination is inconclusive.
     
    Since arthritis can set in relatively quickly after a cruciate ligament rupture, radiographs to assess arthritis are helpful. Another reason for radiographs is that occasionally when the cruciate ligament tears, a piece of bone where the ligament attaches to the tibia breaks off as well. This will require surgical repair and the surgeon will need to know about it before beginning surgery. Arthritis present prior to surgery limits the extent of the recovery after surgery though surgery is still needed to slow or even curtail further arthritis development.
     

    How Rupture Happens

     
    Several clinical pictures are seen with ruptured cruciate ligaments. One is a young athletic dog playing roughly who takes a bad step and injures the knee. This is usually a sudden lameness in a young large-breed dog.
     
    A recent study identified the following breeds as being particularly at risk for this phenomenon: Labrador retriever, golden retriever, Rottweiler, Neapolitan mastiff, Newfoundland, Akita, St. Bernard, Chesapeake Bay retriever, and American Staffordshire terrier.
     
    On the other hand, an older large dog, especially if overweight, can have weakened ligaments and slowly stretch or partially tear them. The partial rupture may be detected or the problem may not become apparent until the ligament breaks completely. In this type of patient, stepping down off the bed or a small jump can be all it takes to break the ligament. The lameness may be acute but have features of more chronic joint disease or the lameness may simply be a more gradual/chronic problem.
     
    Larger, overweight dogs that rupture one cruciate ligament frequently rupture the other one within a year’s time.
     
    An owner should be prepared for another surgery in this time frame.
     
    The cranial cruciate rupture is not limited to large breed dogs. Small dogs can certainly rupture their ligaments as well and, while arthritis is slower to set in when the patient is not as heavy, there is an association with cruciate rupture and medial luxating patella that is very common in small breed dogs. With the patellar luxation, the kneecap flips in and out of the patellar groove. If the condition is relatively mild, it may not require surgical correction but it does stress the cranial cruciate ligament and can predispose to rupture and need to correct both conditions surgically.
     

    What Happens if the Cruciate Rupture is Not Surgically Repaired?

     
    Without an intact cruciate ligament, the knee is unstable. Wear between the bones and meniscal cartilage becomes abnormal and the joint begins to develop degenerative changes. Bone spurs called osteophytes develop resulting in chronic pain and loss of joint motion. This process can be arrested or slowed by surgery but cannot be reversed.
     
    • Osteophytes are evident as soon as 1 to 3 weeks after the rupture in some patients. This kind of joint disease is substantially more difficult for a large breed dog to bear, though all dogs will ultimately show degenerative changes. Typically, after several weeks from the time of the acute injury, the dog may appear to get better but is not likely to become permanently normal.
    • In one study, a group of dogs was studied for 6 months after cruciate rupture. At the end of 6 months, 85% of dogs less than 30 pounds of body weight had regained near normal or improved function while only 19% of dogs over 30 pounds had regained near normal function. Both groups of dogs required at least 4 months to show maximum improvement.
     

    What Happens in Surgical Repair?

     
    There are three different surgical repair techniques commonly used today. Every surgeon will have their own preference for which technique is best for a given patient’s situation.
     
    Extracapsular Repair
    This procedure represents the traditional surgical repair for the cruciate rupture. It can be performed without specialized equipment and is far less invasive than the newer procedures described below. First, the knee joint is opened and inspected. The torn or partly torn cruciate ligament is removed. Any bone spurs of significant size are bitten away with an instrument called a rongeur. If the meniscus is torn, the damaged portion is removed. A large, strong suture is passed around the fabella behind the knee and through a hole drilled in the front of the tibia. This tightens the joint to prevent the drawer motion, effectively taking over the job of the cruciate ligament.
     
    • Typically, the dog may carry the leg up for a good two weeks after surgery but will increase knee use over the next 2 months eventually returning to normal.
    • Typically, the dog will require 8 to 12 weeks of exercise restriction after surgery (no running, outside on a leash only including the backyard).
    • The suture placed will break 2 to 12 months after surgery and the dog’s own healed tissue will hold the knee.
     
    Tibial Plateau Leveling Osteotomy (TPLO)
    This procedure uses a fresh approach to the biomechanics of the knee joint and was developed with larger breed dogs in mind. The idea is to change the angle at which the femur bears weight on the flat “plateau” of the tibia. The tibia is cut and rotated in such a way that the natural weight-bearing of the dog actually stabilizes the knee joint. As before the knee joint still must be opened and damaged meniscus removed. The cruciate ligament remnants may or may not be removed depending on the degree of damage.
    This surgery is complex and involves special training in this specific technique. Many radiographs are necessary to calculate the angle of the osteotomy (the cut in the tibia). This procedure typically costs substantially more than the extracapsular repair as it is more invasive to the joint.
    • Typically, most dogs are touching their toes to the ground by 10 days after surgery although it can take up to 3 weeks.
    • As with other techniques, 8-12 weeks of exercise restriction are needed.
    • Full function is generally achieved 3 to 4 months after surgery and the dog may return to normal activity.
     
    Tibial Tuberosity Advancement (TTA)
    The TTA similarly uses the biomechanics of the knee to create stability though this procedure changes the angle of the patellar ligament. This is done by cutting and repositioning the tibial crest where the patellar ligament attaches and implanting a titanium or steel “cage,” “fork,” and plate as well as bone grafts to stabilize the new angle. Like the TPLO, bone is cut, special equipment is needed including metal implant plates. Similar recoveries are seen relative to the TPLO.
     

    Which Procedure is Better?

     
    The TTA and TPLO are much more invasive, much more expensive, and require special equipment and specially trained personnel. They have greater potential for complication. Are they worth it? For dogs under 45 lbs, it is generally accepted that there is no clear advantage of the newer procedures over extra capsular repair. For larger dogs, there is great controversy. For all the theory behind TPLO and TTA, results one year post-operative seem to be the same regardless of which of the three procedures the dog had performed. There is some evidence that recovery to normal function may be faster with the newer procedures. Controversy continues and there are strong opinions favoring each of the three procedures. Discuss options with your veterinarian in order to decide.
     

    General Rehabilitation After Surgery

     
    Rehabilitation following the extracapsular repair method can begin as soon as the pet goes home. The area can be chilled with a padded ice pack for 10 minutes a couple times daily. (Do not try to make up for a skipped treatment by icing the area longer; prolonged cold exposure can cause injury.) Passive range of motion exercise where the knee is gently flexed and extended can also help. It is important not to induce pain when moving the limb. Let the patient guide you. Avoid twisting the leg. After the stitches or staples are out (or after the skin has healed in about 10 to 14 days), water treadmill exercise can be used if a facility is available. This requires strict observation and, if possible, the patient should wear a life jacket. Rehabilitation for patients with intracapsular repair is similar but slower in progression.
     
    Rehabilitation after TPLO or TTA is gentler. Icing as above and rest are the main modes of therapy. After 3 to 4 weeks, an increase in light activity can be introduced. A water treadmill is helpful. No jumping, running or stair-climbing is allowed at first. Expect the osteotomy site to require a good 6 weeks to heal.
     

    What if the Rupture Isn’t Discovered for Years and Joint Disease is Already Advanced?

     
    A dog with arthritis pain from an old cruciate rupture may still benefit from a TPLO surgery and possibly from the TTA. Ask your veterinarian if it may be worth having a surgery specialist take a look at the knee. Most cases must make do with medical management.
     

    Meniscal Injury

     
    We mentioned the menisci as part of the knee joint. The bones of all joints are capped with cartilage so as provide a slippery surface where the bones contact each other (if the bones contact each other without cartilage, they grind each other down). In addition to these cartilage caps, the stifle joint has two blocks of cartilage in between the bones. These blocks are called the menisci and serve to distribute approximately 65% of the compressive load delivered to the knee. The only other joint with a meniscus is the jaw (temporomandibular joint).
     
    When the cruciate ligament ruptures, the medial (on the inner side of the knee) meniscus frequently tears and must either be removed, partly removed, or ideally repaired. This is generally done at the time of cruciate ligament surgery and we would be remiss not to mention it.
     
    Pets with meniscal damage may have an audible clicking sound when they walk or when the knee is examined, but for a definitive diagnosis the menisci must actually be inspected during surgery. It is difficult to access the menisci and thus repairing a tear in the meniscus is problematic; furthermore, poor blood supply to the menisci also makes good healing less likely. For these reasons, removal of the damaged portion of the meniscus is the most common surgical choice. This leaves some meniscus behind to distribute the compression load on the knee but removes the painful, ineffective portion.
     
    Areas of current research include techniques to improve blood supply to the healing meniscus so that repair can be more feasible. If meniscal damage has occurred in a cruciate rupture, arthritis is inevitable and surgery should be considered a palliative procedure.
     

    Enhancing Recovery after Surgery

     
    Confinement
    Enhancing recovery post-operatively is largely about strict confinement early. This cannot be over-emphasized. Be prepared to crate your dog our employ a pen such as a child’s playpen depending on the dog’s size. A corral of sorts can be constructed with boxes and a baby gate. Be sure you understand the instructions with regard to gradual return to exercise over several months.
     
    Adequan Injections
    A series of Adequan injections can help with joint inflammation as well as lubrication. Typically injections are given twice a week for a total of eight injections.
     
    Glucosamine
    Oral joint supplements such as glucosamine contain cartilage building blocks to help the body repair cartilage damage. This is an excellent time to begin supplementation and there are numerous brands.
     
    Weight Management
    Overweight dogs have an increased risk for arthritis and for cruciate rupture. A weight management program can reduce the potential for arthritis and can reduce the risk of rupture of the opposite cruciate ligament. If your dog is overweight, ask your vet about a weight management plan that might be started during the recovery period.
     
    Professional Rehab/Physical Therapy
    Nothing compares to professional rehab for return to function. If you are lucky enough to have such a facility in your area, consider utilizing their services. A list of home exercises may be obtained and/or the dog can visit weekly or a few times weekly for exercise and treatment. Some facilities allow the dog to board and have daily treatment. Ask your vet about this option.

    Dental Disease in Pets

    Dental disease is not just about bad breath! Dental disease is painful! 80% of dogs and cats over 3 years of age have dental disease. Infections from poor dental health can cause permanent damage to the kidneys, liver and heart. Many pets will continue to eat, even while painful, and show little sign of their poor dental health. Our goal is to treat dental disease at Grade 2-3 to prevent permanent damage to the internal organs that occurs when dental disease progresses to Grade 4.
     
     

    Effects on the Body

     
    Normal
    Healthy mouth allows pet to eat without pain.
    Grade I – Gingivitis
    Redness on gumline and plaque forming.
    Grade 2 – Early Periodontitis
    Tissue swelling and loss of tooth attachment. Gums may bleed. Mouth starts to get painful and odor is noticeable.
    Grade 3 – Moderate Periodontitis
    50% of the attachment of tooth is lost. Roots are exposed. Gums often bleed when probed. Bad breath is present. Pain associated with the teeth may start to change the pet’s behavior.
    Grade 4 – Advanced Periodontitis
    Teeth may fall out. Usually blood and pus are present. Bacteria spread through the body via the bloodstream and can damage the liver, kidneys, and heart.
     

    Recommendations to Slow Periodontal Disease Progression

     
    It is important to note that dental disease is progressive and will worsen over time. Prevention and maintenance are key to ensuring longevity of the teeth. We also recommend the following to help slow progression of disease. Please note that these recommendations offer no help in cases of severe disease, such as Grade 3 and Grade 4. Patients with Grade 3 & Grade 4 periodontal disease will require extractions and aggressive therapy.
     
    Teeth Brushing: Brushing daily with a pet toothpaste and tooth brush or dental wipes is very beneficial in preventing tartar accumulation.

    Diet: Feed a dental health diet such as Hill’s T/D or Royal Canin Dental. These diets are designed to help remove tartar from the tooth as the patient eats.

    Treats: Feed dental treats such as Oravet Dental Chews. Not all treats actually benefit oral health. Use only treats approved by the Veterinary Oral Health Council.

    Oral Rinse: Use an oral rinse such as Hexarinse.

    Water Additives: You may add solutions such as Aquadent to the drinking water.
     

    What is the Veterinary Oral Health Council?

     
    The Veterinary Oral Health Council (VOHC) is made up of board-certified veterinarians with advanced certification as dentistry specialists and dental scientists. These council members are appointed by the president and Board of Directors of the American Veterinary Dental College. The council reviews submissions and recommends whether items are awarded a seal of approval from the VOHC.
     

    What Does the VOHC Seal Mean?

     
    The VOHC Seal indicates that a pet dental product has met pre-set standards that prove that it slows dental plaque and dental tartar accumulation on teeth. Approval indicates that the product has undergone trials created by the VOHC. There are many products on the market that make a claim “to improve dental health”. We encourage you to find product with a VOHC Seal.

    Canine Parvovirus

    Canine Parvovirus Recovery and Environmental Decontamination
    Allegheny Veterinary Services

     
    Diet

    Your pet is recovering from extensive damage to the intestinal tract. It is typical for stool to be a little loose at first or for no stool to be produced for a few days as the tract recovers. The stool should gradually firm up over the first 3 to 5 days at home.

    Your pet may resume normal activity and attitude over the first week at home. If diarrhea persists, vomiting occurs, or your pet seems depressed, please contact our office at once for further instructions.

    Your pet may be ravenously hungry after going so long without food. Do not allow him to gorge as this can result in further vomiting or diarrhea. Feed smaller meals separated by at least an hour or two.

    • Feed the therapeutic diet we have provided for the first few days at home. Then resume the normal diet. Do not feed table scraps. Stick to the diet recommended by your veterinarian.

    Exercise

    Your pet should be considered contagious to other puppies for at least 6 weeks. Therefore, trips to the park, obedience school, or visiting other neighborhood areas where pets comingle, should be avoided during this time. If your pet is less than 16 weeks of age, he should not be allowed in public areas until the vaccination series is fully completed. He can be considered immune to parvovirus after recovery. However, puppy vaccinations include many other infectious diseases for which your pet needs to be vaccinated against.

    Other Pets

    Humans are not susceptible to canine parvovirus infection, though some strains can be contagious to cats. Adult dogs that have been vaccinated are not susceptible either. Introducing new puppies poses a problem as the parvovirus persists a long time in the environment. When in doubt, make the new puppy an older individual (16 weeks or so) who has already completed his/her vaccination series. Any obviously contaminated material should be removed (fecal- or vomit-contaminated objects that cannot be bleached, any remaining areas of feces, etc.). See section below on Decontamination of the Environment.

    Bathing

    Your pet may be bathed any time as long as you do not allow him to get cold or chilled after the bath. Bathing will reduce the amount of virus left on his fur and will help reduce contagion.

    Resuming Vaccines

    Your pet cannot be re-infected with this virus for at least 3 years and is probably protected for life after surviving infection. However, it is imperative that he still receives vaccinations as there are other viruses that he should be protected against.

    Your pet should lead a normal life once the recovery period is completed (1-2 weeks). In rare cases, there may be lasting effects on the heart.

    Disinfecting the Environment

    Canine parvovirus is especially hardy in the environment and particularly difficult to remove. It is readily carried on shoes or clothing to new areas (which accounts for its rapid worldwide spread shortly after its original appearance). It is able to overwinter freezing temperatures in the ground outdoors, plus many household disinfectants are not capable of killing it indoors.

    • Infected dogs shed virus (in their stool) in gigantic amounts during the 7 to 10 days following exposure. Because such enormous amounts of virus are shed, there is a HUGE potential for environmental contamination when an infected dog has been there.
    • It is important to realize that because the canine parvovirus is so hardy in the environment, it is considered ubiquitous. This means that no environment is free from this virus unless it is regularly disinfected.
    • A parvoviral infection can be picked up anywhere, although it is easier to pick up an infection in an area where an infected dog has been simply because of the larger amounts of virus in a contaminated area.
    • Whether an individual dog gets infected or not depends on the number of viral particles the dog experiences, what kind of immune experience the dog has had with the virus before (vaccinated? previously infected? How much past exposure?), and how strong the individual dog is (stress factors, diet, etc.)

    A typical/average infectious dose for an unvaccinated dog is 1,000 viral particles. For some dogs far less is needed. For other dogs, far more is needed. An infected dog sheds 35 million viral particles (35,000 TIMES the typical infectious dose) per OUNCE of stool.

    Environmental Decontamination

    Parvovirus is virtually impossible to completely remove from an environment. The goal of decontamination is to reduce the number of viral particles to an acceptable level. There are many cleaners on the market with claims to eliminate parvovirus. However, realistically it is virtually impossible to remove parvovirus from an environment.

    Bleach: One of the best and most effective disinfectants against parvovirus is BLEACH. However, it important to note that bleach is inactivated in the presence of organic material such as feces, vomitus or other bodily fluids. Therefore, all surfaces and items must first be cleaned with a detergent or other household cleaner. Then, mix one part bleach with 30 parts water. This solution is then applied to bowls, floors, surfaces, toys, bedding, and anything contaminated that is colorfast or for which color changes are not important. The bleach solution must be allowed to soak on the surfaces and items for at least 10 minutes to be effective at killing the virus. Disinfection becomes problematic for non-bleachable surfaces such as carpet or lawn.

    Steam Cleaning: Steam is also able to kill the virus.

    Rescue® (accelerated hydrogen peroxide cleaner): This is a virucidal agent that we use in our hospital. It is safe on all surfaces and effective as a detergent and disinfectant. Gallons of this cleaner can be purchased if you prefer this over bleach.

    Indoor Decontamination

    Indoors, where normal room temperature is maintained, the virus loses its infectivity within one month. Therefore, it should be safe to introduce a new puppy indoors one month after the active infection has ended.

    Outdoor Decontamination

    Freezing does NOT kill the virus. If the outdoors is contaminated and is frozen, you must wait for it to thaw out and warm up before safely introducing a new puppy. Shaded areas should be considered contaminated for seven months. Areas with good sunlight exposure should be considered contaminated for five months.

    If you have any questions about your pet’s care after discharge from the hospital, please feel free to contact our office.