Veterinary Ophthalmology

Veterinary services for pet’s It’s been said that “eyes are the windows to the soul” and certainly when you look into the eyes of your beloved pets, you can see the affection and loyalty reflected there.  Unfortunately, some owners look deep into their pet’s eyes and see problems.  When your pet’s vision is at stake, veterinary ophthalmologists stand ready to take action! Veterinary Services as part of your pet’s regular check-up, the veterinarian will spend time peering into the depths of the animal’s eyes.  In the majority of cases, the doctor will see eyes that are bright, clear and free of any sort of abnormality. Occasionally though, pets present to their veterinarian with injuries, scratches or irritation to their eyes or eyelids.  Some pets have inverted eyelids (entropion) or even extra eyelashes that grow on the inner surface of the eyelid (distichiasis).  Short-faced dogs and cats often find themselves with scratched corneas from normal play and roughhousing with other pets.  Some pups will end up with a condition known as “cherry eye” where the gland of the third eyelid protrudes up and away from its normal position. In many of these cases, your veterinarian can flush the eyes, provide the right medications or possibly even perform minor surgery to protect the pet’s vision.  But, if the issue is complex, not resolving or when serious eye problems, like glaucoma, cataracts or even retinal detachments occur, veterinary ophthalmologists are often called to help the pet and pet owner. These eye specialists undergo intensive training and testing of veterinary services in order to obtain certification from the American College of Veterinary Ophthalmologists (ACVO).  After completing veterinary school, candidates for certification often complete an internship before starting a rigorous residency.  All of this extra education must be completed before the doctor attempts to pass the “board exam”.  It is not unusual for a veterinarian to spend an additional 3-4 years in preparation for a testing process that spans four days and includes written, practical and surgical sections.  All told, there are less than 375 veterinary eye specialists in the United States. These dedicated professionals often have the needed expertise and special equipment that your pet’s regular veterinarian does not have.  Delicate surgical instruments and unique diagnostic tools are just a few of the devices available to veterinary ophthalmologists.  Some of these eye doctors even have special mazes set up at their practice in order to more fully test your pet’s vision capabilities. Beyond helping dogs and cats, it is not uncommon to see ophthalmologists working with horses, birds and even zoo animals, like sea lions or dolphins! Each year, the ACVO and its members provide free eye examinations to the thousands of service animals helping disabled individuals around the country.  Partnering with veterinary companies, the ACVO has helped screen more than 6,000 animals for eye problems and donated more than $250,000 in free services to treat issues they have found.   Individuals with service animals are encouraged to visit www.acvoeyeexam.org to find locations and doctors for this annual event. In addition to this great work, the ACVO has also established the Vision for Animals Foundation.  This not-for-profit organization supports research into many of our pet’s eye disease.  More than $150,000 has been granted to researchers who are focused on eliminating the most serious problems affecting the vision of our pets. Pet owners can help their veterinarian and the veterinary ophthalmologist by addressing any eye issue promptly.  It’s important to have the eyes examined if there is any irritation or injury and to avoid using over the counter or previously prescribed medications.  Some of these might contain steroids which will hinder the healing process.  Signs that your pet is uncomfortable to include continual squinting, pawing at the eyes or even severe redness.  If you note any of these symptoms, or even your pet just doesn’t seem to see as well as he or she ages, an examination with your veterinarian is warranted. Your veterinarian will work closely with the veterinary ophthalmologist in order to do what is best for your pet and to protect his or her vision.

Itching Pets

It’s a common occurrence: Pet owners expressing feelings of frustration, helplessness and even despair from a single symptom. Their pets itch and scratch, itch and scratch — and it is not a flea problem!  Although this may not seem like a big deal, these owners suffer through sleepless nights as their pets scratch and chew and lick, all in an attempt to get some needed relief. If it’s not fleas, what can this common problem be? Atopy Seeing a beloved pet scratch often leads many owners think their pets have fleas. When trips to the veterinarian and doses of flea products fail to resolve the itchiness, it is time to think about environmental allergies, or atopy. Just like people, our pets can suffer from allergies and sensitivities to particles in the air. Many times, pollen, certain grasses and trees or even dust mites can trigger this reaction in pets. Unlike people though, our pets rarely sneeze and show signs similar to “hay fever”. Instead, our pets are itchy and they will do anything to relieve that sensation. Some pets scratch constantly, others lick and chew at certain spots, like their feet and still others might rub against carpets and furniture. This behavior, and the consistent noises and thumps produced, is often too much for many pet owners.  Sadly, some pets are relinquished to shelters or rescues due to a condition that is actually manageable. Whenever your pet is itchy, it is important to remember that external parasites or even food allergies can cause very similar symptoms. Your veterinarian must help you distinguish between flea bite allergies, food allergies or atopy. According to Dr. Kimberly Coyner, a board certified veterinary dermatologist with the Dermatology Clinic for Animals in Las Vegas, about 10% of dogs suffer from atopy and some cats can develop this condition as well. Many pets will start showing signs as early as six months of age and most will occur before the animal is five years old. Beyond the itchiness (known medically as pruritus), pets might also show recurrent skin and ear infections or seem to be obsessed with licking their paws. These symptoms most commonly occur in warm weather for pets with pollen or dust allergies, but can also occur year round in some cases. A Closeup of Dogs’ Allergy Skin Test Diagnostic tests for atopy try to determine what allergens are causing your pet’s problems. Blood tests are often convenient since they can be done by most veterinarians, but Dr. Coyner cautions that this method has drawbacks. Skin testing (similar to scratch testing in people) is the gold standard for determining what is causing your pets allergies and is more accurate than blood tests. While not simple, atopy can be managed with baths, medications, managing the environment and sometimes with immunotherapy. You’ll need good communication with your veterinarian and maybe a veterinary dermatologist! First, for pets that suffer seasonal allergies, being prepared ahead of time is key. Some mildly suffering pets can benefit from daily cool water rinses and a fragrance free shampoo one to two times weekly.  Clipping longhaired pets decreases the allergen load and makes bathing easier. Pollen counts in the home can be reduced by asking family and visitors to remove their shoes at the door. Routine vacuuming of areas that the pets frequent and washing of pet bedding in mild, fragrance free detergents can also limit the allergen exposure inside. Some pet owners opt for antihistamines to help provide relief, but experts caution that they are only effective in 30-40% of dogs. Other owners insist that “steroid shots” or pills are the answer. However steroids simply decrease the symptoms and do not solve the problem — and they are not without secondary side effects. Immunotherapy Vials Ideally, all pets with atopy would undergo skin testing and then start an allergen specific immunotherapy, guided by a veterinary dermatologist. By slowly exposing the pet to increasing quantities of the allergen, this immunotherapy can actually “desensitize” the pet and, over time, help reduce the severity of the symptoms. Dr. Coyner says that 70-75% of allergic pets respond to this treatment and it takes several months to become effective, so it is not a certain cure or a “quick-fix”.

Vertigo or Old Dog Vestibular Syndrome

Vertigo is a syndrome in the elderly dog, which can be very frightening to the owners. The dog is suddenly afflicted with a balance problem, usually staggering, but occasionally unable to stand, and more rarely actually rolling over and over. There is a tilting of the head to one side and nystagmus, a rhythmic flicking movement of the eyes. Nausea and vomiting may also in present. It is not due to a stroke, as most people assume. It is thought to be due to an abnormal flow of fluid in the semi-circular canals of the inner ear. It is more common in older medium to large breeds of dogs. It is rarely seen in cats. Although the symptoms are alarming and often incapacitating to the dog, the prognosis is good. Improvement of clinical signs usually starts within 48-72 hours and most patients are normal within two to three weeks, even with no treatment. A mild head tilt may persist. Veterinarians should be consulted as the symptoms can also be caused by ear infections, foreign bodies in the ear, or tumors. The vestibular system may need treatment, with motion sickness drugs, or intravenous fluids if the nausea is severe or the dog is unable to eat or drink for a few days.

Ticks

Ticks are the small wingless external parasites, living by hematophagy on the blood of mammals, birds, and occasionally reptiles and amphibians. Ticks are blood-sucking parasites that are often found in freshly mown grass, where they will rest themselves at the tip of a blade so as to attach themselves to a passing animal. It is a common misconception that the tick can jump from the plant onto the host. Physical contact is the only method of transportation for ticks. They will generally drop off the animal when full, but this may take several days. Ticks have a harpoon-like structure in their mouth area, known as a hypostome, that allows them to anchor themselves firmly in place while sucking blood. This mechanism is normally so strong that removal of a lodged tick requires two actions: One to remove the tick, and one to remove the remaining head section of the tick. Ticks are important vectors of a number of diseases. Ticks are second only to mosquitoes as vectors of human disease, both infectious and toxic.  Hard ticks can transmit human diseases such as relapsing fever, Lyme disease, Rocky Mountain spotted fever, tularemia, equine encephalitis, Colorado tick fever, and several forms of ehrlichiosis. Additionally, they are responsible for transmitting livestock and pet diseases, including babesiosis, anaplasmosis and cytauxzoonosis.

Tapeworms

Tapeworms live in the digestive tracts of vertebrates as adults and often in the bodies of various animals as juveniles. In a tapeworm infection, adults absorb food predigested by the host, so the worms have no need for a digestive tract or a mouth. Large tapeworms are made almost entirely of reproductive structures with a small “head” for attachment. Symptoms vary widely, depending on the species causing the infection. The largest tapeworms can be 20 m or longer.  Tapeworm awareness is importance to humans because they infect people and livestock. Two important tapeworms are the pork tapeworm, , and the beef tapeworm

Seizures

Seizures are common in dogs, but more unusual in cats. Seizures are just symptoms which can occur with many kinds of diseases. They can happen because of diseases outside the brain or inside the brain. Low blood sugar that can happen with an overdose of insulin or with a tumor of the pancreas can cause seizures. They can happen with diseases of the liver or kidneys. Ingestion of toxins such as snail bait can cause seizures. Lesions of the brain such as tumors, abscesses, granulomas, infections, or inflammatory diseases can cause seizures. Epilepsy may cause seizures. Seizures most commonly last for a few seconds to a couple minutes. Grand mal seizures cause the head to go back and the legs stiffen with rhythmic jerking. The pet is usually unconscious. Smaller partial seizures may be more difficult to recognize, but you should be suspicious of any repetitive rhythmic movements. After the seizure, the pet usually enters the post ictal phase where it is dazed, lethargic, and not able to walk normally. This phase may last for minutes, hours, or days. A pet may have one seizure, and never have another, but most commonly they do recur. Testing should be done to try to determine the cause of the seizures. Blood testing, urinalysis, and liver function tests are commonly done. An MRI of the brain or a spinal tap may also be needed. Intravenous medication can be given by a veterinarian to stop a seizure. If the seizures become too frequent, usually any more than every four to six weeks, anti- convulsant medication can be given to try to reduce future seizures. Anti- convulsant medicine does not guarantee a pet will never have another seizure, but it tends to make the seizures shorter in duration and less frequent. Phenobarbitol is the most common anti-convulsant medicine prescribed. When a dog first starts on this medicine, it will act like it is drunk for the first week or so, until it becomes accustomed to the drug. Phenobarbitol is given twice daily, and once it is started, it is usually given for the life of the pet. Potassium bromide is the second most common anti-convulsant prescribed. It is available only at special compounding pharmacies. It is usually formulated into a liquid. It can be administered to the dog by squirting it onto a piece of bread that is fed to the dog once daily. Potassium bromide can be toxic to people, therefore, it is advised to wear gloves when handling this drug.

Salmonella

Salmonella is a bacterium that can cause disease in humans, dogs, cats, and other animals.  It can cause a variety of symptoms, commonly vomiting and/ or diarrhea, but also severe infections and septicemia.  It can also cause abscesses, meningitis, bone infections, and abortion. Salmonella is found worldwide and is commonly associated with contaminated food, reptiles, and birds.  Epidemics of salmonellosis in migrating songbirds in the spring can create disease in bird-hunting cats.  Most, if not all, reptiles carry Salmonella in their intestines, and occasionally shed it in their feces.  The bacteria usually do not cause disease in reptiles, but a growing number of Salmonella infections each year in people can be traced to pet reptiles.  It is virtually impossible to eliminate Salmonella from pet reptiles. Rarely, contamination of commercial dog food or treats with Salmonella has occurred.  More common, a popular fad diet of feeding raw food for dogs and cats has caused illness in pets and the people in the household. A study showed that families that fed raw food to their pets had a much higher incidence of salmonellosis in the people. Contaminated human food can also be a source of Salmonella, especially raw eggs, chicken, and undercooked meat.  Even lettuce, fruits and vegetables have been incriminated.  Food can become contaminated if someone infected with Saclmonella handles it without washing his or her hands. Treatment of salmonellosis in the milder cases may just involve oral antibiotics.  More severe cases will need hospitalization with intravenous fluids and antibiotics.  Recovering patients may shed the bacteria in the stool for six weeks or longer.

Ruptured Anterior Cruciate Ligament

The rupture of the cruciate ligament is the most common knee injury in the dog. This injury has two common presentations. One is the young athletic dog playing roughly who acutely ruptures the ligament and is non-weight bearing on the affected hind leg. The second presentation is the older, overweight dog with weakened or partially torn ligaments that rupture with a slight misstep. In this patient the lameness may be acute or there may be more subtle chronic lameness related to prolonged joint instability. Your veterinarian will perform an orthopedic exam and take radiographs (x-rays) in order to diagnose this injury. The orthopedic exam involves an analysis of the gait, examination of the joint for swelling and/or pain and the presence of “drawer movement” (the presence of forward instability of the knee joint). Sedation is often required to do an adequate evaluation of the knee, especially in large dogs. Sedation prevents the pet from tensing the muscles and temporarily stabilizing the joint and preventing the demonstration of the drawer sign. Radiographs confirm inflammatory changes in the joint and establish the level of osteoarthritic changes present. Surgical repair is recommended in most cases to stabilize the joint and prevent further osteoarthritic changes secondary to the joint instability. There are three primary types of surgical repair: intracapsular, extracapsular, and tibial plateau leveling osteotomy (TPLO). The type of surgical repair will be determined by the size, age and activity level of the pet as well as the degree of osteoarthritis already present in the joint. The recovery time and recommendation for physical therapy will depend on the type of surgical repair performed.

Roundworms

There are many types of roundworms, but some of the most common are intestinal parasites of dogs, cats, and raccoons.  Puppies are frequently born with roundworms, and kittens can be infected via the mother’s milk or feces. Adult roundworms are ivory colored, four to six inches long, and round (not flat ) in shape.  These parasites can cause diarrhea, vomiting, weight loss, and even coughing in these young patients. In the usual case, the owner will not see the adult roundworms passed in the stool.  This is why it is important for the veterinarian to do a laboratory test to check for any parasites that might be present. We check for parasite eggs with a  microscope.  You should bring a fresh stool sample (one that was produced that day) to your puppy or kitten’s appointment. It is important to know that animal roundworms can be transmitted to people, and in some cases can cause serious disease. In a recent study from the Center for Disease Control (CDC), it was reported that almost 14 % of all Americans are infected with Toxocara, the most common roundworm of pets.  Although most people infected have no symptoms, the parasite is capable of causing blindness (especially in children) and other systemic illness.  The infective agent is the microscopic egg in the animal’s stool.  It is known that these eggs are very resistant to environmental conditions.  They have been shown to live in yards, playgrounds, and fields for up to 10 years. The most dangerous roundworm is Baylisascaris, a parasite of raccoons that has an affinity for brain tissue. Children infected with this parasite have suffered severe, permanent mental retardation.  The majority of raccoons carry this parasite.  If wildlife is present on your property, you should patrol the grounds and any raccoon stools should be treated as hazardous waste.  Wear disposable gloves to double bag and dispose of the feces.  The only thing that will kill the remaining eggs in the soil is fire. The CDC recommends regular deworming of all puppies and kittens to try to reduce the exposure to people. A medication will be dispensed when your puppy or kitten is first seen.  Another important measure is monthly parasite preventative, or what we sometimes call “heartworm preventative”.  Many of these drugs are also effective for roundworms, and are an important part of a wellness program. The CDC prevention measures include: Keep dogs and cats under a veterinarian’s care for early and regular deworming Clean up after the pet and dispose of stool Keep animals’ play area clean Wash hands after playing with dogs or cats Keep children from playing in areas where animals have soiled Cover sandboxes to keep animals out Don’t let children eat dirt

Rabies

Rabies is a fatal viral infection that is transmitted primarily through bite wounds. Skunks, bats, raccoons, and foxes are the primary carriers. Rabies is also fatal to humans, there has been only one case of a person surviving rabies when treatment was started after clinical signs were present. Puppies are vaccinated when three to four months of age and then one year later. Each state varies in its rabies law, most states require rabies vaccine every three years for adult pets, but some states still require them annually. If a person or a pet is bitten by an unknown or unvaccinated animal(dog, cat, or wild animal), the local health department or your veterinarian should be consulted. The animal that bit should be apprehended, if possible, and your veterinarian or local health official should be contacted immediately. A test can be done to see if rabies is present, but it does require the animal be euthanized because the test can be done only on the brain. Rabies is preventable through regular vaccination of dogs and cats.