Monthly Archives: February 2014

The Importance of Dental Exams for pets!

February is National Pet Dental Health Month, so let’s talk about the importance of dental health for your pet. Dental exams are very important, yet sometimes are placed on a lesser-priority list than an overall health exam. However, dental health and exams are equally as important. Poor oral health is often a sign of the dog’s overall health and can impact the whole body. Periodontal diseases may cause bacteria and toxins to enter the body with negative effects, while dogs with poor systemic health may have periodontal issues as well.

We usually think of white shiny teeth as an example of a well-balanced and nourished dog. Some dogs with brilliant white “smiles” can have dental disease hidden in and under the gum line. Unfortunately, not all dogs have radiant “smiles.” Many dogs have severe plaque and tartar that accumulates on their teeth, similarly to humans. Plaque is caused by proteins from the saliva that interact with the bacteria naturally found in your dog’s mouth, as well as from bacteria from the environment. If plaque is left for long periods of time, it can multiply and invade the gums, causing inflammation called gingivitis.

For senior dogs and for small dogs, plaque accumulation can develop quickly. Tartar forms when minerals from your dog’s saliva hardens plaque and becomes a ‘crust’. In cases of gingivitis, bacteria that are in your dog’s mouth can cross into the bloodstream. This “showering” of bacteria has been linked to kidney disease and harmful bacterial growth on the valves of the heart. This bacterial growth can change the valve’s function, leading to heart murmurs and even heart failure.

Dental Exams are extremely important in maintaining healthy teeth and gums. It’s recommended that you check your dog’s teeth at least once a month and take your dog for an examination every 6 months to a year. Large dogs are found to have fewer problems with plaque buildup and the consequent gingivitis, however large dogs can sometimes have tooth fractures from the power of their jaws. Small breeds, particularly toy breeds like Yorkshire terriers, are more prone to issues with tartar buildup and gum disease. Frequent examinations of your dog’s oral health are important due to the fact that tooth and gum diseases may start at any time.

What will the veterinarian look for? The vet will start by looking at your dog’s facial structure and the tissues around it. Unusual swellings can be a sign of dental or jaw diseases such as tooth root abscesses. The severity of tartar, plaque and gingivitis will be noted. The enamel will be evaluated and checked for cracks and wear patterns. If your dog has been chewing on too-hard toys or treats, their teeth may be worn down to the interior of the tooth, known as the pulp. Exposed pulp can lead to pain and infection. Certain breeds may have crowded teeth or retained baby teeth that can be sources of infection. Your veterinarian can determine from the exam when the next dental cleaning will be necessary.

There are several contributing factors to dental issues. Genetics play a large role! — the conformation and structure of your dog’s mouth may also cause problems. Some dogs have strong oral chemistry (lysozymes) that helps prevent excess bacterial growth. Saliva plays a very important role in your dog’s dental health but it does not contain the amylase enzyme responsible for the digestion of carbohydrates like in humans. Therefore the starches tend to stick to their teeth causing plaque and tartar build up. This may irritate the gums and dogs are more prone to gingivitis while humans are more prone to cavities from the carbohydrates (sugar). Saliva in a dog may act solely as a lubricant for swallowing and to moisten food before it reaches the stomach. Saliva does not really aid digestion in pets!

Diet is also exceedingly important, although controversial. Many holistic veterinarians believe that the excess amounts of carbohydrates and sugars found in commercial dog foods are to credit for the buildup of plaque and tartar. Some believe, although controversial, that feeding a raw diet, complete with raw meaty bones such as chicken necks and backs, can help to reverse poor dental health and create stronger teeth and gums. Based on my experience, dog that eat bones and cats that hunt mice usually have nicer looking teeth. Although I am still a bit wary of recommending raw bones in pets because of the potential of leading to a bowel obstruction, they need to be considered for proper dental health. This is a pretty good article by a trusted source about feeding raw bones in pets from the Integrative Veterinary Care Journal. There are veterinary prescribed dental diets for pets like Medical Dental, Sc. Diet t/d and Purina DH that may help reduce tartar and maintain dental health in some pets. These types of diets may provide an alternative to some clients. 

There are also some dental toys, gels, water additives and dental treats available on the market that are intended to help keep your dog’s teeth clean and healthy. Unfortunately, these toys and treats do not work for every individual. For some dogs, these items can be greatly beneficial, while for others, these products either do not help, and may even result in broken teeth, bleeding gums, or intestinal blockages from ingestion. Only products approved by the Veterinary Oral Health Council (VOHC.org) have passed minimum required protocols to prove their efficacy. You can find a list of products that have proven the ability to help reduce tartar/plaque in pets at http://vohc.org/accepted_products.htm . Always consult with your veterinarian to see what he or she recommends for your pet. 

Some pets like to eat rawhide and pig ears and they can help mechanically abrade off some tartar but they have been cases of contamination of these treated by salmonella and other pathogenic bacteria. Also, remember that these types of treats are high in fat and not recommended if your pet is overweight.

Getting your dog’s teeth cleaned regularly can help to keep the plaque and tartar in check. Routine periodontal treatments include ultrasonic scaling of plaque and tartar, manual scalingof plaque and tartar, and polishing. Teeth cleanings are performed under anesthesia, so it is typically a stress-free operation for your dog. In the US, it is now standard of care to have dental radiographs performed at the time of cleaning. In Canada, dental radiographs are not offered at every clinics and it may be a few years before we see them being offered everywhere. These radiographs are fast and can expose potentially painful tooth root abscesses and structural problems. If any loose or infected teeth are present, they can be removed painlessly. 

It is important to brush your dog’s teeth daily between professional cleanings. Teaching a puppy to accept having their teeth brushed is usually easy. Some puppies learn to enjoy it. Start slow and introduce them to the idea of having someone touching their teeth and gums. You can even teach your older dog to sit for brushing with a little patience and reward-based training. Be careful to avoid human toothpaste, as some contain foaming agents that can irritate your dog’s stomach, while others contain xylitol, which is toxic to dogs. Only brush your dog’s teeth with enzymatic toothpaste that is specifically made for use in pets.

Even with regular brushing at home, it’s still important to have your dog’s teeth checked even professionally cleaned when needed. Keep in mind that the old proverb that an ounce of prevention is worth pound of cure” is certainly true when it comes to home dental care. Daily brushing and monitoring will keep disease at bay and early treatment can prevent your dog (and wallet) from having to endure extensive dental procedures at the veterinarian.

Written by Dr Cindy Lizotte, DVM, MBA, CVFT (CHI institute), CVA (IVAS), Grad Dip Vet Western Herb Med (CIVT) Cert CVHM (IVAS)

Advertisements

Omega supplements in pets

Part 4 Immunity series: Omegas in pets

In today’s society, the word “fat” has a negative connotation on multiple levels. However, contrary to popular belief, not all dietary fats are bad, nor are they the root of obesity. In fact, there are many good fats that enhance and support your dog’s immune system, even enhancing energy production and promoting weight loss. Fats are also important for maintenance and growth of tissues. Although many fats are naturally produced in the body, some fats can only be obtained by eating certain foods. For example, your dog’s body cannot naturally produce linoleum acid (omega-6) or alpha-linolenic acid (omega-3).

 

If your dog is not receiving adequate amounts of omega-6 essential fatty acids, your dog may experience significant skin problems, loss of hair, slow healing from wounds, liver and kidney issues, weak immune system, circulatory problems, weakness, sterility, and much more. Most dogs suffer from mild deficiencies with minimal symptoms. Common minor symptoms of an omega-6 deficiency include dull, flaky coat, loss of hair, abnormally greasy skin, and excess itching.

 

Omega-3 fats, or alpha-linolenic acid, are also tremendously important to your dog’s health. Dogs that do not receive enough omega-3’s may experience stunted growth, eye problems, and weakness. Omega-3’s help with the production of compounds that regulate inflammation and blood clotting, as well as arthritis and bowel conditions such as colitis and inflammatory bowel disease. Omega-3’s also have an impact on the heart and circulatory system, helping with arrhythmia, high blood pressure, strengthening then immune system and decreasing blood cholesterol levels. The absence of essential fats in dogs is one of the most common nutritional deficiencies and clearly a large issue. So what can you do to help this?
 Image
Luckily, the answer is simple. Omega-6 fats are found naturally in sunflower, safflower, corn, borage, evening primrose, and black current oilsOmega-3 fats are found in fish oils, such as salmon, halibut, herring, and mackerel. They are also found in sea buckthorn, flax seeds, walnuts, soybeans, and wheat germ. Dried beans, such as kidney, northern, and navy, are sources of both omega essential fatty acids. It seems that fish oils are  better absorbed then flax seeds in pets. Although you can supplement home-made diets with grounded flax seeds or flax seed oil, I prefer using fish based products in cases where I want to help a dog with arthritis, immunity issues, anxiety, cognitive dysfunction, cancer or a pet with skin problems.

 

It is extremely important to ensure that your dog is receiving enough of both essential fatty acids. Commercial dog foods may contain proportionately incorrect ratios, and can result in high levels of omega-6’s and  low levels of omega-3’s. All sources of essential fatty acids oxidize and break down quickly, becoming destroyed by light, heat, and oxygen. High processing temperatures, transport and long shelf-life of commercial dog foods can all affect the actual amount of omegas being consumed by your dog.

 

If you fortify your dog’s diet with omega fatty acids, you are helping to ensure that he/she is receiving enough. Essential fatty acids are a crucial necessity to your dog’s overall wellbeing. Choosing a quality product to support your dog’s need for these fats is very important and one that will benefit your dog for the rest of his/her life.There are a variety of quality products available on the market and we recommend you check with your veterinarian about which he/she recommends since not all omega 3 products are created equal. The quality of fish oils is important since they can be contaminated with heavy metals and pesticides and some can be high in vitamin A and D. If you would prefer a vegan product, there are others on the market containing flax seed or sea buckthorn oil.   When selecting an omega 3 supplement, make sure to look for the inclusion of Vitamin E. Vitamin E is necessary to insure that the omega-3s are completely metabolized.

 

If a pet is allergic to Linum family of plants, flax seed would be contra-indicated and if your pet is allergic to shellfish avoid krill oil. In some cases pets may also be allergic to fish and in particular instances flax seed oil may be recommended instead. Fish oils can cause diarrhea in some pets and sometimes it is best to start them at 1/4 of the recommended daily dose and slowly increase to the full dose over 1-2 weeks. This would be the same recommendation as when introducing your pet to a new food. Omega-3 fatty acids can interfere with blood thinners, beta blockers and diuretics therefore always consult your veterinarian. Because fish oil supplements can reduce blood coagulation and increase bleeding, we always recommend to discontinue omega-3 fatty acids supplements at least 7 days prior to any surgery and they can be restarted about 48 hours after.

 

Long term supplementation of omega 3 can lead to deficiency in omega 6 so this is why we recommend to  always consult with your veterinarian about using supplements in your pet. Omega-6 oils can be pro-inflammatory and usually Omega-3 supplements are preferred. If you are looking into using a combined product that contains both these types of omegas, make sure that a ratio 2:1 is respected (Omega-3:Omega-6). Cod liver oil contains vitamin A, so it is not the exact same product as a capsule of Fish oil. High amounts of vitamin A and in some cases low amounts of vitamin D can increase the risk of  vitamin A toxicity.  This is why some vets will suggest fish oils instead of cod liver oil.  If you do want to use cod liver oil, then make sure the ratio is 1 part vitamin A to 4-5 parts vitamin D. Fish Oil should be kept refrigerated. The dose recommend by veterinarians may vary, but the dose I recommend for arthritis, cancer and skin issues is 30 mg/kg of DHA. Usually Omega-3 supplements will show their benefits within 6-8 weeks but in some cases skin and coat can improve in as little as two weeks. I personally prefer the Ascenta Dog and Cat fish oil supplement as they contain higher amounts of DHA versus other products. This allows pet parents to give less of this supplement versus others to get the correct amount of DHA required.
Written by Dr Cindy Lizotte, DVM, MBA, CVFT (CHI institute), CVA (IVAS), Grad Dip Vet Western Herb Med (CIVT) Cert CVHM (IVAS). Elmwood Veterinary Hospital
  1. Resources
•           Dodds, Jean. Alternative Therapies for Pain Management. Holistic Veterinary Medicine Club Symposium, 2013.
•           Larsen, Jennifer. Evidence-Based Benefits of Omega-3 Fatty Acids for Dogs & Cats. ACVIM Forum Proceedings, 2011.
•           Schenck, Patricia. Anti-Inflammatory Effects of Omega-3 Fatty Acids in Dogs and Cats. ACVIM Forum Proceedings, 2011.

Boxer puppy with neonatal conjunctivitis.

Emma, a puppy that had to be bottlefed when she was 5 days old, developed neonatal conjunctivitis when she was about 9 days old. Emma and her littermates are going to day6be part of our Immunity blog series because of the simple fact that all their issues are related to a weak immune system. We will be looking at herbs to support her immune system once she is started on normal dog food and not bottle fed anymore. She, like the three other puppies in the litter have been a constant struggle, having to deal with one medical problem after another. This is often the case when the mother is too old and weak to have normal healthy puppies. Their mom was very sick and had to be euthanized for humane reasons. To the right is a picture of Emma at 5 days of age.

Emma and her littermates were all born with unclosed fontanelles which in some cases has been linked to hydrocephaleus and seizures issues in some smaller breed dog. Although this is not a condition often seen in young boxers, we are hoping it they will close up by around 6 months of age. She and her littermates also had demodex lesions, fleas and weak hind legs that required physio and acupuncture (we will be posting a blog about this and their other issues in January 2014. In cases like these, with dogs that have multiple problems, is where I find that Integrative Veterinary Medicine shows its true potential.

Neonatal conjunctivitis is described as being an infection and inflammation of the conjunctivae. In some cases it can happen before or after the puppies open their eyes. In Emma’s case, the infection set in her left eye behind her closed eyelids. This caused her eyelids to become very swollen. Since the pus was stuck between her eye and her closed eyelid, it caused major swelling since the pus had nowhere to drain. In cases where the eyes are open, it will cause squinting, discharge, redness, swelling and other signs that are typically associated with pink eye in people.

neonatal conjunctivitis

This a picture of another puppy that had neonatal conjunctivitis like she had, the exact same left eye and the swelling was as obvious as it is on this puppy. No pictures of Emma were taken at that time

Neonatal conjunctivitis will require immediate veterinarian attention, because it may lead to permanent damage to the eye and in some cases it may lead to blindness. If you are unable to bring your puppy to a vet, then there are a few things you may do at home.

Treatment for Emma’s neonatal conjunctivitis.

In this case, since Emma was only 9 days old, we wanted to avoid surgery at all cost. A vet can use anesthesia to open the eyelids in cases where they are still closed, flush the eye, instill eye drops and suggest home treatment afterwards. Because the eyelids are not meant to be open that early mechanically (before they are ready on their own), tear gel or artificial tears will need to be applied every 2-4 hours in the eyes because puppy have limited tear production abilities.

But, because I wanted to avoid any type of surgery and anesthesia on Emma, we elected to try lukewarm compress on her eyelids.  We took cotton balls with lukewarm water and gently applied it to left eyelid (about 2 minutes of compress). Then we gently did a small left to right movement with the cotton ball and pus stared to come out from what we call the medial canthus area (the area where the left eye corner is the closet to the nose). We did this 4-5 times a day and after 72 hours, pus stopped coming out. We also applied over the counter polysporin eye drops every 4 hours (even if her eyelids were closed). We aimed to get in the same area where the pus would come out. If pus can drain, that means there is a hole and hopefully eye drops will get in from that same hole. About 5 days later, she opened her eyelids naturally. She reacted with a tiny yelp when polysporin was applied, so we discontinued that. She was now 14 days old. We switched from polysporin eye drops to fucithalmic gel and we kept doing artificial tears for a few days.

A few days later, her eye took a turn for the worst. Basically, the epithelium of her cornea detached itself from the stroma of the cornea (formed a liquid bubble). The eye looked mushy like what we see in a burst eye (perforated eye) or uveitis, but it looked bigger like we see in glaucoma cases (bupthalmia).

Once her left eye started to bulge out to the point her eyelids would not close over it, it seemed painful. This happened in under 24 hours, going from an almost-normal looking cornea to an abnormal looking eye that looked like it had ruptured. She started to whine constantly and had to be rushed to the vet hospital for emergency eye surgery (and of course this always happens during a huge snowstorm when the clinic is closed). Emma was put under general gas anesthesia and I was mentally preparing myself to remove an eye the size of an eraser pencil tip, thinking for sure her eye had ruptured for some unknown reasovideo-cornealayersn at this point.

While under anesthesia, I used a q-tip to investigate the origin of what I suspected was a hole in her cornea, trying to determine the cause of all of her trouble. Suddenly the bubble popped and liquid started to come out, exactly like we see in ruptured eyes, but imagine my surprise when I saw an intact stroma hidden behind that bubble. Basically, with the q-tip, I tore a hole in what was the epithelium part of the cornea and the stroma underneath was intact!

visi0245

So, if you look at these pictures, the entire epithelium had detached itself from the stroma and stuck in between was fluid with blood and pus. That meant that the eye itself was not leaking fluid which also meant NO EYE REMOVAL!

After doing some research, the closest thing I found that would come close to describing this condition is a condition called Keratoconus in peopthCZG380EZle. Emma had a condition that I had never seen before and that I could not find documented cases of in dogs. You can see on this image that the cornea is bulging out, so if you try to close your eyelids, well technically that bulge would get squeezed in between them.

We still had a chance to save her eye. So, I debrided the entire epithelium part of the cornea (usually we would do a grid technique on deep ulcer). In this case, the entire superficial layer of the cornea was stretched out, abnormal looking and hiding a pocket of infection/fluid that I suspect came from her original neonatal conjunctivitis. I removed as much of the epithelium  as I could, but even under anesthesia the exam of the eye was hard since it was tiny. Looking at her eye, we could see a line when I suspect the infection got in between the lawyers of the cornea (between 10-12 o’clock there was a 3-4 mm line where the sclera and the cornea joined). I suspect this is the tear that allowed the infection to set in. Usually, I would do serum drops in cases where we have deep ulcers, but since this looked superficial and because this was a 1 lbs puppy, we elected not to take blood from any veins to make serum drops. We did a third eyelid flap similar as what you can see in this Youtube video. This protects the eye in hopes to allow the cornea to heal itself. It brings vessels and nutrition to the sick and injured cornea. It keeps the eye moist and allows us to apply medication to the eye with less of a struggle. I usually use a human contact lense more often now days then a third eyelid flap but finding a contact lense that tiny would have been a challenge. So, as a last resort, we had to do a third eyelid flap under anesthesia.

She was put on Artificial tear gel every 4 hours, Oflaxacin (my favourite for Boxers with indolent ulcers) twice a day, Diclofenac twice a day and Atropine twice a day. The third eyelid flap was removed 7 days later and it seems that her cornea is slowly healing. She was also put on a probiotic called Fortiflora.day1 thrid eyelid flap for ulcer

Emma had a third eyelid flap surgery on December 18th. This is her on December 22th. On the upper left eyelid, there are 3 tiny purple stitches.

dec22 eye drops with eye flap
December 22th: Emma getting tear gel. We see the purple stitches on her eyelid flap on her upper eyelid.
dec23
December 23rd: Emma is drinking from a bottle. Her third eyelid flap still holding well.
dec24
December 24th: This is a few minutes after we removed her eye flap. There is still a lot of swelling and corneal edema (blueness on her eye).

dec30

December 25th, a lot less swelling

dec26

December 26th: Note the eye cornea seems to be healing!
dec26pict2
December 26th: Note the cornea is intact and it is beautiful to see this after we thought her eye had ruptured!
dex29
December 29th: Her cornea is showing signs of healing!
dec29 7 days after flap removed
December 29th: This is about 11 days after her ulcer was noted and debrided, and about 5 days after her third eyelid flap was removed.
dec30

December 30th: There is still a lot of swelling with her third eyelid, but once her cornea is fully healed up we will start her on Maxitrol to reduce all that. Her cornea is almost ready, it will be 14 days post-ulcer on January 1st 2014.  A few days later, she was started on Maxitrol twice a day for 7 days once we tested her eye with a fluorescine stain to make sure the ulcer was healed up! This will reduce any scaring left on her cornea and allow what we hope is a full return to normality.

boxer jan 4

 January 4th, 2014. Left eye looking a lot better and almost normal!

boxer jan 7th

January 7th, you can barely see a scar in her left eye!

cindy lizotte

Last update: January 22th, barely not scar visible in her left eye! We will be looking into each herbs and the Immunity support formula that we will be using on these puppies as the immunity series blog progresses. This is more a case presentation so that we may see how she and the rest of the litter progress as we move into re-balancing their immune system. Sometimes even very sick puppies can be supported to make them healthier long term and this is our goal with herbs and natural supplements. Integrative Veterinary medicine means that we combine conventional therapies with natural therapies in order to try and promote a more a healthier life! The goal is to nurse these sick puppies back to health in hopes that we will not have complications related to their immune system as they grow older.

Written by Dr Cindy Lizotte, DVM, MBA, CVFT (CHI institute), CVA (IVAS), Grad Dip Vet Western Herb Med (CIVT) Cert CVHM (IVAS)