The hidden iceburg: Dental Disease

We just recently had an interesting case that brought home to me how important dental radiographs are when doing a proper dental cleaning.  Tao is a 12 year old Retriever mix with numerous problems.  She has many problems including epilepsy and blindness which made her person hesitate to do anesthesia.  Yes she had really bad breath, but her teeth really didn't look all that bad.

As you can see the back teeth (premolars and molars) are somewhat covered in calculus, but the gums aren't red and bleeding and there is no obvious major disease.  Because her gums are pigmented (black in color) it makes detecting gingivitis more difficult.  In Tao's case instead of the gums receding back they became inflamed and thickened, but it isn't very obvious to the casual glance. 
Once Tao was under anesthesia we took some radiographs and found some major periodontal disease.  There were many teeth where the bone was eaten away by infection and I was able to pull several teeth, some with 3 roots, without having to section them.  (Normally you have to cut the teeth apart and pull each root separately).
Below is a radiograph of a normal adult molar (right) and premolar (left).  The red arrow points to the crown of the tooth.  The blue arrow points to the root tip.  The yellow arrow points to the pulp cavity and the green arrow points to the think dark line going around the root tip.  This is the periodontal ligament.  Both of these teeth have two roots and notice how there is bone (the mottled white material) all the way up to where the roots join at the top.  The line around the roots is thin and uniform.

Now here is a radiograph of the same teeth on Tao.  Notice the yellow arrow points to where the bone should be up to.  The black is air on an radiograph.  The bone on this premolar has been eaten away. This was one of the teeth I was able to remove without cutting.

 This next radiograph is of the maxillary teeth (upper) right behind the canines.  The blue arrows are pointing to the edge or a root abscess.  If you notice the area around the tooth is a darker grey than the rest of the bone.  There is no longer ANY bone around this tooth.  It has been completely eaten away.  The green and red arrows point to defects in the actual teeth.  The roots on these two teeth have actually been "eaten through" (darker areas) by bacteria.  Compare them to the radiograph of the normal teeth above.

Once we were done poor Tao was left with only 15 teeth in her mouth.  We had to remove all 26 molars and premolars and one incisor. Adult dogs have 42 teeth.  Adult cats have 30.

 That being said her breath was instantly better and her mouth probably hurt less than before and within a few days she should be feeling so much better.  Since her teeth were already so bad she probably wasn't chewing on anything, including her food so she won't miss the teeth.

 

Facts and Fiction about Heartworms

When I was in vet school I saw a large 9 year old lab mix by the name of Gator.  He came to the school health clinic every year since he was a puppy and every year diligent veterinary students like me tried to convince his owner to put him on heartworm prevention.  Every year it was a different reason, but I think the one I got takes the cake.  Gator's owner told me that he did not need to be on heartworm prevention because he only went outside into his fenced in backyard.  When I asked about the fence (picturing a screened in area), i was told it was a chain-link fence.  I breathed a sigh of relief to learn that Gator and his owner lived out in the country, because if the mosquitoes in his area were too big to fit through a chain-link fence then I think heartworms were the least of their concerns.
I hear almost on a daily basis hundreds of different reasons why someone doesn't want to put their dog or cat on heartworm prevention.  I want to address the common ones I hear and explain why it is so important, especially in Florida where we have mosquitoes year round.

1) Scenario: "My dog doesn't go outside." says the owner.
"Oh! You have him litterbox trained?" I ask.
"No," replies the owner.
"Then where does he urinate and defecate?"
"Outside," the owner replies. "But, he is on a leash at all times and I am right with him."

I don't know about where you live, but mosquitoes are really common in my backyard.  I may be able to protect Fido from another dog, or from being hit by a car by keeping him on a leash, but I can't even protect myself from those tiny little vampires.  Even stepping outside long enough to get the mail can be enough for a bite or two.  And for those cat owners who's cats never go outside....I just killed a mosquito that landed on my arm, in a closed room, in a closed house where no one has been outside for several hours.

Heartworms have a two host life cycle.  A mosquito takes a blood meal from a dog infected with heartworms.  With the blood meal the mosquito ingests the microfilariae (baby heartworms).  The mosquito then flies happily on its way.  Over the next 10 to 14 days the microfilariae mature into L3 stage larvae and migrate to the mosquito's salivary gland.  When that mosquito bites another dog or cat the droplet of saliva it leaves behind will contain heartworm larvae.  The larvae then burrow into the body of the animal through the mosquito bite wound.  Over the next two to four months the larvae travel throughout the body until they finally end up pulmonary vasculature.  During this time the larvae are also maturing into L4 and then L5 (adult) heartworms.  The adult heartworms then mate and start producing microfilariae in six to nine months after the initial bite.  Now they are carriers and start the whole cycle again.
It only takes a single bite from an infected mosquito to give your dog or cat a life threatening disease. 

2)Heartworm prevention is too expensive.
If someone told you that for a mere $7 a month (thats $0.23 a day) you could protect yourself from a deadly form of heart disease don't you think you would find a way to do it?  I know times are tight and every penny counts, but $7 is one meal at McDonalds, or two Mochas at Starbucks.  Considering treatment is anywhere from $300 to $1000+, I think heartworm prevention is VERY affordable.

3)Giving your pet poison:  Many people are afraid to give their dog or cat heartworm prevention because they believe they are giving them a cehmical that is staying in their body for the whole month.  While there are a few topical medications that do stay around for that length of time, most oral preventions are out of their system in 24 to 48 hours.   The medication is a dewormer that kills any susceptible parasites as soon as it is administered.  The reason we can get away with only giving it once a month is because the L3 and L4 larvae take at least 50 days to mature to adult heartworms.  Once the parasite has matured into the adult stage heartworm preventatives can no longer kill them.  Another thing to note is that most heartworm preventatives contain an active ingrediant at such a small dose that the chance of a bad reaction are almost non-exsistant.  More pets react to the taste additives than to the active ingredient.

4)Why not just treat if your pet gets heartworms instead of giving a prevention?
First reason is that the medication we use to kill adult heartworms is on manufacturer back-order that is expected to last for at least several months.  This means that other than surgically removing the adult heartworms from the heart, there is NO treatment available for adult heartworms.  This has always been the case in cats because the available treatments are more likely to kill the cat than the worms.

Second reason is that once treatment becomes available again it is risky.  If you want to compare poisons, Melarsomine (the active ingrediant in Immiticide) is a nuclear bomb compared to the vinegar and baking soda bomb that the active ingredients in preventatives.  While Ivermectin (the active ingredient in Heargard and Iverhart) can be given at 800 times the dose in heartworm prevention before serious side effects occur (the LD50 is 6500x the dose) just two times the standard dose of melarsomine can be fatal. 

The third reason is the actual death of the hearworms can be fatal not only to the heartworms, but to the dog as well.  Preventing heartworms provides almost no negative effects to the dog.  Its like wearing sunscreen to prevent a sunburn.  Once you ahve the sunburn it is painful and can have lasting negative effects such as skin cancer.  The same thing is true for heartworms.  An adult heartworm can reach a foot in lenght and it lives inside the heart and pulmonary vessels.  Not only is it causing damage by existing, but when you kill it where do you think it is going to go?  Thats right, right into the lungs.  If too many worms break off at the same time or there is too much inflamation you can get a serious pulmonary embolism which can be fatal.  Heartworm treatment requires two to three injections with a 1 and a half inch needle into the lower back muscles.  Then you MUST keep you dog calm and quiet for six to eight weeks after the last injection because anything that increases his heart rate could lead to a pulmonary emboli and death.

5) Why should cats be on heartworm prevention?  Cats are not the preferred host for heartworms and are much more resistent to infection than dogs.  According to the American Heartworm Society "When dogs not previously exposed to heartworms are injected with 100 L3 larvae, approximately 75 adult worms develop in almost 100% of the dogs whereas in cats, 3 to 10 adult worms develop in 75% of the cats."  Cats will usually only have 1-6 adult worms, but when you take a single foot long worm and place it into the tiny heart and lungs of a cat you can still have major problems.  There is NO treatment for adult heartworms in cats except for surgery which in itself is very risky.  Common clinical signs of a cat with heartworm disease are asthsma-like symptoms, coughing, collapse, or sudden death.  Treatment is supportive with fluids and oxygen.

If you haev any other questions about heartworm disease or any "facts" that you would like verified please ask!  Heartworm disease is 100% preventable.  We walk our dogs on a leash to keep them from being hit by a car.  We vaccinate our cats for Feline Leukemia to protect them from that fatal disease.  Lets protect them from heartworms as well.

Summer Heat

In these unbearably hot days we have been having it is important to remember Fido and Frisky aren't going to like the heat anymore than you will.  Brachycephalic breeds (pets with short noses), breeds with thick fur coats, the very young and the elderly, and pet;s with heart or respiratory problems are even more susceptible to the dangers of heat stroke, though any animal can succumb. Here are some tips to help keep your furry family member safe from the Florida heat.

Water
Even though dogs and cats don't sweat as much as people do, they still lose a lot more water through panting when the weather is hot.  Excessive water loss can lead to dehydration so make sure there is plenty of fresh, clean water available for your pet.  Normal water consumption for a dog is about 2 ounces per pound body weight in a 24 hour period.  This will increase with hot weather. 

Outdoor Cooling Tips
If at all possible keep your pet indoors where there is air conditioning.  If that is not possible then plenty of shade is essential to prevent overheating.  Freeze gallon jugs full of water overnight and put them in the shaded areas to keep them cooler (don't fill them too full because water expands as it freezes).  You can also place a fan outside and put the frozen jugs in front of the fan to cool the air even more.  If your pet has a long thick coat giving them a summer hair cut will be appreciated.  Clip the hair down to 1 inch in length.  If your pet has light or pink skin then consider leaving the hair a little longer to protect from sun burn.

I have to get on my soap box real fast so bear with me.  For all those runners out there, I know your dog loves to go running with you, but do you realize how hot the asphalt and sidewalks are?  Can you imagine having to walk on blistered feet?  Also you can stop when you get too hot, but your dog, being the loyal companion that he is, will go as long as you can.  He is also closer to the ground and will be affected more by the reflected heat from the ground. Do yourself and your dog a favor and don't run with him except for in the really early morning or late evening. 

Parked Car
NEVER leave your pet in a parked car. On a 85 degree day (we can wish for temperatures that cool!), the temperature in your car with the windows open can reach 102 degrees in just 10 minutes.  In just 30 minutes, the temperature can reach 120 degrees. With the windows closed, the temperature can reach 160 degrees.  In 10 short minutes your pet will start feeling the effects of heat exhaustion and within 30 minutes will be suffering from heat stroke and could die, even with intensive veterinary care.

Know the Warning Signs
Signs of heat exhaustion include excessive panting or difficulty breathing, increased heart and respiratory rate, drooling, and weakness.  Signs of heat stroke include all previous signs in addition to stupor or even collapse, seizures, petechia, bright red gums, bloody diarrhea and vomit along with an elevated body temperature of over 104 degrees.  Body temperatures above 107.5 degrees can lead to rapid organ failure and death.
As the body temperature increases, the body begins to go into shock.  This leads to a drop in blood pressure which decreases blood flow to the vital organs, especially the heart and brain.  The increased temperature also affects the normal physiology of the body which causes fluid to accumulate in the lungs (pulmonary edema), the heart to have irregular beats, the blood clotting factors and functionality to go haywire, DIC (disseminated intravascular coagulation), etc.  If normal body temperature is restored permanent liver, kidney, heart, and brain damage are common complications.

What to Do?
If you suspect your pet is suffering from heat stroke take a rectal temperature.  A dog and cat's normal body temperature is up to 102.5 degrees and up to 103 degrees can occur with excitement or activity.  A temperature above 104 degrees is serious and you need to bring your pet into the vet immediately.  In the mean time it is essential that you do NOT try and cool your pet down too quickly.  A rapid drop in body temperature can cause the body to go into shock more quickly and can also cause ischemic necrosis. You can put your pet and a bathtub of lukewarm water or put wet cloths on their groin, arm pits, and abdomen.  Placing them in front of a fan in an air conditioned room is also helpful.  Encourage your pet to drink.  Sports drinks are better than water if you can.  Do NOT apply alcohol or ice to your pet's body as this will increase dehydration and drop body temperature too rapidly.

The dangers of internet pharmacies

In today's economy everyone is looking to save every penny possible.  I am no exception.  I love being able to have people take advantage of the free antibiotics at Publix or $4 and $10 generic drugs at WalMart or Target, but let the buyer beware when hunting for a bargin.  As much as I would like to believe in the inner goodness of all people, there are a lot of people out there that make that difficult.  Scams and cons abound in today's society and the Internet has made it even easier because you can scam someone from thousands of miles away in a different country where it would be almost impossible to catch you. 

There are hundreds or even thousands of pet medication pharmacies on the Internet and according to the NABP (National Association of  Boards of Pharmacies) at least 96% of them are fake.  World-wide drug counterfeiting is a 32 BILLION dollar industry and the Internet pharmacies are their main store fronts.  They are not run by licensed pharmacists, they do not acquire their drugs from legitimate sources, they are not located in the United States to be regulated by the FDA, and many of them are selling counterfeit, adulterated, or contaminated drugs .  It may look like the same product you get from your vet or from the pharmacy, but packaging is easy to copy.  Anyone with a good scanner and printer can make a realistic looking package.

How can you protect yourself from purchasing a product that at best may be an innocuous sugar pill to at worst a toxic chemical contaminated with E. coli?   The most obvious solution is to buy your medications directly from a brick and mortar pharmacy or directly from your vet, but that can often be more expensive.  To cut out the middle man ordering directly from the source can sometimes save you a significant amount of money.  The NABP has created an accreditation program called Vet-VIPPS.  There are 13 pet prescription pharmacies that are listed on the site.  The is a great place to start.  The NABP also has a list of Not-Recommended online pharmacies.  There are close to 8,000 of those listed.  The Better Business Bureau is another good place to look to see if a company has many complaints against it, but many companies are too new or too small to be listed on their site.  

Saving a few dollars here and a few dollars there is smart budgeting, but if a deal seems too good to be true, then it probably is.  Items are priced at what the market will allow them to sell for.  If someone is selling something for substantially less than everyone else, it probably isn't the same thing.