Dr. Thomas Geiselhardt, DVM
Homestead Animal Hospital
6900 South Holly Circle
Englewood, CO 80112
303-771-7350

Dr. Greg Burns, DVM
South Mesa Veternary Hospital
3801 South Mason
Fort Collins, CO 80535
970-226-6526

It may seem like normal ‘dog’ behavior, but when Fido (or Morris the Cat) is scratching his ears it usually means an undiagnosed problem. Ear pain and ear diseases are very common problems in dogs and cats and often go unnoticed by the pet owner. At Veterinary Referral Center of Colorado, I see hundreds of ear infections of each year.

Ear problems usually go undiagnosed because owners dismiss certain behaviors as normal in their animal. Some of the most common signs or symptoms are head shaking, scratching at the ear or ear flap, ear pain, abnormal carriage of the ear, red or inflamed ears, abnormal discharge, and odor from the ear. You may also see hair loss on or near the ears usually caused by scratching or head shaking. While some pets with ear pain will cry or wince, others will simply become quiet or not play or go on walks as happily. They may also have a poor appetite or have a difficult time chewing hard food.

Ignoring the symptoms can lead to very serious consequences. Excessive head shaking can result in an aural hematoma which is a pocket of blood located under the skin of the ear pinna and often requires surgery. Diminished or complete loss of hearing may be seen with chronic ear problems.

Your general veterinarian can treat minor ear infections, but if your dog or cat has a chronic or recurrent problem a board certified specialist in veterinary dermatologist can help. Veterinary dermatologists have advanced training and specialize in ear problems because they are an extension of the skin.

Bacteria and/or yeast cause the most common ear infections seen by my team at VRCC. Underlying disease such as allergies and hormonal imbalance can also cause ear infections as well as anatomical makeup in certain breeds. One or both ears may be affected at the same time.

Ear infections are typically treated with ear cleansers and topical application of medications that aim to kill the yeast or bacteria. Many topical medications also have anti-inflammatory agents (usually steroids) in them to help with the inflammation and irritation caused by the infection. Oral medications and ear cleansers are the first step. The cleansers aim to break up the wax and debris in the ear, as pets with ear infections have discharge that fills their ear canals. Cleaning is essential to successfully eradicating the infection, and your pet will be more comfortable. If home cleaning is not successful, then deep ear cleaning under anesthesia may be necessary. The type of infection and its chroncity will dictate the medication needed.

If your pet has recurrent or chronic ear problems, it is likely that either the infection was not completely cleared up initially and/or that the underlying cause of the ear problem has not been addressed. The most common underlying cause of ear problems in dogs and cats is allergies. The allergy may be towards food or airborne environmental allergens such as pollens, dusts or molds. Over 20% of dogs with food allergies begin with ear problems as the only sign, and ear disease may be found in up to 80% of the dogs with food allergy. Similarly, ear problems have been reported in approximately 17-55% dogs with allergies to airborne environmental allergens. In cats, food allergy is a common cause of chronic or recurrent ear problems.

In dogs, other common underlying causes of chronic or recurrent ear problems are hormonal in nature. Most common are hypothyroidism (where the body does not produce enough thyroid hormone) and Cushing’s syndrome (where the body makes too much cortisol). In addition, anatomical (structural) problems may be related to the ear problems. For example, Sharpei often have very narrow ear canals, while cocker spaniels have heavy pendulous ear flaps.

Other causes of ear problems include ear mites, foreign bodies (esp. plant awns), tumors, polyps, abnormalities in wax production and more.

Both people and animals have two different systems that can be affected by high blood pressure - the body and the lungs. Typically, we think in terms of body blood pressure. That is what is taken at the doctor’s office every year. However, people and animals can get high blood pressure in the lungs - called pulmonary hypertension – a very serious condition that is also difficult to measure AND is more common in Colorado.

Why in Colorado? The altitude can cause or contribute to high blood pressure developing in the lungs in some individuals. In fact, there are more cases of pulmonary hypertension here than anywhere else in the country.

When I worked in California, I rarely saw pulmonary hypertension. But once in Colorado, where I was the first Veterinary Cardiologist in practice, I have seen cases almost daily, most noticeably in animals with preexisting lung disease. The combination of difficulty breathing because of lung disease and the altitude raises the blood pressure in the lungs.

Although it is a serious condition, technology has made it easier to diagnose. As an owner, you know your dog the best, so watch for signs of pulmonary hypertension. Symptoms to look for include:
• Rapid breathing even at rest
• Declining activity levels
• Persistent cough
• Collapsing
• Very sudden and severe signs of difficult breathing

Additionally, pulmonary hypertension is more common in animals with preexisting health conditions including: underlying lung or airway disease, heart disease, or blood clots in their lungs.

Because pulmonary hypertension is so common in animals with lung disease, it often goes undetected and can lead very severe problems. At Veterinary Referral Center of Colorado, we consider it as a possible problem in every case of lung disease. Normally, animals with signs of lung disease such as coughing and breathing hard have X-rays performed to begin to find the source of the problem. The right side of the heart often enlarges if there is high blood pressure in the lungs. If this enlargement is present, we will pursue more extensive testing for the disease.

The cardiology department at VRCC has very sophisticated equipment to determine whether or not pulmonary hypertension is present. The tests are generally non-invasive and are only done after all other signs point to the disease. The diagnosis is two-fold, If an animal has lung disease and the x-ray shows a heart enlargement, we perform an echocardiogram. To determine the severity of the disease (classified as mild, moderate or severe) very sensitive echocardiogram equipment with color flow Doppler and spectral Doppler capabilities is needed, along with the training and experience to look for the subtleties of pulmonary hypertension.

Unfortunately, pulmonary hypertension is a chronic disease, meaning it cannot be cured. But animals with an accurate diagnosis can be made more comfortable with medication and through at-home monitoring. An accurate diagnosis is necessary however, because of the many other health issues that can mask this serious disease.

####

Dr. Loyer is one of only 100 certified veterinary cardiologists in the country. He is a leader in the use of technology for diagnosis and treatment and introduced the use of spectral Doppler echocardiography to Colorado State University, where he received his Doctorate. In addition to his practice at VRCC, he is cardiology consultant for several large veterinary corporations and travels throughout the country training other veterinarians.

It seems the old adage that people eventually begin to look like their pets has changed. Now, our pets are starting to look like us.

Recent studies show a disproportionately large percentage of the American population is obese. A new study from the National Research Council finds that one-quarter of our pets are overweight too.

“Because pets are commonly viewed as members of a family, people show them affection by sharing food and treats. Yet many people don’t realize the potential dangers and health risks involved with overfeeding their pets,” said Dr. Carroll Loyer, a board certified specialist in cardiology at the Veterinary Referral Center of Colorado (VRCC).

Like humans, obese animals are at risk of diabetes, heart disease, orthopedic problems, breathing problems and reduced life expectancy.

“As the human population becomes more sedentary and stops exercising, our pets suffer as well,” said Dr. Steven Wheeler, a board certified internist at VRCC.

VRCC, a specialty vet hospital located in Englewood, helps obese pets resume their natural weight and keep it off, while dealing with the health problems associated with obesity. Each specialty encounters different problems as a result of the extra pounds.

For example, Dr. Loyer, cardiologist at VRCC, focuses on the impact of weight on the heart and lungs. He counsels clients on their pet’s diet, how to control weight and helps formulate exercise routines.

“Reducing weight in animals is difficult, just as it is in people,” said Dr. Loyer. “It is accomplished through a combination of reducing calories and increasing exercise.”

He recommends giving pets low calorie treats, like raw or cooked vegetables, such as baby carrots, broccoli, cauliflower and green beans, and avoiding fruits, as they contain sugars.

The neurology department deals with the negative effect weight has on the spine and increased risk of intervertibral disc disease. The Internal Medicine department also helps customize diets for pets suffering from diabetes and thyroid disorders.

Dr. Wheeler said owners can usually tell if their pets are overweight through several cues.

“You should be able to see a discernible waist line and be able to feel your pet’s ribs and hipbones with a gentle touch of the sides. Your pet should also be able to sustain some form of activity and exercise.”

ABOUT VRCC

VRCC is one of the largest specialty veterinary clinics in the United States. Located in Englewood, VRCC offers specialized veterinary medicine by board-certified doctors in the fields of Surgery, Emergency care, Neurology, Internal Medicine, Oncology, Ophthalmology, Dermatology and Allergy, Cardiology, Radiology and Acupuncture as well as Anesthesia Recovery and Animal Rehabilitation.

It’s been proven that second hand smoke can lead to health problems in humans. Can it lead to health problems in pets?

A recent study suggests that a relationship does exist between environmental tobacco smoke and development of lymphoma (lymph node cancer) in cats. On the other hand, past studies on the effect of second hand smoke in dogs show a very weak association between primary lung cancer in dogs and owners who smoke.

Lymphoma in Cats
In the summer of 2002, the American Journal of Epidemiology reported a retrospective study about the risk(s) of malignant lymphoma in cats with second-hand smoke exposure. Pet owners of all feline patients were sent a questionnaire inquiring about the level of smoking in the household during the two years prior to diagnosis. After adjustment for age and other factors, cats with any household environmental tobacco smoke exposure had 2 and 1/2 times greater likelihood of developing lymphoma. That risk increased with both duration and quantity of exposure. Cats with 5 or more years of environmental tobacco smoke exposure were over three times more likely to develop lymphoma than those in non-smoking households.

Primary Lung Cancer in Dogs
In 1992, the American Journal of Epidemiology reported a case-control study to determine whether household exposure to environmental tobacco smoke was associated with an increased risk for lung cancer in pet dogs. Unlike the more recent cat study, no association was found between lung cancer and second-hand smoke. The risk of developing lung cancer was not increased with any of the variables. Risk was not increased with more than one smoker in the home, nor was a significant trend observed for increasing number of packs of cigarettes smoked per day, number of smokers in each household, packs smoked per day, or the proportion of time the dog spent within the home. This study revealed that exposure to environmental smoke does not significantly increase the risk of pet dogs developing primary lung cancer.

One can rely on scientific research, but it is a good idea to observe the risks of passive smoke and cancer in humans as a model for the problems that may arise in our pets.

For more information on these two studies click on http://www.vrcc.com/passive_smoking.shtml

They may not ski the moguls, but dogs can tear their knee ligaments just like humans can. Although the names are different – dogs have a cranial cruciate ligament (CCL) while humans have a anterior cruciate ligament (ACL) - both ligaments work with the other ligaments in the knee to create a stable joint. In both dogs and their owners, if the ligament is damaged or torn the knee joint becomes unstable and painful and can involve other structures in the knee such as the meniscus.

If dogs don’t ski - how does a CCL injury occur?
In people, an ACL injury is a traumatic event often sustained during sports activities. The knee is hyper-extended and twisted inward exceeding its physical limits thus tearing the ACL. In dogs, the mechanism of injury is much different because of their anatomy. Picture a dog’s knee. The top surface of the shinbone, called the tibial plateau, is tilted towards the back of the knee joint (caudal tibial slope). This creates a unique mechanical feature of the knee called the cranial tibial thrust. Because of this physical phenomenon, even the normal weight of a dog can put stress on the CCL. Over time, the ligament becomes weakened and fibers begin to tear (partial tear). Eventually, a complete tear occurs.

Female dogs (especially spayed), overweight, and poorly conditioned dogs are more at risk. CCL rupture occurs in dogs of all sizes, but is most prevalent in large and giant breeds. Although most common in dogs ages 5-7, young dogs of large breeds are susceptible.

How are CCL injuries diagnosed?
Diagnosis of a CCL injury is based on orthopedic examination of the knee. Symptoms include: 1.Pain localized to the knee joint. 2. Mild to moderate swelling of the knee. 3. Early scar tissue formation around the knee. 4. Instability of the CCL. Additionally, X-rays are used to correlate findings from the orthopedic evaluation. Although x-rays do not show ligaments, they can indicate fluid accumulation in the knee joint. Diagnostic arthroscopy can also be used for evaluation, and can be used for treatment of disorders. At Veterinary Referral Center of Colorado, we can also clearly delineate the CCL ligament with our in-house MRI equipment.

How are CCL injuries treated?
Although an injured CCL never completely heals, a wide range of treatment options exists to manage CCL disorders. Conservative management is focused on three main points: 1. Weight management. 2. Avoiding extremes in activity. 3. Controlling pain. Outcomes change based on the dog’s body size. In dogs weighing less than 30 lbs., approximately 70% return to acceptable function after 4-6 weeks. In larger dogs that number shrinks to only 15-20% of patients. As scar tissue forms around the joint, the knee heals (periarticular fibrosis). In smaller patients, this scarring restores normal stability, but in larger or active dogs, it is not adequate in strength to restore stability. Surgery is often necessary to correct the CCL disorder and to avoid sustaining injury to other structures in the knee.

A variety of techniques exist for surgical management of CCL injuries. All have two common surgical goals: 1. Evaluation inside the knee and removal of injured tissue (Intra-articular evaluation and debridement). 2. Restoration of joint stability.

Intra-articular evaluation and debridement:
To evaluate the condition, the knee is opened through one of two methods – arthrotomy or arthroscopy. The most common method of evaluation is an open approach called an arthrotomy. An arthrotomy is simple, does not require specialized equipment and is economical to perform.

More recently, arthroscopy has been modified for evaluation and treatment of knee injuries in dogs. Arthroscopy utilizes a small diameter telescope to visualize the interior of the knee and uses specialized instruments to remove damaged ligaments and tissue. The procedure is minimally invasive and is accomplished through smaller incisions than arthrotomy. The degree of trauma is significantly less and can result in less pain associated with the procedure, less muscle mass loss during the recovery period, and an improved quality of recovery.

Restoration of joint stability:
Conventional techniques for CCL injuries are modeled after human medicine. The damaged CCL ligament or its function is replaced. Because of the dog’s anatomy, these techniques are not overwhelmingly successful. We see a high recurrence of instability, progressive arthritis and deteriorating function. Additionally, continued instability increases the risk of subsequent meniscal injuries.

More recently, the tibial plateau leveling osteotomy (TPLO) has become a popular treatment of CCL injuries. The goal of the TPLO is to eliminate the high degree of slope (cranial tibial thrust). A cut in the upper portion of the tibia is made allowing the surgeon to rotate the tibial plateau, secure the cut with a bone plate and eliminate the cranial tibial thrust to create a stable joint. Once the bone cut is healed a lifelong repair exists. Approximately 90% of patients return to normal function with a very low risk of re-injury.

What procedure is right for my dog?
Functional goals for your pet, risk factors, such as recurrence, and economic constraints all determine which procedure is appropriate. The professionals at Veterinary Referral Center of Colorado or your own animal hospital can assist in the decision-making.
###
Dr. Chad Devitt is a board-certified surgeon with VRCC’s surgery practice.