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http://www.cdc.gov/NCIDOD/DPD/parasites/dipylidium/factsht_dipylidium.htm http://www.bulldoginformation.com/common-health-care-issues.html http://www.thebulldogexchange.com/bulldog_health_issues.html ALLERGIES Dogs, like humans, can also suffer from allergies. Itching of the skin is the most common symptom of a dog allergy. The respiratory tract can be affected causing coughing, sneezing, and/or wheezing. At times, the eyes and nose may develop a discharge. Also, the digestive system may be affected causing vomiting or diarrhea. About 20 percent of the dogs in the United States suffers from some type of allergy, whether it be atopic dermatitis, flea allergy, food allergy, inhalant allergy, contact allergy, or bacterial allergy. Atopic Dermatitis An allergic skin disease of dogs, known as canine atopic dermatitis, is caused by the dog's immune system hypersensitivity to common substances in the environment, such as dust mites or molds. If the dog begins to groom excessively, with licking or chewing of the paws, abdomen, and hind quarters, then it may suffer from atopic dermatitis. Also, check to see if the ears are reddened and hot to the touch. A hidden sign that a dog is atopic is in the armpits, groin, or between the toes of the paws. Check to see if there is saliva staining. In light colored dogs, it appears as a red-brown staining. In chronic cases the skin, mostly in the abdomen, may change color from a pinkish, to angry red, to black mottling. Flea allergy, food allergy, and parasitic infestations may mimic the symptoms of atopic dermatitis making it difficult to diagnose. Once fleas, foods, and parasitic infestations are eliminated as being the offending culprits, then allergy skin testing for dust mites, pollens, and molds may be done to determine what causes the dog's atopic dermatitis. Flea Allergy The most common form of canine allergy is flea allergy dermatitis. The flea itself is not the culprit in canine flea allergies. It is their saliva that causes the allergic reaction. A skin allergy test can be preformed to determine if a dog is allergic to flea saliva. If it is, then a strict flea control regimen is required to reduce symptoms. Caution must be used however to make sure the chemicals in the flea preparations are not harmful to the dog. Inhalant Allergy Just like humans, canine inhalant allergies are caused by pollens (tree, grass, and weed), dust mites, molds, and chemicals. Although any pure bred or mutt can acquire inhalant allergies, the most common breeds that are affected include terriers (especially the West Highland white terrier, Skye terrier, Scottish terrier and Boston terrier), golden retrievers, poodles, dalmatians, German shepherds, Chinese Shar-peis, shih tzus, lhasa apsos, pugs, Irish setters, and miniature schnauzers. The symptoms of an inhalant allergy include scratching, biting, chewing at feet and constant licking. The itching may be most severe on feet, flanks, groin, and armpits. Inhalant allergies are often the reason for recurrent ear infections in your dog. Food Allergy Dogs can become allergic to a food they have eaten for years which causes many people to over look the possibility of a food allergy. Food allergies only account for 10 percent of allergy problems in dogs. Dogs often can not tolerate soy products, wheat, corn, beef, pork, chicken, milk, whey, eggs, fish, chemical preservatives, or artificial sugars in their food. Determining the food allergen can be time consuming. First, eliminate all the possible allergens from the diet, by using a home made diet consisting of a protein and a starch the dog has not eaten before. Gradually add back, one at a time for a week, the ingredients of the dog food. If symptoms return, then the offending food allergen should be easily determined. Commercial dog foods can be found that do not contain the offending allergen. Food sensitivities in a dog may manifest as itchy skin, scratching at ears, shaking of the head, licking and biting at the hind quarters or feet, rubbing faces on carpeting, ear inflammations, coughing, and rarely vomiting, diarrhea, flatulence, sneezing, asthma like symptoms, behavioral changes, seizures, gagging, and vomiting. Contact Allergy Contact allergy is the least common of all the types of dog allergies. Some of the common contact allergens include flea collars, wood bedding, grass, plants, and sometimes chemicals. Bacterial Allergy Several species of Staphylococcus (Staph) bacteria live on normal dog skin. Normally Staph does not cause a problem with its host, but some dogs develop an allergy to it. With this type of allergy the dog develops areas of hair loss that look much like ring worm. These areas become infected and need to be treated with antibiotics. The Staph allergic dog usually has recurrent Staph infections. WHAT ON EARTH ARE ANAL SACS? Anal sacs (also called "anal glands") are two small glands just inside your pet's anus. The material secreted into these glands is thick and foul smelling. Most animals can empty these glands voluntarily for scent marking or in self defense (like a skunk might do). Domestic animals have largely lost their ability to empty these sacs voluntarily. Walking around and normal defecation serves to empty the glands but some animals become unable to empty their glands on their own at all. The sacs become impacted and uncomfortable. Dogs with impacted anal sacs usually scoot their rear on the ground in an attempt to empty the glands. Some dogs will lick their anal area and other dogs will chase their tails. Cats often lick the fur off just under their tails. WHAT TO DO ABOUT SCOOTING? The first step is to check the anal sacs when any pet has a history of scooting. The anal sacs can be emptied. HAT IF SCOOTING CONTINUES? If scooting continues for more than a few days after sac emptying, the sacs should be re-checked. For some individuals, it takes several sac emptyings in a row before the sacs stay emptied. If the sacs are empty and scooting is persisting, another cause (such as itchy skin, tapeworms, or even lower back pain) should be pursued. WHAT HAPPENS IF AN IMPACTED SAC DOES NOT GET EMPTIED? An abscess can form and rupture out through the skin. This is a painful, messy and pretty smelly condition often mistaken for rectal bleeding. If an anal sac abscess forms, it must be properly treated by your veterinarian. Antibiotics will be needed. HOW OFTEN SHOULD ANAL SACS BE EMPTIED? This is a highly individual situation. The best recommendation is to let the pet tell you when the sacs are full. If the pet starts scooting again, it is time to bring him in. WHAT IF MY PET'S SACS SEEM TO REQUIRE EMPTYING ALL THE TIME? To avoid the expense of having the sacs emptied, you can learn to empty them yourself at home but most people feel it is well worth having someone else perform this service. A non-invasive technique that helps some patients is a change to a high fiber diet. This will produce a bulkier stool that may be more effective in emptying the sac as it passes by. ANAL SACCULECTOMY If the sacs need to be emptied every few weeks or more, you may opt to have the sacs permanently removed. This procedure is complicated by many local nerves controlling fecal continence, the fact that any change in the local musculature of the anal sphincter area can affect fecal continence, and the fact that with chronic anal sac problems anatomy is distorted. Draining tracts can develop after surgery if the gland is not completely removed. Still, despite these pitfalls anal sac removal is considered a relatievely simple surgery by most board certified surgery specialists. If this procedure is to be done we generally recommend that a specialist (or a veterinarian with extensive experience with anal sacculectomy) perform it. CHERRY EYE Description of the Condition The gland of the third eyelid is located within the base of the third eyelid. The third eyelid (nictating membrane) lies between the lower eyelid and the eyeball at the inside corner of each eye. The third eyelid protects the eye and helps contain and distribute tears over the surface of the eye. The third eyelid gland is a tear-producing gland. This gland is responsible for contributing 30-40 percent of the normal tear volume. This is commonly referred to as "Cherry Eye." Enlargement (hypertrophy) of the gland is usually associated with the prolapse. The prolapse can occur in one or both of the eyes, yet one eye may precede the other by weeks to months. The cause for the prolapse is believed to be partially due to a weakness of the connective tissue attachment of the gland to the periorbita. Old timers believe "Cherry eye" is often seen as a direct result of puppies after playing on carpet, rubbing their face, or playing in the dirt. The tear duct becomes blocked, and obstructs tear flow. After a couple of days it begins to swell because now an infection has begun. Once the BLOCKED tear duct swells, there is no room for it in it's present position, and even strong tissue cannot hold it. Thus the result is a cherry eye. This same situation happens a lot in newborn human babies who do not have good tear flow at birth and their tear ducts become blocked with the semi-solid matter that develops in the corners of their eyes. Breeds predisposed to prolapse include Cocker Spaniel, Bulldog, Lhasa Apso, Beagle, Bloodhound, Boston Terrier, Bull Terrier, and St. Bernard, and the Burmese cat. Restoring the hypertrophied and prolapsed third eyelid gland to its normal position will preserve tear production, enhance appearance, and prevent corneal and conjunctive disease caused by the prolonged exposure. Surgically replacing the gland to its normal position is especially important in breeds (Bulldog) that are also prone to develop tear insufficiency disease (dry eye). Surgical removal of the prolapsed gland could precipitate the development of dry eye syndrome and this is a very serious disease. Treatment Options for the Condition Non-Surgical There are old timers with extensive experience with "Cherry Eye Condition" that recommend an alternative to surgery, especially those breeds that have high surgical risks. The first thing that is done to "treat" this condition is to prescribe an antibiotic ointment, second use warm compresses to the corner of the eye, third is to massage the gland lightly with the index finger applying even gentle pressure in a circular motion. Once the tear duct becomes "unblocked" even if it is out of its normal place it is now of a size that usually can be returned by pulling very gently the outer tissue and "popping" the tear duct back into place. You may have to replace the tear duct several times over a two week period, sometimes I have heard for even a month, but then it does not require surgery, and the dog as a general rule has no more problems with the condition whatsoever. We urge new pet owners to be very careful when attempting to use this technique because you can cause injury to the eyeball if you scratch it when trying to massage the tear duct. Try to find another owner of a bulldog or similar breed to walk you through it the first time to make sure you are doing it correctly. We do urge you to seek veterinarian assistance if the condition worsens or if this technique fails to make an improvement. There are some bulldogs that have an inflammatory disease as well and you may see a worsening of the condition. Inflammatory conditions must be treated with an anti-inflammatory antibiotic drop or ointment. Surgical There are several different techniques for replacing the gland, surgically and manually. Surgery requires general inhalation anesthesia, but your pet can go home the same day as surgery once fully recovered. Surgery is performed under strict aseptic conditions. Please make sure your veterinarian is familiar with the special anesthesia needs of Bulldogs, and is experienced in the surgical procedure of "cherry eye". The most popular and successful surgical technique is called the Conjunctive Mucosa Pocket Procedure which creates a pocket to place the prolapsed gland inside and then the pocket is closed with very fine absorbable ophthalmic sutures. Another method is to merely suture the replaced gland again with very fine absorbable ophthalmic sutures. Another procedure, not recommended, is the removal of the gland. This procedure often leaves your pet with VERY inefficient tear flow which can lead to the serious problem of dry eye, and can result in permanent corneal damage. After Care Recommendations for the surgical procedure Some swelling and redness of the third eyelid and lower eyelid is normal after surgery. Keep the eye clean of discharges. Mucous discharges trap bacteria and inflammatory cells and inactivate medications. Some vet's may recommend you use Bausch & Lomb Sensitive Eyes Saline Solution and white tissues to clean the eye. The saline solution can be directly irrigated into the eye. Some coughing for the first postoperative week may be normal if the airway is sore from the tracheal tube used for inhalation anesthesia. If coughing is severe, please call your veterinarian or ophthalmologist. Please restrict your pet's activity for the first 2 weeks after surgery to enhance retention of the gland. A topical antibiotic and anti-inflammatory eye medication is prescribed to try and prevent infection and to minimize inflammation, but cannot be used if there is a scratch on the surface of the eye. Carefully monitor the cornea for an irregularities. Squinting can also indicate a corneal injury. An occasional pet may rub at the eye. Distract your pet with treats or attention when this occurs. Some pets may need an E collar. A very rare pet will develop a re-prolapse of the gland. Though this is very disappointing, the surgery can be repeated and is usually successful at this time. Hot Spots or Acute Moist Pyoderma "Hot spots" are also known as "acute moist pyoderma". What that means is that they are rapidly appearing, oozing, skin infections. This is just a description of a symptom, sort of like saying "your dog has scabs". A hot spot starts because something irritates the dog's skin. The body's response is to either itch or create an inflammatory response at the site. In cases of itching, the dog then rubs, licks or chews the site and adds to the problem. These sores can develop into severe problems in an hour or two at times. The most common irritants are probably fleas and allergies. These cause the itching that leads to the skin infection. There are many other possible sources of irritation. Tick bites, besetting, burrs, mats, mosquitos, summer heat and other problems all contribute to the initial irritation that can develop into a hot spot. The best treatment for these is prevention. Keep fleas off your dog. Groom and bathe your dog as necessary to keep the haricot in good condition. Limit other sources of irritation to the best of your ability. If allergies are a problem for your dog, work with your vet to control the itching they cause. In some dogs, all of this won't be enough and you will occasionally see hot spots anyway. The first step in treating a hot spot is to get it dry. Bacteria like the hot moist environment of irritated skin. Using something to dry the sore makes it harder for bacteria to grow. Clipping the hair over and around a hot spot can help a great deal in allowing it to dry. There are lots of astringents that will help dry the sore, as well. My favorite is NeoPredef powder because it dries the sore, has an antibiotic that acts locally and a corticosteroid to control the itching and inflammation. Other vets and pet owners have their own favorites. People have advocated using athlete's foot powders, over-the-counter medicated powders, Listerine, rubbing alcohol and many other drying agents. Personally, I think rubbing alcohol is too irritating. Antiseptic solutions can also be helpful, especially if they are also a little astringent. Butadiene solution is a good antiseptic. If the hot spot doesn't respond very quickly to efforts to keep it dry, then you should seek help from your vet. Small areas of acute moist pyoderma can become large area quickly. Some dogs will continue to dig and scratch until they really damage their own skin. Your vet can help make your dog comfortable pretty quickly in most cases. Spaying & Neutering Spaying or Neutering Is Good for Your Pet " Spaying and neutering helps dogs and cats live longer, healthier lives. " Spaying and neutering can eliminate or reduce the incidence of a number of health problems that can be very difficult or expensive to treat. " Spaying eliminates the possibility of uterine or ovarian cancer and greatly reduces the incidence of breast cancer, particularly when your pet is spayed before her first estrous cycle. " Neutering eliminates testicular cancer and decreases the incidence of prostate disease. Spaying or Neutering Is Good for You " Spaying and neutering makes pets better, more affectionate companions. " Neutering cats makes them less likely to spray and mark territory. " Spaying a dog or cat eliminates her heat cycle. Estrus lasts an average of six to 12 days, often twice a year, in dogs and an average of six to seven days, three or more times a year, in cats. Females in heat can cry incessantly, show nervous behavior, and attract unwanted male animals. " Unsterilized animals often exhibit more behavior and temperament problems than do those who have been spayed or neutered. " Spaying and neutering can make pets less likely to bite. " Neutering makes pets less likely to roam the neighborhood, run away, or get into fights. Spaying and Neutering Are Good for the Community " Communities spend millions of dollars to control unwanted animals. " Irresponsible breeding contributes to the problem of dog bites and attacks. " Animal shelters are overburdened with surplus animals. " Stray pets and homeless animals get into trash containers, defecate in public areas or on private lawns, and frighten or anger people who have no understanding of their misery or needs. " Some stray animals also scare away or kill birds and wildlife. Fix That Bunny! When being conscientious about the pet overpopulation, don't forget to spay or neuter your pet rabbit. Altering rabbits can reduce hormone-driven behavior such as lunging, mounting, spraying, and boxing. Spaying females can prevent ovarian, mammarian, and uterine cancers, which can be prevalent in mature does. Also, rabbits reproduce faster than dogs or cats and are the third-most surrendered animal to shelters. Spay or neuter surgery carries a one-time cost that is relatively small when one considers its benefits. It's a small price to pay for the health of your pet and the prevention of more unwanted animals. ARTHRITIS The canine skeletal system is a marvel of bones, cartilage, and ligaments that provide the body with a framework to erect on four strong legs, protect internal organs, and provide a full range of motion. The muscles furnish the power to propel the dog into action, but without healthy bones, joints, and connective tissue, the muscles cannot do their job. Joints - the skeletal hinges - give the skeleton flexibility for walking, trotting, running, jumping, climbing, and moving the head and neck to increase the field of vision. The dog's body has three types of joints: ball and socket such as the hip and shoulder joints; hinged joints such as the knees and elbows; and gliding or plane joints such as the wrists and ankles. The joints are lubricated for smooth action by synovial fluid and are stabilized by tendons and ligaments. When the joints are damaged by injury or disease, arthritis (joint inflammation) can occur. "He has arthritis" is probably the most common reaction of the pet owner whose Fido or Fluffy is stiff-legged after exercise, has trouble getting up in the morning, or is reluctant to go up or down stairs. But since such stiffness or lameness can have several causes and since arthritis itself comes in different types, a trip to the veterinarian is a more prudent move than slipping the pooch a couple of aspirin for the discomfort. Degenerative joint disease Arthritis results from inflammation in the joints and is generally divided into two types - degenerative and inflammatory - according to the source of that irritation. Degenerative joint disease (osteoarthritis) results from destruction of the cartilage that protects the bones that make up the joint. Cartilage destruction can be the result of normal stress on abnormal joints or abnormal stress on normal joints(1). Hip dysplasia(2), a malformation of the hip sockets, is one example of normal stress on abnormal joints. Constant jumping over obstacles, stretching or tearing ligaments during strenuous exercise, or injuries in a fall or accident are examples of abnormal stress on normal joints. Degenerative joint disease can be further subdivided into primary disease for which no known cause is evident and secondary disease for which a cause can be pinpointed. Among the causes of secondary degenerative joint disease are hip dysplasia, patella luxation (loose kneecaps), osteochondritis dissecans (OCD, the development of cartilage "flaps" in the joints when bone development is disturbed), trauma, and ruptured cruciate (knee) ligaments. Secondary degenerative joint disease can sometimes be prevented or halted by surgical repair of the joint before arthritis progresses. Degenerative arthritis may not manifest until the dog has had years of abnormal stress. Since cartilage has no nerves, the damage can progress with no outward signs until the joint is severely compromised and the lubricating fluid has thinned and lost its ability to protect the bone surfaces. Inflammatory joint disease Inflammatory joint disease can be caused by infection or by underlying immune-mediated diseases. Inflammatory arthritis usually affects multiple joints and is accompanied by signs of systemic illness including fever, anorexia, an all-over stiffness. Again, this type of arthritis is subdivided into infectious and immune-mediated categories. Infectious joint disease can be caused by bacteria, by tick-borne diseases such as Rocky Mountain spotted fever, and by fungal infection. Immune-mediated arthritis is cause by underlying weakness in the immune system and can be hereditary. Rheumatoid arthritis, a deforming type of immune-mediated arthritis, is rare in dogs. Systemic lupus and an idiopathic (unidentified) immune-related arthritis both can cause nondestructive joint infections. Because infectious joint disease and immune-mediated joint disease call for different treatment protocols, diagnosis must be accurate. The immuno-suppressive drugs used to treat the immune-mediated disease may allow the infectious type of disease to thrive. Signs of arthritis(3) " Reluctance to walk, climb stairs, jump, or play " Limping " Lagging behind on walks " Difficulty rising from a resting position " Yelping in pain when touched " A personality change resisting touch Treatment Degenerative joint disease can sometimes be halted or prevented by surgery when x-rays indicate joint malformations. If surgery is not indicated or advisable, relief can be achieved with painkillers, exercise, rest, and diet. However, even over-the-counter painkillers should not be used without the advice of a veterinarian.(4) Researchers are ever busy trying to find new generations of drugs to relieve pain. The latest in pain relievers for canine arthritis includes " Rimadyl, Adequan, and Palaprin, all available only from veterinarians. " Rimadyl (generic name carprofen) has gotten raves from veterinarians for its ability to relieve pain with few side effects. Long-term use of this drug requires periodic blood tests for liver function, but most dogs apparently do well on it. Like all drugs, however, Rimadyl is not effective for all patients. " Adequan (polysulfated glycosaminoglycan)(5) is given by injection twice each week for four weeks. It not only relieves the pain of arthritis, it binds to damaged cartilage to facilitate repair, blocks the action of destructive enzymes that cause inflammation, and stimulates the production of healthy joint fluid. " Palaprin6 is a buffered aspirin specifically for dogs; it can be used in the same circumstances in which aspirin is used but without the gastrointestinal irritation that sometimes occurs with aspirin. There are other drug treatments; dogs with arthritis should be under veterinary care, and the veterinarian can determine which treatment is best for each dog. Diet also plays an important part in arthritis treatment, especially to control the patient's weight. Excess weight causes more stress on the joints and exacerbates existing arthritis pain. In large breed dogs, periods of rapid growth can lead to development of OCD and joint dysplasias if the underlying genetic code is present, so special attention should be paid to the diets of these puppies to prevent too-rapid weight gain. Whether drugs, surgery, or both are indicated in arthritis treatment owners should make sure their pets get plenty of rest and are not asked to perform painful exercise during treatment and recuperation. Veterinary advice in the matter of exercise should be followed even though it may seem that the recovery is slow. Ultimately, the type and duration of exercise will have to be restricted to reduce the pain as much as possible. Inflammatory Bowel Disease What is inflammatory bowel disease? Inflammatory bowel disease (IBD) is not a specific disease. Rather, it is a specific reaction that the stomach or intestines have to chronic irritation. What are the clinical signs of IBD? If the stomach is involved, your dog will have chronic vomiting. If the intestines are involved, chronic diarrhea will occur. This is the most common form. In some dogs, both parts of the digestive tract are involved so both vomiting and diarrhea occur. If the disease occurs for several weeks to months, weight loss and poor appetite are common. When is the most common occurrence? IBD is most common in middle-aged to older dogs. How is IBD diagnosed? The chronic irritation that causes IBD stimulates the body to send cells from the immune system to the area. The most commonly found cells are lymphocytes and plasmacytes. Occasionally, eosinophils and neutrophils will be found. Thus, the disease is diagnosed when these cells are identified in abnormal levels in the tissue. A pathologist is responsible for this part of the diagnosis; his or her report usually calls the disease lymphoplasmacytic gastritis (stomach) or l ymphoplasmacytic colitis (colon) . In order to obtain these cells, a biopsy is required. In most cases, an endoscope is passed into the dog's stomach or colon (with the dog under anesthesia). A tiny biopsy instrument is passed through the endoscope and used to take small samples of the lining (mucosa) of the affected organ. Is that all that is required for diagnosis? The tissue reaction that occurs in the stomach or colon is diagnosed with biopsy. However, determining what is causing the tissue reaction to occur requires further testing. Tests or treatments should be performed to rule out stomach a nd intestinal parasites, cancer, and infections. Diseases such as hyperthyroidism and diabetes are considered. In addition, diseases of the kidney, liver, and pancreas should also be ruled out. How is IBD treated? The ideal way to treat this problem is to diagnose the underlying disease that is causing the reaction. Sometimes the above mentioned tests will do that, and sometimes a cause cannot be found. In the latter situation, the disease is called idiopathic. That means that a disease is present, but there is no known cause. Many cases of IBD are considered idiopathic. Some dogs with IBD respond to a change in diet. This is done in two ways. First, a food is chosen that contains a protein source that the dog has never had. If that is not effective, a high-fiber diet is tried. Unfortunately, a true food trial requires that the test diet be fed exclusively for 4-6 weeks. If dietary therapy is not successful or feasible, drugs are used to suppress the inflammatory reaction. Corticosteroids ("cortisone") are the most effective so they are used first. Other drugs are tried if corticosteroids are not successful. Do corticosteroids cause side-effects in dogs? Corticosteroids are notorious for causing a variety of side- effects in humans. However, this is rarely the case in dogs. However, to minimize any possible adverse effects, our goal is to use the lowest dose that is effective and to give it on an every other day schedule. It will be necessary to begin therapy with a rather high dose, but once response occurs the dose is tapered to a minimal level. Why are they given every other day? Prednisolone, the most commonly used corticosteroid, is in the body about 36 hours after it is given by mouth. If it is given daily, some of the previous day's dose is still present. The adrenal glands produce corticosteroids for the body. If a prolonged level of prednisolone is in the body, the adrenal glands receive a message telling them to stop production. This will affect the production of corticosteroids and other important substances. By giving prednisolone every other day, the last dose is out of the body for about 12 hours before the next dose is given. During this 12 hour period, the adrenal glands are stimulated to function. The dog's adrenal glands function primarily in the evening hours. By giving prednisolone in the morning, the 12 hour off period will occur when the adrenal glands are ready to work. Thus, the preferred way to give prednisolone on a long-term basis is to give it every other morning. Even if several tablets are given, all are given at the same time. Does this mean that I will be giving prednisolone for the rest of my dog's life? Long-term therapy is required for many dogs. Generally, a dog is treated for a few months then prednisolone is discontinued to see if it is still needed. If the signs of vomiting or diarrhea recur, it is resumed. Are other anti-inflammatory drugs used? Prednisolone is the most effective anti-inflammatory drug with the least side-effects. However, it is not effective in all dogs. Sometimes a stronger drug is used initially to gain control of the disease. Then, prednisolone is tried again as a maintenance drug. Could stomach infections be a cause of IBD? There are some spiral-shaped bacteria that can cause vomiting in dogs. The most common is Helicobacter. These bacteria have been shown to be the cause of disease , including stomach ulcers, in humans and are also pathogens in dogs. However, they are also found in many normal dogs and humans. Therefore, just finding spiral- shaped bacteria on biopsy is not always meaningful. It is considered a pathogen only if an associated inflammation is in the stomach mucosa. Are these infections treatable? Usually. When found in humans, successful treatment may require several medications or combinations of medications. Currently we are using what is effective in humans to treat dogs. This approach is successful in most dogs, but we have quite a great deal to learn about the most effective means of treatment. Can these bacteria affect me or my family? This is a concern for all of us who have dogs. It is known that many people have these bacteria in their stomach for decades before disease occurs. Therefore, it is almost impossible to know the source of the bacteria. It is doubtful that dogs are involved in the transmission process, but that has not been determined at this time. What is the prognosis? If response occurs to a diet change, the dog can be maintained on a different diet for the rest of its life (if the diet is a balanced diet for dogs). If the dog responds to medication for stomach bacteria, a good prognosis is justified. If response occurs to corticosteroids, the long- term prognosis is also good if administration of the drug is feasible. However, if there is no response to diet or corticosteroids, the prognosis is more guarded. At that point, further testing is suggested to see if an underlying disease can be found. WHAT IS A PYOMETRA? The word “pyometra” is derived from latin “pyo” meaning pus and “metra” meaning uterus. The pyometra is an abscessed, pus-filled infected uterus. Toxins and bacteria leak across the uterine walls and into the bloodstream causing life-threatening toxic effects, Without treatment death is inevitable. WHAT MIGHT MAKE THE VET SUSPECT THIS INFECTION? Classically, the patient is an older female dog. (Pyometra can occur in the cat but its not nearly as common.) Usually, she has finished a heat cycle in the previous 1-2 months. She has a poor appetite and may be vomiting or drinking an excessive amount of water. In the more usual “open pyometra” the cervix is open and the purulent uterine contents is able to drip out thus a smelly vaginal discharge is usually apparent. There is also a form of pyometra called a “closed pyometra” where the cervix is closed. In these cases, there is no vaginal discharge and the clinical presentation is more difficult to diagnose. These patients also tend to be sicker than those with open pyometra due to retention of the toxic uterine contents. Lab work shows a pattern typical of widespread infection which is often helpful in narrowing down the diagnosis. Radiographs may show a gigantic distended uterus though sometimes this is not obvious and ultrasound is needed to confirm the diagnosis. HOW DOES THIS INFECTION COME ABOUT? With each heat cycle, the uterine lining engorges in preparation for pregnancy. Eventually, some tissue engorgement becomes excessive or persistent (a condition called “cystic endometrial hyperplasia”). This lush glandular tissue is ripe for infection (recall that while thei inside of the uterus is sterile, the vagina below is normally loaded with bacteria.). Bacteria ascend from the vagina and the uterus becomes infected and ultimately pus filled. WHAT IS THE USUAL TREATMENT? The usual treatment for pyometra is surgical removal of the uterus and ovaries. It is crucial that the infected uterine contents do not spill and that no excess hemorrhage occurs. The surgery is challenging especially if the patient is toxic. Antibiotics are given at the time of surgery and may or may not be continued after the uterus is removed. Pain relievers are often needed post-operatively. A few days of hospitalization are typically needed after the surgery is performed. It is especially important that the ovaries be removed to remove future hormonal influence from any small stumps of uterus that might be left behind. If any ovary is left, the patient will continue to experience heat cycles and be vulnerable to recurrence. While this surgery amounts to the same end result as routine spaying, there is nothing routine about a pyometra spay. As noted, the surgery is challenging and the patient is in a life-threatening situation. For these reasons, the pyometra spay typically costs five to ten times as much as a routine spay. PROS: The infected uterus is resolved rapidly (in an hour or two of surgery). No possibility of disease recurrence. CONS: Surgery must be performed on a patient that could be unstable. IS THERE AN ALTERNATIVE TO SURGERY? In the late 1980’s another treatment protocol became available that might be able to spare a valuable animal’s reproductive capacity. Here, special hormones called “prostaglandins” are given as injections to cause the uterus to contract and expel its pus. A week or so of hospitalization is necessary and some cramping discomfort is often experienced. The treatment takes place over the course of a week. This form of treatment is not an option in the event of a “closed” pyometra as described above. PROS: There is a possibility of future pregnancy for the patient (though often there is too much uterine scarring). Surgery can be avoided in a patient with concurrent problems that pose extra anesthetic risk CONS: Pyometra can recur. The disease is resolved more slowly (over a week or so). There is a possibility of uterine rupture with the contractions. This would cause peritonitis and escalates the life-threatening nature of the disease. PREVENTION Spaying represents complete prevention for this condition. Spaying cannot be over-emphasized. Often an owner plans to breed their pet or is undecided, time passes, and then they fear she is too old to be spayed. The female dog or cat can benefit from spaying at any age. The best approach is to figure that pyometra will eventually occur if the female pet is left unspayed; any perceived risks of surgery are very much out-weighed by the risk of pyometra. |