Dental Disease

The previous post on the safety of anesthesia was a direct response to yet another client who absolutely refused to let me clean her dog’s teeth. I can only imagine the pain these animals must be in. I would love to talk about prevention, but let’s be honest, most people are not going to brush their dog’s teeth. I’m lucky to get them to agree to a treat or toy that scrapes the film that develops over time. I would like to spend this blog on why you should keep your pet’s mouth healthy.

I do feel we need to spend some time on prevention. Brushing is the best way to avoid tartar buildup. However, they make tons of treats and toys, available for very little money, available at any pet store or veterinary office. I really like the nylon strand toys that scrape the teeth each time the dog bites into them. (http://www.funnfloss.com/Products%201.htm I get no money from them). If you’re going brush your dog’s teeth, it’s best to do it before a meal (as it is for us, we’ve been told wrong all these years http://www.emaxhealth.com/79/1063.html)

Ok, on to why your pet’s dental health is so important. Check out the human advice: http://www.emedicine.com/derm/topic936.htm. All that stuff goes for your pet as well. And only 35% of pets with grade 2 dental disease and 15% of pet with grade 1 dental disease get treated. Those are the two worst grades, but still only 50% of pets with dental disease get treated! And, the consequences are profound: increase risk of cardiac disease, pneumonia. Most cats with diabetes have dental disease (cause and/or effect?) In a 2006 study by IDEXX ( a maker of in-house blood tests for the veterinary profession found that 14% of cats with retroviral disease had oral cavity infections, compared with 3% who were virus negative. Could a bad mouth be the first sign of something serious?

Acute Disk Herniation Study

Here's a new study for intervertebral disk disease. If I had a dog that was prone to this disease, I might look this information up now. This way if your dog does get this disease you will already have the information handy.

www.cvm.ncsu.edu/doc/neuro/acutedischerniations.html

Most Expensive Conditions to Treat

Ok, I know I talk a lot about getting pet insurance, but here goes again. VPI just released the most expensive insured conditions to treat. This list is not a guide to prices, but does show how expensive it can be to treat your pet some very common problems.

Dogs:
Intervertebral Disk Disease ("ruptured disk") $2844
Lung Cancer $2032
Gastric Torsion (Bloat) $1955
Foreign Body Removal $1629
Cruciate Repair $1517

Cats:
Foreign Body Removal (intestines) $1629
Urinary Tract reconstruction $1399
Foreign body Removal (stomach) $1011
Bladder Stones $989

Incidence of these disease:
Ruptured Disk (1.2-3.8%)
http://www.ivis.org/special_books/ortho/chapter_62/IVIS.pdf

Bloat (2.3-2.6%)
http://www.sunstrike-great-danes.com/health-bloatdw-art.htm

Crucitate Disease (up to 80%)
http://www.animalhealthchannel.com/ccl/index.shtml

Feline Obstruction (1%)
http://www.vet.uga.edu/sams/courses/urology/lectures/Lecture06_FelineIdiopathicCystitis.pdf

New Parvo Virus

There has been a new strain of parvo virus identified in the US. Right now, there is no indication that the current vaccine won't protect against the new strain. However, it bears watching.....

http://www.cvhs.okstate.edu/index.php?option=com_content&task=view&id=437

Canine Heart Disease

There's a new study opening at The Ohio State University to detect and identify the different stages of canine congestive heart failure. Any dog with mitral valve disease or dilated cardiomyopathy is eligible for the study as long as they are not on high doses of diuretics. Dogs that are currently suffering from another systemic disease are also not eligible.
Owners who place their dogs in the study are given substantial discounts on treatment. You can contact the senior cardiovascular technician at Schober.4@osu.edu.

Anesthsia Complications

One of the most frustrating clients I run across is the client who's pet has a problem I can fix, but the client won't let me because of their stubborn attachment to outdated or just wrong information. It's one of the reasons I write this blog. One of the worst offenders are owners who pets have dental disease. Have you ever had one tooth that was infected? I have, and it hurt like heck. I can only imagine the pain some of these dogs feel when their whole mouth is covered in tartar!

I'll get to dental disease in another blog, seeing as how dental disease leads to heart problems, kidney problems, liver problems.... However, today I want to talk about the excuse that you don't want to put your dog under anesthesia. It always makes me wonder, if Grandma broke a hip, would these people tell the doctor that she's too old to handle the anesthesia? Yes, anesthesia in pets is different, but not all that much. We have new drugs and protocols that make anesthesia of the dog and cat as safe as it's ever been.

Take this study for example: Perioperative deaths in small animals: findings so far(Vet Rec. April 2004;154(17):516-7). Here are some of their findings:

in the canine population

- healthy dogs had a mortality rate of 1 in 1795

- 33 deaths associated with anesthesia or sedation

- sick dogs had a mortality rate of 1 in 64

- 70 deaths associated with anesthesia or sedation

in the feline population

- healthy cats had a mortality rate of 1 in 872

- 53 deaths associated with anesthesia or sedation

- sick cats had a mortality rate of 1 in 118

- 69 deaths associated with anesthesia or sedation

And the results appear to indicate that things are getting better:

- in a similar study in the mid‑1980s, 1 in 679 healthy dogs and cats died primarily due to anesthesia

- North America studies in the early 1990s estimated 1 in 1000 for cats and dogs

The fact of the matter is anesthesia in the dog and cat is relatively safe. Since that study was published we have newer and better anesthetic protocols. We do a better job of screening patients and better monitoring equipment. Anesthesia is getting safer all the time.

Bloat

Bloat is the common term for Gastric Dilatation with Volvulus. This occurs when the stomach twists so that both the esophagus (intake) and pylorus (outflow) are blocked. This is a life-threatening disease that can kill up to 40% of affected dog.


Occurrence:
Most cases of bloat occur in deep-chested, large-breed dogs. Think German Shepards, Great Danes, St. Bernards, although, you can see this occur in almost any breed of dog. I’ve actually seen this in a Beagle and a Shitz Tzu. Most of the dogs that bloat are over 7 years old, and dogs that have bloated once tend to do so again.

Causes:
Many causes have been associated with this disease, although no one knows for sure. It is thought that there needs to be a loosening of the ligaments that hold the stomach in place. But, since there are so many ways for the stomach to flip in a deep and narrow chested dog, it’s unlikely that one factor will emerge as the sole cause. Some factors that may be associated with bloat include: drinking large amounts of water; eating a single, large meal daily; fearfulness, anxiety; exercising just after eating. I strongly recommend that people not exercise their large dogs for 1 hour after meals to help reduce the chances of bloat occurring. My last bloat was an 8 week old puppy that rolled over on his back to be petted just after eating.

Signs:
Most professors will tell veterinary students that bloat is the only disease you should be able to recognize while driving by a dog on the street. The tell-tale sign for veterinarians is an abdomen that is swollen on the left side. Most clients will bring that dog in because “he acts like he’s trying to vomit, but nothing comes up”. This sign is an emergency that requires you leave the house with the dog, before you call the emergency clinic. By the time the dog is doing this you have about 30 minutes before the dog will die, in most cases. Other signs that can occur are often vague and confusing to the owner: the dog will appear restless, the dog will hunch-up, some dogs will appear to try and defecate repeatedly. All large-breed dog owners should be concerned about bloat whenever the dog is not feeling well or refuses to eat. In many cases, the dog will swell and deflate several times before the stomach finally twists.

Treatment:
The best thing you can do for your dog is to be prepared. You should know where your closest emergency clinic is. And I also recommend all owners carry pet health insurance. Often the treatment for this disease will run more than $1000.
Once the dog is at the emergency clinic, they will take X-rays to confirm the diagnosis and begin to prepare the patient for surgery. This disease always requires surgical replacement of the stomach, with or without removal of the spleen. In my experience, about 50% of the dogs also have a spleen that has twisted, which requires removal of that organ as well.
Outcome:
The prognosis for dogs with GDV is generally fair to good. The highest mortality rates appear to be associated with:

Increased levels of lactate at time of presentation. Since lactate accumulates when tissues are deprived of oxygen, it’s safe to assume that high levels of lactate would be associated with tissue death.

Increased length of time between insult and presentation. The longer it takes for the veterinarian to decompress the stomach the more damage is done.

Financial Reasons. Many of these dogs that are savable are euthanized due to the cost of the surgery.

Inadequate veterinary care. I know I’m biased because I own an emergency clinic; however, it’s just not possible for one doctor to treat this disease, by himself late at night. For one thing, the surgery is very demanding. There is no way for someone to do this surgery and monitor the patient at the same time. Before surgery, these patients require a catheter, fluids, antibiotics, pain medication, tubing of the stomach to let the gas out, X-rays and continuous monitoring. You may very well save some money, but you be doing so at some risk to your dog.


Here are some references for you:

http://www.globalspan.net/bloat.htm
http://www.animalhealthchannel.com/gdv/symptoms.shtml
http://www.peteducation.com/article.cfm?cls=2&cat=1571&articleid=402