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auto immuneWe see many diseases and disorders that involve our pet’s legs, hips, and other muscles, but what if they prevented your pet from eating? What if the disease prevented your dog from even opening his mouth? Masticatory muscle myositis (MMM) is the inflammation of the muscles in the jaw and head that involve chewing. It is also known as eosinophilic myositis or atrophic myositis. There are many kinds of myositis, which literally means inflammation of the muscle tissue ("myo" meaning muscle; "itis" meaning inflammation). Masticatory muscle myositis affects mainly large breeds, but Cavalier King Charles Spaniels and German Shepherds are especially predisposed to the disease. MMM is an auto-immune disease that is caused by the dog's immune system attacking the muscles of the jaw. The presence of 2M fibers (that are not found elsewhere in the dog's body) have a structure similar to that of proteins found on some bacteria, and so the body illicits an immune response to attack the "foreign" substance. A similar disease is found in the eye muscles of Golden Retrievers

MMM can be acute or chronic. Symptoms of acute MMM include swelling in the jaw, drooling, pain in opening the mouth, and anorexia. The eyes can also be affected, as some muscles are connected to both parts of the face. Opthamalic symptoms include third eyelid protrusion, red eyes, and protruding eyeballs. Chronic MMM problems include an atrophy of the jaw muscle (causing the skull and bones of the head to become prominent), malnutrition, weight loss, dehydration, and an inability to open the mouth (trismus). Masticatory muscle myositis causes no neurological or gastrointestinal symptoms, but your dog could exhibit dizziness, vomiting, diarrhea, and other problems if the malnutrition or dehydration is severe. auto immune 2

MMM is diagnosed with a biopsy of the muscle fibers themselves, or a blood test looking for 2M antibodies, or both (the antibody test can have a false negative if in the end stages). Your veterinarian may also have some x-rays taken to rule out problems with the bones or joints of the skull and jaw. It is usually treated with corticosteroids like Prednisone, which calm the body's inflammation response. Pets should also be fed soft or liquid food, and supplementary nutrition and fluids may be given intravenously. Often, the vet will prescribe a high dose of steroids, then attempt to taper off the drugs gradually while monitoring the dog for a relapse.

MMM is by no means fatal, and the prognosis is usually good if diagnosed early on. Sometimes the pet will get "better" (no symptoms present) for a few months, then have a relapse. If the muscles have atrophied and begun to scar, that damage in itself is usually not repairable. The dog may have to remain on a limited diet or liquid food permanently. So if your dog stops eating or shows an abnormality in their face and head, check them out as soon as possible!

Sources: Small Animal Veterinary Association, Textbook of Veterinary Internal Medicine, Merck Veterinary Manual, McFarland Animal Hospital, Davies Veterinary Specialists, www.vetneuromuscular.ucsd.edu 

Note: This post is NOT anti-vaccine. The initial course of vaccines during the first year of a pet’s life is crucial and can save them (and sometimes us) from fatal diseases. This post simply examines the need for yearly boosters later in an animal’s life.

titerblogpicAs responsible pet owners, many of us take our animal to the vet every year for their annual check-up. This includes a physical exam, sometimes a stool sample is checked, and of course, the pet’s yearly vaccines. But wait, my pet has to be given vaccines EVERY YEAR?! I certainly don’t need boosters on my human vaccines every year. Shouldn’t the immunity last a little longer?

Previously, veterinarians have found that in research, the immunity does last longer than a year in some pets. However, when you bring your animal to your local clinic, they couldn’t look at them and determine if they still had immunity to a disease, or whether they needed a booster shot. So veterinarians have been practicing yearly boosters as a safeguard. Disease cannot spread if most of the animals it contacts are immune, and therefore vaccines keep problems like rabies and parvovirus less wide-spread. New research has shown that vaccines may sometimes cause problems in pets (tumors near injection site, gastrointestinal distress, allergies, seizures, etc.) Even mild reactions like local swelling, low-grade fevers, decreased appetite and activity are beginning to be examined for long-term results. Pet owners are starting to question if yearly vaccines are truly needed, or if this is an easy buck for the vet clinic.

Enter titer tests. Titers, in short, are when a blood sample is drawn, and checked for the concentration specific antibodies. This is a way to see if the human or animal is retaining immunity to the disease they were vaccinated for. Titers are already used in human medicine pretty regularly. If you were to be hired by a hospital, your employer may require you to have titers drawn, to make sure the vaccines you received as a child are still giving you immunity. If not, you may need a booster shot before you go to work in healthcare. Titers are now also being used in veterinary practice to determine if an animal needs to be re-vaccinated every 12 months. After receiving initial vaccines in their puppy/kitty years, your pet may retain enough antibodies to be considered immune. A vet can draw blood, perform a titer test, and determine whether or not they need a booster shot. This could potentially reduce the side effects from vaccination, whether chronic or acute problems.

Seems like a perfect solution, right? Well it isn’t without detractors. Titers can be reliable, when done in the right setting, and with certain diseases. However, for some diseases, a titer test can show plenty of antibodies in the blood, but not necessarily correlate with field immunity (if your pet is exposed to an infected animal, it may still contract the disease). Research from the AAFP Feline Vaccination Advisory Panel shows that titer tests can be used to measure immunity in a cat for feline pan leukopenia, but that titers for feline leukemia virus and feline immunodeficiency virus “do not correlate with immunity and should not be used to determine the need for vaccination”. Some states also require yearly vaccination, especially for rabies. Titers are not accepted by most counties, and they require proof (vet records) before licensing a dog. There is also a cost factor in all this. While vaccines are expensive, some titer tests are too. Look for a veterinary office that can do titer tests for a lower cost, to ensure that they aren’t just trying to push you into over-vaccinating.

So what is the best option here? As with many veterinary solutions, it still needs more research. Titers are now becoming more popular, and are done at more clinics across the country. Some doctors only want to vaccinate when the titer test comes back negative, or when required by law. Others are using titer tests annually to check immunity, but still vaccinating every three years regardless. Some do not find titer tests to be accurate enough, and will still recommend yearly boosters. The bottom line is this: YOU are your pet’s owner. YOU decide what is best. For pets that are elderly or have had an allergic reaction to a vaccine, you may want to give shots as little as possible, or only when the titers show no immunity. Other pets may be fine on the three year plan, especially if the vaccination site is rotated each time (neck/shoulder area vs thigh) to reduce irritation and tumor development. Inform yourself before taking refusing or accepting vaccines at your pet’s next visit. Beware of any articles that claim vaccines are all risk and no benefit, or clinics that only vaccinate in bundles or charge outrageous amounts of money for titers. I encourage you to talk to various veterinary clinics, do some research, and decide what the most appropriate vaccination course for your pet is.

Here are some great articles:

https://www.avma.org/news/javmanews/pages/160701a.aspx

www.petmd.com/blogs/fullyvtted/2010/june/titering_or_vaccines-10182

Other sources: American Veterinary Medical Foundation, PetMD, Journal of Feline Medicine and Surgery, HealthyPets.mercola.com

waterdiabetesblogMany of us are familiar with diabetes mellitus, which affects the way sugar is processed in the body. While that is definitely more common, there is another rare form of diabetes our pets can get, called diabetes insipidus. Diabetes insipidus is completely separate from diabetes mellitus, and affects the body completely differently as well. Diabetes insipidus (DI) affects the way water is processed in the body. It is also known as water diabetes, or even just the “other diabetes”. DI prevents water conservation, causing the body to release too much of the fluids that are being taken in. Symptoms of DI are increased urination, increased thirst and water intake, diluted urine, soiling in the house, poor hair coat, and dehydration. Simply put, no matter how much water your pet drinks, it is just being flushed out; not hydrating the body at all.

There are two types of DI, although the external symptoms are the same. The first type is neurogenic, or central DI. This is when there is a lack of the hormone vasopressin, which regulates water conservation. Vasopressin, also known as ADH (antidiuretic hormone), is created and regulated in the hypothalamus and pituitary gland. A brain tumor, head injury, or failure of the pituitary gland could all cause neurogenic DI. The second type of DI is nephrogenic, where the failure is not in the brain, but in the kidneys. Plenty of vasopressin/ADH is being produced and transported, but the cells in the kidneys are not responding to it. Kidney problems like cysts or amyloidosis (abnormal buildup of proteins), or kidney failure are often the cause of nephrogenic DI.

Diagnosis of diabetes insipidus sometimes requires hospitalization. The vet will collect blood and urine samples to test, and may use imaging (like an MRI or CT scan) to check for possible tumors or damage. While hormone levels are easy to check in the blood, the final diagnosis usually comes from a water deprivation test. Your pet will be tested to see if they can produce more concentrated urine when water is withheld, all while their vitals are monitored. The vet may also choose to test the effectiveness of vasopressin injections at this time. Sometimes a vet will test for other problems such as a urinary tract infection, hyperthyroidism, diabetes mellitus, or Cushing’s disease, to rule out a more serious problem.

Treatment of DI will depend on the cause. Neurogenic DI can be treated with synthetic hormones to replace the lack of vasopressin. These can be given via injection, nasal spray, or eye drops. Nephrogenic DI has to be treated by first dealing with the underlying cause. This may require surgery to remove tumors, treatment of kidney failure, or other remedies. No matter the type of diabetes inspidius, there are things you should do at home as well to help your pet. NEVER LIMIT THEIR WATER. Even if they seem to be drinking “too much” (often laying in front of their bowl drinking until it is gone), or have soiled the house, you cannot limit their water intake. Always have plenty of clean, fresh, water out for your pet. You will also need to provide more urination options for them as well. A cat will need two or three more litter boxes, and a dog would benefit from a dog door into a fenced yard. Your pet should always be monitored for signs of dehydration as well.

While diabetes insipidus is a permanent condition, it is also treatable and not fatal alone. When your dog can’t stop obsessively drinking water, and is urinating far too frequently, it may be time for a vet to check for water diabetes!

Sources: PetMD, Merck Veterinary Manual, VCA Animal Hospitals, caninediabetes.org

During the summer, we often worry about our pets dehydrating. Exercising in the heat, out in the sun and water, we are conscious of their water intake and possible dehydration symptoms. But during the rest of the year, we may forget about the lingering danger of dehydration. The air is dry, the heat is running, and your pet may not be as thirsty. Older dogs or pets with health problems (especially if vomiting or have diarrhea!) may need more water than usual, yet have decreased thirst. In my recent attempts to get a dog to drink water, I did some research on the symptoms of dehydration, and what you can do to get fluids back into them. dehydrationblog2

Signs of dehydration can be vague, like sunken eyes and lethargy. There are a few tests you can do to check their hydration levels though. Pinch and lift slightly the skin on the back of their shoulders. If it doesn’t immediately return to normal, the skin has lost elasticity, and the pet is dehydration. You can also check their gums and mouth. Push slightly on the gum so it turns white. When you remove pressure, it should return to the normal color within less than two seconds. If the blood is not returning to the area as quickly, or their mouth is dry and sticky, the animal is dehydrated. When a pet is vomiting or has diarrhea repeatedly, you can also assume they are becoming dehydrated.

So what can you do? In some circumstances, veterinary attention is required. If there are other health problems, or the pet has been ill for a few days, IV fluids probably need to be given. But at home, there are several tricks you can use to get your pet to drink more water.

  1. Make sure there are several locations with fresh water in clean bowls. Remember that your pet’s nose is more sensitive than yours, and bacteria or dirt can build in water dishes within a few hours. Clean dishes every day and refresh water twice a day.
  2. Try ice cubes. If they don’t want to drink out of their dish, have them munch or lick ice cubes. Some pets prefer cold water, so you can add ice to their dish as well.
  3. Add water to their food. Whether they eat dry kibble or wet canned food, you can add a bit of water to it so they get more while eating a meal.
  4. Make the water more delicious. You can add a few tablespoons of unsalted chicken or beef broth to their water dish. The smell and taste will appeal to the animal, and can often replenish electrolytes as well.
  5. Soak a new toy in water. They will ingest the water as they chew on the toy. Some pet owners will also freeze toys or treats in ice, so the animal has to lick the water to get the treat.
  6. Change dishes. Some animals are picky about the material or shape of the dish they drink out of. You can try putting water in a human cup or bowl and leaving that out. Cats especially like to drink out of glasses or from running water out of a faucet.
  7. Consider electrolyte replacements The Gilroy Veterinary Hospital in California recommends 1 tablespoon of Pedialyte every hour for every 10 lbs the animal weighs. For example, if you have a 40 lb dog, you can give them 4 tbsp every hour. Consult your vet before giving electrolyte replacements, as this means they probably need IV fluids anyway.While many of these solutions are simple, they are often the difference between a sick, hospitalized pet, or a healthy, energetic one. You can monitor your pet’s fluid intake daily by refilling it at the same time every day, and keeping an eye on their fluid loss (urine output, bowl consistency, drooling, etc). Keeping your pet hydrated is key for every day, not just the hot ones!

While many of these solutions are simple, they are often the difference between a sick, hospitalized pet, or a healthy, energetic one. You can monitor your pet’s fluid intake daily by refilling it at the same time every day, and keeping an eye on their fluid loss (urine output, bowl consistency, drooling, etc). Keeping your pet hydrated is key for every day, not just the hot ones!

Sources: PetMD, Gilroy Veterinary Hospital, pethelpful.com, bestpethomeremedies.com dehydrationblog1