Doc, My Dog Has a Rash

itchy dog

Last month, Nationwide Pet Insurance announced the top pet insurance claims for the 650,000 pets they insure. The top four are skin issues. Number one and four are both skin diseases. Allergic dermatitis and pyoderma (skin infection) result in a skin rash which is the topic of this blog post.

Atopic or Allergic Dermatitis
Allergies are common in dogs and can be seasonal or non-seasonal. About this time of year, dogs with seasonal allergies start scratching and itching because pollen, mold or some beautiful spring plant is the source of their allergies. If your dog scratches year round, then the allergen might be dust, wool, feathers, or even the family cat! The itch-scratch cycle makes the skin red and inflamed. The itch-scratch cycle also sets off a cascade of events that can lead to infections in the hair follicle. Hot spots are a localized inflammation of the skin stemming from allergies. A severe hot spot can become infected with bacteria or yeast.

Bacterial Infection
A bacterial infection in the hair follicles is called pyoderma and was the number four most common insurance claim paid by Nationwide in 2017. If your dog has pyoderma, you will see a red, bumpy rash Pyoderma occurs most commonly as a result of allergies. Puppy pyoderma can be found on the tummy of puppies, likely because their immune system is not quite grown up yet. Flea bites, mange, clipper burn, and hair mats can also incite a skin infection. Licking and scratching a skin infection can make it much worse and is why veterinarians often recommend the dreaded cone in patients with skin infections.

Yeast Infection
Fungal or yeast skin infections are another allergy-induced skin problem. Certain breeds, like the West Highland white terrier, are predisposed to yeast skin infections, but any dog can get one. Face folds or skin folds in general hold moisture promoting the overgrowth of yeast which can be very itchy.

Ears Are Really Just Skin
The ear flaps are actually skin folded over on itself. Number two on the list of insurance claims is ear infections. Like skin infections, ear infections are tied to allergies. Follow your veterinarian’s instructions on managing the allergies and the ear infections will abate. Occasionally we see ear mites causing infections in dogs, but bacteria and yeast are much more common organisms causing an infection.

While clearly allergies are the most common cause of skin rashes, keep in mind systemic diseases such as Cushing’s disease and hypothyroidism may trigger a rash.

Q&A on SiriusXM Radio

Ann hohenhaus and carly fox

Last week was somewhat of a personal record for me. I appeared on three different radio programs on SiriusXM in a single week. On Tuesday with my good friend Dr. Frank Adams on “Doctor Radio” (channel 110) powered by NYU Langone Medical Center, on Thursday night with “Just Jenny” on SiriusXM Stars (channel 109) and then on my own show, “Ask the Vet,” which is also on SiriusXM Stars.

The callers asked very interesting and important medical questions, many of which I have written about here previously. In case you missed the radio programs, I will recap them here.

Thyroid Disease
The caller explained her dog had an overactive thyroid gland, a very uncommon occurrence. Typically, dogs have an underactive thyroid gland (hypothyroidism) and cats have an overactive thyroid gland (hyperthyroidism).

Feline Infectious Peritonitis (FIP)
I always grit my teeth when a caller asks about this feline disease. FIP is pretty much always fatal, and because cat lovers usually have multiple kitties, a cat with FIP poses a risk to the healthy cats in the family. Not only has the family lost a cat to FIP, but they are now distraught over the health of their other cats.

Behavior
Whenever I am interviewed on a call-in program, I can be sure to have questions on behavior primarily relating to normal, destructive, or bad behaviors in pets. Recently, Dr. Jean DeNapoli of Pieper Memorial Veterinary Center in Middletown, CT, spoke at a Usdan Institute for Animal Health Education event at AMC. Dr. DeNapoli completed a behavior residency and shared useful information about pet behavior with pet owners in attendance. View a video of her presentation.

Bladder Stones
Two callers asked about bladder stones. In both the dog and cat, calcium oxalate stones are the most common type of bladder stone, but struvite or triple phosphate is a close second. Veterinarians have a variety of methods to treat bladder stones. The type of stone often dictates the best treatment.

Feeding Cats
A cat owning caller was concerned about her cat’s passion for dry food and lack of interest in wet food. Cat’s taste preferences are set during kittenhood and some cats just want what they want and nothing else. Read more about cats and food in this post from Adopt-a-Cat Month 2011.

Have a question that was not answered here? Follow us on Twitter @amcny to learn when AMC expert veterinarians will be speaking in public or tune in to SiriusXM Stars 109 for “Ask the Vet” which airs the first Friday of every month from 1-2 pm ET and call 888-94-STARS (888-947-8277) to ask your pet health questions.

#PreventDogBites

dog bite prevention week

April 8-14, 2018 is National Dog Bite Prevention Week® sponsored by the National Dog Bite Prevention Coalition. Although any dog can bite, this post is based on recent research into the causes of dog bite injury and is devoted to helping readers recognize situations where a bite injury is imminent. If this blog prevents even one bite injury, it will have achieved its goal.

Telltale Signs
Animal behaviorists talk about a canine body language ladder of aggression. The higher the behavior on the ladder, the level of aggressive behavior increases. Low-risk behaviors include blinking and lip licking. At the top of the ladder is biting. The rungs in between include crouching, hair standing on end, ears pinned back, yawning, tucking the tail between the legs, and spinning. Recognition of canine body language cues is critical to protection against bite injuries. A recent study of an adult’s ability to recognize these canine body language cues found adults observing child-dog interactions do not always recognize anxious or fearful dogs. Important point: be sure you monitor your dog’s interactions with children and remove her if she exhibits anxious or fearful behaviors.

Snarling = Bite Danger
In the past, bite injuries have been linked to dogs tied up on the family’s property. Veterinary researchers at Ohio State University studied the bite history of dogs confined to their family’s property by fences, tethers and electronic fences. Four percent of dogs had bitten a person in the past, and twice that number had bitten another dog. The type of confinement system was not related to a past history of biting, but dogs greeting other dogs or humans by snapping, snarling or growling were more likely to bite than dogs greeting others by sniffing or licking. Important point: protect yourself by steering clear of snapping, snarling or growling dogs.

Children at Risk
The National Trauma Data Bank contains a large amount of information on traumatic injuries. In a paper published just last month, nearly 8,000 dog bite injuries in children under 17 years of age were studied over a seven year period. One-third of the injuries were to children less than two years of age and another third were girls six to twelve years of age. Eighty percent of the bites occurred at home and by a dog known to the family rather than a stray dog. Important point: always supervise dog-child interactions as children may be too young to recognize warning signs of an impending dog bite.

Friendly Dogs Can Bite
A dog that is normally very friendly may bite if put in the right situation. Resource guarding and pain are two common reasons a friendly dog may bite. A tragic story from a local television channel reported bites to the face of a toddler who tried to take a bone away from a friendly dog. Important point: never take food away from a dog. Teach your dog the “drop it” command for the times when he picks up some undesirable treat from the sidewalk. If a friendly dog is sick, injured or painful, he may bite. Important point: if you find an injured dog, alert the authorities and let professionals transport the injured dog to a veterinary hospital.

Download a cute, informative and FREE poster on dog body language.

Everyday Medicine: Physical Examination

physical exam

“Everyday Medicine” is an intermittent series of blog posts highlighting tests, treatments, and procedures common in daily Animal Medical Center practice. Some past examples of this type of blog post include “Cytology” and “PCV.” Today’s post focuses on the physical examination.

A physical examination is the foundation of your pet’s medical care. Abnormalities of the eyes, ears, skin, and mouth are easily visualized during an examination. A physical examination identifies any deviations from normal, such as pale gums or weight loss which require further testing, like blood counts or x-rays. If the examination is normal, your veterinarian will recommend preventive care like a heartworm test, fecal analysis or vaccinations.

Head
When I examine a patient, I try to follow a set order. I usually start at the head, open the mouth, look at the teeth and under the tongue. Then I use a special light and lens to look inside the cat or dog’s eyes. The same light has an adapter which allows me to look inside the ears.

Chest or Thorax
Examination of the thorax involves using a stethoscope. During examination of the thorax, I count the heart rate and respirations. I listen to the heart in several different places to identify heart murmurs. Then, I feel the pulse on a hind leg and listen to the heart at the same time to confirm the pulses match the heartbeat. Each heartbeat should generate one pulse. Next, I move my stethoscope around on both sides of the chest to listen to the sounds made by the lungs.

Abdomen
Depending on the size of the patient, I can feel the kidneys, intestines, liver, spleen, and bladder. In really big dogs or really obese patients, I can’t feel too much. (Another good reason to keep your pet trim is that they get a better physical examination!). In vomiting pets, we might be able to feel a stuck toy or a tumor of one of the abdominal organs. In dogs, I typically do a rectal examination. Cats are not big fans of this procedure and only in select cases will I do a rectal examination on a cat. Sometimes this procedure requires sedation. A rectal examination is critical in cases of diarrhea, constipation or when a pet is excessively licking at their rear end. If necessary, I can also obtain a fecal sample or express the anal glands during a rectal examination.

Skin
While I am working my way from nose to toes, I look at the skin, feel for lumps and also run my hands down the legs feeling for any swellings or lumps. Being an oncologist by training, I can’t resist checking the lymph nodes under the chin, in front of the shoulders, in the armpits, and behind the knees.

Exam Room Testing
In the exam room, I perform some small tests like measuring a pet’s temperature and body weight. I will also look at the pet and determine the cat or dog’s
body condition score which is a veterinarian’s version of a BMI. I might also sample the ears or skin and look at it under the microscope to determine the cause of an infection.

Once the examination is completed, all the information collected is recorded in your pet’s medical record for comparison to last year’s findings and next year’s findings. Monitoring trends in a pet’s status helps veterinarians recognize subtle but important changes so we can keep your pet in tip-top health.

Poison Prevention Week 2018: 31 Admissions in 62 Days

poison prevention

Every morning at about 5 am, the Animal Medical Center’s overnight admissions list is distributed via email. The list is a fascinating snapshot of our emergency room. I have written about this list in a previous post highlighting AMC’s ER.
Since March 18-24 is National Poison Prevention Week, I have used the overnight admissions list to collate all the pets hospitalized for poisoning between December 21, 2017 and February 21, 2018. In those 62 days, 31 pets were sick enough to require hospitalization following ingestion of a toxic substance. The admissions list did not capture those pets treated in the ER and immediately discharged. Even so, the numbers tell how serious an issue poisoning is in our ER.

Every Age and Type of Pet Can Be Poisoned
The majority of hospitalizations for poisoning were dogs. I would have guessed the list would be composed of lots of silly puppies with indiscriminate eating habits. Wrong. Yes, there was a 2-month-old puppy, but the list contained several 12, 13 and 14-year-old dogs who should have known better than to eat what they did. The list also included three cats and a cockatoo.

Chocolate takes gold, while medications and marijuana tied for silver
Of the 31 pets admitted for poisoning, 11 had overindulged in chocolate. Six dogs, including a cute two-month-old mixed breed puppy and an 11-month-old poodle sniffed out their family’s marijuana stash and helped themselves to earn their spot on our ER list. Six different dogs overdosed on some form of human medication; and the most surprising to me was the dog who ate a bag of cough drops while his flu-stricken family struggled to recover from their illness.

Cats and Lilies
Only three cats were hospitalized during this time period and all three cats came to the ER because they had eaten lilies. Any form of lily, including Easter lily, tiger lily or Asiatic lily, can cause kidney failure if ingested by a cat. Happily, all three of these cats recovered and were discharged from the hospital to relieved families.

AMC’s ER has a wealth of experience in managing poisoning in pets, but many of these pets would not have required medical attention if chocolate and medication were stored carefully and floral arrangements selected judiciously.

Accidents do happen and here are the contact numbers for animal poisonings:
ASPCA Animal Poison Control
888-426-4435

Pet Poison Hotline
800-213-6680

For more in-depth information common toxicities in pets, please view a lecture by Dr. Carly Fox, staff doctor in Emergency & Critical Care at AMC.

Should You Be Concerned About Fatty Tumors in Your Dog?

lipoma

The Animal Medical Center’s Usdan Institute for Animal Health Education provides our clients and the broader community with important, relevant, and timely animal health information. A dog owner reached out to the Institute for information on lipoma, a fatty tumor found most commonly in dogs. I will recap my answer to their question here.

What is a lipoma?
A lipoma is the most common skin tumor found in dogs and is a benign accumulation of fat cells. Some dogs never have one, and others can be very lumpy because of multiple lipomas. Because medical terms can be confusing, be sure you don’t confuse lipoma with lymphoma. Lymphoma is a malignant tumor of lymph nodes and is the most common malignant canine tumor treated by AMC oncologists.

What does a lipoma look and feel like?
A lipoma is a mass under the skin, which you may notice because the lipoma causes the fur to stick up funny, or you run into the lump when you are petting your dog. Lipomas are usually soft and easily movable; they are not attached to the underlying body wall. Some lipomas can attain giant proportions and cover the entire side of your dog, without causing any medical issues. Veterinarians cannot rely on how the skin mass looks or feels to determine if the mass is a lipoma. Mast cell tumors and soft tissue sarcomas, two potentially malignant tumors, also develop under the skin and can feel soft and squishy just like a lipoma. I have seen dogs with ten lumps, nine are lipomas and the tenth is a nasty mast cell tumor.

Should I have my dog’s lipomas removed?
The presence of a lump on your fur baby is worrisome to many dog families, but the vast majority of lipomas never cause a problem in a dog. Occasionally, a lipoma becomes very large and interferes with ambulation. These are often found in the armpit, and removal improves the dog’s quality of life immeasurably.

Are lipomas ever malignant?
The word, lipoma, implies a benign tumor, but there is a malignant version of lipoma, a liposarcoma. A liposarcoma is not a lipoma gone bad, but a tumor arising from juvenile fat cells. Dogs affected by a liposarcoma can have a good prognosis, but usually need a major surgical procedure to completely remove the tumor.

My dog is really lumpy, now what?
Lipomas are easily diagnosed via cytology. Cytology can sort out the difference between mast cell tumors and soft tissue sarcoma as well. Talk to your veterinarian about any lumps you find on your dog. If the lumps are sometimes hard to find, use a permanent marker or white-out painted on the fur to make finding them easier during your pet’s examination.

What Could Be Better Than a Puppy?

puppy

The title of the blog is a direct quote from the human belonging to one of my patients. This gentleman was delirious at the prospect of the new fluff ball with puppy breath about to come into his life. The family already included a very sociable, well-mannered adult dog and they thought this dog would like a canine little brother, hence the new puppy.

Over the years, I have discovered pet owners develop a selective memory about the effort involved in raising a new puppy. Somehow, all the family can remember are the cute antics, the playful exuberance, and the fun associated with a new furry family member. The lack of sleep, the mess and damage inflicted by those razor sharp puppy teeth fades quickly from their minds once the puppy grows up and I often hear lamentations about the work of having a new puppy.

Sleep?
Jake arrived for his first examination and did not disappoint. Simply said, the puppy was darling and very peppy. His human was not so peppy. Housebreaking and training a puppy requires time and dedication 24/7 and the lack of sleep was taking its toll on the human, but it did not dampen his enthusiasm and delight with the puppy scampering around my exam room.

A clean house?
With any puppy, accidents will happen. Be prepared with an odor neutralizing cleaner, a carpet cleaner formulated for pet accidents, and an extra shipment of paper towels. Making clean up quick and easy gives you more time to throw that ball and give treats for its return.

Perfect furniture?
The family of another one of my patients swore their new puppy was not a Cavalier King Charles Spaniel, but a dog-beaver mix. Coco chewed her way through just about anything she could put her mouth on: the other dog’s ears, shoes and the legs of the kitchen chairs. Chewing is normal for teething puppies. Baby teeth start to fall out at about four months of age and the permanent teeth are all in by about 6 months or so. During this time, it is critical to protect important objects and divert your puppy’s chewing to appropriate toys. The Animal Medical Center’s dentists say no to furry tennis balls, nylon bones, real bones, and hooves because of their tooth-damaging properties. They recommend sturdy cloth, rope and rubber chew toys.

A crate, lots of chew toys and another dog?
In addition to the chew toys, a crate is an invaluable puppy accoutrement. The crate provides your puppy with a space to call their own and keeps them safe while you run to the store or jump in the shower. Most puppies prefer not to eliminate where they sleep, so the crate also facilitates housebreaking. Jake was a lucky puppy, with an older brother to show him the ropes. The humans in Jake’s family were grateful for the efforts of their older dog who helped to diffuse some of Jake’s boundless puppy energy allowing them to revel in the camaraderie of their furry family members.

So in the end, maybe selective memory happens because sleep, a clean house, and perfect furniture don’t really matter because NOTHING is better than a puppy!

New Travel Regulations Affect Service Animals

emotional support animal

“Can peacocks fly?”
“Pets on the fly”
“Delta tightens the leash on emotional support animals”

These are but a few of the clever headlines online and in print over the past few weeks regarding emotional support animals traveling in airplane cabins. The topic of traveling with emotional support animals came to the forefront when Delta Airlines announced that beginning March 1, 2018, it would require additional documentation for customers traveling with an emotional support animal. For travel after March 1, passengers will need to provide documentation from a certified mental health professional, a veterinary health form documenting the health and vaccination records for the animal, as well as confirming that the animal has appropriate behavioral training. I completed the veterinary health form for a patient of mine today. Forms were readily accessible on the airline’s website.

Can Spiders, Sugar Gliders or Hedgehogs Fly?
One of the issues highlighted in the series of articles with clever titles was the story of an emotional support peacock denied the opportunity to board his flight and occupy the seat his human purchased for the trip. The peacock, named Dexter, was trying to fly on a United Airlines flight, but even if he had switched airlines, he would have also been disallowed on a Delta Airlines flight for not meeting several requirements for a flying service animal: must fit under the seat, cannot occupy a seat intended for a person, must be a household bird. In addition, the emotional support animal cannot encroach on other passengers. Whoever was booked to sit next to the support peacock probably doesn’t know it, but they really dodged a bullet on that flight. I also found a report of some support bees that were not allowed to board a Southwest Airlines flight.

Delta Airlines has a very specific list of what animals cannot be accommodated in the cabin. I could not find a similar list for United, but Southwest Airlines will not accept rodents, ferrets, insects, spiders, reptiles, hedgehogs, rabbits, or sugar gliders, a list nearly identical to Delta’s.

Before You Go
Before traveling with your emotional support animal, service dog or any animal, you have some legwork to do before you buy tickets. First, check the website of your airline for their requirements for traveling with pets or support animals. If you plan to travel outside the United States, each country sets its own rules regarding animal importation. The United States Department of Agriculture maintains a very informative website to assist pet families in navigating these rules. Start early in getting your pet’s travel papers in order as some countries require preapproval and special blood tests for entry. One, you know what tests and documentation are required, make an appointment with your veterinarian to obtain the proper travel papers.

Are Purebred Dogs Sicker than Mutts?

westminster dog show

This week was the week New York City went to the dogs; the annual Westminster Kennel Club Dog Show was in Madison Square Garden on Monday and Tuesday and there were activities all over the city related to man’s best friend. The Animal Medical Center veterinarians were at the Show triaging dogs unlucky enough to get sick during the second longest running sporting event in the United States.

I always love to visit the rows and rows of cossetted purebred dogs in the benching area of the show. But all those purebred dogs made my veterinary mind drift to lists of diseases prevalent in certain breeds: Addison’s disease in Nova Scotia duck tolling retrievers, renal dysplasia in Shih Tzu dogs, or cardiomyopathy in the Doberman pinscher, to name a few. I can also assure you all three of these diseases are not exclusive to purebred dogs and can be diagnosed in any dog.

Is Hybrid Vigor a Myth or “Dog”-Ma?
The list of diseases associated with purebred dogs is long, but does that mean purebred dogs are less healthy than the basic Heinz 57 model? Probably not. One way to assess health is to look at cause of death. In a study of over 70,000 dogs from North America where the cause of death was known, the number one cause in most breeds was cancer, but the number one cause in mixed breed dogs was also cancer! The fact that cancer is so common in our canine companions reflects the high-quality medical care available to dogs in the United States and Canada. Well cared for dogs don’t die of distemper or parvovirus, they get vaccinated. Dog owners use heartworm preventative and flea/tick medications to prevent parasitic and tick-borne illnesses. Few people let their dogs off leash unattended, protecting them against trauma from automobile accidents. Good health care allows dogs to live to a ripe old age where they are at risk for developing cancer.

Common Diseases Occur Commonly
A recent study of Border Terrier health from England looked at common disorders in this healthy, hearty breed. When seen by a primary care veterinarian, dental disease, ear infections and obesity topped the list of diagnoses in this group of British Border Terriers. Compare that to a widely published list of pet insurance claims and you see the same disease in a large population of insured American dogs, where ear infections and tooth abscess are included in the top ten list. Seems that no matter where you look, dogs all seem to have similar problems.

Lifestyle and Disease
Lifestyle may play as much a role, if not more, than breed does when it comes to health. The study of 70,000 dogs reported infectious disease as the most common cause of death in Treeing Walker Coonhounds. These dogs are commonly used as hunting dogs and their outdoorsy lifestyle may predispose them to infections. The bold Jack Russell Terrier most commonly fell victim to trauma, perhaps due to daredevil personality. Age plays a role in cause of death as well. Young dogs were more likely to die from traumatic causes, but rarely cancer.

The best way to have a healthy dog, purebred or mutt, is to keep him at an ideal body weight, feed a good quality food, make sure he has plenty of exercise and at a minimum, an annual veterinary visit. Hats off to all the Westminster competitors, all of us at AMC think you are all top dogs.

February is National Pet Dental Health Month

pet dentistry

Maintaining dental health is an important part of your pet’s preventive health care regimen. Dental health is so important at the Animal Medical Center, we have a Dentistry Service staffed by three veterinarians devoted to full-time dentistry for dogs and cats (and the occasional less common pet!). In honor of National Pet Dental Health Month, I have amalgamated some prior blogs on the topic of dentistry to serve as a resource for pet dental issues.

Inside the Mouth
Many pets resist an oral examination in the veterinarian’s office and completely refuse to let their family even have a peek inside their mouth. In the photo blog post, “Hound’s Tooth and Cat’s Teeth,” you can view some great images of the inside of dog and cat mouths. Better yet, you can see the magic a good dental cleaning can do for your pet’s teeth in some before and after photos highlighting AMC’s dentists’ work.

Dental Do’s and Don’ts
AMC’s dentists have a list of do’s and don’ts for your pet. I found the fact that tennis balls are a don’t to be fascinating. The felt on tennis balls abrades a dog’s tooth enamel, which is how the dayglow yellow balls landed on the don’ts list. Who knew? Our dentists recommend felt-less tennis balls.

Smile, If You Have Clean Teeth
Prophylactic tooth cleaning is generally recommended every 12-24 months, but certain dogs and cats have dental problems requiring a different protocol. Many pet families resist dental cleaning recommendations made by their veterinarian because of the need for anesthesia to properly perform a comprehensive veterinary dental cleaning. Read about anesthesia in veterinary dental care which explains why your pet will get optimal dental care only if the procedure is done under general anesthesia.

Have I convinced you to take better care of your pet’s teeth? Watch our video on dog tooth brushing to get you started. Check out the list of Veterinary Oral Health Council approved products and choose the ones that best meet your pet’s oral health needs.