Pulmonary arterial hypertension (PH) is an increase in the pressure within the arteries that supply the lungs. PH can be secondary to a variety of causes, including severe acquired left sided heart disease, certain congenital heart diseases, heartworm disease, pulmonary thromboembolism (blood clot) or any type of primary lung disease. Some of these causes are reversible, but others are not. Mild pulmonary hypertension does not cause any clinical signs. If pulmonary hypertension is severe, it can lead to symptoms, such as respiratory difficulty, syncope (fainting), exercise intolerance, and cyanosis (blue discoloration of gums/tongue).

Non-invasive diagnosis of pulmonary hypertension is possible by performing an echocardiogram (ultrasound of the heart). Additional tests can be performed to help identify the primary cause of the pulmonary hypertension, but in some cases a cause cannot be identified. If an underlying disease process is identified and treatable (pneumonia, for example), it may be possible to improve or even resolve the PH with appropriate therapy. If a primary cause cannot be identified or treated, or if the patient has significant clinical signs associated with pulmonary hypertension, specific therapy directed at the PH can be extremely beneficial. In some patients, oxygen supplementation is very important during the first few days of treatment to help the patient breathe more comfortably.

Specific medications, such as Sildenafil (Viagra) can be given to help dilate the pulmonary vessels without causing low blood pressure. Severe pulmonary hypertension can carry a poor prognosis, but treatment with Sildenafil (Viagra) and some other similar medications have led to significant improvements or resolution of clinical signs in many patients.

What is Osteoarthritis in Pets?

Osteoarthritis is a chronic degenerative disease that may affect any joint but is commonly found in a pet’s hip, elbow, shoulder, stifle (knee) , carpus (wrist), hock (ankle) or intervertebral joints (in the spine). It occurs when cartilage in the joint is damaged, either following a traumatic event or with wear and tear that increases in athletic animals, obese animals, or when the joint is congenitally abnormal.

Cartilage decreases joint stress by reducing impact on the ends of the bones in joints, like a gelatinous shock absorber. When cartilage is damaged, a cascade of inflammatory changes occurs, eventually leading to destruction of the cartilage and subsequent damage to the underlying bone. Cartilage contains no nerves – if your pet is showing any signs of pain, the damage and changes in underlying bone have already begun.
Signs of arthritis include:

• Reluctance totake walks of usual length
• Stiffness (thatmay disappear once the pet has ‘warmed up’)
• Difficultyclimbing stairs, climbing in the car, on the bed or a sofa
• Difficultyrising from rest
• Limping
• Abnormal gait
• Licking of asingle joint
• Actingwithdrawn, spending less time playing with family (which is often misunderstood as a sign of ‘aging’)
• Soreness when touched
• Rarely, aggression when touched or approached

What can I do?

• WeightReduction: Ask your doctor about your pet’s body condition score (BCS), which shouldbe normal (5/9) or slightly underweight (4/9). If your pet isoverweight, discuss a weight loss diet with your veterinarian.
• ControlledExercise: Low-impact exercise is best; swimming or walking through shallow water isideal. Leash walking and controlled jogging are also acceptable.
• Nutraceuticals: Synergistic combinations of nutraceuticals such as glucosamine/chondroitin sulfate contain compounds that support cartilage structure, prevent furtherdeterioration, suppress inflammation, and reduce free radical damage.
• InjectableChondroprotective Agent: Talk to your veterinarian aboutan injectable agent that may also help preserve cartilage in the joints.
• Acupuncture andMassage:Both of these therapies may provide additional non-drug pain control.

Prescription Drugs: Drugs are available that can reduce inflammation and suppress pain in dogs with more advanced disease. Side effects can be minimized by monitoring your dog’s blood work regularly.

M. H. Archer, DVM
Loveland Veterinary House Call

Emergency visits and traveling

We often go on vacations or trips requiring extra preparations for our pets. This preparation will help you when unexpected events occur. Here are a few things that can be done to make sure that you are not caught off guard, or if you are, it is less stressful.

When leaving your pet with someone while you go on a trip, make sure that person or facility has a copy of your vaccination records for each pet. Also, you should have a signed permission to treat form in case of emergency with an amount that cannot be exceeded without contacting you. Make sure your relationship is such that your pet sitter or boarding facility knows that they should get emergency care when necessary. Also, use your judgment when selecting someone who would be qualified at determining what is wrong.

When traveling with your pets, you should carry or have copies of veterinary records and a health certificate for your pets when necessary. Having copies of veterinary records is imperative even if you are traveling within the state. This because the importance of an up to date rabies shot cannot be emphasized enough. When traveling in state, if your pet gets sick and you have to make a veterinary visit, if you have the records it will make the visit less stressful and prevents unnecessary vaccinations if your regular veterinary office cannot be reached. Secondly, when traveling out of state, you are supposed to get a health certificate for all traveling animals. This is required when flying with a pet, but it is strongly encouraged when driving with that pet. If you do not get a health certificate, you should carry the veterinary records of most recent vaccinations with you. This will help if you are stopped by a police officer or other state official or if you have to make a veterinary visit.

Whether you are at home or traveling, emergencies can happen. You can do a few key things to help the process when an emergency occurs and during the process to decrease the stress. If you are not going to your regular hospital, take a copy of your most recent veterinary records that show proof of vaccinations, especially rabies. Some hospitals will not see patients that do not have proof of vaccinations or require rabies and other vaccinations before the visit. This is imperative in cases of animal-human bites with lack of rabies. Without vaccinations your pet may be quarantined or euthanized without your permission depending on the state or county policy. The veterinarian will have a policy or at least obey state laws for this situation.

The best advice if you are worried about your pet is to call your veterinarian or a veterinarian several hours before close of the business day. If your pet is sick, do not wait until the end of the business day to call about receiving care. You know how it is at the end of the workday. Think about whether you would want to stay an extra 2 or 3 hours if a customer just showed up right before close. This is rude and, often, you knew your pet was sick before 12pm on Saturday or 5 or 6pm on a weeknight. Therefore, expect that you may be told to go to the emergency clinic if you call or show up right before closing time. Unfortunately, when you do not have a relationship with that veterinary hospital, you are more likely be told to go to the emergency clinic than if they know you. Remember, most veterinary clinics or hospitals are small businesses that run on daily revenue. They are less likely to pay people to stay after hours if they don’t know you and can be assured that you will pay for services or agree to care if they do stay open for an extra hour.

If you have to go to a veterinary emergency clinic, expect to spend at least $350 to $500 dollars. Emergency clinics often have a minimum office visit fee that is often 2 to 3 times what a regular hospital charges. They will do more diagnostics than your regular vet and often cannot reach your regular veterinary hospital which makes having copies of all records important for after hours or holiday emergency visits.

Other tips for emergency visits to either an emergency clinic or a new vet hospital

Give a good history and answer all questions as best you can. Sometimes what seem to be insignificant changes or details are actually the key to figuring out what is wrong. Remember this veterinarian does not know your pet like your regular veterinarian does so don’t leave out any details and be as honest as possible.

Sometimes questions or subjects may be embarrassing to discuss. Even if you are embarrassed by your pet eating underwear, dirty diapers or drugs (prescription or recreational), the veterinarian will be less likely to judge you than you think. Even if he/she does seem shocked, it is irrelevant as you will likely never see him again after your pet is well. Plus, not being up front may result in delayed treatment and even death for your pet. I can tell stories of clients denying something and later changing their original answer several days later. In these situations the best treatment was delayed or not considered for a long period of time. The major consequences of this is a ravaging on your pocketbook and often worsening of your pets health due to delaying the best treatment. Furthermore, if you think that a lawsuit will solve the problem, you will find that an expert witness will likely find in the favor of the veterinarian as you were not upfront on the problem and this delayed or prevented appropriate care.

Some other things to consider with the visit are:

1. Always be upfront with the veterinarian about money.

If you can only spend $500, then tell the office that you will only authorize treatment for up to $500. This will give a good idea of what can be done and the veterinarian can prioritize testing and treatment options.

2. Get the prognosis compared with the cost.

During the initial exam, we can often tell how the patient is and get an idea of what needs to be done. The veterinarian will often try to give you an idea of whether the disease is treatable or an end of life situation, unless you spend huge amounts of money.

The thing that is most heartbreaking to me is when we can treat, but the owner refuses to spend a little bit of money, and the outcome is death without any treatment.

3. Ask for all of the treatment options.

Often the veterinarian will have a best way to handle treatment, which is usually more expensive. Sometimes there will be other options that can work, but you need to know how effective these are as well as the cost. The other option for the absolute best care is a referral if the office cannot handle the treatment.

4. Listen to what the veterinarian is saying.

In stressful or emergency situations, we often do not follow discussions as well as when we are relaxed. If you are having trouble following what the veterinarian is saying, ask for a moment to be alone and collect your thoughts about what is going on. Get the vet to write the main diagnostic and treatment points down, get an estimate and go over the main points again. Sometimes a decision to stabilize has to be done immediately. In this case, you have to make a decision to spend usually around $200 right then.

If the veterinarian tells you that you have to treat soon (ASAP) or death will result, this means that you cannot treat the patient at home. If you ask several times and you are still told hospitalization, then you need to understand that hospitalization is the only way. I have told this to clients and explained why. Some have still refused care and then called back trying to know what to do to treat at home. We have had to explain again, we told you this already, your pet has to stay in the hospital to treat this. You have to do this or your pet will not get better. Often you will be asked to sign a form stating that you decline treatment and that you understand what you are doing. This is because the office wants you to understand what you have agreed to. If you are not sure, ask directly about the outcome if you do not treat.

5. If you cannot treat or will not treat, consider euthanasia.

Finally, if you are not able to do what is best for the patient and you are not morally opposed to euthanasia, you should consider it as a final option. Unlike in human medicine, where patients can be forced to treat conditions or have less say in treatment, veterinary medicine gives you the option on how to proceed. Consider euthanasia if you are unable to spend the money and it is condition that will result in death. I point this out, because I would not want to die in a huge amount of pain with no treatment if another option were available to me.

S. Mason, DVM

Dog Flu

Back around 2005 I saw my first case of dog flu (canine influenza) in the ER, it hit fast, it hit hard, and within hours the dog or puppy would be dead.  Now a new strain of dog flu has hit the Midwest and last week it moved a little further west to Iowa.  I was planning on writing this blog but when I was researching articles I couldn’t sum it up better than the AVMA did-  Here is their Q&A session about dog flu….Canine influenza (CI), or dog flu, is a highly contagious respiratory infection of dogs that is caused by an influenza A virus. In the U.S., canine influenza has been caused by two influenza strains. The first strain reported in the United States, beginning in 2004, was an H3N8 influenza A virus. This strain is closely related to the virus that causes equine influenza, and it is thought that the equine influenza virus mutated to produce the canine strain. In 2015, an outbreak that started in Chicago was caused by a separate canine influenza virus, H3N2. The strain causing the 2015 outbreak was almost genetically identical to an H3N2 strain previously reported only in Asia – specifically, Korea, China and Thailand. In Asia. This H3N2 strain is believed to have resulted from the direct transfer of an avian influenza virus  – possibly from among viruses circulating in live bird markets – to dogs.

Two clinical syndromes have been seen in dogs infected with the canine influenza virus—a mild form of the disease and a more severe form that is accompanied by pneumonia.

• Mild form — Dogs suffering with the mild form of canine influenza develop a soft, moist cough that persists for 10 to 30 days. They may also be lethargic and have reduced appetite and a fever. Sneezing and discharge from the eyes and/or nose may also be observed. Some dogs have a dry cough similar to the traditional “kennel cough” caused by Bordetella bronchiseptica/parainfluenza virus complex. Dogs with the mild form of influenza may also have a thick nasal discharge, which is usually caused by a secondary bacterial infection.
• Severe form — Dogs with the severe form of canine influenza develop high fevers (104ºF to 106ºF) and have clinical signs of pneumonia, such as increased respiratory rates and effort. Pneumonia may be due to a secondary bacterial infection.

Q: Are all dogs at risk of getting canine influenza?
A: Because this is still an emerging disease and dogs in the U.S. have not been exposed to it before, almost all dogs, regardless of breed or age, lack immunity to it and are susceptible to infection if exposed to the active virus. Virtually all dogs exposed to the virus become infected, and nearly 80% show clinical signs of disease, though most exhibit the mild form described above.
However, the risk of any dog being exposed to the canine influenza virus depends on that dog’s lifestyle. Dogs that are frequently or regularly exposed to other dogs – for example at boarding or day care facilities, dog parks, grooming salons, or social events with other dogs present – are at greater risk of coming into contact with the virus. Also, as with other infectious diseases, extra precautions may be needed with puppies, elderly or pregnant dogs, and dogs that are immunocompromised. Dog owners should talk with their own veterinarian to assess their dog’s risk.

Q: Do dogs die from canine influenza?
A: Fatal cases of pneumonia resulting from infection with canine influenza virus have been reported in dogs, but the fatality rate is low (less than 10%). Most dogs recover in 2-3 weeks.

Q: How widespread is the disease?
A: The first recognized outbreak of canine influenza in the world is believed to have occurred in racing greyhounds in January 2004 at a track in Florida. From June to August of 2004, outbreaks of respiratory disease were reported at 14 tracks in 6 states (Alabama, Arkansas, Florida, Kansas, Texas, and West Virginia). Between January and May of 2005, outbreaks occurred at 20 tracks in 11 states (Arizona, Arkansas, Colorado, Florida, Iowa, Kansas, Massachusetts, Rhode Island, Texas, West Virginia, and Wisconsin). The canine influenza virus has been reported in at least 30 states and Washington, DC.
The H3N2 strain of canine influenza virus had been reported in Korea, China and Thailand, but had not been detected outside of those countries until 2015. In April 2015, an outbreak that started in Chicago was determined to be caused by an H3N2 strain that was genetically almost identical to the one one in Asia.

Q: Is there a vaccine?
A: The first canine vaccine for H3N8 canine influenza was approved in 2009, and there are several H3N8 canine influenza vaccines available. At this time, there is not an H3N2 vaccine available in the United States, and it is not known whether the H3N8 vaccine will offer any protection against the H3N2 strain. Canine influenza vaccines are considered “lifestyle” vaccines, meaning the decision to vaccinate is based on a dog’s risk of exposure. Dog owners should consult their veterinarian to determine whether vaccination is needed.

Q: How is a dog with canine influenza treated?
A: As with any disease caused by a virus, treatment is largely supportive. Good animal care practices and nutrition assist dogs in mounting an effective immune response.
The course of treatment depends on the pet’s condition, including the presence or absence of a secondary bacterial infection, pneumonia, dehydration, or other medical issues (e.g., pregnancy, pre-existing respiratory disease, compromised immune system, etc.). The veterinarian might prescribe medications, such as an antibiotic (to fight secondary infections) and/or a nonsteroidal anti-inflammatory (to reduce fever, swelling and pain). Dehydrated pets may need fluid therapy to restore and maintain hydration.  Other medications, or even hospitalization, may also be necessary for more severe cases.

Q: Is canine influenza virus transmissible from dogs to humans?
A: To date, there is no evidence of transmission of canine influenza virus from dogs to people.

Q: Is canine influenza virus transmissible from dogs to cats, horses or other animal species?
A: At this time, there is no evidence of transmission of H3N8 canine influenza from dogs to horses, cats, ferrets, or other animal species. The H3N2 strain, however, has been reported in Asia to infect cats, and there’s also some evidence that guinea pigs and ferrets can become infected.
Precautions to prevent spread of the virus are outlined below, in the answer to “I work in a kennel/animal care facility. What should I do to prevent transmission of influenza virus from infected dogs to susceptible dogs?”

Q: Do I need to be concerned about putting my dog in day care or boarding it at a kennel?
A: Dog owners should be aware that any situation that brings dogs together increases the risk of spread of communicable illnesses. Good infection control practices can reduce that risk, so dog owners involved in shows, sports, or other activities with their dogs or who board their dogs at kennels should ask whether respiratory disease has been a problem there, and whether the facility has a plan for isolating dogs that develop respiratory disease and for notifying owners if their dogs have been exposed to dogs with respiratory disease.
As long as good infection control practices are in place, pet owners should not be overly concerned about putting dogs in training facilities, dog parks, kennels, or other areas frequented by dogs.

Q: My dog has a cough…what should I do?
A: Consult your veterinarian. Coughing can be caused by many different medical problems, and your veterinarian can examine and evaluate your dog and recommend an appropriate course of treatment. If canine influenza is suspected, treatment will usually focus on maximizing the ability of your dog’s immune system to combat the virus. A typical approach might include administration of fluids if your dog is becoming dehydrated and prescribing an antimicrobial if a secondary bacterial infection is suspected.

Canine influenza virus can be spread via direct contact with respiratory secretions from infected dogs, and by contact with contaminated inanimate objects. Therefore, dog owners whose dogs are coughing or exhibiting other signs of respiratory disease should not participate in activities or bring their dogs to facilities where other dogs can be exposed to them. Clothing, equipment, surfaces, and hands should be cleaned and disinfected after exposure to dogs showing signs of respiratory disease to prevent transmission of infection to susceptible dogs. Clothing can be adequately cleaned by using a detergent at normal laundry temperatures.

Q: I manage a kennel/veterinary clinic/animal shelter/dog day care center. How do I keep canine influenza out of my facility, and if it does enter my facility, what should I do?
A: Viral disease is usually best prevented through vaccination. A vaccine against H3N8 canine influenza has been available since 2009. It is considered a “lifestyle” vaccine, which means that the decision to vaccinate a dog against CIV is based on the risk of exposure. A veterinarian should determine whether vaccination is needed based on related risks and benefits, and should administer these vaccinations at least 2 weeks prior to planned visits to dog activity and care facilities (e.g., kennels, veterinary clinics, dog day care centers, training facilities, dog parks). This differs from “core” vaccines – such as distemper, parvo and rabies – that are required for all dogs, regardless of lifestyle.
Vaccination against other pathogens causing respiratory disease may help prevent more common respiratory pathogens from becoming secondary infections in a respiratory tract already compromised by influenza infection.
Routine infection control precautions are key to preventing spread of viral disease within facilities. The canine influenza virus appears to be easily killed by disinfectants (e.g., quaternary ammonium compounds and bleach solutions at a 1 to 30 dilution) in common use in veterinary clinics, boarding facilities, and animal shelters. Protocols should be established for thoroughly cleaning and disinfecting cages, bowls, and other surfaces between uses. Employees should wash their hands with soap and water (or use an alcohol-based hand cleaner if soap and water are unavailable) before and after handling each dog; after coming into contact with a dog’s saliva, urine, feces, or blood; after cleaning cages; and upon arriving at and before leaving the facility. (See “I work in a kennel/animal care facility. What should I do to prevent transmission of influenza virus from infected dogs to susceptible dogs?”)
Animal care facility staff should be alerted to the possibility that a dog with a respiratory infection could be presented for care or boarding. If a dog with respiratory signs is presented, staff members should inquire whether the dog has recently been boarded or adopted from a shelter, has recently participated in dog-related group activities, or has been exposed to other dogs known to have canine influenza or kennel cough. The dog should be brought directly into a separate examination/triage area that is reserved for dogs with respiratory signs and should not be allowed to enter the waiting room or other areas where susceptible dogs may be present.
Dogs with suspected canine influenza virus infection discovered after entry into the facility should be evaluated and treated by a veterinarian. Isolation protocols should be rigorously applied for dogs showing signs of respiratory disease, including the wearing of disposable gloves by persons handling infected dogs or cleaning contaminated cages. Respiratory disease beyond what is considered typical for a particular facility should be investigated, and the investigation should include submission of appropriate diagnostic samples. (See “What diagnostic tests will tell me whether a dog has canine influenza?”)

Q: What diagnostic tests will tell me whether a dog has canine influenza? What samples do I send? Where do I send the samples? How do I distinguish between canine influenza and kennel cough?
A: There is no rapid test for the specific diagnosis of acute canine influenza virus infection. Nasal or throat swabs from dogs that have been ill for less than 4 days may be sent to a diagnostic laboratory for testing. Your veterinarian may also offer other testing, such as an in-house test to detect influenza types A and B.
Antibodies to canine influenza virus may be detected as early as seven days after onset of clinical signs. Convalescent-phase samples should be collected at least two weeks after collection of the acute-phase sample. If an acute-phase sample is not available, testing a convalescent-phase sample can reveal whether a dog has been infected with or exposed to CIV at some point in the past.
For dogs that have died from pneumonia or other conditions in which CIV is suspected, additional diagnostic tests are available to your veterinarian through reference laboratories.

Q: I work in a kennel/animal care facility. What should I do to prevent transmission of influenza virus from infected dogs to susceptible dogs?
A: Canine influenza is not known to be transmissible from dogs to people. However, caretakers can inadvertently transmit canine influenza virus from infected dogs to susceptible dogs by not following good hygiene and infection control practices. To prevent spread of canine influenza virus, caretakers should take the following precautions:

• Wash hands with soap and water (if soap and water are unavailable, use an alcohol-based hand cleaner):
  • Upon arriving at the facility
  • Before and after handling each animal
  • After coming into contact with animal saliva, urine, feces or blood
  • After cleaning cages
  • Before eating meals, taking breaks, smoking or leaving the facility
  • Before and after using the restroom
• Wear a barrier gown over your clothes and wear gloves when handling sick animals or cleaning cages. Discard gown and gloves before working with other animals.
• Consider use of goggles or face protection if splashes from contaminated surfaces may occur.
• Bring a change of clothes to wear home at the end of the day.
• Thoroughly clean clothes worn at the animal facility.
• Do not allow animals to “kiss” you or lick your face.
• Do not eat in the animal care area.
• Separate newly arriving animals from animals that have been housed one week or longer.
• Routinely monitor animals for signs of illness. Separate sick animals from healthy animals, especially animals with signs of respiratory disease.
• There is no evidence of transmission of canine influenza virus from dogs to people. However, because of concerns about diseases that are transmissible from dogs to people, in general, it may be prudent for young children, the elderly, pregnant women, and immunocompromised persons to limit or avoid contact with animals that are ill.

For additional information and updates, please visit these websites:
Iowa State University Center for Food Security & Public Health
University of Florida College of Veterinary Medicine
Cornell University Veterinary Diagnostic Laboratory
Centers for Disease Control and Prevention
Association of Shelter Veterinarians

M. H. Archer, DVM
Loveland Veterinary House Call