Hepatic encephalopathy is a neurological condition that can occur in pets, more commonly in dogs, that already have liver disease. Neurological conditions affect the nervous system, which includes the brain, nerves, and spinal cord. The condition is potentially life threatening.

The liver normally filters out certain substances that are toxic to the body’s nervous system, such as ammonia. When the liver isn’t working properly, it can lead to a buildup of these substances in the blood stream. The most common liver disease that causes hepatic encephalopathy is a portosystemic shunt, a condition in which certain blood vessels bypass the liver’s filtration system. Hepatic lipidosis, a build-up of fat within liver cells, is another common cause of hepatic encephalopathy, especially among cats.

Signs

Signs of hepatic encephalopathy include unusual behavior, trouble or wobbliness when walking, seizures, drooling, vocalizing (i.e. whimpering, whining, crying, and other unusual noises), blindness, weakness, and/or coma. Signs of liver disease may also be noted, which include poor appetite, weight loss, yellow skin, gums, and eyes, enlarged belly, drinking and urinating often, throwing up, and/or loose stool. Any or all of these signs may be worse after eating. That is because the gastrointestinal (GI) tract is one of the main organs from which ammonia is filtered, so eating potentially causes an influx of this toxin into the blood stream.

Diagnosis

To diagnose the condition, your veterinarian will give the pet a physical examination looking for signs of neurologic or liver disease. Bloodwork will assess the body’s immune system and check for evidence of inflammation or infection (e.g. complete blood count/CBC) and determine how well the major organ systems are working (e.g. serum biochemistry profile). Common findings with liver disease include anemia, low red blood cell percentage; elevated liver enzymes e.g. ALT, alkaline phosphatase, and bilirubin; and decreased blood glucose. Sometimes with liver disease, pets are at increased risk for bleeding. Coagulation tests, which can determine how well the blood is clotting, may be run if bleeding tendencies are suspected.

Bile acid tests and ammonia measurements, also known as ammonia tolerance tests, can help confirm liver disease and hepatic encephalopathy, especially when combined with signs and laboratory findings. Occasionally, such tests do not provide a full diagnosis. Additional tests may be needed to figure out what caused the liver disease, such as X-rays and an abdominal ultrasound. Treatment may be started before all tests are finished if most signs point to liver disease and hepatic encephalopathy. This speed allows veterinarians to help the patient as quickly as possible and prevent the disease from getting worse.

Treatment

Hepatic encephalopathy can be life-threatening, so treating symptoms quickly is important. Hospitalization may be required. In some cases, brain swelling can occur, which is treated with intravenous (IV) medications. Patients with brain swelling need to be monitored very closely. Many such patients are admitted to veterinary ER hospitals for round-the-clock care. Seizures are treated with anti-epileptic medications such as diazepam, levetiracetam, or phenobarbital.

Additional medications may include antibiotics and/or certain types of enemas to minimize ammonia-producing bacteria; lactulose, which helps prevent ammonia from being absorbed from the GI tract; and/or liver protective medications, such as SAM-e or Denamarin®, which combines silymarin with SAMe. Other treatments will depend on the symptoms and bloodwork of the pet, such as IV fluids, therapy for bleeding, etc.

In some cases, feeding a lower protein diet may be helpful to minimize the volume of ammonia produced in the GI tract, but this is not always needed and will depend on the veterinarian’s recommendations. Once the cause of liver disease is determined, treating it will help stop hepatic encephalopathy from worsening or returning after treatment. Such treatments will depend on the type and cause of liver disease.

Will My Pet Recover?

If signs are mild and treated quickly, most pets recover. Treating the liver disease is important to prevent hepatic encephalopathy from recurring, although this is not always possible. Unfortunately, severely affected pets can die, even with treatment. This is why it is important to seek treatment as soon as you notice your pet is showing unusual symptoms. Call your veterinarian for an appointment as soon as possible if you think your pet is experiencing liver disease or hepatic encephalopathy.

Hemangiomas are a type of tumor of the blood vessels or the skin. They are benign, but the related hemangiosarcomas are a malignant cancer that also target the blood vessels. They come from the same type of cells and the only difference is that one is malignant.

Hemangiomas arise from a mutation in the cells and the cause is unknown. Research suggests that solar radiation through UV light may play a role when these tumors occur in the skin. Both dogs and cats can get hemangiomas. Depending on where the disease is and its progression, clinical signs can vary. There may be no clinical signs, dark purple blisters on the skin, or internal bleeding causing weakness and anorexia. Treatment and long-term outcome for animals vary depending on the type of tumor.

Who gets hemangiomas?

Both dogs and cats can get hemangioma.

Subcutaneous (under the skin) tumors tend to occur as a single mass. The masses may bleed and bruise easily, contain areas with ulcers and dead tissue, and be painful when touched. Approximately one-third of dogs with subcutaneous form have a history of tumor-associated illness that may include lack of appetite, lethargy, lameness, neurologic abnormalities, cough, voice change, and hemorrhages and/or bruises involving the mass.

Cats and dogs with the skin-related form typically have one or more red to purple skin bumps that are located in areas of sparsely haired, lightly pigmented skin. In dogs, these tumors most commonly occur on the chest and belly, sometimes because they like to sunbathe on their backs. In cats, lesions are most common on lightly colored pinnae (ear flaps) and other areas of the head. Lesions are usually small and nonpainful.

Dogs:

Breeds: American Pitbull Terrier, basset hound, Beagle, Boxer, Dalmatian, English Bulldog, English Pointer, Greyhound, Italian greyhound, Staffordshire terrier, Whippet . These breeds are mostly predisposed to the solar-induced form because they are light-skinned dogs with short hair, especially over the chest and belly – at least in those that like to sunbathe on their backs. However, any breed can get hemangiomas, especially the kind that are not related to the sun.

Sex: Both males and females are equally affected.

Age: Middle aged to older.

Cats:

Breeds: No breeds are predisposed.

Sex: Both males and female cats are equally affected.

Age: Middle aged to older.

Diagnosis

Definitive diagnosis usually requires surgical removal of all or part of a mass and its analysis at a laboratory. Blood tests, clinical signs, and predispositions (age, breed, hair coat color/type, sun exposure history) may suggest that your animal has hemangioma or hemangiosarcoma. Routine blood tests may show anemia. A fluid sample may show cancer cells, although many times these samples only show blood. Your veterinarian may suggest an ultrasound if they suspect hemangioma or hemangiosarcoma before surgery to look for more of an internal mass.

Treatment and Prognosis

The treatment options and long-term prognosis of your pet depends on the type of tumor they have. Once a benign hemangioma is removed surgically, your pet usually requires no additional treatment and is back to normal health. Dogs and cats with solar-induced hemangiomas may develop new hemangiomas (or other solar-induced tumors) at other sites of sun-damaged skin, potentially requiring additional surgeries to remove them.

Many products may be helpful for dogs with weakness, especially rear leg weakness. These products may be available through your local pet supply store, various internet sources, or your regular veterinarian’s office. They may facilitate the lifestyle you and your dog enjoyed prior to arthritic limitations.

We can’t vouch for any of these products or their companies, but if something seems like it may be helpful for your pet, please research it further or contact the company directly and find out for yourself.

Shoes

Slippery floors are trouble for the weak dog. Many a dog can exhaust himself trying to rise on a hardwood or tile floor. Rubber shoes for dogs have been used to protect the paws of performance and rescue dogs. They also help with negotiating slippery floors. Since the introduction of boots, other products have been introduced to support mobility on slippery floors such as paw friction pads and toe covers that help grip.

Other items useful for slippery floors are rubber bathtub mats and yoga mats. These frequently provide the necessary friction for mobility.

Handles and Special Leashes

Raised Bowls

When the food and water bowls are located on the floor, it may be hard for a dog to lean down to reach them. Your dog may not be able to steadily bend his elbows and knees slightly so as to reach the food without becoming weak and having to lie down. And then it may be all the more difficult to stand up again.

Pet Ramp

Consider getting a ramp for your dog to get in and out of vehicles. This may be more comfortable for you and your dog than trying to lift them in or out when they are no longer able to jump. If your dog spends time with you on the bed or couch, the ramp may be helpful for them as well.

When a patient, human or non-human, is said to have kidney failure, renal insufficiency, or even chronic renal failure, what most people are talking about is a toxin build up when the kidney cannot adequately remove the body’s harmful wastes. This toxic state is called uremia and is associated with nausea, appetite loss, weight loss, listlessness, and other unpleasant issues.  It is also not the kind of kidney disease we are going discuss here. 

Glomerular disease is a completely different kind of kidney disease and may not involve any toxin build up at all. Glomerular disease is one of protein loss. 

What is a Glomerulus Anyway?

Consider for a moment what an important resource protein is to your body. Your blood, for example, is full of necessary circulating proteins handling clotting, fluid balance, transporting other chemicals etc. Your body went to a lot of trouble to build those proteins and you can’t afford to waste them. If you were to lose them, your body would have to break down muscle in order to recreate them because that is how important they are.

The illustration to the right shows the nephron, which is the functional unit of the kidney. There are millions of these making urine every moment of every day. Only about 30 percent of them must be working in order to maintain normal kidney function. The rest form a back up system so that we will have plenty of extra nephrons should some of them get plugged with debris, damaged by scarring or infection, or starved for oxygen during a traumatic event.

The glomerulus, which in a way looks like a little dandelion tuft, is where our interest lies today. Blood flows through an afferent arteriole into the glomerulus. Inside the glomerular tuft, the blood vessel narrows into a complicated spiral of tiny capillaries, so small that the blood cells pass through single file. The capillaries are gripped by cells called podocytes. Like hands, the podocytes have tiny fingers (ironically called foot processes) that encase the capillaries. Fluid and small molecules can flow in between the fingers while cells and large molecules like proteins cannot pass through.

The cells and large molecules/proteins exit the glomerulus through an efferent arteriole and return to normal circulation. This first step in filtration is driven both by blood pressure as well as by the protein content of the blood.

A latent, more internal infection might be the cause (such as heartworm, Lyme disease, prostate infection, or Ehrlichiosis). Even a tumor might generate enough of the immune system’s attention to lead to this sort of reaction. If it is at all possible to identify and resolve the underlying cause of inflammation, this should be done as other therapy is unlikely to fully resolve the protein loss.

How is the Diagnosis Made?

There are several common scenarios that might lead to the diagnosis but they all boil down to one or both of two findings: excess urine protein found on a routine urinalysis and/or low albumin found on a blood test.

Let’s start with excess urine protein found on a routine urinalysis.

A urinalysis examines a urine sample for some of its chemical contents and properties. Protein content is one of the parameters that is checked and reported as a small, medium or large amount. On a urinalysis report this will be designated as “+,” “++,” or “+++.”

This seems like it would be easy enough to interpret but unfortunately there is more to the story. A small amount of protein in a well-concentrated sample may be  normal while the same amount of protein in a dilute sample would be highly significant. How dilute or concentrated the urine is depends on the patient’s water consumption, and we need a method to examine urine protein that is independent of the water consumption. Further, we need to determine if any protein in the urine is truly coming from the kidneys; after all, a bladder infection or other bladder condition might generate urine protein. To help distinguish renal protein loss, the rest of the urinalysis will be helpful. When your veterinarian is confident that other issues with the urinary tract have been excluded, it is time for a urine protein:creatinine ratio (we will come back to this).

Low Blood Albumin Level found on a Blood Panel

Albumin is one of those proteins that the body really wants to conserve and here’s why. There are plenty of substances the body needs to circulate that simply are not water soluble. How do we circulate these things if they won’t dissolve in water? We bind them to a carrier protein that will circulate and carry them as if they were commuters on a city bus. The albumin molecule is that city bus, carrying important biochemicals around your body.

There’s more. Albumin also is important in keeping water in the bloodstream. This sounds odd but blood is basically a liquid and without enough water, it sludges and clots abnormally. Furthermore, if water is not held in the vasculature, it leaks into other body cavities such as the chest and abdomen, filling these cavities with liquid.

Your body prioritizes the maintenance of its albumin levels and will not allow them to drop. When the albumin levels are down, a serious protein loss is afoot. It could be intestinal or liver-related, but glomerular protein loss is going to be one of the first conditions to rule out. If there is no protein in the urine, the focus shifts to other organs but if there is protein in the urine, it must be quantified and that means there is a urine protein:creatinine ratio.

Interpretation of the Urine Protein: Creatinine ratio

The urine protein:creatinine ratio compares the amount of protein in the urine to the amount of creatinine, one of the metabolic wastes filtered by the kidneys. By using this ratio, it does not matter how dilute the urine is or how concentrated it is. The ratio allows for protein loss to be quantified and then we can tell how significant the protein loss actually is. If the urine protein: creatinine ratio is found to be abnormal, ideally it is repeated in 2 to 4 weeks to be sure that the protein loss is persistent, but this depends on how high the ratio is and whether or not there is a known inflammatory condition that would be expected to damage the glomeruli.

Determining how serious a patient’s protein loss is depends on overall kidney function as well. In other words, a protein-losing kidney that is effectively removing the daily load of toxins and wastes is in less trouble than a protein-losing kidney that is failing.

The International Renal Interest Society (IRIS) considers a urine protein:creatinine ratio of greater than 0.5 for dogs or 0.4 for cats to be abnormal, and if it is persistent, then further diagnostics and treatment are recommended.

Depending on how your pet responds to the therapies above, a biopsy may be recommended. Biopsy is most commonly recommended for patients with UPC ratios more than 3.5 or with significant proteinuria combined with low albumin levels or high blood pressure.

The goal of treatment is to reduce the UPC ratio to below 0.5 or to reduce it by at least 50%. Higher reductions are sought for cats (see later).

Ratios greater than 3.5 are particularly concerning and require more aggressive treatment and more extensive diagnostics. These patients have an increased risk of abnormal blood clotting and generally have more extensive kidney damage.

The urine protein: creatinine ratio varies by up to 30% above or below baseline as a matter of course. A significant change in the ratio caused by disease progression (up) or response to therapy (down) must be greater than 30%.

If Intervention is Recommended what Does that Mean?

Adding omega 3 fatty acids to the regimen appears to improve the protein loss situation and supplementation is recommended. Most renal diets are already fortified with these anti-inflammatory fats but additional use is felt to be beneficial.

Low Protein, Low Sodium Diet

Most commercial renal diets would fit in this category. It seems paradoxical that a disease that causes body protein to be lost would be treated with a protein-restricted diet but, in fact, supplementing protein causes albumin to drop faster.

ACE Inhibitor

These medications have been shown to reduce renal protein loss. Typically enalapril is recommended for dogs and benazepril is recommended for cats. These medications inherently reduce blood flow to the kidneys so care must be taken in patients with elevated creatinine ratios to be sure the uremia does not worsen. Lower doses are used and monitoring becomes more important.

Omega 3 Fatty Acid Supplementation

Most commercial renal diets are fortified with omega 3 fatty acids. These anti-inflammatory fats have been shown to improve survival of dogs with renal disease. It is still unclear how helpful they are for cats but studies are ongoing.

Angiotensin II Receptor Blockers (ARBs)

Angiotensin II receptor blockers are becoming more popular in human medicine and their use is trickling down to manage canine glomerular disease. These medications work with ACE inhibitors to further help reduce urinary protein loss though they can also be used alone. Like the ACE inhibitors, they not only reduce urine protein loss but also lower blood pressure as well and seem to have some effect on reducing the clotting tendency. They are new to veterinary medicine and protocols are still being worked out. The two commonly used medications are losartan and telmisartan.

Spironolactone

Aldosterone is the hormone that acts on the kidney to retain sodium and water and get rid of potassium. Spironolactone is an antagonist of this hormone, which means it increases urine production, retains potassium and removes sodium. In humans, it has been found to reduce urine protein loss by 34 percent, which makes it an attractive medication for this situation especially in patients with nephrotic syndrome (see below). In dogs it might be used when ACE inhibitors or ARBs have not controlled the proteinuria. It is not a medication for cats.

The goal in managing urine protein loss is a 50% reduction in urine protein:creatinine ratio for dogs and a 90% reduction in urine protein:creatinine ratio for cats. A combination of the above medications is likely to be prescribed, and urine and blood test monitoring will be periodically (at least quarterly) recommended in hope of achieving and finally maintaining these results.

Nephrotic Syndrome

In severe cases, a complication called nephrotic syndrome can result due to the extreme urinary protein loss. Nephrotic syndrome is defined as the combination of: 1) significant protein loss in urine; 2) low serum albumin; 3) edema or other abnormal fluid accumulation; or 4) elevated blood cholesterol level. This is a severe complication of glomerular disease and suggests a poor prognosis, especially if creatinine levels are elevated in the blood. High blood pressure is a common complication of nephrotic syndrome. Patients also tend to form inappropriate blood clots (embolism) that can lodge in small blood vessels, causing loss of circulation to entire organs or sections of organs. Nephrotic syndrome is an advanced state of urinary protein loss and must be treated aggressively.

Biopsy the Kidney?

There are pros and cons to this relatively invasive test. The kidney receives 25 percent of the blood supply at any given time, which means it is highly vascularized and can bleed in an extreme way. Blood transfusion is needed for 10 percent of dogs and 17 percent of cats having this procedure, and a three percent mortality rate has been reported. So why take the chance on this procedure? The main reason is to obtain information on prognosis. There are different types of glomerular disease and glomerular inflammation, all of which may have different associated expectations. There is a type of glomerular disease called amyloidosis that involves abnormal protein (called amyloid) infiltrating the kidneys and has a much more progressive and damaging course. Approximately 50 percent of glomerular disease patients have diseases that can benefit from immune-suppressive therapy but the only way to identify these patients is with a biopsy. 

Conclusion

When the kidney cannot retain blood proteins, the body loses its ability to carry out normal blood functions. In an attempt to replace these proteins, muscle is broken down and the patient becomes debilitated. Maintaining proper nutrition and using medication to reduce the protein loss are crucial to managing this form of kidney disease. It is important for the pet owner to keep up the monitoring schedule and to stay in contact with the veterinarian as to the pet’s progress and response to therapy. 

In Summary

1. Glomerular disease is one broad type of kidney disease in which the primary problem is loss of renal proteinuria. Glomerulonephritis is one broad classification of kidney inflammation. It usually results in protein loss in urine. There are subtypes that can be determined by specialist pathologists based on renal biopsy.
2. It is not typical Glomerular disease differs somewhat from “classic” kidney failure renal disease, although it glomerular disease can lead to chronic kidney disease if undetected.
3. In the kidney, there are a million nephrons that make urine every minute of the day and send that urine to the bladder and out of the body through a filtration system. A body only needs approximately 30% of those nephrons working correctly for normal kidney function, at least as far as veterinarians could detect with typical lab tests. The rest are a backup system called the functional reserve.
4. Inflammatory cells punch small holes along the filtration route. Those holes are big enough for proteins to pass through.
5. Sources of chronic inflammation are believed to cause the problem, possibly stemming from issues such as chronic ear or skin infections, dental disease, heartworm disease, vector-borne diseases like Lyme disease, or feline immunodeficiency.
6. Diagnosis is suspected by excess urine protein found in urine, and/or low albumin found on a blood test. Definitive diagnosis of glomerulonephritis and its specific type requires a kidney biopsy.
7. When the kidney cannot retain blood proteins, the body cannot carry out normal blood functions. In an attempt to replace these proteins, muscle is broken down and the patient becomes debilitated.
8. The urine protein:creatinine ratio (UPC) found in a urine test compares the amount of protein in the urine to the amount of creatinine, a metabolic waste filtered by the kidneys. The ratio tells what the magnitude of the protein loss actually is. A persisting, reproducible urine protein:creatinine ratio of greater than 0.5 for dogs or 0.4 for cats is too high. Mild elevations can be due to causes other than glomerulonephritis.
9. Determining how serious the protein loss also depends on overall kidney function. A protein-losing kidney that is still effectively removing the daily load of toxins and wastes is in less trouble than one that is failing. Once the urine protein:creatinine reaches a certain ratio, a biopsy may be recommended. Ratios greater than 3.5 (typical US units) are particularly concerning.
10. The best treatment is when a specific cause is found, such as a systemic infectious disease, and that disease can be successfully treated. However, sometimes despite extensive searching with imaging and blood tests, no underlying cause can be found.
11. One goal is to reduce the urine protein:creatinine ratio to below 0.5 or to reduce it by at least 50% in dogs and 90% in cats.
12. Potential interventions expected to help specifically with proteinuria include: omega-3 fatty acid supplementation; a controlled protein, low sodium diet; and RAAS inhibition (with drugs called ARBs or ACEIs). Accompanying hypertension, when present, may require additional treatment.
13. In severe cases, a complication called nephrotic syndrome can result due to extreme urinary protein loss. The prognosis for this complication is comparatively poor, although it does depend on whether the problem developed acutely or chronically.
14. A kidney biopsy can be informative about a prognosis and suggest whether additional treatments are expected to help. Since immunosuppressive treatments can also do harm, biopsy is usually recommended to justify trying that type of medication. Biopsy can be expensive and requires pre-planning to make it safe. For sample evaluation to be truly valuable, the specimens are analyzed by a specialist veterinary nephropathologist.
15. It is important for you to keep up the monitoring schedule and stay in contact with your veterinarian.

Their presence in the host intestine can cause diarrhea, though some hosts are symptom-free carriers. Different types of Giardia infect different types of animals; it is rare for Giardia from a pet to transmit to a human; furthermore, dog and cat Giardia species are separate and are unlikely to cross from dog to cat or vice versa.

Giardia have two forms: the trophozoite and the cyst. The trophozoite is the form that lives within the host, swimming around and attaching with its suction cup. The cyst, however, is the form that lives out in the environment. Trophozoites round up to cysts as they approach the colon and then are passed in feces. Trophozoites that don’t round up into cysts and form a shell prior to passing into the cold, cruel world cannot withstand the temperature/moisture variability of the outside world. Cysts are the contagious stage. Trophozoites are in the parasitic stage.

Life as a Giardia Organism

As mentioned, trophozoites and cysts may be passed in fresh feces, but only the hard-shelled little cysts can withstand the conditions of the outside world. The cysts live in the environment (outside the host’s body) potentially for months until they are consumed by a host. Inside the host, the cyst’s shell is digested away, releasing two trophozoites into the intestine, and the cycle begins again. Contaminated water is the classical source of a Giardia infection.

When a fecal sample is analyzed, the appearance of the Giardia organism depends on whether the sample is freshly obtained or if it has been outside of the host’s body for a while. Giardia organisms begin to round up into cysts in a matter of hours. The active trophozoites rather look like funny faces with the two nuclei forming the eyes and median bodies forming the mouth. Cysts look a bit more generic.

In the environment, cysts survive in water and soil as long as it is relatively cool and wet. A host animal will accidentally swallow a cyst when drinking from a puddle, or toilet, or when licking fur. After the cyst has been swallowed, the cyst’s shell is digested away, freeing the two trophozoites that go forth and attach to the intestinal lining.

As mentioned, the trophozoite will swim to a spot using its flagella and attach with its suction cup (more correctly called its “ventral disc”). Trophozoites tend to live in different intestinal areas in different host species but will move to other areas depending on the diet the host is eating. The trophozoite may round itself up and form a cyst while still inside the host’s body. If the host has diarrhea, both trophozoites and cysts may be shed in diarrhea; either form can be found in fresh stool.

After infection, it takes 5 to 12 days in dogs or 5 to 16 days in cats for Giardia to be found in the host’s stool. Diarrhea can precede the shedding of the Giardia. Infection is more common in kennel situations where animals are housed in groups.

How Does Giardia Cause Diarrhea?

No one is completely sure, but infection seems to cause problems with normal intestinal absorption of vitamins and other nutrients. Diarrhea is generally not bloody with a Giardia infection. Immune-suppressive medications, such as corticosteroids, can re-activate an old Giardia infection. We do not know why some infected hosts get diarrhea while others never do.

Diagnosis

In the past, diagnosis was difficult. The stool sample being examined needed to be fresh, plus Giardia rarely show up on the usual fecal testing methods used to detect other parasites. Several tricks have been developed to make Giardia easier to find (special stains, using special processing solutions, etc.), but what has made the biggest difference in the diagnosis of Giardia is the ELISA test kit, which is similar in format to a home pregnancy test. This method has dramatically improved the ability to detect Giardia infections and the test can be completed in just a few minutes while you wait.

Giardia shed organisms intermittently and may be difficult to detect. Sometimes pets must be retested in order to find an infection, and asymptomatic carrier animals are common. It should also be mentioned that the ELISA test can remain positive for some time after the infection has been eradicated so if re-testing is desired after a positive test, another test format may be more helpful than the ELISA test kit.

Treatment

Because cysts can stick to the fur of the infected patient and be a source for re-infection, the positive animal should receive a bath at least once in the course of treatment. 

At the least, the patient should have a bath at the end of treatment, plus it is especially important to promptly remove infected fecal matter to minimize environmental contamination.

Can Humans Be Infected?

The short answer is only rarely, so the concern is pretty low in general. However, maintain good hygiene practices such as regular hand-washing and removing fresh pet fecal matter promptly, as mentioned.

That said, here is a more detailed answer: Giardia duodenalis is classified into several subcategories called assemblages and designated A through G. Some assemblages are specific as to which host animals they can infect, and other assemblages are not so picky. Assemblage F, for example, only infects cats, and assemblages C and D only infect dogs but assemblage A will infect dogs, cats, people, rodents, wild mammals, and cattle. Common testing methods do not indicate what assemblage has been detected, so there is always a possibility of human transmission as long as the assemblage is unknown. 

Environmental Decontamination

Giardia cysts are killed in the environment by freezing temperatures and by direct sunlight. If neither of these is practical for the area to be disinfected, a chemical disinfectant will be needed. Organic matter such as dirt or stool is protective of the cyst, so on a concrete surface, do basic cleaning before disinfecting. Quaternary ammonia compounds can be used to kill Giardia cysts.

Animals should be thoroughly bathed before being reintroduced into a clean area. A properly chlorinated swimming pool should not be able to become contaminated. As for areas with lawns or plants, decontamination will not be possible without killing the plants and allowing the area to dry out in direct sunlight.

A Footnote on Vaccination

A vaccine against Giardia was previously available, not to prevent infection in a vaccinated pet but to reduce the shedding of cysts by the vaccinated patient. In other words, the vaccine was designed to reduce the contamination of a kennel where Giardia was expected to be a problem. This would be helpful during an outbreak in a shelter or rescue situation but is not particularly helpful to the average dog whose owner wants to simply prevent infection. Because of the limited usefulness of the vaccine, manufacturing was discontinued in 2009.

In Summary:

1. Giardia is a parasite that sticks to its host’s small intestine to feed.
2. It has two forms: one that lives in the environment (cyst) and one that lives in the host (trophozoite).
3. Cysts are the contagious stage. Trophozoites are in the parasitic stage.
4. Transmission is by the fecal-oral route from infected stool or contaminated water.
5. After infection, it takes 5 to 12 days in dogs or 5 to 16 days in cats to be found in the host’s stool.
6. Infection is more common in kennels or shelters where animals are housed in groups.
7. The parasite can cause diarrhea ranging from minor to severe.
8. We do not know why some infected hosts get diarrhea while others never do.
9. Giardia rarely transmits from a pet to a human or vice versa.
10. Diagnosis uses a fresh fecal sample. Several tests may be needed as false negatives can occur.
11. Treatment is dewormers and metronidazole (antibiotic).
12. A low-residue, highly digestible diet may be beneficial until stools are firm.
13. Because infective cysts can stick to fur, patients should receive a bath during and at the end of treatment.
14. The environment has to be cleaned after a case of giardiasis because it is so contagious. Giardia can be killed with common disinfectants. Quaternary ammonia compounds are the most effective.
15. Giardia cysts are killed in the environment by freezing temperatures and by direct sunlight.
16. To kill Giardia on a concrete surface, do basic cleaning before disinfecting.
17. Lawns and plants cannot be decontaminated without killing the plants and allowing them to dry out in direct sunlight.
18. No vaccine is available.

Inside the eye, a clear fluid called aqueous humor circulates in the front chamber between the cornea and the pupil. The aqueous humor leaves the eye through a small sieve-like structure between the base of the cornea and front of the iris. Normal pressure is a dynamic function of the balance between aqueous production and drainage. When the drainage sieve does not work properly or becomes clogged, or when the flow of aqueous through the pupil becomes obstructed, intraocular pressure can increase to an unsafe level. This is particularly true if aqueous production continues at a normal level. Glaucoma is never caused by over production of aqueous humor. It is always a drainage problem.

Glaucoma occurs far more frequently in dogs (0.675%) than in cats (0.197%). Primary, hereditary, breed-related glaucoma is most commonly seen in purebred dogs. Cats usually have secondary glaucoma that is associated with chronic inflammation of the iris (uveitis) or with intraocular tumors. Primary glaucoma in cats is very rare but Siamese and Burmese cats may be predisposed. Over forty different breeds of dogs are predisposed to glaucoma, with common ones being the cocker spaniel, beagle, basset, Akita, chow chow, Samoyed, Bouvier de Flandres, Shih Tzu and Chinese Shar Pei.

Glaucoma can be a very painful disease for pets – more so than for people – as the intraocular pressure can become rapidly elevated to levels much higher than typically occur in people. In people, the pain feels like a constant bad headache. Normal intraocular pressure in people is 12-22 mmHg. The normal pressure for dogs and cats is 10-25 mmHg. With glaucoma in cats and dogs, the pressure may go up to 30 mmHg and higher. Values above 50 mmHg rapidly cause blindness, are painful and may cause the eye to stretch and enlarge.

An affected eye may look normal to a pet owner when the glaucoma is mild. Early signs can include a bloodshot eye, cloudy cornea, dilated pupil, and squinting/holding the eye closed. Over time, the eye size can increase and it may bulge.

Unfortunately in cases of severe glaucoma, the eye is often permanently blind by the time of diagnosis. Pets can act normal with vision in just one eye, which is one reason glaucoma is often diagnosed late in the disease’s course.

Diagnosis and Treatment

Glaucoma can be detected by measurement of eye pressure using an instrument called a tonometer. Tonometry can be done by your veterinarian during the eye exam. Pressures are measured in both eyes and then compared.

If glaucoma is found, then numerous medications are available to lower the pressure. All glaucoma medications used in dogs and cats are medications that have been manufactured for human glaucoma. The treatment of glaucoma requires faithful, consistent application of the medications. These are not medications that can be skipped or forgotten without risk of the eye pressure rapidly deteriorating.

Some cases of primary glaucoma are also treated with surgery. A major emphasis in secondary glaucoma is to determine the underlying cause and to treat it, as well as the elevated pressure. If primary glaucoma is diagnosed in one eye, it is common for the other eye to be started on preventative medication because both eyes are prone to the disease.

Removal of the eye (enucleation) is sometimes recommended. Examples include a blind eye in which the glaucoma does not respond to medications; any eye containing a tumor; when the eye is blind and the owner cannot afford glaucoma medications; and when infection is the cause of the glaucoma and it does not respond well to appropriate therapy.

Prognosis

In most cases, glaucoma is not curable and once vision is lost it will not return. With primary glaucoma, vision is often lost over time, even with appropriate treatment. For secondary glaucoma, prognosis depends on the underlying disease and its response to treatment.

The liver makes bile to help digest food and break down fats. The gallbladder is a sac-like organ connected to the liver. The gallbladder stores bile and releases it into the intestines through a bile duct. Sometimes, when things go awry, gallstones form inside the gallbladder. Gallstones are also called choleliths or cholelithiasis. For some pets they can be no trouble at all for the rest of their lives. For others, gallstones can be potentially fatal if the gallbladder bursts open.

Gallstones are often made up of parts of the bile, such as cholesterol, bilirubin, and calcium. Under the right conditions, these substances layer together inside the bile, essentially forming a hard blob that eventually results in a solid stone.

These stones form because either the gallbladder isn’t functioning properly or something is wrong with the bile. A common cause is when a tumor or especially thick bile blocks the bile’s movement into the intestines. Abnormal bile can also occur when the pet has high cholesterol, bilirubin, or triglycerides. Poor diets, such as those with too much fat or not enough taurine and protein, can also cause gallstones.

In some cases, gallstones don’t cause the pet any problems, and no symptoms will be noticed; however, gallstones can sometimes lead to cholangitis, a painful, inflammatory condition in the gallbladder. Gastrointestinal symptoms, such as vomiting, diarrhea or loose stool, poor appetite, and sometimes a yellow tinge to the skin and eyes (jaundice) may be seen.

Should gallstones block the bile duct, bile may overfill the gallbladder, causing it to eventually burst open (rupture) like a water balloon, which is an absolute emergency. The pain from a rupture is significant: it’s the kind of pain that would send you to the ER in the middle of the night in a blizzard. Pets in this kind of pain may bite, so be careful during transport to the emergency hospital. Dogs and cats may also become weak or faint quite suddenly.

Gallbladder rupture is a life-threatening emergency

A ruptured gallbladder is a worst-case scenario; just be aware that it is a possibility.

To diagnose stones before they ever get to the point of rupturing the gallbladder, a veterinarian will perform a thorough physical examination. The tummy will be checked for signs of pain around the gallbladder. Bloodwork will likely be run to check for liver changes; increased bilirubin, calcium, or cholesterol in the blood; and to look for evidence of inflammation, dehydration, or infection. Next, x-rays will be taken to see if any stones are visible. Unfortunately, only about 50% of gallstones can be seen on x-rays. An ultrasound of the belly may also be needed. This allows the veterinarian to check the size of the gallbladder; look for signs of bile inside the belly; confirm gallstones; make sure the liver looks healthy; and see if the bile duct is blocked. These tests can also help the veterinarian determine what caused the stones, so that steps can be taken to prevent more from forming.

In all cases, treatment will depend on what signs your pet is experiencing. If the pet is not showing any symptoms, there likely isn’t any treatment needed other than watching and waiting. The veterinarian will probably want to monitor the pet periodically with bloodwork, x-rays, and/or ultrasound to ensure the stones don’t change or cause discomfort.

If your pet is showing symptoms of duct obstruction or pain, surgery to either remove the gallstones or the entire gallbladder may be necessary. If the gallbladder bursts, emergency surgery to remove it and uncontained bile from inside the belly is needed immediately. (Remember, a ruptured gallbladder is a life-threatening emergency.) Hospitalization and intensive care are often required after gallbladder surgery.

Sometimes medications that protect the liver, such as ursodiol or SAMe, will be prescribed to help keep the liver healthy. Antibiotics may also be given if an infection is suspected or if the gallbladder ruptured. Treating the cause of the stones with diet change or dietary supplementation may also be recommended.

For pets that don’t show symptoms, the long-term risk for issues is low. Bile duct obstruction may occur, but it’s not set in stone (no pun intended). Your veterinarian may recommend a special diet or discuss the importance of cutting out any table scraps or people food. A well-balanced diet is important for pets with gallstones.

For pets that need surgery, the chance for improvement is good, but gallbladder surgery can be risky. If bile leaks into the belly, pets can become extremely ill and may die. For pets that need emergency surgery because their gallbladder ruptured, chances of improvement are much lower than those whose gallbladder didn’t burst. Pets that survive the surgery may need to be hospitalized for a long time before they can safely be sent home to continue to improve.

If you suspect your pet has gallstones, call your veterinarian for a checkup. Fortunately, gallstones are not common, but the symptoms could be caused by something else that needs to be taken care of. If your pet was recently diagnosed with gallstones, be sure to follow all your veterinarian’s instructions and give all medications as prescribed. Call your clinic with any questions or concerns, especially if your pet does not improve.

With the dog producing milk and sometimes mothering soft toys or pillows like Rosie in the illustration. So what should you do when this happens?

A Female Dog’s Normal Reproductive Cycle

Before talking about treatment, let’s explain the dog’s natural estrus cycle. The female dog comes into season approximately every 6 to 8 months, though this period becomes more erratic with age and is somewhat irregular when cycles first begin, and can come at longer intervals in certain breeds. 

When female dogs get older (say, seven or older), they do not stop cycling; there is nothing similar to menopause. Instead, as mentioned, cycles become irregular and long periods of time (years) can pass between cycles.

The second phase of the cycle is called estrus, which is characterized by the change in the character of the vaginal discharge from bloody to straw-colored. At this time, the female begins to allow the male to mount. It is classically the change from proestrus to estrus when ovulation occurs, and the female is most fertile. 

When the puppies are ready for birth, the corpus luteum is rapidly destroyed in a completely different hormonal sequence of events.

If she is not pregnant, the corpus luteum will simply wear out gradually and she will go back into the period of hormonal inactivity in which she spends the bulk of her time. This process of the corpus luteum wearing out in the absence of pregnancy takes at least 70 days, starting at the time of ovulation.  

Remember, during the 70+ days she has an active corpus luteum, her body essentially thinks she is pregnant and proceeds accordingly.

All the hormones are present; only the puppies are missing. If she is actually pregnant, the corpus luteum lasts through the 63 days of pregnancy. When the puppies are ready for birth, the corpus luteum is rapidly destroyed in a completely different hormonal sequence of events. Because the female dog is hormonally pregnant for 70 days after ovulation, one could say false pregnancy is a normal part of the cycle. We only treat it as a disease when it becomes extreme or fails to resolve naturally.

Clinical False Pregnancy

When false pregnancy persists, it can be a nuisance. The female dog can show the following signs:

• Nesting
• Mothering inanimate objects
• Lactating (giving milk)
• Abdominal distension
• She can even appear to go into labor.

Some female dogs are very sensitive to the hormonal fluctuations of their cycle. Diagnosis is made by history and physical examination rather than by blood test (though a blood test can be used to determine if she is actually pregnant or not). The key is to find symptoms of pregnancy in a female dog who is not pregnant. Symptoms generally become noticeable 6 to 12 weeks after estrus.

Treatment

If a more aggressive approach is needed, a diuretic such as furosemide can be prescribed. The idea is that mild dehydration will end the lactation.

Some people may want to try water deprivation, but this is potentially dangerous and should not be attempted without specific veterinary guidance.

If the above medication does not work, hormonal medications can be used. Progesterone can be used, but after the course of medication is complete, the false pregnancy recurs, so this is not a good choice. Estrogens are also not a good choice as they bring the dog back into estrus (vaginal discharge, attracting males, etc.). A week’s course of the male hormone mibolerone has generally been successful, but this medication is no longer available.

Hormones that inhibit prolactin (the hormone of milk production) are currently the best choices when medications are needed. Bromocriptine can be obtained from a compounding pharmacy and is given until lactation ceases (about a week or two). An upset stomach is not unusual with this medication. Cabergoline has fewer side effects and is given similarly but tends to be more expensive. Both these medications will cause abortion if the dog actually turns out to be pregnant, so it is important to be sure. A third medication called metergoline works a little differently to reduce prolactin but can also be used to end false pregnancy. Approximately 4-5 days of treatment are needed to stop the lactation and get things back to normal. Supplementing with vitamin B6 has been found to be helpful in regressing the false pregnancy as well.

A blood test can reliably detect canine pregnancy after 30 days from the breeding date. Ask your veterinarian about this test if you are not sure whether your dog is pregnant.

Spay during False Pregnancy?

It might seem like a good idea to spay the female to end the false pregnancy, as spaying will remove the ovaries and the corpora lutea they carry.

Unfortunately, this does not end the prolactin production from the pituitary gland so spaying may actually prolong the false pregnancy. Spaying during the diestrus period described above can actually trigger a false pregnancy. It is best to wait until the false pregnancy is over and then spay her to prevent future episodes. It is best to spay well after the 70-day diestrus period to avoid triggering a false pregnancy.

The Science of Flatulence

Flatulence comes from an excess of gases in the intestinal tract. These gases may represent air that has been swallowed (especially in short-faced/brachycephalic breeds), gas produced in the biochemical process of digestion, gas diffusion from the bloodstream, or gases produced by the bacteria that populate the intestinal tract.

Over 99% of the gases that pass from the intestinal tract are odorless; the gases with objectionable odors are typically those containing hydrogen sulfide.

Flatulence is a normal biological function. A surprising amount of air is swallowed with the simple act of eating and if this is not burped out, it must exit through the other end. The amount of air swallowed tends to be increased when dogs feel they must eat quickly or in the brachycephalic breeds who tend to breathe more by mouth rather than by nose. Swallowed air tends not to have objectionable odor.

The really stinky gases are produced by colon (large intestine) bacteria. Dietary fiber in pet food is not readily digestible by the pet’s own enzyme systems but is readily digested by the gas-producing bacteria of the colon. As these fibers are broken down, gases are produced. A diet heavy in fibers tends to favor these gas-producing organisms. The more supportive the intestinal environment, the more bacteria there will be and ultimately more gas will be produced.

What To Do About It

The following are easy changes that can be made in your management of the pet:

• Avoid fruit-based treats.
• Change to a high digestibility/low residue diet. There are therapeutic diets sold at most veterinary offices that would be perfect. Ideally, rice would be the diet’s carbohydrate source.
• If possible, walk the dog within 30 minutes of eating so as to encourage passing gases outside.
• Avoid canned foods containing the texturing ingredient carrageenan.
• Encourage regular exercise as this keeps intestinal gases moving and prevents intestinal gasses from pooling/building up.

Changing to a low residue diet means that most of the nutrients of the food are digested and absorbed by the pet before they reach the colon where the gas-forming bacteria are. This means there will be less food for the gas-forming organisms, which will ultimately mean fewer gas-forming organisms and less gas formed. Sometimes just going through a case and/or bag of a low residue diet solves the problem and the pet can return to a regular food afterwards. If necessary, the therapeutic diet can become the pet’s regular food. Low-residue diets are available through your veterinarian.

Prescription Low Residue Diets

Changing to a low residue diet means that most of the nutrients of the food are digested and absorbed by the pet before they reach the colon where the gas-forming bacteria are. This means there will be less food for the gas-forming organisms, which will ultimately mean fewer gas-forming organisms and less gas formed. Sometimes just going through a case and/or bag of such a low residue diet solves the problem and the pet can return to a regular food afterwards. If necessary, the therapeutic diet can become the pet’s regular food.

Sometimes Medication is Needed

A carminative is a medication that reduces flatulence. There is an assortment of available products, but unfortunately most are not helpful or even labeled for animal use. Changing the diet and ruling out actual intestinal disease are of primary importance in addressing flatulence. If further therapy is needed, the following products have some basis to suspect they might work:

Yucca shidigera supplementation

Currently this extract is labeled as a flavoring agent for pet food but it is also available as an oral supplement. Several studies have shown that it helps decrease the odor in flatulence.

Zinc acetate supplementation

Zinc binds to sulfhydryl compounds in flatulence ultimately serving to deodorize the gas.

Non-absorbable antibiotic

Such antibiotics serve to kill the gas-forming bacteria of the colon and may be helpful as long as their use is not ongoing. This is not an ideal method, however, as beneficial bacteria may also be killed off.

Probiotics

There are many ineffective probiotics being marketed so it is important to use one that has been shown to actually contain live cultures and that its cultures actually withstand stomach digestion so as to populate the small intestine with beneficial bacteria. It is unknown if this type of product would really help in flatulence as it is asking a great deal for such bacteria to travel all the way to the colon and attempt to displace the gas-forming resident bacteria. That said, there are several veterinary products that are felt to be reputable: Prostora®  Proviable®, Visbiome®,  and Fortiflora®. Fortiflora has been shown to be effective in reducing flatulence.

Prebiotics 

Prebiotics are special nutrients included in the diet to support and nourish beneficial bacteria and promote a healthy microflora in the colon. Special fibers are usually involved. Use of prebiotics allows the patient to essentially grow their own probiotics right there in their own colon. There are many intestinal diets that include prebiotic mixtures for this purpose.

Questionable Products

Activated charcoal tablets

Charcoal works by binding material in the intestinal tract so the material in question is not absorbed into the body, or in this case, so that the material is sequestered away from gas-forming bacteria. The idea is to make nutrients unavailable to gas-forming bacteria. Unfortunately, activated charcoal tablets are not likely to be effective as the charcoal binding sites are filled on the journey from mouth to colon and by the time the tablet sees the gas-forming large bowel bacteria, it has essentially been used up and cannot adsorb any more material.

Simethicone

Simethicone may control the volume of gas produced but not the odor. It is an antifoaming agent that reduces gas bubbles.

Pancreatic enzyme supplementation

In the absence of exocrine pancreatic insufficiency, it is unlikely that a patient would be helped by extra digestive enzymes. Furthermore, this treatment is relatively expensive for something that only might be helpful.

This causes the flea to either jump off the pet or be eaten by the pet. For this reason, most dogs and cats with severe flea allergies have never been found with fleas on them!

The Life Cycle of the Flea: Ctenocephalides felis

The majority of the flea population is found off the pet and around the home. Flea eggs are laid in the hair coat and are designed to fall off your pet and into your home. Flea larvae hatch from the eggs and develop in a pet’s environment by feeding on adult flea feces (i.e. digested blood) that fall out of the hair coat of the pet. Flea larvae eventually spin cocoons, often within carpet fibers, for pupation.

The ideal flea control program uses products that target all of the various stages of the flea life cycle and treats the pet’s environment.

Flea Control Recommendations

For the flea allergic patient, 100% flea control is required to remain symptom-free. Even very minimal exposure (i.e. one flea bite a week) may be enough to keep a flea-allergic patient itchy!

• Your pet should remain on monthly flea control year-round. Any pets in contact with that pet should also be on monthly flea control.
• Your pet’s veterinarian may ask you to treat your pet’s indoor environment for fleas with a spray designed to quickly kill fleas and stop their reproduction. To use a spray around your home:
  1. Remove your pets from the area to be sprayed.
  2. Wash all bedding.
  3. Vacuum all carpets and upholstery and then discard the vacuum bag (flea eggs can continue to hatch in vacuum bags).
  4. Spray all surfaces until damp to the touch.
• Sometimes a pet’s outdoor environment will also need to be treated for fleas. Your veterinarian can recommend a product for you to use or the outdoor environment can be treated professionally by pest specialists.

Always wait until all surfaces have dried before allowing your pets back into a treated area.