Otitis externa is an inflammation or infection of the external ear canal. Bacteria, yeast, ear mites, and allergies can all cause otitis externa.

Addressing this problem involves four steps:

2. Massage into ear canal by gently massaging the base of the ear.

3. With a cotton ball over your fingertip, wipe the accessible portion of the ear clean. Let your dog or cat shake out any excess. Clean the same portion of the ear with a dry cotton ball once again. Repeat if necessary.

4. Apply the medication prescribed by your pet’s veterinarian deeply into the ear canal. Ear medications for dogs and cats will have a nozzle or tip that is correctly sized to deliver medication into your pet’s ear canal. 

Do not insert cotton swabs into the ear canal.

Use cotton swabs only to clean the parts of the ear you can actually see.

1. Pain in the jaw joints as well as in the gums, lips, cheeks, and teeth.

Genetic or Not?

Occlusion is the way in which teeth align with each other. Occlusion is controlled by genetics, nutrition, environment, and by mechanical forces generated by the interlock of the upper and lower teeth. Some abnormal bites (malocclusions) are genetically influenced, such as severe over or under bites and wry bites. Other bite abnormalities are known to be acquired (non-genetic). Acquired malocclusions can result from tug of war games played with towels or ropes that move teeth into an abnormal position. Traumatic birthing can also be responsible for some acquired abnormalities.

To help define whether the malocclusion is genetic in origin, interdigitation of the premolars is studied. In breeds that have medium and long muzzles, the premolars should meet in a saw toothed fashion. For example, the tip of the lower third premolar should be positioned equally between the crowns of the upper third and fourth premolars. If the tip of one premolar points to the tip of another premolar, there may be a genetically-induced malocclusion. This only holds true in breeds that do not have shortened muzzles.

Some genetic bite problems do not show up in each litter because they are passed on recessively. The goal of selective breeding is to mate one animal to another that has superior occlusion.

Retained Deciduous Teeth

Normally the root of the deciduous (baby) tooth is reabsorbed, making room for an adult tooth. Should this fail, the adult tooth may move from its normal position, resulting in malocclusion. The resulting double set of teeth overcrowds the dental arch, causing food to become trapped between the teeth, which lead to early periodontal disease. A double set of roots may also prevent normal development of the socket and erode periodontal support around the adult tooth, resulting in early tooth loss. A retained deciduous tooth should be extracted as soon as an adult tooth is found in the same area as the baby tooth. If the extraction is performed early, the abnormally positioned adult tooth usually moves to its normal location.

Some breeders trim or cut deciduous teeth in the hope that they will be shed early and prevent orthodontic problems. When the tooth is cut in half, pulp is exposed to oral bacteria causing infection, pain, and tooth loss. Unfortunately, the remaining infected root can interfere with the emerging adult tooth, which may not come in normally.

Dental Interlock

Jaws do not grow at equal rates. If deciduous (baby) teeth erupt during an accelerated growth phase of one jaw, both sets of primary teeth can interlock and result in an abnormal bite. Even genetically normal dogs can occasionally develop abnormal bites due to the interlock of primary teeth. If an under bite is noted before the permanent teeth erupt, treatment may be helpful. Removing the primary teeth (from the shorter jaw) that are interfering with the forward jaw growth may allow the upper jaw to lengthen unimpeded, if the procedure is performed by 10 weeks of age. This procedure, called interceptive orthodontics will correct about 50% of minor jaw length malocclusions by the time permanent teeth erupt. Extracting teeth does not stimulate jaw growth; it only removes a mechanical barrier to genetic control of the growth process.

Breeders, show judges, veterinarians, and others who wish to describe specific dental conditions in dogs and cats should use proper orthodontic terms. Over bite, open bite, over jet, level bite, overshot, under bite, anterior cross bite, posterior cross bite, wry bite, and base narrow canines are orthodontic terms that are confusing at times.

Missing or Extra Teeth

Dogs and cats may be born without the proper number of teeth. The overcrowding from extra (supernumerary) teeth can cause periodontal disease. The American Kennel Club sets acceptable standards for show dogs about the minimum number of teeth for each breed. Dental x-rays can be taken as early as 10 weeks of age to evaluate if the dog has the correct number teeth. X-rays are recommended as a part of the prepurchase examination in certain breeds. Missing teeth (hypodontia) usually occur in the premolar area, but any tooth in the mouth may not erupt. Missing or extra teeth are considered genetic faults. Collies and Doberman Pinchers are most commonly affected. Sometimes the missing tooth is trapped below the gum line, and a dental x-ray can be taken to determine if there is an unerupted tooth.

Misdirected Canine Syndrome

Misdirected canine syndrome is a bite abnormality where retention of the deciduous (baby) tooth tilts the erupting permanent canine tooth into an abnormal location. The opposing canines may not have room to occlude properly, resulting in abnormal wear, periodontal disease, or early tooth loss.

Occlusion

The way in which teeth align with each other is called occlusion. Normal occlusion in most medium and long muzzled breeds consists of the upper (maxillary) incisors that just overlap the lower (mandibular) incisors (scissors bite). The lower canine should be located equidistant between the corner (lateral) incisor and the upper canine tooth. Premolar tips of the lower jaw should point between the spaces of the upper jaw teeth.

Malocclusion

Malocclusion refers to an abnormal tooth alignment. Over bite (mandibular distoclusion, parrot mouth, over shot, class two, over jet, mandibular brachygnathism) occurs when the lower jaw is shorter than the upper. There may be a gap between the upper and lower incisors when the mouth is closed. The upper premolars are displaced at least 25% toward the front compared to the lower premolars. An over bite malocclusion is not considered normal in any breed and is a genetic fault. The most commonly affected breeds are those with elongated muzzles (Collies, Shelties, Dachshunds, and Russian Wolfhounds).

An underbite (mandicular mesioclusion, under shot, reverse scissors bite, prognathism, class III) occurs when the lower teeth protrude in front of the upper jaw teeth. Some short-muzzled breeds (Boxers, English Bull Dogs, Shih-Tzus, and Lhasa Apsos) normally have an under bite, but it is abnormal when it occurs in medium-muzzled breeds. When the upper and lower incisor teeth meet each other edge to edge, the occlusion is considered an even or level bite. Constant contact between upper and lower incisors can cause uneven wear, periodontal disease, and early tooth loss. Level bite is considered normal in some breeds, although it is actually an expression of under bite.

Rostral cross bite occurs when canine and premolar teeth on both sides of the mouth occlude normally, but one or more of the lower incisors are positioned in front of the upper incisors. This condition can be caused by tug-of-war games, retained primary teeth, or impacted roots. Anterior cross bite is a common malocclusion. It is not considered a genetic or inherited defect. Posterior cross bite occurs when one or more of the premolar lower jaw teeth overlap the upper jaw teeth. This is a rare condition that occurs in the longer nosed dog breeds. A wry mouth or wry bite occurs when one side of the jaw grows more than the other.

Wry bites show as triangular defects in the incisor area. Some of the incisors will meet their opposing counterparts while others will not. Wry bite is a severe inherited defect. Base narrow canines occur when the lower canine teeth protrude inward, often producing damage to the upper palate. This condition is either due to retained deciduous teeth, or by an overly narrow mandible. Base narrow canines may be corrected through orthodontic devices that push the teeth into normal occlusion. An open bite occurs when some incisors are displaced vertically and do not touch.  The tongue will often protrude.

Rotated teeth, commonly affecting the upper third premolar, occur mostly in short-muzzled breeds. Selective breeding has created undersized mouths that cannot accommodate 42 teeth in normal alignment. The rotated tooth root closest to the palate is prone to periodontal disease. Strict tooth brushing may be helpful in saving a rotated tooth, but frequently it cannot be saved.

Orthodontic Care

Many abnormal bites can be corrected. Orthodontic care should be performed by veterinarians familiar with tooth movement principles. Sometimes breeders use rubber bands to move teeth but they compromise the gum tissue around teeth, leading to periodontal disease, pain, and early tooth loss. Orthodontic care should be reserved to ease pet discomfort by realigning teeth in those animals that will not be used for show. Tooth movement is accomplished by employing brackets, acrylic retainers, springs, and elastics. Fortunately, in animals orthodontic movement can usually be accomplished in months rather than years.

If your dog’s or cat’s teeth do not appear to meet normally, have your veterinarian take a peek and make recommendations to help your pet.

The most common location of oral SCC in cats is on the base of the tongue on the underside. SCC may also come from the gingiva (gums), particularly along the maxillary (upper) teeth.

SCC on the gingiva expand and progress locally and are usually associated with destruction of the bone. SCC of the maxilla (upper jaw) often appears as a depressed, ulcerated area. The tumors on the tongue, mandible (lower jaw), and pharynx (throat) tend to be proliferative and raised.

SCC metastasizes (spreads) to the regional lymph nodes less than 10% of the time in dogs and 31% of the time in cats. Metastasis to the lungs occurs 3-36% of the time in dogs and 10% of the time in cats. SCC are typically very invasive and can become quite large, especially in cats.

SCC affects middle-aged to older cats (range 7-20 years). There is no increased likelihood based on breed or gender.

Signs

Signs can include drooling (with or without blood), difficulty eating, and halitosis (very bad breath). Depending on the tumor’s location, the pet can have trouble swallowing or may cough. If the mouth is too uncomfortable for the pet to eat normally, they will lose weight. As is true with many cancers, affected dogs and cats tend to be older animals.

Diagnostic Tests

Diagnostics include radiographs (X-rays) of the local site, radiographs of the lungs to see if it has spread (metastasized) to other locations, CT scans, biomarker assessment (laboratory tests), and biopsies. Sometimes a fine needle aspirate will provide enough sample tissue for diagnosis. In a study of oral SCCs, biomarkers (such as proliferating cell nuclear antigen and Ki-67) were associated with higher-grade tumors and increased likelihood of spread. 

Treatment

Treatment may involve surgery, radiation therapy, chemotherapy, electromagnetic thermoablation, supportive therapy, or a combination of these depending on location, the amount of tissue involved, etc. Your primary veterinarian or veterinary oncologist will recommend treatment options specifically for your pet’s condition.

Surgery

If the tumor hasn’t spread, surgery is the preferred treatment. The entire tumor, including the extensions into underlying tissue and bone, will be removed. Often, part of the jawbone has to be removed. Surgery can provide a cure if the pet has clean margins (the tumor was completely removed). Dogs do quite well with partial jaws. It doesn’t typically alter the dog’s appearance as much as people might expect. Even if surgery isn’t curative, surgery can extend survival.

As for cats, following radical mandibulectomy (removal of the lower jaw) most can eat independently, but a few may require hand feeding. In cats, surgical excision, with or without partial removal of the tongue, may be considered for SCC of the tongue. When dealing with SCC of the pharynx (throat) or tonsils, the specialist may recommend removing as much of the mass as possible to make the cat more comfortable. This is palliative, but it’s not curative.

Radiation Therapy

Radiation therapy can be used if surgery isn’t an option, or if surgery can’t completely remove the tumor.

In cats, radiation therapy is not very effective as the sole therapy for SCC because median survival times (MST) range from only a few weeks to months. In a report of combined radiotherapy and chemotherapy, the overall MST was 163 days, and cats with tumors of the tonsil or cheek had MST of 724 days. Radiation therapy has been used as palliative care for cats with nonresectable SCC.

Chemotherapy

Chemotherapy may be added to therapy, depending on the circumstances. Chemotherapy has some drawbacks, so your veterinarian or oncology specialist will have to determine if this treatment would be useful.

Electromagnetic Thermoablation 

Electromagnetic thermoablation (hyperthermia, in which body tissue is exposed to high temperatures) may be used. This technique applies a high-frequency alternating electromagnetic field to heat alloy needles. The needles are placed into and surrounding the tumor to destroy the malignant tissue.

Supportive Therapy

Supportive therapy includes pain medications, acupuncture, feeding tubes to provide nutritional support, antibiotics for secondary infections, etc. A few cats with oral SCC have been treated with the medication zoledronate in an attempt to reduce bony destruction and pain. Pamidronate is also a medication option for cats. Your veterinarian will work with you to determine what therapies apply to your pet.

The median survival time for maxillary (upper jaw) SCC that was treated with maxillectomy varies from 10-39 months. The local recurrence rate after mandibulectomy or maxillectomy is less than 10%. 

Tumor-associated inflammation and invasion of the lymphatic system are indicators of a poorer prognosis. Overall survival times are lower with SCC of the tonsils. In one study, the median survival time was only 243 days, with a 1-year survival rate of 40% and a 2-year survival rate of 20%. The longest survival times occurred when surgery and chemotherapy were used together.

Prognosis For Cats

Overall prognosis is poor. One study of 21 cats treated with mandibulectomy reported a median survival time (MST) of 217 days, with 1 and 2-year survival of 43%. The local recurrence rate was 38%. Cats with rostral (nose/mouth) tumors had a longer MST of 911 days. When SCCs of all oral tissues are included, MST with no therapy is only 30-45 days. MST was 106 days following stereotactic radiotherapy for oral SCC of any location, with 38.5% of the cats showing a positive response. Most cats with this tumor type die of uncontrolled local disease. Another factor adversely affecting survival is that many cats with advanced SCC have metastatic disease (lymph node 31%, lungs 10%) at the time of diagnosis. 

Other causes of otitis media can include infections in the nose and throat, trauma, foreign bodies, fungal infections, inflammatory polyps, cancer, etc. In addition, developmental abnormalities of the external ear canal and pharynx can lead to otitis media.

Otitis media does not affect any particular age or animal, and males and females are affected equally.

Dogs that have long, pendulous ears, such as beagles and basset hounds, are more likely to develop otitis externa, which can lead to otitis media.

The Cavalier King Charles Spaniel breed is known to have a condition called primary secretory otitis media (PSOM). Dogs with PSOM typically have mild to moderate pain in the head/neck, neurologic signs (e.g. ataxia, facial paralysis, head tilt), and itchy ears, but without otitis externa. Owners of this breed will want to keep this disease in mind. 

Diagnosis

Diagnosis includes physical examination, ear examination with an otoscope, bacterial/fungal culture, radiography, and possibly advanced imaging.

Physical Examination

During the physical examination, your veterinarian will be looking for some of these signs: head shaking, pawing at the ear, pain when opening the mouth, signs of otitis externa (ear odor, redness, etc.), head tilt, facial nerve signs, Horner syndrome, ataxia, etc. Not every affected pet will exhibit all of these signs. In addition, cats are more likely to have neurologic signs than dogs are.  

Ear Examination (Otoscopy)

In order to do a complete examination of the ear, a deep ear cleaning may be necessary. To keep your pet comfortable, your veterinarian may decide to sedate or anesthetize your pet for the procedure. Then the infection can be more easily seen with an otoscope, which can see the eardrum.

Culture and Sensitivity

Your veterinarian will usually take samples of the material in the ear and culture those samples to determine what medications will work best.

Radiographs

Your veterinarian may take radiographs, also called X-rays. Radiographs can help show changes (thickening, destruction) to the bony structures of the ear. However, even if the radiographs appear normal, that does not mean that your pet does not have otitis media.

Advanced Imaging

In some cases, your veterinarian may suggest using computed tomography (CT) and/or magnetic resonance imaging (MRI) to further evaluate the tympanic bulla. CT is usually better than MRI at detecting bony changes, while MRI is better at detecting soft tissue abnormalities.

Treatment

Cleaning both the external and middle ear canals is an important step in treating otitis media. Debris can inactivate some topical medications and prevent medications from contacting infected tissues. Anesthesia will be necessary in order to do the deep ear cleaning and ear flushing that will remove the debris.

Your veterinarian may need to infuse (fill) the ear with medication in order to deliver a high concentration of antimicrobial products or corticosteroids directly to the affected area.

Topical medications may need to be used to control an otitis externa.

Systemic therapy with antibiotics, antifungals, and corticosteroids may also be used, depending on the infection.

If severe, irreversible changes to the external ear canal are found, if there are masses in the inner ear, or if medical therapy has failed to resolve the otitis media, your veterinarian may advise surgery, such as an ear canal ablation. This surgery is not undertaken lightly, but it may be necessary to control the infection. An ear canal ablation involves removing the vertical and horizontal portions of the ear canal, along with the bones of the middle ear and eardrum.

Monitoring (Rechecks)

During treatment, your veterinarian will usually want to recheck your pet’s external ear canal and tympanic membrane every 10-14 days. (A ruptured tympanic membrane will generally begin to heal within 21-35 days.) Topical medications will be given until the external ear canal and the tympanic membrane are normal, and until cytology of the ear canal reveals no infection. Systemic therapy is typically given for at least 4-6 weeks.

Prognosis

In general, the prognosis for dogs is good if appropriate therapy is started in time. The prognosis is not as good if the infection is resistant to the medications; if the concurrent otitis externa is not managed adequately; if there is significant bone infection; or if there is no response to surgery. In addition, some neurologic signs (e.g., facial nerve problems, Horner syndrome) may be permanent.

Reminder

Keeping your pet’s ears clean is critical to preventing ear infections of any kind. However, It is not always possible to prevent every infection in some pets. 

In some situations, the flap separates, floating uselessly around the inside of the joint and causing pain and further destruction to the joint.

OCD is most commonly seen in the shoulder, but can also be seen in the knee, elbow, and ankle joints. OCD causes differing levels of pain and lameness, making it hard for your young dog to be active.

Generally speaking, OCD is a developmental disease seen in rapidly growing puppies of some but not all large breeds, including Great Danes, Bernese Mountain Dogs, Golden Retrievers, and German Shepherds. Some breeds are more likely to have it than others. It’s typically a disease of adolescence with onset often seen around the age of 4 to 9 months. In people, it is usually seen in children and adolescents. OCD is seen far more often in male dogs than females.

If your dog is stiff and sore after rising or heavy play, or is lame, it’s best to see the veterinarian as early as possible. Typically, when a lameness is noted in a young dog with an OCD lesion (the entire area affected), the lesion is chronic and warrants immediate treatment.

Causes

No one really knows what causes OCD, although various factors can contribute. A hereditary component is suspected in most dogs, especially Newfoundlands. Before you buy a puppy, ask your breeder specifically if the puppy’s parents have OCD. In general, it is considered multi-factorial in that a combination of factors contribute to it.

Along with genetics, diet also plays a role; in particular, puppies whose diet has too much calcium or vitamin D. Supplementation should be avoided in puppies. In addition, any effort to make the dog grow as big as possible as quickly as possible should be avoided. It’s healthiest to let the dog grow to the size nature intended without any dietary interference.

Other potential causes of OCD include injury, lack of blood flow and hormonal issues.

Signs

Dogs will initially show stiffness and soreness when rising or after heavy play. Overtime, this will turn into a limp in the affected leg or legs because they avoid bearing weight on a painful leg. If you press on that sore area, the dog may cry. Sometimes an affected joint is warm and swollen.

Lameness is a sign of pain. An OCD lesion can either be constant or once in a while.

Diagnosis

Most dogs are taken to the veterinarian because they are stiff after rising or play or are lame in at least one leg. Various causes of stiffness and lameness can occur in the joints of developing dogs. Diseases and problems such as elbow dysplasia, patella (kneecap) luxation, and growth plate fractures can have similar signs as an OCD lesion.  A thorough orthopedic examination and imaging should be performed by your veterinarian for a diagnosis and to rule out other diseases.

Radiographs (X-rays) should always be taken in a lame growing dog. Oftentimes sedation is needed because specific positioning is necessary, and several images must be taken. Radiographs are a great screening tool, but an OCD lesion is not always seen. In some cases, your veterinarian may prefer that the X-rays be reviewed by a veterinary radiologist. If there is a high suspicion of an OCD lesion, your veterinarian may recommend a CT scan or even an arthroscopy evaluation. A CT scan allows veterinarians to view the bone in more of a three-dimensional manner while an arthroscopic examination involves inserting a small video camera into the joint. This allows direct visualization and treatment of an OCD lesion. 

Treatment

Obviously, treatment depends on severity of the OCD lesion. Conservative management is only recommended for dogs less than 6 months of age with minimal clinical signs and no overt radiographic changes. Conservative management may consist of pain medications, exercise restriction, dietary changes, and formal rehabilitation therapy.

Arthroscopic surgery is the gold standard for OCD treatment given the minimally invasive nature, better visualization, and quicker recovery. Total recovery time is about 8-12 weeks of exercise restriction to avoid running, jumping, and playing. The first 2 weeks after surgery activity is restricted to short, leashed walks – basically just enough for the dog to relieve themselves along with passive range of motion exercises. Beginning 2 weeks after surgery, a structured daily leash walking program and home exercise plan are begun along with formal rehabilitation guided by a rehabilitation therapist.

Prognosis

The earlier the problem is dealt with, the better the prognosis is. Any stiffness or lameness in a puppy warrants immediate evaluation by your veterinarian. More times than not, the stiffness or lameness may not be anything significant. However, the earlier your veterinarian can diagnosis the problem and recommended surgery, the better off your dog’s recovery will be.

Your dog’s prognosis depends on which joint or joints are affected, and how severely. Prognosis for full recovery is good if only the shoulder is affected. Other joint involvement has a more guarded prognosis, meaning progression of arthritis as well as possible periods of intermittent lameness.

Keeping your dog at a healthy weight helps keep the joints working properly. Your veterinarian can help you help your dog lose weight if that would be beneficial.

There are many reasons an older dog may have difficulty sleeping at night. Dogs do get cognitive dysfunction, which is similar to dementia in people.  The hallmarks of these syndromes are progressive confusion, reversal of day-night wake-sleep patterns, and poor adaptability to new situations. Just like older people with early-stage dementia, the dog may function well in routine and familiar situations but be confused in new situations.

Waking at night may occur for reasons other than cognitive dysfunction, such as pain or discomfort. Dogs who are feeling discomfort may pace, pant, vocalize, or be restless at night but may not show any physical limitations during the day. The effects of pain or sore muscles may be more noticeable to the dog at night.

The urge to eliminate may wake many dogs. Senior pets are more likely to have medical conditions that would increase the pet’s urination or defecation frequency or decrease control of these bodily functions.

Many physical and medical conditions should be considered, including urinary tract infections, kidney disease, hormone imbalances, Cushing’s Syndrome, gastrointestinal (GI) upset, and neurological impairments.

Anxiety can cause nighttime waking. Dogs may be anxious because of weather-related noises such as thunderstorms or noises in the home from people or other animals.  The dog may also be anxious during the day but the severity is often increased at night since these noises are more pronounced and start when it is quiet. Furthermore, the dog’s reaction may be limited to restlessness or pacing, which is often not noticed during the day. Seizures may occur anytime but often seizures that occur at night are not seen by the family, so people are awakened by a dog in a confused state.

Thinking about the pattern of when the dog wakes can help figure out the cause and at least partially correct the problem. Some dogs have difficulty settling down or falling asleep while other dogs may go to sleep easily and then wake up in the middle of the night. Some dogs go to sleep, enjoy slumber much of the night, and then wake up early. A definitive diagnosis may be difficult because there are so many medical conditions to consider. Cognitive dysfunction is only diagnosed with certainty in the later stages, and there is no test for it.

Management

After evaluating possible medical causes, try to establish a predictable routine for nighttime slumber. The pet’s routine as a younger dog may provide some insight into his preferences but consider age-related changes. An older dog may require an orthopedic bed to ease pressure on bones and joints. Warmth may also be important as the dog may not be able to regulate body temperature and cold weather may affect sensitive joints.  Establish a bedtime routine that may include a late trip outside for elimination, a massage, and quiet time settling in a comfortable area. Most dogs prefer to be with family members but some prefer to rest alone. Quiet, soothing music may obscure sounds and a night light may help a dog with vision problems to walk in dark hallways with more ease.

Even though this condition may be frustrating, avoid punishing or scolding. After addressing your dog’s physical needs, try gently and calmly returning your dog to where he likes to sleep. Some dogs want to sleep in bed with people; this is a matter of personal preference and family tolerance. Unless it is unsafe due to aggression, it is acceptable for dogs to sleep with people. Be sure to consider if this pattern of slumber with canine companions will continue to be acceptable since once they have tried it, many dogs like to sleep on comfortable mattresses with comforters. Despite commonly perpetuated myths, this type of “spoiling” does not cause other behavior problems; it does, however, teach a dog it is nice to sleep in a person’s bed.

Nutraceutical and Pheromone Interventions

Cognitive dysfunction is a slow, degenerative, and progressive disorder. Supplements are available that may ease the severity and slow its course. Ask your veterinarian about diets designed for the unique needs of senior pets. Some of them provide antioxidants (vitamins C and E, beta carotene, selenium, flavonoids, and carotenoids) that may reduce the neurological damage caused by free radicals and fatty acids as well as dl-alpha-lipoic diet and l-carnitine. Others include botanic oils such as medium chain triglycerides (MCT’s) that provide an alternative energy source. These diets are shown to improve a senior dog’s performance on cognition tests.

Dietary supplements that contain phosphatidyl serine, ginkgo biloba, and grape extract (resveratrol) are likely to slow and minimize cognitive impairment. S-adenosyl-l-methionine, or SAMe, may reduce anxiety and increase awareness and activity in the senior dog. Furthermore, SAMe is safe or even beneficial for patients with compromised liver function. These supplements are most beneficial in the early stages of cognitive decline.

A dog-appeasing pheromone (such as Adaptil) may ease anxiety and promote a feeling of well-being. The diffuser may be especially useful to create an area and support the use of a desired area for resting. The collar is most useful for dogs who experience anxiety all the time.

Melatonin may help create a normal nighttime sleeping cycle. This supplement should be given at bedtime on a regular basis. Combined with a predictable nighttime routine, it can help create a normal sleep pattern.

Pharmacological Treatments

Sometimes medications may be helpful to induce sleep. Benzodiazepines (anti-anxiety medications) such as diazepam (Valium), alprazolam (Xanax), or oxazepam (Serax). Trazodone may also be helpful. These medications are relatively quick-acting but don’t last long so administration must be timed carefully. Medication should be combined with other recommendations described above.

Generalized anxiety may be reduced with medications such as SSRI’s or TCA’s but these medications require many weeks before positive effects are seen.  Cognitive dysfunction symptoms may be reduced with selegiline (Anipryl), which when given in the morning may help to keep the dog more alert and active during the daytime. Old age onset of anxiety may reflect the additive effect of lifelong learning or be a sign of progressive decline from cognitive dysfunction.

Expected Outcome

Nighttime waking may be caused by medical or behavioral changes common in senior dogs. Often these problems may be managed and good sleeping patterns can be re-established, though many of the underlying conditions may be persistent and worsen with age. Quick intervention is important since undesirable habits may form quickly and people may become frustrated when they’re sleep deprived.

Dogs, cats, and other pets who develop lung diseases such as pneumonia, asthma, kennel cough, bronchitis, and so on can benefit from a nebulizer delivering saline, albuterol, antibiotics, or other drugs. A nebulizer is a machine that aerosolizes medicine into a fine mist; it’s like spraying medicine. A face mask is held over the pet’s muzzle (most pets can learn to accept the face mask) so that medication is inhaled deep into the respiratory tract.
 
The esophagus lies above the trachea and is protected by the epiglottis. Pneumonia may result from infections caused by kennel cough, viruses and bacteria. Pets with megaesophagus are prone to developing aspiration pneumonia because they tend to regurgitate food and fluids into the back of the throat and then aspirate the material into the lungs.

A nebulizer can be purchased from human medical supply stores, online, or from eBay. There are several good nebulizer brands, such as Pulmo-Aide, Omron, Devilbiss, etc. Make sure that you obtain the compressor (the machine), tubing, and the medication cup. The tubing, T-piece (a t-shaped tube that attaches the machine to the pet and to an exit) and medicine cup are called a nebulizer kit.

A vaporizer is not the same as a nebulizer. A vaporizer is typically used for sinus or upper respiratory issues rather than lung issues. Vaporized droplets are too big to get as deeply into the lungs the way nebulized particles

You can purchase an appropriately sized mask from a veterinarian, or make one yourself.

Using a Nebulizer

1. b. Put a little canned dog/cat food, baby food, cream cheese or peanut butter inside of the mask and allow the pet to lick it. This can also distract a pet while the treatment is proceeding.
2. After 5 to 10 minutes, you’ll see and hear that the medicine is running out.
3. Shake the cup downward a few times to make sure all the medicine has come through.
4. Take apart the plastic parts of the nebulizer and wash all the parts.

Cleaning the Nebulizer

Bacteria and viruses can live and reproduce in a nebulizer that is not routinely cleaned.

After each use, swish each piece in warm running water. At the end of the day, after you use it the last time, scrub each piece with warm soapy water. Rinse each piece under warm running water. Let each piece air-dry on a clean dish towel or paper towel. When the pieces are completely dry, put the nebulizer back together. If not using for a period of time, store it in a clean, dry bag.

Twice each week, or after the treatment is completed, mix a half cup of white vinegar with 1.5 cups of tap water. Soak each piece in this mixture for one hour. Rinse each piece under warm running water. Let each piece air-dry on a clean dish towel or a paper towel. When the pieces are completely dry, reassemble the nebulizer.

What do I do if I have Cleaned my Nebulizer and the Tubing is still Wet?

The easy way to dry the tubing is to attach it to the compressor. Then switch on the machine, and let it run for a minute or two. The blowing air will dry out the tubing. Use a paper towel or clean hand towel to dry the other parts.

What Medications can be Given with a Nebulizer?

A variety of drugs can be given using a nebulizer: bronchodilators like albuterol (open up the bronchioles allowing debris to more easily be removed from the lungs), steroids, water-soluble antibiotics, saline, N-acetylcysteine, etc. Albuterol opens up the bronchioles, making it easier to breath and allowing antibiotics to get deeper within the lungs. As albuterol can increase the heart rate, it should be used with caution in dogs with heart disease. Do not exceed three treatments per day unless advised by your veterinarian. The dose of albuterol may need to be adjusted based on the size of the dog. Following the albuterol, use the nebulizer with 2–3 cc of sterile saline. Some pets have side effects from albuterol although that is rare. Sometimes side effects are seen, such as nervousness, a rapid heart rate or excessive panting, and they will disappear within an hour or so. If this happens, report it to your veterinarian for a possible adjustment of dosage or change in frequency of treatments.

If your veterinarian has not previously written a prescription for albuterol, for which there is no veterinary version, here is an example of how to write it.

Albuterol 0.083% 2.5 cc vials × 25
sig: using a nebulizer, administer q8–24hr as directed

Albuterol comes in a box of 25 vials, each containing 2.5 cc.

1. Your veterinarian will prescribe the dose of albuterol for your pet.
2. Nebulize the computed dose of albuterol; if it is 1 cc or less, mix it with 1 cc of saline solution.
3. Nebulize an additional 2–3 cc. of saline after the albuterol treatment is completed.

Warning: Albuterol should not be administered to pets by people who have heart or lung disorders. Ask your physician if it is safe for you to be exposed to the albuterol mist given off during nebulization.  

Saline decreases the thickness of mucus and helps moisturize the bronchioles, which helps the pet cough up debris blocking the lungs. Saline solution can be obtained from your veterinarian, or nebulizer saline can be obtained online.

Do not use saline solution intended for contact lenses.

Antibiotics such as gentocin or amikacin, which are intravenous antibiotics, can be mixed with saline. These drugs can be hard on the kidneys, so ideally it is best to monitor kidney function with blood and urine tests. These antibiotics are more kidney friendly when given with a nebulizer than when given intravenously.

Preventing Aspiration Pneumonia

Nebulizer treatments with either saline and/or albuterol can help prevent recurrence of aspiration pneumonia in pets with megaesophagus, pneumonia or bronchitis, and may be helpful in managing laryngeal paralysis by helping to clear aspirated debris from the lungs. Ask your veterinarian if your pet should have a preventive treatment daily, every other day or twice weekly.

A pet doesn’t have to be a senior citizen to require joint care supplements, pain medication, or physical therapy. Degenerative arthritis can result from an injury or can be the result of genetics/joint conformation. If your pet is stiff or has poor range of motion in a joint, then you will need some education about joint care options and an understanding of what is happening in your pet’s joints, especially if surgery is not feasible for one reason or another. The following represents a beginner’s overview of joint structure and function so as to provide a foundation for understanding treatment options for the arthritic pet.

The Structure of a Normal Joint

They consist of two bones and a fibrous capsule holding the two bones together; however, the joint is far more complicated than just a hinge made of fiber and bone. The two bones have surfaces covered with slippery cartilage that must be able to glide across each other with minimal friction no matter what the patient’s activity level is and they must continue to be able to glide easily in this way repeatedly throughout the patient’s life. Furthermore, the joint capsule secretes assorted nutrients, lubricating fluid, and immunological materials that help keep the joints healthy.

For illustrative purposes, we will use the knee, or stifle joint as it is called in animals, as an example. The illustration at the right shows the structures of the shoulder.

Articular Cartilage Surfaces

The articular cartilage surfaces of the joint are the cartilage caps on the ends of the bone. These are the smooth surfaces that must glide across each other. Cartilage is made up of cartilage cells called chondrocytes and the matrix in which they live.

Matrix

Chondrocytes

These are the cells that actually secrete the cartilage matrix. The matrix is the soft (relative to the bone beneath it) material that represents 95% of the cartilage. While the cells represent only a small portion of the cartilage, they must remain healthy so as to produce new matrix when the old matrix is damaged.

 Why Should You Know these Complex Words?

Many of you reading the word glycosaminoglycan may simply let your eye pass over it and not even try to pronounce it in your mind. If you want to know about the nutrition of joint care, though, glycosaminoglycan is an important word to know.

The three GAGs that can make up a proteoglycan molecule are:

1. Chondroitin sulfate
2. Keratan sulfate (which is made in the body from a biochemical called glucosamine)
3. Dermatan sulfate

It simply binds and connects the proteoglycans together in the matrix. (In the graphic above, it is shown as a sort of core to which the proteoglycans are attached.) Hyaluronan is also a major component of the joint lubricating fluid, which we review in the next section.

The Joint Capsule or Synovial Membrane

This is the capsule that encloses the joint, creating the structure of the hinge. The capsule has an outer tough, fibrous layer and an inner layer that secretes joint fluid, a fluid that provides both nutrition and lubrication to the enclosed joint. The joint capsule must keep unwanted proteins and biochemicals out of the joint and only let the desired nutrients inside. After all, the joint must be kept smooth and the lubricants pure if they are to maintain the joint throughout the patient’s entire lifetime.

The joint capsule has two types of cells: Type A Synoviocytes and Type B Synoviocytes. The Type A cells are all about removing impurities and cleaning up debris. Type B cells produce Hyaluronan (mentioned above), an important lubricant in the joint.

Degenerative Arthritis

When there is an injury or simply poor conformation, the cartilage becomes roughened and can chip, flake off, or even wear down. The joint capsule becomes inflamed and thickened and no longer functions normally. Impurities enter the joint, the lubricating fluid loses its natural properties and ultimately a progressively abnormal and painful joint is created. In providing treatment, our goal is to alleviate the pain and inflammation and provide the biochemical building blocks that allow the joint to heal itself. In the next sections, we will review medications, supplements, and even exercises that may help with the arthritic patient.

These tumors begin as a small scabby area that may not attract much attention as it can be mistaken for a minor abrasion. This minor abrasion, however, does not heal and continues to get larger.

Because squamous cell carcinoma does not spread distantly in the body until late in its course, this provides a window during which it can be successfully treated. Once it gets too big, that window has closed even if the tumor has not yet spread.

Surgical Treatment

If the tumor is not too big, surgical removal is curative. That said, squamous cell carcinoma can spread to surrounding tissues, so a wide margin of normal tissue must be removed in order to get the whole tumor.  If the tumor has grown too large, there will not be enough tissue to get a good margin around it, and it will regrow, resuming its destructive course.

The surgery is ideally done with laser equipment to reduce bleeding; it is probably best to seek the skills of a surgery specialist or at least a veterinarian with a great deal of facial surgery experience. Your veterinarian may recommend a nerve block during surgery to help control pain after the procedure. 

The leather of the nose is removed along with some of the surrounding haired skin. The nasal opening will heal cosmetically but will look a little unusual. Discuss with your veterinarian whether or not a referral to a specialist is in the best interest of you and your pet.

Surgical Recovery

Recovery can vary depending on the tumor size, location, and overall health of your cat. Your veterinary surgeon will give you post- operative instructions and can tell you what to monitor after taking your cat home, including what would be considered an emergency.

Preventing self-harm is crucial, and your cat may have to wear an e-collar or “cone” to prevent pawing at their face and harming the surgical site(s). Pain medications and antibiotics are commonly prescribed.

You may notice small drops of blood or nasal fluid coming from the nostrils right after bringing your cat home. They may also cough or have a “rougher” sounding voice from the tube placed during surgery which helps them to breathe while under anesthesia (endotracheal tube). Many cats don’t want to eat as much after surgery, and your veterinarian may recommend offering various foods to entice them, appetite stimulants, and surgery site cleaning under sedation (to allow them to smell their food).

Any excessive bleeding, difficulty breathing, changes in sleeping habits, or other situations after surgery should be discussed with your veterinarian.

Cryotherapy

Cryotherapy may be less invasive. This involves using a probe to freeze the tumor. Again, this can be curative if the tumor is small enough, but in freezing the tissue, the cells are damaged and can’t be analyzed by biopsy. The biopsy (lab analysis) of the tissue can confirm squamous cell carcinoma and  enables the pathologist to tell if the excision was complete. This is valuable information that we would prefer not to forgo for obvious reasons.

Side effects of cryotherapy are generally mild and include swelling, redness, and pain. For the next 3-6 months your veterinarian will monitor your cat for signs of tumor regrowth. Cats with tumors that have grown into surrounding tissues also need to be checked for cancers in other areas. This may include X-rays of your cat’s chest and lymph node exams. For cases of nasal squamous cell carcinoma caused by sun exposure, the ears and eyelid margins also must be closely monitored along with the nose for regrowth of cancerous areas.

Radiation Therapy

Alternatively, external radiation beams can be aimed at the tumor under general anesthesia. In one study, 60 percent of irradiated cats had a complete response, and 33 percent had a partial response.

Radiation therapy obviously requires specialized equipment that is usually found only in specialty facilities. It is not available everywhere. A consultation with a veterinary oncologist will help determine if a given patient is a good candidate and what is involved in finding the nearest radiofacility.

Imiquimod 5% Creme

Imiquimod is an immunity-modifying topical crème that is palliative for tumors too large for curative removal or to treat the more superficial form of squamous cell carcinoma called Bowenoid carcinoma or squamous cell carcinoma in situ. Imiquimod is a relatively expensive product, and an upset stomach can result if the crème is licked (which it inevitably would be). 

NSAIDs

You may not know the term “cyclooxygenase,” but you are probably familiar with human anti-inflammatory cyclooxygenase inhibitors like aspirin, ibuprofen (Advil®), naproxen (Aleve®), and others. While these human anti-inflammatories are not safe for cats, there are some prescripton veterinary medications that are. This comes into play with nasal squamous cell carcinomas because there is potential for carcinomas to express enough cyclooxygenase that a feline-friendly non-steroidal anti-inflammatory pain reliever (such as piroxicam, meloxicam, or robenacoxib) may have anti-tumor effects. These medications are not completely without issues but may be helpful when other treatments are not an option, especially since they offer some pain relief.

Prognosis (Outlook)

Nasal squamous cell carcinomas usually do spread to tissues close by, but are slow to move to other areas in the body. Cats with superficial tumors (those that have not spread to deeper tissues in the nose or face) have better outlooks vs. large and deeply penetrating tumors.

Even though squamous cell carcinomas do not spread until relatively late in their course, they can still be extremely difficult to address. The nasal version is an exception to the poor prognosis rule as long as it is detected early and removed or treated with radiation promptly.

The potential for a full recovery depends on the size and location of the tumor, treatment procedures, and your cat’s overall health. Discuss your questions with your veterinarian. Also, talk about what you and your cat might experience. This will help you prepare for managing this condition as effectively as possible.

Are Any Bones Safe for My Dog’s Teeth? 

No. Steak bones are too hard for teeth. Antlers are worse than bones because they’re even harder. Poultry bones – chicken, turkey, and duck – are awful because they are full of air and thus splinter easily. The pieces can get stuck in your dog’s palate (roof of the mouth) and cause infection or get stuck in the esophagus or intestines, most of which requires a surgical fix.

What Happens if My Dog’s Teeth Are Injured by Bones? How Will I Know if There is a Problem?

For many dogs, broken teeth do not show signs of discomfort even though they experience pain like humans. Some show apparent signs and symptoms of disease, including an open tract below the eye or under the chin that may be draining.

When the nerves die, the pain decreases until infection sets in. Signs relating to dental disease from a broken tooth include:

1.  chewing on one side;
2.  dropping food from the mouth when eating;
3.  excessive drooling;
4.  grinding teeth;
5.  pawing at the mouth;
6.  facial swelling;
7.  fistulous tract below the eye or under the lower jaw;
8.  regional lymph node enlargement;
9.  shying away when the face is petted;
10.  refusing to eat hard food;
11.  refusing to chew on hard treats or toys.

Types of Tooth Damage

• Enamel fracture:  A fracture with loss of crown substance confined to the enamel 
• Complicated crown fracture:  A fracture of the crown that exposes the pulp
• Uncomplicated crown-root fracture:  A fracture of the crown and root that does not expose the pulp 
• Complicated crown-root fracture:  A fracture of the crown and root that exposes the pulp 
• Root fracture:  A fracture involving the root 

How Severe is the Damage to the Tooth?

Some fractures are limited to the enamel and require little or no therapy; others involve dentin and might not require endodontic care; others expose enamel, dentin, and pulp and require root canal care or extraction. The goal of endodontic care is to return the tooth to function if possible, and if not, extract the tooth to prevent further pain.

How Important is the Tooth?

The upper and lower canines (eye teeth) are the most common teeth broken, followed by the incisors and the upper cheek teeth.

Although endodontic care can be performed on any tooth, the canines and maxillary fourth premolars generally are the only teeth where endodontic therapy would be considered due to the importance of the tooth and ease of pulp chamber access.

Age of the Patient

The age of the patient is also essential when choosing endodontic therapy options. Canine teeth of patients younger than twelve months of age may have open root apices (the tip of the tooth’s root). Lower molar teeth generally have closed apices by seven months of age. Standard root canal therapy is not performed on teeth with open root apices because appropriate sealing of the apex cannot be assured.

Treatment options for teeth with open root apices include:

1. Vital pulp therapy (partial coronal pulpectomy, direct pulp capping, and restoration) to promote the preservation of vital pulp tissue or
2. A procedure called apexification is used to stimulate root development if the pulp is dead. Teeth with pulp exposure and closed root apices can be treated with standard root canal therapy.

 In the mature animal that has an acutely fractured tooth with a closed apex, standard root canal therapy results in a more predictable outcome compared to vital pulp therapy.

Aftercare Support

Tooth support is critical to the long-term success of endodontic treatment. If obvious periodontal disease is present before therapy, victory will be unlikely unless epic measures are taken, and strict home care is provided. 

Dogs love to chew. To find out what products are safe and effective in decreasing the accumulation of plaque and tartar, discuss with your veterinarian.